Impact of Oral Nutritional Supplementation and Dietary Counseling on Outcomes of Linear Catch-Up Growth in Indian Children Aged 3–6.9 Years: Findings from a 6-Month Randomized Controlled Trial

<b>Background/Objectives</b>: In India, according to the National Family Health Survey (NFHS-5), 36% of children under five years old are stunted, 19% are wasted, and 32% are underweight, indicating widespread undernutrition. <b>Methods</b>: A randomized controlled trial was conducted between August 2023 and May 2024 (CTRI/2023/04/051566), enrolling 223 undernourished Indian children, randomly assigned to the oral nutritional supplement (ONS) + dietary counseling (DC) (n = 111) arm or the dietary counseling (DC) arm (n = 112). This study recruited both male and female subjects with picky eating habits and with height-for-age (HAP) and weight-for-height percentiles (WHP) below the 25th percentile according to the WHO Growth Standards and Growth Reference. Outcomes assessed were anthropometric indices, dietary intake, sick days, and nutrient adequacy. Data were analyzed using ANCOVA, with statistical significance at <i>p</i> < 0.05. <b>Results</b>: At 6 months, the ONS + DC group showed significant improvements compared to DC in HAP (12.1 vs. -0.4, LS Mean difference [95% CI], 13.3 [11.13, 15.48], <i>p</i> < 0.0001), and WAP (9.7 vs. 2.3, LS Mean difference [95% CI] 7.9 [5.07, 10.78], <i>p</i> < 0.0001). MUACP significantly increased in the ONS + DC group (11.1 vs. -1.0 in DC, LS Mean difference [95% CI], 11.1 [5.28, 16.99], <i>p</i> < 0.0001). Dietary intake of carbohydrates, proteins, and energy was significantly higher in the ONS + DC group at 3 months, with sustained improvements at 6 months. By 6 months, the ONS + DC group showed a significantly higher protein-to-energy intake ratio compared to the DC group (0.0027 vs. -0.0003, LS Mean difference [95% CI] 0.00224 [0.00025, 0.00423], <i>p</i> = 0.0204). <b>Conclusions</b>: The addition of ONS + DC significantly improved linear catch-up growth outcomes in children at risk of undernutrition as a result of improved energy and nutrient intake and a higher protein-to-energy ratio.