Achmad Surjono

Tracking for Underweight, Overweight and Obesity from Childhood to Adolescence: A 5-Year Follow-Up Study in Urban Indonesian Children

Aims: To assess tracking of body mass index (BMI) of urban Indonesian children from childhood to adolescence and to compare the prevalence of underweight, overweight and obesity in 6- to 8-year-old children from two surveys: years 1999 and 2004. Methods: A longitudinal study assessing BMI tracking of 308 urban children followed from age 6–8 to 11–13 years and two cross-sectional surveys comparing the prevalence of underweight, overweight and obesity in 6- to 8-year-old children: year 1999 (n = 1,524) and 2004 (n = 510). Results: Childhood BMI determined 52.3% variation of later BMI. After 5.1 (0.6) years the prevalence of overweight and obesity increased from 4.2 and 1.9% in childhood to 8.8 and 3.2% in adolescence. The prevalence of underweight decreased from 27.3 to 18.8%. All obese children remained obese, 84.6% overweight children stayed overweight, 56.0% underweight children remained underweight. In cross-sectional comparison the prevalence of overweight and obesity raised from 5.3 to 8.6% and from 2.7 to 3.7%, respectively. The prevalence of underweight remained constant. Conclusions: The prevalence of overweight and obesity increases as children grow into adolescence. Overweight or obese children are more likely to remain overweight or obese. Cross-sectional comparison shows, while the prevalence of underweight stays constant, the prevalence of overweight and obesity increases.

Influence of socioeconomic status on the prevalence of stunted growth and obesity in prepubertal Indonesian children.

This cross-sectional study assesses the prevalence of stunting, overweight, and obesity in prepubertal children from different socioeconomic groups in Indonesia. Children from rural, poor urban, and nonpoor urban communities were studied (n = 3,010). The prevalences of stunting, wasting, overweight, and obesity were 19.3%, 5.0%, 2.7%, and 0.8%, respectively. The odds ratios (OR) for stunting, as compared with nonpoor urban children, were higher among rural children (2.92; 95% confidence interval [CI], 2.37–3.59) than among poor urban children (1.58; 95% CI, 1.18–2.13). The prevalence of wasting was not influenced by socioeconomic status. Both rural and poor urban children were significantly less likely to be overweight than were nonpoor urban children: in comparison with nonpoor urban children, the OR values were 0.19 (95% CI, 0.10–0.36) for rural and 0.13 (95% CI, 0.04–0.43) for poor urban children. Boys were more likely to be stunted or obese than girls: OR for stunting, 1.75 (95% CI, 1.44–2.12); OR for obesity, 4.07 (95% CI, 1.40–11.8). Stunted children were less likely than non-stunted children to be overweight: OR, 0.10 (95% CI, 0.03–0.43). In Indonesia, undernutrition is still related to poverty, whereas obesity is more related to prosperity.

Food Patterns during an Economic Crisis among Pregnant Women in Purworejo District, Central Java, Indonesia

In March 2002, there were reports of a hemorrhagic fever outbreak in western Afghanistan. It was later confirmed that the hemorrhagic symptoms and increased mortality were actually due to scurvy. Most aid workers did not include scurvy in the initial differential diagnosis because it is uncommon throughout the world and has mainly been reported in refugee populations in recent times. A rapid assessment confirmed the cases clinically, estimated a prevalence rate of 6.3% (a severe public health problem), and determined that the attack rates peaked each year in January and February (the end of the winter). Many Afghans have limited dietary diversity due to isolated locations, lengthy winters, the continuing drought of the last four years, asset depletion, and loss of livelihood. After numerous food and fortification options to prevent future outbreaks had been considered, vitamin C tablet supplementation was selected because of the relatively rapid response time as compared with other prevention methods. A three-month course of vitamin C tablets was distributed to 827 villages in at-risk areas. The tablets were acceptable and compliance was good. No cases of scurvy were reported for the winter of 2002–03. The case study from Afghanistan demonstrates that scurvy can occur in nonrefugee or nondisplaced populations; vitamin C supplementation can be an effective prevention strategy; there is an urgent need to develop field-friendly techniques to diagnose micronutrient-deficiency diseases; food-security tools should be used to assess and predict risks of nutritional deficiencies; and the humanitarian community should address prevention of scurvy in outbreak-prone areas.A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

The influence of socioeconomic status on blood pressure of Indonesian prepubertal children.

This cross-sectional study assesses the association between socioeconomic status and blood pressure of school-aged prepubertal children living in Indonesia. It has been shown that elevated blood pressure (BP) contributes to the development of coronary artery disease and to the pathogenesis of cerebrovascular accidents. There is also evidence of some correlations between childhood BP and BP in adulthood.1 In contrast to consistently negative association between socioeconomic status (SES) and BP in industrialized countries, findings in developing countries are heterogeneous.2 The aim of the present study was to evaluate the association between nutritional status and SES, defined as rural, poor urban and non-poor urban, and BPs of school-aged prepubertal children living in Indonesia.

The influence of socioeconomic status and birth weight on blood pressure of Indonesian pre-pubertal children

Background It has been shown that elevated blood pressure (BP) in childhood contributes to the development of coronary artery disease, cerebrovascular accidents, heart failure, and renal failure in adults. There is also evidence of some correlations between childhood BP and BP in adulthood. Obesity as well as low birth weight are a risk factors for elevated BP, both in children and in adults. Most epidemiological studies have also shown a relationship between high BP and socioeconomic status (SES). Objective To assess the influence of socioeconomic status and birth weight on blood pressure of school-aged prepubertal children living in Indonesia. Methods A cross-sectional survey on 2922 school-aged prepubertal children from the rural, poorurban and nonpoor urban communities was performed. Data on age, sex, stature, BMI, birth weight, systolic and diastolic BP were collected from all children. Results Overall and within every socioeconomic status group, blood pressures were positively associated with stature and body mass index (BMI). Children from poor-socioeconomic families, i.e. rural and poor urban, had significantly lower height and BMI, and hence, in the unadjusted analyses, poor socioeconomic status was associated with lower systolic and diastolic BP. However, after adjustment for age, sex, stature and BMI, rural children were found to have significantly higher systolic BP compared to nonpoor urban children, with regression coefficient (95% CI) of 1.19(0.42 to 1.96). Birth weight was not associated with blood pressure in childhood. Conclusion This study indicated that for a given stature and BMI, poor children had a higher systolic BP