Disertasi

Development of Complementary Feeding Recommendation by Inclusion of Local or Underutilized Foods on Improving Nutrient Adequacy and Nutrient-to-price Ratio for Children age 12-23 Months = Pengembangan panduan gizi seimbang makanan pendamping ASI dengan pangan lokal dan pangan underutilized untuk meningkatkan kecukupan gizi dan nutrient-to-price ratio bagi anak usia 12-24 bulan.

Introduction. At the period of first 2 years of life, appropriate breastfeeding and complementary feeding practices are critical issues. Inadequate complementary feeding in resource poor setting require certain strategy. Developing a specific complementary feeding recommendation which consider the nutrient gaps, local foods availability and cost issue can be an alternative solution. This study is aimed to know whether inclusion of local or underutilized foods in food based recommendation during complementary feeding period, able to improve nutrient adequacy and nutrient-to-price ratio. Methods. Dietary survey by using 2x24 hours food recall, 1 day weighed food record and 4 days food tally, was conducted in Bangkalan District, Indonesia in 2018, involving 60 breastfed children age 12-23 month and the mothers. Food price was collected from 2 closest traditional markets in the study area. Nutrient-to-price ratio was calculated by dividing Nutrient Adequacy Score with the price. Linear programming by using Optifood software was performed to identify problem nutrients and develop complementary food recommendation which include potential local or underutilized foods. Results. Two absolute problem nutrients (folate and iron), 1 partial problem nutrient (vitamin C) and 2 dietary inadequacies (Vitamin B6 and Vitamin B12) were identified from the linear programming analysis. Diet modelling by optimizing the existing food pattern able to improve nutrient adequacy of 4 out of 5 problematic nutrients. Folate remains below 65%. The second linear programming was run, by including 11 local or underutilized foods which were not present in the children’s dietary pattern, i.e. sweet potato, taro, greater yam, lead tree seed, cassava leaves, taro leaves, sweet potato leaves, moringa pods, snake fruit, clams, and seablite. The optimum combination were seablite- 2, taro leaves-2, moringa fruit-2, legumes nut seeds-7, MFE-7, which able to improve nutrient adequacy and nutrient to-price-ratio, as well as solved all of the problem nutrients. Conclusion and Recommendation. Inclusion of local or underutilized foods on the Food Based Recommendation for rural children age 12-23 months able to improve nutrient adequacy and nutrient-to-price ratio. Further intervention studies to assess the effectiveness of FBR which include local or underutilized foods on improving nutritional outcomes need to be conducted to strengthen the evidence
Key words: underutilized foods, linear programming, complementary feeding recommendation, nutrient-to-price ratio


Latar Belakang. Pada periode 2 tahun pertama kehidupan, pemberian ASI yang tepat dan praktik pemberian makanan pendamping ASI merupakan isu penting. Pemberian makanan pendamping ASI yang tidak memadai di daerah dengan sumber daya yang terbatas memerlukan strategi tertentu. Mengembangkan rekomendasi pemberian makanan tambahan yang spesifik dengan mempertimbangkan kesenjangan gizi, ketersediaan pangan lokal dan masalah biaya dapat menjadi solusi alternatif. Penelitian ini bertujuan untuk mengetahui apakah dimasukkannya pangan lokal atau pangan yang kurang termanfaatkan dalam panduan gizi seimbang untuk MP-ASI, mampu meningkatkan kecukupan gizi dan nutrient-to-price ratio. Metode. Penilaian pola makan menggunakan 1 hari weighed food record, 2 hari 24 hours food recall, dan 4 hari food tally dilakukan terhadap 60 anak usia 12-23 bulan yang masih diberi ASI di Kabupaten Bangkalan, Indonesia pada tahun 2018. Harga pangan diperoleh dari survey pada 2 pasar tradisional terdekat. Linear programming dengan menggunakan Optifod dilakukan untuk mengidentifikasi permasalahan gizi dan menyusun panduan gizi seimbang MP-ASI. Nutrient-to-price ratio dihitung dengan membagi rata-rata Angka Kecukupan Gizi dengan biaya. Hasil. Dua masalah gizi absolut (folat and zat besi), 1 parsial (vitamin C) and 2 dietary inadequacies (Vitamin B6 dan Vitamin B12) teridentifikasi dalam analisis linear programming. Permodelan diet dengan mengoptimalkan pola makan yang ada dapat meningkatkan kecukupan 4 dari 5 zat gizi bermasalah. Folat tetap di bawah 65% AKG. Pada linear programming kedua dimasukkan 11 pangan lokal atau underutilized yang tidak ada dalam pola makan anak, antara lain ubi jalar, talas, uwi, lamtoro, dun singkong, daunt alas, daun ubi jalar, buah kelor, salak, kerang, dan daun alur. Kombinasi pola optimum adalah alur-2, daun talas-2, buah kelor-2, kacang-kacangan-7, daging/ikan/telur-7, yang dapat meningkatkan kecukupan gizi dan nutrient-to-price ratio, serta menyelesaikan semua zat gizi yang bermasalah. Kesimpulan dan rekomendasi. Dimasukkannya pangan lokal atau underutilized pada panduan gizi untuk MP-ASI berbasis pangan lokal untuk anak pedesaan usia 12-23 bulan mampu meningkatkan kecukupan gizi dan nutrient-to-price ratio. Studi intervensi lebih lanjut untuk menilai efektivitas panduan gizi ini perlu dilakukan untuk memperkuat bukti
Kata kunci: pangan underutilized, linear programming, panduan gizi seimbang, nutrient-to-price ratio