Abstract
Background and objectives: Adequate nutrition is a key determinant of growth in children, and Oral Nutritional Supplement (ONS) represents an important strategy to improve growth and nutritional adequacy in nutritionally at-risk children. We aimed to assess the effect of ONS combined with dietary counselling (DC) on the growth and nutritional adequacy in 1–3-year-old children ≤ 25th weight-for-length percentile. Methods: In this prospective single-arm, open-label intervention study (N = 108), children received 2 servings/day of ONS plus DC for 16 weeks. The ONS was energy and nutrient dense, with increased levels of vitamin A, iron, and zinc (growth-limiting micronutrients), as well as DHA and phospholipids, including sphingomyelin. Anthropometric assessments were performed at baseline and weeks 3, 6, 9, 12, and 16. Change scores from baseline to week 16 were analyzed by a mixed model adjusted for age, sex, and baseline, and was corrected for regression to mean. Nutrient intake was assessed using three-day food intake diaries at baseline, week 6, and week 16. Nutritional adequacy was estimated by comparing against the Estimated Average Requirements, based on the Philippines Dietary Reference Intakes. Acceptance of the ONS was assessed using a toddler milk satisfaction questionnaire. Results: The children´s mean age at baseline was 21.3 ± 6.6 months and 44.4% were male. Weight (0.740 kg) and height (3.02 cm) significantly increased (p < 0.001) from baseline to week 16 including at weeks 3, 6, 9, and 12. There was a significant increase in change score for weight-for-height (0.188 SD), weight-for-age (0.146 SD), height-for-age (0.062 SD), and BMI-for-age (0.163 SD) Z scores, and intakes of energy, protein, and critical micronutrients, such as zinc, iron, selenium, and vitamins A, B1, B3, B6, B9, B12, C, and D, all significantly increased from baseline to week 16 (p < 0.05 for all). The percentage of children achieving nutrient adequacy increased (p < 0.05) and reached close to 100% for iron, zinc, calcium, and vitamins A, B1, B3, B6, B9, B12, and C. Compliance to the ONS intake was high (86%) and 99% reported their overall opinion on the product to be good, very good, or excellent. Conclusion: ONS combined with DC promotes growth and nutritional adequacy, and is well accepted in toddlers with growth concerns.
Author Contributions
Conceptualization, E.E.; Project administration, J.L.; Data curation and analyses, D.G. and I.A.-A.; Writing, review and editing, T.M.S., D.G., J.B., J.L., R.L., I.A.-A. and E.E. All authors have read and agreed to the published version of the manuscript.
Funding
The study was funded by Nestlé Nutrition, Société des Produits Nestlé S.A., Switzerland.
Institutional Review Board Statement
The study was approved by the Asian Hospital and Medical Center Research Ethics Committee (2020-016) in October 2020.
Informed Consent Statement
Written Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The raw data supporting the conclusions of this article can be made available by the authors on request.
Conflicts of Interest
Tinu Mary Samuel, Dominik Grathwohl, Jodi Bettler and Jowena Lebumfacil are employees of Société des Produits Nestlé SA. Imelda Angeles-Agdeppa, Rachel Lawenko and Elvira Estorninos received a grant from Nestle to conduct the study.
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