Household Income and Unbalanced Diet Among Urban Adolescent
Girls
Rian Diana, Sri Sumarmi, Triska Susila Nindya, Mahmud Aditya Rifqi, Stefania Widya
Setyaningtyas and Emalia Rhitmayanti
Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
rian.diana@fkm.unair.ac.id
Keywords: Adolescent girls, Dietary intake, Income, Urban.
Abstract: Dietary intakes are important for adolescent girls’ growth and development. Not all adolescents have an
adequate daily intake, particularly in urban areas which have a high disparity of household income. This
study was aimed to examine the relationship between household income and dietary intakes among
adolescent girls in urban areas. This cross-sectional study included 132 subjects aged 12-16 years old,
conducted in Junior high school in Surabaya City, East Java, Indonesia. Dietary intakes were obtained by
using 24-hour dietary recall method. Spearman’s rank correlation was applied to analyse the association
between household income and dietary intakes. High disparity of household income was found in this study
with median IDR 4,000,000 (≈$308). Adolescent girls had low dietary intakes with median as follows,
energy 1235kcal, protein 45.1g, fat 46.1g, carbohydrate 141.6g, iron 5.0mg, calcium 182.8mg. The
proportion of energy from carbohydrate was 49.5%, fat 34.9% and protein 14.8%. There was a significant
correlation between household income with protein intake (p=0.010, r=0.224) and energy proportion from
protein (p=0.043, r=0.177). Generally, adolescent girls eat an unbalanced diet, with less carbohydrate and
high fat. Urban adolescent girls with low household income have a low protein intake.
1 INTRODUCTION
Dietary intakes are important for adolescent girls’
growth and development. Adolescence is a crucial
time for puberty and body image development.
Negative body image, which includes body
dissatisfaction, is a strong predictor of disordered
eating behaviours. Bad eating behaviour can lead to
malnutrition (Reel et al, 2015). Not all adolescents
have an adequate intake (Badan Penelitian dan
Pengembangan Kesehatan, 2014). Poor intake can
lead to malnutrition (Branca et al, 2015), delay in or
faster sexual maturation (Soliman et al, 2014), and
not reaching optimal catch up growth (Modan-
Moses et al, 2012). Adolescent eating behaviour is
influenced by personal factors, physical, social
environment (Salvy et al, 2012) and socioeconomic
factors (El-Gilany and Elkhawaga, 2012).
There have been many studies about dietary intake
and its determinants among female adolescents (de
Andrade et al, 2016), including association between
socioeconomics and diet quality (Darmon and
Drewnowski, 2008). Few studies have been
conducted on dietary intake and its correlation with
household income in Surabaya City with high
income disparity. The purpose of this study was to
examine the relationship between household income
and dietary intakes among adolescent girls in urban
area.
2 METHODS
This cross-sectional study included 132 subjects
aged 12-16 years old, conducted in Santa Agnes and
Unggulan Bina Insani junior high school in
Surabaya City, East Java, Indonesia. The two school
represent the diversity of household socio-economic
in urban area (low-high income household). Dietary
intakes were obtained by using 24-hour dietary
recall method. Energy and nutrient intakes were
calculated by Nutrisurvey (2007). Descriptive
analysis was determined by median, minimum,
maximum and proportion. Energy proportion from
carbohydrate, fat and protein were categorised into
Diana, R., Sumarmi, S., Nindya, T., Rifqi, M., Setyaningtyas, S. and Rhitmayanti, E.
Household Income and Unbalanced Diet Among Urban Adolescent Girls.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 295-297
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
295
two groups (carbohydrate: <55% energy and ≥ 55%
energy; fat: < 30% energy and ≥ 30% energy;
protein: < 15% energy and ≥ 15% energy)
(Hardinsyah et al, 2014). Spearman’s rank
correlation was applied to analyse the correlation
between household income and dietary intakes and p
value <0.05 was considered statistically significant.
3 RESULTS
High disparity of household income and dietary
intake was found in this study. Household income
median was IDR 4,000,000 per month (1 USD =
around IDR 13,000). The lowest household income
was IDR 500,000 ((≈$38) and the highest was IDR
50,000,000 ((≈$3846) per month. Table 1 shows that
dietary intake of adolescent girls in urban areas was
below the adequacy level. Adolescent girls had low
dietary intakes with median as follows: energy
1235kcal, protein 45.1g, fat 46.1g, carbohydrate
141.6g, iron 5.0mg and calcium 182.8mg. High
disparity in dietary intake can be seen from the
lowest intake and the highest intake.
Table 1: Median of household income and dietary intake
Variable
Median (min; max)
Household income
(IDR/month)
4,000,000
(500,000; 50,000,000)
Dietary intake
Energy (kcal)
1235 (374; 4027)
Protein (g)
45.1 (8.8; 171.5)
Fat (g)
46.1 (4.2; 185.1)
Carbohydrate (g)
141.6 (24.9; 821.0)
Iron (mg)
5 (0.8; 71.0)
Calcium (mg)
182.8 (25.6; 1886.8)
Based on the proportion of energy from
carbohydrate, fat and protein, adolescent girls have
an unbalanced diet. Table 2 shows that energy
proportion from carbohydrate was 49.5%, fat 34.9%
and protein 14.8%. More than half of adolescent
girls have a low energy proportion from
carbohydrate and protein, contrarily with energy
proportion from fat. Generally, adolescent girls eat
an unbalanced diet with less carbohydrate, protein
and high fat.
Table 2: Energy proportion
Energy Proportion (%)
n (%)
Carbohydrate
< 55% energy
85 (64.4)
≥ 55% energy
47 (35.6)
Median (min; max)
49.5 (10.9; 90.5)
Fat
< 30% energy
48 (36.4)
≥ 30% energy
84 (63.6)
Median (min; max)
34.9 (4.5; 70.9)
Energy Proportion (%)
n (%)
Protein
< 15% energy
69 (52.3)
≥ 15% energy
63 (47.7)
Median (min; max)
14.8 (2.7; 28.5)
Correlation between variables in this study can
be seen in Table 3. Protein intake (p=0.010, r=0.224)
and energy proportion from protein (p=0.043,
r=0.177) have a positive correlation with household
income. There was no significant correlation for
energy, fat, carbohydrate, iron and calcium with
household income.
Table 3: Correlation between dietary intake, energy
proportion and household income
Variable
p
Intake of energy (kcal)
0.346
Intake of fat (g)
0.535
Intake of protein (g)
0.010
Intake of carbohydrate (g)
0.535
Intake of iron (mg)
0.069
Intake of calcium (mg)
0.780
Energy proportion from
carbohydrate (%)
0.627
Energy proportion from fat
(%)
0.920
Energy proportion from
protein (%)
0.043
4 DISCUSSION
Household income of adolescent girls are very
diverse, from IDR 500,000-50,000,000. This high
disparity income can lead to high differences of food
access. The median of adolescent household income
was higher than Surabaya minimum wages (IDR
3.296.212). Higher incomes enhanced the
sustainability of food access (Adom, 2014).
Table 1 shows that adolescent nutrient intake
was below the recommended dietary allowance
(RDA). RDA for adolescent girls was: energy
2125kcal, protein 69g, fat 72g, carbohydrate 292g,
iron 26g and calcium 1200mg. Low nutrient intake
can cause suboptimal growth (Alshammari et al,
2017) and development (Solimin et al, 2014).
Unbalanced diet among adolescent girls is found
in this study with a high energy proportion from fat
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
296
(>30%) and low energy proportion from
carbohydrate (<55%) and protein (<15%).
Adolescents eat a lot of fried food, so they have a
high energy proportion from fat. Table 3 shows that
there was a significant association between protein
intake and energy proportion from protein with
household income. This implies that parents with
higher incomes can fulfil their children's protein
intake better than those of low incomes. Animal
sources of protein have a better quality than non-
animal protein. But, animal protein prices are more
costly than non-animal. Muzayyanah et al. (2017)
revealed that increase in household income can
improve the animal protein consumption. Darmon
and Drewnowski (2008) in their review stated that
socioeconomic status can influence diet quality and
diet cost. People with lower socioeconomic status
have a lower diet quality than higher ones. There
was no significant association between other nutrient
intake with household income. This may be because
a result of the homogeneous data of nutrient intake.
Limitation of this study was dietary intake
collected using 24-hour recall. This method has
recall bias and is not representative for micronutrient
intake. The trained enumerator questioned and
probed to reduce the recall bias and food picture
were used to visualise the portion size.
5 CONCLUSIONS
Adolescent girls in urban area eat an unbalanced
diet, with high fat and less carbohydrate. Urban
adolescent girls with low household income have a
low protein intake.
ACKNOWLEDGEMENTS
We thanks to Faculty of Public Health, Universitas
Airlangga for funding this study.
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