RESUMEN
Oral nutrition supplements (ONS) are widely recommended for the management of unintentional weight loss in patient populations, long-term care residents, and community-dwelling older adults. Most marketed ONS are ultra-processed, with precision nutrition and aseptic composition, as well as convenience and availability, driving their selection. However, therapeutic effectiveness is mixed and the potential health risks of consuming ultra-processed ONS long-term in lieu of less-processed foods have received little attention. A diverse and balanced microbiota supporting immunity and wellness is maintained by a diet rich in plant-sourced foods. The implications of ultra-processed ONS displacing plant-sourced foods, and specifically the potential for undesirable impacts on the gut microbiota, require consideration. Most ONS are either devoid of fiber or are supplemented with isolated or purified fibers that may contribute to adverse gastrointestinal symptoms and appetite suppression. In contrast, the diversity of microbial-available, nondigestible carbohydrates, together with the array of phytochemicals found in plant-sourced foods, support microbial diversity and its resiliency. This review outlines the clinical dilemma of recommending commercial ultra-processed ONS vs nutritionally adequate (eg, high-energy/high-protein) foods and beverages that contribute to diet quality, maintenance of a diverse and stable gut microbiota composition, and support nutrition status and health. Ultra-processed ONS may fall short of expected health benefits, and overreliance may potentially contribute to the risk for patient and older adult populations because of the displacement of a variety of healthful foods.
Asunto(s)
Dieta , Estado Nutricional , Humanos , Anciano , Suplementos Dietéticos/efectos adversos , Pérdida de Peso , Apoyo Nutricional , Comida Rápida , Manipulación de AlimentosRESUMEN
BACKGROUND: Obesity within the USA is a public health crisis. Nutrition counselling in primary care is an effective yet underutilized intervention because of both health care professional (HCP) barriers and patient barriers. OBJECTIVE: The purpose of this study was to: (i) identify HCP and patient perceptions, needs and barriers surrounding nutrition counselling, (ii) develop nutrition resources for HCPs and patients and (iii) assess utility of the approach. METHODS: Paper surveys were completed by 48 HCPs (response rate: 63.2%) and 185 patients in five family medicine clinics. Based on results, nutrition resources were developed and integrated into the electronic medical record. To assess utility, paper surveys were completed by 25 HCPs (response rate: 32.9%) after 4 weeks. Results were presented as descriptive statistics. RESULTS: Both HCPs and patients indicated that nutrition counselling is necessary to improve dietary behaviours, but barriers prevented HCPs from providing counselling and patients from improving dietary behaviours. HCPs indicated that improved patient handouts (74.5%), community nutrition classes (72.3%) and community cooking classes (63.8%) could enhance nutrition counselling. Patients identified that coupons and discounts (45.5%), sample meal plans and recipes (44.3%) and websites for recipes, grocery guides, and cooking videos (35.9%) would help them to consume a healthy diet. Patient education handouts, patient resource guides and HCP education were created. Following receipt, most HCPs (85%) indicated that the resources enhanced their nutrition counselling. CONCLUSIONS: HCP and patient barriers to nutrition counselling are multiple and varied. Design and implementation of an approach tailored to stakeholders' needs have potential to improve nutrition counselling in primary care.