Disertasi

Effect of optimized complementary feeding recommendation and fortified foods on growth of stunted children aged 12-23-month-old in Dompu district, West Nusa Tenggara.

Introduction. Stunting affects about one third of children underfive in developing countries and is associated with poor health and development. Golden (2009) proposed that stunted children may need higher nutrient density diets as compared to normal children to catch-up their growth. The purpose of this study is to investigate the effect of Standard (SND-CF)and higher (HND-CF) nutrient density complementary food diets developed from optimized complementary feeding recommendation (CFR) and fortified foods. on growth of stunted children aged 12-23-month compare to control. Methodology. A community-based, double blind randomized, controlled trial was conducted among stunted children aged 12-23 mo. This study consisted of two phases: Phase I to develop optimized CFR using linear programming (LP) approach and to formulate different nutrient density level of CF. Phase II, 6-month intervention with 3 intervention groups (a) HND-CF (received optimized CFR and higher fortified biscuit), (b) SND-CF (received optimized CFR and standard fortified biscuit) and (c) ND-CF (received optimized CFR and unfortified biscuit/control). Body length and weight were measured every month. Biscuit consumption was recorded on weekly visit. Results. Dietary survey shows that niacin was identified as partial problem nutrient and seven nutrients could not achieve 65% dietary requirements. There were improvement on proportion of children meeting the recommended weekly frequency of promoted nutrientdense

foods such as fortified foods, fruits (all groups), chicken liver (SND and HND groups) and anchovy (ND group). Energy, protein, vit B1, B6 intakes increased in all groups. HND-CF group tend to have higher episode and duration of diarrhea and fever. Findings show there were no significant differences on length gain and LAZ gain between intervention groups after adjusting for covariates. Compared to ND-CF, effect size on length gain were -0.39 and -0.39 for HND-CF and SND-CF, respectively. There was no significant weight gain, WAZ gain and WHZ between intervention groups between the HND-CF as compared to SND-CF and control. But there is a trend that SND-CF has better WAZ gain. In all groups there were 8.5% (ND-CF), 8.7% (SND-CF) and 11.1% (HND) stunted children became non stunted (normal) after 6-mo intervention. Conclusion and Recommendation. Our data shows that there is no significant difference of higher nutrient density CF on the growth of stunted children as compared to SND-CF and ND-CF. Further study should investigate the effect of optimized CFR with nutrient adequacies designed at Estimated Average Requirement level in comparison to optimized CFR with fortified food. Fortification program should be designed after identifying nutrient gaps between the requirements and optimized intakes.
Keywords: complementary feeding recommendation, fortified foods, growth, linear programming approach, nutrient density, stunting, young children,