Effects of high protein ONS in older gastric cancer patients receiving neoadjuvant chemotherapy
In older gastric cancer patients receiving neoadjuvant chemotherapy, high-protein oral nutritional supplements (ONS) improved calorie and protein intake and showed reduced malnutrition risk compared to controls, but physical function and quality of life remained similar.
Effects of high protein nutritional supplementation on nutritional status, physical function, and quality of life in older gastric cancer patients receiving neoadjuvant chemotherapy: a randomized trial
Doğan Akagündüz D, Türker PF, Akagündüz B. Support Care Cancer. 2025 Aug 9;33(9):775.
Background
- Gastric cancer is a leading cause of cancer deaths globally, especially in older adults; it’s the fifth most common cancer per 2020 Global Cancer Observatory data.
- Malnutrition affects 30–60% of cancer patients and is especially common in gastric cancer; proper nutrition can lower morbidity and mortality in older patients.
- ESPEN advises elderly individuals to consume at least 1.0–1.2 g/kg/day of protein for muscle health.
- High Protein Oral Nutritional Supplements (ONS) are used to combat malnutrition in cancer, improving intake, nutritional status, physical function, and quality of life; however, research on high-protein supplements for older gastric cancer patients receiving NAC is limited.
Objectives
Primary:change in MNA score over 8 week intervention
Secondary:changes in energy and protein intake, body composition (fat mass, fat-free mass, and muscle mass), handgrip strength, and health-related QOL measured by the EORTC QLQ-C30
Methods
This study was a prospective, RCT conducted from February 2023 - February 2024 which included adults 65 and over who applied to a Medical Oncology Outpatient Clinic, newly diagnosed locally advanced gastric cancer with plans to begin Neoadjuvant Chemotherapy (NAC). Fifty-six patients were randomized and after exclusions for treatment discontinuation of chemotherapy and non-compliance, 23 remained in each group: the interventional ONS group and the control (non-ONS) group. Two malnourished patients who declined ONS were assigned to standard nutrition care.
Intervention
The ONS group received a high-protein, gluten-free oral nutritional supplement (18.8 g protein, 7 g fat, 28 g carbohydrates, 250 kcal per 200 mL provided by Nestlé Health Science), in addition to standard nutrition care, while the control group received only standard care without supplementation. Both groups aimed for similar nutritional targets (about 30 kcal/kg/day and 1.5 g/kg/day protein) based on ESPEN guidelines, but only the intervention group was supported with ONS, whereas the control group depended on dietary counseling only.
Results
Measure | ONS group | Non-ONS group |
|---|---|---|
Body weight | p < 0.001 | |
Lean body mass | p = 0.039 | Not reported |
Muscle mass | p = 0.004 | |
Body fat mass | p < 0.001 | Not reported |
Total body water | p < 0.001 |
Limitations
- Small sample size and short follow-up: may limit both statistical power and generalizability
- Self-reported 3-day dietary records - could introduce recall bias, especially in participants over 65 with possible memory issues.
- Lack of physical activity or rehabilitation intervention - may restrict functional gains from nutrition alone.
- Gender-based subgroup analysis with a small sample - limits statistical power and generalizability
This randomized controlled trial assessed high-protein ONS in older gastric cancer patients receiving NAC. The ONS group improved calorie and protein intake and showed reduced malnutrition risk compared to controls, but physical function and quality of life remained similar. These results suggest nutritional benefits for this group, yet further larger and longer studies are needed to clarify long-term effects.