Adequate Levels of Vitamin A, Folic Acid, C, and D in Stunting

Under-Five Children in Tanah Bumbu Regency, South Kalimantan

Triawanti

, Muhammad Irwan Setiawan

, Agung Waskito

, Muhammad Abdan Shadiqi

Tyas Ningrum Rahmadayanti

, Lulu Septiannisa

, Ira Maharani

, Mia Arpilawati

Andi Anwar Sadat

, Romatua S. Simanjuntak

, Dyah Hartati Dewi

, Rahmasari

, Elvina Masrina

Hayatunnisa

and Sughi Mukti

Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia

Bappedalitbang Tanah Bumbu Regency, Tanah Bumbu, Indonesia

Keywords: Stunting, Vitamin A, Folic Acid, Vitamin C, Vitamin D.

Abstract: Background: Stunting is a chronic nutritional problem due to a lack of long-term nutrition, disrupting

children's growth. WHO states that stunting is conditioned by the value of Z-score height by age (PB/ U or

TB/U) less than -2 standard deviation (SD). Nutritional intake that affects stunting is not only macronutrients

but also vitamins and minerals. Objective: The study aimed to determine the adequacy intake of vitamin A,

folic acid, vitamin C, and vitamin D in stunting under-five children aged 4-59 months in Tanah Bumbu District.

Methods: The type of research was cross-sectional quantitative analytic. This research was conducted from

May to August 2023 in Tanah Bumbu Regency. The population of this study was stunting under-five children.

The cluster random sampling method was used to obtain a sample of 314 stunting under-five aged 4-59 months.

Stunting was analyzed by PB/U or TB/U index. Nutrient intake data was measured using the food recall 1 x

24 hours and analyzed using Nutrisurvey Software. Vitamin adequacy was calculated based on the total intake

of vitamins compared to the RDA. Results: The 190 under-five children (60.5%) had insufficient vitamin A

levels, and 124 under-five (39.5%) were sufficient. Folic acid adequacy was insufficient for 303 under-five

children (96.5%) and classified as sufficient for 11 under-five children (3.5%). Vitamin C adequacy was

insufficient for 244 under-five children (77.7%) and classified as sufficient for 70 under-five children (22.3%).

Vitamin D adequacy was insufficient for 300 under-five children (95.5%) and classified as sufficient for 14

under-five children (4.5%). Conclusion: Based on the results of this study, it can be concluded that children

stunting in Tanah Bumbu Regency obtained deficiency intake of vitamins A, folic acid, C, and D. For this

reason, it is necessary to give multi-vitamin supplements to stunting under-five children and not just increased

protein intake.

1 INTRODUCTION

Stunting is a chronic nutritional problem due to a lack

of long-term nutrition, disrupting children's growth.

WHO states that stunting is conditioned by the value

of Z-score height by age (PB/ U or TB/U) less than -

2 standard deviation (SD). Stunting is also one of the

causes of stunted children's height, so it is lower than

children their age. It is not uncommon for people to

think that the condition of a short body is a genetic

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factor and has nothing to do with health problems. In

fact, genetic factors have little effect on a person's

health compared to environmental factors and health

services. Stunting usually begins to occur while the

child is still in the womb and is seen when they enter

the age of two.

The Indonesian nutritional status study (SSGI) in

2022 showed a national stunting prevalence of under-

five children of 21.6%, and South Kalimantan

recorded a stunting rate of 24.6%. The incidence of

Triawanti, , Setiawan, M. I., Waskito, A., Shadiqi, M. A., Rahmadayanti, T. N., Septiannisa, L., Maharani, I., Arpilawati, M., Sadat, A. A., Simanjuntak, R. S., Dewi, D. H., Rahmasari, , Masrina,

E., Hayatunnisa, and Mukti, S.

Adequate Levels of Vitamin A, Folic Acid, C, and D in Stunting Under-Five Children in Tanah Bumbu Regency, South Kalimantan.

DOI: 10.5220/0013219900003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 45-49

ISBN: 978-989-758-740-5

stunting in South Kalimantan is spread across various

districts. Tanah Bumbu Regency is one of the districts

that has become the National stunting locus since

2019. Based on the SSGI in 2022, the prevalence of

stunted under-five children in Tanah Bumbu Regency

was 16.1%, and based on E-PPBGM data in 2022, the

stunting rate in Tanah Bumbu Regency was1,095

stunted children (Ministry of Health, 2022). This is

still a challenge for Tanah Bumbu Regency to reduce

stunting rates with a national target of 14% by 2024,

as targeted by the government through Presidential

Regulation No. 72 in 2021.

Stunting has an impact that is not only short but is

accompanied by a decrease in intelligence. Stunted

under-five children have imperfect growth potential,

low motor skills and productivity, and a higher risk of

suffering from degenerative diseases (Widiant,

2016). The risk of psychosocial dysfunction in

stunted children is higher than in normal conditions.

Children can tend to have anxiety, prone to

depression, and low self-confidence when they are in

their adolescents. Stunting can also affect the quality

of human resources at a productive age (Rafika,

2019).

Stunted under-five children need immediate

treatment. Handling stunting can be started by

providing optimal nutritional intake. Nutrient intake

that affects stunting is not only macronutrients but

also vitamins and minerals. Vitamin deficiency can

occur due to low intake of food sources of vitamins.

Stunting children still can get higher if their

nutritional intake is met. Lack of nutritional intake in

under-five children, if not immediately corrected, can

cause a decrease in physical quality (Amelia, 2019).

Based on this, it is necessary to know the level of

adequacy of nutritional intake, especially vitamin

intake. Vitamin A, folic acid, vitamin C, and vitamin

D have an indirect role in the process of bone growth

(Pontang, 2020), (Salvatore et al., 2023, Bening et al.,

2017, Taylor, 2020).

2 METHOD

This type of research was an observational study with

a cross-sectional design. The study was conducted

from May to August 2023 in Tanah Bumbu Regency.

This study has received ethical clearance from the

Faculty of Medicine, University of Lambung

Mangkurat No.172/KEPK-FKULM/EC/VII/2023.

The population of this study was all stunting under-

five children in Tanah Bumbu Regency. We used the

cluster random sampling method to obtain 314

stunting toddlers aged 4-59 months. Stunting Data

were analyzed with the PB/U or TB/U index based on

Permenkes RI Number 2 of 2020. Nutrient intake was

measured using the 1 × 24-hour food recall method

and analyzed using Nutrisurvey software. Vitamin

adequacy levels were calculated based on total

vitamin intake compared to the RDA based on

Permenkes RI Number 28 of 2019. The level of

vitamin adequacy was considered insufficient if it

was >77% and sufficient if it was ≤77%.

3 RESULT AND DISCUSSION

3.1 Result

The characteristics of under-five children in this study

are as follows

Table 1: Characteristics of under-five children.

Characteristic n %

Gende

Male 176 56

Female 138 44

Age

≤ 2 years 112 36

> 2 years 202 64

Stunting under-five children in this study were

primarily male (56%). The age of many under-five

children in this study were > 2 years old (64%).

Table 2: Nutrients intake of stunting under-five children.

Nutrients

intake

n % Average

Vitamin A

Sufficient 124 39.5

± 314

mcg

Insufficient 190 60.5

Folic aci

Sufficient 11 3.5

± 53

mcg

Insufficient 303 96.5

Vitamin C

Sufficient 70 22.3

± 18

mcg

Insufficient 224 77.7

Vitamin D

Sufficient 14 4.5

± 3 mcg

Insufficient 300 95.5

Table 2 shows the level of vitamin A insufficient

in stunting under-five children, as many as 190

children (60.5%) and stunting under-five children

with sufficient vitamin A, as many as 124 children

(39.5%). The level of insufficient folic acid in

stunting under-five children were 303 children

(96.5%) and stunting under-five children with

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

sufficient intake of folic acid were 11 children

(3.5%). The level of vitamin C insufficient in stunting

under-five children were 224 children (77.7%) and

stunting under-five children with sufficient intake of

vitamin C intake were 70 children (22.3%). The level

of vitamin D insufficient in stunting under-five

children were 300 children (95.5%), and stunting

under-five children with sufficient intake of vitamin

D were 14 children (4.5%).

3.2 Discussion

Gender determines the amount of nutritional needs,

so there is a relationship between nutritional status

and gender. The amount of nutritional needs is

influenced by differences in body composition

between men and women. So, the intake that must be

consumed is even more (Febriana et al., 2018).

Children aged > 2 years can already choose food

or eat certain foods only, and the child's habit of

snacking carelessly. Research by (Azzahrah et al.,

2023) in Luwu Regency showed that as many as

84.6% of children aged > 2 years experienced picky

eating. Children with picky eating behaviour tend to

have nutritional status problems due to consuming

foods that do not vary, so intake tends to be

inadequate (Sagihira, 2021). Children who can

already choose their food will consume fewer

vegetables and fruits as a nutritious food source.

3.2.1 Adequate Levels of Vitamin A

The average intake of vitamin A was ± 314 mcg while

the adequacy of vitamin A in stunting children,

according to Permenkes RI number 28 of 2019, is 450

mcg. Research (Pontang, 2020) states that there was

a meaningful relationship between vitamin A and the

incidence of stunting. Vitamin A regulates osteoblasts

(bone cell formation) and osteoclasts (bone cell

resorption). Vitamin A deficiency can cause

gastrointestinal mucosal disorders resulting in

reduced absorption of nutrients that cause growth

failure and susceptibility to infectious diseases such

as diarrheal diseases (Ssentongo et al., 2021).

Vitamin A also plays an essential role in the

development and normal functioning of the brain and

the development of the central nervous system.

Insufficient nutritional intake, such as vitamin A, can

lead to brain dysfunction and changes in the immune

system (Sanyoto DD et al., 2021).

3.2.2 Adequate Levels of Folic Acid

The average intake of folic acid was ± 53 mcg while

the adequacy of folic acid in stunting children,

according to Permenkes RI number 28 of 2019, is 200

mcg. Folic acid is essential for the growth and

development of children under five. Folic acid is an

essential nutrient that plays a role in many biological

processes, including DNA and protein synthesis, cell

growth, and differentiation. Folic acid deficiency can

affect child growth (Salvatte et al., 2023). Folic acid

influences the brain's formation and the nervous

system's development. Folic acid also plays an

essential role in neurotransmitter synthesis,

proliferation, and growth of glial and nerve cells and

prevents neural tube defects (Valera et al., 2014).

3.2.3 Adequate Levels of Vitamin C

The average intake of vitamin C was ± 18 mcg, while

the adequacy of vitamin C in stunting children,

according to Permenkes RI number 28 of 2019, is 50

mcg. Vitamin C is an organic bone component

responsible for cell changes and the formation of a

new bone matrix (Amalia et al., 2018). Research

(Bening et al., 2017) states that low levels of vitamin

C adequacy were a risk factor for stunting in children.

Under-five children with vitamin C deficiency will

experience barriers to forming structural proteins and

collagen, thus inhibiting growth. Vitamin C

deficiency results in impaired bone health due to

increased osteoclast formation and decreased bone

formation (Chin & Ima, 2018). Vitamin C also has

antioxidant properties to protect against free radicals

in the brain. Insufficient vitamin C intake can lead to

neurodevelopmental and cognitive disorders (Tveden

& Lykkesfeldt, 2009).

3.2.4 Adequate Levels of Vitamin D

The average intake of vitamin D in stunting under-

five children was ± 3 mcg while the adequacy of

vitamin D in stunting children, according to

Permenkes RI number 28 of 2019 is 15 mcg. The

primary function of vitamin D is to maintain calcium

homeostasis and bone health. Vitamin D deficiency

affects linear growth, ranging from infants, toddlers,

and children to adolescents (Taylor, (2020). Research

(Nurhayati et al., 2020) states that toddlers with

adequate vitamin D were more or less likely to

experience stunting indirectly; vitamin D plays a role

in calcium metabolism, which is also essential in bone

growth. Vitamin D also plays a role in brain

development and function. Vitamin D and protein are

involved in learning, memory, motor control, and

social activities such as adaptability. Vitamin D

deficiency can increase the risk of depression,

schizophrenia and seasonal affective disorder

(Weydert, 2014).

Adequate Levels of Vitamin A, Folic Acid, C, and D in Stunting Under-Five Children in Tanah Bumbu Regency, South Kalimantan

3.2.5 Insufficiency of Vitamin A, Folic Acid,

C, and D Intake in Stunting Under-Five

Children

Insufficient adequate levels of vitamins can occur due

to the low intake of food sources of micronutrients in

the daily consumption of stunting under-five children.

The age of children who can choose their food and

low mother nutrition education can also worsen the

selection of foods with low nutritional value,

increasing the risk of malnutrition in children. Mother

nutrition knowledge is important in managing

household consumption, and it will affect the

mother's attitude in the selection and processing of

food ingredients that the family will consume.

Mothers with good nutritional knowledge will

understand the importance of good nutritional status

for their family's health and well-being (Adelia et al,

2018).

Most mothers stated that their children did not like

eating nutritious foods such as vegetables and fruits.

Their children preferred eating snacks and drinking

flavored and sweetened condensed milk rather than

formula or growth milk. Flavored milk and sweetened

condensed milk contain more sugar than nutrients, so

it cannot be used to fulfill nutritional intake. If

children consume non-nutritious foods or drinks

regularly, it will impact their health in the future

(Hidayat et al, 2022).

Achieving adequate vitamin consumption should

be done by eating various foods such as vegetables

and fruits. Fulfilling nutritional intake is not easy if it

is not accompanied by the mother's role in good

consumption patterns for the family. Nutritious food

consumption can be started by processing local food

ingredients. Nutritional needs that are well met can

improve and increase the nutritional status of children

(Sari & Montessori, 2021).

4 CONCLUSIONS

Based on the results of this study, it can be concluded

that children stunting in Tanah Bumbu Regency

obtained deficiency intake of vitamins A, folic acid,

C, and D. For this reason, it is necessary to give multi-

vitamin supplements to stunting under-five children

and not just increased protein intake and also give

nutrition education for mothers of stunting under-five

children.

ACKNOWLEDGEMENTS

We want to appreciate and thanks Bappedalitbang

Tanah bumbu Regency for supporting our research.

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Adequate Levels of Vitamin A, Folic Acid, C, and D in Stunting Under-Five Children in Tanah Bumbu Regency, South Kalimantan