The Correlation Between the Type, Quantity, and Frequency of

Eating with Defecation Patterns and Muslim Students’ Indigestion

During Ramadan Fasting

Anisa Ramadani, Laily Hidayati and Praba Diyan Rachmawati

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Diet, Defecation Pattern, Indigestion.

Abstract: Introduction: Diet is a description of the regulation of the quantity, frequency, and type of food consumed

daily by a person. The purpose of this study was to analyze the correlation between the type, quantity, and

frequency of eating and the bowel pattern and digestive complaints of Muslim students during Ramadan

fasting. Method: the research design used a cross-sectional study approach with type, number, and

frequency of feeding as the independent variables and bowel pattern and indigestion as the dependent

variables. The sample comprised of 107 college students. The data were collected by questionnaires and

analyzed using the Chi-square test. Results and Analysis: The statistics test regarding food typed and

defecation patterns obtained a p value of 0.000 at α≤0.05. The quantity of food and defecation patterns

obtained a p value of 0.577. The frequency of eating with defecation pattern obtained ap value of 0.778. The

food types with indigestion obtained a p value of 0.015. The quantity of food and indigestion obtained a p

value of 0.339. The frequency of eating with indigestion obtained a p value of 0.368. Discussion and

Conclusion: There was a correlation between the type of food and bowel patterns and indigestion. There

was no correlation between the number of meals and the frequency of eating with bowel patterns, and the

same applied to the number of meals and the frequency of eating with digestive complaints.

1 INTRODUCTION

Students are at an adult age during which food

consumed is very influential for the body’s health.

The body still needs the same nutritional intake both

when fasting and not fasting. However, from the

results of interviews, it is evident that students often

consume spicy foods, foods containing sugar and

salt, and fatty foods when fasting during Ramadan.

Students rarely consume fruit during suhoor.

Students also often experience diarrhea and

complain about pain and nausea in their stomachs.

Research by Riawanti (2008) found that the

average consumption of nutrition by students (9.8%)

decreased during Ramadan, including energy,

protein, fat, iron, vitamin C, and vitamin B. The

World Health Organization (WHO) in 2009

discovered the percentage of gastritis occurrence in

Indonesia was 40.8%. The occurrence of gastritis in

some areas of Indonesia is quite high with the

prevalence of 274,396 cases from 238,452,952

inhabitants. In Surabaya, the occurrence of gastritis

is 31.2% (Maulidiyah, 2006), whereas the

prevalence of peptic ulcers (known as ulcer disease).

Indonesia was found in 6%–15%, especially at

the age of 20–50 years (Suyono 2001). One way to

overcome eating behaviors is to change the

perception of individuals; this suggestion is based on

the theory of the Health Belief Model (HBM), in

which individuals perceive the vulnerability and

seriousness of diseases. Such perceptions

simultaneously increase individuals’ awareness of

the fact that a healthy diet can reduce symptoms of

indigestion, hence prompting a change in the

behavior of a person regarding their diet.

2 METHODS

This research design used a correlational research

design with a cross-sectional approach. This

research was conducted at a university in Surabaya

city during Ramadan. The population in this

research were 121 6th semester Muslim students and

746

Ramadani, A., Hidayati, L. and Rachmawati, P.

The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During Ramadan Fasting.

DOI: 10.5220/0008332207460751

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 746-751

ISBN: 978-989-758-336-0

the sample comprises of students that meet the

inclusion and exclusion criteria. This study used

total sampling, i.e. taking all members of the

population as samples. Independent variables in this

study are the type, quantity, and frequency of eating.

The dependent variables are defecation patterns and

indigestion. A questionnaire was used to collect

data, which were analyzed using the Chi-square

statistical test.

3 RESULTS

Most respondents in this research is female students

aged 21–22 years old. According to the results in

Table 2, it was discovered that most students choose

the right foor during Ramadan fasting.

Table 1 showed that the majority of the

respondents choose correct food type and have

normal defecation pattern. The result of statistical

test using chi-square shows 0,000 p value. Therefore

it can be concluded that there is a significant relation

between food type and defecation patterns. The

majority of the respondents with normal eating

quantitiy have normal defecation pattern. The result

of statistical test using chi-square shows 0577 p

value, therefore it can be concluded that there is no

significant relation between eating quantity and

defecation patterns. Respondents with regular eating

frequency have normal defecation pattern. The result

of statistical test using chi-square shows 0,778 p

value. Therefore it can be concluded that there is no

significant between eating frequency and defecation

patterns.

Based on table 2, it showed that food type which

is correct often leads to the respondents having mild

indigestions. The result of statistical test using chi-

square shows 0,015 p value, therefore it can be

concluded that there is significant relation between

food type and indigestions. Also, the majority of

resondents with normal eating quantity have mild

indigestions. The result of statistical test using chi-

square shows 0,339 p value, therefore it can be

concluded that there is no significant relation

between eating quantity and indigestions. Majority

of the respondent with no indisgestion showed

regular eating frequency with statistical result of

Chi-Square p value was 0.039. It can be concluded

that there was no significant relation between eating

frequency and indisgestions.

4 DISCUSSION

4.1 The Relationship between Food

Type and Defecation Patterns

The results from the Chi-square analysis indicated

that there was a significant relationship between

food type and defecation patterns (p <0.05). The

pattern of food consumption is the composition of

the type and amount of food consumed by a person

or group at a certain time (Khomsan, 2010). A

healthy diet should pay attention to nutritional

adequacy rates, in terms of carbohydrates, proteins,

fats, and minerals (Supratman et al., 2013). During

fasting, the diet should still follow the pattern of

healthy and balanced foods (four sehat and five

sempurna) in accordance with the needs of the

calories required for each individual. Intake of

carbohydrates, proteins, fats, vitamins and minerals

in the month of fasting must remain complete. Diet

(food) is a major factor affecting defecation,

especially fiber. An important role of fiber is the

elimination of feces by increasing its volume to help

the defecation process (Miguel et al., 2004).

Research conducted by Ambarita (2014)

indicates that there is a significant relationship

between fiber intake and the frequency of

defecation. Yang et al. (2012) also proved that there

is a relationship between fiber intake and the

frequency of defecation. Foods that contain lots of

fiber will also increase intestine movements,

smoothing the feces so it is easier to move through

the colon, increasing the frequency of defecation. In

addition, the quantity and types of foods that are

consumed each day also affect defecation patterns,

Table 1: The analysis of relation between food type,

eating quantity, eating frequency with defecation pattern

on muslim students during ramadhan fasting.

No.

Analysis

P Value

Food type

0.000

Eating quantity

0.577

Eating frequency

0.778

Table 2: The analysis of relation between food type,

eating quantity, eating frequency with indigestions on

muslim student during ramadhan fasting.

No.

Analysis

P Value

Food type

0.015

Eating quantity

0.339

Eating frequency

0.368

The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During

Ramadan Fasting

747

such as spicy foods, unhygienic foods, and some

contain irritants that may irritate the gastric mucosa

and intestine, hence increasing intestine motility

(Funnell & Koutoukidis, 2005).

Dietary fiber will affect the defecation process

by facilitating the passage of food through the

digestive system (Eswaran et al., 2013). Fiber can be

obtained through vegetables and fruit (Khomsan,

2009).

4.2 The Relationship between the

Quantity of Food Eaten and

Defecation Patterns

Based on the results of this study, it was determined

that there is no relationship between the quantity of

food consumed and defecation patterns. This can be

caused by other factors that have a dominant relation

to defecation pattern. Every individual requires a

number of nutrients to live healthy and sustain life.

Therefore, the amount of nutrients obtained through

food consumption must be sufficient to perform

activities and maintain the immune system.

According to the Ministry of Health (2005) the

portion of food eaten each day should follow the

general guidelines of balanced nutrition; the dishes

are comprised of staple foods (3–5 servings per day),

side dishes (2–3 servings per day), vegetables (2–3

servings per day) and fruit (3–5 servings per day).

Nutritional needs are the minimum number of

nutrients that must be consumed through food

intake. A deficiency in, or excess intake of, nutrients

compared to normal requirements for an extended

time can endanger health. Fiber is a non-nutrient

substance that belongs to one type of group of

polysaccharides or complex carbohydrates

(Soelistijani, 2002). Lubis (2009) stated that dietary

fiber is a component of complex carbohydrates that

cannot be digested via digestive enzymes, but can be

digested by micro-bacteria digestion. Fiber

consumption deficiency can lead to diseases such as

constipation, hemorrhoids, and colon cancer.

Fiber works to stimulate intestinal tract activity

to release feces regularly. Fiber in the feces can also

absorb a lot of water, thus making the feces soft and

preventing constipation (Waluyo & Irianto, 2007).

Sari et al. (2016) proved that there is no significant

relation between fiber consumption and defecation

patterns. The higher the consumption of dietary fiber

smoother the defecation process will be, avoiding

straining. A theory by Beck (2011) suggests that the

consistency of feces depends on the amount of fiber

consumed. Adequate fiber intake will facilitate the

defecation process because fiber can retain moisture

in the feces by drawing water osmotically and

stimulating the peristalsis of the colon through

stretching.

4.3 The Relationship between the

Frequency of Eating and

Defecation Patterns

The results of this study indicated that there is no

significant relationship between the frequency of

eating with defecation patterns. The frequency of

eating consists of the main meal frequency, i.e.

breakfast, lunch, and dinner. However, this is

certainly different during Ramadan. When we are

fasting during Ramadan, most Muslims will have

two meals, i.e. suhoor (at dawn) and iftar, so the

fasting duration ranges from 11 to 18 hours each day

(Azizi 2010). Eating suhoor is preceded by drinking

a glass of milk, then eating a balanced menu and a

large portion of food. During suhoor, it is

recommended to eat a high protein content, so that

food stays in the stomach for longer. Digestion and

protein absorption also lasts longer than foods with

high carbohydrate levels (Sekarindah 2002).

Dietary pattern during fasting that need to be

considered is the pattern of eating when breaking the

fast (iftar). There are lots of people who eat during

iftar, no longer called the nutritional value of food

consumed (Sugung, 2013). Breaking the fast should

be done with care, taking a sweet drink and eating

date palm fruit or with fruits. Sweet foods contain

carbohydrates that are easily absorbed and can

immediately raise blood sugar levels, hence

transforming into calories to recover energy after a

day with no food and (Sekarindah 2002). A lot of

people use Ramadan to lose weight. Losing weight

can be done as long as the need for calories remains

fulfilled. If we only consume vegetables and fruit, it

will lead to illness (Idris 2000). The American

Dietetic Association (ADA) in Muthmainnah (2013)

recommend that the value of adult fiber adequacy is

20–35 grams per day. A lack of fiber in food eaten

daily can cause abnormalities in the processing of

feces causing constipation. The average fiber

consumption in Indonesia has still not reached the

ideal amount of fiber consumption per day. The

average fiber consumption in Indonesia is 10.5

grams per day (July 2001). The study by Sari et al.

(2016) proves that the average fiber consumption of

respondents is 15.47 grams per day, whereas the

ideal fiber consumption value recommended by the

ADA is 20–35 grams per day. Regarding the

consumption of fiber, respondents only reached half

of the recommended ideal requirements.

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4.4 The Relationship between Food

Types and Indigestion

Based on the results of this study, it was found that

there is a significant relationship between food types

and indigestion. Types of food are very important for

emptying the stomach. A large amount of food will

produce a large number of kimus. The exceeding

amount of kimus in the duodenum will slow the

process of emptying the stomach. Suratun (2010)

stated that spicy and acidic foods will stimulate the

stomach wall to remove stomach acid that can cause

injury to the wall of the stomach. Foods that contain

a lot of carbohydrates leave the stomach within a

few hours. Protein-rich foods last longer. They leave

the stomach slower, and the slowest discharged

foods after eating are fatty foods (Sherwood 2001).

Acidic foods are foods that stimulate the

digestive organs and can directly erode gastric

mucosa. Acidic foods stimulate excessive stomach

acid secretion and can stimulate increased motility or

peristalsis of the digestive organs, leading to

inflammation of the wound on the walls of the

digestive organs (Susanti, et al., 2011). Research

conducted by Susanti et al. (2011) indicated that

consuming spicy and sour foods affected the onset of

symptoms in the stomach. Another study conducted

by Angkow et al. (2014) demonstrated that there is a

significant relationship between types of food and

the occurrence of gastritis. Research by Pratiwi

(2013) indicated that there is a significant

relationship between types of eating with gastritis

occurrence. The results of this study showed that

respondents liked spicy and sour foods. Irritating

foods such as spicy foods can cause injury to the

stomach wall (Sediaoetama, 2008). Notoatmodjo

(2007) believes that consuming spicy and acidic

foods can cause excessive heat and pain in the pit of

the stomach, accompanied by nausea and vomiting.

4.5 The Relationship between Food

Types and Indigestion

Based on the results of this study, it was found that

there is no significant relationship between the

quantity of food consumed and indigestion. When

insufficient food was consumed, non-fulfillment was

evident, caused by an inadequate number of calories.

This resulted in a lower fulfillment of energy and

other nutrients required by the body. A poor diet is

seen in terms of quantity, type, and function, and, in

the long term, causes non-fulfillment of the body's

need for nutritional elements (including

carbohydrates, proteins, and fats).

According to the Health Department (2005) daily

portions of food should follow a balance of nutrients,

consisting of staple foods (3–5 portions per day),

side dish (2–3 portions per day), vegetables (2–3

portions per day) and fruit (3–5 portions per day).

The consumption behavior of a person, a family, or a

society is influenced by insight and perspective and

other factors related to appropriate actions. On the

other hand, nutrition is very useful for maintaining

health and preventing disease. The lack of nutrients

issue has lately caused the occurrence of diseases

due to incorrect diets, such as overeating or eating a

less-balanced diet. A study conducted by Pratiwi

(2013) indicated that there was no significant

relationship between quantity of food and gastritis.

Another research study conducted by Putri et al.

(2010) in which the frequency of food quantities

were analyzed, 100% of respondents consumed less

food than the body needed and the analysis results

concluded that there is a dietary relationship with the

occurrence of gastritis. The results showed that most

respondents had less carbohydrate, protein, and fat.

The lower nutritional value of carbohydrates can be

caused by the intake of less food than the body

needs. Carbohydrates are nutritional elements that

provide the main energy; the recommended

carbohydrate requirement is 60% of total calories

with a breakdown of 90% other than sugar, and 10%

sugar. Carbohydrate deficiencies in food

consumption can lead to a state of malnutrition.

Lower protein intakes can be caused by eating a

smaller quantity of food that is less than the body

requires and less varied types of food. Protein is a

nutrient that works for the growth and maintenance

of skin and nails, regulates fluid balance, the

formation of antibodies, and energy sources. Lack of

protein causes many problems such as weight loss,

weakness, muscle tissue shrinkage, and edema

(Erfandi 2009).

Lack of fat of respondents is caused by lack of

food intake in the body. The respondents’ preference

for types of food as a source of fat is less varied.

Basically, fat serves as a source and energy reserve.

Fat is stored in the tissue under the skin (Pratiwi,

2013). Fat deficiency can cause neurological and

vision problems, reproductive failure, and disorders

of the skin, kidneys, and liver (Erfandi, 2009).

Lower intake of carbohydrates, fats, and proteins

will result in non-fulfillment of the functions of

these nutritional elements.

The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During

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4.6 The Relationship between the

Frequency of Eating and

Indigestion

Based on the results of this study, it was determined

that there is no significant relationship between the

frequency of eating and indigestion. The main

factors causing disturbances in the digestive system

are the patterns of food consumption and body

nutrition intake, as these are unfulfilled. In addition,

factors that can affect the occurrence of indigestion

are an irregular and unsuitable diet. Digestive

disorders that often arise are gastritis and ulcers.

Typical symptoms of gastritis and peptic ulcers are

pain or discomfort in the area of the epigastrum or

upper abdomen, bloating after eating, a full stomach

and feeling full quickly, nausea, vomiting, and

frequent burping. This set of symptoms is often

referred to as dyspepsia syndrome (Sofro &

Anurogo, 2013).

The frequency of eating can be used as an

indicator of eating regularity. Eating regularity is

related to the production of stomach acid, to which

gastric acid is a contributing factor for gastritis and

peptic ulcers. Irregular eating schedules will cause

the stomach to struggle to adapt, so the acid

production of the stomach becomes uncontrolled,

leading to symptoms of dyspepsia. Eating more

frequently (more than twice per day) can relieve

gastric work so the production of stomach acid is not

excessive; it must accommodate incoming foods in

excessive amounts, thus preventing dyspepsia

(Djojoningrat 2009).

The frequency of irregular eating affects the

occurrence of indigestion, but in this study there was

no significant relationship between the frequency of

eating with indigestion where p> 0.05. The results of

this study differ from research conducted by Susanti

(2011) in which the frequency and regularity of

eating was associated with the risk of digestive

symptoms Other research conducted by Angkow et

al. (2014) indicates that there is a significant

relationship between the frequency of eating with

the occurrence of gastritis. People who have an

irregular diet are susceptible to disease. When

stomach should be filled but is left empty or meals

are overdue, gastric acid will digest the mucosal

layer of the stomach, because when the stomach is

empty, intestinal peristaltic movements occur

intensively, stimulating an increase in acid

production causing pain in the epigastrium (Ikawati,

2010). The results of research by Nasution (2001)

states there is no significant relationship between the

frequency of eating with gastritis. From the results it

can be concluded that there is no difference in the

frequency of eating more than twice a day with less

than twice a day. The stomach will continue to

produce stomach acid every time in small amounts

after 4–6 hours after meals. If a person is late eating

by 2–3 hours, more and more stomach acid is

produced. Eating more than twice a day, interspersed

with the consumption of food interludes, can keep

stomach acid under control (Octaviani, 2011).

5 CONCLUSIONS

The more precise the type of food selected, the more

normal the defecation pattern of the respondent and

no indigestion. The quantity of food eaten does not

have a significant relationship with defecation

patterns. Regarding the frequency of eating, there is

no significant relationship with defecation patterns.

Furthermore, quantity of food eaten does not have a

significant relationship with indigestion. There was

also no significant relationship between the

frequency of eating and indigestion.

The researchers can give examples of amounts

for the number of food portions to obtain more

accurate results.

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The Correlation Between the Type, Quantity, and Frequency of Eating with Defecation Patterns and Muslim Students’ Indigestion During

Ramadan Fasting

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