20
Intervention
Oral Nutrition Supplements (ONS)
• Oftentimes a proper diet alone will not be sufficient for optimal wound
healing.
• Starting ONS early is especially important for patients who are at greater
risk for malnutrition and for those who are already showing signs of
malnutrition.
• ONS are liquids, semi-solids or powders that provide macro- and
micronutrients needed for wound healing.
• For many patients with DFUs, ONS will be more effective than dietary
changes alone.
• The addition of specific supplements such as arginine, glutamine and HMB
as an adjunct to standard of care may improve healing of diabetic foot
ulcers, especially in patients with poor limb perfusion and/or low albumin
levels.
▶ In a study of healthy elderly subjects, supplementation with arginine, glutamine,
and HMB increased collagen deposition (as reflected by hydroxyproline content)
at the wound site, suggesting that supplementation may provide a safe, non-
invasive, nutritional means for improving wound repair.
• Therapeutic Nutrition Powders (e.g., Juven
®
) are among the most commonly
used supplements.
▶ These have been shown to support wound healing by enhancing collagen
production and can help replenish critical nutrients needed for wound healing
such as arginine, glutamine, HMB and also other micronutrients.
• When offering nutritional supplements discuss oral supplements available
and flavor options.
• Encourage oral supplement intakes in-between meals.
• All ONS should always be administered along with proper hydration and a
balanced diet.
Table 9. ONS Options
Approach Form Delivery*
• Complete meal replacement
• Modular
• Enhanced modular
• Multivitamin
• Powder
• Prepared drink
• Semi-solid
• Tablet/pill/chewable
• Oral eaten
• Oral drinks
• Feeding tube
• Intravenous
* Some products fall under multiple delivery mechanisms.
