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IntroductionPatient compliance with oral nutritional supplements (ONS) is not optimal for meeting energy and nutritional requirements in a high proportion of patients with disease-related malnutrition (DRM). Energy density or prescribed volume of ONS may impact compliance.MethodsA randomized, open-label crossover trial was conducted in outpatients with DRM to compare compliance with a high energy-dense ONS (edONS, 2.4 kcal/mL) and a reference ONS (heONS, 2.0 kcal/mL; NCT05609006). Patients were randomly assigned to two 8-week treatment sequences of four-weeks periods: edONS + heONS (sequence A) or heONS + edONS (sequence B). Patients daily reported the amount of product left over gastrointestinal tolerance and satisfaction with ONS. A non-inferiority analysis was performed to compare the compliance rate (percentage of consumed energy over the prescribed) for each period and sequence.ResultsFifty-three patients were assigned to sequence A and 50 to sequence B (55.7 ± 13.9 years, 37.0% female, 67.1% oncology patients). In sequence A, the compliance rates were 88.6% ± 14.3% vs. 84.1 ± 21.8% (p = 0.183), while in sequence B, they were 78.9% ± 23.8% vs. 84.4% ± 21.4% (p CompA was 4.5% [95% CI, −2.0% to 10.0%], and for sequence, B ΔCompB was 5.6% [95% CI, −3.0% to 14.0%]). The total discarded cost for each ONS was higher for heONS than edONS, being the difference statistically significant in sequence B. BMI increased slightly and not significantly in both sequences, and the percentage of patients with severe malnutrition was reduced. The frequency of gastrointestinal symptoms was low for both sequences, and satisfaction with ONS was slightly higher for edONS.ConclusionOur findings highlight that edONS was non-inferior to heONS in terms of consumed energy over the prescribed, with a lower amount of edONS discarded, which suggests a higher efficiency of edONS.

Une enquete retrospective a ete realisee en 1994, incluant 496 patients adultes qui ont debute une nutrition parenterale a domicile (NPAD) au cours de l'annee 1993, au sein de 75 centres repartis dans 13 pays europeens. Pour les pays ayant enregistre plus de 80% des nouveaux cas (423 patients), l'incidence et la prevalence furent estimees dans une echelle de 0,2 a 4,6 patients et de 0,3 a 12,2 patients pour 1 000 000 habitants par an, respectivement. Chez les patients etudies, la maladie sous-jacente etait soit un cancer (42%), une maladie de Crohn (15%), une maladie vasculaire (13%), une enterite radique (8%), un syndrome d'immunodeficience acquise (4%) ou autre (18%), Le syndrome du grele court et l'obstruction intestinale etaient les deux indications majeures pour la NPAD, respectivement dans 31% et 22% des cas. Soixante-trois pour cent des centres avaient une equipe de nutrition. La NPAD etait le plus souvent administree via un catheter central tunnelise (73%) et sous le mode cyclique nocturne (90%), alors qu'elle etait la seule source de nutrition dans 33% des cas. Seulement 44 % de patients prenaient en charge de maniere autonome leur NPAD. La presente etude indique que le cancer est devenu actuellement l'indication majeure pour la NPAD en Europe ; il existe cependant une grande heterogeneite dans les indications parmi les pays europeens ayant participe a l'enquete. La probabilite de survie apres une duree allant de 6 a 12 mois etait faible en cas de SIDA (n = 8; 12%) et de cancer (n = 78; 29%) mais tres satisfaisante dans les autres indications de NPAD (n = 115 ; 92%).