a holistic approach to prevent stunting from early life

4th International Symposium on Health Research 14th National Congress of Indonesian Public Health Association

Bali, November 27-30, 2019

Prof. Hardinsyah MS. PhD Profesor in Nutrition, IPB University President, Food and Nutrition Society of Indonesia President, Federation of Asian Nutrition Societies (FANS)

A HOLISTIC APPROACH

TO PREVENT STUNTING FROM EARLY LIFE

1 Hardin ISHR & NCIPHA 29/11/19

1. Stunting 2. Risk Factors 3. Holistic Approach 4. Conclussions

A HOLISTIC APPROACH

TO PREVENT STUNTING FROM EARLY LIFE


1.

STUNTING


Umur Median panjang

atau Tinggi Badan

Normal (cm)

Tambahan Panjang atau

tinggi dari periode

sebelumnya (cm/tahun)

At born 50 cm -

6 months 68 cm 18 cm/6 months

1 yrs 76 cm 8 cm/6 months

2 yrs 97 cm 5 cm/6 months

8 yrs 127 cm 2.5 cm/6 months

Median Length or Height of Normal Children


Am J Clin Nutr 2019;110:498–507.

Stunting is in part a biological response to

previous episodes of being wasted or a

deleterious form of adaptation to more overt

undernutrition (wasting).

We are failing to recognize the importance of

wasting simply because it tends to be more

acute and treatable.

2.

RISK FACTORS:

A REVIEW FROM DEVELOPING COUNTRIES

Major Risk Factors

Nutrient adequacy & food safety

Hygiene & Sanitation

Metabolic disorders

Genetic

Two Decades Ago:

Low birthweight and early childhood protein-

energy effects of malnutrition on mental, motor,

and behavioural development (Grantham-

McGregor eta al, 1999)

Vir SC (2016)

Improving women’s nutrition imperative for rapid

reduction of childhood stunting in South Asia:

coupling of nutrition specific interventions with

nutrition sensitive measures essential Maternal &

Child Nutrition (2016), 12 (Suppl. 1), pp. 72–90

Prawirohartono, EP et al (2016). Prognostic factors at birth for stunting at 24

months of age in rural Indonesia. Paediatr Indones, Vol. 56, No. 1, January 2016

Li, Chao (2017). Efect of maternal pre-pregnancy underweight and average

gestational weight gain on physical growth and intellectual development of

early school-aged Children. Scientific Report (2018) 8:12014

Underweight Maternal Pre-pregnancy double the risk

of underweight, stunting and thinnies of infant born

Infants born with LBW were 1.74 times more likely to be

stunted than those born with normal weight.

Boys were 1.27 times more likely to be stunted than

girls.

Infants with a history of neonatal illness 1.23 times

more susceptible to stunting.

Being poor significantly associated with stunting

(OR = 1.3)

Based on 3024 children

aged of 12–23 months of

the Riskesdas (2010) by

Aryastami, NK (2017).

Nguyen PH (2017). Preconception Micronutrient Supplementation

with Iron and Folic Acid Compared with Folic Acid Alone Affects Linear

Growth and Fine Motor Development at 2 Years of Age: A Randomized

Controlled Trial in Vietnam. J Nutr 2017;147:1593–601

3.

HOLISTIC APPROACH

Vir SC (2016) Maternal &

Child Nutrition (2016), 12

(Suppl. 1), pp. 72–90

Nutrients Yes – It is mostly from Food

What sort of nutrients and foods?

Nutrients proven for linear growth:

Protein, especially collagen & a complete

AA for GH

Fatty acids - EFA

Energy

Water

Mineral: Ca, P, Zn, Mg, I, Fe

Vitamin : A, C, D, Folate

Bone science related to Linear Growth

20 Hardin PERGIZI NTT 23/11/19

Cartillage development during infant

Majority of Cartillage components are collogaen, water, minerals and other organic compound


Bone composition


AA in Collagen

1

2

3

4

5


IGF1 Hormone and Stunting

Syed, S et al (2018)

Growth Hormone (GH) 1. Growth 2. Development 3. Sexual 4. Mineral mobilization

Headey D (2018) in IFPRI

Eating an egg a day for children 6-

9 Mo during 6 Mo reduced the

prevalence of stunting (Lora

Lannotti et al, 2017)

Fish & Meat Intake


Environtmental factors

Vilcins et al (2018)

Environmental Factors

Associated with Child Stunting


Arsenic exposure reduce (IGF-1) & hampers linear

growth

lower IGF-1 effects on stunting (Ahmed S et al 2014)


In USA &n Medan: As terendah dlm beras

putih d& tertinggi dlm beras merah (US-

FDA 2007 & Ginting et al 2015)

= 0.069 - 0.371 mg/kg 1 Hardin ISHR & NCIPHA 29/11/19

Negara Rice samples Mean ± SD (mg/kg)

Indonesia (Silalahi et al 2018) 4 0.069 ±0.003 (P)

0.306 ± 0.010 (M)

Thailand 6 0.200 ± 0.025

Pakistan 9 0.147 ± 0.055

India 38 0.103 ± 0.048

Mesir 5 0.097 ± 0.044

Arab (Madinah) 70 0.136 (0.026–0.464)

Autralia (Brisbane) 12 0.0188

USA 9 0.257 ± 0.142

Perancis 1 0.183

Suriname 1 0.290

Shraim AM et al (2017). Rice is a potential dietary source of not only arsenic but also other toxic elements like lead and chromium. Arabian Journal of Chemistry, vol 34. S

Additional policy and programs on

1. Strengthening and scale up the current nutrition & health programs for teen girls and pregnant women

2. Surveillance (include intervention) on pre-pregnancy nutritional status (CED) & pregnancy weight gain (1st, 2nd, & 3rd trimester) for preventing LBW & SL on new infants born (healthy mothers healthy infants)

3. Better hygiene, sanitation & environmental health

4. Strengthening roles of posyandu on maternal & child nutrition & health

5. Promoting balance diet, especially animal foods & fruits

6. Strengthening food & nutrition security (include food safety)


Optimize the role/function of family

To Optimize PPPPP -

Public, private, profesional people partnership)


Let know girls and young women:

Preventing stunting

=> both child & mother will look healthier

& younger


4.

CONCLUSIONS

Stunting caused by several direct & indirect causal factors

Preventing stunting holistically from the early

life through • Quality nutrient adequacy (animal food &

fruit) • Better food safety & security • Better hiegine & sanitation • Healthy life style • Family & social economic empowerment • PPPPP


Hardinsyah 08129192259


a holistic approach to prevent stunting from early life

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