Researchers in Malaysia, the Netherlands and the United States assessed the effects of an 180-day nutrient-dense ONS intervention on growth and nutrient intake among Malaysian children between the ages of 12 and 36 months who were stunted or at risk.
“Clinically, the intervention achieved an approximate 38% reduction in stunting prevalence within six months, representing a meaningful shift in nutritional status within this high-burden population,” the researchers wrote in the journal Nutrients.
Childhood micronutrient deficiencies drive lifelong health issue
Stunting, as defined by the World Health Organization (WHO), is the impaired growth and development in children under the age of 5, characterized by low height-for-age. It is a marker of chronic malnutrition, poor health and repeated infection, often occurring within the first 1,000 days of life.
Stunting can affect children throughout life, however early intervention is critical, and it has been shown that children who recover before age 5 can achieve normal cognitive and health outcomes.
Micronutrient deficiencies play a key role in reduced childhood growth and act as a major contributor to poor health outcomes in early life. Deficiencies in key micronutrients such as vitamin A, iron, zinc and iodine can substantially impair immune function, cellular growth and bone development, together accounting for approximately 35% of deaths among children under the age of 5.
Inadequate intake of calcium and vitamin D further compromise skeletal growth and increase the risk of stunting. These deficiencies often coexist in undernourished populations, compounding their negative effects on child growth and survival.
Some previous research has found that multi-micronutrient supplementation and nutrient-dense ONS when combined with dietary counseling may significantly improve child growth.
Oral nutrition supplement boosts growth and cuts stunting in toddlers
The researchers conducted the community-based single-arm intervention trial in Kelantan, Malaysia, from December 2022 to March 2024, enrolling 91 Malaysian children between the ages of 12 and 36 months who were stunted or at risk of stunting based on WHO growth standards.
The researchers assessed participants’ height and weight at baseline, 90 days and 180 days, dietary intake at baseline and post-intervention using three-day 24-hour recalls, and nutrient intake. All children consumed the ONS supplied by Dutch Lady Milk, a FrieslandCampina brand, three times a day for 180 days.
Following the intervention, children showed significant improvements in linear growth. Mean height-for-age z-scores (HAZ) increased significantly from baseline to 90 days and were maintained at 180 days, with both stunted and at-risk children experiencing significant HAZ gains. Continued improvements were observed between 90 and 180 days only among stunted children.
Body weight also increased over time, while BMI decreased slightly and remained stable, indicating proportional growth. Weight-for-age z-scores improved mainly among children at risk of stunting, whereas weight-for-height z-scores did not change significantly.
The prevalence of stunting also declined significantly from 40.7% at baseline to 25.3% at 180 days, representing a significant reduction of nearly 38%. Underweight and wasting also declined, while a small number of children were classified as overweight, consistent with normal growth patterns.
After 180 days, intake of most macro- and micronutrients increased significantly, with the proportion of children meeting Malaysian Recommended Nutrient Intake levels rising sharply across nearly all nutrients.
Findings showed that calcium increased from 36% at baseline to 91% at 180 days, while vitamin D rose from 2% to 89%. Thiamine (99%) and vitamin B12 (98%) also improved markedly, though they remained slightly lower than other nutrients.
“A daily intake of 510 mL of oral nutrition supplement improved linear growth and nutrient intake,” the researchers wrote. “These findings support the potential of targeted supplementation in addressing child growth faltering and micronutrient inadequacies.”
They added that future studies should address maternal nutrition as a factor in child growth and nutrition.
Source: Nutrients. doi: 10.3390/nu16050754. “Impact of an Oral Nutrition Supplement on the Nutritional Status of Stunted and At-Risk of Stunting Children: A Community-Based Intervention Trial”. Authors: Al-Talib, S. A. et al.
