# Acceptability trial of local Indonesian snack (SISTIK) enriched with chicken liver and eggshell powder as a potential food to increase micronutrient intakes among women of reproductive age

## TL;DR

A study in Indonesia tested enriched crackers made with chicken liver and eggshell powder to improve micronutrient intake among women, finding them acceptable and potentially helpful in reducing stunting.

## Contribution

The study introduces a culturally relevant, micronutrient-enriched snack (sistik) to address maternal micronutrient deficiencies in Indonesia.

## Key findings

- Participants rated the enriched crackers similarly to standard crackers in terms of color, smell, flavor, and texture.
- Daily adherence to the enriched crackers was comparable to standard crackers, indicating good acceptability.
- The study suggests the potential of the snack to improve micronutrient intake among women of reproductive age.

## Abstract

Addressing stunting is a key global nutrition goal for 2025, with Indonesia among the top five countries grappling with high stunting rates in children. Chronic micronutrient deficiencies in women and young children in Indonesia have been associated with poor foetal and infant growth. To tackle this issue, we developed micronutrient-enriched crackers (MEC) incorporating nutrient-rich chicken liver and powdered eggshells. These crackers, known locally as '
sistik,' may provide a sustainable solution to boost micronutrient intakes. Our study among Indonesian women aimed to gauge their acceptability of MEC, which have the potential to enhance maternal micronutrient status and thus combat stunting during early childhood.

We conducted a two-phase acceptability trial involving 81 women aged 19-35 years in Ujung Berung Sub-district, Bandung City, Indonesia. Each phase was a single-blinded trial; only the researcher was aware of product assignment. The first phase entailed a test feeding session in a local community house which participants sampled both MEC and standard wheat crackers (SWC) on one day. Participants assessed each product using a 7-point cued facial response scale, evaluating colour, smell, flavour, and texture. In the second phase, all participants received a 14-day supply (75 g/day) of either MEC (n=41) or SWC (n=40) to consume at home under real-life conditions. Adherence was determined by weighing unconsumed products.

The test MEC food received favourable ratings from participants on a 7-point scale, with no significant differences in liking scores between MEC and SWC regarding colour, smell, flavour, and texture. Mean (SD) daily adherence was 51 (21) g/d, with no significant difference between groups.

This study provides valuable insights for stakeholders and policymakers regarding the potential options for MEC as a food or as daily snacks to increase the intakes and status of micronutrients among adult women.

ClinicalTrials.gov (
NCT04564222, 25
th September 2020).

In Indonesia, addressing the pressing issue of child stunting is imperative due to high prevalence rates. The underlying problem of micronutrient deficiencies calls for innovative solutions. In response, we developed micronutrient-enriched crackers (MEC), or 'sistik,' enriched with chicken liver and powdered eggshells, aiming to improve maternal micronutrient status and combat childhood stunting. Our study focused on assessing MEC's acceptance among Indonesian women. To achieve this, we conducted a trial in Bandung City, involving 81 participants, to evaluate MEC's acceptance compared to standard wheat crackers (SWC). Participants reported positive feedback on MEC, appreciating its color, aroma, flavor, and texture. Furthermore, daily compliance with MEC was similar to that with SWC, indicating MEC's potential to enhance micronutrient consumption among adult women. Despite these promising results, our study recognizes limitations, including a modest sample size that may limit broader applicability of our findings. This research highlights MEC's potential to increase micronutrient intake among women, providing insights for policymakers and healthcare stakeholders. It emphasizes the need for further investigation into MEC's long-term impacts and to include a broader range of participants to ensure results are representative of adult Indonesian women.