|Activity, Energy Expenditure and Energy Requirements of Infants and Children (International Dietary Energy Consultative Group - IDECG, 1989, 412 pages)|
|The relationship between undernutrition, activity levels and development in young children|
Several questions were asked to clarify further details of the Jamaican study. McGregor's answers and clarifications were that (1) all the children in the study were already walking; (2) no days when they were ill were included in the observations; (3) there were no important differences in the behaviors of the mothers (at least among those that had been assessed); (4) the four hours of observation were selected at random; (5) the behavior of the mothers was spontaneous, i.e., mothers received no instructions on what to do or not to do.
According to Pollitt, at least three aspects must be considered when interpreting McGregor's results: (1) developmental assessments at this early age are not conceptually significant, unless they can be related to behavior at a later age (e.g., about two years later); (2) studies done in children suffering from hypopituitarism showed that although the development of these children was delayed, this could largely be explained by the mothers' attitude and behavior; (3) during the first three years of life, one can find associations between developmental assessments and growth indicators. Super added that there may be age-related differences in the accomodation response of children to low energy intake, as discussed by Torun in his presentation on short- and long-term effects of low energy intake on activity.
McGregor added that data on the dietary intake of the children in her study indicated that, per kg body weight, stunted children had higher intakes than non-stunted ones. When expressed in absolute terms, i.e., as kcal or g protein per day, intakes were similar in both groups. Since the stunted children were smaller and ligher, their intake per kg body weight was greater.
Shetty also found that energy intake per kg weight was greater in undernourished than in well-nourished Indian adults. Allen reported analogous findings among undernourished children in Mexico. Others commented that these findings are not universally consistent, as in several other studies undernourished children had lower intakes in absolute and relative terms.
Jackson commented that there may be other specific nutrient deficits that lead to 'wastage' of dietary energy. Torun added that studies on the dietary management of diarrhea in Guatemala showed that children gained more weight when vegetable-based diets were supplemented with Na, K and micronutrients.