Journal of Indonesian Specialized Nutrition

FOOD SYSTEM DETERMINANTS INFLUENCING THE SUCCESS OF IRON FORTIFICATION PROGRAMS AMONG CHILDREN IN SOUTHEAST ASIA: A SYSTEMATIC REVIEW

Refani Alycia Kusuma — 2026-06-25

Background: Iron deficiency and anemia remain major public health challenges among children in Southeast Asia, contributing to impaired growth, cognitive development, and long-term health outcomes. Although iron fortification has been widely implemented, program effectiveness has remained inconsistent across the region. This systematic review aimed to examine food system determinants influencing the success of iron fortification programs among children in Southeast Asia and their implications for Indonesia. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed using PubMed/MEDLINE and Scopus. Studies published between 2015 and 2026 were screened for eligibility. Quantitative, qualitative, mixed-methods, and implementation studies evaluating iron fortification interventions among children in Southeast Asia were included. Data were synthesized narratively using a food systems perspective. Results: Nine studies were included, primarily randomized controlled trials and community-based interventions conducted in Cambodia and Indonesia. Iron fortification interventions, particularly fortified rice delivered through school feeding programs, generally improved hemoglobin levels, micronutrient status, and cognitive outcomes. However, intervention effectiveness was influenced by adherence, cultural acceptability, caregiver practices, inflammation, gut health, and implementation sustainability. Conclusions: The success of iron fortification programs was influenced not only by nutrient delivery but also by broader food system determinants. Integrated food systems approaches were considered essential to improve child nutrition outcomes in Southeast Asia, particularly in Indonesia.

THE IMPORTANCE OF ANIMAL PROTEIN FULFILLMENT FOR OPTIMAL GROWTH OF UNDER-5 CHILDREN: MECHANISTIC INSIGHTS AND CLINICAL IMPLICATIONS

Rahayu Kania — 2026-06-25

Background: Protein plays a fundamental role in growth regulation through its structural, metabolic, and signaling functions. Increasing evidence indicates that the consumption of animal-source foods is associated with improved linear growth and a reduced risk of stunting during infancy and early childhood. This review aimed to evaluate the contribution of animal protein intake to linear growth among children under five years of age. Methods: A literature review was conducted to synthesize current evidence from studies indexed in PubMed and Scopus between 2016 and 2026. Eligible publications included observational studies, randomized controlled trials (RCTs), and review articles that examined the relationship between animal protein intake and indicators of linear growth in children younger than five years. Results: Animal-source proteins, including those derived from fish, eggs, milk, and meat, were consistently associated with favorable linear growth outcomes during the first five years of life. Evidence from randomized trials and meta-analyses demonstrated modest but significant improvements in length-for-age z-scores (LAZ), while cohort studies reported lower stunting prevalence among children with higher animal-source food consumption. Nevertheless, the magnitude of these effects varied according to contextual factors, including dietary adequacy, maternal nutritional status, infection burden, and environmental conditions. Conclusion: Regular consumption of modest amounts of animal-source foods can contribute to measurable improvements in linear growth, with pooled evidence indicating significant benefits across low- and middle-income countries. However, the effectiveness of animal protein interventions is optimized when integrated with strategies addressing underlying determinants of growth.

FROM GUT TO BRAIN: THE ROLE OF FRUCTOOLIGOSACCHARIDES AND GALACTOOLIGOSACCHARIDES IN MODULATING THE GUT-BRAIN AXIS DURING EARLY CHILDHOOD

Addini Pascaramadhani — 2026-06-25

Background: The first five years of life are an essential stage during which the gut microbiota and the brain develop simultaneously. This development is mediated by the gut-brain axis (GBA), a bidirectional communication system operating through neural, endocrine, immune, and metabolic pathways. Fructooligosaccharides (FOS) and galactooligosaccharides (GOS) are well-researched prebiotics that promote beneficial gut bacteria producing neuroactive molecules such as short chain fatty acids, gamma-aminobutyric, and serotonin precursors, which are associated with neurotransmitter synthesis, blood-brain barrier function, HPA axis regulation, and neuroinflammation. Methods: This narrative review discusses the potential mechanisms by which FOS and GOS might affect gut-brain communication in early childhood, drawing from experimental animal studies and clinical trials in adults and children. Results: In animal models, FOS and GOS reduce anxiety and depression-like behaviors and may support cognitive function through SCFA-mediated effects on neurotransmitter modulation. Human pediatric evidence remains limited, though recent findings suggest GOS can lower emotional responsiveness and cortisol levels in school-age children. Conclusion: Important gaps remain, particularly the lack of long-term studies in children under five and insufficient data from low- and middle-income countries. Well-designed pediatric studies are needed to understand FOS and GOS effects on early brain development.

EARLY FEEDING CHALLENGES AS BARRIERS TO CATCH-UP GROWTH IN LOW BIRTH WEIGHT INFANTS: A NARRATIVE REVIEW

Selma Avianty — 2026-06-25

Background: Low birth weight (LBW) infants are highly vulnerable to postnatal growth failure due to physiological immaturity, increased metabolic demands, and feeding-related complications. Early feeding challenges may interfere with adequate nutritional intake during a critical period of growth and development, thereby impairing catch-up growth. Objective: This narrative review aimed to synthesize current evidence regarding early feeding challenges as barriers to catch-up growth in LBW infants. Methods: A narrative literature search was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar databases. Relevant articles published between 2016 and 2026 were reviewed, focusing on feeding difficulties, nutritional management, and growth outcomes in LBW infants. Results: Early feeding challenges in LBW infants include impaired suck–swallow coordination, feeding intolerance, delayed enteral feeding progression, breastfeeding difficulties, and inadequate post-discharge feeding support. These factors may contribute to insufficient energy and protein intake, impaired nutrient utilization, and persistent growth faltering. Inadequate catch-up growth is associated with adverse neurodevelopmental, immunological, and metabolic outcomes. Conclusion: Early feeding challenges are major barriers to optimal catch-up growth in LBW infants. Comprehensive nutritional and multidisciplinary interventions are essential to support balanced postnatal growth and improve long-term health outcomes.

POSTPARTUM DEPRESSION AND THE RISK OF STUNTING AMONG CHILDREN IN INDONESIA: A LITERATURE REVIEW

Al Ilham Ksatria Gagah Perkasa Perkasa — 2026-06-25

Background: Postpartum depression was found to be linked to disrupted growth development patterns, particularly stunting. In Indonesia, challenges are found in correlating the two variables due to the lack of official data. The findings of this review may provide valuable initiatives for further research and intervention on maternal mental well-being. Objective: This study aims to review the correlation between postpartum depression and the risk of stunting, alongside the trends in Indonesia; and how it is compared with the global context. Method: We searched PubMed, Scopus, Taylor and Francis, and Google Scholar (2016-2026) for cross-sectional studies, cohort studies, systematic reviews, and meta-analyses examining the correlation between postpartum depression and stunting within a global and local context, alongside challenges faced by the healthcare system regarding postpartum depression. Results: Despite the lack of official data on postpartum depression, we found studies that examined positive correlations between depression and the risk of stunting in Indonesia. A higher risk of stunted children was found in mothers with postpartum depression. Several challenges in the Indonesian healthcare system were also found, these consist of lack of focus on mental health indicators, stigmatization of mental illnesses especially in mothers, a lack of access to maternal mental health care, and the limited training provided to healthcare workers on maternal mental health. Conclusion: Despite consistent evidence from multiple studies, Indonesia still faces major gaps in data, awareness, and mental health services for mothers; gaps that are worsened by stigmatization, and prioritization of physical over psychological healthcare. Integration of maternal mental health screening and support into existing mother-child health programs is recommended to mitigate stunting and improve child development outcomes.

THE RELATIONSHIP BETWEEN KNOWLEDGE, PARENTING STYLES, FATHER’S SMOKING HABITS AND STUNTING INCIDENCE AMONG CHILDREN AGED 24–59 MONTHS AT DINOYO COMMUNITY HEALTH CENTER IN MALANG CITY

Zahrotul Fakhriyyah — 2026-06-25

Background: The latest data from 2024 shows that the stunting rate in Malang City has increased by 5.4%, with the Dinoyo Community Health Center reporting the highest prevalence among the 16 community health centers, at 15.3%. Stunting is a national priority health issue due to its long-term impact on children’s physical and cognitive development. Indirect factors such as parental knowledge, parenting styles, and fathers’ smoking habits also contribute to the occurrence of stunting. This study aims to analyze the relationship between these factors and the incidence of stunting at the Dinoyo Community Health Center in Malang City. Methods: This observational study employed a quantitative cross-sectional design involving 106 respondents selected through purposive sampling. Data were collected via anthropometric measurements and validated, reliable questionnaires, and analyzed using the chi-square test at a significance level of α = 0.05. Results: The results showed significant association between knowledge (P=0.004), parenting style (P=0.004), and the father’s smoking habits (P=0.025) with the prevalence of stunting. Conclusion: that the parenting style variable was the most significant risk factor for stunting, with an Odds Ratio (OR) of 3.9 (95% CI: 1.489–10.719). The conclusion of this study is that sensitive interventions focused on improving parenting practices—particularly regarding feeding practices, sanitation, and psychosocial stimulation—play a crucial role in the growth of infants and toddlers.