A developmental view of the effects of an energy and micronutrient supplement in undernourished children in Indonesia

Abstract

Objectives: This paper presents the results of a structural equation model testing whether the longitudinal data of the Pangalengan subjects fit the theoretical model regarding the intellectual delay of undernourished children.

Design: Two cohorts of children were randomly assigned to three treatments: E=1171 kJ+12 mg iron; M=12 mg iron+209 kJ; S=104 kJ. Supplementation was given for 6 months.

Setting: The sites were six tea plantations in Indonesia.

Subjects: A 12-month-old (n=53) and an 18-month-old (n=83) cohort were recruited from day-care-centers. Inclusion criteria were: no chronic disease; length-for-age=<1 standard deviation (s.d.) and weight-for-length between −1 and −2 s.d. of the median of the reference of the World Health Organization.

Methods: Twenty-four-hour dietary intakes were assessed using the weighted individual inventory technique. Body weight and length were obtained using standard procedures; motor development was assessed with the Bayley Scale and with a custom made scale for motor development leading to bipedal locomotion. Four-hour observations were made of the child’s interactions with the environment. Carrying a child in the arms and exploratory behavior were used as indicators of caregiving and exploration. All measurements were obtained every 2 months.

Results: The original model did not fit the data. The model was then modified with the inclusion of two new pathways: from activity and from motor development to mental development. Following these adjustments the model fit the data for each cohort and for both cohorts combined.

Sponsorship: Nestlé Foundation.

European Journal of Clinical Nutrition (2000) 54, Suppl 2, S107–S113