Effectivity and cost-effectiveness of oral nutrition supplement on malnourished children: A literature review

Siti Helmyati, Maria Wigati, Yuliana Novita Rachmawati, Cut Alima Syarifa, Gifani Rosilia, Renita -

Abstract


Background: Child undernutrition has been a global problem that could be potentially treated with the support of food for special medical purposes, including oral nutrition supplements (ONS). This literature review aims to examine the effectiveness of ONS on growth indicators, length of stay, and the occurrence of adverse events and explore the cost-effectiveness of ONS.

Methods: This review summarized findings from 16 articles. The articles were experimental, with or without comparison or control group, and examine nutrition status, other outcomes directly or indirectly related to malnutrition, and cost-effectiveness. Articles were collected from electronic database including PubMed, ProQuest, and Google Scholar with additional articles from Google search engine.

Results: Some articles reported that ONS administration, good ONS consumption, and higher ONS density resulted in weight and height gain, improvements in nutrition status, and shorter length of stay compared to those who don’t receive ONS, had poor ONS consumption, and had lower ONS density, although several adverse events of ONS consumption such as gastrointestinal symptoms, diarrhea, and vomiting were also recorded.

Conclusion: Studies on the cost-effectiveness of ONS are limited, yet available studies suggest ONS might potentially be a cost-effective nutrition intervention in child malnutrition treatment due to its relatively low cost which potentially reduces direct medical costs.


Keywords


oral nutrition supplements; malnutrition; children; growth indicators; cost-effectiveness

References


World Health Organization. Malnutrition. 2021. Available at: https://www.who.int/news-room/fact-sheets/detail/malnutrition. Accessed February 20, 2023.

World Health Organization. Urgent action needed as acute malnutrition threatens the lives of millions of vulnerable children. 2023. Avaible at: https://www.who.int/news/item/12-01-2023-urgent-action-needed-as-acute-malnutrition-threatens-the-lives-of-millions-of-vulnerable-children. Accessed March 9, 2023.

Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet (London, England). 2013;382(9890):427-451. doi:10.1016/S0140-6736(13)60937-X

Kellett J, Kyle G, Itsiopoulos C, Naunton M, Luff N. Malnutrition : The Importance of Identification , Documentation , and Coding in the Acute Care Setting. 2016;2016. doi:10.1155/2016/9026098

Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health. 2014;34(4):250-265. doi:10.1179/2046905514Y.0000000158

Torlesse H, Cronin AA, Sebayang SK, Nandy R. Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health. 2016;16(669):1-11. doi:10.1186/s12889-016-3339-8.

European Parliament. Background Document: The social and economic consequences of malnutrition in ACP countries. 2014. Available at: https://www.europarl.europa.eu/meetdocs/2009_2014/documents/acp/dv/background_/background_en.pdf. Accessed on March 10, 2023.

UN General Assimbly. A/RES/55/2: United Nations Millennium Declaration. 2000;(September).

Vassilakou T. Childhood Malnutrition: Time for Action. Child (Basel, Switzerland). 2021;8(2). doi:10.3390/children8020103

International Special Dietary Foods Industries (ISDI). Standards for the Labelling of and Claims for Foods for Special Medical Purposes Codex Stan 180-1991. 2020. Available at: https://www.isdi.org/wp-content/uploads/2020/04/CODEX-STAN-180-1991.pdf. Accessed on March 10, 2023.

Lenters L, Wazny K, Bhutta ZA. Management of severe and moderate acute malnutrition in children. In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. ; 2016. doi:10.1596/978-1-4648-0348-2_ch11

British Specialist Nutrition Association. Medical Foods. 2018. Available at: https://bsna.co.uk/pages/about-specialist-nutrition/medical-oral-nutritional-supplements. Accessed on January 7, 2023.

International Special Dietary Foods Industries (ISDI). Introducing a Patient to The Benefits of ONS. 2018. Available at: https://www.isdi.org/introducing-a-patient-to-the-benefits-of-ons/. Accessed on January 7, 2023.

Medical Nutrition International Industry (MNI). Oral Nutritional Supplements to Tackle Malnutrition. Third vers.; 2012. Available at: https://www.medicalnutritionindustry.com/files/user_upload/documents/publications/Dossier2012FINAL2012-09-04.pdf. Accessed on January 10, 2023.

Huybregts L, Becquey E, Zongrone A, et al. The impact of integrated prevention and treatment on child malnutrition and health : the PROMIS project , a randomized control trial in Burkina Faso and Mali. 2017:1-11. doi:10.1186/s12889-017-4146-6

Manary MJ, Ndkeha MJ, Ashorn P, Maleta K, Briend A. Home based therapy for severe malnutrition with ready-to-use food. Arch Dis Child. 2004;89(6):557-561. doi:10.1136/adc.2003.034306

Becker PJ, Carney LN, Corkins MR, et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators Recommended for the Identification and Documentation of Pediatric Malnutrition (Undernutrition). J Acad Nutr Diet. 2014;114(12):1988-2000. doi:10.1016/j.jand.2014.08.026

Kamugisha JGK, Lanyero B, Nabukeera-Barungi N, et al. Weight and mid-upper arm circumference gain velocities during treatment of young children with severe acute malnutrition, a prospective study in Uganda. BMC Nutr. 2021;7(1):26. doi:10.1186/s40795-021-00428-0

Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. fourth edi.; 2018.

Clarke SE, Evans S, MacDonald A, Davies P, Booth IW. Randomized comparison of a nutrient-dense formula with an energy-supplemented formula for infants with faltering growth. J Hum Nutr Diet. 2007;20(4):329-339. doi:10.1111/j.1365-277X.2007.00805.x

Huynh DTT, Estorninos E, Capeding RZ, Oliver JS, Low YL, Rosales FJ. Longitudinal growth and health outcomes in nutritionally at-risk children who received long-term nutritional intervention. J Hum Nutr Diet. 2015;28(6):623-635. doi:10.1111/jhn.12306

Eveleens RD, Dungen DK, Verbruggen SCAT, Hulst JM, Joosten KFM. Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay. J Hum Nutr Diet. 2019;32(1):3-10. doi:10.1111/jhn.12603

Scheeffer VA, Ricachinevsky CP, Freitas AT, et al. Tolerability and Effects of the Use of Energy-Enriched Infant Formula After Congenital Heart Surgery: A Randomized Controlled Trial. J Parenter Enter Nutr. 2019;44(2):348-354. doi:10.1002/jpen.1530

Hubbard GP, Fry C, Sorensen K, et al. 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. Eur J Pediatr. 2020;179(9):1421-1430. doi:10.1007/s00431-020-03620-9

Khanna D, Yalawar M, Saibaba PV, et al. Oral nutritional supplementation improves growth in children at malnutrition risk and with picky eating behaviors. Nutrients. 2021;13(10):1-15. doi:10.3390/nu13103590

Soliman A, De Sanctis V, Elsiddig S, et al. Impact of oral nutritional supplements (ONS) on growth outcomes and IGF-1 level in underweight older children and young adolescents (5-14 years) with short stature and no systemic disease: High versus normal calories density formula. Acta Biomed. 2021;92(4):1-9. doi:10.23750/abm.v92i4.11868

Devaera Y, Syaharutsa DM, Jatmiko HK, Sjarif DR. Comparing compliance and efficacy of isocaloric oral nutritional supplementation using 1.5 kcal/mL or 1 kcal/mL sip feeds in mildly to moderately malnourished Indonesian children: A randomized controlled trial. Pediatr Gastroenterol Hepatol Nutr. 2018;21(4):315-320. doi:10.5223/pghn.2018.21.4.315

BAPEN: British Association of Parenteral and Enteral Nutrition. Oral nutrition supplements (ONS). 2016. Available at: https://www.bapen.org.uk/nutrition-support/nutrition-by-mouth/oral-nutritional-supplements. Accessed on February 10, 2023.

NHS Scotland. Scottish Oral Nutritional Supplements Short Life Working Group ( ONS SLWG ) Report and Recommendations April 2018.; 2018. Available at: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2019/06/Scottish-Oral-Nutritional-Supplements-Short-Life-Working-Group-Final-Report-1.pdf. Accessed on February 10, 2023.

Khadilkar A, Dhongade A, Agrawal N. Impact of oral nutritional supplement on growth , nutrient intake and frequency of illness in children aged 4-6 years : A randomised controlled study. 2021:11-16. doi:10.7860/JCDR/2021/49599.15605

Huynh DTT, Estorninos E, Capeding MR, Oliver JS, Low YL, Rosales FJ. Impact of long-term use of oral nutritional supplement on nutritional adecuacy, dietary diversity, food intake and growth of Filipino preschool children. J Nutr Sci. 2016;5(20):1-11. doi:10.1017/jns.2016.6

Fatima S, Malkova D, Wright C, Nutrition KG-C, 2018 U. Impact of therapeutic food compared to oral nutritional supplements on nutritional outcomes in mildly underweight healthy children in a low-medium income society. Elsevier. 2018. Available at: https://www.sciencedirect.com/science/article/pii/S0261561417300973. Accessed on May 28, 2023.

Zhang H, Gu Y, Mi YP, Jin Y, Fu W, Latour JM. High-energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial. Nurs Crit Care. 2019;24(2):97-102. doi:10.1111/nicc.12400

El-Ganzoury MM, El-Farrash RA, Ahmed GF, Hassan SI, Barakat NM. Perioperative nutritional prehabilitation in malnourished children with congenital heart disease: A randomized controlled trial. Nutrition. 2021;84:111027. doi:10.1016/j.nut.2020.111027

Shim JO, Kim S, Choe BH, Seo JH, Yang HR. Effect of nutritional supplement formula on catch-up growth in young children with nonorganic faltering growth: A prospective multicenter study. Nutr Res Pract. 2020;14(3):230-241. doi:10.4162/nrp.2020.14.3.230

Evans S, Twaissi H, Daly A, Davies P, MacDonald A. Should high-energy infant formula be given at full strength from its first day of usage? J Hum Nutr Diet. 2006;19(3):191-197. doi:10.1111/j.1365-277X.2006.00689.x

Zhang Z, Li F, Hannon BA, et al. Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis. Nutrients. 2021;13(9). doi:10.3390/nu13093036

Ghosh AK, Kishore B, Shaikh I, et al. Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: a randomized, controlled trial. J Int Med Res. 2018;46(6):2186-2201. doi:10.1177/0300060518757355

World Health Organization, UNICEF. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund.; 2009. Available at: https://apps.who.int/iris/bitstream/handle/10665/44129/9789241598163_eng.pdf;jsessionid=E55964DD7D490A372C381C35C3EFE7C3?sequence=1. Accessed on March 23, 2023.

Sheng X, Tong M, Zhao D, et al. 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 Metab Insights. 2014;7:85-94. doi:10.4137/NMi.s15097

Moghadam EA, Mirzaaghayan MR, Goedhart A, et al. Nutritional support with energy and nutrient-dense formula for children with congenital heart defects: A clinical trial. 2020:1-15.

Abrha MW, Seid O, Gebremariam K, Kahsay A. Nutritional status significantly affects hospital length of stay among surgical patients in public hospitals of Northern Ethiopia : single cohort study. BMC Res Notes. 2019. doi:10.1186/s13104-019-4451-5

Cui Y, Li L, Hu C, et al. Effects and Tolerance of Protein and Energy-Enriched Formula in Infants Following Congenital Heart Surgery: A Randomized Controlled Trial. J Parenter Enter Nutr. 2018;42(1):196-204. doi:10.1002/jpen.1031

Lakdawalla DN, Mascarenhas M, Jena AB, et al. Impact of oral nutrition supplements on hospital outcomes in pediatric patients. J Parenter Enter Nutr. 2014;38(6):42S-49S. doi:10.1177/0148607114549769

Ilesanmi OS, Fatiregun AA. Length of Stay of Surgical Inpatients at University College Hospital , Ibadan , Nigeria. 2014;4(10):1992-2001.

Pollack MM, Holubkov R, Reeder R, et al. PICU Length of Stay: Factors Associated With Bed Utilization and Development of a Benchmarking Model. Pediatr Crit care Med a J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2018;19(3):196-203. doi:10.1097/PCC.0000000000001425

FDA. Food and Drugs: Investigational New Drug (IND) Application. 2010. Available at: https://www.accessdata.fda.gov. Accessed on March 17, 2023.

Zorzela L, Loke YK, Ioannidis JP, et al. PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ. 2016;352:i157. doi:10.1136/bmj.i157

Dunet DO. CDC Coffee Break: Introduction to Economic Evaluation. 2012. Available at: https://www.cdc.gov/dhdsp/pubs/docs/cb_january_10_2012.pdf. Accesssed on March 20, 2023.

Marino L V, Meyer R, Cooke ML. Cost comparison between powdered versus energy dense infant formula for undernourished children in a hospital setting. ESPEN J. 2013;8(4):e145-e149. doi:https://doi.org/10.1016/j.clnme.2013.04.002

National Institute for Health and Care Excellence (NICE). Nutrition Support for Adults : Oral Nutrition Support , Enteral Tube Feeding and Parenteral Nutrition Clinical Guideline. National Institute for Health and Clinical Experience; 2019.

Caccialanza R, Laviano A, Bosetti C, et al. Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. Support Care Cancer. 2022;30(11):9667-9679. doi:10.1007/S00520-022-07269-Y

Freijer K, Nuijten MJC. Analysis of the health economic impact of medical nutrition in the Netherlands. Eur J Clin Nutr. 2010;64(10):1229-1234. doi:10.1038/ejcn.2010.147




DOI: http://dx.doi.org/10.21927/ijnd.2024.12(2).%25p

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