Emyr Reisha Isaura, Te-Chih Wong, Shwu-Huey Yang Nutrition literacy and trend of double burden malnutrition in Indonesian adolescent since 1993-2014 Emyr Reisha Isaura, Te-Chih Wong, Shwu-Huey Yang

Outline Background Objective Methods Results Discussion Conclusion Suggestion

Background WHO, 2014

Indonesia NCDs country profile Cardiovascular disease, cancer, respiratory diseases, and diabetes are four major types of NCD killers WHO, 2014

Risk factors Tobacco use, physical inactivity, the harmful use of alcohol, overweight and obesity increase the risk of dying from an NCD “Along with other lifestyle choices and genetic predisposition, excessive intake of calories is one of the main common factors behind those conditions and risk factors” Kolčić, 2014

The Double Burden of Malnutrition WHO, 2015

Double burden of malnutrition is a growing concern in Indonesia In 2008, 37.2% of children under the age of five are stunted In 2013 Indonesian national survey, the prevalence of combined stunting and overweight/obesity in adolescence as 6.8%, a higher prevalence than that of children who were of healthy body height but who were overweight or obese 5.1%. The public awareness is low , which means low nutrition literacy BPS, 2013

related with the double burden malnutrition Objective 1993 - 2014 To describe the trends of the Indonesian adolescence body mass index according to nutrition status related with the double burden malnutrition

Subject and Methods Subject : Adolescence aged 15-19 years old Normal (without physical disability) Not pregnant/breastfeeding Methods: Cross-sectional Data from Indonesian Family Life Surveys (IFLS) in Indonesia (1993- 2014) Body weight, body height Body mass index (BMI),based on 2007 WHO Growth Standards Overweight/obesity was defined as >85th percentiles Underweight were defined as <15th percentiles

Exclusion criteria Aged <15 or >19 Having physical disability Sickness/refuse Pregnant/breastfeeding Missing data No body weight/height No sex

Results There are 522, 3022, 3623, 3087 and 3414 separate adolescents in the 5 waves, respectively. The prevalence of underweight increased from waves 1 to 3 (28.4% to 33%), and slightly decreased to waves 5 (31.9%). The prevalence of overweight/obesity increased from 3.4% to 9.1% (P<0.05). Mean of body height is increased from 154.1 to 157.9, the same in body weight from 47.6 to 51.0. Prevalence of overweight/obesity is elevating from 3.4% to 5.0%, accompanied by underweight from 28.4% to 33.5%.

From this figure, both of body mass indexs are increasing by the time in boys, but the underweight problem still exist in the population

Almost similar phenomenon for Girls

Body height of boys are slowly increasing

For girls, the body height are slower than boy, and it will be more vulnerable to have stunted, and overweight in the future

Discussion Unequally distribution related to the population’s economic condition Domestic economic problem  food security problem  food insecurity on several areas  malnutrition problem Indonesia national statistical data, 2015 “Shortness is not the real problem. When it comes to stunting, other processes in the body are also stunted, such as brain development, which affects intelligence” Achadi, 2015 May lead to poorer health outcomes particularly related to NCDs prevention and management Education and income protect Indonesians from being undernourished. Hanandita and Tampubolon, 2015

Conclusion The existence of the double burden malnutrition from 1993-2014 which remain increase in Indonesia. Understanding the risks associated with and the causes of the DBM is not an easy task, not only because of the complexity of the issue but also because of the rapidly evolving situation in most low- and middle-income countries People with better the nutrition literacy would have more appropriate BMI.

Suggestion So, the combination of management of concurrent under and over nutrition through the compulsory education curriculum to increase the nutrition literacy as the prevention of the non-communicable diseases could be a policy solution.