Oral Nutritional Supplementation:
A Nutritional Pathway to Enhanced Quality of Life for Chronic Disease Patients

Preface Malnutrition arises when energy or nutrient intake is insufficient, excessive, or imbalanced. It encompasses non-disease-related malnutrition—often due to hunger—and disease-related malnutrition (DRM), driven by cachexia or inflammation. DRM remains highly prevalent, undermining patient health and quality of life. Chronic diseases and malnutrition are deeply intertwined; with an aging population, the number of chronic disease sufferers in China continues to grow. Factors such as inadequate dietary intake, malabsorption, and metabolic disorders make these patients particularly vulnerable to malnutrition, especially among the elderly. A decade-long survey revealed that 41.2% of older Chinese adults with chronic illnesses suffer from malnutrition, severely impacting their health and daily living. Improving nutritional status in this population has therefore become a cornerstone of national health promotion.

Multiple Guidelines Recommend ONS as First-Line Nutrition for Patients at Risk of Malnutrition

Current strategies to address malnutrition include balanced diet, moderate exercise, oral nutritional supplementation (ONS), and combined interventions—among which ONS delivers the most immediate benefits. ONS involves orally consuming formula foods for special medical purposes (FSMPs) to make up for dietary shortfalls. FSMPs are specially engineered to meet the unique nutritional needs of individuals with restricted intake, absorption impairments, metabolic disorders, or specific medical conditions. They come in three categories: nutritionally complete formulas, disease-specific complete formulas, and incomplete formulas. Complete formulas alone can fulfill all nutritional requirements of the intended patient group.

Several national and international guidelines endorse ONS/FSMP intervention for malnutrition:

1. Chinese Clinical Guidelines for Adult Parenteral and Enteral Nutrition (2023)

Patients at nutritional risk or with malnutrition who have a functional gastrointestinal tract and can safely use enteral feeding should receive enteral nutrition (EN) as first choice. For those able to eat orally, ONS is the preferred option.

2. ESPEN Guidelines for Nutritional Support of Multimorbid Hospitalized Patients (2023)

Malnourished or at-risk inpatients who can safely take in nutrition orally should receive personalized ONS to meet energy and protein requirements, thereby improving nutritional status, quality of life, and overall survival.

3. Clinical Practice Guidelines for Non-Pharmacological Interventions in Malnourished Elderly (2023)

Elderly individuals at nutritional risk or with malnutrition should use ONS as the primary intervention. Standard whole-protein complete ONS is recommended; if protein or essential amino acid intake remains insufficient after energy needs are met, targeted oral supplementation of protein or amino acids—via small sips—is advised.

Nutritionally Complete ONS/FSMP Formulations: Broad Applicability and High Clinical Benefit

ONS aligns with physiological eating patterns, is convenient, cost-effective, and portable—making it a flexible intervention across acute and chronic conditions. Clinical trials demonstrate that ONS not only improves nutritional parameters but also delivers multifaceted patient benefits:

• A 2023 multicenter randomized trial in long-term care facilities compared ONS against nutrition education in elderly residents at risk of malnutrition. Among 107 participants, those receiving ONS experienced significant gains in weight, BMI, walking speed, and Mini Nutritional Assessment Short-Form (MNA-SF) scores.

• In another randomized study of adults (average age 66.5 years) at malnutrition risk, 12 weeks of a fiber-enriched ONS (Fresubin® powder fiber) led to a 1.38 kg weight gain versus control (p < 0.001), alongside improvements in BMI, mid-arm and calf circumference, and daily intake of energy, protein, vitamin D, and calcium.

• A third trial in elderly patients evaluated the effect of ONS on muscle strength and function. Participants receiving ONS showed significant improvements in handgrip strength (43.96 kg vs. 32.81 kg) and knee extension strength (23.45 kg vs. 16.41 kg), as well as gait speed, functional mobility, and activity levels.

Beyond these clinical endpoints, ONS has been shown to enhance quality of life, reduce healthcare costs, and boost overall cost-effectiveness—making it a first-line choice whenever medically appropriate.

Selecting the Right Nutritionally Complete Powder for Individual Needs

Patients at nutritional risk or with malnutrition should choose ONS formulas tailored to their disease profile and nutrient requirements. Different nutrient ratios yield distinct clinical advantages:

Fatty Acids

• Monounsaturated Fatty Acids (MUFA): Replacing saturated fats with MUFA effectively lowers cholesterol. Higher MUFA intake is linked to reduced sarcopenia and all-cause mortality.

• Polyunsaturated Fatty Acids (PUFA): The ω-6/ω-3 ratio in ONS influences outcomes; a balance between 1:1 and 5:1 reduces cardiovascular mortality in secondary prevention and improves lipid, glucose, and inflammatory markers.

Protein

Augmenting protein in ONS benefits both nutritional and functional status. Whey protein boosts lower-limb muscle strength and knee extension force, while casein promotes muscle mass accretion and strength gains.

Dietary Fiber

Current Chinese guidelines recommend routine use of fiber-containing EN formulas for general patients. Dietary fiber supports gut microbiota balance, helps regulate blood sugar and lipids, and enhances mineral absorption.

✦✦Expert Commentary✦✦ Chronic diseases represent a leading global public health challenge, with over 260 million patients affected in China alone. Social, psychological, and physiological factors leave these individuals at high risk for malnutrition, compromising immunity and extending recovery time. Malnutrition not only worsens prognosis and diminishes quality of life but also raises treatment costs and financial burden. Nutritional support, particularly with nutritionally complete ONS, plays a pivotal role in chronic disease management. When gastrointestinal function is intact and oral intake is feasible, ONS should be the first choice—either as a sole nutrition source or alongside regular meals—to deliver balanced, scientifically structured, safe nourishment and improve patient outcomes.

Expert Profile

Sun Jianqin,
PhD Professor and Doctoral Supervisor, Department of Nutrition, Huadong Hospital, Fudan University Director,
Shanghai Geriatric Nutrition and Health Quality Control Center Executive Director, Chinese Nutrition Society Member, National Nutrition Standards Expert Committee,
National Health Commission Reviewer, Special Medical Foods and Health Foods One of China’s First Health Science Promotion Experts Vice Chair & Secretary-General, Shanghai Society of Diet Therapy Board Member, Asia Pacific Clinical Nutrition Society Distinguished Contribution Expert, Chinese Nutrition Society Specializes in nutrition support therapy, nutritional assessment, and health management across diverse diseases. Lead investigator for dozens of research projects, recipient of three provincial-level science and technology awards as principal investigator, author of over 200 academic papers, and editor of more than ten nutrition monographs and popular science books. Spearheaded national standards for dietary nutrition and expert consensus on sarcopenia nutrition and exercise interventions. Serves on editorial boards of multiple journals.

For healthcare professionals only.