***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Undernutrition in early childhood is associated with poor mental development and affects 45 % of children in Bangladesh . Although limited evidence shows that psychosocial stimulation can reduce the deficits , no such interventions have been reported from Bangladesh . The Bangladesh Integrated Nutrition Program ( BINP ) has provided nutrition supplementation to undernourished children through community nutrition centers ( CNCs ) . We added psychosocial stimulation to the treatment of undernourished children in a r and omized controlled trial to assess the effects on children 's development and growth and mothers ' knowledge . Twenty CNCs were r and omly assigned to intervention or control groups with 107 children in each group . We also studied 107 nonintervened better-nourished children from the same villages . Pre- and postintervention measurements included children 's height , weight , development assessed on Bayley Scales , behavior ratings during the test , and a question naire on mothers ' knowledge of childrearing . The intervention comprised home visits and group meetings with mothers and children for 12 mo . Intervention benefited children 's mental development ( 4.6 + /- 2.0 , P = 0.02 ) , vocalization ( 0.48 + /- 0.23 , P = 0.04 ) , cooperation ( 0.45 + /- 0.16 , P = 0.005 ) , response-to-examiner ( 0.50 + /- 0.15 , P = 0.001 ) , emotional tone ( 0.33 + /- 0.15 , P = 0.03 ) , and mothers ' knowledge ( 3.5 + /- 0.49 , P < 0.001 ) . At the end , undernourished controls had poorer mental ( -4.6 + /- 2.0 , P = 0.02 ) and motor ( -6.6 + /- 2.2 , P = 0.003 ) development , were more inhibited ( -0.35 + /- 0.16 , P = 0.03 ) , fussier ( -0.57 + /- 0.16 , P < 0.001 ) , less cooperative ( -0.48 + /- 0.17 , P = 0.005 ) , and less vocal ( -0.76 + /- 0.23 , P = 0.001 ) than better-nourished children . Intervened children scored lower only in motor development ( -4.4 + /- 2.3 , P = 0.049 ) . Neither group of undernourished children improved in nutritional status , indicating that treatment had no effect . In conclusion , adding child development activities to the BINP improved children 's development and behavior and their mothers ' knowledge ; however , the lack of improvement in growth needs to be examined further BACKGROUND Undernourished children have poor levels of development that benefit from stimulation . Zinc deficiency is prevalent in undernourished children and may contribute to their poor development . OBJECTIVE We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children . DESIGN This was a r and omized controlled trial with 4 groups : stimulation alone , zinc supplementation alone , both interventions , and control ( routine care only ) .  Subjects were 114 children aged 9 - 30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics . Clinics were r and omly assigned to receive stimulation or not ; individual children were r and omly assigned to receive zinc or placebo . The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged . The supplementation was 10 mg Zn as sulfate daily or placebo .  Development ( assessed by use of the Griffiths Mental Development Scales ) , length , and weight were measured at baseline and 6 mo later . Weekly morbidity histories were taken . RESULTS Significant interactions were found between zinc supplementation and stimulation . Zinc benefited the developmental quotient only in children who received stimulation , and benefits from zinc to h and and eye coordination were greater in stimulated children . Zinc supplementation alone improved h and and eye coordination , and stimulation alone benefited the developmental quotient , hearing and speech , and performance . Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth . CONCLUSION Zinc supplementation benefits development in undernourished children , and the benefits are enhanced if stimulation is also provided The benefits of nutritional supplementation , with or without psychosocial stimulation , on the growth of  stunted children  were evaluated . Children aged 9 - 24 mo with lengths less than -2 SD of the National Center for Health Statistics references ( n = 129 ) were r and omly assigned to four groups :  control , nutritional supplementation , stimulation , and both interventions . A fifth group with lengths greater than -1 SD was also enrolled . Length , weight , head and arm circumferences , and triceps and subscapular skinfold thicknesses were measured on enrollment and 6 and 12 mo later . Multiple-regression analysis was used to determine the effects of the interventions in which age , sex , initial status , initial dietary intake , and several socioeconomic variables were controlled for . Stimulation had no effect on growth and there was no interaction between the interventions . After 12 mo supplemented children had significantly increased length , weight , and head circumference ( all P less than 0.01 ) . The effects of supplementation were not cumulative but occurred in the first 6 mo The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 The long-term benefits of  early childhood supplementation  and the extent to which catch-up growth occurs following linear growth retardation remain controversial . Stunted children ( height-for-age < -2 SD of NCHS references , n = 122 ) recruited from a survey of poor neighborhoods in Kingston , Jamaica , participated in a 2-yr r and omized , controlled trial of supplementation beginning at ages 9 - 24 mo . A group of 32 non-stunted children from the same neighborhoods was also followed . Four years after the intervention ended , when children were 7 to 8 y old , there were no effects of supplementation on any anthropometric measure . From the end of the trial until follow-up , the children who had been supplemented gained 1.2 cm less ( P < 0.05 ) than the non-supplemented children , approximately the same amount as they had gained during the trial compared with the non-supplemented children . After adjustment for regression to the mean , the height-for-age of stunted children ( supplemented and non-supplemented combined ) increased from enrollment to follow-up by 0.31 Z-score ( 95 % CI 0.17 , 0.46 ) . The height-for-age of the non-stunted children also increased ( 0.96 Z-score ; 95 % CI 0.70 , 1.22 ) . Our results suggest that some catch-up growth is possible even when children remain in poor environments . Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished Little is known about the long-term benefits of interventions that aim to promote early childhood development programs . The goal of this research was to determine whether an early childhood development intervention added to a nutrition intervention during preschool ages had lasting effects on the cognitive development of school-age children in communes of Thanh Hoa province in rural Vietnam . The study focused on a total of 313 children aged 6.5 - 8.5 y ( grade s 1 and 2 in primary school ) in 2 communes that were exposed to nutrition intervention or nutrition and early childhood development ( ECD ) intervention from 1999 to 2003 . Measurements of height and cognitive test scores ( Raven 's Progressive Matrices Test ) were collected from the children ; household characteristics were determined by interviews with mothers . Longitudinal analysis was performed by integrating the data with that collected from the same children in past surveys . Significant effects of the ECD intervention  compared with the nutrition intervention were detected . The beneficial effect of ECD intervention  on the cognitive test scores was large for the most nutritionally challenged children whose height-for-age Z-scores declined or remained in the stunted range . The findings help provide useful insights into the development of an effective integrated model of ECD and nutrition intervention for children in rural Vietnam It is not known whether nutritional supplementation in early childhood has long-term benefits on  stunted children 's mental development . We followed up 127 7 - 8-y old children who had been stunted in early childhood and received supplementation , stimulation , or both .  At 9 - 24 mo of age , the children had been r and omly assigned to four treatment groups : nutritional supplementation , stimulation , both treatments , and control . After 2 y , supplementation and stimulation had independent benefits on the children 's development and the effects were additive . The group receiving both treatments caught up to a matched group of 32 nonstunted children . Four years after the end of the 2-y intervention 97 % of the children were given a battery of cognitive function , school achievement , and fine motor tests .  An additional 52 nonstunted children were included . Factor analyses of the test scores produced three factors : general cognitive , perceptual-motor , and memory . One , the perceptual-motor factor , showed a significant benefit from stimulation , and supplementation benefited only those children whose mothers had higher verbal intelligence quotients . However , each intervention group had higher scores than the control subjects on more tests than would be expected by chance ( supplemented and both groups on 14 of 15 tests , P = 0.002 ; stimulated group in 13 of 15 tests , P = 0.01 ) , suggesting a very small global benefit . There was no longer an additive effect of combined treatments at the end of the intervention . The stunted control group had significantly lower scores than the nonstunted children on most tests . Stunted children 's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up The Cali Study involved the r and om assignment of 301 malnourished children to be exposed to one ( CT1 , n = 113 ) , two ( CT2 , n = 64 ) , three ( CT3 , n = 62 ) or four ( CT4 , n = 62 ) 9-mo periods of a multifocal day care-based intervention ( i.e. ,  education , health and nutrition )  . The ages at which the intervention was initiated for Groups CT4 , CT3 , CT2 and CT1 were 3.5 , 4.2 , 5.2 and 6.1 y , respectively . After the experimental phase , children were followed up in elementary school until they were 10.4 y old . Our secondary data analyses show that children who were exposed at an earlier age and for a longer period of time showed the highest degree ( P < or = 0.05 ) of improvement in weight and linear growth during the pre-school period . These improvements in physical growth could no longer be detected 3 y after the termination of the intervention OBJECTIVES We used 37 years of follow-up data from a r and omized controlled trial to explore the linkage between an early educational intervention and adult health . METHODS We analyzed data from the High/Scope Perry Preschool Program ( PPP )  , an  early school-based intervention in which 123 children were r and omized to a prekindergarten education group or a control 
    Output:
    
The trials showed nutritional interventions usually benefited nutritional status and sometimes benefited child development .
Stimulation consistently benefited child development .
There was no significant loss of any effect when interventions were combined , but there was little evidence of synergistic interaction between nutrition and stimulation on child development .
There was generally little benefit of at-scale programs to nutritional status .
We found no rigorous evaluations of adding stimulation to health and nutrition services at scale and there is an urgent need for them .
There is also a need to determine if there are any sustained benefits for the children after programs finish