Effect of oral nutritional supplements administration on the management of children with picky eating and underweight: A systematic review and meta-analysis

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-22 DOI:10.1016/j.clnesp.2025.03.039

Julia Iwańska , Łukasz Pskit , Agata Stróżyk, Andrea Horvath, Sonia Statuch, Hania Szajewska

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引用次数: 0

Abstract

Background & aims

Feeding difficulties, including picky eating and avoidant/restrictive food intake disorder (ARFID), are common in children and can result in inadequate nutrient intake, poor growth, and even undernutrition. Oral nutritional supplements (ONS) are specialized high-calorie, nutrient-rich products that are commonly recommended in clinical practice to help improve growth outcomes in children with feeding difficulties. This systematic review aims to evaluate the efficacy and safety of ONS in managing children with ARFID and/or picky eating alongside dietetic consultation (DC).

Methods

We systematically searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from 2000 to March 2024 for randomized controlled trials (RCTs) that compared the use of ONS (regardless of type and dosage) to any comparator in children of any age with ARFID or picky eating. The primary outcome was growth (reported using any measures) during the intervention.

Results

We summarized 5 RCTs involving 874 randomised children with picky eating and underweight. All RCTs assessed the use of ONS with DC compared to DC only. In three RCTs, there was an increase in weight, weight-for-height and weight-for-age in the ONS + DC group compared to the control group. Inconsistencies were noted with regard to height and Body Mass Index (BMI). Adverse events were reported in all RCTs, with no difference found between groups at 90 days (meta-analysis of three RCTs; relative risk [RR] = 0.92, 95 % confidence interval [CI], 0.71 to 1.20, I² = 17 %, n = 573) and at 180 days (1 RCT; RR = 1.16, 95 % Cl 0.85 to 1.59, n = 35) in the ONS + DC group compared to the control group. Fewer children with upper respiratory tract infections were found in the ONS + DC group compared to the DC only group in a meta-analysis of two RCTs (RR = 0.62, 95 % Cl, 0.42 to 0.91, n = 359, I² = 0 %; number needed to harm [NNH] = 10.4). In all RCTs, adherence to pre-specified ONS intake was assessed as high.

Discussion

This systematic review provides moderate evidence supporting the combined use of ONS and DC in managing picky eating and underweight in children. However, further research is needed to assess long-term outcomes and to better understand the potential benefits and risks of this approach.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.