Exciting New Products to Treat Involuntary Weight Loss

W

hen I walked into the patient's room, a familiar sight greeted me--a dozen cans of medical nutrition supplements stacked on the nightstand, unopened and waiting to be returned to the kitchen. When I asked the patient why there were so many cans, she looked at me wide-eyed and stated the obvious, "Because I don't drink them." Her answer seemed so simple yet touched upon the much more complex issue of nutrition intervention programs--an issue that is facing practitioners in every healthcare setting. I had been summoned to this patient's room for a nutrition consultation due to her continued involuntary weight loss (IWL). The patient had lost 20 pounds over a five-month period, and these supplements were ordered as a way to boost the caloric and protein content of her diet. Most liquid supplements are nutritionally complete, high in protein, and rich in vitamins and minerals. It seems to make perfect nutritional sense except for one small problem--she didn't drink them. For patients like this, the registered dietitian (RD) is a crucial member of the healthcare team. The nutrition professional should be consulted to design a nutrition intervention program that will meet the individual tastes and needs of each patient.
       The treatment of IWL is a high priority in healthcare today as more information becomes known about the importance of maintaining lean body mass and proper body composition, including adequate hydration. The role of nutrition in such diseases as diabetes, wound healing, cancer, HIV, renal disease, and many others is clearly defined in the scientific literature and has led to the development of dozens of nutritional products designed to help maintain optimal nutritional status. These products fall into two categories: 1) products to increase the caloric and nutrient density of the meal and 2) products to supplement meals and serve as between-meal snacks or as meal replacements when meal intake is poor. The recent proliferation of new products on the market has made nutrition intervention programs very exciting and now offers facilities the opportunity to be creative with their meals and snacks. Some examples of products that will add variety and meet the many different tastes and preferences of patients are listed below.* For information on how to obtain these products, see Table 1.
       Resource Arginaid (Novartis Nutrition). Resource Arginaid is an arginine-intensive powdered beverage mix that provides 4.5 grams of arginine per serving. Arginine supplementation has been linked to improved wound healing and immune function. This product is appropriate for patients with pressure ulcers, burns, recent surgery, and other similar medical problems. It is very simple to prepare and requires only a minute of preparation time. It is packaged in individual packets that are simply added to a 6- to 8-ounce glass of water and briskly stirred. The mixes are available in cherry, lemon, and orange flavors.
       Resource Arginaid Extra (Novartis Nutrition). As the name implies, this product adds something "extra" to the regular Resource Arginaid. It is ready to serve in an 8-ounce brick pack and contains 10.5 grams of protein. In addition to the 4.5mg of arginine, it also has 250mg of vitamin C, 15mg of zinc, and 90 IU of vitamin E, which makes it another excellent choice for wound healing. This product is available in two flavors: Orange Burst and Wildberry.
       Hormel Solutions Nutritional Cookies (Hormel HealthLabs). Some patients prefer to eat a snack rather than drink a 6- or 8-ounce beverage. Cookies make a familiar and comforting snack for patients who require finger foods and for pediatric patients. The Hormel Solutions 206 cookie is an individually wrapped thaw-and-serve product that comes in four flavors and one sugar-free flavor perfect for diabetic patients. The flavors include blueberry filled, apple filled, raspberry filled, peanut butter, and sugar-free lemon. Each cookie provides 200 calories and 6 grams of protein, hence its name, the 206 cookie.
       Hormel High Protein Gelatin Mix (Hormel HealthLabs). This gelatin mix is available in cherry and orange flavors and each 1/4 cup provides 150 calories and 12 grams of protein. This product is easy to prepare and is extremely economical. It can be served as a dessert with meals or as a high-protein snack between meals.
       NuBasics Complete Nutrition Decaffeinated Coffee Beverage (Nestle Clinical Nutrition). Quite often, patients don't feel like eating anything at all but prefer to sit quietly with a cup of coffee. A cup of coffee can still provide calories and protein if it is enriched. NuBasics Coffee is an instant coffee mix that comes in a can like most other coffees. Two level scoops are mixed with 6 ounces of warm water to make a cup of full-bodied decaffeinated coffee. Each cup of coffee will then provide 125 calories and 6.25 grams of protein. That is quite an improvement when compared to regular coffee, which is non-nutritive. If a patient drinks a cup of coffee with each meal, that is almost 19 grams of supplemental protein per day.
       Carnation Instant Breakfast (Nestle Clinical Nutrition). Some patients don't like "medical" drinks and prefer to stick with items that they are familiar with. Carnation Instant Breakfast may be just what they need. A one-ounce packet of powder is mixed with 8 ounces of 2% milk to provide a meal replacement or between-meal snack. Each serving provides 250 calories and 12 grams of protein plus vitamins and minerals. It is available in a variety of flavors including chocolate, vanilla, strawberry, mocha, and chocolate malt. Carnation Instant Breakfast is also available in a no-sugar added formulation that provides 190 calories and 12 grams of protein. The no-sugar product is available in all flavors except mocha.
       Campbell's Healthcare Soups (Campbell's Soup). Often, patients that are ill don't want a large meal but will accept a bowl of soup and some crackers. Campbell's has two new soups that are high protein and convenient to serve. Super Chicken Noodle is made with dark meat chicken and wheat and soy noodles. A 1/2 cup serving provides 90 calories and 6 grams of protein. While the calories are not extraordinary, the protein content is much greater than an average bowl of soup. In fact, this chicken soup has 200 percent more chicken meat than Campbell's regular condensed chicken noodle soup. Totally Taco Soup is another high-protein choice that may appeal to the demand for ethnic flavors. Each 1/2 cup serving provides 130 calories and 8 grams of protein. This soup contains isolated soy protein crumbles and taco-shaped pasta.
       Ensure Nutrition and Energy Bars (Ross Products). This product is similar to a candy bar and great for patients who wander or require a fluid restriction. Each bar provides 230 calories and 6 grams of protein and is a good source of vitamins and minerals. The bars are individually wrapped and available in Chewy Chocolate Peanut, Cinnamon Oat 'n Raisin, Cookies 'n Cream, and Chocolate Maple Nut (this flavor provides 220 calories).
       Ensure Pudding (Ross Products). Puddings are excellent snacks for patients with chewing and swallowing problems and those on texture-modified diets, such as the pureed diet. Ensure pudding can be served as a dessert with a meal or as a between-meal snack. Each four-ounce serving provides 170 calories and 4 grams of protein. Many patients like the small four-ounce serving and are able to consume 100 percent. This product is ready to serve and requires no refrigeration. It is now packaged in safe and easy-open plastic cups. It is available in Chocolate Supreme, Butterscotch Delight, and Old Fashioned Vanilla.
       Boost Breeze (Mead Johnson Nutritionals). This juice product provides an alternative to milk-based products. Many patients are simply tired of the usual sweet chocolate and vanilla milk-based products and may prefer the light taste of Tropical Fruit or Mixed Berry Boost Breeze. Each eight-ounce serving provides 160 calories, 8 grams of protein, and 22 vitamins and minerals.
       Cookies, puddings, candy bars, juices, soups, coffee, instant breakfast drinks, and gelatin desserts are only the beginning of the wide variety of products now available to treat IWL. There are dozens of disease-specific products for everything from HIV to dysphagia to renal disease and many, many more. Until recently, small facilities and home care patients did not have access to a wide variety of medical nutrition products. Most facilities can store only a limited number of products and may have difficulty meeting the minimum orders imposed by traditional suppliers. Local drugstores carry only the most common products, and most have never even heard of many of the disease-specific products. One solution to this problem is a Florida-based company called 4WebMed. This company was started when the owner's mother and grandmother were ill and he could not find the nutrition products they were served in the hospital for home use. He called the company that made the product in question and was told there was a 100-case minimum order. In response, he started a company to help others in the same situation. 4WebMed stocks over 100 nutrition products, including frozen and shelf-stable products, and will allow customers to break cases, mix flavors, and even combine products from different manufacturers. This flexibility certainly can help patients at home but is also available to facilities that wish to offer a greater variety of products in order to meet each patient's individual tastes and preferences without minimum orders or long contracts.
       Snack and supplement programs of the new millennium offer a wide variety of flavors, tastes, and textures. Treating the problem of involuntary weight loss may take a little creativity and new thinking, but with innovative products from all the major nutrition companies and easy access via the web from 4WebMed, we are making great strides.

* All product information was taken from the company web sites and company literature.