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Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition

Published in Nutrients, August 2021

 OPEN ACCESS  View online here

Undernutrition is a leading cause of growth restriction in children, in particular, an inadequate dietary intake in the first 1000 days (conception to child’s 2nd birthday) can directly lead to stunting. To address these growth shortfalls, various dietary supplementations have been used, including the use of oral nutritional supplements (ONS) which provide both macronutrients and essential micronutrients. This systematic review and meta-analysis aimed to summarise the evidence of the effects of ONS on catch-up growth in children aged 9months – 12 years with undernutrition.

The search (April 2021) investigated randomised controlled trials using ONS in children (<18 years) with undernutrition and who did not have a chronic disease. The ONS were consumed in addition to the diet and were cow-milk-based polymeric ONS (other types of formula such as pre-digested, therapeutic foods, micronutrients only or predominantly a single macro-nutrient were excluded). The control group was usual diet, placebo or dietary counselling alone. Outcomes included growth (e.g. weight, height, body mass index (BMI) and weight for age Z-score (WAZ), height for age Z-score (HAZ)) and nutritional intake. 

Eleven studies met inclusion criteria, representing 2287 children without chronic diseases (mean age 5.87 years, 56% boys) most with mild-moderate undernutrition. The majority of subjects were from less developed countries, with the length of ONS intervention ranging from 7-365 days. Meta-analysis showed that at the longest time point (6 months) children in the ONS group had significantly greater catch up growth for weight (0.423kg, p<0.001); WAZ (0.166kg, p=0.001) compared with the control group. Seven studies reported height, and meta-analysis at the longest time point showed the children in the ONS group had significantly greater catch-up growth in height (0.417cm, p=0.022); HAZ (0.041, p=0.018). See paper for full growth data. Eight of the 11 papers reported a significantly higher energy intake in the children consuming the ONS (the remaining 3 papers did not report energy intake). 

While the authors note limitations of a wide variation in countries and not all papers had all data available, they conclude that the ‘ONS intervention is effective in promoting better growth outcomes for children with undernutrition’.