A randomised controlled crossover study to assess adherence and palatability of a porridge supplement compared to a drink-based supplement in hospitalised older adults at risk of malnutrition.
Meredith S, Sheppard K, et al. • Journal of nutritional science • 2026
Median daily porridge supplement intake (26.31%) was significantly lower compared to drink-based supplement intake (66.8%), and the texture of the porridge supplement was significantly disliked compared to the drink-based supplement in hospitalised older adults at risk of malnutrition.
Key Findings
Results
Median daily porridge supplement intake was significantly lower than drink-based supplement intake.
Median daily PS intake was 26.31% (IQR 10.23–48.02) compared to DS intake of 66.8% (IQR 26.29–75.37)
Each participant was prescribed both supplements twice per day for 4 days in crossover sequence
The porridge supplement provided 16 g protein and 249 kcal per serving; the drink-based supplement provided 18 g protein and 306 kcal per serving
Twenty-seven older people participated (mean age 80 years, 17 female)
Results
The texture of the porridge supplement was significantly disliked compared to the drink-based supplement.
Palatability ratings were assessed using a 7-point Likert scale
Texture was identified as a key palatability dimension on which the porridge supplement performed significantly worse than the drink-based supplement
Qualitative interviews with 9 older adults and 5 staff further explored product acceptability, with thickness and taste also identified as palatability concerns
Results
There were no significant differences in the absolute volume consumed between the porridge supplement and the drink-based supplement.
ONS leftovers were weighed and adherence was calculated as percentage consumed
Despite the difference in percentage adherence, the absolute volume consumed did not differ significantly between products
This may reflect the differing serving sizes or energy densities of the two products
Results
Neither supplement significantly replaced normal dietary intake in hospitalised older adults.
Supplements did not replace normal dietary intake during the study period
This finding suggests the supplements functioned as adjuncts rather than meal replacements
The study was conducted in a single-centre setting in adults aged ≥65 years with a Malnutrition Universal Screening Tool (MUST) score of 1–4
Results
Multiple factors influenced oral nutritional supplement acceptability, including physical ability, appetite, hospital culture, and palatability.
Qualitative interviews were conducted with 9 older adults and 5 staff members
Changes in physical ability and appetite were identified as influencing ONS acceptability
Hospital culture, including staff attitudes toward nutritional care, was identified as a contextual factor
Palatability factors including thickness and taste were highlighted by participants
Results
Participants requested a wider range of food-based supplementation with natural ingredients and enhanced staff training in nutritional care.
These preferences emerged from qualitative interviews with older adult participants and hospital staff
Participants specifically called for more 'patient-centred nutritional care'
Staff training in nutritional care was identified as an area for improvement in the hospital setting
What This Means
This research suggests that a new porridge-style nutritional supplement was less well consumed by older hospital patients at risk of malnutrition compared to a standard drink-based supplement. In a crossover study where 27 patients (average age 80) each tried both supplements twice daily for four days, patients consumed on average only about 26% of the porridge supplement versus about 67% of the drink supplement. The porridge was also rated significantly worse for texture. However, the actual volume of food consumed was similar between the two products, and neither supplement caused patients to eat less of their regular meals.
The study also used interviews with patients and staff to understand why people did or did not consume the supplements. Factors such as reduced appetite, declining physical ability, the taste and thickness of the products, and the attitudes of hospital staff all played a role in whether patients accepted the supplements. These qualitative findings highlight that simply providing a supplement is not enough — the experience of eating it and the support offered by staff matter greatly.
This research suggests that food-based supplements like porridge may not automatically be better accepted than drink-based ones, and that texture in particular is an important factor for older hospital patients. Patients expressed a desire for more variety in food-based supplement options, particularly those made with natural ingredients, and better nutritional training for hospital staff. These findings point to the importance of tailoring nutritional support to individual patient preferences and improving the broader hospital food culture.
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Meredith S, Sheppard K, Calder P, Patel H, Lim S. (2026). A randomised controlled crossover study to assess adherence and palatability of a porridge supplement compared to a drink-based supplement in hospitalised older adults at risk of malnutrition.. Journal of nutritional science. https://doi.org/10.1017/jns.2026.10108