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

Objectives: This paper presents the results of a structural equation model testing whether the longitudinal data of the Pangalengan subjects fit the t heoretical model regarding the intellectual delay of undernourished childre n. 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. Supplementa tion 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 diseas e; length-for-age = < 1 standard deviation (s.d.) and weight-for-length bet ween -1 and -2 s.d. of the median of the reference of the World Health Orga nization. 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 a nd with a custom made scale for motor development leading to bipedal locomo tion. Four-hour observations were made of the child's interactions with the environment. Carrying a child in the arms and exploratory behavior were us ed as indicators of caregiving and exploration. All measurements were obtai ned every 2 months. Results: The original model did not fit the data. The model was then modifi ed with the inclusion of two new pathways: from activity and from motor dev elopment to mental development. Following these adjustments the model fit t he data for each cohort and for both cohorts combined.