Peer-reviewed article
The Triple Burden of Malnutrition among Children and Adolescents in Indonesia during the COVID-19 Pandemic: A Narrative Review.
Mansur MA, Oddo VM ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This narrative review examines malnutrition among Indonesian children and adolescents during COVID-19, focusing on the triple burden of malnutrition: undernutrition, anemia, and overweight/obesity occurring simultaneously. The pandemic disrupted school-based nutrition programs including iron-folic acid supplementation and changed food security, physical activity, and diet. The review finds high rates of all three malnutrition forms, mixed dietary changes, and gaps in nutrition policy implementation, while noting some positive innovations in nutrition education delivery.
Key points
- Indonesian children and adolescents experienced high prevalence of undernutrition, overweight and obesity, and anemia during COVID-19
- Online learning halted school-based nutrition programs including iron-folic acid supplementation
- Children and adolescents faced higher levels of food insecurity and lower physical activity during the pandemic
- Nutrition-sensitive programs like conditional cash transfers and food assistance were poorly distributed or contained processed foods
- Dietary changes were mixed, with some consuming more fried foods and snacks but also reporting increased vegetable consumption and reduced sugary drink intake
Limitations
This is a narrative review synthesizing existing literature rather than original research, so it cannot establish causal relationships between COVID-19 and malnutrition changes. The review notes that national-level data on how dietary changes contribute to triple burden of malnutrition is lacking.
Abstract
Children and adolescents in Indonesia are experiencing the triple burden of malnutrition (TBM), resulting from an increasing prevalence of overweight and obesity paired with persistent undernutrition and anemia. The extent to which the coronavirus disease 2019 (COVID-19) further exacerbated TBM within this group, because of lifestyle changes and increased food insecurity, has not been well documented. This narrative review aimed to fill that gap by exploring components of TBM (i.e., undernutrition, anemia, and overweight and obesity), its determinants (e.g., diet), and related nutrition policies and programs among school-aged children and adolescents in Indonesia during the pandemic. We reviewed a total of 10 peer-reviewed articles published between 2021 and 2025 on children and adolescents' nutrition status and TBM-related determinants. Results suggested that during COVID-19, children and adolescents in Indonesia experienced a high prevalence of undernutrition, overweight and obesity, and anemia. Most children and adolescents also faced higher levels of food insecurity and lower physical activity. The implementation of online learning halted several school-based nutrition programs, including iron‒folic acid supplementation. Nutrition-sensitive programs, such as conditional cash transfers and food assistance, were poorly distributed and contained processed foods, respectively. Nevertheless, some positive changes were also observed, including innovations in the delivery of nutrition education. Dietary changes were mixed. Although some reported a higher consumption of deep-fried foods and snacks, more frequent vegetable consumption and less frequent consumption of sugary drinks were also reported. Future research is needed to understand the mixed findings related to dietary changes and how this contributes to TBM in Indonesia at the national level. Additionally, it is crucial to strengthen children and adolescent nutrition policies and programs that target TBM simultaneously.