Nutritional and Supplemental Interventions for Prevention and Treatment of Oral Mucositis in Pediatric Oncology.

2025-11-11
Nutrients 17(22)
- Razvan Mihai Horhat
- Alexandru Alexandru
- Cristiana-Smaranda Ivan
- Norberth-Istvan Varga
- Madalina-Ianca Suba
- Elena Ciurariu
- Monica Susan
- Razvan Susan
- Adrian Cote

PubMed: 41305573
DOI: 10.3390/nu17223521

Study Design

Type: Systematic Review
Population: pediatric cancer patients (≤18 years; up to 25 years for follow-up) receiving chemo-/radiotherapy
Methods: Systematic search (17 August 2025) of Scopus, PubMed/MEDLINE, and Google Scholar (1 January 2000–1 June 2025) following PRISMA guidelines; included 20 RCTs

Rigorous Journal

Background: Oral mucositis (OM) is a frequent complication of anticancer therapy which arises from cytotoxic injury, having significant clinical implications. Nutritional and supplement-based interventions have been proposed as adjunctive strategies to improve outcomes. Objectives: This systematic review aimed to identify and synthesize evidence from randomized controlled trials (RCTs) evaluating nutritional or natural supplement interventions for prevention or management of OM in pediatric oncology. Methods: We conducted a systematic search (17 August 2025) of Scopus, PubMed/MEDLINE, and Google Scholar (1 January 2000-1 June 2025) following PRISMA guidelines and registered in PROSPERO (CRD420251134454). The review included randomized controlled trials in pediatric cancer patients (≤18 years; up to 25 years for follow-up) receiving chemo-/radiotherapy, assessing nutritional, dietary, or natural product interventions for oral mucositis prevention or treatment. Non-randomized, adult, non-English, non-peer-reviewed, or inaccessible studies were excluded. Outcomes included incidence, severity, duration of OM, and mucositis-associated pain. Risk of bias was assessed using the NIH Study Quality Assessment Tools and the Cochrane RoB 2 tool. Results were qualitatively summarized. Results: Of 5870 records identified, 20 RCTs met inclusion criteria resulting in 1430 total included patients. Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes. Discussion: Study designs and sample sizes varied considerably, and outcome measures were heterogeneous. Challenges with blinding, variable compliance, and inconsistent reporting reduce confidence and precision in the findings. Conclusions: Evidence from pediatric RCTs remains limited but highlights nutritional and natural products as promising supportive care options for OM. Findings suggest potential for practical, low-cost adjuncts to established oral care protocols, warranting further high-quality multicenter trials.

Research Insights

Aloe Vera→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Bovine Colostrum→Reduced Abdominal Pain
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Bovine Colostrum→Reduced Oral Mucositis Duration
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
Bovine Colostrum→Reduced Oral Mucositis Incidence
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
Bovine Colostrum→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Chamomile→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Honey→Reduced Abdominal Pain
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Honey→Reduced Oral Mucositis Duration
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
Honey→Reduced Oral Mucositis Incidence
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
Honey→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
L-Glutamine→Reduced Abdominal Pain
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
L-Glutamine→Reduced Oral Mucositis Duration
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
L-Glutamine→Reduced Oral Mucositis Incidence
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
L-Glutamine→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Olive Oil→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Vitamin E→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Zinc→Reduced Abdominal Pain
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small
Zinc→Reduced Oral Mucositis Duration
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
Zinc→Reduced Oral Mucositis Incidence
Honey-based interventions showed promising outcomes.
Effect
Beneficial
Effect size
Small
Zinc→Reduced Oral Mucositis Severity
Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes.
Effect
Neutral
Effect size
Small