International Journal of Nutrition Sciences

International Journal of Nutrition Sciences

The Efficacy of Fortified Rice Consumption on Nutritional Status of Stunted Children Less Than Five Years Old in Yogyakarta, Indonesia

Document Type : Original Article

Authors
Siti Helmyati 1, 2
Lily Arsanti Lestari 1, 2
Lintang Aryanti 2
Heriski Dwiutami 2
Ulfatul Karomah 2
Hari Kusnanto Josef 3
Susetyowati Susetyowati 1
Bayu Satria Wiratama 3
Sonya Mamoriska M. Harahap 4
Amrullah Amrullah 5
Dandy Arianto 5
Eny Cahyaningsih 5
Iksanah Ratri Astuti 5
Andi Purnama 5
Eriel Mar 5
Cynthia Ghaniyyu Magda 5
1 Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
2 Center for Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
3 Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
4 Management Department, BINUS Business School Master Program, Bina Nusantara University, Jakarta, Indonesia
5 Center for Research, Strategic Planning, and Policy Analysis, Perum BULOG, Jakarta, Indonesia
10.30476/ijns.2026.106671.1458
Abstract
Background: Stunting still remains a priority issue of malnutrition in Indonesia. Nutrition deficiency during the first 1000 day of life is the main factor of stunting in children. The strategy to address the nutrition deficiency through food fortification showed a positive impact of malnourished children in several studies. This study aimed to examine the effect of consuming fortified rice on nutritional status of stunted children.
Methods: A double-blind randomized controlled trial study enrolled 96 children aged 12-59 months with the height-for-age z-score lower than -2 SD. Participants were assigned to treatment fortified rice (FR) and control non-fortified rice (NFR) group. FR group received fortified rice; while NFR received non-fortified rice for 24 weeks of intervention. The comparison of heigh-for age z-score (HAZ), weight-for-age z-score (WAZ), and weightfor- height z-score (WHZ) between groups was undertaken.
Results: No significant differences were noticed for HAZ, WAZ, and WHZ between groups. FR group showed a greater improvement in the number of participants transitioning from stunted to normal status when compared to NFR group. Linear regression analysis revealed that consumption of fortified rice could significantly increase the HAZ in children aged 4-5 years, particularly among those whose mothers had high self-efficacy. Factors associated with the increase in HAZ coefficient included adequate energy intake, infrequent milk consumption, and effective feeding practices.
Conclusion: Consumption of fortified rice had no significant impact on nutritional status of stunted children. Maternal or caregiver self-efficacy had a potential positive influence on the HAZ of stunted children.

Highlights

Siti Helmyati (Google Scholar)

Keywords
Fortified rice
Nutrition
Stunting
Children
Indonesia
  1. Titaley CR, Ariawan I, Hapsari D, et al. Determinants of the stunting of children under two years old in indonesia: a multilevel analysis of the 2013 indonesia basic health survey. Nutrients. 2019;11:1106. DOI: 10.3390/nu11051106. PMID: 31109058.
  2. Indonesian Ministry of Health. Riset Kesehatan Dasar. Jakarta; 2018.
  3. Setiawan E, Machmud R, Masrul M. Faktor-faktor yang berhubungan dengan kejadian stunting pada anak usia 24-59 bulan di wilayah kerja puskesmas andalas kecamatan Padang Timur kota Padang tahun 2018. J Kesehat Andalas. 2018;7:275. DOI: 10.25077/jka.v7i2.813.
  4. Kementerian PPN/Bapenas. Rancangan rencana pembangunan jangka menengah nasional (RPJMN) 2020-2024. Rencana Pembang Jangka Menengah Nas 2020-2024. 2019;257.
  5. WHO & FAO. Global progress - food fortification. UnscnOrg. 2006;341. Available from: http://www.unscn.org/layout/modules/resources/files/fortification_eng.pdf
  6. Syam A, Taslim NA, Budu, et al. Effect of folic acid fortification on local premix rice to concentration and student learning outcomes. Media Kesehat Masy Indones. 2019;15:349-57. DOI: 10.30597/mkmi.v15i4.7621 .
  7. Perignon M, Fiorentino M, Kuong K, et al. Impact of multi-micronutrient fortified rice on hemoglobin, iron and vitamin a status of Cambodian schoolchildren: a double-blind cluster-randomized controlled trial. Nutrients. 2016;8:29. DOI: 10.3390/nu8010029. PMID: 26751473.
  8. Thankachan P, Rah JH, Thomas T, et al. Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of Indian school children. J Nutr. 2012;142:846-52. DOI: 10.3945/jn.111.149021. PMID: 22437556.
  9. Bening, Salsa, Margawati A. Hubungan asupan gizi makro dan mikro sebagai faktor risiko stunting anak usia 2-5 tahun di Semarang. Med Hosp. 2016;4:45-50.
  10. Hanna M, Jaqua E, Nguyen V, et al. B Vitamins: functions and uses in medicine. Perm J. 2022;26:89-97. DOI: 10.7812/TPP/21.204. PMID: 35933667.
  11. Mursalim M, Juffrie M, Mulyani NS. Pemberian fortifikasi multi-mikronutrien berpengaruh terhadap pertumbuhan balita keluarga miskin. J Gizi Klin Indones. 2011;8:69. DOI: 10.22146/ijcn.17771.
  12. Nuhan HG, Yulianti E. Faktor-faktor yang berhubungan dengan perilaku sulit makan pada balita di rw 001 kelurahan Jatinegara Jakarta Timur. J Ilm Kesehat. 2023;15:202-10. DOI: 10.37012/jik.v15i2.1881.
  13. Adriani M, Wirjatmadi B. The effect of adding zinc to vitamin A on IGF-1, bone age and linear growth in stunted children. J Trace Elem Med Biol. 2014;28:431-5. DOI:10.1016/j.jtemb.2014.08.007.
  14. Fares MF, Aboulghar H, Eltatawy SS, Aziz MM. Effect of iron and zinc supplementation on linear growth of stunted egyptian children under 5 years of age. Curr Pediatr Res. 2021;25:600-5.
  15. Moradpour GR, Minaei MR, Haghighat N, et al. The Effect of Gastric Bypass and Sleeve Gastrectomy Surgery on the Level of Vitamin A, Iron, Copper, Ferritin, Hemoglobin, Vitamin D, Vitamin B12, Zinc and Cardiometabolic Factors in Patients with Morbid Obesity. Int J Nutr Sci. 2025;10:467-475. DOI: 10.30476/ijns.2025.104992.1386.
  16. WHO. Guidline: fortification of rice with vitamins and minerals as a public health strategy. Geneva: World Health Organization; 2018.
  17. Mamun A Al, Mahmudiono T, Yudhastuti R, et al. Effectiveness of food-based intervention to improve the linear growth of children under five: a systematic review and meta-analysis. Nutrients. 2023;15:2430. DOI: 10.3390/nu15112430. PMID: 37299393.
  18. Wang J, Chang S, Zhao L, et al. Effectiveness of community-based complementary food supplement (Yingyangbao) distribution in children aged 6-23 months in poor areas in China. PLoS One. 2017;12:e0174302. DOI: 10.1371/journal.pone.0174302. PMID: 28319154.
  19. Li Z, Li X, Sudfeld CR, et al. The effect of the yingyangbao complementary food supplement on the nutritional status of infants and children: a systematic review and meta-analysis. Nutrients. 2019;11:2404. DOI: 10.3390/nu11102404. PMID: 31597360.
  20. Draffin K, Hamilton J, Godsil S, et al. Comparison of a low carbohydrate intake and standard carbohydrate intake on refeeding hypophosphatemia in children and adolescents with anorexia nervosa: a pilot randomised controlled trial. J Eat Disord. 2022;10:50. DOI:10.1186/s40337-021-00519-0. PMID: 35413883.
  21. Mamoriska S, Gelar, Hidayat M, et al. Karakterisasi kandungan gizi, sensori, dan biaya produksi beras fortifikasi (fortivit) dan beras biofortifikasi (inpari nutri zinc). PANGAN Media Komun dan Inf. 2022;31:95-112.
  22. Faghih Sh, Ebrahimi N. Nutritional Status and Its Related Factors among 6-24 Month-Old Children Referring to Health Care Centers in Arsanjan City, Southern Iran. Int J Nutr Sci. 2016;1:11-15.
  23. Setia A, Saleh AS, Mirah Adi AAA, Demu YDB. Determinants of Nutritional Status of TwoYear-Old Infant’s First Thousand Days of Life in Work Area of Oepoi Public Health Center, Kupang, Indonesia. Int J Nutr Sci. 2021;6:81-89. DOI: 10.30476/IJNS.2021.90302.1124.
  24. Pusparini, Isdiany N, Tursilowati S. The effects of multiple-nutrients fortified biscuits and/or psychosocial parenting education intervention programs on anthropometric and cognitive measures of toddlers. J Nutr Sci Vitaminol (Tokyo). 2020;66:S443-9. DOI: 10.3177/jnsv.66.S443. PMID: 33612639.
  25. Mahfouz EM, Sameh Mohammed E, Alkilany SF, et al. The relationship between dietary intake and stunting among pre-school children in Upper Egypt. Public Health Nutr. 2021;25:2179-2187.  DOI: 10.1017/S136898002100389X. PMID: 34496999
  26. Pupu Saeful Rahmat. Perkembangan peserta didik. Hastuti SB, editor. Jakarta Timur, Indonesia: Bumi Aksara; 2018.p.6.
  27. Heryanto ML, Wianti H, Herwandar FRU, Srimulyawati T. Hubungan antara picky eater dengan perkembangan motorik kasar dan motorik halus anak prasekolah. J Midwifery Care. 2024;4:81-6.
  28. Purnamasari AR, Adriani M. Hubungan perilaku picky eater dengan tingkat kecukupan protein dan lemak pada anak prasekolah [correlation of picky eater behavior to protein and fat intake in adequacy pre-school children]. Media Gizi Indones. 2020;15:31-37. DOI:10.204736/mgi.v15i1.31-37.
  29. Mohit M, Mousavinezhad H, Karami E, et al. The Effect of Different Types of Dietary Fatty Acids on Body Fat: A Review. Int J Nutr Sci. 2022;7:125-130. DOI: 10.30476/IJNS.2022.95602.1190.
  30. Albert Bandura. Albert bandura self-efficacy: the exercise of control. Vol. 43, W.H Freeman and Company New York. 1997.p.1-602.
  31. Bahorski JS, Childs GD, Loan LA, Azuero A, Morrison SA, Chandler-Laney PC, et al. Self-efficacy, infant feeding practices, and infant weight gain: an integrative review. J Child Heal Care. 2018;23:286-310. DOI:10.1177/1367493518788466. PMID: 30071746.
  32. Doaei S, Gholamalizadeh M, Entezari MH. Maternal self-efficacy and feeding practices in children aged 3-6 years. Iran J Psychiatry. 2015;10:278-84. PMID: 27006673.
  33. Cooke R, Goulet O, Huysentruyt K, et al. Catch-up growth in infants and young children with faltering growth: expert opinion to guide general clinicians. J Pediatr Gastroenterol Nutr. 2023;77:7-15. DOI: 10.1097/MPG.0000000000003784. PMID: 36976274.
  34. Jones AD, Rukobo S, Chasekwa B, et al. Acute illness is associated with suppression of the growth hormone axis in Zimbabwean infants. Am J Trop Med Hyg. 2015;92:463-70. DOI: 10.4269/ajtmh.14-0448. PMID: 25535308.
  35. Mehrabani D, Masoumi SJ, Masoumi AS, et al. Role of Diet in Mesenchymal Stem Cells’ Function: A Review. Int J Nutr Sci. 2023;8:9-19. DOI: 10.30476/IJNS.2023.97788.1221.
  36. Kim K, Melough MM, Kim D, et al. Nutritional adequacy and diet quality are associated with standardized height-for-age among U.S. children. Nutrients. 2021;13:1689. DOI: 10.3390/nu13051689. PMID: 34065650.
  37. Endrinikapoulos A, Afifah DN, Mexitalia M, et al. Study of the importance of protein needs for catch-up growth in Indonesian stunted children: a narrative review. SAGE Open Med. 2023;11:20503121231165560. DOI: 10.1177/20503121231165562. PMID: 37101818.
  38. Komariyah S, Wijayanti AR. Gambaran pertumbuhan (BB/U, TB/U, BB/TB) Anak Usia 4-5 Tahun (Di TK endah Bandar Lor kecamatan Mojoroto kota Kediri). J Kebidanan. 2019;8:30-9.
  39. Tampubolon R, Pambuka K, Kurniasari MD, et al. Pola konsumsi dan tumbuh kembang balita usia 24-60 bulan di wilayah kerja puskesmas Cebongan, kota Salatiga. J Keperawatan Muhammadiyah. 2020;5:106-115. DOI: 10.30651/jkm.v5i1.3766.
  40. Hizni A, Muis AA, Kunaepah U, Sulistiyon P. Feeding practices and frequency of food refusal in children. Pakistan J Nutr. 2019;19:25-31.