Introduction Nutritional supplementation programmes for pregnant women and young children exist in much of the developing world, but their long term health consequences, particularly in the context of nutrition transition, are unknown.

Methods The Hyderabad Nutrition Trial was a community trial to evaluate a supplemental nutrition programme for pregnant women and young children (<6 years), conducted in 29 villages (15 intervention, 14 control) near Hyderabad city in India during 1987–1990. The supplement was a cereal based meal providing 2 MJ calories and 20 g protein per day. Children born during the trial period were re-examined ∼20 years later, and adiposity was assessed by DXA scans.

Results We recruited 1120 participants (27% female) aged 18–21 years: 581 intervention and 539 controls. The body mass index of the intervention and control participants was similar (19.3 kg/m²). There was some indication of greater adiposity in the intervention arm participants, but these differences were broadly consistent with chance. The total body fat (geometric mean) was 18.0% in the intervention arm, compared to 17.1% in the control arm (ratio: 1.04; 95% CI 0.99 to 1.09). The intervention and control arms had similar levels of central adiposity (8.5 % of the total body fat was in the L1L4 region).

Conclusion In this sample of rural Indians, modest protein-calorie supplementation in early life on the whole was not associated with greater total or central adiposity in young adulthood. Whether stronger differences emerge with age or progression of nutrition transition remains to be established.