Oral Nutritional Supplements FAQs
What are Oral Nutritional Supplements (ONS)?
ONS are Foods for Special Medical Purposes. ONS are special nutritional products which contain energy (calories), protein, vitamins and minerals. They are designed for people who, because of illness or incapacity, are unable to eat enough food to meet their body's daily needs for energy and nutrients. Most ONS are flavoured drinks which are sometimes called 'sip feeds'. ONS are also available as powders that can be made up into drinks or added to drinks or foods like tea, coffee, custard and cereal. ONS are available in a variety of flavours and styles to suit every patient's needs. These include milkshake-, juice- and dessert-style supplements as well as powders that are added to foods and drinks.
Who recommends ONS? How do patients get them?
A healthcare professional will assess requirements and identify a deficit in macro and micronutrients. In hospitals there will be a local system in place to ensure that patients receive the ONS they need. In the community, patients will need to have their ONS prescribed by a GP or other prescribing healthcare professional. Once an individual has a prescription, local pharmacies are able to dispense prescribed supplements. Targets should be discussed and agreed so that the patient and healthcare professional can measure the effectiveness and review outcomes.
Can patients get ONS without a prescription?
ONS are classed as 'food for special medical purposes'. They are products that must be used under medical supervision. Therefore, although it may be possible for someone to buy an ONS over the counter from a pharmacist, if they have disease-related malnutrition, they should see the relevent healthcare professional who will assess whether an ONS is required.
When should patients take their ONS?
For patients with disease-related malnutrition, ONS must be taken as recommended by a healthcare professional. Studies have shown that taking sip feed between meals does not reduce the oral intake from normal diet. Patients may also use ONS to fortify their normal diet. Nutricia provides a variety of patient booklets detailing how they can be incorporated.
How many ONS should a patient take?
A dietitian, nurse or doctor should recommend the specific product and number of ONS a patient requires depending on their needs and medical condition. In general 2-3 servings are prescribed each day as a 'top up' to normal food intake. If a patient is unclear or has not been given advice on how many ONS they should take, then they should go back to their healthcare professional who will be able to advise.
What should a patient do if they don’t want their ONS anymore?
The first priority is to understand why the patient does not want to take their ONS anymore. If their food intake has improved and after re-screening they are no longer at risk of malnutrition, this is a good time for them to stop taking the ONS and to encourage them to increase their oral food intake. However, if they are continuing to eat poorly and still require nutritional support, it may be that they got bored or have 'taste fatigue' with the ONS they have been taking, this is a good time to introduce other flavours and styles of ONS to them to ensure they continue to get the extra nutrition they need.
Can ONS be heated?
Yes, some patients may prefer to take ONS warm or want to mix their ONS with food or drink, for example, adding to a soup, custard, hot chocolate or coffee. To heat an ONS, pour it into a pan and warm through gently without boiling, or decant into a microwave suitable container and warm without bringing to the boil. Boiling the ONS or adding to boiling food should be avoided as it may alter the taste and destroy the heat sensitive vitamins in the product.
Can ONS be frozen?
Yes. Some people may prefer to take ONS frozen either as a change to sipping them, or because they find them more palatable or easier to take if they have a sore mouth. To freeze the ONS pour it into a freezer safe container (or ice cube tray) and freeze. ONS can also be frozen in ice-lolly moulds. ONS should always be decanted from their bottles before freezing.
Can ONS be used in cooking or mixed with other foods?
Yes. Some people prefer to take their ONS by adding them to or mixing them with other foods and drinks, either as a change to sipping them or because they find them easier and more palatable to take this way. ONS can be used to fortify a variety of drinks, savoury and sweet foods, for example, hot chocolate, macaroni cheese and muffins. Ideas and tips on incorporating ONS into foods and drinks can be found in the Resource Centre-patient resources.
Are ONS lactose free?
Many of the products in the Nutricia ONS range can be classified as clinically lactose free and are therefore suitable for patients with lactose intolerance. These include: Fortisip Bottle, Fortijuce, Calogen, Calogen Extra, Calogen Extra Shots, Nutricia preOp, FortiCare, Nutilis Powder, Nutilis Clear, Nutilis Fruit Stage 3, Super Soluble Maxijul, Polycal Powder and Polycal Liquid
Are ONS suitable for vegetarians?
The majority of Nutricia's ONS are suitable for vegetarians as defined by The Vegetarian Society. Carminic Acid, a colouring derived from cochineal, may not be acceptable to some patients and is used in the following ONS:
|Product name||Flavours containing Carminic Acid|
|Fortisip Compact||Strawberry, Forest Fruit & Apricot|
|Fortisip Compact Fibre||Strawberry|
|Fortisip Compact Protein||Strawberry, Peach/Mango & Berries|
|Fortisip Bottle||Orange, Strawberry & Tropical|
|Fortisip Yogurt Style||Raspberry & Peach/Orange|
|Forticreme Complete||Banana & Forest fruit|
|Calogen Extra Shots||Strawberry|
|Nutilis Complete Stage 1||Strawberry|
|Nutilis Complete Stage 2||Strawberry|
|Nutilis Fruit Stage 3||Strawberry|
|Super Soluble Maxijul||None|
Which ONS are suitable for patients with diabetes?
Many of the Nutricia range of ONS can be used for individuals with diabetes. Good nutritional intake is important for any patient and if a patient who has diabetes is at risk of malnutrition, nutrition support should be considered to ensure their nutritional requirements are being met. It is very important that patients with diabetes are provided with a regular intake of carbohydrate to control blood sugar and prevent low blood sugar levels. ONS should be sipped slowly over a period of approximately 20 minutes in order to avoid any rapid rise in blood glucose levels. Blood glucose levels should be monitored regularly and oral hypoglycaemic tablets/insulin modified accordingly. In terms of specific products that you may consider, Fortisip Bottle Neutral flavour is a good choice as it contains lower levels of sugar. The fibre present in Fortisip Compact Fibre may help control blood sugar levels. If a patient requires an ONS, advice should be sought from a dietitian, diabetes nurse or doctor as to the most appropriate ONS for that patient, the number they require, and how they should be taken.
Are ONS suitable for patients with coeliac disease?
Yes. All Nutricia's ONS are gluten free and are suitable for patients with coeliac disease or who have gluten intolerance.
Are ONS suitable for patients with cows’ milk protein allergy?
Most ONS are based on cows' milk protein and are therefore not suitable for patients with cows' milk protein allergy. For further information about specific ingredients used in Nutricia's products and their suitability for people with food allergies or intolerances please visit the contact us page.
Are ONS suitable for use during pregnancy?
ONS can be suitable for use in pregnancy. It is very important to have a good nutritional intake at this time, however, it is also important that an excessive intake of vitamin A should be avoided as it may cause harm to the unborn baby. Many of Nutricia's ONS are designed to provide the complete range of micronutrients which includes vitamin A. The level of vitamin A present in Nutricia's ONS is well within the upper limit suggested during pregnancy, however, intake of vitamin A from normal dietary foods should also be considered and intakes of vitamin A rich foods should be limited (e.g. liver). The decision to use ONS during pregnancy should be made by a dietitian or doctor.
Are ONS suitable as part of a Halal diet?
Nutricia’s range of ONS do not contain ingredients that are forbidden in a Halal diet and some products have Halal certification. For further information please visit the Contact Us page.
Are ONS suitable as part of a Kosher diet?
Most of Nutricia's ONS have Kosher approval. For a list of these products, please get in touch via our Contact Us page.