I respond to the startlingly ill-informed views reported in Des Spence's 'From the Frontline - 'Bad medicine: medical nutrition' speaking as chair of the NICE Guideline Development Group on Nutrition Support (published 2006).

The evidence for the use of oral nutritional supplements (ONS) in the treatment of disease related malnutrition is overwhelming (Grade A according to the independent NICE assessments) and there are many probable reasons why they are effective in treating malnutrition when simple dietary manipulation is not. These include their protein and micronutrient content and anyone who knows anything about malnourishment, would realise that the benefits of treatment are likely to have little to do with 'total calories' as Des Spence seems to think . It is therefore absolute nonsense to suggest that they can be replaced with a chocolate bar or biscuit to the same effect. GPs have repeatedly failed to recognise the importance of nutritional screening, despite 93% of malnourished individuals or those at risk of malnutrition living in the community and as a consequence they often fail to ensure adequate intakes of protein and micronutrients in addition to calories. This is actually very difficult to achieve with foodstuffs in those who are at nutritional risk from the decreased appetite seen so often with disease or injury, whilst study after study has shown that it can be at least partly achieved using ONS which probably explains why Cochrane meta-analyses demonstrate little or no effect from trying to manipulate food intake whilst they do confirm outcome benefits from ONS usage in line with the Grade A findings from NICE.

Finally, Des Spence has no right to impugn the integrity of the many health professionals in BAPEN who are trying to translate the Grade A evidence to improve clinical practice related to all aspects of nutritional care.

Yours sincerely

Dr Mike Stroud FRCP Consultant Gastroenterologist and Senior Lecturer in Medicine and Nutrition, Southampton
Chair of the NICE GDG on Nutrition Support

Competing interests: None declared