Child Nutrition

Darmono SS
Thirty Countries Have Stunting Rates of 40% or
More

State of the World’s Mothers 2012

• Findings Globally, 52·9 million (95% uncertainty interval [UI] 48·7–57·3; or 8·4% [7·7–9·1]) children younger than 5
years (54% males) had developmental disabilities in 2016 compared with 53·0 million (49·0–57·1; or 8·9% [8·2–9·5])
in 1990. About 95% of these children lived in low-income and middle-income countries. YLDs among these children
increased from 3·8 million (95% UI 2·8–4·9) in 1990 to 3·9 million (2·9–5·2) in 2016. These disabilities accounted for
13·3% of the 29·3 million YLDs for all health conditions among children younger than 5 years in 2016. Vision loss was
the most prevalent disability, followed by hearing loss, intellectual disability, and autism spectrum disorder.
However, intellectual disability was the largest contributor to YLDs in both 1990 and 2016. Although the prevalence of
developmental disabilities among children younger than 5 years decreased in all countries (except for North
America) between 1990 and 2016, the number of children with developmental disabilities increased significantly in
sub-Saharan Africa (71·3%) and in North Africa and the Middle East (7·6%). South Asia had the highest prevalence of
children with developmental disabilities in 2016 and North America had the lowest.
• Interpretation The global burden of developmental disabilities has not significantly improved since 1990, suggesting
inadequate global attention on the developmental potential of children who survived childhood as a result of child
survival programmes, particularly in sub-Saharan Africa and south Asia. The SDGs provide a framework for policy
and action to address the needs of children with or at risk of developmental disabilities, particularly in resource-poor
countries.
• Funding The Bill & Melinda Gates Foundation. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an
Open Access article under the CC BY 4.0 license. www.thelancet.com/lancetgh Vol 6 October 2018
• Findings Globally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths
(90% uncertaint interval 7·2–8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying
between birth and age 5 years, which was 41 deaths (39–44) per 1000 children. The mortality risk in
children aged 5–14 years decreased by 51% (46–54) between 1990 and 2016, despite not being
specifically targeted by health interventions. The annual number of deaths in this age group decreased
from 1·7 million (1·7 million–1·8 million) to 1 million (0·9 million–1·1 million) in 1990–2016. In 1990–2000,
mortality rates in children aged 5–14 years decreased faster than among children aged 0–4 years.
However, since 2000, mortality rates in children younger than 5 years have decreased faster than
mortality rates in children aged 5–14 years. The annual rate of reduction in mortality among children
younger than 5 years has been 4·0% (3·6–4·3) since 2000, versus 2·7% (2·3–3·0) in children aged 5–14
years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to
die than those in other regions; 55% (51–58) of deaths of children of this age occur in sub-Saharan Africa,
despite having only 21% of the global population of children aged 5–14 years. In 2016, 98% (98–99) of all
deaths of children aged 5–14 years occurred in low-income and middle-income countries, and seven
countries alone accounted for more than half of the total number of deaths of these children.
Interpretation Increased efforts are required to accelerate reductions in mortality among older children
and to ensure that they benefit from health policies and interventions as much as younger children.
Funding UN Children’s Fund, Bill & Melinda Gates Foundation, United States Agency for International
Development. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article
World Health Asembly 2025
 PREVALENCE OF UNDER-FIVE STUNTING AND OVERWEIGHT FOR
HIGHEST AND LOWEST WEALTH QUINTILES IN SELECTED
COUNTRIES (%)

Note: Red circles are the lowest wealth quintiles; blue circles are the highest wealth quintiles. BAZ = body
mass index-for-age Z-score. HAZ = height-for-age Z-score. DHS = Demographic and Health Survey. MICS =
World Child Stunting
Stunting & Product Domestic Bruto

Gambar. Angka stunting pada anak usia <5 tahun dan Gross Domestic Product
tiap Pertumbuhan perkapita dari 2003-2013

Sumber: Hou X. Stagnant Stunting Rate despite Rapid Economic Growth—An Analysis of Cross
Sectional Survey Data of Undernutrition among Children under Five . AIMS Public Health. 2016.
Volume 3, Issue 1, 25-39
 • Gangguan pertumbuhan telah terjadi sejak usia 4-6 bulan pertama kehidupan bayi;
terjadi baik di desa maupun kota
• Mulai umur 6 bulan gangguan pertumbuhan makin nyata dan mencapai puncaknya
pada umur 11 bulan
• Kurva pertumbuhan masih tetap menurun hingga umur 23 bulan
• Sesudah 23 bulan kurva pertumbuhan relatif mendatar

1.5

1
K eadaan gizi m enurut B B/U

1999 2000 2002

0.5

0
0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60
-0.5

-1

-1.5

-2
Umur (bulan)
 PREVALENSI GIZI KURANG DAN BURUK
DI INDONESIA (1989-2003)

40 37.5 Gizi Kurang

35.6
35 Gizi Buruk
31.6
29.5
30 26.4 27.3 27.5
24.7 26.1
25
20
15 11.6
10.1
10 7.2 8.1 7.5 8 8.55
6.3 6.3
5
0
1989 1992 1995 1998 1999 2000 2001 2002 2003
Susenas 1989-2003
 Stunting by Weight for Height

Risk for Stunting

Weight for Height Category, Riskesdas 2007

Terjadi di semua daerah
Chronic Enteropathy & Malnutrition

Chronic enteropathy : villus atrophy, siklus infeksi dan malnutrisi. DeBoer MD, Lima AA,
Oria RB, Scharf RJ, Moore SR, Luna MA, Guerrant RL, Nutrition Review, Vol 70(11), 2012, :
Growth faltering in HEIGHT is following growth
Waterlow Classification Indonesia
33 Prov Riskesdas 2007
 Perbedaan Tinggi Badan rata-rata Anak 15-19 thn
(Riskesdas 2007) dg Standar WHO 2005

200.0 200.0
Perempuan
Laki-laki
190.0
Lebih pendek 13,6 cm 190.0 Lebih pendek 10,4 cm
180.0 180.0 pada usia dewasa
pd usia dewasa
Tinggi Badan rata-rata

Tinggi Badan rata-rata

170.0 170.0

160.0 WHO 160.0

2005
150.0 150.0 WHO
2005
140.0 140.0

130.0 Anak laki-laki 130.0

Indonesia Anak perempuan
Indonesia
120.0 120.0

110.0 110.0

100.0 100.0
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Umur (thn) Umur (thn)

Sumber: Atmarita. MOH

 10
%

90
%

Stunted and brain

development
Child development: risk factors for adverse outcomes in developing countries
*Susan P Walker,*Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto Pollitt,
Julie A Carter, and the International Child Development Steering Group†
 Child development: risk factors for adverse outcomes in developing
countries
*Susan P Walker,*Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto Pollitt,
Julie A Carter, and the International Child Development Steering Group†
 Child development: risk factors for adverse outcomes in developing
countries
*Susan P Walker,*Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto Pollitt, Julie A
Carter, and the International Child Development Steering Group†
 Terjadi Peningkatan
Prevalens Balita Stunting
Stunting 2007-2013 stagnan
antara tahun 2010 dg 2013 (Riskesdas)
 10
20
30
40
50
60

0
D .I. Y o g y a k a r ta 2 2 ,5
D K I J a k a r ta 2 6 ,6
K e p u la u a n R ia u 2 6 ,9
S u la w e s i U ta r a 2 7 ,8
P ap u a 2 8 ,3
B a n g k a B e litu n g 29
K a lim a n ta n T im u r 2 9 ,1
B a li 2 9 ,3
M a lu k u U ta r a 2 9 ,4
Ja m b i 3 0 ,2
B e n g k u lu 3 1 ,6
R ia u 3 2 ,2
S u m a te r a B a r a t 3 2 ,8
B a n te n 3 3 ,5
Ja w a B a r a t 3 3 ,6
Ja w a T e n g a h 3 3 ,9
K a lim a n ta n S e la ta n 3 5 ,3
In d o n e s ia 3 5 ,6
Ja w a T im u r 3 5 ,9
S u la w e s i T e n g a h 3 6 ,2
Lam p u n g 3 6 ,3
M a lu k u 3 7 ,5
S u la w e s i T e n g g a r a 3 7 ,8
A ceh 3 8 ,9
S u la w e s i S e la ta n 3 8 ,9
K a lim a n ta n T e n g a h 3 9 ,6
K a lim a n ta n B a r a t 3 9 ,7
G o r o n ta lo 4 0 ,3
S u m a te r a S e la ta n 4 0 ,4
S u la w e s i B a r a t 4 1 ,6
S u m a te r a U ta r a 4 2 ,3
N u sa Te n ggara B arat 4 8 ,2
P ap u a Barat 4 9 ,2
Prevalensi Stunting di Indonesia

N u s a T e n g g a r a T im u r 5 8 ,4
Prevalensi balita stunting di Indonesia masih cukup tinggi (35,6%). Kondisi ini
berdampak pada perkembangan kognitif dan produktivitas anak pada jangka panjang

32
Countries Falling Above and Below Expectations
Based on GDP

—Note: All 127 countries with available data were included in this analysis. Stunting rates are for the latest available year 2000-
2010. Data sources: WHO Global Database on Child Growth and Malnutrition (who.int/nutgrowthdb/); UNICE F Global Databases
(childinfo.org); recent DHS and MIC S (as of March 2012) and The World Bank, World Development Indicators
(data.worldbank.org/indicator). State of the World’s Mothers 2012
Thirty Countries Have Stunting Rates of 40% or More

State of the World’s Union Summit 2016

 Integrated Gaps
1 Integration of child development intervention with health services
2 Evaluation of integrated intervention at scale
3 Long term follow-up of intervention with modest initial impacts
4 Studies designed to show individual and combined effects
5 Evaluation of different approaches to reach children 1 – 3 years of age
6 Evaluation of effect of program quality
7 Evaluation of ways to improve quality of center based strategies for children 3 – 6 year of
ages
8 Evaluation of sustainability of benefits from integrated intervention using cohorts
9 Id effects of nutrition intervention on both growth and development entification of the essential
components of child development interventions for maximum effect
10 Techniques to enhance
Annals of US Academy of Sciences, 2016
WHA nutrition targets/SDGs 2025
Worldwide Timing of Growth Faltering: Revisiting
Implications for Interventions

Mean anthropometric z scores according to age for all 54 studies, relative to the WHO standard (1 to 59 months).
pediatrics.aappublications.org at Tulane Univ on November 19, 2014
Findings Sample sizes were 462 854 for stunting, 485 152 for underweight, and 459 538 for
wasting. Overall, 35·6% (95% CI 35·4–35·9) of young children were stunted (ranging from 8·7%
[7·6–9·7] in Jordan to 51·1% [49·1–53·1] in Niger), 22·7% (22·5–22·9) were underweight
(ranging from 1·8% [1·3–2·3] in Jordan to 41·7% [41·1–42·3] in India), and 12·8% (12·6–12·9)
were wasted (ranging from 1·2% [0·6–1·8] in Peru to 28·8% [27·5–30·0] in Burkina Faso). At the
country level, no association was seen between average changes in the prevalence of child
undernutrition outcomes and average growth of per-head GDP. In models adjusted only for
country and survey-year fi xed eff ects, a 5% increase in perhead
GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989–0·995) for stunting, 0·986
(0·982–0·990) for underweight, and 0·984 (0·981–0·986) for wasting. ORs after adjustment for
the full set of covariates were 0·996 (0·993–1·000) for stunting, 0·989 (0·985–0·992) for
underweight, and 0·983 (0·979–0·986) for wasting. These fi ndings were consistent across
various subsamples and for alternative variable specifi cations. Notably, no association was
seen between per-head GDP and undernutrition in young children from the poorest household
wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990–1·004) for stunting,
0·999 (0·991–1·008) for underweight, and 0·991 (0·978–1·004) for wasting. Interpretation A
 10
%

90
%

Stunted and brain

development
Child development: risk factors for adverse outcomes in
developing countries

*Susan P Walker,*Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto Pollitt, Julie
A Carter, and the International Child Development Steering Group†
Child development: risk factors for adverse outcomes in
developing countries
*Susan P Walker,*Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto Pollitt, Julie A
Carter, and the International
Child Development Steering Group†
Child development: risk factors for adverse outcomes in
developing countries
*Susan P Walker,*Theodore D Wachs, Julie Meeks Gardner, Betsy Lozoff , Gail A Wasserman, Ernesto
Pollitt, Julie A Carter, and the International
Child Development Steering Group†
 Worldwide Timing of Growth Faltering: Revisiting
Implications for Interventions

Mean anthropometric z scores according to age for all 54 studies, relative to the WHO standard (1 to
59 months). Pediatrics 2010;125;e473; originally published online February 15,
2010pediatrics.aappublications.org at Tulane Univ on November 19, 2014
Increasing Pregnancy Body weight
BMI Pregravide total BW BW increasing BW increasing Trimester
Kg / m 2 increasing (Kg) Trimester II (rate kg III (rate kg per week)
per week)

underweight < 12,5 – 18 0,51 (0,44 – 0.58 ) 0,51 (0,44 – 0.58 )

18,5

Normal weight 11.5 - 16 0.42 (0.5 – 0.50 ) 0.42 (0.5 – 0.50 )

(18.5 – 24.9)

Overweight 7 – 11.5 0.28 (0.23 – 0.33) 0.28 (0.23 – 0.33)

25 – 29.9

Obese (> 30) 5–9 0.22 (0.17 – 0.27) 0.22 (0.17 – 0.27)

Institute of Medicine Research Centre, Rasmussen, 2009

Findings Sample sizes were 462 854 for stunting, 485 152 for underweight, and 459 538 for
wasting. Overall, 35·6% (95% CI 35·4–35·9) of young children were stunted (ranging from
8·7% [7·6–9·7] in Jordan to 51·1% [49·1–53·1] in Niger), 22·7% (22·5–22·9) were underweight
(ranging from 1·8% [1·3–2·3] in Jordan to 41·7% [41·1–42·3] in India), and 12·8% (12·6–12·9)
were wasted (ranging from 1·2% [0·6–1·8] in Peru to 28·8% [27·5–30·0] in Burkina Faso). At
the country level, no association was seen between average changes in the prevalence of
child undernutrition outcomes and average growth of per-head GDP. In models adjusted
only for country and survey-year fi xed eff ects, a 5% increase in perhead GDP was
associated with an odds ratio (OR) of 0·993 (95% CI 0·989–0·995) for stunting, 0·986 (0·982–
0·990) for
underweight, and 0·984 (0·981–0·986) for wasting. ORs after adjustment for the full set of
covariates were 0·996 (0·993–1·000) for stunting, 0·989 (0·985–0·992) for underweight, and
0·983 (0·979–0·986) for wasting. These fi ndings were consistent across various subsamples
and for alternative variable specifi cations. Notably, no association was seen between per-
head GDP and undernutrition in young children from the poorest household wealth quintile.
ORs for the poorest wealth quintile were 0·997 (0·990–1·004) for stunting, 0·999 (0·991–
1·008) for underweight, and 0·991 (0·978–1·004) for wasting.
Interpretation A quantitatively very small to null association was seen between increases in
per-head GDP and reductions in early childhood undernutrition, emphasising the need for
direct health investments to improve the nutritional status of children in low-income and
middle-income countries. Sebastian Vollmer, Kenneth Harttgen, Malavika A Subramanyam,
Current understanding of biologic processes indicates that women’s nutritional status before and
during early pregnancy may play an important role in determining early developmental processes
and ensuring successful pregnancy outcomes. We conducted a systematic review of the evidence
for the impact of maternal nutrition before and during early pregnancy (<12 weeks gestation) on
maternal, neonatal and child health outcomes and included 45 articles (nine intervention trials and
32 observational studies) that were identified through PubMed and EMBASE database searches
and examining review articles. Intervention trials and observational studies show that
periconceptional (<12 weeks gestation) folic acid supplementation significantly reduced the risk of
neural tube defects. Observational studies suggest that preconceptional and periconceptional
intake of vitamin and mineral supplements is associated with a reduced risk of delivering offspring
who are low birthweight and/or small-forgestational age (SGA) and preterm deliveries (PTD). Some
studies report that indicators of maternal prepregnancy size, low stature, underweight and
overweight are associated with increased risks of PTD and SGA. The available data indicate the
importance of women’s nutrition prior to and during the first trimester of pregnancy, but there is a
need for well-designed prospective studies and controlled trials in developing country settings that
examine relationships with low birthweight, SGA, PTD, stillbirth and maternal and neonatal
mortality. The knowledge gaps that need to be addressed include the evaluation of
periconceptional interventions such as food supplements, multivitamin-mineral supplements and/or
specific micronutrients (iron, zinc, iodine, vitamin B-6 and B-12) as well
as the relationship between measures of prepregnancy body size and composition and maternal,
neonatal and child health outcomes. Usha Ramakrishnan,a,b Frederick Grant,a,b Tamar
• Bukan masalah kesehatan semata, namun masalah
kependudukan
• Diperlukan aksi untuk menciptakan generasi emas di Th 2045
dimulai dari Jawa Tengah
Sumber: Guerrant et al. The impoverished gut-a triple burden of diarrhea, stunting, and chronic
diasease. Nat Rev Gastroenterol Hepatol. 2013 April ; 10(4): 220–229
MALNUTRITION HINDERS COGNITIVE
ACTIVITY
OLD THEORY
MALNUTRITION BRAIN DAMAGE DELAYED
INTELLECTUAL
NEW THEORY BRAIN DAMAGE DEVELOPMENT
(SOMETIMES REVERSIBLE)
LETHARGY AND MINIMAL
WITHDRAWAL EXPLORATION
OF ENVIRONMENT DELAYED
INTELLECTUAL
MALNUTRITIONILLNESSDELAYED DEVELOPMENT DEVELOPMENT
OF MOTOR SKILLS SUCH AS
CRAWLING AND WALKING LOWERED
EXPECTATIONS OF
CHILD FROM ADULTS
BECAUSE CHILD
APPEARS YOUNG

DELAYED PHYSICAL
GROWTH
POVERTY
LACK OF EDUCATIONAL
AND MEDICAL RESOURCES
 Figure. The stunting
syndrome
Sumber : Prendergrast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatrics and
International Child Health. 2014.34(4): 250-265
Prevalensi Stroke (0/00 ) berdasarkan kuintil,
Riskesdas2007
10
9
8
7
6
5
4
3
2
1
0
Q1 Q2 Q3 Q4 Q5 Total
Sumber: Atmarita