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Dietary supplements

If patients are unable to meet their nutritional requirements with food alone then they may require appropriate supplementation using dietary supplements. These may be used to improve an inadequate diet or as a sole source of nutrition if taken in sufficient quantity.

Sip feeds

These come in a range of flavours, both sweet and savoury, and are presented as a powder in a packet or ready prepared in a can, bottle or carton. Sip feeds contain whole protein, hydrolysed fat and carbohydrates. Most are called ‘complete feeds’ since they provide all protein, vitamins, minerals and trace elements to meet requirements if a prescribed volume is taken (Thomas and Bishop 2007). Others may be aimed at specific needs, for example high protein.

Energy supplements

Carbohydrates

Glucose polymers in powder or liquid form contain approximately 350 kcal (1442 kJ) per 100 g and 187–299 kcal (770–1232 kJ) per 100 mL respectively. Powdered glucose polymer is virtually tasteless and may be added to anything in which it will dissolve, for example milk and other drinks, soup, cereals and milk pudding; liquid glucose polymers may be fruit flavoured or neutral (Thomas and Bishop 2007). Such supplements would be used to increase the energy content of the diet.

Fat

Fat may be in the form of long-chain triglycerides (LCT) or medium-chain triglycerides (MCT) and comes as a liquid which can be added to food and drinks. These oils provide 416–772 kcal (1714–3181 kJ) per 100 mL: the oils with a lower energy value are presented in the form of an emulsion and those with a higher energy value are presented as pure oil (Thomas and Bishop 2007).

Mixed fat and glucose polymer solutions and powders are available and provide 150 kcal per 100 mL or 486 kcal per 100 g, depending on the relative proportion of fat and carbohydrates in the product.

Products containing MCT are used in preference to those containing LCT where a patient suffers from GI impairment causing malabsorption. Patients require specific advice about their use to ensure that they are introduced into the diet slowly and GI tolerance is assessed (Thomas and Bishop 2007).

Always check with the manufacturer for the exact energy content of products. Note: products containing a glucose polymer are unsuitable for patients with diabetes mellitus.

Protein supplements

These come in the form of a powder and provide 55–90 g protein per 100 g. Protein supplement powders may be added to any food or drink in which they will dissolve, for example milk, fruit juice, soup, milk pudding.

Energy and protein supplements are not used in isolation as these would not provide an adequate nutritional intake. They are used in conjunction with sip feeds and a modified diet. The detailed nutritional compositions of dietary supplements are available from the manufacturers.

Vitamin and mineral supplements

When dietary intake is poor a vitamin and mineral supplement may be required. This can often be given as a one-a-day tablet supplement that provides 100% of the dietary reference values. Care should be taken to avoid unbalanced supplements or those containing amounts larger than the dietary reference value (FSA and Expert Group on Vitamins and Minerals 2003). Excessive doses of vitamins and minerals may be harmful, particularly as some vitamins and minerals are not excreted by the body when taken in amounts exceeding requirements. Additionally, vitamins and minerals may interact with medication to influence its efficacy; for example, vitamin K may influence anticoagulants such as warfarin.

Anticipated patient outcomes

It is anticipated that feeding an adult will ensure safe delivery of the meal, in a comfortable environment which the patient feels is a pleasurable and positive experience, promoting adequate nutritional care.

Legal and professional issues

Protected Mealtimes should be in place on the wards, whereby all non-essential clinical activities have been discontinued and a calm environment exists (Age Concern 2006). The use of Protected