DECRYPTION – Used to support malnourished patients, high-calorie and high-protein oral nutritional supplements (ONS) come in various flavors and formats. Their consumption is part of rigorous medical monitoring, but are they effective?
Vanilla, caramel, apricot… CNOs (oral nutritional supplements), high in calories and high in protein, do everything to be appreciated. These products are used for medical purposes, for cancer patients, elderly people in a state of malnutrition or following major surgeries. “ Ideally, they should not replace a meal », explains Camille Besson, dietitian nutritionist. We recommend taking them as snacks, at 10 a.m. or 4 p.m., to suppress the appetite as little as possible during real meals.
In these patients, the consumption of foods rich in protein, such as cheese or eggs, is not always sufficient: the needs are high and to cover them, it would be necessary to consume too large quantities of these foods which are certainly rich in protein, but also in unhealthy fats. In what context should I take NOCs? “ There are two parameters to take into accountspecifies Bruno Raynard, head of department at the Gustave Roussy cancer center, in Villejuif. The first is the nutritional status, they are prescribed if the patient loses more than 5 % of its weight in 1 month, or more than 10 % in 6 months. The second is the ingesta level (what the person is able to eat per day). If the patient eats less than 70 % of what corresponds to its caloric needs CNOs can be prescribed. »
Fighting against cachexia: a vital issue for patients
These nutritional supplements aim on the one hand to fight against weight loss, a real enemy in cancer or in very elderly patients. Cachexia, a significant loss of adipose tissue and muscles, is common in many diseases, and harmful: 20 to 30% of cancer-related deaths are in reality due to this complication! In the context of major surgery, and in particular visceral and digestive surgeries, metabolism may be disrupted, forced fasting in the days following the operation may weaken the patient, and inflammation leads to very high consumption of proteins to the detriment of the rest of the body. CNOs may therefore be necessary even if the patient does not have a loss of appetite.
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The consumption of these foods is always done on the prescription of a doctor, and they are covered by Social Security. “ It’s somewhere between a food and a medicine, but it’s not real food », continues Bruno Raynard. It is a food for medical purposes. For most patients, CNOs enriched with protein and fat are recommended. How are they made? These are classic foods, to which protein powder of plant origin and lipids, such as omega-3, are added. The best known remain yogurts and milk drinks, but we now also find biscuits and soups. There are also protein-enriched powders, also for medical purposes, to add to yogurts, compotes, soups or purees. “ They are rarely used as CNO alone, but rather to enrich the diet with proteins. » underlines Stéphane Schneider, who heads the Nutritional Support Unit of the digestive center of the Achet Hospital in Nice. These powders do not in fact allow you to gain weight, since they are not enriched with fats.
Is it effective?
« The range is wide, there is a wide variety of tastes and textures, it is easier than before to find a product that will please the patient », continue Bruno Raynard. « There are patients who will look for a strong taste, others, prone to nausea, will prefer neutral CNO… The patient is really at the center of the care, we must adapt to him », explains Camille Besson. “ Sometimes there’s a little metallic taste, and people get tired of it, it’s not always very good ,” teased Bruno Raynard. “ If they are well tolerated by patients, and they consume the prescribed number of CNOs per day, they are effective, and can avoid artificial feeding which is the last resort. », concluded Camille Besson.
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The duration of the prescription may vary depending on the illness or the importance of the surgery, but there is a mandatory 10 day test in order to find the best CNO. You should not be discouraged, even if you do not see immediate results. “ Malnutrition is progressive. In one week of CNO, we will not necessarily see great improvements, but it is important to continue to exceed the patient’s nutritional needs, particularly to reduce complications linked to the disease which can be aggravated by weight loss. », says Stéphane Schneider.
Not to be confused with protein powders intended for athletes
Be careful not to replace them with products sold commercially without medical supervision. Indeed, since the 1980s, protein powders have been all the rage in sports circles, and we can now even find protein milk products on supermarket shelves. But the composition of these products is different from that of NOCs. They contain fewer carbohydrates and fats and are often designed to be, unlike NOCs, low in calories in order to promote the gain of so-called “lean” muscle mass.
Furthermore, oral nutritional supplements for medical purposes are easy to digest, while powders intended for athletes may contain proteins that digest more slowly (such as casein) to support muscle growth overnight. It is therefore essential to differentiate between these two types of products, which fulfill distinct functions.
