American Journal of Clinical Nutrition, Vol 66, 247-253, Copyright © 1997 by The American Society for Clinical Nutrition, Inc

ORIGINAL RESEARCH COMMUNICATIONS

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

SM Grantham-McGregor, SP Walker, SM Chang and CA Powell
Tropical Metabolism Research Unit, University of the West Indies, Kingston, Jamaica. s.mcgregor@ich.ucl.ac.uk

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% 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 tests 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.

This article has been cited by other articles:

				A. D. Stein, M. Wang, A. DiGirolamo, R. Grajeda, U. Ramakrishnan, M. Ramirez-Zea, K. Yount, and R. Martorell Nutritional Supplementation in Early Childhood, Schooling, and Intellectual Functioning in Adulthood: A Prospective Study in Guatemala Arch Pediatr Adolesc Med, July 1, 2008; 162(7): 612 - 618. [Abstract] [Full Text] [PDF]

				S. P. Walker, S. M. Chang, C. A. Powell, E. Simonoff, and S. M. Grantham-McGregor Early Childhood Stunting Is Associated with Poor Psychological Functioning in Late Adolescence and Effects Are Reduced by Psychosocial Stimulation J. Nutr., November 1, 2007; 137(11): 2464 - 2469. [Abstract] [Full Text] [PDF]

				H. Alderman, J. R. Behrman, and J. Hoddinott Economic and Nutritional Analyses Offer Substantial Synergies for Understanding Human Nutrition J. Nutr., March 1, 2007; 137(3): 537 - 544. [Abstract] [Full Text] [PDF]

				K. Watanabe, R. Flores, J. Fujiwara, and L. T. H. Tran Early Childhood Development Interventions and Cognitive Development of Young Children in Rural Vietnam J. Nutr., August 1, 2005; 135(8): 1918 - 1925. [Abstract] [Full Text] [PDF]

				J. P. A. Ioannidis Contradicted and Initially Stronger Effects in Highly Cited Clinical Research JAMA, July 13, 2005; 294(2): 218 - 228. [Abstract] [Full Text] [PDF]

				H. Li, H. X. Barnhart, A. D. Stein, and R. Martorell Effects of Early Childhood Supplementation on the Educational Achievement of Women Pediatrics, November 1, 2003; 112(5): 1156 - 1162. [Abstract] [Full Text] [PDF]

				L. C. Fernald and S. M. Grantham-McGregor Growth Retardation Is Associated with Changes in the Stress Response System and Behavior in School-Aged Jamaican Children J. Nutr., December 1, 2002; 132(12): 3674 - 3679. [Abstract] [Full Text] [PDF]

				G. H. Pelto Improving Complementary Feeding Practices and Responsive Parenting as a Primary Component of Interventions to Prevent Malnutrition in Infancy and Early Childhood Pediatrics, November 1, 2000; 106(5): 1300 - 1300. [Full Text]

				A Lucas, R Morley, and T J Cole Randomised trial of early diet in preterm babies and later intelligence quotient BMJ, November 28, 1998; 317(7171): 1481 - 1487. [Abstract] [Full Text]