We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Effect of Preventive Supplementation on Young Children in Niger

Dominique Roberfroid, MD, MSc, MPhil; Lieven Huybregts, MSc; Patrick Kolsteren, MD, PhD
JAMA. 2009;301(21):2208-2209. doi:10.1001/jama.2009.739.
Text Size: A A A
Published online


To the Editor: In their randomized controlled trial, Ms Isanaka and colleagues1 found that providing children younger than 5 years with ready-to-use therapeutic food during periods of food insecurity can prevent cases of malnutrition. However, their study presents 2 important methodological difficulties.

First, the authors used different reference distributions to define malnutrition at inclusion in the study (National Center for Health Statistics/World Health Organization [NCHS/WHO], 1978) and at inclusion in the analysis (WHO Child Growth Standards, 2006). A proportion of participants were thus excluded from the analysis on the grounds that they were already malnourished at recruitment according to the WHO reference.2 This proportion was likely substantial and would be expected to consist mainly of children younger than 24 months because the 2 references yield different diagnoses principally in that age range.2 Unfortunately, this age range has the highest risk of malnutrition.3 This compromises the internal validity of the study, and extrapolation of results to children aged 6 to 60 months requires caution. The problem could be amplified by the interaction of the intervention with child age at baseline (P = .07), a result not fully discussed by the authors.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




June 3, 2009
Debashis Ghosh, PhD
JAMA. 2009;301(21):2208-2209. doi:10.1001/jama.2009.740.
June 3, 2009
Sheila Isanaka, BA; Rebecca F. Grais, PhD
JAMA. 2009;301(21):2208-2209. doi:10.1001/jama.2009.741.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.