Nutritional Knowledge, Energy Intake, Iron Intake and Nutritional

Status of Teenage Girls in Rural and Urban Areas

Erni Rukmana

, M. Edwin Fransiari

, Kanaya Yori Damanik

and Latifah Rahman Nurfazriah

Nutrition Study Program, Department of Family Welfare Education, Faculty of Engineering,

University of Negeri Medan, North Sumatera, Indonesia

Keywords: Nutritional Knowledge, Energy Intake, Iron Intake.

Abstract: Teenage girls must meet their needs for energy intake and micronutrients such as iron to achieve optimal

nutritional status. This study was proposed to determine different nutritional knowledge, energy intake, iron

intake, and nutritional status of teenage girls in rural and urban areas. This study used a comparative cross-

sectional observation design with 30 girls (15 - 17 years old) from Bandung High School Foundation, Deli

Serdang Regency and 30 girls at Pertiwi Private High School, Medan City, as the sample subjects. The

nutritional knowledge was earned through a questionnaire, food consumption data were collected using the

food recall method (1 × 24 hours), and Z-scores were applied for the BMI-for-age. The independent T-test

analysis was used to differentiate the nutritional knowledge, energy intake, and iron intake between groups

of subjects with normal data distribution. Differences were found in nutritional knowledge and energy intake

among teenage girls in rural and urban areas, while iron intake and BMI for age revealed no difference.

Therefore, nutritional knowledge is necessary for teenage girls to improve attitudes and actions in choosing

healthy and nutritious foods.

1 INTRODUCTION

Adolescence is a transitional period between

childhood and adulthood. Teenagers in Indonesia

face numerous nutrition-related issues, including

malnutrition, overnutrition, and nutrient deficiency.

About one-fourth of the total teenagers in Indonesia

suffer from stunting, and nine percent of them are

underweight (UNICEF, 2021). The nutritional issues

in teenagers are associated with physical,

physiological, and psychosocial alterations.

Nutritional problems in teenagers gain more

attention, as they will affect growth in adulthood. (Al-

Jawaldeh et al., 2020). The lack of nutritional

knowledge causes nutritional problems in t teenagers.

The lack of nutritional knowledge and mistakes in

food choices affect the health condition and lead to

malnutrition. Low nutrition knowledge can be

detected in appropriate eating behaviours (Hasanah et

al., 2022).

https://orcid.org/0000-0002-9442-8010

https://orcid.org/0009-0009-7744-384X

https://orcid.org/0009-0001-8469-995X

https://orcid.org/0000-0003-1415-8477

During the rapid growth period, teenagers require

adequate nutrient intake, specifically for teenage girls

(Kahssay et al., 2020). For optimal nutrition,

teenagers must meet their macro- and micronutrient

intake requirements.

Teenagers with deficient energy have a poor

nutritional status, whereas excessive energy intake

can contribute to overweight and obesity. Obesity and

other health hazards will likely manifest and impact

adulthood (Norris et al., 2022). For teenage girls, the

nutritional status of teenagers plays a vital role in

hereditary health (Vaivada et al., 2020). Therefore,

adolescence is crucial time to establish a healthy diet

and lifestyle.

In addition, teenage girls frequently follow diets

and restrict food consumption to maintain their

appearance, which can result in essential minerals

deficiency, particularly iron. A diet that does not meet

the body's nutritional requirements causes iron and

macronutrient deficiencies (Utami et al., 2022).

Rukmana, E., Fransiari, M. E., Damanik, K. Y. and Nurfazriah, L. R.

Nutritional Knowledge, Energy Intake, Iron Intake and Nutritional Status of Teenage Girls in Rural and Urban Areas.

DOI: 10.5220/0012919500004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 203-208

ISBN: 978-989-758-727-6; ISSN: 2975-8297

203

Furthermore, low food intake and inadequate diet

in teenage girls due to their preference to eat fast

foods that contain high energy, fat, and sodium, and

low vitamins, calcium, and iron, can result in

malnutrition (ELMoslemany et al., 2019).

According to Nurwanti (2019), distinct risk

factors are associated with overweight and obesity in

both rural and urban regions in Indonesia. Urban

dwellers have a prevalence of overweight and

obesity. The presence of health services and access to

nutritious food impact both urban and rural

communities. The nutritional intake might be

influenced by the environmental circumstances

present in the residential setting.

This study was conducted in a rural area, namely

Deli Serdang District, close to urban areas in Medan

City, North Sumatra. Health disparities in rural and

urban areas are the focus of this study.

This study aimed to examine the disparities in

nutritional knowledge, energy intake, iron intake, and

nutritional status among teenage girls residing in rural

and urban areas.

2 METHODS

The present study used a comparative cross-sectional

design. This study was carried out in June-July, 2023.

This study investigated teenage girls as a study

subject who attend the Bandung High School

Foundation in a rural area and Pertiwi Private High

School in an urban area. The collective focus of

investigation for each educational institution

encompassed a cohort of 30 teenage girls. Subjects

were selected non-systematic within each class, with

a minimum number of subjects required.

In this study, data were composed of primary and

secondary sources. The primary data includes

information on the subject's characteristics and

expertise, obtained through a questionnaire.

Additionally, data on food intake, including energy

and iron, were collected using the 24-hour food recall

questionnaires. The weight data were collected using

digital thumb scales with 0.1 kg accuracy, while body

height data were obtained using microtoise with 0.1

cm accuracy. These data were collected for the

nutritional status of individuals across different age

groups according to their body mass index (BMI).

The secondary data were derived from school records

regarding the student population within the school.

The nutritional knowledge was classified into

three distinct categories. The first category is

characterized by a low level of knowledge, as the

percentage of correct answers is below 60%. The

second category represents a moderate level of

knowledge, with a percentage of correct answers

between 60% to 80%. The third and final category

signifies a high level of knowledge, as the percentage

of correct answers exceeds 80% (Khomsan A, 2000).

The concept of nutrient adequacy encompasses two

distinct categories, namely macronutrients and

micronutrients. The macronutrient adequacy level is

classified into five categories: severe deficiency

(<70%), moderate deficiency (70%–79%), mild

deficiency (80–89%), normal intake (90–119%), and

excessive intake (120%) (Kartono et al., 2012). The

micronutrient adequacy level is bifurcated into two

classifications: insufficient, denoted by levels below

70%, and sufficient, indicated by levels equal to or

over 70% (Houghton et al., 2019). The classification

of nutritional status is based on the body mass index

(BMI) in relation to age. Poor nutrition is indicated

by a z-score less than -3 of standard deviations (SD),

low nutrition is indicated by a z-score between -3 of

SD and -2 of SD, normal nutritional status is indicated

by a z-score between -2 of SD and +1 of SD,

overweight is indicated by a z-score between +1 of

SD and +2 of SD, and obesity is indicated by a z-score

greater than +2 of SD (Kemenkes RI, 2020)

The acquired data were subjected to both

descriptive and inferential analyses. This study

examined the descriptive data pertaining to age

characteristics, knowledge levels, energy levels, iron

intake, and nutritional status. If the data was assumed

to follow a normal distribution, the inferential

analysis employed an independent t-test. An

independent t-test was used to examine the disparities

in nutritional knowledge, energy intake, iron intake,

and nutritional status among teenage girls residing in

rural and urban areas. The study has been formally

submitted for ethical clearance in the Medical Faculty

of the Christian University of Maranatha, as indicated

by ethical committee decision No. 137/KEP/VI/2023

on June 13, 2023

3 RESULTS

The subject quality is presented in Table 1. The

teenage girls as the subjects are between 15 - 18 years

old. The majority of participants in both the rural

group (56.7%) and the urban group (36.7%) were 17

years old.

ICSDH 2023 - The International Conference on Social Determinants of Health

204

Table 1. Distribution of subject characteristic.

Subject

Characteristics

Rural

n (%)

Urban

n (%)

Age

15 1 (3.3) 12 (40)

16 17 (56.7) 11 (36.7)

17 10 (33.3) 7 (11.7)

18 2 (6.7) -

Total 30 30

Table 2 illustrates a nutrition knowledge disparity

between girls residing in rural and urban areas, with

lower knowledge levels. Specifically, the percentage

of rural girls who possess healthy nutrition

knowledge is 6.7%, while their urban counterparts

demonstrate a significantly higher rate of 56.7%. This

finding demonstrates that individuals residing in

urban areas possess superior nutritional knowledge

compared to their rural counterparts. The scope of

obtaining nutritional information is more extensive

among teenage girls residing in rural areas.

Table 2. Distribution of nutritional knowledge.

Nutritional

knowledge

Rural

n (%)

Urban

n (%)

Low 5 (16.7) 3 (10)

Medium 23 (76.7) 10 (33.3)

High 2 (6.7) 17 (56.7)

Total 30 30

Table 3 displays the average nutrition knowledge in

rural and urban areas. In rural areas, the average

nutritional knowledge is 68.88 (10.22). The 86.67

value is the utmost output of rural knowledge. In

statistical comparison analysis, the nutrient

knowledge results reveal a significant difference (p

0.05).

Table 3. Percentage of mean and differences in nutritional

knowledge between rural and urban areas.

Variable Rural

(Mean±

SD)

Min-

Max

Urban

(Mean±

SD)

Min-

Max

value

Nutritional

nowledge

68.88±

10.22

40-

86.67

81.77±

13.32

53.33-

100

0.00

The findings indicate that energy intake was recorded

for a 24-hour period in both rural and urban food data.

The information is presented in Table 4. A significant

proportion of rural (40%) and urban (30%)

populations experience substantial deficiencies in

energy intake adequacy across various levels.

Table 4. Distribution of nutrient adequacy levels.

The level of

nutritional adequac

Rural

n (%)

Urban

n (%)

Energy

Severe deficiency 24 (80) 18 (60)

Moderate deficiency 1 (3.3) 3 (10)

Low Deficiency 2 (6.7) 4 (13.3)

Normal Intake 2 (6.7) 3 (10)

High Intake 1 (3.3) 2 (6.7)

Iron (Fe)

Deficit 25 (83.3) 22 (73.3)

Normal 5 (16.7) 8 (26.7)

A difference in the sufficient energy intake in

rural and urban groups was found (p<0.05). The

energy intake of rural teenage girls is 462.41

kcal,

which is lower than that of urban teenagers.

Table 5. Mean and differences in nutritional adequacy

levels between rural and urban area.

Nutritional

adequacy

level

Rural

(Mean±S

)

Min-

Max

Urban

(Mean

±SD

)

Min-

Max

value

Energy

(kcal/day)

962.10±

563.50

259.60

2399.2

1424.5

1±555.

482.0

2943.

0.00

Iron (Fe)

(mg/day)

5.79±6.7

0.80-

26.8

5.62±4.

1.50-

19.20

0.97

The nutritional status of the subjects is presented in

Table 6. Most respondents in both rural and urban

groups exhibit a normal nutritional status. The rural

group exhibits a greater nutritional level of 20%,

whereas the urban group demonstrates a nutritional

status of 13.3%.

Table 6. Distribution of nutritional status (BMI-for-age).

Nutritional Status Rural

n (%)

Urban

n (%)

Underweight 1 (1.7) 1 (3.3)

Normal 23 (76.7) 25 (83.3)

Overweight 6 (20) 4 (13.3)

The mean Z-score of teenage females' BMI for

age in rural areas was 0.12, while in urban areas was

-0.17. Notably, there was no variation in BMI for age.

Both sources suggest that typical teenagers possess a

typical body mass index (BMI-for-age).

Nutritional Knowledge, Energy Intake, Iron Intake and Nutritional Status of Teenage Girls in Rural and Urban Areas

205

Table 7. Mean and Differences of nutritional status (BMI-

for-age) between rural and urban area.

Nutrional

Status (Z-

score)

Rural

(Mean±

Min-

Max

Urban

Mean±

Min-

Max

valu

BMI-for-

age

0.12±1.

-2.25-

2.32

0.17±0.

-2.15-

1.54

0.3

4 DISCUSSIONS

Adolescence is the phase of life between childhood

and adulthood, which begins at 9 years old to 19 years

old (WHO, 2022). Nutritional deficits can have

severe effects on teenage girls. If their nutritional

needs are not addressed, they are more likely to have

undernourished offspring, then pass on to future

generations (Rasyid et. al, 2022).

This study shows nutritional knowledge between

rural and urban girls is significantly different. Girls in

urban areas understand the importance of breakfast

and animal and vegetable protein consumption

compared to rural areas. According to Gultom (2020),

the average nutritional knowledge of rural teenagers

was 3.49 points, which was lower than that of urban

teenagers. A person's dietary preferences and food

intake are factors in determining their nutritional

status. Egg et al. (2020) showed that higher

nutritional knowledge is independently associated

with meat intake, low-sugar energy drinks, and iced

tea, besides higher vegetable and vegetable oil intake.

The results indicate differences in energy intake

and energy sufficiency levels among girls in rural and

urban areas. Merlisia, (2017) showed that smaller

rural teenagers had a proclivity to have meals more

than three times a day (odds ratio: 0.82). Additionally,

these individuals tend to consume higher amounts of

fruits (odds ratio: 1.39) and vegetables (odds ratio:

1.22). In contrast to Rakhmawati (2020), urban areas

exhibit a greater average energy intake of 1176 kcal

than rural areas at 1092 kcal. There is no statistically

significant difference in energy intake. Iron

deficiency is observed in teenage girls both across

rural and urban areas.

A minimal disparity was observed in the average

iron intake between the rural and urban areas. The

study's findings indicate no discernible disparity in

nutritional sufficiency degree between the two

treatments, as reinforced by Annisa (2021). The

present study suggests a lack of iron intake disparity

between urban and rural teenagers. This observation

can be attributed to various variables, including the

availability of dietary resources, the influence of

modernization, and globalization in both regions.

Consequently, the observed homogeneity in iron

intake across urban and rural girls indicates a limited

degree of variety in this aspect. Similarly, Faradilla et

al. (2019) reported no significant disparities in food

choices between urban and rural areas. The

consumption of unsuitable dietary options has a

detrimental impact on inadequate iron intake in urban

and rural areas. These findings contradict Gultom

(2020), who demonstrated that the iron level among

teenagers in rural areas was comparatively lower than

in urban areas, resulting in a higher prevalence of

anaemia (70% of teenagers in rural areas).

These findings indicate no discernible disparity in

nutritional status between rural and urban

populations. The results align with Armi & IMP

(2018), indicating no significant differences in

nutritional status between rural and urban

populations. Contreras et al. (2021) discovered that

teenagers who live in rural areas had higher levels of

internalizing mental health symptoms and a greater

propensity to engage in the emotional overeating

condition. Several factors within the rural

environment have been identified as potential

contributors to the prevalence of obesity. These

factors encompass economic conditions, limitations

on physical activity, barriers to accessing nutritious

food, healthcare services availability, and the

provision of nutrition education. (Buro et al., 2015).

In contrast to (Thapa et al., 2021), urban teenagers

exhibit an elevated IMT and a greater likelihood of

obesity, which may be attributed to economic

considerations, as socioeconomic status is associated

with an increased prevalence of obesity.

5 CONCLUSIONS

There are differences between rural and urban

teenage girl's nutritional knowledge and energy

intake. Nutritional knowledge levels and energy

intake among teenage girls in rural areas is

comparatively lower than in urban areas. There is no

significant difference in iron intake and nutritional

status (BMI-for-age) between teenage girls in rural

and urban areas.

Enhancing nutritional awareness among teenage

girls might positively influence their attitudes and

behaviours towards choosing a healthy and

nourishing diet. Teenage girls require conscientious

endeavours to optimally uphold their dietary intake

and nutritional well-being. This can be achieved

through guidance on consuming a balanced diet,

ICSDH 2023 - The International Conference on Social Determinants of Health

206

adhering to appropriate portions, and avoiding any

imbalances in essential nutrients.

ACKNOWLEDGMENTS

The authors would like to thank all parties who have

assisted this project, namely high school teenage

girls, to participate in this study. In particular,

Authors would also like to show gratitude to the

Institute for Research and Community Service,

Medan State University (LPPM Universitas Negeri

Medan), for funding this project through BOPTN

research grant in 2023.

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