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Meta-Analysis
. 2012 Jun 13;2012(6):CD005039.
doi: 10.1002/14651858.CD005039.pub3.

Community-based supplementary feeding for promoting the growth of children under five years of age in low and middle income countries

Yanina Sguassero  1 , Mercedes de Onis, Ana María Bonotti, Guillermo Carroli
Affiliations
Meta-Analysis

Community-based supplementary feeding for promoting the growth of children under five years of age in low and middle income countries

Yanina Sguassero et al. Cochrane Database Syst Rev. .

Abstract

Background: Supplementary feeding is defined as the provision of extra food to children or families beyond the normal ration of their home diets. The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and non-governmental organisations on this intervention to improve child health in low and middle income countries (LMIC). This is an update of a Cochrane review first published in 2005.

Objectives: To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of children under five years of age in LMIC.

Search methods: For this updated review we searched the following databases on 31 January 2011: CENTRAL (The Cochrane Library), MEDLINE (1948 to January week 3, 2011), EMBASE (1980 to week 3, 2011), CINAHL (1937 to 27 January 2011), LILACS (all years), WorldCat for dissertations and theses (all years) and ClinicalTrials.gov (all years).

Selection criteria: Randomised controlled trials (RCTs) evaluating supplementary feeding in comparison to a control group (no intervention or a placebo such as food with a very low number of nutrients and calories) in children from birth to five years of age in LMIC.

Data collection and analysis: Two review authors independently extracted and analysed the data.

Main results: We included eight RCTs (n = 1243 children) that were at relatively high risk of bias. We found high levels of clinical heterogeneity in the participants, interventions and outcome measures across studies. Nevertheless, in order to quantify pooled effects of supplementary feeding, we decided to combine studies according to prespecified characteristics. These were the children's age (younger or older than 24 months), their nutritional status at baseline (stunted or wasted, or not stunted or wasted) and the duration of the intervention (less or more than 12 months). A statistically significant difference of effect was only found for length during the intervention in children aged less than 12 months (two studies; 795 children; mean difference 0.19 cm; 95% confidence interval (CI) 0.07 to 0.31). Based on the summary statistic calculated for each study, the mean difference (MD) between intervention and control groups ranged from 0.48 cm (95% CI 0.07 to 0.89) to 1.3 cm (95% CI 0.03 to 2.57) after 3 and 12 months of intervention, respectively. Data on potential adverse effects were lacking.

Authors' conclusions: The scarcity of available studies and their heterogeneity makes it difficult to reach any firm conclusions. The review findings suggest supplementary feeding has a negligible impact on child growth; however, the pooled results should be interpreted with great caution because the studies included in the review are clinically diverse. Future studies should address issues of research design, including sample size calculation, to detect meaningful clinical effects and adequate intervention allocation concealment. In the meantime, families and children in need should be provided appropriate feeding, health care and sanitation without waiting for new RCTs to establish a research basis for feeding children.

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Conflict of interest statement

Yanina Sguassero: I have received fees for participation in review activities from HQ/NHD Nutrition for Health and Development, World Health Organization. This did not influence my work on this review. Mercedes de Onis: none known. Ana María Bonotti: none known. Guillermo Carroli: none known.

Figures

1
1
Updated flowchart of searches up to 2005. The four country RCT conducted in Bolivia, Congo, New Caledonia and Senegal was included in the current version of the review due to a change of exclusion criteria between the protocol and review. The corresponding citation is Multicountry study 1996. See Differences between protocol and review for further explanations.
2
2
Flowchart of 2011 searches.
3
3
Risk of bias summary: review authors' judgements about each risk of bias domain for each included study
4
4
Risk of bias graph: review authors' judgements about each risk of bias domain presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 1 Weight (kg) at the end of the intervention.
1.2
1.2. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 2 Length (cm) at the end of the intervention.
1.3
1.3. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 3 Weight‐for‐length z‐score at the end of the intervention.
1.4
1.4. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 4 Head circumference (cm) at the end of the intervention.
1.5
1.5. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 5 Mid‐upper‐arm circumference (cm) at the end of the intervention.
1.6
1.6. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 6 Triceps skinfold thickness (mm) at the end of the intervention.
1.7
1.7. Analysis
Comparison 1 Energy‐protein supplementation versus no supplementation in stunted children after 12 months, Outcome 7 Subscapular skinfold thickness (mm) at the end of the intervention.
2.1
2.1. Analysis
Comparison 2 High energy and protein supplementation versus low‐energy, low protein supplementation in stunted or wasted children after 12 months, Outcome 1 Weight (kg) at the end of the intervention.
2.2
2.2. Analysis
Comparison 2 High energy and protein supplementation versus low‐energy, low protein supplementation in stunted or wasted children after 12 months, Outcome 2 Height/length (cm) at the end of the intervention.
2.3
2.3. Analysis
Comparison 2 High energy and protein supplementation versus low‐energy, low protein supplementation in stunted or wasted children after 12 months, Outcome 3 Head circumference (cm) at the end of the intervention.
2.4
2.4. Analysis
Comparison 2 High energy and protein supplementation versus low‐energy, low protein supplementation in stunted or wasted children after 12 months, Outcome 4 Arm circumference (cm) at the end of the intervention.
3.1
3.1. Analysis
Comparison 3 Energy‐protein supplementation versus no supplementation in poor children after three months, Outcome 1 Weight z‐scores at the end of the intervention.
3.2
3.2. Analysis
Comparison 3 Energy‐protein supplementation versus no supplementation in poor children after three months, Outcome 2 Height z‐scores at the end of the intervention.
4.1
4.1. Analysis
Comparison 4 Multi‐mixture versus no supplementation in poor children after 10 months, Outcome 1 Weight‐for‐age z‐score at the end of the intervention.
4.2
4.2. Analysis
Comparison 4 Multi‐mixture versus no supplementation in poor children after 10 months, Outcome 2 Height‐for‐age z‐score at the end of the intervention.
4.3
4.3. Analysis
Comparison 4 Multi‐mixture versus no supplementation in poor children after 10 months, Outcome 3 Weight‐for‐height z‐score at the end of the intervention.
5.1
5.1. Analysis
Comparison 5 Yogurt supplementation versus no supplementation in nutritionally‐at‐risk children after nine months, Outcome 1 Weight gain (kg) during the intervention.
5.2
5.2. Analysis
Comparison 5 Yogurt supplementation versus no supplementation in nutritionally‐at‐risk children after nine months, Outcome 2 Height gain (cm) during the intervention.
5.3
5.3. Analysis
Comparison 5 Yogurt supplementation versus no supplementation in nutritionally‐at‐risk children after nine months, Outcome 3 MUAC (cm) at the end of the intervention.
5.4
5.4. Analysis
Comparison 5 Yogurt supplementation versus no supplementation in nutritionally‐at‐risk children after nine months, Outcome 4 Change in weight‐for‐age z‐score during the intervention.
5.5
5.5. Analysis
Comparison 5 Yogurt supplementation versus no supplementation in nutritionally‐at‐risk children after nine months, Outcome 5 Change in height‐for‐age z‐score during the intervention.
6.1
6.1. Analysis
Comparison 6 Multi‐mixture versus placebo in nutritionally‐at‐risk children after two months, Outcome 1 Weight‐for‐age z‐score at the end of the intervention.
6.2
6.2. Analysis
Comparison 6 Multi‐mixture versus placebo in nutritionally‐at‐risk children after two months, Outcome 2 Height‐for‐age z‐score at the end of the intervention.
6.3
6.3. Analysis
Comparison 6 Multi‐mixture versus placebo in nutritionally‐at‐risk children after two months, Outcome 3 Weight‐for‐height z‐score at the end of the intervention.
7.1
7.1. Analysis
Comparison 7 Energy‐protein supplementation versus no supplementation in poor Bolivian children after three months, Outcome 1 Weight (kg) at the end of the intervention.
7.2
7.2. Analysis
Comparison 7 Energy‐protein supplementation versus no supplementation in poor Bolivian children after three months, Outcome 2 Length (cm) at the end of the intervention.
7.3
7.3. Analysis
Comparison 7 Energy‐protein supplementation versus no supplementation in poor Bolivian children after three months, Outcome 3 Weight gain (kg) during the intervention.
7.4
7.4. Analysis
Comparison 7 Energy‐protein supplementation versus no supplementation in poor Bolivian children after three months, Outcome 4 Length gain (cm) during the intervention.
8.1
8.1. Analysis
Comparison 8 Energy‐protein supplementation versus no supplementation in poor Caledonian children after three months, Outcome 1 Weight (kg) at the end of the intervention.
8.2
8.2. Analysis
Comparison 8 Energy‐protein supplementation versus no supplementation in poor Caledonian children after three months, Outcome 2 Length (cm) at the end of the intervention.
8.3
8.3. Analysis
Comparison 8 Energy‐protein supplementation versus no supplementation in poor Caledonian children after three months, Outcome 3 Weight gain (kg) during the intervention.
8.4
8.4. Analysis
Comparison 8 Energy‐protein supplementation versus no supplementation in poor Caledonian children after three months, Outcome 4 Length gain (cm) during the intervention.
9.1
9.1. Analysis
Comparison 9 Energy‐protein supplementation versus no supplementation in poor Congolese children after three months, Outcome 1 Weight (kg).
9.2
9.2. Analysis
Comparison 9 Energy‐protein supplementation versus no supplementation in poor Congolese children after three months, Outcome 2 Length (cm).
9.3
9.3. Analysis
Comparison 9 Energy‐protein supplementation versus no supplementation in poor Congolese children after three months, Outcome 3 Weight gain (kg).
9.4
9.4. Analysis
Comparison 9 Energy‐protein supplementation versus no supplementation in poor Congolese children after three months, Outcome 4 Length gain (cm).
10.1
10.1. Analysis
Comparison 10 Energy‐protein supplementation versus no supplementation in poor Senegalese children after three months, Outcome 1 Weight (kg) at the end of the intervention.
10.2
10.2. Analysis
Comparison 10 Energy‐protein supplementation versus no supplementation in poor Senegalese children after three months, Outcome 2 Length (cm) at the end of the intervention.
10.3
10.3. Analysis
Comparison 10 Energy‐protein supplementation versus no supplementation in poor Senegalese children after three months, Outcome 3 Weight gain (kg) during the intervention.
10.4
10.4. Analysis
Comparison 10 Energy‐protein supplementation versus no supplementation in poor Senegalese children after three months, Outcome 4 Length gain (cm) during the intervention.
11.1
11.1. Analysis
Comparison 11 Energy‐protein supplementation versus no supplementation in children from four countries after three months, Outcome 1 Weight (kg) at the end of the intervention.
11.2
11.2. Analysis
Comparison 11 Energy‐protein supplementation versus no supplementation in children from four countries after three months, Outcome 2 Length (cm) at the end of the intervention.
11.3
11.3. Analysis
Comparison 11 Energy‐protein supplementation versus no supplementation in children from four countries after three months, Outcome 3 Weight gain (kg) during the intervention.
11.4
11.4. Analysis
Comparison 11 Energy‐protein supplementation versus no supplementation in children from four countries after three months, Outcome 4 Length gain (cm) during the intervention.
12.1
12.1. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 1 Weight (kg) at the end of the intervention.
12.2
12.2. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 2 Length/height (cm) at the end of the intervention.
12.3
12.3. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 3 Weight (kg) gain during the intervention.
12.4
12.4. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 4 Length/height (cm) gain during the intervention.
12.5
12.5. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 5 Weight‐for‐age z‐score at the end of the intervention.
12.6
12.6. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 6 Length/height‐for‐age z‐score at the end of he intervention.
12.7
12.7. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 7 Weight‐for‐length/height z‐score at the end of the intervention.
12.8
12.8. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 8 Change in weight‐for‐age z‐score during the intervention.
12.9
12.9. Analysis
Comparison 12 Supplementary feeding by age of children, Outcome 9 Change in height‐for‐age z‐score.
13.1
13.1. Analysis
Comparison 13 Supplementary feeding by nutritional status of children, Outcome 1 Weight (kg) at the end of the intervention.
13.2
13.2. Analysis
Comparison 13 Supplementary feeding by nutritional status of children, Outcome 2 Length/height (cm) at the end of the intervention.
13.3
13.3. Analysis
Comparison 13 Supplementary feeding by nutritional status of children, Outcome 3 Weight‐for‐length/height z‐score at the end of the intervention.
14.1
14.1. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 1 Weight (kg) at the end of the intervention.
14.2
14.2. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 2 Length/height (cm) at the end of the intervention.
14.3
14.3. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 3 Weight gain (kg) during the intervention.
14.4
14.4. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 4 Length/height gain (cm) during the intervention.
14.5
14.5. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 5 Weight‐for‐age z‐score at the end of the intervention.
14.6
14.6. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 6 Length/height‐for‐age z‐score at the end of the intervention.
14.7
14.7. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 7 Weight‐for‐length/height z‐score at the end of the intervention.
14.8
14.8. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 8 Change of weight‐for‐age z‐score during the intervention.
14.9
14.9. Analysis
Comparison 14 Supplementary feeding by duration of the intervention, Outcome 9 Change in height‐for‐age z‐score during the intervention.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Brazil 2006 {published data only}
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Brazil 2008 {published data only}
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China 2005 {published data only}
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Jamaica 1991 {published data only}
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Multicountry study 1996 {published data only}
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References to studies excluded from this review

Bangladesh 1992 {published data only}
    1. Fauveau C, Siddiqui M, Briend A, Silimperi DR, Begum N, Fauveau V. Limited impact of a targeted food supplementation programme in Bangladeshi urban slum children. Annals of Tropical Paediatrics 1992;12(1):41‐6. - PubMed
Brazil 2007 {published data only}
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Colombia 1981 {published data only}
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Gambia 1998 {published data only}
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References to other published versions of this review

Sguassero 2005
    1. Sguassero Y, Onis M, Carroli G. Community‐based supplementary feeding for promoting the growth of young children in developing countries. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD005039.pub2] - DOI - PubMed
Sguassero 2007
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