Effects of an energy and micronutrient supplement on skeletal maturation in undernourished children in Indonesia

Objectives: This paper reports the effects of an energy and micronutrient s upplement on skeletal maturation of nutritionally at risk infants and toddl ers in Pangalengan, Indonesia. Design: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJoule + 12 mg iron; M = 12 mg iron + 209 kJ; S = 104 kJ. Supplem entation 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: Skeletal maturation was measured by X-ray of the left hand and wri st. The number of ossified centers and two different measures of skeletal a ge (Skel-1 and Skel-2) were the outcome variables measured. Results: In the 12-month-old cohort, there were intergroup differences 6 an d 12 months after baseline. First, the children in the E group were about 2 months more advanced in ossified centers that the children in the S group (P < 0.10). At 12 months, the children in the E group were about 3 months m ore advanced in skeletal age than the children in the M group. M group chil dren were about 2.5 months behind the children in the S group.