The Effect of Comprehensive Feeding Practices and Physical

Activities on the Over-nutritional Status of Preschoolers in the

Working Area of Juanda Community Health Center Samarinda

Debora Injilia Hartati, Reny Noviasty and Rahmi Susanti

Department of Public Health Mulawarman, Samarinda, Indonesia

Keywords: Physical Activity, Overweight, Comprehensive Feeding Practices, Preschool.

Abstract: The prevalence of obesity in children under five based on the latest Riskesdas (2018) is 8.0%. This is still a

nutritional problem in Indonesia¸ although it’s has shown a decrease case. Because it’s causing other health

problems. This study aimed to determine the effect of comprehensive feeding practices and physical activity

on over nutritional status in preschool children at the working area of Puskesmas Juanda. The design of the

study was a case control 1:2 with a total sample 36 IRT. Primary data collection used the CFPQ and Pre-PAQ,

as well as secondary data through the latest posyandu weighing records. Data analysis used Chi Square test

and Odds Ratio with a significance value of 0.05. The results showed that there was an effect of

comprehensive feeding practices (p = 0.001; OR=26,714) and physical activity (p = 0.000; OR=33) on the

over-nutrition status of preschool children (3-5 years) in the working area of Juanda Community Health

Center Samarinda. It’s advisable for mothers to pay more attention to the needs of the child's nutritional needs

when feeding, and to support the child more actively by bringing the child to an open space area regularly (at

least 180 minutes a day for children to move actively).

1 INTRODUCTION

Global data in 2018 shows that the number of under-

fives who are over-nutrition is estimated at 5.9% (40

million) children, almost half of whom live in Asia

and a quarter live in Africa. Since 2000-2018 cases of

overnutrition in children under five in all countries

have increased by 10 million cases. (UNICEF, WHO

and The World Bank, 2019). In 2019 there were 38

million children under five who were overweight and

obese (WHO, 2020).

Based on the latest trends, the number of children

under five who are overnutrition is expected to

increase (from 40 million children) to 43 million in

2025. Therefore, WHO sees that the problem of

obesity in children under five is one of their attention

focuses, because besides being important for the

welfare of children, nutrition is also needed in

achieving sustainable development goals. So that

WHO sets obesity as one of the SDGs indicators and

sets it as a global target to stop the increase in obesity

by 2025 (UNICEF, 2019).

Indonesia's national data, according to Riskesdas

in the last years 2018 (8,0%), has actually alredy

shown a declining trend of over nutrition and obesity

(BB/TB > 2 SD) (Kemenkes RI, 2019). However, it

is still a nutritional problem in Indonesia because it is

a contributor to the incidence of global obesity which

must continue to be suppressed, because it is at risk

of causing new problems, namely health problems,

especially the increase in the incidence of PTM that

arises faster than age in general (Kemenkes RI, 2020).

Indonesian national data shows that there are still

12 provinces with prevalence of overweight and

obesity (Z score according to BB/TB > 2 SD) above

the national prevalence in 2018, including East

Kalimantan which is in the 6th highest rank after the

national prevalence, with a percentage by 9.4%

(Kemenkes RI, 2019). Then seen from DKP Kaltim

data obtained through PSG in the last 3 years for over

nutrition aged 0-59 months, namely 2015 (5.5%),

2016 (4.6%) and 2017 (4.7%). Seen from the PSG

data, the trend of overnutrition is still fluctuating, so

there are still two possibilities for the next PSG result,

to go down/up.

Samarinda is one of the cities in Indonesia that

also contributes to the incidence of overweight

(BB/TB) in children under five, with a prevalence of

Hartati, D., Noviasty, R. and Susanti, R.

The Effect of Comprehensive Feeding Practices and Physical Activities on the Over-nutritional Status of Preschoolers in the Working Area of Juanda Community Health Center Samarinda.

DOI: 10.5220/0010758500003235

In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 53-63

ISBN: 978-989-758-542-5

3.0% in 2017, and ranks the 2nd highest obesity case

in children aged 0-4 years after Kukar, with 19 old

and new cases, the 4th highest obesity case at the age

of 5-9 years with a total of 11 cases, and the 3rd

highest according to the overall age group, with a

total of 2,242 cases (DKP Kaltim, 2018). The highest

incidence of overweight and obesity in children under

five in Samarinda in 2019 was in the Juanda

Community Health Center work area, with a total of

71 cases (DKK Samarinda, 2019).

In the current millennial era, coupled with the

enactment of the fourth industrial revolution (4.0)

which applies an all-machine system and the concept

of automation, it seems that it is increasingly

supporting humans to carry out less physical activity.

Related to this, WHO states that children aged 3-4

years should do more physical activity than sedentary

activities (eg sitting still or staring at a screen for a

long time). Guidelines for physical activity for

children this age are at least 180 minutes / day with

various types of physical activity and intensity

(WHO, 2019).

Previous studies with the aim of analyzing the

relationship between sleep duration, food intake and

physical activity with the incidence of obesity in

toddlers aged 3-5 years, the results showed that there

was a significant relationship between sleep duration,

food intake and physical activity with the incidence

of obesity in toddlers aged 3-5 years. years (p <

0.005) (Tristiyanti, Tamtomo and Dewi, 2018).

Several related studies also state that children's

eating behavior is strongly influenced by the family

environment, especially at the age of 3-5 years.

Where at this age the growth line in KMS begins to

look flat, but his/her cognitive and psychosocial

development is increasing rapidly (there is an

increase in comprehension and memory). So that

good habits that are applied since the child is at this

age will play an important role in the independence of

the child at a later age, including the application of a

good diet. This is also in line with the CDC (2020) on

Child Development (Mountin, 2020).

Changes in diet and physical activity are often the

result of environmental and social changes associated

with development and the lack of supportive policies

(WHO, 2020). Parents, especially mothers, play a

very important role in determining the diet of their

toddlers. Knowledge of maternal nutrition is very

influential in the selection of family food, which in

turn will affect the nutritional status of all family

members (especially toddlers) (Aditianti, Prihatini

and Hermina, 2016). The comprehensive feeding

practice carried out by the mother in question is

providing food with nutrition that is in accordance

with the child's needs, both in physical, mental and

emotional development, starting from preschool age

(Rysha, Gjergji and Ploeger, 2017).

In a preliminary survey conducted in Kemuning

Village, Arjasa District regarding the comprehensive

feeding practices of 5 mothers, the results showed that

on average the mother gave more restrictions to the

child if the child was sick, but when their returned to

health, the mother would again free the child's food

(Rahmawati, 2018). Based on the description above,

the researcher wants to conduct a study related to the

nutritional status of preschool aged children (3-5

years) in the working area of the Juanda Community

Health Center Samarinda with the independent

variables studied are the practice of feeding

comprehensive and physical activity of children.

Which the purpose of this study was to determine the

effect of the practice of comprehensive feeding and

physical activity on the nutritional status of preschool

age children (3-5 years) in the Working Area of

Juanda Community Health Center Samarinda.

2 RESEARCH METHOD

This type of this study was a analytic observational

with a matched case control design, namely a study

conducted retrospectively (looked at backwards

events) by identifying the case group and the control

group first, then examining the risk factors (in this

case the negative comprehensive feeding practices

and less physical activity). The independent variables

in this study was the comprehensive feeding practices

and physical activity, while the dependent variable

was the nutritional status of preschoolers.

The total population in this study were all pairs of

mothers and their preschool age children (3-5 years)

with an age calculation range seen from the month

and year of birth, with the upper limit being > 10

months in 2015 and the lower limit < 10 months in

2017 and with Zscore BMI/U - 2 SD, which was

recorded in the results of anthropometric

measurements of the posyandu in the Juanda Health

Center work area in 2019 with a total of 283 children.

Meanwhile, the population of cases with Zscore

BMI/U > + 2 SD is 25 children.

The time used in the implementation of this study

is mid-January - mid-March 2021. This research was

carried out in the Juanda Community Health Center

Work Area, Samarinda City, which consists of 2

Urban Village namely Air Hitam Urban Village and

Gunung Kelua Urban Village. Sampling was carried

out by non-probabilty sampling using a type of

purposive sampling technique (this sampling was

ICSDH 2021 - International Conference on Social Determinants of Health

based on subjective considerations from the

researchers themselves in accordance with the

inclusion and exclusion criteria that had been

determined and considered). For samples using the

formula Lemeshow as follows:

𝑛 

𝑍

∝/

2𝑃



1𝑃



𝑍





𝑃



1  𝑃



𝑃



1  𝑃







𝑃



𝑃







Information:

n = Number of samples needed each

group (cases and controls)

Z_(1-∝/2) = Standard normal distribution value

at a certain 1.96 = 95% CI

significance degree with of 5%

Z_(1-β ) = The value of the standard normal

distribution at a certain (1.28 = test

power (power) by 90%)

= Estimated proportion of exposure in

the case group (ill) which is 0.191

(Setiawan, Machmud and Masrul,

2018)

= Estimated proportion of exposure in

the control group (not sick) which is

0.809 (Setiawan, Machmud and

Masrul, 2018)

P =





 





P =

,,



0,5

So, total of sample (n) in this study was:



1,96





0,5



10,5



1,28



0,191



1  0,191



 0,809 1  0,809



0,191  0,809



11,52

To facilitate the calculation and processing of data

on the sample, the researchers rounded the total

sample into 12 toddlers (with BMI/U > 2 SD) as the

case group, and 24 toddlers (with BMI/U -2 SD to 2

SD) as the control group, with a comparison of the

samples used is 1: 2 (case group and control group)

and the total number of children under five is 36

children under five. The inclusion criteria are as

follows: Registered to be part of the Juanda

Community Health Center working area, Samarinda

City; Children aged 3-5 years whose BMI/U value is

seen from the Z score > + 2 SD (for the case group),

and Z score - 2 SD to + 2 SD according to BMI/U (for

the control group); Mother's occupation as a

Housewife (IRT) or taking care of her own children

at home; Mother is willing to be a respondent in this

study; Mentally and physically healthy both mother

and child under five. Then the exclusion criteria are

if: During the research, there is a family member (at

home) who is sick so that the mother's time is taken

up to take care of it; Die; or Resign.

Data collection using primary data and secondary

data. Primary data collected using the Comprehensive

Feeding Practices Questionnaire (CFPQ) and

Preschool-age Physical Activity Questionnaires (Pre-

PAQ), as well as secondary data through the latest

posyandu weighing records. Data analyzed by Chi

Square test and Odds Ratio with a significance value

of 0.05.

All questionnaires were distributed via WhatsApp

personal messages and filled out by mothers of

toddlers who were the research sample or may be

assisted by other family members, if at the time of

filling out the questionnaire the mother was not fluent

in using smartphones or lacked understanding in

answering the available questionnaires. This CFPQ

scoring system uses a Likert scale with a different

format, namely for item numbers 1-12 Never = 1,

Rarely = 2, Sometimes = 3, Often = 4, Always = 5.

While for item numbers 13-38 No Agree = 1,

Disagree = 2, Neutral = 3, Slightly Agree = 4, Agree

= 5. Then, there is a statement that ends with the R

logo, which indicates the statement is negative, so the

assessment uses an inverted Likert scale. The

measurement results from this CFPQ will be in the

form of categories, which are as follows (Warkentin

et al., 2016):

a. Negative feeding practices (if score < median)

b. Positive feeding practice (if score median)

The results of the questionnaire Pre-PAQ are

categorized into less physical activity (when the child

is active <180 minutes/day) and sufficient physical

activity (when the child is active 180 minutes/day)

(WHO, 2019) .

Validity test is the principle of instrument

reliability (questionnaire) which is measured and

observed for data collection. In making a decision on

the validity test, we must compare the r count with the

r table. If r count > r table then the question item from

the questionnaire is said to be valid, but if r count < r

table then the question item from the questionnaire is

said to be invalid. Reliability test is a test used to see

the stability of the instrument (questionnaire) in

collecting measurement results and research

observations. That is, in every measurement and

observation result with the same questionnaire

questions but at different times will get the same

results. (Donsu, 2017). The reliability test in this

study was carried out using the Alpha Cronbach

method. A variable in the questionnaire can be said to

be reliable if it produces Cronbach's Alpha (α) > 0.6

(Ghozali, 2011).

The Effect of Comprehensive Feeding Practices and Physical Activities on the Over-nutritional Status of Preschoolers in the Working Area

of Juanda Community Health Center Samarinda

3 RESULT AND DISCUSSION

3.1 Respondent Characteristics

Table 1: Frequency Distribution of Respondents'

Characteristics on the Preschool Age Children in the

Working Area of the Juanda Community Health Center,

Samarinda.

Respondent

Characteristics

Child’s Nutritional Status

Over-Nutrition

n=12(%)

Normal

n=24(%)

Mother's Last Education

No school/Not

finished

elementary

school

1 (8,3%)

0 (0%)

Finished

Elementary

School

1 (8,3%)

1 (4,2%)

Finished Junior

High School

0 (0%) 5 (20,8%)

Finished Senior

h School

6 (50,0%) 10 (41,7%)

Graduated

(D3/S1/S2/S3)

4 (33,3%) 8 (33,3%)

Mother's Employment Status

Housewife 12 (100,0%) 24 (100,0%)

Etc 0 (0%) 0 (0%)

Number of Family Members in One House

le 4

(

33,3%

)

(

8,3%

)

4 people 2 (16,7%) 12 (50,0%)

5 people 3 (25,0%) 6 (25,0%)

6 people 3 (25,0%) 4 (16,7%)

Child Gender

Male 5 (41,7%) 10 (41,7%)

Female 7

(

58,3%

)

(

58,3%

)

Source: Primary Data, 2021

Based on the table 1 above, information can be

obtained that most of the mothers last education in the

sample group was high school graduates, namely in

the group of preschool age children who experienced

well-nutrition/normal (41.7%) and over-nutrition

(50.0%) in the Juanda Health Center Samarinda. The

occupational status of mothers from both groups

(both normal and over-nutrition) are housewives

(100%).

The majority of family members in one house in

the group of preschool-aged children with normal

status are 4 family members (50.0%) and in the group

of preschool-aged children with over-nutrition status

are 3 family members (33.3%). Then, the majority of

respondents had preschool-aged children who were

female in both groups, namely the normal group

(58.3%) and the over-nutrition group (58.3%).

This research was conducted in the working area

of Juanda Community Health Center Samarinda,

which is located in the Samarinda Ulu District. The

working area of the Juanda Samarinda Health Center

consists of 2 Urban Village, namely Air Hitam Urban

Village and Gunung Kelua Urban Village. Air Hitam

and Gunung Kelua Urban Villages are geographically

next to each other (to the east, Air Hitam Urban

Village is Gunung Kelua Urban Village, and to the

west Gunung Kelua Urban Village is Air Hitam

Urban Village). Gunung Kelua Urban Village is

located in the heart of the capital city of East

Kalimantan Province where the centers of community

activities such as economics (shopping centers) and

academics (colleges and schools) are located in this

area.

In line with the general description of the location

of this study, in general the problems of overweight

and obesity are supported by an increase in intake of

energy-dense foods (high in fat and sugar) and an

increase in sedentary activity due to the increasing

number of sedentary jobs, changes in transportation

modes, and increasing urbanization. (WHO, 2020).

Likewise, the description of the location of this study

which is overall in an urban area which is an

obesogenic environment (an environment with a

sedentary lifestyle and lots of fast food available with

a relatively close distance from the house making it

easier to access).

In line with the results of this study, the research

of Schrempft et al. (2015) showed that preschoolers

with obesogenic living environments, consumed less

vegetables and fruits, compared to consuming high-

energy snacks and drinking sugary drinks. In

addition, the behavior of children in choosing their

food is also inseparable from what they like and have

known before. Therefore, the experience of children

from an early age will greatly affect their food choices

and preferences later (Scaglioni et al., 2011).

The quality of food intake at preschool age is very

dependent on parents (especially mothers). All

supplies, serving, and eating habits at home will

affect children's consumption patterns. There are

several factors that influence parental feeding to their

children, including economic, socio-cultural,

educational, environmental, and maternal age

(Sulistyoningsih, 2011). The results of research

Farhan (2014) state that, one of the factors that

determine whether or not someone easily absorbs and

understands the nutritional knowledge they get is the

level of education.

The characteristics of the research results in table

1 show the description of the last education of the

majority of mothers who graduated from senior high

ICSDH 2021 - International Conference on Social Determinants of Health

school, namely as many as 16 people (44.5%). At

least, the majority of mothers have completed their

education to fulfill the 12-year compulsory education

program. From these results, it can also be seen that

it is precisely at the level of high school graduation

that on average they have children with more

nutritional problems. This shows that in fact not all

highly educated people will have good knowledge as

well, or knowledge and higher education are not

always directly proportional to that person's attitude

or behavior.

The results of the study in the table 1 state that the

majority of the number of family members in one

house in the group of preschool age children with

good nutritional status are 4 family members (50.0%)

and in the group of preschool age children with more

nutritional status are 3 family members (33.3%).

Djala research (2016) says that the amount of food

and the frequency of food consumed by each family

member is influenced by the size of the number of

family members.

The results of the study itn table 1 state that the

majority of children with overnutrition status are

female, as many as 7 children (58.3%). There are

several factors that can be the cause of more girls than

boys with more nutritional status, one of which is that

women's metabolism is slower than men's. Men have

a 10% higher basal metabolic rate than women,

because women tend to convert food into fat, whereas

in men more food is converted into muscle and as a

ready-to-use energy reserve. (Lestari, 2017).

In addition to differences in basal metabolic rate,

it was also stated in Lestari's research (2017) that

lighter physical activity in women will certainly be a

triggering factor for fat accumulation in the body as

well. In line with the previous research, the results of

the analysis in this study also showed that more or

less physical activity occurred in children of the

female sex than boys.

3.2 Univariat

3.2.1 Frequency Distribution of

Respondents based on Comprehensive

Feeding Practice

Table 2: Frequency Distribution of Respondents Based on Comprehensive Feeding Practices.

Category

Comprehensive Feeding Practices

Ove

-Nutrition Normal Total

n=12 % n=24 % n=36 %

Total

12 100,0% 24 100,0% 36 100,0%

Restriction for Weight

Negative Feeding Practices

6 50,0% 5 20,8% 11 30,6%

Positive Feeding Practices

6 50,0% 19 79,2% 25 69,4%

Total

12 100,0% 24 100,0% 36 100,0%

Healthy Environment

Negative Feeding Practices

9 75,0% 3 12,5% 12 33,3%

Positive Feeding Practices

3 25,0% 21 87,5% 24 66,7%

Total

12 100,0% 24 100,0% 36 100,0%

Arrangements

Negative Feeding Practices

10 83,3% 5 20,8% 15 41,7%

Positive Feeding Practices

2 16,7% 19 79,2% 21 58,3%

Total

12 100,0% 24 100,0% 36 100,0%

Source: Primary Data, 2021

Based on the table 2, information can be obtained that

in the monitoring category in the characteristics of

parental feeding practices to their preschool age

children, there are 9 respondents (75.0%) in the case

group and 6 respondents (25.0%) in the control group

who carry out monitoring characteristics negatively.

In the emotion regulation category, there were 10

respondents (83.3%) in the case group and 4

respondents (16.7%) in the control group who carried

out negative emotion regulation characteristics. In the

food as a reward category, there were 8 respondents

(66.7%) in the case group and 8 respondents (33.3%)

in the control group who carried out the

characteristics of the food as a reward negatively. In

the child control category, there were 10 respondents

(83.3%) in the case group and 4 respondents (16.7%)

in the control group who had negative child control

characteristics.

In the healthy eating guide category, there were 9

respondents (75.0%) in the case group and 5

respondents (20.8%) in the control group who carried

out the characteristics of the healthy eating guide

negatively. In the restriction for weight category,

there were 8 respondents (66.7%) in the case group

and 9 respondents (37.5%) in the control group who

carried out the characteristics of restriction for weight

negatively. In the weight control category, there were

6 respondents (50.0%) in the case group and 5

respondents (20.8%) in the control group who had

negative weight control characteristics. In the healthy

environment category, there were 9 respondents

(75.0%) in the case group and 3 respondents (12.5%)

in the control group who carried out healthy

environment characteristics negatively. In the

arrangements category, there were 10 respondents

(83.3%) in the case group and 5 respondents (20.8%)

in the control group who had negative arrangements

characteristics.

Positive feeding practices are feeding practices

carried out by parents to their children by paying

attention to the interaction between parents and

children during the feeding process and in accordance

with balanced nutrition or nutritional needs for the

child's body, while negative feeding practices are the

opposite. Overall, as seen from table 2, the most

negative comprehensive feeding practices carried out

by mothers in preschool aged children (3-5 years) in

the Working Area of Juanda Community Health

Center Samarinda is the "Pressure to Eat" category

with a total of 17 respondents (47.2% ) and the least

negative is the “Restriction for Weight” category with

a total of 11 respondents (30.6%). The results of the

study in table 2 for the "monitoring" category show

that mothers of preschool-aged children who are

overweight are still relatively lacking in monitoring

food intake consumption in children (with a

percentage of 75%), so that the nutritional status

needed by children is not met properly. Preschool age

children are able to choose and know what food they

want to eat and what they like, so this period can also

be referred to as the transition period for children

from passive consumers to active consumers.

However, they do not understand to choose which

foods are good and which are not good for health, so

parents in this case play an important role in being

able to control their children's eating choices in order

to win nutritionally balanced food choices.

(Permenkes RI No 41, 2014).

The results of the "emotional" category research

show that mothers of preschool-aged children who

ICSDH 2021 - International Conference on Social Determinants of Health

experience over-nutrition relatively often use food as

an ingredient to divert children's feelings when

children are angry or upset, in other words, parents

use food or drink as a regulator of children's emotions

(by percentage of 83.3%). When a child feels angry

or upset, making his heart calm first and then helping

him to talk about his feelings to the mother so that the

child can find ways to deal with his emotions will be

much better, than having to involve food

(Misnadiarly, 2007).

The results of the "food as a reward" category

research show that mothers of preschool-aged

children who are over-nutrition still relatively often

use their children's favorite food or drink as a reward

for good behavior that has been carried out by

children, usually in this case preschoolers prefer

foods and drinks high in sugar (ie with a percentage

of 66.7%). In appreciating a child's good behavior and

stopping his bad behavior, giving snacks as a gift for

him is not the right solution to appreciate his

behavior. Looking for other ways, such as praising or

thanking children for their good behavior will be

better (Misnadiarly, 2007).

The results of the "child control" category

research show that mothers of preschool-aged

children who experience over-nutrition are still

relatively lacking in controlling/controlling children's

eating behavior and interacting in their feeding to

maintain children's consumption patterns so that they

are not arbitrary in choosing and consuming their

food (with the percentage of 83.3%). An unhealthy

child's diet can indeed lead to weight gain, but

explicitly forbidding him to eat such foods is also not

good. If children are too restricted/forbidded, they can

eat more quietly behind their parents' back. So the

best way is to control access to food like this at home.

For example, when mothers shop for their daily food

needs, mothers can pay more attention to preferences

for food and snacks to be purchased (Misnadiarly,

2007).

The results of the research category "guidance for

healthy eating" show that mothers of preschool-aged

children who experience over-nutrition are still

relatively lacking in carrying out healthy eating

guidelines (such as telling, clearly describing,

discussing, offering, and/or exemplifying good eating

patterns) to their children (ie with a percentage of

75%). When parents want their children to live

healthy, then parents must be the main example in

their lives. Parents who have a good diet will also

form a good diet in their children which can continue

until they grow up (Misnadiarly, 2007). In line with

this theory, the research conducted by

Prasetyaningrum et al. (2016) also mentions that

parental behavior plays a role in shaping eating

behavior in children. It is known that preschool

children (3-5 years) who live with mothers with

unhealthy eating behavior are 2.45 times more likely

to be obese.

The results of the "pressure to eat" category of

research show that mothers of preschool-aged

children who experience over-nutrition are still

relatively feeding their children in a pressing or

coercive style, so that children eat more food,

especially when it is time to eat, usually done to

increase the child's weight (ie with a percentage of

66.7%). As parents (especially mothers who take care

of children intensely) must be able to realize

nutritional needs for children in accordance with the

activities they do everyday. If the child is full enough,

the mother should not get used to forcing the child to

continue eating or to always finish the contents of his

plate (Misnadiarly, 2007).

The results of the research in the "restriction for

weight" category show that mothers of preschool-

aged children who are over-nutrition are still

relatively unable to control/regulate their children's

food intake to reduce or maintain their child's weight

(that is, with a percentage of 50%). Getting used to

eating regularly at predetermined hours can prevent

children from obesity. But it must also be

remembered that giving snacks that are high in sugar,

fat and calories too often can also lead to obesity.

Thus, making a commitment within the family to

carry out healthy habits and determine the pattern and

adhere to it, will make children interested in doing it

and they will not feel alienated because of the same

treatment for all family members including mothers

(Misnadiarly, 2007).

The results of the "healthy environment" category

research show that mothers of preschool-aged

children who experience over-nutrition are still

relatively lacking in providing healthy food and not a

few of them actually provide more stock of unhealthy

snacks at home, even though the family is the most

important factor in determining children's diet (ie

with a percentage of 75%). Children usually do not

shop for their own food needs, parents are fully

responsible for the stock of healthy food available at

home. For mothers, it is recommended that when

shopping, you should choose fruits and vegetables as

a snack supply at home and avoid choosing fast food,

limit the purchase of sugary drinks because they only

provide less nutrition than the high calories they have,

and choose recipes and cooking methods with the use

of as little fat as possible (such as baking/boiling)

(Misnadiarly, 2007).

The Effect of Comprehensive Feeding Practices and Physical Activities on the Over-nutritional Status of Preschoolers in the Working Area

of Juanda Community Health Center Samarinda

The results of the research in the “arrangements”

category show that mothers of preschool-aged

children who are more over-nutrition are still

relatively insensitive to the importance of their role as

mothers in regulating their children's consumption

patterns (ie with a percentage of 83.3). Of the 9

variables of comprehensive feeding practices studied,

the variable that was mostly carried out on preschool-

aged children (3-5 years) in the Working Area of

Juanda Community Health Center Samarinda with a

negative category (in case and control groups) was the

"coercive" variable, namely 17 respondents (47.2%).

Meanwhile, the variable that was the least negative (in

both case and control groups) was the “weight

control” variable, namely 11 respondents (30.6%).

3.2.2 Frequency Distribution of

Respondents based on Children's

Physical Activity

Table 3: Frequency Distribution of Respondents Based on

Children's Physical Activity.

Category

Children’s

Physical

Activity

Over-

Nutrition

Normal Total

Less 9 75% 2 8,3% 11 30,6%

Sufficient 3 25% 22 91,7% 25 69,4%

Total 12 100% 24 100% 36 100%

Source: Primary Data, 2021

In table 3 above, information can be obtained that

from 12 preschool-aged children with over-

nutritional status as many as 9 children (75%) do

physical activity in the less category and 3 children

(25%) do physical activity in the sufficient category.

Meanwhile out of 24 children with normal nutritional

status, 2 children (8.3%) did physical activity in the

less category and 22 children (91.7%) did physical

activity in the sufficient category.

From table 3, information can also be obtained

that the physical activity of preschoolers (3-5 years)

in the Working Area of the Juanda Samarinda Health

Center is on average in the sufficient category, as

many as 25 children (69.4%) have sufficient physical

activity category. It's just that in children with more

nutritional status, the majority of preschoolers still

have a category of less physical activity, as many as

9 children (75%). In line with the results of this study,

the research of Carson et al. (2017) also found that

children with over-nutritional status had less physical

activity than children with normal nutritional status.

The results of this study also showed that children

with normal nutritional status but classified as having

less physical activity were 2 children (8.3%) out of 36

children (100%). This shows that physical activity is

not also the only factor that influences the incidence

of overnutrition. Research conducted by Wilks et al.

(2011) actually get the results that there is no

significant relationship between physical activity and

body fat mass. In the study, physical activity was not

the main determinant of unhealthy weight gain in

children.

3.3 Bivariat

3.3.1 The Effect of Comprehensive Feeding

Practices on over Nutritional Status of

Preschool Age Children in the

Working Area of Juanda Community

Health Center Samarinda

Based on table 4, it can be seen that of the 12

respondents who have preschool-aged children with

over-nutritional status, there are 11 respondents

(91.7%) of whom practice comprehensive feeding in

the negative category and 1 respondent (8.3%) does

comprehensive feeding practices with positive

category. Meanwhile, of the 24 respondents who had

preschool-aged children with good nutritional status,

7 respondents (29.2%) does comprehensive feeding

practices with negative category and 17 respondents

(70.8%) does comprehensive feeding practices with

positive category.

Table 4: The Effect of Comprehensive Feeding Practices on

Over Nutritional Status of Preschool Age Children in the

working area of Juanda Community Health Center

Samarinda.

Nutritional Status

Value

(CI:95%)

Bottom-

Over-

Nutrition

Normal

Comprehensive

Feeding

Practices

Negative

Feeding

Practices

Count 11 7

0,001

26,714

(2,877 –

248,023)

% within

Status

Gizi

91.7% 29.2%

Expected

Count

6.0 12.0

Positive

Feeding

Practices

Count 1 17

% within

Status

Gizi

8.3% 70.8%

Expected

Count

6.0 12.0

Source: Primary Data, 2021

Based on the results of the statistical test, the P

value (P Value) was 0.001. Because the P Value

(significance) is less than 0.05, it can be concluded

that there is an effect of comprehensive feeding

practices on the nutritional status of preschool age (3-

ICSDH 2021 - International Conference on Social Determinants of Health

5 years) in the Working Area of Juanda Community

Health Center Samarinda, with an Odds Ratio (OR)

of 26.714 OR > 1) which means that there is a

possibility that a child with a negative comprehensive

feeding practice will have a 26.7 times greater risk of

experiencing overnutrition than a child with a positive

comprehensive feeding practice..

In line with the results of this study, other studies

also state that the practice of caring for toddlers and

mother's knowledge affect the nutritional status of

toddlers (Masita, Biswan and Puspita, 2018). The

results of other studies that support also state that

there is a significant relationship between eating

patterns and the nutritional status of children under

five (P Value = 0.014) (Pratiwi, Masrul and Yerizel,

2016). How parents apply their parenting style to their

children, will also determine what their child's life

will be like in the future, and this is in line with the

research of Suratman et al. (2018). Thus, parents

(especially in this case mothers) play an important

role in the growth and development of children

through parenting practices and the provision of

nutrients to children.

Without having to look at whether children are at

risk of being overweight or even having an ideal

weight, paying attention to the food you eat so that

you can consistently maintain an ideal weight is a

good example for children. So, from here, mothers

can invite their children to participate in doing

healthy habits together. (Misnadiarly, 2007).

3.3.2 The Effect of Physical Activity on over

Nutritional Status of Preschool Age

Children in the Working Area of

Juanda Community Health Center

Samarinda

Table 5: The Effect of Physical Activity on Over

Nutritional Status of Preschool Age Children in the working

area of Juanda Community Health Center Samarinda.

Nutritional Status

Value

(CI:95%)

Bottom-

Over-

Nutrition

Normal

Physical

Activity

Less

Count 9 2

0,000

33,000

(4,695 –

231,956)

% within

Status

Gizi

75.0% 8.3%

Expected

Count

3.7 7.3

Sufficient

Count 3 22

% within

Status

Gizi

25.0% 91.7%

Expected

Count

8.3 16.7

Source: Primary Data, 2021

Based on the results of the statistical test on the

table 5, the P value was 0.000 (<0.05). Thus, it can be

concluded that there is an effect of physical activity

on the over-nutritional status of preschool aged

children (3-5 years) in the Working Area of Juanda

Community Health Center Samarinda, with an Odds

Ratio (OR) of 33 (OR > 1) which means that there is

a possibility that a child experiencing over-nutrition

due to lack of physical activity which is 33 times

greater than if the child has sufficient physical

activity. In line with the results of this study, the

research of Rahmah et al. (2019) also stated that

physical activity (p= 0.004) and physical activity

parenting (p= 0.01) were the most influential risk

factors for the incidence of over-nutrition in

preschool children.

The results show that almost all children spend

their time eating in front of a screen (be it a

smartphone or television). Habits like this can make

children consume food unconsciously how much

food they have eaten and make children eat in a hurry

(Misnadiarly, 2007). In addition, parents also very

rarely bring their children to play in open spaces/areas

such as riverbanks, nature reserves, environmental

parks/tourist parks, or even playgrounds to increase

children's activities.

Children, especially preschoolers, should not

spend their time solely on sedentary activities, such

as watching television coupled with excessive

snacking, playing video games and the like, or just

lying in bed for more than 60 minutes. Spending time

with active activities is very important for

preschoolers, there are at least 180 minutes per day to

do physical activity of any intensity which 60 minutes

in it includes doing moderate to strenuous physical

activity (energetic games) such as running, cycling

and dancing, that makes children sweating and

panting (WHO, 2019).

The results of this study also show that on average

children need someone to accompany them to be

motivated to play. Meanwhile, on the other hand, the

results of this study also show that the time used by

children to play outdoors (whether on weekends or

weekdays) is very little or even no time for children

to play outdoors, especially for children with over-

nutritional status, even in good weather conditions.

So that children's activities at home are sufficient

limited and more use of screens or smartphones.

Parents are also responsible for the habits of

activities carried out by children. Parents must have a

"supportive" attitude for every activity children. In

supporting the activities carried out by children,

parents can make family policies/commitments to be

obeyed and carried out by every family member,

The Effect of Comprehensive Feeding Practices and Physical Activities on the Over-nutritional Status of Preschoolers in the Working Area

of Juanda Community Health Center Samarinda

including parents. Some examples of good policies to

do are parents being a real example for every activity

both indoors/outdoors, encouraging children to try

new activities and responding positively when they

do it, and providing fun and interesting activities

every day (Nemours Health & Prevention Services,

2013).

When children are active and there are dangers of

safety problems and/or other problems (such as mud,

fights over fighting over toys with friends, etc.),

parents need to direct their children well and slowly

so that children return to playing in safe activities or

invite them to discussion about what to do when faced

with it. Parents also need to avoid using physical

activity as a punishment. (Nemours Health &

Prevention Services, 2013).

4 CONCLUSIONS

After conducting research on 36 respondents to

housewives (IRT) who have preschool aged children

(3-5 years) in the working area of Juanda Health

Center Samarinda, it can be concluded that there is an

effect of the practice of comprehensive feeding on the

nutritional status of preschool children (3-5 years) in

the working area of the Juanda Health Center,

Samarinda, with a P Value of 0.001 (<0.05) and an

Odds Ratio of 26.714 (OR > 1) which that is, children

with mothers who practice negative comprehensive

feeding have a 26,714 times greater risk of

experiencing over-nutrition compared to children of

mothers who practice positive feeding. Parents need

to provide an "exemplary" attitude in terms of eating

behavior, for example if the mother wants her child to

eat healthy food, the mother also needs to set an

example and start as early as possible to create a

"good habit/activity".

There is an effect of physical activity on the

nutritional status of preschool children (3-5 years) in

the working area of Juanda Community Health Center

Samarinda, with a P Value of 0.000 (<0.05) and an

Odds Ratio of 33 (OR> 1) which means, Children

with less physical activity have a 33 times greater risk

of experiencing over-nutrition than children of

mothers who do quiet physical activity. It is

recommended for mothers to be more supportive of

children in moving more actively by bringing

children to open space areas regularly (at least 180

minutes a day for children to be active).

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The Effect of Comprehensive Feeding Practices and Physical Activities on the Over-nutritional Status of Preschoolers in the Working Area

of Juanda Community Health Center Samarinda