Submit your papersSubmit Now
For Enquiries: [email protected]
IIARD LogoIIARD

Early Childhood Nutritional Supplementation and the Risk of Excess Weight Gain: Balancing Growth Promotion and Obesity Prevention

Atiqur Rahman Khan, MBBS, DCH, MD PhD Paediatrics, MRCPS Glasg, FRCP UK, Corresponding Author, Manuscript Type

Abstract

Background Childhood obesity has emerged as a major global public health concern, with increasing prevalence in both developed and developing countries, including the Kingdom of Saudi Arabia. Simultaneously, nutritional supplementation remains an important therapeutic intervention for children with growth faltering, chronic diseases, feeding difficulties, and increased nutritional requirements. This presents a clinical challenge of promoting adequate growth while minimizing the risk of unnecessary excess weight gain. Objective This narrative review aims to examine the relationship between early childhood nutritional supplementation and the potential risk of later obesity, with particular emphasis on oral nutritional supplements, early-life nutritional programming, neonatal feeding practices, and individualized growth monitoring. Methods A comprehensive narrative review of the available literature was conducted using major medical databases, including PubMed, Google Scholar, Scopus, and the Cochrane Library. Evidence related to childhood obesity, infant feeding practices, developmental metabolic programming, prematurity, neonatal intensive care unit nutrition, Ready-to-Feed formulations, and Saudi Arabian epidemiological trends was critically reviewed and synthesized. Results Current evidence demonstrates that nutritional supplementation offers significant clinical benefits when appropriately prescribed for children with documented undernutrition, chronic illness, increased metabolic demands, or feeding difficulties. However, unnecessary or prolonged use of energy-dense supplements in healthy children with normal growth trajectories may contribute to excessive caloric intake and increased adiposity. NICU nutritional strategies, including human milk fortification and RTF formulas, are essential for vulnerable preterm infants but require individualized follow-up and periodic reassessment to ensure balanced catch-up growth and favorable long-term metabolic outcomes. Conclusion Childhood obesity is a complex multifactorial condition influenced by genetic, prenatal, nutritional, behavioral, and environmental factors rather than any single nutritional product or feeding practice. The modern goal of pediatric nutrition should focus on growth optimization rather than growth maximization. Individualized nutritional assessment, regular growth monitoring, parental education, and evidence-based use of nutritional supplements are essential to support healthy growth, neurodevelopment, and lifelong metabolic health.

Keywords

Childhood obesity; Nutritional supplementation; Early nutrition; Oral nutritional supplements; Breastfeeding; Formula feeding; Catch-up growth; Prematurity; NICU nutrition; Developmental origins of he

References

Agostoni, C., Buonocore, G., Carnielli, V. P., De Curtis, M., Darmaun, D., Decsi, T., Domellöf, M., Embleton, N. D., Fusch, C., Genzel-Boroviczeny, O., et al. (2010). Enteral nutrient supply for preterm infants: Commentary from the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 50(1), 85–91. https://doi.org/10.1097/MPG.0b013e3181adaee0 Al-Hussaini, A., Bashir, M. S., Khormi, M., AlTuraiki, M., Alkhamis, W., Alrajhi, M., & Halal, T. (2019). Overweight and obesity among Saudi children and adolescents: Where do we stand today? Saudi Journal of Gastroenterology, 25(4), 229–235. https://doi.org/10.4103/sjg.SJG_617_18 Alqarni, S. S. (2016). A review of prevalence of obesity in Saudi Arabia. Journal of Obesity and Eating Disorders, 2(2), 25. American Academy of Pediatrics. (2023). Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640 Barker, D. J. P. (2004). The developmental origins of adult disease. Journal of the American College of Nutrition, 23(6 Suppl.), 588S–595S. Belfort, M. B., Gillman, M. W., Buka, S. L., Casey, P. H., McCormick, M. C., & Preterm Infant Growth Study Group. (2013). Infant growth before and after term: Effects on neurodevelopment and adiposity in preterm infants. Pediatrics, 132(4), e899–e905. https://doi.org/10.1542/peds.2013-0007 Baird, J., Fisher, D., Lucas, P., Kleijnen, J., Roberts, H., & Law, C. (2005). Being big or growing fast: Systematic review of size and growth in infancy and later obesity. BMJ, 331(7522), 929. https://doi.org/10.1136/bmj.38586.411273.E0 Daniels, S. R. (2006). The consequences of childhood overweight and obesity. The Future of Children, 16(1), 47–67. Embleton, N. E., Pang, N., & Cooke, R. J. (2001). Postnatal malnutrition and growth retardation: An inevitable consequence of current recommendations in preterm infants? Pediatrics, 107(2), 270–273. https://doi.org/10.1542/peds.107.2.270 Fewtrell, M. S., Kennedy, K., Singhal, A., Martin, R. M., Ness, A., Hadders-Algra, M., Koletzko, B., & Lucas, A. (2011). How much loss to follow-up is acceptable in long-term studies of preterm infants? Acta Paediatrica, 100(7), 999–1003. https://doi.org/10.1111/j.1651- 2227.2011.02190.x Gillman, M. W. (2008). The first thousand days and childhood obesity. American Journal of Clinical Nutrition, 87(5), 1587–1589. Grummer-Strawn, L. M., Reinold, C., & Krebs, N. F. (2010). Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recommendations and Reports, 59(RR-9), 1–15. Harding, J. E., Cormack, B. E., Alexander, T., Alsweiler, J. M., & Bloomfield, F. H. (2017). Advances in nutrition of the newborn infant. The Lancet, 389(10079), 1660–1668. https://doi.org/10.1016/S0140-6736(17)30552-4 Horta, B. L., & Victora, C. G. (2013). Long-term effects of breastfeeding: A systematic review. World Health Organization. Jebeile, H., Kelly, A. S., O'Malley, G., & Baur, L. A. (2022). Obesity in children and adolescents: Epidemiology, causes, assessment, and management. The Lancet Diabetes & Endocrinology, 10(5), 351–365. https://doi.org/10.1016/S2213-8587(22)00047-X Koletzko, B., Brands, B., Chourdakis, M., Cramer, S., Grote, V., Hellmuth, C., Kirchberg, F., Prell, C., Rzehak, P., & Uhl, O. (2014). The power of programming and the Early Nutrition Project: Opportunities for health promotion by nutrition during the first thousand days of life. American Journal of Clinical Nutrition, 99(3), 628S–635S. https://doi.org/10.3945/ajcn.113.072603 Koletzko, B., von Kries, R., Closa, R., Escribano, J., Scaglioni, S., Giovannini, M., Beyer, J., Demmelmair, H., Gruszfeld, D., et al. (2009). Lower protein in infant formula is associated with lower weight up to age 2 years: A randomized clinical trial. American Journal of Clinical Nutrition, 89(6), 1836–1845. https://doi.org/10.3945/ajcn.2008.27091 Lapillonne, A., Bronsky, J., Campoy, C., Embleton, N., Fewtrell, M., Mis, N. F., Hojsak, I., Hulst, J. M., Indrio, F., et al. (2019). Feeding the late and moderately preterm infant: A position paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 69(2), 259– 270. https://doi.org/10.1097/MPG.0000000000002442 Lucas, A. (1991). Programming by early nutrition in man. Ciba Foundation Symposium, 156, 38– 50. https://doi.org/10.1002/9780470514038.ch3 Monteiro, P. O. A., & Victora, C. G. (2005). Rapid growth in infancy and childhood and obesity in later life: A systematic review. Obesity Reviews, 6(2), 143–154. https://doi.org/10.1111/j.1467-789X.2005.00183.x Ong, K. K., & Loos, R. J. F. (2006). Rapid infancy weight gain and subsequent obesity. Acta Paediatrica, 95(8), 904–908. https://doi.org/10.1080/08035250600719754 Robertson, R. C., Manges, A. R., Finlay, B. B., & Prendergast, A. J. (2019). The human microbiome and child growth—First 1000 days and beyond. Trends in Microbiology, 27(2), 131–147. https://doi.org/10.1016/j.tim.2018.09.008 Saudi Ministry of Health. (2024). Statistical yearbook 2024. Ministry of Health, Kingdom of Saudi Arabia. Saudi Public Health Authority . (2024). National initiatives for childhood obesity prevention. Saudi Public Health Authority. Schwarzenberg, S. J., & Georgieff, M. K. (2018). Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics, 141(2), e20173716. https://doi.org/10.1542/peds.2017-3716 Singhal, A. (2017). Long-term adverse effects of early growth acceleration or catch-up growth. Annals of Nutrition and Metabolism, 70(3), 236–240. https://doi.org/10.1159/000464302 Styne, D. M., Arslanian, S. A., Connor, E. L., Farooqi, I. S., Murad, M. H., Silverstein, J. H., & Yanovski, J. A. (2017). Pediatric obesity—Assessment, treatment, and prevention: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(3), 709–757. https://doi.org/10.1210/jc.2016-2573 Taveras, E. M., & Gillman, M. W. (2021). Childhood obesity: Prevention and management in early life. Pediatric Clinics of North America, 68(5), 1021–1034. https://doi.org/10.1016/j.pcl.2021.05.004 UNICEF, World Health Organization, & World Bank Group. (2023). Levels and trends in child malnutrition: Key findings of the 2023 edition. Vandenplas, Y., Berger, B., Carnielli, V. P., Ksiazyk, J., Lagström, H., Sanchez Luna, M., Migacheva, N., Mosselmans, J. M., Picaud, J. C., Possner, M., Singhal, A., & Wabitsch, M. (2020). Human milk oligosaccharides: 2'-Fucosyllactose and lacto-N-neotetraose in infant nutrition and health. Nutrients, 12(3), 763. https://doi.org/10.3390/nu12030763 Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7 Woo, J. G. (2019). Early nutrition and obesity development. Current Opinion in Pediatrics, 31(6), 789–795. https://doi.org/10.1097/MOP.0000000000000821 World Health Organization. (2022). Report of the Commission on Ending Childhood Obesity: Implementation plan. World Health Organization. World Health Organization. (2023). WHO guideline for complementary feeding of infants and young children 6–23 months of age. World Health Organization. World Health Organization. (2024). Obesity and overweight: Fact sheet. World Health Organization. World Obesity Federation. (2024). World obesity atlas 2024. World Obesity Federation. Arslanoglu, S., Moro, G. E., Ziegler, E. E., & the WAPM Working Group on Nutrition. (2010). Optimization of human milk fortification for preterm infants: New concepts and recommendations. Journal of Perinatal Medicine, 38(3), 233–238. https://doi.org/10.1515/JPM.2010.041 Arslanoglu, S., Corpeleijn, W., Moro, G., Braegger, C., Campoy, C., Colomb, V., Decsi, T., Domellöf, M., Fewtrell, M., Hojsak, I., et al. (2019). Donor human milk for preterm infants: Current evidence and recommendations. Journal of Pediatric Gastroenterology and Nutrition, 68(6), 786–797. https://doi.org/10.1097/MPG.0000000000002183 National Academies of Sciences, Engineering, and Medicine. (2023). Nutrition during pregnancy and early childhood: Current evidence and future directions. National Academies Press. American Society for Nutrition. (2023). Precision nutrition and health: Current perspectives and future directions. Current Developments in Nutrition, 7(Supplement_1), 100001.