High Caloric Density and Optimal Protein-to-Energy Ratio of Oral Nutritional Supplements: Impacts on Catch-Up Growth in Undernourished Indonesian Children

BACKGROUND: Pediatric oral nutritional supplements (ONS) are nutrient-dense foods that provide high calories in restricted volumes to meet nutritional requirement of undernourished children. Beyond providing high caloric content, ONS should maintain an optimal protein-to-energy ratio (PER). This study evaluated the efficacy of two ONS formulations, i.e., 1.0 kcal/mL with PER of 9.6% or 1.5 kcal/mL ONS with PER of 8.9%, to support catch-up growth among at-risk and undernourished pediatric outpatients in Surabaya, Indonesia. METHODS: A retrospective cohort study was conducted using electronic medical record of 150 eligible pediatric patients aged 1-5 years old with feeding difficulties and infection. The subjects were categorized into 2 groups: (i) who consumed 400 kcal of solid food and received 400 mL/day of 1.5 kcal/mL ONS, and (ii) who consumed 600 kcal of solid food and received 400 mL/day of 1 kcal/mL ONS. RESULTS: Interventions with both ONS for 90 days improved average weight and height of subjects. Nonetheless, the 1.5 kcal/mL ONS induced higher weight gains at Day 30 and higher height gains at Day 30, 60 and 90. In the sub-stratification analyses, the 1.5 kcal/mL ONS induced significant weight gain at Day 30 for severely underweight and wasted subjects as well as promoted significant height gain at Day 30 for severely stunted patients. CONCLUSION: The 1.5 kcal/mL ONS with PER of 8.9% demonstrated a better effectiveness in promoting catch-up growth among undernourished children.