Low intake of essential amino acids and other risk factors of stunting among under-five children in Malang City, East Java, Indonesia


Background: The lack of energy-protein intake has been shown to increase the risk of stunting in under-five children. The quality of protein in food is assessed by the completeness of amino acid content. This study aims to determine the amount of essential amino acid (EAAs) intake and other risk factors of stunting among under-five children.
Design and methods: A descriptive, case-control study was performed in the work area of Kedungkandang Health Center Malang. The subjects were 24-59 month-old children with a total of 23 stunted (height-for-age Z-score (HAZ) <-2 SD) and 57 normal children (HAZ ≥-2 SD). Furthermore, the data were collected using anthropometric measurement, validated and pre-tested questionnaires, which were analyzed using multiple logistic regression.
Results: The intake of all the nine EAAs in stunted children was lower than that of non-stunted children. However, only histidine, isoleucine, and methionine were significantly different (p<0.05). The significant risk factors of stunting include a family income per month fewer than the Regional Minimum Wages [OR=12.06, 95% CI 1.83-79.53], being underweight [OR=7.11, 95% CI 1.49-33.93], breastfeeding of less than 6 months [OR=5.34, 95% CI 1.28-22.20], and the lack of EAA methionine intake [OR=0.14, 95% CI 0.03-0.67].
Conclusions: Stunted children may not receive sufficient dietary intake of EAAs in their diet. Furthermore, the lack of EAAs intake, especially methionine, alongside low family income, underweight, lack of breastfeeding and variety in food consumption were the risk factors of stunting among under-five children in a selected Health Center in Malang City, Indonesia.



PlumX Metrics


Download data is not yet available.


UNICEF, WHO, World Bank Group. Levels and trends in child malnutrition. UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates. Key findings of the 2017 edition. New York: World Health Organization; 2017.

Ministry of Health Republic of Indonesia. Basic Health Research 2018. Jakarta, Indonesia; Ministry of Health Republic of Indonesia; 2018.

World Health Organization. Country Profile Indicators: Interpretation Guide. Nutrition Landscape Information System. Geneva: World Health Organization; 2010.

World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva: World Health Organization; 1995.

Dewey KG, Begum K. Long-term consequences of stunting in early life. Matern Child Nutr 2011;7:5–18. DOI: https://doi.org/10.1111/j.1740-8709.2011.00349.x

Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427–51. DOI: https://doi.org/10.1016/S0140-6736(13)60937-X

Semba RD, Shardell M, Sakr Ashour FA, et al. Child stunting is associated with low circulating essential amino acids. EBioMed 2016;6:246–52. DOI: https://doi.org/10.1016/j.ebiom.2016.02.030

Satriawan E. [Strategi Nasional Percepatan Pencegahan Stunting 2018-2024 (National strategy for the acceleration of stunting prevention 2018-2024)].[in Indonesian]. National Team for the Acceleration of Poverty Reduction (TNP2K) Secretariat of the Vice President of the Republic of Indonesia. 2018. Available from: http://www.tnp2k.go.id/filemanager/files/Rakornis 2018/Sesi 1_01_RakorStuntingTNP2K_Stranas_22Nov2018.pdf

Wu G. Functional amino acids in growth, reproduction, and health. Adv Nutr 2010;1:31–7. DOI: https://doi.org/10.3945/an.110.1008

Almatsier S. [Prinsip Dasar Ilmu Gizi (Basic principles of nutrition)].[Book in Indonesian]. Jakarta: PT Gramedia Pustaka Utama; 2009.

Nuss ET, Tanumihardjo SA. Quality protein maize for Africa: Closing the protein inadequacy gap in vulnerable populations. Adv Nutr 2011;2:217-24. DOI: https://doi.org/10.3945/an.110.000182

Lwanga SK, Lemeshow S. Sample size determination in health studies: A practical manual. World Health Organization. Geneva, Switzerland; 1991.

de Onis M, Onyango AW, Van den Broeck J, et al. Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull 2004;25:S27–36. DOI: https://doi.org/10.1177/15648265040251S105

Mukrie N, Chatijah S, Mosoar S, et al. Daftar komposisi zat gizi pangan Indonesia (List of nutritional composition of Indonesian food)].[in Indonesian]. Jakarta: Directorate of Community Nutrition, Center for Nutrition Research and Development; 1995.

Nutrisurvey. Nutrition surveys and calculations. Jakarta: Guidelines, software and additional Information. SEAMEO TROPMED RCCN-University of Indonesia; 2007.

Ministry of Health of the Republic of Indonesia. [Angka Kecukupan Gizi (AKG) (Nutritional Adequacy Rate (RDA)].[in Indonesian]. Jakarta: Ministry of Health of the Republic of Indonesia; 2013.

Ministry of Health of the Republic of Indonesia. [Studi Diet Total: Potret Pola Makan Penduduk Indonesia Saat Ini. Pertemuan Ilmiah Berkala Badan Litbangkes (Total Diet Study: A Portrait of Indonesia's Current Diet. Periodic Scientific Meeting of the National Research and Development Agency)].[in Indonesian]. Jakarta: Ministry of Health of the Republic of Indonesia; 2014.

Bender DA. Protein-energy malnutrition: problems of undernutrition. In: Introduction to nutrition and metabolism. New York: CRC Press Taylor & Francis Group; 2004. p. 233–6.

Pillai RR, Kurpad A V. Amino acid requirements in children and the elderly population. Br J Nutr 2012;108:S44–9. DOI: https://doi.org/10.1017/S0007114512002401

Uauy R, Suri DJ, Ghosh S, et al. Low circulating amino acids and protein quality: An interesting piece in the puzzle of early childhood stunting. EBioMedicine 2016;8:28–9. DOI: https://doi.org/10.1016/j.ebiom.2016.05.026

National Research Council (US) Subcommittee. The Tenth Edition of the Recommended Dietary Allowances. Recommended Dietary Allowances. Washington: National Academies Press; 1989.

Maulidiana AR, Dwipajati D. [Perbandingan Jumlah Asupan Asam Amino Antara Balita Stunting Dan Tidak Stunting Di Kecamatan Kedungkandang Kota Malang (Comparison of amino acid intake between stunting and non-stunting toddlers in Kedungkandang District, Malang City)].[Article in Indonesian]. J Inf Kesehat Indones 2019;5:12. DOI: https://doi.org/10.31290/jiki.v5i1.928

World Health Organization. Protein and amino acid requirements in human nutrition. Technical Report Series. Geneva, Switzerland: World Health Organization; 2007.

Khoirun N, Nadhiroh SR. [Faktor Yang Berhubungan Dengan Kejadian Stunting Pada Balita (Factors associated with the incidence of stunting in toddlers)].[Article in Indonesian]. Media Gizi Indones 2015;10:13–9.

Jesmin A, Yamamoto SS, Malik AA, et al. Prevalence and determinants of chronic malnutrition among preschool children: A cross-sectional study in Dhaka City, Bangladesh. J Heal Popul Nutr 2011;29:494. DOI: https://doi.org/10.3329/jhpn.v29i5.8903

Setiawan E, Machmud R, Masrul M. [Faktor-Faktor yang Berhubungan dengan Kejadian Stunting pada Anak Usia 24-59 Bulan di Wilayah Kerja Puskesmas Andalas Kecamatan Padang Timur Kota Padang Tahun 2018 (Factors associated with the incidence of stunting in children aged 24-59 months in the work area of the Andalas Public Health Center, Padang Timur District, Padang City in 2018)].[Article in Indonesian]. J Kesehat Andalas 2018;7:275–84. DOI: https://doi.org/10.25077/jka.v7i2.813

Correia LL, Silva AC e, Campos JS, et al. Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil. Rev Saude Publica 2014;48:19–28. DOI: https://doi.org/10.1590/S0034-8910.2014048004828

Apriluana G, Fikawati S. [Analisis Faktor-Faktor Risiko terhadap Kejadian Stunting pada Balita (0-59 Bulan) di Negara Berkembang dan Asia Tenggara (Analysis of risk factors for stunting incidence in toddlers (0-59 months) in developing countries and Southeast Asia)].[Article in Indonesian]. Media Penelit dan Pengemb Kesehat 2018;28:247-56. DOI: https://doi.org/10.22435/mpk.v28i4.472

Semba RD, de Pee S, Sun K, et al. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet 2008;371:322–8. DOI: https://doi.org/10.1016/S0140-6736(08)60169-5

Maryunani A. Ilmu Kesehatan Anak Dalam Kebidanan (Child health science in midwifery)].[ in Indonesian].Jakarta: Trans Info Media; 2010.

Sundari E, Nuryanto N. [Hubungan asupan protein, seng, zat besi, dan riwayat penyakit infeksi dengan z-score TB/U pada balita (The relationship between protein, zinc, iron intake, and a history of infectious disease with the z-score of TB in children under five)].[Article in Indonesian]. J Nutr Coll 2016;5:250–9.

Lestari W, Margawati A, Rahfiludin Z. [Faktor risiko stunting pada anak umur 6-24 bulan di kecamatan Penanggalan kota Subulussalam provinsi Aceh (Risk factors for stunting in children aged 6-24 months in the Penanggalan sub-district, Subulussalam city, Aceh province)].[Article in Indonesian]. Indones J Nutr 2014;3:37–45.

Fikadu T, Assegid S, Dube L. Factors associated with stunting among children of age 24 to 59 months in Meskan district, Gurage Zone, South Ethiopia: A case-control study. BMC Public Health 2014;14:800. DOI: https://doi.org/10.1186/1471-2458-14-800

Paudel R, Pradhan B, Wagle RR, et al. Risk factors for stunting among children: A community based case control study in Nepal. Kathmandu Univ Med J 2012;10:18–24. DOI: https://doi.org/10.3126/kumj.v10i3.8012

Walvekar AS, Srinivasan R, Gupta R, et al. Methionine coordinates a hierarchically organized anabolic program enabling proliferation. Mol Biol Cell 2018;29:3183–200. DOI: https://doi.org/10.1091/mbc.E18-08-0515

Finkelstein JD. Methionine metabolism in mammals. J Nutr Biochem 1990;1:228–37. DOI: https://doi.org/10.1016/0955-2863(90)90070-2

Krasevec J, An X, Kumapley R, et al. Diet quality and risk of stunting among infants and young children in low- and middle-income countries. Matern Child Nutr 2017;13:e12430. DOI: https://doi.org/10.1111/mcn.12430

Mahmudiono T, Sumarmi S, Rosenkranz RR. Household dietary diversity and child stunting in East Java, Indonesia. Asia Pac J Clin Nutr 2017;26:317.

Ethics Approval
All procedures were approved by the research ethics committee of Poltekkes Kemenkes Malang, Indonesia (No.: 435/KEPK-POLKESMA/2018)
Children, essential amino acid, protein quality, stunting, under-five
  • Abstract views: 603

  • PDF: 67
How to Cite
Rizky Maulidiana, A., & Sutjiati, E. (2021). Low intake of essential amino acids and other risk factors of stunting among under-five children in Malang City, East Java, Indonesia. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2161