Relationship between BMI, Energy Intake,

Macro Nutrient Intake and Cardiorespiratory Fitness among Female

College Students in Jakarta

Anna Fitriani, Desiani Rizki Purwaningtyas

Universitas Muhammadiyah Prof. Dr. Hamka, Jakarta, Indonesia

Keywords: BMI, Cardiorespiratory, Fitness, Intake.

Abstract: Scientific evidence has shown a relationship between cardiorespiratory fitness in young adults and health status

in later life. In the past decade, there has been a global decline in cardiorespiratory fitness at a young age,

especially among college students. This study aims to examine the level of cardiorespiratory fitness among

UHAMKA female students and their relationship with various factors such as nutritional status, calorie intake

and macro nutrients. With a cross-sectional design, this study tested different proportions of low fitness level

in various groups with the chi square test. A total of 164 samples participated in this study where body mass

index, calorie intake, carbohydrates, protein and fat were measured. The results showed that the proportion of

low cardiorespiratory level was higher among respondents with higher and lower BMI and an excessive fat

intake. It suggested to the young women to have a normal BMI and a non-excessive fat intake.

1 INTRODUCTION

Fitness status, especially at a young age, is important

to be monitored regularly because it has implications

for health status ((Nassif et al., 2012); (Cale, Harris

and Chen, 2014). Several types of fitness related to

health include cardiorespiratory fitness (Caspersen,

Powell and Christenson, 1985. A Meta-analysis

showed that cardiorespiratory fitness is associated

with the incidence of coronary heart disease,

cardiovascular diseases and all-cause mortality in

healthy adults ((Kodama et al., 2009); (Barry et al.,

2014). Cardiorespiratory fitness is also associated

with bone health (Hervás et al., 2018). Moreover,

cardiorespiratory fitness is also associated with

cognitive function in all age groups (Pinilla &

Hillman, 2013) and academic performance at a young

age (Ariza et. al., 2017).

However, although various studies show a

relationship between fitness and health status, there

has been a decline in fitness levels at a young age

across the globe. Meta-analysis showed a significant

decline in cardiorespiratory fitness in children and

young adults by 43% per year from 1981-2000 in

developed countries ((Tomkinson and Olds, 2003).

The same thing happened in Korea, where since

1968-2000 there has been a decline cardiorespiratory

fitness level among children and young people (Olds,

Kang and Kim, 2007). In the United States, it has

been shown that there has been a decline in the level

of cardiorespiratory fitness of young people from the

1960s-1990s (Hoeger and Hoeger, 2011). Previous

research among college students in Depok, West

Java, Indonesia showed that 86.3% of subjects were

unfit (Indrawagita, 2009). Four years later in the same

location, a study showed that 67.9% of students were

unfit (Komala and Achmad , 2013).

Several factors affect fitness status, including:

caloric intake (Marco et al., 2017), macronutrient

intake (Marco et al., 2017) and micronutrient intake

(Cao et al., 2012) and body mass index ((Ortlepp et

al., 2003); (Chen et al., 2020). Other factors include

gender (Busing and West, 2016) and age (Milanović

et al., 2013).

Based on the data of the low level of fitness at the

young age, both at the global level and in Indonesia,

especially in college students, the authors were

interested to examine the factors that are related to

cardiorespiratory fitness among female college

students in Jakarta.

Fitriani, A. and Purwaningtyas, D.

Relationship between BMI, Energy Intake, Macro Nutrient Intake and Cardiorespiratory Fitness among Female College Students in Jakarta.

DOI: 10.5220/0010759700003235

In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 94-99

ISBN: 978-989-758-542-5

2 METHOD

2.1 Design

This study used a cross-sectional study design. In this

study, primary data was collected once at a time to

measure the dependent variable, namely

cardiorespiratory fitness and the independent

variable, namely nutritional intake, physical activity,

and nutritional status. The research is located on the

Limau campus of the Faculty of Health Sciences,

UHAMKA Jakarta during December 2018 to

December 2018. February 2019.

2.2 Subject

The target population in this study were Semester 3

students of the Nutrition Science Study Program,

FIKES UHAMKA for the academic year 2018/2019,

amounting to 245 people. By using the 80% test

power, a minimum sample size of 164 people was

obtained. Sampling was carried out purposively with

the condition that it met the inclusion criteria

(healthy, had no history of cardiovascular disease and

followed all fitness test protocols). The entire sample

participated in this study from beginning to end.

2.3 Cardiorespiratory Fitness Test

Protocol

In this study, the measurement of cardiorespiratory

fitness was carried out using the YMCA 3 minute step

test method. Respondents were asked to go up and

down the board with a height of 31 cm in a duration

of 3 minutes with a specified rhythm. After that, the

pulse is measured for 1 minute and matched against

the norm table.

The protocol test are:

1) Preparation of tools: 31 cm high YMCA step test

bench, timer, metronome

2) Subjects measured their own pre-test RHR. RHR

was measured for 1 minute.

3) Subjects were asked to go up and down the YMCA

bench for 3 minutes with an up and down rhythm

according to the beat of the metronome which was set

to 96 beats/minute. The timer is set to 3 minutes.

4) Exactly 3 minutes timer, the test is over and the

subject is asked to rest by sitting in a chair

comfortably. Turn on the 1 minute timer for rest time.

5) Exactly 1 minute timer, the subject measures the

post-test pulse by himself. The pulse is measured for

1 minute.

6) Post-test pulses were recorded and compared with

the norm table.

2.4 BMI Measurement

Nutritional status is determined according to the body

mass index (BMI) which is calculated by the formula

for body weight in kg/(height in meters)2. The results

were categorized into undernourished (BMI < 18.5),

normal (BMI = 18.5 – 24.9), overweight (BMI 25 –

29.9) and obesity (BMI > 30) according to the

Indonesian Ministry of Health. The validity of BMI

in predicting health benefits such as fitness has been

recognized by the American Society of Sport

Medicine (Tuttle, Montoye and Kaminsky, 2016).

2.5 Dietary Assesment

The intake of calories (kcal), carbohydrates (grams),

protein (grams) and fat (grams) was obtained from the

results of the 3 days food record. Respondents were

asked to record food and drinks consumed for 3 days

consisting of 2 weekdays and 1 weekend. The results

were categorized into: intake deficit (< 80% RDA),

normal (80 – 110% RDA) and more (> 110% RDA).

2.6 Instruments

Measurement of cardiorespiratory fitness using the

YMCA 3 minute step test instrument consisting of: a

wooden box with a height of 31 cm, a timer measuring

device, and a metronome. The collection of nutritional

status data using the Omron brand Karada Scan digital

weight measurement tool with an accuracy of 0.1 kg.

Measurement of height using a microtoise with an

accuracy of 0.1 cm. measurement of nutritional intake

using the 3 days food record form.

2.7 Data Analysis

Data was analysed using chi square test to examine the

difference in the proportion of unfit between normal

and abnormal BMI (overweight and underweight) and

between adequate and excessive intake.

3 RESULT

3.1 Description of Characteristics,

Cardiorespiratory Fitness Level,

Nutritional Status and Nutritional

Intake of Respondents

Respondents were 164 students of the Nutrition Study

Program, Faculty of Health Sciences, UHAMKA,

with an average age of 19.26 years. The average

Relationship between BMI, Energy Intake, Macro Nutrient Intake and Cardiorespiratory Fitness among Female College Students in Jakarta

weight was 53.56 kg and the average height was

155.42 cm (Table 1).

Table 1: Subject’s Characteristics.

Characteristic Mean ± SD Min

–

Max

Age 19.26 ± 0.774 18

–

Bod

Wei

ht 53.56 ± 0.629 40

–

Hei

ht 155.42 ± 0.978 140 - 168

Cardiorespiratory fitness is classified into 7 levels

from the lowest to the highest, namely: very poor,

poor, below average, average, above average, good,

and excellent from the American College of Sport

Medicine (Blair et al., 2014). Table 2 shows a

description of the respondents' cardiorespiratory

fitness.

Table 2: Subjects Distribution by Cardiorespiratory Fitness

Level.

Fitness Level n Percentage (%)

Ver

Poo

19 11.6

Poo

22 13.4

Below Avera

e 31 18.9

Average 51 31.1

Goo

17 10.4

Excellent 24 14.6

Total 164 100.0

If the seven levels were grouped into categories of

fit (good and excellent) and not fit (very poor, poor,

below average, average, above average), three

quarters of respondents (75%) were not fit (figure 2).

The measurement results show that one-fifth of

the respondents (19.5%) have poor nutritional status.

The same thing also happened to excess nutritional

status (a combination of overweight and obesity)

where the proportion reached one-fifth of the

respondents (20.1%).

Table 3: Subjects Distribution by BMI

Nutritional status n Percentage (%)

Underweight 32 19.5

Normal 99 60.4

Overwei

ht 24 14.6

Obesit

9 5.5

Total 164 100.0

The results of data collection through 3 days food

record show that a quarter of respondents have a

deficit energy intake (25%). One third of respondents

experienced a deficit in carbohydrate intake (32.2%),

and more than half (69.5%) experienced a protein

intake deficit. For fat intake, almost half of the

respondents had excessive intake (47.6%).

Table 4: Subject Distribution by Dietary Intake Level

Intake n Persentage (%)

Energ

Deficit 41 25.0

Normal 98 59.8

Excessive 25 15.2

Total 164 100.0

Carboh

drate

Deficit 53 32.3

Normal 81 49.4

Excessive 30 18.3

Total 164 100.0

Protein

Deficit 114 69.5

Normal 50 30.5

Total 164 100.0

Fat

Deficit 1 0.6

Normal 85 51.8

Excessive 78 47.6

Total 164 100.0

3.2 Relationship between

Cardiorespiratory Fitness and

Nutritional Status

The different proportion test was carried out by

compositing the nutritional status categories into 2

categories, namely: abnormal (combined nutritional

status of less and more) and normal. The results of the

analysis showed that the proportion of respondents

who were not fit was higher in those with abnormal

nutritional status (73.8%). This figure is almost 2

times the proportion of unfit in respondents who have

normal nutritional status (44.4%). The results of the

analysis show that this difference is significant with p

value = 0.048.

ICSDH 2021 - International Conference on Social Determinants of Health

Table 5: Relationship between Cardiorespiratory Fitness and BMI

BMI Cardiores

irator

fitness Status Total OR

(95% CI)

P value

Unfit Fit

n % n % n %

Underweight,

overwei

ht & obese

73.8

26.2

100

2.36

2.14 – 2.86

0.048

Normal 44 44.4 55 61.1 99 100

Total 123 75.0 41 25.0 164 100

Table 6: Relationship between Cardiorespiratory Fitness and Dietary Intake

Dietary Intake Cardiorespiratory Fitness Status Total OR

(95% CI)

P value

Fit Unfit

n %n %n%

Calorie

Deficit 32 78.0 9 22.0 41 100 1.25

0.54 – 2.90

0.755

Normal & Excessive 91 74.0 32 26.0 123 100

Carbohydrate

Deficit 41 77.4 12 22.6 53 100 1.208

0.56 – 2.61

0.772

Normal & excessive 82 73.9 29 26.1 111 100

Protein

Deficit 94 77.0 28 23.0 122 100 1.51

0.69 – 3.28

0.409

Normal & excessive 29 69.0 13 31.0 42 100

Fat

Excessive 52 66.6 26 25.6 78 100 3.24

0.46 – 1.90

0.000

Normal & deficit 21 24.4 65 75.6 86 100

3.3 Relationship between

Cardiorespiratory Fitness and

Dietary Intake

The difference in proportion test was carried out by

compositing the categories of calorie, carbohydrate,

and protein intake into 2, namely deficit and normal-

over. As for fat intake, the categories were

composited into more and normal-deficit. The results

of the analysis for calorie, carbohydrate and protein

intake showed similar results, where the proportion of

non-fitters was slightly higher in respondents who

had a deficit intake compared to those who were more

normal. Even this slight difference in proportion was

not statistically significant (Table 6).

Different results are shown in fat intake, where

the proportion of respondents who are not fit is 3

times higher in those who have more intake than

normal-deficit intake (Table 6). The chi square test

shows that this difference is significant with an OR of

3.24, which means that respondents with more fat

intake have a 3 times higher risk of being unfit than

those with normal-deficit intakes.

4 DISCUSSION

The results of the analysis show that three quarters of

the respondents are not fit, even though the

respondents are students of the health sciences

faculty. These results are in line with previous

research on health science students at several

campuses in Indonesia. Research (Indrawagita, 2009)

found that most (86.3%) students at a public health

faculty in Depok, West Java were declared unfit after

doing the YMCA 3 minute step test. Research in the

next 4 years, still at the same campus, research

(Komala and Achmad, 2013) which also used the

YMCA 3 minute step test showed that more than half

(67.9%) of students were not fit. In 2016 it was

reported that 93.3% of nursing students in Tanjung

Pura, West Kalimantan had a low level of fitness

using the multistage fitness test method (Purnomo,

Samodra and Yanti, 2015). Surprising results were

reported by research from (Safaringga and

Herpandika, 2018) which showed that 100% of

physical education and health students had low fitness

using the multistage fitness test method. The latest

report shows that 80% of female students who are

members of the student center in Padang have very

low fitness (Anggri, 2019).

Relationship between BMI, Energy Intake, Macro Nutrient Intake and Cardiorespiratory Fitness among Female College Students in Jakarta

For college students, low fitness is associated

with academic performance, as reported in several

studies ((Lipošek et al., 2019); (Zhai et al., 2020);

(Hou et al., 2020)). In addition to leading to academic

achievement, fitness level also affects nutritional and

health status. A review shows that the level of fitness

as a result of regular physical activity shows a long-

term protective effect on health, which can prevent

obesity and various degenerative diseases such as

coronary heart disease, diabetes mellitus, Alzheimer's

and dementia (Reiner et al., 2013).

One of the factors that affect cardiorespiratory

fitness is nutritional status. Research on female

students shows that the higher the BMI, the lower the

level of cardiorespiratory fitness (Bonney, Ferguson

and Smits-Engelsman, 2018). A recent study from

(Chen et al., 2020) also showed a significant

relationship between BMI and fitness as measured

comprehensively using the Physical Fitness Index

(PFI). In detail, the study (Chen et al., 2020) states

that respondents who have an abnormal BMI (less,

more and obese) have a lower PFI score than the

normal one. This finding certainly supports the results

we found in this study, where the proportion of unfit

is higher in respondents with abnormal BMI

compared to normal ones. This supports the theory

that normal nutritional status in young adults is a

protective factor for cardiovascular diseases

considering that cardiovascular fitness is positively

related to cardiovascular functions such as blood

vessel elasticity (Davison et al., 2010).

In addition to nutritional status, cardiorespiratory

fitness cannot be separated from calorie intake and

macronutrients. The results of this study are in line

with previous research by (Rahmawati, 2020) which

also did not show a significant relationship between

cardiorespiratory fitness and calorie, carbohydrate,

protein intake. Cardiorespiratory fitness actually

correlated significantly with fat intake, where the

proportion of those who consumed excess fat was not

fit more than the normal-deficit. The explanation of

how fat intake affects cardiorespiratory fitness begins

with the theory that total fat intake affects obesity

rates as summarized in a systematic review by

(Hooper et al., 2015) and research by (Raatz et al.,

2017). The high intake of total fat and saturated fatty

acids will trigger adiposity which in turn causes

obesity (Raatz et al., 2017). Obesity is what will

ultimately reduce the level of cardiorespiratory

fitness as previously discussed.

5 CONCLUSIONS

This study showed that cardiorespiratory fitness in

female students was significantly associated with

BMI and total fat intake, but not with calorie,

carbohydrate and protein intake. Future research

should investigate fitness levels more

comprehensively, not only cardiorespiratory fitness

but also muscle strength, muscle endurance and

flexibility.

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