Chronic energy deficiency prevention model for adolescent girls
Abstract
Adolescence is a critical developmental phase marked by rapid physical growth, requiring adequate nutrition to support reproductive health. However, many adolescents fail to meet their nutritional needs, contributing to a high prevalence of Chronic Energy Deficiency (CED), particularly in developing countries like Indonesia. In Lampung, the prevalence of CED among women of reproductive age is 11.28%, with Islamic boarding schools (pesantren) reporting even higher rates, reaching 30%. This study examines the prevalence of CED at Darul 'Ulum Islamic Boarding School, Central Lampung, identifies contributing factors, and develops a prevention model. A total of 87 randomly selected female students across education levels participated. Data collection involved questionnaires assessing knowledge, attitudes, peer support, fasting habits, length of stay, food recall forms, and mid-upper arm circumference (MUAC) measurements. The findings indicate a 52% prevalence of CED, with significant correlations between CED and knowledge, attitudes, nutritional intake, education, physical activity, fasting habits, and peer support. Multivariate analysis highlights attitudes, fat intake, and length of stay as key factors. The study proposes a prevention model emphasizing behavior change, improved nutrition, and enhanced environmental management to reduce CED prevalence in Islamic boarding schools.
References
Amoadu, M., Abraham, S. A., Adams, A. K., Obeng, P., & Hagan, J. E. (2024). Risk Factors of Malnutrition among In-School Children and Adolescents in Developing Countries: A Scoping Review. Children, 11(4), 476. https://doi.org/10.3390/children11040476
Astuti, C., Majid, R., & Prasetya, F. (2022). Chronic Energy Deficiency in Women from Muna District: Association with Body Image and Knowledge. Diversity: Disease Preventive of Research Integrity, 76–83. https://doi.org/10.24252/diversity.v2i2.21442
Baceviciene, M., & Jankauskiene, R. (2021). Changes in sociocultural attitudes towards appearance, body image, eating attitudes and behaviours, physical activity, and quality of life in students before and during COVID-19 lockdown. Appetite, 166, 105452. https://doi.org/10.1016/j.appet.2021.105452
Bailey, C. P., Sharma, S., Economos, C. D., Hennessy, E., Simon, C., & Hatfield, D. P. (2020). College campuses' influence on student weight and related behaviours: A observational and intervention research review. Obesity Science & Practice, 6(6), 694-707. https://doi.org/10.1002/osp4.445
Best, O., & Ban, S. (2021). Adolescence: physical changes and neurological development. British Journal of Nursing, 30(5), 272-275. https://doi.org/10.12968/bjon.2021.30.5.272
Biswas, U. N. (2021). Adolescent Reproductive Health in South Asia: Issues and Challenges. Gender Equality, 32-41. https://doi.org/10.1007/978-3-319-95687-9_47
Chakrabarty, M., Singh, A., Singh, S., & Chowdhury, S. (2023). Is the burden of anaemia among Indian adolescent women increasing? Evidence from Indian Demographic and Health Surveys (2015–21). PLOS Global Public Health, 3(9), e0002117. https://doi.org/10.1371/journal.pgph.0002117
Chen, Y. (2024). Psychological Factors Contributing to Juvenile Delinquency: Exploring the Impact of Family Dynamics, Peer Influence, and Psychological Disorders, Implications for Factor Interactions and Intervention and Prevention Strategies. Lecture Notes in Education Psychology and Public Media, 44, 225-237. http://dx.doi.org/10.54254/2753-7048/44/20230149
Cohen, C. T., & Powers, J. M. (2024). Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem. Advances in Nutrition, 15(5), 100215. https://doi.org/10.1016/j.advnut.2024.100215
Dagnew, G. W., & Asresie, M. B. (2020). Factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia: An analysis of the 2016 Ethiopia demographic and health survey data. PLOS ONE, 15(12), e0243148. https://doi.org/10.1371/journal.pone.0243148
Deshmukh, P. R., Gupta, S. S., Bharambe, M. S., Dongre, A. R., Maliye, C., Kaur, S., & Garg, B. S. (2006). Nutritional status of adolescents in rural Wardha. The Indian Journal of Pediatrics, 73(2), 139–141. https://doi.org/10.1007/BF02820204
Di Bella, S., Sanson, G., Monticelli, J., Zerbato, V., Principe, L., Giuffrè, M., ... & Luzzati, R. (2024). Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clinical Microbiology Reviews, 37(2), e00135-23. https://doi.org/10.1128/cmr.00135-23
Duan, C., Liu, L., Wang, T., Wang, G., Jiang, Z., Li, H., ... & Cao, Y. (2024). Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review. BMC medicine, 22(1), 116. https://doi.org/10.1186/s12916-024-03334-x
Faradila, U. N., Wijayanti, H. S., Tsani, A. F. A., Widyastuti, N., Fitranti, D. Y., & Dieny, F. F. (2020). Fasting habits, sleep duration, energy availability, and chronic energy deficiency (CED) risk in female students. Food Research, 4(S3), 92–98. https://doi.org/10.26656/fr.2017.4(S3).S21
Faris, M. E., Al Gharaibeh, F., Islam, M. R., Abdelrahim, D., Saif, E. R., Turki, E. A., ... & Obaid, R. S. (2023). Caffeinated energy drink consumption among Emirati adolescents is associated with a cluster of poor physical and mental health, and unhealthy dietary and lifestyle behaviors: a cross-sectional study. Frontiers in Public Health, 11, 1259109.
Febry, F., Etrawati, F., & Arinda, D. F. (2020). The Determinant of Chronic Energy Deficiency Incidence in Adolescent Girls in Ogan Komering, Ilir Regency. Proceedings of the 2nd Sriwijaya International Conference of Public Health (SICPH 2019). 2nd Sriwijaya International Conference of Public Health (SICPH 2019), Palembang, Indonesia. https://doi.org/10.2991/ahsr.k.200612.048
Feskens, E. J., Bailey, R., Bhutta, Z., Biesalski, H. K., Eicher-Miller, H., Krämer, K., ... & Griffiths, J. C. (2022). Women’s health: optimal nutrition throughout the lifecycle. European Journal of Nutrition, 61(Suppl 1), 1-23. https://doi.org/10.1007/s00394-022-02915-x
Gizaw, Z., Yalew, A. W., Bitew, B. D., Lee, J., & Bisesi, M. (2022). Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia. Scientific Reports, 12(1), 1-11. https://doi.org/10.1038/s41598-022-23981-5
Hargreaves, D., Mates, E., Menon, P., Alderman, H., Devakumar, D., Fawzi, W., ... & Patton, G. C. (2022). Strategies and interventions for healthy adolescent growth, nutrition, and development. The Lancet, 399(10320), 198-210. https://doi.org/10.1016/S0140-6736(21)01593-2
Indrio, F., Mestrovic, J., Carrasco-Sanz, A., Vural, M., Namazova-Baranova, L., Giardino, I., Pop, T. L., & Pettoello-Mantovani, M. (2022). Overview on child health, nutrition and food hazards during the first thousand days of life. Global Pediatrics, 2, 100018. https://doi.org/10.1016/j.gpeds.2022.100018
Jovanović, G. K., Janković, S., & Pavičić ŽeŽelj, S. (2023). The effect of nutritional and lifestyle education intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of Croatian school children. Frontiers in Sustainable Food Systems, 7. https://doi.org/10.3389/fsufs.2023.1019849
Kamsiah, K., Yuliantini, E., Eliana, E., & Rachmawati, R. (2023). The Effect of Nutrition Education on Knowledge, Attitudes and Consumption Patterns of Young Women in Prevention of Chronic Energy Deficiency in Bengkulu City. Media Gizi Indonesia, 18(1SP), Article 1SP. https://doi.org/10.20473/mgi.v18i1SP.7-13
Khani Jeihooni, A., Hoshyar, S., Afzali Harsini, P., & Rakhshani, T. (2021). The effect of nutrition education based on PRECEDE model on iron deficiency anemia among female students. BMC women's health, 21(1), 256. https://doi.org/10.1186/s12905-021-01394-2
Lewis, M. E. (2022). Exploring adolescence as a key life history stage in bioarchaeology. American Journal of Biological Anthropology, 179(4), 519-534. https://doi.org/10.1002/ajpa.24615
Maehara, M., Rah, J., Roshita, A., Suryantan, J., Rachmadewi, A., & Izwardy, D. (2019). Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia. PloS One, 14, e0221273. https://doi.org/10.1371/journal.pone.0221273
Marcone, M. F., Madan, P., & Grodzinski, B. (2020). An Overview of the Sociological and Environmental Factors Influencing Eating Food Behavior in Canada. Frontiers in Nutrition, 7, 536125. https://doi.org/10.3389/fnut.2020.00077
Miller, G. D., Kanter, M., Rycken, L., Comerford, K. B., Gardner, N. M., & Brown, K. A. (2020). Food Systems Transformation for Child Health and Well-Being: The Essential Role of Dairy. International Journal of Environmental Research and Public Health, 18(19), 10535. https://doi.org/10.3390/ijerph181910535
Moya, M. (2020). Socioeconomic Status and Psychological Well-Being: Revisiting the Role of Subjective Socioeconomic Status. Frontiers in Psychology, 11, 543258. https://doi.org/10.3389/fpsyg.2020.01303
Nadimin, N., & Asikin, H. (2025). Impact of nutrition mentoring by dietetic students on knowledge, dietary intake, and nutritional status in pregnant women with chronic energy deficiency in South Sulawesi. Healthcare in Low-resource Settings. https://doi.org/10.4081/hls.2024.12958
Nogueira Firme, J., Dos Santos, E. B., Zandonadi, R. P., Nakano, E. Y., & Botelho, R. B. (2023). Dietary Challenges in Children with Gluten-Related Disorders: A Study on Food Neophobia. Nutrients, 16(22), 3924. https://doi.org/10.3390/nu16223924
Nurhaeni, N., Huda, M. H., Chodidjah, S., Agustini, N., Waluyanti, F. T., K. Nadi, H. I., Sri Armini, N. K., Sari, M., & Jackson, D. (2024). Exploring the strategies and components of interventions to build adolescent awareness about stunting prevention in West Java: A qualitative study. PLOS ONE, 19(12), e0314651. https://doi.org/10.1371/journal.pone.0314651
Paro, F. R., Davour, R., Acosta, D., Mechlowitz, K., Tiwari, C., & McKune, S. L. (2024). Improving Nutrition Security in Low-and Middle-Income Countries and the Role of Animal-Source Foods. Annual Review of Animal Biosciences, 13. https://doi.org/10.1146/annurev-animal-111523-102149
Petry, N., Jallow, B., Sawo, Y., Darboe, M. K., Barrow, S., Sarr, A., Ceesay, P. O., Fofana, M. N., Prentice, A. M., Wegmüller, R., Rohner, F., Phall, M. C., & Wirth, J. P. (2019). Micronutrient Deficiencies, Nutritional Status and the Determinants of Anemia in Children 0–59 Months of Age and Non-Pregnant Women of Reproductive Age in The Gambia. Nutrients, 11(10), Article10. https://doi.org/10.3390/nu11102275
Proia, P., Amato, A., Drid, P., Korovljev, D., Vasto, S., & Baldassano, S. (2021). The Impact of Diet and Physical Activity on Bone Health in Children and Adolescents. Frontiers in Endocrinology, 12, 704647. https://doi.org/10.3389/fendo.2021.704647
Puspitasari, V., Qotijah, R. S., & Qamaria, A. A. (2023). Analysis of Eating Patterns and Parity with the Incidence of Chronic Energy Deficiency in Pregnant Women: Literature Review. Open Access Health Scientific Journal, 4(2), 50–58. https://doi.org/10.55700/oahsj.v4i2.44
Putri Rahma Aulia, Enda silvia Putri, Itza Mulyani, & Hanif Muchdatul Ayunda. (2024). The Relationship Between Macronutrient And Micronutrient Intake On Ced In Adolescent Girls In Man 1 Aceh Barat. Medalion Journal: Medical Research, Nursing, Health and Midwife Participation, 5(1), 9–17. https://doi.org/10.59733/medalion.v5i1.101
Rollo, I., Gonzalez, J. T., Fuchs, C. J., van Loon, L. J., & Williams, C. (2020). Primary, secondary, and tertiary effects of carbohydrate ingestion during exercise. Sports Medicine, 50, 1863-1871. https://doi.org/10.1007/s40279-020-01343-3
Shine, D., Minehan, M., & Knight-Agarwal, C. (2022). #Healthpromotion: A qualitative exploration of how dietitians can use social media to positively influence women aged 18–35 years. Nutrition & Dietetics, 79(4), 489-496. https://doi.org/10.1111/1747-0080.12765
Siddiqui, F., Salam, R. A., Lassi, Z. S., & Das, J. K. (2020). The intertwined relationship between malnutrition and poverty. Frontiers in public health, 8, 453. https://doi.org/10.3389/fpubh.2020.00453
Soliman, A., Sanctis, V. D., Alaaraj, N., Ahmed, S., Alyafei, F., Hamed, N., & Soliman, N. (2021). Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Bio Medica : Atenei Parmensis, 92(1), e2021168. https://doi.org/10.23750/abm.v92i1.11346
Stanek, A., Myśliński, W., Cholewka, A., & Zolghadri, S. (2022). The Influence of Dietary Interventions on Arterial Stiffness in Overweight and Obese Subjects. Nutrients, 15(6), 1440. https://doi.org/10.3390/nu15061440
Thurstans, S., Opondo, C., Seal, A., Wells, J. C., Khara, T., Dolan, C., Briend, A., Myatt, M., Garenne, M., Mertens, A., Sear, R., & Kerac, M. (2021). Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. Nutrients, 14(5), 948. https://doi.org/10.3390/nu14050948
Toomey, A. H. (2023). Why facts don't change minds: Insights from cognitive science for the improved communication of conservation research. Biological Conservation, 278, 109886. https://doi.org/10.1016/j.biocon.2022.109886
Warf, C., Eisenstein, E., AlMakadma, A. K., Howard, J., Birch, D., Jillson, I., & Charles, G. (2020). Challenges Faced by International Migrants and Refugees to the Health, Development, and Well-Being of Adolescents and Youth. Clinical Care for Homeless, Runaway and Refugee Youth: Intervention Approaches, Education and Research Directions, 349-403.
Wati, E. K., Murwani, R., Kartasurya, M. I., & Sulistiyani, S. (2024). Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia. Narra J, 4(1), e742. https://doi.org/10.52225/narra.v4i1.742
Wrottesley, S. V., Mates, E., Brennan, E., Bijalwan, V., Menezes, R., Ray, S., ... & Lelijveld, N. (2023). Nutritional status of school-age children and adolescents in low-and middle-income countries across seven global regions: a synthesis of scoping reviews. Public health nutrition, 26(1), 63-95. https://doi.org/10.1017/s1368980022000350
Yang, Y., He, D., Wei, L., Wang, S., Chen, L., Luo, M., & Mao, Z. (2020). Association between diet-related knowledge, attitudes, behaviors, and self-rated health in Chinese adult residents: a population-based study. BMC Public Health, 20, 1-8. https://doi.org/10.1186/s12889-020-08896-y
Ziegler, A. M., Kasprzak, C. M., Mansouri, T. H., Gregory, A. M., Barich, R. A., Hatzinger, L. A., ... & Temple, J. L. (2021). An ecological perspective of food choice and eating autonomy among adolescents. Frontiers in Psychology, 12, 654139. https://doi.org/10.3389/fpsyg.2021.654139
Zuraida, R., Lipoeto, N. I. ., Masrul, M., & Februhartanty, J. . (2020). The Effect of Anemia Free Club Interventions to Improve Knowledge and Attitude of Nutritional Iron Deficiency Anemia Prevention among Adolescent Schoolgirls in Bandar Lampung City, Indonesia. Open Access Macedonian Journal of Medical Sciences, 8(E), 36–40. https://doi.org/10.3889/oamjms.2020.3287
