23 Nov 2023 — While many supplements targeting malnutrition are based on animal products, a Nutricia-funded study signals an emerging need for plant-based alternatives. The research finds that consuming a plant-based oral nutritional supplement (ONS) improved the dietary outcomes of patients at risk of malnutrition. 

Participants in the study consumed Fortisip PlantBased ONS by Nutricia — the Danone brand — for 28 days. The 24 participants of the study increased the intake of total energy, protein and the number of micronutrients meeting the UK reference nutrient intake. 

At the end of the study, patients at high risk of malnutrition were reduced from 20 to 16 people, body weight increased by an average of 0.6 kg and body mass index (BMI) rose by 0.2 kg/m2. 

“We hope this study provides reassurance to healthcare professionals that plant-based oral nutritional supplements meet the needs of patients with disease-related malnutrition and improve nutritional outcomes while being enjoyable and easy to comply with,” lead author Marta Delsoglio, clinical research manager of Danone UK and Ireland, tells Nutrition Insight. 

“As such, we hope healthcare professionals will feel confident to prescribe plant-based nutritional support alongside other oral nutritional supplements (e.g., products including animal-derived ingredients) to their patients to offer greater variety and personalization.”

Choosing vegan options   
The study, published in Frontiers in Nutrition, included 24 adults at risk of malnutrition and requiring plant-based nutritional support due to personal preference or variety (33% of participants), religious or cultural reasons (28%), veganism (17%), environmental or sustainability reasons (17%) and health reasons (5%). 

The authors underscore that veganism or vegetarianism are not the only reasons patients request plant-based nutritional support. Therefore, they urge healthcare providers to offer plant-based alternatives alongside other forms of nutritional support, such as those including animal-derived ingredients. 

Nutricia’s plant-based ONS improved nutritional outcomes in patients with disease-related malnutrition (Image credit: Nutricia).After a one-day baseline assessment, the study participants received standardized dietary advice and were asked to consume at least one bottle per day of Nutricia’s Fortisip PlantBased ONS. This product contains 300 kcal and 12 g of plant-based protein in a 200 ml bottle. It has 28 vitamins and minerals. 

The researchers opted for this design to mimic the current clinical practice of combining ONS with dietary advice. However, they caution that as a result, the individual effect of the ONS is unknown. At the same time, over half of the participants followed dietary advice before the study, with little to no effect. 

The compliance rate was 94%, and participants maintained their appetite for food while the gastrointestinal tolerance was stable. However, participants did report increases in mild gastrointestinal symptoms, such as flatulence and burping, as well as limited adverse events in mild to moderate abdominal pain, acid reflux and nausea. 

Plant-based options malnutrition 
The researchers assert that this study is the first to investigate and provide novel data on the value of “plant-based nutritional support using a ready-to-drink, nutritionally complete, plant-based (vegan suitable) ONS alongside dietary advice in adult community-based patients at risk of disease-related malnutrition.”

Delsoglio notes that while plant-based and animal-derived ONS can address nutritional deficiencies and improve nutritional intake, their choice may depend on availability and individual preferences.  

“Plant-based oral nutrition supplements can effectively manage malnutrition by providing essential nutrients, such as energy, proteins, vitamins and minerals, similar to animal-derived ONS.” 

“Most supplements available to patients at risk of malnutrition are based on cow’s milk and contain additional ingredients from animal sources (i.e., vitamin D).”

She details that although the study did not compare Fortisip PlantBased directly with animal-derived products, the findings report “similar outcomes to those found in studies using animal-derived ONS, including an increase in body weight and BMI, total energy, protein and micronutrient intakes, and reduction of malnutrition risk at the end of the intervention.” 

Expanding the range 
While research and innovation in plant-based medical nutrition are expanding the range of products addressing disease-related malnutrition, Delsoglio underscores that the “availability of plant-based, vegan suitable medical feeds is still limited.”

Delsoglio adds that plant-based ONS are meant for patients that want it for lifestyle preferences, taste and variety.She adds that this risks compromising the nutritional status of patients who prefer or require plant-based dietary support. 

“These patients are currently prescribed non-vegan or vegan consumer products, which may not comply with or meet their nutritional requirements. However, the availability of plant-based products to treat malnutrition is expected to increase in the near future with the plant-based rising trends.” 

“We are currently working on a longitudinal study to assess the long-term impact of a plant-based enteral tube feed,” Delsoglio continues. “Long-term studies are required to explore the effects of plant-based nutritional support on muscle strength and functionality, and other clinical outcomes such as complications and mortality.” 

Moreover, she notes that Nutricia aims to investigate other applications of plant-based nutritional support, such as pediatric feeding.

Research and development 
While Delsoglio cannot discuss detailed future developments or plans for Fortisip PlantBased, she highlights the company’s intention to “continue to develop a range of plant-based medical nutrition products to support and meet our patients’ needs.” 

“People in good health can choose to eat and drink products that fit their lifestyle and dietary preferences. When unwell and needing nutritional support, they still want to be empowered to choose various enjoyable products that fit their preferences and values. Nutricia aims to meet these needs.” 

She adds that Fortisip PlantBased could help with ONS compliance. The product is not only for “patients who may require it for lifestyle preferences but also for any patients who may want it for taste and variety reasons.” 

The authors highlight that additional investigation is needed to build the evidence base for plant-based nutritional support. They point to longitudinal studies (over three months) with a larger sample size to confirm long-term implications and effects on muscle and other clinical outcomes. 

Moreover, they add that randomized-controlled trials are necessary to compare plant with animal-based nutritional support, including research on the mechanisms of action. The authors also highlight the need to investigate other applications of plant-based dietary support, such as enteral tube and infant feeding. 

By Jolanda van Hal

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