Systematic review and meta-analysis of the effects of high protein oral nutritional supplements
Abstract
Disease-related malnutrition is common, detrimentally affecting the patient and healthcare economy. Although use of high protein oral nutritional supplements (ONS) has been recommended to counteract the catabolic effects of disease and to facilitate recovery from illness, there is a lack of systematically obtained evidence to support these recommendations. This systematic review involving 36 randomised controlled trials (RCT) (n=3790) (mean age 74 years; 83% of trials in patients >65 years) and a series of meta-analyses of high protein ONS (>20% energy from protein) demonstrated a range of effects across settings and patient groups in favour of the high protein ONS group. These included reduced complications (odds ratio (OR) 0.68 (95%CI 0.55-0.83), p<0.001, 10 RCT, n=1830); reduced readmissions to hospital (OR 0.59 (95%CI 0.41-0.84), p=0.004, 2 RCT, n=546); improved grip strength (1.76 kg (95%CI 0.36-3.17), p<0.014, 4 RCT, n=219); increased intake of protein (p<0.001) and energy (p<0.001) with little reduction in normal food intake and improvements in weight (p<0.001). There was inadequate information to compare standard ONS (<20% energy from protein) with high protein ONS (>20% energy from protein). The systematic review and meta-analysis provides evidence that high protein supplements produce clinical benefits, with economic implications.
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With increased protein intake, older people may experience improved bone health, cardiovascular function, wound healing, and recovery from illness.
“With increased protein intake, older people may experience improved bone health, cardiovascular function, wound healing, and recovery from illness.73”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [73]
Nutritional supplementation has been linked to reduced complications and readmission to hospitals.
“Furthermore, more recently, nutritional supplementation has been linked to reduced complications and readmission to hospitals.73”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [73]
Protein supplementation may serve as an important preventive and therapeutic intervention against functional decline, especially when implemented in frail older people with malnutrition.
“Protein supplementation may serve as an important preventive and therapeutic intervention against functional decline, especially when implemented in frail older people with malnutrition.73,227,238”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [73]
Findings from 3 comprehensive reviews/meta-analyses and 2 recently published clinical trials may suggest some beneficial effects of dietary protein on physical function, especially in individuals who are older, malnourished, frailer, and with interventions used for at least 3 months.
“However, findings from 3 comprehensive reviews/meta-analyses 73,74,84 and 2 recently published clinical trials 227,228 may suggest some beneficial effects, especially in individuals who are older, malnourished, frailer, and with interventions used for at least 3 months (Table 8).”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [73]
Nutrition, especially dietary protein intake, is known to affect overall function of the body.
“Nutrition, especially dietary protein intake, is known to affect overall function of the body.73,74,84,208e212”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [73]
Positive effects of ONS on dietary intake and body weight, and reduced risk of complications and readmissions were reported, whereas length of hospital stay and mortality risk were not significantly reduced.
“Altogether, positive effects of ONS on dietary intake (115, 116, 119, 121) and BW (115, 116, 119, 121), and reduced risk of complications (121) and readmissions (115, 120, 121) were reported, whereas the length of hospital stay (114, 115, 121) and mortality risk (114-116, 119, 121) were not significantly reduced.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [121]
A systematic literature search found six high-quality SLRs that have assessed the efficacy of ONS versus usual care in older persons.
“A systematic literature search found six high-quality SLRs that have assessed the efficacy of ONS versus usual care in older persons (114-121).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [121]
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- Authors
- Cawood, A. L., Elia, M., & Stratton, R. J.
- Affiliations
- Nutricia (United Kingdom) (GB)
- University of Southampton (GB)
- Corresponding author
- Cawood, A.L.
- Venue
- Ageing Research Reviews
- Publisher
- Elsevier BV
- Published
- 2012-04
- Volume
- 11
- Issue
- 2
- Pages
- 278-296
- ISSN
- 1568-1637 (ISSN-L)
- OpenAlex
- W2085351092
- Cited by
- 376
- References
- 10
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 14 · 2023: 12 · 2022: 33 · 2021: 38 · 2020: 35 · 2019: 31 · 2018: 42 · 2017: 40 · 2016: 25 · 2015: 34 · 2014: 22 · 2013: 18 · 2012: 2
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ageing Research Reviews (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- disease-related malnutrition, protein intake, hospital readmission, complications, grip strength, weight gain, energy intake, older adults, economic implications
- MeSH terms
- Administration, Oral, Adult, Aged, Aged, 80 and over, Energy Intake, Dietary Proteins, Energy Metabolism, Enteral Nutrition, Humans, Middle Aged, Nutritional Status, Risk Factors, Odds Ratio, Treatment Outcome, Risk Assessment, Evidence-Based Medicine, Dietary Supplements, Recovery of Function, Malnutrition
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