# Effects of Oral Nutritional Supplementation on Body Composition and Bone Health in Undernourished Children: A Randomized Controlled Study

## TL;DR

This study shows that adding nutritional supplements and dietary advice helps improve bone health and body composition in undernourished Indian children aged 3 to 7.

## Contribution

The study provides new evidence on the specific benefits of oral nutritional supplements and dietary counseling for bone and body composition in undernourished children.

## Key findings

- Children receiving ONS + DC had significantly greater increases in bone mineral density and bone mineral content.
- Lean mass increased more in the ONS + DC group compared to the control group.
- Fat mass decreased more in the ONS + DC group, though not statistically significant.

## Abstract

Background/Objectives: While oral nutritional supplements (ONSs) are known to support general growth in undernourished children, their specific effects on body composition and bone health remain underexplored. This manuscript evaluates the impact of ONS combined with dietary counselling (DC) on these outcomes in Indian children aged 3 to 6.9 years at nutritional risk, within the framework of a larger randomized controlled trial assessing multiple growth parameters. Methods: This prospective, randomized controlled trial was conducted among Indian children, both male and female participants with picky eating habits and at risk of undernutrition, aged 3 to 6.9 years (height-for-age and weight-for-height below the 25th percentile per WHO Growth Standards and Growth Reference). Participants were randomized in a 1:1 ratio to receive either ONS + DC or DC alone for 6 months. Body composition, bone mineral density (BMD), and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry (DXA) at baseline and after 6 months. Group differences were analyzed to evaluate intervention effects. Results: A total of 223 children were enrolled and randomized. At 6 months, the test group showed significantly greater improvements in BMD (0.023 g/cm2) compared to the control (0.017 g/cm2; p = 0.004), and a greater gain in BMC (36.60 g vs. 28.48 g; p =0.0007). Lean mass increased significantly more in the test group (926.33 g) versus the control (801.48 g; p = 0.0401). Fat mass showed a numerical reduction in the test group (−171.42 g) compared with the control group (−114.60 g), although this difference was not statistically significant. Conclusions: These findings highlight the potential of targeted nutritional interventions to favorably improve body composition and bone health during critical growth periods in undernourished children, offering a promising approach to address early-life nutritional deficits with lasting health benefits.