Daily consumption of growing-up milk is associated with less stunting among Indonesian toddlers
BACKGROUND In Indonesia, animal protein intake in children is low and might contribute to a high prevalence of stunting. This study was aimed to evaluate the association between animal protein source consumption and stunting in toddlers.
METHODS This cross-sectional study obtained secondary data from the Ironcheq questionnaire validation study to detect the risk of iron deficiency in toddlers. The Ironcheq study was carried out in five integrated health service posts (Posyandu) in Jakarta from 2013 to 2014. Data from 172 subjects, consisting of 41 stunted (height-for-age z-score less than -2) and 131 normal children, were analyzed to evaluate the association between animal protein source consumption and stunting using multivariate logistic regression test.
RESULTS Stunted children tend to come from a family with low parental education and socioeconomic status. Consuming growing-up milk (GUM) ≥300 ml/day was protective against stunting (adjusted OR 0.28, 95% CI 0.13–0.63), whereas consuming red meat product ≥5 times/week was a risk factor (crude OR 3.70, 95% CI 1.17–11.74), however after adjusted to age, sex, and other variables in the questionnaire, the OR was not significant (adjusted OR 3.64 95% CI 1.00–13.26).
CONCLUSIONS A daily consumption of 300 ml of GUM may be considered to prevent stunting in toddlers. Red meat products (sausage, nugget, and meatball), which are commonly consumed because of its practicality, could not be considered as significant animal protein sources because of a wide variation of their nutritional content.
Branca F, Ferrari M. Impact of micronutrient deficiencies on growth: The stunting syndrome. Ann Nutr Metab. 2002;46:8-17. https://doi.org/10.1159/000066397
Golden MH. Proposed recommended nutrient densities for moderately malnourished children. Presented at the WHO, UNICEF, WFP and UNHCR Consultation on the Dietary Management of Moderate Malnutrition in Under-5 Children by the Health Sector, September 30th October 3rd, 2008. DoWHO, UNICEF, WFP and UNHCR Consultation on the Dietary Management of Moderate Malnutrition in Under-5 Children by the Health Sector 2008. Available from: www.who.int/nutrition/publications/moderate_malnutrition
Golden MH. The development of concepts of malnutrition. J Nutr. 2002;132(7):2117S-22S. https://doi.org/10.1093/jn/132.7.2117S
UNICEF [Internet]. Malnutrition rates remain alarming: stunting is declining too slowly while wasting still impacts the lives of far too many young children. [cited 2018]. Available at: https://data.unicef.org/topic/nutrition/malnutrition/
WHO. Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva: WHO Document Production Services; 2014.
Uauy R. Improving linear growth without excess body fat gain in women and children. Food Nutr Bull. 2013;34(2):259-62. https://doi.org/10.1177/156482651303400222
FAO. Research approaches and methods for evaluating the protein quality of human foods.Bangalore: FAO; 2014.
Wu G. Amino acids: biochemistry and nutrition. Boca Raton: CRC Press; 2013. https://doi.org/10.1201/b14661
Sandjaja S, Budiman B, Harahap H, Ernawati F, Soekatri M, Widodo Y, et al. Food consumption and nutritional and biochemical status of 0·5-12-year-old Indonesian children: the SEANUTS study. Br J Nutr. 2013;110 Suppl:S11-20. https://doi.org/10.1017/S0007114513002109
Allen LH, Uauy R. Guidelines for the study of mechanisms involved in the prevention or reversal of linear growth retardation in developing countries. Eur J Clin Nutr. 1994;48:S212-6.
Codex STAN 72-1981. Standard for infant formula and formulas for special purposes intended for infants.
Baker DH. Lysine, arginine, and related amino acids: an introduction to the 6th amino acid assessment workshop. J Nutr. 2007;137(6 Suppl 2):1599S-601S. https://doi.org/10.1093/jn/137.6.1599S
Rolland M, Dalsgaard J, Holm J, Gómez-Requeni P, Skov PV. Dietary methionine level affects growth performance and hepatic gene expression of GH-IGF system and protein turnover regulators in rainbow trout (Oncorhynchus mykiss) fed plant protein-based diets. Comp Biochem Physiol B Biochem Mol Biol. 2015;181:33-41. https://doi.org/10.1016/j.cbpb.2014.11.009
Hoppe C, Udam TR, Lauritzen L, Mølgaard C, Juul A, Michaelsen KF. Animal protein intake, serum insulin-like growth factor I, and growth in healthy 2.5-y-old Danish children. Am J Clin Nutr. 2004;80(2):447-52. https://doi.org/10.1093/ajcn/80.2.447
Michaelsen KF, Hoppe C, Roos N, Kaestel P, Stougaard M, Lauritzen L, et al. Choice of foods and ingredients for moderately malnourished children 6 months to 5 years of age. Food Nutr Bull 2009;30:(3 Suppl):S343-404. https://doi.org/10.1177/15648265090303S303
Lien do TK, Nhung BT, Khan NC, Hop le T, Nga NT, Hung NT, et al. Impact of milk consumption on performance and health of primary school children in rural Vietnam. Asia Pac J Clin Nutr. 2009;18(3):326-34.
Millward DJ, Layman DK, Tomé D, Schaafsma G. Protein quality assessment: impact of expanding understanding of protein and amino acid needs for optimal health. Am J Clin Nutr. 2008;87(5):1576S-81S. https://doi.org/10.1093/ajcn/87.5.1576S
Millward DJ. Amino acid scoring patterns for protein quality assessment. Br J Nutr. 2012;108:S31-S43. https://doi.org/10.1017/S0007114512002462
FAO/WHO. Protein quality evaluation in human diets. Food and Agriculture Organization, Food and Nutrition paper 51. Rome: FAO/WHO; 1991. p.35-36
Michaelsen KF. Cow's milk in the prevention and treatment of stunting and wasting. Food Nutr Bull. 2013;34(2):249-51. https://doi.org/10.1177/156482651303400219
Copyright (c) 2019 Damayanti Rusli Sjarif, Klara Yuliarti, William Jayadi Iskandar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.