Oral nutritional supplements (ONS) provide additional calories, protein, vitamins and minerals for patients who cannot meet their nutritional needs through diet alone. ONS are used to increase calorie and protein intake for malnourished patients, those with increased needs, and those with poor appetites or difficulty chewing. Common ONS include Ensure, Ensure Plus, Ensure Clear, Glucerna, Nepro, and Resource Health Shake. Tube feeding is an alternative for patients unable to eat; formulas like Jevity, Glucerna, Nepro, Pulmocare and Oxepa are administered via feeding tubes into the stomach or intestines. Higher calorie tube feeding formulas provide more nutrients in less volume for patients with fluid

1. What are Oral Nutritional Supplements?
ONS are typically used in addition to the normal diet, when diet alone is insufficient to meet
daily nutritional requirements. Oral nutritional supplements provide additional calories,
protein, carbohydrates, fats, and vitamins and minerals to the diet.
Why are they used?
ONS are used to increase protein and calorie intake. Oral nutrition supplements should be
considered for any patients taking inadequate food and fluid to meet their requirements.
What types of patients often receive supplements?
 Patients who are malnourished- thin, weak, have lost a lot of weight
 Patients with increased calorie needs
o Difficulty breathing
 Patients with increased protein needs
o Wounds, Malnutrition
 Patients with poor appetites
o Oncology (cancer) patients
o Patients with conditions causing confusion such as dementia
 Patients who have difficulty chewing
Supplements on the Edward Hospital Formulary1
What is Tube Feeding?3
Supplement Name Properties Types of Patients
Ensure Original - Standard supplement.
Contains a moderate
amount of protein.
- For patients requiring
additional protein and
calories but who do not
have any special
considerations
Ensure Plus - Higher protein
- Higher calories
- Malnourished, at risk for
malnutrition.
- Weight gain
- Conditions requiring
increased protein

2. Ensure Clear - Clear supplement
- Contains no fat
- Contains less calories and
protein than other
supplements
- Patients on clear liquid
diets
- Conditions requiring low
fat diets such as
pancreatitis
Glucerna Shake - Contains less
carbohydrates
- Patients who have
diabetes
Nepro - Contains more protein
- Contains less of specific
minerals: potassium,
phosphorus, sodium
- Patients with end stage
kidney disease who are
receiving dialysis
Resource Health Shake - Consistency similar to a
milkshake
- ONLY supplement that
contains lactose
- No specific population-
alternative to standard
supplement
- Not suitable for those
with lactose intolerance
Carnation Instant Breakfast - Standard supplement.
Contains a moderate
amount of protein.
- No specific population-
alternative to standard
supplement
Arginaid - Powder supplement: mix
with water, juice
- Contains a special amino
acid (protein) called
Arginine
- For patients with wounds
and pressure ulcers

3. Tube Feeding is other wise known as “Enteral Nutrition.” Tube feeding is nutrition provided
through the GI tract via a tube, catheter, or a surgically made hole into the GI tract. It is the
preferred method of feeding when patients are unable to eat enough calories on their own.
Tube feedings may be administered through the nasal tube that extends into the GI tract, or
directly into the stomach or intestines via a surgical hole.
Formula Name Properties Types Patients
Jevity 1 Cal - Fiber fortified standard
formula
Standard formula for patients
receiving tube feeding who do not
have special considerations
Jevity 1.5 Cal - High calorie
- Fiber fortified
May be used patients on fluid
restrictions or patients with elevated
energy needs
Glucerna 1.0 Cal - Reduced carbohydrate
- Fiber fortified
Patients with diabetes
Glucerna 1.2 Cal - High calorie
- Reduced carbohydrate
- Fish Oil fortified
- Fiber fortified
May be used for patients with
diabetes who are on a fluid restriction
or who have elevated energy needs
Nepro - Elevated protein
- Lower levels of
phosphorus, sodium,
potassium
- Fiber fortified
For patients with end stage kidney
disease. This formula is meant
especially for those on dialysis- as
dialysis depletes the body of protein
Pulmocare/Oxepa - High calorie
- Reduced carbohydrates
- Does not contain fiber
“low residue”
For patients with COPD, respiratory
failure, mechanical ventilation
The importance of distinguishing between Jevity 1 Cal vs Jevity 1.5 Cal, Glucerna 1.0 Cal vs
Glucerna 1.2 Cal
Higher calorie formulas provide more calories in a smaller amount. Patients on fluid restrictions
or with elevated calorie needs may need to receive a higher calorie formula. If a patient
receives a 1 Cal formula instead of a higher calorie formula the patient may not be able to meet
their calorie and protein requirements.

4. Quiz: Test Your Knowledge!
1. Which of the following are reasons an oral nutritional supplement may be used?
a. Malnutrition
b. Increased protein needs
c. Increased calorie needs
d. Decreased ability to chew solid foods
e. All of the above
2. What is the difference between Ensure Original and Ensure Plus?
a. Ensure Original has more calories than Ensure Plus
b. Ensure Original is used for standard patients whereas Ensure Plus is used for
patients with end stage renal disease
c. Ensure Original has more protein than Ensure Plus
d. Ensure Plus has more protein and more calories than Ensure Original
3. If a patient is lactose intolerant which supplement are they not able to have?
a. Glucerna
b. Nepro
c. Resource Health Shake
d. Carnation Instant Breakfast
4. What is the ONLY oral nutritional supplement that can be ordered for patients on a
“Clear Liquid Diet?” __________________
5. Name the oral nutritional supplement for those with end stage kidney disease receiving
dialysis _____________.
6. Name the tube feeding formula intended for those with diabetes __________________.
7. A patient is in the ICU with respiratory failure. The patient needs to receive nutrition
through a tube feed. What formula would be appropriate for this patient?
a. Pulmocare
b. Nepro
c. Jevity 1.5 Cal
d. Oxepa
e. a and d
8. A patient is on a fluid restriction. The patient is going to receive nutrition through a tube
feed. The dietitians are trying to give all the required nutrients in the least amount of
volume. Which formula will help the dietitians reduce the volume?
a. Jevity 1 Cal
b. Jevity 1.5 Cal

5. References
1. Oral nutritional supplements (ONS). Available at: http://malnutritionpathway.co.uk/ons
2. Laboratories A. Abbott brands. 2015. Available at:
http://abbottnutrition.com/brands/abbott-brands [Accessed March 8, 2016].
3. American College of Gastroenterology. Enteral and Parenteral nutrition. 2016. Available
at: http://patients.gi.org/topics/enteral-and-parenteral-nutrition/