World Nutrition Journal

A Human rights approach to clinical nutrition : addressing the challenges of disease-related malnutrition in resource limited settings

Gil Hardy — 2025-08-29

A human rights-based approach can be the cornerstone in the field of clinical nutrition. By endorsing the five principles of the Vienna Declaration, the global clinical nutrition network is developing initiatives and strategies for implementing programmes for improving awareness, advocacy, education, research and collaboration. The prevalence of disease-related malnutrition in hospitalized patients is higher in Asian resource limited countries than in Europe with unacceptably high nutrition risks in cancer, tuberculosis and intestinal failure in Indonesia. The international human rights working group has recommended practical steps involving evaluation of the applicability of the current international guidelines, and development of new resource-stratified guidelines followed by promotion and implementation.

Effects of probiotics supplementation on reducing inflammation in burn patients

Nadhira Nuraini Afifa — 2025-08-29

Background: Burn injuries cause significant physical trauma and complex inflammatory responses, accounting for more than 300,000 deaths per year. Probiotics may help modulate inflammation in burn patients by improving biomarkers such as hs-CRP and IgA levels. This case report aims to investigate the effect of probiotics supplementation on reducing inflammation in burn patients.

Methods & Materials: A literature search was on three large databases: PubMed, Cochrane Library, and Google Scholar. MeSH terms, advanced search, and eligibility criteria were used for title and abstract screening after removing duplicates. Critical assessment tools and levels of evidence of the final articles are based on the Oxford Center for Evidence-Based Medicine.

Results: Two randomized controlled trials (RCTs) met the PICO and eligibility criteria. One RCT found that probiotics supplementation significantly reduced hs-CRP levels (21.38 ± 44.45 vs 36.36 ± 79.03; p < 0.001) and improved wound healing in burn patients. The other RCT found that single and mixed strain probiotic administration significantly increased IgA levels (p < 0.001 and p = 0.025, respectively) in burn patients.

Conclusions: Probiotics supplementation demonstrates significant benefits in reducing systemic inflammation and enhancing immune function. Further research is necessary to provide recommendations of probiotic use in burn care.

The role of nutritional management in preventing stroke and improving clinical outcomes

Anggita Citra Resmi Mauluddy — 2025-08-28

Background: Stroke is a leading cause of global morbidity, mortality, and substantial economic burden. Modifiable stroke risk factors, including hypertension, dyslipidemia, obesity, and diabetes mellitus, can be effectively managed through targeted nutritional interventions. Nutritional management also supports neurological recovery and contributes to improved clinical outcomes in stroke survivors.

Methods: A literature review was conducted using PubMed, MEDLINE, and EMBASE databases from the last ten years, focusing on nutritional management for stroke prevention, clinical outcomes, dietary patterns, and nutrient supplementation during post-stroke recovery.

Results: Dietary strategies, including Dietary Approaches to Stop Hypertension (DASH), high intake of dietary fiber, and omega-3 fatty acids, significantly reduce stroke risk by improving cardiovascular health and decreasing inflammation. Supplementation with micronutrients such as B vitamins supports neurological and vascular function. Post-stroke nutritional issues such as dysphagia, malnutrition, sarcopenia, and pressure injuries commonly impair patient recovery. Targeted nutritional intervention, particularly adequate protein and branched-chain amino acid (BCAA) supplementation, help preserve muscle mass, enhance functional recovery, and optimize rehabilitation outcomes.

Conclusions: Nutritional management plays a crucial role in both preventing stroke and improving clinical outcomes following stroke. Implementing effective nutritional strategies, together with patient education on healthy dietary practices, is fundamental for reducing stroke risk, accelerating recovery, and enhancing quality of life.

Association of food security and dietary diversity with stunting among toddlers in Gunungkidul regency, Indonesia

Rindi Nuryani — 2025-08-29

Background: Stunting is impaired child growth due to prolonged undernutrition. In 2022, Indonesia’s stunting prevalence was 21.46% (SSGI), with Gunungkidul regency in Yogyakarta, Indonesia experiencing the highest rate at 23.5%. food security and dietary diversity can influence the occurrence of stunting in toddlers.

Objective: This study aims to determine the association of food security and dietary diversity with stunting among toddlers in Gunungkidul Regency.

Methods: This cross-sectional study was conducted in the Wonosari and Gedangsari District, Gunungkidul Regency. The sample of this study were 105 children from 6 Posyandu (integrated health care center), which were selected based on the stunting prevalence. The sample were selected using quota sampling techniques. Household food security was assessed using a questionnaire adapted from the 2012 USDA Household Food Security Survey Module, and dietary diversity was assessed using a questionnaire adapted from the 2011 Food and Agriculture Organization (FAO) guidelines. Data were analyzed using the Chi-Square test.

Results: More than 30% of the children were stunted (31.4%), 51.5% had dietary diversity in the low and medium categories, and 44.8% of respondents come from food insecure families. There was a significant relationship between dietary diversity and stunting (p<0.05), however the relationship with food security was not statistically significant (p>0.05).

Conclusion: Dietary diversity is significantly associated with stunting among toddler however food security is not related to stunting. Caregiver education promoting diverse toddler diets, especially local foods, is needed.

Understanding challenges and opportunity of data recording and reporting of malnutrition intervention programs

Chyntia Aryanti Mayadewi — 2025-08-29

Background: The number of stunting in Indonesia was reported to be 21.6% in 2022, still far from the 2024 target of 14%. The large-scale programs of nutrition-specific intervention have been done, including moderate-acute malnutrition (MAM) and severe-acute malnutrition (SAM) interventions. However, limited findings on the process of monitoring and evaluation of both interventions.

Objective: This paper aims to describe the implementation, challenges, and opportunities of malnutrition intervention data recording and reporting among healthcare workers in DKI Jakarta Province, Indonesia.

Methods: Qualitative data collection was taken with in-depth interview (IDI) and focus group discussion (FGD) in August-October 2024 towards healthcare workers in selected Puskesmas in DKI Jakarta who were involved with MAM and SAM interventionss and data management. Data triangulation was done to health cadres and mothers of children under five (CU-5) as the beneficiaries.

Results: This study involved eight informants from South and Central Jakarta Puskesmas, and 16 cadres and 13 mothers who were involved in MAM and SAM interventionss. The dissemination and adaptation of indicators has been done and digital data recording has been used, despite its lack of supporting resources and data integration which may affect its data quality. Leveraging resources and enabling data-sharing between facilities and maintaining communication between stakeholders are essential.

Conclusions: The process of data recording and reporting of malnutrition interventions required well-informed indicators, trained personnel, and streamlined information systems. Maintaininghigh quality data, collaboration between stakeholders and utilizing accessible technology are recommended for the healthcare worker to improve the process of data recording and reporting.

Association between muscle-to-visceral fat ratio and vascular elasticity in medical students

Tsabita Ayudia — 2025-08-29

Background: Medical students often adopt lifestyles that contribute to decreased muscle mass and increased visceral fat accumulation, which can negatively impact vascular elasticity, a biomarker for the early detection of cardiovascular disease.

Objective: This study aims to evaluate the association between the muscle mass to visceral fat ratio and vascular elasticity in medical students at Universitas Pembangunan Nasional Veteran Jakarta (UPNVJ).

Methods: A cross-sectional design was conducted from November 2023 to January 2024 at UPNVJ. The sample consisted of 51 subjects who met the research criteria. The muscle-to-visceral fat (MVF) ratio was measured using Bioelectrical Impedance Analysis (BIA), while vascular elasticity was assessed using the Accelerated Photo plethysmograph Analyzer SA-3000P.

Results: The results revealed that 68.6% of the subjects had the lowest MVF ratio and 54.9% exhibited sub-optimal vascular elasticity. No differences were found in age, gender, physical activity, or eating habits between the vascular elasticity groups (p > 0.05). The Chi-square test revealed a significant association between the MVF ratio and vascular elasticity (p = 0.009; OR = 6.545; 95% CI = 1.7–24.9).

Conclusion: Students with the lowest MVF ratio were found to be 6.54 times more likely to have sub-optimal vascular elasticity, compared to those with low and high MVF ratios, indicating an increased risk of cardiovascular disease. These findings underscore the importance of early preventive intervention aimed at optimizing body composition through targeted wellness programs. The implementation of nutritional education and structured physical activity initiatives, particularly in young adults, may play a critical role in reducing the risk of cardiovascular disease.

Association between animal protein adequacy and anemia among pregnant women in Palembang, Indonesia

Ardesy Melizah Kurniati — 2025-08-29

Background: Palembang City has the highest prevalence of anemia in South Sumatra, Indonesia. Protein contributes to hemoglobin formation and insufficient protein intake increases the risk of anemia. However, Sumatera studies on protein intake based on protein sources in pregnant women are still limited.

Objective: This study aimed to examine the association between animal protein consumption and anemia prevalence in pregnant women.

Methods: A cross-sectional analytic study was conducted from July to October 2024 at six public health centers and seven private midwife clinics selected to represent Palembang’s geographic diversity. A total of 62 pregnant women in their second or third trimester were recruited using consecutive sampling. Dietary intake was assessed via interviewer-administered 2×24-hour recalls on non-consecutive days. Protein intake was analyzed using modified NutriSurvey 2004 and categorized based on the Indonesian RDA. Hemoglobin levels were measured using venous blood samples and classified according to trimester-specific anemia thresholds. Bivariate analysis with Fisher’s exact test was used to examine the association between animal protein intake and anemia prevalence.

Results: The Fisher Exact Test showed a statistically significant association between animal protein consumption levels and anemia in pregnant women in Palembang City (p = 0.018). The mean total protein intake was 80.40 ± 20.53 g/day, with animal and vegetable proteins contributing 40.22 ± 18.63 g/day and 40.91 ± 24.5 g/day, respectively. Mean hemoglobin level was 11.18 ± 1.17 g/dL.

Conclusion: Sufficient consumption of animal protein was found to be more protective against the occurrence of anemia.

Relation between body mass index, waist circumference, and a body shape index with VO2 max among medical students in Jakarta, Indonesia

Mikhaella Pritananda Anughrayasa — 2025-08-29

Background: Individuals with low VO₂ max have higher potential of chronic disease in later life. Body fat composition is a factor that affects VO₂ max. A sedentary lifestyle and poor diet in medical students can lead to excess body fat mass, which can be measured through BMI, WC, and ABSI.

Objective: The study aimed to determine the relation between BMI, WC, ABSI, and VO₂ max in medical students.

Methods: This study used an observational analytic method and a cross-sectional approach. It was conducted at the Medical Education and Research Center UPNVJ from January to December 2024. The sampling technique was simple random sampling with total sample size of 46 respondents. Data collection involved filling out a questionnaire and measuring BMI, WC, ABSI, and VO₂ max. Statistical analysis in this study was performed using the Mann-Whitney test.

Results: Most respondents had normal BMI, normal WC, and low ABSI. The results of bivariate analysis showed relation between WC and VO₂ max (p = 0.000), and there was no relation between VO₂ max with BMI (p = 0.344) and ABSI (p = 0.956).

Conclusion: The study's results conclude that WC and VO₂ max are related. However, there was no relation between BMI and ABSI and VO₂ max in medical students.

Sleep quality and its association with waist circumference among undergraduate students

Chinenyenwa Violet Nwoke — 2025-08-29

Background: Poor sleep quality has been associated with metabolic disturbances and behavioural changes that promote obesity, with growing evidence linking inadequate sleep to increased central adiposity. Waist circumference (WC), a key indicator of abdominal fat and cardiometabolic risk, has also been implicated in disrupted sleep through mechanisms such as hormonal imbalance and sleep-disordered breathing. Exploring the relationship between WC and sleep quality among undergraduate students is important to better understand early risk factors for obesity and related health outcomes.

Objective: This study aimed to examine sleep quality and its association with Body Mass Index (BMI) and Waist Circumference (WC) in an undergraduate population.

Methods: A total of 277 undergraduate students from Universiti Sultan Zainal Abidin (UniSZA), Gong Badak Campus, Malaysia, aged 18 to 25 years, were recruited for this cross-sectional study using non-probability proportionate stratified sampling. The students were weighed, and their BMI and WC were measured. The Pittsburgh Sleep Quality Index (PSQI) was completed to assess sleep quality.

Results: The results of the multiple linear regression analysis revealed that sleep quality did not significantly predict BMI (p>0.05). However, sleep quality significantly predicted WC (p=0.026), indicating a significant influence of sleep quality on WC.

Conclusion: While sleep quality was not significantly associated with body mass index, it was significantly associated with waist circumference. These findings highlight the potential importance of promoting a consistent sleep schedule as a preventative strategy to enhance sleep quality and mitigate weight-related risks in undergraduate students.

Association of eating behavior and diet quality among students in Taruna Nusantara Senior High School, Indonesia

Barkah Triatmoko — 2025-08-29

Background: Poor adolescent diet quality is influenced by family eating habits, media promoting unhealthy foods, and body image pressures, leading to disordered eating, neglect of health considerations, and obesity. Even in controlled environments like boarding schools.

Objective: This study aims to assess association between eating behavior and dietary quality among students in Taruna Nusantara Senior High School (TN-SHS), Indonesia.

Methods: A cross-sectional study with 200 subjects aged 15-18 was conducted in January 2024. Participants were purposively sampled from TN-SHS boarding school. Data was collected using the Dutch Eating Behavior Questionnaire (DEBQ) and Diet Quality Index International (DQI-I), along with sociodemographic information, nutritional status, and physical activity. Analysis was performed using SPSS 29, employing multiple linear regression to examine the relationship between eating behaviors and diet quality.

Results: There was strong relationship between eating behavior and diet quality on different days, revealing that restrained eating correlates with better diet quality on average days (r=0.158, p=0.026), while external eating is linked to poorer diet quality. The association between eating behavior and diet quality on weekdays is weaker than on weekends. External eating consistently reduces diet quality across all periods (β=–1.380 to –1.854, p<0.01). Males exhibiting lower diet quality (β=–3.021 to –4.904, p≤0.002) and higher pocket money associated with improved diet quality, particularly on weekends (β=–3.633, p=0.021).

Conclusion: The study findings highlight the importance of managing external eating behaviors such as emotional eating, social eating, mindless eating, and binge eating, and suggest avenues for targeted interventions to promote healthier dietary habits.