Animal Protein Intake as a Key Determinant of Wasting among Children under Two Years of Age in Indonesia: Evidence from the 2023 National Health Survey

Abstract

Background: Animal protein is a nutrient that is important for the growth and development of children Under Two Years old, when viewed from the quality, animal protein has better quality than with vegetable protein, this is because the content of animal protein plays a role in the growth of body cells needed during the growth period. Aims: This study aimed to evaluate the relationship between animal protein consumption and various nutritional status indicators (stunting, underweight, and wasting) among children aged 6–23 months in Indonesia, utilizing a large-scale national dataset. Study Design: An observational analytical study with a cross-sectional approach, conducted in accordance with STROBE guidelines (menambahkan standar pelaporan internasional). Place and Duration of Study: This study used secondary data from the 2023 Indonesian Health Survey conducted across 38 provinces in Indonesia. Data analysis was carried out from February to May 2025. Methodology: Nationally representative secondary data from the 2023 Indonesian Health Survey (SKI) were analyzed, covering 38 provinces. The final sample included 108,673 children who met strict inclusion criteria. Predictor variables focused on animal protein intake, while outcomes were assessed using WHO-standardized HAZ, WAZ, and WHZ indices. Data were analyzed using Chi-square and adjusted multivariate binary logistic regression to control for demographic and socioeconomic confounders. Results: While 78.8% of children consumed animal protein, critical nutritional gaps persisted: stunting (19.6%), wasting (14.4%), and underweight (11.1%). Multivariate analysis revealed that animal protein consumption was not significantly associated with stunting (p=0.524; OR=0.974) or underweight (p=0.161; OR=1.083). In contrast, a statistically significant association was found with wasting (p=0.016; OR=1.122; 95% CI: 1.021–1.231), demonstrating that children without animal protein intake have a higher vulnerability to acute malnutrition. Additionally, male children exhibited a significantly higher risk of stunting and underweight (p<0.05). Conclusion: Animal protein is a key determinant in preventing acute malnutrition (wasting) but does not appear to be the primary driver for chronic conditions like stunting in this population. Policy interventions should prioritize improving the accessibility and affordability of animal-source foods to combat wasting, while stunting strategies must remain multisectoral, addressing broader socioeconomic and environmental factors.