MJN 2019 Issues

Malaysian Journal of Nutrition

Volume 25 No.1, 2019


Download PDF

Table of Content

Association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with quality of life among elderly haemodialysis patients
Fatin Izzaty Mohd Shahrin, Lim Zhi Yu, Noraida Omar, Nor Fadhlina Zakaria & Zulfitri ‘Azuan Mat Daud

ABSTRACT

Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients.
Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records.
Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001).
Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.
Key words: Quality of life, nutritional status, depression, haemodialysis, elderly

Download PDF

Prevalence and determinants of Instrumental Activities of Daily Living (IADL) disability among communitydwelling elderly in a semi-urban setting in Peninsular Malaysia
Muhammad Faizal bin Murat, Zuriati binti Ibrahim, Siti Nur ‘Asyura binti Adznam & Chan Yoke Mun

ABSTRACT

Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls.
Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively.
Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1).
Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.
Key words: IADL disability, elderly, functional status, Malaysia

Download PDF

Health-related quality of life of elderly with chronic obstructive pulmonary disease from selected government institutions
Nor-Farahain Yahya, Noraida Omar, Siti Nur’ Asyura Adznam, Ummi- Nadira Daut & Barakatun Nisak Mohd Yusof

ABSTRACT

Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD.
Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status.
Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10.
Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.
Key words: HRQOL, elderly, COPD, CAT score

Download PDF

Simple method for assessing standing height using recumbent length in bedridden patients using soft and firm mattresses
Wong Wei Yee, Lim Su Lin & Chan Yiong Huak

ABSTRACT

Introduction: The accurate measurement of the height of bedridden patients is difficult. Height assessment is required for the calculation of body mass index, which is crucial for determining the nutrition status of a patient. This study aimed to validate recumbent length measurement against the standing height measurement using soft and firm mattresses and to derive predictive equations to calculate the actual height of bedridden patients on mattresses with different firmness.
Methods: Ninety-nine hospitalised participants (mean age 48.9±13.9 years; range 21–80 years) (49 men, 50 women) and 100 healthy participants (mean age 36.8±13.6 years; range 21–77 years) (50 men, 50 women) were recruited. Standing height was measured using a stadiometer. Recumbent length was measured using a 2 metre long measuring tape. Hospitalised participants lay on soft mattress and healthy participants on firm mattress.
Results: Using Bland–Altman plot, 96% of hospitalised participants using soft mattress were within 2.5±2.7 cm (mean±2SD) whereas 97% of healthy participants using firm mattress were within 2.1±2.1 cm. The regression equation developed using firm mattress was Standing height (cm) = 0.993 x Recumbent length – 0.943; (r2=0.982). The regression equation developed using soft mattress was Standing height (cm) = 1.012 x Recumbent length – 4.477; (r2=0.981).
Conclusion: We concluded that recumbent length is a valid clinical tool to estimate standing height. Standing height can be estimated from the predictive equations developed for patients lying on soft or firm mattresses.
Key words: Recumbent length, height, measuring tape, Asian, bedridden

Download PDF

Identification of dietary patterns associated with characteristics of successful aging
Nik Nur Izzati Nik Mohd Fakhruddin, Suzana Shahar, Roslee Rajikan, Mohd Azahadi Omar, Normah Che Din, Rosdinom Razali, Sakinah Harith, Hamid Jan Jan Mohamed & Bibi Nabihah Abdul Hakim

ABSTRACT

Introduction: This study aimed to identify dietary patterns (DPs) and their association with successful aging (SA).
Methods: A comparative cross-sectional study was conducted among 579 elderly subjects recruited from four states in Malaysia through a multistage random sampling method. SA was defined as having no chronic illnesses, no functional limitation, normal global function, no depression, a good quality of life and good self-perceived health. Information on dietary intake was obtained using a diet history questionnaire. Cognitive functions were assessed using the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric Depression Score-15 items (GDS-15) and a question regarding their perceived health and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to determine functional status. DPs were obtained using the principal component analysis (PCA) approach. An ordinal logistic regression model was used to examine associations between DP scores and SA.
Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and ‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished when the model was adjusted for education level. Further analysis indicated that this DP increased the chance of SA among those with secondary education and above [Adjusted OR=2.43 (95% CI: 1.09–5.42)].
Conclusion: Tropical fruits-oats’ DP is associated with SA among elderly with secondary education and above. There is a need to investigate DPs among those with lower education.
Key words: Cognitive function, dietary pattern, elderly, principal component analysis, successful aging

Download PDF

Prevalence and factors affecting food insecurity among university students in Pahang, Malaysia
Wan Azdie Mohd Abu Bakar, Shahidah Ismail, Suriati Sidek & Rozlin Abdul Rahman

ABSTRACT

Introduction: Food insecurity exists whenever people are unable to access sufficient food at all times for an active and healthy life. University students are a potentially vulnerable group of people to face food insecurity. This study aimed to identify the prevalence and determinants of food insecurity among a population of university students in Kuantan, in the state of Pahang.
Methods: Food security status was identified using the United States Adult Food Security Survey Module (USAFSSM). Factors, which include demographic background, spending expenditure pattern and time constraints, were assessed. A total of 316 students were selected through stratified random sampling throughout six faculties of the International Islamic University Malaysia, of whom 307 successfully completed the survey.
Results: The result shows that 54.4% of the students were experiencing food insecurity, from which 32.9% were sub-categorised as low food security and 21.5% as very low food security. Food insecurity was found to be significantly associated with time constraints (p<0.05), spending on books (p<0.05), miscellaneous items (p<0.05), parents’ income (p<0.001) and scholarship type (p<0.001).
Conclusion: Apart from the high incidence of food insecurity among the students, time and financial affordability appeared to be critical concerns in this study. Since food insecurity has become a significant issue with university students, it should be addressed and prioritised by the relevant authorities.
Key words: Food insecurity, students, food security status

Download PDF

A feasibility study of multiple micronutrient supplement for home fortification of foods among Orang Asli children in Negeri Sembilan, Malaysia
Nur Dayana Shaari, Zalilah Mohd Shariff, Gan Wan Ying & Loh Su Peng

ABSTRACT

Introduction: The prevalence of child undernutrition and micronutrient deficiencies are higher in the Orang Asli (OA) than the general Malaysian population. The World Health Organization recommends the use of multiple micronutrient supplement (MMS) that is a blend of micronutrients in powder form that can be sprinkled onto foods for home fortification to prevent undernutrition among children. This pilot study aimed to assess the feasibility of using MMS among OA children.
Methods: A total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2 months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks. Caregivers were instructed to add MMS to three types of food from the same food group per week varying with a different food group weekly. Written instruction for using MMS in simple language was given prior to the supplementation. Caregivers were interviewed for information on socio-demographics, compliance, acceptance, preference and adverse effect of MMS.
Results: A high level of compliance was observed (85%). All caregivers reported that the instructions for use were easy to read. No noticeable changes to the foods mixed with MMS were observed and no adverse effects were reported.
Conclusion: This study demonstrated feasibility of the use of MMS for future trials among OA children. The easy to read information that comes with the MMS, frequent monitoring of MMS use and support to caregivers were required to ensure compliance. Cultural feeding practices and financial constraints may limit the types of food that can be mixed with MMS.
Key words: Multiple micronutrients supplement, feasibility study, Orang Asli children, micronutrient powder, home food fortification

Download PDF

Linguistic validity and reliability of cariogenic food frequency and oral health knowledge, attitude and practice questionnaires for parents of 6-11 years old children in Kota Bharu, Kelantan
Rosnani Ngah, Ruhaya Hasan & Normastura Abd Rahman

ABSTRACT

Introduction: Cariogenic food intake and oral health knowledge, attitude and practices (KAP) of parents are contributing factors that influence the oral health status of children. As there is lack of a validated questionnaire in Bahasa Melayu (the Malay language) to measure the factors, this cross-sectional study was carried out to establish a linguistically valid and reliable cariogenic food frequency questionnaire (M-CFFQ) and oral health kap questionnaire (M-OHKAPQ) in Bahasa Melayu, for parents of children aged 6-11 years in Kota Bharu, Kelantan.
Methods: Relevant questionnaires in English were selected and translated to Malay language. This process included forward translation, synthesis, backward translation and consolidation to produce the preliminary drafts of M-CFFQ and M-OHKAPQ. Pretesting was conducted on ten parents of children from a primary school in Kota Bharu by face-to-face interview. The findings were reviewed to produce the final versions of M-CFFQ and M-OHKAPQ. A test-retest reliability study was undertaken involving 49 parents. The participants were asked to answer the final M-CFFQ and M-OHKAPQ versions twice, within a 7-14 days interval. Data collected were entered into IBM SPPS version 22 software and analysed using the Intraclass Correlation Coefficient (ICC) test.
Results: Semantic, idiomatic, experiential, conceptual as well as content and face validity issues were successfully resolved. Fifteen categories of food/drinks for M-CFFQ and 26 items/questions M-OHKAPQ were produced. The total ICC values achieved for M-CFFQ and M-OHKAPQ were 0.887 and 0.807, respectively.
Conclusion: The M-CFFQ and M-OHKAPQ appeared to be linguistically valid and reliable with excellent test-retest reliability (ICC>0.80).
Key words: Linguistic, cariogenic, oral health, questionnaire, test-retest reliability

Download PDF

Module development and its effectiveness for improving the competencies of voluntary health workers in communicating safe complementary feeding to caregivers in Indonesia
Dwi Nastiti Iswarawanti, Siti Muslimatun, Endang Basuki & Ahmad Hadi

ABSTRACT

Introduction: In Indonesia, most training modules for health paraprofessionals have been adapted from existing foreign modules without assessment. In addition, there have been few studies on training development for this group. We aimed to develop, using a systematic tool, implement and evaluate a training module to improve the competencies of voluntary health workers (cadres) in communicating safe complementary feeding practice to caregivers of young children in Indonesia.
Methods: A mixed methods approach was used. A qualitative study employing in-depth interviews, focus group discussions, mini-workshops, documentary reviews and expert validation was used to develop the training module, following a systematic approach. The module’s effectiveness for improving the health workers’ competencies was evaluated using a quantitative study with a non-equivalent pre-test and post-test control group design that included 70 (intervention group) and 68 (comparison group) voluntary health workers from a peri-urban district. Changes in the workers’ cognitive, affective and psychomotor competencies were tested before and after attending a 3-day training module (intervention group) or a half-day event (comparison group).
Results: A 24-hour learning session module on communicating safe complementary feeding was developed and used to train voluntary health workers. After the training, a significantly higher proportion of workers in the intervention group than in the comparison group were assessed as competent in the psychomotor and composite domains (psychomotor: 67.1% vs. 20.6%; composite: 74.3% vs. 36.8%; p<0.001).
Conclusion: This systematically developed module was effective in improving the competencies of voluntary health workers regarding communicating safe complementary feeding practice to caregivers in Indonesia.
Key words: Competencies, complementary feeding, communication, training, voluntary health workers

Download PDF

Breastfeeding knowledge among indigenous Temiar women: a qualitative study
Sharifah Zahhura Syed Abdullah & Rozieyati Mohamed Saleh

ABSTRACT

Introduction: The benefits of breastfeeding for both mothers and infants are widely recognised. Breastfeeding confirms a woman’s unique ability to care for her infant in the best way possible and promotes optimum infant and maternal health.
Methods: A qualitative research method involving five focus group discussions (n=33) was chosen in this study to compare and contrast the breastfeeding practice in two different locations: the communities of Pos Pulat and the regroupment scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in Kelantan, Malaysia which represents different lifestyle experiences of indigenous Temiar population.
Results: The benefits of breastfeeding to the infants reported by some Temiar women (42.4%) were for the infant’s health and growth. Responses from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%), delays in the return of regular ovulation (6.1%), thus lengthening birth intervals and bonding between maternal-baby (6.1%). In general, respondents from Pos Pulat seemed to have little knowledge regarding this issue, except for a woman who mentioned that maternal milk contains vitamins. Based on the narrative analysis, knowledge gap was observed between these two communities.
Conclusion: Although all the women interviewed had the experience of breastfeeding their infants, most of them lacked the knowledge regarding the benefits of the breastfeeding either to the infants or to the mothers. The findings from this study are crucial for the preservation of breastfeeding culture among the Temiar women and can be used to improve promotion of breastfeeding to other Orang Asli groups in Malaysia.
Key words: Breastfeeding, knowledge, health, indigenous, qualitative

Download PDF

Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia
Yunita Febrianingtyas, Judhiastuty Februhartanty & Dian Nurcahyati Hadihardjono

ABSTRACT

Introduction: The primary reason that compels working mothers to decrease their ability to continue to breastfeeding successfully is their return to work. Attempts to continue breastfeeding at work encounters several difficulties. This study aims to provide an overview of the workplace environment and how facilities at the workplace affect breastfeeding in Indonesia.
Methods: We used a qualitative approach to provide a detailed picture of the influence of workplace support for working mothers to perform breastfeeding. We enrolled working mothers (n=18) in Jakarta, as participants and obtained the following information from them: parity, type of family and type of work.
Results: The findings provided the general overview of the workplace environment and identified three factors that affected breastfeeding: seeking information during pregnancy, expression of breast milk at office facilities and the problem faced by working mothers.
Conclusion: Although the breastfeeding performance of most working mothers in this study comprised exclusive breastfeeding, some fed their infants with formula milk. This study suggests that working mothers who continue to breastfeed after returning to work need the support of their employers, co-workers and others in the workplace to ensure the provision of health facilities and the protection and dissemination the rights of breastfeeding working mothers that might lead them to discontinue their breastfeeding practice.
Key words: Breastfeeding performance, workplace support, qualitative study, Jakarta, Indonesia

Download PDF

Nutrition labelling: an exploratory study on personal factors that influence the practice of reading nutrition labels among adolescents
Norsakira Jefrydin, Norazmir Md Nor & Ruzita Abd. Talib

ABSTRACT

Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels.
Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software.
Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information.
Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.
Key words: Nutrition labels, adolescents, food choice, focus group discussion

Download PDF

Nutrient composition of milkfish (Chanos chanos, Forskal) from Pangkep, South Sulawesi, Indonesia
Sriwati Malle, Abu Bakar Tawali, Mulyati Muhammad Tahir & Maryati Bilang

ABSTRACT

Introduction: Milkfish is a potential source of animal nutrition, especially for supplying human protein needs. In the present paper, we provide complete data on nutrient content of milkfish that can be used as a reference for diet formulation and for the further processing of milkfish.
Methods: Proximate analysis, amino acid and fatty acid composition, and vitamin and mineral content of milkfish were determined.
Results: The results showed that milkfish contained high concentration of protein (24.18%) and high proportion of monounsaturated fatty acids as oleic acid (32.11%). The amino acid found in the highest concentration was glutamic acid (1.28%). The macro-minerals in the milkfish were calcium (Ca), magnesium (Mg), sodium (Na) and potassium (K). Among the micro-minerals present were iron (Fe), zinc (Zn), copper (Cu) and manganese (Mn), and the main vitamins present include A, B1 and B12.
Conclusion: Based on their protein content, milkfish may be classified as a source of high protein. Glutamic acid which is the highest amino acid in milkfish as well as fatty acid content of oleic acid makes milkfish a healthful fish.
Key words: Amino acids, fatty acids, milkfish, minerals, proximate, vitamins

Download PDF

Total lipid and omega-3 content in Pangasius catfish (Pangasius pangasius) and milkfish (Chanos chanos) from Indonesia
Marcelia Sugata, Priscilia Felita Wiriadi, Jap Lucy & Tan Tjie Jan

ABSTRACT

Introduction: Supplementation of the diet with fish oil omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been associated with multiple health benefits. This study aimed to determine total lipid and omega-3 content in two fishes from Indonesia, which were Pangasius pangasius (P. pangasius) and Chanos chanos (C. chanos).
Methods: Total lipid was extracted from P. pangasius and C. chanos and the lipid content was then analysed using gas chromatography–mass spectrometry (GC-MS).
Results: Lipid content of C. chanos (4.63±3.84%) was higher than P. pangasius (3.94±1.43%) but less than that found in Salmo salar (S. salar) which was found to contain 6.98±2.56% lipid. Furthermore, polyunsaturated fatty acid omega-3 (EPA and DHA) analysis showed that C. chanos oil contained 0.36% EPA and 1.17% DHA. These levels are lower than that found in S. salar, often referred to as the “gold standard” for omega-3 fatty acids.
Conclusion: C. chanos contains considerable amounts of EPA and DHA. As it is widely available in Indonesia, it may be used as source of omega-3 fatty acids instead of salmon.
Key words: Chanos chanos, Pangasius pangasius, omega-3 fatty acids

Download PDF

Energy density of ethnic cuisines in Singaporean hawker centres: a comparative study of Chinese, Malay and Indian foods
Rina Yu Chin Quek, Goh Hui Jen & Christiani Jeyakumar Henry

ABSTRACT

Introduction: A major focus in the prevention and management of obesity has been in the self-monitoring of foods consumed to reduce total energy intake. The present study used a novel instrument called the Calorie Answer™ to measure the energy content of various local foods in Singapore. The study aimed to build a database on energy density of commonly consumed Chinese, Malay and Indian foods to facilitate appropriate food choices by the consumer.
Methods: The first part consisted of measuring the energy density of 15 popular local foods purchased from 8 different hawker centres. In the second part, 46 additional local foods were analysed, again using the Calorie Answer™ instrument.
Results: Despite the different locations from which the foods were purchased, the energy content of the same foods was remarkably similar with a coefficient of variation (CV) of <15% for all foods. There was a higher average energy density of Indian foods compared to Chinese and Malay foods (Welch test, p=0.027).
Conclusion: Our results suggest that the energy density of commonly consumed foods from different locations was remarkably similar. The average energy density of Indian foods was significantly higher than that of Chinese and Malay. Knowledge of the energy density of foods is essential information that is needed in the battle against being overweight and obesity. The application of the Calorie Answer™ may be used as a means to collate data on the energy density of foods consumed in other countries in the ASEAN region.
Key words: Energy density, calories, food intake, variability, Singapore

Download PDF

Malaysian Journal of Nutrition

Volume 25 (Supplement), 2019



Download PDF

Table of Content

Dietary diversity beliefs and practices among working mothers in Jakarta: a qualitative study
Aria Kekalih, Judhiastuty Februhartanty, Muchtaruddin Mansyur & Anuraj Shankar

ABSTRACT

Introduction: Dietary diversity is a global challenge in complementary feeding. Despite more women joining the workforce in developing countries, there are limited studies on the beliefs of working mothers and their experiences in relation to the provision of dietary diversity as recommended by the World Health Organization.
Methods: This qualitative study explored the behavioural, normative and control beliefs of working mothers on dietary diversity practices, based on the Theory of Planned Behaviour (TPB). A total of 25 mothers of different occupational levels were recruited from workplaces in Jakarta.
Results: Working mothers at the lower occupational levels showed a lack of understanding of the importance of dietary diversity and reported poor practices. These included the late introduction of animal protein as a food source, and few types of feeding instant foods. Due to their limited knowledge of nutrition, these working mothers tended to accept poor dietary diversity practices as normal.
Conclusion: Working mothers at the lower occupational levels practised poor dietary diversity owing to work-related factors. Efforts should be undertaken to provide correct nutritional information related to complementary feeding at workplaces, especially to working mothers in the unskilled occupations.
Key words: Child-feeding, working mothers, unskilled labour, qualitative study, Indonesia, dietary diversity

Download PDF

Comparing intake adequacy and dietary diversity between adolescent schoolgirls with normal nutritional status (NG) and undernutrition (UG) based on BMI-forage (BAZ) living in urban slums in Central Jakarta
Rika Rachmalina, Helda Khusun, Luluk Basri Salim, Luh Ade Ari Wiradnyani & Drupadi HS Dillon

ABSTRACT

Introduction: Undernutrition among adolescent girls is an important concern due to their rapid growth velocity that requires adequate intake of energy and nutrients. This study compared intake adequacy and dietary diversity between adolescent public schoolgirls from slum areas in Central Jakarta who had normal and poor nutritional status.
Methods: A total of 220 eligible girls aged 14–18 years were recruited, with an equal proportion in the normal group (NG) [-1 to +1 SD body mass index-for-age z-score (BAZ)], and undernutrition group (UG) (BAZ < -1SD). Dietary intake was assessed using two non-consecutive 24-hour recalls. Dietary diversity scores (DDS) were determined with reference to the intake of 13 food groups with a minimum daily intake of 15 gram/food group. Receiver operating curve analysis was performed to obtain the DDS cut-off. The Mann–Whitney test was performed to compare DDS between the NG and UG. Logistic regression analysis was conducted to examine the likelihood of potential factors in predicting nutritional status outcome.
Results: Overall, almost half of the girls’ daily food intake showed low dietary diversity based on DDS cut-off <5, with no significant difference between NG and UG adolescents. Protein intake inadequacy showed significant unlikelihood of a NG outcome (OR=0.4; 95% CI: 0.2-0.8), while low socioeconomic status (SES) showed a strong likelihood of an UG (OR=2.7; 95% CI: 1.3-5.5) compared to high SES.
Conclusion: Low dietary intake and DDS were common among adolescent schoolgirls in slum areas in Jakarta. Nutrition interventions promoting appropriate dietary intake among adolescent girls are recommended.
Key words: Adolescent girls, dietary diversity, nutrient adequacy, undernutrition, Jakarta slums

Download PDF

Food purchasing behaviour among urban slum women in East Jakarta: a qualitative study
Dian Sufyan, Judhiastuty Februhartanty, Saptawati Bardosono, Helda Khusun, Evi Ermayani, Purnawati Hustina Rachman & Anthony Worsley

ABSTRACT

Introduction: Urbanisation in Indonesia has been associated with a transition in nutrition which has been, in part, marked by an increased purchasing of readyto-eat, energy-dense, nutrient-poor foods. Women are responsible for purchasing and preparing food for the family. Their purchasing behaviours differ in various environments and population groups. This qualitative study was undertaken to explore the food environmental factors that influenced food purchasing behaviour of women who were the household food gatekeepers.
Methods: The study was conducted in a slum area in East Jakarta. Eighteen overweight-obese and nonobese women who fulfilled the study’s inclusion criteria were recruited for interviews that used a semi-structured questionnaire. Emic observations were conducted in order to identify typical food purchasing activities. The data were coded and categorised using qualitative data analysis and research software (Atlas.ti 7 for Windows).
Results: Most of the women purchased ready-to-eat foods rather than cook at home, either for the family or their own consumption. Several food environmental factors influenced women’s purchasing behaviour, including time and cost efficiency, food availability, family, exposure to ready-to-eat foods and food store marketing strategies. These factors led to the consumption of unhealthy foods that were high in fat, carbohydrate, sugar and salt that some of which may cause obesity.
Conclusion: Purchasing unhealthy food was observed to be strongly linked with food-related environmental factors. This study provides an understanding of women’s food purchasing behaviour and highlight potential ways to foster healthier purchasing behaviour among urban slum dwellers.
Key words: Food purchasing behaviour, food environment, food stores, urban slum women, Indonesia

Download PDF

Exposure and approval of food marketing strategies: a mixed methods study among household food providers in Jakarta
Selma Avianty, Helda Khusun, Saptawati Bardosono, Judhiastuty Februhartanty & Anthony Worsley

ABSTRACT

Introduction: Food marketing influences consumers’ food choices leading to unplanned food purchasing.
Methods: This study used a mixed methods approach to investigate the association between food marketing exposure and approval of food marketing strategies among household food providers in Jakarta. Responses from 279 survey participants to questions on exposure and their approval of marketing strategies were analysed. An additional 16 informants who fulfilled the inclusion criteria were recruited for the in-depth interview. Logistic regression was conducted to assess the relationship between the categorical predictor variable (“exposure to active or passive marketing”) and the categorical outcome variable (“approval response to food marketing strategies”).
Results: Almost half of the respondents reported not having exposure to active marketing in the past month, whereas approximately one-third had experienced such exposure 1-2 times. Most of the respondents disapproved the marketing of fast foods and sugar-sweetened foods. The highest disapproval was for the placement of vending machines carrying such foods in schools (69.9%). Respondents who were exposed to active marketing at least once in the previous month were 1.99 times more likely (AOR; 95% CI: 1.07-3.73) to approve the marketing of unhealthy foods.
Conclusion: Exposure to food marketing promotion appeared to influence approval of marketing strategies among household food providers in Jakarta. In-depth interviews provided supportive evidence for the quantitative results. A mixed methods approach is suggested for larger studies to confirm these findings.
Key words: Food marketing exposure, approval of food marketing, household food providers, Indonesia

Download PDF

Association between food marketing exposure and consumption of confectioneries among pre-school children in Jakarta
Maria Meilan Y Fernandez, Judhiastuty Februhartanty & Saptawati Bardosono

ABSTRACT

Introduction: Prevalence of obesity among pre-school children in Indonesia is increasing. Since food advertisements reach all age groups, this study was conducted to assess the association between food marketing exposure and children’s consumption of confectioneries at home.
Methods: Two hundred and forty caregivers of children aged 3-5 years attending 25 early childhood education centres in Central Jakarta, were interviewed in this cross-sectional study. A structured food frequency questionnaire was used to determine food marketing exposure and child dietary consumption. Chi-square tests compared consumption of confectioneries with different levels of marketing exposure.
Results: Out of a total 240 caregivers, most were mothers of the study children (79.2%) and other family members (19.2%). The majority of the caregivers did not work (81.7%), and <15.0% had graduated from university, while 42.0% lived with extended family members. The top ten confectioneries consumed by the children included chocolate wafer crisp, chocolate stick and soft candy. Among the most common food marketing practices were as advertisements on public transport, print and electronic media. The significant associations between four food marketing practices and consumption of eight types of confectioneries were key findings of this study. Receiving food promotion through short message service (SMS) was not significantly associated with consumption of the top ten confectioneries.
Conclusion: A positive association was found between food marketing practices and consumption of confectioneries by pre-school children in Central Jakarta. An appropriate policy on food advertisements that targets children combined with parental food education is recommended for improving food consumption habits of young children.
Key words: Dietary consumption, food marketing, preschoolers, sugar and confectionery products, Indonesia

Download PDF

Eating behaviour of young female workers with low socioeconomic status in Malang City, East Java: a qualitative study
Intan Yusuf Habibie, Inge Brouwer & Judhiastuty Februhartanty

ABSTRACT

Introduction: Eating behaviour is one of the important factors affecting nutritional status that has been widely investigated. However, there are few studies on the eating behaviour of young female workers in Indonesia. This study aimed at investigating the factors affecting eating behaviour of young female workers of low socioeconomic status in Malang, East Java province, Indonesia.
Methods: Participants were recruited using purposive sampling from low-income families living in Malang City. The eligibility criteria were based on demographic information, including monthly household income and expenses. The participants recruited comprised 21 women aged 18-22 years who were employed outside their homes, unmarried and living with their parents. A qualitative methodology was used to understand the meaning and context of the eating behaviour of these women. In-depth interviews and focus group discussions were used as the primary data collection methods.
Results: Two primary themes emerged as the main influences of the participants’ eating behaviour: individual attributes (food preferences, healthy eating knowledge and self-efficacy), and socio-environmental factors (peer influence, mother’s role and food availability). In general, the participants had some knowledge about healthy eating behaviour; however, they lacked self-efficacy to practise such behaviour.
Conclusion: Individual motivations and socio-environmental factors were found to mediate the eating behaviour of young working women from poor households. These factors should be considered when designing nutrition programmes for achieving healthier eating behaviour among young working women.
Key words: Young female workers, eating behaviour, qualitative study, low socioeconomic status, Indonesia

Download PDF

Eating behaviour of adolescent schoolgirls in Malang, East Java: a qualitative study
Mulia Sondari, Inge Brouwer & Judhiastuty Februhartanty

ABSTRACT

Introduction: Poor eating behaviour is known to lead to nutritional deficiency among adolescents. At the same time, poor eating behaviour characterised by dietary excesses could lead to overweight and obesity. The present study aimed to explore the eating behaviour of adolescent schoolgirls in Malang, East Java Province, Indonesia, and to determine the factors that influenced their eating behaviour.
Methods: This was a qualitative study, guided by the Social Cognitive Theory (SCT), which focused on individual and environmental influences to better understand health-related behaviours, such as eating behaviour. Triangulation was applied to the study subjects (adolescent girls, their mothers, and school staff). The methods used included individual in-depth interviews and focus group discussions. Qualitative data analyses were performed using Atlas.ti 7.
Results: Most participants showed poor eating behaviour that was characterised by skipping breakfast, frequent consumption of fast foods and the consumption of local food with low nutrient content. Their eating behaviour was influenced by individual factors including personal preferences, the price of the food, and by environmental factors, such as the family, school and neighbourhood.
Conclusion: Our findings showed that adolescent girls in Malang appeared to be aware of healthy eating but they showed unsatisfactory eating practices. Interventions are suggested to improve the poor eating behaviour of the adolescents toward avoiding malnutrition consequences.
Key words: Eating behaviour, adolescent schoolgirls, Malang, Indonesia

Download PDF

Perceptions of the causes of obesity among normal weight, overweight and obese Indonesian women: a mixed methods approach
Ismi Irfiyanti Fachruddin, Judhiastuty Februhartanty, Saptawati Bardosono, Helda Khusun & Anthony Worsley

ABSTRACT

Introduction: Overweight and obesity (OW/OB) among adults is a public health concern in Indonesia. While OW/OB is generally attributed to consumption in excess of expended energy, understanding the perceptions of the causes of obesity among OW/OB individuals may provide insights for developing appropriate obesity-reduction interventions.
Methods: This study used a mixed methods approach, comprising a quantitative online survey and in-depth interviews. The online “International Families and Food Survey” was conducted in 2014 by Global Market Insite (GMI) to elicit response of Indonesian women to 12 likely causes of obesity, based on a 5-point rating ranging from ‘definitely disagree’ to ‘definitely agree’. A total of 377 respondents aged 18-49 years from Jakarta participated, comprising 221 normal weight (NW) and 156 OW/OB based on World Health Organization (WHO) cut-offs. Additional 16 informants who fulfilled the inclusion criteria were recruited for indepth interviews to gather further insights on causes of obesity. Logistic regression was conducted to assess the likelihood of socioeconomic factors in predicting “agreement on the likely causes of obesity”.
Results: The online survey showed that the NW and OW/OB respondents provided quite similar rating response to each of the likely causes of obesity. Unmarried and middle socioeconomic status (SES) respondents were significantly more likely to agree on the perceived causes of obesity, compared to married and high SES. In-depth interviews revealed OW/OB informants attributed obesity to environmental factors, compared to individual factors attributed by NW informants.
Conclusion: Use of mixed methods approach provided insights for the development of obesity-reduction interventions among Indonesian adult women.
Key words: Indonesia, obesity, overweight, women, perception on obesity causes

Download PDF

A qualitative study comparing the coping strategies between food secure and food insecure households of Kaluppini indigenous people in South Sulawesi
Nurbaya, Aria Kekalih & Judhiastuty Februhartanty

ABSTRACT

Introduction: Food insecurity remains a global challenge, especially among vulnerable indigenous populations. Coping strategies to maintain food security among indigenous groups can be unique and complex, being influenced by cultures. This study aimed to explore the coping strategies employed by food secure and food insecure households in times of food insufficiency, in the Kaluppini indigenous population of South Sulawesi, Indonesia.
Methods: The study recruited mothers of children aged below 5 years, who agreed to participate in the study’s focus group discussions (FGDs) and in-depth interviews. All information was recorded, transcribed verbatim and analysed.
Results: A total of 61 mothers participated in 22 in-depth interviews and six FGDs. Five coping strategies were used by the Kaluppini people i.e. additional income generation, dietary alteration, access to alternative food sources, access to alternative cash sources, and, traditional ways of coping. Both food insecure and secure households reported making dietary changes, such as reducing consumption or substituting foods, borrowing food or money, and practising traditional coping strategies, such as food sharing after performing rituals. In order to generate income, food insecure households reported seeking additional work in the neighbourhood areas, while food secure households migrated in search of work to the other islands or other countries.
Conclusion: Food insecure and food secure households changed their diets, borrowed food or money from relatives and relied on traditional coping mechanisms such as food sharing. It is suggested that food insecure Kaluppini households be encouraged to grow essential foods in their gardens to enhance food security.
Key words: Food security, coping strategies, indigenous people, Indonesia

Download PDF

Early development process of drama and storytelling scripts as media for nutrition education on balanced diets among elementary school children
Suci Destriatania, Fenny Etrawati & Judhiastuty Februhartanty

ABSTRACT

Introduction: The Indonesian Guide on Balanced Nutrition endorsed in 2014, needs to be more widely publicised. One way is to use fun learning methods such as drama and storytelling, especially in schools. This study aimed to develop drama and storytelling scripts for educating students on balanced nutrition.
Methods: Sixteen focus group discussions (FDGs) with thematic activities were conducted among 96 mother-child pairs in four elementary schools. The mothers’ age ranged from 30-50 years and the children 9-13 years. In-depth interviews were conducted with eight teachers (two from each participating school). The FGDs and interviews were designed to elicit information on knowledge and implementation of balanced nutrition guidelines at three levels, namely intrapersonal (students), family (mother) and environment (school teacher). Content analysis was used to identify relevant themes, which were developed into scripts for drama and storytelling.
Results: The students, mothers, and teachers were not familiar with the general guidelines for balanced nutrition. The lack of variety of the food provided at home was reported. The draft scripts were discussed and modified for accuracy of the nutrition messages that were applied in character dialogues, song lyrics, dramas and storytelling.
Conclusion: Storytelling and drama are effective for use by teachers and mothers for delivering nutrition messages in schools and the home.
Key words: Drama, storytelling, nutrition education, elementary school students, Indonesia

Download PDF

Malaysian Journal of Nutrition

Volume 25 No.3, 2019


Table of Content


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF

REVIEW


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF

SHORT COMMUNICATIONS


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF

Malaysian Journal of Nutrition

Volume 25 No.4, 2019


Table of Content


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF

SHORT COMMUNICATIONS


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


ABSTRACT

Introduction:
Methods:
Results:
Conclusion:
Key words:

Download PDF


Download PDF