Adherence to Indonesia's Dietary Guidelines Among Lactating Women: Insights for Policy and Practice

This study investigated adherence to Indonesia's Dietary Guidelines (IDG) among lactating women, examining related factors and association with nutrient intake adequacy, maternal and infant biomarkers, body mass index, and growth. Participants were lactating women (n = 220) from urban and rural West Java, Indonesia. Dietary intake (via 3-day weighed food records), anthropometry and blood samples were assessed. Adherence was evaluated using a scoring system tailored for IDG and adapted from the Healthy Eating Index to assess intake of food groups, sugar, salt, fat, water, coffee, and breakfast habits. Starchy staples intake exceeded recommendations by nearly double (median 7.1 vs. recommended 3-4 servings/day), while vegetable (0.5 servings/day), fruit (1.0), and water (1300 mL/day) intake fell notably short. Protein-rich food intake (3.5 servings/day) was closer to target. Only 1% of participants met three out of four food group targets. Adherence to the meal-based MyPlate framework showed similar imbalances, with 68% of the plate occupied by starchy staples versus the recommended 33%. Sociodemographic factors, including education, wealth, and family size, were associated with adherence to IDG components. For instance, women in the highest wealth quintile had higher adherence scores for starchy staple moderation (mean 4.3) than those in the lowest (mean 2.9). Adherence to IDG components correlated positively with nutrient intake adequacy (e.g. protein-rich food and overall adequacy: r = 0.19, 95% CI: 0.06-0.32) but not consistently with maternal or infant biomarkers. These findings highlight the need to refine dietary guidelines with clearer portion guidance and consideration of factors beyond intake adequacy during lactation.