Quantifying and exploiting the age dependence in the effect of supplementary food for child undernutrition

Milinda Lakkam; Stefan Wager; Paul H Wise; Lawrence M Wein

doi:10.1371/journal.pone.0099632

Quantifying and exploiting the age dependence in the effect of supplementary food for child undernutrition

PLoS One. 2014 Jun 26;9(6):e99632. doi: 10.1371/journal.pone.0099632. eCollection 2014.

Authors

Milinda Lakkam¹, Stefan Wager², Paul H Wise³, Lawrence M Wein⁴

Affiliations

¹ Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California, United States of America.
² Statistics Department, Stanford University, Stanford, California, United States of America.
³ School of Medicine, Stanford University, Stanford California, United States of America.
⁴ Graduate School of Business, Stanford University, Stanford, California, United States of America.

Abstract

Motivated by the lack of randomized controlled trials with an intervention-free control arm in the area of child undernutrition, we fit a trivariate model of weight-for-age z score (WAZ), height-for-age z score (HAZ) and diarrhea status to data from an observational study of supplementary feeding (100 kCal/day for children with WAZ [Formula: see text]) in 17 Guatemalan communities. Incorporating time lags, intention to treat (i.e., to give supplementary food), seasonality and age interactions, we estimate how the effect of supplementary food on WAZ, HAZ and diarrhea status varies with a child's age. We find that the effect of supplementary food on all 3 metrics decreases linearly with age from 6 to 20 mo and has little effect after 20 mo. We derive 2 food allocation policies that myopically (i.e., looking ahead 2 mo) minimize either the underweight or stunting severity - i.e., the sum of squared WAZ or HAZ scores for all children with WAZ or HAZ [Formula: see text]. A simulation study based on the statistical model predicts that the 2 derived policies reduce the underweight severity (averaged over all ages) by 13.6-14.1% and reduce the stunting severity at age 60 mo by 7.1-8.0% relative to the policy currently in use, where all policies have a budget that feeds [Formula: see text]% of children. While these findings need to be confirmed on additional data sets, it appears that in a low-dose (100 kCal/day) supplementary feeding setting in Guatemala, allocating food primarily to 6-12 mo infants can reduce the severity of underweight and stunting.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Female
Food, Fortified*
Guatemala
Humans
Infant
Infant Nutrition Disorders / diet therapy*
Infant Nutrition Disorders / prevention & control
Male
Models, Statistical

Grants and funding

Graduate School of Business, Stanford University and a B.C. and E.J. Eaves Stanford Graduate Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.