SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1654637
This article is part of the Research TopicIntegrating Nutrition in Cancer Therapy: Approaches to Improve Patient Outcomes and SurvivalView all 4 articles
High protein oral nutritional supplement use in patients with cancer reduces complications and length of hospital stay: A systematic review and meta-analysis
Provisionally accepted
- 1Clinical Research, Nutricia Ltd, Trowbridge, United Kingdom
- 2Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- 3Sussex Cancer Centre, University Hospitals Sussex NHS Foundation Trust, Worthing, United Kingdom
- 4University of Southampton Faculty of Medicine, Southampton, United Kingdom
- 5University of Nottingham School of Biosciences, Sutton Bonington, United Kingdom
- 6R&I, Danone, Utrecht, Netherlands
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Introduction: Oral nutritional supplements (ONS) have been reported to improve nutritional status, quality of life and clinical outcomes in many patient groups. This systematic review investigated the effects of high protein ONS (HPONS), ≥20% energy from protein, on clinical outcomes in cancer patients.Methods: A systematic review (searches to January 2025) identified 32 publications reporting results from 29 randomised controlled trials (RCT) (n=2,279) of HPONS (mean daily intake 580kcal, 34g protein, ranging from 5 to 365 days) alongside dietary intake in patients with gastrointestinal (14RCT), lung (4RCT), head and neck (4RCT), liver (2RCT), breast (1RCT), and mixed (4RCT) cancers across hospital and community undergoing surgery, chemotherapy and/or radiotherapy.Studies reporting relevant outcomes (complications, length of hospital stay (LOS), hospital readmission and mortality) were pooled into meta-analysis (Comprehensive Meta-Analysis software v4).Results: Meta-analysis showed a significant overall reduction (101 fewer per 1,000 patients) in complications (15RCT, n=1,230) including infectious, non-infectious and postoperative complications, and radiotherapy-related toxicities in patients using HPONS undergoing surgery and/or chemo/chemo-radiotherapy (OR 0.62, 95% CI 0.48 to 0.81; p=0.0005; I 2 =0%) vs control. The number needed to treat (NNT) for preventing one additional complication with HPONS was 12 (95% CI 9 to 29). A sub-group of studies (9RCT) with HPONS enriched with omega-3 fatty acids, also showed a positive effect on complications vs control (OR 0.69, 95% CI 0.51 to 0.93; p=0.02; I 2 =16%).A reduction in LOS was observed (8RCT, n=865) with HPONS (-0.26days, 95% CI -0.49 to -0.03; p=0.02, I 2 =60%), while no significant difference was detected in hospital readmissions (5RCT, n=479) and mortality (7RCT, n=694).Conclusions: This systematic review and meta-analysis provides evidence that use of HPONS (including those enriched with omega-3 fatty acids) alongside dietary intake is associated with a significant reduction in complications and LOS in cancer patients. The review found no significant effects on hospital readmissions or mortality. Given the heterogeneity of the patient population, further investigation is needed to comprehensively evaluate the effect of nutritional support on patient outcomes according to specific cancer and treatment types in various clinical settings.
Keywords: Cancer, High protein oral nutritional supplements, Malnutrition, Meta-analysis, nutrition support, oncology, ONS, Systematic review
Received: 26 Jun 2025; Accepted: 12 Aug 2025.
Copyright: © 2025 Delsoglio, Capener, Smith, Donald, Hubbard and Stratton. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marta Delsoglio, Clinical Research, Nutricia Ltd, Trowbridge, United Kingdom
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