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 supplement on skeletal maturation of nutritionally at risk infants and toddlers 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. 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-old cohorts. Inclusion criteria were: no chronic disease; length-for-age < or = -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 wrist. The number of ossified centers and two different measures of skeletal age (Skel-1 and Skel-2) were the outcome variables measured.

RESULTS

In the 12-month-old cohort, there were intergroup differences 6 and 12 months after baseline. First, the children in the E group were about 2 months more advanced in ossified centers than the children in the S group (P < 0.10). At 12 months, the children in the E group were about 3 months more advanced in skeletal age than the children in the M group. M group children were about 2.5 months behind the children in the S group.