Nutritional supplementation: effects on child stunting because of diarrhea.

ABSTRACT

PIP: To test the hypothesis that supplementation modifies the negative effect of diarrhea on linear growth, body length and diarrheal morbidity were compared at 36 months of age for 2 cohorts of Columbian children: those receiving supplements from birth and those not receiving supplements. The sample was a subset from a longitudinal study that took place in Bogota, Columbia, between 1973 and 1980 and consisted of 456 families randomly assigned to 6 experimental groups. There were 148 children in the unsupplemented group. The 140 children from the supplemented group received supplements from the 6th month of pregnancy until they were 36 months old. The supplementary feeding included 30 g of protein daily, and 7.5 mg or 15 mg of ferrous sulphate daily as well as vitamin A every 6 months. Supplemented children had a mean 16 episodes of diarrhea, compared with a mean of 18 episodes of the unsupplemented cohort, and they spent a total of 73 days ill, compared with 83 days ill for unsupplemented children. Linear regression analysis showed that the slopes for unsupplemented children were significantly different from 0 (p 0.001). Each day with diarrhea was associated with a reduction of about 0.03 cm in attained length at age 36 months. In contrast, for supplemented children diarrhea had no effect on attained length at age 36 months. 2-way analysis of variance showed that the difference between supplemented and unsupplemented children in attained length in the lowest quartile of diarrhea was small, but the difference in the highest quartile was almost 5 cm. Cumulative growth patterns of children in the high quartile of diarrheal disease revealed that the difference between unsupplemented children was a median of 13 cm, thus supplementation made up nearly 40% of the deficit, compared with the reference standard (5 cm/13 cm). Targeting supplementation programs to the critical period of high diarrheal prevalence among infants and young children should help prevent growth retardation associated with diarrhea.