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"This cross sectional study was carried out in Jakarta, among institutionalized elderly aged 60 - 74 years. Rabe study reported that there is a high prevalence of low body mass index (BMI) value among the elderly in Jakarta. Ferro-Luzzi et at (1992) and James et al (1988) stated that an adult person with BMI less than 18.5 kg/m2 was proposed being chronic energy deficient (CED) and had functioning and health impairment. General aim of this study is to investigate whether low BMI among elderly is associated with adaptation in energy expenditure and had negative consequences on health. Based on James and colleague classification of BMI, two groups of elderly with different BMI value represented this study. Twenty elderly subjects with BMI < 11.00 kg/m2 (low BMI group) and 20 elderly subjects with BMI 22.0 --25.00 kg/m2 (normal BMI group). To every subject in each group was conducted questionnaires, Hb level measurement, 2 days combined record and recall daily physical activity, 2 days combined food weighing and 24-hour food recall intake, and resting energy expenditure (REE). Body composition was assessed by skinfolds technique and bioelectrical impedance analysis (BIA) using Lukaski and Deurenberg equations. Result revealed that fat mass and fat free mass of low BMI subjects are significantly lower than the normal BMI subjects. The low BMI subjects had very low fat mass. However, both groups had same PAL [1.3 X basal Metabolic rate (BMR)]. The low BMI subjects who were considered as CED had similar level of activity of daily living (ADL) as those with normal BMI subjects. Both BMI group had no significant different on the number of health complaint. On the whole, findings indicated that the CED elderly had no physical adaptation and negative consequences on health. Anyway using the cut-off point to define CED proposed by Ferro-Luzzi and colleague for Indonesian elderly needs carefully consideration. "

"The urban population in Indonesia will soon be 50% of its total population. In the past, nutrition improvement programs were addressed to the rural community stressing on underweight. It is presumed that in the urban area both under and overweight are found. However, data on the subject are insufficient. A cross sectional study was done in East Jakarta. The study consisted of 679 households and 3442 peoples were chosen through a multistage random sampling. The analyses of the findings were based on households as well as on individuals.The households were categorized based on the anthropometry of the individual family members. The indicator used, was BMI with a cut off 18.5 and 25 for those aged 17 years and more, and weight-for-age based on NCHS median + 2SD for those aged less then 17-year-old. Four households' categorizations were identified, Normal (all members had normal anthropometric status) 22.2%, Normal-Under (a combination of normal and underweight) 31.6%, Normal-Over (a combination of normal and overweight) 27.1% and Normal-Under-Over (a combination of normal, under and overweight) 17.2%. It covered 98.3% of all households.Within households classified as having any overweight members, there were 37.9% overweight adults vs 2.3% overweight children. Within households classified as having any underweight members, there were 26.9% underweight adults vs 35.8% underweight children. Poorer households and households with children faced the risk for having underweight members, while richer households and households with adults faced the risk for having overweight members. Underweight is not only caused by poor socioeconomic background. There were differences in the food distribution patterns among the household members, and households with over weight members consumed more variety of foods.Among children aged less than 17 years old, 21.4% were stunted (HAZ<-2SD), and 21.2% were underweight (WAZ<-2SD). Children aged less than 11 years 11.4% were wasted (WHZ<-2SD)_ Children aged less than 17 years whose HAZ, WAZ and WHZ were 2SD were less than 3%. Children aged 11 to 17 years old whose BMI was below 5%-tiles were 5.2%, while those whose BMI was above 85%-tiles were 15.2%. Adults aged 17 to 55 years old with BMI <18.5 were 15.6% and those with BMI >25 was 19.6%_ People aged more than 55 years old with BMI <18.5 was 18.7%, while those with BMI of X25 were 20.9%. Thus, underweight was prevalent in all age groups, but overweight was mainly found in adults and elderly. Among the adolescents the older age group showed a tendency of being overweight.It is recommended that, household groupings according to the anthropometric status of the nuclear family members can be used as a screening method which serves the purpose of distinguishing the target population, in administrative, and project design and management terms, and to do an anthropometry assessment at regular intervals for all age groups. Special attention to detect overweight among adolescents should be given. Prevention of overweight in the community requires a multi sectoral approach rather than purely nutrition oriented programs. To continue the existing programs in nutrition and health, to prevent underweight in the community, especially for under fives, school children and adults. Within the poorer households there is positive deviance (as shown in Normal groups), this gives room for intervention."

"ABSTRACTCoronary Heart Disease (CHD) morbidity and mortality rate is increasing dramatically in the last 15 years in Indonesia. Available data show that among the contribution factor changes in life style and demographic transition are prominent.A hypothetical risk factor for CHD is lipid peroxidation, a reaction between oxygen free radical and lipid parts of cell membranes and low density lipoprotein (LDL). Food habit is following a pattern of nutrient and non-nutrient intakes, including fatty acids and antioxidants. Fatty acid intakes determine the susceptibility of the lipid parts of eell membranes and LDL to peroxidation by free radicals. Theoretically, antioxidants will protect against oxidative damage caused by oxygen free radicals. Commercially available and advertised antioxidants such as vitamin E are widely used inspite of limited information on the interrelation between lipid peroxide levels in the Indonesian elderly with CHD risk factors such as food habits, dyslipidemia and obesity.A two-phase study on the elderly (55-85 years.) guided by the health centers was undertaken in Jakarta. Data for both phases were collected through interviews, anthropometric measurements, blood analysis and blood pressure measurements. Univariate, bivariate and multivariate analysis were done using SPSS and WorldFood 2 programs.The first phase was a cross-sectional study to see the association between lipid peroxides and fatty acids, vegetables, fruits, tempe intakes, obesity, smoking, dyslipidemia and hypertension. The samples were 394 elderly. The variables found correlated with lipid peroxides were LDL, intake of mono and poly-unsaturated fatty acids, tempe, and vitamin E. The study showed an increase level of lipid peroxides with age and ethnic differences with the highest level of lipid peroxides among the Minangkabau.The second phase is a randomized double-blind trial giving 600 mg/day vitamin E supplementation or placebo for 12 weeks to 152 elderly with the high level of lipid peroxides found in the cross-sectional study. The objective was to see if there was a change of lipid peroxide levels after the intervention. The results showed a significant decrease of lipid peroxides level in the vitamin E group compared to placebo after being adjusted with age, waist-hip ratio (WHR), plasma cholesterol, and saturated fatty acids (SAFA) intake. The high density lipoprotein (HDL) was also increased significantly in the vitamin E group compared to placebo group.Randomized controlled trial taking into account the confounding variables such as age, sex, ethnic, waist-hip ratio, saturated fat intake, carbohydrate intake and plasma cholesterol might be able to elucidate the specific beneficial effect of vitamin E supplementation. Health education and information concerning foods that have effect on lipid peroxidation, such as tempe should be endorsed. More studies should be undertaken to find other food or beverage that have protecting effects against lipid peroxides."

"Cardiovascular disease has not only affected the quality of human resources, but also a primary cause of deathin Indonesia today. The high incidence of cardiovascular risk factors among diverse ethnicity in Indonesia have incurred a speculation that is closely related to the food consumption as well as nutrient intake patterns among ethnic group in Indonesia, such as Minangkabau, Sundanese, Javanese and Buginese.The general objective of this study is to study the importance of the ethnic factors for known risk factor of CVD. This study consists of three cross sectional studies. Each cross sectional study had its own objective and own sample size. The objectives of the first cross sectional study was to describe nutrient intake patterns and body mass index among the four ethnic group. The objective of the second cross sectional study was to describe lipid profiles among the four ethnic groups. While the objective of the third cross sectionl study were to assess the interplay between ethnics, nutrient intake patterns, body mass index and physical activity index as predictors determinant of lipid profiles in the study population and also to assess the association between nutrient intake patterns and lipid profiles among MInangkabau, Sundanese, Javanese and Bugines ethnic."

"Anemia is the main micronutrient deficiency problem among adolescent school girls in Indonesia. Anemia due to iron deficiency often coexists with zine deficiency. Iron and zinc have anlagonistic interaction. Therefore, it was appropriate ratio of iron-zinc supplementation.ObjectiveThe study was aimed to investigate the different ratios of iron-zinc supplementation Fe: Zn = 2: 1 and Fe: Zn = 4: 1 on improving the iron and zinc status and eventually reduction of the morbidity of anemic adolescent school girls compared to iron supplementation alone.MethodologyA randomized, double blind community trial was conducted among anemic adolescent school girls (10-12 years old). Selection of subjects was conduted in two steps. Firstly, 238 girls (out of 1358 girls), with hemoglobin concentration level < 115 g/L using Hemocue were recruited and given antihelminthic drug (500 mg mebendazole as a single dose). Secondly, those who had hemoglobin concentration < 120 g/L using Cell Dyn from venous blood one week after deworming (n+133) were enrolled into the study.The 133 subjects were assigned randomly to one of the three groups for daily iron-zinc supplementation for 12 weeks with: Group 1 (n=45): iron (60 mg/day), Group 2 (n=45): iron and zinc (30 mg and 15 mg/day) or group 3 (n=43): iron and zinc (60 mg and 15 mg/day).Supplement intake was supervised at base line, weight and height were measured and the available iron and zinc intake from diet was estimated using a model modified from WHO/FAO and Murphy, based on the data 24-hour Food Recall and Food Frequency Questionnare. Iron (hemoglobin/Hb, serum ferritin/SF, serum transferrin receptor/TfR, zinc protoporphyrin/ZPP, Mean Corpuscular Volume/MCV, Red-cell Distribution Width/RDW, body iron/BI) and zinc (serum zinc/SZ) status and supplementation. Morbidity status of diarrhea and Acule Respiratory Infection (ARI) were recorded weekly. The phagocytes cell and Cell-Mediated Immunity were measured only for 50% of the subjects.Results and DiscussionBy the end of the supplementation, most indicators of iron status were increased significantly in all subjects both they took iron supplementation with or without zinc, and the proportion of iron deficiency anemia reduced. Iron supplementation alone or iron-zinc improved zinc status. The proportion of zinc deficiency was sinificantly reduced only among subjects who took iron-zinc supplementation with the ratio of Fe: Zn =2: 1. which was significantly lower compared to the other two groups at the end of supplementation. In iron/zinc 2 : 1 group, no subject had iron deficiency anemia and zinc deficiency after 12 weeks of supplementation, which suggested that iron-zinc supplementation with the ration of Fe: Zn = 2 : 1 had reduced both iron deficiency anemia and zinc deficiency.In this study, iron deficiency among anemic school girls was due to insufficiency of iron in red blood cell, and iron or iron-zinc supplementation for 12 weeks had less benefit to increase iron status. The possibility; of hemoglobinopathies such as thalassemia trait affecting adolescent girls in this study should be considered as several studies indicated that the prevalence of tlinlassemia trait among the same population in Indonesia is high.Iron deficiency also occurred at the storage level, which increased and reached the normal value with iron or iron-zinc supplementation. At the end of supplementation, the mean value of most indicators of iron status in all groups did not reach the normal value (such as Hb < 120 g/L, ZPP > 40 umol/mol heme, MCV <2 80 fL, RDW > l4%), perhaps the 12-weeks of iron supplementation was not long enough to fulfill iron for the 120 erythrocyte life cycle.lt seems, that the competition between iron and zinc occurred both at the storage level and the erythrocyte formation, and iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction as the improvement of both iron and zinc status was higher compared to the other groups. Most anemic adolescent school girls in this study had low available iron and zinc intake from the diet, with low intake of enhancers and high intake of inhibitors, which is not enough to promote either iron or zinc absorption from the supplements.The reduction of the proportion ol' subjects suffering from ARI was the highest among subjects who took either iron alone (3l.1% to 6.7%) compared to those who took iron- zinc supplement with ratio 2: 1 (1 7.3% to l1.l%) or iron-zinc supplement with ratio 4: 1(16.3 % to l4%), indicating that iron alone reduced morbidity status in tenn of Acute Respiratory Infection (ARI). However, adding zinc to iron supplements with ratio 2: 1 scents to improve the specific immune response of anemic adolescent school girls, as shown that the ratio of CD-4/CD-S was slightly increased among subjects who took iron-zinc supplement with the ratio of Fe: Zn= 2: 1.Conclusions and Recommendationslt was concluded, that both iron deficiency anemia (22%) and zinc deficiency (15.8%) were problems in the study area. Iron deficiency and hemoglobinopathies such as that assemia trait might be the causes of anemia among adolescent school girls. A daily 30 mg iron and 15 mg zinc supplementation among anemic adolescent schools girls for 12 weeks improved iron and zinc status and reduced iron deficiency anemia and zinc deficiency. Iron supplementation alone increased iron status, while adding zinc to iron supplementation protected the adverse effect of iron on decreasing zinc status.The competition between iron and zinc might occur in the role of both nutrients for erythrocytes formation as well-as at storage level, and supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction on improving bot.h iron and zinc status. As most of the anemic adolescent school girls had inadequate iron and zinc intake from the diet, the deficiencies of other micronutrients such as; vitamin A, folic acid and vitamin B12 should also be considered as the causes of anemia.Combined iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 was appropriate on reducing the risk of anemic adolescent school girls suffering from Acute Respiratory Infection, however the mechanism of both iron and zinc on enhancing immune system could not clearly be shown from the results of this study.It is recommended to establish an iron-zinc supplementation program with ratio of 2: 1 through the existing channel of school health program to alleviate iron de iciency anemia and zinc deficiency 'among adolescent girls. Research cum action prioritized is to explain the contribution of bioavailability iron and zinc intake from the diet including increase the enhancers and minimize the inhibitors to the absorption of iron-zinc supplementation with ratio of Fe: Zn = 2: 1. The possibility of hemoglobinopathies such as thalassemia trait, as the cause of anemia needs further investigations."

"Anemia is the main micronutrient deficiency problem among adolescent school girls in Indonesia. Anemia due to iron deficiency often coexists with zine deficiency. Iron and zinc have anlagonistic interaction. Therefore, it was appropriate ratio of iron-zinc supplementation. Objective The study was aimed to investigate the different ratios of iron-zinc supplementation Fe: Zn = 2: 1 and Fe: Zn = 4: 1 on improving the iron and zinc status and eventually reduction of the morbidity of anemic adolescent school girls compared to iron supplementation alone. Methodology randomized, double blind community trial was conducted among anemic adolescent school girls (10-12 years old). Selection of subjects was conduted in two steps. Firstly, 238 girls (out of 1358 girls), with hemoglobin concentration level < 115 g/L using Hemocue were recruited and given antihelminthic drug (500 mg mebendazole as a single dose). Secondly, those who had hemoglobin concentration < 120 g/L using Cell Dyn from venous blood one week after deworming (n+133) were enrolled into the study. The 133 subjects were assigned randomly to one of the three groups for daily iron-zinc supplementation for 12 weeks with: Group 1 (n=45): iron (60 mg/day), Group 2 (n=45): iron and zinc (30 mg and 15 mg/day) or group 3 (n=43): iron and zinc (60 mg and 15 mg/day).Supplement intake was supervised at base line, weight and height were measured and the available iron and zinc intake from diet was estimated using a model modified from WHO/FAO and Murphy, based on the data 24-hour Food Recall and Food Frequency Questionnare. Iron (hemoglobin/Hb, serum ferritin/SF, serum transferrin receptor/TfR, zinc protoporphyrin/ZPP, Mean Corpuscular Volume/MCV, Red-cell Distribution Width/RDW, body iron/BI) and zinc (serum zinc/SZ) status and supplementation. Morbidity status of diarrhea and Acule Respiratory Infection (ARI) were recorded weekly. The phagocytes cell and Cell-Mediated Immunity were measured only for 50% of the subjects. Results and Discussion By the end of the supplementation, most indicators of iron status were increased significantly in all subjects both they took iron supplementation with or without zinc, and the proportion of iron deficiency anemia reduced. Iron supplementation alone or iron-zinc improved zinc status. The proportion of zinc deficiency was sinificantly reduced only among subjects who took iron-zinc supplementation with the ratio of Fe: Zn =2: 1. which was significantly lower compared to the other two groups at the end of supplementation. In iron/zinc 2 : 1 group, no subject had iron deficiency anemia and zinc deficiency after 12 weeks of supplementation, which suggested that iron-zinc supplementation with the ration of Fe: Zn = 2 : 1 had reduced both iron deficiency anemia and zinc deficiency. In this study, iron deficiency among anemic school girls was due to insufficiency of iron in red blood cell, and iron or iron-zinc supplementation for 12 weeks had less benefit to increase iron status. The possibility; of hemoglobinopathies such as thalassemia trait affecting adolescent girls in this study should be considered as several studies indicated that the prevalence of tlinlassemia trait among the same population in Indonesia is high. Iron deficiency also occurred at the storage level, which increased and reached the normal value with iron or iron-zinc supplementation. At the end of supplementation, the mean value of most indicators of iron status in all groups did not reach the normal value (such as Hb < 120 g/L, ZPP > 40 umol/mol heme, MCV <2 80 fL, RDW > l4%), perhaps the 12-weeks of iron supplementation was not long enough to fulfill iron for the 120 erythrocyte life cycle. lt seems, that the competition between iron and zinc occurred both at the storage level and the erythrocyte formation, and iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction as the improvement of both iron and zinc status was higher compared to the other groups. Most anemic adolescent school girls in this study had low available iron and zinc intake from the diet, with low intake of enhancers and high intake of inhibitors, which is not enough to promote either iron or zinc absorption from the supplements. The reduction of the proportion ol' subjects suffering from ARI was the highest among subjects who took either iron alone (3l.1% to 6.7%) compared to those who took iron- zinc supplement with ratio 2: 1 (1 7.3% to l1.l%) or iron-zinc supplement with ratio 4: 1(16.3 % to l4%), indicating that iron alone reduced morbidity status in tenn of Acute Respiratory Infection (ARI). However, adding zinc to iron supplements with ratio 2: 1 scents to improve the specific immune response of anemic adolescent school girls, as shown that the ratio of CD-4/CD-S was slightly increased among subjects who took iron- zinc supplement with the ratio of Fe: Zn= 2: 1 Conclusions and Recommendations lt was concluded, that both iron deficiency anemia (22%) and zinc deficiency (15.8%) were problems in the study area. Iron deficiency and hemoglobinopathies such as that assemia trait might be the causes of anemia among adolescent school girls. A daily 30 mg iron and 15 mg zinc supplementation among anemic adolescent schools girls for 12 weeks improved iron and zinc status and reduced iron deficiency anemia and zinc deficiency. Iron supplementation alone increased iron status, while adding zinc to iron supplementation protected the adverse effect of iron on decreasing zinc status. The competition between iron and zinc might occur in the role of both nutrients for erythrocytes formation as well-as at storage level, and supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction on improving bot.h iron and zinc status. As most of the anemic adolescent school girls had inadequate iron and zinc intake from the diet, the deficiencies of other micronutrients such as; vitamin A, folic acid and vitamin B12 should also be considered as the causes of anemia. Combined iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 was appropriate on reducing the risk of anemic adolescent school girls suffering from Acute Respiratory Infection, however the mechanism of both iron and zinc on enhancing immune system could not clearly be shown from the results of this study. It is recommended to establish an iron-zinc supplementation program with ratio of 2: 1 through the existing channel of school health program to alleviate iron de iciency anemia and zinc deficiency 'among adolescent girls. Research cum action prioritized is to explain the contribution of bioavailability iron and zinc intake from the diet including increase the enhancers and minimize the inhibitors to the absorption of iron-zinc supplementation with ratio of Fe: Zn = 2: 1. The possibility of hemoglobinopathies such as thalassemia trait, as the cause of anemia needs further investigations."