Longitudinal growth and health outcomes in nutritionally at‐risk children who received long‐term nutritional intervention

Abstract

Background: The benefits of short-term oral nutritional supplementation (ONS) in undernourished children are well-established. The benefits of long-term ONS in promoting longitudinal growth and health in children who are at risk of undernutrition have not been reported previously. Methods: In this 48-week prospective, single-arm, multicentre trial, 200 Filipino children aged 3-4 years with weight-for-height percentiles from 5th to 25th (WHO Child Growth Standards) were enrolled. Parents received dietary counselling at baseline, and at weeks 4 and 8. Two servings of ONS (450 mL) were consumed daily, providing 450 kcal, 13.5 g protein and micronutrients. Weight, height, dietary intake using 24-h dietary recalls, and physical activity and appetite using the visual analogue scales were assessed at baseline and weeks 4, 8, 16, 24, 32, 40 and 48. The number of sick days for acute illnesses was collected over the study period. Results: At baseline, mean age was 41.2 months with 50% being male. Weight-for-height percentiles showed the greatest increase in the first 4 weeks (12.1 and 12.8 percentiles, respectively, P < 0.0001) and remained significantly higher than baseline (P < 0.0001) but were relatively stable from week 4 onwards. Height-for-age percentiles increased steadily over time and became significantly higher than baseline from week 24 onwards (P < 0.0001). Appetite and physical activity scores at all post-baseline visits improved from baseline (P < 0.0001), and a reduction in the number of sick days from week 16 onwards was also observed (P < 0.0001). Higher parental education level, being male and higher baseline weight-for-height percentiles were significantly associated with higher ponderal and linear growth over time in repeated measures analysis of covariance. Conclusions: Intervention consisting of initial dietary counselling and continued ONS helped sustain normal growth after a catch-up growth in nutritionally at-risk children.

Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims

“…One example involves a FUF-YC product specifically marketed as “Nutrition to help kids grow” [78] and presently advertising its significance as a “2 per day” snack, helping “kids ages 3–4 grow out of at-risk weight-for-height percentiles” as it “helps kids gain weight in just 8 weeks” [79]. The corporate-sponsored study cited as the evidentiary base is an intervention with no control arm, involving 199 Filipino children with baseline mean age of 41 months (range, 3 months to 48 months), weight-for-height of 14.8 and 17th percentiles (female, male), and daily intake of 1379 kcal [80]. The authors define individuals between the 2.3 and <25th percentile in weight-for-height as at-risk of wasting.…”

“…This “improvement” was a mean increase of 3.5 cm in height (a 0.12 Z-score change) by week 24 (accrued as 0.5, 0.7, 1.2, and 1.1 cm sequential increments at 4, 8, 16, and 24 weeks) and a weight-for-height Z-score (WHZ) change of 0.46 by week eight. The authors conclude that these results show a catch-up growth phase in weight followed by a maintenance growth phase of height gain, a successful “preventive approach of targeting children at risk of undernutrition” with “significant benefits on growth” and “low risk of excessive weight gain” as the WHZ change was below 0.67 [80]. …”

“…The categorical criterion employed to rule-out concerns of inappropriate weight gain, 0.67 increased WHZ scores [80], is the distance between two major WHO growth standard percentiles [86]. While frequently used as a predictor of subsequent risk for overweight and obesity at the group level [87], 45% to 50% of three- to four-year-olds do not cross one or more weight-for-height percentile line(s) [50].…”

Effect of Oral Nutritional Supplementation on Growth in Vietnamese Children with Stunting

“…In the present study, treatment of stunted children with ONS for 6 months significantly improved HAZ by 0.25 units, WHZ by 0.72 units, and WAZ by 0.65 units from baseline. Other studies have also shown significant improvements in linear and ponderal growth in non-stunted children after intervention with ONS [34,35]. However, in some studies that used similar ONS in non-stunted children, there was no significant improvement in HAZ after ONS application, although there was a trend towards the improved height and HAZ in the intervention groups [39,40].…”

“…ONS also significantly reduced the incidence of upper respiratory tract infections in these children [34]. Additionally, long-term intervention with ONS plus initial DC promoted longitudinal ponderal and linear growth in nutritionally-at risk children aged 36-48 months [35]. Long-term ONS with initial DC was also associated with improved dietary diversity as well as adequate dietary intake of nutrients over 48 weeks and did not interfere with the intake of family foods [36].…”