Malnutrition comes in many forms, but the sort described in the article is actually protein-energy malnutrition. This is a deficiency in protein AND energy (calories) and therefore one is never malnourished in only a calorific sense.
Calories are most certainly not the only valuable thing in sip feeds, which are helpful in many ways but particularly when assurance of an intake of essential nutrients such as water-soluble vitamins, essential fatty acids, and minerals is needed. Although I do agree with the point that vulnerable members of our community are being denied assistance to prevent malnutrition, this point is not why I’m replying to this article.
The costs of inappropriate prescribing (and not just of oral nutritional supplements which are considerably smaller fry than drugs) are considerable but that comes as no surprise, as NHS commissioners and dietitians up and down the country have already noted several years ago. Many dietitians are commissioned for this purpose in medicines management in order to inform the correct and appropriate prescription of oral nutritional supplements. So it’s not particularly a topic up for debate - it’s already been questioned and debated.
Have a look at just such a project started in 2008 in London: http://www.lpp.nhs.uk/page.asp?fldArea=2&fldMenu=6&fldSubMenu=6&fldKey=101.
Thus the point of this article is a little like shutting the stable door after the horse has bolted. Perhaps the article could have been more informed and therefore interesting for other GPs like Des Spence who want to know how they can change current practice.
A definition of what is meant by a “food supplement” (or oral nutritional supplement) for readers who may have been confused:
It is a food product, defined by the Advisory Committee on Borderline Substances, as a “borderline substance” that is prescribable and indicated for those; with disease-related malnutrition, dysphagia, inflammatory bowel disease, following total gastrectomy, short bowel syndrome, bowel fistula.
They take many forms but as examples, they may be milkshake-style drinks, juice-style drinks, puddings, soups. These usually contain protein, carbohydrate, fat, essential fatty acids and vitamins and minerals.
A dietary supplement is usually a pill containing one / all of the following; vitamins, minerals, or plant products (herbs, botanicals etc). They generally do not provide calories or protein.
Rapid Response:
Re: Bad medicine: medical nutrition
Malnutrition comes in many forms, but the sort described in the article is actually protein-energy malnutrition. This is a deficiency in protein AND energy (calories) and therefore one is never malnourished in only a calorific sense.
Calories are most certainly not the only valuable thing in sip feeds, which are helpful in many ways but particularly when assurance of an intake of essential nutrients such as water-soluble vitamins, essential fatty acids, and minerals is needed. Although I do agree with the point that vulnerable members of our community are being denied assistance to prevent malnutrition, this point is not why I’m replying to this article.
The costs of inappropriate prescribing (and not just of oral nutritional supplements which are considerably smaller fry than drugs) are considerable but that comes as no surprise, as NHS commissioners and dietitians up and down the country have already noted several years ago. Many dietitians are commissioned for this purpose in medicines management in order to inform the correct and appropriate prescription of oral nutritional supplements. So it’s not particularly a topic up for debate - it’s already been questioned and debated.
Have a look at just such a project started in 2008 in London:
http://www.lpp.nhs.uk/page.asp?fldArea=2&fldMenu=6&fldSubMenu=6&fldKey=101.
Thus the point of this article is a little like shutting the stable door after the horse has bolted. Perhaps the article could have been more informed and therefore interesting for other GPs like Des Spence who want to know how they can change current practice.
A definition of what is meant by a “food supplement” (or oral nutritional supplement) for readers who may have been confused:
It is a food product, defined by the Advisory Committee on Borderline Substances, as a “borderline substance” that is prescribable and indicated for those; with disease-related malnutrition, dysphagia, inflammatory bowel disease, following total gastrectomy, short bowel syndrome, bowel fistula.
They take many forms but as examples, they may be milkshake-style drinks, juice-style drinks, puddings, soups. These usually contain protein, carbohydrate, fat, essential fatty acids and vitamins and minerals.
A dietary supplement is usually a pill containing one / all of the following; vitamins, minerals, or plant products (herbs, botanicals etc). They generally do not provide calories or protein.
This article means the former not the latter.
Competing interests: No competing interests