Protein intake recommendation for stunted children: an update review.


  • Al Mukhlas Fikri University of Singaperbangsa Karawang
  • Widya Astuti Nutrition Study Program, Faculty of Sport and Health Education, Universitas Pendidikan Indonesia, Bandung, Indonesia, 40154
  • Vieta Annisa Nurhidayati Management of Food Service and Nutrition Study Program, College of Vocational Studies, IPB University, Bogor, Indonesia, 16128
  • Fajria Saliha Puspita Prameswari Nutrition Study Program, Faculty of Sport and Health Education, Universitas Pendidikan Indonesia, Bandung, Indonesia, 40154
  • Nazrul Hadi Ismail Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Malaysia


Palabras clave:

intake, protein, recommendation, stunting, under-five children


Introduction: Childhood stunting remains a pervasive
global health issue affecting millions of children, with significant repercussions on their physical and cognitive development.
Objective: This study aimed to collect information on dietary guidelines and protein recommendation specifically designed for stunted children.
Methods: A systematic review was performed using several databases, including Pubmed, Scopus, and Google
Scholar. A literature search was conducted to collect studies
on dietary guidelines (keywords: Dietary recommendation OR Dietary Guidelines AND Stunting OR Stunted OR Retarded Growth) and protein recommendation (keywords: protein AND catch-up growth AND stunting AND children OR infant) for stunted children. This review also included a narrative review for additional information.
Results: A total of 12 and 9 related articles were included
in this systematic review on dietary guidelines and protein intake, respectively. This systematic review shows that protein intake stands out as a critical determinant in stunting, with low intake associated with growth faltering. However, guidelines specifically tailored to manage stunting remain scarce.
Current evidence suggests protein’s beneficial role in supporting linear growth, but excessive intake may contribute to obesity risk, highlighting the need for balanced recommendations.
Conclusion: This review synthesizes existing knowledge
on protein’s role in stunting management, emphasizing the
importance of appropriate protein intake in promoting optimal growth while mitigating associated risks.


WHO. Joint Child Malnutrition Estimate. 2022.

Vaivada T, Akseer N, Akseer S, Somaskandan A, Stefopulos M, Bhutta ZA. Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline. Am J Clin Nutr. 2020;112(Supplement_2):777S-791S.

Soliman A, De Sanctis V, Alaaraj N, Ahmed S, Alyafei F, Hamed N, et al. Early and long-term consequences of nutritional stunting: from childhood to adulthood. Acta Bio Medica: Atenei Parmensis. 2021;92(1).

Bank W. Repositioning nutrition as central to development: a strategy for large scale action. The World Bank; 2005.

Nasser MS, Akhlaq A, Ali H, Nasser D. Evidence Linking Stunting to Economic Outcomes in the SAARC Region: A Systematic Review. Pakistan Journal of Public Health. 2022;12(2):88–101.

Organization WH. Reducing stunting in children: equity considerations for achieving the Global Nutrition Targets 2025. 2018;

Anshori LM, Sutrisna B, Fikawati S. Relationship energy and protein intake with the incidence of stunting among toddler aged (25-60 months) in Mangkung village, District of Central Lombok. Indian J Public Health Res Dev. 2020;11(3):1593–8.

Fikawati S, Syafiq A, Ririyanti RK, Gemily SC. Energy and protein intakes are associated with stunting among preschool children in Central Jakarta, Indonesia: a case-control study. Malays J Nutr. 2021;27(1).

Rahayu A, Yulidasari F, Anggraini L, Rahman F, Laily N, Sari AR, et al. Energy and Protein Intake-Related Risks Affected the Occurrence of Stunting Among Young Children. In: 4th International Symposium on Health Research (ISHR 2019). Atlantis Press; 2020. p. 330–6.

Rizky Maulidiana A, Sutjiati E. Low intake of essential amino acids and other risk factors of stunting among under-five children in Malang City, East Java, Indonesia. J Public Health Res. 2021;10(2):jphr-2021.

Kaimila Y, Divala O, Agapova SE, Stephenson KB, Thakwalakwa C, Trehan I, et al. Consumption of animal-source protein is associated with improved height-for-age z scores in rural Malawian children aged 12–36 months. Nutrients. 2019;11(2):480.

Tang M, Krebs NF. High protein intake from meat as complementary food increases growth but not adiposity in breastfed infants: a randomized trial. Am J Clin Nutr. 2014;100(5):1322–8.

Kabir I, Rahman MM, Haider R, Mazumder RN, Khaled MA, Mahalanabis D. Increased height gain of children fed a high-protein diet during convalescence from shigellosis: a six-month follow-up study. J Nutr. 1998;128(10):1688–91.

Semba RD. The rise and fall of protein malnutrition in global health. Ann Nutr Metab. 2016;69(2):79–88.

Semba RD, Trehan I, Li X, Salem Jr N, Moaddel R, Ordiz MI, et al. Low serum ω-3 and ω-6 polyunsaturated fatty acids and other metabolites are associated with poor linear growth in young children from rural Malawi. Am J Clin Nutr. 2017;106(6):1490–9.

Joosten K, Meyer R. Nutritional screening and guidelines for managing the child with faltering growth. Eur J Clin Nutr. 2010;64(1):S22–4.

Pencharz PB. Protein and energy requirements for ‘optimal’ catch-up growth. Vol. 64, European Journal of Clinical Nutrition. 2010. p. S5–7.

Scrimshaw NS, Waterlow JC, Schurch B. Energy and protein requirements: proceedings of an IDECG workshop. Eur J Clin Nutr. 1996;50.

Abrams SA, Hawthorne KM, Pammi M. A systematic review of controlled trials of lower-protein or energy-containing infant formulas for use by healthy full-term infants. Advances in Nutrition. 2015;6(2):178–88.

Patro-Gołab B, Zalewski BM, Kouwenhoven SMP, Karaś J, Koletzko B, van Goudoever JB, et al. Protein concentration in milk formula, growth, and later risk of obesity: A systematic review. Journal of Nutrition. 2016;146(3):551–64.

Weber M, Grote V, Closa-Monasterolo R, Escribano J, Langhendries JP, Dain E, et al. Lower protein content in infant formula reduces BMI and obesity risk at school age: follow-up of a randomized trial. Am J Clin Nutr. 2014;99(5):1041–51.

Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016. JAMA Pediatr. 2020;174(2):e194498–e194498.

Hudson JL, Baum JI, Diaz EC, Børsheim E. Dietary Protein Requirements in Children: Methods for Consideration. Nutrients. 2021;13(5):1554.

Khotimah DF, Faizah UN, Sayekti T. Protein sebagai zat penyusun dalam tubuh manusia: tinjauan sumber protein menuju sel. In: PISCES: Proceeding of Integrative Science Education Seminar. 2021. p. 127–33.

Luque V, Closa-Monasterolo R, Escribano J, Ferré N. Early programming by protein intake: the effect of protein on adiposity development and the growth and functionality of vital organs. Nutr Metab Insights. 2015;8:NMI-S29525.

DR ALD, Millward DJ, LANHAM-NEW SA. Dietary protein and bone health: towards a synthesised view. Proceedings of the Nutrition Society.

Hamidah S, Sartono A, Kusuma HS. Perbedaan Pola Konsumsi Bahan Makanan Sumber Protein di Daerah Pantai, Dataran Rendah dan Dataran Tinggi. Jurnal gizi. 2017;6(1).

Mehta N, Rao P, Saini R. A review on metabolites and pharmaceutical potential of food legume crop mung bean (Vigna radiata L. Wilczek). BioTechnologia. 2021;102(4):425.

Endrinikapoulos A, Afifah DN, Mexitalia M, Andoyo R, Hatimah I, Nuryanto N. Study of the importance of protein needs for catch-up growth in Indonesian stunted children: a narrative review. SAGE Open Med. 2023;11:20503121231165560.

Herring CM, Bazer FW, Johnson GA, Wu G. Impacts of maternal dietary protein intake on fetal survival, growth, and development. Exp Biol Med. 2018;243(6):525–33.

Bailes J, Soloviev M. Insulin-like growth factor-1 (IGF-1) and its monitoring in medical diagnostic and in sports. Biomolecules. 2021;11(2):217.

Cohen P. Overview of the IGF-I system. Horm Res Paediatr. 2006;65(Suppl. 1):3–8.

Masrul DI, Nindrea RD, Sudji IR, Purnakarya I. Cut off Point of Insulin-Like Growth Factor-I (IGF-1) for Prediction of Child Stunting. Indian J Public Health Res Dev. 2020;11(1):1234–9.

Tessema M, Belachew T, Ersino G. Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. Pan African Medical Journal. 2013;14(1).

Grenov B, Larnkjær A, Ritz C, Michaelsen KF, Damsgaard CT, Mølgaard C. The effect of milk and rapeseed protein on growth factors in 7–8 year-old healthy children–A randomized controlled trial. Growth Hormone & IGF Research. 2021;60:101418.

Lestari ND, Rizkiyah N. The workplace stress and its related factors among indonesian academic staff. Open Access Maced J Med Sci. 2021;9(T4):70–6.

Parikh P, Semba R, Manary M, Swaminathan S, Udomkesmalee E, Bos R, et al. Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low‐and middle‐income countries. Matern Child Nutr. 2022;18(1):e13264.

Hermawan D, Kurniasari D, Sandayanti V, Sari N, Listyaningsih E. Relationships of deworming drug consumption and animal protein intake with stunting. Parasite Epidemiol Control. 2023;23:e00326.

Senekal M, Nel JH, Eksteen G, Steyn NP. Dietary Patterns, Socio-Demographic Predictors Thereof, and Associations of Dietary Patterns with Stunting and Overweight/Obesity in 1–< 10-Year-Old Children in Two Economically Active Provinces in South Africa. Nutrients. 2023;15(19):4136.

Mahmudiono T, Sumarmi S, Rosenkranz RR. Household dietary diversity and child stunting in East Java, Indonesia. Asia Pac J Clin Nutr. 2017;26(2):317–25.

Ilmani DA, Fikawati S. Nutrition Intake as a Risk Factor of Stunting in Children Aged 25–30 Months in Central Jakarta, Indonesia. Jurnal Gizi Dan Pangan. 2023;18(2):117–26.

Furuta C, Sato W, Murakami H, Suri DJ, Otoo GE, Tano-Debrah K, et al. Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial. Front Nutr. 2021;8:606002.

Rizky Maulidiana A, Sutjiati E. Low intake of essential amino acids and other risk factors of stunting among under-five children in Malang City, East Java, Indonesia. J Public Health Res. 2021;10(2):jphr-2021.

Xiong T, Wu Y, Hu J, Xu S, Li Y, Kong B, et al. Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study. Nutrients. 2023;15(22):4821.

Lind M V, Larnkjær A, Mølgaard C, Michaelsen KF. Dietary protein intake and quality in early life: impact on growth and obesity. Curr Opin Clin Nutr Metab Care. 2017;20(1):71–6.

Rahayuwati L, Komariah M, Sari CWM, Yani DI, Hermayanti Y, Setiawan A, et al. The Influence of Mother’s Employment, Family Income, and Expenditure on Stunting Among Children Under Five: A Cross-Sectional Study in Indonesia. J Multidiscip Healthc. 2023;2271–8.

WHO U. Global nutrition targets 2025: breastfeeding policy brief (WHO/NMH/NHD14. 7). Geneva: World Health Organization. 2014;

Shaw V, McCarthy H. Principles of paediatric dietetics: nutritional assessment, dietary requirements and feed supplementation. Clinical Paediatric Dietetics. 2020;1–17.

Clarke SE, Evans S, MacDonald A, Davies P, Booth IW. Randomized comparison of a nutrient‐dense formula with an energy‐supplemented formula for infants with faltering growth. Journal of human nutrition and dietetics. 2007;20(4):329–39.

Hörnell A, Lagström H, Lande B, Thorsdottir I. Protein intake from 0 to 18 years of age and its relation to health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res. 2013;57(1):21083.

Savarino G, Corsello A, Corsello G. Macronutrient balance and micronutrient amounts through growth and development. Ital J Pediatr. 2021;47(1):1–14.

Luca S, Laura C, Maurizio M, Claudio M, Pierluigi P, Angela P, et al. LARN Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana. IV Revisione. SICS editore; 2014.

Mis NF, Braegger C, Bronsky J, Campoy C, Domellöf M, Embleton ND, et al. Sugar in infants, children and adolescents: a position paper of the European society for paediatric gastroenterology, hepatology and nutrition committee on nutrition. J Pediatr Gastroenterol Nutr. 2017;65(6):681–96.

Koshy B, Srinivasan M, Gopalakrishnan S, Mohan VR, Scharf R, Murray-Kolb L, et al. Are early childhood stunting and catch-up growth associated with school age cognition?—Evidence from an Indian birth cohort. PLoS One. 2022;17(3):e0264010.

Faye CM, Fonn S, Levin J. Factors associated with recovery from stunting among under-five children in two Nairobi informal settlements. PLoS One. 2019;14(4):e0215488.

Damayanti D. Ilmu Gizi Teori dan Aplikasi. Jakarta: Penerbit Buku Kedokteran EGC. 2017;

Doherty T, deBenoist MH, Hibbert J, Persaud C, Jackson AA. The effect of the level of dietary protein and the quality of dietary energy on urea kinetics in young children recovering from severe malnutrition. Proceedings of the Nutrition Society. 1989;48:55.

Putet G, Labaune JM, Mace K, Steenhout P, Grathwohl D, Raverot V, et al. Effect of dietary protein on plasma insulin-like growth factor-1, growth, and body composition in healthy term infants: A randomised, double-blind, controlled trial (Early Protein and Obesity in Childhood (EPOCH) study). British Journal of Nutrition. 2016 Jan 28;115(2):271–84.

Varkey A, Devi S, Mukhopadhyay A, Kamat NG, Pauline M, Dharmar M, et al. Metabolome and microbiome alterations related to short-term feeding of a micronutrient-fortified, high-quality legume protein-based food product to stunted school age children: A randomized controlled pilot trial. Clinical Nutrition. 2020 Nov 1;39(11):3251–61.

Braun KVE, Voortman T, Kiefte-de Jong JC, Jaddoe VW V, Hofman A, Franco OH, et al. Dietary intakes of folic acid and methionine in early childhood are associated with body composition at school age. J Nutr. 2015;145(9):2123–9.

Wang J, Wu Z, Li D, Li N, Dindot S V, Satterfield MC, et al. Nutrition, epigenetics, and metabolic syndrome. Antioxid Redox Signal. 2012;17(2):282–301.

Plaisance EP, Greenway FL, Boudreau A, Hill KL, Johnson WD, Krajcik RA, et al. Dietary methionine restriction increases fat oxidation in obese adults with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(5):E836–40.

Orgeron ML, Stone KP, Wanders D, Cortez CC, Gettys TW. The impact of dietary methionine restriction on biomarkers of metabolic health. Prog Mol Biol Transl Sci. 2014;121:351–76.

Koletzko B, Von Kries R, Closa R, Escribano J, Scaglioni S, Giovannini M, et al. Lower protein in infant formula is associated with lower weight up to age 2 y: A randomized clinical trial. American Journal of Clinical Nutrition. 2009 Jan 6;89(6):1836–45.

Turck D, Grillon C, Lachambre E, Robiliard P, Beck L, Maurin JL, et al. Adequacy and safety of an infant formula with a protein/energy ratio of 1.8 g/100 kcal and enhanced protein efficiency for term infants during the first 4 months of life. J Pediatr Gastroenterol Nutr. 2006;43(3):364–71.

Patro-Gołab B, Zalewski BM, Kouwenhoven SMP, Karaś J, Koletzko B, van Goudoever JB, et al. Protein concentration in milk formula, growth, and later risk of obesity: A systematic review. Journal of Nutrition. 2016;146(3):551–64.

Günther ALB, Remer T, Kroke A, Buyken AE. Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nutr. 2007;86(6):1765–72.




Cómo citar

Fikri, A. M., Astuti, W., Nurhidayati, V. A., Prameswari, F. S. P., & Ismail, N. H. (2024). Protein intake recommendation for stunted children: an update review. Nutrición Clínica Y Dietética Hospitalaria, 44(3).