High fat versus high carbohydrate nutritional supplementation: a one year trial in stunted rural Gambian children

Abstract

Objective: The study tests the hypothesis that a low daily fat intake may induce a negative fat balance and impair catch-up growth in stunted children between 3 and 9 y of age. Design: Randomized case-control study. Setting: Three rural villages of the West Kiang District, The Gambia. Subjects: Three groups of 30 stunted but not wasted children (height for age z-score 72.0, weight for height zscore ! 7 2.0) 3±9 y of age were selected by anthropometric survey. Groups were matched for age, sex, village, degree of stunting and season. Intervention: Two groups were randomly assigned to be supplemented ®ve days a week for one year with either a high fat (n 29) or a high carbohydrate biscuit (n 30) each containing approximately 1600 kJ. The third group was a non supplemented control group (n 29). Growth, nutritional status, dietary intake, resting energy expenditure and morbidity were compared. Results: Neither the high fat nor the high carbohydrate supplement had an effect on weight or height gain. The high fat supplement did slightly increase adipose tissue mass. There was no effect of supplementation on resting energy expenditure or morbidity. In addition, the annual growth rate was not associated with a morbidity score. Conclusions: Results show that neither a high fat nor a high carbohydrate supplement given during 12 months to stunted Gambian children induced catch-up growth. The authors suggest that an adverse effect of the environment on catch-up growth persists despite the nutritional interventions. Sponsorship: Nestle  Foundation for the Study of the Problems of Nutrition in the World, Lausanne, Switzerland. Descriptors: stunting; dietary fats; dietary carbohydrates; nutritional supplementation; catch-up growth; energy intake; resting energy expenditure; morbidity IntroductionIn 1983 the prevalence of stunting in children under ®ve years of age in developing countries was estimated using national prevalence values at approximately 40%, yielding a total of 125 million children (Keller, 1988). Ten years later, in a recent WHO report on child growth, the prevalence was estimated at 43% and a total of 230 million children were identi®ed as being stunted (de Onis et al, 1993). These ®gures illustrate the magnitude of the problem of stunting and serve as a reminder of how little is known about its causes in nutritional, metabolic and biochemical terms.Despite access to medical care, young children in Keneba (West Kiang District, Gambia) have repeated infectious episodes with growth faltering followed by inadequate catch-up growth (Rowland et al, 1977). Children gradually become stunted during the ®rst two years of life and tend to remain stunted through childhood into adult life. There is however evidence that stunting can be reversed during infancy and even during late childhood through adoption and to a lesser degree with nutritional supplementation (Martorell et al, 1994). This suggests that catch-up growth is impaired by conditions found in the environment in which the children became stunted. It is well esta...

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