The Benefits of Midmorning Snack to Combat Stunting: A Longitudinal Panel Study in the Riau Province of Indonesia

Abstract

Aim: The aim of this research was to help stunted adolescents improve their nutritional status. Background: Stunting is a leading global nutritional problem, especially in developing countries such as Indonesia. This was a longitudinal panel study in the SMP Negeri 3 Pekanbaru Riau Province Junior High School in Indonesia. Objective: The objective of this study was to determine the impact of calcium and phosphorus supplementation via additional midmorning snacks for adolescents with stunting conditions. Methods: We included 36 participants, aged 12–15 years with a height-for-age Z-score of <-2 standard deviation. They underwent a one-month nutritional intervention during which selected snacks and high-calcium milk were given for midmorning snacks. The midmorning snack menu varied daily and included gado-gado (rice, boiled egg, potato, tempeh, tofu, long beans, cabbage & peanut sauce), fried vermicelli (vermicelli, omelet, cucumber & prawn crackers), batagor (tofu, cassava flour crackers, boiled egg & peanut sauce), lontong medan (rice, boiled egg, vermicelli, french fries, fried anchovy, green bean & carrots curry), sandwich (plain toast, omelet, cucumber, lettuce, tomato & chili sauce), chicken porridge (rice porridge, fried bread, shredded chicken & chicken broth), and fried rice teri (rice, anchovy, prawn crackers, cucumber, chili sauce & soy sauce). The total amount of energy from the meals and milk was 541.8 kcal (30 % of RDARecommended Dietary Allowance), 25 g of protein (50 % of RDA), 90 g of carbohydrate (30 % of RDA), and 600 mg of calcium (35 % of RDA). Meal and milk administration lasted 34 days in total. Data analysis and food intake consumption were conducted using the Pearson Product moments test. Results: The participants’ mean height-for-age Z-score before and after the nutritional intervention was -2.5 ± 0.4 (-3.2 — -2.0) and -2.3 ± 0.4 (-3.2 — -1.2), respectively. After the intervention, the rate of stunting was reduced up to 19.4%; the rate of calcium intake before the nutritional intervention was 50% below the recommended dietary allowance—27.3 ± 27.8 (3.3:100.0) %; the rate of phosphorus intake among the participants was sufficient. The rate of calcium intake after the nutritional intervention was 59.1 ± 19.0 (15.5 — 100.0) % due to which the nutritional quality of food before the intervention was still lacking, namely 52.7 ± 15.5 (28.4 — 86.3) after the nutrition intervention increased to 84.8 ± 20.3 (30.9 — 100.0); (r-value = 0.43; p-value = 0.01). Conclusion: The nutritional intervention increased calcium intake. The outcome of the nutritional intervention led to the improvement of nutritional status from stunting to the normal category. Other: The midmorning snack given to teenagers is a snack meal available in the school canteen that they can buy with pocket money. It is necessary to create awareness about the importance of consuming high calcium midmorning snacks for teenagers. The activity of consuming high-calcium midmorning snacks by adolescents can be continued independently. So far, teenagers do not use pocket money to buy midmorning snacks that are high in calcium, but they buy other types of snacks that are low in calcium, consisting of pastel, noodles, tofu, fritters, pao, tempeh, rice cake, and eclairs. So far, no nutritional intervention has significantly increased the nutritional status of stunted children to normal levels; however, this type of intervention may become a viable option in the future.