Intended for healthcare professionals

Letters Response

Tim Bowling and colleagues reply to Des Spence

BMJ 2012; 344 doi: (Published 14 February 2012) Cite this as: BMJ 2012;344:e811
  1. Tim Bowling, chair, BAPEN, and consultant in gastroenterology and clinical nutrition1,
  2. Mike Stroud, chair, NICE guideline development group on nutrition support, and consultant gastroenterologist and senior lecturer in medicine and nutrition2,
  3. Richard Leach, chairman3,
  4. Anne Holdoway, chair4
  1. 1Queen’s Medical Centre Campus, Nottingham University Hospitals, Nottingham NG7 2UH, UK
  2. 2University of Southampton, Southampton SO17 1BJ, UK
  3. 3Nutrition Committee, Royal College of Physicians, London NW1 4LE, UK
  4. 4Parenteral and Enteral Nutrition Group, British Dietetic Association, Birmingham B3 3HT, UK
  1. tim.bowling{at}

Des Spence’s article “Bad medicine: medical nutrition” contains factual inaccuracies that could result in harm to patients if doctors believed and acted on them.1

He says that total calorie intake is the main issue in malnutrition, but protein and micronutrients are probably more important in improving clinical outcomes in sick, malnourished patients. Protein rich oral nutritional supplements (ONS) reduce the incidence of complications such as infection, poor wound healing, and ulcers in patients with hip fracture, leg ulcer, and acute illness in hospitals and community settings (10 trials, n=1830; odds ratio 0.68, 95% confidence interval 0.55 to 0.83).2 They also significantly reduce (by a quarter) the risk of developing pressure ulcers in high risk patients (four trials, n=1224; odds ratio 0.75, 0.62 to 0.89).3

ONS increase protein intake in older people in hospitals and community settings.4 5 They work in patients recently discharged home and in malnourished older patients in hospital, even compared with controls who did not receive ONS but received careful attention by nursing staff to try to ensure that they finished meals (65% v 32% protein intake, P <0.0001).6 7 That ONS improve function and clinical …

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