Household dietary diversity and child stunting in East Java, Indonesia

Background and Objectives: More than one-quarter of under-five children in the developing world are stunted, and those with poor nutrient intake are at risk of irreversible cognitive impairment. The purpose of this study was to determine the relationship between dietary diversity and child stunting in an Indonesian context. Methods and Study Design: Dietary diversity was assessed using a maternal-reported checklist of 12 food groups, summed as a Household Dietary Diversity Score. Stunting was defined as ≤-2.0 height-for-age z-score by WHO-Anthro 2005. Trained interviewers administered the household dietary diversity questionnaire to 768 households with children aged < 5 years in East Java, Indonesia. Logistic regression models were constructed to test the association between dietary diversity and child stunting. Results: The prevalence of child stunting was 39.4%, and the percentage of households consuming food groups high in protein and calcium, like dairy products (41%), and meat/poultry, (65%) was lower compared with other food groups. The unadjusted model revealed that higher dietary diversity scores were associated with lower likelihood of child stunting (OR=0.89; 95% CI=0.80-0.98). This relationship remained significant after adjustment for family size, maternal literacy, food expenditure, breastfeeding, energy, and protein intake (OR=0.89; 95% CI=0.80-0.99). Conclusions: The dietary diversity score was moderate, with consumption of dairy products and meat/poultry lowest among 12 food groups. Hence, population interventions should focus on promoting food groups currently lacking in maternal and child diet, including those rich in growth-promoting nutrients like dairy, meat/poultry. These results, from an Indonesian context, confirm the widely observed protective relationship between dietary diversity and child stunting.