Abstract
Children with or at risk of faltering growth require nutritional support and are often prescribed oral nutritional supplements (ONS). This randomised controlled trial investigated the effects of energy-dense paediatric ONS (2.4 kcal/ml, 125 ml: cONS) versus 1.5 kcal/ml, 200 ml ONS (sONS) in community-based paediatric patients requiring oral nutritional support. Fifty-one patients (mean age 5.8 years (SD 3)) with faltering growth and/or requiring ONS to meet their nutritional requirements were randomised to cONS (n = 27) or sONS (n = 24) for 28 days. Nutrient intake, growth, ONS compliance and acceptability, appetite and gastro-intestinal tolerance were assessed. Use of the cONS resulted in significantly greater mean total daily energy (+ 531 kcal/day), protein (+ 10.1 g/day) and key micronutrient intakes compared with the sONS group at day 28 and over time, due to high ONS compliance (81% of patients ≥ 75%), maintained intake from diet alone and improved appetite in the cONS group, compared with the sONS group. Although growth increased in both intervention groups, results were significant in the cONS group (weight (p = 0.007), height (p < 0.001) and height z-score (p = 0.006)).Conclusions: This study shows that use of energy-dense (2.4 kcal/ml) low-volume paediatric-specific ONS leads to improved nutrient intakes, growth and appetite in paediatric patients requiring oral nutrition support compared with standard energy density ONS.Trial registration: The trial is registered at clinicaltrials.gov, identification number NCT02419599.What is Known:• Faltering growth is the failure of children to achieve adequate growth at a normal rate for their age and requires nutritional support, including the use of oral nutritional supplements (ONS).• Energy-dense, low-volume ONS have benefits over standard ONS in adults.What is New:• This is the first RCT to investigate the effects of energy-dense, low-volume ONS (2.4 kcal/ml, 125 ml) in children with faltering growth, showing significant improvements in total nutrient intake and increased growth.• Energy-dense, low-volume ONS can play a key role in the management of faltering growth.
Highlights
Faltering growth is the failure of children to achieve adequate growth at a normal rate for their age, as a result of inadequate nutritional intake/absorption of nutrients in relation to their requirements
This study shows that use of energy-dense (2.4 kcal/ml) low-volume paediatric-specific oral nutritional supplements (ONS) leads to improved nutrient intakes, growth and appetite in paediatric patients requiring oral nutrition support compared with standard energy density ONS
One possible strategy to improve nutrient intake in children with faltering growth is to reduce the volume of ONS by increasing the energy and nutrient-density, which when undertaken with food has been shown to increase energy intake and appetite without affecting fullness [3, 8, 22, 28,29,30]
Summary
Faltering growth is the failure of children to achieve adequate growth at a normal rate for their age, as a result of inadequate nutritional intake/absorption of nutrients in relation to their requirements. Where faltering growth continues and dietary intake alone is insufficient, multi-nutrient, nutritionally complete oral nutritional supplements (ONS) designed for children should be considered to help patients meet their nutritional requirements [21] These have been shown to be effective at improving nutrient intakes, growth and outcomes [1, 4, 12, 15, 20, 24, 33, 34, 36, 43] (reviewed [49] and included in guidelines [25, 31]), evidence is often in specific patients groups including Crohn’s disease, cystic fibrosis and cancer. Whilst it can be hypothesised that a similar effect would be seen with energydense, low-volume ONS in children, no comparative studies have been published to date
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