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A preliminary test of a developmental model for the study of undernourished children in Indonesia
Insights
Micronutrient and energy supplementation improved growth in undernourished children. Structural equation modeling showed the conceptual model fit older children
Area of Science:
- Nutritional Science
- Developmental Pediatrics
- Public Health
Background:
- Undernutrition in children impairs growth and development.
- Micronutrient and energy supplementation are potential interventions.
- Understanding the pathways of these interventions is crucial.
Purpose of the Study:
- To test a conceptual model of micronutrient and energy supplementation effects on growth and development.
- To analyze baseline data from a longitudinal study in West Java.
- To use structural equation modeling to assess model fit.
Main Methods:
- Two cohorts of nutritionally-at-risk children (12- and 18-month-olds) were recruited.
- Children received condensed milk + micronutrients (E), skimmed milk + micronutrients (M), or skimmed milk (S) for 12 months.
- Socioeconomic status, nutritional status, motor development, and behavior were measured.
Main Results:
- The structural equation model fit the data for the older cohort.
- The model did not fit the data for the younger cohort.
- No significant differences were found in model parameter estimations between cohorts.
Conclusions:
- The conceptual model is applicable to older undernourished children.
- Further refinement may be needed for younger children.
- Supplementation strategies should consider age-specific effects.
Objectives:
Structural equation modeling of an abbreviated version of the conceptual model of the effects of micronutrient and energy supplementation on growth and development of undernourished children in West Java. The study focused on the baseline data from the Pangalengan longitudinal project.
Design:
This trial included two cohorts of children classified as nutritionally-at-risk who were randomly assigned to three treatments (condensed milk + micronutrients (E); skimmed milk + micronutrients (M); skimmed milk (S)). Supplements were given for a period of up to 12 months.
Setting:
The sites were six tea plantations in Pangalengan.
Subjects:
A 12-month-old (n=53) and an 18-month-old (n=83) cohort were recruited from 24 day care centers. Twenty children that received the S supplement were part of the 12- and 18-month-old cohorts. Criteria for inclusion were: no chronic disease; length-for-age < -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.
Variables:
Indicators of socioeconomic status were economic and educational resources; length-for-age and weight-for-length were used as indicators of nutritional status; motor development and motor activity were measured with custom-made procedures; and carrying by caretaker and manipulation of objects were used as indicators of caretaking and exploratory behavior.
Results:
The model fitted the data of the older but not of the younger cohort (chi2 statistic and three other indices of goodness to fit). However, there were no differences between cohorts in the estimation of the models.