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Table 2 Characteristics and results of included oral nutrition supplementation (ONS) interventions

From: Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis

Study Design Setting, supplement type Number completed Dementia stage Dementia type Effect on nutrition or hydration status Effect on intake of nutrients or fluid Quality and Other outcomes Duration
ONS (including energy, protein and often other nutrients) plus usual food vs. usual food (with or without placebo ONS)
 Abalan 1992 France [30] RCT Geriatric inpatients. Proprietary ONS (‘Tonexis’) vs usual food I = 15
C = 14
NR AD N/A → E intake ↑ Cognitive function 15 weeks
 Beck 2002 Denmark [32] RCT Nursing home (risk of malnourishment). Home-made ONS vs usual food I = 8
C = 8
NR NR → Weight → E intake N/A 2 months
 Carlsson 2009 Sweden [34] CCT (BA) Group-living facilities for people with dementia. Drinkable yogurt 13 NR Mixed ↓ Weight → E intake
→ Fluid intake
→ Functional status 6 months
 Carver 1995 UK [36] RCT Psychiatric hospital/elderly ward (under-weight).
Proprietary ONS (‘Fortisip’) vs placebo
I = 20
C = 20
NR NR ↑ Weight
↑* BMI
→TSF
↑ MAMC
N/A N/A 12 weeks
 de Sousa 2012 Portugal [37] RCT Psychiatric hospital, geriatric unit, mild dementia patients (malnourished).
ONS vs usual care & advice
I = 20
C = 15
Mild AD ↑ Weight
 ↑ BMI
↓ Nutritional risk → Functional status
→ Cognitive function
3 weeks
 Faxen-Irving 2002 Sweden [38] CCT Group-living for people with dementia.
ONS & diet advice vs usual care
I = 21
C = 12
Mixed Mixed a Weight
a BMI
↑‡ TSF
→ AMC
N/A → ADL
↓ Cognitive function
5 months
 FICSIT Fiatarone Singh 2000 USA [39, 8688] RCT Nursing home (long term rehabilitation centre).
ONS vs placebo
I = 24
C = 26
NR NR Weight
 BMI
→ MAMA
→ TBW
→ E intake
→ Fluid intake
→Functional status 10 weeks
 FOPANU Carlsson 2011 Sweden [35, 89, 90] RCT Residential care facilities.
Protein-enriched drink (+/− exercise) vs placebo drink (+/− exercise)
I = 96
C = 95
NR NR → Weight
→ ICW
N/A → Balance
→ Gait
→ Lower limb strength
3 months
 Gregorio 2003 Spain [40] RCT Nursing home residents with AD.
Proprietary ONS (‘Nutrison’) vs usual food
IG = 24
C = 74
Mod AD ↑* BMI ↓* Nutritional risk N/A 12 months
 Lauque 2000 France [44] RCT Nursing homes (risk of malnourishment).
Proprietary ONS (Clinutren, Nestle) vs usual food
I = 19
C = 22
NR NR → Weight
→ BMI
↑ E intake
↑ Protein intake
→ Grip strength 2 months
 Lauque 2004 France [45] RCT Geriatric wards & day centres (risk of malnourishment). Proprietary ONS (Clinutren) vs usual food I = 37
C = 43
Mod NR Weight
BMI
↑ E intake
Nutritional risk
→ADL
→ Cognitive function
→ Eating behaviour
3 months
 Manders 2009 Netherlands [46] RCT Nursing homes.
ONS vs placebo
I = 78
C = 33
NR NR Weight
↑ Calf circumference
N/A → Functional status
→ Grip strength
→ Cognitive status
24 weeks
 Navrátilová 2007 Czech Republic [47] RCT Institutionalised residents with AD (type of institution unclear).
Proprietary ONS (‘Nutridrink’) vs usual food
I = 50
C = 50
NR AD → Weight
→ BMI
E intake
Protein intake
Cognitive function 1 year
 Pivi 2011 Brazil [55] RCT Setting unclear. Proprietary supplement (Ensure with FOS®) vs usual care I = 26
C = 27
Mild-severe AD ↑* Weight
↑* BMI
↑* AMC
↑* AC
 → TSF
N/A N/A 6 months
 Planas 2004 Spain [48] CCT (BA) Dementia care day centre.
ONS +/− micronutrients
I = 23
C = 21
Mild AD → BMI
↑ MAMC
↑ TSF
↑ E intake → Cognitive function 6 months
 Simmons 2010a USA [50] RCT Long-term care facilities, type unclear. Between meal nutritional supplements vs. usual care I = 18
C = 20
NR NR → Weight → E intake ↑ Costs & staff time 6 weeks
 Souvenir I
 Scheltens 2010 USA & Europe [49, 9196]
CCT (BA) AD Treatment Centres.
Proprietary ONS (Souvenaid) vs isocaloric placebo
I = 98
C = 97
Mild AD → BMI N/A → Cognitive function
→ QoL
12 & 24 weeks
 Stange 2013 Germany [51, 9799] RCT Nursing home (risk of malnutrition).
ONS vs usual care
I = 45
C = 42
Mod-severe NR ↑ Weight
→ BMI
↑ UAC
↑ Calf circumference
→ E intake
→ Protein intake
→ Nutritional risk
→ Cognitive function
→ ADL
12 weeks
 Wouters-Wesseling 2002 Netherlands [53] RCT Nursing homes, residents with dementia.
ONS vs placebo
I = 19
C = 16
NR Mixed ↑ Weight
→ BMI
N/A → Functional status 12 weeks
 Wouters-Wesseling 2006 Netherlands [52] RCT Psychogeriatric nursing homes (with acute infection).
ONS vs usual care
I = 18
C = 16
NR NR → Weight
→ TST
→ AMC
→ E intake → Functional status 5 weeks
 Young 2004 Canada [54, 62, 100] RCT Dementia units within a nursing home. ONS vs high carbohydrate meals I = 15
C = 19
NR AD ↑ Weight ↑ E intake
↑ Protein intake
N/A 3 weeks
Fruit juice plus normal food vs control drink plus normal food
 Krikorian 2010a USA [42] RCT Community-dwelling.
Grape juice vs placebo
I = 5
C = 7
MCI N/A →* Weight
→* Waist
N/A ↑ Learning,
→ Spatial awareness,
→ Recall
12 weeks
 Krikorian 2010b USA [43] CCT Community-dwelling.
Blueberry juice vs placebo
I = 9
C = 7
MCI N/A →* Weight
→* Waist
N/A ? Cognition,
? Spatial awareness
12 weeks
 Krikorian 2012 USA [41] RCT Community-dwelling.
Grape juice vs placebo
I = 10
C = 11
MCI N/A → Weight
→ Waist
N/A NR 16 weeks
Additional snacks between meals plus usual food vs usual food
 Simmons 2010b USA [50] RCT Long-term care facilities.
Between meal snacks & assistance vs usual care
I = 25
C = 20
NR NR → Weight → E intake ↑ Costs
↑ Staff time
6 weeks
Multicomponent interventions including ONS
 Beck 2010 Denmark [31, 101] RCT Elderly nursing home residents.
ONS, Gratin diet, exercise, oral care vs usual care
I = 54
C = 55
NR NR ↑ Weight
↑ BMI
→ E intake
↑ Protein intake
→ Cognitive performance
→ ADL
11 weeks
 Boffelli 2004 Italy [33] CCT (BA) Malnourished residents of dementia unit. Individualised diet including mealtime assistance, environmental modification and ONS if required 19 Severe Mixed → Weight
→ BMI
↑ Serum albumin
N/A N/A 18 months
  1. *Variance NR; significance stated but no p values presented; Reported for females only; astatistical significance reported in paper but change data not provided so significance does not appear in meta-analysis, ♣ these were RCTs, but we used their data as before-after comparisons, so they are reported here as BA.
  2. ↑ indicates statistically significant increase; ↓ indicates statistically significant reduction; → indicates no statistically significant effect; statistical significance of all effects were checked by reviewers where data were available, and reviewers results used when they differed from the original paper.
  3. AD Alzheimer’s disease, AC Arm Circumference, ADL activities of daily living, AMC arm muscle circumference, BA before-after or pre-post, BMI body mass index, C control group, CCT controlled clinical trial (with a concurrent control arm unless indicated as BA), CDR Clinical Dementia Rating Scale, C control group, E energy, GDS Global Deterioration Scale, I intervention group, ICW intracellular water, MAMA mid-arm muscle area, MAMC mid-arm muscle circumference, MCI mild cognitive impairment, mod moderate, N/A not applicable, NR not reported, ONS oral nutritional supplement, QoL quality of life, RCT randomised controlled trial, suppl supplement, TSF triceps skin fold, TST triceps skin fold thickness, TBW total body water, UAC upper arm circumference, vs versus