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Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition)
Jurnal Gizi Indonesia Vol. 9, No. 2, June 2021 (111-122)

Submitted: 11 April 2020, Accepted: 2 March 2021
Online https://ejournal.undip.ac.id/index.php/jgi
Household food security and diet quality with chronic energy

deficiency among preconception women
Pradita Putri Ramadhani1, Fillah Fithra Dieny*1, Dewi M. Kurniawati1 , Hartanti Sandi 1 Deny Yudi Fitranti1
Ayu Rahadiyanti1 A.Fahmy Arif Tsani 1
ABSTRACT
Background: Chronic energy deficiency (CED) that occurs at risk preconception women during pregnancy increased
low birth weight (LBW) in infants. Household food security and diet quality are factors that cause CED. Therefore,
this study aims to determine the relationship between household food security and diet quality with CED preconception
women.
Materials and Methods: We used a cross-sectional study design. The subject of 70 preconception women aged 16-
35 years registered in the religious affairs office in Sumowono and Pringapus Subdistrict were selected by consecutive
sampling method. Weight and height were measured to assess body mass index to determine CED. Household food
security was measured using the Household Food Security Scale Module (HFSSM). Food intake data were obtained
using the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) and DQI-I (Diet Quality Index-International)
to measure diet quality. Bivariate analyses were tested using Rank Spearman and Pearson Product Moment.
Results: The prevalence of subjects with CED risk was 48.6% and subjects with CED was 15.7%. 38.6% of subjects
married at the age of 16-20 years, 75.1% of subjects had low household food security and 80% of subjects had low
diet quality. There was no significant relationship between household food security and diet quality with CED, namely
(p = 0.537) and (p = 0.711). The components of diet quality, namely variation, adequacy, moderation and balance also
did not show a significant relationship with CED, respectively with p-value (p = 0.711), (p = 0.523), (p = 0.412), (p =
0.604 )
Conclusions: There was no correlation between household food security and CED, also no correlation between diet
quality and CED.
Key Words: CED; Diet quality; food security; Preconception woman
prolonged or chronic lack of calories and protein.

BACKGROUND CED is characterized by a mid-upper arm
The preconception period is the period before circumference (MUAC) of <23.5 cm.2 Another
pregnancy. Preconception women are women of indicator in defining CED is body mass index (BMI)
reproductive age, who will have to be ready to of <18.5 kg/m2.3 Based on the results of Basic Health
become mothers. The preconception period needs Research (Riskesdas) 2013, the prevalence of
different nutritional support compared to the pregnant women aged 15-49 years who suffer from
previous period. The nutritional status of pregnant CED was 24.3%, while the prevalence of women of
women is determined by the period before reproductive age who were not pregnant was
pregnancy, thus the poor nutritional status of 20.8%.4 A preceding research stated that the
preconception women will have an impact on the prevalence of CED in pregnant women in Semarang
pregnancy. Preconception women are also defined District was 10.28%.5 Another study conducted by
as women of reproductive age who are also prone to Sumarmi also stated that the prevalence of CED
CED.1 among future brides in 4 sub-districts of
Chronic energy deficiency (CED) in women is Probolinggo District was 27.3%.6
defined as a condition when a person experiences a
1
Departemen Ilmu Gizi FK UNDIP, Jalan Prof Soedharto SH, Tembalang. Semarang
*
Correspondence: [email protected]
Copyright © 2021; Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition), 9 (2), 2021
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Pradita Putri Ramadhani, Fillah Fithra Dieny, Dewi M. Kurniawati , Hartanti Sandi, Deny Yudi Fitranti, Ayu
Rahadiyanti, A.Fahmy Arif Tsani
The impact of the incidence of CED among diet quality with chronic energy deficiency (CED)
pregnant women in Indonesia includes the high rate in preconception women.
of infant mortality (IMR) due to low birth weight
(LBW) where the prevalence of LBW reached MATERIALS AND METHODS
10.2% in 2013.7 Other impacts that can arise due to This study was conducted between March-April
CED are bleeding, abnormal weight gain in 2018 in the Office of Religious Affairs (Kantor
pregnant women, and infectious diseases. Pregnant Urusan Agama/KUA) of Sumowono and Pringapus
women with CED have a high risk of miscarriage, sub-districts, Semarang District. This is a cross-
abortion, stillbirth, congenital defects, anemia in the sectional study within the scope of Public Health
baby, and die in the womb (Asphyxia intrapartum).8 Science. This study has been granted a permit by the
The quality and quantity of diet are some of the Health Research Ethics Commission of the Faculty
factors that cause CED in preconception women. of Medicine, Universitas Diponegoro - Central
The quality of the diet is an important index to Public Hospital Dr. Kariadi Semarang with No. 480
determine the intake of macro and micro-nutrients / EC / FK-RSDK / VII / 2018.
as well as dietary patterns that may affect the risk of The minimum sample size was calculated using
diet-related diseases. According to researches that a correlative analytic formula and the 70 study
have been conducted in developing countries such participants were selected through the consecutive
as Indonesia and India, it is known that the quality sampling method. The sample inclusion criteria
of diet will affect the nutritional status of women of include preconception women registered in the
reproductive age (WRA) including brides.9 Other Office of Religious Affairs Sumowono and
studies have shown that a poor quality diet before Pringapus sub-districts, aged 16-35 years, never and
pregnancy will affect the nutritional status of not currently pregnant (at the time of the data
pregnant women which may lead to low birth weight collection), and willing to fill in their information
(LBW) in children.10 and sign a statement of willingness as research study
The quality of one's diet is determined by the participants.
food security of the household, the better household The independent variables in this study were
food security, the better its diet quality. Food household food security and diet quality, while the
insecurity in WRA often results in the consumption dependent variable was chronic energy deficiency
of food that is not following their needs. This can (CED). The cut-off point of CED is Mid-Upper Arm
cause a lack of energy, protein, and micronutrients Circumference (MUAC) of <23.5 cm and has a BMI
which will affect the nutritional status of women of of <18.5 kg / m2. The collected data in this study
childbearing age, namely chronic energy deficiency were study participants’ general data,
(CED).11,12 anthropometric data, household food security, and
Sumowono and Pringapus subdistricts are areas diet quality.
with a fairly high prevalence of infant mortality rate Household food security is a condition when
(IMR) and maternal mortality rate (MMR). Based people have the right to have physical and economic
on the Health Profile of Semarang District in 2016, access at any time to obtain sufficient food to meet
there were 5 cases of MMR within 2011-2016. their needs for a productive and healthy life. The
Meanwhile, during the same period, 70 and 49 cases household food security was measured using the
of IMR were recorded in Sumowono and Pringapus Household Food Security Scale Module (HFSSM)
districts respectively.13 One of the risk factors of low on study participants who live with no children aged
birth weight (LBW) and also a major risk factor in under 18 years. Each of the questions from the
infant mortality is CED during pregnancy.14 The HFSSM was assigned a 1 score if the study
number of CED cases in Sumowono and Pringapus participants answered frequently or occasionally
districts occurred due to the intake of protein and and a 0 score for never. Food security is categorized
energy of their people which was relatively low into 4 categories, namely high food security with 0
compared to people in other areas in Central Java.15 scores, moderate food security with a score of 1-2,
Therefore, this study aims to examine the low food security with a score of 3-5, and very low
relationship between household food security and (food insecurity) with a score of 6-10.16,17
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Household Food Security and Diet Quality with Chronic Energy Deficiency Among Preconception Women
Diet quality is an assessment of food performed to describe the characteristics of the

consumption that consists of 4 categories, namely subject. The bivariate analysis started with a
variation, sufficiency, moderation, and overall normality test with the Kolmogorov-Smirnov test.
balance based on dietary guidelines using the Diet Furthermore, bivariate analysis was carried out to
Quality Index International (DQI-I) form. The total determine the correlation between the independent
score of the DQI-I varies between 0 as the lowest and dependent variables with the Rank-Spearman
score and 100 as the highest score. Diet quality is and Pearson Product Moment tests.
rated low if the score is ≤ 60 and is rated high if the
score is > 60.18 Data on the diet quality was collected RESULTS
through food intake interviews using the Semi- Subject Characteristics
Quantitative Food Frequency (SQ-FFQ) form The participants’ characteristics consist of data
during the last month. Food photo books are used to on age, education, occupation, nutritional status,
minimize bias in intake data collection. household food security, and diet quality.
Data processing and analysis were carried by a
computer program. Univariate analysis was
Table 1. Subjects characteristics
Characteristics n %
Age
Adolescents (16-20 years old) 27 38.6
Adult (21-35 years old) 43 61.4
Educational Level
Elementary School 8 11.4
Junior High School 23 32.9
Senior High School 29 41.4
Bachelor 10 14.3
Occupation
Employment 45 64.3
Unemployment 25 35,7
Chronic Energy Deficiency (CED)
CED (BMI <18.5kg/m2, MUAC< 23.5 cm) 11 15.7
Normal (BMI ≥18.5kg/m2, MUAC< 23.5 cm) 59 84.3
Risk of Chronic Energy Deficiency
Risk of CED (MUAC< 23.5 cm) 34 48.6
Normal (MUAC ≥ 23.5 cm) 36 51.4
Household Food Security
High Food Security 14 17.1
Medium Food Security 2 2.4
Low Food Security 53 75.1
Very low (Food Insecurity) 1 1.4
Diet Quality
Low (score ≤60) 56 80
High (score >60) 14 20
A total of 38.6% of the study participants aged level, only 14.3% of the participants had an
16-20 years old, within the youth category. Most of education up to diploma or bachelor's degree. The
the participants were junior and senior high school nutritional status based on BMI indicated that 11
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participants (15.7%) suffered from CED and the old. The average BMI was 21.46 kg/m2, which was
other 84.3% of participants were normal The normal. However, there was a participant who had a
MUAC measurement showed that 48.6% of BMI score of 15.6 kg/m2 which was classified as
participants were at risk of CED and another 51.4% CED. On the other hand, there was a study
of the participants were normal. A total of 53 participant who had a BMI score of
participants (75.1%) were in the low food security 32.8 kg/m2 which was classified as over-nutrition.
category. Most of the participants (80%) also had The average MUAC score was 23.9 cm which was
poor diet quality, and only 14 participants (20%) had normal, but some study participants’ MUAC were
good diet quality. less than 23.5 cm. They were classified as at risk of
CED. The median score of household food security
Table 2 describes the minimum, maximum, was 3, which showed that most of the participants
average, and median values of age, BMI, MUAC, had low household food security. The average score
household food security score, and diet quality of diet quality was 51.77, which was classified as
score. The youngest study participant was 16 years low dietary quality.
Table 2. Minimum, maximum, average, and median values of age, BMI, MUAC,
household food security score, and diet quality score
Variable Minimum Maximum Mean±DS/Median
Age (years) 16 29 21±3.4b
2
BMI (kg/m ) 15.6 32.8 21.45±3.23b
MUAC (cm) 17 30.7 23.8±2.83b
Household Food Security (score) 0 8 3a
Diet Quality (score) 28 75 52±11b
a
Median b Mean (Deviation Standard)
Household Food Security of 20, which means that the participants were
Table 3 showed that 72.9% of the participants already consuming a variety of foods including
were worried about not being able to buy food overall variance and variety of protein. The
before they get another income and were only able minimum score (0) was given if a participant did not
to buy food to survive. A total of 57.1% of consume any fruit and vegetable. Moderation scores
participants were unable to consume a balanced diet showed that the average consumption of total fat
because they had no money. There were 21.4% of was 36%, which was relatively high compared to the
the participants who consciously reduced their recommendation of DQI-I, which is less than 30%
eating portions due to financial constraints. energy needs. Additionally, the average score of
Furthermore, there were 14.3% of the participants saturated fat consumption was 16.9%, which was
ate less than usual. Meanwhile, 5.7% of the relatively high. It was also higher than the
participants were unable to buy food when they got recommendation (less than 10%). The adequacy
hungry. A total of 17.1% of the participants lost aspect, shown in table 5, consists of some
their weight due to financial constraints to buy food, components, i.e., vegetable, fruit, staple foods, fiber
and 7.1% of the participants experienced not eating intake, protein intake, iron intake, calcium intake,
any food for the whole day because they did not and vitamin C intake. The results of this study
have enough money to buy food. showed that the consumption of vegetable, iron, and
Diet Quality calcium groups was low, which lead to the low
The diet quality consists of four aspects, i.e., quality of the overall diet. On the other hand, the
variety, adequacy, moderation, and overall balance. intake of staple food, protein, and vitamin C was
Table 4 shows that the median score of the variation adequate.
of the participants was 17 out of a maximum score
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Table 3. Components of the HFSSM Questionnaire

Statements Responses n %
Household Level
Worried about not being able to buy food before getting next S, K 51 72.9
income T 19 27.1
Only buying food to survive and unable to stock on food S, K 51 72.9
T 19 27.1
Unable to consume a balanced diet S, K 40 57.1
T 30 42.9
Individual Level
Having the experience to reduce an eating portion or skip meal time S, K 15 21.4
due to having not enough money to buy food T 55 78.6
Having the experience to eat less than you usually consumed due to S, K 10 14.3
having not enough money to buy food T 60 85.7
Feeling hungry, but do not have enough money to buy food S, K 4 5.7
T 66 94.3
Having an experience of weight loss due to having not enough S, K 12 17.1
money to buy food T 58 82.9
Having an experience to not eat all day long due to having not S, K 5 7.1
enough money to buy food T 65 92.9
S= happens often, K=sometimes happens, T= never happen
Table 4. Value of Minimum, Maximum, and Mean Diet Quality Subjects

Variable Minimum Maximum Meana±DS/Medianb
Variety (score) 4 20 17a
Overall group food variety 1 5 4a
Within-group variety for Protein sources 1 6 6a
Adequacy (score) 11 38 22±6,3b
Vegetable group (servings/day) 0 4 0,5a
Fruit Group (servings/day) 0 12 1,2a
Grain Group (servings/day) 0.1 7.3 3.65±1.5b
Fiber intake (gr/day) 2 60.1 12.35a
Protein Intake (gr/day) 7.5 20 13.25±2.9b
Iron Intake (mg/day) 1.7 32.8 9.5a
Calcium Intake (mg/day) 41.1 1505.6 415.4a
vitamin C Intake (mg/day) 5.8 139.3 112.05a
Moderation (score) 3 24 12a
Total Fat (% total energy/day) 16.2 59 36±8.59b
Saturated Fat (% total energy/day) 3.6 37 16.9a
Cholesterol (mg/day) 26 921.9 240a
Natrium (mg/day) 94.5 4565.6 559.3a
Empty Calory Food (gr/day) 1 41 14±9.3b
Overall Balance (skor) 0 6 0.0a
Macronutrient Ratio (KH:P:L) 0 6 0.8a
Fatty Acid Ratio (PUFA:MUFA:SFA) 0 2 0.0a
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An assessment by moderation category was The last category was the balance category
used to evaluate food intake that indicated a link to consisting of macronutrient balance and fatty acid
chronic diseases and might need to be restricted, i.e. ratio. The balance category evaluated the overall
fats, saturated fats, cholesterol, sodium, and low- diet in terms of the proportion of energy sources and
nutrient foods. This study showed that the fatty acid composition. Tables 5 and 6 show that
moderation score was low, which means that the most participants consumed foods high in fat and
food intake of the participants was still not enough for protein which led to the low intake of
appropriate. carbohydrates. Moreover, the intake of saturated
Table 6 shows the total consumption of fats, fatty acid (SFA) and monounsaturated fatty acid
saturated fats, and junk food which then (MUFA) were high (>10%). The recommendation
contributing to the score of the diet quality. stated that the intake of MUFA should be higher
According to the balanced nutritional guidelines, the compared to the intake of PUFA.
intake of cholesterol and sodium of the participants
was relatively good.
Table 5. Description of Adequacy in Diet Quality
Variable components n %
Adequacy
Vegetable Group Good (≥3-5 servings/day) 2 2.9%
Adequate (<3-1.5 servings/day) 9 12.9%
Less (<1.5 servings/day) 59 84.3%
Fruit Group Good (≥2-3 servings/day) 22 31.4%
adequate (<2-1 servings/day) 26 37.1%
Less (<1 servings/day) 22 31.4%
Grain Group Good (≥3-5 servings/day) 50 71.4%
Adequate (<3-1.5 servings/day) 17 24.3%
Less (<1.5 servings/day) 3 4.3%
Fiber Intake Good (≥20-30 gram/day) 14 20%
Adequate (<20-10 gram/day) 31 44.3%
Less (<10 gram/day) 25 35.7%
Protein intake Good (≥15% energi/day) 21 30%
Adequate (<15-7.5 energy/day) 49 70%
Iron intake Good (≥ 100 % RDA mg/day) 3 4.3%
Adequate (<100%-50%RDA/day) 18 25.7%
Less (<50 %RDA/day) 49 70%
Calcium Intake Good (≥ 100 % RDA mg/day) 2 2.9%
Adequate (<100%-50%RDA/day) 22 31.4%
Less (<50 %RDA/day) 46 65.7%
Vitamin C intake Good (≥ 100 % RDA mg/day) 45 64.3%
Adequate (<100%-50%RDA/day) 11 15.7%
Less (<50 %RDA/day) 14 20%
Carbohydrate Intake Excessive (>100% carbohydrate need/day) 27 38.6%
Adequate (80-100% (>100% carbohydrate need/day) 8 11.4%
Less (<80% (>100% carbohydrate need/day) 35 50%
Energy intake Excessive (>100% energy need/day) 27 38.5%
Adequate (80-100% energy need/day) 18 25.7%
Less (<80% energy need/day) 25 35.7%
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Table 6. Description Moderation in Diet Quality
Variable Components n %
Moderation
Total Fat Good (≤30% total energy/day) 17 24.3%
excessive (>30% total energy/day) 53 75.7%
Saturated Fat Good (≤10% total energy/day) 10 14.3%
Cholesterol Good (≤300 mg/day) 44 62.9%
excessive (>300 mg/dayi) 26 37.1%
Natrium Good (≤2400 mg/day) 66 94.3%
excessive (>2400 mg/day) 4 5.7%
Empty Calory Foods Good (≤10% total energy/day) 22 31.4%
Relations between Household Food Security and Diet Quality with CED
Bivariate analysis was conducted to investigate participants. Table 7 shows no significant link
the relationship between household food security (p=0.537) between household food security and
and the quality of diet with CED in the study chronic energy deficiency.
Table 7. Relations between Household Food Security and Diet Quality with CED
Variable CED
p r
Household Food Security 0.537b 0.075
Diet Quality 0.711a 0.045
a
Pearson bRank Spearman
DISCUSSION Probolinggo, which was only 27.3%, and a study

Study Participant Characteristics conducted in Gorontalo, which was only 28.3%.6,23
This study consisted of 38.6% of adolescents Meanwhile, the prevalence of CED in this study was
(16-20) years. Marriage under the age of 20 years lower compared to a study conducted in India which
also occurred in Palestine where the prevalence of reported a prevalence of CED among preconception
married women under the age of 18 was 41.4% women of 32.1%.21 We also found that 14.3% of the
while in India it was 44.5%.19,20 Marriage under the participants were over nutrition, which means that
age of 20 years is an important risk factor of there was a double burden of malnutrition in this
adolescent pregnancy, where a pregnant young study.
mother and suffers from CED would have a higher
risk of perinatal death and give birth to low birth Household Food Security
weight (LBW) babies.21 Education was one of the 75.1% of the study participants in this study had
underlying factors of early marriage in Indonesia.22 low food security and 1.4% had food insecurity. The
Most of the participants were only graduated from prevalence of low food security observed in this
junior and high school. Also, some of the study is higher compared to the prevalence of food
participants only graduated from elementary school. security among adult women in Malaysia which was
The prevalence of participants who were at risk only 43.5%.24 The high prevalence of low food
of CED based on MUAC measurement was still security may be affected by culture and habits
high (48.6%). However, this prevalence was lower among villagers who prioritize the food sufficiency
(15.7%) when assessed based on BMI measurement. of children. Besides children, working adults with
The higher prevalence of CED based on MUAC an important role in the household, like fathers,
measurement in this study was also reported by a become the main prioritize to get first and more food
preceding study conducted among brides in compared to other family members.25
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The statement in the HFSSM questionnaire that overall balance) contributed a low score to the total
contributed the highest score is the statement at the diet quality score.28
household level. A total of 72.9% of the participants The sufficiency of vegetables, iron, and calcium
were worried they could not buy food before they in participants recorded a low mean. The average
get another income and could only buy enough food vegetable intake was only 0.5 portions/day
to survive and not being able to stock up on food. compared to the recommended 3-5 portions/day.
Furthermore, 57.1% of the participants could not Similarly, a study in Spain also showed that the
buy balanced food. This is due to 64.3% of the average vegetable and fruit intake among female
participants were working but only get low income adolescents was low.28 Iron and calcium are
as factory workers (regional minimum wage) in important minerals needed during pregnancy. Most
Semarang District. The other 35.7% of participants of the participants consumed iron and calcium-rich
were unemployed thus dependent on their parents. food which are not following the recommendation.
The economy is the underlying factor for household A preceding study on pre-pregnancy women in
food security. Low – middle-income households Bogor supports this finding. The said study found
tend to have low food security. While high-income that the iron and calcium intake pre-pregnancy
households often spend more on healthy food.26 among women was low.29 Low intake of vegetable,
Low income in a household and the number of fruit, and other micronutrients like iron and calcium
family members that live in it will affect the can cause low diet quality among preconception
household food security.27 Low-income households women.30
with many dependent members lead to insufficient The DQI-I score shows an imbalance of total fat,
intake of each family member due to limited access total saturated fat, and low-nutrients food compare
to food. This condition was shown in the statement to the requirement. Based on the DQI-I, the
at the individual level where 21.4% of participants recommended consumption of total fat per day is
have experienced reducing of skipping a meal due <30% total energy/day, saturated fat is <10% total
to financial constraint. A total of 14.3% of energy/day and low-nutrients food is <10% total
participants have experienced eating less than usual energy/day. However, most of the participants still
and 5.7% of participants have experienced hunger consumed high-fat and low-nutrient food like sugar,
due to financial constraints which led them to not be which contributes a low score to their diet quality
able to purchase food. score. A high intake of total and saturated fat
resulted from the high consumption of fried food.
Diet Quality A low score was also found in the overall
Results show that the average score of diet balance category. The high intake of fat among
quality among study participants was low. A total of participants hinders the balance of other
80% of the participants had a low-quality diet and macronutrient intakes. Very few of the participants
the other 20% had high diet quality. The low-quality consumed total fat less than 30% of the total
diet among participants was affected by the energy/day. This has an impact on the low intake of
discrepancy between the nutrient intake and the carbohydrates and protein. Results show that the
recommendation. consumption of carbohydrates and protein among
The quality of diet consists of four categories the participants was relatively low compared to the
which are variation, sufficiency, moderation, and recommendation even though many of the
overall balance. The variation evaluates the participants consumed sufficient protein. The high
variation of the overall food and overall protein of intake of fat increases the total energy intake which
the participants. Results show that in general, the then affects the nutritional status.31
participants consume varied food. Insufficiency, This study also reported an imbalance of fatty
moderation, and overall balance categories, the acids. The average intake of SFA was higher than
results show a low mean which led to a low score of PUFA and MUFA. This finding is in line with the
diet quality. Another study in Spain reported a findings in Iran which showed that the high intake
similar finding, where female adolescents in the said of SFA was higher than PUFA and MUFA in female
study were found to consume varied food, but the adolescents. This may be caused by the shift in the
other categories (sufficiency, moderation, and diet pattern where adolescents tend to consume
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more high-energy foods like fast food and snack.32 Very limited studies evaluated the diet quality
Fast food has become an easy and cheap option even of preconception women using the DQI-I
though it contributes to excessive energy intake. questionnaire. The overall diet quality of the
participants in this study did not show a significant
Relations between Household Food Security and correlation with CED (p=0.711). This finding is
Diet Quality with CED supported by findings of other studies conducted in
Based on the test, household food security is not the USA among female adolescents which explains
significantly correlated to CED among the quality diet of female adolescents did not have a
preconception women (p=0.536). Very limited significant relationship with their nutritional status
studies evaluated household food security of based on BMI.38 However, this finding contradicts a
preconception women using the HFSSM preceding study that reported a significant
questionnaire. This study is supported by studies relationship between diet quality and BMI before
conducted in Bangladesh among pregnant women pregnancy among pregnant women.1 Another direct
and in Kenya among women of reproductive age factor that may cause CED in preconception women
between 15-49 years which found no significant is infection. During infection or another sickness,
relations between household food security with we tend to lose appetite thus lead to malnutrition. If
nutritional status by BMI measurement.33,34Yet, the it continues for a prolonged time, it can cause
results of these studies contradicted the findings of CED.39,40
a study conducted in Ethiopia which found a This disagreement may happen because CED in
significant status between household food security preconception women is not only affected by
and nutritional status by BMI measurement.35 household food security and diet quality. Energy
In this study, household food security did not and protein intake plays an important role in the
indicate low energy and protein intake. This can be incidence of CED among preconception women. A
seen from the high (and sometimes excessive) intake low protein and energy intake for a prolonged time
of energy and protein among the participants which can cause CED.23 In this study, most of the
was 64.2%. The high energy intake was acquired participants had sufficient energy intake, moreover,
from sugar and fat intake and low fiber which tend 38.5% of the participants had excessive energy
to be low in micronutrients. Thus, the CED rate was intake. Looking at the sufficiency of staple food, the
not high as the participants were close to being over average consumption of staple food of a participant
nutrient. was 3.65 portions/day and is categorized as
On the other hand, diet patterns in society also sufficient. Also, the protein intake of the participants
went through a shift where most households with was categorized as sufficient and good, thus it can
low food security only paid attention to quantity and be concluded that by quantity the intake of the
not the quality of the food. For example, by participants was adequate.
accessing fried food and low intake of vegetables This study differs from the Central Java
and fruit. A study in Kenya backed this finding. It Individual Food Consumption Survey in 2014
reported a shift in diet patterns in the household with which stated that women who live in the village tend
low food security. Fried food was chosen because it to have low consumption of energy and protein thus
is cheap and easy to consume compared to causing malnutrition. However, in this study, the
vegetables and fruit even though fried food is high participants had high energy high-fat diets thus tend
in energy and is unhealthy.34,36 Statements from to be over nutrition. This is supported by the result
most of the participants portray this by stating that that shows 14.35% of the participants had over
they cannot consume a balanced diet due to financial nutrition. Diets that tend to be over nutritious is a
constraints. Also, access to fried food is easier, as low vegetable and fruit yet high fat intake.15,28
most of the participants work as factory workers Diet quality is influenced by household food
where access to buy food was limited. A limited security, where a family with high food security will
break time is a reason that the participants consumed have a good diet quality.12,41 A low household food
an unhealthy diet that in prolonged time will cause security caused most of the participants in this study
overnutrition.37 to consume cheap and easily accessed food like fried
food. It was shown by the high intake of fat among
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119
the participants in the moderation category which 8. Rahmi L. Faktor-Faktor yang Berhubungan
was more than 30% of total energy. A low dengan Kekurangan Energi Kronik (KEK) pada
moderation score will affect the overall balance Ibu Hamil di Puskesmas Belimbing Padang
score where most of the participants had a high Tahun 2016. Jurnal Kesehatan Medika Saintika.
intake of fat and impair the balance of other 2017 Jun 12;8(1):35–46.
macronutrients. A high intake of fat will contribute 9. Arimond M, Elin L, Wiesmann D, Joseph M,
to excessive energy thus cause a build-up of fat on Carriquiry A. Dietary Diversity as a Measure of
the adipose tissue and plays an important role in the Women’s Diet Quality in Resource-Poor Areas:
incidence of overnutrition.42 Results from Rural Bangladesh Site. Food and
Nutrition Technical Assistance. 2008;58.
CONCLUSIONS 10. Potdar RD, Sahariah SA, Gandhi M, Kehoe SH,
A total of 48.1% of participants were at risk of Brown N, Sane H, et al. Improving women’s
CED, but only 15% of preconception women were diet quality preconceptionally and during
categorized as CED. The household food security of gestation: effects on birth weight and
the participants was mostly low (75.1%). Most of prevalence of low birth weight--a randomized
the participants (80%) had low-quality diets where controlled efficacy trial in India (Mumbai
the mean diet quality was 51.77. there was no Maternal Nutrition Project). Am J Clin Nutr.
significant correlation between household food 2014 Nov;100(5):1257–68.
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Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition)

Jurnal Gizi Indonesia Vol. 9, No. 2, June 2021 (111-122)

Household food security and diet quality with chronic energy

Key Words: CED; Diet quality; food security; Preconception woman

prolonged or chronic lack of calories and protein.

Diet quality is an assessment of food performed to describe the characteristics of the

Table 3. Components of the HFSSM Questionnaire

Table 4. Value of Minimum, Maximum, and Mean Diet Quality Subjects

Table 6. Description Moderation in Diet Quality

DISCUSSION Probolinggo, which was only 27.3%, and a study

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