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The articles in this supplement deal with the effects of improving the nutrition of preschool Guatemalan children on status and function measured in the same individuals as adolescents and young adults. This collective effort is a unique scientific contribution and represents the first, comprehensive, long-term evaluation of a nutrition intervention aimed at mothers and children in a developing country.
Many institutions and people have contributed to making possible the research included in this supplement to the Journal of Nutrition. Foremost is the Institute of Nutrition of Central America and Panama (INCAP), which successfully implemented and conducted the two related studies reviewed: the INCAP longitudinal study on the effects of nutrition supplementation on child growth and development (1969-1977) and the follow-up study (1988-1989) of former participants.
We are grateful to the people of the four villages in eastern Guatemala in which the studies took place. The overwhelming majority gave willingly of their time and cheerfully tolerated the many examinations and interviews. Though we made efforts to compensate them directly, particularly through the provision of medical care, we doubt we matched their generosity. Through analysis and dissemination of the results, we hope to impact positively on policies and programs aimed at preventing childhood malnutrition and in this manner, justify the many demands we made on the peoples of San Miguel de Conacaste, Santo Domingo los Ocotes, San Juan de las Flores and Espíritu Santo.
The longitudinal study of 1969-1977 is the work of many outstanding scientists in the mid-sixties, first laying the groundwork and later carrying out the study. Much is owed to the leadership of the two directors of the former Division of Human Development at INCAP, Drs. Cipriano Canosa (1969-1970) and Robert E. Klein (1970-1977), who guided the study throughout its initial history.
The U.S. National Institute of Child Health and Human Development (NICHD) supported the initial longitudinal study (Contract No. PH 43-65-640). Through timely monitoring, including periodic site visits, NICHD helped the project remain scientifically rigorous. Two smaller but important contributions to the financing of the study were a grant from the U.S. Agency for International Development (USAID), which supported the collection of birthweight data in the later stages of the project, and a grant from the Rockefeller Foundation to the RAND Corporation and INCAP, which financed the collection of wealth, fertility and other social data starting in 1974.
The follow-up study was a natural extension of the longitudinal study. Seed money (from the Alfred Sloan Foundation) from Stanford University to R. Martorell made possible the submission of a proposal to the U.S. National Institutes of Health (NIB), which was eventually approved and funded (RO1-HD-2240) with R. Martorell as principal investigator. Funding from NIH (RO1-HD24684) to J. Himes permitted the collection of bone mineral data. Other support included a grant from the Pew Charitable Trusts (No. 99G0070-0001), which funded the analyses of educational data, with E. Pollitt and R. Martorell as principal investigators, and a grant from the Thrasher Research Fund to J. A. Rivera, R. Martorell, and J.-P. Habicht for a pilot study of the newborns of follow up females (No. 2805-5). Assistance has also been obtained for analyses of the growth and maturation of adolescents through a grant from the International Center for Research on Women (LIC-75/031). made to R. Martorell and J. A. Rivera, and for analyses of the functional consequences of growth failure through a grant from UNICEF to R. Martorell. A grant from the United Nations University helped to obtain additional social data on the communities during the follow-up study. The Pew Charitable Trusts is funding an effort to apply the lessons of the INCAP studies to nutrition and educational programs in Central America, through a grant (No. 93-03448-000) to R. Martorell, E. Pollitt and M. Ruel.
The present set of articles is an outgrowth of a workshop held at the Rockefeller Conference Center in Bellagio, Italy, in July 1990, under the aegis of the International Dietary Energy Consultative Group (IDECG). Travel funds and per diem were generously provided by the Office of Nutrition of USAID and the United Nations University. Articles emphasizing the results of reanalysis of data from the longitudinal study of 1969-77 were published in a supplement of the Food and Nutrition Bulletin (Vol. 14, No. 3, 1992) with the financial assistance of UNICEF and the World Food Program. This second volume emphasizes the results of the 1988-89 follow-up study; a preliminary version of some of these papers, including the contribution of Lindsay Allen, were presented at the 1992 FASEB meetings held in Anaheim, California. We appreciate the contribution of Laura Caulfield and colleagues on the subject of bone mineralization; this was an analysis carried out at the University of Minnesota, independent of efforts at Emory and Cornell, a fact which explains the different analytic approaches undertaken.
While the emphasis is on the follow-up study, the collection also includes three papers which summarize the history and design of the longitudinal study, the analytic strategies and the types of inferences which can be made from the study and the effects of nutritional supplementation on physical growth in children less than seven years of age. This is important information for understanding the papers on the follow-up study which form the major part of the set. All of the follow-up papers with one exception contain unpublished, original results. They are published as a set rather than individually in various journals to enable readers to locate them easily in a single source. An important aspect of the research is the results on intellectual performance, and any presentation of the follow-up would be incomplete without it. This is the reason for including in this volume a brief paper by Pollitt et al. summarizing previously published results.
All papers were subjected to rigorous peer review. Six external reviewers read about four papers each and one reviewed the entire set. All reviewers were well known experts in nutrition, growth or development.
We are grateful to the American Institute of Nutrition for encouraging publication of the research as a unit in the Journal of Nutrition and for its financial contribution.
Reynaldo Martorell, Ph.D.
Robert W. Woodruff Professor of
Department of International Health
The Rollins School of Public Health of
1518 Clifton Road, N.E.
Atlanta, Georgia 30322
Nevin S. Scrimshaw, M.D., Ph.D.
Director, Food and Nutrition Programme
for Human and Social Development
The United Nations University
Charles Street Station, P.O. Box 500
Boston, MA 02114-0500
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