The Effectiveness of Oral Nutrition Supplementation on Growth Indicators, Dietary Intake, Appetite, and Health Outcomes Among Underweight Preschool Children in Urban Area of Kuala Lumpur, Malaysia: A Multi-Centre Community-Based Randomised Controlled Trial.
Abdul Wahid A, Hamzaid N, et al. • Nutrients • 2026
ONS combined with nutrition education improved weight-related growth, dietary adequacy, catch-up growth energy achievement, and appetite among underweight preschool children, suggesting ONS may serve as an effective community-based strategy for nutritional rehabilitation in this population.
Key Findings
Results
Children receiving ONS plus nutrition education demonstrated significantly greater improvements in weight-for-age z-scores compared to nutrition education alone.
Improvements in weight-for-age z-scores were significant at both day 60 and day 90 (p < 0.05)
The study enrolled 96 underweight preschool children aged 4-6 years from 16 government-subsidised preschools in Kuala Lumpur
Participants were randomised to ONS + NE (n = 56) or NE only (n = 40)
The intervention duration was 90 days
Between-group differences were analysed using analysis of covariance adjusted for baseline values
Results
The ONS plus nutrition education group achieved significantly higher catch-up growth attainment at both day 60 and day 90.
At day 60, catch-up growth attainment was 116.6 ± 38.5% in the ONS + NE group versus 99.1 ± 17.4% in the NE only group (p = 0.029)
At day 90, catch-up growth attainment was 114.6 ± 37.2% in the ONS + NE group versus 95.5 ± 23.8% in the NE only group (p = 0.021)
The NE only group's catch-up growth attainment fell below 100% by day 90, indicating failure to meet catch-up growth energy targets on average
Results
Children in the ONS plus nutrition education group had significantly higher energy, macronutrient, selected micronutrient intakes, and appetite scores compared to the nutrition education only group.
All between-group differences in energy, macronutrients, selected micronutrients, and appetite scores were statistically significant (all p < 0.05)
Dietary intake and appetite were assessed as part of the multi-centre, community-based, cluster-randomised controlled trial
The trial was registered under ISRCTN15093638
Methods
The study design was a multi-centre, community-based, cluster-randomised controlled trial conducted across 16 government-subsidised preschools in Kuala Lumpur, Malaysia.
Participants were underweight preschool children aged 4-6 years
The intervention period was 90 days
Outcomes assessed included anthropometric measurements, dietary intake, appetite, attainment of catch-up growth, and parent-reported common illnesses
The ONS group received oral nutritional supplementation in addition to nutrition education, while the control group received nutrition education alone
Background
Undernutrition remains a public health concern among preschool children in Malaysia, and community-based randomised controlled trial evidence for ONS in underweight Malaysian preschool children was previously limited.
The study was conducted in Kuala Lumpur, the capital city of Malaysia
Although ONS has been globally recommended to improve nutritional status, evidence from community-based RCTs among underweight Malaysian preschool children was described as limited prior to this study
The study targeted children from government-subsidised preschools, reflecting a focus on a vulnerable urban population
What This Means
This research studied whether giving underweight preschool children a nutritional supplement drink (oral nutritional supplementation, or ONS) alongside nutrition education for parents and children would help them grow better than nutrition education alone. The study followed 96 children aged 4 to 6 years from 16 preschools in Kuala Lumpur, Malaysia, over 90 days. Children were randomly assigned to either receive the supplement plus nutrition education or nutrition education only.
The results showed that children who received the supplement in addition to nutrition education gained more weight relative to their age compared to children who only received nutrition education. They were also more likely to achieve the level of calorie intake needed to 'catch up' in growth, and they ate more energy, protein, and key nutrients overall. Their appetite scores were also higher in the supplement group. These improvements were seen at both the 60-day and 90-day checkpoints.
This research suggests that providing an oral nutritional supplement alongside nutrition education can be an effective way to help underweight young children in urban community settings improve their weight and overall nutritional intake. This could have practical implications for public health programs targeting child undernutrition in Malaysia and potentially in similar settings elsewhere, pointing to ONS as a feasible tool for nutritional rehabilitation when delivered through community-based preschool programs.
Check Your Own Numbers
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
Abdul Wahid A, Hamzaid N, Abdul Hamid H, Sutan R, Abdul Manaf Z. (2026). The Effectiveness of Oral Nutrition Supplementation on Growth Indicators, Dietary Intake, Appetite, and Health Outcomes Among Underweight Preschool Children in Urban Area of Kuala Lumpur, Malaysia: A Multi-Centre Community-Based Randomised Controlled Trial.. Nutrients. https://doi.org/10.3390/nu18162714