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Early supplementary feeding, child development, and health policy
Ernesto Pollitt and Se-Young Oh
We carried out a meta-analysis of six field studies that assessed the effects of supplementary feeding on infants' performance on mental and motor development scales—conducted in nutritionally at-risk populations in Colombia, Guatemala, Indonesia, Jamaica, Taiwan, and the United States—which showed that early high energy and protein supplementary feeding has a beneficial effect on motor development in young infants (8-15 months old) and on both motor and mental development in older infants (1824 months old) who are nutritionally at risk. These findings provide justification for food assistance programmes targeted to young at-risk children. However, positive findings in field studies do not guarantee that similar results will be achieved by large-scale programmes, as complex bureaucracies and inadequate infrastructure are often obstacles to success.
National health policies often include the provision of food to nutritionally at-risk populations [1, 2]. For example, in the United States the Supplemental Food Program for Women, Infants, and Children (WIC), authorized by a 1972 amendment (Public Law 92-433) to the Child Nutrition Act of 1966, has the objective of preventing health problems and improving the health status of the recipients The 1972 amendment mandates cash grants to state health departments and local health clinics for providing specified food supplements to pregnant and lactating women, and to children from birth to the age of four years.
Although skeptics may not agree [3], WIC is considered a successful, cost-effective programme with increasing coverage of those eligible [4]. There is persuasive information on the dietary benefits of WIC to pregnant and lactating women, and on weight gain during and after pregnancy [4, 5]. Conclusive evidence has yet to be obtained on its effects on postnatal growth and development in children [4].
Evaluations of WIC and of experimental studies on supplementary feeding have focused on the impact on specific or aggregate measures of mental development [57]. Because of methodological weaknesses, these evaluations have been, at best, controversial [3, 8]. A review of four experimental studies on the effects of early supplementary feeding on the development of infants and young children concluded that three of these studies showed mild, albeit statistically significant, benefits, particularly in the motor domain [9]. Recently, the results of one of these four studies have been re-analysed and data from two additional experimental studies have been published [10-12], strengthening the data base and allowing for more definitive conclusions.
We included the results of these six studies in a metaanalysis to test for the effects of supplementary feeding, primarily protein and calories, during pregnancy and the first two years of postnatal life on performance on the motor and mental components of developmental scales.