Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Effectiveness of Zinc Supplementation to Full Term Normal Infants: A Community Based Double Blind, Randomized, Controlled, Clinical Trial Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomized, controlled, intervention trial. Short-term supplementation with zinc and vitamin A has no significant effect on the growth of undernourished Bangladeshi children. Maternal zinc supplementation does not affect size at birth or pregnancy duration in Peru. Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. A randomized, placebo-controlled trial of the effect of zinc supplementation during pregnancy on pregnancy outcome in Bangladeshi urban poor. Maternal zinc supplementation and growth in Peruvian infants. Effects of bovine serum concentrate, with or without supplemental micronutrients, on the growth, morbidity, and micronutrient status of young children in a low-income, peri-urban Guatemalan community GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials 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 Does the consumption of amylase-containing gruels impact on the energy intake and growth of Congolese infants? Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies Apolipoprotein E4 influences growth and cognitive responses to micronutrient supplementation in shantytown children from northeast Brazil Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries. Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau Maternal nutritional knowledge and the nutritional status of preschool children in a Nairobi slum. Zinc supplementation for four months does not affect growth in young north Indian children. Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomised controlled trial Livelihoods, nutrition and health in Dhaka slums. Short-Term Nutrition Education Reduces Low Birthweight and Improves Pregnancy Outcomes among Urban Poor Women in Bangladesh Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial Impact of zinc supplementation on diarrheal morbidity and growth pattern of low birth weight infants in kolkata, India: a randomized, double-blind, placebo-controlled, community-based study. Effects of Third Trimester Counseling on Pregnancy Weight Gain, Birthweight, and Breastfeeding among Urban Poor Women in Bangladesh Intervention study shows suboptimal growth among children receiving a food supplement for five months in a slum in Bangladesh Probiotics Lactobacillus reuteri DSM 17938 and Lactobacillus casei CRL 431 modestly increase growth, but not iron and zinc status, among Indonesian children aged 1-6 years. Impact of a cash-for-work programme on food consumption and nutrition among women and children facing food insecurity in rural Bangladesh. Use of fermented foods to combat stunting and failure to thrive.
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 The study was aim ed to test whether zinc supplementation , if initiated early , can prevent stunting and promote optimum body composition in full term infants . For this , full term pregnant women from low income urban community were enrolled and were followed-up for 24 months postpartum . Body mass index ( BMI ) was calculated from maternal weight and height that were collected one month after delivery . Infants ' weight , and length , head , chest and mid upper arm circumferences and skin fold thicknesses at triceps , biceps and subscapular area were collected at baseline ( before r and omization ) and once in three months up till 24 months . Three hundred and twenty four infants were r and omized and allocated to zinc ( 163 ) or placebo ( 161 ) groups respectively . Supplementation of zinc was initiated from 4 months of age and continued till children attained 18 months . The control ( placebo ) group of children received riboflavin 0.5 mg/day , whereas the intervention ( zinc ) group received 5 mg zinc plus riboflavin 0.5 mg/day . When infants were 18 months old , dietary intakes ( in 78 children ) were calculated by 24 hour diet recall method and hemoglobin , zinc , copper and vitamin A were quantified in blood sample s collected from 70 children . The results showed prevalence of undernutrition ( body mass index < 18.5 ) in 37 % of the mothers . Mean±SD calorie consumption and zinc intakes from diets in infants were 590±282.8 Kcal/day and 0.97±0.608 mg/day respectively . Multiple linear regression models demonstrated maternal weight as a strong predictor of infants ' weight and length at 18 months of age . As expected , diarrhea duration impacted infants ' linear growth and weight gain adversely . Zinc supplementation for a mean period of 190 days , starting from 4 months up to 18 months of age , in full term normal infants , consuming an average energy of 590 Kcal/day , had significant effect on the skin fold thicknesses , but not on their linear growth . Trial Registration Clinical Trail Registration India ( CTRI ) BACKGROUND Despite ample food supplies , the incidence of childhood underweight and stunting remains high in Ug and a. Many factors contribute to this situation , but the role of low zinc intakes has not been adequately explored . OBJECTIVE Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight , height , and midupper arm circumference ( MUAC ) . DESIGN The study was r and omized , double-blind , placebo-controlled , parallel , and 8 mo long , and incorporated 6 mo of zinc supplementation .  Children ( n = 153 ) aged 55.8 + /- 11.2 mo from 3 r and omly selected nursery schools of medium , low , and very low socioeconomic status in a suburb of Kampala took part . The intervention comprised 10 mg Zn ( as ZnSO4 ) or placebo daily in freshly prepared fruit juice , Monday to Friday inclusive . RESULTS Zinc supplementation increased MUAC by the end of the study ( P = 0.029 ) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo ( P = 0.019 and P = 0.038 , respectively ) . There was no effect on weight gain of the children from the other schools . Zinc supplementation had no influence on height . Infection rates ( of which 82 % were recorded as malaria ) were lower in the zinc-supplemented group than in control subjects ( P = 0.063 ) . CONCLUSIONS Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries . The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status , but may become so as nutritional status improves BACKGROUND Several vitamin A supplementation trials have failed to improve the  growth rate  in children . Addition of zinc to vitamin A might result in enhanced growth . OBJECTIVE This study evaluated the effect on growth in children of simultaneous supplementation with zinc and vitamin A.  DESIGN This was a r and omized , double-blind , placebo-controlled intervention trial . Six hundred fifty-three children aged 12 - 35 mo were r and omly assigned to 1 of 4 intervention groups : 20 mg Zn/d for 14 d ( Z group ) , 60000 retinol equivalents ( 200000 IU ) vitamin A on day 14 ( A group ) , zinc plus vitamin A ( ZA group ) , or placebo syrup and placebo capsule ( placebo group ) . Weight and length were measured at enrollment and again after 3 and 6 mo . RESULTS Gains in weight and length during the 6-mo follow-up period were not significantly different among the 4 groups by analysis of variance . Catch-up growth also did not differ significantly among the groups . The proportions of children whose weight-for-age z scores did not change or decreased were 57 % in the Z group , 46 % in the A group , 50 % in the ZA group , and 54 % in the placebo group ( NS ) . The proportions of children whose length-for-age z scores did not change or decreased were 42 % in the Z group , 48 % in the A group , 53 % in the ZA group , and 46 % in the placebo group ( NS ) . CONCLUSION Combined short-term zinc supplementation and a single dose of vitamin A has no significant effects on weight and length increments in children over a 6-mo period To estimate the effect of maternal zinc deficiency on pregnancy outcomes , we conducted a zinc supplementation trial in an urban shantytown in Lima , Peru , a population with habitual low zinc intakes . Beginning at 10 - 24 wk gestation , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg iron and 250 ( g folate , with or without 15 mg zinc . Women were followed up monthly during pregnancy . At birth , newborn weight was recorded , and crownheel length , head circumference and other circumferences and skinfold thicknesses were assessed on d 1 . At delivery , 1016 remained in the study ;  duration of pregnancy  was known for all women , and birth weight information was available for 957 newborns . No differences were noted in duration of pregnancy ( 39.4 + /- 2.2 vs. 39 . 5 + /- 2.0 wk ) or birth weight ( 3267 + /- 461 vs. 3300 + /- 498 g ) by prenatal supplement type ( iron + folate + zinc vs. iron + folate ; P > 0.05 ) , and there were no differences in the rates of preterm ( < 37 wk ) or post-term ( > 42 wk ) delivery , low birth weight ( < 2500 g ) or high birth weight ( > 4000 g ) . Finally , there were no differences by prenatal supplement type in newborn head circumference , crownheel length , chest circumference , mid-upper arm circumference , calf circumference or skinfold thickness at any of three sites . Adjustment for covariates and confounding factors did not alter these results . Adding zinc to prenatal iron and folate tablets did not affect duration of pregnancy or size at birth in this population BACKGROUND Maternal zinc deficiency during pregnancy may be widespread among women in developing countries , but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status . OBJECTIVE We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima , Peru . DESIGN Beginning at gestation week 10 - 24 , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate , with or without 15 mg Zn .  Venous blood and urine sample s were collected at enrollment , at gestation week 28 - 30 , and at gestation week 37 - 38 . At birth , a sample of cord vein blood was collected . We measured serum zinc concentrations in 538 women , urinary zinc concentrations in 521 women , and cord zinc concentrations in 252 neonates . RESULTS At 28 - 30 and 37 - 38 wk , mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc ( 8.8 + /- 1.9 compared with 8.4 + /- 1.5 micromol/L and 8.6 + /- 1.5 compared with 8.3 + /- 1.4 micromol/L , respectively ) . Urinary zinc concentrations were also higher in mothers who received supplemental zinc ( P < 0.05 ) . After adjustment for covariates and confounding factors , neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc ( 12.7 + /- 2.3 compared with 12.1 + /- 2.1 micromol/L ) . Despite supplementation , maternal and neonatal zinc concentrations remained lower than values reported for well-nourished population s. CONCLUSION Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status , but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population BACKGROUND Maternal zinc supplementation has been suggested as a potential intervention to reduce the incidence of low birth weight in developing countries . To date , placebo-controlled trials have all been performed in industrialized countries and the results are inconsistent . OBJECTIVE The objective of this study was to evaluate whether zinc supplementation in Bangladeshi urban poor during the last 2 trimesters of pregnancy was associated with pregnancy outcome . DESIGN We conducted a double-blind , placebo-controlled trial in which 559 women from Dhaka slums , stratified by parity between 12 and 16 wk of gestation , were r and omly assigned to receive 30 mg elemental Zn/d ( n = 269 ) or placebo ( n = 290 ) . Supplementation continued until delivery .  Serum zinc was estimated at baseline and at 7 mo of gestation . Dietary intake was assessed at baseline and anthropometric measurements were made monthly . Weight , length , and gestational ages of 410 singleton newborns were measured within 72 h of birth . RESULTS At 7 mo of gestation , serum zinc concentrations tended to be higher in the zinc-supplemented group than in the placebo group ( 15.9 + /- 4.4 compared with 15.2 + /- 4.3 micromol/L ) . No significant effect of treatment was observed on infant birth weight ( 2513 + /- 390 compared with 2554 + /- 393 g ; NS ) or on gestational age , infant length , or head , chest , or midupper arm circumference . The incidence and distribution of low birth weight , prematurity , and smallness for gestational age also did not differ significantly after zinc supplementation . CONCLUSIONS Supplementation with 30 mg elemental Zn during the last 2 trimesters of pregnancy did not improve birth outcome in Bangladeshi urban poor . These results indicate that interventions with zinc supplementation alone are unlikely to reduce the incidence of low birth weight in Bangladesh BACKGROUND Little is known about how maternal zinc intake influences growth in utero and in postnatal life in humans . OBJECTIVE We aim ed to assess the effect of maternal zinc supplementation during pregnancy on infant growth through age 1 y. DESIGN A double-blind , r and omized controlled trial of prenatal zinc supplementation was conducted from 1995 to 1997 in Lima , Peru . Women ( n = 1295 ) were enrolled at 15.6 + /- 4.6 wk gestation and assigned to receive daily supplements with zinc ( 15 mg Zn + 60 mg Fe + 250 microg folic acid ) or without zinc ( 60 Fe + 250 microg folic acid ) through pregnancy to 1 mo after delivery . At birth , 546 infants were followed for 12 mo to assess growth . Anthropometric measures of body size and composition were collected monthly , and morbidity and dietary intake surveillance was carried out weekly . RESULTS No differences in maternal socioeconomic characteristics by treatment group or follow-up period were found . Infants born to mothers prenatally supplemented with zinc had significantly ( P < 0.05 ) larger average growth measures beginning in month 4 and continuing through month 12 . In longitudinal regression modeling , prenatal zinc was associated with greater weight ( by 0.58 + /- 0.12 kg ; P < 0.001 ) , calf circumference ( by 1.01 + /- 0.21 cm ; P < 0.001 ) , chest circumference ( by 0.60 + /- 0.20 cm ; P = 0.002 ) , and calf muscle area ( by 35.78 + /- 14.75 mm(2 ) ; P = 0.01 ) after adjustment for a range of covariates . No effect was observed for linear growth . CONCLUSION Maternal zinc supplementation in this population was associated with offspring growth , which is suggestive of lean tissue mass accretion Objective : To determine the effects of dietary supplements containing bovine serum concentrate ( BSC , a source of immunoglobulins ) and /or multiple micronutrients ( MMN ) on children 's growth velocity , rates of common infections , and MN status . Design : R and omized , controlled , community-based intervention trial . Setting : Low-income , peri-urban Guatemalan community . Subjects : Children aged 6–7 months initially . Interventions : Children received one of four maize-based dietary supplements daily for 8 months , containing : ( 1 ) BSC , ( 2 ) whey protein concentrate ( WPC , control group ) , ( 3 ) WPC+MMN , or ( 4 ) BSC+MMN . Results : There were no significant differences in growth or rates of morbidity by treatment group . Children who received MMN had lower rates of anemia and ( in the group that received WPC+MMN ) less of a decline in serum ferritin than those who did not , but there were no differences in other biochemical indicators of MN status by treatment group . Conclusions : MMN supplementation reduced anemia and iron deficiency in this population , but the MMN content and source of protein in the supplements did not affect other indicators of MN status , growth or morbidity . Sponsorship : Funding was provided by LG Laboratories ( Ames , Iowa ) , which produces the bovine serum concentrate used in this study . The members of the research team have no financial involvement in this company In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 OBJECTIVE To assess the effect of the incorporation of amylase in maize-based flours prepared as gruels on the energy intake and growth of Congolese infants . DESIGN A r and omised controlled trial . At 18 weeks of age , infants were r and omised into either an intervention group , where they were provided with a maize/soya-based flour that contained amylase , or a control group , where they were provided with a similar flour that did not contain amylase . SETTING Urban borough of Poto-Poto in Brazzaville , The Congo . SUBJECTS Eighty infants ( 40 in each group ) were r and omised into intervention and control groups . Three infants in the intervention group and two controls subsequently dropped out . RESULTS At 24 weeks , the addition of amylase result ed in a significant increase in energy intake ( in kJ kg-1 day-1 ) from gruels without affecting breast milk consumption . In contrast , total energy intake ( in kJ kg-1 day-1 ) did not differ significantly between groups ( P= 0.08 ) . After adjustment for morbidity and previous growth , infants in the intervention group showed better growth in length during the trial ( + 0.22 cm month-1 ; P= 0.04 ) , especially between 24 and 31 weeks of age ( + 0.51 cm month-1 ; P < 0.01 ) . There were no differences in weight velocity between groups . CONCLUSIONS The findings of this study suggest that the consumption of amylase-treated gruels allows an increase in energy intake from these gruels without affecting breast milk consumption but has no impact on total daily energy intake . However , if started after 6 months , it could be effective in preventing faltering of infant linear growth Background Child undernutrition affects millions of children globally . We investigated associations between suboptimal growth and mortality by pooling large studies . Methods Pooled analysis involving children 1 week to 59 months old in 10 prospect i ve studies in Africa , Asia and South America . Utilizing most recent measurements , we calculated weight-for-age , height/length-for-age and weight-for-height/length Z scores , applying 2006 WHO St and ards and the 1977 NCHS/WHO Reference . We estimated all-cause and cause-specific mortality hazard ratios ( HR ) using proportional hazards models comparing children with mild ( −2≤Z<−1 ) , moderate ( −3≤Z<−2 ) , or severe ( Z<−3 ) anthropometric deficits with the reference category ( Z≥−1 ) . Results 53 809 children were eligible for this re- analysis and contributed a total of 55 359 person-years , during which 1315 deaths were observed . All degrees of underweight , stunting and wasting were associated with significantly higher mortality . The strength of association increased monotonically as Z scores decreased . Pooled mortality HR was 1.52 ( 95 % Confidence Interval 1.28 , 1.81 ) for mild underweight ; 2.63 ( 2.20 , 3.14 ) for moderate underweight ; and 9.40 ( 8.02 , 11.03 ) for severe underweight . Wasting was a stronger determinant of mortality than stunting or underweight . Mortality HR for severe wasting was 11.63 ( 9.84 , 13.76 ) compared with 5.48 ( 4.62 , 6.50 ) for severe stunting . Using older NCHS st and ards result ed in larger HRs compared with WHO st and ards . In cause-specific analyses , all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases . The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality . Conclusions All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO St and ards . Even mild deficits substantially increase mortality , especially from infectious diseases OBJECTIVE : Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline . We examined whether apolipoprotein E4 affects intestinal barrier function , thereby improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children . METHODS : A total of 213 Brazilian shantytown children with below-median height-for-age z-scores ( HAZ ) received 200,000 IU of retinol ( every four months ) , zinc ( 40 mg twice weekly ) , or both for one year , with half of each group receiving glutamine supplementation for 10 days .  Height-for-age z-scores , weight-for-age z-scores , weight-for-height z-scores , and lactulose : mannitol ratios were assessed during the initial four months of treatment . An average of four years ( range 1.4 - 6.6 ) later , the children underwent cognitive testing to evaluate non-verbal intelligence , coding , verbal fluency , verbal learning , and delayed verbal learning .  Apolipoprotein E4 carriage was determined by PCR analysis for 144 children . RESULTS : Thirty-seven children were apolipoprotein E4(+ ) , with an allele frequency of 13.9 % . Significant associations were found for vitamin A and glutamine with intestinal barrier function . Apolipoprotein E4(+ ) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning , along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients . There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+ ) children and improved delta lactulose/mannitol . Apolipoprotein E4(- ) children , regardless of intervention , exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence . CONCLUSIONS : During development , apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status , which can translate into better long-term cognitive outcomes Background Nutrition in the first 1,000 days of life ( during pregnancy and the first two years ) is critical for child growth and survival . Poor maternal , infant and young child nutrition ( MIYCN ) practice s are widely documented in Kenya , with potential detrimental effects on child growth and survival . This is particularly a problem in slums , where most urban residents live . For example , exclusive breastfeeding for the first six months is only about two per cent . Innovative strategies to reach slum residents are therefore needed . Strategies like the Baby Friendly Hospital Initiative have proven effective in some setting s but their effectiveness in re source -limited setting s , including slums where many women do not deliver in hospital , is question able . We propose to test the effectiveness of a home-based intervention on infant feeding practice s , nutrition and health outcomes of infants born in two slums in Nairobi , Kenya . Methods / Design The study , employing a cluster-r and omised study design , will be conducted in two slums in Nairobi : Korogocho and Viw and ani where 14 community units ( defined by the Government ’s health care system ) will form the unit of r and omization . A total of 780 pregnant women and their respective child will be recruited into the study . The mother-child pair will be followed up until the child is one year old . Recruitment will last approximately one year and three months from September 2012 to December 2013 . The mothers will receive regular , personalised , home-based counselling by trained Community Health Workers on MIYCN . Regular assessment of knowledge , attitudes and practice s on MIYCN will be done , coupled with assessment s of nutritional status of the mother-child pairs and diarrhea morbidity for the children . Statistical methods will include analysis of covariance and multinomial logistic regression . Additionally , cost-effectiveness analysis will be done . The study is funded by the Wellcome Trust and will run from March 2012 to February 2015 . Discussion Interventions aim ed at promoting optimal breastfeeding and complementary feeding practice s are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates . This study will inform policy and practice in Kenya and similar setting s regarding delivery mechanisms for such high-impact interventions , particularly among urban poor population s . Trial registration IS RCT BACKGROUND In sub-Saharan Africa , ~ 40 % of children < 5 y old are stunted , with levels that have remained largely unchanged over the past 2 decades . Although the complex determinants of undernutrition are well recognized , few studies have evaluated strategies that combine nutrition-specific , health-based approaches with food system- and livelihood-based interventions . OBJECTIVE We examined changes in childhood stunting and its determinants after 3 y of exposure to an integrated , multisector intervention and compared these changes with national trends . DESIGN A prospect i ve observational trial was conducted across rural sites in 9 sub-Saharan African countries with baseline levels of childhood stunting > 20 % . A stratified r and om sample of households and resident children < 2 y old from villages exposed to the program were enrolled in the study . Main outcome measures included principal determinants of undernutrition and childhood stunting , which was defined as a height-for-age z score less than -2 . National trends in stunting were generated from demographic and health surveys . RESULTS Three years after the start of the program in 2005 - 2006 , consistent improvements were observed in household food security and diet diversity , whereas coverage with child care and disease-control interventions improved for most outcomes . The prevalence of stunting in children < 2 y old at year 3 of the program ( 2008 - 2009 ) was 43 % lower ( adjusted OR : 0.57 ; 95 % CI : 0.38 , 0.83 ) than at baseline . The average national stunting prevalence for the countries included in the study had remained largely unchanged over the past 2 decades . CONCLUSION These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting Objectives : To assess the effects of daily prenatal multimicronutrient supplementation on  birth weight ( BW ) and perinatal mortality . Design : R and omised , controlled , double masked trial . Setting : Urban Guinea-Bissau , West Africa . Subjects : A total of 2100 pregnant women ( 22±7 weeks pregnant at entry ) were recruited through antenatal clinics , of which 1670 ( 79.5 % ) completed the trial . BW was available for 1100 live born babies . Interventions : Identical-looking supplements containing one ( MN-1 ) or two ( MN-2 ) Recommended Dietary Allowances ( RDA ) of 15 micronutrients , or iron and folic acid ( control ) . Results : Mean BW among 1100 live born infants was 3050±498 g with 11.9 % being low birth weight ( LBW , BW<2500 g ) . Perinatal mortality was 82 per 1000 deliveries ( N=1670 ) , and neonatal mortality 45 per 1000 live births ( N=1599 ) . Mean BW in MN-1 ( n=360 ) and MN-2 ( n=374 ) groups were 53 [ −19 ; 125 ] and 95 [ 24 ; 166 ] g higher than controls ( n=366 ) . Proportion of LBW was 13.6 % in control , and 12.0 and 10.1 % in the MN-1 and MN-2 groups , respectively ( P=0.33 ) . Among anaemic women ( 30 % ) , MN-2 increased BW with 218 [ 81 ; 354 ] g compared to controls , with a decreased risk of LBW of 69 [ 27 ; 87]% . There were apparently no differences in perinatal mortality between groups . Conclusions : Prenatal micronutrient supplementation  increased BW but did not reduce perinatal mortality in this study . Multimicronutrient supplementation with two RDA should be considered in future programmes to reduce the proportion of LBW Most nutrition education programmes in Kenya operate on the premise that nutritional knowledge can have an impact on children 's nutritional status . It has , however , been argued that nutritional knowledge among low income groups is unlikely to have an impact , hence , the need to establish whether there is a relationship between nutritional status and maternal nutritional knowledge . In a cross-sectional survey carried out in a Nairobi slum ( Kibera ) , nutritional status of 363 children aged six to 24 months was measured and nutritional knowledge of their mothers assessed . Makina village was r and omly selected as the study site and all consenting households were involved in the study . The study established that most mothers ( 97.5 % ) have access to nutrition education .  Prevalence of stunting ( 86.2 % ) and underweight ( 58.4 % ) was high but that of wasting ( 1.9 % ) was low . There was no significant relationship between the nutritional status of children and overall nutritional knowledge . Unexpectedly , a negative relationship was found between nutritional status and mothers ' ability to recognise clinical signs of malnutrition , knowledge in the weaning process and dietary management during sickness . Knowledge on frequency of feeding was , however , positively related to nutritional states . In conclusion , nutritional knowledge alone is inadequate in ensuring young children 's nutrition security and , hence , for nutrition education programmes to have a positive impact , facilitational strategies must be incorporated Our objective in this trial was to assess the impact of daily zinc supplementation on growth in young children .  A double-blind , r and omized , placebo-controlled trial was conducted in New Delhi , India . We enrolled 2482 children aged 6 - 30 mo who were supplemented daily with placebo or zinc ( 10 mg elemental zinc to infants and 20 mg to older children ) for 4 mo . At enrollment , all children also received a single dose of vitamin A ( 104.7 micromol for infants and 209.4 micromol for older children ) . Weight and length were measured at enrollment and 4 mo later . Weekly visits were conducted by field workers to ascertain morbidity in the previous 7 d. Change in length , weight , length-for-age Z-scores ( LAZ ) , and weight-for-length Z-scores ( WLZ ) after 4 mo of supplementation were assessed in the zinc and placebo groups . After 4 mo of supplementation , the weight and length gains in the 2 groups did not differ and there was no impact on LAZ , weight-for-age , and WLZ in the 2 groups . There was no substantial effect in any of the subgroups defined for age , income , gender , zinc levels in the crude analysis nor after adjusting for age , gender , income , breast-feeding status , and baseline anthropometric status . Despite successful zinc supplementation reflected in increased plasma zinc concentration and a substantially reduced incidence of diarrhea and pneumonia in zinc-supplemented children , the intervention did not have a beneficial effect on growth BACKGROUND Malnutrition is the underlying cause of half of child mortality . Many programmes attempt to remedy this issue but there is a lack of evidence on effective ways to decrease child malnutrition . METHODS We did a cluster-r and omised trial of an educational intervention in a poor periurban area ( ie , shanty town ) of Peru . Guided by formative research , the intervention aim ed to enhance the quality and coverage of existing nutrition education and to introduce an accreditation system in six government health facilities compared with six control facilities . The primary outcome measure was growth that was measured by weight , length , and Z scores for weight-for-age and length-for-age at age 18 months . Main secondary outcomes were the percentage of children receiving recommended feeding practice s and the 24-h dietary intake of energy , iron , and zinc from complementary food at ages 6 , 9 , 12 , and 18 months . Analysis was by intention to treat . FINDINGS We enrolled a birth cohort of 187 infants from the catchment areas of intervention centres and 190 from control areas . Caregivers in intervention areas were more likely to report receiving nutrition advice from the health service than were caregivers in control health facilities ( 16 [ 52 % ] of 31 vs 9 [ 24 % ] of 37 , p=0.02 ) . At 6 months more babies in intervention areas were fed nutrient-dense thick foods at lunch ( a recommended complementary feeding practice ) than were controls ( 48 [ 31 % ] of 157 vs 29 [ 20 % ] of 147 ; difference between groups 19 [ 11 % ] , p=0.03 ) . Fewer children in intervention areas failed to meet dietary requirements for energy ( 8 months : 30 [ 18 % ] of 170 vs 45 [ 27 % ] of 167 , p=0.04 ; 12 months : 64 [ 38 % ] of 168 vs 82 [ 49 % ] of 167 , p=0.043 ) , iron ( 8 months : 155 [ 91 % ] of 170 vs 161 [ 96 % ] of 167 , 9 months : 152 [ 93 % ] of 163 vs 165 [ 99 % ] of 166 , p=0.047 ) , and zinc ( 9 months : 125 [ 77 % ] of 163 vs 145 [ 87 % ] of 166 , p=0.012 ) than did controls . Children in control areas were more likely to have stunted growth ( ie , length for age less than 2 SD below the reference population median ) at 18 months than children in intervention groups ( 26 [ 16 % ] of 165 vs 8 [ 5 % ] of 171 ; adjusted odds ratio 3.04 [ 95 % CI 1.21 - 7.64 ] ) . Adjusted mean changes in weight gain , length gain , and Z scores were all significantly better in the intervention area than in the control area . INTERPRETATION Improvement of nutrition education delivered through health services can decrease the prevalence of stunted growth in childhood in areas where access to food is not a limiting factor OBJECTIVES To identify groups within Dhaka slums that report similar patterns of livelihood , and to explore nutritional and health status . DESIGN A r and om sample of households participated in a longitudinal study in 1995 - 1997 . Socio-economic and morbidity data were collected monthly by question naire and nutritional status was assessed . Cluster analysis was used to aggregate households into livelihood groups . SETTING Dhaka slums , Bangladesh . SUBJECTS Five-hundred and fifty-nine households . MAIN OUTCOME MEASURES Socio-economic and demographic variables , nutritional status , morbidity . RESULTS Four livelihood groups were identified . Cluster 1 was the richest cluster with l and , animals , business assets and savings .  Loans as well as income were higher , which shows that this group was credit-worthy . The group was mainly self-employed and worked more days per month than the other clusters . The cluster had the second highest body mass index ( BMI ) score , and the highest children 's nutrition status . Cluster 2 was a poor cluster and was mainly dependent self-employed .  Savings and loans  were lower . Cluster 3 was the most vulnerable cluster . Members of this group were mainly casual unskilled , and 40 % were female-headed households .  Total income and expenditure were lowest amongst the clusters . BMI and children 's nutritional status were lowest in the slum . Cluster 4 was the second richest cluster . This group comprised skilled workers . BMI was the highest in this cluster and children 's nutritional status was second highest . CONCLUSIONS Cluster analysis has identified four groups that differed in terms of socio-economic , demographic and nutritional status and morbidity . The technique could be a practically useful tool of relevance to the development , monitoring and targeting of vulnerable households by public policy in Bangladesh Background Maternal malnutrition and poor gestational weight gain are the most important causes of low birthweight and infant mortality in Bangladesh . Objective To assess the effect of short-term nutrition education on weight gain in the third trimester of pregnancy , birth outcomes , and breastfeeding . Methods Three hundred pregnant women participated in this r and omized , controlled trial during a 3-month intervention period . The study was conducted in two antenatal clinics in urban Dhaka . One group of women was given monthly education sessions during the third trimester of pregnancy to promote consumption of khichuri , while the control group received only routine services from the health facilities .  Birthweight was recorded within 24 hours after delivery . Breastfeeding practice s were observed for 1 month after delivery . Results In the intervention group , maternal weight gain in the third trimester was 60 % higher ( 8.60 vs. 5.38 kg , p = .011 ) , mean birthweight was 20 % higher ( 2.98 vs. 2.49 kg , p < .001 ) , the rate of low birth-weight was 94 % lower ( 2.7 % vs. 44.7 % , p < .001 ) , and the rate of initiation of breastfeeding within 1 hour after birth was 52 % higher ( 86.0 % vs. 56.7 % , p < .001 ) , in comparison with the control group . Birthweight was associated with frequency of intake of khichuri ( p < 0.001 ) . Conclusions Nutrition education with a focus on promoting consumption of khichuri during the third trimester of pregnancy significantly reduced the rate of low birthweight and increased maternal weight gain BACKGROUND Powders containing iron and other micronutrients are recommended as a strategy to prevent nutritional anaemia and other micronutrient deficiencies in children . We assessed the effects of provision of two micronutrient powder formulations , with or without zinc , to children in Pakistan . METHODS We did a cluster r and omised trial in urban and rural sites in Sindh , Pakistan . A baseline survey identified 256 clusters , which were r and omly assigned ( within urban and rural strata , by computer-generated r and om numbers ) to one of three groups : non-supplemented control ( group A ) , micronutrient powder without zinc ( group B ) , or micronutrient powder with 10 mg zinc ( group C ) . Children in the clusters aged 6 months were eligible for inclusion in the study . Powders were to be given daily between 6 and 18 months of age ; follow-up was to age 2 years . Micronutrient powder sachets for groups B and C were identical except for colour ; investigators and field and supervisory staff were masked to composition of the micronutrient powders until trial completion . Parents knew whether their child was receiving supplementation , but did not know whether the powder contained zinc . Primary outcomes were growth , episodes of diarrhoea , acute lower respiratory tract infection , fever , and incidence of admission to hospital . This trial is registered with Clinical Trials.gov , number NCT00705445 . RESULTS The trial was done between Nov 1 , 2008 , and Dec 31 , 2011 . 947 children were enrolled in group A clusters , 910 in group B clusters , and 889 in group C clusters . Micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group ( odds ratio [ OR ] for micronutrient powder without zinc=0·20 , 95 % CI 0·11 - 0·36 ; OR for micronutrient powder with zinc=0·25 , 95 % CI 0·14 - 0·44 ) . Compared with the control group , children in the group receiving micronutrient powder without zinc gained an extra 0·31 cm ( 95 % CI 0·03 - 0·59 ) between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm ( 0·29 - 0·84 ) . We recorded strong evidence of an increased proportion of days with diarrhoea ( p=0·001 ) and increased incidence of bloody diarrhoea ( p=0·003 ) between 6 and 18 months in the two micronutrient powder groups , and reported chest indrawing ( p=0·03 ) . Incidence of febrile episodes or admission to hospital for diarrhoea , respiratory problems , or febrile episodes did not differ between the three groups . INTERPRETATION Use of micronutrient powders reduces iron-deficiency anaemia in young children . However , the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in population s with malnourished children and high diarrhoea burdens . FUNDING Bill & Melinda Gates Foundation OBJECTIVE To assess the impact of zinc supplementation on  diarrheal morbidity and growth pattern of low birth weight ( LBW ) infants . METHODOLOGY In a r and omized , double-blind , placebo-controlled , community-based study conducted in the Tiljala slum of eastern Kolkata , India , between 1999 and 2001 , a birth cohort of 100 LBW infants was r and omly allocated into either an intervention group receiving 1 mL daily dose of 5 mg of elemental zinc as zinc sulfate in vitamin B complex-based syrup or a placebo group receiving an identical placebo of 1 mL of vitamin-based syrup from birth up to 1 completed year of age . Active weekly surveillance was conducted for detection of diarrhea . Anthropometric measurements of each child were recorded once every month as close to the child 's birth date as possible . Data were analyzed by using statistical software packages SPSSPC+ 4.0 ( SPSS , Inc , Chicago , IL ) and Epi Info 6.0 ( Centers for Disease Control and Prevention , Atlanta , GA ) . RESULTS Among the zinc-supplemented group , diarrheal incidence of 1.36 episodes per child per year were observed , whereas it was 1.93 episodes per child per year among the placebo group , giving a relative risk of 1.4 ( 95 % confidence interval : 1.02 - 2.00 ) . Linear growth and weight for age showed significant differences between the supplemented and placebo groups only at the end of 1 year . Interestingly , the impact of zinc supplementation was masked to a large extent by the protective action of breastfeeding . CONCLUSIONS The study showed that zinc supplementation had a beneficial impact on the incidence of diarrhea and also weight gain among LBW infants Background Maternal malnutrition and poor gestational weight gain are the most important causes of low birth weight and high rates of newborn mortality . Objective To assess the effects of nutrition counseling in the third trimester of pregnancy on maternal weight gain , birth weight of newborn , and breastfeeding practice s. Methods This was a longitudinal experimental study with nutrition intervention for a period of 3 months . One hundred fifteen women ( 57 in the intervention group and 58 in the comparison group ) who were visiting the Maternal and Child Health Training Institute at 6 months of pregnancy were r and omly selected . The intervention group was given nutrition education twice in the first month and once a month for the next 2 months before delivery ; the comparison group received routine hospital advice on food intake , immunization , personal hygiene , and breastfeeding . The women were weighed monthly up to delivery , the newborn infants ' birth weights were measured within 24 hours after delivery , and breastfeeding practice s were observed 1 month after delivery . Results Women in the intervention group gained 1.73 kg more weight during the third trimester than women in the comparison group ( 5.61 vs. 3.88 kg , p < 0.001 ) . The mean birthweight of babies of women in the intervention group was 0.44 kg greater than that of babies of women in the comparison group ( 2.86 vs. 2.42 kg , p < 0.001 ) . In the intervention group , 10.5 % of babies were born with low birthweight , compared with 48.3 % of the babies of women in the comparison group ( p < 0.001 ) . In the intervention group , 75.4 % of mothers initiated breastfeeding within 1 hour after birth , compared with 34.5 % of mothers in the comparison group ( p < 0.001 ) . Conclusions Nutrition education only during the third trimester improved weight gain during pregnancy , reduced 78 % of low birth weight , and improved breast-feeding practice This study assessed weight and height changes among underweight children who received a locally produced , cereal‐based , ready‐to‐use supplementary food Probiotics and milk calcium may increase resistance to intestinal infection , but their effect on growth and iron and zinc status of Indonesian children is uncertain . We investigated the hypotheses that cow milk with added probiotics would improve growth and iron and zinc status of Indonesian children , whereas milk calcium alone would improve growth but reduce iron and zinc status . A 6-mo r and omized trial was conducted in low-socioeconomic urban communities of Jakarta . Healthy children ( n = 494 ) were r and omly assigned to receive low-lactose milk with a low calcium content of ∼50 mg/d ( LC ; n = 124 ) , a regular calcium content of ∼440 mg/d ( RC group ; n = 126 ) , regular calcium with 5 × 10(8 ) CFU/d Lactobacillus casei CRL 431 ( casei ; n = 120 ) , or regular calcium with 5 × 10(8 ) CFU/d Lactobacillus reuteri DSM 17938 ( reuteri ; n = 124 ) . Growth , anemia , and iron and zinc status were assessed before and after the intervention . Compared with the RC group , the reuteri group had significantly greater weight gain [ 0.22 ( 95 % CI : 0.02 , 0.42 ) kg ] , weight-for-age Z-score ( WAZ ) changes [ 0.09 ( 95 % CI : 0.01 , 0.17 ) ] , and monthly weight [ 0.03 ( 95 % CI : 0.002 , 0.05 ) kg/mo ] and height [ 0.03 ( 95 % CI : 0.01 , 0.05 ) cm/mo ] velocities . Casei significantly increased monthly weight velocity [ 0.03 ( 95 % CI : 0.001 , 0.05 ) kg/mo ] , but not height . However , the changes in underweight , stunting , anemia prevalence , and iron and zinc status were similar between groups . In conclusion , L. reuteri DSM 17938 modestly improved growth by increasing weight gain , WAZ changes , and weight and height velocity , whereas L. casei CRL 431 modestly improved weight velocity . Independent from probiotics supplementation , regular milk calcium did not affect growth or iron and zinc status OBJECTIVE To determine whether a cash-for-work programme during the annual food insecurity period in Bangladesh improved nutritional status in poor rural women and children . METHODS The panel study involved a r and om sample of 895 households from over 50,000 enrolled in a cash-for-work programme between September and December 2007 and 921 similar control households . The height , weight and mid-upper arm circumference of one woman and child aged less than 5 years from each household were measured at baseline and at the end of the study ( mean time : 10 weeks ) . Women reported 7-day household food expenditure and consumption on both occasions . Changes in parameters were compared between the two groups . FINDINGS At baseline , no significant difference existed between the groups . By the study end , the difference in mean mid-upper arm circumference between women in the intervention and control groups had widened by 2.29 mm and the difference in mean weight , by 0.88 kg . Among children , the difference in means between the two groups had also widened in favour of the intervention group for : height ( 0.08 cm ; P<0.05 ) , weight ( 0.22 kg ; P<0.001 ) , mid-upper arm circumference ( 1.41 mm ; P<0.001 ) and z-scores for height-for-age ( 0.02 ; P<0.001 ) , weight-for-age ( 0.17 ; P<0.001 ) , weight-for-height ( 0.23 ; P<0.001 ) and mid-upper arm circumference ( 0.12 ; P<0.001 ) . Intervention households spent more on food and consumed more protein-rich food at the end of the study . CONCLUSION The cash-for-work programme led to greater household food expenditure and consumption and women 's and children 's nutritional status improved OBJECTIVES With the adoption of vigorous child survival strategies , infant and  child mortalities in India have declined significantly , even among the poorest , most undernourished segments of the population . Of the surviving infants and children , however , many remain stunted and undernourished . The present study was based on the hypothesis that failure to thrive is the result of damage to the gut epithelium incurred during repeated bouts of gastrointestinal infections . Promoting the regeneration of the damaged gut epithelium through the use of lactobacillus-rich fermented foods may yield beneficial results . This low-cost procedure can be widely used , even in poor communities . The objectives of this study were to investigate the effect in poor Indian communities of supplementation with a probiotic on the growth of children ( aged 2 to 5 years ) with growth retardation and assess the difference in morbidity between those receiving the supplement ( n = 50 ) and the control group ( n = 50 ) , mainly with respect to the frequency , severity , and duration of diarrheal episodes . METHODS One hundred children aged 2 to 5 y from an urban slum of New Delhi were matched for their age ( + /-36 d ) , sex and weight ( + /-1 kg ) and assigned to one of two groups ( experimental n= 50 and control n= 50 ) . The experimental group received a probiotic supplement ( 50 ml curd containing Lactobacillus acidophilus ) and the control group received an isocaloric supplement daily for 6 mo .  Weight , height , and morbidity profile with respect to diarrhea , fever , cough , and cold was recorded . RESULTS Increases in weight ( P < 0.002 ) and height ( P < 0.001 ) were significantly greater in the experimental group than in the control group . In addition , after 6 mo , of supplementation , there were fewer cases of diarrhea ( P < 0.005 ) and fever ( P < 0.001 ) in the intervention group then in the control group . CONCLUSIONS From this study , it can be concluded that 6 mo of probiotic supplementation may be beneficial with respect to decrease in diarrheal morbidity and accelerated growth in the experimental group
BACKGROUND Nutritional interventions to prevent stunting of  infants and young children are most often applied in rural areas in low- and middle-income countries ( LMIC ) .
Few interventions are focused on urban slums .
The literature needs a systematic assessment , as infants and children living in slums are at high risk of stunting .
Urban slums are complex environments in terms of biological , social , and political variables and the outcomes of nutritional interventions need to be assessed in relation to these variables .
For the purpose s of this review , we followed the UN-Habitat 2004 definitions for low-income informal settlements or slums as lacking one or more indicators of basic services or infrastructure .
OBJECTIVES To assess the impact of nutritional interventions to reduce stunting in infants and children under five years old in urban slums from LMIC and the effect of nutritional interventions on other nutritional ( wasting and underweight ) and non-nutritional outcomes ( socioeconomic , health and developmental ) in addition to stunting .