Weight was measured using a digital scale, appropriately calibrated and suitable for every age group. Length measurement Autophagy inhibitor in children younger than 2 years was performed using an infantometer; a stadiometer was used for the older children. The z-scores of the weight/height (W/H), height/age (H/A),
and weight/age (W/A) indicators were calculated using the Anthro program, available from the WHO. The nutritional diagnosis was made following the WHO criteria.18 Before the intervention, all meals served to the children (four per day) were calculated using food composition tables19 and 20 and product labels, in order to quantify the macro and micronutrients present in a serving of 100 g, followed by estimates of daily consumption. To quantify the consumption, the preparations were weighed before and after ingestion of each meal using www.selleckchem.com/products/Everolimus(RAD001).html a scale accurate to 1 g. All records of consumption and anthropometry were made by the study dietitians. During 90 days, the subjects in group A received one sachet of sprinkles with added zinc and micronutrients daily, whereas group B received
the same micronutrients, without zinc (Table 1). The supplements were mixed in a small portion of the meal, always at the same time. Due to the nutritional composition and day-care routine, the most adequate meal for addition of supplements and the one best accepted by the children was the afternoon snack (silver banana). The supplements were only opened and added to food immediately before serving, by dietitians not blinded to the study, as the sachets were identified for the presence of zinc. The snacks were monitored by the team members (physicians SPTLC1 and dietitians blinded to the study) to prevent exchange of plates or loss of the food serving that contained the supplements, as well as to identify those who did not ingest it. Based on the assessment of what had been eaten at the afternoon snack, it was recorded in a form whether the child had ingested all the supplement (the entire snack), at least half of it (half the snack), or none of it. Based on this information, acceptance of the supplement was assessed. On weekends, holidays,
and planned absences, to ensure the continuity of the intervention process, parents or guardians were given enough supplements for consumption during the period. They were instructed to offer them once per day, in a meal similar to that served at the daycare. DD was defined as the presence of three or more liquid or semi-liquid stools in 24 hours, lasting less than 14 days. The Brazilian Ministry of Health criteria was used for the diagnosis of ARI.21 Daily, prior to the start of the day at the daycare, the parents/guardians were questioned by the nursing staff, which were properly trained, as to the health status of the children. If any child was identified as having one of the outcomes (DD and/or ARI), he or she was referred for evaluation by the physicians of this project.