International Journal of Child Health and Nutrition

Increased Maternal Education and Knowledge of Nutrition and Reductions in Poverty are Associated with Dietary Diversity and Meal Frequency in an Observational Study of Indonesian Children - Pages 132-138
Benjamin T. Crookston, Cudjoe Bennett, P. Cougar Hall, Muhamad Hasan, Mary Linehan, Ahmad Syafiq, Scott Torres, Joshua H. West and Kirk A. Dearden


Published: 12 November 2018


Abstract:  Background: Optimal infant and young child feeding during the first two years of life is essential to optimum child development and health. While the link between feeding practices and child health outcomes is well documented, little is known about the determinants of these feeding practices in Indonesia. The purpose of this study was to better understand factors associated with appropriate child feeding among Indonesian children 6–23 months of age.

Methods: Interviewers conducted interviews with 1498 mothers of children 6–23 months of age to identify practices. Measures of feeding practices included dietary diversity, meal frequency, and minimum acceptable diet. Multivariate logistic regression was used to identify factors associated with dietary diversity and separately with meal frequency.

Results: After adjusting for covariates, increased maternal education was associated with improved dietary diversity. Age of child [OR=1.11], knowledge of stunting [OR=1.80], and having ever received nutrition information [OR=1.89] were also associated with greater dietary diversity. Wealth [OR=0.86] and age of child [OR=0.92] were inversely associated with meal frequency. Maternal education, age of child, being a male child, knowledge of stunting, and having received nutrition information increased the odds of the child consuming a minimum acceptable diet.

Conclusion: Increasing maternal education, knowledge of stunting, and knowledge of nutrition may improve dietary diversity while poverty alleviation has the potential to improve minimum meal frequency. These findings corroborate similar studies and confirm the importance of government efforts that help girls stay in school, improve families’ understanding of nutrition, and reduce poverty.

Keywords:  Dietary diversity, Meal frequency, Nutrition, Children, Indonesia.


International Journal of Child Health and Nutrition

Maternal Knowledge of Stunting in Rural Indonesia - Pages 139-145

Cougar Hall, Cudjoe Bennett, Benjamin Crookston, Kirk Dearden, Muhamad Hasan, Mary Linehan, Ahmad Syafiq, Scott Torres and Joshua West


Published: 12 November 2018


Abstract:  Child undernutrition and stunting remain serious public health problems in Indonesia. According to the Health Belief Model, increasing mothers’ knowledge of stunting is fundamental to establishing accurate threat perceptions predictive of behavior change. The purpose of this study was to increase understanding of factors related to maternal knowledge of stunting in Indonesia by addressing three questions: 1) How familiar with stunting are Indonesian mothers? 2) What antecedent factors do Indonesian mothers associate with stunting? and 3) What health effects do Indonesian mothers associate with stunting? A total of 3,150 mothers participated in structured face-to-face interviews. Study measures targeted four main variables. Mothers were asked: 1) Have you heard of stunting?; 2) Have you heard of shortness?; 3) What causes stunting/shortness?; and 4) What are the effects of stunting? Only 66 (2.1%) mothers reported having heard of, read about, or knew something about stunting. Approximately two-thirds of participants attributed stunting to hereditary factors. Interrupted growth (33.7%), idiocy (13.8%), and easy to get sick (11.8%) were identified as health effects of stunting. Results highlight the need for health promotion and education efforts focused on increasing basic knowledge of stunting, its causes, and its health effects among Indonesian mothers.

Keywords:  Stunting, knowledge, childhood nutrition, Indonesia, Health Belief Model.


International Journal of Child Health and Nutrition

Evaluating the Impact of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children Fruit Juice Allotment on Fruit Intake, Dietary Quality, and Energy/Nutrient Intakes among Children 1-4 Years of Age - Pages 146-156

T.A. Nicklas, C.E. O’Neil and V.L. Fulgoni III


Published: 12 November 2018


Abstract:  Objective: The goals of this study were to assess the impact of recent changes in the WIC allotment on fruit intake, dietary quality/adequacy, energy/nutrient intakes, and potential impact of the complete removal of 100% fruit juice (FJ) from the package.

Methods: 24-hour recalls from children 1-4 years who were WIC participants or income-eligible nonparticipants in the NHANES 2007-2008 and 2011-2014 (before and after WIC package changes) were analyzed.

Results: There were no differences in the Healthy Eating Index-2015 total score; subcomponent scores for “greens and beans” and for “fatty acid ratio” were higher in 2011-2014 than in 2007-2008 in children participating in WIC; scores for “sodium” were higher in 2011-2014 than in 2007-2008 in children not participating in WIC but income-eligible. In WIC participants mean intakes of riboflavin, vitamins B12 and C, and zinc were significantly (p<0.01) lower, and intake of vitamin E was significantly (p<0.01) higher in 2011-2014 compared to 2007-2008. One significant difference in nutrient adequacy in children was that of a lower (p<0.01) percentage of inadequacy for WIC participants for vitamin E and a higher (p<0.01) percentage of inadequacy for WIC participants for vitamin A in 2011-2014 as compared to those in 2007-2008. The elimination of FJ from the WIC food packages resulted in a 38-50% lower total fruit intake and a 4-5% reduction in total HEI-2015 score.

Conclusion: Changes in the WIC program resulted in potential adverse effects on mean intakes of some nutrients but not on the nutrient adequacy or overall diet quality. Confirmatory studies are needed.

Keywords:  WIC program, dietary intake, children, NHANES, fruit juice.


International Journal of Child Health and Nutrition

Preschool Children in Childcare Settings Do Not Consume a Healthy Diet Despite Menus that Meet Recommended Dietary Standards - Pages 157-162

Stacie M. Kirk and Erik P. Kirk


Published: 12 November 2018


Abstract:  Purpose/Objective: To compare preschool lunch menus that meet dietary guidelines to what is actually served and consumed.

Methods: Fifty-two preschool children (mean±SD, age 3y and 10m ± 8m) from a university early childhood center participated in the 10-week study. Dietary intake was measured by a registered dietitian using direct observation for pre and post meal analysis. Energy and nutrient content was completed using Food Processor Nutrition Analysis by ESHA.

Results: There was a significant (p<0.05) difference for total kilocalories (kcals) between what was on the menu (448 ± 130) and to what was served to the children (523 ± 148) compared to what was consumed (361 ± 178) by the children.There was a significant (p<0.05) difference for grams of fat between what food was listed on the menu (16.0 ± 8.7g), the food served to the children (21.2 ± 9.7g), and the food consumed (14.5 ± 10.0g) by the children. There was a significant (p<0.05) difference for grams of carbohydrate between what food was listed on the menu (55.3 ± 18.9g) and the food served to the children (56.5 ± 20.5g) compared to what was consumed (38.5 ± 21.7g) by the children. Children consumed only 46.9% of the vegetables, 88.9% of dairy products, 82.0% of fruits, 81.8% of grains and 72.8% of meats served, and 77.9% of all fats/sweets served to them at lunch.

Conclusion: The results indicated that menus that meet recommended dietary standards do not translate into what children are served or consumed, in particular, for vegetables.

Keywords:  Dietary Intake, Early Childhood, Served, Food Preference.