Oral Presentation Australian & New Zealand Obesity Society 2014 Annual Scientific Meeting

The double burden of malnutrition: a longitudinal, nationally representative study of Indonesian children (#16)

Cut N Rachmi 1 , Louise A Baur 1 2 , Mu Li 2 , Kingsley E Agho 3
  1. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
  2. School of Public Health, University of Sydney, Sydney, NSW, Australia
  3. School of Science and Health, University of Western Sydney, Sydney, NSW, Australia


Malnutrition remains a major public health concern in Indonesia and the double burden of malnutrition refers to the presence of under- and over-nutrition in the same population. This study aimed to determine the prevalence of under-nutrition (stunting, thinness) and over-nutrition (overweight, obesity) in Indonesian children.


We analysed a merged dataset of children <5 years old in 1993, and followed them up in the 1997, 2000, and 2007 waves of the Indonesian Family Life Survey (IFLS). IFLS is a longitudinal, nationally representative survey of a stratified random sample of households involving both questionnaires and anthropometric measurements. The survey included 7,224 households and 22,000 individuals in 1993, with a re-contact rate of more than 90% in each wave. Height/length and body mass index (BMI) were expressed as z-scores with reference to WHO Standard (2006; <5 years) or WHO Reference (2007; 5-19 years) charts. Children with height-for-age-z-scores <-2SD were categorised as stunted. Children with BMI-z-scores <-2SD, >+2SD, >+3SD in WHO 2006 and <-2SD, >+1SD, >+2SD in WHO 2007 were categorised as thin, overweight or obese, respectively.


1742 children had complete anthropometry in all four waves. The mean (95% CI) age at each wave was 2.1 (2.0-2.2), 6.1 (6.0-6.2), 8.9 (8.8-8.9) and 16.3 (16.2-16.3) years. The prevalence of stunting in each wave was 22.5% (CI: 20.8-24.3%), 28.9% (CI: 25.6-31.1%), 28.7% (CI: 26.9-30.7%), and 27.1% (CI: 25.1-29.2%), respectively. The prevalence of thinness increased from 1993-2000 (8.3%, 9.4%, and 11.1%), but decreased in 2007 (8.0%). The trends in prevalence of overweight and obesity showed the opposite pattern, decreasing from 1993 (6.7% and 5.3%) to 1997 (2.2% and 1.5%) then increasing in the two recent waves  (4.1% and 1.9%) in 2000 and (6.4% and 2.3%) in 2007.


There is strong evidence that the Double Burden of Malnutrition occurs in Indonesian children. A coordinated approach to overcome chronic malnutrition and over-nutrition is required.