The double burden of malnutrition and dietary patterns in rural Central Java, Indonesia

Background: Indonesia is undergoing a nutrition transition (NT) comprised of rising rates of over- weight/obesity and consumption of high fat food/snacks but is still struck by undernutrition, causing a double burden of malnutrition. Little research pertains to the double burden of malnutrition and its associations with diet in rural Indonesia using primary village level data. Methods: We conducted a 24-hour food recall and food frequency questionnaire and assessed anthropo- metric status of rural villagers from four villages in Central Java, Indonesia. Exploratory principal compo- nent analysis was used to identify dietary patterns and multi-level modeling was performed to identify variables associated with dietary pattern indicative of the NT. Findings: 1,521 participants were included in analysis. Double burden of malnutrition was prevalent whereby 32.3% of children were stunted, 68.8% of women 35-49 years-old were overweight, and 39% of homes were classified as double burden. The NT was evident in a dietary pattern associated with soft drink, snacks, and animal products. There was small but significant correlation between undernutri- tion and stunting status among children (r = −0.139, p < 0.01). The NT was associated with young age (B = 1.696, 95% CI = 1.508-1.885) but not with overweight (B = −0.099, 95% CI = −0.184-−0.013). Interpretation: Our findings suggest that whilst the typical pattern of the double burden of malnutrition (stunted child/overweight adult) exists in rural Central Java, dietary patterns indicative of the NT are predominant among children, not adults. Overweight among adults may not be necessarily due to a diet indicative of the NT, and nutrition interventions in rural Central Java should focus on educating parents of young children about the health-risks of a diet associated with a NT. Funding: Funding was obtained from the UBS-Optimus Foundation and the National Health and Medical Research Council