Improved nutritional recovery on an elemental diet in Zambian children with persistent diarrhoea and malnutrition. Prevention of Malnutrition among Young Children in Rural Bangladesh by a Food-Health-Care Educational Intervention: A Randomized, Controlled Trial Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration. A pilot study on the effects of curd (dahi) & leaf protein concentrate in children with protein energy malnutrition (PEM). Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition? Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia. Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain. Iron-containing micronutrient powder provided to children with moderate-to-severe malnutrition increases hemoglobin concentrations but not the risk of infectious morbidity: a randomized, double-blind, placebo-controlled, noninferiority safety trial. Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6-18 months. Impact of food supplementation during lactation on infant breast-milk intake and on the proportion of infants exclusively breast-fed. School breakfast improves verbal fluency in undernourished Jamaican children. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Prospective study of protein-energy supplementation early in life and of growth in the subsequent generation in Guatemala. Early feeding of an energy dense diet during acute shigellosis enhances growth in malnourished children. Age-specific responsiveness of weight and length to nutritional supplementation. Effects of dietary energy density and feeding frequency on total daily energy intakes of recovering malnourished children. Nutritional supplementation: effects on child stunting because of diarrhea. The effects of nutritional supplementation on physical growth of children at risk of malnutrition. Changes in body composition of malnourished children after dietary supplementation as measured by bioelectrical impedance. Multiple micronutrient supplementation improves anemia, micronutrient nutrient status, and growth of Vietnamese infants: double-blind, randomized, placebo-controlled trial. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth, and morbidity of Peruvian infants. Fortified complementary foods with or without alpha-amylase treatment increase hemoglobin but do not reduce breast milk intake of 9-mo-old Zambian 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. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y. Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Growth improvements in children above 3 years of age: the Cali Study. Upward weight percentile crossing in infancy and early childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES). Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Home‐based therapy with ready‐to‐use therapeutic food is of benefit to malnourished, HIV‐infected Malawian children Home based therapy for severe malnutrition with ready-to-use food Neither a zinc supplement nor phytate-reduced maize nor their combination enhance growth of 6- to 12-month-old Guatemalan infants. Effectiveness of a community-based responsive feeding programme in rural Bangladesh: a cluster randomized field trial. Effect of Oral Supplementation on Catch-Up Growth in Picky Eaters Home-Based Treatment of Malnourished Malawian Children with Locally Produced or Imported Ready-to-Use Food Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger. Nutritional supplementation in early childhood, schooling, and intellectual functioning in adulthood: a prospective study in Guatemala. Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola Micronutrient Fortification to Improve Growth and Health of Maternally HIV-Unexposed and Exposed Zambian Infants: A Randomised Controlled Trial Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial Evaluation of the impact of a nutritional program for undernourished children in Brazil. Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children. The impact of an integrated community-based micronutrient and health programme on stunting in Malawian preschool children. Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial Ready-to-Use Therapeutic Food for Catch-Up Growth in Children after an Episode of Plasmodium falciparum Malaria: An Open Randomised Controlled Trial Effect of an Integrated Nutrition Program on Child Morbidity Due to Respiratory Infection and Diarrhea in Northern Viet Nam Age differences in the impact of nutritional supplementation on growth. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Effects of an energy and micronutrient supplement on growth and activity, correcting for non-supplemental sources of energy input in undernourished children in Indonesia Protein-energy malnutrition: the role of nutrition education in rehabilitation. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras An Integrated Child Nutrition Intervention Improved Growth of Younger, More Malnourished Children in Northern Viet Nam Impact of NGO run mid day meal program on nutrition status and growth of primary school children Locally made ready-to-use therapeutic food for treatment of malnutrition: A randomized controlled trial Fish oil supplementation improves docosahexaenoic acid status of malnourished infants Acceptability of lipid-based nutrient supplements (LNS) among Ghanaian infants and pregnant or lactating women. Effect of dietary energy density on total ad-libitum energy consumption by recovering malnourished children. Goat's milk as a substitute for cow's milk in undernourished children: a randomized double-blind clinical trial. Energy compensation in young children who fail to thrive. Randomized controlled trial of the effectiveness of a soybean-maize-sorghum-based ready-to-use complementary food paste on infant growth in South Kivu, Democratic Republic of Congo. 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 anthropometry in undernourished children in Indonesia High fat versus high carbohydrate nutritional supplementation: a one year trial in stunted rural Gambian children Randomized clinical trial comparing hospital to ambulatory rehabilitation of malnourished children in Niger. WEIGHT-GAIN INHIBITION BY LACTOSE IN AUSTRALIAN ABORIGINAL CHILDREN: A Controlled Trial of Normal and Lactose Hydrolysed Milk Nutritional status of pre-school children and women in selected villages in the Suvannakhet Province, Lao PDR--an intervention trial. 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. The Kingston Project. III. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: morbidity and growth. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso. Seasonal variation of wasting and stunting in preschool children during a three-year community-based nutritional intervention study in northeast Thailand. Effect of an Integrated Child Nutrition Intervention on the Complementary Food Intake of Young Children in Rural North Viet Nam Provision of Micronutrient-Fortified Food From 6 Months of Age Does Not Permit HIV-Exposed Uninfected Zambian Children to Catch Up in Growth to HIV-Unexposed Children: A Randomized Controlled Trial Effects of an energy and micronutrient supplement on iron deficiency anemia, physical activity and motor and mental development in undernourished children in Indonesia Supplement of three eggs a week improves protein malnutrition in Thai children from rural areas. 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. Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial. Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children. Supplementary Feeding of Underweight, Stunted Malawian Children With a Ready-To-Use Food Locally produced ready-to-use supplementary food is an effective treatment of moderate acute malnutrition in an operational setting The Kingston Project. II. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry. A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia Growth pattern of infants fed with a mixture of extruded malted maize and cowpea. Long-term effects of food supplementation and psychosocial intervention on the physical growth of Colombian infants at risk of malnutrition. A novel fortified blended flour, corn-soy blend "plus-plus," is not inferior to lipid-based ready-to-use supplementary foods for the treatment of moderate acute malnutrition in Malawian children. Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition. Absorption of macronutrients from a calorie-dense diet in malnourished children during acute shigellosis. A Cluster-Randomized Evaluation of a Responsive Stimulation and Feeding Intervention in Bangladesh 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. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Results and implications of the INCAP follow-up study. Effect of a Low-Cost Food on the Recovery and Death Rate of Malnourished Children The recovery of Guatemalan children with mild to moderate wasting: factors enhancing the impact of supplementary feeding. Effects of Community-based Follow-up Care in Managing Severely Underweight Children Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh. Design of a Prospective, Randomized Evaluation of an Integrated Nutrition Program in Rural Viet Nam Effects of a nutrition education programme on the psychological performance of malnourished children. A 3-year follow-up study. The effect of nutritional supplementation and stunting on morbidity in young children: the Jamaican study. Complementary feeding messages that target cultural barriers enhance both the use of lipid-based nutrient supplements and underlying feeding practices to improve infant diets in rural Zimbabwe. Acceptability of three novel lipid-based nutrient supplements among Malawian infants and their caregivers. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Enhancements to nutrition program in Indian integrated child development services increased growth and energy intake of children. Introduction of red palm oil into the 'ready to eat' used supplementary feeding programme through ICDS. Increased Food Intake after the Addition of Amylase-Rich Flour to Supplementary Food for Malnourished Children in Rural Communities of Bangladesh Activity and behavioral development in stunted and nonstunted children and response to nutritional supplementation. The clinical challenge of preventing and treating malnutrition. Protein requirements of infants and children: growth during recovery from malnutrition. [Anthropometric evolution during hospitalization of severe malnourished children with persistent diarrhea receiving standardized nutritional support]. Use of fermented foods to combat stunting and failure to thrive. A randomized clinical trial of home intervention for children with failure to thrive. Value of a Chicken‐Based Formula for Refeeding of Children with Protracted Diarrhea and Malnutrition in a Developing Country Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery.
The persistent diarrhoea-malnutrition syndrome ( PDM ) remains a leading cause of morbidity and mortality in hospitals in re source -poor countries . In view of the benefits of elemental or oligomeric feeds in inflammatory bowel diseases , we performed a r and omized controlled trial of an exclusive diet of amino acid-based elemental feed ( AAF ) compared with st and ard nutritional rehabilitation ( based on skimmed milk and then soya ) for PDM . Treatment was given for 4 weeks in the malnutrition ward of the University Teaching Hospital , Lusaka , in a single-blind study . Intestinal and systemic infections were treated with routine therapies . The main outcome measures were weight gain , recovery from diarrhoea , and mortality .  Two hundred children ( 106 HIV seropositive , 90 HIV seronegative ) were r and omized ; 155 children completed therapy , 39 died , and six were lost to follow-up . At r and omization , they were severely malnourished : median baseline weight-for-age z-score was -4.0 ( interquartile range , IQR -4.4 , -3.5 ) ; 9 per cent were underweight , 23 per cent had marasmus , 47 per cent had kwashiorkor , and 21 per cent had marasmic-kwashiorkor .  Weight gain was greater in the AAF group ( median gain in weight-for-age z-score was 1.23 , IQR 0.89 - 1.57 ) compared with the control group ( 0.87 , IQR 0.47 - 1.25 ; p=0.002 ) , although calorie intakes were higher in the control group . The increase in haemoglobin concentration was also greater in the AAF group ( 0.8 g/dl , IQR 0 - 1.8 ) than in the control group ( 0.3 , IQR -0.6 , -1.6 ; p=0.04 ) . Diarrhoea frequency and global recovery scores improved equally in both treatment groups and mortality did not differ . A diet of reduced molecular complexity was associated with significantly improved weight gain Background As a result of inappropriate feeding , poor health and hygiene , and poor caring practice s , the nutritional status of many young infants deteriorates with advancing age . Objective To explore the effectiveness of a nutrition education package to prevent malnutrition among young children . Methods A community-based , r and omized , controlled trial was conducted among 605 normal and mildly malnourished children aged 6 to 9 months in 121 Community Nutrition Centers ( CNCs ) of the Bangladesh Integrated Nutrition Project ( BINP ) in four regions of Bangladesh from 2000 to 2002 . The intervention group received weekly nutrition education based on the nutrition triangle concept of UNICEF for 6 months , whereas the control group received regular BINP services . Both groups were observed for a further 6 months to assess the sustainability of the effects . Information on socio-economic status , feeding patterns , morbidity , and anthropometric features was collected . Results A significant increase in the frequency of complementary feeding was observed in the intervention group as compared with the control group , and the increase was sustained throughout the observation period . The intervention group had a higher weight gain than the control group after the end of the intervention ( 0.86 vs. 0.77 kg , p = 0.053 ) and after the end of the observation period ( 1.81 vs. 1.39 kg , p < .001 ) . The proportion of normal and mildly malnourished children was greater in the intervention group than in the control group after the end of the observations ( 88.9 % vs. 61.5 % , p < .001 ) . Nutrition education successfully prevented malnutrition in all the areas . Variation in the outcome of nutrition education among the regions was observed . Conclusions This culturally appropriate nutrition education package based on the nutrition triangle model effectively prevented growth faltering and malnutrition among young children OBJECTIVE To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients ( MM ) on  Hb concentration of young children . DESIGN In a nutrition centre that we opened in their villages , children received either MM supplement ( containing iron , zinc , vitamin A , vitamin C and iodine ) with the improved gruel ( MMGG ) or the improved gruel only ( GG ) , twice daily , 6 d/week , for 6 months . We assessed baseline and endpoint Hb concentration and anthropometric indices . SETTING Kongoussi , a rural and poor district of Burkina Faso . SUBJECTS In a community-based trial , we r and omly assigned 131 children aged 6 - 23 months with Hb concentrations in the range of 80 - 109 g/l into two groups . RESULTS The groups did not differ significantly at baseline . Mean baseline Hb concentration was 89·2 ( sd 6·5 ) g/l and 90·3 ( sd 8·4 ) g/l in the GG and the MMGG , respectively ( P = 0·42 ) . It increased to 104·1 ( sd 11·4 ) g/l in the GG ( P < 0·001 ) and 107·6 ( sd 14·7 ) g/l in the MMGG ( P < 0·001 ) . The between-group difference of 3·5 ( 95 % CI -1·0 , 8·1 ) g/l in mean ( sd ) endpoint Hb concentration was not significant ( P = 0·13 ) . The endpoint anthropometric indices were not different between the groups . CONCLUSIONS This MM supplement  had no additional effect on Hb concentration . Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine BACKGROUND & OBJECTIVE In protein-energy malnutrition ( PEM ) there is a significant impairment of immunity , both cell-mediated and humoral , which may be reversed with nutritional rehabilitation . With the use of probiotics like curd ( dahi ) and micronutrient-rich leaf protein concentrate ( LPC ) , this immune recovery may be hastened . This study was conducted to assess the impact of supplementation of curd and LPC on nutritional status , and immunity as assessed by anthropometry , haemoglobin , ferritin levels , T- cell sub population and C-reactive protein ( CRP ) , in children suffering from PEM . METHODS Eighty moderate to severely malnourished children ( 1 - 5 yr ) were r and omized to receive either curd or LPC in addition to WHO recommended two-step diet over 15 days . Nutritional , immunological and haematological parameters were measured before and after supplementation and compared within the groups . RESULTS The change in weight , haemoglobin level and CD4:CD8 T-cell sub population was significant in both the groups after supplementation . Response of CRP was blunted in PEM . Serum ferritin decreased significantly after supplementation in both groups . INTERPRETATION & CONCLUSION Curd and LPC when added to diet of malnourished children , may have therapeutic value by accelerating immune recovery . More studies need to be done on a larger sample to confirm these findings To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger , we analysed three cohorts of severely malnourished patients in terms of daily weight gain , length of stay , recovery , case fatality and defaulting . A total of 1937 children aged 6 - 59 months were followed prospect ively from 15 August 2002 to 21 October 2003 . For the three cohorts , 660 children were maintained in the therapeutic feeding centre ( TFC ) during the entire treatment , 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home . For all cohorts , average time in the programme and average weight gain met the international st and ards ( 30 - 40 days , > 8 g/kg/day ) . Default rates were 28.1 , 16.8 and 5.6 % for TFC only , TFC plus home-based and home-based alone strategies , respectively . The overall case fatality rate for the entire programme was 6.8 % . Case fatality rates were 18.9 % for TFC only and 1.7 % for home-based alone . No deaths were recorded in children transferred to rehabilitation at home . This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies Summary Background Fast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development , but might increase risk of obesity and related adult cardiometabolic diseases . We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults . Methods We used data from five prospect i ve birth cohort studies from Brazil , Guatemala , India , the Philippines , and South Africa . We investigated  body-mass index , systolic and diastolic blood pressure , plasma glucose concentration , height , years of attained schooling , and related categorical indicators of adverse outcomes in young adults . With linear and logistic regression models , we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth ( relative weight gain ) in three age periods : 0–2 years , 2 years to mid-childhood , and mid-childhood to adulthood . Findings We obtained data for 8362 participants who had at least one adult outcome of interest . A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 ( odds ratio 1·28 , 95 % CI 1·21–1·35 ) and a reduced likelihood of short adult stature ( 0·49 , 0·44–0·54 ) and of not completing secondary school ( 0·82 , 0·78–0·87 ) . Faster linear growth was strongly associated with a reduced risk of short adult stature ( age 2 years : 0·23 , 0·20–0·52 ; mid-childhood : 0·39 , 0·36–0·43 ) and of not completing secondary school ( age 2 years : 0·74 , 0·67–0·78 ; mid-childhood : 0·87 , 0·83–0·92 ) , but did raise the likelihood of overweight ( age 2 years : 1·24 , 1·17–1·31 ; mid-childhood : 1·12 , 1·06–1·18 ) and elevated blood pressure ( age 2 years : 1·12 , 1·06–1·19 ; mid-childhood : 1·07 , 1·01–1·13 ) . Faster relative weight gain was associated with an increased risk of adult overweight ( age 2 years : 1·51 , 1·43–1·60 ; mid-childhood : 1·76 , 1·69–1·91 ) and elevated blood pressure ( age 2 years : 1·07 , 1·01–1·13 ; mid-childhood : 1·22 , 1·15–1·30 ) . Linear growth and relative weight gain were not associated with dysglycaemia , but a higher birthweight was associated with decreased risk of the disorder ( 0·89 , 0·81–0·98 ) . Interpretation Interventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors , with few adverse trade-offs . Funding Wellcome Trust and Bill & Melinda Gates Foundation To assess the impact of intensive nutrition education ( INE ) with or without the provision of micronutrient powder ( MNP ) on the nutritional status of mildly wasted children in Nias , Indonesia , two groups of mildly wasted ( > = -1.5 to < -1.0 WHZ ) children aged > = 6 to < 60 months in the Church World Service ( CWS ) project areas were assigned by village r and omization to receive INE ( n=64 ) or INE+MNP ( n=51 ) in a weekly program . Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program ( NNE ) with or without MNP ( n=50 both respectively ) . WHZ , weight , height , haemoglobin ( Hb ) level , and morbidity data were assessed at admission , during the study , and at individual discharge .  Children 's weight gain ( g/kg body weight/day ) was highest in INE+MNP group ( 2.2±2.1 ) , followed by INE ( 1.1±0.9 ) , NNE+MNP ( 0.3±0.5 ) and NNE ( 0.3±0.4 ) group . In both MNP intervention groups ( INE+MNP , NNE+MNP ) , supplements significantly increased Hb value ( g/L ) of respective children ( 10.0±10.0 ; p<0.001 and 3.0±8.0 ; p<0.05 respectively ) . Proportion of children who reached discharge criterion was highest among the INE+MNP ( 70.6 % ; n=36 ) , followed by INE ( 64.1 % ; n=41 ) , NNE+MNP ( 26.0 % ; n=13 ) , and NNE ( 20.0 % ; n=10 ) groups ( p<0.001 ) . Shortest length of stay until recovery was observed among children in the INE+MNP group ( 29.9 days ) , followed by INE ( 40.0 days ) , NNE+MNP ( 80.6 days ) , and NNE ( 86.2 days ) respectively ( p<0.001 ) . Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children BACKGROUND Therapeutic feeding with micronutrient-fortified lipid-based nutrient supplements ( LNSs ) has proven useful in the rehabilitation of severely malnourished children . We recently reported that complementary feeding of 6 - 18-mo-old infants with an LNS known as FS50 was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period . OBJECTIVE Our objective was to assess whether a reduction in stunting seen with 12-mo LNS supplementation was sustained over a subsequent 2-y nonintervention period . DESIGN One hundred eighty-two 6-mo-old healthy rural Malawian infants were r and omly assigned to receive daily supplementation for 12 mo with 71 g of maize-soy flour [ likuni phala ( LP ) ; control group , 282 kcal ] or either 50 g of FS50 ( 264 kcal ; main intervention group ) , or 25 g of FS25 ( 130 kcal ) . Main outcome measures were incidence of severe stunting and mean z score changes in weight-for-age , length-for-age , and weight-for-length during a 36-mo follow-up period . RESULTS The cumulative 36-mo incidence of severe stunting was 19.6 % in LP , 3.6 % in FS50 , and 10.3 % in FS25 groups ( P = 0.03 ) . Mean weight-for-age changes were -1.09 , -0.76 , and -1.22 ( P = 0.04 ) ; mean length-for-age changes were -0.47 , -0.37 , and -0.71 ( P = 0.10 ) ; and mean weight-for-length changes were -1.52 , -1.18 , and -1.48 ( P = 0.27 ) . All differences were more marked among individuals with baseline length-for-age below the median . Differences in length developed during the intervention at age 10 - 18 mo , whereas weight differences continued to increase after the intervention . CONCLUSIONS Twelve-month-long complementary feeding with 50 g/d FS50 is likely to have a positive and sustained impact on the incidence of severe stunting in rural Malawi . Half-dose intervention may not have the same effect . This trial was registered at ( clinical trials.gov ) as NCT00131209 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 BACKGROUND A link between the provision of iron and infectious morbidity has been suggested , particularly in children with malnutrition . Two meta-analyses concluded that iron is not harmful , but malnourished children were underrepresented in most available studies . OBJECTIVE This study evaluated the effect of iron-containing micronutrient powder ( iron MNP ) on infectious morbidities when provided to children with moderate-to-severe malnutrition and anemia . DESIGN A r and omized , double-blind , placebo-controlled , noninferiority safety trial using a 2-mo course of daily iron MNP or placebo powder ( PP ) was conducted in 268 Bangladeshi children aged 12 - 24 mo with moderate-to-severe malnutrition ( weight-for-age z score ≤ -2 ) and a hemoglobin concentration between 70 and 110 g/L. The primary endpoint was a composite of diarrhea , dysentery , and lower respiratory tract infection episodes ( DDL ) recorded through home visits every 2 d during the intervention and then weekly for 4 mo . The noninferiority margin was 1.2 . Secondary endpoints included hemoglobin and anthropometric changes at 2 and 6 mo . All deaths and hospitalizations were documented . To capture seasonal variation , the study was repeated in the winter and summer with 2 distinct groups . An intention-to-treat analysis of recurrent events was performed by using the univariate And erson-Gill model . RESULTS The baseline characteristics of the subjects were similar . Analysis of phase-aggregated DDL data showed that iron MNP was not inferior to PP ( relative risk : 0.81 ; 95 % CI : 0.62 , 1.04 ) and improved hemoglobin concentrations ( P < 0.0001 ) . We recorded no deaths , and hospitalizations were rare . CONCLUSION Iron MNP is safe and efficacious when provided to children aged 12 - 24 mo with moderate-to-severe malnutrition and anemia . This trial is registered at clinical trials.gov as NCT00530374 BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy Poor complementary feeding practice s are associated with stunting and growth faltering throughout the developing world . The objective was to compare the effect of using peanut-/soy-based fortified spread ( FS ) and corn porridge fortified with fish powder ( FP ) as complementary foods on growth in rural Malawian children . A total of 240 children were enrolled at the age of 6 mo and r and omized to receive FS or FP .  Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age . Children were followed monthly for anthropometry and fortnightly for the symptoms of fever , cough , or diarrhea until they were 18 mo old . Zn and Se status were assessed at 6 and 12 mo . The primary outcomes were the rates of weight and length gain from 6 - 12 mo and from 12 - 18 mo . Children who received FS gained 110 g more ( 95 % CI 220 to 10 ) from 6 - 12 mo of age than children receiving FP .  Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age , nor did statural growth from 6 to 12 mo or 12 to 18 mo . A total of 23 % of all children were Zn deficient at 6 mo of age and this increased to 37 % at 12 mo of age . Neither FS nor FP was associated with significantly improved Zn status .  FS was associated with better weight gain from 6 - 12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world To evaluate whether milk production can be improved by increasing food intake , a r and omized , double-blind , supplementation trial was completed among 102 lactating Guatemalan women . The subjects were undernourished , as indicated by their low values for calf circumference ( CC ) and the small size of their infants at birth .  A high-energy ( 2.14 MJ/d , HES ) and a low-energy ( 0.50 MJ/d , LES ) supplement were distributed 6 d/wk from wk 5 to 25 of lactation . Data were evaluated using repeated- measures analysis of variance on the increments from initial values for each outcome variable with one-tailed tests of statistical significance . The maternal energy intake increased 1.18 MJ/d ( P < 0.01 ) more among the HES than the LES women . Benefit from supplementation was more evident among the more undernourished ( CC < /= median value , 29.5 cm ) women . Among these 53 lower-CC women , infant milk and milk energy intakes were 10 % higher ( 64 g/d and 14 MJ/d , respectively , at wk 25 ) in the HES than the LES group . After controlling for other determinants of infant milk and energy intakes in regression analyses , the significance of these differences increased to P < 0.04 . However , there was no detectable effect on infant growth . Logistic regression analysis was used to show that HES women were significantly ( P < 0.05 ) more likely than LES women to be exclusively breast-feeding their infants at wk 20 , the time when the effect of supplementation was most evident . These findings establish that milk production and the duration of exclusive breast-feeding of undernourished women  can be improved with the provision of supplemental food School feeding programs exist in many countries , but few have been properly evaluated . In this study , the short-term effects of breakfast on children 's cognitive functions were examined . The subjects were 97 undernourished ( weight-for-age < or = -1 SD of reference ) and 100 adequately nourished ( weight-for-age > -1 SD ) children in four primary schools in rural Jamaica . The children were r and omly assigned to a group provided with breakfast or a group given a quarter of an orange as a placebo , and then given a battery of four cognitive function tests . After a few weeks the treatments were reversed and the tests repeated . Undernourished children 's performance improved significantly on a test of verbal fluency when they received breakfast , whereas that of the adequately nourished children did not change ( breakfast x group interaction , P < 0.05 ) . There were no other effects of breakfast on test scores . The findings extend those of a previous Jamaican study conducted under more controlled conditions , and support the targeting of school meals to undernourished children BACKGROUND Koko , a fermented maize porridge used as the primary complementary food in Ghana , has been implicated in the high prevalence of child malnutrition . Weanimix , a cereal-legume blend developed by the United Nations Children 's Fund and the Ghanaian government , has been promoted as an alternative . OBJECTIVE We evaluated the effect of feeding Weanimix and 3 other locally formulated , central ly processed complementary foods on the nutritional status of 208 breast-fed infants . DESIGN Infants were r and omly assigned to receive 1 of 4 foods from 6 to 12 mo of age : Weanimix ( W ) , Weanimix plus vitamins and minerals ( WM ) , Weanimix plus fish powder ( WF ) , and koko plus fish powder ( KF ) . Dietary and anthropometric data were collected regularly . Blood was collected at 6 and 12 mo of age to assess iron , zinc , vitamin A , and riboflavin status . Before and after the intervention , cross-sectional data on the anthropometric status of infants not included in the intervention ( NI ; n = 464 ) were collected . RESULTS There were no significant differences between intervention groups in weight or length gain or in hemoglobin , hematocrit , transferrin saturation , plasma zinc , or erythrocyte riboflavin values between 6 and 12 mo of age . From 9 to 12 mo of age , z scores were lower in NI infants than in the combined intervention groups [ at 12 mo : -1.71 + /- 0.90 compared with -1.19 + /- 0.93 for weight and -1.27 + /- 1.02 compared with -0.63 + /- 0.84 for length ( P < 0.001 for both ) , respectively ] . The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W , WF , and KF but not in group WM . Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined ( 0.14 + /- 0.3 compared with -0.04 + /- 0.3 micromol/L , P = 0 . 003 ) . CONCLUSIONS All 4 foods improved growth relative to the NI group . Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods BACKGROUND The secular increase in height is assumed to result from long-term improvements in nutritional intakes and reductions in infectious disease burdens . Nutritional supplementation in early life reduces stunting in chronically undernourished population s. It is unknown whether these improvements can be transmitted to subsequent generations . OBJECTIVE Our objective was to estimate the intergenerational effect on offspring length of improved nutrition in the mother 's childhood . DESIGN We studied 263 children born in 1996 - 1999 to 231 women who had received nutritional supplementation , ie , atole ( high-protein , moderate-energy drink ) or fresco ( nonprotein , low-energy drink ) , prenatally and up to age 7 y as part of a community trial in Guatemala between 1969 and 1977 . Child length was measured at different times to age 36 mo . RESULTS Children born to women who received the enhanced supplement were taller ( age-adjusted difference : 0.80 cm ; 95 % CI : 0.16 , 1.44 cm ) than were children whose mothers received the low-energy supplement . This increment was independent of the children 's birth weight or socioeconomic status but was substantially attenuated and no longer significant after adjustment for maternal height ( adjusted difference : 0.43 cm ; 95 % CI : -0.10 , 0.96 cm ; P > 0.10 ) . The effect of maternal nutritional supplementation  was more pronounced in boys than in girls ( P for interaction < 0.10 ) and in children born to women who received supplements at ages 3 - 7 y than in children born to women who received supplements at ages 0 - 3 y ( P for interaction < 0.01 ) . CONCLUSION Nutritional supplementation in childhood has positive effects on both the supplemented persons and on the subsequent generation In a controlled clinical trial , we examined the effect of the short-term feeding of an energy-dense milk cereal formula in malnourished children with clinical ly severe dysentery due to acute shigellosis . Seventy-five malnourished children , aged 12 - 48 mo , passing blood or blood with mucous in the stool for < or = 96 h , were offered a hospital diet . In addition , study children ( n = 36 ) were offered a milk-cereal formula with an energy of 5 kJ/g ( an 11 % protein diet ) ; similarly , control children ( n = 39 ) were offered a  milk-cereal formula with an  energy content of 2.5  kJ/g ( an 11 % protein diet ) . Patients were admitted to the metabolic ward of the Clinical Research and Service Centre , Dhaka , at the International Centre for Diarrhoeal Disease Research , Bangladesh . Patients were studied for 10 hospital days and were then followed up at home after 30 d. After 10 d of dietary intervention , children in the study group had a significantly greater increase vs. controls in weight-for-age ( 6 vs. 3 % , P < 0.001 ) and in weight-for-height ( 7 vs. 3 % , P < 0.001 ) . Serum prealbumin concentrations were significantly higher ( study vs. control ) after 5 d ( 0.214 vs. 0.170 g/L , P = 0.01 ) and after 10 d ( 0.244 vs. 0.193 g/L , P = 0.006 ) of the study . Greater weight-for-age was sustained at home 1 mo after discharge ( 8 vs. 5 % , P = 0.005 ) from the hospital . Similarly , higher weight-for-height was sustained 1 mo after discharge ( 8 vs. 5 % , P = 0.01 ) . During their stay at home , there was no dietary intervention . The results of this study suggest that short-term feeding of an energy-dense diet enhances growth in malnourished children with acute dysentery due to shigellosis Evaluation of the responsiveness of weight and length to supplementary feeding shows that the two periods of greatest response coincide with weaning ( ages 3 - 6 mo ) and peak incidence and duration of diarrheal disease ( ages 9 - 12 mo ) . Analyses were done for seven consecutive nonoverlapping intervals comparing children r and omly assigned to receive supplemental feeding from birth to age 36 mo or to serve as control subjects .  Absolute responsiveness was greatest between ages 3 - 6 mo ; supplemented infants grew 0.61 cm more and gained 162 g more than did unsupplemented infants ( p less than 0.005 ) . Relative to rates of growth , responsiveness was greatest between ages 9 and 12 mo ( the period of peak diarrheal prevalence ) , followed by ages 3 - 6 mo ( the period of weaning ) . Responsiveness to supplementation is thus directly related to age-dependent risk patterns for malnutrition . Targeting supplementation programs to coincide with periods of high nutritional risk should maximize their effectiveness in reducing malnutrition , though caution should be exercised to avoid disruption of breast-feeding To develop recommendations for the design of special foods for young children , we measured total daily energy consumption from semisolid food mixtures with energy densities of 1.67 , 2.93 , 4.18 , or 6.28 kJ/g ( 0.4 , 0.7 , 1.0 , or 1.5 kcal/g ) and that were fed ad libitum three , four , or five times per day to 18 fully weaned children from 6 to 18 mo of age who were recovering in the hospital from malnutrition . The diets were generally indistinguishable by sensory qualities , and were fed in a r and omized sequence . The mean amounts consumed ( g.kg body wt-1.d-1 ) were significantly less with successively greater energy density of the diet ( P < 0.001 ) . The total daily consumption was approximately 16 % more when the number of meals was increased from three to four per day , with energy density controlled for ( P < 0.001 ) , and 7 % more when the feeding frequency rose from four to five meals per day ( P = 0.005 ) . The total daily energy intakes ( kJ.kg body wt-1.d-1 ) increased significantly with the more concentrated diets ( P < 0.001 ) and varied positively in relation to feeding frequency ( P < 0.001 ) . Approximately 15 - 20 min were required per meal for the children to reach satiety . The total amount of time required to feed the children each day was related to the number of meals served ( P < 0.001 ) and not to energy density . Implication s for child feeding are discussed Research has shown that the positive effect of nutritional supplementation on child growth in malnourished population s is small relative to the large negative effect of diarrheal disease . To test the hypothesis that the effects of supplementation and diarrhea are synergistic in that supplementation modifies the negative effect of diarrhea on linear growth , length and diarrheal morbidity were compared at 36 mo of age for two cohorts of Colombian children : supplemented from birth and unsupplemented .  Among unsupplemented children diarrhea was negatively associated with length . Among supplemented children diarrhea had no effect on length and differed from that of unsupplemented children . Thus , supplementation completely offset the negative effect of diarrheal disease on length . Targeting supplementation programs to the critical period of high diarrheal prevalence among infants and young children should increase the effectiveness of such programs in preventing growth retardation associated with diarrhea 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 Body composition was measured with bioelectrical impedance in 35 malnourished children aged 24 - 59 mo to investigate the effect of a 3-wk feeding supplementation . Twenty children received a high-protein diet with 15 % of total energy as protein , whereas 15 children received an isoenergetic st and ard-protein diet with 7.5 % of energy as protein .  Bioelectrical impedance analysis and anthropometry were done before and after 21 d of dietary supplementation . The children fed the high-protein diet gained significantly more body weight than those receiving the st and ard-protein diet ( 1.33 + /- 0.54 vs 0.88 + /- 0.47 kg , P < 0.02 ) . The total body water and fat-free mass determined by bioelectrical impedance analysis showed that the group fed the high-protein diet increased significantly more ( 0.92 vs 0.58 kg ) than those on the st and ard-protein diet ( P < 0.02 ) . Results of this study suggest that feeding a high-protein diet accelerates catch-up growth and restores the reference body composition in children recovering from malnutrition A r and omized , double-blind , placebo-controlled trial was performed to assess the efficacy of different micronutrient supplementation regimes for improving micronutrient status , preventing anemia , and growth faltering of Vietnamese infants . A population -based sample of 306 infants aged 6 - 12 mo , split in 4 treatment groups , received daily multiple micronutrient ( DMM ) , daily placebo ( P ) , weekly multiple micronutrient ( WMM ) , or daily iron ( DI ) supplements for 6 mo , 7 d/wk , under supervision . Weight and length were measured monthly , and anemia and plasma levels of ferritin , zinc , riboflavin , retinol , tocopherol , and homocysteine were determined before and after the supplementation . Z-scores for length-for-age and weight-for-age worsened significantly in all groups , but the length-for-age Z-score decreased significantly less in the DMM group ( -0.32 + /- 0.05 ) than in the P and WMM groups ( -0.49 + /- 0.05 and -0.51 + /- 0.05 , respectively , P = 0.001 ) . Hemoglobin levels increased significantly more in the DMM group [ mean ( 95%CI ) : 16.4 g/L ( 12.4 - 20.4 ) ] than in the P group [ 8.6 g/L ( 5.0 - 12.2 ) , P = 0.04 ) , with intermediate nonsignificant increases in the WMM [ 15.0 g/L ( 11.5 - 18.5 ) ] and the DI [ 12.9 g/L ( 8.4 - 17.3 ) ] groups . Ferritin changes were significantly greater in DMM ( 12.1 microg/L ) and DI ( 9.5 microg/L ) than in P ( -14.7 microg/L ) and WMM groups ( -9.7 microg/L ) . Of the other micronutrients , only tocopherol showed a significantly greater level in the DMM group compared with P. Anemia still affected a quarter and zinc deficiency affected a third of infants although there was no iron deficiency after 6 mo of supplementation with DMM , suggesting that multiple factors are causing anemia and that the dose of zinc is too small Anemia , micronutrient deficiencies , and growth faltering are still common in Peru . The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure , anemia , and  micronutrient deficiencies  in Peruvian infants . Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind , masked , controlled trial in which they were r and omly assigned to receive either a daily dose of iron ( DI ) , a daily dose of multiple micronutrients ( DMM ) , a weekly dose of multiple micronutrients , or a placebo ( P ) for 6 mo . None of the supplements tested prevented growth faltering or the morbidities common during infancy . Anemia and plasma homocysteine concentrations fell significantly in all groups during the study , but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups , and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups . Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron ( DI and DMM ) . There were no significant differences among groups in mean final values or changes in plasma zinc , retinol , tocopherol , or riboflavin . Although the DMM intervention was the most efficacious for preventing anemia , iron , and zinc deficiencies , 15 % , 20 % , and 50 % of this group still remained anemic , zinc deficient , and iron deficient , respectively , at the end of the study . Further research thus should investigate whether higher doses of iron and zinc , together with infection control measures , are more efficacious BACKGROUND Malnutrition in late infancy in developing countries may result from poor- quality complementary foods that displace breast milk . OBJECTIVE The objective of the study was to assess the effects of fortified complementary blends of different energy densities on growth , hemoglobin concentrations , and breast milk intake of 9-mo-old Zambian infants . DESIGN Infants were r and omly assigned at 6 mo of age to receive for 3 mo a fortified blend of maize , beans , bambaranuts , and groundnuts [ Chilenje Baby Mix ( CBM ) ; energy density : 68 kcal/100 g ; n = 37 ] or a similar blend with alpha-amylase ( CBMA ; energy density : 106 kcal/100 g ; n = 44 ) . Cross-sectional data were obtained at 9 mo for a control group of infants ( n = 69 ) not given the diets . Breast milk intake was measured by using the dose-to-the-mother deuterium dilution technique . RESULTS No differences in weight or length z scores , all of which were within normal ranges , were seen between groups at 9 mo . Percentage fat mass was significantly ( P = 0.01 ) greater in the infants in both the CBM ( 23.2 + /- 2.7 % ) and CBMA ( 23.4 + /- 2.5 % ) groups than in the control group ( 21.6 + /- 2.6 % ) . Hemoglobin concentrations were significantly ( P = 0.03 ) greater in both intervention groups ( CBM group : 104 + /- 12 g/L : CBMA group : 103 + /- 12 g/L ) than in the control group ( 98 + /- 14 g/L ) . Breast milk intake was not significantly ( P = 0.87 ) different between groups ( CBM group : 614 + /- 271 g/d ; CBMA group : 635 + /- 193 g/d ; control group : 653 + /- 221 g/d ) . CONCLUSIONS The study foods improved hemoglobin concentrations without reducing breast milk intake and may be used to improve the nutritional status of infants in developing countries 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 BACKGROUND Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded linear growth and reducing anemia in stunted children . DESIGN Saharawi refugee children ( n = 374 ) aged 3 - 6 y with initial height-for-age z scores < -2 were assigned to 1 of 5 groups : fortified spread ( FS ) , fortified spread plus metronidazole ( FS+M ) , unfortified spread ( US ) , unfortified spread plus metronidazole ( US+M ) , or control . Supervised supplementation was given daily for 6 mo . Weight , height , knee-heel length , hematologic indexes , parasitic infections , and morbidity were assessed at 0 , 3 , and 6 mo . RESULTS Linear growth of children fed FS was 30 % faster at 3 mo than in US and control groups , after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups . No additional benefits from metronidazole were observed . Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups ( 37 + /- 40 , 19 + /- 15 , and 16 + /- 17 g/L , respectively ; P < 0.0001 ) , and anemia was reduced by nearly 90 % . CONCLUSIONS FS , and not US , induces catch-up growth in stunted children whose diets are poor in micronutrients . Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 BACKGROUND Micronutrient deficiencies are common during infancy , and optimal approaches for their prevention need to be identified . OBJECTIVE The objective was to compare the efficacy and acceptability of Sprinkles ( SP ) , crushable Nutritabs ( NT ) , and fat-based Nutributter ( NB ; 108 kcal/d ) , which provide 6 , 16 , and 19 vitamins and minerals , respectively , when used for home fortification of complementary foods . DESIGN Ghanaian infants were r and omly assigned to receive SP ( n = 105 ) , NT ( n = 105 ) , or NB ( n = 103 ) daily from 6 to 12 mo of age . We assessed dietary intake , morbidity , and compliance weekly . Hemoglobin and plasma ferritin , TfR , C-reactive protein , and zinc were measured at 6 and 12 mo . We used an exit interview to assess acceptability . A r and omly selected control group of infants who received no intervention ( NI ; n = 96 ) were assessed at 12 mo . RESULTS All supplements were well accepted , and the mean percentage of days that supplements were consumed ( 87 % ) did not differ between groups . At 12 mo , all 3 intervention groups had significantly higher ferritin and lower TfR concentrations than did the NI control group . Mean ( + /- SD ) hemoglobin was significantly higher in NT ( 112 + /- 14 g/L ) and NB ( 114 + /- 14 g/L ) but not in SP ( 110 + /- 14 g/L ) infants than in NI infants ( 106 + /- 14 g/L ) . The prevalence of iron deficiency anemia was 31 % in the NI control group compared with 10 % in the intervention groups combined ( P < 0.0001 ) . CONCLUSION All 3 options for home fortification of complementary foods are effective for reducing the prevalence of iron deficiency in such population 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 Rapid early postnatal weight gain predicts increased subsequent obesity and related disease risks . However , the exact timing of adverse rapid postnatal weight gain is unclear . OBJECTIVE The objective was to examine the associations between rapid weight gain in infancy and in early childhood in relation to body composition at age 17 y. DESIGN This prospect i ve cohort study was conducted in 248 ( 103 males ) singletons and their mothers . Height and weight were measured at birth , 6 mo , and 3 and 6 y. The rates of weight gain during infancy ( 0 - 6 mo ) and early childhood ( 3 - 6 y ) were calculated as changes in sex- and age-adjusted weight SD scores during these time periods . At 17 y , body composition was measured by air-displacement plethysmography . RESULTS Increasing weight gain during infancy and early childhood were both independently associated with larger body mass index , fat mass , relative fat mass , fat-free mass , and waist circumference at 17 y ( P < 0.005 for all ; adjusted for sex , birth weight , gestational age , current height , maternal socioeconomic status , and maternal fat mass ) . Rapid weight gain in infancy , but not in early childhood , also predicted taller height at 17 y ( P < 0.001 ) . CONCLUSIONS Rapid weight gain in both infancy and early childhood is a risk factor for adult adiposity and obesity . Rapid weight gain in infancy also predicted taller adult height . We hypothesize that rapid weight gains in infancy and early childhood are different processes and may allow separate opportunities for early intervention against obesity risk later in life 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 Aim : To determine if home‐based nutritional therapy will benefit a significant fraction of malnourished , HIV‐infected Malawian children , and to determine if ready‐to‐use therapeutic food ( RUTF ) is more effective in home‐based nutritional therapy than traditional foods . Methods : 93 HIV‐positive children > 1 y old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RUTF , RUTF supplement or blended maize/soy flour . RUTF and maize/soy flour provided 730 kJ·kg−1·d−1 , while the RUTF supplement provided a fixed amount of energy , 2100 kJ/d . These children  did not receive antiretroviral chemotherapy . Children were followed fortnightly . Children completed the study when they reached 100 % weight‐for‐height , relapsed or died . Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups . Results : 52/93 ( 56 % ) of all children reached 100 % weight‐for‐height . Regression modeling found that the children receiving RUTF  gained weight more rapidly and were more likely to reach 100 % weight‐for‐height than the other two dietary groups ( p<0.05 ) Background : The st and ard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care , and after discharge results in high rates of relapse . Aims : To test the hypothesis that the recovery rate , defined as catch-up growth such that weight-for-height z score > 0 ( WHZ , based on initial height ) for ready-to-use food ( RTUF ) is greater than two other home based dietary regimens in the treatment of malnutrition . Methods : HIV negative children > 1 year old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RTUF , RTUF supplement , or blended maize/soy flour . RTUF and maize/soy flour provided 730 kJ/kg/day , while the RTUF supplement provided a fixed amount of energy , 2100 kJ/day . Children were followed fortnightly . Children completed the study when they reached WHZ > 0 , relapsed , or died . Outcomes were compared using a time-event model . Results : A total of 282 children were enrolled . Children receiving RTUF were more likely to reach WHZ > 0 than those receiving RTUF supplement or maize/soy flour ( 95 % v 78 % , RR 1.2 , 95 % CI 1.1 to 1.3 ) . The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups . Six months later , 96 % of all children that reached WHZ > 0 were not wasted . Conclusions : Home based therapy of malnutrition with RTUF was successful ; further operational work is needed to implement this promising therapy After age 6 mo , the combination of breast-feeding and unfortified plant-based complementary feeding provides inadequate zinc ( Zn ) . Additionally , high phytate intakes compromise the bioavailability of zinc . Our principal objective in this r and omized controlled , doubly masked trial was to determine the effect of substituting low-phytate maize , a daily 5-mg zinc supplement , or both , in infants between ages 6 - 12 mo on impaired linear growth velocity , a common feature of zinc deficiency . In the Western Highl and s of Guatemala , 412 infants were r and omized to receive low-phytate or control maize .  Within each maize group , infants were further r and omized to receive a zinc supplement or placebo .  Length , weight , and head circumference were measured at 6 , 9 , and 12 mo of age . There were no significant differences between the 2 maize groups or between the Zn supplement and placebo groups and no treatment interaction was observed for length-for-age ( LAZ ) , weight-for-length ( WLZ ) or head circumference Z-scores . Overall mean ( + /- SD ) Z-scores at 6 mo for combined treatment groups were : LAZ , -2.1 + /- 1.1 ; WLZ , 0.7 + /- 1.0 ; and head circumference Z-score , -0.7.0 + /- 1.0 . At 12 mo , these had declined further to : LAZ , -2.5 + /- 1.1 ; WLZ , -0.0 + /- 0.9 ; and head circumference Z-score , -0.9 + /- 1.1 ; 83.3 % were stunted and 2 % were wasted . Low linear growth in older Guatemalan infants was not improved with either low-phytate maize or a daily 5-mg zinc supplement . Low contribution of maize to the complementary food of the infants negated any potential advantage of feeding low-phytate maize Responsive complementary feeding , whereby the mother feeds her child in response to child cues of hunger state and psychomotor abilities , is a problem in some countries , and likely contributes to malnutrition . Interventions are needed to evaluate whether promoting responsive feeding would add any benefit . Using a cluster r and omized field trial , we evaluated a six-session educational programme that emphasized practice of two key behaviours , namely child self-feeding and maternal responsiveness . One hundred mothers and their 12- to 24-month-olds attended the sessions as part of village clusters r and omly assigned to the intervention group . A similar number of controls received sessions on foods to feed and nutritional disorders . Outcomes assessed at pre-test , 2-week post-intervention and again 5-months post-intervention included weight , mouthfuls of food taken , self-feeding and maternal responsiveness . Research assistants , blind to group assignment , observed and coded mother and child behaviours during the midday meal . Secondary measures included foods fed and feeding messages recalled . Analysis was based on intention to treat and accounted for clustering . Only 10 % of each group was lost to follow-up . Weight ( d = 0.28 ) , weight gain ( d = 0.48 ) and child self-feeding ( d = 0.30 ) were significantly higher in the responsive feeding group . Mouthfuls of food eaten and maternal responsiveness were not significantly increased by the intervention . Mothers in the intervention gave their children more vegetables , and spontaneously recalled more feeding messages at the 5-month follow-up . These results provide evidence that self-feeding and weight gain can improve by targeting specific behaviours , while maternal responsiveness may require more intensive strategies Ninety-two subjects ages 36 to 60 months who had picky-eater behavior and evidence of growth faltering were r and omized to receive either nutrition counseling alone , or nutrition counseling plus a nutritional supplement ( Study ) for 90 days . The Study group had significantly greater increases in weight and height . There were no significant differences between groups in changes in appetite or activity levels , or in gastrointestinal symptom scores . The percent of subjects who developed upper respiratory tract infections was significantly lower in the Study group . These data suggest that a nutritional supplement in addition to nutrition counseling promote catch-up growth and may contribute to lower rates of infectious disease in children with picky eater behavior Objectives : To determine the efficacy of home-based therapy with ready-to-use food ( RTUF ) in producing catch-up growth in  malnourished children and to compare locally produced RTUF with imported RTUF for this purpose . Methods : After a brief inpatient stabilization , 260 children with severe malnutrition were enrolled and systematic ally allocated to receive home therapy with either imported , commercially produced RTUF or locally produced RTUF . Each child received 730 kJ/kg/day and was followed up fortnightly . Children completed the study when they reached a  weight-for-height Z score > −0.5 ( WHZ ) , relapsed , died , or failed to achieve WHZ > −0.5 after 16 weeks . Analyses were stratified by human immunodeficiency virus ( HIV ) status . Results : 78 % of all children reached WHZ > −0.5 , 95 % of those with HIV-negative status and 59 % of those with HIV-positive status . Eighty percent of those receiving locally produced RTUF and 75 % of those receiving imported RTUF reached WHZ > −0.5 . The difference between recovery rates was 5 % ( 95 % confidence interval [ CI ] , −5–15 % ) . The rate of weight gain was 0.4 g/kg/day ( 95 % CI , −0.6 , 1.4 ) greater among children receiving locally produced RTUF . The prevalence of diarrhea reported by mothers was 3.7 % for locally produced RTUF and 4.3 % for imported RTUF . After completion of home therapy and resumption of habitual diet for 6 months , 91 % of all children maintained a normal WHZ . Conclusions : Home-based therapy with RTUF was successful in affecting complete catch-up growth . In this study , locally produced and imported RTUF were similar in efficacy in treating of  severe childhood malnutrition St and ard nutritional treatment of moderate acute malnutrition ( MAM ) relies on fortified blended flours though their importance to treat this condition is a matter of discussion . With the newly introduced World Health Organization growth st and ards , more children at an early stage of malnutrition will be treated following the dietary protocol s as for severe acute malnutrition , including ready-to-use therapeutic food ( RUTF ) . We compared the effectiveness of RUTF and a corn/soy-blend (CSB)-based pre-mix for the treatment of MAM in the supplementary feeding programmes ( SFPs ) supported by Médecins Sans Frontières , located in the Zinder region ( south of Niger ) . Children measuring 65 to < 110 cm , newly admitted with MAM [ weight-for-height ( WHM% ) between 70 % and < 80 % of the NCHS median ] were r and omly allocated to receive either RUTF ( Plumpy'Nut ® , 1000 kcal day(-1 ) ) or a CSB pre-mix ( 1231 kcal day(-1 ) ) . Other interventions were similar in both groups ( e.g. weekly family ration and ration at discharge ) . Children were followed weekly up to recovery ( WHM% ≥ 85 % for 2 consecutive weeks ) . In total , 215 children were recruited in the RUTF group and 236 children in the CSB pre-mix group with an overall recovery rate of 79.1 and 64.4 % , respectively ( p < 0.001 ) . There was no evidence for a difference between death , defaulter and non-responder rates . More transfers to the inpatient Therapeutic Feeding Centre ( I-TFC ) were observed in the CSB pre-mix group ( 19.1 % ) compared to the RUTF group ( 9.3 % ) ( p = 0.003 ) . The average weight gain up to discharge was 1.08 g kg(-1 ) day(-1 ) higher in the RUTF group [ 95 % confidence interval : 0.46 - 1.70 ] and the length of stay was 2 weeks shorter in the RUTF group ( p < 0.001 ) . For the treatment of childhood MAM in Niger  , RUTF result ed in a higher weight gain , a higher recovery rate , a shorter length of stay and a lower transfer rate to the I-TFC compared to a CSB pre-mix . This might have important implication s on the efficacy and the quality of SFPs OBJECTIVE To estimate the association of improved nutrition in early life with  adult intellectual functioning , controlling for years of schooling . DESIGN Prospect i ve cohort study . SETTING Four villages in Guatemala , as well as locations within Guatemala to which cohort members migrated . PARTICIPANTS Individuals who had participated as children in a nutrition supplementation intervention trial from March 1 , 1969 , through February 28 , 1977 ( N = 2392 ) . From May 1 , 2002 , through April 30 , 2004 , adequate information for analysis was obtained from 1448 of 2118 individuals ( 68.4 % ) not known to have died . INTERVENTIONS Individuals exposed to atole ( a protein-rich enhanced nutrition supplement ) at birth through age 24 months were compared with those exposed to the supplement at other ages or to fresco , a sugar-sweetened beverage . We measured years of schooling by interview . MAIN OUTCOME MEASURES Scores on the Serie Interamericana ( InterAmerican Series ) tests of reading comprehension and the Raven Progressive Matrices , obtained from May 1 , 2002 , through April 30 , 2004 . RESULTS In models controlling for years of schooling and other predictors of intellectual functioning , exposure to atole at birth to age 24 months was associated with an increase of 3.46 points ( 95 % confidence interval , -1.26 to 8.18 ) and 1.74 points ( 95 % confidence interval , 0.53 - 2.95 ) on the InterAmerican Series and Raven Progressive Matrices tests , respectively . There was no statistical interaction between exposure to atole at birth to age 24 months and years of schooling on either outcome ( P = .24 and P = .60 , respectively ) . CONCLUSION Improved early-life nutrition is associated with increased intellectual functioning in adulthood after taking into account the effect of schooling Background Malnutrition constitutes a public health problem throughout the world and particularly in developing countries . Aims The objective of the study is to assess the impact of an elementary integrator composed of Spiruline ( Spirulina platensis ) and Misola ( millet , soja , peanut ) produced at the Centre Medical St Camille ( CMSC ) of Ouagadougou , Burkina Faso , on the nutritional status of undernourished children . Material s and methods 550 undernourished children of less than 5 years old were enrolled in this study , 455 showed severe marasma , 57 marasma of medium severity and 38 kwashiorkor plus marasma . We divided the children r and omly into four groups : 170 were given Misola ( 731 ± 7 kcal/day ) , 170 were given Spiruline plus traditional meals ( 748 ± 6 kcal/day ) , 170 were given Spiruline plus Misola ( 767 ± 5 kcal/day ) . Forty children received only traditional meals ( 722 ± 8 kcal/day ) and functioned as the control group . The duration of this study was eight weeks . Results and Discussion Anthropometrics and haematological parameters allowed us to appreciate both the nutritional and biological evolution of these children . The rehabilitation with Spiruline plus Misola ( this association gave an energy intake of 767 ± 5 kcal/day with a protein assumption of 33.3 ± 1.2 g a day ) , both greater than Misola or Spiruline alone , seems to correct weight loss more quickly . Conclusion Our results indicate that Misola , Spiruline plus traditional meals or Spiruline plus Misola are all a good food supplement for undernourished children , but the rehabilitation by Spiruline plus Misola seems synergically favour the nutrition rehabilitation better than the simple addition of protein and energy intake Background The period of complementary feeding , starting around 6 months of age , is a time of high risk for growth faltering and morbidity . Low micronutrient density of locally available foods is a common problem in low income countries . Children of HIV-infected women are especially vulnerable . Although antiretroviral prophylaxis can reduce breast milk HIV transmission in early infancy , there are no clear feeding guidelines for after 6 months . There is a need for acceptable , feasible , affordable , sustainable and safe ( AFASS by WHO terminology ) foods for both HIV-exposed and unexposed children after 6 months of age . Methods and Findings We conducted in Lusaka , Zambia , a r and omised double-blind trial of two locally made infant foods : porridges made of flour composed of maize , beans , bambaranuts and groundnuts . One flour contained a basal and the other a rich level of micronutrient fortification .  Infants ( n = 743 ) aged 6 months were r and omised to receive either regime for 12 months . The primary outcome was stunting ( length-for-age Z<−2 ) at age 18 months . No significant differences were seen between trial arms overall in proportion stunted at 18 months ( adjusted odds ratio 0.87 ; 95 % CI 0.50 , 1.53 ; P = 0.63 ) , mean length-for-age Z score , or rate of hospital referral or death . Among children of HIV-infected mothers who breastfed < 6 months ( 53 % of HIV-infected mothers ) , the richly-fortified porridge  increased length-for-age and reduced stunting ( adjusted odds ratio 0.17 ; 95 % CI 0.04 , 0.84 ; P = 0.03 ) . Rich fortification improved iron status at 18 months as measured by hemoglobin , ferritin and serum transferrin receptors . Conclusions In the whole study population , the rich micronutrient fortification did not reduce stunting or hospital referral but did improve iron status and reduce anemia . Importantly , in the infants of HIV-infected mothers who stopped breastfeeding before 6 months , the rich fortification improved linear growth . Provision of such fortified foods may benefit health of these high risk infants . Trial registration Controlled-Trials.com IS RCT BACKGROUND Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age . Previous evidence suggests that targeting nutrition interventions earlier in life , before children become undernourished , might be more effective for reduction of childhood undernutrition . METHODS We used a cluster r and omised trial to compare two World Vision programmes for maternal and child health  and nutrition , which included a behaviour change and communication component : a  preventive model , targeting all children aged 6 - 23 months ; and a  recuperative model  , targeting underweight ( weight-for-age Z score < -2 ) children aged 6 - 60 months . Both models also targeted pregnant and lactating women . Clusters of communities ( n=20 ) were paired on access to services and other factors and were r and omly assigned to each model . Using two cross-sectional surveys ( at baseline and 3 years later ) , we tested differences in undernutrition in children aged 12 - 41 months ( roughly 1500 children per survey ) . Analyses were by intention to treat , both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex . This study is registered with Clinical Trials.gov , number NCT00210418 . FINDINGS There were no differences between programme groups at baseline . At follow-up , stunting , underweight , and wasting ( using WHO 2006 reference data ) were 4 - 6 percentage points lower in preventive than in recuperative communities ; and mean anthropometric indicators were higher by + 0.14 Z scores ( height for age ; p=0.07 ) , and + 0.24 Z scores ( weight for age and weight for height ; p<0.0001 ) . The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter duration s during this period . The quality of implementation did not differ between the two programmes ; nor did use of services for maternal and child health and nutrition . INTERPRETATION The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model 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 OBJECTIVE To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets . DESIGN Quasi-experimental post-test design with a non-equivalent control group . SETTING Four villages in Mangochi District , Southern Malawi . PARTICIPANTS Households with children aged 3 - 7 years in two intervention ( n = 200 ) and two control ( n = 81 ) villages participated in a 6-month intervention employing dietary diversification , changes in food selection patterns , and modifications to food processing to reduce the phytate content of maize-based diets . Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics , anthropometry , knowledge and practice s , morbidity , haemoglobin and hair zinc . After 12 months , knowledge and practice s and dietary intakes were assessed by interactive 24-hour recalls , one during the food plenty and a second during the food shortage season . Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach . RESULTS Intervention children had diets that were significantly more diverse and of a higher quality than those of controls . Median daily intakes of protein , calcium , zinc ( total and available ) , haem iron , vitamin B12 and animal foods ( grams ; % of total energy ) were higher ( P < 0.05 ) whereas phytate intakes , phytate/zinc and phytate/iron molar ratios were lower ( P < 0.01 ) in the intervention group ; some spread of knowledge and practice s to controls occurred . CONCLUSIONS Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein , calcium , zinc and vitamin B12 , but not iron , in children from Malawian households with very limited re sources OBJECTIVE To assess the impact of the 1996 - 2005 integrated community-based micronutrient and health ( MICAH ) programme on linear growth retardation ( stunting ) in Malawian preschool children living in rural areas . DESIGN Prospect i ve study of three large-scale cross-sectional surveys conducted in 1996 , 2000 and 2004 in MICAH and Comparison population s. SETTING Rural areas in Malawi . SUBJECTS Preschool children ( 6.0 - 59.9 months ) from r and omly selected households ( 474 from the 1996 baseline survey ; 1264 from 2000 MICAH areas ; 1500 from 2000 Comparison areas ; 1959 from 2004 MICAH areas ; and 1008 from 2004 Comparison areas ) , who responded to a household question naire  , were weighed and measured using st and ard protocol s. RESULTS At the baseline in 1996 , the prevalence of stunting ( 60.2 % ) was very high . By 2000 , the prevalence of stunting had declined to 50.6 % and 56.0 % ( chi2 = 7.8 , P = 0.005 ) in MICAH and Comparison areas , respectively . In 2004 , the prevalence of stunting did not differ significantly between MICAH and Comparison areas ( 43.0 % v. 45.1 % ; chi2 = 1.11 , P = 0.3 ) . Severe stunting affected 34.7 % of children at baseline , which declined to 15.8 % and 17.1 % ( chi2 = 0.86 , P = 0.4 ) in MICAH and Comparison areas , respectively , by 2004 . Regional variations existed , with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts . CONCLUSION Given the length of implementation , wide-scale coverage and positive impact on child growth in Phase I ( 1996 - 2000 ) , the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi , although the catch-up improvement in Comparison areas during Phase II ( 2000 - 2004 ) can not be adequately explained Background Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering . Given the limited success of supplementation and health education programs , fortification of foods could be a viable and sustainable option . We report results from a community based double-masked , r and omized trial among children 1–4 years evaluating the effects of micronutrients ( especially of zinc and iron ) delivered through fortified milk on growth , anemia and iron status markers as part of a four group study design , running two studies simultaneously . Methods and Findings Enrolled children ( n = 633 ) were r and omly allocated to receive either micronutrients fortified milk ( MN = 316 ) or control milk ( Co = 317 ) . Intervention of MN milk provided additional 7.8 mg zinc , 9.6 mg iron , 4.2 µg selenium , 0.27 mg copper , 156 µg vitamin A , 40.2 mg vitamin C , and 7.5 mg vitamin E per day ( three serves ) for one year . Anthropometry was recorded at baseline , mid- and end- study . Hematological parameters were estimated at baseline and end- study . Both groups were comparable at baseline . Compliance was over 85 % and did not vary between groups . Compared to children consuming Co milk , children consuming MN milk showed significant improvement in weight gain ( difference of mean : 0.21 kg/year ; 95 % confidence interval [ CI ] 0.12 to 0.31 , p<0.001 ) and height gain ( difference of mean : 0.51 cm/year ; 95 % CI 0.27 to 0.75 , p<0.001 ) . Mean hemoglobin ( Hb ) ( difference of 13.6 g/L ; 95 % CI 11.1 to 16.0 , p<0.001 ) and serum ferritin levels ( difference of 7.9 µg/L ; 95 % CI 5.4 to 10.5 , p<0.001 ) also improved . Children in MN group had 88 % ( odds ratio = 0.12 , 95 % CI 0.08 to 0.20 , p<0.001 ) lower risk of iron deficiency anemia . Conclusions / Significance Milk provides an acceptable and effective vehicle for delivery of specific micronutrients , especially zinc and iron . Micronutrient bundle improved growth and iron status and reduced anemia in children 1–4 years old . Trial Registration Clinical Trials.gov Background Catch-up growth after an infection is essential for children to maintain good nutritional status . To prevent malnutrition , WHO recommends that children are given one additional healthy meal per day during the 2 weeks after onset of illness . We investigated to what extent ready-to-use therapeutic food ( RUTF ) promotes catch-up growth in children after an acute , uncomplicated episode of Plasmodium falciparum malaria . Methods We did an open r and omised trial of children aged 6–59 months with confirmed malaria who attended a Médecins Sans Frontières-supported outpatient clinic in Katanga Province , Democratic Republic of Congo . All children received a clinical examination and malaria treatment . Patients were then r and omly assigned to either an RUTF group , who received daily supplemental RUTF ( a high-protein peanut-based paste ) for 14 days , or to a control group , who received no supplemental food . Children were weighed at baseline and on days 14 and 28 . The primary outcome was mean weight change after 14 days ' RUTF . Analysis was by intention-to-treat . Results 93 children received RUTF and 87 received no food supplementation .  At day 14 , the RUTF group had a mean weight gain of 353 g compared with 189 g in the control group ( difference 164 [ 95%CI 52–277 ] , p = 0.005 ) . However , at day 28 there was no statistically significant difference between the groups ( 539 g versus 414 g , respectively [ p = 0.053 ] ) . Similarly , rate of weight gain per kg bodyweight per day was significantly higher at day 14 in the RUTF group ( 2.4 g/kg per day versus 1.3 g/kg per day , p = 0.005 ) but at day 28 was 1.9 g/kg per day in the RUTF group versus 1.5 g/kg per day in the control group ( p = 0.076 ) . Conclusions Children receiving RUTF for 14 days after effective treatment of an uncomplicated malaria episode had a faster weight gain than children not given supplementation , reducing the period that children were at risk of malnutrition . Trial Registration Clinical Trials.gov Infectious disease and poor diet are the two proximal causes of malnutrition in children . During the 1990s , integrated nutrition programs implemented by Save the Children ( SC ) in Vietnam reduced severe child malnutrition , but it has not been clear if this impact was due primarily to improved diet or reduced disease . The aim of this study was to determine whether a community-based , integrated nutrition program in Vietnam reduced child morbidity due to diarrhea or acute respiratory infections . Children 5 to 25 months old were r and omly selected from r and omly assigned intervention and comparison communes . Caregivers of children from the intervention and comparison groups ( n = 119 per group ) were interviewed about their child 's morbidity at program baseline and at study months 2 , 4 , 6 , and 12 . Multiple logistic regression and general estimating equations ( GEE ) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks . Respiratory illness , mainly upper respiratory illness , was more common than diarrheal disease at baseline ( 54 % vs. 6 % , respectively ) . During follow-up , children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes ( AOR = 0.5 ; p = .001 ) . Diarrheal disease was also lower in the intervention group , although differences were not statistically significant . We conclude that SC 's integrated nutrition program was associated with reduced upper respiratory illness , perhaps due to improved hygiene practice s and /or improved micronutrient intakes 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 OBJECTIVE To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread ( FS ) or micronutrient-fortified maize-soy flour ( likuni phala [ LP ] ) . DESIGN R and omized , controlled , single-blind trial . SETTING Rural Malawi . PARTICIPANTS A total of 182 six-month-old infants . INTERVENTION Participants were r and omized to receive 1 year of daily supplementation with 71 g of LP ( 282 kcal ) , 50 g of FS ( FS50 ) ( 256 kcal ) , or 25 g of FS ( FS25 ) ( 130 [ corrected ] kcal ) . OUTCOME MEASURES Weight and length gains and the incidences of severe stunting , underweight , and wasting . RESULTS Mean weight and length gains in the LP , FS50 , and FS25 groups were 2.37 , 2.47 , and 2.37 kg ( P = .66 ) and 12.7 , 13.5 , and 13.2 cm ( P = .23 ) , respectively . In the same groups , the cumulative 12-month incidence of severe stunting was 13.3 % , 0.0 % , and 3.5 % ( P = .01 ) , of severe underweight was 15.0 % , 22.5 % , and 16.9 % ( P = .71 ) , and of severe wasting was 1.8 % , 1.9 % , and 1.8 % ( P > .99 ) . Compared with LP-supplemented infants , those given FS50 gained a mean of 100 g more weight and 0.8 cm more length . There was a significant interaction between baseline length and intervention ( P = .04 ) ; in children with below-median length at enrollment , those given FS50 gained a mean of 1.9 cm more than individuals receiving LP . CONCLUSION One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants , but it is likely to boost linear growth in the most disadvantaged individuals and , hence , decrease the incidence of severe stunting 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 , A r and omized trial was carried out to test the effectiveness of nutrition education  as a rehabilitation measure for childhood protein-energy malnutrition . The intervention comprised a series of home-based nutrition counselling sessions for the mothers/caretakers of 65 children ( hospital out patients ) aged 7 - 36 months , who were suffering from mild to moderate protein-energy malnutrition . Both the intervention and control groups of children and their caretakers were assessed over a 12-month period : the children on admission and at 3-monthly intervals for weight-for-age , weight-for-height , height-for-age , triceps skinfold-for-age and clinical features ; the caretakers on admission and at the final follow-up for nutrition knowledge . Although the nutrition knowledge score of the caretakers in the intervention group improved significantly , no significant differences developed between the two groups of children regarding any of the nutritional status measures assessed . Thus , nutrition education per se was not found to be a major factor in promoting recovery from malnutrition . Nevertheless , both groups of children showed highly significant improvements in all age-adjusted anthropometric assessment s except height-for-age In developing countries , the age at which breastfed infants are first given complementary foods is of public health importance because of the risk of diarrhoeal disease from contaminated weaning foods , and the potential risk of growth faltering if foods are inappropriately delayed . To evaluate whether there are any advantage of complementary feeding prior to 6 months , low-income primiparous mothers who had exclusively breastfed for 4 months were r and omly assigned to one of 3 groups : continued exclusive breastfeeding to 6 months ( EBF ) ( n = 50 ) ; introduction of complementary foods at 4 months with ad libitum nursing from 4 - 6 months ( SF ) ( n = 47 ) ; and introduction of complementary foods at 4 months , with maintenance of baseline nursing frequency from 4 - 6 months ( SF-M ) ( n = 44 ) . Baby foods in jars were provided to the SF and SF-M groups from 4 to 6 months . Subjects were visited weekly and provided with lactation guidance ; at 4 , 5 , and 6 months measurements were made of infant intake and breast milk composition . At 4 months , breast milk intake averaged 797 ( 139 ) g per day ( no difference among groups ) . Between 4 and 6 months , breast milk intake was unchanged in EBF infants ( + 6 ) but decreased in the SF ( -103 ) , and SF-M ( -62 ) groups ( p < 0.001 ) . Change in total energy intake ( including solid foods ) and infant weight and length gain did not differ significantly between groups . Weight and length gain from 4 - 6 months were comparable to those of breastfed infants in an affluent USA population . The results indicate that breastfed infants self-regulate their total energy intake when other foods are introduced . As a result , there is no advantage in introducing complementary foods before 6 months in this population , whereas there may be disadvantages if there is increased exposure to contaminated weaning foods 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 Objective To study the impact of wholesome mid day meal ( MDM ) program run by an NGO on the growth of the primary school students in rural area of Mathura district . Methods This intervention study involved children enrolled in Government run rural primary schools in Mathura district in Uttar Pradesh from March 06 through August 07 . A wholesome , nutritionally balanced MDM provided by an NGO for the students in the 6 primary schools was selected as intervention group . Control group consisted of children in 8 schools which received locally prepared MDM  by village panchayats . Height , weight , change in height/month , change in weight/month , prevalence of protein-energy malnutrition and prevalence of signs of vitamin deficiencies , were measured . Results Food was provided for 221 days in one year . Within group and between groups repetitive measures were compared using generalized estimating equation ( GEE ) . Within both intervention and control groups height and weight had significantly increased ( p < 0.05 ) , while there was no significant difference between the groups . There was no change in prevalence of malnutrition within either of the groups . Reduction in vitamin A deficiency signs was 38 % more in intervention group ( p < 0.001 ) . Prevalence of Vitamin D deficiency reduced by 50 % more in intervention group . No such differences between groups were observed for vitamin B complex and vitamin C. Conclusions MDM provided by the NGO has no better impact on growth of the primary school children , however , it reduced prevalence of vitamin deficiency significantly in comparison to the MDM run by Village Panchayats Objective To evaluate the effectiveness of a locally made ready-to-use therapeutic food ( RUTF ) in decreasing mild to moderate malnutrition . Design A r and omized open label , controlled trial . Setting Pre-schools run by the Department of Community Health in Kaniyambadi administrative block , Vellore , India ; duration of follow-up - 3 months from the date of recruitment . Participants Pupils aged 18–60 months with Weight-for-Age ≤2 SD . Interventions A locally produced energy-dense supplement ( RUTF ) , and the current st and ard of care [ teaching caregivers how to make a fortified cereal-milk supplement called High Calorie Cereal Milk (HCCM)].Main outcome measures Increase in weight-for-age status ; increase in levels of plasma zinc , vitamin B12 , serum albumin and haemoglobin . Results The Mean ( SD ) weight gain at 3 months was higher in the RUTF group : RUTF ( n=51 ) : 0.54 kg ; ( SE = 0.05 ; 95 % CI = 0.44–0.65 ) vs HCCM ( n=45 ) : 0.38 kg ; ( SE = 0.06 ; 95 % CI = 0.25–0.51 ) , P = 0.047 . The weight gain per kilogram of body weight was directly proportional to the severity of malnutrition . Conclusions Community-based treatment showed weight gain in both groups , the gain being higher with RUTF AIM To investigate whether the low docosahexaenoic acid ( DHA ) status of malnourished , mostly breast fed , Pakistani children can be improved by fish oil ( FO ) supplementation . METHODS Ten malnourished children ( aged 8–30 months ) received 500 mg FO daily for nine weeks . The supplement contained 62.8 mol% ( 314 mg ) long chain polyunsaturated fatty acids of the ω3 series ( LCPUFAω3 ) and 22.5 mol% ( 112 mg ) DHA . Seven FO unsupplemented children served as controls . Red blood cell ( RBC ) fatty acids were analysed at baseline and at the study end . RESULTS FO supplementation  augmented mean ( SD ) RBC DHA from 2.27 ( 0.81 ) to 3.35 ( 0.76 ) mol% , without significantly affecting the concentrations of LCPUFAω6 . Unsupplemented children showed no RBC fatty acid changes . One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol% , whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol% . CONCLUSION FO supplementation improves the DHA status of malnourished children . The supplement is apparently well absorbed and not exclusively used as a source of energy Inadequate micronutrient intake during pregnancy , lactation and infancy is a major problem in many developing countries . Lipid-based nutrient supplements ( LNS ) can improve micronutrient status , growth and development of infants , and also have potential to improve nutritional status of pregnant and lactating women . The objective of the study was to test the acceptability of LNS design ed for infants ( LNS-20gM ) and pregnant or lactating women ( LNS-P&L ) . Participants were infants ( n = 22 , mean age = 8 months ) and pregnant or lactating women ( n = 24 ) attending routine services at a hospital in Ghana . Infants consumed 45 g of a test meal consisting of one part LNS-20gM and three parts fermented maize porridge , while women consumed 50 g of a similar test meal containing LNS-P&L instead . Participants also used their respective LNS at home for 14 days . Primary outcome was the proportion of the test meal consumed . On average , infants consumed 76.2 % of the test meal [ 95 % ( confidence interval ) CI : 65.7 , 86.7 ] , while women consumed 87.1 % ( 95 % CI : 82.6 , 91.6 ) . During the 14-day period , median daily consumption of LNS-20gM was 19.3 g , very close to the recommended 20 g d(-1 ) , while that of LNS-P&L was one sachet , as recommended . We conclude that LNS-20gM and LNS-P&L were well accepted Clinical trials were conducted to measure the effect of dietary energy on total daily energy intakes by nine hospitalized young children recovering from protein-energy malnutrition .  Semi-solid mixed diets containing either 50 or 100 kcal/100 g were offered at fixed intervals five times per day until the children refused further intake . Each diet was offered for seven consecutive days in alternate order . The mean + /- SD amount consumed with the low-density ( LD ) diet was significantly greater than with the high-density ( HD ) diet ( 220 + /- 35 vs 148 + /- 21 g/kg/d , P less than 0.001 ) , but the amount of energy consumed with the HD diet was significantly greater than with the LD diet ( 148 + /- 21 vs 110 + /- 18 kcal/kg/d , P less than 0.001 ) . There were no differences in total daily intake by day of diet period with the HD diet , but the intakes increased during the first 2 - 4 days with the LD diet . The maximum intakes at a single meal averaged between 40 and 66 g/kg/d for individual children receiving the LD diet , and were negatively related to the children 's lengths and weight-for-length Z scores . We conclude that dietary energy density limited the amount of energy consumed from LD weaning diets offered at fixed frequencies , presumably because the volume of intake required to satisfy the children 's energy needs exceeded their gastric capacity OBJECTIVE This paper compares the effects of goat 's milk and cow 's milk on weight gain and fat absorption , in children with overt malnutrition . METHODS Thirty hospitalized malnourished children aged from 1 to 5 years were included in a r and omized double-blind trial . The children were fed either goat or cow 's milk with a r and omized will defined composition , added with vegetable oil , sugar , vitamins and minerals o achieve 1,000 kcal/liter . Children were offered 100 kcal/kg on the first day , with a regular daily increase in energy intake thereafter that reached 200 kcal/kg per day on the tenth day . RESULTS Both groups of children had the same degree of malnutrition on inclusion . The mean weight-for-height Z score was -1.7 in both groups . One death with c and idiasis occurred in the goat 's milk group . Weight gain was similar in both groups : 8.5 g/kg/day ( SE = 1.37 ) with goat 's milk and 7.8 ( SE = 1.9 ) with cow 's milk . There was no significant difference in HEM intake : 157 ml/kg/day ( SE = 4 ) , vs 162 ( SE = 4 ) for goat and cow 's milk , respectively . Fat absorption coefficients on the 15th day of treatment were also similar in both groups . CONCLUSION These results suggest that goat 's milk has a nutritional value similar to that of cow 's milk and could be used as an alternative to cow 's milk for rehabilitating undernourished children BACKGROUND Failure to thrive is generally attributed to undernutrition , but little is known about the appetite or eating behaviour of children with the condition . The hypothesis that young children who fail to thrive lack a normal sensitivity to internal hunger or satiation cues was tested in this study using an energy compensation procedure . METHOD Twenty-seven children under assessment by a community-based service for failure to thrive , with weight gain in the lowest 5 % for their age , were studied at one year of age with 26 controls of the same age and sex with normal weight gain , resident in the same local geographical area .  Test meals were given in the child 's own home on two separate days . The test meals were preceded by either a high energy ( 402 kJ ) drink , or by a low energy ( 1 kJ ) drink on a control day . The order was r and omised , and the study conducted double blind , without the experimenter or the mother knowing which drink was which . Energy intake at the test meal was measured . RESULTS There was no significant difference in the birth weight of the children in the two groups but by the time of the test the cases weighed significantly less than controls , with mean ( SD ) weight 9.06 ( 1.05 ) kg and 11.59 ( 1.59 ) kg respectively . In relation to the British Growth Reference for weight this is a difference of 2.2 SD . Mean ( SD ) energy intake at the meal on the control day was significantly lower in the case children than the controls ( FTT 687.5 ( 334.3 ) kJ ; controls 1065.9 ( 431.8 ) kJ ; p < .001 ) . After the high energy drink , controls reduced their energy intake at the meal by a mean ( SD ) -257.3 ( 383.3 ) kJ while the cases showed a slight average increase of + 78.1 ( 365.9 ) kJ ; t = 3.26 , df 51 , p < .001 . Per kJ of the pre-load , the average change was -1.18 kJ in controls and + 0.80 kJ in cases . CONCLUSIONS The controls compensated as expected for their high energy load at the subsequent meal , but the case children did not , showing that they lack the normal responses to internal hunger/satiation cues . High energy snacks may improve the nutritional status of children who fail to thrive BACKGROUND Evidence of the effectiveness of lipid-based ready-to-use complementary foods ( RUCF ) at improving linear growth among infants aged 6 - 12 mo is scarce , and further work is warranted . OBJECTIVE The objective was to assess the effectiveness of a fortified soybean-maize-sorghum RUCF paste compared with a fortified corn soy blend ( UNIMIX ) porridge on the prevalence of underweight  and stunting among infants in South Kivu Province , Democratic Republic of Congo . DESIGN Infants were r and omly assigned at 6 mo of age to receive either RUCF ( n = 691 ) or UNIMIX ( n = 692 ) for 6 mo . In addition to admission and monthly anthropometric measurements , hemoglobin , triglyceride , and cholesterol were measured at enrollment and at the end of the study . RESULTS No significant differences in the prevalence of stunting ( RUCF : 48.6 % ; UNIMIX : 46.4 % ; P = 0.31 ) , the prevalence of underweight ( RUCF : 20.4 % ; UNIMIX : 18.2 % ; P = 0.42 ) , or weight gain ( RUCF : 1.2 ± 0.7 kg ; UNIMIX : 1.3 ± 0.7 kg ; P = 0.08 ) were found . A small but statistically significant difference in length gain ( RUCF : 5.2 ± 2.0 ; UNIMIX : 5.4 ± 2.0 ; P = 0.03 ) was found . No significant differences in the concentrations of hemoglobin , serum triglyceride , and serum cholesterol were found between the 2 groups . CONCLUSION No significant differences were found between the RUCF and UNIMIX in the reduction of the prevalence of stunting and underweight at 12 mo of age among rural Congolese infants . This trial was registered at controlled-trials.com as IS RCT N20267635 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 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 , Objective : The study tests the hypothesis that a low daily fat intake may induce a negative fat balance and impair catch-up growth in stunted children between 3 and 9 y of age . Design : R and omized case-control study . Setting : Three rural villages of the West Kiang District , The Gambia . Subjects : Three groups of 30 stunted but not wasted children ( height for age z-score≤−2.0 , weight for height z-score≥−2.0 ) 3–9 y of age were selected by anthropometric survey . Groups were matched for age , sex , village , degree of stunting and season . Intervention : Two groups were r and omly assigned to be supplemented five days a week for one year with either a high fat ( n=29 ) or a high carbohydrate biscuit ( n=30 ) each containing approximately 1600 kJ. The third group was a non supplemented control group ( n=29 ) . Growth , nutritional status , dietary intake , resting energy expenditure and morbidity were compared . Results : Neither the high fat nor the high carbohydrate supplement had an effect on weight or height gain . The high fat supplement did slightly increase adipose tissue mass . There was no effect of supplementation on resting energy expenditure or morbidity . In addition , the annual growth rate was not associated with a morbidity score . Conclusions : Results show that neither a high fat nor a high carbohydrate supplement given during 12 months to stunted Gambian children  induced catch-up growth . The authors suggest that an adverse effect of the environment on catch-up growth persists despite the nutritional interventions .Sponsorship : Nestlé Foundation for the Study of the Problems of Nutrition in the World , Lausanne , Switzerl and This study compared hospital to ambulatory nutritional rehabilitation outcomes and costs . Following a hospital stay to resolve initial acute medical conditions , 100 malnourished children ( 54 per cent male , ages 5 to 28 months ) in Niger were r and omly assigned to either hospital or ambulatory nutritional rehabilitation .  Anthropometric measures were assessed at 15 , 30 , 60 , 90 and 180 days post-r and omization . Following r and omization , the hospital group received a mean of 12.9 days of hospital rehabilitation and 5.6 days of ambulatory rehabilitation , while the ambulatory group received 2.2 days of hospital rehabilitation and 11.9 days of ambulatory rehabilitation . No significant differences between the two study groups in mortality rates or weight gain were found . The mean cost for hospital rehabilitation  was 120 per cent higher ( P < 0.001 ) than ambulatory rehabilitation . This study was the first r and omized clinical trial directly comparing hospital to ambulatory nutritional rehabilitation and suggests that ambulatory rehabilitation is more cost-effective Weight-gain in 35 slightly undernourished Australian Aboriginal infants was studied in hospital ( 49 admissions ) during a blind controlled trial of a pre-hydrolysed low-lactose milk preparation and reconstituted full-cream milk powder . Infants fed the lactose hydrolysed milk gained 70 % more weight than those receiving normal milk . Better weight-gains were achieved in those on the lactose hydrolysed milk irrespective of percentage st and ard weight for age , the presence of diarrhoea on admission to the trial , and stool sugar concentrations . The use of low-lactose milk should be considered in nutritional aid programmes for undernourished children throughout the world A project to promote the health and nutritional status of women and pre-school children was started from 1995 to 1997 in three villages in Suvannakhet Province , Lao PDR . One village served as control . In 1995 , for the baseline survey , 456 females , and in 1997 , for the final evaluation , 363 females from the four villages volunteered for further investigations . An attempt was made to involve all females in the reproductive age residing in the villages . At the same time also the nutritional status of 321 and about 540 r and omly selected pre-school children respectively was also assessed through physical examination and anthropometric measurements . Intervention measures included introducing  growth charts  and taking regular anthropometric measurements of women in the reproductive age and of pre-school children . Training in nutritional aspects such as giving colostrum to new-borns , prepare proper weaning food and supplementary feeding , animal-raising and home gardening was also introduced and provided to health personnel , village leaders and in women clubs . Special attention was given to the control of acute infectious diseases . The conventional EPI program was enforced as well . Health education in matters of mother and child health care was also provided . The proportion of undernourished women was rather high at about 15 % . For pre-school children , the proportion of wasting was around 5 % , and of stunting 50 % and above . Intervention did not improve the nutritional status either of the women or of the children . It was concluded that the time span of two years is too short for a decrease in the proportion of undernourishment to be observed . An improvement was achieved for some indicators of mother and child health care . This seems to indicate the population 's willingness to follow suggestions to improve their health . Most probably , if attempts to improve the nutritional status were continued , an improvement in this aspect could also be observed , if the population can be encouraged to take actions and develop initiatives by themselves 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 In the Kingston Project malnourished children referred from public health clinics to a metabolic ward were treated at home using community health aides within the existing health service . We have previously provided anthropometric results showing significantly greater gains in weight and length for groups given a high energy supplement ( 3.31 MJ daily ) for 3 months during treatment , and greatest gains for a group treated with metronidazole at the beginning of supplementation [ Heikens et al. , Eur . J. Clin . Nutr . 43 , 145 - 160 ( 1989 ) ; 47 , 160 - 173 ( 1993 ) ] . We now present findings on morbidity and relate these to the separate interventions and to growth velocities . Although referral was solely on nutritional criteria , 65 % of the sample were found to have additional illnesses at enrollment . During the study period ( 6 months ) upper respiratory tract infections ( URTI ) were the commonest illness in all groups ; there were significantly more gastroenteric infections in the group given the supplement , but not the antibiotic , treatment ; the children who received only the  st  and  ard health service care were ill more often and for longer periods than children in the other groups . Diarrhoea , fever and dysentery prevalences were all found to relate significantly to weight velocity , and although prevalences differed between treatment groups , the detrimental effect on velocity was similar whichever the group 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 BACKGROUND Management of moderate acute malnutrition ( MAM ) is , currently , focused on food supplementation approaches . However , the sustainability of these strategies remains weak in low- and middle-income countries . In food-secure setting s , an educational/behavioral intervention could be an alternative for improving MAM management . OBJECTIVE This study compared the effectiveness of weekly context -appropriate child-centered counseling ( CCC ) , with an improved corn-soy blend [ corn-soy blend with added micronutrients ( CSB++ ) ] or a locally produced ready-to-use supplementary food ( RUSF ) , in treating MAM through first-line rural health services . DESIGN We used a cluster r and omized controlled trial design with 3 arms , involving 18 rural health centers ( 6 by arm ) and children aged 6 - 24 mo with uncomplicated MAM . In the first arm ( CCC ) , trained health workers provided weekly personalized counseling to caretakers . In the 2 other arms , children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF . Both food supplements provided ∼250 kcal/d . RESULTS The recovery rate after 3 mo of treatment was significantly lower with CCC ( 57.8 % ) than with CSB++ ( 74.5 % ) and RUSF ( 74.2 % ) ( P < 0001 ) . Mothers ' attendance at health facilities was also substantially lower in the CCC arm ( P < 0001 ) ; this arm had a high defaulter rate ( P < 0.003 ) . When the analysis was adjusted for attendance , we did not find a significant difference between the 3 arms , with incidence rate ratios of 1.14 ( 95 % CI : 0.99 , 1.31 ) and 1.13 ( 95 % CI : 0.98 , 1.30 ) for the CSB++ and RUSF arms , respectively , compared with the CCC arm . CONCLUSION Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC , we hypothesize that appropriate and specific nutrition counseling centered on children 's needs , through primary health facilities , might be an alternative strategy for MAM treatment in rural food-secure areas , provided that attendance at counseling sessions by the caregiver is ensured . This trial was registered at clinical trials.gov as NCT01115647 A nutritional intervention project was undertaken for three years in four villages located in a relatively prospero us irrigation area in northeast Thail and where sub- clinical undernutrition is still prevalent . Data were collected at each measuring pont from approximately 270 preschool children in four intervention villages . Approximately 120 children in three other villages in the same area served as controls for each measuring point . Various activities such as teaching nutrition , introducing supplementary feeding , and using and underst and ing weight charts , as well as home visits , were carried out in the intervention villages . An obvious improvement in the nutritional status of children in the intervention villages could be observed only after two years and nine months . In order that immediate action could be taken when a child was found to be undernourished or at risk of becoming undernourished in the near future , the nutritional indicator weight-for-height  was used to assess the children 's nutritional status . However , the best indicator determining the impact of the project was height-for-age . Intervention measures were successful in diminishing marked seasonal variations in the nutritional status observed in the study area . Statistical methods are given to evaluate a prospect i ve study based on an incomplete repeated measure method Forty-two percent of Vietnamese children are stunted by two years of age . Since 1990 , Save the Children Federation/US ( SC ) has implemented integrated nutrition programs targeting young children . We evaluated the effect of SC 's nutrition program on the complementary food intake of young rural Vietnamese children . Using a longitudinal , prospect i ve , r and omized design , we followed 238 children ( 119 each from intervention and comparison communes ) age 5 to 25 months old for six months with a re-survey at 12 months . We gathered 24-hour recall data at baseline and at months 2 , 4 , 6 , and 12 . Dietary energy intake was calculated using the 1972 Vietnamese food composition table . Key outcomes were daily frequency of consuming intervention-promoted food and non-breastmilk liquids and food , daily quantity of non-breastmilk liquids and food consumed , daily energy intake , and proportion of children meeting daily median energy requirements .  Young rural children exposed to SC 's program consumed intervention-promoted and any foods more frequently , ate a greater quantity of any food , consumed more energy , and were more likely to meet their daily energy requirements than comparison children . Some effects were only observed during the intensive intervention period ; others persisted into or were evident only at the 12-month follow-up , approximately four months after program completion . Based on the mothers ' reports , the intervention did not apparently compromise breastfeeding prevalence or frequency . The intervention improved children 's food and energy intake and protected them from declining as rapidly as comparison children in meeting their energy requirements Background : HIV-exposed , uninfected ( HIV-EU ) children represent a large proportion of children in southern Africa . The reasons for their poorer growth and higher morbidity and mortality than their HIV-unexposed peers are unclear . Objective : We compared anthropometry of 125 HIV-EU with 382 HIV-unexposed young Zambian children participating in a trial of micronutrient-fortified complementary/replacement food .  Design : The r and omized controlled trial provided children from age 6 to 18 months with a porridge flour containing either a basal or a rich level of micronutrients . Weight and length were measured 3 monthly and head and arm circumferences and triceps and subscapular skinfolds 6 monthly . Results : There were no significant anthropometric differences between the 2 treatment groups . In unadjusted analyses , most anthropometric Z scores of HIV-EU children were lower than those of HIV-unexposed children ; after adjustment for treatment arm , socioeconomic factors , breastfeeding and sex , head and arm circumference Z scores remained lower . Subscapular skinfold Z scores were lower among HIV-EU than HIV-unexposed children at 6 months but not 18 months . Conclusions : Socioeconomic factors accounted for some but not all of the impaired growth of HIV-EU children . Micronutrient malnutrition may not be the socioeconomic factor responsible for the growth faltering . Factors acting earlier in life had irreversible effects Objectives : This paper reports the effects of an energy and micronutrient supplementation on mental and motor development , activity and behavior under natural conditions of children classified as iron deficient anemic and iron replete . Design : Children were r and omly assigned to two different nutritional supplements : ( 1 ) 12 mg iron+either 1171 or 209 kJ ; ( 2 ) 104 kJ+0 iron . Treatment lasted for 6 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : Eighteen anemic subjects ( hemoglobin<110 g/L ; transferrin saturation (TS)<16 % ) and 18 matched ( sex and age ) controls ( hemoglobin>110 g/L ; TS>16 % ) were selected from a pool of children with the following characteristics : 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 : Hemoglobin , ferritin , transferrin saturation and erythrocyte protoporphyrin were evaluated before and 6 months after treatment . The following psychological measurements were obtained at baseline and 2 , 4 and 6 months later . Mental and motor development was evaluated with the Bayley Scale . Motor activity was measured by 4 h continuous observations at home and at day care centers . The interactions between the child and its social and physical environment were also evaluated during 4 h of observations . Results : Anemic children  showed faster motor development and greater physical activity than the control children did . None of the other tests showed inter-group differences . Sponsorship : Nestlé Foundation . European journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , BACKGROUND Protein Malnutrition is one of the most important health indexes that affect children 's growth and development . In Thail and National Health Survey 2004 , 21.5 % of primary school students living in the rural area were below the 90th percentile of the st and ard weight for age . OBJECTIVE To compare nutritional status with serum proteins and lipids , and to determine the effect of egg supplement for primary school students aged 6 - 15 years . MATERIAL AND METHOD A r and omized experimental study was performed in 417 participants received an addition of either three or ten eggs per week for 12 consecutive weeks to basal diet .  RESULTS The anthropometric and biochemical indexes were measured , 29.1 % and 20.8 % of whom were Protein Malnutrition according to serum albumin and PreAlbumin 's criteria , respectively . Albumin and PreAlbumin levels were positively correlated with Total Cholesterol and LDL-C levels . No difference in any biochemical index has been found between 3 eggs/wk group and 10 eggs/wk group . Besides , due to continuing egg supplement , Total Cholesterol , LDL and ratio of Total Cholesterol to HDL level have decreased ( p < 0.001 ) but albumin , PreAlbumin and HDL levels have demonstrated significantly increasing levels ( p < 0.001 ) . CONCLUSION Nowadays in rural areas of Thail and there are still primary school students with protein malnutrition especially in rural area . An addition of at least 3 eggs/wk supplements can effectively correct the problem of protein malnutrition among primary school students at risk as shown by biochemical indices , and it benefits the blood cholesterol level as well 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 BACKGROUND Moderate and severe acute malnutrition affects 13 % of children < 5 y of age worldwide . Severe acute malnutrition affects fewer children but is associated with higher rates of mortality and morbidity . Supplementary feeding programs aim to treat moderate acute malnutrition and prevent the deterioration to severe acute malnutrition . OBJECTIVE The aim was to compare recovery rates of children with moderate acute malnutrition in supplementary feeding programs by using the newly recommended ration of ready-to-use supplementary food ( RUSF ) and the more conventional ration of corn-soya blend ( CSB ) in Ethiopia . DESIGN A total of 1125 children aged 6 - 60 mo with moderate acute malnutrition received 16 wk of CSB or RUSF . Children were r and omly assigned to receive one or the other food . The daily rations were purpose ly based on the conventional treatment rations distributed at the time of the study in Ethiopia : 300 g CSB and 32 g vegetable oil in the control group ( 1413 kcal ) and 92 g RUSF in the intervention group ( 500 kcal ) . The higher ration size of CSB was provided because of expected food sharing . RESULTS The HR for children in the CSB group was 0.85 ( 95 % CI : 0.73 , 0.99 ) , which indicated that they had 15 % lower recovery ( P = 0.039 ) . Recovery rates of children at the end of the 16-wk treatment period trended higher in the RUSF group ( 73 % ) than in the CSB group ( 67 % ) ( P = 0.056 ) . CONCLUSION In comparison with CSB , the treatment of moderate acute malnutrition with RUSF result ed in higher recovery rates in children , despite the large ration size and higher energy content of the conventional CSB ration We aim ed to analyse growth and recovery from undernutrition among moderately underweight ambulatory children receiving micronutrient-fortified maize-soy flour ( Likuni Phala , LP ) or ready-to-use fortified spread ( FS ) supplementary diet . One hundred and seventy-six 6 - 18-month-old individuals were r and omized to receive 500 g LP or 350 g FS weekly for 12 weeks . Baseline and end of intervention measurements were used to calculate anthropometric gains and recovery from underweight , wasting and stunting . Mean weight-for-age increased by 0.22 ( 95 % CI 0.07 - 0.37 ) and 0.28 ( 0.18 - 0.40 ) Z-score units in the LP and FS groups respectively . Comparable increase for mean weight-for-length was 0.39 ( 0.20 - 0.57 ) and 0.52 ( 0.38 - 0.65 ) Z-score units . Recovery from underweight and wasting was 20 % and 93 % in LP group and 16 % and 75 % in FS group . Few individuals recovered from stunting and mean length-for-age was not markedly changed . There were no statistically significant differences between the outcomes in the two intervention groups . In a poor food-security setting , underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize-soy flour porridge show similar recovery from moderate wasting and underweight . Neither intervention , if limited to a 12-week duration , appears to have significant impact on the process of linear growth or stunting Objective Maize and soy flour mixes are often used in the treatment of moderate malnutrition in Malawi . Their efficacy has not been formally evaluated . A recently developed ready-to-use food ( RTUF ) effectively promotes growth among severely malnourished children . The authors compared the effect of maize and soy flour with that of RTUF in the home treatment of moderately malnourished children . Methods Sixty-one underweight , stunted children 42 to 60 months of age were recruited in rural Malawi , in southeastern Africa . They received either RTUF or maize and soy flour for 12 weeks . Both supplements provided 2 MJ ( 500Kcal ) of energy daily but had different energy and nutrient densities . Outcome variables were weight and height gain and dietary intake . Results Before intervention , the mean dietary intake and weight and height gain were similar in the two groups . During the supplementation phase , the consumption of staple food fell among children receiving maize and soy flour but not among those receiving RTUF . There was thus higher intake of energy , fat , iron , and zinc in the RTUF group . Both supplements result ed in modest weight gain , but the effect lasted longer after RTUF supplementation . Height gain was not affected in either group . Periodic 24-hour dietary recalls suggested that the children received only 30 % and 43 % , respectively , of the supplementary RTUF and maize and soy flour provided . Conclusions RTUF is an acceptable alternative to maize and soy flour for dietary supplementation of moderately malnourished children . Approaches aim ed at increasing the consumption of supplementary food by the selected recipients are needed Abstract Background : Typical treatment of moderate acute malnutrition , simple wasting , in sub-Saharan Africa consists of dietary counselling and /or general or targeted distribution of corn/soy-blended flour ( CSB ) . A r and omised clinical effectiveness trial in 2007 showed CSB to be less effective than ready-to-use supplementary food ( RUSF ) . Aim : To determine the operational effectiveness of treating moderate acute malnutrition with RUSF . Methods : Children aged 6–59 months were recruited in rural southern Malawi . Each child received 65 kcal/kg/d of locally produced soy/peanut RUSF , a product that provided about 1 RDA of each micronutrient . Anthropometric measurements were taken every 2 weeks and additional rations of RUSF were distributed at this time if the child remained wasted . Study participation lasted up to 8 weeks . Results : Of the 2417 children enrolled , 80 % recovered , 4 % defaulted , 0.4 % died , 12 % remained moderately wasted and 3 % developed severe acute malnutrition . Weight , length and MUAC gain were 2.6 g/kg/d , 0.2 mm/d and 0.1 mm/d respectively . Cost per child treated was $ 5.39 . Conclusions : This intervention proved to be robust , maintaining high recovery rates and low default rates when instituted without the additional supervision and beneficiary incentives of a research setting Malnourished children ( mean age 1.2 years ) referred from public health clinics to a paediatric metabolic ward in Kingston , Jamaica , were enrolled for treatment in a community-based health care project and were r and omly allocated to one of two groups . The first group was treated at home with metronidazole and then for 6 months using the st and ard health care provided from local clinics by community health aides . The second group was given the same drug and home treatment , but in addition received a high energy supplement of 3.31 MJ daily for 3 months . We have previously shown a significant advantage in both weight and height gain for a group given the same supplement in contrast with st and ard health care controls ( Heikens et al. , 1989 , Eur . J. Clin . Nutr . 43 , 145 - 160 ) , and in this study test the addition of a drug treatment aim ed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children . This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments . Greatest gains were by the group given both treatments , but the group given the antibiotic treatment , without energy supplementation , also made better growth recovery than did controls . Only 8 % of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital , compared with 19 % for the other groups ( P < 0.05 ) . These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinic care , and suggest further that such programs should include antibiotic treatment directed at SBBO 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 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 280 Colombian infants at risk of malnutrition were r and omly assigned to 1 of 4 experimental groups formed by the presence/absence of 2 interventions : ( 1 ) food supplementation for the entire family , from mid-pregnancy until the target child was 3 years old , and ( 2 ) a twice-weekly home-visiting program to promote cognitive development , from birth until age 3 . All families received free medical care and were studied prospect ively . At 3 years of age , children who had received food supplementation averaged 2.6 cm and 642 grams larger than controls . Home visiting and supplementation together reduced the number of children with severe growth retardation . 3 years after intervention ( age 6 ) ,  supplementation effects remained . Children in the home visit condition had become larger than controls , by 1.7 cm and 448 grams . The interactive effect to reduce stunting was marginally significant at this age , and the overall distribution of scores was improved . Other results suggest that changes in family functioning as well as biological mechanisms account for the observed pattern of results BACKGROUND Children with moderate acute malnutrition ( MAM ) are often treated with fortified blended flours , most commonly a corn-soy blend ( CSB ) . However , recovery rates remain < 75 % , lower than the rate achieved with peanut paste-based ready-to-use supplementary foods ( RUSFs ) . To bridge this gap , a novel CSB recipe fortified with oil and dry skim milk , " CSB++ , " has been developed . OBJECTIVE In this trial we compared CSB++ with 2 RUSF products for the treatment of MAM to test the hypothesis that the recovery rate achieved with CSB++ will not be > 5 % worse than that achieved with either RUSF . DESIGN We conducted a prospect i ve , r and omized , investigator-blinded , controlled noninferiority trial involving rural Malawian children aged 6 - 59 mo with MAM . Children received 75 kcal CSB++ · kg(-1 ) · d(-1 ) , locally produced soy RUSF , or an imported soy/whey RUSF for ≤12 wk . RESULTS The recovery rate  for CSB++ ( n = 763 of 888 ; 85.9 % ) was similar to that for soy RUSF ( 795 of 806 , 87.7 % ; risk difference : -1.82 % ; 95 % CI : -4.95 % , 1.30 % ) and soy/whey RUSF ( 807 of 918 , 87.9 % ; risk difference : -1.99 % ; 95 % CI : -5.10 % , 1.13 % ) . On average , children who received CSB++ required 2 d longer to recover , and the rate of weight gain was less than that with either RUSF , although height gain was the same among all 3 foods studied . CONCLUSIONS A novel , locally produced , fortified blended flour ( CSB++ ) was not inferior to a locally produced soy RUSF and an imported soy/whey RUSF in facilitating recovery from MAM . The recovery rate observed for CSB++ was higher than that for any other fortified blended flour tested previously . This trial is registered at clinical trials.gov as NCT00998517 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 A metabolic balance study was performed to determine the absorption of macronutrients  and  energy  from different food items in 23 malnourished children aged 12 to 48 months with clinical ly severe acute dysentery due to shigellosis . In a 72-h balance period , the absorption of carbohydrate , protein , fat , and total energy was determined . All the children received a st and ard hospital diet ; 12 children in the test group were offered an additional calorie-dense milk ( 5.0 kJ/ml with a protein-energy ratio of 11.0 ) , and 11 children in the control group , on the other h and , received a milk formula with an energy of 2.5 kJ/ml with a protein-energy ratio of 11.0 . The intakes ( g/kg/day ) of protein , fat , carbohydrate , and energy between test and control groups were 4.25 versus 2.32 ( p = 0.01 ) , 7.63 versus 3.00 ( p = 0.01 ) , 21.09 versus 11.14 ( p = 0.01 ) , and 711 kJ/kg/day versus 338 kJ/kg/day ( p = 0.01 ) , respectively . The coefficients of absorption of protein , fat , carbohydrate , and energy between test and control groups were 61 versus 67 % ( p = 0.45 ) , 69 versus 82 % ( p = 0.11 ) , 77 versus 86 % ( p = 0.13 ) , and 72 versus 82 % ( p = 0.13 ) , respectively . The losses ( g/kg/day ) of protein , fat , carbohydrate , and energy between the two groups were 1.61 versus 0.76 ( p = 0.00 ) , 2.44 versus 0.55 ( p = 0.00 ) , 5.0 versus 1.6 ( p = 0.00 ) , and 204 kJ/kg/day versus 60 kJ/kg/day , respectively . The results of this study indicate that during the acute stage of shigellosis ( with a substantially enhanced total intake of protein , fat , carbohydrate , and energy ) , by adding calorie-dense meals in malnourished children younger than 5 years , the absorption of macronutrients is not significantly different from that with the usual diet but suboptimal dietary energy intake , as is the case under ordinary treatment conditions OBJECTIVES : The goal of this study was to determine if a responsive stimulation and feeding intervention improved developmental and nutritional outcomes compared with a regular information-based parenting program . The hypothesis was that mothers in the intervention would exhibit better parenting skills and children would exhibit better developmental and nutritional outcomes than controls . METHODS : A cluster-r and omized field trial was conducted with 302 children aged 8 to 20 months and their mothers in rural Bangladesh who were r and omly assigned according to village to 1 of 3 groups . The control mothers received 12 informational sessions on health and nutrition . The intervention groups received an additional 6 sessions delivered by peer educators who included modeling and coached practice in self-feeding and verbal responsiveness with the child during play . A second intervention group received , along with the sessions , 6 months of a food powder fortified with minerals and vitamins . Developmental outcomes included the Home Observation for Measurement of the Environment ( HOME ) Inventory , mother-child responsive talk , and language development . Nutritional outcomes included weight , height , self-feeding , and mouthfuls eaten . We used analysis of covariance to compare the 3 groups at the posttest and at follow-up , covarying the pretest levels and confounders . RESULTS : At follow-up , responsive stimulation-feeding groups had better HOME inventory scores , responsive talking , language , mouthfuls eaten , and h and -washing . Micronutrient fortification result ed in more weight gain . CONCLUSIONS : A brief behavior-change program that focused on modeling and practice in stimulation and feeding was found to benefit children 's nutrition and language development . Micronutrients benefited children 's weight but not length 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 BACKGROUND The low micronutrient content of complementary foods is associated with growth faltering in many population s. A potential low-cost solution is the home fortification of complementary foods with Sprinkles ( SP ) powder , crushable Nutritabs ( NT ) tablets , or energy-dense ( 108 kcal/d ) , fat-based Nutributter ( NB ) . OBJECTIVE The objective was to test the hypothesis that multiple micronutrients added to home-prepared complementary foods would increase growth and that the effect would be greatest in the presence of added energy from fat . DESIGN We r and omly assigned 313 Ghanaian infants to receive SP , NT , or NB containing 6 , 16 , and 19 vitamins and minerals , respectively , daily from 6 to 12 mo of age . We assessed anthropometric status at 6 , 9 , and 12 mo ; micronutrient status at 6 and 12 mo ; motor development at 12 mo ; and morbidity weekly . Infants ( n = 96 ) not r and omly selected for the intervention ( nonintervention ; NI ) were assessed at 12 mo . RESULTS The groups did not differ significantly at baseline , except that the NB group had a higher proportion of boys and weighed slightly more . The dropout rate ( 15/313 ) was low . At 12 mo , after control for initial size , the NB group had a significantly greater weight-for-age z score ( WAZ ) ( -0.49 + /- 0.54 ) and length-for-age z score ( LAZ ) ( -0.20 + /- 0.54 ) than did the NT group ( WAZ : -0.67 + /- 0.54 ; LAZ : -0.39 + /- 0.54 ) and the NT and SP groups combined ( WAZ : -0.65 + /- 0.54 ; LAZ : -0.38 + /- 0.54 ) ; the difference with the NI group ( WAZ : -0.74 + /- 1.1 ; LAZ : -0.40 + /- 1.0 ) was not significant . A lower percentage of the NI infants ( 25 % ) than of the intervention groups ( SP : 39 % ; NT : 36 % ; NB : 49 % ) could walk independently by 12 mo . CONCLUSION All 3 supplements had positive effects on motor milestone acquisition by 12 mo compared with no intervention , but only NB affected growth This article is a critical synthesis of 12 papers included in this supplement . The set deals with the short- and long-term effects of improving nutrition in Guatemalan villages characterized by deficient diets , high rates of infection and pronounced growth retardation in the first 3 y of life . The data review ed come from two studies carried out over two decades : the Institute of Nutrition of Central America and Panama ( INCAP ) longitudinal study ( 1966 - 1977 ) and its follow-up ( 1988 - 1989 ) . The longitudinal study included a nutrition intervention that improved the energy and nutrient intakes of women and preschool children . Its effects included improved birthweights , reduced infant mortality rates and improved growth rates in children < 3 y of age . Growth rates from 3 to 7 y of age , similar to those of well-nourished children , were not affected by the intervention . The follow-up study was conducted when the subjects were 11 - 27 y old . Among the long-term effects found were greater stature and fat-free mass , particularly in females , improved work capacity in males and enhanced intellectual performance in both genders . The nutrition intervention did not , on the other h and , accelerate maturation during adolescence , as measured by skeletal age or age at menarche . It is concluded that improved nutrition in early childhood has important long-term effects in the adolescent and adult Objectives : Nutritional rehabilitation in Africa relies mainly on imported skim milk enriched with a sugar and salt mixture . We evaluated whether milk plus porridge made from local ingredients improves the outcome of childhood nutritional rehabilitation versus milk alone . Patients and Methods : This study was conducted in a nutritional unit in Lacor ( Northern Ug and a ) . The porridge , made from cheap locally available ingredients ( maize flour , dried fish or meat , peanut butter and oil ) supplemented with proteins and fats , provides 1.1 energy units , 4.4 kJ/g . We r and omly sample d the files of 100 cases discharged in October , November and December 2001 ( preintervention ) , in 2002 ( soon after intervention onset ) and in 2003 ( more than 1 year after intervention onset ) . We recorded the average hospital days and average oedema-free weight gain at discharge in the 3 groups . Results : Average oedema-free weight gain increased from 21 g/d ( 95 % confidence interval [ CI ] , 12 - 29 ) in 2001 to 35 g/d ( 95 % CI , 25 - 45 ) in 2002 and reached 59 g/d ( 95 % CI , 51 - 65 ) in 2003 . Mortality decreased from 22 % to 7.8 % , and nutritional failures ( insufficient weight gain ) decreased by greater than 50 % . Conclusions : The low-cost porridge supplement ( & U20AC;2640/yr per 100 children ) was effective in treating malnutrition . Widespread use of the porridge , which result ed in better outcomes than milk alone , could produce a savings in the medium- to long-term , thereby releasing re sources for other uses . A high-energy porridge that is made from locally available ingredients and does not require imported foods seems to be appropriate for supplementary feeding after mother 's milk in this setting OBJECTIVES The purpose of this study was to identify factors that enhance the recovery due to supplementary feeding in wasted children . METHODS Recovery rates were obtained in mild to moderately wasted 6- to 48-month-old rural Guatemalan children living in four villages . Children in two villages received a high protein-energy supplement ( supplemented children ) , while children in the other villages received a low protein-energy supplement ( nonsupplemented children ) . The difference in recovery rates between the groups was the attributable benefit . The net supplementation amounted to 11 % of the recommended energy intake and its associated nutrients . RESULTS Attributable supplement benefits were achieved in younger children ( 6 to 24 months old ) and increased with decreasing weight for length , longer duration of supplementation , and duration of diarrhea , but not with chronicity of wasting . CONCLUSIONS Supplementation 's effectiveness can be improved in similar population s by programs targeted according to these findings Objective : The aim of the present study was to assess the effects of community-based follow-up care , food supplementation , and /or psychosocial stimulation on the recovery of severely underweight children . Patients and Methods : A total of 507 severely underweight children ( weight-for-age z score < −3 ) ages 6 to 24 months hospitalized at the International Center for Diarrheal Disease Research , Bangladesh , were r and omly assigned to 1 of the following regimens for 3 months once they recovered from diarrhea : fortnightly follow-up care at the International Center for Diarrheal Disease Research , Bangladesh Hospital , including growth monitoring , health education , and micronutrient supplementation ( group H-C , n = 102 ) ; fortnightly follow-up at community clinics , using the same treatment regimen as group H-C ( group C-C , n = 99 ) ; community-based follow-up as per group C-C plus cereal-based supplementary food ( SF ) ( group C-SF , n = 101 ) ; follow-up as per group C-C plus psychosocial stimulation ( PS ) ( group C-PS , n = 102 ) ; or follow-up as per group C-C plus both SF and PS ( group C-SF + PS , n = 103 ) . Results : There were no significant differences in baseline characteristics by treatment group . Attendance at scheduled follow-up visits was greater in groups C-SF , C-SF + PS , and C-PS than in C-C and H-C ; P < 0.05 . Rates of weight gain were greater in groups C-SF + PS , C-SF , and C-PS ( 0.88–1.01 kg ) compared with groups C-C and H-C ( 0.63–0.76 kg ) , P < 0.05 . Three-factor analysis of covariance of the effects of treatment components indicated that weight gain and change in weight-for-age z score and weight-for-length z score were greater in groups that received SF ( P < 0.05 ) and linear growth was greater among children managed in the community ( P = 0.002 ) . Conclusions : Positioning follow-up services in the community increases follow-up visits and promotes greater linear growth ; providing SF , with or without PS , increases clinic attendance and enhances nutritional recovery . Community-based service delivery , especially including SF , permits better rehabilitation of greater numbers of  severely  underweight children 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 Few prospect i ve studies of child growth and its determinants take place in programmatic context s. We evaluated the effect of Save the  Children 's ( SC ) community empowerment and nutrition program ( CENP ) on child growth , care , morbidity , empowerment , and behavioral determinants . This paper describes the research methods of this community-based study . We used a longitudinal , prospect i ve , r and omized design . We selected 12 impoverished communes with documented child malnutrition , three comparison , and three intervention communes in each of two districts in Phu Tho Province , west of Hanoi . SC taught district trainers in November 1999 to train local health volunteers to implement the 10-month CENP , including situation analysis , positive deviance ( PD ) inquiry , growth monitoring and promotion , nutrition education and rehabilitation program ( NERP ) , deworming , and monitoring . PD inquiries aim to discover successful care practice s in poor households that likely promote well-nourished children . NERPs are neighborhood-based , facilitated group learning sessions where caregivers of malnourished children learn and practice PD and other healthy behaviors . We dewormed all intervention and comparison children . We weighed all children less than 24 months of age living in the intervention and comparison communes and r and omly selected 240 children ( 120 intervention and 120 comparison ) . We gathered information on nutritional status , diet , illness , care , behavioral determinants , empowerment , and program quality , monthly for six months with a re-survey at 12 months . We collected most information through maternal interview but also observed hygiene and program quality , and videotaped feedings at home . Some implementation and research limitations will attenuate CENP impact and measurement of its effectiveness A group of 63 black children who were treated for protein energy malnutrition within their first 3 years of life were followed up after a period of 3 years . Half the group had undergone a home-based nutrition education programme in addition to receiving routine medical care , while the remaining children received only medical care and formed a control group . No differences were found at follow-up between these two groups on either growth or psychological performance measures . The malnourished group was subsequently matched for age and sex with a normal group of children and compared for psychological functioning , growth and socio-economic background . The malnourished children were found to be smaller and to have significant deficits in psychological performance compared with the normal group . While the findings illustrate the need for preventive and remedial action , they also reveal the shortcomings of brief unidimensional intervention programmes Infection and undernutrition in young children are thought to act synergistically . However , studies of the relationship between low height-for age ( stunting ) and morbidity in young children have had inconsistent findings and there are few adequate data on the effects of nutritional supplementation on morbidity .  129 stunted and 21 non-stunted children aged between 9 and 24 months , from poor Kingston neighbourhoods , identified from a house-to-house survey , were studied . The stunted children were r and omly assigned to supplementation or no supplementation . Every week for 24 months the mothers were asked about the occurrence of any symptoms of illness .  Supplementation had no consistent effect on the incidence or duration of symptoms . The stunted children had significantly more attacks of diarrhoea , fever , anorexia and apathy than the non-stunted children . The differences remained after controlling for social background and previous attacks of diarrhoea . There was also some indication of more severe illness in the stunted than in the non-stunted children Supplementation with lipid-based nutrient supplements ( LiNS ) is promoted as an approach to prevent child undernutrition and growth faltering . Previous LiNS studies have not tested the effects of improving the underlying diet prior to providing LiNS . Formative research was conducted in rural Zimbabwe to develop feeding messages to improve complementary feeding with and without LiNS . Two rounds of Trials of Improved Practice s were conducted with mothers of infants aged 6 - 12 months to assess the feasibility of improving infant diets using ( 1 ) only locally available re sources and ( 2 ) locally available re sources plus 20 g of LiNS as Nutributter ® /day . Common feeding problems were poor dietary diversity and low energy density . Popular improved practice s were to process locally available foods so that infants could swallow them and add processed local foods to enrich porridges . Consumption of beans , fruits , green leafy vegetables , and peanut/seed butters increased after counselling ( P < 0.05 ) . Intakes of energy , protein , vitamin A , folate , calcium , iron and zinc from complementary foods increased significantly after counselling with or without the provision of Nutributter ( P < 0.05 ) . Intakes of fat , folate , iron , and zinc increased only ( fat ) or more so ( folate , iron , and zinc ) with the provision of Nutributter ( P < 0.05 ) . While provision of LiNS was crucial to ensure adequate intakes of iron and zinc , educational messages that were barrier-specific and delivered directly to mothers were crucial to improving the underlying diet We tested the acceptability of three new lipid-based nutrient supplements ( LNSs ) in two independent phases among 18 8 - 12-month-old healthy rural Malawians and their caregivers . In phase 1 , acceptability was assessed by offering three new LNSs in r and om order , and an LNS already determined to be acceptable , Nutributter ( ® ) , each added to 30 g of warm maize porridge over three consecutive days . In phase 2 , infants from each village were provided one of the new supplements for a 2-week home-use trial . Outcome measures included the amount consumed , time completion of the dose and the maternal rating of likeability on a 5-point scale . The supplements were rated acceptable if consumption was over 50 % of the offered dose in phase 1 . The mean ( 95 % confidence interval ) proportion of the LNS test meals consumed under direct observation was 88 % ( 82 - 94 % ) for LNS-10gM , 90 % ( 84 - 95 % ) for LNS-20gM , 87 % ( 79 - 95 % ) for LNS-20gNoM , and 86 % ( 83 - 90 % ) for Nutributter . The median ( 25th and 75th centile ) time ( minutes ) for completing the offered test meal was 4 ( 2 , 7 ) for LNS-10gM , 5 ( 3 , 6 ) for LNS-20gM , 4 ( 3 , 8) for LNS-20gNoM and 4 ( 2 , 6 ) for Nutributter . During both phases , almost all caregivers rated all study foods very likeable for themselves and their children , with mean scores slightly lower among the caregivers than among the infants . In the home-use phase , the test foods were almost exclusively used by the study participants with minimal sharing with siblings and other household members . Some infants were reported to prefer the new investigational products over traditional complementary food . Considering that the novel LNS was largely acceptable . Efficacy trials are now needed to assess their impact on child growth and development 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 The Indian Integrated Child Development Services ( ICDS ) provides supplemental food to children aged 6 mo to 6 y. This study assessed the impact of enhancements to the existing Supplemental Nutrition Program of local production of supplemental food , home fortification with a micronutrient powder , and improved program monitoring . A quasi-experimental longitudinal design was used . Data were collected from 15 Anganwadi centers r and omly selected from the enhanced program and 15 from the usual program .  Multilevel linear regression was used to examine changes over time between the 2 groups accounting for village-level variation in intent-to-treat analysis . Children in the enhanced program initially aged 12 - 18 mo gained 0.72 ( P = 0.02 ) greater height-for-age Z-score . Significant differences were observed in gain in weight-for-age Z-score among those initially aged 9 - 11 ( 2.48 ; P = 0.01 ) , 12 - 18 ( 0.76 ; P = 0.01 ) , and 19 - 24 mo old ( 0.73 ; P = 0.01 ) , and gain in weight-for-height Z-score among 9 - 11 ( 2.66 ; P = 0.04 ) and 19 - 24 mo old ( 0.99 ; P = 0.01 ) . For these age groups , the prevalence of stunting , underweight , or wasting averted ranged from 20.3 to 33.4 % . Energy intake in the enhanced program was significantly greater for boys initially aged 12 - 18 mo ( 575.1 kJ/d ; P = 0.03 ) . Results from a qualitative sub study supported the plausibility of observed outcomes . ICDS would be more effective in improving child nutrition if it included these enhancements . The enhancements studied may be useful in improving program delivery and uptake of other similar programs Children attending the anganwadi centres were fed with Ready to eat ( RTE ) food containing 2 g of Red Palm Oil ( RPO ) . Daily children 's attendance , their participation in the feeding programme , quantity of food supplement consumed were recorded . Heights , weights , clinical signs of vitamin A deficiency and morbidity pattern of the beneficiary children were assessed . There was increase in attendance of the children in the feeding programme after introduction of RPO .  Quantity of the food supplement consumed by the children also increased . An improvement in the nutritional grade s of children was observed . Signs of vitamin A deficiency were absent . Anganwadi teachers , helpers and parents accepted the inclusion of RPO in the supplementary feeding programme Background In Bangladesh , as in other developing countries , protein – energy malnutrition is most prevalent among children during weaning . After weaning , children are often fed cereal-based diluted low-calorie porridge , result ing in growth-faltering . Objective To assess the effect on food intake of adding amylase-rich flour ( ARF ) from germinated wheat to supplementary food among children in nine rural Community Nutrition Centers under the Bangladesh Integrated Nutrition Project ( BINP ) . Methods A total of 166 malnourished children of either sex , aged 6 to 24 months , received one of three diets r and omly allocated to the Community Nutrition Centers . The composition of the diets was the same ; however , the consistency and calorie density were altered by adding either ARF or water . Thirty-five children received the st and ard supplementary food of the BINP ( S-SF ) , 65 received supplementary food with added ARF ( ARF-SF ) , and 66 received supplementary food with added water ( W-SF ) . The children were studied for six weeks . Results The mean ± SD intake of supplementary food from a single meal by children completing six weeks on the diets was higher for children receiving ARF-SF ( 33.91 ± 8.25 g ) than for those receiving S-SF ( 25.66 ± 6.73 g ) or W-SF ( 30.26 ± 8.39 g ) ( p < .05 for both comparisons ) . The weight of vomited food was significantly higher for children receiving W-SF than for children in the other two groups . Weight gain and increments in length and weight-for-height were higher for children who received ARF-SF than for children in the other two groups , but the differences were not statistically significant . The acceptability of ARF-SF was higher than that of the two other diets . The additional cost of adding 2 g of ARF to the diet was about Taka 0.25 ( US$ 1 = Taka 48 ) . Conclusions Addition of ARF to existing st and ard supplementary food , as used under the BINP program , is a simple and effective means to increase the intake of food by changing its consistency , thus making it easier for malnourished children to ingest 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 Malnutrition remains a major problem in children in large parts of the developing world . About 150 million young children in the developing world are either wasted or stunted , and it has been estimated that over half of childhood deaths are attributable to the potentiating effects of malnutrition . Thus , tackling both mild-moderate and severe malnutrition effectively is essential if the millennium development goals are to be achieved . Intervention strategies to promote exclusive breastfeeding for about 6 months in the absence of maternal HIV infection will result in significant improvements in nutrition , and are key to prevention strategies for malnutrition . Careful evaluation and effective counseling of HIV-positive mothers regarding feeding choices is essential . Evidence from a number of r and omized controlled trials shows that ready to use foods have an important role to play in the prevention and treatment of both outpatient and inpatient malnutrition . Such foods were initially produced commercially , but it has been shown , particularly in Malawi , that such foods can be locally produced at low cost . In some parts of the world , HIV is a major underlying cause of malnutrition in children and is associated with high mortality rates in those with severe malnutrition . Strategies for the prevention and treatment of children with HIV  need to be escalated OBJECTIVE To evaluate the adequacy of protein intakes now recommended as safe for infants and toddlers . METHODS Subjects were recovering malnourished infants , age 5.3 to 17.9 months , length age ( LA ) 2.5 to 6.4 months , weight age ( WA ) 1.5 to 5.2 months , weight/length ( W/L ) 78 % to 100 % of National Center for Health Statistics data ; and toddlers age 11.4 to 31.6 months , LA 6.1 to 17.9 months , WA 3.9 to 12.0 months , W/L 79 % to 99 % . Infants were assigned at r and om to formulas with 5.5 % , 6.7 % , or 8.0 % energy as 60:40 whey : casein protein . The 5.5 % was based on FAO-WHO-UNU safe protein and average energy for ages 2.5 to 6.0 months . Toddlers received 4.7 % ( recommended for 6 to 18 months ) , 6.4 % , or 8.0 % . Identical concentrations ( weight/kcal ) of other nutrients were maintained ; intakes were adjusted weekly to reach , in 90 days , the 50th percentile of weight for a LA 3 months greater than the initial one . RESULTS Infants consumed 125 + /- 11 ( SD ) , 116 + /- 10 , and 126 + /- kcal and 1.7 + /- 0.1 , 1.9 + /- 0.2 , and 2.5 + /- 0.3 g protein kg-1 . d-1 ; gained 2.4 + /- 0.7 , 2.9 + /- 0.7 , and 2.6 + /- 0.5 months in LA , and reached a W/L of 105 + /- 5 , 103 + /- 6 , and 105 + /- 5 % of reference . Sum of four fat-folds ( sigma FF ) grew 13.1 + /- 6.9 , 10.4 + /- 4.8 , and 11.7 + /- 5.3 mm to 32.5 + /- 5.2 , 31.7 + /- 4.7 , and 30.5 + /- 5.5 mm ; arm muscle areas ( AMA ) 57 % , 51 % , 70 % to 1004 + /- 109 , 1017 + /- 110 , and 1004 + /- 116 mm2 , still low ; arm fat areas ( AFA ) 93 % , 66 % , and 93 % to higher-than-normal 598 + /- 105 , 610 + /- 101 , and 541 + /- 116 mm2 . Regression of intake on weight gain estimated energy for maintenance + activity to be 81.0 + /- 7.5 ( SEM ) kcal . kg-1 . d-1 , and cost of gain ( storage + metabolic cost ) as 7.6 + /- 1.7 kcal/g , with no significant effect of % protein . Toddlers consumed 107 + /- 9 , 103 + /- 12 , and 105 + /- 10 kcal and 1.3 + /- 0.1 , 1.6 + /- 0.2 , and 2.1 + /- 0.2 g protein . kg-1 . d-1 , gained 3.3 + /- 0.7 , 2.9 + /- 0.6 , and 3.3 + /- 0.7 months in LA ; to a W/L of 102 + /- 1 , 102 + /- 3 , and 101 + /- 4 % . Sigma FF grew 9.2 + /- 4.0 , 7.4 + /- 4.3 , and 6.0 + /- 3.8 to 28.9 + /- 5.2 , 30.5 + /- 3.7 , and 27.0 + /- 2.7 mm ; AMA 31 % , 33 % , and 34 % to 1121 + /- 115 , 1124 + /- 110 , and 1117 + /- 120 mm2 ; AFA 53 % , 44 % , and 45 % to higher-than normal 578 + /- 106 , 636 + /- 99 , and 569 + /- 68 mm2 . Cost of maintenance + activity was 70.8 + /- 3.8 ( SEM ) kcal . kg-1 . d-1 , that of weight gain 9.7 + /- 1.35 kcal/g , with no effect of % protein . CONCLUSIONS Within age groups , there were no significant protein-related differences in growth . In both infants and toddlers , high-energy intakes result ed in mild obesity , with lean body mass still deficient . Protein intakes two SD below the means in the lowest protein/energy cells , 1.5 g . kg-1 . d-1 for infants and 1.1 g times kg-1 . d-1 for toddlers , should still be safe for nearly all children of comparable biological ages In order to estimate the nutritional rehabilitation ( NR ) during admission of malnourished children with persistent diarrhea ( PD ) receiving st and ardized nutritional support ( NS )  , we prospect ively evaluated the weight , height , head circumference and arm measurements ( AM ) of 20 children , 19 below 1 year , admitted to the ward with weigh/age -2.89 to -5.21 st and ard deviation . Four infants comprised the death group ( DG ) and 16 survived ( SG ) . The SG was separated , according to initial weight behavior , into  weight gain ( WG ) or  weight loss ( WL )  . Compared to SG at admission , DG only had lower AM and more metabolic-infectious alterations ( p<05 ) . The survivors presented NR but this was evident for WL only when considering the minimum weight . DG received less calories than SG and weight loss during the pre-death period was higher than for WL ( p<05 ) . It was concluded that very altered AM , severe metabolic-infectious insults , low caloric input and high weight loss velocity are associated to bad prognosis ; severely malnourished infants with PD began NR during hospitalization while receiving adequate NS , but minimum weight must be considered for this evaluation ; AM must be obtained at admission , due to its prognostic value , and adequate NS as well as anthropometric follow-up during the hospital stay are essential 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 OBJECTIVE To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive ( NOFTT ) . DESIGN R and omized clinical trial . PARTICIPANTS The NOFTT sample included 130 children ( mean age , 12.7 months ; SD , 6.4 ) recruited from urban pediatric primary care clinics serving low income families . All children were younger than 25 months with weight for age below the fifth percentile . Eligibility criteria included gestational age of at least 36 weeks , birth weight appropriate for gestational age , and no significant history of perinatal complications , congenital disorders , chronic illnesses , or developmental disabilities . Children were r and omized into two groups : clinic plus home intervention ( HI ) ( n = 64 ) or clinic only ( n = 66 ) . There were no group differences in children 's age , gender , race , or growth parameters , or on any of the family background variables . Most children were raised by single , African-American mothers who received public assistance . Eighty-nine percent of the families ( 116 of 130 ) completed the 1-year evaluation . INTERVENTIONS All children received services in a multidisciplinary growth and nutrition clinic . A community-based agency provided the home intervention . Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors , supervised by a community health nurse . The intervention provided maternal support and promoted parenting , child development , use of informal and formal re sources , and parent advocacy . MEASUREMENTS Growth was measured by st and ard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting . Cognitive and motor development were measured with the Bayley Scales of Infant Development , and language development was measured by the Receptive/Expressive Emergent Language Scale . Both scales were administered at recruitment and at the 12-month follow-up . Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up , and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment . ANALYSES Repeated- measures multivariate analyses of covariance were used to examine changes in children 's growth and development and parent-child interaction . Analyses of covariance were used to examine the quality of the home . Independent variables were intervention status and age at recruitment ( 1.0 to 12.0 vs 12.1 to 24.9 months ) . Maternal education was a covariate in all analyses . When changes in developmental status and parent-child interaction were examined , weight for height and height for age at recruitment were included as covariates . RESULTS Children 's weight for age , weight for height , and height for age improved significantly during the 12-month study period , regardless of intervention status . Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group . The impact of intervention status on cognitive development varied as a function of children 's ages at recruitment , with younger children showing beneficial effects of home intervention . There were no changes in motor development associated with intervention status . During the study period , children gained skills in interactive competence during feeding , and their parents became more controlling during feeding , but differences were not associated with intervention status . CONCLUSIONS Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors . Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income , urban infants with NOFTT : Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT Two hospital-made , lactose-free , hypoosmolar formulas were compared for therapy for 61 children aged 10–28 months who had severe malnutrition and protracted diarrhea . The formulas were isocaloric and contained dextrin-maltose , carrots , sunflower oil , minerals , and vitamins . One had chicken meat as the protein source and the other had hydrolyzed lactalbumin ( LAD ) . Initially the formulas were given as a continuous enteral feeding by nasogastric tube and pump . Six patients died from metabolic and infectious complications ; four failed to equilibrate and changed diet . The remaining 51 were divided into two groups : group A , chicken formula ( n = 26 ) , and group B , LAD formula ( n = 25 ) . The mean duration of diarrhea was similar in both groups : number of days with liquid stools = 6.0 ± 4.1 in group A , 5.5 ± 2.8 in group B ; number of days with > 4 stools/day = 3.5 ± 3.4 in group A , 4.1 ± 2.1 in group B. The time until beginning nutritional recovery was 13.2 ± 12.0 days in group A and 13.3 ± 7.8 days in group B. Intercurrent infections were significantly more frequent in patients receiving chicken formula  ( 12 of 30 patients ) than in those receiving LAD formula ( 4 of 27 patients ) ( p < 0.05 ) . We conclude that chicken formula is an efficient substitute to expensive semielemental formulas for continuous enteral feeding of protracted diarrhea in severely malnourished children Moderate acute malnutrition ( MAM ) affects 11 % of children < 5 y old worldwide and increases their risk for morbidity and mortality . It is assumed that successful treatment of MAM reduces these risks . A total of 1967 children aged 6 - 59 mo successfully treated for MAM in rural Malawi following r and omized treatment with corn-soy blend plus milk and oil ( CSB++ ) , soy ready-to-use supplementary food ( RUSF ) , or soy/whey RUSF were followed for 12 mo . The initial supplementary food was given until the child reached a weight-for-height Z-score ( WHZ ) > -2 . The median duration of feeding was 2 wk , with a maximum of 12 wk . The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++ . The primary outcome , remaining well-nourished , was defined as mid-upper arm circumference ≥12.5 cm or WHZ ≥-2 for the entire duration of follow-up . During the 12-mo follow-up period , only 1230 ( 63 % ) children remained well-nourished , 334 ( 17 % ) relapsed to MAM , 190 ( 10 % ) developed severe acute malnutrition , 74 ( 4 % ) died , and 139 ( 7 % ) were lost to follow-up . Children who were treated with soy/whey RUSF were more likely to remain well-nourished ( 67 % ) than those treated with CSB++ ( 62 % ) or soy RUSF ( 59 % ) ( P = 0.01 ) . A seasonal pattern of food insecurity and adverse clinical outcomes was observed . This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished ; however , all children successfully treated for MAM remain vulnerable
BACKGROUND Moderate acute malnutrition , also called moderate wasting , affects around 10 % of children under five years of age in low- and middle-income countries .
There are different approaches to addressing malnutrition with prepared foods in these setting s ; for example , providing lipid-based nutrient supplements or blended foods , either a full daily dose or in a low dose as a complement to the usual diet .
There is no definitive consensus on the most effective way to treat children with moderate acute malnutrition .
OBJECTIVES To evaluate the safety and effectiveness of different types of specially formulated foods for children with moderate acute malnutrition in low- and middle-income countries , and to assess whether foods complying or not complying with specific nutritional compositions , such as the WHO technical specifications , are safe and effective .