OUTLI LINE NE Background Objectives Output Methods Results - - PDF document
1/22/2013 Study on Nutritional Status and Food Pattern of Pre-Pregnant, Pregnant and Lactating Mothers in Bogor, West Java Siti Madanijah, Dodik Briawan, Rimbawan, Zulaikhah, Nuri Andarwulan, Lilis Nuraida & Jacques Bindels Southeast Asian
Southeast Asian Food & Agricultural Science & Technology (SEAFAST) Center, Bogor Agricultural University PB)
Background Objectives Output Methods Results Conclusion
DOUBLE BURDEN NUTRITION PROBLEMS Source : Harian Kompas, 2006
The malnutrition problems in Indonesia occur at the every stage of the life cycle
Location : Bogor area 3 groups:
Number of respondent :
Criteria of subject:
Methods of data collection
Interview using Questionnaire STOP
Interview using screening form
1st screening : meet the inclusion criteria for each group
Respondent candidate (1) Stop 2nd screening : meet 2nd, 3rd and 4th Quintile
Population
Q BOGOR CITY **) (Rp/cap/month) Range Mean Q 5 622,421 - 6,676,869 1,158,923 Q 4 432,210 – 618,983 517,468 Q 3 332,781 – 430,137 378,730 Q 2 253,875 – 330,787 295,701 Q 1 127,869 – 247,698 213,570
** SUSENAS 2009 No Yes
Respondent candidate (2)
Yes No
Blood Analysis
The Indonesian Food Composition Table (2007 and 2008), ASEAN Food Composition
Table (2000), Nutrisurvey, The Composition of Foods, Wfood Composition (FAO) were used to calculate the nutrients intake.
The nutrients adequacy was assessed by comparing the actual nutrients intake with the
Indonesian RDA’s (ID-RDA) / Angka Kecukupan Gizi (WKNPG, 2004)
Nutrients CBA (=PP) Pregnant Lactating Energy (kcal/day) 1800-1900 2100-2200 2350-2450 Protein (g/day) 50 67 67 Iron (mg/day) 26 35 32 Calcium (mg/day) 800 950 950 Vitamin A (RE/day) 500 800 800 Vitamin C (mg/day) 75 85 100 Folate (µg/day) 400 600 500 Zinc (mg/day) 9.3-9.8 13.5-14.0 13.9-14.4
Cut-off point for nutrients intake Nutrients Category and cut off Source Energy and protein intake Clear deficit (<70% RDA) Moderate-mild deficit (70-90% RDA Sufficient (>90% RDA) Ministry of Health, RI (1996) Vitamin and mineral intake (Fe, Ca, Vitamin A, Vitamin C, Folate, Zinc) Estimated Average Requirement: 77% RDA Deficient (< 77% RDA) Sufficient (≥77% RDA) Gibson (2005)
No Analysis Pre- pregnant Pregnant Lactating Method 1. Hb v v v Peroxidation/Colorimetry 2. Ferritin serum v v v Chemiluminescent Immunoassay (CMIA) 3. Zn v v v AAS 4. Se v v v AAS 5 Vitamin A v v v HPLC 6 Folic acid v
Immunoassay (CMIA)
Blood samples : +15 ml/respondent (135 respondent, 45 respondent/group)
Blood biomarker Category and cut-off Hemoglobin
Deficiency (< 12 g/dL) Deficiency (< 11 g/dL) Ferritin
Deficiency (<15 µg/L) Deficiency (<12 µg/L) Folate (pre-pregnant women) Deficiency (<6.7 ng/ml) Selenium Deficiency (< 0.75 µmol/L) Zinc Deficiency (<65 µmol/L) Vitamin A (All group) Deficiency (<20 µg/dL) Cut-off point for blood biomarker
Nutrition status CBA / PP (n=200) Lactating (n=220) Underweight (< 18.5) 28 (14%) 20 (9.1%) Normal (18.5 – 24.9) 110 (55%) 113 (51.4%) Overweight (25.0 – 29.9) 45 (22.5%) 69 (31.4%) Obese (≥ 30.0) 17 (8.5%) 16 (8.2%) Mean ± SD 23.2 ± 4.7 22.5 ± 3.2
Nutrition status CBA /PP (n=200) Pregnant (n=203) Lactating (n=220) CEM (< 23.5 cm) 25 (12.5%) 38 (18.7%) 32 (14.5%) Normal (≥ 23.5 cm) 175 (87.5) 165 (81.3%) 188 (85.5%) Mean ± SD 27.4 ± 3.8 26.1 ± 3.7 26.7 ± 3.3
No Food Category CBA / PP Pregnant Lactating 1 Cereals and cereal products 511.1 495 567.0 2 Meat and meat products 7.8 5 6.7 3 Poultry and poultry products 37.3 30 34.4 4 Fish and fish products 23 23 23.4 5 Egg and egg products 20.1 21 30.1 6 Milk and dairy products 64.6 182 56.2 7 Legume and legume products 67.7 82 100.0 8 Vegetables and veg. products 138.8 160 234.3 9 Fruit and fruit products 29.1 59 26.8 10 Beverages 1133.7 1197 1292.3 11 Snack foods 75.6 101 88.5 TOTAL 2108.7 2352.4 2459.6
10 20 30 40 50 60 70
pre pregn pregnancy lactation Protein
Energy intake was below Indonesia RDA’s (77.6 %, 76.2% and 73.9%, respectively) Protein intake was below Indonesia RDA (93.2%, 72.1% and 86%, respectively)
Energy intake (kcal/day) Protein intake (g/day)
(ID-RDA: 50, 67 , 67 g/d)
10 20 30 40 50 60 70
Q2 Q3 Q4 Protein
Energy and protein intake of total group were below Indonesia RDA’s (75.7% and 72.1%, respectively)
“wealth quintiles” “wealth quintiles” Energy intake (kcal/day) Protein intake (g/day) (ID-RDA (AKG): 2100-2200 kcal/d) (ID-RDA (AKG): 67 g/d)
10 20 30 40 50 60 70 quintile 2 quintile 3 quintile 4
Intake of animal protein sources and vegetable protein Next to the low absolute protein intake in Q2, the poor protein quality (only 31.3% animal protein) increases the level of concern ! Protein intake (g/day)
Nutrients CBA / PP Pregnant Lactating %ID-RDA % def %ID-RDA % def %ID-RDA % def Energy 77.4 45.0 75.7 39.7 73.8 45.9 Protein 93.3 27.0 72.1 57.6 86.4 34.1 Iron 94.7 63.0 59.7 84.7 94.5 68.2 Calcium 69.7 68.0 79.8 55.7 75.5 60.5 Vitamin A 89.1 62.5 72.1 66.5 73.2 65.9 Vitamin C 37.1 88.0 45.5 84.7 49.5 76.8 Folate 40.7 90.0 33.8 98.0 45.5 90.9 Zinc 127.6 30.0 89.6 53.7 91.8 50.0
10 20 30 40 50 60 Energy Protein 45,0 27,0 39,7 57,6 45,9 34,1 CBA Pregnant Lactating
10 20 30 40 50 60 70 80 90 100
Iron Calcium Vit amin A Vitamin C Folate Zinc
63,0 68,0 62,5 88,0 90,0 30,0 84,7 55,7 66,5 84,7 98,0 53,7 68,2 60,5 65,9 76,8 90,9 50
CBA Pregnant Lactating
Deficiency CBA / PP (n=200) Pregnant (n=203) Lactating (n=220) n (%) n (%) n (%) 5 micronutrients 34 (17) 62 (30.5) 50 (22.7) 4 micronutrients 66 (33) 77 (37.9) 72 (32.7) 3 micronutrients 64 (32) 46 (22.6) 58 (26.4) 2 micronutrients 30 (15) 13 (6.4) 25 (11.4) 1 micronutrient 5 (2.5) 5 (2.5) 12 (5.5) TOTAL 199 (99.5) 203 (100) 217 (98.6)
Micronutrients include Iron, Vitamin A, Vitamin C, Folate, Zinc Deficiencies can be derived from any combinations of those five micronutrients
Deficiency CBA / PP (n=200) Pregnant (n=203) Lactating (n=220) n (%) n (%) n (%) 5 micronutrients 19 (9.5) 48 (23.7) 30 (13.6) 4 micronutrients 24 (12) 50 (24.6) 33 (15) 3 micronutrients 9 (4.5) 17 (8.4) 10 (4.6) 2 micronutrients 2 (1) 1 (0.5) 2 (0.9) 1 micronutrient
54 (27) 117 (57.6) 75 (34.1) 57.6% of pregnant women who are deficient in protein also deficient in at least one micronutrient
CBA / PP No Type of food % 1 Sour food 6.0 2 Spicy food 6.0 3 Shrimp 5.5 4 Instant noodle 4.5 5 Salted fish 3.5 6 Pineapple 2.5 7 Tuna fish 2.5 8 Water spinach 2.5 9 Offal 2.5 10 Cucumber 2.0 Pregnant No Type of food % 1 Pineapple 18.2 2 Tape (fermented cassava) 9.4 3 Durian 9.4 4 Salak 6.9 5 Spicy food 4.4 6 Softdrink 3.9 7 Sticky rice 3.4 8 Jengkol/petai” 3.0 9 Sour food 2.5 10 Shrimp 2.5 Lactating No Type of food % 1 Taro 10.0 2 Spicy food 10.0 3 Banana 6.8 4 Sour food 6.4 5 Shrimp 6.4 6 Salted fish 4.5 7 Fish 4.5 8 Offal 4.1 9 Pumpkin, squash 3.6 10 Kangkong leaves 3.6 Reason Scare of suffering from: 1. Allergy (8%) 2. Gastritis (7.5%) 3. Hypertension (4.5%) 4. Womb’s health (3%) 5. Leucorrhea (1.5%) Reason: Scare of suffering from 1. Abortion (8.4%) 2. Heartburn sensation (3.4%) 3. Gastritis (1.5%) 4. Hypertension (1.0%) Reason: Scare of suffering from 1. Baby’s health (9.5%) 2. Allergy (7.7%) 3. Parental believe (6.4%) 4. Disease (5.0%) 5. Fishy odor breast milk (4.5%)
Biomarker CBA / PP Pregnant Lactating Mean±SD % def Mean±SD % def Mean±SD % def Haemoglobin (g/dL) 13.2±1.2 11.1 11.6±0.9 22.2 12.7±1.2 17.8 Ferritin (µg/L) 65.2±50.4 23.08 31.8±36.2 41.2 44.8±49.4 27.9 Vitamin A (µg/dL) 49.8±21.8 6.7 41.1±20.1 13.3 56.7±28.8 11.1 Selenium (µmol/L) 1.5±0.6 4.4 1.4 ±0.5 8.9 1.1±0.7 28.9 Zinc (µmol/L) 74.2±21.0 42.2 62.3 ±21.7 55.6 84.7±38.7 24.4 Folate (ng/mL) 17.6 ±5.2 ND
% RDA : 40.7
10 20 30 40 50 60 Haemoglobin Ferritin Vitamin A Selenium Zinc 11,1 23,08 6,7 4,4 42,2 22,2 41,2 13,3 8,9 55,6 17,8 27,9 11,1 28,9 24,4
CBA Pregnant Lactating
Prevalence of pregnant mother is the highest among other groups in anemia, ferritin deficiency, VAD, and zinc deficiency Criteria of Deficiency Group % Deficient
Source of Infornmation