Development of Food Based Complementary

Feeding Recommendations using Linear Program

Yohannes Willihelm Saleky (5936015)

(UNICEF-WHO-World Bank 2015)
 Indonesia
• In 2007 Indonesia has 18.4% of underfive
children with underweight
• 2010 = 17.9%; 2013 = 19.6%
• Prevalence of underfive children with stunting
in 2013 was 37.2%
• (2010=35.6%; 2007=36.8%)

(Badan Penelitian dan Pengembangan Kesehatan 2013)

 Indonesia
Underfive Underweight and Stunting in Indonesia
36.8 37.2
35.6

19.6
18.4 17.9

2007 2010 2013

Underweight Stunting

(Badan Penelitian dan Pengembangan Kesehatan 2013)

(Black et al. 2008)
 Introduction
• Adequate nutrition (during infancy-early
childhood) is fundamental to the children’s
development.
• 0-2 yo is a “critical window” for the promotion
of optimal growth, health and behavioral
development.
• Complementary feeding is generally given
from 6 to 24 months of age, even though
breastfeeding may continue beyond two years
 What is complementary feeding?

Complementary feeding is defined as the

process starting when breast milk alone is no
longer sufficient to meet the nutritional
requirements of infants, and therefore other
foods and liquids are needed, along with breast
milk (Kathyrn Dewey 2001).
 What is happening?
• increasing diversity in complementary feeding is
one of the crucial factors to reduce the
prevalence of malnourished in India (Borkotoky
et al. 2017).
• In Maharashtra children’s birthweight and
feeding practices, women’s nutrition status and
household sanitation and poverty are the most
significant predictors of stunting and poor linear
growth in children under 2 years (Aguayo et al.
2016)
 What is happening?
• Suboptimal complementary feeding practices
contribute to a rapid increase in the
prevalence of stunting in young children from
age 6 months in Peru (Daelmans et al. 2013).
• In Indonesia, complementary feeding diets
often provide <20% of a child’s estimated
recommended dietary allowances for iron and
zinc (Santika et al. 2009).
 Dietary Assessment
• 12-h weighed diet record (WDR) 06.00-18.00
• 12-h recall for all foods and beverages consumed
from 18.00-0600 the next morning.
• 24-h recall was performed to obtain information
on the foods and beverages consumed 1 d prior
to WDR day.
• 5-d food tally using a self-administered
questionnaire
• Outcome 7-d food group patterns, a list of foods
consumed by infants (g/d) and the percentage of
infants consuming it.
 4 Phase in CFRs Development
Phase I: Draft set of CFR were formulated using
goal programming.
Phase II: The keyproblem nutrients were
identified.
Phase III: Model was modified from the original
phase I. Nutrient-dense food selected.
Phase IV: Produce alternative acceptable sets of
CFR.
 Nutrisurvey

Dr. Juergen
Erhardt
Phase I
Phase I
Phase I
 Phase I
• 3 servings/d of staples;
• 4 servings/wk of all protein source foods,
including 3 servings/wk of animal protein
foods;
• 5 servings/wk of vegetables; and
• 16 servings/wk of all snacks, including 2
servings/wk of fruits.
 Discussion
• LP is particularly useful for countries such as
Indonesia which has high of geographic and
ethnic diversity in food availability and dietary
practices.
• Ministry of Health of Indonesia guidelines (i.e.
feeding 9- to12-mo-old infants minced mixed
porridge of rice, meat, red pumpkin, and minced
tofu 3 times/d; snacks, such as biscuit or cake 2
times/d, and the use of oil when cooking infant
foods). However, those are not available in Bogor
Selatan
 Discussion
• Even after CFRs is completed, Fe is still
insufficient.
• Low intake of calcium and vitamin D is
associated with stunting (van Stuijvenberg et
al. 2015).
• Indonesia still have high prevalence of
stunting, despite adequate intake of EFL
(Badan Penelitian dan Pengembangan
Kesehatan 2013).
 Reference
Aguayo, V.M. et al., 2016. Determinants of stunting and poor linear growth in children under 2 years of
age in India: An in-depth analysis of Maharashtra’s comprehensive nutrition survey. Maternal and
Child Nutrition, 12, pp.121–140.
Badan Penelitian dan Pengembangan Kesehatan, 2013. Riset Kesehatan Dasar (RISKESDAS) 2013.
Laporan Nasional 2013, pp.1–384.
Black, R.E. et al., 2008. Maternal and child undernutrition: global and regional exposures and health
consequences. The Lancet, 371(9608), pp.243–260.
Borkotoky, K., Unisa, S. & Gupta, A.K., 2017. State-Level Dietary Diversity As a Contextual Determinant of
Nutritional Status of Children in India: a Multilevel Approach. Journal of Biosocial Science, pp.1–27.
Available at:
https://www.cambridge.org/core/product/identifier/S0021932017000013/type/journal_article.
Kathyrn Dewey, 2001. Guiding Principles for Complementary Feeding of the Breastfed (PAHO and WHO).
Pan American Health Organization and World Health Organization, pp.18–25.
Santika, O., Fahmida, U. & Ferguson, E.L., 2009. Development of food-based complementary feeding
recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming.
The Journal of nutrition, 139(1), pp.135–141.
UNICEF-WHO-World Bank, 2015. Levels and trends in child malnutrition. , pp.1–8.
Terima Kasih 