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.
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@# 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.
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@# 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.
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@# 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.
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@# Introduction: Studies on the development and validation of semi-quantitative food frequency questionnaires (SQ-FFQ) for assessing omega-3 (Ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs) intake by pregnant women are few. This study aimed to determine the validity of a newly developed SQ-FFQ for assessing the LC-PUFA intake among Indonesian urban pregnant women. Methods: A cross- sectional study was carried out in 2015 on 100 Indonesian pregnant women who were in their late 3rd trimester, living in the urban setting of Jakarta. As a test tool, the SQ-FFQ was administered before the trained nutritionists executed the reference tool of non-consecutive two-day 24-hour dietary recalls (2DRs). The nutrients of interest were a total of Ω-3, eicosapentanoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), total Ω-6, linoleic acid (LA), arachidonic acid (AA), and LC-PUFAs. Statistical correlation, cross-classification and the Bland-Altman plot analysis were done to determine the agreement between tools. Results: Energy-adjusted correlation coefficients between SQ-FFQ and 2DRs were 0.385, 0.349, 0.352, 0.380, 0.338, 0.408, 0.409, 0.331, 0.341 and 0.341 for fat, total Ω-3, ALA, EPA, DHA, total Ω-6, LA, AA and LC-PUFAs, respectively and were statistically significant (p<0.05). Misclassification of these nutrients from SQ-FFQ and 2DRs was <6%. The Bland-Altman plots showed most of the points fell within the 95% limits of acceptable agreement for DHA, EPA, and LA. Conclusion: The newly developed SQ-FFQ of this study is a valid instrument for assessing of Ω-3 LC-PUFAs intake among Indonesian pregnant women living in urban area. Its further validation with relevant biomarkers is recommended.