Abstract
BACKGROUND: In Indonesia, food security and dietary patterns varied by regions. This might lead to differences in problem nutrients (PN) and should be considered in developing local-specific food-based recommendations (FBRs) for stunting prevention. OBJECTIVES: This study aims to identify PNs in diet of under-five children in selected 37 stunting priority districts in Indonesia and assess whether the number of PNs was associated with district food security status. METHODS: Linear programming analysis (LP) using Optifood was done using single 24-hour dietary recall data Ministry of Health 2016 Food Consumption Survey. PN was defined as nutrient which did not meet 100% Recommended Nutrient Intake (RNI) based on Indonesian-RNI in the 2-best-diets scenario. District's food security status was determined using Food Security Vulnerability Atlas 2018. RESULTS: The top three PNs amongst under-five childrenwere iron, folate, vitamin B12 (6-11mo); folate, calcium, zinc (12-23mo); folate, calcium, vitamin C (24-35mo); and calcium, folate, vitamin C (36-59mo). There were no significant differences in number of PNs based on food security status. After integrating the nutrient-dense foods into FBRs, the number of districts with dietary inadequacy decreased for the top-3 problem nutrients in each age group, with the exception of iron for infants. CONCLUSIONS: Our findings showed that problem nutrients and dietary inadequacy were prevalent in diet of under-five children, even in food-secure areas. Promoting locally available nutrient-dense foods through FBRs (nutrition-specific intervention) and ensuring availability and access to these foods (nutrition-sensitive intervention) are recommended. Additional intervention(s), particularly for iron in infants, are required.