processes Article Synbiotic Fermented Milk with Double Fortification (Fe-Zn) as a Strategy to Address Stunting: A Randomized Controlled Trial among Children under Five in Yogyakarta, Indonesia Siti Helmyati 1,2, * , Karina Muthia Shanti 3 , Fahmi Tiara Sari 3 , Martha Puspita Sari 3 , Dominikus Raditya Atmaka 4 , Rio Aditya Pratama 5 , Maria Wigati 2 , Setyo Utami Wisnusanti 1,2 , Fatma Zuhrotun Nisa’ 1,2 and Endang Sutriswati Rahayu 6   Citation: Helmyati, S.; Shanti, K.M.; Sari, F.T.; Sari, M.P.; Atmaka,D.R.; Pratama, R.A.; Wigati, M.; Wisnusanti, S.U.; Nisa’, F.Z.; Rahayu, E.S. Synbiotic Fermented Milk with Double Fortification (Fe-Zn) as a Strategy to Address Stunting: A Randomized Controlled Trial among Children under Five in Yogyakarta, Indonesia. Processes 2021, 9, 543. https://doi.org/10.3390/pr9030543 Academic Editors: Maria Tufariello and Francesco Grieco Received: 29 January 2021 Accepted: 25 February 2021 Published: 19 March 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; setyo.utami.w@ugm.ac.id (S.U.W.); fatma.znisa@gmail.com (F.Z.N.) 2 Center for Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; maria.wigati@mail.ugm.ac.id 3 Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; karinamuthia.s@gmail.com (K.M.S.); fahmi.tiara.sari@gmail.com(F.T.S.); martha.puspita6@gmail.com (M.P.S.) 4 Faculty of Public Health, Airlangga University, Surabaya 60115, Indonesia; dominikus.raditya@fkm.unair.ac.id 5 Study Program of Public Health Science, Specialization of Health Informatics System, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; rioadityapratama@outlook.com 6 Faculty of Agricultural Technology, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; endangsrahayu@ugm.ac.id * Correspondence: siti.helmyati@gmail.com; Tel.: +62-274-547775 Abstract: Stunting is one of the public health problems that has yet to be solved in Indonesia. This study developed synbiotic fermented milk with iron and zinc fortification that was then tested in a clinical setting. The product was made from skimmed milk and fructooligosaccharides (FOS) and fermented with Lactobacillus plantarum. A sample of 94 stunted children under five years old were randomly assigned to intervention or control groups. The intervention group received double- fortified synbiotic milk, while the control group drank non-fortified milk. After three months, the number of normal children in both groups, according to weight- or height-for-age z-score category, was found to be increasing. However, the difference between the two groups was not significant (p > 0.05). The study suggests that fermented milk may have a good effect on child growth. Further research is needed to deepen the potency of synbiotic fermented milk for stunted children. Keywords: children; double fortification; fermented milk; iron and zinc; stunting; synbiotic 1. Introduction Developing countries are known for their complex public health problems, including stunting. Globally, it is estimated that 171 million children under five are stunted. Although this number lowered to 149 million children in 2019, stunting remains one of the serious global health challenges that need to be solved. This problem is also happening in Indonesia as one of the developing countries [1–3]. The prevalence of stunting among Indonesian children under five reached 30.8% in 2018. This situation is highly varied in each of the 34 provinces—for example, in East Nusa Tenggara, the stunting prevalence has reached more than 40% [4]. This alarming number emphasizes the need for innovative approaches to combat stunting [5,6]. Stunting is marked by diminished nutritional status and quality of life. Prendergast and Humphrey [7] mentioned that stunting in children is associated with morbidity and mortality, low physical and economic capacity, and an increased risk of metabolic disease in Processes 2021, 9, 543. https://doi.org/10.3390/pr9030543 https://www.mdpi.com/journal/processes