The effects of nutritional supplementation on physical growth of children at risk of malnutrition.

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 randomly 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 resulted 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 hand, 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 standards. 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.