Effects of an energy and micronutrient supplement on growth and activity, correcting for non-supplemental sources of energy input in undernourished children in Indonesia

Objectives: This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement, adj usting for all non-supplemental energy intakes. Any additional change in gr owth and activity after this adjustment was then compared across supplement s at three points felt to be representative of the study. Design: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 209 kJ + 12 mg iron; S = 104 kJ. Supplementa tion was given for 12 months. Setting: The sites were six tea plantations in Pangalengan, West Java. Subjects: A 12-month-old (n = 53) and an 18-month-old (n = 83) cohort were recruited from day-care-centers. Twenty children that received S belonged t o the 12- and 18-month-old cohorts. Inclusion criteria were: no chronic dis ease; length-for-age less than or equal to -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: Length was measured with a portable measuring board; a Detecto sca le with an accuracy of 0.1 kg was used for the measurement of body weight. Arm and head circumferences were measured using similar fiberglass tapes. M otor activity was assessed through continuous 4 h observations at home and at day care centers. Anthropometry and activity were measured every two mon ths over 12 months. Results: After correcting for non-supplemental sources of energy intake, th e effects of the supplement on weight and activity were observed at 2 month s, effects on length and activity were observed at 6 months; and effects on weight alone were observed at 12 months.