Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Nutrient intake and iron status of urban poor and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women

European Journal of Clinical Nutrition volume 57, pages 654–666 (2003)Cite this article

Abstract

Objective: We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status.

Design: Cross-sectional study.

Setting: Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia.

Subjects: During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake.

Results: Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05).

Conclusions: Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  • Achadi, EL, Hansell, MJ, Sloan, NL & Anderson, MA (1995). Women's nutritional status, iron consumption and weight gain during pregnancy in relation to neonatal weight and length in West Java, Indonesia. Int. J. Gyn. Obstet., 48, (Suppl) S110–S119.

    Google Scholar 

  • Blundell, JE, Green, S & Burley, V (1994). Carbohydrates and human appetite. Am. J. Clin. Nutr., 59, (Suppl) 728S–734S.

    Article  CAS  Google Scholar 

  • Blundell, JE, Lawton, CL, Cotton, JR & Macdiarmid, JI (1996). Control of human appetite: implications for the intake of dietary fat. A. Rev. Nutr., 16, 285–319.

    Article  CAS  Google Scholar 

  • Booth, SL, Johns, TA & Kulnlein, HV (1997). Culture, Environment, and Food to Prevent Vitamin A Deficiency in the Complexities of Understanding Vitamin A in Food and Diets: the Problem, ed. HV Kuhnlein & GH Pelto Quebec: Centre for Nutrition and the Environment of Indigenous Peoples

    Google Scholar 

  • Briawan, D & Hardiansyah, (1990). Penilaian dan Perencanaan Konsumsi Pangan, Bogor: Gizi Masyarakat-Institut Pertanian Bogor

    Google Scholar 

  • Cook, JD & Skikne, BS (1989). Iron deficiency definition and diagnosis. J. Intern. Med., 226, 349–355.

    Article  CAS  Google Scholar 

  • Department of Information (1996). Republic of Indonesia. Indonesia 1996., Jakarta: Promosi Citra Indonesia

  • de Pee, S & Bloom, M (1999). 24-VASQ Method for Estimating Vitamin A Intake (24-hour Vitamin A Semi-quantitative), DraftJakarta: Helen Keller International (HKI) Asia Pacific Regional Office

    Google Scholar 

  • Development and Planning Board of District Level & Central Bureau of Statistics (1999). Purworejo Dalam Angka 1998 (Purworejo in Figures 1998), Purworejo: DPBD & CBS

  • FAO/WFP Special Report (2000). Global Information and Early Warning System on Food and Agriculture, FAO/WFP crop and food supply assessment mission to Indonesia. Available at: www.fao.org/giews/english/alertes/1999/srins994.htm(accessed 9 September 2000)

  • Gibson, RS & Huddle, JM (1998). Suboptimal zinc status in pregnant Malawian women: its association with low intakes of poorly available zinc, frequent reproductive cycling and malaria. Am. J. Clin. Nutr., 67, 702–709.

    Article  CAS  Google Scholar 

  • Hansen, RG & Wyse, BW (1980). Expression of nutrient allowances per 1000 kilocalories. J. Am. Diet. Assoc., 76, 223–227.

    CAS  PubMed  Google Scholar 

  • Hartini, TNS, Winkvist, A, Lindholm, L, Stenlund, H, Surjono, A & Hakimi, M (2002). Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women. Health Policy, Jul61, (1) 57–71.

    Article  CAS  Google Scholar 

  • Helen Keller International (1999). The Posible Impact of the Indonesian Crisis on Maternal and Child Survival through Micronutrient Deficiencies: Trends Toward Higher Rates of Malnutrition in Urban Slums, Jakarta: HKI

  • Huddle, JM, Gibson, R & Cullinan, TR (1998). Is zinc a limiting nutrient in the diets of rural pregnant Malawian women?. Br. J. Nutr., 79, 257–265.

    Article  CAS  Google Scholar 

  • Hunt, IF, Murphy, NJ, Martner-Hewes, PM, Faraji, B, Swendseid, ME, Reynolds, RD, Sanches, A & Meijia, A (1987). Zinc, vitamin B-6 and other nutrients in pregnant women attending prenatal clinics in Mexico. Am. J. Clin. Nutr., 46, 563–569.

    Article  CAS  Google Scholar 

  • Institute of Medicine (1990). Subcommittees on Nutritional Status and Weight Gain During Pregnancy and Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutrition During Pregnancy and Lactation, Food and Nutrition Board. Nutrition During Pregnancy: Part I, Weight Gain; Part II, Nutrient Supplements, Washington, DC: National Academy Press

  • Kardjati, S, Kusin, JA & Renqvist, UH (1994). Nutrition during Pregnancy in Maternal and Child Nutrition in Madura, Indonesia, Netherlands: The Netherlands Royal Tropical Institute

    Google Scholar 

  • Kodyat, BA, Mukrie, N, Latief, D, Alhabsyi, A & Palupi, L (1996). Indonesian Weaning Food Program (Lesson Learned), Paper in the International Workshop on infant and young child feeding. Surabaya, 14–18 January

  • Ladipo, OA (2000). Nutrition in pregnancy: mineral and vitamin supplements. Am. J. Clin. Nutr., 72, (Suppl) 280S–290S.

    Article  CAS  Google Scholar 

  • Latief, D, Harianto, B & Kartono, J (1997). Penanggulangan kekurangan energi kronis pada ibu hamil dengan pemberian makanan tambahan. Gizi Indonesia, 12, 20–30.

    Google Scholar 

  • Latief, D, Atmarita,, Minarto,, Johari, A & Tilden, R (2000). The tendency of household food consumption before and during the crisis in Indonesia. In:Proceedings, Prosiding Widya Karya Nasional Pangan dan Gizi VI (National Symposium on Food and Nutrition), 29 February–2 March Jakarta: LIPI

    Google Scholar 

  • Mahmud, MK, Slamet, DS, Apriyanto, RR & Hermana, (1990). Komposisi Zat Gizi Pangan Indonesia, Jakarta: Dit Bina Gizi Masyarakat dan Pusat Penelitian dan Pengembangan Gizi

    Google Scholar 

  • Ministry of Health (1995). Nutritional Guidelines for Indonesia (Basic Messages), Jakarta: Directorate of Community Nutrition, MOH

  • Ministry of Health (1998). Pedoman penanggulangan anemi gizi untuk remaja putri dan wanita usia subur, Jakarta: Dit. Bina Gizi Masyarakat, MOH

  • Ministry of Health, WHO (2000). National Plan of Action on Food and Nutrition 2001–2005, Jakarta: MOH & WHO

  • Muhilal, (2002). (Inaugural speech). Peran gizi dalam meningkatkan kualitas sumber daya manusia: Telaah dari aspek biokimia gizi hingga pedoman gizi seimbang. Pidato pengukuhan jabatan Guru Besar dalam ilmu gizi, Bandung: Universitas Padjadjaran

    Google Scholar 

  • Muhilal,, Jalal, F & Hardiansyah, (1998). Angka Kecukupan yang Dianjurkan (RDA). Prosiding Widya Karya Nasional Pangan dan Gizi VI (Proceedings of National Symposium on Food and Nutrition), 17–20 February Jakarta: LIPI

    Google Scholar 

  • Mukrie, NA, Chatijah, S, Mosoar, S, Alhabsyi, A, Djasmidar,, Bernadus, HA, Mahmud, MK, Hermana,, Dewi, SS, Rossi, RA, Soebagyo, S & Dedy, M (1995). Daftar Komposisi Zat Gizi Pangan Indonesia, Jakarta: Dirjen Binkesmas Dit Bina Gizi Masyarakat, Pusat Penelitian dan Pengembangan Gizi

    Google Scholar 

  • National Academy of Sciences (1997). Dietary Reference Intakes: Calcium, Phosporus, Magnesium, Vitamin D and Fluoride, Food and Nutrition Board, Institute of Medicine Washington, DC: National Academy Press

  • National Development Planning Agency (2000). Indonesia's social safety nets, programs and safeguarding activities. Available at: www.pin-jps.or.id/data/publikasi/JPS-English1.htm (accessed 16 May 2000)

  • National Research Council (1989). Recommended Dietary Allowances, 10th edn Washington, DC: National Academy Press

  • Nurdiati, DS, Hakimi, M, Wahab, A & Winkvist, A (1998). Concurrent prevalence of cronic energy deficiency and obesity among women in Purworejo, Central Java, Indonesia. Food Nutr. Bul., 19, (4) 321–333.

    Article  Google Scholar 

  • Panwar, B & Punia, D (1998). Nutrient intake of rural pregnant women of Haryana State, Northern India: relationship between income and education. Int. J. Food Sci. Nutr., 49, 391–395.

    Article  CAS  Google Scholar 

  • Persson, V, Winkvist, A, Hartini, TNS, Greiner, T, Hakimi, M & Stenlund, H (2001). Variability in nutrient intakes among pregnant women in Indonesia: Implications for the design of epidemiological studies using the 24-h recall method. J. Nutr., 131, 325–330.

    Article  CAS  Google Scholar 

  • Prentice, A, Lasley, MA, Shaw, J, Hudson, GJ, Day, KC, Jarjou, LM, Dibba, B & Paul, A (1993). The calcium and phosphorus intakes of rural Gambian women during pregnancy and lactation. Br. J. Nutr., 69, 885–896.

    Article  CAS  Google Scholar 

  • Purworejo District Health Office (2000). Profil Kesehatan Kabupaten Purworejo (Purworejo District Health Profile) 1999, Purworejo: District Health Office

  • Rad, AH, Omidvar, N, Mabmood, M, Kolahdooz, F & Amini, M (1998). Dietary intake, anthropometry and birth outcome of rural pregnant women in two Iranian Districts. Nutr. Res., 18, (9) 1469–1482.

    Article  Google Scholar 

  • Rolls, BJ & Hammer, VA (1995). Fat, carbohydrate, and the regulation of energy intake. Am. J. Clin. Nutr., 62, (Suppl) 1086S–1095S.

    Article  CAS  Google Scholar 

  • Schneeman, BO (2001). Carbohydrate: friend or foe? Summary of research needs. J. Nutr., 131, 2764S–2765S.

    Article  CAS  Google Scholar 

  • Sen, A (1997). Poverty and Famines: an Essay on Entitlement and Deprivation, New York: Clarendon Press

    Google Scholar 

  • Siong, TE, Noor, MI, Azudin, MN & Idrus, K (1988). Nutrient Composition of Malaysian Food (Komposisi zat dalam makanan Malaysia), Malaysia: ASEAN Food habits Project–National Sub Committee on Protein, Food Habits Research and Development

    Google Scholar 

  • Soekirman,, Tarwotjo, I, Jus'at, I, Sumodiningrat, G & Djalal, F (1992). Economic Growth, Equity and Nutritional Improvement in Indonesia, United Nations, ACC/SCN

    Google Scholar 

  • Suara Merdeka, (1998). Harga bahan pokok melonjak, Pasar Rejowinangun sepi, Kamis, 8 January

  • Suharno, D, West, CE, Muhilal,, Logman, MHGM, Waart, FGD, Karyadi, D & Hautvast, GAJ (1993). Cross-sectional study on the iron and vitamin A status of pregnant women in West Java, Indonesia. Am. J. Clin. Nutr., 56, 988–993.

    Article  Google Scholar 

  • Sumarno, I, Latinulu, S & Saraswati, E (1997). Food consumption pattern of households in Indonesia. Gizi Indonesia, 22, 39–61.

    Google Scholar 

  • Sundararaj, R & Pereira, SM (1973). Diets of pregnant women in South Indian Community. Trop. Geogr. Med., 25, 381–386.

    CAS  PubMed  Google Scholar 

  • Vitolo, MR, Gama, CM, Kondo, MR, Barrere, APN & Nobrega, FJC (1997). Food intake of pregnant adolescent women. Ann. NY Acad. Sci., 817, 386–388.

    Article  CAS  Google Scholar 

  • Warta kesehatan perkotaan (1992). Masalah gizi di daerah perkotaan, no. 0081–2.

  • Wasito, E, Pritasari,, Susilowati, D, Iswarawati, DN, Schultink, W & Gross, R (2001). Temporary stability of Urban food and nutrition security: the East Jakarta Study. Asia Pasific. J. Clin. Nutr., 10, (Suppl) S29–S33.

    Google Scholar 

  • Whiteford, LM (1993). Child and maternal health and international economic policies. Soc. Sci. Med., 37, (11) 1391–1400.

    Article  CAS  Google Scholar 

  • Willett, WC, Howe, GR & Kushi, LH (1997). Adjustment for total energy intake in epidemiologic studies. Am. J. Clin. Nutr., 6, (Suppl) 1220S–1228S.

    Article  Google Scholar 

  • Wilopo, SA (2001). Community Health and Nutrition Research Laboratories (CHN-RL), Faculty of Medicine, Gadjah Mada University: Key Issues on the Research Design, Data Collection and Management, Available at: www.chnrl.org/survaillance/page.htm (accessed 2 November 2001)

  • Winkvist, A, Persson, V & Hartini, TNS (2001). Under reporting of energy intake is less common among pregnant women in Indonesia. Publ. Hlth. Nutr., Aug5, (4) 523–529.

    Article  Google Scholar 

  • World Bank (2000). GNP per Capita 1998. Atlas Method and PPP, Available at: www.worldbank.org/databytop/GNPPC.pdf (accessed 21 May 2000)

  • Yip, R & Ramakrishnan, U (2002). Experiences and challenges in developing countries. J. Clin. Nutr., Apr132, (4 Suppl) 827S–830S.

    CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank all the women in Purworejo District who participated in the study and the staff of CHN-RL. We would also like to thank the following organisations for funding the project: Sida/SAREC (the Swedish International Development Authority/the Swedish Agency for Research Cooperation in Developing Countries), Mother Care, John Snow Inc., Washington, DC, USA, UNICEF, Jakarta, Indonesia, and STINT (the Swedish Foundation for International Cooperation in Research and Higher Education) and the World Bank through the Community Health and Nutrition Development Project of the Ministry of Health, Indonesia (IBRD Loan no. 3550-IND).

Author information

Authors and Affiliations

  1. Nutrition Academy, Ministry of Health, Yogyakarta, Indonesia

    T N S Hartini

  2. Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden

    T N S Hartini, A Winkvist, L Lindholm, H Stenlund, V Persson & D S Nurdiati

  3. Community Health and Nutrition Research Laboratories, Gadjah Mada University, Faculty of Medicine, Yogyakarta, Indonesia

    T N S Hartini, D S Nurdiati & A Surjono

  4. Department of Women's and Children's Health, Section for International Maternal and Child Health, Uppsala University, Uppsala, Sweden

    V Persson

  5. Department of Obstetrics and Gynaecology, Gadjah Mada University, Faculty of Medicine, Yogyakarta, Indonesia

    D S Nurdiati

Authors
  1. T N S Hartini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Winkvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Lindholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H Stenlund
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V Persson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D S Nurdiati
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A Surjono
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Guarantor: TNS Hartini.

Contributors: A Winkvist, L Lindholm, H Stenlund, DS Nurdiati, A Surjono.

Corresponding author

Correspondence to T N S Hartini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hartini, T., Winkvist, A., Lindholm, L. et al. Nutrient intake and iron status of urban poor and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women. Eur J Clin Nutr 57, 654–666 (2003). https://doi.org/10.1038/sj.ejcn.1601595

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601595

Keywords

This article is cited by

Search

Advanced search

Quick links