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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.

Introduction: The field testing of the preliminary WHO child growth standards was conducted in Rosario, Argentina. The objective of the article is to analyze the anthropometrical outcomes based on the national and international growth references. POPULATION, MATERIALS AND METHODS: Descriptive, cross-sectional study. Healthy children born at term, aged 0 to 5 years, and users of the health care network of the municipality from January to May 2005 were included. A data collection form was designed for the study. The weight (kg) was measured with an electronic scale. The length/height (cm) was taken with instruments constructed locally. The measurements techniques were based on national guidelines. The NUTRI 1.3: 5 and ANTHRO 2005 software were used., Results: A sample of 1.804 boys and girls was analyzed. The prevalence of underweight was 1,7 times higher in children less than 6 months with the application of the new standards compared to the national reference. For the rest of the age groups, the situation was the opposite. A major prevalence of stunting was observed after 6 months of age based on the new standards compared to the national reference. The prevalence of overweight, in comparison with the old growth international reference, increased with the use of the new standards., Conclusions: Differences in underweight, stunting and overweight were found based on the tool used. The prevalence of stunting and overweight may increase with the application of the new growth standard.

Background: Supplementary feeding is defined as the provision of extra food to poor 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 NGOs on this intervention to improve child health in developing countries., Objectives: To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of pre-school children in developing countries., Search Strategy: Searches of CENTRAL 2005 (Issue 2), MEDLINE 1966 to 2005, EMBASE 1980 to 2005, CINAHL 1982 to 2005, LILACS 1982 to 2005, Social Science Citation Index 1956 to 2005, and Dissertation Abstracts International (late 1960s to 2005) were conducted., Selection Criteria: Randomised controlled trials evaluating supplementary feeding in children aged 0-5 years old in developing countries., Data Collection and Analysis: Data were extracted and analysed independently by two authors., Main Results: Four trials met the inclusion criteria for this review. No meta-analysis is currently appropriate due to the clinical heterogeneity among the included studies. We group these trials into two categories: a) studies without formally assessment of malnourishment at baseline and, b) studies involving children formally assessed as malnourished.a) A cluster RCT conducted in Indonesia in 1991(20 Day Care Centres, n = 113 children), found no benefit in weight-for-age and height-for-age z-scores of the intervention group compared to the control group after three months of intervention. A study in Guatemala included four villages as unit of analysis (exact sample sizes were not provided). The length of 3-yr-old children was based on a 'before-after comparison' by village size and type of supplement. According to this analysis, the difference in net change in the large villages was 2.55 cm and in the small villages was 2.35 cm. The mean of these differences is 2.45 +- 0.10 cm (mean +- SD).b) A study conducted in Jamaica (n = 65 children) reported a positive effect on length (cm) in the supplemented group compared to controls [WMD 1.3 (0.03 to 2.57)] after 12 months of intervention. A trial from Indonesia (n = 75 children) found no benefit in growth after 12 months of supplementation., Authors' Conclusions: Based on the small number of available trials, no firm conclusions of the effectiveness of supplementary feeding to the growth of pre-school children could be drawn. Issues of research design such as blinding and sample size calculation need to be addressed in future studies.