Background: Undernutrition among children under-five years of age is a long-term major concern in Indonesia. Over 20 years, the prevalence of undernutrition in this target group only decreased by 7.3% from 44.5% in 1990 to 37.2% in 2013. The most common forms of undernutrition in Indonesian young children are stunting and wasting, strong predictors of mortality and morbidity among young children. Inappropriate dietary intake is an important immediate risk factor for development of undernutrition as demonstrated in Indonesian children by a low rate of exclusive breastfeeding and poor complementary feeding, specifically relative to a high consumption of unhealthy snacks. Links between maternal and child dietary intake have been well documented, but few have examined the association of snacks with child nutrition status, which is critical for facilitating the efficacy of prevention and treatment of undernutrition among Indonesian young children.Specific aims: The two Specific Aims of this study were: 1) to examine the relationship between mother’s dietary intake quality and weight status and risk for stunting and wasting in children 6-23 months of age in Indonesia, and 2) to examine the relationship between child feeding practices, including unhealthy snack consumption, dietary quality, and risk for stunting and wasting in children 6-23 months of age in Indonesia. Methods: The Indonesia Demographic and Health Survey (IDHS) of 2010 was used to assess maternal and child diet-related factors in association with stunting and wasting in children 6-23 months of age in Indonesia. The IDHS, conducted by The Ministry of Health every three years, included a single 24-hour dietary recall and anthropometric measurements from the targeted sample. Mothers’ weight status was calculated using body mass index (BMI). Dietary quality for the mothers was determined from the 24-hour dietary recalls using the minimum dietary diversity (MDD) score recommended by FAO in 2014. Stunting and wasting were defined as height-for-age z-scores (HAZ) and weight-for-height z-scores (WHZ) lower than -2 respectively. Child dietary intake data included breastfeeding (past and current) and complementary feeding (minimum dietary diversity score and frequency of unhealthy snack consumption) practices. Path model analysis was conducted using Mplus software. Results: After data cleaning, there were 2,457 mother and child dyads. Stunting and wasting rates were 37.3% and 14.5% respectively. Mothers’ BMI had direct a positive effect on stunting (p = 0.05). There was a significant moderating effect of mothers’ MDD on child’s unhealthy snack consumption relative to wasting status, but not stunting. Risk for child stunting was for not breastfeeding (OR: 1.29, p-value < 0.05) and high consumption of unhealthy snacks (OR: 1.13, p-value < 0.05), while risk for wasting was lower with a high consumption of unhealthy snacks (OR: 0.80, p-value < 0.05). Conclusion: Not breastfeeding and a high consumption of unhealthy snacks were found as the independent factors associated with stunting in Indonesian children 6-23 months of age. High consumption of unhealthy snacks interestingly had a protective effect for wasting, while mothers’ MDD moderated the association between child high consumption of unhealthy snacks and wasting status. Therefore, findings from the current study suggest that improving breastfeeding and complementary feeding of young children can enhance their nutritional status and have short- and long-term impacts on reducing stunting and wasting.
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