Hubungan Status Sosial Ekonomi dengan Kualitas Diet Penduduk Dewasa Indonesia

Abstract

Tingginya konsumsi makanan cepat saji serta kurangnya asupan serat menjadi tanda adanya perubahan pola makan di masyarakat. Salah satu cara mencapai tujuan global dalam mengurangi beban Penyakit Tidak Menular (PTM) adalah dengan memilih pola makan dan gaya hidup sehat. Pedoman Gizi Seimbang (PGS) merupakan danacuan perilaku hidup sehat yang merekomendasikan diet dengan susunan gizi seimbang untuk mencapai status kesehatan optimal. Acuan diet sehat dalam PGS ini sudah seharusnya diterapkan oleh masyarakat Indonesia untuk mengurangi risiko terkena PTM. Individu dengan pendapatan rendah cenderung memiliki kualitas diet buruk yang tidak mengonsumsi makanan sesuai rekomendasi. Faktor sosial ekonomi ini menjadi salah satu pertimbangan dalam penilaian kualitas diet. Contohnya populasi dewasa dengan status sosial ekonomi tinggi di Belanda lebih banyak mengonsumsi sayur dan keju dan di negara Swiss mengonsumsi pangan olahan susu, ikan, dan minuman berpemanis. Hasil penilaian kualitas diet di Indonesia dengan menggunakan survey nasional masih terbatas pada konsumsi sayur, buah, gula, garam, dan lemak, namun belum menunjukkan konsumsi pangan dan zat gizi terkait PTM. Alternate Healthy Eating Index (AHEI) merupakan instrumen penilaian kualitas diet dengan susunan kelompok bahan makanan dan zat gizi yang spesifik menurunkan risiko terjadinya PTM seperti omega-3 dan polyunsaturated fatty acid (PUFA) serta kelompok bahan makanan dan zat gizi yang spesifik meningkatkan risiko terjadinya PTM seperti lemak trans, alkohol dan natrium. Peningkatan nilai AHEI berhubungan signifikan dengan penurunan risiko PTM. Oleh karena itu, peneliti tertarik untuk menganalisis hubungan status sosial ekonomi dewasa Indonesia dengan kualitas diet menggunakan instrumen AHEI dengan penyesuaian porsi PGS. Penelitian menggunakan data sekunder Survei Konsumsi Makanan Individu (SKMI) dari rangkaian Studi Diet Total (SDT) 2014 oleh Badan Penelitian dan Pengembangan Kesehatan Republik Indonesia (Balitbangkes RI). Desain studi menggunakan deskriptif kuantitatif dengan kriteria inklusi berusia 19-55 tahun dan sehat, sedangkan kriteria eksklusi adalah keadaan biologis sedang hamil, menyusui, dan sakit. Variabel karakteristik subjek meliputi jenis kelamin, usia, besar keluarga, status kawin, tingkat pendidikan, status kerja, klasifikasi wilayah, dan status ekonomi. Variabel kualitas diet berupa konsumsi pangan dari recall 1x24 jam. Kualitas diet dengan mengelompokkan 11 komponen AHEI yang terdiri atas tujuh pangan dan empat zat gizi. Kandungan zat gizi dibuat database khusus, yakni natrium mengacu pada dataset SKMI/TKPI dan asam lemak (lemak trans, omega-3, PUFA) mengacu pada Food Composition Table (FCT) ASEAN, FOCOS (Singapura) dan Bowes and Church’s Food Values, sedangkan tujuh komponen pangan langsung dikelompokkan, dihitung total konsumsinya dan dikonversi ke dalam porsi, Omega-3, dan natrium disesuaikan dengan porsi makan PGS dan Angka Kecukupan Gizi (AKG) dewasa Indonesia, sedangkan komponen lainnya berdasarkan porsi AHEI. Skor AHEI per masing-masing komponen dinilai 10 (skor maksimum) dan nilai 0 (skor minimum) sehingga total skor akhir AHEI bekisar 0-110 poin. Kualitas diet didapatkan dari skor akhir AHEI yang dikategorikan menjadi kualitas “baik” dan “butuh perbaikan”. Analisis data menggunakan SPSS versi 23.0 dan Ms. Excel for mac 16.20 terdiri dari analisis univariat (deskriptif), bivariat (Chi-square, Mann-Whitney, Kruskal-wallis), dan multivariat (regresi logistik multinomial). Mayoritas subjek (52,4%) berjenis kelamin perempuan dan berusia 37,7 ± 10,1 tahun dengan besar keluarga tergolong kecil (53,8%). Sebanyak 63,3% subjek berpendidikan rendah (tidak sekolah hingga sudah menyelesaikan jenjang SMP). Pada umumnya subjek sudah bekerja (68,6%) dan sebanyak 54,5% subjek tinggal di wilayah pedesaan. Persentase tertinggi status ekonomi terdapat kategori kuintil kekayaan menengah atas (21,7%). Median skor kualitas diet subjek adalah 55,6 dari 110 dengan IQR 49,9-61,3 poin. Jenis komponen makanan yang porsinya sudah sesuai dan mendapatkan skor maksimum (10) pada penilaian kualitas diet adalah padi-padian/pangan pokok (100g/hari), daging merah dan olahannya (0 porsi), serta alkohol (0 porsi), dengan skor median AHEI 10 dan IQR 10-10. Sebagian besar subjek (65,9%) perlu perbaikan dalam kualitas dietnya. Butuh peningkatan konsumsi sayur sebanyak tiga porsi, buah-buahan sebanyak lima porsi, kacang-kacangan sebanyak tiga porsi, omega-3 dan PUFA minimal 100g ikan segar, serta mengurangi lemak trans dan natrium. Jeinis keilamin, beisar keiluarga, status pekerjaan, tingkat peindidikan, klasifikasi wilayah, dan status eikonomi memiliki hubungan signifikan (p<0,05) terhadap kualitas diet. Status kawin tidak ada hubungan yang signifikan (p>0,05) terhadap kualitas diet. Terdapat perbedaan signifikan (p<0,05) median skor kualitas diet antar jenis kelamin, besar keluarga, tingkat pendidikan, klasifikasi wilayah, status ekonomi dan subjek kawin dengan subjek cerai. Subjek perempuan, subjek yang bekerja, dan yang tinggal di perkotaan cenderung memiliki kategori baik dalam kualitas dietnya. Semakin tinggi pendidikan dan kuintil kekayaan akan meningkatkan peluang kualitas diet menjadi baik. Sama halnya dengan semakin kecil jumlah anggota keluarga, maka peluang kualitas dietnya semakin baik sebesar 1,3 kali (95%CI:1,19-1,34). Anjuran makan yang secara spesifik berkaitan dengan PTM perlu diperbaharui dalam PGS, seperti meningkatkan porsi ikan segar sebanyak dua porsi. Sebaiknya penyuluhan gizi dalam meningkatkan buah, sayur, kacang-kacangan dan ikan serta membatasi makanan tinggi lemak dan makanan kemasan yang tinggi natrium. Selain itu, perlu dilakukan penelitian lanjut untuk menentukan batasan porsi maksimum (upper level) konsumsi padi-padian/pangan pokok agar skor kriteria maksimum tidak overestimate.

The high consumption of fast food, processed and ultra-processed food and the lack of fiber intake are signs of a change in eating patterns in society. One of the most important ways to achieve the global goal of reducing the burden of Non-Communicable Diseases (NCDs) is to choose a healthy diet and lifestyle. Balanced Nutrition Guidelines (PGS) is a reference for healthy living behavior that recommends a diet with a balanced nutritional composition to achieve optimal health status. The reference to a healthy diet in PGS should be implemented by the Indonesian people to reduce the risk of getting NCDs. Individuals with low income tend to have poor quality diets who do not consume food according to recommendations. This socio-economic factor becomes one of the considerations in assessing the quality of the diet. For example, the adult population with high socioeconomic status in the Netherlands consumes more vegetables and cheese and in Switzerland consumes dairy foods, fats, fish and sweetened drinks. The results of assessing the quality of the diet in Indonesia using a national survey are still limited to the consumption of vegetables, fruit, sugar, salt and fat, but have not shown the consumption of food and nutrients related to NCDs. The Alternate Healthy Eating Index (AHEI) is an instrument for assessing the quality of a diet with a composition of groups of food ingredients and specific nutrients that reduce the risk of NCDs such as omega-3 and polyunsaturated fatty acids (PUFA) as well as groups of food ingredients and nutrients that specifically increase the risk of NCDs such as trans fats, alcohol and sodium. An increase in the AHEI score is significantly associated with a reduced risk of NCDs.Therefore, researchers are interested in analyzing the relationship between Indonesian adult socio-economic status and diet quality using the AHEI instrument with adjustments to the portion of PGS. This study used secondary data from the Individual Food Consumption Survey (SKMI) from the 2014 Total Diet Study (SDT) series by the Republic of Indonesia Health Research and Development Agency (Balitbangkes RI). The study design used descriptive quantitative with inclusion criteria aged 19-55 years and healthy, while the exclusion criteria were pregnant, lactating, and sick biological condition. Subject characteristic variables include gender, age, family size, marital status, education level, work status, regional classification, and economic status. Diet quality variable in the form of food consumption from 1x24 hour recall. Diet quality by grouping 11 AHEI components consisting of seven foods and four nutrients. The nutritional content is made up of a special database, namely sodium refers to the SKMI/TKPI dataset and fatty acids (trans fats, omega-3, PUFA) refers to the ASEAN Food Composition Table (FCT), FOCOS (Singapore) and Bowes and Church's Food Values, while seven food components are directly grouped, total consumption is calculated and converted into portions. Omega-3 and sodium are adjusted according to the PGS food portion and the Indonesian adult nutritional allowance (RDA), while the other components are based on AHEI. AHEI score for each component is rated 10 (maximum score) and 0 (minimum score) so that the total final AHEI score ranges from 0-110 points. Diet quality was obtained from the final AHEI score which was categorized into "good" and "needs improvement" quality. Data were analyzed with SPSS ver 23.0 and Ms. Excel for mac 16.20 consists of univariate (descriptive), bivariate (Chi-square, Mann-Whitney, Kruskal-wallis), and multivariate (multinomial logistic regression) analysis. The majority of subjects (52,4%) were female and aged 37,7 ± 10,1 years with a relatively small family size (53,8%). As many as 63,3% of the subjects had low education (did not go to school until they had completed junior high school). In general, the subjects were already working (68,6%) and as many as 54,5% of the subjects lived in rural areas. The highest percentage of economic status is in the upper middle wealth quintile category (21,7%). The subjects' median diet quality score was 55,6 out of 110 with an IQR of 49,9-61,3 points. The types of food components whose portions are appropriate and get the maximum score (10) on the quality assessment of the diet are grains/staple food (100g/day), red meat and processed products (0 portions), and alcohol (0 portions), with a median score AHEI 10 and IQR 10-10. Most of the subjects (65,9%) need improvement in the quality of their diet. Need to increase consumption of three servings of vegetables, five servings of fruit, three servings of nuts, omega-3 and PUFA at least 100g of fresh fish, and reduce trans fat and sodium. Gender, family size, employment status, education level, regional classification, and economic status had a significant relationship (p<0,05) to diet quality. Marital status had no significant relationship (p>0,05) to diet quality. There were significant differences (p<0,05) in the median score of diet quality between sexes, family size, education level, area classification, economic status and subjects married to subjects divorced. Female subjects, working subjects, and those living in urban areas tend to have a good category in terms of the quality of their diet. The higher the education and wealth quintile, the higher the chances of a good quality diet. Similarly, the smaller the number of family members, the better the quality of the diet chance of 1,3 times (95% CI: 1,19-1,34). Meal recommendations specifically related to PTM need to be updated in the PGS, such as increasing the portion of fresh fish by two servings. It is better to provide nutrition counseling in increasing fruits, vegetables, nuts and fish and limiting high-fat foods and packaged foods that are high in sodium. In addition, it is necessary to carry out further research to determine the maximum portion limit (upper level) of grain/staple food consumption so that the maximum criterion score is not overestimated.