The combination of nutrition education at school and home visits to improve adolescents' nutritional literacy and diet quality in food-insecure households in post-disaster area (De-Nulit study): A study protocol of cluster randomized controlled trial (CRCT).

Nutrition education is selected as a method which often used to change eating behaviour, yet, the effectiveness of this method in adolescents who live in household with food insecurity status is rarely investigated. The purpose of this study was to assess the impact of a combination of nutritional education held at school and home visits for increasing the nutritional literacy and its effect on the quality of adolescent diet, so that the result can be used as a strategy to improve nutritional literacy dan diet quality in those adolescents who live in food-insecure households in post-disaster areas. The De-Nulit Study is a Cluster Randomized Controlled Trial (CRCT) with an intervention from a combination of nutritional education given at school and home visits conducted for three months for adolescents who live in food-insecure households with ages ranging from 15 to 17 years old. A randomization sampling was carried out at four schools located the nearest locations which were affected heavily by the major natural disasters in 2018. The nutritional education intervention groups in schools were given in eight sessions, whereas home visits with an interview approach for students with a motivational interview approach were carried out four times. The control group will receive leaflets three times a month for three months, and each group will receive a food stamp $ 7.6 per month for three months. The trial research has been recorded in Thai Clinical Trials Registry (TCTR) with identification number of TCTR 20220203003 issued on 03 February 2022.

Factors Associated with Diet Quality among Adolescents in a Post-Disaster Area: A Cross-Sectional Study in Indonesia.

The diet quality of adolescents in low-middle-income countries is low. Especially in post-disaster areas, adolescents are not a priority target for handling nutritional cases compared with other vulnerable groups. The aim of this study was to examine the factors associated with diet quality among adolescents in post-disaster areas in Indonesia. A cross-sectional study was performed with 375 adolescents aged 15-17 years, representing adolescents living close to the areas most affected by a significant disaster in 2018. The variables obtained include adolescent and household characteristics, nutritional literacy, healthy eating behavior constructs, food intake, nutritional status, physical activity, food security, and diet quality. The diet quality score was low, with only 23% of the total maximum score. Vegetables, fruits, and dairy scored the lowest, whereas animal protein sources scored the highest. Higher eating habits of animal protein sources; being healthy; normal nutritional status of adolescents; higher vegetable and sweet beverage norms of mothers; and lower eating habits of sweet snacks; animal protein sources; and carbohydrate norms of mothers are associated with higher diet quality scores in adolescents (p < 0.05). Improving the quality of adolescent diets in post-disaster areas needs to target adolescent eating behavior and changes in mothers' eating behavior.

Effectiveness of optimized food-based recommendation promotion to improve nutritional status and lipid profiles among Minangkabau women with dyslipidemia: A cluster-randomized trial.

BACKGROUND: In women of Minangkabau ethnicity, a high prevalence of dyslipidemia, overweight, and obesity is thought to be closely related to poor dietary practices. Promotion of local specific food-based recommendations (FBRs) was previously found to be effective in improving dietary practice and nutrient intakes related to dyslipidemia. This study aimed to describe the effects of the FBR promotion on the nutritional status and lipid profiles of Minangkabau women with dyslipidemia. METHODS: We used a cluster-randomized design with a total subject of 123 Minangkabau women of reproductive age with dyslipidemia. They were recruited from 16 sub-villages and assigned to either the FBR group (n = 61) or the non-FBR group (n = 62). Data on body weight, height, waist circumference, and lipid profiles were collected at the baseline and the end of the trial. Linear mixed model analysis was used to analyze the effect of the intervention on nutritional status and lipid profiles. RESULTS: The mean effect (95% confidence interval) of the intervention on body weight, body mass index, and waist circumference for the FBR group versus the non-FBR group were -1.1 (-1.8; -0.39) kg, -0.43(-0.76; -0.11) kg/m2 and -2.1(-3.7;-0.46) mm respectively (p <0.05). The Castelli's index in the FBR group improved, but there was no significant between-group difference in the change of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides at the end of the intervention. CONCLUSION: The promotion of the FBRs positively impact the nutritional status but did not significantly affect the blood lipid profile of Minangkabau women with dyslipidemia. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov Protocol Registration and Result System (PRS) as NCT04085874, in September 2019.

Promotion of optimized food-based recommendations to improve dietary practices and nutrient intakes among Minangkabau women of reproductive age with dyslipidemia.

BACKGROUND AND OBJECTIVES: Using a linear programming approach, an optimized food-based recommendations (FBRs) had been formulated for Minangkabau women of reproductive age with dyslipidemia in Indonesia. This study aimed to assess the effectiveness of the promotion of the FBRs for improving dietary practices and nutrient intakes. METHODS AND STUDY DESIGN: A community-based, clustered-randomized trial was conducted among Minangkabau women of reproductive age (20-44 years) with dyslipidemia. The subjects were assigned either into the FBR group (n=48), or the non-FBR group (n=54). Baseline and end-line dietary data were assessed through interviews using a one-week semiquantitative food frequency questionnaire (SQ-FFQ) and two replicate 24-hour dietary recalls. The changes in dietary practice and nutrient intakes were analysed using ANCOVA test. RESULTS: Significant changes were observed (p<0.005) in the consumption of the promoted food items and subgroups (sea fish, soy protein, dark green leafy vegetables, and potatoes). Significant changes were also observed in nutrient intake, especially energy intake from carbohydrates and unsaturated fatty acids (total PUFA, MUFA, n-3 and n-6 fatty acids), as well as the dietary P/S ratio and fiber intake. CONCLUSIONS: With current dietary practices, intakes of some typical problem nutrients such as n-6, zinc, iron, and fiber still could not achieve 100% of the RNIs, while the intake of SFA still exceeded the recommended intake. Further approaches are needed to expand the population food basket and promote behavioral change to address established cultural food habits, including reducing the use of cooking oil in food preparation and increasing vegetable consumption.

Determinant Factors of Maternal Knowledge on Appropriate Complementary Feeding of Children Aged 6-23 Months in Aceh.

The aim of this study was determine mothers knowladge on appropriate complementary feeding of children aged 6-23 mo. A cross-sectional design was applied on 392 mothers of children aged 6-23 mo selected through a cluster sampling in Aceh Besar District Aceh Province Indonesia. Data on mothers knowledge and determinant factors included socio-demographic of mothers were collected using valid and reliable structured questionnaire. The data was analyzed using binary logistic regression at 95% confident interval. Overall, there was less than one-fourth (20.2%) of the mothers have good knowledge on appropriate Complementary feeding. Education level of mothers were significantly associated with mothers knowledge, mothers who have education level elementary school, junior high school and senior high school higher risk of having low knowledge on appropriate complementary feeding (OR=3.11, OR=5.22 and OR=10.20) than those have graduted level. Therefore, an effort and a research to developing nutrition education model is warranted to improving knowledge and skill of mothers is important.

Effect of Nutrition Education and Multi-Nutrient Biscuit Interventions on Nutritional and Iron Status: A Cluster Randomized Control Trial on Undernourished Children Aged 6-23 Months in Aceh, Indonesia.

Undernutrition and iron deficiencies on under-five children in Indonesia remain high and very closely related to inadequate complementary feeding. This study investigated the effect of weekly nutrition education by home visite using the food monitoring card (FMC) models and daily provision multi-nutrient biscuits and combination on growth and reduction of iron deficiency and anemia among underweight children aged 6-23 mo in Aceh Indonesia. A 6-mo, cluster randomized, control trial was conducted on 121 children received nutrition education (NE), multi-nutrient biscuit (MNB), combination both nutrition education and biscuits (NE+MNB), and control group. The outcome weight gain and prevalence of underweight (weight for age z-score <-2SD) were collected by anthropometric and iron deficiency were serum ferritin measuring with ELISA method. After the 6-mo intervention, the rate of weight gain was higher in combination intervention group 1.51±0.68 kg than multi-biscuit group 1.40±0.72 kg, NE group 1.34±0.66 kg and control group 1.21±0.42 kg, and the rate increase of serum ferritin was higher in combination NE+MNB and biscuit group (2.54 µg/L and 2,17 µg/L). At the end of study there were a significant decrease in prevalence of underweight (p=0.003), the incidence of underweight in NE+MNB (45.2%) lower than NE group (63.3%), MNB group (64.5%) and control group (69,0%) and significant decrease of iron deficiency (p=0.02), the incidence lower in MNB group (6.5%) than NE+MNB (22.6%), NE group (23.3%) and control group (24.1%). The combination of nutritional education and multi-nutrient biscuits intervention improving nutritional and iron deficiency status on undernourished children. These risearch highlight the need integration of nutrition education and food base intervention to prevent underweight and iron deficiency on children 6-23 mo old.

Complementary feeding practices and nutritional status of children 6-23 months old: formative study in Aceh, Indonesia.

BACKGROUND/OBJECTIVES: The 6-23 months for infants is the longest period in the "first 1,000 days" of life. This period is very important for child development, so complementary feeding (CF) practices should be optimized to maximize children's potential for growth and development. The aim of this study was to analyze the CF practices and nutritional status of children aged 6-23 months. SUBJECTS/METHODS: For this cross-sectional study, 392 children aged 6-23 months were selected using stratified random sampling. Socio-demographic data were collected through interviews. CF practices, collected by interviews and repeated 24-hour food recall method, were the timely introduction of CF, minimum meal frequency, dietary diversity and minimum acceptable diet, consumption food rich in proteins and vitamin A. Nutritional status was assessed using the indicators of underweight, wasting and stunting. To analyze the association between socio-demographic indicators and CF with nutritional status, the chi-square test with a confidence interval of 95% was used. RESULTS: Results showed that 39% were exclusively breastfed, only 61% received prolonged breastfeeding and 50% received timely introduction of CF. Minimum meal frequency was met by 74% of subjects, but dietary diversity and minimum acceptable diet were only realized in 50% and 40% of the children, respectively. The prevalence of underweight, wasting, and stunting were 26%, 23%, and 28%, respectively. Age of the child, birth order, birth weight, parents' education level, family size and incidence of fever and diarrhea during the previous two weeks were associated with underweight, while child's birth order, fathers' education level, mother's age, family size, completion of the age-appropriate vaccination and fish consumption frequency were associated with wasting. Age of the child, incidence of fever and acute respiratory infection, and fortified food consumption were associated with stunting. CONCLUSIONS: Suboptimal CF practices and high prevalence of underweight, wasting and stunting were found among children aged 6-23 months old in Aceh. These results highlight the need to improve CF and nutritional status.