Distribution of oral nutritional supplements with medication: Is there a benefit? A systematic review

Introduction: Disease related Malnutrition remains a major burden for patients and healthcare systems. The Medication Pass Nutritional Supplement Program (MEDPass) involves providing patients with oral nutritional supplements (ONS) in unusually small amounts three to four times a day during medication rounds. This systematic review aims to evaluate the impact of MEDPass ONS administration on compliance, total energy and protein intake, food intake, body weight (BW), and handgrip strength (HGS) in hospitalized adults and nursing home residents. Methods: We conducted a systematic literature search in the databases MEDLINE, Embase, Sciencedirect and the Cochrane Library. Included study types were randomized controlled trials (RCT), non-randomized controlled trials (non-RCT) and before-after studies. Validated tools specific to the study design were used to assess included studies. Results: Ten studies were identified with two being RCTs, three non-RCTs and five before-after trials. Compliance increased by 23.4-66% with MEDPass administration, resulting in compliance rates of 72.7-96%. With MEDPass administration, BW increased by 1-6.8% or remained stable. The assessed evidence on total energy intake is ambiguous for protein, with a trend towards an increased intake. Trials on energy intake from food show mixed results as well. One study suggests a slight increase in HGS. The included studies predominantly raise concerns for bias. Conclusion: We conclude that MEDPass ONS administration increases compliance in hospitalized adults and nursing home residents. For all other outcomes, robust and well-powered trials are necessary