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The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population.

Improving women's knowledge of pregnancy-related risks and involving family members, particularly the husband and importantly for less-educated women, improved adherence to IFA supplementation. ANC visit opportunities must be optimized to provide women with sufficient numbers of IFA tablets along with health information (especially on pregnancy-related risks) and partner support counselling.

To investigate the efficacy of two different iron supplements administered either on a weekly basis or during menstruation, a 16-week community experimental study was carried out among postmenarcheal female adolescent students in Kupang, East Nusa Tenggara, Indonesia. Forty eight students received a placebo tablet weekly, 48 other students got an iron tablet weekly and 41 students took an iron tablet for four consecutive days during their menstruation cycle. All subjects were given deworming tablets before supplementation. Haemoglobin, serum ferritin, height, weight, mid-upper arm circumference and dietary intake were assessed before and after intervention. The supplementation contributed to a significant improvement in the iron status of the intervention groups compared to the placebo group (P < 0.05). In the menstruation group, the haemoglobin concentrations of the anaemic subjects improved significantly (P < 0.05) while for the non-anaemic subjects, serum ferritin concentrations also increased significantly (P < 0.05). In the weekly group for anaemic and nonanaemic subjects, there was a significant increase in both haemoglobin and serum ferritin concentrations (P < 0.05). This study revealed that weekly supplementation of iron tablets continued for 16 weeks contributed a higher improvement to haemoglobin concentration, compared with supplementing iron tablets for four consecutive days during menstruation for four menstrual cycles. This suggests that weekly iron supplementation is preferable.

Countries in South East Asia are undergoing a nutrition transition, which typically involves a dietary shift from plant to animal proteins. To explore the main drivers of protein consumption, the SCRiPT (Socio Cultural Research in Protein Transition) study recruited a population sample in Malaysia (N = 1604). Participants completed in-person 24 h dietary recalls and socio-demographic surveys. Energy and nutrient intakes were estimated using Nutritionist Pro. A novel recipe-based frequency count coded protein sources as meat (chicken, beef, pork, and mutton), fish, eggs, dairy, and plants (cereals, pulses, tubers). Dietary intakes and frequencies were examined by gender, age, income, education, ethnicity, religion, and family status, using ANOVAs and general linear models. Energy intakes were 1869 kcal/d for men and 1699 kcal/d for women. Protein intakes were 78.5 g/d for men and 72.5 g/d for women. Higher energy and protein intakes were associated with Chinese ethnicity, higher education and incomes. Frequency counts identified plant proteins in 50% of foods, followed by meat (19%), fish (12%), eggs (12%), and dairy (7%). Most frequent source of meat was chicken (16%) rather than pork or beef (1.5% each). In bivariate analyses, animal protein counts were associated with younger age, higher education and incomes. In mutually adjusted multivariate regression models, animal proteins were associated with education and ethnicity; plant proteins were associated with ethnicity and religion. Protein choices in Malaysia involve socio-cultural as well as economic variables.

BackgroundPlant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes.ObjectiveTo examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia.DesignThe SCRiPT (Socio Cultural Research in Protein Transition) study was based on population-based samples recruited in Indonesia (N = 1665) and in Malaysia (N = 1604). Data from 24-h in-person dietary recalls in each country were used to construct the frequency counts of protein sources by food group. Protein sources were defined as fish, poultry, red meat (beef, pork, and mutton), eggs, dairy, and plants (cereals, pulses, and tubers). The percent reported frequencies for animal and plant proteins were compared across socio-demographic strata and by country. Analyses were based on one-way Anovas and general linear model regressions adjusting for covariates.ResultsAnimal protein frequency counts were 34% of total in Indonesia, but 50% in Malaysia's. Higher reported consumption frequencies for poultry and red meat in both countries were associated with urban living, greater modernization, and higher socioeconomic status, with stronger social gradients observed in Indonesia. Reported fish consumption was higher in Indonesia than in Malaysia. Fish was more likely to be listed by rural island populations in Indonesia and was associated with lower education and incomes. Consumption frequencies for plant-based proteins were associated with lower socio-economic status in Indonesia and in Malaysia.ConclusionsMore affluent groups in both countries reported higher frequencies for meat, eggs, and dairy as opposed to fish. Greater economic development in Southeast (SE) Asia is associated with more animal protein, particularly from poultry, which may displace fish, the traditional source of high quality protein for the region.

The aim of this study was to examine the associations of food store choice with food consumption among urban slum women. A cross-sectional survey was carried out among 188 urban slum women (19-50 years old) in Jakarta, Indonesia. A semiquantitative food frequency questionnaire was used to assess food consumption. Associations between food consumption and food store choice were tested by linear regression. This study found that frequencies of buying food from small shops (warung), street food vendors, and modern food stores were significantly associated with consumption of snacks, mixed dishes, and fruit respectively. In addition, buying food from traditional markets and small cafes (warung makan) was not significantly associated with particular types of food consumption. As modern food stores are rarely utilized by these women, small shops (warung) and street food vendors are likely to be important channels to improve slum dwellers' diet.

Developing countries including Indonesia imperatively require an understanding of factors leading to the emerging problem of obesity, especially within low socio-economic groups, whose dietary pattern may contribute to obesity. In this cross-sectional study, we compared the dietary patterns and food consumption of 103 obese and 104 normal-weight women of reproductive age (19-49 years) in urban slum areas in Central Jakarta. A single 24-h food recall was used to assess energy and macronutrient intakes (carbohydrate, protein and fat) and calculate energy density. A principal component analysis was used to define the dietary patterns from the FFQ. Obese women had significantly higher intakes of energy (8436·6 (SD 2358·1) v. 7504·4 (SD 1887·8) kJ (2016·4 (SD 563·6) v. 1793·6 (SD 451·2) kcal)), carbohydrate (263·9 (SD 77·0) v. 237·6 (SD 63·0) g) and fat (83·11 (SD 31·3) v. 70·2 (SD 26·1) g) compared with normal-weight women; however, their protein intake (59·4 (SD 19·1) v. 55·9 (SD 18·5) g) and energy density (8·911 (SD 2·30) v. 8·58 (SD 1·88) kJ/g (2·13 (SD 0·55) v. 2·05 (SD 0·45) kcal/g)) did not differ significantly. Two dietary patterns were revealed and subjectively named 'more healthy' and 'less healthy'. The 'less healthy' pattern was characterised by the consumption of fried foods (snacks, soyabean and roots and tubers) and meat and poultry products, whereas the more healthy pattern was characterised by the consumption of seafood, vegetables, eggs, milk and milk products and non-fried snacks. Subjects with a high score for the more healthy pattern had a lower obesity risk compared with those with a low score. Thus, obesity is associated with high energy intake and unhealthy dietary patterns characterised by consumption of oils and fats through fried foods and snacks.