Fresh Benefits: Alternatives to Oral Nutritional Supplement


As we age, the perception of taste, hunger, and thirst becomes more difficult to recognize. This can have a significant impact on quality of life and lead to decreased appetite and poor nutrition, especially in seniors. Seniors may also struggle with illnesses and medication that alter their taste perception and ultimately food acceptance. COVID-19, sinus infections, types of cancers, chemo radiation treatments, and other illnesses cause a lack of taste and smell entirely, metallic-like taste of some foods, heightened bitterness and diminished sweet flavors that may cause lack of enjoyment around foods and mealtime.

Appearance, texture, and mouthfeel of foods also plays a big part of food acceptance for seniors. As the saying goes, “we eat with our eyes first.” Presentation can make a huge impact in food acceptance. If a food is warm and comforting or cool and refreshing can lead to enhanced intake.

Cognition can play a large role in what foods or types of foods are accepted. We all have various emotions surrounding food, good and bad. Often with cognitive impairments, such as dementia, food preferences change. What once was a favorite food may not be desired at all and vice versa. As well, consuming the same food item daily, or multiple times in a day, can result in taste fatigue. Taste fatigue can happen with nutrition supplements and food alike.

Poor nutritional status can ultimately result from changes in taste, hunger, and thirst in the elderly. Poor nutrition can lead to a host of other issues. Look at these facts below:

  • The presence of malnutrition increases risk factors for comorbidities, pressure injuries, and mortality.
  • Mortality rates can be as high as 12.4% in those classified with malnutrition versus 4.7% of those considered to be well nourished.
  • Anorexia, the lack or loss of appetite for food, accounts for a large percentage of undernutrition in older adults whether it’s due to illness, lack of access to foods, needing help with shopping or even the ability to cook for themselves.

Factors associated with the development of malnutrition include disease, social segregation, psychological factors, economic status or lack of medical awareness. On top of physical changes that can occur, the cost of caring for a malnourished patient in a health care setting has been shown to increase up to 308.9% from increased treatment, clinical oversight as well as nutritional supplementation, especially in older adults.

With all the changes happening during the aging process, nutrition becomes more and more important. Often in healthcare settings, commercial oral nutritional supplements (ONS) are a typical solution. They come in various forms and textures, such as thickened, powdered, ice creams, puddings, etc. There are specialized formulas given for reasons such as poor nutrition intake, wound healing, and weight gain or stabilization. However, patient satisfaction and enjoyment of these products can at times be limited and acceptance declines when flavor fatigue quickly sets in. Wouldn’t it be nice to have the foods regularly enjoyed but providing additional nutrition?

The alternative to commercial ONS is fortified foods. Fortified foods provide additional nutrients that do not naturally occur that can meet high nutrient demands. These foods offer an often more pleasing appearance while also being known to increase acceptance. There are many benefits to fortifying foods:

  • They are energy dense! More calories are included to support nutrition needs.
  • They have extra protein! Older adults require a greater amount of protein to support lean body mass.
  • They can boost intake of more vitamins and minerals when a part of a balanced diet.
  • They boost the social dining experience. Consuming an ONS versus eating real food items at the table with your peers can seem isolating. Fortified foods do not look medicinal, and they encourage participation in communal dining without embarrassment.
  • They are visually appealing. Real food is more visually appealing than commercial ONS and can lead to greater acceptance and consumption.
  • They promote a food first
  • They can prevent taste fatigue by offering a variety of items instead of consuming an ONS daily.

Unidine uses their signature program, Fresh Benefits, to offer fortified foods to those in need of higher calories and protein instead of the traditional ONS. The culinary and nutrition teams have developed a series of recipes that includes super smoothies, enriched snacks, and other fortified foods that are all prepared with their fresh food pledge in mind. There are no artificial sweeteners or protein powders used as fillers. They utilize natural products such as nuts, plant oils, full fat dairy products, and butter.

In addition, the Fresh Benefits program provides food items that align with mechanically altered diets and can be adjusted to an individual’s needs. Previously, in 2011-2013, Unidine monitored the use of 3 different commercial supplements over a 12-month period following implementation of Fresh Benefits. Use of all 3 ONS showed a marked decrease at the 12 month follow up. They saw a 35% decrease in supplement orders, a 56% decrease in ONS cost, and a 64% decrease in weight loss.

With the Fresh Benefits program, residents feel included in the dining process while also receiving the personalized nutrition plan. They receive the same food items as their peers, just prepared differently. For example, Unidine’s fortified macaroni and cheese has 490 calories per serving, much higher than when compared to non-fortified macaroni and cheese that is approximately 310 calories per serving, and even more than compared to commercial ONS providing approximately 250 calories per serving. A resident on Fresh Benefits can have as much as an additional 1000-1500 calories per day. With the utilization of this signature program, Registered Dietitians, other members of the interdisciplinary team, and family members can see improvements in residents’ health through greater acceptance of meals to impact their nutrition and enhance their quality of life more effectively.


Submitted by Timmi Bishop, MS, RD, LD, Nutrition Care Manager

Timmi is a registered and licensed dietitian working clinically and supporting foodservice performance on a campus with LTC, skilled rehab, assisted living, and independent living. Bishop is an acting Nutrition Care Manager with Unidine at their Methodist Senior Services account in Tupelo, MS. She has three dogs and regularly fosters others.

At Unidine, the Directors of Nutrition support the development of dietitians through clinical documentation evaluation and teaching clinical skills to improve quality of care to the patients served. Our competency training for dietitians centers around performing the NFPE, documenting malnutrition criteria and obtaining a diagnosis of malnutrition so dietitians are prepared, knowledgeable and able to make informed interventions to improve patient outcomes.