The Oportunidades program increases the linear growth of children enrolled at young ages in urban Mexico. Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Efficacy of meat and iron-fortified commercial cereal to prevent iron depletion in cow milk-fed infants 6 to 12 months of age: a randomized controlled trial. Effect of the consumption of high energy dense and fortified gruels on energy and nutrient intakes of 6–10-month-old Vietnamese infants Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain. Poverty and childhood undernutrition in developing countries: a multi-national cohort study. Three-month nutritional supplementation in Indonesian infants and toddlers benefits memory function 8 y later. Nutrition studies in Thailand: effects of calories, nutrient supplements, and health interventions on growth of preschool Thai village children. Nutritional supplementation, psychosocial stimulation, and growth of stunted children: the Jamaican study. The effects of nutritional supplementation on physical growth of children at risk of malnutrition. Developmental effects of short-term supplementary feeding in nutritionally-at-risk Indonesian infants. Growth and micronutrient status in children receiving a fortified complementary food. Effect of supplementary feeding on recovery from mild to moderate wasting in preschool children. Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial. Effects of early childhood supplementation with and without stimulation on later development in stunted Jamaican children. Growth improvements in children above 3 years of age: the Cali Study. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Eliminating bias in randomized controlled trials: importance of allocation concealment and masking. Effects of an energy and micronutrient supplement on play behavior in undernourished children in Indonesia Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh The effects of high energy and micronutrient supplementation on iron status in nutritionally at risk infants. Evaluation of the impact of a nutritional program for undernourished children in Brazil. Age differences in the impact of nutritional supplementation on growth. Effects of an energy and micronutrient supplement on growth and activity, correcting for non-supplemental sources of energy input in undernourished children in Indonesia An Integrated Child Nutrition Intervention Improved Growth of Younger, More Malnourished Children in Northern Viet Nam Iron supplementation of breastfed infants from an early age. A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month-old moderately underweight children in rural Malawi. Effects of an energy and micronutrient supplement on motor development and motor activity in undernourished children in Indonesia Effects of an energy and micronutrient supplement on anthropometry in undernourished children in Indonesia Effects of an energy and micronutrient supplement on growth and development in undernourished children in Indonesia: methods Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study Limited impact of a targeted food supplementation programme in Bangladeshi urban slum children. Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition. Effectiveness of the nutritional supplement used in the Mexican Oportunidades programme on growth, anaemia, morbidity and cognitive development in children aged 12-24 months. A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia Effects of yogurt supplementation on the growth of preschool children in Beijing suburbs. Growth pattern of infants fed with a mixture of extruded malted maize and cowpea. Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition. Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Effects of an energy and micronutrient supplement on mental development and behavior under natural conditions in undernourished children in Indonesia Nutritional intake of an undernourished infant population receiving an energy and micronutrient supplement in Indonesia Activity and behavioral development in stunted and nonstunted children and response to nutritional supplementation. Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6- to 18-month-old infants and children in rural Malawi. History and design of the INCAP longitudinal study (1969-77) and its follow-up (1988-89).
The goal of this study was to evaluate the impact of  Mexico 's  conditional cash transfer program , Oportunidades  , on the growth of children < 24 mo of age living in urban areas . Beneficiary families received cash transfers , a fortified food ( targeted to pregnant and lactating women , children 6 - 23 mo , and children with low weight 2 - 4 y ) , and curative health services , among other benefits . Program benefits were conditional on preventative health care utilization and attendance of health and nutrition education sessions . We estimated the impact of the program after 2 y of operation in a panel of 432 children < 24 mo of age at baseline ( 2002 ) . We used difference-in-difference propensity score matching , which takes into account nonr and om program participation and the effects of unobserved fixed characteristics on outcomes . All models controlled for child age , sex , baseline anthropometry , and maternal height . Anthropometric Z-scores were calculated using the new WHO growth reference st and ards . There was no overall association between program participation and growth in children 6 to 24 mo of age . Children in intervention families younger than 6 mo of age at baseline grew 1.5 cm ( P < 0.05 ) more than children in comparison families , corresponding to 0.41 height-for-age Z-scores ( HAZ ) ( P < 0.05 ) . They also gained an additional 0.76 kg ( P < 0.01 ) or 0.47 weight-for-height Z-scores ( P < 0.05 ) . Children living in the poorest intervention households tended ( 0.05 < P < 0.10 ) to be taller than comparison children ( 0.9 cm , 0.27 HAZ ) . Oportunidades , with its strong nutrition component , is an effective tool to improve the growth of infants in poor urban households BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas . Stunting affects 1 in 5 young children . OBJECTIVE We aim ed to test the efficacy of a daily lipid-based nutrient supplement ( LNS ) for increased linear growth in  young children . DESIGN Healthy , singleton infants aged 6 - 11 mo ( n = 589 ) were recruited from an urban slum of Cap Haitien and r and omly assigned to receive : 1 ) a control ; 2 ) a 3-mo LNS ; or 3 ) a 6-mo LNS . The LNS provided 108 kcal and other nutrients including vitamin A , vitamin B-12 , iron , and zinc at ≥80 % of the recommended amounts . Infants were followed monthly on growth , morbidity , and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects . The Bonferroni multiple comparisons test was applied , and generalized least-squares ( GLS ) regressions with mixed effects was used to examine impacts longitudinally . RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group . GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score ( ±SE ) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age ( P < 0.001 ) . The effects were sustained 6 mo postintervention . Morbidity and developmental outcomes did not differ by trial arm . CONCLUSION A low-energy , fortified product improved the linear growth  of young children in this urban setting . The trial was registered at clinical trials.gov as NCT01552512 OBJECTIVE To determine whether utilization of iron from infant cereal and pureed meat was sufficient to prevent iron depletion and /or anaemia in infants 6 to 12 months old fed whole cow milk ( WCM ) as their primary milk source . DESIGN Six-month-old infants were r and omized into a treatment group ( n = 43 ) receiving iron-fortified infant cereal ( 10.2 mg iron ) , pureed meat ( 0.75 - 1.7 mg iron ) and WCM for six months or a control group ( n = 54 ) receiving no dietary intervention .  Haemoglobin < 110 g/L or ferritin < 10 micrograms/L ( measured bi-monthly ) , confirmed in a second blood sample , defined end-points . RESULTS Proportion reaching end-point was similar between the treatment ( 3/43 ) and control infants ( 5/54 ) ( p = 0.66 ) . Infants not complying with the protocol were at greater risk of reaching end-point ( p = 0.0002 ) . Change in haemoglobin and ferritin across age was similar in both groups . CONCLUSIONS Iron deficiency is not a concern in WCM-fed infants after six months of age if iron-containing complementary foods are concurrently ingested The aim of this study was to test the ability of two new products , an instant infant flour and a food supplement containing amylases , to increase energy and micronutrient intakes of infants older than 6 months . Three groups of 48 infants were r and omly constituted . Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement . Infants from the control group received complementary foods prepared in the usual way . Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed . Foods consumed by infants in the two experimental groups differed considerably in energy , micronutrient density and in consistency from the home-made complementary foods . Due to the incorporation of amylases , gruels made from the food supplement had a higher energy density , a more appropriate consistency and result ed in higher intakes per meal than gruels made from instant flour . In comparison with home-made complementary foods , both experimental products result ed in significantly higher energy and nutrient intakes . The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions . The study was design ed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age . In a controlled trial , 418 infants 4 mo of age were individually r and omized to one of the four groups and followed until 12 mo of age . The first group received a milk-based cereal and nutritional counseling ; the second group monthly nutritional counseling alone . To control for the effect of twice-weekly home visits for morbidity ascertainment , similar visits were made in one of the control groups ( visitation group ) ; the fourth group received no intervention . The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk ( P < 0.001 ) , 1739 kJ at 38 wk ( P < 0.001 ) and 2257 kJ at 52 wk ( P < 0.001 ) . The food supplementation infants gained 250 g ( 95 % confidence interval : 20 - -480 g ) more weight than did the visitation group . The difference in the mean increment in length during the study was 0.4 cm ( 95 % confidence interval : -0.1 - -0.9 cm ) . The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages ( P < 0.05 at all ages ) but no significant benefit on weight and length increments . Methods to enhance the impact of these interventions need to be identified The importance of reducing childhood undernutrition has been enshrined in the United Nations ' Millennium Development Goals . This study explores the relationship between alternative indicators of poverty and childhood undernutrition in developing countries within the context of a multi-national cohort study ( Young Lives ) . Approximately 2000 children in each of four countries - Ethiopia , India ( And hra Pradesh ) , Peru and Vietnam - had their heights measured and were weighed when they were aged between 6 and 17 months ( survey one ) and again between 4.5 and 5.5 years ( survey two ) . The anthropometric outcomes of stunted , underweight and wasted were calculated using World Health Organization 2006 reference st and ards . Maximum-likelihood probit estimation was employed to model the relationship within each country and survey between alternative measures of living st and ards ( principally a wealth index developed using principal components analysis ) and each anthropometric outcome . An extensive set of covariates was incorporated into the models to remove as much individual heterogeneity as possible . The fully adjusted models revealed a negative and statistically significant coefficient on wealth for all outcomes in all countries , with the exception of the outcome of wasted in India ( And hra Pradesh ) and Vietnam ( survey one ) and the outcome of underweight in Vietnam ( surveys one and two ) . In survey one , the partial effects of wealth on the probabilities of stunting , being underweight and wasting was to reduce them by between 1.4 and 5.1 percentage points , 1.0 and 6.4 percentage points , and 0.3 and 4.5 percentage points , respectively , with each unit ( 10 % ) increase in wealth . The partial effects of wealth on the probabilities of anthropometric outcomes were larger in the survey two models . In both surveys , children residing in the lowest wealth quintile households had significantly increased probabilities of being stunted in all four study countries and of being underweight in Ethiopia , India ( And hra Pradesh ) and Peru in comparison to children residing in the highest wealth quintile households . R and om effects probit models confirmed the statistical significance of increased wealth in reducing the probability of being stunted and underweight across all four study countries . We conclude that , although multi-faceted , childhood undernutrition in developing countries is strongly rooted in poverty Does short-term supplementary feeding during infancy and childhood have long-lasting effects ? In 1986 , 334 children aged 6 - 60 mo living on rural tea plantations in West Java , Indonesia , participated in a 3-mo r and omized trial to test the effects of a dietary supplement providing approximately 1672 kJ ( 400 kcal ) energy/d , with about the same nutrient density as local foods . We returned to the same communities in 1994 and enrolled 231 ( 125 supplemented , 106 control ) of the original subjects in a follow-up study of the long-term effects of supplementation . We assessed these subjects by using several measures : anthropometry , iron status , information processing , Peabody Picture Vocabulary Test , word fluency , and an arithmetic test . The supplemented group showed no differences from those in the control group . However , when the analysis was limited to subjects who had received the supplement before the age of 18 mo ( n = 73 ) , the supplemented children performed better than control children on the Sternberg test of working memory ( decision time intercept : probe absent , P = 0.002 ; probe present , P = 0.053 ) . After considering possible confounders , we concluded that the supplementation during infancy was responsible for the difference . This finding shows that supplementation can have long-lasting effects on a specific domain if the child receives it at the appropriate stage of development A study of the effects of providing high-calorie and vitamin-mineral supplements to preschool village children retarded in growth and development in Chiang Mai , Thail and was done . The preschool children of 24 villages with a population of approximately 11,000 were divided into five control and intervention groups . The interventions consisted of a village health program , high-calorie snacks , and vitamin-mineral supplements . The supplements when used were provided in day care centers for preschool children . The health and nutrition interventions used did not significantly affect growth during the study period reported from December 1981 to October 1983 . Monthly changes in length and weight observed in this and a previous study indicate that growth patterns in Thai children are different from those seen in industrialized societies . Factors other than lack of nutrients and infection may be responsible for the inadequate growth often reported in developing countries The benefits of nutritional supplementation , with or without psychosocial stimulation , on the growth of  stunted children  were evaluated . Children aged 9 - 24 mo with lengths less than -2 SD of the National Center for Health Statistics references ( n = 129 ) were r and omly assigned to four groups :  control , nutritional supplementation , stimulation , and both interventions . A fifth group with lengths greater than -1 SD was also enrolled . Length , weight , head and arm circumferences , and triceps and subscapular skinfold thicknesses were measured on enrollment and 6 and 12 mo later . Multiple-regression analysis was used to determine the effects of the interventions in which age , sex , initial status , initial dietary intake , and several socioeconomic variables were controlled for . Stimulation had no effect on growth and there was no interaction between the interventions . After 12 mo supplemented children had significantly increased length , weight , and head circumference ( all P less than 0.01 ) . The effects of supplementation were not cumulative but occurred in the first 6 mo The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 This study assessed the developmental effects of supplementary feeding over 90 consecutive days on infants aged 6 - 20 mo at six tea plantations in West Java , Indonesia . Every day except Sunday , the infants attended day-care centers distributed throughout the plantations . Twenty centers and 113 infants were selected ; the infants in 9 centers received a dietary supplement , while the infants in 11 centers served as control subjects . Supplements were given twice a day providing , on average , 10.66 kJ ( 400 kcal ) and 5 g protein/d . Measurements of body growth , dietary intake , and mental and motor development were made on all infants . Supplementary feeding had significant effects on weight gain and on motor development . Changes in caloric intake were independently associated with changes in weight and in motor test scores . The data suggest that the effects of the supplement may not have followed a simple mechanistic relationship from intake to weight change to motor development , but , rather , intake may have affected both growth and development domains simultaneously Linear growth retardation and anemia are the most prevalent nutritional problems in the world ; effective interventions are urgently needed . We evaluated Ecuador 's National Food Nutrition Program ( PANN 2000 ) that included a micronutrient-fortified complementary food ( FCF ) , Mi Papilla , in poor periurban and rural communities of Ecuador . The program is preventive and targeted to all infants and young children living in poor communities and receiving government health services . We compared dietary intake , micronutrient status , and growth over 11 mo in a cohort of children from the catchment areas of the PANN 2000 with same-age control children in nearby communities eligible to enter the program 1 y later . PANN 2000 children enrolled in the program when they were age 9 - 14 mo and were age 20 - 25 mo at the final survey . They consumed significantly more energy , protein , fat , iron , zinc , vitamin A , and calcium than control children because of their FCF consumption . Anemia , 76 % in both groups at baseline , fell to 27 % in PANN 2000 children but only to 44 % in control children ( P < 0.001 ) . The odds of being anemic were 58 % lower for PANN 2000 children ( P = 0.003 ) . The effects on linear growth and weight were limited to children who were older when the program began ( 12 - 14 mo ) and were significant for weight ( interaction with age , 0.38 kg ; P = 0.029 ) and positive but not significant for length ( 0.66 cm ; P = 0.08 ) . An FCF , including ferrous sulfate , delivered through public health services , is highly effective in improving weight and hemoglobin and reducing anemia Three-month recovery rates from moderate wasting ( less than 90 % weight-for-length ) were compared in 6 - 24-mo-old children in four Guatemalan villages that had been r and omly assigned to receive a moderate ( Atole ) or low ( Fresco ) energy supplement .  The recovery rate ( Rr ) in the Atole villages was 12 % higher than in the Fresco villages ( P less than 0.05 ) . This effect was above all due to the children in the Atole villages who consumed greater than or equal to 10 % of the daily recommended dietary intake of energy ( RDI ) from the supplement ( high-Atole group ) and whose total energy intake ( including home diet ) was 10.5 % of the RDI higher than a comparable high-Fresco group with low supplemental energy intake . All those in the high-Atole group whose wasting was due to malnutrition recovered . Much of this recovery ( range 29 - 52 % ) was due to the increased supplementation . This proportion rose after potential confounding variables were controlled for The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries It is not known whether nutritional supplementation in early childhood has long-term benefits on  stunted children 's mental development . We followed up 127 7 - 8-y old children who had been stunted in early childhood and received supplementation , stimulation , or both .  At 9 - 24 mo of age , the children had been r and omly assigned to four treatment groups : nutritional supplementation , stimulation , both treatments , and control . After 2 y , supplementation and stimulation had independent benefits on the children 's development and the effects were additive . The group receiving both treatments caught up to a matched group of 32 nonstunted children . Four years after the end of the 2-y intervention 97 % of the children were given a battery of cognitive function , school achievement , and fine motor tests .  An additional 52 nonstunted children were included . Factor analyses of the test scores produced three factors : general cognitive , perceptual-motor , and memory . One , the perceptual-motor factor , showed a significant benefit from stimulation , and supplementation benefited only those children whose mothers had higher verbal intelligence quotients . However , each intervention group had higher scores than the control subjects on more tests than would be expected by chance ( supplemented and both groups on 14 of 15 tests , P = 0.002 ; stimulated group in 13 of 15 tests , P = 0.01 ) , suggesting a very small global benefit . There was no longer an additive effect of combined treatments at the end of the intervention . The stunted control group had significantly lower scores than the nonstunted children on most tests . Stunted children 's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up The Cali Study involved the r and om assignment of 301 malnourished children to be exposed to one ( CT1 , n = 113 ) , two ( CT2 , n = 64 ) , three ( CT3 , n = 62 ) or four ( CT4 , n = 62 ) 9-mo periods of a multifocal day care-based intervention ( i.e. ,  education , health and nutrition )  . The ages at which the intervention was initiated for Groups CT4 , CT3 , CT2 and CT1 were 3.5 , 4.2 , 5.2 and 6.1 y , respectively . After the experimental phase , children were followed up in elementary school until they were 10.4 y old . Our secondary data analyses show that children who were exposed at an earlier age and for a longer period of time showed the highest degree ( P < or = 0.05 ) of improvement in weight and linear growth during the pre-school period . These improvements in physical growth could no longer be detected 3 y after the termination of the intervention BACKGROUND Previous analyses derived the relative risk ( RR ) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight . OBJECTIVES The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight . DESIGN Data were obtained from investigators of 10 cohort studies with both weight-for-age category ( < -3 SDs , -3 to < -2 SDs , -2 to < -1 SD , and > -1 SD ) and cause of death information . All 10 studies contributed information on weight-for-age and risk of diarrhea , pneumonia , and all-cause mortality ; however , only 6 studies contributed information on deaths because of measles , and only 3 studies contributed information on deaths because of malaria or fever . With use of weighted r and om effects models , we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition . Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys . With use of the RR and prevalence information , we then calculated the fraction of deaths by cause attributable to undernutrition . RESULTS The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality . Overall , 52.5 % of all deaths in young children were attributable to undernutrition , varying from 44.8 % for deaths because of measles to 60.7 % for deaths because of diarrhea . CONCLUSION A significant proportion of deaths in young children worldwide is attributable to low weight-for-age , and efforts to reduce malnutrition should be a policy priority R and omization in r and omized controlled trials involves more than generation of a r and om sequence by which to assign subjects . For r and omization to be successfully implemented , the r and omization sequence must be adequately protected ( concealed ) so that investigators , involved health care providers , and subjects are not aware of the upcoming assignment . The absence of adequate allocation concealment can lead to selection bias , one of the very problems that r and omization was supposed to eliminate . Authors of reports of r and omized trials should provide enough details on how allocation concealment was achieved so the reader can determine the likelihood of success . Fortunately , a plan of allocation concealment can always be incorporated into the design of a r and omized trial . Certain methods minimize the risk of concealment failing more than others . Keeping knowledge of subjects ' assignment after allocation from subjects , investigators/health care providers , or those assessing outcomes is referred to as masking ( also known as blinding ) . The goal of masking is to prevent ascertainment bias . In contrast to allocation concealment , masking can not always be incorporated into a r and omized controlled trial . Both allocation concealment and masking add to the elimination of bias in r and omized controlled trials Objectives : This paper reports the effects of an energy and micronutrient supplementation on quantitative and qualitative aspects of play among poorly nourished children . At issue is whether the supplement led to a progression in complexity of play . Design : two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=12 mg iron+209 kJ ; S=104 kJ. Supplementation was given for 6 months . Evaluations of play behavior were repeated four times . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : The present study utilized a sub sample of 55 children recruited for the larger Pangalengan project 6 months into the study . Thirty-eight children were recruited late enough to allow for longitudinal observations . The remaining cases were used for cross sectional observations only . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : The children were videotaped during play . These tapes were coded for eight mutually exclusive categories of activities . Four activities coded represented manipulative , relational , functional and symbolic play . Results : Treatment did not affect qualitative play . Girls that received E increased functional play but boys showed the opposite effect . Children in the S group were breastfed more during play as compared to the E group . Children in the E group waited less to begin play . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Study objective : There is little guidance on how to select the best available evidence of health effects of social interventions . The aim of this paper was to assess the implication s of setting particular inclusion criteria for evidence synthesis . Design : Analysis of all relevant studies for one systematic review , followed by sensitivity analysis of the effects of selecting studies based on a two dimensional hierarchy of study design and study population . Setting : Case study of a systematic review of the effectiveness of interventions in promoting a population shift from using cars towards walking and cycling .  Main results : The distribution of available evidence was skewed . Population level interventions were less likely than individual level interventions to have been studied using the most rigorous study design s ; nearly all of the population level evidence would have been missed if only r and omised controlled trials had been included . Examining the studies that were excluded did not change the overall conclusions about effectiveness , but did identify additional categories of intervention such as health walks and parking charges that merit further research , and provided evidence to challenge assumptions about the actual effects of progressive urban transport policies . Conclusions : Unthinking adherence to a hierarchy of study design as a means of selecting studies may reduce the value of evidence synthesis and reinforce an “ inverse evidence law ” whereby the least is known about the effects of interventions most likely to influence whole population s. Producing generalisable estimates of effect sizes is only one possible objective of evidence synthesis . Mapping the available evidence and uncertainty about effects may also be important The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status , linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape , South Africa . The study was design ed as an intervention study . In both the experimental and control groups , serum retinol concentration showed a decline over the intervention period of 6 months . The decline was less pronounced in the experimental group . This result ed in a significantly ( P<005 ) higher serum retinol concentration at 12 months in the experimental group ( 26.8±5.8 μg/dl ) compared with the control group ( 21.4±5 μg/dl ) . Serum iron concentration also declined over the intervention period . The decline was less pronounced in the experimental group . No difference was observed in haemoglobin levels between the groups at 12 months . Serum zinc concentration did not differ significantly between the two groups at follow up . Weight gain over the 6 months period did not differ significantly between the experimental ( 2.1±0.9 kg ) and control groups ( 2.1±1.2 kg ) . There was no difference in linear growth between the experimental ( 10.0±1.5 cm ) and control group ( 10.1±2.1 cm ) at the end of the follow-up period . Weight and length at 6 months significantly predicted weight and length at 12 months . No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention . Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group . No benefit was observed in serum zinc concentration , linear growth and psychomotor development Background There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations ( MMS ) on their offspring 's growth . We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth . The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0 - 54 months and a combination of these interventions would further improve these outcomes . Methods In the large , r and omized MINIMat trial ( Maternal and Infant Nutrition Interventions in Matlab ) , Bangladesh , 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009 . Participants were r and omized into six groups comprising 30 mg Fe and 400 μg folic acid ( Fe30F ) , 60 mg Fe and 400 μg folic acid ( Fe60F ) or MMS combined with either an early ( immediately after identification of pregnancy ) or a later usual ( at the time of their choosing , i.e. , usual care in this community ) program invitation to food supplementation .  The anthropometry of 3267 children was followed from birth to 54 months , and 2735 children were available for analysis at 54 months . Results There were no differences in characteristics of mothers and households among the different intervention groups . The average birth weight was 2694 g and birth length was 47.7 cm , with no difference among intervention groups . Early invitation to food supplementation ( in comparison with usual invitation ) reduced the proportion of stunting from early infancy up to 54 months for boys ( p = 0.01 ) , but not for girls ( p = 0.31 ) . MMS result ed in more stunting than st and ard Fe60F ( p = 0.02 ) . There was no interaction between the food and micronutrient supplementation on the growth outcome . Conclusions Early food supplementation in pregnancy reduced the occurrence of stunting during 0 - 54 months in boys , but not in girls , and prenatal MMS  increased the proportion of stunting in boys . These effects on postnatal growth suggest programming effects in early fetal life . Trial registration numberIS RCT N : IS RCT The study assessed the effects of supplementary feeding over 180 consecutive days on iron status of infants and toddlers at six tea plantation in West Java , Indonesia . The design used was a clinical trial : two eohorts ( i.e. , 12 and 18 months old children ) and three treatment groups ( i.e. , energy + micronutrient , micronutrient alone , and placebo ) per cohort . Every day except Sunday , the infants attended day-care centers . Twenty four centers and 136 infants were selected . The infants were screened for weight and length and those meeting the criteria ( i.e. , < -1 SD of length-for-age , and between -1 and -2 SD of weight-for-length of the NCHS reference ) were included . The experimental unit was the day-care centers ( DCC ) , where each DCC was r and omly assigned to one of the three treatment . As expected , groups of energy + micronutrient and micronutrient alone of the 12 months cohort experienced a significant upward shift in hemoglobin , ferritin and TS and a downward change in FEP , while the values for the group of placebo remain about the same as at base line . In the first 6 month of treatments , the ANOVA for each iron indicator yielded significant main effects of treatment ( P < 0.01 ) and for Hb with ( P = 0.059 ) on 12 months cohort . On the other h and , the main effects of treatment on hemoglobin , TS , ferritin and FEP were not significant for the 18 months cohort . In the second 6 months of treatments , the only significant of the treatment effect ( P < 0.01 ) was in serum ferritin on 18-month cohort . Under these circumstances , energy has a positive role in improving iron stores . It is likely that the equilibrium of hemoglobin and each iron indicators were reached in 6 months of treatment except ferritin still continued to increase up to 12 month . The effects of treatment on the improvement of iron status was stronger in 12 months than in 18 months To assess the effectiveness on child growth and body composition of a supplementary feeding program ( Milk Supplement Program ) , a prospect i ve , controlled study was conducted in Northeast Brazil . When entering the Program , children from 10 municipalities with the highest coverage rates in the Program ( intervention group ) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates ( control group ) . A total of 219 children aged 6 - 18 months were enrolled . At entry , both groups were comparable in terms of age , sex , and nutritional status . There were frequent gaps in delivery of the supplement , no extra milk was provided to siblings less than 5 years of age , intra-household redistribution of milk was high , and maternal compliance with recommendations was low . Adjusted analyses by multilevel modelling showed average changes in weight , length , weight-age and length-age Z-scores , and % body water ( deuterium method ) , at 6 months , of 1.53 kg , 6.34 cm , 0.33 , 0.05 , and 1.11 % respectively among supplemented children as compared to 1.54 kg , 6.5 cm , 0.26 , 0.07 , and 4.10 % among controls , with no statistically significant difference between groups . Thus , the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil Supplementary feeding programs are common in developing countries . These programs often can not demonstrate an impact on child growth , however , possibly because they tend to reach older children . This study examines the impact of nutritional supplementation on annual growth rates in length and weight from birth to 7 y of age in 1208 rural Guatemalan children . A series of multiple linear regression models is used to control for initial body size , diarrheal disease , home diet , socioeconomic status and gender . During the first year of life , each 100 kcal/d ( 418 kJ ) of supplement was associated with approximately 9 mm in additional length gain and 350 g in additional weight gain ; the benefit decreased to approximately 5 mm in length gain and 250 g in weight gain during the 2nd y of life . Between 24 and 36 mo of age , supplement only had a significant impact on length . There was no impact of nutritional supplementation on growth between 3 and 7 y of age . Patterns were the same if supplement intakes were expressed as a percent of recommended allowances or growth was expressed as a percent of the expected rate . These impacts of nutritional supplementation on growth coincide with the ages when growth velocities , as well as growth deficits , are greatest in this population Objectives : This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement  , adjusting for all non-supplemental energy intakes . Any additional change in growth and activity after this adjustment was then compared across supplements at three points felt to be representative of the study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Motor activity was assessed through continuous 4 h observations at home and at day care centers . Anthropometry and activity were measured every two months over 12 months . Results : After correcting for non-supplemental sources of energy intake , the effects of the supplement on weight and activity were observed at 2 months ; effects on length and activity were observed at 6 months ; and effects on weight alone were observed at 12 months . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Integrated nutrition programs are widely used to prevent and /or reverse childhood malnutrition , but rarely rigorously evaluated . The impact of such a program on the physical growth of young rural Vietnamese children was measured . We r and omized six communes to receive an integrated nutrition program implemented by Save the Children .  We matched six communes to serve as controls . Our sample consisted of 238 children ( n = 119 per group ) who were 5 to 30 months old on entry . Between December 1999 and December 2000 , we measured weight and height monthly for six months and again at month 12 . Principle outcomes were weight-for-age Z score ( WAZ ) , height-for-age Z score ( HAZ ) , and weight-for-height Z score ( WHZ ) , and the changes among these measures . As expected , anthropometric indicators relative to international references worsened as the children aged . Overall , children in the intervention communes who were exposed to the integrated nutrition program did not show statistically significant better growth than comparison children . Intervention children who were younger ( 15 months or less ) and more malnourished ( less than −2 Z ) at baseline , however , deteriorated significantly less than their comparable counterparts . Between baseline and month four , for example , intervention children who were malnourished and less than 15 months old at entry lost on average 0.05 WAZ while similar comparison children lost 0.25 WAZ ( p = .02 ) . Lack of overall impact on growth may be due to a lower than expected prevalence of malnutrition at baseline and /or deworming of comparison children . Targeting nutrition interventions at very young children will have the maximum impact on growth BACKGROUND In breastfed infants , iron deficiency at < 6 mo of life , although uncommon , is observed in industrialized countries . Iron supplementation starting at an early age may prevent iron deficiency . OBJECTIVE The study assessed the effect of early iron supplementation of breastfed infants and tested the hypothesis that iron supplementation enhances iron status . Potential adverse effects ( tolerance and growth ) were monitored . DESIGN The prospect i ve , placebo-controlled study involved exclusively breastfed infants who were r and omly assigned at 1 mo of age to iron ( n = 37 ) or placebo ( n = 38 ) .  Iron ( 7 mg/d as multivitamin preparation with ferrous sulfate ) or placebo ( multivitamin preparation without iron ) was given from 1 to 5.5 mo of age . Complementary foods were allowed at > 4 mo . Infants were followed to 18 mo . Blood concentrations of ferritin , transferrin receptor , hemoglobin , and red cell indexes were determined at bimonthly intervals . Stool consistency and color and feeding behavior were recorded . RESULTS Iron supplementation caused modest augmentation of iron status during the intervention at 4 and 5.5 mo but not thereafter . Iron supplements were well tolerated and had no measurable effect on growth . One infant developed iron deficiency anemia by 5.5 mo of age . Plasma ferritin and hemoglobin tracked over time . CONCLUSION Early iron supplementation of breastfed infants is feasible and transiently increases iron status but not hematologic status . Iron is tolerated by most infants . The prevalence of iron deficiency anemia is low ( 3 % ) among unsupplemented breastfed infants in the first 6 mo of life Although widely used , there is little information concerning the efficacy of corn-soy blend ( CSB ) supplementation in the treatment of moderate underweight in African children .  Lipid-based nutrient supplements ( LNS ) , which have proven to be beneficial treatment for severely wasted children , could offer benefits to less severely affected individuals . We conducted a clinical r and omized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children . A total of 182 underweight [ weight-for-age Z-score ( WAZ ) < -2 ] 6- to 15-mo-old children were r and omized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB , providing 1189 and 921 kJ , respectively , or no supplementation ( control ) . The primary outcome was weight change ; secondary outcomes included changes in anthropometric indices , hemoglobin levels , and morbidity . The body weight increases ( mean ± SD ) did not differ and were 620 ± 470 , 510 ± 350 , and 470 ± 350 g in the LNS , CSB , and control groups , respectively ( P = 0.11 ) . Compared with controls , infants and children in the LNS group gained more weight [ mean ( 95 % CI ) = 150 g ( 0 - 300 g ) ; P = 0.05 ] and had a greater increase in WAZ [ 0.33 ( -0.02 - 0.65 ) ; P = 0.04 ] . Weight and WAZ changes did not differ between the control and CSB groups . In exploratory stratified analysis , the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [ 250 g ( 60 - 430 g ; P = 0.01 ] . Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ Objectives : This paper reports the effects of an energy and micronutrient supplement on the motor development , motor milestones and motor activity of nutritionally at risk infants and toddlers in Pangalengan , Indonesia . Design : Two cohorts of children were r and omly assigned to three treatments E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Evaluations of intake were made at baseline and every 2 months thereafter . Motor development was assessed with the Bayley Scale and with a custom-made scale to assess gross motor development leading to bipedal locomotion . Motor activity was assessed through 4 h continuous observations of the child ’s interaction with the social and physical environment . Results : In the 12-month-old cohort , as compared to the M and S groups the children that received the E supplement walked at an earlier age , had higher scores in the Bayley Scale and were motorically more active . Similar intergroup differences were observed in the 18-month-old cohort in the total motor activity score . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Objectives : This paper reports the effects of early supplementary feeding on body weight , length , head circumference and arm circumference among the children in the Pangalengan study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care centers . Twenty children that received S belonged to the 12- and 18-month cohorts . Inclusion criteria were : no chronic disease ; length-for-age≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Results : Body weight showed effects on both cohorts at 2 , 8 and 12 months ; head circumference showed effects at 4 months in the 12-month-old cohort and at 10 months among the females of the 18-month-old cohort ; and arm circumference showed effects across cohorts at 2 , 8 and 12 months . In general the benefits are clearer for females and for the 12-month-old cohort . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Objectives : To describe the method ologies of a clinical trial on the effects of an energy and micronutrient supplement on the growth and development of undernourished children . Design : This trial included two cohorts of children classified as nutritionally-at-risk who were r and omly assigned to three treatments  ( condensed milk+micronutrients ( E ) ; skimmed milk+micronutrients ( M ) ; skimmed milk ( S ) ) . Supplements were given for a period up to 12 months . Setting : Six tea plantations in Pangalengan , West Java were the site for this study .Subjects : A 12-month-old ( N=53 ) and an 18-month-old ( N=83 ) cohort were recruited from 24 day-care-centers ( DCC ) . Twenty children that received the S supplement were part of the 12- and 18 month-old cohort . Criteria for case inclusion were absence of chronic disease ; length-for-age≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Variables : Social variables included assessment of health facilities , childcare , housing , income and parental education . Nutrition and growth variables included dietary intake measured over a 24 hr period every 2 months ; hemoglobin and three iron indicators measured at baseline , 6 and 12 months ; anthropometry measured every 2 months and skeletal maturation measured every 6 months . Cognition and behavior included the assessment of mental and motor development and the behavior of the child under natural conditions . Data analysis : An ANOVA was the statistic most frequently used to test inter-group differences and structural equation modeling was used to test the internal validity of the conceptual model of the study .Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , CONTEXT Malnutrition causes death and impaired health in millions of children . Existing interventions are effective under controlled conditions ; however , little information is available on their effectiveness in large-scale programs . OBJECTIVE To document the short-term nutritional impact of a large-scale , incentive-based development program in Mexico ( Progresa )  , which included a nutritional component . DESIGN , SETTING , AND PARTICIPANTS A r and omized effectiveness study of 347 communities r and omly assigned to immediate incorporation to the program in 1998 ( intervention group ; n = 205 ) or to incorporation in 1999 ( crossover intervention group ; n = 142 ) . A r and om sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward . Participants were from low-income households in poor rural communities in 6 central Mexican states . Children ( N = 650 ) 12 months of age or younger ( n = 373 intervention group ; n = 277 crossover intervention group ) were included in the analyses . INTERVENTION Children and pregnant and lactating women in participating households received fortified nutrition supplements , and the families  received nutrition education , health care , and cash transfers . MAIN OUTCOME MEASURES Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children . RESULTS Progresa was associated with better growth in height among the poorest and younger infants . Age- and length-adjusted height was greater by 1.1 cm ( 26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group ) among infants younger than 6 months at baseline and who lived in the poorest households . After 1 year , mean hemoglobin values were higher in the intervention group ( 11.12 g/dL ; 95 % confidence interval [ CI ] , 10.9 - 11.3 g/dL ) than in the crossover intervention group ( 10.75 g/dL ; 95 % CI , 10.5 - 11.0 g/dL ) who had not yet received the benefits of the intervention ( P = .01 ) . There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention . The age-adjusted rate of anemia ( hemoglobin level < 11 g/dL ) in 1999 was higher in the crossover intervention group than in the intervention group ( 54.9 % vs 44.3 % ; P = .03 ) , whereas in 2000 the difference was not significant ( 23.0 % vs 25.8 % , respectively ; P = .40 ) . CONCLUSION Progresa , a large-scale , incentive-based development program with a nutritional intervention , is associated with better growth and lower rates of anemia in low-income , rural infants and children in Mexico Moderate childhood wasting is defined as having a weight-for-height Z-score ( WHZ ) < -2 , but > or = -3 . These children are typically given fortified corn/soy blended flour ( CSB ) , but this intervention has shown limited effectiveness . Fortified spreads ( FS ) can be used as supplementary foods instead ; they are energy-dense , lipid-based pastes with added powdered micronutrients . In this r and omized clinical effectiveness trial , the recovery rates were compared among children with moderate wasting who received either milk/peanut FS , soy/peanut FS , or CSB .  Children received isoenergetic quantities of food , 314 kJ x kg(-1 ) x d(-1 ) , for up to 8 wk with biweekly follow-up . The primary outcome was recovery , defined as having a WHZ > -2 . Time-event analysis was used to compare the recovery rate . A total of 1362 children were enrolled in the study . Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB ( 80 % in both FS groups vs. 72 % in the CSB group ; P < 0.01 ) . The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS ( 2.6 g x kg(-1 ) x d(-1 ) , n = 465 ) or children receiving soy/peanut FS ( 2.4 g x kg(-1 ) x d(-1 ) , n = 450 ) than among children receiving CSB ( 2.0 g x kg(-1 ) x d(-1 ) , n = 447 ; P < 0.05 ) . Rates of length gain did not differ among the 3 groups . A total of 8 % of children in each feeding group developed edema , indicative of severe malnutrition , while receiving supplemental feeding . We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children There is little unequivocal evidence that nutritional supplementation of undernourished children has a beneficial effect on their mental development . The effects of nutritional supplementation , with or without psychosocial stimulation , of growth-retarded ( stunted ) children aged 9 - 24 months were assessed in a study in Kingston , Jamaica . 129 children from poor neighbourhoods were r and omly assigned to four groups -- control , supplemented only , stimulated only , and supplemented plus stimulated . A group of matched non-stunted children ( n = 32 ) was also included . The supplement comprised 1 kg milk-based formula per week for 2 years , and the stimulation weekly play sessions at home with a community health aide . The children 's development ( DQ ) was assessed on the Griffiths mental development scales . Initially the stunted groups ' DQs were lower than those of the non-stunted group , and those of the control group declined during the study , increasing their deficit . Stimulation and supplementation had significant independent beneficial effects on the children 's development . Estimates of the supplementation effect ranged from 2.2 ( 95 % confidence limits-1.4 , 5.7 ) for the h and and eye subscale to 12.4 ( 5.4 , 19.5 ) for the locomotor subscale and those for the stimulation effect from 6.4 ( 2.8 , 10.0 ) for h and and eye to 10.3 ( 3.3 , 17.3 ) for locomotor . The treatment effects were additive , and combined interventions were significantly more effective than either alone . These findings suggest that poor mental development in stunted children is at least partly attributable to undernutrition An energy-dense supplementary food , together with nutrition education , was given to a group of moderately malnourished children aged 6 - 12 months in a poor slum community of urban Bangladesh . An age- and sex-matched control group received only nutrition education . Both groups were followed monthly with respect to weight gain and morbidity . The purpose of the study was to assess the differential impact of a targeted supplementary feeding programme with nutrition education and a nutrition education programme alone on monthly weight gain during 6 months . During the 1st 3 months of the intervention , the monthly weight gain of the supplemented children was 205 g vs 159 g in the control children ( p less than 0.05 ) . In the following 3 months , differences in weight gain were no more significant . Several possible explanations for this transient impact are discussed . It is suggested that nutrition education in the control group may have been responsible for the limited difference between the two groups , but seasonal and epidemiological factors may also have played a part The study was a controlled , comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi . Being at risk of malnutrition was defined as weight-for-height < 85 % , but > 80 % of the international st and ard . A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food ( RUTF ) ( n=331 ) or micronutrient-fortified corn/soy-blend ( n=41 ) for up to eight weeks . The primary outcomes were recovery , defined as weight-for-height > 90 % , and the rate of weight gain . Children receiving RUTF were more likely to recover ( 58 % vs 22 % ; difference 36 % ; 95 % confidence interval [ CI ] 20 - 52 ) and had greater rates of weight gain ( 3.1 g/kg.d vs 1.4 g/kg x d ; difference 1.7 ; 95 % CI 0.8 - 2.6 ) than children receiving corn/soy-blend . The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the st and ard fortified cereal/legume-blended food OBJECTIVE To determine the effectiveness of the nutritional supplement developed for the Oportunidades programme on growth , prevalence of anaemia , morbidity and cognitive function of pre-school children . DESIGN In a r and omised , placebo-controlled longitudinal trial , children were assigned to one of three experimental treatment groups : Oportunidades food supplement ( OFS ) , powdered milk ( PM ) and placebo ( PL ) . Treatments were administered daily for 6 months . Weight , height and Hb were measured in all participants before and after supplementation . Morbidity was assessed two times per week for 6 months using vali date d question naires . The Bayley Scale of Infant Development Test was administered at baseline and after 6 months . SETTING Three marginal rural communities of the state of Queretaro , Mexico . SUBJECTS A total of 224 children , mean age 22·4 ( SD 5·9 ) months , were recruited . After the 6-month intervention , 186 completed the study . RESULTS No differences were found in the adjusted changes of weight , height or anaemia between treatment groups and PL . No differences were found in the number of episodes of gastrointestinal or respiratory disease , nor were there any differences in cognitive performance between treatment and PL groups after 6 months of supplementation . CONCLUSIONS Daily supplementation of 12 - 24-month-old children with OFS has no additional benefits in growth , anaemia , morbidity or cognitive performance Objectives : This paper presents the results of a structural equation model testing whether the longitudinal data of the Pangalengan subjects fit the theoretical model regarding the intellectual delay of undernourished children . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=12 mg iron+209 kJ ; S=104 kJ. Supplementation was given for 6 months . Setting : The sites were six tea plantations in Indonesia . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Inclusion criteria were : no chronic disease ; length-for-age=<1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Twenty-four-hour dietary intakes were assessed using the weighted individual inventory technique . Body weight and length were obtained using st and ard procedures ; motor development was assessed with the Bayley Scale and with a custom made scale for motor development leading to bipedal locomotion . Four-hour observations were made of the child ’s interactions with the environment . Carrying a child in the arms and exploratory behavior were used as indicators of caregiving and exploration . All measurements were obtained every 2 months . Results : The original model did not fit the data . The model was then modified with the inclusion of two new pathways : from activity and from motor development to mental development . Following these adjustments the model fit the data for each cohort and for both cohorts combined . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , OBJECTIVE To investigate the effect of yogurt supplementation on the growth of preschool children in Beijing suburbs . METHODS Four hundred and two preschool children ( 217 males , 185 females ) , aged 3 - 5 years , whose height for age and /or weight for age were less than the reference level , were selected as subjects from 7 kindergartens in Beijing Fangshan District . The subjects were divided r and omly into control group ( CG , 201 ) and yogurt supplemented group ( YG , 201 ) . Each subject in YG was given one serving of yogurt ( 125 g ) for 5 days a week from March to December in 2001 , while nothing additional was provided to CG . All subjects kept their usual diet during the study . Anthropometry ( body height and weight and upper-arm circumference ) and the bone mineral density ( BMD ) of forearm were measured every 3 months . Disease status and dietary intake were also recorded and assessed . RESULTS The intake of calcium , zinc , and vitamin B2 in YG was significantly higher than that in CG . The incidence and duration of upper-respiratory infection and diarrhea of children in YG were significantly less than those in CG . The height gain of children in YG was significantly higher than that in CG after yogurt was supplemented for 3 , 6 , and 9 months ( P<0.05 ) ( 1.90+/-0.49 cm vs 1.77+/-0.54 cm , 3.83+/-0.57 cm vs 3.64+/-0.66 cm and 5.43+/-0.69 cm vs 5.24+/-0.76 cm , respectively ) . The weight gain of children in YG was significantly higher than that in CG after yogurt was supplemented for 3 , 6 , and 9 months ( P<0.05 ) ( 0.70+/-0.43 kg vs 0.49+/-0.35 kg , 0.98+/-0.62 kg vs 0.80+/-0.60 kg and 1.42+/-0.76 kg vs 1.20+/-0.67 kg , respectively ) . The BMD of children in YG was significantly higher than that in CG after yogurt was supplemented for 9 months ( P<0.05 ) ( 0.415+/-0.058 g/cm2 vs 0.400+/-0.065 g/cm2 ) . CONCLUSION Yogurt is beneficial to the improvement of calcium , zinc , and vitamin B2 intake , the decreasing of the incidence and duration of upper-respiratory infection and diarrhea , and the promotion of the health and the growth and development of preschool children OBJECTIVE Breast milk alone is insufficient to support normal growth during the second half of infancy , so I investigated supplementary feeding for infants ' successful transition to solid food . METHODS The nutrition status of 30 infants from a low socioeconomic background weaned onto an extruded formulated complementary diet from maize and cowpea ( L(1)A(1 ) ) were compared with 30 infants with a similar socioeconomic background ( L(2)N , control group ) and 30 infants from an above-average socioeconomic background ( HN , reference group ) without the supplementary diet .  Infants within the control and reference groups were weaned onto different foods of the mothers ' choice . The formulated diet was analyzed for nutrient composition . RESULTS The results showed similarity in the estimated annual family income of the L(1)A(1 ) and L(2)N groups , which ranged from N 25 000 to 74 000 ( US $ 208.30 to 616.70 ) , whereas the estimated family income for the HN group was above N 225 000 ( US $ 1875.00 ) annually . The formulated blend contained 17.3 % protein , 5.0 % fat , and 2106 kJ of energy . Mean weight at birth and 4 mo before the feeding intervention in HN infants was statistically ( P < 0.05 ) higher than in L(1)A(1 ) and L(2)N infants . At the end of the study , L(1)A(1 ) and HN infants had a mean length within -1 st and ard deviation of the st and ard length for age . The mean length of L(2)N infants was within -3 st and ard deviations of the st and ard length for age . The effectiveness of the formulated diet  was expressed in terms of similarity in anthropometric measurements of L(1)A(1 ) ) and HN infants . CONCLUSIONS Based on similarities in socioeconomic background and weight at birth and 4 mo in the L(1)A(1 ) and L(2)N infants , the better nutrition status of the L(1)A(1 ) is attributed to the formulated complementary diet . The contribution of this mixture to total nutrient intake seemed substantial enough to meet the infants ' nutritional requirements . The use of a cheaply available plant protein will go a long way in reducing protein-energy malnutrition among children in developing countries . However , because of the low purchasing power of the low-income family , the costs of this product should be studied Infants born to families at risk of malnutrition were studied prospect ively from the beginning of the 3rd trimester of the mother 's pregnancy until the child reached 3 yr of age to ascertain the effects of nutritional supplementation and /or a maternal education program on their cognitive development . Four hundred thirty-three families were assigned r and omly to six groups : group A served as a control ; group B received the supplement from the age of 6 months to 3 yr ; group C received the supplement during the 3rd trimester of pregnancy and the first 6 months of the child 's life ; and group D received the supplement throughout the entire study period . In addition , group A1 was enrolled in a maternal education program but received no nutritional supplement and group B1 received both treatments . The Griffiths test of infant development was administered at 4 , 6 , 12 , 18 , 24 , and 36 months of age , and the Corman-Escalona Einstein scale was administered at each age up to 18 months . Children who received food supplementation performed better than those who did not , especially on subtests that were primarily motoric . The effect of food supplementation on behavior appeared to be contemporaneous . In addition , the treatment effects were more pronounced for girls than for boys in this sample . Although these interventions reduced the gap in cognitive performance between lower and upper socioeconomic classes , a disparity nevertheless remained by the end of the study CONTEXT Ready-to-use therapeutic foods ( RUTFs ) are an important component of effective outpatient treatment of severe wasting . However , their effectiveness in the population -based prevention of moderate and severe wasting has not been evaluated . OBJECTIVE To evaluate the effect of a 3-month distribution of RUTF on the nutritional status , mortality , and morbidity of children aged 6 to 60 months in Niger . DESIGN , SETTING , AND PARTICIPANTS A cluster r and omized trial of 12 villages in Maradi , Niger . Six villages were r and omized to intervention and 6 to no intervention . All children in the study villages aged 6 to 60 months were eligible for recruitment . INTERVENTION Children with weight-for-height 80 % or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF ( 92 g [ 500 kcal/d ] ) from August to October 2006 . Children in the 6 nonintervention villages received no preventive supplementation . Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007 . MAIN OUTCOME MEASURES Changes in weight-for-height z score ( WHZ ) according to the World Health Organization Child Growth St and ards and incidence of wasting ( WHZ < -2 ) over 8 months of follow-up . RESULTS The number of children with height and weight measurements in August , October , December , and February was 3166 , 3110 , 2936 , and 3026 , respectively . The WHZ difference between the intervention and nonintervention groups was -0.10 z ( 95 % confidence interval [ CI ] , -0.23 to 0.03 ) at baseline and 0.12 z ( 95 % CI , 0.02 to 0.21 ) after 8 months of follow-up . The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z ( 95 % CI , 0.13 to 0.30 ) . The absolute rate of wasting and severe wasting , respectively , was 0.17 events per child-year ( 140 events/841 child-years ) and 0.03 events per child-year ( 29 events/943 child-years ) in the intervention villages , compared with 0.26 events per child-year ( 233 events/895 child-years ) and 0.07 events per child-year ( 71 events/1029 child-years ) in the nonintervention villages . The intervention thus result ed in a 36 % ( 95 % CI , 17 % to 50 % ; P < .001 ) reduction in the incidence of wasting and a 58 % ( 95 % CI , 43 % to 68 % ; P < .001 ) reduction in the incidence of severe wasting . There was no reduction in mortality , with a mortality rate of 0.007 deaths per child-year ( 7 deaths/986 child-years ) in the intervention villages and 0.016 deaths per child-year ( 18 deaths/1099 child-years ) in the nonintervention villages ( adjusted hazard ratio , 0.51 ; 95 % CI , 0.25 to 1.05 ) . CONCLUSION Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00682708 This prospect i ve r and omized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practice s , care-giving , and health-seeking practice s under the Bangladesh Integrated Nutrition Project ( BINP ) . The study was conducted in rural Bangladesh among 282 moderately-malnourished ( weight-for-age between 61 % and 75 % of median of the National Center for Health Statistics st and ard ) children aged 6 - 24 months . Mothers of the first intervention group received intensive nutrition education ( INE group ) twice a week for three months . The second intervention group received the same nutrition education , and their children received additional supplementary feeding ( INE+SF group ) . The comparison group received nutrition education from the community nutrition promoters twice a month according to the st and ard routine service of BINP . The children were observed for a further six months . After three months of interventions , a significantly higher proportion of children in the INE and INE+SF groups improved ( 37 % and 47 % respectively ) from moderate to mild or normal nutrition compared to the comparison group ( 18 % ) ( p < 0.001 ) . At the end of six months of observation , the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group ( 59 % and 86 % vs 30 % , p < 0.0001 ) . As the intensive nutrition education and supplementation given were highly effective , more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity . The frequency of child feeding and home-based complementary feeding improved significantly ( p < 0.001 ) in both the intervention groups after three months of interventions and six months of observation . Body-weight gain was positively associated with age , length-for-age , weight-for-length , frequency of feeding of khichuri , egg , and potato ( p < 0.05 ) . Ability of mothers to identify malnutrition improved from 15 % to 99 % in the INE group and from 15 % to 100 % in the INE+SF group , but reduced from 24 % to 21 % in the comparison group . Use of separate feed pots , frequency of feeding , and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation . It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding Objective : Fortified spreads ( FSs ) have proven effective in the rehabilitation of severely malnourished children . We examined acceptability , growth and change in blood haemoglobin ( Hb ) concentration among moderately underweight ambulatory infants given FS . Methods : This was a r and omised , controlled , parallel-group , investigator-blind clinical trial in rural Malawi . Six- to 17-month-old underweight infants ( weight for age < −2 ) , whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes : nothing , 5 , 25 , 50 , or 75 g/day milk-based FS or 25 , 50 , or 75 g/day soy-based FS . Outcome measures included change in weight , length and blood Hb concentration . Results : A total of 126 infants started and 125 completed the intervention . All infants accepted the spread well , and no intolerance was recorded . Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS . Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS . All average gains were largest among infants receiving 50 g of FS daily : mean difference ( 95 % confidence interval ) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g ( range , −130 to 700 g ) , 0.9 cm ( range , −0.3 to 2.2 cm ) , and 17 g/L ( range , 0 to 34 g/L ) for weight , length and blood Hb concentration , respectively . In soy- vs milk-based FS groups , average outcomes were comparable . Conclusions : Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants . Further trials should test this hypothesis Objectives : This paper reports the effects of an energy and micronutrient supplement on mental development and on the social – cognitive and emotionally regulatory behaviors of nutritionally at risk infants and toddlers in Pangalengan , Indonesia . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=12 mg iron+209 kJ ; S=104 kJoule . Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( N=53 ) and an 18-month-old ( N=83 ) cohort were recruited from day-care-centers . Twenty children who received S belonged to the 12- and 18-month-old cohort . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Evaluations of intake were made at baseline and every 2 months thereafter . Motor development was assessed with the Bayley Scale and with a custom-made scale to assess gross motor development leading to bipedal locomotion . Four hours of continuous observations were made of the child ’s interaction with the social and physical environment . Results : In the 12-month-old cohort , as compared with the M and S groups , the children who received the E supplement walked at an earlier age , had higher scores in the Bayley Scale and showed more mature social – cognitive and emotional regulatory behaviors . Similar intergroup differences were observed in the 18-month-old cohort in social cognition and regulation of emotions . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Objectives : This paper reports the dietary intake ( home , day care centers , supplement and breast milk ) of the children in the clinical trial in Pangalengan . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children who received S belong to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S = 104 kJ. Supplementation was given for 12 months . Evaluations of intake were made at baseline and every 2 months thereafter . Results : For the 12-month-old cohort the mean increase in daily energy intake∼2931 kJ for E , ∼1675 kJ for M , and ∼837 kJ increase over the 6 months for the S group . For the 18-month-old cohort the changes were ∼2512 kJ for E∼1675 for the M group and ∼1047 for the S group . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , It is frequently assumed that undernutrition in young children leads to poor development through reduced activity . 3 groups of 26 1-year-old stunted children were studied :  nutritional supplementation , supplementation with psychosocial stimulation , and controls .  26 nonstunted comparison children were also studied .  Activity levels were measured by extensive observation in the homes , and development using 4 subscales of the Griffith 's Mental Development Scales . Initially , stunted children were less active than nonstunted ones ( p < .01 ) , but after 6 months they caught up regardless of treatment . The mental ages of the stunted children were lower than those of the nonstunted children initially , and improved with either treatment . Initially , activity levels made a significant contribution to the variance in the locomotor subscale only , but not 6 months later . Activity did not predict change in development over 6 or 12 months , nor did change in activity over 6 months predict change in development over 12 months Low nutritional value of complementary foods is associated with high incidence of childhood growth stunting in low-income countries . This study was done to test a hypothesis that dietary complementation with lipid-based nutrient supplements ( LNS ) promotes linear growth and reduces the incidence of severe stunting among at-risk infants . A total of 840 6-month-old healthy infants in rural Malawi were enrolled to a r and omised assessor-blinded trial . The participants received 12-month supplementation with nothing , milk-LNS , soy-LNS , or corn-soy blend ( CSB ) . Supplements provided micronutrients and approximately 280 kcal energy per day . Outcomes were incidence of severe and very severe stunting [ length-for-age z-score , ( LAZ ) < -3.00 and < -3.50 , respectively ] , and change in LAZ . The incidence of severe stunting was 11.8 % , 8.2 % , 9.1 % and 15.5 % ( P = 0.098 ) and that of very severe stunting 7.4 % , 2.9 % , 8.0 % and 6.4 % ( P = 0.138 ) in control , milk-LNS , soy-LNS and CSB groups , respectively . Between 9 and 12 months of age , the mean change in LAZ was -0.15 , -0.02 , -0.12 and -0.18 ( P = 0.045 ) for control , milk-LNS , soy-LNS and CSB groups , respectively . There was no significant between-group difference in linear growth during other age-intervals . Although participants who received milk-LNS had the lowest incidence of severe and very severe stunting , the differences between the groups were smaller than expected . Thus , the results do not provide conclusive evidence on a causal association between the LNS supplementation and the lower incidence of stunting . Exploratory analyses suggest that provision of milk-LNS , but not soy-LNS promotes linear growth among at-risk infants mainly between 9 and 12 months of age This is an overview of the design and methods of the INCAP longitudinal study ( 1969 - 77 ) and its follow-up study ( 1988 - 89 ) . The first study had the objective of assessing the effects of intrauterine and preschool malnutrition on growth and mental development . To achieve this , food supplements were provided to pregnant women and young children residing in four Gautemalan villages . Two villages were given a high-protein , high-energy drink and two were provided a no-protein , low-energy drink . Both supplements contained vitamins and minerals . Longitudinal information was collected during the first seven years of life on physical growth , mental development , attendance and consumption of supplement , home diet , morbidity and on characteristics of the family . Health and nutrition data on mothers also were collected . The INCAP follow-up study was a cross-sectional evaluation of former participants of the first study and was carried out when the subjects were 11 - 27 y old . The hypothesis of the INCAP follow-up study was that improved nutrition in early childhood leads to enhanced human capital formation in adolescents and adults . Data were collected on physical growth and body composition , maturation , work capacity , intellectual performance and school achievement
BACKGROUND Undernutrition contributes to five million deaths of children under five each year .
Furthermore , throughout the life cycle , undernutrition contributes to increased risk of infection , poor cognitive functioning , chronic disease , and mortality .
It is thus important for decision-makers to have evidence about the effectiveness of nutrition interventions for young children .
OBJECTIVES Primary objective 1 .
To assess the effectiveness of supplementary feeding interventions , alone or with co-intervention , for improving the physical and psychosocial health of disadvantaged children aged three months to five years .
Secondary objectives 1 .
To assess the potential of such programmes to reduce socio-economic inequalities in undernutrition.2 .
To evaluate implementation and to underst and how this may impact on outcomes .3 .
To determine whether there are any adverse effects of supplementary feeding .