Diet Diversity Assessment Among Under Two Children in

Srikamulyan Village Tirtajaya District Karawang

Arindah Nur Sartika, Guntari Prasetya, Nadia Puspita, Amelia Lityasusanti and Arrifah Nurrobiah

Nutrition Bachelor Study Program, Sekolah Tinggi Ilmu Kesehatan Mitra Keluarga, Bekasi, Indonesia

Keywords: Complementary Feeding, Dietary Diversity, Under Two Children.

Abstract: Breastmilk is the best food for babies. However, when babies reach 6 months of age, breastmilk alone is

insufficient to meet their nutritional needs. To address these requirements, breastmilk feeding should be

supplemented with appropriate complementary feeding. The more diverse the food provided, the better it can

reduce the risk of undernutrition. Hence, this study aims to assess the dietary diversity of complementary

feeding in an area designated as a priority for reducing stunting. The study is conducted in Srikamulyan

Village, Tirtajaya Sub-district, Karawang, using a cross-sectional design. Dietary diversity is evaluated using

9 food groups based on repeated 24-hour food recalls. Approximately 100 children under the age of two,

ranging from 6 to 23 months old, participated in the study. The study's findings reveal that 52% of the subjects

consume diverse foods (≥4 food groups). All of the children include staple foods in their diet. The most

commonly consumed foods after staple foods are meat and fish (71%) and green leafy vegetables (63%). The

highest proportion of children achieved a dietary diversity score of 6. However, the study did not find a

significant relationship between dietary diversity and nutritional status (weight for age and length for age),

with a p-value >0.05. Based on the study, it is clear that there are caregivers who do not provide varied meals

to children. Although a significant relationship is not established, offering a variety of food groups can

establish a strong foundation for the food habits of children in the future. The foods provided as

complementary feeding can help children become familiar with different tastes and nutritious options.

1 INTRODUCTION

The first thousand days of life, starting from the

womb until the child turns two years old, are a crucial

phase. This period presents both potential benefits

and vulnerabilities as it can significantly affect the

growth and development of children. Providing good

nutrition and care during this time can promote

healthy growth and development, which can have a

lasting impact on their future lives.(FHI Solutions,

n.d.)

To achieve good nutrition and care, infants must

be fed exclusively with breastmilk from birth until

they reach six months of age, followed by the

introduction of complementary feeding starting at six

months. While breastfeeding can continue after six

months, it is essential to provide high-quality meals

to meet the baby's nutritional requirements, as breast

milk alone is insufficient. According to UNICEF's

complementary feeding guidance, a proper diet for

young children should include breastmilk, animal-

source foods, vegetables, fruits, and promote dietary

diversity (United Nations Children’s Fund, 2020).

A variety of foods can contribute to a variety of

nutrients metabolized in the body. The body needs not

only macronutrients, but also micronutrients. A

variety of foods can contribute to a range of nutrients

metabolized in the body. The body requires not only

macronutrients but also micronutrients. Micro-

nutrients, such as vitamins and minerals, play a

crucial role in metabolism. The adequacy of nutrients

can be achieved by consuming a wide variety of food

groups (Alyssa L. Morris; Shamim S. Mohiuddin,

2023). In cases where a baby cannot obtain sufficient

nutrients, the risk of inadequacy increases, which in

turn raises the risk of undernutrition (Ermawati et al.,

2020; Ernawati et al., 2021). Underweight reflects

acute conditions, while stunting represents chronic

nutrient deficiency. Stunting is the most common

nutrition problem as it has both short-term and long-

term implications (De Sanctis et al., 2021).

Short-term consequences of stunting become

evident as affected children grow. They may be more

likely to exhibit lower intelligence levels during their

school years. Additionally, children with a history of

stunting may experience reduced immunity compared

Sartika, A. N., Prasetya, G., Puspita, N., Lityasusanti, A. and Nurrobiah, A.

Diet Diversity Assessment Among Under Two Children in Srikamulyan Village Tirtajaya District Karawang.

DOI: 10.5220/0012901500004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 111-114

ISBN: 978-989-758-727-6; ISSN: 2975-8297

111

to their peers who have not faced stunting. This

reduced immunity can result in higher rates of school

absenteeism, often due to infections such as diarrhea

and respiratory illnesses (Stewart et al., 2013).

Besides its short-term impact, stunting also has

long-term consequences. Due to altered metabolism,

individuals with a history of stunting are at a higher

risk of obesity and may suffer from non-

communicable diseases, including type 2 diabetes,

stroke, and heart disease. These conditions can impact

work performance and lead to increased absenteeism

at the workplace. If this affects a significant portion

of the workforce, it can reduce company profits and

even have implications for a country's gross domestic

product (GDP) (Stewart et al., 2013; Suryana & Azis,

2023).

In Indonesia, the prevalence of stunting among

children under two years old was 21.6% in 2022.

West Java, as one of the densely populated provinces,

had a stunting prevalence of 20.2%. As part of the

government's first program to address stunting, one of

the regions in West Java was selected for

intervention. In 2013, the stunting rate in Karawang

was 34.87%, and it increased to 39.15% in 2018.

However, as of 2022, Karawang has managed to

reduce the prevalence to 20.6% (Kementerian

Kesehatan Republik Indonesia, 2022).

Studies have found a relationship between diet

diversity and undernutrition, including stunting and

being underweight (Aboagye et al., 2021;

Handriyanti & Fitriani, 2021; Wantina et al., 2017).

Therefore, this study aims to assess diet diversity in a

selected area designated as a priority for stunting

eradication. Additionally, it aims to explore the

association between stunting and nutritional status.

2 SUBJECTS AND METHODS

This study utilized a cross-sectional design. The total

sample consisted of 100 children under the age of two

(6 – 23 months), represented by their mothers,

grandmothers, or caregivers. The study was

conducted in Srikamulyan Village, Tirtajaya District,

Karawang, West Java. The researchers obtained the

necessary permissions from the local government and

acquired ethical clearance from KPEK Universitas

Muhammadiyah Prof. Dr. Hamka.

The variables in the study included characteristics

of the respondents, diet diversity, and nutritional

status. Data were recorded in written form and

collected by enumerators with a background in

nutrition studies. The dietary assessment method used

was a 24-hour food recall. Food intake data was then

transformed into a dietary diversity scoring form

(Food and Agriculture Organization (FAO), 2013).

There were nine food groups: 1) Milk and dairy

products, 2) Legumes, nuts, seeds, 3) Eggs, 4) Meat

and fish, 5) Organ meats, 6) Other fruits and

vegetables, 7) Fruit and vegetable–source of vitamin

A, 8) Green leafy vegetable, and 9) Staple food.

Classification of dietary diversity is classified into not

diverse (<4) and diverse (≥4). The nutritional status

of the children was evaluated through anthropometric

assessments using a length board and weigh scale. Z-

scores for weight-for-age and height-for-age were

calculated, and children with z-scores less than -2SD

were categorized as stunted and underweight

(Kementerian Kesehatan Republik Indonesia, 2020).

The data were analyzed using both univariate and

bivariate analyses. The characteristics of the

respondents were presented in terms of frequency and

percentage. The statistical test employed in the study

was the chi-square test.

3 RESULTS

Table 1: Characteristics respondents.

rou

(

)

6-11 months 32

(

)

12-23 months 68

(

)

Sex n

(

)

(

)

Girl 57

(

)

Number of famil

(

)

≤4 person

erson

48 (48)

(

)

Mother’s education n

(

)

No school

Elementary school

Junior high school

Senior high school

Universit

2 (2)

67 (67)

22 (22)

6 (6)

(

)

Mother’s occupation n (%)

No work

Private sectors

Entrepreneur

Farmers, labou

94 (94)

2 (2)

N = 100

Table 2: Dietary diversity score (DDS).

DDS n (%)

1 9 (9)

2 4 (4)

3 13 (13)

4 15 (15)

5 20 (20)

6 24 (24)

7 10 (10)

8 5 (5)

9 0 (0)

N: 100

ICSDH 2023 - The International Conference on Social Determinants of Health

112

The results showed that the proportions of age

groups and sexes were similar. Most of the mothers

had an elementary school education, and they were

primarily engaged as housewives. The percentage of

family size was comparable between families with ≤4

and >4 individuals per family.

According to the data, the lowest score of dietary

diversity was 1, and the highest score was 8. Half of

the respondents had achieved more than 4 food

groups. However, there were some

mothers/caregivers who provided their babies with

non-diverse complementary feeding. All of the

children consumed staple food. The most commonly

consumed foods after staple food were meat and fish,

as well as green leafy vegetables.

From the results, it is evident that the proportion

of children who consume a less varied diet was lower

in the stunting and underweight groups compared to

the normal group. Additionally, the statistical

analysis using the chi-square test showed no

significant relationship between dietary diversity and

nutritional status.

Figure 1: Proportion of food groups (N= 100).

Table 3: Association of dietary diversity and nutritional

status.

Dietary

diversity

Underweight Normal p-value

Not diverse

3 (10.7) 25 (89.3) 0.297

Diverse 14 (19.4) 58 (80.6)

Dietary

diversity

Stunting Not stunting p- value

Not diverse

1 (3.6) 27 (96.4) 0.309

Diverse 7 (9.7) 65 (90.3)

N = 100, chi-square test

4 DISCUSSIONS

This study revealed that not all mothers or caregivers

provided a diverse range of foods to their children.

Some caregivers offered fewer than four food groups,

and in some cases, only one group, such as rice

porridge. Such dietary habits led to inadequate

nutrient intake. Despite this, it's noteworthy that more

than half of the children consumed meat, fish, as well

as legumes, nuts, and seeds, which are excellent

sources of protein (Gonçalves et al., 2023; Semba et

al., 2021).

Protein has benefits for children's linear growth.

One of the explanations is that amino acids play an

important role in relation to growth hormones (Uauy

et al., 2015). Another study explains that protein,

particularly from animal-source foods, provides

essential amino acids that support neurocognition via

the mTORC1 pathway (Parikh et al., 2022). However,

to realize these benefits, the protein portion should

meet the daily requirements of the children.

No relationship between dietary diversity and

nutritional status was identified in this study. This

result aligns with findings from previous studies

(Gassara et al., 2023; Kamila et al., 2022).

Undernutrition is likely influenced by other factors.

According to UNICEF, factors such as infection and

childcare practices can also have an impact on a

child's nutritional status (United Nations Children’s

Fund, 2021).

Although dietary diversity did not reveal an

association with undernutrition, this study

demonstrated that not all children under the age of

two consumed a varied diet. Introducing a variety of

food groups can help infants become accustomed to

different tastes, laying a strong foundation for their

future food habits. This can reduce the risk of them

becoming picky eaters or refusing certain foods.

During complementary feeding, children acquire

knowledge about different foods, which they can

apply after the age of 2. The foods provided during

complementary feeding help them become familiar

with various tastes and nutritious options (De Cosmi

et al., 2017; Maier-Nöth, 2019).

5 CONCLUSIONS

Based on the study, it is evident that some caregivers

do not provide diverse meals to children. Although

this lack of dietary diversity may not exhibit a

significant relationship with stunting and

underweight, offering a range of food groups can lay

0 50 100 150

Staple food

Green leafy vegetable

Fruit & vegetable -…

Other fruit & vegetable

Organ meats

Meat & fish

Egg

Legumes, nuts, seeds

Milk & dairy products

Diet Diversity Assessment Among Under Two Children in Srikamulyan Village Tirtajaya District Karawang

113

a robust foundation for the future food habits of

children.

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