The use of oral protein calorie supplements in children with chronic disease

Cochrane: A lack of growth and poor nutrition are common in children with chronic diseases like cystic fibrosis and paediatric cancer. This may be due to reduced appetite, poor absorption and the need for extra calories due to the disease. Oral protein calorie supplements, either as milk or juices, may improve nutritional status and help children gain weight. Side effects of taking these supplements include the risk that the protein and calories in the supplement end up replacing those from normal food and have a negative effect on eating behaviour and physical side effects (e.g. bloating, vomiting and diarrhoea).

We looked for trials of oral protein calorie supplements compared to usual treatment or no alternative treatment where the children took the supplements for at least one month. The review included four trials with 187 children; in three of these the children had cystic fibrosis and in one they had cancer. Studies lasted from three months to one year. We recorded the results and judged whether the trials were at risk of being biased based on the design or the way it was run. We looked at outcomes such as weight and height, calorie intake, behaviour and also side effects.


One study (with 58 children) showed increases in the total calories consumed at both six and 12 months. None of the other outcomes we looked at showed any difference between treatments. This is an updated version of the review, which found no conclusive evidence to support the use of oral protein supplements. We suggest that at least one high quality trial be conducted.Therefore, we suggest that these products are used sparingly and with caution.


Overall the included studies had a low risk of bias, except for two studies in which it was possible that the organisers knew which treatment group in which the children would be placed. These issues are unlikely to change the results as knowing which treatment one receives is unlikely to affect the results of body measurements (e.g. weight, height outcomes). All planned outcomes were reported on, with the exception of one study that did not report on eating behaviour and lipase intake which were measured. The quality of the results for the eating behaviour assessment was questionable and many of the children did not return the food diaries from which the lipase intake could be calculated.

Authors' conclusions: 

Oral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We identified a small number of studies assessing these products in children with cystic fibrosis and paediatric malignant disease, but were unable to draw any conclusions based on the limited data extracted. We recommend a series of large, randomised controlled trials be undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we suggest these products are used with caution.