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Oral Nutritional Supplements (ONS)

  • ONS are typically used in addition to the normal diet, when diet alone is insufficient to meet daily nutritional requirements.
  • ONS not only increase total energy and protein intake, but also the intake of micronutrients7,17. ONS do not reduce intake of normal food17.
  • Evidence from systematic reviews including NICE demonstrate that ONS are a clinically and cost effective way to manage malnutrition particularly amongst those with a low BMI (BMI < 20kg/m2)4,7,17.
  • ONS increase energy and protein intakes, can improve weight and have functional benefits (e.g. improved hand grip strength)7,17,18,20.
  • Clinical benefits of ONS include reductions in complications (e.g. pressure ulcers, poor wound healing, infections)7,17,20, mortality (in acutely ill older people)7,17, hospital admissions and readmissions18,20,21.
  • Clinical benefits of ONS are often seen with: 300-900kcal/day (e.g. 1-3 ONS servings per day) with benefits seen in the community typically with 2 - 3 month’s supplementation7,17,20 however, supplementation periods maybe shorter, or longer (up to 1 year), according to clinical need.


View The Pathway For Using ONS In The Management Of Malnutrition Download The Pathway For Using ONS In The Management Of Malnutrition Download ONS PDF Leaflet

Oral nutritional supplements (ONS) – range and selection of products

There are a wide range of ONS styles (milk, juice, yoghurt, savoury), formats (liquid, powder, pudding, pre-thickened), types (high protein, fibre containing, low volume) energy densities (1-2.4kcal/ml) and flavours available to suit a wide range of needs.

Most ONS provide ~300kcal, 12g of protein and a full range of vitamins and minerals for serving16.

There are a number of different ONS which may be of benefit in specific groups:

The majority of people requiring ONS can be managed using standard ONS (1.5-2.4kcal/ml); these are often used for people who are frail, elderly or with diagnoses of dementia, COPD and cancer.

High protein ONS are suitable for individuals with wounds, post-operative patients, some types of cancer, and the elderly.

Fibre-containing ONS are useful for those with constipation (not suitable for those requiring a fibre-free diet).

Pre-thickened ONS and puddings are available for individuals with neurological conditions that affect their swallow.

Small volume high energy dense ONS may aid compliance22,23 and may be better tolerated by patients who cannot consume larger volumes.

Commencing ONS

  • Aim to establish preferred flavours, likes and dislikes e.g. milk or juice, sweet or savoury.
  • Test preferences and compliance with a prescribable 'starter pack' (offers a range of products/flavours).
  • Prescribe preferred product or range of products/flavours; 2 ONS per day (1-3 per day), initially for up to 3 months (see flow chart for guidance)7,17,18,20,21.
  • For those that require ONS as a sole source of nutrition and those with complex nutritional needs referral to a Dietitian is recommended.
  • Modular ONS that provide only one or two nutrients should be used under dietetic supervision.

Discontinuing ONS

Discontinue ONS when adequate oral intake is established, targets are achieved and the individual is stable7 and no longer at risk of malnutrition. Continue to monitor to check individual remains stable (consider relapsing remitting conditions e.g. COPD, IBD).

This section

Managing Malnutrition according to ‘MUST’ Dietary Advice Oral Nutritional Supplements (ONS)
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