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European Journal of Pediatrics
Published in: European Journal of Pediatrics 9/2020

Open Access 01-09-2020 | Nutrition | Original Article

Energy-dense, low-volume paediatric oral nutritional supplements improve total nutrient intake and increase growth in paediatric patients requiring nutritional support: results of a randomised controlled pilot trial

Authors: Gary P. Hubbard, Catherine Fry, Katy Sorensen, Catherine Casewell, Lydia Collins, Annaruby Cunjamalay, Michelle Simpson, Amanda Wall, Elmarie Van Wyk, Matthew Ward, Sophie Hallowes, Hannah Duggan, Jennifer Robison, Helen Gane, Lucy Pope, Jennifer Clark, Rebecca J. Stratton

Published in: European Journal of Pediatrics | Issue 9/2020

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Abstract

Children with or at risk of faltering growth require nutritional support and are often prescribed oral nutritional supplements (ONS). This randomised controlled trial investigated the effects of energy-dense paediatric ONS (2.4 kcal/ml, 125 ml: cONS) versus 1.5 kcal/ml, 200 ml ONS (sONS) in community-based paediatric patients requiring oral nutritional support. Fifty-one patients (mean age 5.8 years (SD 3)) with faltering growth and/or requiring ONS to meet their nutritional requirements were randomised to cONS (n = 27) or sONS (n = 24) for 28 days. Nutrient intake, growth, ONS compliance and acceptability, appetite and gastro-intestinal tolerance were assessed. Use of the cONS resulted in significantly greater mean total daily energy (+ 531 kcal/day), protein (+ 10.1 g/day) and key micronutrient intakes compared with the sONS group at day 28 and over time, due to high ONS compliance (81% of patients ≥ 75%), maintained intake from diet alone and improved appetite in the cONS group, compared with the sONS group. Although growth increased in both intervention groups, results were significant in the cONS group (weight (p = 0.007), height (p < 0.001) and height z-score (p = 0.006)).
Conclusions: This study shows that use of energy-dense (2.4 kcal/ml) low-volume paediatric-specific ONS leads to improved nutrient intakes, growth and appetite in paediatric patients requiring oral nutrition support compared with standard energy density ONS.
Trial registration: The trial is registered at clinicaltrials.​gov, identification number NCT02419599.
What is Known:
• Faltering growth is the failure of children to achieve adequate growth at a normal rate for their age and requires nutritional support, including the use of oral nutritional supplements (ONS).
• Energy-dense, low-volume ONS have benefits over standard ONS in adults.
What is New:
• This is the first RCT to investigate the effects of energy-dense, low-volume ONS (2.4 kcal/ml, 125 ml) in children with faltering growth, showing significant improvements in total nutrient intake and increased growth.
• Energy-dense, low-volume ONS can play a key role in the management of faltering growth.
Literature
1.
2.
Barnard J, Rubin DB (1999) Small-sample degrees of freedom with multiple imputation. Biometrika 86(4):948–955CrossRef
3.
Bell EA, Castellanos VH, Pelkman CL, Thorwart ML, Rolls BJ (1998) Energy density of foods affects energy intake in normal-weight women. Am J Clin Nutr 67(3):412–420PubMedCrossRef
4.
Black MM, Dubowitz H, Krishnakumar A, Starr RH Jr (2007) Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics 120(1):59–69PubMedCrossRef
5.
6.
Cawood AL, Elia M, Stratton RJ (2010) Meta-analysis shows reduced health care use and costs with oral nutritional supplements. Clin Nutr Suppl 5:123
7.
8.
de Castro JM (2006) Macronutrient and dietary energy density influences on the intake of free-living humans. Appetite 46(1):1–5PubMedCrossRef
9.
DoH (1991) Dietary reference values for food energy and nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy HMSO, London
10.
Elia M, Parsons EL, Cawood AL, Smith TR, Stratton RJ (2017) Cost-effectiveness of oral nutritional supplements in older malnourished care home residents. Clin Nutr 37(2):651–658PubMedCrossRef
11.
12.
Fiore P, Castagnola E, Merolla R (2002) Effect of nutritional intervention on physical growth in children at risk of malnutrition. Int Pediatr 17(3):179–183
13.
Freeman R, Ralph AF, Cawood AL, Stratton RJ (2011) A survey of compliance and use of ready-made liquid oral nutritional supplements in elderly malnourished care home residents. Aging Clin Exp Res 23 (Suppl to No.1):159
14.
Grogan J, Watling R, Davey T, Maclean A, Cairns L, Dunlop C, Cawood AL (2006) Gastrointestinal tolerance of two fibre enriched paediatric enteral tube feeds. J Hum Nutr Diet 19(6):462
15.
16.
Hubbard GP, Holdoway A, Stratton RJ (2009) A pilot study investigating compliance and efficacy of a novel, low volume, energy dense (2.4kcal/ml) multi-nutrient supplement in malnourished community patients. Clin Nutr Suppl 4(2):41CrossRef
17.
Hubbard GP, Buchan B, Sanders K, Brothers S, Stratton RJ (2010) Improved compliance and increased intake of energy and protein with a high energy density, low volume multi-nutrient supplement. Proc Nutr Soc 69(OCE 2):E164CrossRef
18.
Hubbard GP, Elia M, Holdoway A, Stratton RJ (2012) A systematic review of compliance to oral nutritional supplements. Clin Nutr 31(3):293–312PubMedCrossRef
19.
Joosten K, Meyer R (2010) Nutritional screening and guidelines for managing the child with faltering growth. Eur J Clin Nutr 64(Suppl 1):S22–S24PubMedCrossRef
20.
Kasese-Hara M, Wright C, Drewett R (2002) Energy compensation in young children who fail to thrive. J Child Psychol Psychiatry 43(4):449–456PubMedCrossRef
21.
22.
Kral TV, Rolls BJ (2004) Energy density and portion size: their independent and combined effects on energy intake. Physiol Behav 82(1):131–138PubMedCrossRef
23.
Krugman SD, Dubowitz H (2003) Failure to thrive. Am Fam Physician 68(5):879–884PubMed
24.
25.
NICE (2017) Faltering growth - recognition and management. National Institute for Health and Care Excellence (UK), London
26.
Parsons EL, Elia M, Cawood AL, Smith TR, Warwick H, Stratton RJ (2011) Randomised controlled trial in care home residents shows improved quality of life (QOL) with oral nutritional supplements. Clin Nutr Suppl 6(1):31
27.
Pocock SJ (1999) Clinical trials: a practical approach. John Wiley and Sons, Chichester, UK
28.
29.
Rolls BJ, Castellanos VH, Halford JC, Kilara A, Panyam D, Pelkman CL, Smith GP, Thorwart ML (1998) Volume of food consumed affects satiety in men. Am J Clin Nutr 67(6):1170–1177PubMedCrossRef
30.
Rolls BJ, Bell EA, Castellanos VH, Chow M, Pelkman CL, Thorwart ML (1999) Energy density but not fat content of foods affected energy intake in lean and obese women. Am J Clin Nutr 69(5):863–871PubMedCrossRef
31.
Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall’Oglio L, Mis NF, Hojsak I, Orel R, Papadopoulou A, Schaeppi M, Thapar N, Wilschanski M, Sullivan P, Gottrand F (2017) European Society for Paediatric Gastroenterology, Hepatology and nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 65(2):242–264. https://​doi.​org/​10.​1097/​mpg.​0000000000001646​ PubMedCrossRef
32.
Rubin DB (2004) Multiple imputation for nonresponse in surveys. John Wiley and Sons, New York
33.
Schrezenmeir J, Heller K, McCue M, Llamas C, Lam W, Burow H, Kindling-Rohracker M, Fischer W, Sengespeik HC, Comer GM, Alarcon P (2004) Benefits of oral supplementation with and without synbiotics in young children with acute bacterial infections. Clin Pediatr (Phila) 43(3):239–249. https://​doi.​org/​10.​1177/​0009922804043003​05 CrossRef
34.
Sheng X, Tong M, Zhao D, Leung TF, Zhang F, Hays NP, Ge J, Ho WM, Northington R, Terry DL, Yao M (2014) Randomized controlled trial to compare growth parameters and nutrient adequacy in children with picky eating behaviors who received nutritional counseling with or without an oral nutritional supplement. Nutr MetabInsights 7:85–94. https://​doi.​org/​10.​4137/​nmi.​s15097 CrossRef
35.
Shields B, Wacogne I, Wright CM (2012) Weight faltering and failure to thrive in infancy and early childhood. BMJ 345:e5931PubMedCrossRef
36.
Skypala I, Ashworth A, Hodson M, Leonard C, Knox A, Hiller E, Wolfe S, Littlewood J, Morton A, Conway S, Patchell C, Weller P, McCarthy H, Redmond A, Dodge J (1998) Oral nutritional supplements promote significant weight gain in cystic fibrosis patients. J Hum Nutr Diet 11(2):95–104CrossRef
37.
Smith C, Cawood AL, Jenkins C, Ralph A, Neville C, Lowdon J, S RJ (2009) Review of use and compliance with oral nutritional supplements in dietetic paediatric outpatient clinics. J Hum Nutr Diet 22(6):606–607
38.
Smith TR, Guildford N, Cawood AL, Walters ER, Cotton J, Stratton RJ (2018) Randomised controlled trial shows ready-made low volume energy dense oral nutritional supplements reduce health care use in malnourished free living older people. J Parenter Enter Nutr 42(2) S43
39.
Smith T, Cawood AL, Guildford N, Stratton RJ (2018) Randomized trial shows low volume energy dense oral nutritional supplements improve total nutritional intake with little suppression of food intake in malnurished free living older people. Clin Nutr 37:S7CrossRef
40.
41.
Stange I, Bartram M, Liao Y, Pöschl K, Stehle P, Sieber CC, Volkert D (2011) Low volume, energy- and nutrient-dense oral nutritional supplement improves nutritional status of nursing home residents. Clin Nutr Suppl 6(1):127–128CrossRef
42.
Stange I, Bartram M, Liao Y, Pöschl K, Stehle P, Sieber CC, Volkert D (2013) Effects of a low-volume, nutrient- and energy-dense oral nutritional supplement on nutritional and functional status: a randomized, controlled trial in nursing home residents. J Am Med Dir Assoc 14(8):628.e621–628.e628CrossRef
43.
Steinkamp G, Demmelmair H, Ruhl-Bagheri I, von der Hardt H, Koletzko B (2000) Energy supplements rich in linoleic acid improve body weight and essential fatty acid status of cystic fibrosis patients. J Pediatr Gastroenterol Nutr 31(4):418–423PubMedCrossRef
44.
45.
Stratton RJ, Elia M (1999) A critical, systematic analysis of the use of oral nutritional supplements in the community. Clin Nutr 18(Supp2):29–84
46.
Stratton RJ, Elia M (2000) Are oral nutritional supplements of benefit to patients in the community? Findings from a systematic review. Curr Opin Clin Nutr Metab Care 3(4):311–315PubMedCrossRef
47.
Stratton RJ, Elia M (2007) A review of reviews: a new look at the evidence for oral nutritional supplements in clinical practice. Clin Nutr Suppl 2:5–23CrossRef
48.
Stratton RJ, Elia M (2010) Encouraging appropriate, evidence-based use of oral nutritional supplements. Proc Nutr Soc 69(4):477–487PubMedCrossRef
49.
Stratton RJ, Green CJ, Elia M (2003) Disease-related malnutrition: an evidence-based approach to treatment. CABI publishing, OxfordCrossRef
50.
Stratton R, Hebuterne X, Elia M (2013) Systematic review and meta-analysis of the effects of oral nutritional supplements on hospital admissions. Ageing Res Rev 12(4):884–897PubMedCrossRef
51.
Walters ER, Cawood AL, Smith TR, Guildford N, Stratton RJ (2018) Compliance, acceptability and satisfaction with low volume oral nutritional supplements: results from a randomised trial in malnourished free living older people Clinical Nutrition 37 Supp 1 S94
52.
Watling R, Grogan J, Larmour K, Court-Brown F, Davidson C, Cooke S, Bolch R, Sijben JW, Dhawan A (2008) Gastrointestinal tolerance and convenience of a new ready-to-use paediatric peptide feed. BSPGHAN Annual Winter Conference
53.
Metadata
Title
Energy-dense, low-volume paediatric oral nutritional supplements improve total nutrient intake and increase growth in paediatric patients requiring nutritional support: results of a randomised controlled pilot trial
Authors
Gary P. Hubbard
Catherine Fry
Katy Sorensen
Catherine Casewell
Lydia Collins
Annaruby Cunjamalay
Michelle Simpson
Amanda Wall
Elmarie Van Wyk
Matthew Ward
Sophie Hallowes
Hannah Duggan
Jennifer Robison
Helen Gane
Lucy Pope
Jennifer Clark
Rebecca J. Stratton
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Keyword
Nutrition
Published in
European Journal of Pediatrics / Issue 9/2020
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-020-03620-9

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