The Correlation Between the Type, Quantity, and Frequency of
Eating with Defecation Patterns and Muslim Students Indigestion
During Ramadan Fasting
Anisa Ramadani, Laily Hidayati and Praba Diyan Rachmawati
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: Diet, Defecation Pattern, Indigestion.
Abstract: Introduction: Diet is a description of the regulation of the quantity, frequency, and type of food consumed
daily by a person. The purpose of this study was to analyze the correlation between the type, quantity, and
frequency of eating and the bowel pattern and digestive complaints of Muslim students during Ramadan
fasting. Method: the research design used a cross-sectional study approach with type, number, and
frequency of feeding as the independent variables and bowel pattern and indigestion as the dependent
variables. The sample comprised of 107 college students. The data were collected by questionnaires and
analyzed using the Chi-square test. Results and Analysis: The statistics test regarding food typed and
defecation patterns obtained a p value of 0.000 at α≤0.05. The quantity of food and defecation patterns
obtained a p value of 0.577. The frequency of eating with defecation pattern obtained ap value of 0.778. The
food types with indigestion obtained a p value of 0.015. The quantity of food and indigestion obtained a p
value of 0.339. The frequency of eating with indigestion obtained a p value of 0.368. Discussion and
Conclusion: There was a correlation between the type of food and bowel patterns and indigestion. There
was no correlation between the number of meals and the frequency of eating with bowel patterns, and the
same applied to the number of meals and the frequency of eating with digestive complaints.
1 INTRODUCTION
Students are at an adult age during which food
consumed is very influential for the body’s health.
The body still needs the same nutritional intake both
when fasting and not fasting. However, from the
results of interviews, it is evident that students often
consume spicy foods, foods containing sugar and
salt, and fatty foods when fasting during Ramadan.
Students rarely consume fruit during suhoor.
Students also often experience diarrhea and
complain about pain and nausea in their stomachs.
Research by Riawanti (2008) found that the
average consumption of nutrition by students (9.8%)
decreased during Ramadan, including energy,
protein, fat, iron, vitamin C, and vitamin B. The
World Health Organization (WHO) in 2009
discovered the percentage of gastritis occurrence in
Indonesia was 40.8%. The occurrence of gastritis in
some areas of Indonesia is quite high with the
prevalence of 274,396 cases from 238,452,952
inhabitants. In Surabaya, the occurrence of gastritis
is 31.2% (Maulidiyah, 2006), whereas the
prevalence of peptic ulcers (known as ulcer disease).
Indonesia was found in 6%15%, especially at
the age of 2050 years (Suyono 2001). One way to
overcome eating behaviors is to change the
perception of individuals; this suggestion is based on
the theory of the Health Belief Model (HBM), in
which individuals perceive the vulnerability and
seriousness of diseases. Such perceptions
simultaneously increase individuals awareness of
the fact that a healthy diet can reduce symptoms of
indigestion, hence prompting a change in the
behavior of a person regarding their diet.
2 METHODS
This research design used a correlational research
design with a cross-sectional approach. This
research was conducted at a university in Surabaya
city during Ramadan. The population in this
research were 121 6th semester Muslim students and
746
Ramadani, A., Hidayati, L. and Rachmawati, P.
The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During Ramadan Fasting.
DOI: 10.5220/0008332207460751
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 746-751
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
the sample comprises of students that meet the
inclusion and exclusion criteria. This study used
total sampling, i.e. taking all members of the
population as samples. Independent variables in this
study are the type, quantity, and frequency of eating.
The dependent variables are defecation patterns and
indigestion. A questionnaire was used to collect
data, which were analyzed using the Chi-square
statistical test.
3 RESULTS
Most respondents in this research is female students
aged 2122 years old. According to the results in
Table 2, it was discovered that most students choose
the right foor during Ramadan fasting.
Table 1 showed that the majority of the
respondents choose correct food type and have
normal defecation pattern. The result of statistical
test using chi-square shows 0,000 p value. Therefore
it can be concluded that there is a significant relation
between food type and defecation patterns. The
majority of the respondents with normal eating
quantitiy have normal defecation pattern. The result
of statistical test using chi-square shows 0577 p
value, therefore it can be concluded that there is no
significant relation between eating quantity and
defecation patterns. Respondents with regular eating
frequency have normal defecation pattern. The result
of statistical test using chi-square shows 0,778 p
value. Therefore it can be concluded that there is no
significant between eating frequency and defecation
patterns.
Based on table 2, it showed that food type which
is correct often leads to the respondents having mild
indigestions. The result of statistical test using chi-
square shows 0,015 p value, therefore it can be
concluded that there is significant relation between
food type and indigestions. Also, the majority of
resondents with normal eating quantity have mild
indigestions. The result of statistical test using chi-
square shows 0,339 p value, therefore it can be
concluded that there is no significant relation
between eating quantity and indigestions. Majority
of the respondent with no indisgestion showed
regular eating frequency with statistical result of
Chi-Square p value was 0.039. It can be concluded
that there was no significant relation between eating
frequency and indisgestions.
4 DISCUSSION
4.1 The Relationship between Food
Type and Defecation Patterns
The results from the Chi-square analysis indicated
that there was a significant relationship between
food type and defecation patterns (p <0.05). The
pattern of food consumption is the composition of
the type and amount of food consumed by a person
or group at a certain time (Khomsan, 2010). A
healthy diet should pay attention to nutritional
adequacy rates, in terms of carbohydrates, proteins,
fats, and minerals (Supratman et al., 2013). During
fasting, the diet should still follow the pattern of
healthy and balanced foods (four sehat and five
sempurna) in accordance with the needs of the
calories required for each individual. Intake of
carbohydrates, proteins, fats, vitamins and minerals
in the month of fasting must remain complete. Diet
(food) is a major factor affecting defecation,
especially fiber. An important role of fiber is the
elimination of feces by increasing its volume to help
the defecation process (Miguel et al., 2004).
Research conducted by Ambarita (2014)
indicates that there is a significant relationship
between fiber intake and the frequency of
defecation. Yang et al. (2012) also proved that there
is a relationship between fiber intake and the
frequency of defecation. Foods that contain lots of
fiber will also increase intestine movements,
smoothing the feces so it is easier to move through
the colon, increasing the frequency of defecation. In
addition, the quantity and types of foods that are
consumed each day also affect defecation patterns,
Table 1: The analysis of relation between food type,
eating quantity, eating frequency with defecation pattern
on muslim students during ramadhan fasting.
No.
Analysis
P Value
1.
Food type
0.000
2.
Eating quantity
0.577
3.
Eating frequency
0.778
Table 2: The analysis of relation between food type,
eating quantity, eating frequency with indigestions on
muslim student during ramadhan fasting.
No.
Analysis
P Value
1.
Food type
0.015
2.
Eating quantity
0.339
3.
Eating frequency
0.368
The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During
Ramadan Fasting
747
such as spicy foods, unhygienic foods, and some
contain irritants that may irritate the gastric mucosa
and intestine, hence increasing intestine motility
(Funnell & Koutoukidis, 2005).
Dietary fiber will affect the defecation process
by facilitating the passage of food through the
digestive system (Eswaran et al., 2013). Fiber can be
obtained through vegetables and fruit (Khomsan,
2009).
4.2 The Relationship between the
Quantity of Food Eaten and
Defecation Patterns
Based on the results of this study, it was determined
that there is no relationship between the quantity of
food consumed and defecation patterns. This can be
caused by other factors that have a dominant relation
to defecation pattern. Every individual requires a
number of nutrients to live healthy and sustain life.
Therefore, the amount of nutrients obtained through
food consumption must be sufficient to perform
activities and maintain the immune system.
According to the Ministry of Health (2005) the
portion of food eaten each day should follow the
general guidelines of balanced nutrition; the dishes
are comprised of staple foods (35 servings per day),
side dishes (23 servings per day), vegetables (23
servings per day) and fruit (35 servings per day).
Nutritional needs are the minimum number of
nutrients that must be consumed through food
intake. A deficiency in, or excess intake of, nutrients
compared to normal requirements for an extended
time can endanger health. Fiber is a non-nutrient
substance that belongs to one type of group of
polysaccharides or complex carbohydrates
(Soelistijani, 2002). Lubis (2009) stated that dietary
fiber is a component of complex carbohydrates that
cannot be digested via digestive enzymes, but can be
digested by micro-bacteria digestion. Fiber
consumption deficiency can lead to diseases such as
constipation, hemorrhoids, and colon cancer.
Fiber works to stimulate intestinal tract activity
to release feces regularly. Fiber in the feces can also
absorb a lot of water, thus making the feces soft and
preventing constipation (Waluyo & Irianto, 2007).
Sari et al. (2016) proved that there is no significant
relation between fiber consumption and defecation
patterns. The higher the consumption of dietary fiber
smoother the defecation process will be, avoiding
straining. A theory by Beck (2011) suggests that the
consistency of feces depends on the amount of fiber
consumed. Adequate fiber intake will facilitate the
defecation process because fiber can retain moisture
in the feces by drawing water osmotically and
stimulating the peristalsis of the colon through
stretching.
4.3 The Relationship between the
Frequency of Eating and
Defecation Patterns
The results of this study indicated that there is no
significant relationship between the frequency of
eating with defecation patterns. The frequency of
eating consists of the main meal frequency, i.e.
breakfast, lunch, and dinner. However, this is
certainly different during Ramadan. When we are
fasting during Ramadan, most Muslims will have
two meals, i.e. suhoor (at dawn) and iftar, so the
fasting duration ranges from 11 to 18 hours each day
(Azizi 2010). Eating suhoor is preceded by drinking
a glass of milk, then eating a balanced menu and a
large portion of food. During suhoor, it is
recommended to eat a high protein content, so that
food stays in the stomach for longer. Digestion and
protein absorption also lasts longer than foods with
high carbohydrate levels (Sekarindah 2002).
Dietary pattern during fasting that need to be
considered is the pattern of eating when breaking the
fast (iftar). There are lots of people who eat during
iftar, no longer called the nutritional value of food
consumed (Sugung, 2013). Breaking the fast should
be done with care, taking a sweet drink and eating
date palm fruit or with fruits. Sweet foods contain
carbohydrates that are easily absorbed and can
immediately raise blood sugar levels, hence
transforming into calories to recover energy after a
day with no food and (Sekarindah 2002). A lot of
people use Ramadan to lose weight. Losing weight
can be done as long as the need for calories remains
fulfilled. If we only consume vegetables and fruit, it
will lead to illness (Idris 2000). The American
Dietetic Association (ADA) in Muthmainnah (2013)
recommend that the value of adult fiber adequacy is
2035 grams per day. A lack of fiber in food eaten
daily can cause abnormalities in the processing of
feces causing constipation. The average fiber
consumption in Indonesia has still not reached the
ideal amount of fiber consumption per day. The
average fiber consumption in Indonesia is 10.5
grams per day (July 2001). The study by Sari et al.
(2016) proves that the average fiber consumption of
respondents is 15.47 grams per day, whereas the
ideal fiber consumption value recommended by the
ADA is 2035 grams per day. Regarding the
consumption of fiber, respondents only reached half
of the recommended ideal requirements.
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
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4.4 The Relationship between Food
Types and Indigestion
Based on the results of this study, it was found that
there is a significant relationship between food types
and indigestion. Types of food are very important for
emptying the stomach. A large amount of food will
produce a large number of kimus. The exceeding
amount of kimus in the duodenum will slow the
process of emptying the stomach. Suratun (2010)
stated that spicy and acidic foods will stimulate the
stomach wall to remove stomach acid that can cause
injury to the wall of the stomach. Foods that contain
a lot of carbohydrates leave the stomach within a
few hours. Protein-rich foods last longer. They leave
the stomach slower, and the slowest discharged
foods after eating are fatty foods (Sherwood 2001).
Acidic foods are foods that stimulate the
digestive organs and can directly erode gastric
mucosa. Acidic foods stimulate excessive stomach
acid secretion and can stimulate increased motility or
peristalsis of the digestive organs, leading to
inflammation of the wound on the walls of the
digestive organs (Susanti, et al., 2011). Research
conducted by Susanti et al. (2011) indicated that
consuming spicy and sour foods affected the onset of
symptoms in the stomach. Another study conducted
by Angkow et al. (2014) demonstrated that there is a
significant relationship between types of food and
the occurrence of gastritis. Research by Pratiwi
(2013) indicated that there is a significant
relationship between types of eating with gastritis
occurrence. The results of this study showed that
respondents liked spicy and sour foods. Irritating
foods such as spicy foods can cause injury to the
stomach wall (Sediaoetama, 2008). Notoatmodjo
(2007) believes that consuming spicy and acidic
foods can cause excessive heat and pain in the pit of
the stomach, accompanied by nausea and vomiting.
4.5 The Relationship between Food
Types and Indigestion
Based on the results of this study, it was found that
there is no significant relationship between the
quantity of food consumed and indigestion. When
insufficient food was consumed, non-fulfillment was
evident, caused by an inadequate number of calories.
This resulted in a lower fulfillment of energy and
other nutrients required by the body. A poor diet is
seen in terms of quantity, type, and function, and, in
the long term, causes non-fulfillment of the body's
need for nutritional elements (including
carbohydrates, proteins, and fats).
According to the Health Department (2005) daily
portions of food should follow a balance of nutrients,
consisting of staple foods (35 portions per day),
side dish (23 portions per day), vegetables (23
portions per day) and fruit (35 portions per day).
The consumption behavior of a person, a family, or a
society is influenced by insight and perspective and
other factors related to appropriate actions. On the
other hand, nutrition is very useful for maintaining
health and preventing disease. The lack of nutrients
issue has lately caused the occurrence of diseases
due to incorrect diets, such as overeating or eating a
less-balanced diet. A study conducted by Pratiwi
(2013) indicated that there was no significant
relationship between quantity of food and gastritis.
Another research study conducted by Putri et al.
(2010) in which the frequency of food quantities
were analyzed, 100% of respondents consumed less
food than the body needed and the analysis results
concluded that there is a dietary relationship with the
occurrence of gastritis. The results showed that most
respondents had less carbohydrate, protein, and fat.
The lower nutritional value of carbohydrates can be
caused by the intake of less food than the body
needs. Carbohydrates are nutritional elements that
provide the main energy; the recommended
carbohydrate requirement is 60% of total calories
with a breakdown of 90% other than sugar, and 10%
sugar. Carbohydrate deficiencies in food
consumption can lead to a state of malnutrition.
Lower protein intakes can be caused by eating a
smaller quantity of food that is less than the body
requires and less varied types of food. Protein is a
nutrient that works for the growth and maintenance
of skin and nails, regulates fluid balance, the
formation of antibodies, and energy sources. Lack of
protein causes many problems such as weight loss,
weakness, muscle tissue shrinkage, and edema
(Erfandi 2009).
Lack of fat of respondents is caused by lack of
food intake in the body. The respondents preference
for types of food as a source of fat is less varied.
Basically, fat serves as a source and energy reserve.
Fat is stored in the tissue under the skin (Pratiwi,
2013). Fat deficiency can cause neurological and
vision problems, reproductive failure, and disorders
of the skin, kidneys, and liver (Erfandi, 2009).
Lower intake of carbohydrates, fats, and proteins
will result in non-fulfillment of the functions of
these nutritional elements.
The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During
Ramadan Fasting
749
4.6 The Relationship between the
Frequency of Eating and
Indigestion
Based on the results of this study, it was determined
that there is no significant relationship between the
frequency of eating and indigestion. The main
factors causing disturbances in the digestive system
are the patterns of food consumption and body
nutrition intake, as these are unfulfilled. In addition,
factors that can affect the occurrence of indigestion
are an irregular and unsuitable diet. Digestive
disorders that often arise are gastritis and ulcers.
Typical symptoms of gastritis and peptic ulcers are
pain or discomfort in the area of the epigastrum or
upper abdomen, bloating after eating, a full stomach
and feeling full quickly, nausea, vomiting, and
frequent burping. This set of symptoms is often
referred to as dyspepsia syndrome (Sofro &
Anurogo, 2013).
The frequency of eating can be used as an
indicator of eating regularity. Eating regularity is
related to the production of stomach acid, to which
gastric acid is a contributing factor for gastritis and
peptic ulcers. Irregular eating schedules will cause
the stomach to struggle to adapt, so the acid
production of the stomach becomes uncontrolled,
leading to symptoms of dyspepsia. Eating more
frequently (more than twice per day) can relieve
gastric work so the production of stomach acid is not
excessive; it must accommodate incoming foods in
excessive amounts, thus preventing dyspepsia
(Djojoningrat 2009).
The frequency of irregular eating affects the
occurrence of indigestion, but in this study there was
no significant relationship between the frequency of
eating with indigestion where p> 0.05. The results of
this study differ from research conducted by Susanti
(2011) in which the frequency and regularity of
eating was associated with the risk of digestive
symptoms Other research conducted by Angkow et
al. (2014) indicates that there is a significant
relationship between the frequency of eating with
the occurrence of gastritis. People who have an
irregular diet are susceptible to disease. When
stomach should be filled but is left empty or meals
are overdue, gastric acid will digest the mucosal
layer of the stomach, because when the stomach is
empty, intestinal peristaltic movements occur
intensively, stimulating an increase in acid
production causing pain in the epigastrium (Ikawati,
2010). The results of research by Nasution (2001)
states there is no significant relationship between the
frequency of eating with gastritis. From the results it
can be concluded that there is no difference in the
frequency of eating more than twice a day with less
than twice a day. The stomach will continue to
produce stomach acid every time in small amounts
after 46 hours after meals. If a person is late eating
by 23 hours, more and more stomach acid is
produced. Eating more than twice a day, interspersed
with the consumption of food interludes, can keep
stomach acid under control (Octaviani, 2011).
5 CONCLUSIONS
The more precise the type of food selected, the more
normal the defecation pattern of the respondent and
no indigestion. The quantity of food eaten does not
have a significant relationship with defecation
patterns. Regarding the frequency of eating, there is
no significant relationship with defecation patterns.
Furthermore, quantity of food eaten does not have a
significant relationship with indigestion. There was
also no significant relationship between the
frequency of eating and indigestion.
The researchers can give examples of amounts
for the number of food portions to obtain more
accurate results.
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The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During
Ramadan Fasting
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