High simple carbohydrate intake and its impact on growth biomarkers and stunting risk in early childhood
Stunting in early childhood remains a major public health issue in developing countries, including Indonesia. In addition to undernutrition, excessive intake of simple carbohydrates may disrupt the endocrine pathways crucial for linear growth. This study examined the association between simple carbohydrate consumption and growth biomarkers insulin-like growth factor 1 (IGF-1), leptin, and growth hormone as predictors of stunting risk in children aged 12–36 months of age. A cross-sectional observational study was conducted with 250 children from urban and rural settings. Dietary intake was assessed using a validated 24-hour recall, and biomarker levels were measured using ELISA. The results showed an average daily energy intake of 1,350 kcal, with 65% derived from carbohydrates, predominantly simple sugars and refined starches. Stunted children exhibited significantly lower concentrations of IGF-1, leptin, and growth hormone (p < 0.01), with strong inverse correlations between simple carbohydrate intake and biomarker levels (r = –0.45 for IGF-1; r = –0.38 for growth hormone [GH]). Multiple regression analysis confirmed that a higher intake of simple carbohydrates significantly predicted lower biomarker levels and reduced height-for-age z-scores (HAZ). These findings highlight the importance of dietary quality, emphasizing the need to reduce simple carbohydrate intake to support hormonal balance and optimal linear growth in early childhood.
Keywords : Stunting, Simple Carbohydrates, IGF-1, Growth Hormone, Early Childhood
- Almeida, C. C., Mendonça Pereira, B. F., Leandro, K. C., Costa, M. P., Spisso, B. F., & Conte-Junior, C. A. (2021). Bioactive compounds in infant formula and their effects on infant nutrition and health: A systematic literature review. International Journal of Food Science, 2021, Article 8850080. https://doi.org/10.1155/2021/8850080
- Al Rahmad, A. H., Sofyan, H., Usman, S., & Mudatsir. (2024). The accuracy data of the toddlers’ nutritional status using the “PSG Balita” app. In T. Tahlil & P. Ardia (Eds.), The 6th Aceh International Nursing Conference (pp. 82–86). Journal of Liaquat University of Medical and Health Sciences. https://doi.org/10.22442/jlumhs.2024.01130
- Ashraf, T. S., De Sanctis, V., Yassin, M., & Adel, A. (2017). Growth and growth hormone–insulin like growth factor-I (GH-IGF-I) axis in chronic anemias. Acta Bio Medica: Atenei Parmensis, 88(1), 101–111. https://doi.org/10.23750/abm.v88i1.6345
- Bayod Jaime, L. (2023). Molecular mechanisms of hyperinsulinemia in obesity. Journal of Molecular Endocrinology, 70(2), R17–R35. https://doi.org/10.1530/JME-22-0123
- Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal & Child Nutrition, 14(4), e12617. https://doi.org/10.1111/mcn.12617
- Bujtor, M., Turner, A. I., Torres, S. J., Esteban-Gonzalo, L., Pariante, C. M., & Borsini, A. (2021). Associations of dietary intake on biological markers of inflammation in children and adolescents: A systematic review. Nutrients, 13(2), 356. https://doi.org/10.3390/nu13020356
- Cammisa, I., Rigante, D., & Cipolla, C. (2025). A theoretical link between the GH/IGF-1 axis and cytokine family in children: Current knowledge and future perspectives. Children, 12(4), 495. https://doi.org/10.3390/children12040495
- Childs, G. V., Odle, A. K., MacNicol, M. C., & MacNicol, A. M. (2021). The importance of leptin to reproduction. Endocrinology, 162(2), bqaa204. https://doi.org/10.1210/endocr/bqaa204
- Clemmons, D. R. (2004). The relative roles of growth hormone and IGF-1 in controlling insulin sensitivity. The Journal of Clinical Investigation, 113(1), 25–27. https://doi.org/10.1172/JCI20660
- Cristin, L., Montini, A., Martinino, A., Scarano Pereira, J. P., Giovinazzo, F., & Agnes, S. (2023). The role of growth hormone and insulin-like growth factor 1 in the development of non-alcoholic steatohepatitis: A systematic review. Cells, 12(4), 517. https://doi.org/10.3390/cells12040517
- De Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal & Child Nutrition, 12(S1), 12–26. https://doi.org/10.1111/mcn.12231
- Dimitriadis, G. D., Maratou, E., Kountouri, A., Board, M., & Lambadiari, V. (2021). Regulation of postabsorptive and postprandial glucose metabolism by insulin-dependent and insulin-independent mechanisms: An integrative approach. Nutrients, 13(1), 159. https://doi.org/10.3390/nu13010159
- Freeling, J. L. (2024). The relationship of macronutrient intake with growth in children with type 1 diabetes mellitus (Doctoral dissertation, South Dakota State University). Open PRAIRIE. https://openprairie.sdstate.edu/etd2/986
- Friedman, J. M. (2019). Leptin and the endocrine control of energy balance. Nature Metabolism, 1(8), 754–764. https://doi.org/10.1038/s42255-019-0095-y
- Global Nutrition Report. (2023). Global nutrition report 2023: The state of global nutrition. Global Nutrition Report. https://globalnutritionreport.org
- Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). Cengage Learning.
- Harrison, E., Syed, S., Ehsan, L., Iqbal, N. T., Sadiq, K., Umrani, F., Ahmed, S., Rahman, N., Jakhro, S., & Ma, J. Z. (2020). Machine learning model demonstrates stunting at birth and systemic inflammatory biomarkers as predictors of subsequent infant growth: A four-year prospective study. BMC Pediatrics, 20(1), 287. https://doi.org/10.1186/s12887-020-02174-y
- Humphries, D. L., Scott, M. E., & Vermund, S. H. (2021). Nutrition and infectious diseases. In Nutrition and health (pp. 492–510). Springer. https://doi.org/10.1007/978-3-030-69764-1_20
- Iannotti, L. L., Gyimah, E. A., Reid, M., Chapnick, M., Cartmill, M. K., Lutter, C. K., Hilton, C., Gildner, T. E., & Quinn, E. A. (2022). Child dietary patterns in Homo sapiens evolution: A systematic review. Evolution, Medicine, and Public Health, 10(1), 371–390. https://doi.org/10.1093/emph/eoac027
- Kementerian Kesehatan Republik Indonesia. (2023). Riset kesehatan dasar (Riskesdas) 2023. Badan Penelitian dan Pengembangan Kesehatan, Kemenkes RI. https://www.litbang.kemkes.go.id
- Könner, A. C., & Brüning, J. C. (2012). Selective insulin and leptin resistance in metabolic disorders. Cell Metabolism, 16(2), 144–152. https://doi.org/10.1016/j.cmet.2012.07.004
- Lee, M.-J., & Fried, S. K. (2009). Integration of hormonal and nutrient signals that regulate leptin synthesis and secretion. American Journal of Physiology–Endocrinology and Metabolism, 296(6), E1230–E1238. https://doi.org/10.1152/ajpendo.90994.2008
- Locatelli, V., & Bianchi, V. E. (2014). Effect of GH/IGF-1 on bone metabolism and osteoporosis. International Journal of Endocrinology, 2014, Article 235060. https://doi.org/10.1155/2014/235060
- Maigoda, T. C., Simbolon, D., & Al Rahmad, A. H. (2023). Kenali stunting sejak dini (1st ed.). PT Nasya Expanding Management. SINTA
- McGrath, C. J., Arndt, M. B., & Walson, J. L. (2017). Biomarkers to stratify risk groups among children with malnutrition in resource-limited settings and to monitor response to intervention. Hormone Research in Paediatrics, 88(1), 111–122. https://doi.org/10.1159/000454940
- Millward, D. J. (2017). Nutrition, infection and stunting: The roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children. Nutrition Research Reviews, 30(1), 50–72. https://doi.org/10.1017/S0954422416000238
- Mupunga, I., Mngqawa, P., & Katerere, D. R. (2017). Peanuts, aflatoxins and undernutrition in children in sub-Saharan Africa. Nutrients, 9(12), 1287. https://doi.org/10.3390/nu9121287
- Papakonstantinou, E., Oikonomou, C., Nychas, G., & Dimitriadis, G. D. (2022). Effects of diet, lifestyle, chrononutrition and alternative dietary interventions on postprandial glycemia and insulin resistance. Nutrients, 14(4), 823. https://doi.org/10.3390/nu14040823
- Pei, Y.-F., Song, Z., Bu, F., Li, K., Xu, Q., Zhao, Q.-G., Ma, X.-L., Zhang, L., & Li, B. (2023). Non-linear causal association of body mass index with serum insulin-like growth factor 1: A Mendelian randomization study. Journal of Clinical Endocrinology & Metabolism, 108(4), e161–e170. https://doi.org/10.1210/clinem/dgad012
- Pyne, V., & Macdonald, I. A. (2016). Update on carbohydrates and health: The relevance of the Scientific Advisory Committee on Nutrition report for children. Archives of Disease in Childhood, 101(10), 876–880. https://doi.org/10.1136/archdischild-2015-309272
- Quarta, A., Quarta, M. T., Mastromauro, C., Chiarelli, F., & Giannini, C. (2024). Influence of nutrition on growth and development of metabolic syndrome in children. Nutrients, 16(22), 3801. https://doi.org/10.3390/nu16223801
- Rachmawati, R., Iskandar, I., Al Rahmad, A. H., Fadjri, T. K., & Hidayat, T. (2024). Penguatan metode deteksi dini faktor risiko dalam keluarga sebagai upaya pencegahan stunting pada tim pendamping keluarga di desa lokus. Jurnal PADE: Pengabdian & Edukasi, 6(2), 121–126. https://doi.org/10.30867/pade.v6i2.2218 Jurnal Poltekkes Aceh
- Robertson, R. C., Edens, T. J., Carr, L., Mutasa, K., Gough, E. K., Evans, C., Geum, H. M., Baharmand, I., Gill, S. K., & Ntozini, R. (2023). The gut microbiome and early-life growth in a population with high prevalence of stunting. Nature Communications, 14(1), 654. https://doi.org/10.1038/s41467-023-36135-6 Nature
- Savarino, G., Corsello, A., & Corsello, G. (2021). Macronutrient balance and micronutrient amounts through growth and development. Italian Journal of Pediatrics, 47(1), 109. https://doi.org/10.1186/s13052-021-01061-0 SpringerLink
- Shalitin, S., & Phillip, M. (2003). Role of obesity and leptin in the pubertal process and pubertal growth: A review. International Journal of Obesity, 27(8), 869–874. https://doi.org/10.1038/sj.ijo.0802319
- Silverstein, D. M. (2018). Growth and nutrition in pediatric chronic kidney disease. Frontiers in Pediatrics, 6, Article 205. https://doi.org/10.3389/fped.2018.00205
- Soliman, A., De Sanctis, V., Alaaraj, N., Ahmed, S., Alyafei, F., Hamed, N., & Soliman, N. (2021). Early and long-term consequences of nutritional stunting: From childhood to adulthood. Acta Bio Medica: Atenei Parmensis, 92(1), e2021168. https://doi.org/10.23750/abm.v92i1.11346
- Stavnsbo, M., Resaland, G. K., Anderssen, S. A., Steene-Johannessen, J., Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2020). Correction to: Reference values for cardiometabolic risk scores in children and adolescents: The European Youth Heart Study. Revista Paulista de Pediatria, 38, e2019134. https://doi.org/10.1590/1984-0462/2020/38/2019134
- Suryanis, I. (2022). Studi kejadian stunting pada anak yang ditinjau dari aspek biologi molekuler: Literature review. HEME Health & Medical Journal, 4(3), 214–219. https://doi.org/10.33024/hhmj.v4i3.12345 jurnal.unbrah.ac.id
- Takahashi, Y. (2017). The role of growth hormone and insulin-like growth factor-I in the liver. International Journal of Molecular Sciences, 18(7), 1447. https://doi.org/10.3390/ijms18071447
- Tritos, N. A., & Klibanski, A. (2016). Effects of growth hormone on bone. Progress in Molecular Biology and Translational Science, 138, 193–211. https://doi.org/10.1016/bs.pmbts.2015.10.009
- Wong, S. C., Dobie, R., Altowati, M. A., Werther, G. A., Farquharson, C., & Ahmed, S. F. (2016). Growth and the growth hormone–insulin like growth factor 1 axis in children with chronic inflammation: Current evidence, gaps in knowledge, and future directions. Endocrine Reviews, 37(1), 62–110. https://doi.org/10.1210/er.2015-1046
- Zhao, J., Zuo, L., Sun, J., Su, C., & Wang, H. (2021). Trends and urban-rural disparities of energy intake and macronutrient composition among Chinese children: Findings from the China Health and Nutrition Survey (1991–2015). Nutrients, 13(6), 1933. https://doi.org/10.3390/nu13061933
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