Prevalence of Nutritional Status and Dietary Habits among

Adolescent in Urban Area in Medan, North Sumatera, Indonesia

Sri Lestari

*, Isti Ilmiati Fujiati

, Putri Chairani Eyanoer

, Dina Keumala Sari

Siti Ardianti Ahmad

Panjaitan

and Nur Hidayah Nasution

Department of Public Health, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansur No. 5 Kampus USU,

Medan 20155, Indonesia

Department of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansur No. 5 Kampus USU,

Medan 20155, Indonesia

Deparement of Public Health Nutrition, Faculty of Public Health, Universitas Sumatera Utara, Jl. Universitas No. 32

Kampus USU, Medan 20155, Indonesia

Department of Administration and Health Policy, Faculty of Public Health, Universitas Sumatera Utara, Jl. Universitas

No. 21 Kampus USU, Medan 20155, Indonesia

Keywords: Nutritional status, dietary habit, adolescence, urban area.

Abstract: Adolescence is an important time in life because it is a transition from childhood to adulthood. This research

aimed to determine the prevalence of nutritional status and the association with dietary habits among

adolescent in urban area in Medan, North Sumatera Utara. This research is an analytic study with cross

sectional approach. Total sample is 400 adolescents aged 12-19 years old from 4 schools (SMP Al Wasliyah

Medan, SMA Al Wasliyah Medan, SMPN 41 Medan, SMP Santo Yosep Medan). Study period was from

February to July 2018. Variables included were age, Socio-economic characteristics of the parents, weight,

height and dietary intake pattern. Nutritional status was evaluated according to the anthropometric

indicators, which were based on the WHO criteria. Dietary intake data were gathered by using two 24hr

recall questionnaires and a QFFQ. Chi-square analysis was used in order to find the association between

dietary habits and nutritional status. Prevalence of underweight, overweight and obesity (WHO/National

Center for Health Statistics reference) were respectively, 23.3%, 13.0% and 6.5%. Underweight (32.0%)

was found to be more prevalent among adolescent with aged 10-12 years (early adolescent). Adolescent

boys suffered more underweight (37.8%) than adolescent girls (18.6%).The dietary habits associated with

the nutritional status were having breakfast, consuming meat/fish and vegetables(P <0.05). Underweight in

adolescence has become a true public health problem in North Sumatera province.

1 INTRODUCTION

One of the characteristics of advanced nations is that

has high levels of health, intelligence, and work

productivity. These three things are influenced by

the state of nutrition. Optimal nutrition is essential

for normal growth as well as physical and

intelligence development of infants, children, and

adolescents (Irwandy et al., 2014). Adolescents are

among the most vulnerable groups experiencing

nutritional problems. Adolescence is an important

period in which nutritional needs increase for growth

of bone, muscle and development during this phase (

Tesfaye et al., 2015). Teenagers are children aged

10-19 years. WHO defines adolescence as a time

when the individual develops from the first time he

shows his secondary sexual signs (puberty) until

reaches sexual maturity.

Adolescent nutritional problems need a special

attention for affecting the growth and development

of body and its impact on adult nutritional problems

in the future. Physical growth causes adolescents to

require a greater intake of nutrients than children do.

In this phase, adolescents are intensely active with

various activities, both school and sports activities (3

(Proverawati, 2010). Especially in young women,

nutritional intake is also required for the preparation

of reproduction (Arisman, 2002).

Energy intake influence the incidence of stunting

in school children (Lestari et al., 2018a), anemia in

Lestari, S., Fujiati, I., Eyanoer, P., Sari, D., Panjaitan, S. and Nasution, N.

Prevalence of Nutritional Status and Dietary Habits among Adolescent in Urban Area in Medan, North Sumatera, Indonesia.

DOI: 10.5220/0010086707310735

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

731-735

ISBN: 978-989-758-449-7

731

pregnant women (Lestari et al., 2018b), and obesity

in adult female (Lestari et al., 2017). Nutrition

problems that often occur in adolescence is the lack

of nutrient intake resulting in malnutrition that is too

thin that can trigger chronic energy deficiency

(CED) and can be affected by anemia due to iron

deficiency.

Adolescent nutritional problems occur as a result

of changes in eating habits caused by peers, media

advertising and the need to be respected in the

family (Mase et al., 2015). The development of

adolescent psychology also influences eating habits,

such as leaving time to eat, overeating, taking

supplements, and having favorite foods (Stang and

Marry, 2005). Changes in eating habits in

adolescents are caused by low nutritional knowledge

and inappropriate dieting behavior. The level of

knowledge of one's nutritional affects the attitude

and behavior of a person in choosing foods that will

affect nutritional status. The higher the level of one's

nutritional knowledge, the better the nutritional

status (Khomsan., 2007). The imbalance between

food consumed with the needs in adolescents will

lead to multiple nutritional problems of less nutrition

and more nutrition.

WHO reported in (2009), 1 out of 10 school

children were overweight. About 30 million to 45

million children suffered from obesity. It was

estimated that 2-3 percent were aged 5-17 years (

Delisle and WHO, 2005). While in Indonesia, based

on Riskesdas data in 2010 and 2013 showed an

increased prevalence of obesity (BMI> 25), where

the prevalence of adolescents aged 13-15 years who

had weight obese increased from 5.2% to 5.9% (

MOH, 2013). Another problem faced by teenagers

was malnutrition.

The 2012 Unicef report showed that in 11 of 64

countries, more than a quarter of teenagers had

status lean, were found in 21 countries from 41

countries, and more than one third of adolescent

girls are anemic. Evidence suggests that malnutrition

in young women continues between generations of

mothers to children. Another study by Aguayo V &

Paintal K in South Asia showed that malnutrition

and anemia suffered by 50% of girls in South Asia

(Aguayo and Kajali, 2017). Meanwhile, according to

data MOH (2013), it was known that the national

prevalence of lean in adolescents aged 13-15 years is

11.1%. This study aimed to determine the

prevalence of nutritional status in relation to the

eating habits of adolescents in urban poor areas in

North Sumatra.

2 MATERIAL AND METHOD

This research is an analytic survey with cross

sectional study design. Total samples of 400

adolescent aged 12-19 years coming from 4 schools:

SMP Al WASLIYAH, SMA AL WASLIYAH,

SMPN 41 and SMP Santo Yosep from Medan City,

North Sumatra Province. Data was taken in February

to July 2018.

Type of data collected in this study was primary

data using questionnaires and anthropometry

measurements. Socio-demographic data and dietary

habits were taken by structured interview

questionnaires while anthropometric measurements

included height, weight and Body Mass Index

(BMI). Measurements of height and weight were

taken according to the WHO’s guideline. Weights of

the school adolescents were measured to the nearest

0.1 kg on a battery powered digital scale (SECA,

UNICEF, Copenhagen) and height was measured to

the nearest 0.1 cm using a wooden height-measuring

board with a sliding head bar following standard

anthropometric techniques (WHO, 2009).

Anthropometric indicators used in this study were

BMI for age z-score (BAZ) and height for age z-

score (HAZ). School adolescents below -2 HAZ

score were classified to be stunted and those with

BAZ score less than -2 were classified to be thin.

Food Frequency Questionnaire (FFQ) was used in

order to obtain the dietary habits and food intake

data.

SPSS statistical software was used in order to

analyze the data. Chi square test was applied to

calculate P-value and statistical significance.

3 RESULT

The most father’s education of respondent was High

School (58.3%) then followed by University

(14.4%). While most respondents education was also

High school (44.3%), Junior School (33.3%) and

there were 13.0% graduated University. Viewed

from the economic aspects, the results showed that

most of respondent were in low social economy that

was equal to 86.8%. This data was reinforced by

findings that most respondents (57.0%) received

pocket money less than IDR 7000. Respondents in

this study lived in crowded populated urban areas

where there were 63.3% family's members of more

than four people in one house (Table 1).

Table 2 shows the total number of 400

adolescents participated in this study. It was found

as many as 23.3% of adolescent suffered from

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

732

underweight. About 13.0% of them had overweight,

and 6.5% had obesity (Table 2).

Table 3 shows the age group of 10-12 years

(early) adolescent girls suffered more underweight

(32.0%) and overweight (12.2%). While in the age

group 13-15 years (mid) suffered underweight

(24.0%). Obesity was more suffered by the age 6-19

years (late). This study showed adolescent boys

suffered more underweight (37.8%) than adolescent

girls (18.6%). However, adolescent girls were more

overweight and obese (13.8% and 7.5%) than boys

(Table 4).

The association between dietary habits and

nutritional status is shown in Table 5. This study

found that breakfast habits were significantly

correlated with adolescent nutritional status (p =

0.008). In addition, it was found that most of the

respondents rarely consumed side dishes made from

meat / fish because of social economy conditions of

parents were in the low group. There was a

significant relationship between the consumption of

meat with nutritional status of adolescents. It was

95.0% of that most respondents rarely consumed

vegetables. There was a clear association between

vegetable consumption and adolescent nutritional

status. Not only rare to consumed vegetables, it was

also found that 95.7% of urban youth rarely

consumed vegetables.

Table 1: Distribution of adolescent according to socio-

demographic features.

Variable Cate

Father's educations No Schoolin

3 0.7

Primary School 19 4.7

Junior School 53 13.2

h School 235 58.3

loma 32 7.9

Bachelor De

ree 58 14.4

Mother's educations No Schooling 6 1.5

Primary School 21 5.3

Junior School 133 33.3

h School 177 44.3

loma 11 2.8

Bachelor De

ree 52 13.0

Social Econom

Low 347 86.8

Middle 52 13.0

h 1 0.3

Famil

's membe

1-4

erson 147 36.8

> 4

erson 253 63.3

Daily Pocket Money < Rp 7,000 228 57.0

>= Rp 7,000 172 43.0

Table 2: Prevalence of nutritional status in adolescent in

urban area (n = 400).

utritional status Frequency %

Under wei

93 23.3

ormal 229 57.3

Overwei

52 13.0

Obesit

26 6.5

Total 400 100.0

Table 3: Cross distribution between age and nutritional

status.

Age

Under

weight

(%)

Normal

(%)

Overweight

(%)

Obese

(%)

Total

(%)

Early 32.0 53.7 12.2 2.4 100.0

Mid 24.0 56.1 13.7 6.3 100.0

Late 17.0 62.5 11.4 9.1 100.0

Table 4: Cross distribution between gender and nutritional

status.

Gender

Under

weight

(%)

Normal

(%)

Over

weight

(%)

Obese

(%)

Total

(%)

Boys

37.8% 48.4% 10.5% 3.2%

100.0

Girls

18.6% 60.0% 13.8% 7.5%

100.0

Table 5: Association between dietary habits and

nutritional status.

Dietary

habits

Category

Nutritional status

Underweight

(%)

Normal

(%)

Break

fast

No 13.0 24.8 0.008

Yes

29.8 32.3

Meat/

fish

Never, sometimes 36.6 17.5 0.001

Daily-weekly 32.6 17.5

Tofu/

tempeh

Never, sometimes 26.3 34.8 0.929

Daily-weekly 16.5 22.3

Vegetable Never, sometimes 39.6 55.4 0.040

Daily-weekly 3.3 1.8

Fruit Never, sometimes

41.1 54.6

0.808

Daily-weekly 1.8 2.5

Tea

Never, sometimes

42.1 55.4

0.405

Daily-weekly

.8.0 1.8

4 DISCUSSION

This study found 23.3% of adolescents suffered

from malnutrition. The prevalence of underweight in

urban slums was higher than the national

underweight (MOH, 2013) of 11.1%. This indicates

that malnutrition in adolescents is a serious public

health problem.

Adolescence, a period of transition between

childhood and adulthood, occupies a critical position

Prevalence of Nutritional Status and Dietary Habits among Adolescent in Urban Area in Medan, North Sumatera, Indonesia

733

in the life of human beings. This period is

characterized by an exceptional rapid rate of growth.

The peak rates of growth are exceeded only during

the fetal life and early infancy (

Sengar and

Sharma, 2012)

. In this phase, adolescents are very

active with various activities, both school and sports

activities. Especially in young women, nutritional

intake is also required for the preparation of

reproductive reproduction.

The results of this study were in line with

Kurniawan's research in Tangerang District, Banten

Province involving 1060 children aged 10-12 years

and found underweight, stunting and wasting were

around 49.5%, 38.4% and 26.7% (Kurniawan et al,

2006). Another study was conducted by Hossen in

Bangladesh with respondents 434 adolescent girls

and found 65.9% of respondents had underweight (

Hossen et al, 2016). Subsequently, a study by

Vashist in India with 2000 adolescent participants

found as many as 42.5% suffered from underweight

(Vashist and Goel, 2009). The small underweight

prevalence found by Skhiri in Tunisia (Aounallah-

Skhiri, H., 2017) involving 1295 boys and 1577 girls

aged 15-19 years, prevalence of underweight,

overweight and obesity were, respectively, 8.1%,

17.4% and 4.1% among boys and 1.3%, 20.7% and

4.4% among girls. Similarly, a study conducted by

Özgüven in Turkey involving adolescent students

(284 males and 396 females) aged 14-18 years,

found underweight, and overweight/obesity were

5.0% and 16.8% (Özgüven et al, 2010). This study

showed that the prevalence of anemia in this

population was above 15% indicating a public health

problem.

This study found that the prevalence of

underweight were more common in adolescents

aged 10-12 years (early). Similar results were found

by Joshi in Bhopal India involving 200 teenage girls

found as many as 82.5% of adolescent girls suffering

under weight (Joshi et al, 2014). Similar findings

were reported in Neyamul Akhter study ( Akhter, N.

and Sondhya, 2013). This could be because of the

early growth spurt in the girls with a sudden increase

in height in early age group. The results of this study

also indicate that malnutrition is more commonly

experienced by male adolescents. This is related to

the higher males' malnutrition needs than adolescent

girls (Barker and Helen, 2002) and more teenage

males, while nutritional intake is inadequate because

the economic level of parents is mostly low.

Economic limitation affects the selection of the type

and amount of food consumed by family members.

As we can see in this study found that breakfast

habits associated with adolescent nutrition status.

The results of a similar study conducted by

Bartholomew BM (Bartholomew, 2018) concluded

that there was influence breakfast on nutritional

status, especially obesity. Different results

conducted by Mariza in Semarang (Mariza and

Kusumastuti, 2013] concluded there was no

relationship between breakfasts with nutritional

status. Breakfast frequency has been related to

several health and lifestyle factors. Observational

studies suggest frequent breakfast in adolescence to

be associated with better academic and cognitive

performance.

The consumption of dietary sources of animal

protein such as meat and fish in this study was also

related to the nutritional status of adolescents. It is

known that meat and fish are a source of energy and

protein for adolescent growth. Lack of this type of

food causes adolescents suffer from malnutrition.

Similarly, a study conducted by Samuelson in

Europe involving adolescents aged 13-18 years

concluded that the habit of skipping breakfast and

vegetable consumption was at risk to increase the

incidence of obesity in adolescents (Samuelson,

2000).

5 CONCLUSIONS

Malnutrition in adolescence has become a serious

public health problem in North Sumatera Province

especially in Medan City because of its high

prevalence (23.3%) that it was above the National

Prevalence (11.1%). Dietary habits associated with

nutritional status in adolescent primarily breakfast,

consumption of meat foods and vegetable (p <0.05).

It is necessary to immediately do a nutritional

intervention to reduce the incidence of underweight

and improve the quality of life of adolescents in the

future.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported by Universitas Sumatera Utara.

The support is under the research grant TALENTA

USU of Year 2018 with Contract Number

2590/UN5.I.R/PPM/2018

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

734

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