Abstract
Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).
Highlights
A meta-analysis based on the longest follow-up time point showed that children in the Oral nutritional supplements (ONS) group had significantly greater catch-up growth for weight (0.423 kg, 95% confidence intervals (CIs) [0.234, 0.613] kg, p < 0.001), weight-for-age Z-score (WAZ) (0.166 [0.068, 0.264], p = 0.001), weight-for-age percentile (WAP) (3.577 [0.723, 6.431], p = 0. 014), weight-for-height Z-score (WHZ) (0.254 [0.184, 0.324], p < 0.001), and weight-for-height percentile (WHP) (7.104 [4.034, 10.174], p < 0.001) compared with the control group (Figure 2)
A meta-analysis using the longest followup time point showed that children in the ONS group had significantly greater catch-up growth in height (0.417 [0.059, 0.776] cm, p = 0.022), height-for-age Z-score (HAZ) (0.041 [0.007, 0.074], p = 0.018), and height-for-age percentile (HAP) (2.167 [0.718, 3.616], p = 0.003) compared with the control group (Figure 4)
The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies
Summary
The World Health Organization (WHO) uses growth in children as an indicator of nutritional status. The number of children worldwide with poor growth today, despite a decline over the past 2 decades, remains high [1,2]. Growth statistics from 2019 showed that 144 million children under 5 years old were stunted, and 47 million were wasted [3]. 99 million children under 5 years old were underweight in 2013, while 75 million girls and 117 million boys aged 5–19 years old were moderately or severely underweight [3]
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