Impact of a Nutrient-Dense Oral Nutritional Supplement on Growth in At-Risk Filipino Children: A Single-Arm Study

Growth faltering and dietary inadequacy remain important concerns among Filipino preschool children at nutritional risk. This prospective, community-based, single-arm study evaluated anthropometric and dietary changes during a 120-day intervention of a nutrient-dense oral nutritional supplement (ONS) and dietary counseling. Children aged three to five years received two 250 mL servings daily (500 kcal/day) of a vanilla-flavored ONS for 120 days. Primary outcomes were changes in weight, height, weight-for-age (WFA), height-for-age (HFA), and weight-for-height (WFH) percentiles and z-scores; secondary outcomes included nutrient adequacy relative to the Philippine Dietary Reference Intake estimated average requirements (EARs), dietary diversity score (DDS), compliance, and health events. Of 268 screened children, 245 were enrolled; 223 completed follow-up and were included in the per-protocol (PP) analysis, and 239 were included in the intention-to-treat (ITT) sensitivity analysis. In the PP analysis, mean weight increased from 13.1 ± 1.4 kg to 14.2 ± 1.8 kg, and mean height increased from 95.5 ± 5.6 cm to 98.5 ± 5.4 cm (both p < 0.001). Median WFA z-score improved from -1.6 (IQR, -2.1 to -1.2) to -1.3 (IQR, -1.9 to -0.8), HFA z-score from -1.7 (IQR, -2.4 to -0.9) to -1.5 (IQR, -2.3 to -0.8), and WFH z-score from -0.8 (IQR, -1.1 to -0.7) to -0.7 (IQR, -1.1 to -0.3; all p < 0.001). Significant improvements in growth parameters were observed from day 30 and remained significant over the study follow-up. The proportion of children at or below the 25th percentile for WFH decreased from 100% at baseline to 46.2% by day 120. Energy inadequacy decreased from 76.0%-79.4% at baseline to 11.9%-15.6% at day 120, and protein inadequacy decreased from 24.0%-27.8% to 0%-0.8%. Compliance with video-observed treatment (VOT) ranged from 92.5% to 98.3%, and no ONS-related adverse events were recorded. In conclusion, nutrient-dense ONS combined with dietary counseling was associated with improved anthropometric status and nutrient adequacy over 120 days.