Effect of Supplementation of Zinc, Glutamine, Fiber, and Prebiotics in Presumed Healthy Indonesian Children Aged 1–3 Years / 대한소아소화기영양학회지

Purpose@#Impaired intestinal mucosal integrity may affect the gastrointestinal function, especially in relation to nutrition, absorption, and barrier function. The purpose of this study was to measure the prevalence of impaired intestinal mucosal integrity in presumed healthy children aged 1–3 years and assess the effects of zinc, glutamine, fiber, and prebiotic supplementation in them. @*Methods@#A cross-sectional study was conducted in 200 children aged 1–3 years in Pasar Minggu, South Jakarta, Indonesia. A randomized double-blind parallel group method clinical trial was then performed to assess the effects of zinc, glutamine, fiber, and prebiotic supplementation. @*Results@#Elevated calprotectin was found in 91/200 subjects (45.5%) at the onset of the study. After 10 months, 144 subjects completed the study: 72 subjects received the trial formula, whereas the other 72 received the standard formula. A transitory decrease in fecal calprotectin (FC) was observed after 6 months in the subgroup with normal FC levels, who were fed the test formula (p=0.012). @*Conclusion@#The prevalence of impaired intestinal mucosal integrity in this group of Indonesian children aged 1–3 years was high. Supplementation with zinc, glutamine, fiber, and prebiotics during 6 months reduced FC only in those who had low levels at baseline but not in those with impaired integrity.

Perceptions of the causes of obesity among normal weight, overweight and obese Indonesian women: a mixed methods approach

@# 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.

Association between food marketing exposure and consumption of confectioneries among pre-school children in Jakarta

@# 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.

Exposure and approval of food marketing strategies: a mixed methods study among household food providers in Jakarta

@# 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.

Food purchasing behaviour among urban slum women in East Jakarta: a qualitative study

@# 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.

Challenges and Supports of Breastfeeding at Workplace in Indonesia / 대한소아소화기영양학회지

Due to increased number of women workers in Indonesia in the last decade, numbers of women living as a worker and a housewife have increased. This also increases the potential risk of breastfeeding discontinuation. Three months of maternal leave policy and inadequate lactation promotion support in workplace have been identified as factors that hinder lactating practices. The World Health Organization recommendation of 6 months of exclusive breastfeeding and joined regulation of three Indonesia ministers (Ministry of Health, Ministry of Labour, and Ministry of Women Empower) have failed to improve the exclusive breastfeeding rate among female workers in Indonesia due to the lack of a standardized guideline on lactation promotion at workplace. In addition, very limited or no studies have been conducted to evaluate the impact of workplace-based lactation intervention programs on exclusive breastfeeding rate among female workers. This is because the relationship of lactation with working performance and productivity could not motivate employer to invest in workplace-based lactation promotion facility or program.