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Asia Pacific J Clin Nutr (1996) 5(3): 132-134

Transitions in diet and health: implication of modern lifestyles in Indonesia

Muhilal PhD

Nutrition Research and Development Centre, Ministry of Health, Bogor, Indonesia

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Indonesia is in the midst of major transitions in food intake and health patterns. These changes are predicated on economic growth, rising levels of education and globalisation of culture. Somehow retaining the food-health advantages of traditional Indonesian lifestyle and accommodating the advances which the West has made, especially in life expectancy, without their increasing health problems and costs, is required. From 1972 to 1992, mortality ranking for cardiovascular disease (CVD) in Indonesia had gone from the 11th most common to the most common. The Jakarta Monica studies (1988 and 1993) provide prima facie evidence that similar cardiovascular risk factors to those in industrialised countries are operative for the emergent CVD problem - positive energy balance with obesity, increased animal fat consumption and decreased intake of plant-derived foods, with their many biologically active components, both nutrient and non-nutrient. Nutrition surveys show that the contribution of fat to energy intake has doubled from 1974 to 1992 (10.4% in 1974 to 20.5% in 1992). Effort is now required to enable consumers to overcome prejudice against plant foods, for whatever reason, to use low fat animal-derived food and for food products and their promotion to favour healthy choice.

Key words: Diet, cardiovascular disease risk factors, animal fat consumption.

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Introduction

In Western industrialised countries there have been many studies on the relationship between diet and health. These studies reveal that a high intake of energy and fat, together with a low intake of fibre and antioxidants are contributary to the increasing prevalence of degenerative diseases, such as heart disease, hypertension, non-insulin-dependent diabetes and cancer. In the United States, where heart disease is the number one cause of death, the amount of energy derived from fat is about 40%¹. In developing countries, the dietary pattern is mostly low in fat and high in fibre or, at least, resistant starch along with other biologically important components of plant food. However, wealthier people in developing countries are now tending towards a dietary pattern higher in fat and lower in fibre. They are consuming less food of plant origin and more food of animal origin.

Analysis of studies from 43 countries shows that when the cause of death by infectious diseases is lower than 15 per 1000 and life expectancy is 55-60 years, cardiovascular disease (CVD) becomes a major problem. Indonesia has now reached this le 1000 vel thus, transitions in diet and health in Indonesia is of current interest. Diet itself is influenced by the availability of foods, purchasing power, food habits, nutrition knowledge and globalisation.

Availability of macro nutrients

In line with Indonesia’s economic growth, the availability of food has increased steadily over time. Table 1 clearly shows the increase in the availability of energy, protein, fats and oils, and the percentage of energy derived from fat between 1974 and 1992.

The Indonesian nutrition guidelines recommend that the maximum intake of fat be 25% of energy intake⁴. It is estimated that 9-10% of the population consumes more than 25% of their energy as fat and is therefore at higher risk of getting degenerative diseases.

Dietary pattern

The dietary pattern of Indonesian managers (n=96) and their staff (n=355) has been studied⁵. The group consisted of 182 women and 269 men of which about 23% had a body mass index (BMI) of more than 25.

Their dietary pattern could roughly be divided into three groups: traditional foods; traditional foods and imported foods; traditional foods, trendy foods and imported foods. Those that had a normal body weight mostly consumed traditional foods, whilst those that consumed trendy foods had higher grades of obesity.

No relationship was observed between the kinds of fat consumed and obesity, but the risk of CVD and stroke was related to the kinds of fat consumed. Saturated fatty acids were more strongly related to CVD than unsaturated fatty acids.

These results stress the importance of sticking to a traditional dietary pattern, low in fat with and a predominant consumption of unsaturated fatty acids in order to minimise the risk of suffering from degenerative diseases.

Nutrient consumption and income

In Table 2, the increased concentration of energy, protein and fat with an increase in income is evident. Degenerative diseases

The national prevalence of CVD is not known, but based on the results of the household health surveys from 1972 to 1992, it can be concluded that CVD has become a more important cause of death. In 1972 it was the eleventh cause of 1000 death; by 1986 it was number three, and in 1992 it had become number one, accounting for 16% of the total death. Although this value is lower than that of industrialised countries, where CVD accounts for 50% of the death, there are indications that the prevalence of CVD in Indonesia is escalating. Table 3 shows the results of the MONICA Study (international studies of heart disease risk and events under the auspices of WHO).

Dyslipidaemia, will increase the risk of coronary heart disease (CHD). The results of MONICA studies in Jakarta in 1988 and 1993 revealed that the percentage of people with cholesterol concentrations higher than 250 mg/dl. (6.6 mmol/L) (dyslipidaemia) increases (Table 4).

It has been reported that a 1% decrease of cholesterol concentrations would reduce the risk of coronary heart disease by 2%. Table 4 shows that cholesterol values increased 2-3% within 5 years.

Some studies showed that high intakes of vitamin C, E and b-carotene could lower risk of coronary heart disease⁷. Which again signals that maintenance of high plant food intakes as sources of these and other factors might counter the increased CHD risk.

Discussion

The following conclusions can thus be drawn :

• In 1992 CVDs were the number one cause of death in Indonesia.
• The higher the income, the higher the percentage energy intake from fat. It is estimated that 9-10% of the population consumes more than 25% of energy as fat.
• Some people, especially managers, tend to consume trendy foods and imported foods besides their traditional foods with implications for potentially deleterious trend-setting. This happens at a time when socio-economically advantaged individuals in industrialised countries often seek to avoid such dietary patterns.

Table 1. The availability of foods in relation to energy, protein and fat (per person per day). Nutrient 1974 1979 1984 1990 1992 Energy (Kcal) 2,248 2,443 2,516 2,701 2,968 Protein (g) 45.8 47.1 54.1 60.3 67.9 Fats and oils (g) 26.1 34.4 45.4 56.2 67.3 % energy from fats 10.4 12.7 16.2 18.7 20.5 Sources: References 2 and 3.

Table 2. Nutrient consumption by income. Nutrient consumption Income/person/ mo (rupiah) Energy (Kcal/d) Protein (g/d) Fats and oils (g/d) Energy from fats (%) < 8,000 1,392 28.4 19.9 12.9 8,000 1,453 31.8 21.5 13.3 10,000 1,585 35.1 25.9 14.7 15,000 1,742 40.4 33.5 17.3 20,000 1,935 47.6 42.1 19.5 30,000 2,066 55.8 51.4 22.2 40,000 2,134 63.6 59.4 25.0 60,000 2,192 72.2 68.8 28.2 80,000 2,251 80.3 77.8 31.0 100,000 2,351 90.4 81.9 31.3 150,000 2,320 82.1 91.2 35.4 Source: Reference 2.

Table 3. MONICA study - Jakarta Project Variable Male Female Smoker (%) 60 6 Hypertension (%) Systolic BP (mmHg) Diastolic BP (mmHg) 14 123 (22) 79 (13) 16 125 (24) 78 (13) Lipid profiles Serum cholesterol (mg/dL) Serum triglycerides (mg/dL) HDL-cholesterol (mg/dL) Hypercholesterolaemia (%) 200 (42) 140 (68) 48 (19) 11 207 (44) 144 (102) 55 (17) 15 Blood glucose (mg/dL) 94.5 (30.3) 98.5 (30.7) Alcohol drinker (%) 4.8 0.8 Regular exercise (%) 31.2 14.7 BMI 24.2 25.3 Body weight (kg) 57.9 (15.9) 52.6 (18.1) Body height (cm) 160.0 (5.9) 148.7 (5.8) BMI & 1000 gt; 30 (%) 4.9 ECG finding of myocardial Infarction (%) 2.7 Stroke sequelae (%) 0.5 Source: reference 6.

Table 4. Five-year mean serum cholesterol changes 1988-1993. < 1000 /tr> Finding MONICA I (1988) MONICA II (1993) Cholesterol (mg/dL) Male Female 200 207 205 213 Cholesterol > 250 mg/dL (%) Male Female 11 13 14 16

The percentage of people with high cholesterol levels (hypercholesterolaemia) in 1993 was higher than in 1988, indicating an increase in the number of people at risk of suffering from coronary heart disease.

A diet containing fewer foods of plant origin might also contain less anti-oxidant nutrients such as vitamin E, b-carotene, vitamin C and selenium. But, an increased consumption of animal foods increases the intake of bioavailable iron and zinc.

The Indonesian dietary guidelines were advanced in 1995. These will be gradually made public through social marketing. Wealthy individuals should decrease their fat consumption to less than 25% of energy, for example by reducing their consumption of animal foods, especially fatty meat. It should be noted that in some countries the recommendation for increased intake of vegetables, fruits and cereals seems to have had little effect. This may be due to several factors, such as⁸:

• Consumers preference and convenience
• Concern that an overly vegetarian diet may be nutritionally inadequate
• Some food industry groups, whose product sales could be adversely affected by the recommendation engage in counter-advertising.

With advancing age illness and disease increase. But there are opportunities from fetal life, through childhood and adult life by lifestyle means to prevent or slow the onset of illness and disease with advancing age. Morbidity may be compressed towards the later years, and life expectancy prolonged ⁹. These efforts may be still worthwhile in middle or older age.

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Transitions in diet and health: implication of modern lifestyles in Indonesia

Muhilal

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 132-134

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TRANSISI DIET DAN KESEHATAN: IMPLIKASI DARI POLA HIDUP MODERN DI INDONESIA

 

Pola hubungan antara diet dan kesehatan di Indonesia mengikuti negara maju. Penyakit kardiovaskuler menjadi penyebab kematian utama di Indonesia sejak tahun 1992. Ada indikasi kuat bahwa transisi epidemiologi ini berhubungan dengan gizi. Hasil survei nasional menunjukkan bahwa kontribusi lemak terhadap asupan energi telah meningkat dua kali lipat dari tahun 1974 hingga 1992 (10.4% pada tahun 1974 menjadi 20.5% pada tahun 1992). Pertumbuhan ekonomi yang cepat di Indonesia juga menyebabkan perubahan pola hidup dan kebiasaan makan yang mengarah pada tingginya konsumsi lemak. Prevalensi hiperkholesterolemia (sebagai salah satu faktor resiko penyakit jantung koroner) cenderung meningkat. Hal ini terbukti dengan studi MONICA I pada tahun 1988 yang kemudian dilanjutkan dengan MONICA II pada tahun 1993 di Indonesia.

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References

1. National Research Council. Diet and health: implication for reducing chronic disease risk. Washington DC: National Academy Press, 1989.
2. Central Bureau of Statistics. Consumption of energy and protein in Indonesia and provinces. Jakarta:BPS, 1990.
3. Central Bureau of Statistics. Statistical Year Book of Indonesia. Jakarta:BPS, 1994.
4. Departemen Kesehatan RI. Pedoman Umum Gizi Seimbang, 1994.
5. Hermana, Karmini M. Kebiasaan makan dan gaya hidup karyawan dan manager perusahaan: laporan penelitian. Pusat Penelitian dan Pengembangan Gizi, 1992.
6. Darmojo B. Epidemiologi penyakit kardiovaskuler dan masalah gizi pada golongan usia lanjut di Indonesia. Prosiding Widyakarya Pangan dan Gizi 1994:96-115.
7. Frazer GE. Diet and coronary heart disease: beyond dietary fats and low density lipoprotein cholesterol. Am J Clin Nutr 1994;59:1117S-23S.
8. Campbell TC, Chen J. Diet and chronic degenerative diseases: perspective from China. Am J Clin Nutr 1994: 1 2ff 153S-1161S.
9. JF Fries. Physical activity, the compression of morbidity and the health of the elderly. J of the Royal Society of Medicine. Vol 89; Feb 1996: 64-68.

Copyright © 1996 [Asia Pacific Journal of Clinical Nutrition]. All rights reserved.
Revised: January 19, 1999 .
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