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Undernutrition and oral nutritional supplements

Elderly With Hospital Staff

Undernutrition currently threatens 33 million Europeans, according to the French Society of Clinical Nutrition and Metabolism. Undernutrition can affect the elderly, anorexia sufferers and people with chronic conditions in particular. This nutritional imbalance is associated with worsening prognosis for various diseases.

However, solutions exist. In this article, read about the methods for detecting undernutrition and the solutions available.

What is undernutrition?

Undernutrition should not be confused with cases of malnutrition caused by excess or deficiency of micronutrients or macronutrients. In France, the National Authority for Health defines undernutrition as a disease. This nutritional imbalance is characterised by a lack of energy and nutritional intake and/or an increase in energy needs or losses, usually followed by weight loss due to loss of lean mass.

Undernutrition and the health crisis

The Covid-19 health crisis is behind the increase in risk situations. Indeed, successive lockdowns have worsened the isolation of elderly people in their homes, because they have meant fewer visits by home help and relatives. [1] The anxiety-inducing climate of the current situation may cause depressive disorders [2] in frail people that may be accompanied by their refusal to eat. In addition, Covid-19 and its symptoms promote risk conditions.

People with Covid-19 returning from hospital experience persistent respiratory and digestive tract disorders, fatigue and weight lossSwallowing disorders linked to intubation cause difficulties eating, and this leads to patient undernutrition. [4]

How can undernutrition be diagnosed?

Diagnostic criteria

In France, according to the National Health Authority, diagnosis of undernutrition is based on phenotypic and etiological criteria.

Patient age also plays an important role. Effectively, diagnosis among the under-70s requires at least one phenotypic criterion to be present, i.e. linked to physical appearance, and an etiological criterion linked to the cause of undernutrition. Among the over-70s, a single phenotypic criterion is sufficient. [5]

Knowing how to anticipate risk situations

To prevent undernutrition, it is important to identify risk situations and assess appetite and nutritional status.

Apart from age, undernutrition risk situations may be linked to different inflammatory, infectious, degenerative or chronic diseases, cancer, organ failure, etc., leading to malabsorption and/or poor digestion. [3]

In addition, other situations are more specific to the elderly, such as disorders linked to ageing (oral, swallowing, dementia, etc.), drug treatments, restrictive regimes and psycho-social environment (isolation, bereavement, hospitalisation, etc.). [3]

It is not always easy to accurately assess the appetite of at-risk people. There are tools that enable dieticians to monitor food intake, for example questionnaires on the frequency of meals and the amount of food consumed. In addition, the visual analogue scale helps classify appetite by allocating a score from 0 to 10. Firstly, on the front of this scale there is a marker that the patient can slide between “normal appetite” to “no appetite” to indicate their status. The reverse side of the scale shows the range in more detail for consultation by the doctor. If the score is below 7, the doctor considers the patient to be undernourished.

Oral nutritional supplements: a solution to undernutrition

Nutritional advice tailored for undernourished people

To combat undernutrition, proper nutritional care is essential. Healthcare professionals in France must comply with the recommendations of the National Nutrition Health Programme 4, which aims to reduce the rate of undernourishment among the over-60s by at least 15% and among the over-80s by at least 30%. A second objective is to reduce the percentage of hospitalised patients who are undernourished at time of discharge by 20%. [6]

It is therefore essential to prioritise products with a high energy and protein content as a way of naturally enriching the customary diet. However, the patient’s tastes, allergies and intolerances should not be overlooked.

The composition of meals can vary, as can their frequency , which can for example be increased during daytime hours. Similarly, health professionals advise against night fasting of more than 12 hours. [7] As regards food intake, home help to organise meals can be provided with a view to reducing constraints, i.e. making the environment more pleasant and preparation easier. [7]

Another option is to adapt food texture for people with problems swallowing. Manufacturers can use the IDDSI scale that establishes different levels of product textures.

Oral nutritional supplements

Oral Nutritional Supplements (ONS) are Foods for Special Medical Purposes (FSMP). In specific terms, ONS are blends of nutrients that can be administered orally. There is a wide variety of ONS, the majority of which are high energy (> 1.5 kcal/mL) and/or high protein (> 7 g protein/100 mL), with different flavours and textures. Prescribing them is one way to overcome undernutrition. Lactalis Nutrition Santé offers a wide range of oral nutritional supplements. These products are available in a variety of flavours, textures and formats to meet the needs of undernourished patients. These types of food require medical prescription.

Learn more about ONS


In conclusion, the pandemic situation that we have been experiencing for over a year has seen an increase in undernutrition risk situations. These require rapid and effective nutritional care. Manufacturers of oral nutritional supplements such as Lactalis Nutrition Santé must therefore respond to these needs by offering tailored, varied and constantly innovative solutions.