nutrients Article Dietary Determinants of Anemia in Children Aged 6–36 Months: A Cross-Sectional Study in Indonesia Diana Sunardi 1 , Saptawati Bardosono 1 , Ray W. Basrowi 2 , Erika Wasito 2 and Yvan Vandenplas 3, *   Citation: Sunardi, D.; Bardosono, S.; Basrowi, R.W.; Wasito, E.; Vandenplas, Y. Dietary Determinants of Anemia in Children Aged 6–36 Months: A Cross-Sectional Study in Indonesia. Nutrients 2021, 13, 2397. https://doi.org/10.3390/nu13072397 Academic Editors: Silvia Scaglioni, Alessandra Mazzocchi and Valentina De Cosmi Received: 8 June 2021 Accepted: 9 July 2021 Published: 13 July 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, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; diana_sunardi@yahoo.com (D.S.); tati.bardo@yahoo.com (S.B.) 2 Medical Nutrition for Danone Specialized Nutrition, Yogyakarta 55165, Indonesia; ray.basrowi@gmail.com (R.W.B.); erika.wasito@danone.com (E.W.) 3 Vrije Universiteit Brussel (VUB), UZ Brussels, KidZ Health Castle, 1090 Brussels, Belgium * Correspondence: yvan.vandenplas@uzbrussel.be; Tel.: +32-475-748-794 Abstract: Anemia has been acknowledged as worldwide problem, including in Indonesia. This cross-sectional study aims to explore dietary determinants as risk factors for anemia in children aged 6–36 months living in a poor urban area of Jakarta. The study was done in Kampung Melayu sub-district in Jakarta, Indonesia. Data was collected within two weeks in September–October 2020. A structured questionnaire for a 24-h recall and a semi-quantitative Food Frequency Questionnaire (FFQ) were used to collect the dietary intake data, and venous blood was withdrawn to determine the hemoglobin levels. Bivariate chi-square and multiple logistic regression tests were executed to explore the dietary determinant factors for anemia. We recruited 180 subjects. The average hemoglobin concentration was 11.4 ± 1.7 mg/dL; the anemia prevalence was 29.4%. The following variables were significantly associated with higher risk of anemia: no cow’s milk formula consumption, inadequate intake of fats, protein, calcium, vitamin D, iron, zinc, vitamin A, vitamin C, vitamin B6, and vitamin B12. Only cow’s milk formula consumption and zinc intake were revealed as the determinant factors of anemia. In conclusion, the prevalence of anemia was 29.4% among children aged 6–36 months old. Anemia was significantly associated with two dietary determinants as risk factors that are cow’s milk formula consumption and zinc intake. Keywords: anemia; cow’s milk; cow’s milk formula; zinc; toddler; Indonesia 1. Introduction Anemia has been acknowledged as a worldwide health problem that young children are specifically vulnerable. The data from the World Health Organization (WHO) shows that anemia prevalence in children aged 6–59 months in Indonesia are 43.9% in 2000 and 38.4% in 2019 [1]. A similar anemia prevalence (38.5%) is also reported from Indonesian national data in 2018 [2]. Another study in Indonesian rural area in 2009–2010 showed that the prevalence of anemia and iron deficiency anemia (IDA) in children aged 6–59 months were 56.9 and 29.4%, respectively [3]. The prevalence was higher than the WHO data in 2000 or the latest national data in 2018 that might indicate higher risk of anemia in the rural area. Childhood anemia contributes to poor motor and cognitive development resulting in poor school performance, and results in increased morbidity and mortality [4]. There are two types of anemia: nutritional and non-nutritional related. In nutritional anemia, there is insufficient intake of nutrients to meet the need for hemoglobin and erythrocyte synthesis. Special attention needs to be given to the consumption of iron-rich or iron fortified foods because iron deficiency is the common cause of anemia among under-five year old children [5]. It is estimated to contribute to 42% of anemia cases in under 5-year-old children worldwide [6]. Other nutrients that contribute to anemia are deficiencies of vitamin A, B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin), C, D, E, folate, and copper [6]. Most anemia studies in under-five-year-old children highlighted Nutrients 2021, 13, 2397. https://doi.org/10.3390/nu13072397 https://www.mdpi.com/journal/nutrients