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Review
. 2025 Jan 9;13(1):e4722.
doi: 10.1002/fsn3.4722. eCollection 2025 Jan.

Adherence to Oral Nutritional Supplements: A Review of Trends in Intervention Characteristics and Terminology Use Since the Year 2000

Malin Skinnars Josefsson  1 , Sandra Einarsson  2 , Linn Seppälä  3 , Liz Payne  4 , Lisa Söderström  5 , Evelina Liljeberg  1   6   7
Affiliations
Review

Adherence to Oral Nutritional Supplements: A Review of Trends in Intervention Characteristics and Terminology Use Since the Year 2000

Malin Skinnars Josefsson et al. Food Sci Nutr. .

Abstract

Research on disease-related malnutrition and adherence to oral nutritional supplements (ONS) has increased in recent years. To guide future studies, it is important to identify trends in terminology use and intervention characteristics. This review aimed to map characteristics of research investigating adherence to ONS in patients with disease-related malnutrition and explore changes over time. This review is a secondary analysis of quantitative studies from a systematic mixed-studies review. Online databases, including PubMed, Cinahl, Cochrane Central Register of Controlled Trials, and APA PsycInfo, were searched to identify studies published from 2000 to March 2022. A quantitative content analysis of extracted data was performed, and the Mixed Methods Appraisal Tool (MMAT) was used to assess methodological risk of bias. This review includes 137 articles, over half of which are randomized controlled trials (52%). The term "oral nutritional supplements" was used in 40% of the studies. Adherence to ONS was mainly described by the term "compliance" (69%). It was most common to offer ready-made milk-based ONS (56%) and ONS as a sole intervention (51%). The prescribed dose of ONS was fixed in 64% of studies and individualized in 22% of studies. There was variation in the methods used to assess adherence to ONS, and adherence was not reported in nearly a fifth of studies. There was an increase in methodological quality over time (p = 0.024). To ensure better understanding and increase the rigor and reproducibility of ONS intervention research, it is crucial to standardize the terminology used and to describe the interventions clearly.

Keywords: adherence; adherence assessment; compliance; nutrition intervention; oral nutritional supplement.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Characteristics of included articles, n = 137. (a) The number of included articles published each year from January 2000 to March 2022, divided by study design. (b) Study design and mixed‐method appraisal tool (MMAT)‐score risk of bias. High percentage indicates high quality. (c) Distribution (%) of patient population in the included articles.
FIGURE 2
FIGURE 2
Distribution of included articles (n = 137) by country. Map created in mapchart.net.
FIGURE 3
FIGURE 3
Oral nutritional supplement (ONS) intervention characteristics in included articles, n = 137. (a) Distribution of ONS intervention contents and study design. (b) Distribution (%) of intervention type. (c) Distribution (%) of intervention dose.
FIGURE 4
FIGURE 4
Terminology used in included articles published between January 2000 and February 2022, n = 137 (a). Terminology used for “oral nutritional supplement”. (b) Terminology used for adherence to oral nutritional supplements.
FIGURE 5
FIGURE 5
Assessment of oral nutritional supplement (ONS) adherence or intake in includes articles, n = 137. (a) Distribution of assessment method for adherence or intake of ONS by study design. (b) Distribution of adherence rate by study design. (c) Heat map ranging from red to green with increasing frequency of the distribution of assessment method of ONS intake and reporting of the adherence rate. Presented in frequencies.
See this image and copyright information in PMC

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