PhD THESIS 2000

Cross-Cultural Comparison of Nutrition and Ageing in Indonesia and Other Communities

Martalena br Purba

Summary

This thesis examines CVD risk factors in relation to food, nutrient intakes, and body composition of older Indonesians aged 65 years and over living in urban metropolitan Jakarta and urban non-metropolitan Semarang, Central Java, Indonesia. A total of 461 elderly (220 elderly residing in Jakarta and 241 elderly in Semarang) was recruited with an attempt to establish the baseline characteristics of older Indonesians. The Indonesian data, then, were compared to Caucasian data of IUNS study on Food Habits in Later Life. This thesis also explores skin ageing as an integrative index of healthy ageing and its association with food intakes amongst Caucasian elderly (177 Greek Australian, 69 Greeks in Greece, 48 Anglo-Celtic Australians, and 159 Swedes in Sweden).

The main findings were:

FOOD HABITS
1. This study confirmed that older Indonesians were still following traditional food habits. Traditional Indonesian diet can be defines as vegetarian - foods from plant sources formed the core of the diet, while foods from animal sources formed the fringe of the diet. Legumes and vegetables were used as an integral part of meals, not served on the side and meat was used as a condiment. Daily diet of the elderly subjects comprised 33% rice, 23% tempeh, tofu, and other legumes, 19% vegetables, 14% fruits, and the rest animal foods.

2. Jakarta elderly had significantly higher total food intakes than Semarang elderly. Of the animal foods, Jakarta elderly had a higher intake of meat, lower of dairy products, and similar of egg and fish, compared to their Semarang counterparts. Jakarta elderly had significantly higher plant foods including tempeh, tofu, other legumes, rice, fruit, vegetables, and coconut milk. The only foods consumed higher in Semarang were sugar, milk, and dairy products. Jakarta men had significantly higher consumption of meat, fish, and rice than Jakarta women; while Semarang men had significantly higher consumption of tempeh, tofu, and rice than their female counterparts.

3. The averaged total food intake of the Indonesians (659g/d) was half the amount of Caucasians (1179-1531g/d). The men in all communities tended to have a higher total food intake compared to the women. The majority of Indonesian elderly (75%) and fewer Caucasian elderly (30% or less) had total food intake below 1000g daily. In contrast, more Caucasian elderly 40% SWE, 33% GRA, 28% ACA, and 16% GRG) than Indonesian elderly (2%) had total food above 1500g/d or more.

4. Animal food intake of Indonesians was a third of the amount of Greeks in Greece, a fourth of Greek Australians, a fifth of Anglo-Celtic Australians, and a sixth of Swedes. The former, however, ate fish as much as Anglo-Celts did (22g/d). Their fish consumption was significantly lower than that of Greeks and Swedes (64-83g/d).

5. Average intake of plant food including legume, nuts and other pulses, vegetables, fruits, rice and cereals of Indonesian elderly (553g/d) was markedly lower than that of Caucasian elderly (772g/d for Anglo-Celts, 846g/d for Greeks in Greece, 891g/d for Swedes, and 944g/d for Greeks in Australia). Nevertheless, Indonesian elderly consumed more legumes and nuts (mainly tempeh and tofu) than Caucasian elderly.

6. Indonesian elderly with a high intake of tempeh, tofu, vegetables, and low intake of cereal had a lower LDL/ HDL ratio. Moreover, elderly with a high intake of cereal had lower concentrations of glucose and folate and higher LDL/ HDL ratio. Homocysteine concentration was positively associated with cereal intakes and negatively associated with intakes of legumes.

7. Multiple regression analyses of Indonesian data indicated that about 16% of the variance for LDL/ HDL ratio, 21% for triglyceride, 32% glucose, 42% for serum folate, 21% for serum cobalamin, and 30% for homocysteine could be predicted by food intake.

8. In the pooled data (INA, ACA, GRA, GRG, SWE), subjects with a high intake of animal foods such as meat, fish, and dairy had higher concentrations of cholesterol. Legumes were positively associated with folate, cobalamin, triglyceride and glucose. Vegetables were positively associated with serum folate and cholesterol. Elderly with a high intake of fruit had a lower glucose, triglyceride, and higher cholesterol.

ANTHROPOMETRY AND BODY COMPOSITION
1. Jakarta elderly had significantly higher weight, height, BMI, MUAC, MAMA, A/H ratio, and calf circumference compared to Semarang elderly. In the pooled data, Indonesian elderly were shorter in stature and lower in body weight compared to Caucasian elderly.

2. General obesity (BMI 30 or above) was less detected in Indonesian elderly (< 7%) than Caucasian elderly (9% SWE, 14% ACA, 30% GRG, and 41% GRA). Women, particularly in Australia and Indonesia tended to be more obese.

3. Even though general obesity was low in Indonesia, a high proportion of them (54% Jakarta women and 42% Semarang women) were abdominally obese. The prevalence, however, was lower than that of Greeks and Anglo-Celts. Alarming figures for central obesity prevalence have been shown, particularly in Greek and Anglo-Celtic women (100% and 89% respectively).

CVD RISK FACTORS
1. Hypertension and smoking prevalences were found to be high in Indonesians, particularly amongst the men. Approximately 21% of Indonesian men and Swedish men had raised blood pressure; less than 15% of the men in other ethnic groups had raised blood pressure. More men than women in all communities were current or non-smokers.

2. Dyslipidaemia, particularly high LDL concentrations, was less detected in Indonesian (22%) compared to Caucasian elderly (50-60%). More Caucasian elderly (18-23%) than Indonesian elderly (8%) had LDL/ HDL ratio above 4. Hypertriglyceridaemia was found <5% in all ethnic communities. The majority of the elderly studied (90%) had serum folate and cobalamin in normal range. Hyperglycaemia was found to be high in Indonesian elderly (12%) and Greek elderly both in Australia and in Greece (18%), but it was low in Anglo-Celtic elderly and Swedish elderly (<6%).

3. In Indonesia, A/H ratio, BMI, and total body fat were positively associated with higher concentrations of cholesterol, triglyceride, and glucose. Similarly, in the pooled data (INA, ACA, GRA, GRG, SWE), A/H ratio, BMI, total body fat was positively associated with cholesterol, triglyceride, glucose, and to lesser a extent serum folate and cobalamin concentrations.

SKIN INDEX OF HEALTHY AGEING
1. Results from Caucasian elderly provides evidence that skin wrinkling, particularly in limited sun-exposed sites, may possibly be used as a marker of health status and to some extent index of healthy ageing. Less skin wrinkling was significantly associated with a better General Health Score and Activities of Daily Living Score. Our findings also indicated that Caucasian elderly with less skin wrinkling had a higher DHEA concentration (rs=-0.14, P<0.06).

2. Regression analyses on Caucasian elderly show that 25% of the variance for actinic skin damage could be explained by 8 out of the 10 major food groups. In particular, a high intake of olive oil, legumes, fish, vegetables, and cereal appeared to be protective against cutaneous actinic damage (collectively explained 20% of the variance). In contrast, a high intake of meat, sugar and its products, and dairy products appeared to be adverse (explaining <5% of the variance).

3. Meanwhile, 11% of the variance of skin index of healthy ageing could be explained by 5 out of the 10 major food groups. In particular, a high intake of fish and vegetables appeared to be protective (collectively explained 7% of the variance). On the other hand, a high intake of meat, dairy products, and fruits appeared to be adverse (explaining <5% of the variance).

4. This study found that CVD risk factors (e.g. blood pressure, serum cobalamin, and obesity) were associated with skin ageing in Caucasian elderly. Those with less actinic skin damage had lower BMI, A/H ratio, and serum cobalamin concentrations. Those with a high serum cobalamin had a lower index of healthy ageing. Blood pressures were positively associated with skin index of healthy ageing. Elderly with low DHEA levels had lower BMI, A/H ratio, serum folate, and cobalamin concentrations. Caucasian men with a high DHEA had lower triglyceride (P<0.05). Caucasian women with a high DHEA had lower A/H ratio and serum cobalamin.

 

Copyright: Dr Martalena br Purba 2000;