{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:28:37Z","timestamp":1787300917096,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Quantum Upstream Sdn. Bhd","award":["NN-2024-003"],"award-info":[{"award-number":["NN-2024-003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Undernutrition remains a public health concern among preschool children in Malaysia. Although oral nutritional supplementation (ONS) globally has been recommended to improve nutritional status, evidence from community-based randomised controlled trials among underweight Malaysian preschool children remains limited. This study evaluated the effectiveness of ONS on growth, dietary intake, appetite, and common illnesses among underweight preschool children in Kuala Lumpur, the capital city of Malaysia. Methods: A multi-centre, community-based, cluster-randomised controlled trial was conducted among underweight preschool children aged 4\u20136 years from 16 government-subsidised preschools. Participants were assigned to receive ONS plus nutrition education (ONS + NE) or nutrition education alone (NE only) for 90 days. Anthropometric measurements, dietary intake, appetite, attainment of catch-up growth, and parent-reported common illnesses were assessed. Between-group differences were analysed using analysis of covariance adjusted for baseline values. Results: Ninety-six underweight preschool children were randomised to ONS plus nutrition education (ONS + NE, n = 56) or nutrition education alone (NE only, n = 40). Compared with the NE group, children receiving ONS + NE demonstrated significantly greater improvements in weight-for-age z-scores at day 60 and day 90 (p &lt; 0.05). The ONS + NE group also achieved significantly higher catch-up growth attainment at day 60 (116.6 \u00b1 38.5% vs. 99.1 \u00b1 17.4%; p = 0.029) and day 90 (114.6 \u00b1 37.2% vs. 95.5 \u00b1 23.8%; p = 0.021). In addition, significantly higher energy, macronutrients, selected micronutrient intakes, and appetite scores were observed in the ONS + NE group (all p &lt; 0.05). Conclusions: ONS combined with nutrition education improved weight-related growth, dietary adequacy, catch-up growth energy achievement, and appetite among underweight preschool children. ONS may serve as an effective community-based strategy for nutritional rehabilitation in this population. Trial registration: ISRCTN15093638.<\/jats:p>","DOI":"10.3390\/nu18162714","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T16:12:58Z","timestamp":1787155978000},"page":"2714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7893-4047","authenticated-orcid":false,"given":"Abdul Hakim","family":"Abdul Wahid","sequence":"first","affiliation":[{"name":"Centre for Healthy Ageing & Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5414-446X","authenticated-orcid":false,"given":"Nur Hana","family":"Hamzaid","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation & Special Needs Studies (ICaReHab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1321-891X","authenticated-orcid":false,"given":"Haslina","family":"Abdul Hamid","sequence":"additional","affiliation":[{"name":"Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-4727","authenticated-orcid":false,"given":"Rosnah","family":"Sutan","sequence":"additional","affiliation":[{"name":"Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5657-8608","authenticated-orcid":false,"given":"Zahara","family":"Abdul Manaf","sequence":"additional","affiliation":[{"name":"Centre for Healthy Ageing & Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023). Levels and Trends in Child Malnutrition Child Malnutrition: UNICEF\/WHO\/World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2023 Edition, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1017\/S0954422421000159","article-title":"Malnutrition in early life and its neurodevelopmental and cognitive consequences: A scoping review","volume":"35","author":"Suryawan","year":"2022","journal-title":"Nutr. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lee, W.S., Jalaludin, M.Y., Khoh, K.M., Kok, J.L., Nadarajaw, T., Soosai, A.P., Mukhtar, F., Fadzil, Y.J., Anuar Zaini, A., and Mohd-Taib, S.H. (2022). Prevalence of undernutrition and associated factors in young children in Malaysia: A nationwide survey. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.913850"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5683","DOI":"10.1080\/10408398.2024.2419539","article-title":"Prevalence and key determinants of the triple burden of childhood malnutrition in Southeast Asian countries: A systematic review and meta-analysis within an adapted socio-ecological framework","volume":"65","author":"Tan","year":"2025","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e152","DOI":"10.1017\/S1368980024000053","article-title":"South East Asian Nutrition Surveys II (SEANUTS II) Thailand: Triple burden of malnutrition among Thai children aged 6 months to 12 years","volume":"27","author":"Pongcharoen","year":"2024","journal-title":"Public Health Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1017\/S1368980023002239","article-title":"Triple burden of malnutrition among Malaysian children aged 6 months to 12 years: Current findings from SEANUTS II Malaysia","volume":"27","author":"Poh","year":"2024","journal-title":"Public Health Nutr."},{"key":"ref_7","unstructured":"Institute for Public Health (2023). Technical Report National Health and Morbidity Survey (NHMS) 2022: Maternal and Child Health, Malaysia."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Abdul Wahid, A.H., Abdul Manaf, Z., Hamzaid, N.H., Abdul Hamid, H., and Sutan, R. (2026). Prevalence and factors associated with undernutrition among preschoolers in low-income urban households in Malaysia. Sci. Rep.","DOI":"10.1038\/s41598-026-61024-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"269","DOI":"10.4162\/nrp.2023.17.2.269","article-title":"Food security and diet quality among urban poor adolescents in Kuala Lumpur, Malaysia","volume":"17","author":"Tay","year":"2023","journal-title":"Nutr. Res. Pr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kozio\u0142-Kozakowska, A. (2023). Adequate Nutrition in Early Childhood. Children, 10.","DOI":"10.3390\/children10071155"},{"key":"ref_11","first-page":"425","article-title":"Assessment of dietary diversity score, nutritional status and socio-demographic characteristics of under-5 children in some rural areas of Imo State, Nigeria","volume":"23","author":"Ogechi","year":"2017","journal-title":"Malays. J. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.3945\/ajcn.116.137356","article-title":"Macro- and micronutrient intakes in picky eaters: A cause for concern?","volume":"104","author":"Taylor","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.25182\/jgp.2024.19.3.187-196","article-title":"The Relationship Between Authoritative Parenting Style, Oral Sensory Processing, and Eating Behaviour Related to Picky Eaters among Toddlers in Klang Valley, Malaysia","volume":"19","author":"Kamarudin","year":"2024","journal-title":"J. Gizi Dan Pangan"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/0884533616671861","article-title":"Diagnosing pediatric malnutrition: Paradigm shifts of etiology-related definitions and appraisal of the indicators","volume":"32","author":"Bouma","year":"2017","journal-title":"Nutr. Clin. Pract."},{"key":"ref_15","first-page":"41","article-title":"The Impact of Malnutrition on Child Development: Understanding Long-Term Health and Cognitive Outcomes","volume":"3","author":"Muriithi","year":"2024","journal-title":"Res. Output J. Biol. Appl. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"NMI-S15097","DOI":"10.4137\/NMI.S15097","article-title":"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","volume":"7","author":"Sheng","year":"2014","journal-title":"Nutr. Metab. Insights"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1177\/0300060518757355","article-title":"Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: A randomized, controlled trial","volume":"46","author":"Ghosh","year":"2018","journal-title":"J. Int. Med. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Khanna, D., Yalawar, M., Saibaba, P.V., Bhatnagar, S., Ghosh, A., Jog, P., Khadilkar, A.V., Kishore, B., Paruchuri, A.K., and Pote, P.D. (2021). Oral Nutritional Supplementation Improves Growth in Children at Malnutrition Risk and with Picky Eating Behaviors. Nutrients, 13.","DOI":"10.3390\/nu13103590"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Al-Talib, S.A., Jan Mohamed, H.J., Mitra, A.K., Rostenberghe, H.V., Hazlan, S.N.H., and Khouw, I. (2026). Impact of an Oral Nutrition Supplement on the Nutritional Status of Stunted and At-Risk of Stunting Children: A Community-Based Intervention Trial. Nutrients, 18.","DOI":"10.20944\/preprints202601.0617.v1"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Anwar, F., Yalawar, M., Suryawanshi, P., Ghosh, A., Jog, P., Khadilkar, A.V., Kishore, B., Paruchuri, A.K., Pote, P.D., and Mandyam, R.D. (2023). Effect of oral nutritional supplementation on adequacy of nutrient intake among picky-eating children at nutritional risk in India: A randomized double blind clinical trial. Nutrients, 15.","DOI":"10.3390\/nu15112528"},{"key":"ref_21","unstructured":"World Health Organization (2006). WHO Child Growth Standards: Length\/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development, World Health Organization."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences, Routledge.","DOI":"10.4324\/9780203771587"},{"key":"ref_24","unstructured":"World Health Organization (2011). WHO Anthro for Personal Computers, Version 3.2. 2: Software for Assessing Growth and Development of the World\u2019s Children [Internet], World Health Organization."},{"key":"ref_25","unstructured":"WHO (AnthroPlus, 2009). AnthroPlus, version 1.0.4; For personal computers."},{"key":"ref_26","unstructured":"Abdul Manaf, Z., and Anur, A. (2016). Atlas Makanan Bayi & Kanak-Kanak, Youth Commerce."},{"key":"ref_27","unstructured":"Ministry of Health Malaysia (2025, December 01). Malaysian Food Composition Database (MyFCD), Available online: https:\/\/myfcd.moh.gov.my\/."},{"key":"ref_28","unstructured":"Siong, T.E., Noor, M.I., Azudin, M.N., and Idris, K. (1997). Nutrient Composition of Malaysian Foods."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1038\/sj.ejcn.1600971","article-title":"The sensitivity and specificity of the Goldberg cut-off for EI: BMR for identifying diet reports of poor validity","volume":"54","author":"Black","year":"2000","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/S0002-8223(21)08250-X","article-title":"Team management of failure to thrive","volume":"84","author":"Peterson","year":"1984","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3122\/jabfm.2007.02.060125","article-title":"Validity of parental reporting of recent episodes of acute otitis media: A Slone Center Office-Based Research (SCOR) Network study","volume":"20","author":"Vernacchio","year":"2007","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_32","first-page":"OC11","article-title":"Impact of Oral Nutritional Supplement on Growth, Nutrient Intake and Frequency of Illness in Children aged 4\u20136 Years: A Randomised Controlled Study","volume":"15","author":"Khadilkar","year":"2021","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_33","unstructured":"Bahagian Pemakanan Kementerian Kesihatan Malaysia (2015). Garis Panduan Program Pemulihan Kanak-Kanak Kekurangan Zat Makanan (PPKZM)."},{"key":"ref_34","unstructured":"Bahagian Pembangunan Kesihatan Keluarga Malaysia (2020). Panduan Pencegahan & Pengendalian Kes Berisiko Malnutrisi Dalam Kalangan Kanak-Kanak Bawah 5 Tahun."},{"key":"ref_35","unstructured":"National Coordinating Committee on Food and Nutrition (NCCFN) (2023). Malaysian Dietary Guidelines for Children and Adolescents 2023."},{"key":"ref_36","first-page":"86","article-title":"Review of Oral Nutritional Supplements in Malnutrition Management for Unlocking Nutritional Potential: A Review","volume":"13","author":"Mahmoudifar","year":"2025","journal-title":"J. Nutr. Fasting Health"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Li, F., Hannon, B.A., Hustead, D.S., Aw, M.M., Liu, Z., Chuah, K.A., Low, Y.L., and Huynh, D.T.T. (2021). Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis. Nutrients, 13.","DOI":"10.3390\/nu13093036"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Dipasquale, V., Cucinotta, U., and Romano, C. (2020). Acute Malnutrition in Children: Pathophysiology, Clinical Effects and Treatment. Nutrients, 12.","DOI":"10.3390\/nu12082413"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"323","DOI":"10.3945\/an.116.013938","article-title":"The Impact of Nutritional Interventions beyond the First 2 Years of Life on Linear Growth: A Systematic Review and Meta-Analysis","volume":"8","author":"Roberts","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_40","first-page":"909","article-title":"Metabolic phenotyping of malnutrition during the first 1000 days of life","volume":"58","author":"Swann","year":"2019","journal-title":"Eur. J. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1017\/S1368980013003017","article-title":"Growth faltering and recovery in children aged 1\u20138 years in four low-and middle-income countries: Young Lives","volume":"17","author":"Lundeen","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/MPG.0000000000003784","article-title":"Catch-Up Growth in Infants and Young Children with Faltering Growth: Expert Opinion to Guide General Clinicians","volume":"77","author":"Cooke","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/16\/2714\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:22:26Z","timestamp":1787300546000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/16\/2714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":42,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18162714"],"URL":"https:\/\/doi.org\/10.3390\/nu18162714","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]}}}