The Effects of High Protein Supplementary Feeding on the Growth of Stunting Children Aged 6-59 Months in Indonesia
DOI:
https://doi.org/10.6000/1929-4247.2026.15.01.5Keywords:
Stunting, supplementary feeding, anthropometry, protein energy ratioAbstract
Background: Stunting remains a major public health problem in Indonesia, with a national prevalence of 21.6% in 2022 and nearly 30% in Semarang City. Inadequate protein intake is one of the key contributors, whereas animal-source protein supports growth, in part, through its effect on Insulin-like Growth Factor I (IGF-I).
Objective: To evaluate the effect of high-protein supplementary feeding on the growth of stunted children aged 6-59 months using a quasi-experimental pretest-posttest design.
Methods: A quasi-experimental pretest-posttest study was conducted involving stunted children aged 6-59 months who received supplementary food containing an energy-protein ratio of 10-18% for 90 days. Anthropometric outcomes included body weight (BW), height (Ht), weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and weight-for-height Z-score (WHZ). Dietary intake, infection incidence, and compliance were also assessed. Paired t-test, Wilcoxon signed-rank test, and correlation analyses were applied as appropriate.
Results: In the 101 study participants, energy (+128 kcal), protein (+6.77 g), fat (+11.8 g), and carbohydrate (+22.6 g) intake increased significantly (all p<0.001). Body weight (median Δ=0.50 kg; p<0.001), height (median Δ=1.90 cm; p<0.001), and WHZ (median Δ=0.06; p<0.001) improved significantly. WAZ increased by 0.17 (95% CI: −0.25 to −0.11; p<0.001), whereas HAZ showed no significant change (median Δ=0.05; p=0.608). Infection incidence was negatively associated with gains in body weight and height.
Conclusion: High-protein supplementary feeding effectively improved nutrient intake and short-term growth indicators (BW, WAZ, WHZ), but did not significantly improve linear growth (HAZ), likely due to the short 90-day intervention period.
References
Survei Kesehatan Indonesia (SKI). Indonesian Health Survey 2023. Jakarta: Badan Kebijakan Pembangunan Kesehatan; 2024. Available from: https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/ Accessed 2025 Jun 17.
World Health Organization. Malnutrition [Internet]. Geneva: WHO; 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition Accessed 2025 May 1.
Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health 2014; 34(4): 250-265. DOI: https://doi.org/10.1179/2046905514Y.0000000158
Shapiro MJ, Downs SM, Swartz HJ, Parker M, Quelhas D, Kreis K, et al. A systematic review investigating the relation between animal-source food consumption and stunting in children aged 6-60 months in low- and middle-income countries. Adv Nutr 2019; 10(5): 827-847. DOI: https://doi.org/10.1093/advances/nmz018
Pham TPT, Raoult D, Million M. IGF-1 levels in children with severe acute malnutrition after nutritional recovery: a good predictor for children’s long-term health status. Clin Nutr 2021; 40(5): 3275-3282.
Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. A review of child stunting determinants in Indonesia. Matern Child Nutr 2018; 14(4): e12617. DOI: https://doi.org/10.1111/mcn.12617
Xiong T, Wu Y, Hu J, et al. Associations between high protein intake, linear growth, and stunting in children and adolescents: a cross-sectional study. Nutrients 2023; 15(22): 4821. DOI: https://doi.org/10.3390/nu15224821
Harper KM, Mutasa M, Prendergast AJ, Humphrey J, Manges AR.Environmental enteric dysfunction pathways and child stunting: a systematic review. PLoS Negl Trop Dis 2018; 12(1): e0006205. DOI: https://doi.org/10.1371/journal.pntd.0006205
Semba RD, Trehan I, Gonzalez-Freire M, Kraemer K, Moaddel R, Ordiz MI, et al. The potential role of essential amino acids and the mTORC1 pathway in the pathogenesis of child stunting. Adv Nutr 2016; 7(5): 853-865. DOI: https://doi.org/10.3945/an.116.013276
Badan Litbang Kesehatan. Survei konsumsi makanan individu Indonesia 2014. Jakarta: Kementerian Kesehatan RI; 2014.
Kementerian Kesehatan RI. Petunjuk teknis pemberian makanan tambahan berbahan pangan lokal untuk balita dan ibu hamil. Jakarta: Kementerian Kesehatan RI; 2023.
Mamun AA, Mahmudiono T, Yudhastuti R, Triatmaja NT, Chen HL.Effectiveness of food-based intervention to improve the linear growth of children under five: a systematic review and meta-analysis. Nutrients 2023; 15(11): 2430.
World Health Organization. Guideline for complementary feeding of infants and young children 6-23 months of age. Geneva: WHO; 2023.
World Health Organization, Food and Agriculture Organization of the United Nations, United Nations University. Protein and amino acid requirements in human nutrition. WHO Tech Rep Ser 2007; 935.
Hasan S, Rashid R, Riaz A, Ahmed R, Shehzad A, Iftikhar A, et al. Nutrient and hormonal effects on long bone growth in children. Nutrients 2024; 16(14): 2295.
Jewell JL, Russell RC, Guan KL. Amino acid signalling upstream of mTOR. Nat Rev Mol Cell Biol 2013; 14(3): 133-139. DOI: https://doi.org/10.1038/nrm3522
Thurstans S, Sessions N, Dolan C, Sadler K, Cichon B, Isanaka S,et al. The relationship between wasting and stunting in young children: a systematic review. Matern Child Nutr 2022; 18(1): e13246. DOI: https://doi.org/10.1111/mcn.13246
Semba RD, Shardell M, Sakr Ashour FA, Moaddel R, Trehan I, Maleta KM, et al. Child stunting is associated with low circulating essential amino acids. EBioMedicine 2016; 6: 246-252. DOI: https://doi.org/10.1016/j.ebiom.2016.02.030
Hardjo J, Selene NB. Stunting and gut microbiota: a literature review. Pediatr Gastroenterol Hepatol Nutr 2024; 27(3): 137-145. DOI: https://doi.org/10.5223/pghn.2024.27.3.137
Yan J, Herzog JW, Tsang K, Brennan CA, Bower MA, Garrett WS, et al. Gut microbiota induce IGF-1 and promote bone formation and growth. Proc Natl Acad Sci USA 2016; 113(47): E7554-E7560. DOI: https://doi.org/10.1073/pnas.1607235113
De Sanctis V, Soliman A, Alaaraj N, Ahmed S, Alyafei F, Hamed N, et al. Early and long-term consequences of nutritional stunting: from childhood to adulthood. Acta Biomed 2021; 92(1): e2021168.
Voortman T, Braun KVE, Kiefte-de Jong JC, Jaddoe VWV, Franco OH, van den Hooven EH. Dietary protein intake in early childhood and growth trajectories between 1 and 9 years. J Nutr 2016; 146(11): 2361-2367. DOI: https://doi.org/10.3945/jn.116.237164
Taufiqurrahman AB, Mundiastuti L. The three months balanced diet recommendation education could improve mother’s knowledge and compliance in better diet and nutrient intake for stunted children in Surabaya, Indonesia. Indian J Forensic Med Toxicol 2021; 15(3): 4489. DOI: https://doi.org/10.37506/ijfmt.v15i3.15998
Sumarlan S, Muzakkar M, Nirmalarumsari C, Silfiana A, Sari R. Efektivitas pemberian makanan tambahan terhadap peningkatan tinggi badan pada anak stunting. J Promotif Preventif 2023; 6(1): 1-6.
van Raaij JMA, Koletzko B, Uauy R, Quan MH, Givens I, Astrup A, et al. Protein intake from 0 to 18 years and its relation to health. Food Nutr Res 2013; 57: 21085.
Beal T, Le DT, Trinh TH, Burra DD, Huynh T, Duong TT,et al. Child stunting and its associated child, maternal, and environmental factors in Vietnam. Matern Child Nutr 2019; 15(4): e12826. DOI: https://doi.org/10.1111/mcn.12826
Li Z, Kim R, Vollmer S, Subramanian SV. Factors associated with child stunting, wasting, and underweight in 35 low- and middle-income countries. JAMA Netw Open 2020; 3(4): e203386. DOI: https://doi.org/10.1001/jamanetworkopen.2020.3386
Adelasanti AN, Rakhma LR. Hubungan kepatuhan konsumsi PMT dengan perubahan status gizi balita. J Dunia Gizi 2018; 1(2): 92-100. DOI: https://doi.org/10.33085/jdg.v1i2.3073
Sutini PH, Subandriani DN, Wahyuni T. Partisipasi ibu, tingkat kepatuhan pada program PMT pemulihan, dan status gizi balita. J Riset Gizi 2013; 1(2): 1-5. DOI: https://doi.org/10.31983/jrg.v1i2.74
Eldrian F, Karinda M, Setianto R, Dewi BA, Gusmira YH. Hubungan Riwayat Penyakit Infeksi dengan Kejadian Stunting pada Balita di Puskesmas Cipadung Kota Bandung. Jurnal Manajemen Kesehatan (Yayasan RS Dr. Soetomo) 2023; 9(1): 80-89. DOI: https://doi.org/10.29241/jmk.v9i1.1366
Wahyuningsih SE, Margawati A, Mexitalia M, Noer E. Effectiveness of zinc supplementation on linear growth of stunted toddlers in Semarang City. J Aisyah Ilmu Kesehatan 2022; 7(4): 1273-1280. DOI: https://doi.org/10.30604/jika.v7i4.1482
UNICEF. UNICEF conceptual framework on maternal and child nutrition [Internet]. New York: UNICEF; 2020. Available from: https://www.unicef.org/media/113291/file/UNICEF%20Conceptual%20Framework.pdf Accessed 2024 Nov 18.
Tickell KD, Atlas HE, Walson JL. Environmental enteric dysfunction: a review of potential mechanisms, consequences and management strategies. BMC Med 2019; 17: 181. DOI: https://doi.org/10.1186/s12916-019-1417-3
Mertens A, Benjamin-Chung J, Colford JM, Coyle J, van der Laan MJ, Hubbard AE, et al. Causes and consequences of child growth faltering in low-resource settings. Nature 2023; 1-9.
Syabandini IP, Pradigdo SF, Suyatno, Pangestuti DR. Faktor risiko stunting pada anak usia 6-24 bulan di daerah nelayan. J Kesehat Masyarakat 2018; 6(1): 496-507.
Berhe K, Seid O, Gebremariam Y, Berhe A, Etsay N. Risk factors of stunting (chronic undernutrition) of children aged 6 to 24 months in Mekelle City, Tigray Region, North Ethiopia: An unmatched case-control study. PLoS ONE 2019; 14(6): e0217736. DOI: https://doi.org/10.1371/journal.pone.0217736
Sarfraz A, Jamil Z, Ahmed S, Umrani F, Qureshi AK, Jakhro S,et al. Impact of diarrhoea and acute respiratory infection on environmental enteric dysfunction and growth of malnourished children in Pakistan. Lancet Reg Health Southeast Asia 2023; 15: 100212. DOI: https://doi.org/10.1016/j.lansea.2023.100212
Ulijaszek SJ, Kerr DA. Anthropometric measurement error and the assessment of nutritional status. Eur J Clin Nutr 2016; 70(9): 930-934.
Johnson RK, Driscoll P, Goran MI. Comparison of multiple-pass 24-hour recall estimates with total energy expenditure in children. J Nutr Educ Behav 2017; 49(4): 338-344.
Karkheck-Thomas A, Berk EA, Tanumihardjo SA. Challenges and approaches for dietary assessment in children in low- and middle-income countries. Nutrients 2018; 10(8): 1170.
Beaton GH, Milner JA, McGuire V, Feather TE, Little JA. Sources of variance in 24-hour dietary recall data. Eur J Clin Nutr 2020; 74(2): 345-353.
Goudet SM, Bogin BA, Madise NJ, Griffiths PL. Nutritional interventions for preventing stunting in children living in urban slums. Cochrane Database Syst Rev 2019; 6(6). DOI: https://doi.org/10.1002/14651858.CD011695.pub2
Al Mamun A, Mahmudiono T, Yudhastuti R, Triatmaja NT, Chen HL. Effectiveness of food-based intervention to improve linear growth of children under five: a systematic review and meta-analysis. Nutrients 2023; 15(11): 2430. DOI: https://doi.org/10.3390/nu15112430
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .