Compliance with a powdered energy-dense, high-protein ONS

October 01, 2021 4 min read

ESPEN Conference 2021: Spotlight on our Poster

AYMES were delighted to attend this year’s European Society for Clinical Nutrition and Metabolism (ESPEN) conference. We were proud to present our poster abstract, which explores rates of compliance with powdered oral nutritional supplements (ONS). In this blog, we summarise the key points from our poster, discuss the existing evidence base for powdered ONS and unpack the impact that this research may have on dietetic care.

The European Society for Clinical Nutrition and Metabolism

ESPEN are an organisation which seeks to further develop the field of clinical nutrition and metabolism. ESPEN members are clinicians from across Europe, including gastroenterologists, nutrition nurses, dietitians and speech and language therapists. The aim of the group is to contribute to clinical research, advance education and provide consensus statements about clinical and quality control in areas relating to clinical nutrition¹. ESPEN achieves this by hosting a unique learning programme, special interest groups, clinical nutrition courses, journals and an annual congress²

The ESPEN annual congress is one of the most prestigious meetings of its kind. It is committed to disseminating innovative research and advancing education within the field of nutrition. ESPEN invites clinicians to present research at their annual congress. The committee maintains a strict acceptance criterion which includes relevance of research to ESPEN, originality of work and its potential scientific and clinical value²

Our researcher: Alice Johnson aka The Hereford Dietitian

Alice is a registered dietitian and active member of the British Dietetic Association (BDA). Having completed a post-graduate diploma in clinical nutrition, she has over ten years of clinical experience working within the NHS and private sector³.

Alice worked with us to develop a study examining compliance with a new powdered, high-energy, high-protein, low-volume ONS (ActaSolve Protein Compact)⁴. Her work was chosen by ESPEN to be presented at the 2021 annual congress.

Study results: compliance with a powdered energy-dense, high-protein ONS

The annual cost of disease-related malnutrition (DRM) is estimated at more than £23.5 billion a year within the UK⁵. Appropriate prescribing of ONS has been found to be a successful intervention to prevent complications of DRM⁵. However, ONS are only effective in improving nutritional status if patients are compliant with the volumes prescribed by dietitians. There remains limited research examining compliance of powdered ONS in comparison with ready-to-drink ONS.

AYMES are committed to closing this gap, and our latest poster abstract explores the acceptability and tolerance of a high-energy, high-protein, low-volume powdered ONS amongst older adults living in the community. A small-scale study of 17 adults living with or at risk of DRM were given a short course of a new powdered supplement ‘AYMES ActaSolve Protein Compact’ (containing 312-315kcals, 20.2-20.5g protein/made up with 100ml milk) to replace their previous ONS.

Results showed that acceptance of the powdered ONS was positive and short-term compliance improved from 81% at baseline to 91% post intervention. Palatability was rated as acceptable by all participants with 71% reporting to prefer the new ONS to their previous drinks. Preparation of the ONS was considered to be easy as reported by carers⁴.

Evidence-base for powdered ONS

These results are comparable to a previous systematic review that examined 46 studies focusing on ONS compliance. Overall mean compliance with ONS was found to be 78% (433kcals/day). Compliance was positively associated with high-energy supplements and greater calorie intake⁶. Another study of care home residents living with DRM, found that mean compliance with ONS was 67%. Again, a positive association was found with compliance and low-volume, energy-dense ONS resulting in improved nutritional status ⁷.

A study in a Swedish hospital assessed adherence to ONS amongst outpatients. The study used food frequency questionnaires for 96 participants and found mean compliance of ONS to be 93%. It was suggested that giving patients the opportunity to trial different types of ONS and choose their preferred flavours, helped to achieve high compliance in this group⁸.

How this research may impact dietetic care

Primary care settings often prescribe powdered ONS as a first-line intervention due to their cost⁹. It is suggested that two to three servings of ONS should be prescribed daily to achieve clinical benefit beyond a ‘food first’ approach (providing approximately 600-900kcals/day)¹⁰. Powdered ONS are therefore a valuable option when considering cost saving initiatives.

Many patients who require nutritional support will have limited appetites or early satiety. Evidence shows that low-volume, energy-dense ONS are favoured amongst many patients, and powdered ONS tends to be prescribed more frequently by GP’s due to their price point. AYMES have developed this innovative product which meets the cost effectiveness of a powdered supplement, whilst being available in a compact volume, which is often preferred by patients. You can find out more on AYMES ActaSolve Protein Compact on our website.

  1. European Society for Clinical Nutrition and Metabolism (ESPEN). Who we are. 2021. [Internet]. Available from:
  2. European Society for Clinical Nutrition and Metabolism (ESPEN). Membership. 2021. [Internet]. Available from:
  3. The Hereford Dietitian. About. 2021. [Internet]. Available from:
  4. A. Johnson, L. Nield, G. Fry, C. James, M. McLees. ESPEN Conference 2021. A new powdered, high energy, high protein, low volume oral nutritional supplement demonstrates excellent compliance, is highly palatable and easy to use in community dwelling older adults.
  5. Stratton R, Smith T, Gabe S. Managing malnutrition to improve lives and save money. BAPEN. 2018.
  6. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clinical Nutrition. 2012;31(3):293-312. doi:10.1016/j.clnu.2011.11.020
  7. Jobse I, Liao Y, Bartram M, Delantonio K, Uter W, Stehle P, Sieber CC, Volkert D. Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status. The Journal of Nutrition, Health and Aging. 2015;19(3):356-64. [Internet]. Available from: doi: 10.1007/s12603-014-0544-y.
  8. Liljeberg E, Andersson A, Blom Malmberg K and Nydahl M. High Adherence to Oral Nutrition Supplements Prescribed by Dietitians: A Cross-Sectional Study on Hospital Outpatient. Nutrition in Clinical Practice. 2019; 34(6):887–898
  9. Monthly Index of Medical Specialities (MIMS). Nutrition: Tube and sip feeding. 2021. [Internet]. Available from:
  10. Stratton R, Elia M. A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. 2007. Clinical Nutrition Sup; 2(1): 5-23