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

Abstract

Objectives: This paper reports the effects of early supplementary feeding on body weight, length, head circumference and arm circumference among the children in the Pangalengan 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. Supplementation 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 to the 12-and 18-month cohorts. Inclusion criteria were: no chronic disease; length-for-age À1 standard deviation (s.d.) and weight-for-length between À1 and À2 s.d. of the median of the reference of the World Health Organization. Methods: Length was measured with a portable measuring board; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight. Arm and head circumferences were measured using similar ®berglass tapes. Results: Body weight showed effects on both cohorts at 2, 8 and 12 months; head circumference showed effects at 4 months in the 12-month-old cohort and at 10 months among the females of the 18-month-old cohort; and arm circumference showed effects across cohorts at 2, 8 and 12 months. In general the bene®ts are clearer for females and for the 12-month-old cohort.

Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial

“…40 Nonetheless, an Indonesian study showed that a high energy iron supplement for a year had positive effects on head circumference at 4 months; however, it reported no benefits at 2, 6, 8, 10 and 12 month assessments. 41 Trials of iron supplementation during pregnancy in Nepal and India have shown no effect on head circumference. 42,43 The strength of this study are its randomized design and the fact that it was carried out in a general population of healthy children where zinc and iron deficiencies are common.…”

Effect of iron supplementation on physical growth in children: systematic review of randomised controlled trials

“…In such a scenario, even improvement in the appetite and activity levels of the child may not translate into substantially increased energy intake, and therefore enhanced height and weight gain. A recent study from this setting 27 documented a significant increase in physical growth with combined energy and iron supplementation, but this finding needs further validation. Another factor to be considered is the interaction with other micronutrients like zinc and vitamin A, which may have a role in physical growth.…”

Supplementary feeding for improving the health of disadvantaged infants and young children

“…Indeed, only a minority of studies in our sample increased the amount of the supplementary food as the child got older. 100 93 101 Finally, authors of one study 49 suggested that effects on growth were not stronger because the supplement led to greater physical activity, hence burned off some of the additional calories. …”