den Broeder 2000.

Methods	RCT Parallel design Single‐centre University Hospital Nijmegen, the Netherlands
Participants	27 patients aged 1 to 18 years, newly diagnosed with cancer AGE EN nasogastric (energy enriched) ‐ 6.5 ± 4.5 years (mean ± SD) EN nasogastric (standard) ‐ 5.7 ± 3.8 years (mean ± SD) SEX EN nasogastric (energy enriched) ‐ 7 male, 8 female EN nasogastric (standard) ‐ 5 male, 7 female DISEASE STATUS Nephroblastoma Rhabdomyosarcoma Ewing sarcoma Neuroblastoma Osteosarcoma Germ cell tumour Hepatoblastoma Brain tumour Malnourished at diagnosis CHEMOTHERAPY/RADIOTHERAPY All patients received chemotherapy and/or radiotherapy
Interventions	27 patients randomly assigned: EN nasogastric (energy enriched) ‐ (n = 15), EN nasogastric (standard) ‐ (n = 12) EN tube feeding was administered at home and during hospital admission via a small bore silicone duodenal feeding tube with a weighted tip that was inserted into the stomach. During hospital admissions, the tube feeding was administered by continuous infusion over a 24‐hour period. At home the feeding routine was flexible and tailored to individual needs. The total volume of tube feeding to be administered was set to provide each child with 100% of the total daily energy requirement for the standard formula and 150% of the total energy requirement for the energy enriched formula.
Outcomes	Primary outcomes Change in nutritional  indices ‐ Weight for height measurements weekly ‐ Mid‐upper arm circumference weekly ‐ Triceps skinfold weekly ‐ Biceps skinfold weekly ‐ Calculated muscle (arm area) ‐ Serum albumin at diagnosis, at initiation of tube feeding and weekly thereafter ‐ Pre‐albumin at diagnosis, at initiation of tube feeding and weekly thereafter Adverse events ‐ Occurrence of vomiting (mean number of days per week on which vomiting occurred) Calorie and nutritional intake ‐ Mean daily energy intake per week ‐ Mean daily total protein intake Secondary outcomes ‐ Patient tolerance/adherence with feeding
Notes	The study period started at the initiation of tube feeding (week 0) and ended after 10 weeks
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: random generation unclear, but undertaken in pairs (block randomisation) before study
Allocation concealment (selection bias)	Unclear risk	Comment: not stated how undertaken
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: not clear if formulas were unlabelled or concealed in any way so as researchers or participants were blinded. However it does state in the tube feed regimen description in the methods that it was unknown whether the child received the standard or energy dense formula, as volume of feed was calculated on the assumption that all patients received the standard feed.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: not clear if formulas were unlabelled or concealed in any way so as researchers or participants were blinded
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: many outcomes were measured from patient diaries ‐ unclear how much missing data was present. Also, 27/29 patients were analysed; missing patients were presumed to have dropped out of the control group (15 patients analysed in intervention group). As missing data was not imputed, this is not intention to treat.
Selective reporting (reporting bias)	Low risk	Comment: all measurements stated were reported
Other bias	Low risk	Comment: no other risks of bias noted