SCREENING FOR NUTRITION INTERVENTIONS - THE RISK OR THE DIFFERENTIAL-BENEFIT APPROACH

The risk approach has been promoted to improve screening for nutrition interventions on the premise that indicators of risk also predict gre ater response to interventions. This study tested whether the determin ants of the risk of poor growth (eg, low length-for-age) at 36 mo of a ge were the same as the determinants of differential benefit from food supplementation. The sample included 450 Guatemalan children who were exposed to either a high-energy, high-protein drink (atole) or a low- energy, no-protein drink (fresco) during their first 36 mo of Life [IN CAP (Institute of Nutrition of Central America and Panama) supplementa tion trial]. Low maternal stature, poor socioeconomic status, inadequa te home diet, high diarrhea rates, and low anthropometry scores at 3 o r 6 mo were all determinants of the risk of poor growth. Only indicato rs of child's thinness at 3 or 6 mo of age (low weight-for-age, weight -for-length, or midupper arm circumference) were determinants of diffe rential benefit from supplementation. Thus, the development of screeni ng indicators should be based on analyses of the predictors of differe ntial benefit, not on conventional risk-factor analysis.