Efetividade de programa de suplementação alimentar no ganho ponderal de crianças Efectividad del programa de suplementación alimentaria en la ganancia ponderal de niños Effectiveness of a supplementary feeding program in child weight gain

OBJETIVO: Avaliar a efetividade de programa governamental de suplementação alimentar no ganho ponderal de crianças. MÉTODOS: Estudo de coorte com dados secundários de 25.433 crianças de baixa renda com idade entre seis e 24 meses que ingressaram em programa de distribuição de leite fortificado Projeto Vivaleite, realizado no Estado de São Paulo de 2003 a 2008. O ganho ponderal foi medido por meio dos valores de escores z de peso para idade, calculados pelo padrão da Organização Mundial da Saúde (2007), obtidos, na rotina do programa, ao ingressar e a cada quatro meses durante a permanência. As crianças foram divididas em três grupos de escore z ao entrar: sem comprometimento de peso (z > -1); risco de baixo peso (-2 OBJETIVO: Evaluar la efectividad del programa gubernamental de suplementación alimentaria en la ganancia ponderal de niños. MÉTODOS: Estudio de cohorte con datos secundarios de 25.433 niños de baja renta con edad entre seis a 24 meses, que ingresaron en programa de distribución de leche fortificado Proyecto “Viva Leche” realizado en el Estado de Sao Paulo (sureste de Brasil) de 2003 a 2008. La ganancia ponderal fue medida por medio de los valores de escores z de peso por edad, calculados por el patrón de la Organización Mundial de la Salud (2007), obtenidos, en la rutina del programa, al ingresar y a cada cuatro meses durante la permanencia. Los niños fueron divididos en tres grupos de escore z al entrar: sin comprometer el peso (z>-1); riesgo de bajo peso (-2£zOBJECTIVE: To evaluate the effectiveness of a governmental supplementary feeding program in child weight gain. METHODS: A cohort study including secondary data on 25,433 low-income children aged between six and 24 months, participating in a fortified milk distribution program known as Projeto Vivaleite, was performed in the state of São Paulo, Southeastern Brazil, between 2003 and 2008. Weight gain was measured using weight-for-age z-score values, calculated according to the World Health Organization standards (2007). These values were obtained in the program routine, when a child started it and every four months during their stay. Children were divided into three z-score groups when starting the program: weight gain not compromised (z>-1); risk of low weight (-2<z<-1); and low weight (z<-2). Multilevel linear regression (mixed model) was used, enabling the comparison, at each age, of adjusted mean z-scores between children starting the program and those who had been participating for at least four months, adjusted for correlation between repeated measurements. RESULTS: The program had a positive effect on child weight gain, varying according to child nutritional status when starting this program; among those who started it with weight gain not compromised, the mean adjusted gain z-score was 0.183; among those with risk of low weight, 0.566; and among those with low weight, 1.005. CONCLUSIONS: The program is effective for weight gain in children younger than two years, with a more pronounced effect on children who start the program under less favorable weight conditions