Effects of an energy and micronutrient supplement on iron deficiency anemia, physical activity and motor and mental development in undernourished children in Indonesia

Objectives: This paper reports the effects of an energy and micronutrient s upplementation on mental and motor development, activity and behavior under natural conditions of children classified as iron deficient anemic and iro n replete. Design: Children were randomly assigned to two different nutritional supple ments: (1) 12 mg iron + either 1171 or 209 kJ; (2) 104 kJ + 0 iron. Treatme nt lasted for 6 months. Setting: The sites were six tea plantations in Pangalengan, West Java. Subjects: Eighteen anemic subjects (hemoglobin < 110 g/L; transferrin satur ation (TS) < 16%) and 18 matched (sex and age) controls (hemoglobin > 110 g /L; TS > 16%) were selected from a pool of children with the following char acteristics: no chronic disease; length-for-age less than or equal to -1 st andard 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: Hemoglobin, ferritin, transferrin saturation and erythrocyte proto porphyrin were evaluated before and 6 months after treatment. The following psychological measurements were obtained at baseline and 2, 4 and 6 months later. Mental and motor development was evaluated with the Bayley Scale. M otor activity was measured by 4 h continuous observations at home and at da y care centers. The interactions between the child and its social and physi cal environment were also evaluated during 4 h of observations. Results: Anemic children showed faster motor development and greater physic al activity than the control children did. None of the other tests showed i nter-group differences.