Akses Pangan, Kualitas Diet, Praktik Pemberian Makan pada Anak Usia 24–59 Bulan Stunting dan Normal

Abstract

Kajian mengenai asupan zat gizi mikro pada balita stunting di Indonesia masih terbatas. Sebagian besar penelitian sebelumnya berfokus pada jumlah asupan zat gizi tanpa mempertimbangkan estimasi bioavailabilitas, khususnya zat gizi mikro esensial seperti seng dan besi. Oleh karena itu, penelitian ini bertujuan untuk menganalisis perbedaan Akses Pangan, Kualitas Diet, Praktik Pemberian Makan Pada Balita Stunting dan Normal. Penelitian ini menggunakan desain comparative cross-sectional study. Lokasi penelitian mencakup Puskesmas Purwasari yang membawahi Desa Sukadamai, Purwasari, dan Petir, serta Puskesmas Kampung Manggis yang membawahi Desa Dramaga, Neglasari, dan Sinarsari, Kecamatan Dramaga. Penelitian ini dilaksanakan pada bulan 01 - 26 Agustus 2025 dan telah mendapat Persetujuan Etik dari Komisi Etik Penelitian yang Melibatkan Subjek Manusia Institut Pertanian Bogor, Nomor 1838/IT3.KEPMSM-IPB/SK/2025. Jumlah sampel total 120 balita (60 balita stunting dan 60 balita normal) dipilih berdasarkan kriteria inklusi. Data primer yang dikumpukan mencakup sosioekonomi, karakteristik anak, akses pangan menggunakan Household Food Security Scale Module (HFSSM), praktik pemberian makan menggunakan Child Feeding Questionnaire (CFQ), konsumsi pangan menggunakan repeated recall 2×24 jam dan status gizi. Analisis yang digunakan adalah independent t-test, dan Mann-Whitney test. Hasil analisis menunjukkan bahwa sekitar tiga perempat ibu balita stunting memiliki pendidikan terakhir rendah SD/MI/sederajat (71,4%), sedangkan pada kelompok normal sekitar dua pertiga ibu berpendidikan SMA/MA/sederajat (66,7%) dan sekitar tiga perempat merupakan lulusan perguruan tinggi (75%). Pendidikan ibu berbeda signifikan antara kelompok balita stunting dan normal (?<0,05). Hasil analisis menunjukkan bahwa sekitar tiga perlima ayah balita stunting memiliki pendidikan terakhir SD/MI/sederajat (60%). Sementara itu, pada balita dengan status gizi normal, sekitar tiga perlima ayah berpendidikan SMA/MA/sederajat (60%) dan seluruhnya merupakan lulusan perguruan tinggi (100%). Pendidikan ayah berbeda signifikan antara balita stunting dan normal (?<0,05). Hasil analisis menunjukkan bahwa sekitar setengah ibu balita stunting maupun normal tidak bekerja atau sebagai ibu rumah tangga, dengan persentase masing-masing (52,3% dan 47,7%). Sementara itu, pada balita stunting, lebih dari setengah ayah bekerja sebagai wirausaha/pedagang/jasa (56,0%) dan buruh/sopir (53,8%). Pekerjaan ayah berbeda signifikan (?<0,05) dan ibu tidak berbeda signifikan antara balita stunting dan norma (?>0,05). Sekitar setengah keluarga balita stunting termasuk dalam kategori keluarga kecil (51,5%), sedangkan pada balita dengan status gizi normal sekitar setengah termasuk dalam kategori keluarga besar (51,9%), tidak berbeda secara signifikan (?>0,05). Sekitar dua pertiga balita stunting berasal dari keluarga dengan paritas tidak ideal (66,7%), sedangkan pada balita dengan status gizi normal sekitar setengah berasal dari keluarga dengan paritas ideal (51,8%), terdapat perbedaan secara signifikan (?<0,05). Pendapatan perkapita berbeda secara signifikan antara kelompok balita stunting dan normal (?<0,05). Hasil analisis menunjukkan bahwa sekitar setengah balita stunting memiliki berat badan lahir rendah, dan kondisi ini berbeda signifikan dibandingkan balita normal (?<0,05). Sekitar setengah balita pada kedua kelompok memiliki panjang badan lahir normal serta usia kehamilan cukup bulan, tanpa perbedaan signifikan (?>0,05). Berdasarkan jenis kelamin, sekitar setengah balita stunting berjenis kelamin laki-laki dan balita normal didominasi perempuan, juga tanpa perbedaan signifikan (?>0,05). Sementara itu, sekitar setengah balita stunting memiliki riwayat penyakit infeksi dalam enam bulan terakhir, dengan proporsi lebih tinggi dibandingkan balita normal, dan perbedaannya signifikan (?<0,05). Tidak terdapat perbedaan signifikan skor kualitas diet total (? > 0,05). Asupan serealia, kacang-kacangan, minyak/lemak, lemak jenuh, dan lemak total rendah pada kedua kelompok. Terdapat perbedaan signifikan pada sayuran, buah keragaman pangan, di mana balita normal memiliki keragaman lebih baik. Konsumsi sayur dan buah (enhancer) signifikan lebih tinggi pada balita normal. Tidak terdapat perbedaan signifikan estimasi bioavailabilitas zat besi maupun seng (?>0,05). Berdasarkan hasil analisis, pangan yang dikonsumsi pada kedua kelompok cenderung memiliki estimasi bioavailabilitas besi yang rendah. Median zat besi terserap lebih tinggi pada balita normal (0,50 mg) dibanding stunting (0,36 mg) dengan perbedaan signifikan. Sebaliknya, pangan yang dikonsumsi balita sebagian besar termasuk dalam kategori estimasi bioavailabilitas seng tinggi; median seng terserap lebih tinggi pada balita normal (0,83 mg dengan 0,43 mg) dengan perbedaan signifikan. Kecukupan zat gizi makro dan mikro berbeda signifikan antara balita stunting dan normal (?<0,05), mayoritas orang tua pada kedua kelompok berada pada kategori "kontrol rendah". Terdapat perbedaan yang signifikan akses pangan antara kedua kelompok (?<0,05). Dalam upaya penanggulangan stunting pada balita, diperlukan pendekatan yang tidak hanya berfokus pada peningkatan asupan makanan, tetapi juga pada perbaikan kondisi sosial-ekonomi keluarga yang terbukti berbeda antara kedua kelompok. Selain itu, edukasi gizi perlu diberikan, khususnya terkait pengaturan waktu konsumsi teh agar tidak berdekatan dengan waktu makan utama, guna mendukung peningkatan penyerapan zat gizi serta promosi buah dan sayur lokal terjangkau kaya vitamin C untuk meningkatkan penyerapan besi non-heme dan peningkatan konsumsi protein hewani. Penguatan edukasi gizi yang berfokus pada dampak status gizi ibu hamil, pemantauan pertumbuhan dengan KMS, kebutuhan gizi balita, sumber dan fungsi zat gizi, serta prinsip pola makan seimbang. Perbaikian kualitas diet dengan meningkatkan asupan pada komponen adekuasi yang masih mengalami defisit, khususnya serealia, sayuran, buah-buahan, kacang-kacangan, serta minyak dan lemak, baik pada balita stunting maupun normal. Penelitian selanjutnya diperlukan untuk memperkuat bukti hubungan estimasi bioavailabilitas seng dan zat besi melalui penggunaan indikator biomarker laboratorium, seperti IGF-1 (Insulin-Like Growth Factor 1) untuk status protein, kadar seng darah atau rambut, serta hemoglobin, feritin, dan transferin sebagai indikator status zat besi.

Studies examining micronutrient intake among stunted children in Indonesia remain limited. Most previous research has focused on the quantity of nutrient intake without considering estimated bioavailability, particularly of essential micronutrients such as zinc and iron. Therefore, this study aimed to analyze differences in food access, diet quality, and feeding practices between stunted and normal children. This research employed a comparative cross-sectional study design. The study sites included Purwasari Community Health Center, covering Sukadamai, Purwasari, and Petir villages, and Kampung Manggis Community Health Center, covering Dramaga, Neglasari, and Sinarsari villages, Dramaga District. The study was conducted from 1–26 August 2025 and received ethical approval from the Ethics Committee for Research Involving Human Subjects, IPB University (No. 1838/IT3.KEPMSM-IPB/SK/2025). A total sample of 120 children (60 stunted and 60 normal) was selected based on inclusion criteria. Primary data collected included socioeconomic characteristics, child characteristics, food access using the Household Food Security Scale Module (HFSSM), feeding practices using the Child Feeding Questionnaire (CFQ), dietary intake using repeated 2×24-hour recalls, and nutritional status. Data were analyzed using independent t-tests and Mann–Whitney tests. The results showed that approximately three-quarters of mothers of stunted children had low educational attainment (elementary school level) (71.4%), whereas among normal children about two-thirds of mothers had senior high school education (66.7%) and about three-quarters were university graduates (75%). Maternal education differed significantly between stunted and normal groups (?<0.05). About three-fifths of fathers of stunted children had elementary education (60%), while among normal children about three-fifths of fathers had senior high school education (60%) and all were university graduates (100%). Paternal education differed significantly between groups (?<0.05). Approximately half of mothers in both groups were unemployed or homemakers (52.3% and 47.7%), while more than half of fathers of stunted children worked in self-employment/services (56.0%) and as laborers/drivers (53.8%). Father’s occupation differed significantly (?>0.05) and mother’s occupation did not differ significantly between stunted and normal toddlers (?>0.05) About half of families of stunted children were categorized as small families (51.5%), while about half of normal children belonged to large families (51.9%), with no significant difference (p>0.05). Approximately two-thirds of stunted children came from families with non-ideal parity (66.7%), while about half of normal children came from families with ideal parity (51.8%), showing a significant difference (?<0.05). Per capita income also differed significantly between groups (?<0.05). Approximately half of stunted children had low birth weight, significantly higher than among normal children (?<0.05). About half of children in both groups had normal birth length and full-term gestational age, with no significant difference (?>0.05). By sex, about half of stunted children were male, while normal children were predominantly female, also without significant difference (?<0.05). Around half of stunted children had experienced infectious disease in the previous six months, with a significantly higher proportion than normal children (?<0.05). There was no significant difference in total diet quality scores (?>0.05). Intake of cereals, legumes, oils/fats, saturated fat, and total fat was low in both groups. Significant differences were observed in vegetable, fruit, and dietary diversity components, with normal children showing better diversity. Consumption of vegetables and fruits (enhancers) was significantly higher among normal children. There were no significant differences in the estimated bioavailability of iron or zinc (?>0.05). Based on the analysis results, the foods consumed by both groups tended to have low estimated iron bioavailability. The median absorbed iron was higher in normal toddlers (0.50 mg) than in stunted children (0.36 mg), with significant differences. Conversely, the foods consumed by toddlers mostly fell into the category of high estimated zinc bioavailability; the median absorbed zinc was higher in normal toddlers (0.83 mg and 0.43 mg), with a significant difference. Adequacy of macro- and micronutrients differed significantly between groups (?<0.05). Most parents in both groups were categorized as having “low control” feeding practices. There was a significant difference in food access between the two groups (?<0.05). Efforts to address stunting should not focus solely on improving food intake but also on improving family socioeconomic conditions, which differed between groups. Nutrition education is needed, particularly regarding appropriate timing of tea consumption relative to main meals to enhance nutrient absorption, promotion of affordable local fruits and vegetables rich in vitamin C to improve non-heme iron absorption, and increased consumption of animal protein. Strengthening nutrition education on maternal nutritional status during pregnancy, growth monitoring, toddler nutrient requirements, nutrient sources and functions, and balanced diet principles is essential. Improving diet quality by increasing intake of deficient adequacy components especially cereals, vegetables, fruits, legumes, oils, and fats is recommended for both stunted and normal children. Future research is needed to strengthen evidence on estimated bioavailability of zinc and iron using laboratory biomarker indicators, such as IGF-1 (Insulin-Like Growth Factor-1) for protein status, blood or hair zinc levels, and hemoglobin, ferritin, and transferrin as indicators of iron status.