RESEARCH ARTICLE

Physical Activity Levels and Dietary Fiber Source Preferences

in Obese and Non-Obese
Elementary School Students, Depok, Indonesia
Apriningsih1,*, Dini Novi2
1Faculty of Health Sciences UPN Veteran Jakarta,15615,Indonesia
2, Faculty of Health Sciences UPN Veteran Jakarta,15615,Indonesia

*Corresponding Author: Apriningsih, apriningsih@gmail.com.

Abstract
Background: While undernutrition has long been a public health problem in Indonesian children,
overweight and obesity have in more recent years evolved in certain segments of Indonesian society.Many
factors contribute to childhood obesity; a low-fiber diet, and physical inactivity are two such factors. The Commented [LS1]: Is there evidence from Indonesian research
aim of this research was that these are contributing factors in this population? Or in older
Method: Study design was a cross-sectional study and samples number was 147 students from Depok. children?
Results: Results showed that 31.3% of respondents were obese. Statistical analysis showed that there were Commented [LS2]: Sentence needed here to describe the aim of
significant differences in the average physical activity levels of obese students compared with students who the research.
were not obese (p = 0.007). Also, a relationship between preference for fiber source with obesity (p = 0.046) Commented [LS3]: What age were students?
and a relationship between fiber intake with obesity (p = 0.047) was identified. Multivariate analysis found that
Commented [LS4]: The results section should start by saying
factors which had a significant relationship with the incidence of obesity in primary school students were how many students participated.; Not for methods
physical activity levels and preference for food sources of fiber, while the factor of age, gender and fiber
Commented [LS5]: You might like to identify here the direction
consumption were confounding factors. of this difference.
Conclusion: Obesity among elementary school students could be decreased by doing physical activity and
raising awareness to prefer fiber source food to eat fiber source food Commented [LS6]: If ‘primary’ and ‘elementary’ are used to
mean the same thing, use just one of these terms throughout.
Keywords: Obesity, elementary school student, Physical Activity, dietary sources of fiber Commented [LS7]: This conclusion is unlikely to be justified
based on the results of your study alone. Association does not prove
causation.

1 Adv.Sci.Lett.Vol.v,No.n,2016 1936-6612/2011/4/400/008 doi:10.1166/asl.2011.1261

1
 RESEARCH ARTICLE

1. INTRODUCTION

An increasing prevalence of childhood obesity and got the attention of the governments and
nutritionists globally. In 2013, there were 42 million overweight or obese children, It is predicted that
with a continuation of current trends, by 2025 childhood overweight and obesity will increase to 70
million, an increase of approximately 30%. The incidence of obesity in children is much higher in Commented [LS8]: Do these figures relate to 0-5 year olds?
developing countries compared to developed countries1. If so, this should be specified.
The prevalence of obesity in children aged 5-12 years in Indonesia is 8.8%. The problem of Commented [LS9]: 70M is not a 30% increase of the earlier
figure. Check this.
childhood obesity in children aged 5-12 years in West Java is still high at 18.6%, consisting of 10.7% fat
and 7.9% obese2. Depok has the highest prevalence of overweight in girls in the province of West Java
(13.1%) and ranks second for prevalence in boys after the city of Bogor (14.5%)3. Commented [LS10]: Of what? Obesity? Overweight”? or both?
Consumption of vegetables and fruits in the province of West Java is as much as 71.66 kcal/capita/day Commented [LS11]: Exclude this if it does not relate to your
lower than the average consumption of fruits and vegetables of the Indonesian population. The average population and geographic area>
consumption of fruits is 35.82 percent of the recommended dietary allowance (RDA) that is 200 Commented [LS12]: This paragraph has an important purpose,
kcal/capita. The proportion of average expenditure per capita a month for vegetables and fruits to the total but is currently difficult to read and uses too many statistics. Can
you try and state your main point – Compared to other parts of the
expenditure for all foodstuffs in West Java province in 2007 was 11.6 percent. When in use the average country, West Javanese population has been shown to have a lower
value of minimum requirement of 120 kcal/ capita, the consumption of fruits and vegetables that exist on quality diet. - then be selective about the stats that you use.
the food menu of West Java, had reached about 59.72 percent of the recommended daily allowance Commented [LS13]: Reference required.
(RDA)4.
Commented [LS14]: Clarify – is this the national average
One of the causes of obesity is a high intake of food calories, this time in applied diet is a high- consumption or average consumption in West Java?
calorie food but low in fiber5. Less fiber intake is one of the originators of the overweight status. This is Commented [LS15]: unclear
explained by a study done by Serra-Majem et al., (2006) in Liou, Lioung and Chang (2010)6 which state
Commented [LS16]: Again, I believe that there is some
that consumption of vegetables and fruits are quite a source of dietary fiber, which can prevent confusion here between association and causation.
overweight status.
Commented [LS17]: Inadequate ref/evidence for your claim
The food calories consumed and the physical activity level affect energy balance. Physical activity here.
plays a role in increasing energy expenditure to produce energy balance. If the excessive intake is not
balanced with sufficient physical activity, there will be excessive weight gain7. Physical activity of West
Java province resident is categorized as less active by 33.0% with sedentary behavior ≥6 hours per day2.
According to research, Students who "rarely" consumed fibers 3,050 times likely to be obese, while
students who "do not like" the fiber source 1.240 times likely to be obese. Students who have physical
activity have "low" chance of 3.043 times the obese8.
Based on the above background, the aim of this study was to explore the relationship
between fiber consumption patterns and physical activity levels with obesity in primary school children in
elementary Mardiyuana Depok 2015.

2. METHOD
This study used a cross-sectional study design. Elementary school students were recruited Commented [LS18]: What was the age or year level of the
[FROM WHERE?] using a simple random sampling technique. The data was taken using the instrument children?
which tested the validity of research beforehand. Obesity is measured using BMI figures obtained through
the measurement of height and weight. Then the results of height and weight are calculated based on BMI
for age with a standard anthropometric assessment of nutritional status of children (Z score) are
categorized into, normal = -2 SD up to 1 SD and obesity => 2 SD. Data on fiber consumption habits was
collected using a food frequency questionnaire (FFQ). Commented [LS19]: Did this research receive ethical
clearance?

3. RESULTS
147 students, aged [add] years participated in this study. Majority of the student of Mardiyuana
Elementary School Depok has normal BMI/Age (68,7%). However, there were 31.3% students who were
obese. Table 1 shows the distribution of the nutritional status of students Elementary school Depok based
nutritional status, as measured by BMI / Age.
 RESEARCH ARTICLE

Table 1. Distribution of student’s Nutrition Status by BMI/Age Of Elementary School

Depok Jawa Barat in 2015
BMI/Age n (%)
Normal 101 68,7
Obese 46 31,3 Commented [LS20]: Have overweight and obese students been
Total 147 100 collapsed into a single category here? Why?

As for other respondent characteristics, data are summarized in Table 2 below.

Table 2 Student Characteristics of Elementary School in 2015

Age Frequency (n) Percentage
(%)
7-<10 yo 76 51,7
10-12 yo 71 48,3
Sex
Boy 76 51,7
Girl 71 48,3
Nutrition Knowledge Level Commented [LS21]: Methods section did not describe any
Good 121 82,3 method for assessing this.

Bad 26 17,7
Physical Activity Level Commented [LS22]: Was this self reported PA level or was this
measured directly?
Underscore 72 49,0
Adequate 75 51,0
Fiber Consumption Habit
Often 47 32,0
Seldom 100 68,0
Fiber Source Food Preferences level
Have Preferences 77 52,4
Don’t have preferences 70 47,6
Total 147 100

Majority of respondents aged between 7 to 10 years (51.7%), male sex (51.7%). Overall,
knowledge of good nutrition was high (82.3%) and have a good preference to food sources of fiber (52,
4%) have a sufficient level of physical activity (51%), but rarely consume food sources of fiber (68%).
Commented [LS23]: More accurate here to describe the
respondents as roughly half in the 7-10 year age group and half in
the 10-12 year age group, and approximately equal numbers of
males and females.
Commented [LS24]: Rewrite to highlight meaningful result.

Table 3. The relationship between characteristics of students with obesity in Primary Students
Mardi Yuana Depok, West Java, 2015
Variables Obesity
Category P AOR 95%
variables values CI
Sex Boy 0.06 2.098 1.030
Girl -
 RESEARCH ARTICLE

4.274
Fiber sourceHave 0.046 2.185 1.072-
food Preference 4.454
Preferences Have not
preference
Fiber Often 0.047 2.480 1.079-
consumption Seldom 5.700
habbit

Numeric P Mean 95%

variables values Difference CI
Age - 0.079 -0.294 -0.62-
0.04
Physical 0.002 175,25 67.854
Activity -
282.65
Total

Obesity is influenced by multifactorial causes.In this study chi-square test showed three variables
fiber sources food preferences, fiber consumption habit and physical activity had a significant association
with obesity (p<0.05).Among these variables, the highest AOR is fiber consumption habit (2.480 95% CI
1079-5.7). Also, there is a significant difference between the mean of physical activity among students
with the status of obesity (p <0.005).

Table 4. Logistic Regression Analysis of Significant Predictor of Obesity

Variables Obesity
B p- Exp 95%CI
value (B)
Preferens 1.122 0.007 3.070 1.367-6.892
Physical -0.002 0.005 0.998 0.997-0.999
activity
Age 0.147 0.709 1.158 0.535-2.507
Sex 0734 0.324 2.084 0.485-8.959

Results of statistical analysis using logistic regression seen in the final model that has an
influence on the incidence of obesity in students sd Mardiyuana Depok is a physical activity, preferences
towards food sources of fiber with variable age and gender as a confounding variable.

4. DISCUSSION
Results of the study identified that 31.3% of this elementary school student population are obese.
Based on Riskesdas data, nationally problems obese children aged 5-12 years are still high at 18.8 Commented [LS25]: Reference required.
percent, 10.8 percent consists of fat and very fat (obese) 8.8 percent. The prevalence of obese lowest in
East Nusa Tenggara (8.7%) and highest in Jakarta (30.1%). A total of 15 provinces with very overweight
prevalence above national, namely Central Kalimantan, East Java, Banten, East Kalimantan, Bali, West
Kalimantan, North Sumatra, Riau, Jambi, Papua, Bengkulu, Bangka Belitung, Lampung and Jakarta.
This shows that the proportion of obesity in primary school children in Depok Mardiyuana Elementary
School still quite high as above the national average2
The majority of the respondent (51,7%) aged between 7-<10 years old, and (51,7%). Groups of school
children 7-9 years of age have a slow rate of physical growth but consistent. Commented [LS26]: Unclear where these figures came from. If
they are results from this study, they should appear in previous
section (RESULTS).
 RESEARCH ARTICLE

Eating habits are formed at an early age, and the type of food preferred or not preferred, are the basis for
food consumption and nutrient intake of children aged further. The choice of food is influenced by their
peers and the people around them. School meal programs also affect food intake. Indonesia has not
developed a national school meals program. In fact, these programs have significantly contributed to the
nutritional intake of children9.
Research on nutrition knowledge of students was conducted to determine the level of nutrition
knowledge of Mardiyuana Elementary School students in Depok, West Java. Good category if the value
of nutrition knowledge of> 60% and less category if the value of nutrition knowledge of <60%. Based on
the data that has been obtained shown that as many as 82.3% of respondents have a knowledge of good
nutrition. The knowledge level of nutrition influence the attitudes and behavior in the selection of food
that will be consumed, with the knowledge of good nutrition, students are expected to choose a safe and
nutritious food 10.
Physical activity is a whole body movement that uses the body's muscles, thus increasing energy
expenditure to the maximum. Based on the data that has been obtained shown that 51% of respondents
doing enough physical activity. It can be seen that the percentage of enough activity on the respondents
more than the percentage of respondents who are less physical activity.
According to the table, 3 showed that as many as 34.2% of male respondents more often
consume food sources of fiber compared than female respondents. Indonesia Nutritional Adequacy Score
in 2013 stated that the fiber needs of children aged 7-9 years as many as 26 grams/day, males aged 10-12
as much as 30 grams/day and women aged 10-12 years as many as 28 grams/day.
Based on the type of fiber sources consumed by the respondent source of fiber is most often
consumed as much as 2.5 grams of respondents (9.6%) come from carbohydrate sources this is because
respondents more often consume carbohydrates that contain fiber such as rice, bread, biscuits, noodles,
corn, potato, and cassava. Based Indonesia Nutrition Adequacy Score fiber needs 7- respondents aged <9
years of as much as 9.6% from carbohydrates and fiber as much as 8.33% comes from carbohydrates in
children aged 10-12 years.
Based on the data that has been obtained shown that 52.4% of respondents liked the food sources of fiber.
A total of 52.4% of respondents liked the fruit and vegetables on the grounds of nutritious fruits and
vegetables contain vitamins. A total of 47.6% of respondents do not like because it tastes sour fruit and
some vegetables have a bitter taste. Respondents who like more fiber than those who do not like fiber, but
they only like fiber and rarely consume fiber due to the availability of food sources of fiber are less
environment of the family, could not eat the food source of fiber and in the school cafeteria is not
supplied snacks that contain fiber.
Physical activity is beneficial to health; physical activity helps maintain energy balance thus physical
activity may help prevent obesity11. Obesity also occurs not only because of excessive eating but also due
to lack of physical activity so that there is excess energy.
Some things that contributed to the lack of physical activity among these various facilities that
provide various facilities which can lead to decreased physical activity. Another factor is the advancement
of technology in various fields of life that encourages people to choose a lifestyle that does not require
heavy physical labor. This causes the number of people who do physical work is very limited become
more and more, causing an increase in obesity is a health problem. Most of the student of Mardiyuana
elementary school fo to school by car or motorbike.
Changes of foods pattern from traditional switched to fast food were the trigger for the increased
incidence of obesity due to excess calories. The impact is that the occurrence deficiency of certain
nutrients or non-nutrient, including fiber, whereas fiber, is useful for healthy digestive function and may
prevent colon cancer. Someone with diets containing fiber, rarely found obese. Fiber is a form of complex
carbohydrate foods are abundant in the cell walls of plants, which are resistant to hydrolysis by enzymes
in the stomach and small intestine. Many fibers derived from the cell walls of various vegetables and
fruits8.
Fiber can not be digested and absorbed by the human digestive tract, but it has a very important
function for health maintenance, disease prevention and as an important component in nutrition therapy12.
 RESEARCH ARTICLE

Children who are overweight or obese need more fiber-containing foods such as vegetables and fruits.
Eating habits in children who are obese will not change quickly, because eating habits illustrate eating
habits before and will continue until the children grow up13
World Health Organization (2009) also states that global changes in diet tend to occur in obese
children is the increased input of energy-dense foods that are high in fat and sugars but low in vitamins,
minerals, and other healthy micronutrien14.
Results of research conducted by Utami (2009) states that there is a relationship between fiber
consumption habits to the incidence of obesity in primary school students of Islam Annajah Jakarta. Commented [LS27]: Use number (superscript) at end of
Students who rarely consume food sources of fiber 3,050 times likely to be obese than those commonly sentence for reference.

consumed. This can occur due to 19.2% maternal nutrition knowledge is lacking, so it can cause food
availability will be a source of fiber at home becomes less fulfilled8.
Multivariate analysis found that factors which had a significant relationship with the incidence of
obesity in primary school students was physical activity and preference for food sources of fiber, while
the factor of age, gender and fiber consumption became a confounding factor. This result is in line with
recommendation and report from Division of Adolescent and School Health, National Center for Chronic
Disease Prevention and Health Promotion which developed school health guidelines for promoting
healthy eating and physical activity, including coordination of school policies and practices; supportive
environments; school nutrition services; physical education and physical activity programs; health
education; health, mental health, and social services; family and community involvement; school
employee wellness; and professional development for school staff members15.
5. CONCLUSION
Obesity influenced by many factors, in this study factor that most influences to obesity on a student
of Mardiyuana Depok are physical activity and preference for food sources of fiber. Commented [LS28]: This study has examined association not
ACKNOWLEDGEMENTS causation.
An earlier version of this paper was prepared for student’s final script. The authors wish to
thanks, Dini Novi, Taufik Maryusman academia of faculty health sciences UPN Veteran Jakarta.
REFERENCES
1. World Health Organization. Childhood Obesity, http://www.who.int/end-childhood-obesity/news/echo-
second-meeting/en/. 2013.
2. Badan Penelitian dan Pengembangan
Kesehatan.Kemenkes RI. Laporan Nasional Riset
Kesehatan Dasar 2007. Jakarta,(2013)
3. Profil Kesehatan Jawa Barat Commented [LS29]: ?incomplete reference
4. Badan Pusat Statistik. Pola dan perilaku konsumsisayur dan buah di masyarakat serta strategi
Promosi peningkatannya. BPS : Jakarta, (2007)
5. Gharib, Nadia and Parven Rasheed, Energy and
Macronutrient Intake and Dietary Pattern
Among School Children in Bahrain : A Cross-
Sectional Study, Nutrition Journal, 10-26, (2011).
6. Liou, Yiing Mei, Tsan-Hon Liou, dan Lu-Chuan
Chang, Obesity Among Adolescents:
Sedentary Leisure Time and Sleeping As
Determinants. Journal of Advanced Nursing, 66(6): 1246-1256 (2010). Commented [LS30]: If your study is looking at primary aged
7.Hill,James O,Wyatt Holly R,Peters Jhon C, Energy Balance and Obesity, Circulation, children , then you should be drawing on literature that looks at a
similar population
Commented [LS31]: Check referencing