title: Double Burden of Malnutrition in Rural West Java: Household-Level Analysis for Father-Child and Mother-Child Pairs and the Association with Dietary Intake.
abstract: Indonesia is facing household-level double burden malnutrition. This study aimed at examining (1) household-level double burden for the mother-child and father-child pairs; (2) risk of adiposity of double burden households; and (3) associated dietary factors. Subjects were 5th and 6th grade elementary school children (n = 242), their mothers (n = 242), and their fathers (n = 225) in five communities (1 = urban, 4 = rural) in the Bandung District. Questionnaires on socioeconomic factors, blood hemoglobin measurements, and anthropometric measurements were administered. For adults, body fat percentage (BF%) was estimated by bioelectrical impedance (BF%-BI) and by converting skinfold thickness (ST) data using Durnin and Womersley's (1974) formula (BF%-ST). Food frequency questionnaires were also completed. Double burden was defined as coexistence of maternal or paternal overweight (Body mass index (BMI) ≥ 23) and child stunting (height-for-age z-score <-2) within households. Maternal-child double burden occurred in 30.6% of total households, whereas paternal-child double burden was only in 8.4%. Mothers from double burden households showed high adiposity; 87.3% with BF%-BI and 66.2% with BF%-ST had BF% >35%, and 60.6% had waists >80 cm. The major dietary patterns identified were "Modern" and "High-animal products". After controlling for confounding factors, children in the highest quartile of the "High-animal products" dietary pattern had a lower risk of maternal-child double burden (Adjusted OR: 0.46, 95% CI: 0.21-1.04) than those in the lowest quartile. Given that the "High-animal products" dietary pattern was associated with the decreased risk of maternal-child double burden through a strong negative correlation with child stunting, improving child stunting through adequate intake of animal products is critical to solve the problem of maternal-child double burden in Indonesia.
authors.affiliation: Graduate Program in Sustainability Science-Global Leadership Initiative (GPSS-GLI), Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa City 277-8563, Japan. sekiyama@k.u-tokyo.ac.jp.
authors.forename: Makiko
authors.initials: M
authors.lastname: Sekiyama
authors.affiliation: Research Institute for Humanity and Nature, 457-4 Motoyama, Kamigamo, Kita-ku, Kyoto 603-8047, Japan. jiang@chikyu.ac.jp.
authors.forename: Hong Wei
authors.initials: HW
authors.lastname: Jiang
authors.affiliation: Institute of Ecology, Research Institute, Padjadjaran University, Jl. Sekeloa Selatan I, Bandung 40132, Indonesia. budhi_gunawan@unpad.ac.id.
authors.forename: Budhi
authors.initials: B
authors.lastname: Gunawan
authors.affiliation: Faculty of Medicine, Airlangga University, Jl. Mayjen. Prof. Dr. Moestopo 47, Surabaya 60132, Indonesia. lindaperisdiono@yahoo.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Dewanti
authors.affiliation: RSET, Institute of Science and Engineering, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan. rhonda@se.kanazawa-u.ac.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Honda
authors.affiliation: Department of Human Ecology, School of International Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. hana-shimizu@umin.ac.jp.
authors.forename: Hana
authors.initials: H
authors.lastname: Shimizu-Furusawa
authors.affiliation: Institute of Ecology, Research Institute, Padjadjaran University, Jl. Sekeloa Selatan I, Bandung 40132, Indonesia. oekan.abdoellah54@gmail.com.
authors.forename: Oekan S
authors.initials: OS
authors.lastname: Abdoellah
authors.affiliation: Department of Human Ecology, School of International Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. chiho@humeco.m.u-tokyo.ac.jp.
authors.forename: Chiho
authors.initials: C
authors.lastname: Watanabe
mesh_terms: D050154:Adiposity; D000818:Animals; D001823:Body Composition; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D004032:Diet; D005191:Family Characteristics; D005219:Father-Child Relations; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D009034:Mother-Child Relations; D050177:Overweight / Q000453:epidemiology; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: Indonesia; adiposity; double burden; food frequency questionnaire; malnutrition