Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.
Department of Food and Nutrition Services, Ascension Sacred Heart Pensacola Hospital, Pensacola, Florida, USA.
Nutr Clin Pract. 2023 Feb;38(1):88-101. doi: 10.1002/ncp.10921. Epub 2022 Oct 26.
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.
口服营养补充剂（ONS）被广泛推荐用于管理非故意体重减轻的患者群体、长期护理居民和社区居住的老年人。大多数市售的 ONS 都是超加工食品，具有精准营养和无菌组成，以及方便和可用性，这是它们被选择的原因。然而，ONS 的治疗效果参差不齐，长期食用超加工 ONS 而不是加工较少的食物的潜在健康风险却很少受到关注。富含植物性食物的饮食可以维持支持免疫和健康的多样化和平衡的微生物群。超加工 ONS 取代植物性食物，特别是对肠道微生物群产生不良影响的潜在可能性，需要考虑。大多数 ONS 要么缺乏纤维，要么补充的是分离或纯化的纤维，这可能导致不良的胃肠道症状和食欲抑制。相比之下，微生物可利用的非消化性碳水化合物的多样性，以及植物性食物中发现的各种植物化学物质，支持微生物多样性及其弹性。本综述概述了推荐商业超加工 ONS 与营养充足（例如，高能量/高蛋白）的食物和饮料的临床困境，这些食物和饮料有助于改善饮食质量、维持多样化和稳定的肠道微生物群组成，并支持营养状况和健康。超加工 ONS 可能无法达到预期的健康益处，而且由于各种健康食品的替代，过度依赖可能会对患者和老年人群体造成风险。
