Food and dietary diversity in the context of food and nutrition security
in Indonesia
Dr. Siti Muslimatun Indonesia International Institute for Life Sciences
(i3L)
Wageningen Alumni Chapter Indonesia Jakarta, 24 November 2014
Outline
• Stunting: magnitude, trends, vulnerable groups and nutritional status of adults
• Infant and Young Child Feeding (IYCF) Practices and Dietary Diversity
• Desirable Dietary Pattern Score • Appraisal of food-based dietary
recommendation in SMILING project • Conclusions
Conceptual framework of the determinants of child
nutrition, UNICEF 2013
Stunting among children 0-59 month
36.8 35.6 37.2
0
10
20
30
40
50
2007 2010 2013
Prop
ortio
n (%
)
0
20
40
60
Riau IslandsEast
Nusatenggara
26.1
47.7
26.9
58.4
26.3
51.7
Prop
ortio
n (%
)
2007 2010 2013
Prevalence of stunting >40% indicating severe public health problem; >30% indicating high public health problems
Source: National Basic Health Research (Riskesdas) 2007, 2010, 2013
Indonesia is one of 54 countries participating in the SUN (Scaling Up Nutrition) Movement to reduce stunting.
Stunting among children 0-59 month
0
10
20
30
40
50
60
2007 2010 2013
Prop
ortio
n (%
)
year
Quintile 1 Quintile 2 Quintile 3Quintile 4 Quintile 5
38.2
39.7
42
38.6
28.5
24.8
0 20 40 60
48-59 mo
36-47 mo
24-35 mo
12-23 mo
6-11 mo
0-5 mo
Proportion (%)
Source: National Basic Health Research (Riskesdas) 2007, 2010, 2013
Nutritional status among adults
Central Obesity among adults ≥15 years old Men 11.3 Urban 31.2 Women 42.1 Rural 21.9
Nutritional status among adults ≥18 years old
Description Men Women
Urban Rural Urban Rural Thinness (BMI <18.5 kg/m2) 11.4 12.8 8.7 11.5
Overweight (BMI 25-26.9 kg/m2) 11.9 8.1 13.8 12.1
Obese (BMI ≥27 kg/m2) 12.7 6.5 23.4 16.4
Infant and Young Child Feeding (IYCF) Recommendations for children 0-23 months old
(WHO/UNICEF) • Early initiation of breastfeeding with one hour of
birth; • Exclusive breastfeeding for the first 6 months of
life; and • The introduction of nutritionally-adequate and
safe complementary (solid) foods at 6 months together with continued breastfeeding up to two years of age or beyond. – Meeting minimum meal frequency – Meeting minimum dietary diversity
IYCF practices in 2007 and 2012
41.2
76.3
52.9
32.4
43.9
36.6
58.2
66.1
41.5
49.3
0 20 40 60 80 100
Meeting minimum adequate diet
Meeting minimum dietary diversity
Meeting minimum meal frequency
Exclusive breastfeeding 0-5 months
Early initiation of breastfeeding
Proportion (%)
20122007
Source: Indonesia Demography Health Survey 2007 and 2012
80.8 71.5
27.6 32.9 32.5
50.3 45.5
7.6
51.8
90 82
34.6 38 39.4
64.8 55.8
12.1
75.5
0 20 40 60 80 100
Foods made from grainVitamin A-rich fruit & vegetables
Other fruit & vegetablesFoods made from roots & tubers
Foods made from legumes & nutsMeat, fish, poultry
EggsCheese/yoghurt/other milk
4 or more food groups
Proportion (%)
Non Breastfed Breastfed
Dietary Diversity within IYCF among children 6-23 months year 2012
Source: Indonesia Demography Health Survey 2007 and 2012
71.6
79.3
74.7
58.6
82
64.5
49.4
69.4
53.5
20.5
41.2
23.1
0 20 40 60 80 100
Breastfed
Non breastfed
All
Proportion (%)
6-8 mo 9-11 mo 12-17 mo 18-23 mo
Dietary Diversity within IYCF among children 6-23 months year 2012
Source: Indonesia Demography Health Survey 2007 and 2012
Consumption of different types of food and linear growth (HAZ) among children 12-59 months in
Bandung City
Types of food/food group
HAZ
p-value Not/rarely consumed Consumed
n mean SD n mean SD
Animal source foods
Powder milk 135 -1.77 0.87 75 -1.33 1.03 0.001
Liquid milk 118 -1.72 1.05 93 -1.49 0.80 0.001
Poultry 111 -1.76 0.93 100 -1.46 0.96 0.022
Fish 137 -1.65 0.94 74 -1.55 0.98 0.443
Egg 42 -1.57 0.95 169 -1.63 0.96 0.724
Processed meat 70 -1.10 1.08 133 -1.62 0.97 0.930
Sweetened-condensed milk 143 -1.60 0.96 60 -1.66 0.97 0.719
Legumes/nuts 88 -1.46 0.99 115 -1.74 0.93 0.037
Vitamin-A rich fruits and vegetables 104 -1.47 0.99 99 -1.78 0.91 0.022
Dietary Diversity Score (DDS) and micronutrient intake in Bandung City among children 24-60
months
0 20 40 60 80 100
Cereals & tubers
Flesh foods
Milk and dairy products
Eggs
Legumes & Nuts
Vit-A rich fruit and vegetables
Other fruits
Other vegetables
Fats & oil
Other
49-60 mo (n=93)37-38 mo (n=97)24-36 mo (n=110)
Source: Lina Marlina, 2011
0102030405060708090
100
1 2.5 3.5 4.5 5.5 6.5 7.5 9
Sens
itivi
ty/S
peci
ficity
DDS
se 0.70sp 0.70se 0.50sp 0.50
Dietary Diversity Score (DDS) and micronutrient intake in Bandung City among children 24-60
months Intake of DDS at least of 6 gives the adequacy of micronutrient intake at least of 70%
Source: Lina Marlina, 2011
Consumption of fruit and vegetables among people ≥10 years old in year 2013, portion/day
0% 20% 40% 60% 80% 100%
Quintile 1
Quintile 2
Quintile 3
Quintile 4
Quintile 5
0-2 portion 3-4 portion ≥5 portion
Source: National Basic Health Research (Riskesdas), 2013
Food Security in Indonesia (Food Law, No. 12/2012)
Food Security is a state of condition that food is fulfilled and accessible for all people, from macro level (country) to individual, in terms of its quantity, quality, safety, nutrition, equitable/ evenly distribute, affordable, diversity, halal/ comply with belief and culture, to have a healthy, active, and sustainable productive life.
Desirable Dietary Pattern (DDP) Score as a proxy of food security status
No Food group Energy (kcal)
% DDP Consumption/cap/day
Weight DDP Score
1. Cereals 1100 50 300 0.5 25 2. Roots and tubers 132 5 100 0.5 2.5 3. Animal source foods 264 12 150 2 24 4. Oil and fats 220 10 25 0.5 5 5. Fat-containing
fruit/seeds 66 3 66 0.5 1.5
6. Nuts and legumes 110 5 110 2 10 7. Sugar 110 5 30 0.5 2.5 8. Fruit and vegetables 132 6 250 5 30 9. Spices 66 3 0 0
Total 2200 100 100
Trends of DDP Score
2009 2010 2011 2012 2013 Energy consumption (kcal/cap/day)
1964 1968 2005 1912 1937
Protein consumption (gram/cap/day)
58.8 60.0 61.9 60.3 61.7
Desirable Dietary Pattern Score* 79.4 82.3 84.6 83.9 88.9
Source: Head of Food diversification consumption and food safety, Riau, January 2014
The maximum Desirable Dietary Pattern Score is 100. The national target for 2013 is 95. Data was calculated from SUSENAS with adjustment of Ministry of Marine and Fisheries data.
National DDP according to SUSENAS 2011
Cereals, 25
Roots&tubers, 1.1
Animal source foods, 16.1
oil&fat, 5
Oily fruit/seed,
Nuts&legumes, 5.8
Sugar, 2.1
Fruit&vegetables, 21.5
GAP, 22.5
Overall appraisal by stakeholders on options proposed for improving micronutrient status
of children and women using Multiple Criteria Mapping (MCM) technique
0 10 20 30 40 50 60 70 80 90 100
Food fortification for pregnant women and WORA (C)
Daily Iron folic acid supplementation for pregnant and postpartum women
(C)
MNP for 6-23 months infants and children 24-59 months (C)
Weekly MMN supplementation for WORA (C)
(RULED OUT BY SOME #1) Regularly updated food composition
database (C)
Food-based recommendations for children and WORA (C)
All participants in Indonesia
www.nutrition-smiling.eu
www.nutrition-smiling.eu
Qualitative information from the appraisal on options of food-based
recommendation • The private sector and funders had concern on
infrastructure and cost. • The Civil society/local NGO group highlighted the need
for a good political will from the local government. • The option was scored low on impact, feasibility,
effectiveness, resources and sustainability due to the high need for infrastructure, cost, logistic, human resources, technology input, effective communication with local government and capacity building for local government.
www.nutrition-smiling.eu
Conclusions
• The nutritional problem in Indonesia requires special attention. – Chronic malnutrition among children is persistently high,
while overweight and obesity among adults is escalating. • Dietary pattern has not met the recommendation for a
nutritionally adequate and healthy life. • Policy on food security still focus on production and
has not accounted for nutrition adequacy. • Appraisal on food-based recommendation is low due to
several constraints, mainly on infrastructure, resources and political will.
