title: Consumption of micronutrient-fortified milk and noodles is associated with lower risk of stunting in preschool-aged children in Indonesia.
abstract: BACKGROUND
  Stunting is highly prevalent in developing countries and is associated with greater morbidity and mortality. Micronutrient deficiencies contribute to stunting, and micronutrient-fortified foods are a potential strategy to reduce child stunting.
  
  
  OBJECTIVE
  To examine the relationship between the use of fortified powdered milk and noodles and child stunting in a large, population-based sample of Indonesian children.
  
  
  METHODS
  Consumption of fortified milk and fortified noodles was assessed in children 6 to 59 months of age from 222,250 families living in rural areas and 79,940 families living in urban slum areas in Indonesia.
  
  
  RESULTS
  The proportions of children who consumed fortified milk and fortified noodles were 34.0% and 22.0%, respectively, in rural families, and 42.4% and 48.5%, respectively, in urban families. The prevalence of stunting among children from rural and urban families was 51.8% and 48.8%, respectively. Children from rural and urban families were less likely to be stunted if they consumed fortified milk (in rural areas, OR = 0.87; 95% CI, 0.85 to 0.90; p < .0001; in urban areas, OR = 0.80; 95% CI, 0.76 to 0.85; p < .0001) or fortified noodles (in rural areas, OR = 0.95; 95% CI, 0.91 to 0.99;p = .02; in urban areas, OR = 0.95; 95% CI, 0.91 to 1.01; p = .08) in multiple logistic regression models adjusted for potential confounders. In both rural and urban families, the odds of stunting were lower when a child who consumed fortified milk also consumed fortified noodles, or when a child who consumed fortified noodles also consumed fortified milk.
  
  
  CONCLUSIONS
  The consumption of fortified milk and noodles is associated with decreased odds of stunting among Indonesian children. These findings add to a growing body of evidence regarding the potential benefits of multiple micronutrient fortification on child growth.
authors.affiliation: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. rdsemba@jhmi.edu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.forename: Regina
authors.initials: R
authors.lastname: Moench-Pfanner
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.forename: Saskia
authors.initials: S
authors.lastname: de Pee
authors.forename: Nasima
authors.initials: N
authors.lastname: Akhter
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Rah
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Campbell
authors.forename: Jane
authors.initials: J
authors.lastname: Badham
authors.forename: Martin W
authors.initials: MW
authors.lastname: Bloem
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraemer
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019049:Developed Countries; D005260:Female; D005511:Food Handling; D005527:Food, Fortified / Q000032:analysis; D006130:Growth Disorders / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage / Q000627:therapeutic use*; D008892:Milk / Q000737:chemistry; D011159:Population Surveillance; D011204:Poverty Areas; D015995:Prevalence; D012306:Risk; D012423:Rural Health; D014504:Urban Health
chemical_list: D018977:Micronutrients