Cardiorespiratory fitness, all-cause mortality, and risk of cardiovascular disease in Trinidadian men--the St James survey

BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.

A preliminary study of the indices of obesity among select group of apparently healthy Caribbean subjects

The purpose of this study was to assess the anthropometric indices of obesity among apparently healthy Caribbean subjects who have the potentials of living an affluent lifestyle. One hundred and eleven (38 males, 73 females) young adults aged between 17 and 38 years participated in the study. Subjects provided information on age, ethnic group, educational attainment, occupation, and previous record of body mass index (BMI) and family history of diabetes mellitus in a self-administered research questionnaire. Waist and hip circumferences (cm), weight (kg) and height (m) were measured. Subsequently, BMI and waist-to-hip ratio (W/H) were calculated. The majority of the subjects (83 percent) had never measured BMI. Although the male subjects were significantly taller and heavier than the females (p<0.01), there was no significant difference in the prevalence rates of obesity between the male and female subjects (p>0.05). In this preliminary study there was a trend for more females than males to be under weight (BMI< 20 kg/m2). The male subjects had significantly higher waist circumference than the females (p< 0.01), but both genders had a similar percentage of male and female subjects with increased waist circumference (p>0.05). The limitations of this study are its small size and self selection bias and hence the results obtained must be interpreted with caution. We suggest that assesment of body mass index should be incorporated in the routine clinical measurements of all patients to facilitate early identification, evaluation and treatment of overweight and obesity. (AU)

Obesity, hyperglycaemia and hyperinsulinaemia in Jamaica [abstract]

Insulin resistance (IR), with its associated with higher circulating levels of insulin and glucose occurs in non-insulin-dependent diabetes (NIDDM) and obesity and is often present in hypertension (HTN). The prevalence of these diseases is high in Jamaica and this study sought to determine the relationship between several measures of obesity, hyperinsulinaemia and hyperglycaemia. Anthropometric and glycaemic status variables were assessed in 469 men and 704 women. Fasting C-peptide and insulin levels were measured in subjects from the top and bottom 15 percent of a Body Mass Index (BMI) frequency distribution curve. The glucose/insulin ratio (Glu/Ins) was used as a measure of IR and the C-peptide/insulin as a measure of hepatic extraction. The obese (BMI> 32kg/m2) group had higher levels of fasting (Fglu) and postchallenge (2hGlu) glucose, insulin, C-peptide and lower Glu/Ins than the thin group (BMI<20kg/m2), suggesting greater IR. Forty-six percent of the obese were hyperinsulinaemic compared to 25 percent of the thin. Obese normogloglycaemics had higher levels of Fglu and 2hGlu than the thin normoglycaemics. Levels of glucose and insulin correlated with waist-hip ratio (WHR), waist and conicity measurements but not with BMI in the obese. In the thin group, there was correlation between glucose levels and WHR, Hyperglycaemia was more common in women. The higher levels of Fglu and 2hGlu in obese normoglycaemics suggest that the mechanisms responsible for the association between obesity and hyperglycaemia may already be operating. The association between hyperglycaemia, WHR and conicity but no BMI, suggests that `central tendency' may be a more useful indicator of dysglycaemia. The higher levels of hepatic extraction in the obese group indicate that the observed hyperinsulinaemia is not due to low hepatic extraction. (AU)

Obesity in a cohort of black Jamaican children as estimated by body mass index (BMI) and other indices of adiposity [abstract]

OBJECTIVE: To examine the relationships of Body Mass Index (BMI) to obesity indices derived from anthropometry and to determine tracking of obesity between late childhood and early adolescence. We also compared identification of over-weight children using the International Obesity Task Force (IOTF) BMI cut points with skinfolds. METHODS: Three hundred and six children were examined at 7-8 years and at 11-12 years. Triceps (TSF) and subscapular (SSF) skin folds, height, and weight were measured. The sum of the skinfolds (sum SF), BMI, and fat mass (FM) were calculated. Pubertal stage was assessed at 11-12 years. RESULTS: At age 7-8 years, 11 children were overweight compared with 29 at 11-12 years. BMI was better correlated with the other indices of adiposity in girls than in boys and in the older age group than in the 7-8-year-olds. In regression analysis, BMI predicted FM best and explained 52 percent and 61 percent of the variance in FM among boys and girls at 7-8 years. Using the IOTF cut points, BMI had low sensitivity to identify children >85th percentile of the NHANES references for SSF. The sensitivity for those assessed by TSF and sum SF was higher but between 14 percent and 30 percent of the children were misclassified. The specificity of BMI was high. CONCLUSION: Adiposity increased between mid-childhood and early adolescence but the children remained realtively lean. Girls were fatter than boys, reflecting adult obesity patterns. Children identified as overweight by the IOTF BMI cut points are likley to have high body fatness. However, the concern would be that the BMI cut points may not identify many children with high body fatness. (AU)

The effects of birth weight and postnatal linear growth retardation on blood pressure at age 11-12 years

STUDY OBJECTIVE: To determine the effects of birth weight and linear growth retardation (stunting) in early childhood on blood pressure at age 11-12 years. DESIGN: Prospective cohort study. SETTING: Kingston, Jamaica. Participants: 112 stunted children (height for age < -2 SD of the NCHS references) and 189 non-stunted children (height for age > -1 SD), identified at age 9-24 months by a survey of poor neighbourhoods in Kingston. MAIN RESULTS: Current weight was the strongest predictor of systolic blood pressure (beta= 4.90 mm Hg/SD weight 95 percent CI 3.97, 5.83). Birth weight predicted systolic blood pressure (beta= -1.28 mm Hg/SD change in birth weight, 95 percent CI -2.17, -0.38) after adjustment for current weight. There was a significant negative interaction between stunting in early childhood and current weight indicating a larger effect of increased current weight in children who experienced linear growth retardation in early childhood. There was no interaction between birth weight and current weight. The increase in blood pressure from age 7 to age 11-12 was greater in children with higher weigth at age 11-12 and less in children with higher birth weight and weight at age 7. CONCLUSIONS: Birth weight predicted systolic blood pressure in Jamaican children aged 11-12. Postnatal growth retardation may potentiate the relation between current weight and blood pressure. Greater weight gain between ages 7 and 11 was associated with a greater increase in systolic blood pressure. The relation between growth and later blood pressure is complex and has prenatal and postnatal components. (AU)

Early metabolic defects for developing diabetes mellitus among offspring of patients with type 2 diabetes are independent of gender

The aim of the study was to investigate if the female offspring of patients with type 2 diabetes have more metabolic defects for developing diabetes mellitus than their male counterparts. Thirty-four offspring (10 males, 24 females) of patients with Type 2 diabetes mellitus aged 28.9ñ 1.5 years (mean ñ SEM) underwent a standared oral glucose tolerance tests (OGTT; 75 g glucose in 300 ml water). Antropometric indices, plasma lipids and blood pressure were measured while insulin resistance (IR) and sensitivity (percent S) were assessed using the Homeostasis Model Assessment (HOMA) method. All the offspring had normal glucose tolerance but high HOMA-derived IR values (27.2 ñ 4.2 vs 22.5 ñ 2.7 pmol/mmol/l, p>0.05) and low percent S (48.1 ñ 5.1 vs. 50.6 ñ 3.9 percent, p>0.05), all of which did not differ on gender comparisons. Multiple linear regression analyses suggest that gender had no influence on the outcome of the result (p = 0.37). Again, body mass index (BMI), fasting serum insulin, plasma glucose, triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol were all similar in both genders (p>0.05). The results suggest that though the offspring manifested metabolic defects for developing diabetes in later life, this susceptibility is independent of gender in the population studied. Further studies with a large sample size are warranted to confirm these finding in this population.(Au)

The Human Ruminant

A five-month-old female infant was admitted to the Tropical Metabolism Research Unit with a weight for age of 49 percent and no evidence of oedema giving rise to a diagnosis of marasmus (Wellcome Classification). The underlying reason for her malnutrition was the Infant Rumination syndrome. This is an uncommon disorder which is thought to have a psychological component. A lack of awareness of the syndrome often leads to delay in diagnosis. (AU)

Profile of Uncontrolled Hypertensive patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies

The purpose of this study was to describe the knowledge of hypertension, its management, anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension. Patients (n=80) attending the Specialist Hypertension Clinic at the University Hospital of the West Indies (UHWI) who had a baseline systolic BP> 140 mmHg and/or a diastolic BP> 90 mmHg were invited to participate in the study. Blood pressure, height, weight, waist and hip circumferences were measured. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. A pretested questionannaire with 40 items eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95 percent CI 25.7 - 29.6); mean BMI for women was 30.89 (95 percent CI 26.1 - 35.7). In men, there was an association between BMI and WHR, r = 0.62, p<0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level (r= -0.42, p<0.05). Although the majority of both men and women were classified as obese, only 12 percent of men and 7 percent of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressure in this population, the use of nonpharmacologic theraphy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.(AU)

Second trimester placental volumes predict birth size

OBJECTIVE: To investigate the ability of second trimester placental volume to predict birth size. DESIGN AND METHODS: Prospective study of women attending the antenatal clinic of the University Hospital of the West Indies. SUBJECTS: 561 women were recruited from the antenatal clinic. Placental volume and foetal biometry at 14, 17 and 20 weeks' gestation were measured. At birth, placental and newborn's weight, lengths and circumferences were measured. MAIN OUTCOME MEASURES: Birth and placental weight, head, chest, abdominal, and mid-upper-arm circumferences, crown-heel and crown-rump length and placental volume. RESULTS: Placental volume in the second trimester showed a positive association to birth measurements. Ponderal index and head: length ratio showed no significant associations with placental volume, but there was a significant relationship between placental volume at 20 weeks' gestation and head: abdominal circumference ratio. The placental volume at 20 week gestation had the greatest effect on birth weight, and when placental volume was compared to foetal biometry in predicting birth outcome, placental volume was superior. CONCLUSION: In this study, second trimester placental volume has been shown to be an independent predictor of birth outcome, at a time when foetal biometry was not. It was not until the third trimester that foetal biometry became important. Identification of the growth retarded foetus is desirable in obstetrics for proper management. Earlier indication of this process is presumably important. It appears that in the second trimester, placental volume may be a more reliable predictor than foetal biometry.(AU)

Blood pressure and echocardiographic measures in children of Tobago

OBJECTIVE: To ascertain blood pressure and echocardiographic measurements in Tobagonian children and to determine possible inter-relationships. DESIGN AND METHODS: Over the period 1994-1995, based on data from school enrolment in the area, we evaluated all the school children of Plymouth and Blackrock (n=338, 174 boys, 164 girls; age range 5-13 years). Anthropometric and blood pressure measurements were taken using WHO guidelines, and echocardiographic measurements of heart size were obtained according to the recommendations of the American Society of Echocardiography and the data were analysed. RESULTS: Echocardiographic indices of left heart size varied as a function of blood pressure levels. Male subjects demonstrated significantly higher adjusted left ventricular mass, left ventricular wall thickness, and left ventricular chamber size. After adjustment for body size, blood pressure correlated with left ventricular wall stress (p<0.001). Systolic blood pressure correlated with left ventricular mass (p<0.05), and height correlated with both systolic and diastolic blood pressure (p<0.01). CONCLUSIONS: Our data demonstrated that blood pressure in healthy Tobagonian children correlated with several measures of left ventricular size. Longitudinal studies are indicated.(Au)

Jamaican symmetry project: long-term study of fluctuating asymmetry in rural Jamaican children

Fluctuating asymmetry, small deviations from perfect bilateral symmetry, is negatively correlated with health and positively correlated with sexual selection in human adults, but the accumulation, persistence, and fitness implications of asymmetries during childhood are largely unknown. Here, we introduce the Jamaican Symmetry Project, a long-term study of fluctuating asymmetry and its physical and behavioral correlates in rural Jamaican children. The project is based on an initial sample of 285 children (156 boys and 129 girls), aged 5 to 11 years. We describe the design of the project and the methodology of measuring 10 paired morphometric traits. All traits except hand width showed fluctuating asymmetry. Fluctuating asymmetries of the legs tended to be related and were less than half as great as fluctuating asymmetries of the arms and ears. Therefore the legs may show high developmental stability resulting from selection for mechanical efficiency. A fluctuating asymmetry composite score revealed that boys have significantly lower fluctuating asymmetry than girls and that this effect resides mainly in the elbows. There were significant positive relationships between composite fluctuating asymmetry and age, height, and weight, but multiple regression analyses showed that age was negatively related to fluctuating asymmetry, whereas body size was positively correlated. These findings are compared with results from recent English studies (Au)

Blood pressure in Jamaican children: relationship to body size and composition

Blood pressure levels in adults and children are related to body size and composition, but some of these relationships are unclear and they have been incompletely described in the Jamaican population. In a cross-sectional survey of 2,332 school children (6-16 years old; 1,046 boys, 1,286 girls), we measured systolic and diastolic blood pressure and pulse rate, and explored their relationship to weight, height, and waist, hip and mid-upper arm circumferences. The effect of these and other derived measures of body composition on blood pressure was explored in univariate and multivariate analysis. Blood pressure increased with age in both boys and girls, although the increase was greater for systolic than for diastolic blood pressure. The increase of systolic blood pressure among boys continued after age 11 years, but that for girls levelled off. Height and weight were the major predictors of blood pressure, but were highly correlated with each other and with all measures of body composition. Age, height and height-sex interaction explained 11.4 percent of systolic blood pressure variation, and the largest incremental contribution to this model was provided by the addition of body mass index or hip circumference, each explaining an additional 2.6 percent of the variance. Lean body mass made a larger contribution to blood pressure than percent fatness. Blood pressure in Jamaican children rises with age and this rise may be steeper in boys than girls. Blood pressure variation is significantly related to several measures of body composition including measures of fatness and fat free masses.(AU)

Maternal moods predict breast-feeding in Barbados

This study was designed to identify psychosocial variables affecting early infant feeding practices in Barbados. The sample included 93 healthy women and infants born at the Queen Elizabeth Hospital who were extensively evaluated 7 weeks, 3 months, and 6 months after birth. Maternal moods were assessed with the Zung Depression and Anxiety Scales and the General Adjustment and Morale Scale. Feeding practices were evaluated using a questionnaire developed for this population. The prevalence of mild depression in this population was 16 percent at 7 weeks and increased to 19 percent at 6 months, whereas there were very few cases of moderate-to-severe depression. Disadvantaged environmental conditions, including less information-seeking by the mother, lower family income, and poor maternal health, were closely associated with increased symptoms of depression and anxiety in all women. However, significant predictive relationships between mood and feeding practices remained even when the effects of the home environment were controlled. Specifically, depressive symptoms at 7 weeks postpartum predicted a reduced preference for breastfeeding at current and later infant ages. Conversely, feeding practices did not predict maternal moods at later ages. These findings have important implications for public policy dealing with programs promoting breastfeeding. Early interventions designed to treat mild postnatal depression should be instituted early in the postpartum period to improve the chances for successful breastfeeding.(Au)

Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children

OBJECTIVE: To determine whether nutritional status, anaemia and geohelminth infections were related to school achievement and attendance in Jamaican children. DESIGN: A cross-sectional study using a randomly selected sample. SUBJECTS: Eight hundred children aged 9-13 years randomly selected from those enrolled in grade 5 in 16 primary schools in rural Jamaica. RESULTS: The mean height for age of the children was -0.37 z-score +/-1.0 s.d. with 4.9 percent having the heights for age < -2 s.d. of the NCHS references. Anaemia (Hb < 11 g/dl) was present in 14.7 percent of the children, 38.3 percent were infected with Trichuris trichiura and 19.4 percent with Ascaris lumbricoides. Achievement levels on the Wide Range Achievement Test were low, with children performing at grade 3 level. In multilevel analyses, controlling for socioeconomic status, children with Trichuris infections had lower achievement levels than uninfected children in spelling, reading and arithmetic (P < 0.05). Children with Ascaris infections had lower scores in spelling and reading (P < 0.05) Height for age (P < 0.01) was positively associated with performance in arithmetic. Ascaris infection (P < 0.001) and anaemia (P < 0.01) predicted poorer school attendance. CONCLUSION: Despite mild levels, undernutrition and geohelminth infections were associated with achievement, suggesting that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children(AU)

Effects of early childhood supplementation with and without stimulation on later development in stunted Jamaican children

It is not known whether nutritional supplementation in early childhood has long-term benefits on stunted children's mental development. We followed up 127 7-8-y old children who had been stunted in early childhood and received supplementation, stimulation, or both. At 9-24 mo of age, the children had been randomly assigned to four treatment groups: nutritional supplementation, stimulation, both treatments, and control. After 2 y, supplementation and stimulation had independent benefits on the children's development and the effects were additive. The group receiving both treatments caught up to a matched group of 32 nonstunted children. Four years after the end of the 2-y intervention 97 percent of the children were given a battery of cognitive function, school achievement, and fine motor tests. An additional 52 nonstunted children were included. Factor analyses of the test scores produced three factors: general cognitive, perceptual-motor, and memory. One, the perceptual-motor factor, showed a significant benefit from stimulation, and supplementation benefited only those children whose mothers had higher verbal intelligence quotients. However, each intervention group had higher scores than the control subjects on more test than would be expected by chance (supplemented and both groups on 14 of 15 tests, P = 0.002; stimulated group in 13 of 15 tests, P = 0.01), suggesting a very small global benefit. There was no longer an additive effect of combined treatments at the end of the intervention. The stunted control group had significantly lower scores than the nonstunted children on most tests. Stunted children's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up.(AU)

Biochemical markers of growth in the male and female adolescents - abstract

The biochemical markers of growth, insulin-like growth factor-1 (IGF-1) and the carboxyterminal propeptide of the type 1 procollagen (PICP) have been related to anthropometric indicators of growth. We have demonstrated a relationship among plasma levels of IGF-1 and height (ht) for age and weight (wt) for age Z-scores in children 2-10 years. PICP has been associated with height (kit) velocity. We therefore looked at plasma levels of these indicators in adolscents expected to attain maximum growth velocity during the year: boys ( n=20) 13-14 years old (mean age, 13.7 years) and girls ( n=18) 11-12 years old (mean age, 11.6 years). Ht, wt, mid-upper arm circumference (MUAC), triceps and subscapular skinfold thickness were measured at baseline, then every 3 months for a year. At each visit, a venous blood sample was taken for plasma determinations of IGF - 1 and PICP by radioimmunoassay (RIA). The girls were slightly above and the boys were slightly below the NCHS references for their age with the exception of the triceps skinfold. The observed mean ht and wt velocities among the boys were 5.5 cm/year and 5.3 kg/year and the girls, 5.3 cm/year and 4.9 kg/year. The mean plasma level of IGF -1 in the adolescents were double those in the 2 - 10 year old age group with the girls (41.02 nmol/ml 95 percent CI22.0, 60.0) higher than the boys (35.39 nmol/ml 95 percent CI15.4,55.39). The difference was statistically significant. The mean plasma levels of PICP were similar for boys, (399.63 ng/ml 95 percent CI59.83, 739.43) and for the girls (398.76 ng/ml 95 percent CI 114.36, 683.16). These values were slightly higher than those in the 2-10 year-old age group. These values of IGF-1 and PIUCP are comparable to those of other populations. Mean percent body fat (PBF) increased linearly during the year in the girls, was related to the their body mass index (BMI) and was significantly higher than that in the boys. There was no association between PBF and BMI in the boys. Unlike the 2-10 year-old age group, there were no consistent relationships demonstrated among the anthropometric and the biochemical markers of growth in adolscents. This may reflect the mixed levels of maturity and the influence of the pubertal hormones in this group of adolescents. (AU)

Relationship between maternal nutritional status and infant's weight and body proportions at birth

OBJECTIVE: To examine maternal nutritional status and its relationship to infant weight and body proportions. DESIGN: Retrospective study of births from January-December 1990. SETTING: University Hospital of the West Indies, Jamaica. SUBJECTS: Records for 2394 live, singleton births, between 200-305 d gestation. MAIN OUTCOME MEASURES: Birth weight, crown heel length, head circumference, ponderal index, head circumference: length ratio, placental weight, placental: birth weight ratio. RESULTS: Mothers who were lighter had babies who had lower birth weight, were shorter, had smaller heads and had a higher HC:L ratio. Shorter and thinner women had babies who had lower birth wieghts, were shorter, had smaller heads and lighter placentas. Thinner women also had babies with a lower placental: birth weight ratio, and their BMI's were not linearly related to ponderal index and HC:L ratio. Women whose first trimester Hb levels were < 9.5 g/d1 had babies with the lowest birth weight, crown heel length, placental weight and ponderal index. These measurements increased as the Hb levels rose to 12.5 g/dl but then fell at Hb levels > 12.5 g/dl. In the second and third trimester Hb levels were negatively associated with birth weight, crown heel length, head circumference, placenta weight and ponderal index. CONCLUSIONS: The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by low weight, height, and BMI are associated with smaller, shorter babies with smaller heads. Haemoglobin levels > 12.5 g/dl in pregnancy are associated with lighter, shorter, thinner babies, with smaller heads.(AU)

A method to estimate prevalence of iron-deficiency and iron deficiency anemia in adolescent Jamaican girls

A method is presented to estimate a cutoff for hemoglobin concentration appropriate for estimating the prevalence of iron deficiency anemia in poor Jamaican girls 13-14 years of age. Iron deficiency was determined from a three-variable model of iron status (serum ferritin, erythrocyte protoporphyrin, and mean corpuscular volume). The most appropriate hemoglobin cutoff was considered the one that minimized misclassification of iron deficiency: that yielding the maximum kappa coefficient for correctly classifying iron deficiency between 100 and 120 g/L, at 1-g/L intervals. By using this method, a hemoglobin cutoff and the other indicators were used to estimate prevalences of iron deficiency and iron deficiency anemia in the Jamaican girls: 7.6 percent and 4.3 percent respectively. This approach should be appropriate for determining hemoglobin cutoffs for iron deficiency anemia in other populations.(AU)

Early childhood supplementation does not benefit the long-term growth of stunted children in Jamaica

The long-term benefits of early childhood supplementation and the extents to which catch-up growth occurs following linear growth retardation remain controversial. Stunted children (height-for-age < -2 SD of NCHS reference, n = 122) recruited from a survey of poor neighborhoods in Kingston, Jamaica, participated in a 2-yr randomized, 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 compard with the non-supplemented children. After adjustment for regression to the mean, the height-for-age of stunted children (supplemented and non-supplemented combined) increase from enrollment to follow-up by 0.31 Z-score (95 percent CI 0.17, 0.46). The height-for-age of the non-stunted children also increase (0.96 Z-score; 95 percent 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.(AU)