口服营养补充剂对挑食和体重不足儿童管理的影响：一项系统回顾和荟萃分析。

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

摘要

背景与目的：喂养困难，包括挑食和回避/限制性食物摄入障碍（ARFID），在儿童中很常见，可导致营养摄入不足，生长不良，甚至营养不良。口服营养补充剂（ONS）是一种专门的高热量、营养丰富的产品，在临床实践中通常被推荐用于帮助改善有喂养困难的儿童的生长结果。本系统综述旨在评估ONS在治疗ARFID和/或挑食儿童以及饮食咨询（DC）方面的有效性和安全性。方法：我们系统地检索了Cochrane中央对照试验注册库（Central）、MEDLINE和EMBASE，检索了2000年至2024年3月期间的随机对照试验（rct），这些随机对照试验比较了在患有ARFID或挑食的任何年龄儿童中使用ONS（无论类型和剂量）与任何比较物的情况。主要结果是干预期间的生长（使用任何测量方法报告）。结果：我们总结了5项随机对照试验，涉及874名挑食和体重过轻的随机儿童。所有随机对照试验均评估了与仅使用DC相比，使用DC的ONS。在三个随机对照试验中，与对照组相比，ONS + DC组的体重、身高体重和年龄体重均有所增加。在身高和身体质量指数（BMI）方面发现了不一致。所有随机对照试验均报告了不良事件，在第90天各组间无差异(3项随机对照试验的荟萃分析；相对危险度[RR]=0.92, 95%可信区间[CI]， 0.71 ~ 1.20, I2 = 17%, n=573)和180天(1项RCT；与对照组相比，ONS + DC组的RR=1.16, 95% Cl = 0.85 ~ 1.59, n=35)。在两项rct的荟萃分析中，ONS+DC组发生上呼吸道感染的儿童比仅DC组少(RR=0.62, 95% Cl, 0.42 ~ 0.91, n=359, I2=0%；所需伤害数[NNH]= 10.4)。在所有随机对照试验中，对预先规定的ONS摄入量的依从性被评估为高。讨论：本系统综述提供了适度的证据，支持ONS和DC联合使用在管理挑食和体重不足的儿童。然而，需要进一步的研究来评估长期结果，并更好地了解这种方法的潜在益处和风险。

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

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.