By the end of the trial, it was found that there was a significantly higher percentage of children who were consuming nutrients adequately – meaning they met the estimated average requirements (EAR).
Writing in Nutrients, researchers from Abbott Nutrition R&D India, and various hospitals including Medipoint Hospital, Saint Theresa’s Hospital, and Noble Hospital, said the findings showed that the supplements could help children bridge the gap between their usual dietary intake and recommended nutrients intake value, preventing further deterioration in their growth.
A total of 321 children between two to four years old, identified as picky eaters, and had weight-for-height between the 3rd and 15th percentiles, were enrolled into the 90-day study conducted in 10 hospitals and clinics across India.
They were randomised into three groups to take either 1) a milk-based supplement and dietary counselling or 2) a lactose-free supplement and dietary counselling or 3) the control group which only underwent dietary counselling.
Both the milk-based and lactose-free supplements have similar nutrient compositions, containing matching levels of protein, 28 vitamins and minerals, and the prebiotic fiber FOS.
However, the lactose-free supplement contains a higher fat energy percent and a lower carbohydrate energy percent than the milk-based supplement.
The milk-based and lactose-free supplements were manufactured by PediaSure and PediaSure Advance respectively at Abbott Healthcare in Mumbai.
The dietary counselling, on the other hand, focused on the consumption of a balanced diet.
Data on the children’s anthropometry, including their weight, height, mid-upper-arm circumference, dietary diversity scores, and dietary intake were measured during the trial.
Dietary diversity was measured based on a total score of nine, the higher the score, the more diverse their food intake was.
Findings showed that the intake of all nutrients was significantly higher in both supplementation groups as compared to the control group, although all three groups did see an increase in nutrient intake.
Specifically, there was a significantly higher intake of protein, carbohydrate, total fat, iron, calcium, vitamin A, thiamin, and vitamin C.
For example, vitamin C intake had increased significantly from 28.29mg to 54.40mg in the group taking the milk-based supplement and from 25.65mg to 58.98mg in the group taking the lactose-free supplement.
Vitamin C intake had also significantly increased in the control group but to a smaller extent from 27.68mg to 32.25mg.
In addition, energy intake was significantly much higher in both the supplementation groups at 281.9 kcal higher in the milk-based supplement group and 277.6 kcal higher in the lactose-free supplement group. On the other hand, the control group’s energy intake was up 130.6 kcal.
Improvements in nutritional adequacy
Aside from an increase in nutrient intake, both supplement groups also reported a higher percentage of children who met the adequate amount of nutrient intake.
For example, the percentage of children consuming vitamin C adequately had increased significantly from 40 per cent at the start of the trial to more than 90 per cent by the end of the trial in both the supplemented groups.
Whereas in the control group, the percentage of kids consuming an adequate amount of vitamin C had only increased to a smaller extent from 41.1 per cent to 57.4 per cent.
Also, the percentage of children consuming adequate fats had increased significantly in both the supplemented groups – at 75 per cent in the milk supplement group and 84 per cent in the lactose-free supplement group by the end of the trial. No significant increase was not seen in the control group in this case.
“Overall, the findings indicated that children in both the supplemented groups met their nutrient requirements (EARs) at day 90 as compared to the children in the DC-only group. There were no differences in the nutrient adequacies of various nutrients between the two supplemented groups.
“Post-intervention, significantly higher percentages of children were consuming various nutrients adequately in both the ONS1 (milk-based supplement) + DC group and ONS 2 (lactose-free supplement) + DC group relative to the DC-only group,” said the researchers.
Appetite and dietary diversity
Children receiving the lactose-free supplement reported a significant improvement in both their appetite scores and food dietary intake diversity.
While appetite scores also improved significantly in the milk-based supplement group, this group did not report a significant increase in food dietary intake diversity – where the dietary diversity score was four and above.
“The study clearly indicated that the nutrient intakes of the subjects were much lower than what had been recommended, and that supplements did not act as substitutes for other foods in the daily diets of children in the included age group.
“Thus, the additional intake of nutrients in the form of ONS could help children bridge the gap between their usual intakes and the recommended values without altering their usual food patterns until they start eating a variety of foods in adequate amounts in their daily diets. This practice will help children at mild risk of malnutrition catch up faster and also prevent further deterioration in their growth,” said the researchers.
Previously, the researchers also reported that there was a significant increase in weight and body mass index (BMI) in both supplement groups in a 2021 study published in Nutrients.
Effect of Oral Nutritional Supplementation on Adequacy of Nutrient Intake among Picky-Eating Children at Nutritional Risk in India: A Randomized Double Blind Clinical Trial
Authors: Anwar, F et al