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There is a marked increase in the intake of foods associated with higher risks for hypertension and obesity in Indonesia. However, studies assessing the relationship between dietary patterns and health outcomes are few.The purpose of this study was to characterize dietary patterns and investigate their relationship with hypertension and obesity in Indonesia.Exploratory factor analysis was used to derive dietary patterns from a brief food scanner filled by 31,160 respondents aged 15 y and older in the Indonesian Family Life Survey wave 5 (IFLS 5). Age- and gender-specific quintiles of consumption were created for each pattern and the association between quintiles of each dietary pattern and the odds for hypertension and obesity were assessed using multivariate logistic regression analyses.Two dietary patterns were identified: a modern dietary pattern characterized by fast foods, soft drinks, sweet snacks, and salty snacks and a traditional pattern characterized by fish, vegetables, and fruits. Younger age and being male were significantly correlated with higher consumption of the modern pattern (More studies using gold-standard measures of dietary intake are needed to better understand the relationship between the modern dietary pattern and hypertension in Indonesia. Also, both modern and traditional dietary patterns in Indonesia may be energy dense, leading to higher risk for obesity.

The rapid development of nutrition science is embracing digital transformation to generate large amounts of data. Precision nutrition and "Big Data" place increasing demand for data repositories and visualization, which enhances the digital transformation. We defined the need for an integrated nutrition data platform as a web-based platform that can collect, store, track, analyze, monitor, and visually display key metrics in nutrition and health while allowing users to interact with visuals and download data provided in the platform. Interactive dashboards create new opportunities for scholars and practitioners to generate and test hypotheses. We present the development and implementation of the Global Nutrition and Health Atlas (GNHA; https://sites.tufts.edu/gnha/), an open-access online platform covering nutrition and health data with 26 themes and 500+ indicators from 190+ countries up to 30 y. We view GNHA as an interactive tool aiming to share information and perspectives and foster collaborations and innovations.

OBJECTIVES: Linear growth faltering, failure to achieve one's potential for length or height at each age, is associated with increased risk of mortality and morbidity. Understanding the age-related patterns of growth faltering can inform timing of interventions and policies for prevention; however current knowledge is limited by cross-sectional data. We examine the longitudinal characterization of the timing of growth faltering among young children. METHODS: Using longitudinal anthropometric data originally collected as part of a food-aid cost-effectiveness trial, we investigated individual growth curves of 5,039 children aged 6–27 months in Burkina Faso (108,580 total measurements) to determine whether growth faltering occurs through intermittent episodes of slower growth, or continuously slow growth. We visualized individual growth curves and used two-stage regressions to evaluate growth curve smoothness at different levels of attained length. To do this, we first obtained model fit and diagnostic parameters from individual regressions of each child's length on their age. Parameters extracted included R(2), as a metric of curve smoothness, initial length at 6 months, and average velocity. We then regressed these parameters on individual-level attained length at study end. RESULTS: Growth faltering manifests as both continuously lower growth velocity throughout the observation period and greater heterogeneity in growth velocity amplitude. Children with lower attained length start smaller (Quintile 1 of attained length-63.1 cm initial length; Quintile 5-68.4 cm) and stay on their initial trajectories, continuously growing slower than their taller counterparts. In addition, a 0.01 increase in the R(2) (smoothness) from regression of a child's length on their age is associated with a 3.10 cm increase in attained length (95% CI: 2.80, 3.41), showing that smoother growth is also associated with higher attained length. CONCLUSIONS: Children who experience the most extreme growth faltering are likely to be less resilient to systematic growth-limiting conditions as well as episodic insults to their growth. Future research should investigate ways of improving environmental conditions to support growth. FUNDING SOURCES: Financial support provided by the Food Aid Quality Review project, funded by the United States Agency for International Development.

OBJECTIVES: Anti-inflammatory diets have been suggested to improve psychological health. This research evaluated the combined effects of consuming an anti-inflammatory diet and caloric restriction (CR) on changes in perceived stress and health-related quality of life in a healthy, non-obese population. METHODS: We conducted a secondary analysis of the publicly available CALERIE data. Participants were randomized to a 2 year CR intervention (n = 143) or an ad libitum Control group (n = 75) and self-selected their dietary intake. An energy-adjusted dietary inflammatory index (DII) was calculated based on 28 components from self-reported food records. Self-reported stress and general health outcomes were measured using validated questionnaires. Linear mixed models were used to assess changes in each outcome from baseline to 12 and 24 months. Models were adjusted for age, sex, baseline outcome measure, change in body fat, and a treatment by DII interaction term. RESULTS: On average, participants were 38.1 ± 7.2 years old with a BMI of 25.1 ± 1.7 kg/m(2). Baseline characteristics, including the DII, stress, and general health, did not differ with randomization. There was no significant association between temporal changes in DII and changes in stress or general health in the CR or Control groups. On average, both groups tended to report higher stress at 12 months; however, there was no difference in perceived stress between groups (adjusted mean difference [MD]: 0.5; 95% confidence interval [CI]: −0.4, 1.5; P = 0.25). There was an improvement in reported general health in the CR group at 12 months (MD: 4.1; 95% CI: 2.2, 6.0; P

OBJECTIVES: Destruction of agricultural lands and fisheries due to climate-related disasters has implications for food production and food security in Indonesia. We examine how natural disasters affect the economic productivity of fishing and farming households in Indonesia by exploring whether flooding and landslide disasters trigger differing migratory behaviors by the type of farming/fishery operation. METHODS: We assessed farming and fishing households in the 5(th) Wave of the IFLS survey (2014/2015) adjusting for household survey weighting. Farming and fishing households are described by the presence or absence of migration since the previous IFLS survey (IFLS4: 2007/2008). Next, we further evaluated households by the type of disaster experienced (flooding or landslides) and other characteristics (region, urban/rural, type of operation). Logistic regression models were used to explain the likelihood of migration, assessing effect modification between the type of disaster (flooding or landslide) and type of farm business to better understand their joint influence on migration. RESULTS: Since IFLS4, approximately 33% of farming households migrated and predominantly moved within the same village or sub-district. Flooding and landslides impacted 8% of households and rice was the most common farm business type (45%). A higher percentage of fishing households were affected by flooding or landslides compared to non-fishing households (23% and 7%, respectively). There were lower odds of migration among rice (OR: 0.75 [95% CI: 0.63,0.89]), corn (0.67 [0.48,0.93]), cassava (0.49 [0.34,0.71]), coffee (0.44 [0.28,0.68]), and cattle (0.49 [0.34,0.70]) farming operations. Migration likelihood was not significantly affected by the joint effect of disaster type and operation type. CONCLUSIONS: Understanding how climate change is impacting agricultural lands and fisheries must coincide with responsive efforts to encourage food production and ensure food security in Indonesia. Our results suggest that farming households may be adapting rather than migrating in response to flooding or landslide disasters. The IFLS provides a tool for examining response efforts of farm and fishing businesses in relation to natural disasters. FUNDING SOURCES: NSF IRES US-Indonesian Research Experience #1,826,939.

OBJECTIVES: Factors associated with the double burden of underweight and overweight/obesity are not well investigated in Indonesia. Insufficient information leaves policy makers without tools to develop coherent, impactful legislation on these issues. We aim to describe and explain the association between weight status, socio-demographic factors, and food consumption patterns in Indonesia. METHODS: We used the 5th Wave of the Indonesia Family Life Survey (IFLS) collected in 2014/15. From the total sample (50,148), we included only adults aged ≥20 years (27,496). We converted BMI into three categories: underweight (BMI 25). Sociodemographic factors included location, education, sex, age category, and frequency of commonly eaten food items. We examined associations using multinomial logistic regression models (α < 0.05). RESULTS: Urban residents were less likely to be underweight (RRR = 0.90 [0.82, 0.98]; P = 0.014) and more likely to be overweight/obesity (RRR = 1.38 [1.31, 1.46]; P

OBJECTIVES: Although studies have found co-occurrence of stunting (low height-for-age) with wasting (low weight-for-height), and found that wasting often precedes stunting, none has investigated links between velocities of linear and ponderal growth over time. Understanding temporal dependencies and growth trajectories in both height and weight can help determine optimal timing of interventions to prevent wasting and stunting. METHODS: We re-analyzed monthly height and weight data from a cohort of 6112 children aged 6–23 months in a supplementary feeding trial in Burkina Faso, conducted from July 2014 to September 2016. We built mixed effects models with multiple lag periods to determine links between linear growth trajectory (cm gained/month) and ponderal growth trajectory (kg gained/month), and vice versa, controlling for age, season, study arm, and morbidities. Lag periods included growth velocity measurements taken one (t-1) to four (t-4) months prior to the outcome velocity. RESULTS: On average in these data, ponderal growth is positively associated with future linear growth, but linear growth is followed by lower future weight gain. Doubling the average ponderal growth velocity (0.18 kg/month) is associated with 3%–0.2% higher linear growth velocity one to four months later, while doubling the average linear growth velocity (0.95 cm/month) is associated with 16%–3% lower ponderal growth velocity one to four months later. In all cases, the magnitude of a growth velocity's association with future growth velocities decreases as the time interval increases. These results are all significant at the 5% level. CONCLUSIONS: We find that episodes of faster linear growth are associated with lower subsequent ponderal growth. This finding demonstrates temporal dependencies and suggests that, for infants in Burkina Faso, linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid a slowdown in weight gain. To improve child growth, programs should combine strategies that address both height and weight. FUNDING SOURCES: United States Agency for International Development, Office of Food for Peace.

OBJECTIVES: In Indonesia, exclusive breastfeeding practices are followed by only 46% of mothers, resulting in USD $118 million in health costs annually [2, 3]. Though previous studies have addressed demographic factors related to breastfeeding [5, 6], few studies have examined the relationship between exclusive breastfeeding duration and mother's psychosocial characteristics [5, 6, 7, 8]. Our study used the Indonesian Family Life Survey 5(th) Wave survey (IFLS5) from 2014–2015 to evaluate if demographic and psychosocial factors are associated with exclusive breastfeeding duration among Indonesian mothers [7, 8]. METHODS: Our study included mothers (n = 3024) with children 6 months) according to WHO standards [1]. We described individual mother's characteristics including age, education level, socioeconomic status, and psychosocial factors by these breastfeeding categories. We developed binary breastfeeding duration variables by those never breastfeeding or breastfeeding ≤4 months to perform binary logistic regression models. Finally, we examined differences between categories of breastfeeding duration using multinomial logistic models. RESULTS: Mothers with primary and secondary education had lower odds of having breastfed exclusively for ≤4 months (OR 0.43 [0.30, 0.60] and 0.64 [0.46, 0.89]), respectively, compared to mothers with higher education. Mothers with primary education were also 2.21 [1.05, 4.50] times as likely to have never breastfed relative to breastfeeding exclusively for 4–6 months compared to highly-educated mothers. Compared to younger mothers (30–39 years), older mothers (40 + years) had a greater likelihood of never exclusively breastfeeding, relative to exclusively breastfeeding for 4–6 months (RR 3.28 [1.80, 5.96]). Finally, mothers who had lower perceived life-satisfaction had a lower likelihood (RR 0.60 [0.45, 0.77]) of exclusively breastfeeding >6 months compared to mothers with very high satisfaction. CONCLUSIONS: Our results can help to inform policy makers about disparities in exclusive breastfeeding practices to better tailor services to underserved mothers within Indonesia. FUNDING SOURCES: NSF IRES US-Indonesian Research Experience #182,693.