Is relative leg length a biomarker of childhood nutrition? Long-term follow-up of the Hyderabad Nutrition Trial.

BACKGROUND: Relative leg length is frequently used as a biomarker of childhood nutrition in epidemiological studies, but evidence is lacking. We examined the association between supplemental nutrition in pregnancy and childhood and relative proportions of components of height in adolescence. METHODS: In a community trial of nutritional supplementation, villages from adjacent administrative areas were selected to serve as intervention (n = 15) and control (n = 14) arms. In the intervention villages, balanced protein-calorie supplementation (2.51 MJ, 20 g protein) was offered daily to pregnant women and their offspring until the age of 6 years. Children born in the trial were re-examined 15 years later to assess components of height. RESULTS: A total of 1165 adolescents (intervention: 654, 49% of trial participants; control: 511, 41% of trial participants) aged 13-18 years were examined. Supplemented children were 10 mm taller [95% confidence interval (CI): 1.4 to 18.7 mm], but almost all of the increase was in trunk length (9 mm, 95% CI: 2.6 to 15.4 mm). The age- and gender-adjusted ß-coefficients for the association of nutritional supplementation with relative trunk, leg and lower leg lengths (expressed as standard deviation scores) were 0.26 (95% CI: 0.11 to 0.42), 0.08 (95% CI: -0.03 to 0.19) and 0.03 (95% CI: -0.08 to 0.15) respectively, thereby unsupportive of cephalocaudal gradient in growth. CONCLUSIONS: In this nutritional supplementation trial in an undernourished population, we were unable to confirm relative leg length as a biomarker of childhood nutrition. Alternative explanations may underlie the reported associations between childhood conditions and relative leg length.

Evaluation of the Food and Agriculture Organization's global school-based nutrition education initiative, Feeding Minds, Fighting Hunger (FMFH), in schools of Hyderabad, India.

OBJECTIVE: To assess the efficacy of the Food and Agriculture Organization's global school-based nutrition education initiative, Feeding Minds, Fighting Hunger (FMFH), in improving nutrition-related knowledge levels of schoolchildren. DESIGN: Adopting the cluster randomisation technique, five schools each in experimental and control groups were randomly chosen from the member schools of a voluntary organisation. Repeated measures of knowledge levels were carried out at three points in time to assess pre-, post-intervention and retention of knowledge gained during the intervention. Children from experimental schools were given nutrition education by teachers in the classroom setting using FMFH material. SUBJECTS/SETTINGS: Schoolchildren (n=358 in the control group and n=312 in the experimental group) of grades VIII and IX from schools in Hyderabad, India. RESULTS: The classroom-based intervention resulted in a significant improvement (P<0.01) in nutrition knowledge levels of schoolchildren in the experimental group. Significant improvement in knowledge was also observed in the control group. The effect size indicated that the improvement in knowledge levels of schoolchildren in experimental schools over control schools was medium (d=0.40), indicating the efficacy of the FMFH programme in improving nutrition-related knowledge. No significant decrease (P>0.05) in knowledge levels was observed after 2 months, indicating retention of the knowledge acquired through the intervention. CONCLUSION: The FMFH programme provides an opportunity for schoolchildren to learn more about nutrition through their teachers in a classroom setting if the lesson plans are adapted to the local circumstances. Furthermore, it has the potential to make nutrition education interactive, effective and sustainable.

Effect of micronutrient supplementation on health and nutritional status of schoolchildren: growth and morbidity.

OBJECTIVE: We evaluated the effect of a micronutrient-fortified beverage on growth and morbidity in apparently healthy schoolchildren. METHODS: This was a double-blind, placebo-controlled, matched-pair, cluster, randomized study in semi-urban middle-income residential schoolchildren aged 6 to 16 y. Anthropometrics (height and weight), clinical symptoms of deficiency, and morbidity data were collected at baseline in the supplemented group (n = 446 in 10 grades) and the placebo group (n = 423 in 10 grades) and after 14 mo of supplementation (n = 355 in the supplement group and n = 340 in the placebo group from nine pairs). RESULTS: After 14 mo of supplementation, there was a significant increase in mean increments of height and weight z scores of -0.04 and 0.02, respectively, in the supplemented group compared with -0.14 and -0.09 in the placebo group. Velocity of weight (3.56 versus 3.00) was significantly (P < 0.01) higher with supplementation. Although there were no differences in the incidence of common childhood diseases such as fever, cough and cold, diarrhea, and ear infections elicited for a reference period of 1 mo at every quarterly follow-up examination, the mean duration of illness (calculated per person per year) was significantly shorter (5.0 d) in the supplemented group than in the placebo group (7.4 d). CONCLUSIONS: The micronutrient-fortified beverage was beneficial in promoting growth and decreasing duration of common illnesses among middle-class residential schoolchildren who had adequate energy and protein intakes.