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
 3. Severe undernutrition
 3.1. Developmental levels in the acute stage 3.2. Behavior 3.3. Relationship between development, activity and exploration 3.4. Relationship between development and anthropometry 3.5. Children after recovery from the acute episode 3.6. Jamaican study 3.7. Conclusions

### 3.3. Relationship between development, activity and exploration

Recently we reanalyzed the data to determine whether there was an association between initial behavior and DQs following recovery. We calculated simple correlations between DQ following recovery and the initial behaviors (Table 1). We considered the children's DQs after returning home more valid, and attributed the initial low values to the children's anxiety at being in hospital, fear of strangers and generally feeling unwell. There was a significant negative association between apathy and DQ in the control group, and the association approached significance (p < .1) in the severely undernourished group. There was no association between the amount of toy exploration, or the activity rating and DQ in the separate groups. When the groups were combined, all these associations were significant. In these deprived children, a decline in DQ with age is expected. Controlling for age did not change the pattern of associations. When DQ was predicted in a multiple regression analysis, with age, group, apathy, activity rating, and toy-exploration rating as independent variables, only age, group, and apathy entered the equation.

Table 1. Correlations between DQs one month after recovery and initial behavior

 Severely undernourished Controls Combined groups (n = 18) (n = 20) (n = 38) Age -.46 + -.66 + -.52 ++ Activity rating .01 .23 .54 ++ Apathy -.40 -.45 + -.54 ++ Toy-exploration rating * .22 .07 .44 ++

* undernourished group, n = 17.
+ p < .05
++ p < .01

Within-group associations between activity, exploration and DQs may have failed to reach significance because the groups were small. Also the behavioral measures may not be sensitive to small differences in DQ. A further possibility is that current activity and quantity of exploration are not directly related to development but only to severe undernutrition. The findings established that severely undernourished children had low developmental levels and showed no sign of improvement relative to the controls during nutritional rehabilitation. In contrast, the behavioral abnormalities of apathy, reduced activity and exploration were transient and improved rapidly. It is not possible to say which nutrients were responsible for these changes. There may have been more subtle behavioral differences remaining after recovery that were not measured. Furthermore, the relationships between behavior and developmental level following the establishment of poor development may not be the same as those which preceded it. The relationship between apathy and poor development in both groups requires further investigation; apathy may be related to severity of systemic illness.