國立虎尾科技大學 |

Dietary Behaviors and Cardiovascular Disease Risk Factors in Indonesia in the Context of the Nutrition Transition and the COVID-19 Pandemic.

Record Type:	Language materials, manuscript : Monograph/item
Title/Author:	Dietary Behaviors and Cardiovascular Disease Risk Factors in Indonesia in the Context of the Nutrition Transition and the COVID-19 Pandemic./
Author:	Anyanwu, Oyedolapo A.
Description:	1 online resource (253 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 84-10, Section: B.
Contained By:	Dissertations Abstracts International84-10B.
Subject:	Nutrition. -
Online resource:	click for full text (PQDT)
ISBN:	9798379436087

Dietary Behaviors and Cardiovascular Disease Risk Factors in Indonesia in the Context of the Nutrition Transition and the COVID-19 Pandemic.
Anyanwu, Oyedolapo A.

Dietary Behaviors and Cardiovascular Disease Risk Factors in Indonesia in the Context of the Nutrition Transition and the COVID-19 Pandemic. - 1 online resource (253 pages)

Source: Dissertations Abstracts International, Volume: 84-10, Section: B.

Thesis (Ph.D.)--Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, 2023.

Includes bibliographical references

Background: Consistent empirical evidence suggests that Indonesia and other lower middle-income countries (LMICs) are experiencing increasing prevalence of chronic diseases like cardiovascular disease (CVD due to dietary and lifestyle changes. Without proper policy guidance, this trend will continue, with major public health consequences. However, there is insufficient evidence about the systemic drivers of dietary behaviors and their links to health outcomes in many of these countries to inform policy. Specifically in Indonesia, relatively little has been documented in the literature about the multi-faceted and cross-cutting impacts of the nutrition transition and the COVID-19 pandemic on diets and health. Further, studies relating dietary patterns and CVD risk factors in Indonesia are sparse, with inconsistent and inconclusive results. Additionally, Indonesia, the world's largest archipelagic country, and the world's second largest producer of fish promotes higher fish consumption, concurrent with very high levels of marine pollution. Few studies have investigated the potential adverse effects of promoting fish consumption while marine pollution levels are increasing.Objectives: This thesis project sought to address these gaps through three specific aims: The first aim was to conduct formative research in Indonesia, to explore dietary behaviors and their health impacts, from a socio-ecological perspective. Aim two capitalized on the unique dietary data collected in Indonesian Family Life Survey wave 5 (IFLS 5), to derive dietary patterns and assess their associations with CVD risk factors. Aim three was to synthesize evidence on two methods of inquiry: quantitative and qualitative, to characterize fish consumption in the context of marine pollution.Methods: For specific aim 1, key-informant interview sessions were conducted using remote data collection methods, with multi-disciplinary experts from Indonesia (n = 27) to investigate their perceptions on the impacts of the nutrition transition and the COVID-19 pandemic on diets, health, and environment. Codes and themes were developed using a qualitative content analysis approach. For specific aim 2, dietary patterns were established from exploratory factor analysis using data derived from a food module completed by survey respondents in IFLS 5 (n =31,160). Logistic regression models were developed to investigate the cross-sectional association between each derived dietary pattern and two CVD risk factors-hypertension and obesity. Specific aim 3 utilized a convergent mixed methods design: Fish consumption was assessed among respondents in IFLS 5 (n = 31,032) using multinomial regression analyses to assess the relationship between respondents' sociodemographic profiles and quintiles of fish consumption. Findings were integrated with the perspectives of a multi-disciplinary group of experts (n = 27) on the impacts of marine pollution on fish quality and availability in Indonesia.Results: Key-informants noted a generational divide on food choice and a growing tendency to eat out in Indonesia, due to the nutrition transition. Informants' perspectives indicated that the nutrition transition has increased the availability and intake of unhealthy food options. Our findings further suggest that during the COVID-19 lock-down period, an increased awareness about and adherence to health behaviors was observed but was not sustained, and that the pandemic may have increased food insecurity in Indonesia. Informants also described marked increase in marine pollution levels from hygienic wastes and plastics from food packaging, because of protocols put in place by the government to slow down the spread of the virus. Exploratory factor analysis revealed two dietary patterns: a modern pattern with more meat and fast-food, and a traditional pattern with more fish and vegetables. While there was no significant association between hypertension and the modern pattern, higher adherence to the traditional pattern was associated with lower odds for hypertension (OR: 0.84; 95% CI: 0.74, 0.95; P-trend < 0.05). Higher adherence to both dietary patterns was associated with higher odds for obesity (modern pattern-OR: 1.31; 95% CI: 1.15, 1.49; P-trend < 0.00; traditional pattern-OR: 1.25; 95% CI:1.10, 1.42; P-trend < 0.01). Mixed methods analyses on fish consumption and marine pollution revealed that younger age, living in an urban center and Java region correlated significantly with lower consumption of fish, and key-informants' perspectives implied that fish is scarce in certain regions of Indonesia due to high levels of marine pollution.Conclusion: These results suggest that both the COVID-19 pandemic and the nutrition transition have negatively impacted diets, health, and environment in Indonesia. The pandemic may have heightened food insecurity and marine pollution, while the nutrition may have increased obesity rates, thus exacerbating the burden of diseases in Indonesia. Cross-sectional analyses of dietary patterns and CVD risk factors indicate that suboptimal dietary patterns may have increased the risk for obesity. Findings from mixed methods analyses suggest that marine pollution negatively impacts fish availability and quality in Indonesia, which may pose a threat to food security among low-income Indonesians and to human health globally. This study offers potential hypotheses that can be tested using gold-standard measures of dietary intake and longitudinal analyses, to inform policy and the design of programs to promote higher adherence to healthy diets and reduce the risk factors for CVD among the Indonesian population.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2024

Mode of access: World Wide Web

ISBN: 9798379436087Subjects--Topical Terms:

581367
Nutrition.
Subjects--Index Terms:

Cardiometabolic risk factorsIndex Terms--Genre/Form:

554714
Electronic books.

Dietary Behaviors and Cardiovascular Disease Risk Factors in Indonesia in the Context of the Nutrition Transition and the COVID-19 Pandemic.
LDR:07215ntm a2200421K 4500 001 1141248
005 20240311061552.5
006 m o d
007 cr mn ---uuuuu
008 250605s2023 xx obm 000 0 eng d
020 $a 9798379436087
035 $a (MiAaPQ)AAI30424519
035 $a AAI30424519
040 $a MiAaPQ $b eng $c MiAaPQ $d NTU
100 1 $a Anyanwu, Oyedolapo A. $3 1464926
245 1 0 $a Dietary Behaviors and Cardiovascular Disease Risk Factors in Indonesia in the Context of the Nutrition Transition and the COVID-19 Pandemic.
264 0 $c 2023
300 $a 1 online resource (253 pages)
336 $a text $b txt $2 rdacontent
337 $a computer $b c $2 rdamedia
338 $a online resource $b cr $2 rdacarrier
500 $a Source: Dissertations Abstracts International, Volume: 84-10, Section: B.
500 $a Advisor: Folta, Sara C.
502 $a Thesis (Ph.D.)--Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, 2023.
504 $a Includes bibliographical references
520 $a Background: Consistent empirical evidence suggests that Indonesia and other lower middle-income countries (LMICs) are experiencing increasing prevalence of chronic diseases like cardiovascular disease (CVD due to dietary and lifestyle changes. Without proper policy guidance, this trend will continue, with major public health consequences. However, there is insufficient evidence about the systemic drivers of dietary behaviors and their links to health outcomes in many of these countries to inform policy. Specifically in Indonesia, relatively little has been documented in the literature about the multi-faceted and cross-cutting impacts of the nutrition transition and the COVID-19 pandemic on diets and health. Further, studies relating dietary patterns and CVD risk factors in Indonesia are sparse, with inconsistent and inconclusive results. Additionally, Indonesia, the world's largest archipelagic country, and the world's second largest producer of fish promotes higher fish consumption, concurrent with very high levels of marine pollution. Few studies have investigated the potential adverse effects of promoting fish consumption while marine pollution levels are increasing.Objectives: This thesis project sought to address these gaps through three specific aims: The first aim was to conduct formative research in Indonesia, to explore dietary behaviors and their health impacts, from a socio-ecological perspective. Aim two capitalized on the unique dietary data collected in Indonesian Family Life Survey wave 5 (IFLS 5), to derive dietary patterns and assess their associations with CVD risk factors. Aim three was to synthesize evidence on two methods of inquiry: quantitative and qualitative, to characterize fish consumption in the context of marine pollution.Methods: For specific aim 1, key-informant interview sessions were conducted using remote data collection methods, with multi-disciplinary experts from Indonesia (n = 27) to investigate their perceptions on the impacts of the nutrition transition and the COVID-19 pandemic on diets, health, and environment. Codes and themes were developed using a qualitative content analysis approach. For specific aim 2, dietary patterns were established from exploratory factor analysis using data derived from a food module completed by survey respondents in IFLS 5 (n =31,160). Logistic regression models were developed to investigate the cross-sectional association between each derived dietary pattern and two CVD risk factors-hypertension and obesity. Specific aim 3 utilized a convergent mixed methods design: Fish consumption was assessed among respondents in IFLS 5 (n = 31,032) using multinomial regression analyses to assess the relationship between respondents' sociodemographic profiles and quintiles of fish consumption. Findings were integrated with the perspectives of a multi-disciplinary group of experts (n = 27) on the impacts of marine pollution on fish quality and availability in Indonesia.Results: Key-informants noted a generational divide on food choice and a growing tendency to eat out in Indonesia, due to the nutrition transition. Informants' perspectives indicated that the nutrition transition has increased the availability and intake of unhealthy food options. Our findings further suggest that during the COVID-19 lock-down period, an increased awareness about and adherence to health behaviors was observed but was not sustained, and that the pandemic may have increased food insecurity in Indonesia. Informants also described marked increase in marine pollution levels from hygienic wastes and plastics from food packaging, because of protocols put in place by the government to slow down the spread of the virus. Exploratory factor analysis revealed two dietary patterns: a modern pattern with more meat and fast-food, and a traditional pattern with more fish and vegetables. While there was no significant association between hypertension and the modern pattern, higher adherence to the traditional pattern was associated with lower odds for hypertension (OR: 0.84; 95% CI: 0.74, 0.95; P-trend < 0.05). Higher adherence to both dietary patterns was associated with higher odds for obesity (modern pattern-OR: 1.31; 95% CI: 1.15, 1.49; P-trend < 0.00; traditional pattern-OR: 1.25; 95% CI:1.10, 1.42; P-trend < 0.01). Mixed methods analyses on fish consumption and marine pollution revealed that younger age, living in an urban center and Java region correlated significantly with lower consumption of fish, and key-informants' perspectives implied that fish is scarce in certain regions of Indonesia due to high levels of marine pollution.Conclusion: These results suggest that both the COVID-19 pandemic and the nutrition transition have negatively impacted diets, health, and environment in Indonesia. The pandemic may have heightened food insecurity and marine pollution, while the nutrition may have increased obesity rates, thus exacerbating the burden of diseases in Indonesia. Cross-sectional analyses of dietary patterns and CVD risk factors indicate that suboptimal dietary patterns may have increased the risk for obesity. Findings from mixed methods analyses suggest that marine pollution negatively impacts fish availability and quality in Indonesia, which may pose a threat to food security among low-income Indonesians and to human health globally. This study offers potential hypotheses that can be tested using gold-standard measures of dietary intake and longitudinal analyses, to inform policy and the design of programs to promote higher adherence to healthy diets and reduce the risk factors for CVD among the Indonesian population.
533 $a Electronic reproduction. $b Ann Arbor, Mich. : $c ProQuest, $d 2024
538 $a Mode of access: World Wide Web
650 4 $a Nutrition. $3 581367
650 4 $a Epidemiology. $3 635923
650 4 $a Public health. $3 560998
650 4 $a Environmental science. $3 1179128
653 $a Cardiometabolic risk factors
653 $a COVID-19
653 $a Indonesia
653 $a Marine pollution
653 $a Mixed methods
653 $a Nutrition transition
655 7 $a Electronic books. $2 local $3 554714
690 $a 0570
690 $a 0766
690 $a 0573
690 $a 0768
710 2 $a ProQuest Information and Learning Co. $3 1178819
710 2 $a Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. $b Nutrition Interventions, Communication, and Behavior Change. $3 1464927
773 0 $t Dissertations Abstracts International $g 84-10B.
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30424519 $z click for full text (PQDT)