Title: Preventing Stunting Through Fish Consumption

Introduction
Stunting is a growth disorder caused by malnutrition. Stunting occurs in children under five
(Rahayu, Pamungkasari, and Wekadigunawan, 2018). Stunting can be defined as a nutritional
status problem that indicates a lack of micronutrient intake and the presence of recurrent
chronic infectious diseases. Stunting that occurs during pregnancy, or what can be called
congenital stunting, can result in obstacles to the growth and development of organs such as
the brain, heart, kidneys, and other vital organs. Signs of stunting are not only failed to
develop physically (shortness) but also developmental disorders, intellectual disorders, and
disturbances in the body's metabolism, which cause the risk of non-communicable diseases.
In 2021, the stunting rate in Jember reached 23.9% of the total population of Jember. This is a
good sign because stunting cases can decrease compared to the previous year, which reached
31.81% of cases, but this is still above the national figure, which is equal to 14%.
In general, the causes of stunting are a lack of nutritional intake, the presence of disease
infections, parenting patterns for toddlers, and supporting factors that can influence the
child's parenting patterns. Meanwhile, the factors causing stunting in the womb are the
mother's poor health and nutritional status. Stunting while pregnant is caused by a lack of
micronutrients in pregnant women, which causes growth failure in the baby. It can mainly
occur during the First 1000 Days of Pregnancy (HPK), and half of the growth failure happens
during pregnancy. Some supporting factors inhibiting growth during pregnancy are chronic
lack of energy, anemia, and nicotine and cigarette smoke exposure. Stunting during
pregnancy can be prevented by adequate micronutrient intake for pregnant women. Pregnant
women require higher nutritional intake compared to women who are not pregnant. The
nutrients needed by pregnant women can include carbohydrates, protein, fat, and
micronutrients. Pregnant women need micronutrients for fetal development. Pregnant women
need micronutrients that can prevent anemia, stunting in babies, and malnutrition. Examples
of micronutrients are vitamins (folic acid, vitamin A, vitamin B, vitamin C, vitamin D,
vitamin E, vitamin K) and minerals (iron, zinc, calcium, iodine, phosphorus, fluorine,
sodium).
In Indonesia, one of the nutriments that contain high levels of micronutrients is fish. Fish is a
good source of micronutrients and is easier to obtain than red meat and chicken. The nutrients
found in fish can substitute micronutrients for red meat. To avoid getting bored with fish, it is
necessary to process food ingredients into varied fish preparations to prevent monotony. In
Jember, fish production reaches 9,671.07 per year, and tuna production in Jember is 1,984.88
tons yearly. The people of Jember can use this to make processed tuna that can meet the
nutritional needs of pregnant women. The protein found in tuna has a complete amino acid
composition, so the body needs it. The minerals in tuna meat consist of magnesium, calcium,
iodine, phosphorus, fluorine, iron, zinc, and selenium. Tuna fish is rich in omega-3 and
omega-6, which help strengthen heart muscle endurance, increase brain intelligence, and
prevent blood clots (Susanto, 2012). Per 100 grams of tuna, it has nutritional content in the
form of 25.00% protein, 0.03% carbohydrates, 1.50% fat, 2.25% minerals, and 69.40%
water.

Purpose:
Knowing the role of complete protein in preventing stunting
Specific Purpose:
Identifying micronutrients found in fish and their effect on preventing stunting
 Discussion
A. Stunting
Stunting is a growth disorder caused by malnutrition. Stunting occurs in
children under five (Rahayu et al., 2018). Short toddler presentations ≥ 20% can cause
public health problems. (Indonesian Ministry of Health Data and Information Center,
2016). Meanwhile, based on data from the Badan Pusat Statistik (BPS), the
prevalence of very short and short toddlers according to districts or cities in 2018,
Jember had a prevalence of 38.30%, ranking 8th in East Java Province. Stunting is
another form of growth failure resulting from chronic malnutrition, which has
occurred for a long time and differs from acute malnutrition. Stunting can occur in
fetuses in the womb and is caused by inferior micronutrient intake during pregnancy,
poor parenting patterns, and low-quality intake of food, which is in line with the
occurrence of infections so that it can inhibit growth (Unicef Indonesia, 2012).
In a short term, stunting can cause disruption to brain development and
physical growth, as well as disrupt a person's metabolism and intelligence.
Meanwhile, in the long term, the negative impacts that can occur are decreased
cognitive abilities and learning achievement, decreased immunity so that sufferers
become sick quickly, and a high risk of developing diabetes, cancer, stroke, heart and
blood vessel disease, and even disability in old age (Unicef Indonesia, 2012). The
majority of children with stunting have poor academic achievement (Piculay, 2013).
So, it can reduce the quality of work, which makes children uncompetitive and can
result in low economic productivity. (Unicef Indonesia, 2012). Based on research
conducted by Sorhaindo and Feinstein in London shows a relationship between
nutritional status and learning achievement. In his research, facts were found
regarding the effect of poor nutrition experienced by children on the immune system,
so that children suffer from infectious diseases more easily. This situation can also
affect children's attendance at school, so children tend to fall behind in the learning
process, which will affect learning outcomes. Moreover, poor nutritional status causes
imperfect cognitive development, IQ development and learning abilities, ultimately
affecting children's learning achievement.
Chronic malnutrition not only interferes with growth but also causes cells in
the brain to become smaller and causes immaturity and imperfection in the
biochemical composition of the brain. This situation can affect the development of
children's intelligence. This is supported by the Indonesian Institute of Sciences in the
Main Paper for Sector 5 of the National Widyakarya for Food and Nutrition
consequences for education, income and productivity in adulthood, which can
potentially reduce economic growth. In general, the causes of stunting are a lack of
nutritional intake, the presence of disease infections, parenting patterns for toddlers,
and supporting factors that can influence the child's parenting patterns. Meanwhile,
the factors causing stunting in the womb are the mother's poor health and nutritional
status. Stunting in the womb is caused by a lack of micronutrients in pregnant women,
which causes growth failure in the baby, which can mainly occur during the First
1000 Days of Pregnancy (HPK), and half of the growth failure during this period
occurs in the womb. Some supporting factors that inhibit growth in the womb are
chronic lack of energy, anemia, and exposure to nicotine and cigarette smoke.
Stunting in the womb can be prevented by adequate micronutrient intake for pregnant
women. Nutritional intake in pregnant women plays an essential role in stunting.
Pregnant women who are malnourished or have insufficient food intake will cause
fetal growth disorders in the womb (Picauly, 2013).

B. Micronutrient
Based on the Nutritional Adequacy Rate (RDA), an additional 300 kcal per
day is needed during pregnancy; protein 20g/day; fat 10g/day; and carbohydrates
40g/day during pregnancy, as well as micronutrients to help the growth of the fetus in
the womb (MCAI, 2016). Proteins, lipids and carbohydrates are included in
macronutrients. In contrast to macronutrients, micronutrients are vitamins and
minerals that are consumed in small amounts but are still vital for both physical and
mental development. The following are examples of essential micronutrients: iron,
zinc, calcium, iodine, vitamin A, B vitamins, and vitamin C. The term micronutrients
refers to vitamins and minerals. A balanced diet requires adequate amounts of
micronutrients. Micronutrients are a group of nutrients that the body needs. That
includes vitamins and minerals. Vitamins and minerals are very important for the
development of health, disease prevention, and body fitness. Vitamins are needed to
produce energy, carry out immune function, blood clotting, and other functions.
Meanwhile, minerals play an important role in growth, bone health, fluid balance, and
several other processes. Certain micronutrients also play a role in preventing and
fighting disease. The human body cannot produce most micronutrients, so that
micronutrient consumption can be obtained from food consumption. Therefore,
micronutrients are also called essential nutrients. Vitamins are organic compounds
produced by plants and animals that can be broken down by heat, acid, or air. On the
other hand, minerals are inorganic, found in soil or water, and cannot be decomposed.
The micronutrient content of each food is different. Therefore, consume a variety of
foods to get adequate vitamins and minerals. For optimal body health, adequate
micronutrient intake is needed because each vitamin and mineral has a specific role in
the body.
During pregnancy, diets should be balanced in terms of macronutrients and
micronutrients. The daily energy requirement for healthy average women increases
during pregnancy based on the foetus's trimester. As the pregnancy progresses, the
woman's protein needs increase, peaking in the third trimester. The appropriate
protein intake in the diet supports the protein biosynthesis needed to supply the needs
of maternal tissues, the placenta, and the growing foetus. The total fat intake should
not increase significantly, especially in the first trimester of pregnancy. WHO
recommends various interventions to overcome micronutrient deficiencies. The Role
of micronutrients for Pregnant women is listed below.
Iron
Iron is a mineral that the body needs for growth and development of
motor and cognitive. Ourbody uses iron to make hemoglobin, myoglobin, and
hormons. Pregnant women are vulnerable to the development of iron
deficiency also predisposes women to urinary tract infections. Iron deficiency
leads to anaemia. Anaemia is defined as low haemoglobin concentration,
which affects 40% of children under five and 30% of pregnant women
globally. Anaemia during pregnancy increases the risk of death for the mother,
low birth weight in an infant, and a higher risk of premature birth. The amount
of iron according to the current recommendations, pregnant women need 27
mg of iron daily.

Calcium
 Inadequate calcium intake in pregnant women leads to decreased bone
density in both the mother and the child. A deficiency of calcium also
correlates with hypertension in pregnant women, which increases the threat of
premature birth and newborn death. The daily calcium requirement for
pregnant women is 1200-2000 mg, and the most tolerated dose is 2500 mg.

Zinc
In the bodies of pregnant women, the request for zinc increases to 11-
12 mg daily. Deficient zinc intake during pregnancy can increase chance of
premature birth, low birth weight, and foetal growth defects.

Vitamin A
Vitamin A supports healthy eyesight and prevents miscarriage, iron
anaemia, and failure of organ development. Iodine is required during
pregnancy for the infant's healthy growth and cognitive development.

Folate
Folate or vitamin B9 can make new cells every day. Folate is essential
in the earliest days of fetal growth for brain and spine health development. The
recommended daily intake of copper for pregnant women is 1 mg. Folic acid
supplementation at 0.4 mg a day is widely recommended for potentially
childbearing women.

Vitamin D3
Recent studies advise that all pregnant women take vitamin D3
supplementation at 600 IU or 15 mcg per day.

Magnesium
Studies conducted so far indicate a significant increase in the amount
of magnesium needed by pregnant women, which can be as high as twice the
pre-pregnancy requirement. With a dosage in the range of 200–1000 mg.

C. Micronutrients in Pregnancy
Pregnancy increases metabolic demands because of the growing fetus's needs
as well as modifications to the woman's physiology. Micronutrients are a group of
vitamins and minerals that when not consumed in sufficient amounts can cause
anemia, hypertension, labor complications, and even death in the mother.
Furthermore, the fetus might be affected, which could result in stillbirth, preterm
delivery, congenital malformations, decreased immunocompetence, abnormal organ
development, and intrauterine growth retardation.
Deficits in certain nutrients during pregnancy, particularly in the early stages,
increase the risk of complications like preterm birth, eclampsia/ecampsia, and
abortion. The implantation process will be hampered by early pregnancy
micronutrient deficiencies, such as those in vitamins and minerals. Abortion or
miscarriage results from failure to implant, whereas eclampsia/pre-eclampsia is
brought on by disruptions in the placentation process and remodeling of the spiral
artery blood vessels. Multivitamin-mineral supplements taken during the
preconception or periconceptional period can lower the risk of abortion, prematurity,
pre-eclampsia, and congenital defects, as shown by multiple studies.
 The identification of clinical conditions linked to severe deficiencies of
specific vitamins or minerals, along with subsequent animal experiments, have
demonstrated the essential nature of micronutrients. While the importance of many
micronutrient deficiencies during pregnancy has long been known (e.g., iodine), the
importance of many others is only now being realized.
According to Allen (2005), deficiencies of multiple micronutrients rather than
just one could be the cause of the poor quality of pregnancy outcomes. As of right
now, iron and folate supplements are still regarded by government policy as a specific
intervention for the problem of anemia and poor pregnancy outcomes; however, this
may still need to take into account a number of factors and be backed by research
findings in Indonesia.
There are many micronutrient interactions, so treating two or more
deficiencies at once may be beneficial. For instance, vitamin A interferes with the
utilization of iron, which leads to anemia; iron alone has been demonstrated to have
less of an impact on anemia than vitamin A and iron combined. Another study found
that iron therapy plus zinc and vitamin A had a greater impact on anemia than iron
alone. Another illustration is the fact that vitamin C can improve iron absorption.
On the other hand, some micronutrients might be detrimental to other
micronutrients. As an illustration, excessive zinc dosages may prevent the absorption
of copper or iron, and iron supplements may prevent the absorption of zinc.
Due to low nutritional intake, increased metabolic demands, and increased
nutrient loss, recurring infectious diseases, and reduced appetite, infants and early
children struggle to grow. Although the issue is recognized, there hasn't been much
progress in lowering malnutrition. The methods used to treat childhood stunting and
growth failure have evolved over time. Current efforts emphasize prevention through
combined nutritional and disease prevention and treatment interventions, in contrast
to past efforts that were almost exclusively focused on identifying and rehabilitating
severely malnourished children.
Initially, rather than advocating for improved child feeding practices
generally, efforts to prevent undernutrition concentrated on illnesses. Even though
diseases have a catastrophic impact on nutritional status, lowering undernutrition can
be achieved more effectively through improving dietary intakes than through disease
prevention strategies (Becker, Black, & Brown, 1991). Increasing intakes during
recovery, when appetite may be normal or high, and maintaining energy intakes
despite anorexia were the initial foci of efforts to improve dietary intakes during
illness. This resulted from the sharp decreases in appetite that accompany illness.
Aiming to provide healthy children with optimal diets, including consideration for
dietary quality, are more recent interventions. Lastly, some have claimed that growth
promotion and monitoring must occur in addition to nutritional counseling for it to be
effective; nevertheless, this is becoming more widely acknowledged.
It is obvious that adequate micronutrient intake during gestation and at the
time of conception affects a variety of pregnancy outcomes. It is challenging to
prevent birth defects when certain micronutrients, like zinc and folic acid, are required
during conception. This is because any successful intervention would have to enhance
the health of all women of reproductive age, or at the very least, those who are at high
risk of becoming pregnant When a pregnancy is discovered, intervention may be
helpful for other reasons. Supplementation is the standard method for enhancing
micronutrient status during pregnancy, specifically for folic acid and iron.
D. Tuna Conservation in Indonesia
 One way to stop stunting in children is to provide them with the animal protein
they need. The high protein content of fish, particularly tuna, is beneficial for a child's
growth and brain development as well as helping to prevent stunting. Some research
suggests that eating fish, especially tuna, may help shield kids from stunting. Stunting
reduction and fish consumption are positively correlated, with toddlers who consumed
less fish being more likely to suffer from stunting. Because canned tuna fish has a
high concentration of potassium, manganese, zinc, vitamins A and E, and iron, which
can prevent anemia, it has been identified in another study as one of the fish that can
prevent stunting. But it's important to keep in mind that stunting is a complex issue
that can result from a variety of factors, including infection, insufficient food intake,
and unhygienic conditions. For this reason, in addition to other interventions, a varied
and balanced diet is required to avoid stunting.
Indonesia offers enormous potential for aquaculture. The area between when
possible fishing grounds are accessible and when they are used is 17.9 million
[Link], brackish, or marine cultivation can be planted in this area.
However, marine aquaculture reaches 67.7% of the state space potential, while
freshwater and brackish water cultivation only reaches 16.5%. Furthermore, only
2.7% of Indonesia's fishery land has been put to use for the cultivation of lakes or
ponds, and even then, it has only been for marine aquaculture. In 2018 saw $9.11
billion in fisheries exports from Indonesia. This amount rises to US$ 10.8 billion
when the added value of exports other than gas and oil is taken into account. When
the aquaculture subsector's value is included, this amount rises to $11.7 billion, or
1.13% of their overall value. Additionally, 37.71% of Indonesia's total non-oil and gas
exports in 2018 were represented by this amount.
As many as 37% of the world's fish species are found in the waters around
Indonesia. High economic value fish include tuna, shrimp, lobster, reef fish,
ornamental fish, seaweed, and other shellfish. In addition, since the 1980s, fish
farming has developed. Creating goldfish, tilapia, catfish and milkfish ponds was part
of this expansion. Furthermore, these fish are raised in freshwater settings like
ponds. Outside of ponds, there are fishing methods and pursuits that can be utilized
as a means of fertilization or hiding from predators.
As is well known, Indonesia is the world's fishing paradise, with an extremely
high and steadily rising fisheries production. This circumstance obviously favors
making fish a staple food in the country. Fish can therefore be utilized as a remedy
for today's nutritional issues because, in addition to being widely available and
inexpensive, it also has a high nutrient content that is beneficial to the body.
According to studies, tuna has a low fat content between 0.2 and 22.7g per
100g of meat that may help pregnant women avoid stunting. Tuna waste can also be
converted into supplements that stop stunting. A fresh supply of omega-3 fatty acids,
which can help avoid stunting, may also be found in the eyes and eye muscles of tuna
fish. Furthermore, additional research has demonstrated that giving stunted toddlers
tuna bone meal cookies can enhance their nutritional status.
From this explanation, it is clear that Indonesia's substantial tuna fish
production contributes to the prevention of stunting by using the fish's various parts
for both direct consumption and as a raw material for supplements or other foods that
can prevent stunting.
In order to have high-quality offspring, proper nutrition needs to start early in
life, specifically during the intrauterine stage. Research has demonstrated that both
macronutrient and micronutrient deficiencies can harm a child's development and
growth, and in certain situations, cause lifelong problems. Since some micronutrients
 are particularly important for a child's development, it is best to prevent micronutrient
deficiencies as early in life as possible. Numerous studies have demonstrated the
effectiveness of multi-micronutrient supplementation in addressing deficiencies in
specific micronutrients shortcomings.
Policies for vitamin and mineral supplementation and fortification, specifically
addressing widespread deficiencies of micronutrients essential for individual and
population health, are needed as the epidemiologic, nutritional, and sociological
scientific basis of human nutrition grows. Government accountability for wholesome
and safe food products should mandate the application of additional tactics such as
fortification-appropriate foods and preventive supplementation. For numerous groups
who are particularly vulnerable to micronutrient deficiencies and the resulting
detrimental impacts on their health and society, these should be controlled and
occasionally subsidized.
Several recommendations for national and international governments, public
health professionals, educators, and policy makers flow from these findings. In the
broader context of public health nutrition policies, which include agricultural
practices and subsidies that are widely promoted and involve the food industries as
well as the manufacturing, processing, and marketing of food, they should be an
essential part of active governmental leadership. Their potential to improve a nation's
health at a minimal cost and with safety is what determines how important they are.

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