Stunting Reduction Policy Targets in The Community: Does Dietary Diversity Matter?
DOI:
https://doi.org/10.31605/nutrition.v5i1.6707Keywords:
Children Under Five, Dietary Diversity, StuntingAbstract
The prevalence of stunting in children under five remains a global and national public health challenge. Although various policies have been targeted to reduce stunting cases in the community, dietary diversity plays a key role in determining the quality of children's nutritional intake and preventing chronic malnutrition. Information on what dietary diversity is important is needed so that appropriate stunting reduction policy targets can be determined. This study aims to determine the relationship between dietary diversity and the dominant factors associated with the prevalence of stunting. The study design used correlation analysis with a cross-sectional approach. The study population was all children under five and families in stunting locus villages in the UPTD Trawas Health Center area of Mojokerto Regency, totaling 1734 people. Sampling was carried out using proportional cluster sampling with a total of 315 people. Data were obtained through a dietary diversity questionnaire measured by the DDS, and stunting incidence was measured by the Height/Age index (HAZ). Bivariate analysis used chi- square, and multivariate analysis used multiple logistic regression. The results showed a relationship between dietary diversity and stunting (P 0.001, OR 6.532, CI 3.158- 13.510). There was an association between consumption of vitamin A-rich fruits and vegetables (P 0.037, OR 4.221), meat and fish consumption (P 0.002, OR 5.101), egg consumption (P 0.039, OR 4.145), and milk consumption (P 0.048, OR 1.938) and stunting in children under five. Meat and fish consumption were the dominant variables influencing stunting (P 0.020, AOR 4.205). This study recommends that policymakers, particularly the Ministry of Health, prioritize dietary diversity in efforts to reduce stunting, with a primary focus on ensuring adequate animal protein intake.
References
1. WHO. What’S At Stake. In: Global Nutrition Targets 2025 Stunting Policy Brief. 2023. doi:10.5040/9781350289291.ch-017
2. Hariawan M, Hasanbasri M, Arjuna T. Stunting and Dietary Diversity in Children 24-59 Months in Indonesia (Analysis of Indonesian Family Life Survey 2014-2015). Amerta Nutrition. 2024;8(3SP). doi:10.20473/amnt.v8i3SP.2024.380-389
3. UNICEF, WHO, World Bank. Level and trend in child malnutrition. World Health Organization. 2023.
4. Azriani D, Masita, Qinthara NS, Yulita IN, Agustian D, Zuhairini Y, et al. Risk factors associated with stunting incidence in under five children in Southeast Asia: a scoping review. J Health Popul Nutr. 2024;43(1). doi:10.1186/s41043-024-00656-7 PubMed PMID: 39468694.
5. Kementerian Kesehatan RI. Riskesdas 2018. Kemenkes [Internet]. Jakarta; 2018. Available from:http://www.yankes.kemkes.go.id/assets/downloads/PMK No. 57 Tahun 2013 tentang PTRM.pdf PubMed PMID: 25246403.
6. Mahmudiono T, Sumarmi S, Rosenkranz RR. Household dietary diversity and child stunting in East Java, Indonesia. Asia Pac J Clin Nutr. 2017;26(2):317–25. doi:10.6133/apjcn.012016.01 PubMed PMID: 28244712.
7. UPTD Puskesmas Trawas. Profil Kesehatan UPTD Puskesmas Trawas Tahun 2024 [Internet]. 1st ed. Mojokerto: UPTD Puskesmas Trawas; 2025. Available from: https://puskesmas-trawas.mojokertokab.go.id/download/view/profil-kesehatan- trawas-tahun-2025-20250422_091426.pdf
8. Patriota ÉSO, Abrantes LCS, Figueiredo ACMG, Pizato N, Buccini G, Gonçalves VSS. Association between household food insecurity and stunting in children aged 0−59 months: Systematic review and meta-analysis of cohort studies. Maternal and Child Nutrition. John Wiley and Sons Inc; 2024. doi:10.1111/mcn.13609 PubMed PMID: 38196291.
9. Ekholuenetale M, Barrow A, Ekholuenetale CE, Tudeme G. Impact of stunting on early childhood cognitive development in Benin: evidence from Demographic and Health Survey. Egyptian Pediatric Association Gazette. 2020;68(1).
10. Suryana EA, Azis M. the Potential of Economic Loss Due To Stunting in Indonesia. Jurnal Ekonomi Kesehatan Indonesia. 2023;8(1):52. doi:https://doi.org/ 10.3390/nu15020389
11. Mulyani AT, Khairinisa MA, Khatib A, Chaerunisaa AY. Understanding Stunting: Impact, Causes, and Strategy to Accelerate Stunting Reduction—A Narrative Review. Nutrients . Multidisciplinary Digital Publishing Institute (MDPI); 2025. doi:10.3390/nu17091493 PubMed PMID: 40362802.
12. Zeinalabedini M, Zamani B, Nasli-Esfahani E, Azadbakht L. A systematic review and meta- analysis of the association of dietary diversity with undernutrition in school-aged children. BMC Pediatr. 2023 Dec 1;23(1). doi:10.1186/s12887-023-04032-y PubMed PMID: 37246212.
13. Thahir AIA, Li M, Holmes A, Gordon A. Exploring Factors Associated with Stunting in 6- Month-Old Children: A Population-Based Cohort Study in Sulawesi, Indonesia. Nutrients. 2023;15(15). doi:10.3390/nu15153420 PubMed PMID: 37571357.
14. Hidayati RN, Musadek A, Ibnu F. A Study in Stunting Locus Villages: Analysis of Determinants and Implications for Stunting in Children Under Five. NurseLine Journal [Internet]. 2025 Nov [cited 2025 Dec 28];10(2). Available from:https://nurseline.jurnal.unej.ac.id/index.php/NLJ/.
15. Fayasari A. Penilaian Konsumsi Pangan [Internet]. Kun Fayakun; 2020 [cited 2025 Dec 11]. Available from: https://repository.binawan.ac.id/1680/1/Penilaian%20KOnsumsi%20Pangan_Adhila_b udi-compressed.pdf
16. Islam B, Ibrahim TI, Wang T, Wu M, Qin J. Current trends in household food insecurity, dietary diversity, and stunting among children under five in Asia: a systematic review. Journal of Global Health. University of Edinburgh; 2025. doi:10.7189/jogh.15.04049
PubMed PMID: 39819648.
17. Haque S, Salman M, Hossain MS, Saha SM, Farquhar S, Hoque MN, et al. Factors associated with child and maternal dietary diversity in the urban areas of Bangladesh. Food Sci Nutr. 2024 Jan 1;12(1):419–29. doi:10.1002/fsn3.3755
18. Prasetyo A, Davidson SM, Sanubari TPE. Correlation between Individual Dietary Diversity and Children 2-5 Years Old Nutrition Status in Batur Village, Getasan Regency, Semarang District. Amerta Nutrition. 2023 Sep 1;7(3):343–9. doi:10.20473/amnt.v7i3.2023.343-349
19. Chowdhury ZT, Hurley KM, Shaikh S, Mehra S, Ali H, Shamim AA, et al. Caregiver Feeding Behaviours and Child Dietary Diversity and Growth in Rural Bangladesh. Matern Child Nutr. 2025 Apr 1;21(2). doi:10.1111/mcn.13781 PubMed PMID: 39670331.
20. Kemenkes. Peraturan Menteri Kesehatan RI Nomor 21 Tahun 2020 Tentang Rencana Strategis Kementerian Kesehatan Tahun 2020-2024. In. Jakarta: Kemenkes; 2020.
21. Dinkes Mojokerto. Profil Kesehatan Kabupaten Mojokerto Tahun 2024 [Internet]. Mojokerto: Dinkes Kab. Mojokerto; 2025. Available from: https://dinkes.mojokertokab.go.id/download/view/profil-kesehatan-kabupaten-mojokerto-tahun-2024-20250709_154119.pdf
22. Permanasari Y, Saptarini I, Amalia N, Aditianti A, Safitri A, Nurhidayati N, et al. Determinant factors of under-five children stunting at locus and non lokus villages in 13 stunting locus districts in Indonesia in 2019. Penelitian Gizi dan Makanan (The Journal of Nutrition and Food Research). 2021;44(2):79–92. doi:10.22435/pgm.v44i2.5665
23. Noor MS, Andrestian MD, Dina RA, Ferdina AR, Dewi Z, Hariati NW, et al. Analysis of Socioeconomic, Utilization of Maternal Health Services, and Toddler’s Characteristics as Stunting Risk Factors. Nutrients. 2022;14(20):1–12. doi:10.3390/nu14204373 PubMed PMID: 36297057.
24. Permatasari TAE, Chadirin Y, Ernirita, Elvira F, Putri BA. The association of sociodemographic, nutrition, and sanitation on stunting in children under five in rural area of West Java Province in Indonesia. J Public Health Res. 2023;12(3). doi:10.1177/22799036231197169 PubMed PMID: 37663311.
25. Rah JH, Sukotjo S, Badgaiyan N, Cronin AA, Torlesse H. Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age. Matern Child Nutr. 2020;16(S2):1–8. doi:10.1111/mcn.12741 PubMed PMID: 32835453.
26. Thompson AL. Greater male vulnerability to stunting? Evaluating sex differences in growth, pathways and biocultural mechanisms. Ann Hum Biol. 2021;48(6):466–73. doi:10.1080/03014460.2021.1998622 PubMed PMID: 35105202.
27. Brar S, Akseer N, Sall M, Conway K, Diouf I, Everett K, et al. Drivers of stunting reduction in Senegal: A country case study. American Journal of Clinical Nutrition. 2020;112:860S-874S. doi:10.1093/ajcn/nqaa151 PubMed PMID: 32778881.
28. Dwomoh D, Sewor C, Annim SK, Stranges S, Kandala NB, Amegah AK. Do dietary practices and household environmental quality mediate socio-economic inequalities in child undernutrition risk in West Africa? Public Health Nutr. 2023 May 19;26(5):1022–33. doi:10.1017/S1368980022002269 PubMed PMID: 36259140.
29. Egbuonye NC, Ishdorj A, McKyer ELJ, Mkuu R. Examining the dietary diversity of children in niger. Nutrients. 2021 Sep 1;13(9). doi:10.3390/nu13092961 PubMed PMID: 34578839.
30. Tello B, Rivadeneira MF, Moncayo AL, Buitrón J, Astudillo F, Estrella A, et al. Breastfeeding, feeding practices and stunting in indigenous Ecuadorians under 2 years of age. Int Breastfeed J. 2022 Dec 1;17(1). doi:10.1186/s13006-022-00461-0 PubMed PMID:
35248108.
31. Laar A, Selvamani Y, Harper A. Dietary diversity, food insecurity and the double burden of malnutrition among children, adolescents and adults in South Africa: Findings from a national survey.
32. Basri H, Hadju V, Zulkifli A, Syam A, Ansariadi, Stang, et al. Dietary diversity, dietary patterns and dietary intake are associated with stunted children in Jeneponto District, Indonesia. Gac Sanit. 2021 Jan 1;35:S483–6. doi:10.1016/j.gaceta.2021.10.077 PubMed PMID: 34929881.
33. Belayneh M, Loha E, Lindtjørn B. Seasonal Variation of Household Food Insecurity and Household Dietary Diversity on Wasting and Stunting among Young Children in A Drought Prone Area in South Ethiopia: A Cohort Study. Ecol Food Nutr. 2020;1–26. doi:10.1080/03670244.2020.1789865 PubMed PMID: 32672490.
34. Gassara G, Chen J. Household food insecurity, dietary diversity, and stunting in sub-saharan africa: A systematic review. Nutrients. 2021 Dec 1;13(12). doi:10.3390/nu13124401 PubMed PMID: 34959953.
35. Hidayati RN, Ibnu F S. The Effect Of Family Health Tasks On The Nutritional Status Of Children Under Five Years Old With The Family Centered Nursing (FCN) Model Approach. Jurnal Keperawatan Respati Yogyakarta Yogyakarta. 2025;14(1).
36. Saha J, Chouhan P, Malik NI, Ghosh T, Das P, Shahid M, et al. Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey. Nutrients. 2023 Jan 1;15(1). doi:10.3390/nu15010159 PubMed PMID: 36615816.
37. Elisanti AD, Jayanti RD, Amareta DI, Ardianto ET, Wikurendra EA. Macronutrient intake in stunted and non-stunted toddlers in Jember, Indonesia. J Public Health Res. 2023 Jul 1;12(3). doi:10.1177/22799036231197178
38. Parikh P, Semba R, Manary M, Swaminathan S, Udomkesmalee E, Bos R, et al. Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries. Maternal and Child Nutrition. John Wiley and Sons Inc; 2022. doi:10.1111/mcn.13264 PubMed PMID: 34467645.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Rina Nur Hidayati, Ahmad Musadek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
