Childhood Nutrition

PERANAN GIZI TERHADAP

PERTUMBUHAN DAN PERKEMBANGAN
ANAK USIA SEKOLAH

Lilik Kustiyah

STUDY PROGRAM OF NUTRITION SCIENCE

GRADUATE SCHOOL
IPB UNIVERSITY
Outline:

• Key nutrition concepts for SAC

• Prinsip penentuan kebutuhan gizi pada anak
usia sekolah (AUS)
• Penilaian pemenuhan gizi dan status gizi AUS
• Peran zat gizi dalam pertumbuhan fisik dan
performance akademik AUS
 3

Key Nutrition Concepts

(Brown 2011)

▪ Children continue to grow & develop physically,

cognitively, & emotionally
▪ Children continue to develop eating & physical
activity behaviors
▪ Families continue to exert the most influence,
but external influences begin to have more
impact
▪ With increasing independence, children begin
to eat more meals & snacks away from home
Prinsip Penentuan Kebutuhan Gizi
pada Anak Usia Sekolah
3 fungsi makanan bagi anak usia sekolah:

memenuhi
kebutuhan
elemen kimia dan
menyediakan komponen yang memberikan
bahan bakar dibutuhkan anak kesenangan dan
untuk kepuasan pada
untuk aktivitas pertumbuhan
otot tubuh dan
anak
memperbaiki
jaringan yang
rusak
• The period between the age of 5 and puberty is
characterized by a relative absence of nutritional
problems and rapidly declining nutrient demands.
• The impact of micronutrient deficiencies upon older
children is less severe.
• Although stunting of growth remains a significant issue,
the high rates of morbidity and mortality associated
with undernutrition in younger children are not seen in
the older age groups.
• This stems from more robust immune function, less
vulnerability to dehydration associated with diarrhoeal
disease and a longer period of time in which to accrue
viable nutrient reserves.
Energy
Energy needs determined by:
Dietary energy must
basal be sufficient to
rate of growth ensure growth and
metabolism
spare protein from
being used for
energy energy, while not
expenditure of age allowing excess
activity
weight gain.
Anjuran pemenuhan energi sehari (Kemenkes 2017)
diperoleh dari:
- 50 - 60% karbohidrat,
- 15 - 35% lemak dan
- 10 - 15% protein
Protein
▪ Pada anak usia sekolah, kebutuhan protein
berdasarkan berat badan relatif lebih tinggi jika
dibandingkan dengan orang dewasa.
▪ Kebutuhan protein yang tinggi diperlukan untuk
periode pertumbuhan pesat dan kebutuhannya lebih
rendah ketika periode pertumbuhan yang lebih lambat.
▪ Kualitas protein yang diberikan harus berkualitas baik,
seperti protein hewani.
▪ Jumlah yang diberikan sesuai kebutuhan (10-15% total
asupan energi) dan mengandung semua unsur asam
amino essensial, mudah dicerna dan diserap tubuh.
▪ 10-15% total asupan energi → tersedia cukup energi
untuk tubuh dari semua zat gizi sehingga protein
digunakan untuk pertumbuhan dan perkembangan
jaringan.
• The need for protein decreases from approximately 1.1
g/kg in early childhood to 0.95 g/kg in late childhood
Lemak
▪ Sejumlah lemak dari makanan dalam jumlah
sesuai dibutuhkan untuk memenuhi kebutuhan
kalori anak, asam lemak esensial, dan vitamin
larut lemak.
▪ Anak mampu memenuhi kebutuhan kalori dan
gizi harian untuk pertumbuhan dengan diet
yang mengandung 30% total kalori dari lemak
(American Academy of Pediatrics [AAP],
Committee on Nutrition 1992; Butte 2000).
Vitamin dan Mineral
• Minerals and vitamins are necessary for normal growth
and development.
• Insufficient intake can cause impaired growth and
result in deficiency diseases.
Vitamin Larut Lemak
Angka kecukupan gizi vitamin larut lemak didasarkan
pada berat badan.
▪ Vitamin A:
• Perhatian perlu diberikan untuk menentukan
kecukupan vitamin A karena tingginya kejadian
defisiensi vitamin A pada masa usia sekolah.
▪ Vitamin D:
• Kebutuhan vitamin D dari sumber pangan tergantung
pada faktor bukan makanan dan wilayah tempat
tinggal anak.
• Faktor bukan makanan misalnya lokasi geografis dan
waktu yang dihabiskan di luar ruangan.
• Wilayah tempat tinggal anak terbagi dua, yaitu wilayah
tropis, dimana anak tidak perlu vitamin D dari pangan
atau hanya 2.5 μg (100 SI) atau lebih sedikit untuk
penyerapan kalsium yang optimal serta wilayah
subtropis dimana anak membutuhkan beberapa
pangan sumber vitamin D sehingga memenuhi
kebutuhan 5 μg (200 SI) vitamin D.
• For young children the current DRI for vitamin D is
higher than what may be consumed from a typical diet.
Supplementation may be needed after a careful
assessment or measurement of vitamin D status.
Mineral
Kebutuhan mineral sangat penting untuk proses fisiologi
yang normal.
▪ Kalsium (Ca): Kebutuhan kalsium aktual tergantung
pada kecepatan absorpsi kalsium masing-masing
individu serta faktor makanan misalnya jumlah protein,
vitamin D, dan fosfor. Berdasarkan data NHANES III,
asupan kalsium menurun pada anak usia 6-11 tahun.

▪ Zat besi (Fe): Walaupun defisiensi Fe prevalensinya

tidak sebanyak pada bayi dan balita, asupan Fe yang
cukup, sangat penting.
Recommended intakes must factor in the absorption rate
and quantity of iron in foods, especially those of plant
origin.
Cairan
▪ Anak usia sekolah sangat penting untuk minum cukup
cairan untuk mencegah dehidrasi selama beraktivitas
fisik dan selama berpartisipasi dalam olahraga, karena
anak beresiko mengalami dehidrasi dan stress yng
berhubungan dengan panas.
▪ Anak normal yang sehat membutuhkan asupan harian
cairan total sebanyak 4-6 gelas atau 1-1.5 liter per hari
atau 1mL/kkal/hr (Kemenkes 2017)
Angka kecukupan gizi zat gizi makro

Lemak (g) Karbo-

Kelompok BB TB Energi Protein Serat Air
hidrat
umur (kg) (cm) (kkal) (g) (g) (mL)
total n-6 n-3 (g)

4-6 tahun 19 113 1400 25 50 10.0 0.9 220 20 1450

7-9 tahun 27 130 1650 40 55 10.0 0.9 250 23 1900

Laki-laki

10-12
36 145 2000 50 65 12.0 1.2 300 28 1850
tahun

Perempuan

10-12
38 147 1900 55 65 10.0 1.0 280 27 1850
tahun
 Angka kecukupan gizi vitamin

vitami
kelom vitami vitami vitami vitami vitami vitami vitami n B5 vitami vitami vitami
folat biotin kolin
pok nA nD nE nK n B1 n B2 n B3 (Pantot n B6 n B12 nC
(mcg) (mcg) (mg)
umur (mcg) (mcg) (mcg) (mcg) (mg) (mg) (mg) enat) (mg) (mcg) (mg)
(mg)

4-6
450 15 7 20 0.6 0.6 8 3 0.6 200 1.5 12 250 45
tahun
7-9
500 15 8 25 0.9 0.9 10 4 1 300 2 12 375 45
tahun
Laki-laki
10-12
600 15 11 35 1.1 1.3 12 5 1.3 400 3.5 20 375 50
tahun
Perempuan
10-12
600 15 15 35 1 1 12 5 1.2 400 3.5 20 375 50
tahun
 Angka kecukupan gizi mineral

kelom kalsiu magne iodiu seleni kromi natriu temba

fosfor besi seng manga fluor kalium klor
pok m sium m um um m ga
(mg) (mg) (mg) n (mg) (mg) (mg) (mg)
umur (mg) (mg) (mcg) (mcg) (mcg) (mg) (mcg)

4-6
1000 500 95 10 120 5 21 1.5 1 16 2700 900 1300 440
tahun

7-9
1000 500 135 10 120 5 22 1.7 1.4 21 3200 1000 1500 570
tahun

Laki-laki

10-12
1200 1250 160 8 120 8 22 1.9 1.8 28 3900 1300 1900 700
tahun

Perempuan

10-12
1200 1250 170 8 120 8 19 1.6 1.9 26 4400 1400 2100 700
tahun
Penilaian pemenuhan gizi dan
status gizi anak usia sekolah
Food Intake
Intake patterns
▪ Decreased intakes of sugars and fats in children over age 2
▪ More energy comes from snacks, and portion sizes have
increased
▪ More food is consumed in environments other than the home,
often leading to increased energy intake
▪ Foods with low nutrient density (soft drinks, desserts,
sweeteners, and salty snacks) often displace nutrient-dense
foods.
▪ During the early school years, a pattern of consistent and steadily
increased intakes of most nutrients is seen until adolescence.
▪ In healthy children a wide variability of nutrient intake is seen at
any age.
▪ Children are most likely to consume inadequate amounts of
calcium, vitamin D, fiber, and potassium
 Media
messages

Socioeconomic
Peer influence
influences

Family Food Illness or

environment
intake disease
Family environment
▪ Food attitudes of parents, parental behavior, and food
practices can be strong predictors of food likes and
dislikes and diet complexity in children of primary
school age.
▪ Eating together at family meals is becoming less
common, partly because of family schedules, more time
eating in front of a screen, and the decreasing amount of
time available for planning and preparing family meals.
▪ School age children and adolescents who eat more
dinners with their families consume more fruits and
vegetables, less soda, and fewer fried foods than those
who rarely eat dinner with their families (Larson et al,
2007).
Socioeconomic influences
▪ Single-parent households predominantly headed by
women have lower incomes and less money for all
expenses, including food, than households headed by
men; about half of children in families with a female
householder were in poverty (Semega et al, 2017)
→ increasingly vulnerable to multiple stressors such as
marginal health and nutritional status partly because of
lack of jobs, child care, adequate housing, and health
insurance.
▪ Marginal food insecurity, which is often thought not to
be an indicator of nutrition risk in adults, is associated
with adverse health outcomes in children (Cook et al,
2013).
Media messages
▪ School age children may be exposed to in-school
marketing, sponsorship, product placement, and sales
promotion.
▪ Children younger than 13 years of age who watch 2
hours of television per day may view 56 to 126 food
advertisements; 32% of the ads are for fast food
products in the United States. Eighty percent of the
food ads focus on foods high in energy or nutrients
less desirable using dietary standards (Kelly et al,
2010).
▪ More than 40% of commercials were for food, with
80% to 95% for items high in saturated fat, trans fat,
sugar, and sodium (Powell et al, 2013).
Media messages (cont’d)

▪ Screen time can be detrimental to growth and

development because it encourages inactivity and
passive use of leisure time.
▪ Television viewing with its multiple media cues to eat
has been suggested as a factor contributing to excessive
weight gain in school age children, especially when
there is a television in the child’s bedroom (Gilbert-
Diamond et al, 2014).
▪ Television viewing has also been inversely associated
with fruit and vegetable consumption (American Public
Health Association [APHA], 2017).
Peer influence
▪ Peer influence increases with age and affects food
attitudes and choices → a sudden refusal of a food
or a request for a currently popular food.
▪ Positive behaviors such as a willingness to try new
foods can be reinforced.
▪ Parents must set limits on undesirable influences
but also must be realistic; struggles over food are
self-defeating.
Illness or disease
▪ Children who are ill usually have a decreased appetite and
limited food intake.
▪ Acute viral or bacterial illnesses → an increase in fluids,
protein, or other nutrients.
▪ Chronic conditions such as asthma, cystic fibrosis, or chronic
renal disease → difficult to obtain sufficient nutrients for
optimal growth.
▪ Children with these types of conditions are more likely to
have behavior problems relating to food.
▪ Children requiring special diets (e.g., those who have
diabetes, food allergies, or phenylketonuria) not only have to
adjust to the limits of foods allowed but also have to address
issues of independence and peer acceptance as they grow
older.
Feeding school age children
▪ Growth from ages 6 to 12 years is slow but steady,
paralleled by a constant increase in food intake
▪ The influence of peers and significant adults such
as teachers, coaches, or sports idols increases.
▪ Most behavioral problems connected with food
have been resolved by this age, and children enjoy
eating to alleviate hunger and obtain social
satisfaction.
▪ Snacks are commonly eaten by school age
children, primarily after school and in the evening.
Obesity in children

Food
intake
Physical
activity Genetic

Causes
of
obesity
Physical activity
▪ Physical activity levels often decline with age, reflecting
patterns of play in children, which often change from free,
unstructured and active games (e.g. spontaneous games of
chase and tag) to a more regimented sports-based pattern
in early adolescence
▪ The modern environment encourages low levels of
physical activity in children
▪ The increase in the amount of time spent on sedentary
activities: In developed countries, children spend 4–6
h/day either watching television or using computers and
games consoles. Exceeding a recommended 2 h/day
sedentary screen time is the norm for children in most
developed countries.
▪ Leisure inactivity is a critical component of the modern
obesogenic environment that is driving childhood obesity
Food intake
▪ energy expenditure through physical activity among
children has declined markedly over recent decades
▪ in the past, children were engaged in work-related
activities for much of their time, modernization and
urbanization may have reduced energy requirements by
200 kcal/day.
▪ the nature of the diet has undergone a revolution in
almost all parts of the world, producing an increase in
energy intakes and energy density of foodstuffs
➔the modern environment simultaneously promotes
reduced energy expenditure and increased
consumption.
▪ meal patterns, portion sizes and the energy density of
foods consumed play an important role in determining
risk of overweight and obesity.
Adiposity Rebound
factors in early infancy may be critical in setting the risk of
overweight and obesity in children
Consequences of obesity
psychosocial difficulties such as discrimination, a
negative self-image, depression, and decreased
socialization.

one or more cardiovascular risk factors such as

hyperlipidemia, hypertension, or hyperinsulinemia
(Daniels, 2009).

the rapid increase in the incidence of type 2

diabetes in children and adolescents,

development of other chronic diseases, and health

care costs
Treatment of obesity
Managing obesity in
children is more effective
where a healthy rather
than a restrictive diet is
promoted. Weight loss was
sustained for a longer
period by children who
were advised to increase
their intakes of ‘healthy’
foods than among children
advised to reduce intake of
foods with high energy
density.
A lower prevalence of obesity among children
who were exposed to the following routines
(Anderson and Whitaker, 2010) :
• regularly eating the evening meal as a family
• obtaining adequate night-time sleep
• having limited screen-viewing time
Prevention of obesity
Underweight and failure to thrive
▪ Weight loss, lack of weight gain, or failure to thrive
(FTT)→ pediatric undernutrition or growth
deficiency
▪ Caused by:
• an acute or chronic illness
• a restricted diet
• a poor appetite (resulting from constipation,
medication, or other issues)
• feeding problems
• neglect
• a simple lack of food
Iron deficiency
▪ Iron deficiency is less of a problem among older
preschool and school age children.
▪ Deficiency can have long-term consequences, as
demonstrated by poorer performance on
developmental tests in late childhood and early
adolescence (Lozoff et al, 2007).
▪ Iron intake should be considered during assessments of
individual diets and in policy decisions intended to
address the nutrition needs of low-income, high-risk
children.
▪ Iron deficiency can caused by: growth, the increased
physiologic need for iron and dietary factors
Peran zat gizi dalam pertumbuhan fisik
dan performance akademik
anak usia sekolah
Breakfast
▪ Children who reported eating breakfast on a consistent
basis tended to have superior nutritional profiles than
their breakfast-skipping peers.
▪ Breakfast consumption significantly contributes to
whole-diet nutrient adequacy.
▪ Breakfast eaters generally consumed more daily
calories yet were less likely to be overweight, although
not all studies associated breakfast skipping with
overweight.
▪ Although research strongly supports a relationship
between breakfast consumption and nutritional
adequacy, the relationship between breakfast
consumption and body weight is less well established.
▪ Evidence suggests that breakfast consumption may
improve cognitive function related to memory, test
grades, and school attendance
Rampersaud et al. 2005. Breakfast Habits, Nutritional Status, Body Weight, and Academic
Performance in Children and Adolescents. J Am Diet Assoc. 105:743-760
▪ Nearly half (44.6%) of Indonesian children
breakfast with low nutritional quality.
▪ Approximately 44.6%, 35.4%, 67.8%, 85.0%,
89.4%, and 90.3% of children consume only <15%
RDI for energy, protein, vitamin A, iron, calcium,
and fiber respectively.
▪ It is suggested that the healthy breakfast should be
able to fulfill 15—30% of daily nutrients
requirements.
Hardinsyah, Aries M. 2012. Jenis Pangan Sarapan dan Perannya dalam Asupan Gizi
Harian Anak Usia 6—12 Tahun Di Indonesia. Jurnal Gizi dan Pangan, Juli 2012,
7(2): 89—96
 Students’
thinking skills, Academic
Nutrition
behavior, and performance
health

Learning and
Diet
memory

Wilderresearch. 2014. Nutrition and Students’ Academic Performance

 school-aged
• nutritional children
deficiencies • cognitive
development

Early life

Wilderresearch. 2014. Nutrition and Students’ Academic Performance

The impact of school breakfast programs

Better Improved
attendance behavior

Better
Improved
academic
concentration
performance

Wilderresearch. 2014. Nutrition and Students’ Academic Performance

• Methods: subjects were 1269 children (697 boys and 572 girls) aged 6
years from the Chinese city of Jintan. Cognition was assessed with the
Chinese version of the Wechsler Preschool and Primary Scale of
Intelligence—Revised.
• Results: children who regularly have breakfast on a near-daily basis had
significantly higher full scale, verbal, and performance IQ test scores (all
p<0.001) compared to children who “sometimes” have breakfast.
• Findings may reflect nutritional as well as social benefits of regular
breakfast consumption on cognition
Nutritional effect of breakfast
▪ The overnight fast that occurs during sleep represents
the longest period of fasting, and one important
function of breakfast is to replenish low blood glucose
levels.
▪ Rice and noodles made up 69% of the breakfast meal;
such carbohydrates can be rapidly broken down into
glucose and used to fuel physical and mental function
▪ Glucose is the primary source of the acetyl groups that
are used in the formation of acetyl CoA, a precursor for
the acetylcholine that regulates neurotransmission and
benefits components of cognitive function, such as
memory
▪ The observed differences IQ scores may reflect other
nutritional benefits of regularly consuming breakfast.
Liu et al. 2013. Regular breakfast consumption is associated with increased IQ in
kindergarten children. Early Human Development 89 (2013) 257–262
Social interaction effect of breakfast
▪ Breakfast is a time during which family
members interactively prepare and consume
food while communicating and socially
engaging with one another.
▪ At the age of 6 years, a child's cognitive ability
on both verbal and performance levels is
rapidly developing, and social interaction with
parents may promote cognitive/brain
development
Liu et al. 2013. Regular breakfast consumption is associated with increased IQ
in kindergarten children. Early Human Development 89 (2013) 257–262
• Two experiments compared the effects of two common U.S. breakfast
foods and no breakfast on children’s cognition.
• Using a within-participant design, once a week for 3 weeks, children
consumed one of two breakfasts or no breakfast and then completed a
battery of cognitive tests.
• The two breakfasts were instant oatmeal and ready-to-eat cereal,
which were similar in energy, but differed in macronutrient
composition, processing characteristics, effects on digestion and
metabolism, and glycemic score
▪ Findings showed that breakfast intake enhances cognitive
performance, particularly on tasks requiring processing of a
complex visual display.
▪ Results also showed effects of breakfast type.
▪ Younger children had better spatial memory and better
auditory attention and girls exhibited better short-term
memory after consuming oatmeal.
▪ Due to compositional differences in protein and fiber content,
glycemic scores, and rate of digestion, oatmeal may provide a
slower and more sustained energy source and
consequently result in cognitive enhancement compared
to low-fiber high glycemic ready-to-eat cereal.
▪ These results have important practical implications, suggesting
the importance of what children consume for breakfast before
school.
Mahoney et al. 2005. Effect of breakfast composition on cognitive processes in elementary
school children. Physiology & Behavior 85 (2005) 635 – 645
• Students with unhealthy lifestyle behaviours were more
likely to have poor academic performance for both
English and Mathematics compared to students with healthy
lifestyle behaviours
• associations were statistically significant for diet quality,
physical activity, sugar-sweetened beverage consumption
for English; and breakfast skipping, not being physically
active at morning recess, and not being physically active
after school for Mathematics.
• The effects of diet and physical activity were independent of
each other and there was no interaction between the two
exposures.
• A low-Glycemic Index, high-Glycemic Load breakfast was
associated with better performance on a speed of
information processing (P<0.01) and a serial sevens
(P<0.001) task 90 min later; a high-GI breakfast with better
performance on an immediate word recall task (P<0.01);
and a high-GL breakfast with better performance on a
Matrices task (P<0.01).
• This study suggests that the GI and GL of breakfast may
affect performance in specific cognitive domains and under
real-life conditions, and that performance in the classroom
might be better after a low-GI, high-GL breakfast.
 Masalah gizi pada anak usia sekolah
(Kemenkes 2007, 2010, 2013)

Tahun Usia Pendek Kurus Gemuk

2007 6-14 24.2 15.9

2010 5-12 35.6 12.4 9.2

13-15 25.2 10.1 2.5

2013 6-12 30.7 11.2 18.8

13-15 35.1 11.1 10.8

 Status gizi anak SD di Kota Bogor
(n1=1030, 10 SD; n2=624, 8 SD)
Kategori %1 %2

Normal (-2 SD <Nilai Z IMT/U < +1 SD) 70,4 75.0

OW/Obese (Nilai Z IMT/U > + 1 SD) 22,3 17.9

Underweight (Nilai Z IMT/U < - 2SD) 7,3 7.1

Stunted (Nilai Z TB/U < -2 SD) 12,8 14.6

1Dwiriani et al. (2011)
2Kustiyah et al. (2016):
54 - SDIT Aliya

- SD Regina Pacis
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