Original Article

Effect of Nutrition Intervention on Indices of Growth in Day Care Centers of the City of Birjand, Iran


Background: Childhood malnutrition is the main risk factor for impaired mental and physical growth and several diseases and leads to premature death worldwide. Therefore, reducing childhood malnutrition is a top priority in most countries. In this regard, several studies have explored the effects of nutritional intervention on reducing childhood malnutrition, although mostly in controlled conditions and with small sample sizes. Data on community-based interventions are limited. In this study, we investigated the effects of providing hot meals at lunchtime on the growth of children in day care centers in rural areas of the city of Birjand, Iran.
Methods: This was a quasi-experimental study. Hot meals were offered for 6 months to all the children (n = 1809) in day care centers of rural Birjand. Height and weight of the children were measured before and after the intervention. Z-score indicators were calculated using WHO Anthro and Anthro plus software packages. SPSS was used for data analyses.
Results: Prevalence of wasting and stunting decreased after the intervention in both sexes. The decrease in stunting prevalence was significantly greater in boys than in girls. However, proportions of various categories of height-for-age Z-score (HAZ) did not change significantly in either sex. In both sexes, weight, height, body mass index, and weight-for-age improved significantly after the intervention. The prevalence of obesity and overweight did not change after the intervention.
Conclusion: Based on the findings, providing hot food at lunchtime in day care centers can reduce wasting and stunting in children in rural regions of Birjand, Iran.

1. Engle PL, Black MM, Behrman JR, Cabral de Mello M, Gertler PJ, et al. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet. 2007;369(9557):229-42.
2. Moridi G, Fathi M, Malnutrition in children under five in Iran. Advances in Nursing & Midwifery. 2009; 19(64):49-56.
3. Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013;37(4):460-81.
4. Waterlow, J., Linear growth in children, in Nutrition in Pregnancy and Growth. 1996, Karger Publishers. p. 45-54.
5. WHO, MDG1:eradicate extreme poverty and hunger 2014. 2014.
6. WHO, Global health observatory (GHO) data 2015.
7. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226-34.
8. UNICEF, The state of the world`s children 2014. 2014.
9. de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12 Suppl 1(Suppl 1):12-26.
10. Mohseni M., Aryankhesal A, Kalantari N. Prevalence of Malnutrition Among Iran’s Under Five-Year-Old Children and the Related Factors: A Systematic Review and Meta-Analysis. Iranian Journal of Pediatrics, 2018. 28(1).
11. Aboud FE, Yousafzai AK. Global health and development in early childhood. Annu Rev Psychol. 2015;66:433-57.
12. Engle PL, Fernald LC, Alderman H, Behrman J, O'Gara C, Yousafzai A, et al. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet. 2011;378(9799):1339-53.
13. Grantham-McGregor SM, Fernald LC, Kagawa RM, Walker S. Effects of integrated child development and nutrition interventions on child development and nutritional status. Ann N Y Acad Sci. 2014; 1308:11-32.
14. Larson L, Yousafzai A. Impact of nutritional interventions on mental development of children under-two in developing countries: a systematic review of randomized controlled trials. Eur J Nutr Food Saf. 2015. 5(5): 549-550.
15. Rivera JA, Sepúlveda Amor J. Conclusions from the Mexican National Nutrition Survey 1999: translating results into nutrition policy. Salud Publica Mex. 2003;45 Suppl 4:S565-75.
16. Rivera JA, Sotres-Alvarez D, Habicht JP, Shamah T, Villalpando S. Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study. JAMA. 2004;291(21):2563-70.
17. Burza S, Mahajan R, Marino E, Sunyoto T, Shandilya C, Tabrez M, et al. Community-based management of severe acute malnutrition in India: new evidence from Bihar. Am J Clin Nutr. 2015;101(4):847-59.
18. Sabermahani A, Barouni M, Seyedin H, Aryankhesal A. Provincial human development index, a guide for efficiency level analysis: the case of iran. Iran J Public Health. 2013;42(2):149-57.
19. Abolhallaje M, Mousavi SM, Anjomshoa M, Beigi Nasiri A, Seyedin H, Sadeghifar J, et al. Assessing health inequalities in Iran: a focus on the distribution of health care facilities. Glob J Health Sci. 2014;6(4):285-91.
20. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund. Geneva: World Health Organization; 2009.
21. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-477.
22. Fesharakinia, A. and G. Sharifzadeh, Prevalence of malnutrition in under 5-year old children in Birjand city in 2011. JBUMS. 2013; 20(1): 77-84.
23. Payandeh A, Saki A, Safarian M, Tabesh H, Siadat Z. Prevalence of malnutrition among preschool children in northeast of Iran, a result of a population based study. Glob J Health Sci. 2013;5(2):208-12.
24. Ghodsi D, Omidvar N, Eini-Zinab H, Rashidian A, Raghfar H. Impact of the National Food Supplementary Program for Children on Household Food Security and Maternal Weight Status in Iran. Int J Prev Med. 2016;7:108.
25. Roberts JL, Stein AD. The Impact of Nutritional Interventions beyond the First 2 Years of Life on Linear Growth: A Systematic Review and Meta-Analysis. Adv Nutr. 2017;8(2):323-336.
26. Fatemeh T, Mohammad-Mehdi HT, Toba K, Afsaneh N, Sharifzadeh G; Student Research committee. Prevalence of overweight and obesity in preschool children (2-5 year-olds) in Birjand, Iran. BMC Res Notes. 2012;5:529.
27. Salehiniya H, Yazdani K, Barekati H, Asadi Lari M. The Prevalence of Overweight and Obesity in Children Under 5 Years in Tehran, Iran, in 2012: A Population-Based Study. Res Cardiovasc Med. 2016;5(1):e30425.
28. Shafieian, T, Latiff A L, Huang Soo Lee M, Mazidi, M, Ghayour Mobarhan M, Tabatabaei G, et al. Determinants of Nutritional Status in Children living in Mashhad, Iran. International Journal of Pediatrics. 2013; 1(2): 9-18.
29. Shrimpton R, Victora CG, de Onis M, Lima RC, Blössner M, Clugston G. Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics. 2001;107(5):E75.
30. Devakumar D, Stocks J, Ayres JG, Kirkby J, Yadav SK, Saville NM, et al. Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal. Eur Respir J. 2015;45(6):1566-75.
31. Wu T, Liu GJ, Li P, Clar C. Iodised salt for preventing iodine deficiency disorders. Cochrane Database Syst Rev. 2002;(3):CD003204.
32. Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev. 2010;(12):CD008524.
33. Sachdev H, Gera T, Nestel P. Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials. Public Health Nutr. 2005;8(2):117-32.
34. Imdad A, Bhutta ZA. Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool. BMC Public Health. 2011;11 Suppl 3(Suppl 3):S22.
35. Awasthi S, Peto R, Read S, Clark S, Pande V, Bundy D. Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial. Lancet. 2013;381(9876):1469-77.
36. Bhatia, J., Z.A. Bhutta, and S.C. Kalhan, Maternal and Child Nutrition: The First 1,000 Days. Vol. 74. 2013: Karger Medical and Scientific Publishers.
37. Elmadfa I, Meyer AL. Vitamins for the first 1000 days: preparing for life. Int J Vitam Nutr Res. 2012;82(5):342-7.
38. Ghosh S. Protein Quality in the First Thousand Days of Life. Food Nutr Bull. 2016;37 Suppl 1:S14-21.
39. Singh M. Role of micronutrients for physical growth and mental development. Indian J Pediatr. 2004;71(1):59-62.
IssueVol 5, No 1 (Winter 2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jnsd.v5i1.5214
Underweight Undernutrition Day care center; Intervention

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How to Cite
Sasanfar B, Djazayery A, Nahvijou A, Movahedi A, Asghari SS, Dorosty AR, Minaie M, Abdollahi Z, Toorang F. Effect of Nutrition Intervention on Indices of Growth in Day Care Centers of the City of Birjand, Iran. J Nutr Sci & Diet. 5(1):1-7.