Nutritional Supplement Program Research Articles

Effect of a nutrition supplement and physical activity program on pneumonia and walking capacity in Chilean older people: a factorial cluster randomized trial.

Ageing is associated with increased risk of poor health and functional decline. Uncertainties about the health-related benefits of nutrition and physical activity for older people have precluded their widespread implementation. We investigated the effectiveness and cost-effectiveness of a national nutritional supplementation program and/or a physical activity intervention among older people in Chile. We conducted a cluster randomized factorial trial among low to middle socioeconomic status adults aged 65-67.9 years living in Santiago, Chile. We randomized 28 clusters (health centers) into the study and recruited 2,799 individuals in 2005 (~100 per cluster). The interventions were a daily micronutrient-rich nutritional supplement, or two 1-hour physical activity classes per week, or both interventions, or neither, for 24 months. The primary outcomes, assessed blind to allocation, were incidence of pneumonia over 24 months, and physical function assessed by walking capacity 24 months after enrollment. Adherence was good for the nutritional supplement (~75%), and moderate for the physical activity intervention (~43%). Over 24 months the incidence rate of pneumonia did not differ between intervention and control clusters (32.5 versus 32.6 per 1,000 person years respectively; risk ratio = 1.00; 95% confidence interval 0.61-1.63; p = 0.99). In intention-to-treat analysis, after 24 months there was a significant difference in walking capacity between the intervention and control clusters (mean difference 33.8 meters; 95% confidence interval 13.9-53.8; p = 0.001). The overall cost of the physical activity intervention over 24 months was US$164/participant; equivalent to US$4.84/extra meter walked. The number of falls and fractures was balanced across physical activity intervention arms and no serious adverse events were reported for either intervention. Chile's nutritional supplementation program for older people is not effective in reducing the incidence of pneumonia. This trial suggests that the provision of locally accessible physical activity classes in a transition economy population can be a cost-effective means of enhancing physical function in later life. Current Controlled Trials ISRCTN 48153354.

Impact Assessment of Nutritional Supplement Program in Urban Settings: A study of under nutrition in Slum Community of Mumbai

Malnutrition among 0-6 years is an impending problem, especially among economically backward communities in urban India. In an attempt to alleviate malnutrition, within the target community, the Foundation for Mother and Child, India, prepared a special food supplement, using cheap and locally available resources. A brief evaluation study was conducted to evaluate the impact of this food supplement on improvement in parameters like weight, height, and mental abilities among the participants. The study was conducted between August 2010 to October 2010 (n=51), with the participants divided in four different age groups. The height and weight parameters were compared to ICMR standards for the age to understand the impact of the program. The mean improvement in height was 0.84 cms (SD-0.6) while the mean improvement in weight was 0.57 kgs (SD-0.8). A significant variance was observed due to different consumption levels of the supplement and differing levels of under-nutrition. A strong correlation was observed between the consumption level and the improvement in height and weight parameters. In addition, a positive correlation was observed between the extent of deviation from ICMR standards and levels of improvement in height and weight parameters. No differential in terms of gender was observed within the community. No significant findings were observed with reference to improvement in mental ability, primarily as the study duration was short. The study has laid the roadmap for a larger and multifaceted study to be conducted to critically evaluate the effectiveness of the nutritional supplement.

Diverging opinions of supplementation programmes between mothers of small children and staff at primary health clinics in the Western Cape Province of South Africa

Nutritional status has remained inadequate among disadvantaged mothers and small children in South Africa. Several supplementation programmes are administered through primary health clinics (PHC). The present study examined the perceptions of mothers who attend PHC and of the PHC staff on the purpose, management and eligibility of the vitamin A and nutritional supplementation components of the Nutrition Supplementation Programme (NSP). Observational study based on anthropometry and questionnaires. Random selection of ten urban and ten rural PHC from the Western Cape Province of South Africa. Mothers (n 176) and their children (n 179) aged <5 years, and various PHC staff categories. Half (56 %) of the households were classified as food insecure and about one-third of the children were malnourished, as evidenced by stunting, wasting or underweight. A majority of mothers complained about poor information related to the programmes. More than half of the children who were eligible for NSP were not included. In contrast, the staff felt that they managed both programmes well and problems with implementation were mostly attributed to clients. In general, the mothers expressed more dissatisfaction and ignorance about the vitamin A programme and the NSP than was perceived by the staff. This apparent discrepancy might, at least in part, explain why these programmes do not work optimally.

Influence d’une supplémentation en vitamines sur performance musculaire maximale au cours d’un programme d’entraînement en force chez des athlètes masters

Aim.- The purpose of this study was to analyze the effectiveness of supplementation in vitamin on the maximal muscular performance in master athletes during a strength training program. Method.- Twenty well-trained master athletes took part in a three weeks strength training program and in a same time in a micro nutritional supplementation program. Before and after the training period, blood markers of muscle damages were assessed. Before each training sessions maximal voluntary isometric strength was recorded. They were divided in two groups either with supplementation (Isoxan Force ®, Ao) or without (placebo, Pl). Results.- After the training period, knee extensor’s maximal voluntary strength significantly increased (+9,7% in Ao group vs. + 6,3% in Pl group ) in both groups. However, this increase was more pronounced in Ao group than in Pl group and recovery between training sessions was improved. Moreover significant difference in blood markers of muscle damages was found between groups at the end of the training program. Conclusion.- Results of this study confirm the benefits of a short period of strength training program on maximal muscular performance in master athletes. In all subjects, strength production capacity has significantly increased after the three weeks of training. Moreover the micro nutritional supplement is associated with a lower muscle inflammation suggesting an improvement of the beneficial effect of strength training with vitamin and mineral supplementation. .

Delivery of the Nutrition Supplementation Programme in the Cape Town metropolitan area from the perspective of mothers of under-5s: A qualitative study

Background . Child malnutrition is a major problem in South Africa despite implementation of various policies and programmes. Ideally these programmes should be delivered within a human rights paradigm, i.e. parents are responsible for their children’s health, while the State authority is obliged to help parents meet their responsibility. The Nutrition Supplementation Programme (NSP) aims to help underweight children gain weight and empower parents to tackle malnutrition. Objective . To study mothers’ experience with the NSP, and assess this in relation to South Africa’s emphasis on human rights. Subjects and methods . Seven focus group discussions were conducted with a total of 28 mothers of under-5s included in the NSP. The methodology used is particularly suitable for disclosing unexplored and unexpected issues. Results . Most mothers expressed satisfaction with receiving the supplements, which they perceived to be nutritious. However, they had received little or no education and lacked knowledge and skills regarding how to help their children gain weight. In addition, many mothers had experienced poor communication with staff members as well as unfavourable comments and lack of respect. These experiences and perceptions were real for mothers and indicate that the way the NSP was delivered resulted in inadequate compliance with certain principles of human rights, especially respect for human dignity, client participation and empowerment. Conclusions . Even though small studies are relatively prone to bias, this qualitative study is informative. More focus on the education part of the NSP would enable mothers to manage their children’s nutrition better. Measures to improve health workers’ knowledge of how to work within a human rights paradigm are necessary in order to strengthen accountability of the health authorities and improve children’s health.

Implementation and Effects of a Medication Pass Nutritional Supplement Program in a Long-Term Care Facility: A Pilot Study

The purpose of this 6-month study was to determine the most effective method for implementing an interdisciplinary medication pass nutritional supplement program in Extendicare's long-term care facilities in western Canada by piloting the program in one facility. The program's effects on residents' body weight, skin integrity, and laboratory values related to nutritional status were evaluated. Resident adherence and staff perception were also assessed. Findings indicated that most residents experienced weight gain and improved visceral protein status. Resident adherence to the program was 96%, and staff feedback was positive. The promising results of this pilot study suggest that a medication pass nutritional supplement program could help improve the nutritional status of long-term care residents, thereby resulting in improved quality of life.

Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma

Malnutrition in the head and neck cancer population is a widely recognized factor contributing to negative outcomes. The goal of this study was to determine if providing complimentary oral nutritional supplementation for patients undergoing definitive radiation therapy for oropharyngeal carcinoma reduced weight loss and the need for percutaneous endoscopic gastrostomy (PEG) tube placement. The data from 79 patients undergoing radiotherapy for oropharyngeal cancer were extracted and analyzed retrospectively from an institutional Human Investigation Committee approved database for the study of advanced radiation therapy techniques for head and neck cancer. Forty patients were treated before the initiation of a nutritional supplementation program, and 39 patients received supplementation. Patients were stratified by type of treatment (radiation alone or chemoradiation) and whether or not they had a PEG tube. All patient groups receiving supplementation manifested a significant decrease in weight loss compared to those who did not receive it. Nutritional supplementation was associated with a 40% relative reduction in weight loss in patients treated with radiotherapy alone (6.1 vs 10.1%, p = 0.008) and a 37% reduction in weight loss in patients treated with chemoradiotherapy (6.7 vs 10.7%, p = 0.007). When patients were stratified by the presence or absence of a PEG tube, both groups experienced a 39% relative reduction in weight loss (with PEG, 5.7 vs 9.3%, p = 0.028; without PEG, 6.9 vs 11.2%, p = 0.002). Supplementation was associated with a decreased need for PEG tube placement (31% decreased to 6%) in patients treated with radiotherapy alone. Providing complimentary oral nutritional supplementation significantly decreases weight loss and the need for PEG tube placement in patients undergoing radiation therapy for oropharyngeal cancer.

A factorial-design cluster randomised controlled trial investigating the cost-effectiveness of a nutrition supplement and an exercise programme on pneumonia incidence, walking capacity and body mass index in older people living in Santiago, Chile: the CENEX study protocol.

BackgroundChile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population; the proportion aged 60 years and over, for example, increased from 8% of the population in 1980 to 12% in 2005. In an effort to promote healthy ageing and preserve function, the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population (PACAM) which has been providing a nutritional supplement to older people since 1998. PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme. The recommended serving size (50 g/day) of these supplements provides 50% of daily micronutrient requirements and 20% of daily energy requirements of older people. No information is currently available on the cost-effectiveness of the supplementation programme.AimThe aim of the CENEX cluster randomised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme, and a specially designed physical exercise intervention for older people of low to medium socio-economic status living in Santiago, Chile.MethodsThe study has been conceptualised as a public health programme effectiveness study and has been designed as a 24-month factorial cluster-randomised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago. The main outcomes are incidence of pneumonia, walking capacity and change in body mass index over 24 months of intervention. Costing data (user and provider), collected at all levels, will enable the determination of the cost-effectiveness of the two interventions individually and in combination. The study is supported by the Ministry of Health in Chile, which is keen to expand and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness.Trial registrationISRCTN48153354

Identifying Risk Factors for Postpartum Tobacco Use

To identify factors associated with becoming a mother that may contribute to postpartum smoking-related outcomes. Cross-sectional, correlational. Postpartum women (N=133) who were clients in a nutrition supplement program for low-income families responded to questionnaires about smoking and early motherhood experiences. Inferential statistical tests included hierarchical multiple and logistic regression. After controlling for factors known to be associated with smoking outcomes for the general population, factors associated with becoming a mother significantly contributed to the amount of explained variance in both postpartum self-efficacy to refrain from smoking and smoking within 2 weeks after delivery. Study findings indicated that prenatal intentions about postpartum tobacco use and maternal response to infant cry episodes were areas for risk assessment that might lead to effective smoking cessation interventions uniquely tailored to women who experience becoming a mother.

Chile's National Nutritional Supplementation Program for Older People: Lessons Learned

Demographic changes in developing countries have resulted in rapid increases in the size of the older population. As a result, health-care budgets face increasing costs associated with the declining health and function of older people. Some governments have responded to this situation by designing innovative programs aimed at older people. One such program, implemented by the government of Chile, distributes an instant food mix fortified with vitamins and minerals to all persons over 70 years old who are registered by the national health service. The national health service covers approximately 90% of the older population. The program specifically targets nutritional vulnerability and micronutrient deficiency, which are common among poor older people in Chile. We present here the findings of a one-year investigation into all aspects of Chile's program for the elderly. The research included in-depth interviews with policy makers and program implementers, focus group discussions with user groups, analysis of the micronutrient content of the nutritional supplement, and telephone interviews of a random sample of older people. The results demonstrate that there can be a considerable degree of self-targeting within national programs; programs need to be sufficiently flexible to permit periodic protocol change; user groups must be consulted both before and during program implementation; and the design of an effective program evaluation must be in place before program implementation. It is hoped that these results will be useful to policy makers and implementers planning programs aimed at improving the health and function of older people.

Practical measures that improve human rights – towards health equity for Aboriginal children

If Australian public health policy is driven by the need for health equity, then program gaps and the unaddressed health needs of Aboriginal children should be providing unambiguous direction for health sector investments. This, however, is not the case. This paper details the urgent effort required to meet the needs of Aboriginal children and refers to lessons from within Australia and international studies. It provides examples where health policy and programs can be improved in the areas of child nutrition, hearing loss, immunisation coverage, and preventive health assessments. Recommendations include the need for the adoption of a policy framework for maternal and child health, concomitant national performance indicators, nutritional supplementation programs in order to ensure that no Aboriginal child shall suffer from malnutrition in rural and remote Australia, multifaceted measures to enhance the immunisation coverage of Aboriginal children and preventive child health assessments. Underpinning these measures is a need to augment the capacity of Aboriginal Community Controlled Health Services across Australia as these services play a predominant role in delivering preventive health care, community development and support services to the Aboriginal population. Stated commitments to social justice principles have not translated into 'practical measures' in Australia for Aboriginal children. There must be unequivocal commitment of a sufficient scale for practical measures to reduce health inequalities.

Evaluation of a nutrition supplementation programme in the Northern Cape Province of South Africa.

This study aimed at assessing the effectiveness regarding implementation and impact of a take-home nutrition supplementation programme, the Protein Energy Malnutrition (PEM) Scheme, that targets malnourished pre-school children and pregnant and lactating women in the Northern Cape Province of South Africa. In assessing implementation of the PEM Scheme, a cross-sectional descriptive study was undertaken over a 6-month period in the six regions of the Northern Cape Province. Interviews were conducted with programme managers and health personnel at clinics who were responsible for implementing the PEM Scheme. In assessing the impact of the PEM Scheme on growth, a retrospective review was done of the clinic records (including anthropometric data) of children enrolled in the PEM Scheme over a 1-year period. About 76% of the budget allocated to the PEM Scheme had been utilised over the 1-year period. The budget for the following financial year was based solely on food supplements purchased in the previous year. Coverage of malnourished pre-school children and eligible pregnant and lactating women for enrolment was estimated to be 50% and 60%, respectively. Eighty-five per cent of health facilities in the province participated in the PEM Scheme. Some of the main problems identified included: lack of training, inappropriate targeting of certain groups, incorrect application especially of discharge criteria for pregnant and lactating women, inadequate assessment for nutrition-related disease, inadequate nutrition counselling and no standardised monitoring. Of the 319 children enrolled over a year, the mean age was 16.2 (standard deviation 16.2) months, 41% had been low-birth-weight and 18% had been diagnosed with tuberculosis. Ten per cent of the children with a weight-for-age Z-score of <-2 moved into the normal Z-score range after being on the PEM Scheme for a mean duration of 8 months. There was an overall improvement in the weight-for-age Z-scores of 25% of the sample, with a significant difference between the mean weight-for-age Z-scores at enrolment and follow-up This was mainly related to significant improvement in the mean weight-for-age Z-scores of children <2 years. Numerous problems with the PEM Scheme have been identified which could have limited its impact. Recommendations are proposed for improving the effectiveness and impact of the PEM Scheme in the province.

Anthropometrically Determined Malnutrition Among Preschool Children in an Integrated Child Development Services Block of Gajapati District, Orissa

The purpose of this paper was to assess the growth and nutritional status of infants and school children fed ICDS diets and children of whom received ICDS supplementary nutrition. AWC were established with a view to increase the nutritional status among preschool children aged below 6-years. For this study, data has been collected from ICDS Centre in Gumma block of Gajapati district for the year 2001. The data was analyzed statistically and compared with the data available from the state of Orissa. The results indicate that 38.1%, 39.8%, 21.3% and 0.8% of children are normal, grade-I, grade-II and grade-III&IV malnutrition respectively. Out of total 55.6% and 66.7% of infants and preschool children respectively suffer from varying grades of malnutrition. The prevalence is consistently increased with increase in age from 0-6 years. Female children are behind their male peers. Malnutrition among preschool children continue to be the wide prevalent problem and comparable to those of their rural counterparts. The impact of supplementary nutrition programme on young children seems to be negligible in an area with socially deprived groups. In order to achieve the national goals adopted for child development, there is a definite need to further strengthening the existing ICDS system with targeted time-bound objectives.

A Multinutrient-Fortified Beverage Enhances the Nutritional Status of Children in Botswana

Due to their widespread acceptability, multinutrient-fortified foods and beverages may be useful in reducing micronutrient deficiencies, especially in developing countries. We studied the efficacy of a new fortified beverage in improving the nutritional status of children in Botswana. We screened 311 lower income urban school children, ages 6-11 y, in two primary schools near Gaborone. Children were given seven 240-mL servings weekly of either an experimental beverage (EXP) fortified with 12 micronutrients or an isoenergetic placebo drink (CON) for 8 wk. Weight, mid-upper arm circumference, hemoglobin, retinol, ferritin, vitamin B-12, folate and riboflavin status were measured at baseline and at the end of the study. Plasma zinc and serum transferrin receptors also were measured at study end. A total of 145 children in the EXP group and 118 in the CON group completed the trial. Using multivariate analysis, the changes in mid-upper arm circumference, weight for age and total weight were significantly better in the EXP group than in the CON group (P < 0.01). Ferritin, riboflavin and folate status were significantly better in the EXP group than in the CON group at study end (P < 0.01), but serum vitamin B-12 was not. Zinc was significantly higher and transferrin receptors were significantly lower at the conclusion of the study in the EXP group than in the CON group (P < 0.001). Mean plasma retinol concentrations, which were low (<0.7 micro mol/L) in both groups, did not change. We conclude that a micronutrient-fortified beverage may be beneficial as part of a comprehensive nutritional supplementation program in populations at risk for micronutrient deficiencies.

Antioxidant Supplements and Simvastatin-Niacin Therapy

To the Editor: This article1 attracted our attention first because of the wide implications and second because of the related editorial comments2 that sort of urged the physicians to “stop prescribing antioxidant vitamins to prevent and treat heart disease.” In these studies, subjects with coronary artery disease were divided into 4 treatment groups, namely (1) placebo group, (2) antioxidant group, (3) simvastatin-niacin group (S-N), and (4) simvastatin-niacin plus antioxidant group (S-N+A). The probability values for between-groups comparisons of changes from the individual values at the start and until the end of the study period (12 months) for several parameters (Table 2) indicate that there were no significant differences between the S-N group and the S-N+A group with respect to plasma cholesterol, plasma tri-glycerides, VLDL-C, IDL-C, LDL-C, HDL-C, HDL3-C, apo A-I, apo A-II, apo-B. However, the changes in HDL2-C values differed significantly between these two groups. The intakes of simvastatin in these groups at the start of the studies ranged between 10 and 20 …

The Impact of Nutritional Supplementation and Resistance Training on the Health Functioning of Free-Living Chilean Elders: Results of 18 Months of Follow-up

Body composition changes and loss of functionality in the elderly are related to substandard diets and progressive sedentariness. The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders. Healthy elders aged > or = 70 y were studied. Half of the subjects received a nutritional supplement. Half of the supplemented and nonsupplemented subjects were randomly assigned to a resistance exercise training program. Every 6 mo, a full assessment was performed. A total of 149 subjects were considered eligible for the study and 98 (31 supplemented and trained, 26 supplemented, 16 trained and 25 without supplementation or training) completed 18 mo of follow-up. Compliance with the supplement was 48%, and trained subjects attended 56% of programmed sessions. Activities of daily living remained constant in the supplemented subjects and decreased in the other groups. Body weight and fat-free mass did not change. Fat mass increased from 22.2 +/- 7.6 to 24.1 +/- 7.7 kg in all groups. Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups (ANOVA, P < 0.01). Serum cholesterol remained constant in both supplemented groups and in the trained groups, but it increased in the control group (ANOVA, P < 0.05). Upper and lower limb strength, walking capacity and maximal inspiratory pressure increased in trained subjects. In conclusion, patients who were receiving nutritional supplementation and resistance training maintained functionality, bone mineral density and serum cholesterol levels and improved their muscle strength.

A Collaborative Model to Guide Program Development and Change: Involving the Users

Organizations have different structures and cultures within which to conduct their business activities. Ranging from autocratic and rigid styles to more laissez-faire models, this report describes the program development and change model used by the Missouri Kidney Program (MoKP). Two examples illustrate how involvement of renal community professional staff and MoKP program staff in instituting and modifying program elements help to build in acceptance from the very beginning, avoiding start-up difficulties and miscues on implementation. Examples cited are the inception of the Nutritional Supplement Program and ongoing modification of the Centralized Drug Program's formulary. The Missouri Kidney Program uses a participatory approach to involve the users of service in program design and modification and historically has used this sort of approach with relative success over time.Index WordsCollaborationkidneyorganizationinterdigitationcommunication

Women's perceptions of outcomes of prenatal case management.

Comprehensive case management is a multidisciplinary, community-based service often available to Medicaid-eligible women. The purpose of the study was to identify the variety of maternal outcomes, other than birth outcomes, attributable to comprehensive prenatal case management. This qualitative study used a social ecological approach. Twenty-four women were interviewed about the outcomes they experienced as a result of comprehensive prenatal case management. Ethnographic content analysis was used for data reduction. The participants' mean age was 25.4 (SD = 8.4) years, with an average parity of 1.9 (SD = 1.1). Fifteen participants (68%) had a 12th grade education or less. Ethnic minorities were included in the sample. Eleven participants (47%) worked at least part-time, although 23 (98%) were receiving Medicaid and 21 (88%) were receiving the Women, Infants, and Children's (WIC) supplementary nutrition program. The women attributed improvements of various types to the actions of the case manager, specifically in the areas of emotional well-being, learning, lifestyle behaviors, financial situation, services utilization, and maternal and infant physical health. Case management appeared to have immediate effects on the women, as well as intermediate effects, such as changes in lifestyle behaviors and services utilization. The women attributed those changes to having a healthy pregnancy.

Evaluation of a supplementary nutrition program

The objective of this study was to evaluate the impact of a feeding supplementation program on the growth of undernourished children younger than 5 years in the city of Guariba, state of São Paulo, Brazil. The sample consisted of 469 malnourished children enrolled in a feeding supplementation program sponsored by the State Health Secretariat. The children were divided into four groups according to how long they had been enrolled in the program: in group 1, the children had been enrolled for up to 12 months; in group 2, from 12 to 24 months; in group 3 from 24 to 36 months; and in group 4 the children had been enrolled for more than 35 months. Percentiles for weight/age, height/age and weight/height were calculated for each child. To assess the impact of the program, reference curves for the anthropometric profile were constructed based on expected variations in population percentiles. The changes observed in each group were analyzed statistically (McNemar). Groups 1 and 2 presented weight recovery and gains in the weight/height ratios for the most severely malnourished children; in group 3, the weight/height ratio was maintained and there was a discrete tendency towards weight recovery, which was reversed in group 4, in which the weight was again low in relation to height. The feeding supplementation program temporarily minimized severe nutritional deficiencies but was not sufficient to recover and maintain normal growth.

The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6-24-month-old children.

Mutans streptococci (MS) are the primary pathogens involved in the development of early childhood caries. However, factors that may affect their acquisition in the mouths of young children are not well understood, and the period of initial colonization remains controversial. This study investigated the relationship of age, number of teeth, and bottle usage/content with regard to the isolation of MS in 6-24-month-old children. A total of 122 children from low-income families attending a nutritional supplement program, and their mothers, participated in this study. Children were examined for dental caries and number of erupted teeth and were sampled for MS. Mothers were administered a questionnaire to obtain details of baby bottle use, including what food items were put in the bottle during the last week. MS was detected in more than one-third of the 6-24-month-olds. Unlike some studies that suggest a later period of infectivity, approximately 20% of children under 14 months of age, including 4 of 22 infants aged 6-9 months, were colonized with MS. When examined separately, age, number of teeth, and bottle usage/content were each found to be related to the presence of MS. Mutans streptococci colonization was more likely with increasing age and number of teeth, and children whose bottles contained sweetened beverages were more likely to be colonized than children whose bottles contained milk. Logistic regression models that controlled for both age and number of teeth indicated that children who consumed sweetened beverages in their baby bottle had a statistically significant, four-fold increase in the odds of colonization by MS relative to children who consumed milk. The finding that approximately 20% of the children under 14 months of age were infected with MS indicates that colonization in this sample of low-income preschool children may begin earlier than suggested by some investigations. Additionally, the risk of MS colonization appears lower among infants who consume milk rather than sweetened beverages in the bottle.