Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis

Zhiying Zhang, Fei Li, Bridget A Hannon, Deborah S Hustead, Marion M Aw, Zhongyuan Liu, Khun Aik Chuah, Yen Ling Low, Dieu T T Huynh, Zhiying Zhang, Fei Li, Bridget A Hannon, Deborah S Hustead, Marion M Aw, Zhongyuan Liu, Khun Aik Chuah, Yen Ling Low, Dieu T T Huynh

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).

Keywords: children; malnutrition; meta-analysis; oral nutritional supplements; review; undernutrition.

Conflict of interest statement

Abbott Nutrition was responsible for the study design, data analysis, and manuscript preparation and submission. Z.Z., F.L., B.H., D.S.H., Z.L., K.A.C., Y.L.L. and D.T.T.H. are employees of Abbott Nutrition. M.M.A. did not receive funding from Abbott Nutrition for this work.

Figures

Figure 1
Figure 1
Identification, screening, and selection of articles for the meta-analysis.
Figure 2
Figure 2
Meta-analysis results on the difference in mean change in weight parameters between intervention and control based on the longest follow-up time point. (a) Weight (kg), (b) weight-for-age Z-score (WAZ), (c) weight-for-age percentile (WAP), (d) weight-for-height Z-score (WHZ), (e) weight-for-height percentile (WHP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 2
Figure 2
Meta-analysis results on the difference in mean change in weight parameters between intervention and control based on the longest follow-up time point. (a) Weight (kg), (b) weight-for-age Z-score (WAZ), (c) weight-for-age percentile (WAP), (d) weight-for-height Z-score (WHZ), (e) weight-for-height percentile (WHP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 3
Figure 3
Meta-analysis results on the difference in mean change in weight parameters between intervention and control after 30, 60, and 90 days of intervention. (a) Weight (kg), (b) weight-for-age Z-score (WAZ), (c) weight-for-age percentile (WAP), (d) weight-for-height Z-score (WHZ), (e) weight-for-height percentile (WHP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 3
Figure 3
Meta-analysis results on the difference in mean change in weight parameters between intervention and control after 30, 60, and 90 days of intervention. (a) Weight (kg), (b) weight-for-age Z-score (WAZ), (c) weight-for-age percentile (WAP), (d) weight-for-height Z-score (WHZ), (e) weight-for-height percentile (WHP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 4
Figure 4
Meta-analysis results on the difference in mean change in height parameters between intervention and control based on the longest follow-up time point. (a) Height (cm), (b) height-for-age Z-score (HAZ), (c) height-for-age percentile (HAP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 4
Figure 4
Meta-analysis results on the difference in mean change in height parameters between intervention and control based on the longest follow-up time point. (a) Height (cm), (b) height-for-age Z-score (HAZ), (c) height-for-age percentile (HAP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 5
Figure 5
Meta-analysis results on the difference in mean change in height parameters between intervention and control after 30, 60, and 90 days of intervention. (a) Height (cm), (b) height-for-age Z-score (HAZ), (c) height -for-age percentile (HAP). SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).
Figure 6
Figure 6
Meta-analysis results on the difference in change in total energy intake between intervention and control based on the longest follow-up time point. SU: severely underweight; UW: underweight. The forest plot shows the mean difference (squares) and 95% confidence intervals (CIs) (horizontal bars) for intervention vs. control. The values were combined using a meta-analysis to obtain a pooled estimate of the effect from all the included studies (diamond).

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