Hit Refresh: Innovative Ways to Use Juice-Style ONS During Summer Months

June 24, 2021 6 min read


Oral Nutritional Supplements (ONS) are a useful strategy in the management of disease-related malnutrition, but they are only effective if consumed.¹ ² ³ A recent study found that 64% of patients didn’t comply with their ONS prescription.⁴ Poor compliance to ONS can be attributed to a variety of factors including ONS specific features such as flavour, palatability, texture, variety, volume, and energy density.⁵ ⁶ ⁷ Individual patient factors such as reduced taste or smell function, dysphagia, and gastrointestinal symptoms also influence compliance.⁸⁻¹¹ Additionally, prolonged and repeated consumption of ONS, is known to cause taste fatigue; contributing to lower compliance rates.¹²⁻¹⁵

Patient preference plays an important role in ONS compliance.¹⁶ ¹⁷ For example, some studies have reported poor compliance to standard (milkshake style) ONS due to patients’ dislike of milky drinks, the thickness, mouth-feel, and available flavours. ¹⁸⁻²⁰

Offering a variety of forms and styles of ONS, such as juice-style ONS, in different flavours, may help to combat personal dislike, boredom and taste fatigue, ultimately improving ONS compliance. This article introduces our new high energy juice-style ONS and suggests a number of innovative ways to offer this fresh alternative to patients, especially in the summer months.

Switching without compromise

A recent survey examining ONS prescribing experiences of thirteen Dietitians revealed that the Dietitians thought that switching to a juice-style ONS compromised the nutritional value of an ONS regimen.²¹

It is important to correct this misimpression. Choosing a juice-style ONS can offer a useful and refreshing alternative to milkshake style ONS with minimal nutritional compromise. AYMES’ Actagain Juce has comparable nutritional profiles for protein and energy; when compared with standard milkshake style ready-to-drink (RTD) ONS (see figure 1).

Introducing Actagain Juce

AYMES Actagain Juce is a refreshing new, high-energy juice-style ONS, designed especially for patients who dislike milky drinks or prefer a more refreshing taste. ActagainJuce is available in5flavours (Juicy Apple, Zesty Orange, Berry Medley, Exotic Fruit)and Juicy Peach.ActagainJuceis also a useful choice for patients experiencing taste fatigue, taste changes, (due to medication and/or treatment), and for those who would benefit from a fat-free ONS. Patients can switch from a standard ready-to-drink (RTD) milkshake style ONS product to AYMES Actagain Juce with minimal impact on their protein intake – this is not always the case for other RTD juice-style ONS (see figure 1).

Key facts about AYMES Actagain Juce:

  • Contains the highest amount of protein (11g/200ml bottle) when compared with other available juice-style ONS – meaning minimal impact on protein intake when switching from standard RTD milkshake style ONS (see figure 1).²²
  • Is the most cost-effective juice-style ONS (per gram of protein) at just £1.80 per 200ml serving (see figure 2). ²³
  • Provides the 10μg daily Vitamin D requirements just 2 servings (DoH recommendations for adults and children over 4 years of age). ²4
  • Scores high withtaste; in a recent study,93% of participants ratedActagainJuce as acceptable for palatability (e.g., taste,consistency andappearance).²5
  • Our Tetra Pak cartonscontain63% plant-based material and use 4x less plastic. ²6, ²7 

Figure 1: ONS Nutrient Composition Comparison (200ml)

  Market Leading Juice (apple/orange) AYMES Actagain Juce (apple/orange) Standard RTD (milk-based)
Energy (kcal) 300 300 300
Protein (g) 8 10 12
Fat (g) 0 0 11.6

Figure 2: AYMES Actagain Juce: summary features (200ml carton)

Energy Protein kcal/ml Cost
300Kcal 11g 1.5 £1.80


Innovative ways to use Actagain Juce during summer months

There are plenty of interesting and innovative ways to serve Actagain Juce. Summer is a particularly good time to enjoy Actagain Juce and to experiment with different serving options. Serving drinks at different temperatures can be a simple way to mix things up and improve compliance. Patients often report preferring chilled ONS to room temperature ONS.²⁴

Innovative ways to enjoy AYMES Actagain juce include:

  • Serving chilled with ice. Add a lemon or lime wedge.
  • Freezing into ice lollies, slush drinks, or ice cubes to add to favourite drinks.
  • Mixing into home-made smoothies.
  • Making into jellies for a light and fresh dessert.
  • Using it as a base for a refreshing sorbet.
  • Adding to cold drinks (i.e. lemonade, soda water) to make into a long drink to enjoy on a summer’s evening.
  • Using Actagain Juce as a base for a refreshing mocktail.



ONS are an effective way of managing disease-related malnutrition when taken as prescribed. ONS compliance can be poor due to a number of factors such as patient preference, sensory experiences, and taste fatigue.

Strategies to improve ONS compliance include offering a variety of different types of ONS (formats and flavours). Choosing a juice-style ONS can offer a useful and refreshing alternative to RTD milkshake style ONS with minimal nutritional compromise. AYMES Actagain Juce contains the highest amount of protein (11g/ 200ml bottle) when compared with other available juice-style ONS products and can be served in a variety of interesting and innovative ways, to help improve compliance.


  1. Elia M, et al. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. Clin Nutr [Internet]. 2016;35(1):125–37. Available from: http://dx.doi.org/10.1016/j.clnu.2015.07.012
  2. Smith TR, et al. Ready-made oral nutritional supplements improve nutritional outcomes and reduce health care use—a randomised trial in older malnourished people in primary care. Nutrients. 2020;12(2):1–17.
  3. Seguy D, et al. Compliance to oral nutritional supplementation decreases the risk of hospitalisation in malnourished older adults without extra health care cost: Prospective observational cohort study. Clin Nutr. 2020;39(6):1900–7.
  4. Lidoriki I, et al. Oral Nutritional Supplementation Following Upper Gastrointestinal Cancer Surgery: A Prospective Analysis Exploring Potential Barriers to Compliance. J Am Coll Nutr [Internet]. 2020;0(0):1–7. Available from: https://doi.org/10.1080/07315724.2020.1723453
  5. Özçaǧli TG, Stelling J, Stanford J. A study in four European countries to examine the importance of sensory attributes of oral nutritional supplements on preference and likelihood of compliance. Turkish J Gastroenterol. 2013;24(3):266–72.
  6. Ruxton C. Compliance with Oral Nutritional Supplements and the Role of Taste. 2014;6(2):43–5.
  7. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clin Nutr [Internet]. 2012;31(3):293–312. Available from: http://dx.doi.org/10.1016/j.clnu.2011.11.020.
  8. Risso D, Drayna D, Morini G (2020). Alteration, reduction and taste loss: Main causes and potential implications on dietary habits. Nutrients; 12(11): 1-16.
  9. IJpma I, et al. (2016). The palatability of oral nutritional supplements: before, during, and after chemotherapy. Support Care Cancer.; 24(10): 4301-4308.
  10. Zabernigg A, et al. (2010). Taste Alterations in Cancer Patients Receiving Chemotherapy: A Neglected Side Effect? Oncologist; 15(8): 913-920.
  11. Belqaid K, et al. (2018). Dealing with taste and smell alterations - A qualitative interview study of people treated for lung cancer. PLoS ONE; 13(1): e0191117.
  12. Enríquez-Fernández BE, et al. Sensory preferences of supplemented food products among cancer patients: a systematic review. Support Care Cancer. 2019;27(2):333–49.
  13. Nieuwenhuizen WF, et al. Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake. Clin Nutr [Internet]. 2010;29(2):160–9. Available from: http://dx.doi.org/10.1016/j.clnu.2009.09.003
  14. Rahemtulla Z, et al. The palatability of milk-based and non-milk-based nutritional supplements in gastrointestinal cancer and the effect of chemotherapy. Clin Nutr. 2005;24(6):1029–37.
  15. Galaniha LT, McClements DJ, Nolden A. Opportunities to improve oral nutritional supplements for managing malnutrition in cancer patients: A food design approach. Trends Food Sci Technol. 2020;102(May):254–60.
  16. Norris E, Shelton F, Hetherington MM. Nutrition screening of older adults living in care homes. e-SPEN [Internet]. 2011;6(3):e106–8. Available from: http://dx.doi.org/10.1016/j.eclnm.2011.04.002
  17. Stratton RJ, Elia M. Encouraging appropriate, evidence‐based use of oral nutritional supplements. Proc Nutr Soc. 2010;69:477–87.
  18. Rozenberg S, et al. Effects of Dairy Products Consumption on Health: Benefits and Beliefs—A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Calcif Tissue Int 98, 1–17 (2016).
  19. den Boer A, Boesveldt S, Lawlor J Ben. How sweetness intensity and thickness of an oral nutritional supplement affects intake and satiety. Food Qual Prefer [Internet]. 2019;71:406–14. Available from: https://doi.org/10.1016/j.foodqual.2018.08.009
  20. Hogan SE, Solomon MJ, Carey SK. Exploring reasons behind patient compliance with nutrition supplements before pelvic exenteration surgery. Support Care Cancer. 2019;27(5):1853–60.
  21. Liljeberg E, et al. (2021). A qualitative exploration of dietitians’ experiences of prescribing oral nutritional supplements to patients with malnutrition: A focus on shared tailoring and behaviour change support. J Hum Nutr Diet.; doi: 10.1111/jhn.12867 (Online ahead of print) 22.MIMS May 2021
  22. Comparison based on MIMS data (accessed Jan 2024):ActagainJuce; 5g protein/100ml, Ensure PlusJuce; 4.8g protein/100ml,FresubinJucy; 4g protein/100ml,Fortijuce; 3.9g protein/100ml,Altrajuce; 3.9g protein/100ml.
  23. (MIMS;February,2024) 
  24. Provides 10μg in 2 servings which meetsDoH recommendations for adults and children over 4 years of age. The Scientific AdvisoryCommittee on Nutrition (SACN) recommendations on vitamin D;December, 2023.
  25. AYMES Data on File - AYMESActagainJuceAcceptability and tolerance study.February, 2024. 
  26. Data on file; Tetra Pak Packaging for AYMES presentation;October, 2023.
  27. Comparison based on AYMES data on file; Tetra Pak. Tetra Pak Packaging for AYMES presentation (accessed January 2024):Compared to HDPE bottle weighing 20g 
  28. Methven, L, et al. (2009). Can changing the serving temperature improve the palatability of oral nutritional supplements in older consumers? Proceedings of the Nutrition Society, 68(OCE1), E37. doi:10.1017/S0029665109001785