Determinants of Optimal Breastfeeding Practices in Indonesia: Findings From the 2017 Indonesia Demographic Health Survey.

OBJECTIVES: Understanding the factors influencing mothers' decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia. METHODS: We used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect. RESULTS: The risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant's age, birth pattern, household wealth index, and the mother's occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant's age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05). CONCLUSIONS: Breastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.

A mothers' perspective on fish and her child's fish consumption in Surakarta, Indonesia.

BACKGROUD/OBJECTIVES: Understanding the factors associated with fish consumption is necessary to determine strategies to improve the fish consumption particularly those high in omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). The aim of this study was to analyse the correlation between a mother's perspective on fish and actual fish consumption in their children. SUBJECTS/METHODS: Two hundred thirty-one elementary school children grade 3-6 and their mothers in Surakarta were recruited using multi stage random sampling for this study. Data was collected in July and August 2017. A validated questionnaire consisted of 3 topics including knowledge related to the health benefits and organoleptic properties of fish and cooking technique-related attitudes on fish were used to measure the mother's response to the fish properties. A validated food frequency questionnaire and a food picture book of fish specifically designed for the survey were developed and used to assess fish consumption of the children. A χ2 test was used to analyse the correlation between the mothers' perspective on fish and their children's fish consumption. RESULTS: The median fish consumption in children was 65 g/d with fried non-oily or lean fish, e.g., milkfish (locally called Bandeng) and catfish (locally called Lele) were consumed more than oily fish as well as processed fish products. Of all children, 31% met the fish consumption recommended by the Environmental Protection Agency-Food and Drug Administration 2017. There was no relationship between a mother's knowledge related to health benefits, organoleptic properties and cooking technique-related attitude toward fish and her child's fish consumption. CONCLUSIONS: The fish consumption of children is not influenced by their mother's perspective on fish. Nutrition education strategies are warranted to improve fish consumption and maintain the optimal benefits by consuming fish, including fish high in n-3 LCPUFA.

Stunting is a recognized problem: Evidence for the potential benefits of ω-3 long-chain polyunsaturated fatty acids.

Stunting remains a major nutritional problem worldwide, especially in middle- and low-income countries including Indonesia. A number of nutritional feeding programs to cure stunting are basically addressing the problem of malnutrition. These programs are particularly designed to promote recovery of normal metabolic function and weight gain. The currently available remedial formula for malnutrition contains energy and nutrients to recover the weight, but there is less nutrition that would support optimal functional development of tissues including the central nervous system. Research has documented that sufficient intakes of dietary ω-3 long-chain polyunsaturated fatty acids are important for optimal health throughout the life span, especially brain development and cognition. The aim of this study was to review the evidence for the role of food sources of these fatty acids on children's health and growth. To our knowledge, very little work has been conducted on remedial formulas enriched with ω-3 long-chain polyunsaturated fatty acids for malnutrition and optimal health, highlighting a need for intervention studies investigating the health benefits of the formula for malnutrition and optimal health, which may prevent stunting and also may promote optimal health.

Effect of replacing bread, egg, milk, and yogurt with equivalent ω-3 enriched foods on ω-3 LCPUFA intake of Australian children.

OBJECTIVE: In countries with traditionally low fish consumption such as Australia, foods enriched with ω-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA) may play a role in meeting ω-3 LCPUFA intakes for optimal health. The aim of this study was to assess the effect of replacing bread, egg, milk, and yogurt with ω-3 LCPUFA enrichment of these foods on total ω-3 LCPUFA intake in Australian children's diets. METHODS: Dietary modeling was undertaken using survey data from a nationally representative sample of 4487 children (2249 boys, 2238 girls) ages 2 to 16 y in whom the Multiple Source Method was used to estimate usual ω-3 LPUFA intakes distributions from two 24-h dietary recalls, corrected for within-person variation; 15 models were constructed. RESULTS: The adjusted mean ± SD and median and interquartile range (IQR) of usual dietary intakes of ω-3 LCPUFA gradually increased from 2.5 ± 0.8 to 7.1 ± 4.9 mg/d and 2.3 (1.9-2.9) to 5.4 (3.6-9.2), respectively, after the modeling (P = 0.001 for each model). Median (IQR) intake of total ω-3 LCPUFAs in non-fish eaters and fish eaters was 1.4 (0.8-2.3) and 2.3 (1.0-6.1) mg/d, respectively, which increased threefold to 4.3 (2.6-7.8) and 7.5 (3.9-13) mg/d, respectively, after replacement of all four ω-3 enriched foods. CONCLUSION: Replacement of four core foods with ω-3 enriched alternatives resulted in improved simulated ω-3 LCPUFA intakes in Australian children but not to optimal levels of intake. Increased fish consumption is still the most effective strategy for increasing ω-3 LCPUFA intake.

Food patterns of Australian children ages 9 to 13 y in relation to ω-3 long chain polyunsaturated intake.

OBJECTIVE: The aim of this study was to examine food patterns of Australian children ages 9 to 13 y in relation to ω-3 long-chain polyunsaturated fatty acid (ω-3 LCPUFA) intake. METHODS: Secondary analysis was conducted on nationally representative food data of 1110 Australian children ages 9 to 13 y (525 boys and 585 girls) that was obtained using two 24-h recalls. Principle component factor analysis was used to identify food patterns. Discriminant function analysis was used to identify the relationship between the food patterns and total ω-3 LCPUFA intake. RESULTS: Four major food patterns emerged for each sex. For boys these were labeled: "snack foods," "soft drinks," "vegetables," and "pork and meat chops, steak, and mince." For girls they were labeled: "vegetables," "take-away," "tea, coffee, iced coffee drinks" and "canned meals and soup." Fish consumption bought from take-away outlets was more frequently consumed in the "soft drink" (r = 0.577) and take-away (r = 0.485) food pattern in boys and girls, respectively. In contrast, fish prepared at home was more often consumed in "vegetables" in both boys (r = 0.018) and girls (r = 0.106), as well as in the "pork and meat chops, steak and mince" food pattern in boys (r = 0.060). There was a trend that in boys, the "vegetables" group discriminated children who consumed ω-3 LCPUFA levels similar to adequate intakes (AI) (P = 0.067), whereas in girls, the take-away food pattern discriminated for being a fish consumer (P = 0.060). CONCLUSIONS: Dietary patterns associated with a high consumption of vegetables and "take-aways" food that include meat and fish are likely to positively influence dietary ω-3 LCPUFA intake in Australian children.

Dietary intake and food sources of EPA, DPA and DHA in Australian children.

Secondary analysis of the 2007 Australian National Children's Nutrition and Physical Activity survey was undertaken to assess the intake and food sources of EPA, DPA and DHA (excluding supplements) in 4,487 children aged 2-16 years. An average of two 24-h dietary recalls was analysed for each child and food sources of EPA, DPA and DHA were assessed using the Australian nutrient composition database called AUSNUT 2007. Median (inter quartile range, IQR) for EPA, DPA and DHA intakes (mg/day) for 2-3, 4-8, 9-13, 14-16 year were: EPA 5.3 (1.5-14), 6.7 (1.8-18), 8.7 (2.6-23), 9.8 (2.7-28) respectively; DPA 6.2 (2.2-14), 8.2 (3.3-18), 10.8 (4.3-24), 12.2 (5-29) respectively; and DHA 3.9 (0.6-24), 5.1 (0.9-26), 6.8 (1.1-27), 7.8 (1.5-33) respectively. Energy-adjusted intakes of EPA, DPA and DHA in children who ate fish were 7.5, 2 and 16-fold higher, respectively (P < 0.001) compared to those who did not eat fish during the 2 days of the survey. Intake of total long chain n-3 PUFA was compared to the energy adjusted suggested dietary target (SDT) for Australian children and 20 % of children who ate fish during the 2 days of the survey met the SDT. Fish and seafood products were the largest contributors to DHA (76 %) and EPA (59 %) intake, while meat, poultry and game contributed to 56 % DPA. Meat consumption was 8.5 times greater than that for fish/seafood. Australian children do not consume the recommended amounts of long chain omega-3 fatty acids, especially DHA, which could be explained by low fish consumption.