Healthy eating index, growth status, and household-maternal factors among young children: Evidence from a stunting region in Indonesia.

BACKGROUND AND OBJECTIVES: Diet quality is a key determinant of child growth, yet little is known about its role in stunting-prevalent regions of Indonesia. This study assessed diet quality of young children using a modified Healthy Eating Index (HEI) and examined its associations with growth status and household-maternal factors. METHODS AND STUDY DESIGN: A cross-sectional study was conducted among 215 children aged 12-59 months in Kulon Progo District, Yogyakarta. Dietary intake was assessed using a semi-quantitative food frequency questionnaire and 24-h recall. The HEI was modified to align with Indonesian dietary guidelines and nutrient adequacy standards. Anthropometry, maternal knowledge, education, and household food security were also measured. Children were classified into tertiles of HEI scores (T1: ≤116, T2: 117-127, T3: ≥128). Associations were analyzed using chi-square, ANOVA/Kruskal-Wallis, and multi-nomial logistic regression. RESULTS: The mean HEI score was 122 ± 13.3, with 35.8% of children in the low-est tertile. Low intakes of fruits, vegetables, and dairy were the main contributors to poor scores, while grains and fats/oils scored higher. Younger age was independently associated with higher HEI (aOR 0.93; 95%CI 0.88-0.99; p = 0.03). Maternal education, household food security, and maternal knowledge showed no sig-nificant associations. CONCLUSIONS: Diet quality among children in stunting-prevalent areas remains suboptimal, especially for fruits, vegetables, and dairy. Younger children had better diet quality, underscoring the need for interventions beyond early complementary feeding. Strategies should improve access to diverse, nutrient-rich foods and reduce reliance on processed products.