Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain. Age-specific responsiveness of weight and length to nutritional supplementation. Nutritional supplementation, psychosocial stimulation, and growth of stunted children: the Jamaican study. The effects of nutritional supplementation on physical growth of children at risk of malnutrition. Early childhood supplementation does not benefit the long-term growth of stunted children in Jamaica. Developmental effects of short-term supplementary feeding in nutritionally-at-risk Indonesian infants. Effect of supplementary feeding on recovery from mild to moderate wasting in preschool children. Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial. Age differences in the impact of nutritional supplementation on growth. Effects of an energy and micronutrient supplement on growth and activity, correcting for non-supplemental sources of energy input in undernourished children in Indonesia The eco-cultural context of the undernourished children in a study on the effects of early supplementary feeding in Indonesia 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 Bias in treatment assignment in controlled clinical trials. 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. 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. Supplementary Feeding of Underweight, Stunted Malawian Children With a Ready-To-Use Food Nutritional supplementation during the preschool years influences body size and composition of Guatemalan adolescents. The recovery of Guatemalan children with mild to moderate wasting: factors enhancing the impact of supplementary feeding. The effect of nutritional supplementation and stunting on morbidity in young children: the Jamaican study. Nutritional impact of supplementation in the INCAP longitudinal study: analytic strategies and inferences. Effects of an energy and micronutrient supplement on mental development and behavior under natural conditions in undernourished children in Indonesia History and design of the INCAP longitudinal study (1969-77) and its follow-up (1988-89).
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 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 The benefits of nutritional supplementation , with or without psychosocial stimulation , on the growth of  stunted children  were evaluated . Children aged 9 - 24 mo with lengths less than -2 SD of the National Center for Health Statistics references ( n = 129 ) were r and omly assigned to four groups :  control , nutritional supplementation , stimulation , and both interventions . A fifth group with lengths greater than -1 SD was also enrolled . Length , weight , head and arm circumferences , and triceps and subscapular skinfold thicknesses were measured on enrollment and 6 and 12 mo later . Multiple-regression analysis was used to determine the effects of the interventions in which age , sex , initial status , initial dietary intake , and several socioeconomic variables were controlled for . Stimulation had no effect on growth and there was no interaction between the interventions . After 12 mo supplemented children had significantly increased length , weight , and head circumference ( all P less than 0.01 ) . The effects of supplementation were not cumulative but occurred in the first 6 mo The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 The long-term benefits of  early childhood supplementation  and the extent to which catch-up growth occurs following linear growth retardation remain controversial . Stunted children ( height-for-age < -2 SD of NCHS references , n = 122 ) recruited from a survey of poor neighborhoods in Kingston , Jamaica , participated in a 2-yr r and omized , controlled trial of supplementation beginning at ages 9 - 24 mo . A group of 32 non-stunted children from the same neighborhoods was also followed . Four years after the intervention ended , when children were 7 to 8 y old , there were no effects of supplementation on any anthropometric measure . From the end of the trial until follow-up , the children who had been supplemented gained 1.2 cm less ( P < 0.05 ) than the non-supplemented children , approximately the same amount as they had gained during the trial compared with the non-supplemented children . After adjustment for regression to the mean , the height-for-age of stunted children ( supplemented and non-supplemented combined ) increased from enrollment to follow-up by 0.31 Z-score ( 95 % CI 0.17 , 0.46 ) . The height-for-age of the non-stunted children also increased ( 0.96 Z-score ; 95 % CI 0.70 , 1.22 ) . Our results suggest that some catch-up growth is possible even when children remain in poor environments . Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished This study assessed the developmental effects of supplementary feeding over 90 consecutive days on infants aged 6 - 20 mo at six tea plantations in West Java , Indonesia . Every day except Sunday , the infants attended day-care centers distributed throughout the plantations . Twenty centers and 113 infants were selected ; the infants in 9 centers received a dietary supplement , while the infants in 11 centers served as control subjects . Supplements were given twice a day providing , on average , 10.66 kJ ( 400 kcal ) and 5 g protein/d . Measurements of body growth , dietary intake , and mental and motor development were made on all infants . Supplementary feeding had significant effects on weight gain and on motor development . Changes in caloric intake were independently associated with changes in weight and in motor test scores . The data suggest that the effects of the supplement may not have followed a simple mechanistic relationship from intake to weight change to motor development , but , rather , intake may have affected both growth and development domains simultaneously Three-month recovery rates from moderate wasting ( less than 90 % weight-for-length ) were compared in 6 - 24-mo-old children in four Guatemalan villages that had been r and omly assigned to receive a moderate ( Atole ) or low ( Fresco ) energy supplement .  The recovery rate ( Rr ) in the Atole villages was 12 % higher than in the Fresco villages ( P less than 0.05 ) . This effect was above all due to the children in the Atole villages who consumed greater than or equal to 10 % of the daily recommended dietary intake of energy ( RDI ) from the supplement ( high-Atole group ) and whose total energy intake ( including home diet ) was 10.5 % of the RDI higher than a comparable high-Fresco group with low supplemental energy intake . All those in the high-Atole group whose wasting was due to malnutrition recovered . Much of this recovery ( range 29 - 52 % ) was due to the increased supplementation . This proportion rose after potential confounding variables were controlled for The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries Supplementary feeding programs are common in developing countries . These programs often can not demonstrate an impact on child growth , however , possibly because they tend to reach older children . This study examines the impact of nutritional supplementation on annual growth rates in length and weight from birth to 7 y of age in 1208 rural Guatemalan children . A series of multiple linear regression models is used to control for initial body size , diarrheal disease , home diet , socioeconomic status and gender . During the first year of life , each 100 kcal/d ( 418 kJ ) of supplement was associated with approximately 9 mm in additional length gain and 350 g in additional weight gain ; the benefit decreased to approximately 5 mm in length gain and 250 g in weight gain during the 2nd y of life . Between 24 and 36 mo of age , supplement only had a significant impact on length . There was no impact of nutritional supplementation on growth between 3 and 7 y of age . Patterns were the same if supplement intakes were expressed as a percent of recommended allowances or growth was expressed as a percent of the expected rate . These impacts of nutritional supplementation on growth coincide with the ages when growth velocities , as well as growth deficits , are greatest in this population Objectives : This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement  , adjusting for all non-supplemental energy intakes . Any additional change in growth and activity after this adjustment was then compared across supplements at three points felt to be representative of the study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Motor activity was assessed through continuous 4 h observations at home and at day care centers . Anthropometry and activity were measured every two months over 12 months . Results : After correcting for non-supplemental sources of energy intake , the effects of the supplement on weight and activity were observed at 2 months ; effects on length and activity were observed at 6 months ; and effects on weight alone were observed at 12 months . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Objectives : This paper describes the ecological and cultural backdrop of the subjects enrolled in an experimental study to test the validity of a conceptual model about the intellectual delay of undernourished children . Design : The experiment was a 12-month clinical , r and omized trial on the effects of early supplementary feeding on two cohorts of children classified as nutritionally-at-risk .  Three different supplements ( condensed milk+micronutrients ; skimmed milk+micronutrients ; skimmed milk ) were given to the children during 6 or 12 months of the study . Setting : The plantations are 1500–1800 m above sea level in Pangalengan , 50 km south of B and ung , West Java . Temperature fluctuates from 10 to 17 ° C . A high yearly precipitation is ∼3000 mm . Communities are laid out at 5–15 km from one another . Living conditions are modest . Subjects : The 156 subjects were recruited from 24 day-care-centers ( DCC ) that serviced families of 24 communities in six tea plantations . The 12- and 18-month-old cohorts included 73 and 83 children , respectively ; each cohort included three subgroups that received distinct supplements . Obeservations : The interactions of the caretakers with the children in the DCCs were consistent with the socialization for survival mode . A primary concern was the physical growth , health , cleanliness , sanitation and safety of the children . Stimulating children , providing toys and initiating play or other activities that would emphasize educational development had a low priority . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , Objectives : This paper reports the effects of early supplementary feeding on body weight , length , head circumference and arm circumference among the children in the Pangalengan study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care centers . Twenty children that received S belonged to the 12- and 18-month cohorts . Inclusion criteria were : no chronic disease ; length-for-age≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Results : Body weight showed effects on both cohorts at 2 , 8 and 12 months ; head circumference showed effects at 4 months in the 12-month-old cohort and at 10 months among the females of the 18-month-old cohort ; and arm circumference showed effects across cohorts at 2 , 8 and 12 months . In general the benefits are clearer for females and for the 12-month-old cohort . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , 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 Controlled clinical trials of the treatment of acute myocardial infa rct ion offer a unique opportunity for the study of the potential influence on outcome of bias in treatment assignment . A group of 145 papers was divided into those in which the r and omization process was blinded ( 57 papers ) , those in which it may have been unblinded ( 45 papers ) , and those in which the controls were selected by a nonr and om process ( 43 papers ) . At least one prognostic variable was maldistributed ( P less than 0.05 ) in 14.0 per cent of the blinded-r and omization studies , in 26.7 per cent of the unblinded-r and omization studies , and in 58.1 per cent of the nonr and omized studies . Differences in case-fatality rates between treatment and control groups ( P less than 0.05 ) were found in 8.8 per cent of the blinded-r and omization studies , 24.4 per cent of the unblinded-r and omization studies , and 58.1 per cent of the nonr and omized studies . These data emphasize the importance of keeping those who recruit patients for clinical trials from suspecting which treatment will be assigned to the patient under consideration 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 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 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 Effects of supplementary feeding during early childhood on body size and composition at adolescence are examined in a population with marked growth failure in the first 3 y of life . The data came from a supplementation trial conducted in rural Guatemala from 1969 to 1977 and a 1988 - 89 follow-up study of the same subjects at adolescence . Two pairs of villages participated in the trial . One village from each pair received a high protein-energy supplement ( Atole ) , which significantly improved dietary intakes , whereas the other village of the pair received a low-energy , no-protein supplement ( Fresco ) , which did not impact appreciably on dietary intakes .  Children from Atole villages  grew better during the preschool period than children from  Fresco villages . At adolescence , subjects from Atole villages were taller , weighed more and had greater fat-free masses than subjects from Fresco villages . Differences in height at adolescence were slightly reduced in magnitude relative to differences at 3 y of age . However , differences in weight were increased in adolescence relative to 3 y of age 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 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 From 1969 to 1977 a  supplementation trial  was conducted in Guatemala to ascertain the effects on physical and behavioral outcomes of improved nutrition in pregnant women and in preschool children . This paper review s different strategies to analyze the effect of the intervention on physical growth . One strategy compares outcomes in two villages that were r and omly allocated to receive Atole , a supplement containing high amounts of protein and energy , with values in two other villages that received Fresco , a beverage containing no protein and little energy . Both supplements contained micronutrients . This comparison of village means gives a probability significance statement ( P < 0.005 ) that the difference in growth was because of the supplement intervention , although it does not specify the aspect of the intervention that caused the effect . Complementary strategies increase the credibility that the effect of the supplement was nutritional . Thus , analysis of the dose response with increasing supplement intake within the villages excludes the possibility that the above findings were the result of knowing which villages received which supplement ( i.e. , measuring biases ) . A greater effect in those most likely to respond nutritionally also increases the credibility that the mechanism was nutritional . In study ing other behavioral and biomedical impacts of this supplementation intervention , analyses for credibility should always be included Objectives : This paper reports the effects of an energy and micronutrient supplement on mental development and on the social – cognitive and emotionally regulatory behaviors of nutritionally at risk infants and toddlers in Pangalengan , Indonesia . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=12 mg iron+209 kJ ; S=104 kJoule . Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( N=53 ) and an 18-month-old ( N=83 ) cohort were recruited from day-care-centers . Twenty children who received S belonged to the 12- and 18-month-old cohort . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Evaluations of intake were made at baseline and every 2 months thereafter . Motor development was assessed with the Bayley Scale and with a custom-made scale to assess gross motor development leading to bipedal locomotion . Four hours of continuous observations were made of the child ’s interaction with the social and physical environment . Results : In the 12-month-old cohort , as compared with the M and S groups , the children who received the E supplement walked at an earlier age , had higher scores in the Bayley Scale and showed more mature social – cognitive and emotional regulatory behaviors . Similar intergroup differences were observed in the 18-month-old cohort in social cognition and regulation of emotions . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , This is an overview of the design and methods of the INCAP longitudinal study ( 1969 - 77 ) and its follow-up study ( 1988 - 89 ) . The first study had the objective of assessing the effects of intrauterine and preschool malnutrition on growth and mental development . To achieve this , food supplements were provided to pregnant women and young children residing in four Gautemalan villages . Two villages were given a high-protein , high-energy drink and two were provided a no-protein , low-energy drink . Both supplements contained vitamins and minerals . Longitudinal information was collected during the first seven years of life on physical growth , mental development , attendance and consumption of supplement , home diet , morbidity and on characteristics of the family . Health and nutrition data on mothers also were collected . The INCAP follow-up study was a cross-sectional evaluation of former participants of the first study and was carried out when the subjects were 11 - 27 y old . The hypothesis of the INCAP follow-up study was that improved nutrition in early childhood leads to enhanced human capital formation in adolescents and adults . Data were collected on physical growth and body composition , maturation , work capacity , intellectual performance and school achievement
BACKGROUND Supplementary feeding is defined as the provision of extra food to poor children or families beyond the normal ration of their home diets .
The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and NGOs on this intervention to improve child health in developing countries .
OBJECTIVES To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of pre-school children in developing countries .