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Nutritional Impact of Supplementation in the INCAP Longitudinal Study: Analytic Strategies and Inferences^1,2,

Jean-Pierre Habicht^*,3, Reynaldo Martorell and Juan A. Rivera

^* Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853-6301 Department of International Health, The Rollins School of Public Health of Emory University, Atlanta, GA 30322 Centro de Investigaciones en Salud Pública, Instituto Nacional de Salud Pública, 62508 Cuernavaca, Morelos, México

From 1969 to 1977 a supplementation trial was conducted in Guatemala to ascertain the effects on physical and behavioral outcomes of improved nutrition in pregnant women and in preschool children. This paper reviews different strategies to analyze the effect of the intervention on physical growth. One strategy compares outcomes in two villages that were randomly allocated to receive Atole, a supplement containing high amounts of protein and energy, with values in two other villages that received Fresco, a beverage containing no protein and little energy. Both supplements contained micronutrients. This comparison of village means gives a probability significance statement (P < 0.005) that the difference in growth was because of the supplement intervention, although it does not specify the aspect of the intervention that caused the effect. Complementary strategies increase the credibility that the effect of the supplement was nutritional. Thus, analysis of the dose response with increasing supplement intake within the villages excludes the possibility that the above findings were the result of knowing which villages received which supplement (i.e., measuring biases). A greater effect in those most likely to respond nutritionally also increases the credribility that the mechanism was nutritional. In studying other behavioral and biomedical impacts of this supplementation intervention, analyses for credibility should always be included.

KEY WORDS: • analytic methods • pregnancy • supplementation • growth • Guatemala

¹ Presented in the symposium on Nutrition in Early Childhood and its Long-Term Functional Significance, FASEB, April 6, 1992, Anaheim, CA. Published as a supplement to The Journal of Nutrition. Guest editors for this supplemental publication were Reynaldo Martorell, The Rollins School of Public Health of Emory University, Atlanta, GA, and Nevin Scrimshaw, The United Nations University, Boston, MA.

² The INCAP longitudinal study was supported by contract No. HD-5-0640 from the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Additional sources of support were from the Agency for International Development, Washington, DC (AID-TA-C/1224) and a grant from Rockefeller Foundation (73030-E7352). The follow-up study was supported by RO1 grant HD-22440.

³ To whom correspondence should be addressed: Division of Nutritional Sciences, 210 Savage Hall, Cornell University, Ithaca, NY 14853-6301.

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