A Combined Dietary and Cognitive Intervention in 3–5-Year-Old Children in Indonesia: A Randomized Controlled Trial

Abstract

Early childhood nutritional interventions typically combine nutritional and psychosocial stimulation. Such combined interventions result in long-lasting improvements of cognitive abilities in children who are malnourished. Here, we investigated potential cognitive abilities in normally developing children in Indonesia who were, however, at risk for suboptimal cognitive development due to little psychosocial stimulation in their home environment. In a randomized controlled intervention, children of the experimental group received nutritional supplementation combined with cognitive stimulation. Pre- and post-intervention measurements included cognitive development and functioning, behavior, and mother–child interaction. The experimental and control group received nutritional supplementation in the form of a fortified or unfortified milk powder, respectively. Additionally, the children and parents of the experimental group jointly engaged in daily learning activities at home and performed iPad-based tasks designed to foster cognitive abilities. The experimental group compared to the control group displayed a significantly higher increase in intelligence quotient as well as a significantly larger reduction in attentional problems after the intervention. These results indicate that low-level cognitive stimulation in combination with nutritional supplementation during early childhood can be an effective intervention that improves global cognitive functioning in healthy developing children. ClinicalTrials.gov Identifier: NCT02359669.

Sociodemographic, nutritional, and environmental factors are associated with cognitive performance among Orang Asli children in Malaysia

“…Beside sociodemographic factors, we found that the subscales from the HOME inventory contributed to the children’s cognitive performance, namely, the availability of learning materials at home, variety in daily stimulation, and parental responsiveness. These factors agree with several studies that also indicated that home environment had a significant correlation with children’s cognitive performance [15,39–42]. A longitudinal study of American children from birth to school age found that cognitive stimulation at home was more effective in increasing children’s learning abilities in their early childhood than the stimulation found in primary school [41].…”

“…Furthermore, the composite index scores for WMI, PSI, and CPI in the WPPSI IV are based on the United States norm as no Malaysian norm is available. However, the WPPSI IV has been used in other Asian countries including Indonesia [39] and Pakistan [52]. Future studies should develop a Malaysian norm for the WPPSI IV.…”

“…Fourth, the HOME scale has not been validated in Malaysia and may not truly reflect the culture of OA. However, this instrument has been widely used in developing countries [53] and is a useful measurement tool for factors that are correlated with cognitive performance in homes which stimulate thinking and learning [15,39]. Finally, the study sample may not represent OA children population in the state of Negeri Sembilan as there were only 14 out of 30 OA villages agreed to participate in this study.…”

Stimulation and cognitive function in short-stature preschoolers

“…This finding is consistent with previous studies showing a positive correlation between stimulation and children's cognitive function. 13,20,25,28 The percentage difference in cognitive function between the normal-height and short-stature groups was not significant. This finding was likely because in which most preschoolers received medium-level stimulation.…”

“…A randomized controlled trial on healthy children in Jakarta showed that a combination of cognitive stimulation and nutritional supplementation in early childhood was an effective intervention to improve global cognitive function. 13 Short stature is a linear growth failure that often occurs in early childhood. Stunted growth is short stature mainly due to a lack of nutritional intake and/ or recurrent infections, rather than genetic factors.…”