title: A systematic review of compliance to oral nutritional supplements.
abstract: OBJECTIVE
  Oral nutritional supplements (ONS) play a key role in the management of malnutrition. This systematic review examined patients' compliance with ONS across healthcare settings and the influence of patient and ONS-related factors.
  
  
  METHODS
  A systematic review identified 46 studies (n = 4328) of ONS in which data on compliance (% of prescribed quantity of ONS consumed) was available. Pooled mean %compliance was assessed overall and according to study design and healthcare setting. Inter-relationships between compliance and ONS-related and patient-related factors, and total energy intake were assessed.
  
  
  RESULTS
  Overall mean compliance with ONS was 78% (37%-100%; 67% hospital, 81% community; overall mean ONS intake 433 kcal/d). Percentage compliance was similar in randomised (79%) and non-randomised (77%) trials, with little variation between diagnostic groups. Compliance across a heterogeneous group of unmatched studies was positively associated with higher energy-density ONS and greater ONS and total energy intakes, negatively associated with age, and unrelated to amount or duration of ONS prescription.
  
  
  CONCLUSIONS
  This systematic review suggests that compliance to ONS is good, especially with higher energy-density ONS, resulting in improvements in patients' total energy intakes that have been linked with clinical benefits. Further research is required to address the compliance and effectiveness of other common methods of oral nutritional support.
authors.affiliation: Medical Affairs Dept, Nutricia, Whitehorse Business Park, Trowbridge, Wiltshire, BA14 0XQ, UK. gary.hubbard@nutricia.com
authors.forename: Gary P
authors.initials: GP
authors.lastname: Hubbard
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
authors.forename: Anne
authors.initials: A
authors.lastname: Holdoway
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
mesh_terms: D000328:Adult; D000367:Age Factors; D019587:Dietary Supplements / Q000032:analysis; D002149:Energy Intake; D005526:Food, Formulated / Q000032:analysis; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy*; D010349:Patient Compliance