The Effect of Nutrition Education on Body Mass Index, Waist Circumference, Mid-upper Arm Circumference and Blood Pressure in Obese Adolescents
More details
Hide details
Postgraduate Nutrition Science Study Program, Sebelas Maret University, Surakarta, INDONESIA
Dr. Moewardi Hospital Clinical Pathology Staff, Medical Faculty, Sebelas Maret University, Surakarta, INDONESIA
Online publication date: 2020-04-05
Publication date: 2020-04-05
Electron J Gen Med 2020;17(5):em221
The aim of the study was to determine the effect of nutrition education in the form of DASH diet booklets on body mass index, waist circumference, mid-upper arm circumference, and blood pressure in obese adolescents.

This study was quasi-experimental, which is pre-test and post-test with control group design. The number of subjects was 60 respondents. The groups in this study were divided into two; one treatment group and one control group. The first group was given a nutrition education intervention with a booklet and the second group was not treated. Data analysis used paired t-test and independent t-test (p=0.05; CI=95%), Wilcoxon test, Mann-Whitney test, and Spearman rank test.

There were differences in BMI, waist circumference, mid-upper arm circumference, and significant systolic blood pressure in the treatment group after the intervention. The mean average of the treatment group decreased significantly; BMI: 0.36±0.05 kg/m2; waist circumference: 0.84±0.14 cm; mid-upper arm circumference: 0.37±0.63 cm, and systolic blood pressure: 1.13±1.36 mmHg. In the control group the average BMI, waist circumference, mid-upper arm circumference, and systolic blood pressure were increased significantly. The treatment group experienced a decrease in energy intake by 524.65±85.77 kcal while physical activity increased by 0.635±0.09. Conversely, the control group experienced an increase in energy intake by 147.29±25.18 kcal, while physical activity decreased by 0.470±0.08. Changes in energy intake and physical activity between the treatment group and the control group were identified as significant correlations (p<0.001). Similar to it, the changes in the BMI, waist circumference, mid-upper arm circumference, and significant systolic blood pressure were identified as significant correlations (p<0.001).

The use of booklets can be a solution for the continuation of effective nutrition education as the nutritional information becomes easier to be comprehended and adapted by the booklet recipients and used in everyday life.

Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics, 2016;33(7):673-89. https://doi.org/10.1007/s40273... PMid:25471927 PMCid:PMC4859313.
Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine, 2017;377(1):13-27. https://doi.org/10.1056/NEJMoa... PMid:28604169 PMCid:PMC5477817.
Bhurosy T, Jeewon R. Overweight and obesity epidemic in developing countries: A problem with diet, physical activity, or socioeconomic status? Scientific World Journal, 2014. https://doi.org/10.1155/2014/9... PMid:25379554 PMCid:PMC4212551.
Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 2004;5:4-85. https://doi.org/10.1111/j.1467... PMid:15096099.
WHO. Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: Report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. In World Health Organization. 2016. Available at: https://apps.who.int/iris/bits....
Balitbangkes RI. Riset Kesehatan Dasar (RISKESDAS) 2010 [Basic Health Research Republic of Indonesia 2010]. 2010. Available at: http://labdata.litbang.depkes.....
Balitbangkes RI. Riset Kesehatan Dasar (RISKESDAS) 2013 [Basic Health Research Republic of Indonesia 2013]. 2013. Available at: http://labdata.litbang.depkes.....
Balitbangkes RI. Riset Kesehatan Dasar (RISKESDAS) 2018 [Basic Health Research Republic of Indonesia 2018]. 2018. Available at: http://labdata.litbang.depkes.....
Reicks M, Banna J, Cluskey M, Gunther C, Hongu N, Richards R, et al. Influence of parenting practices on eating behaviors of early adolescents during independent eating occasions: Implications for obesity prevention. Nutrients, 2015;7(10):8783-801. https://doi.org/10.3390/nu7105... PMid:26506384 PMCid:PMC4632451.
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA - Journal of the American Medical Association, 2014;311(8):806-14. https://doi.org/10.1001/jama.2... PMid:24570244 PMCid:PMC4770258.
Venn AJ, Thomson RJ, Schmidt MD, Cleland VJ, Curry BA, Gennat HC, Dwyer T. Overweight and obesity from childhood to adulthood: A follow-up of participants in the 1985 Australian Schools Health and Fitness Survey. Medical Journal of Australia, 2007;186(9):458-60. https://doi.org/10.5694/j.1326... PMid:17484707.
Boyer BP, Nelson JA, Holub SC. Childhood body mass index trajectories predicting cardiovascular risk in adolescence. Journal of Adolescent Health, 2015;56(6):599-605. https://doi.org/10.1016/j.jado... PMid:25746172 PMCid:PMC4442729.
Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. The New England Journal of Medicine, 2010;362(6):485-93. https://doi.org/10.1056/NEJMoa... PMid:20147714 PMCid:PMC2958822.
Gupta-Malhotra M, Shete S, Barratt MS, Milewicz D, Syed, Hashmi S. Epidemiology of Childhood Onset Essential Hypertension. Journal of Human Hypertension, 2018:1-6. https://doi.org/10.1038/s41371... PMid:30224771 PMCid:PMC6265061.
Anyaegbu EI, Dharnidharka VR. Hypertension in the teenager. Pediatric Clinics of North America, 2014;61(1):131-51. https://doi.org/10.1016/j.pcl.... PMid:24267462 PMCid:PMC3947917.
Brady TM, Solomon BS, Neu AM, Siberry GK, Parekh RS. Patient-, Provider-, and Clinic-Level Predictors of Unrecognized Elevated Blood Pressure in Children. Pediatrics, 2010;125(6):e1286-e1293. https://doi.org/10.1542/peds.2... PMid:20439598.
Bhupathiraju SN, Hu FB. Epidemiology of obesity and diabetes and their cardiovascular complications. Circulation Research, 2016;118(11):1723-35. https://doi.org/10.1161/CIRCRE... PMid:27230638 PMCid:PMC4887150.
Soekarjo DD, Roshita A, Thow A-M, Li M, Rah JH. Strengthening Nutrition-Specific Policies for Adolescents in Indonesia: A Qualitative Policy Analysis. Food and Nutrition Bulletin, 2018:1-12. https://doi.org/10.1177/037957... PMid:30099923.
Hill JO, Wyatt HR, Peters JC. Energy balance and obesity. Circulation, 2012;126(1):126-32. https://doi.org/10.1161/CIRCUL... PMid:22753534 PMCid:PMC3401553.
Kar SS, Dube R, Kar SS. Childhood obesity an insight into preventive. Avicenna Journal of Medicine, 2014;4(4):88-93. https://doi.org/10.4103/2231-0... PMid:25298951 PMCid:PMC4183902.
Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin P, et al. Effects of the DASH Diet Alone and in Combination With Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women With High Blood Pressure. Archive of Internal Medicine, 2010;170(2):126-35. https://doi.org/10.1001/archin... PMid:20101007 PMCid:PMC3633078.
Peairs AD, Shah AS, Summer S, Hess M, Couch SC. Effects of the dietary approaches to stop hypertension (DASH) diet on glucose variability in youth with Type 1 diabetes. Diabetes Management (London, England), 2017;7(5):383-91. Available at: http://www.ncbi.nlm.nih.gov/pu... http://www.pubmedcentral.nih.g....
Corsino L, Sotres-Alvarez D, Butera NM, Siega-Riz AM, Palacios C, Pérez CM, et al. Association of the DASH dietary pattern with insulin resistance and diabetes in US Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). BMJ Open Diabetes Research & Care, 2017;5(1):1-9. https://doi.org/10.1136/bmjdrc... PMid:28761660 PMCid:PMC5530245.
Esfandiari S, Bahadoran Z, Mirmiran P, Tohidi M, Azizi F. Adherence to the dietary approaches to stop hypertension trial (DASH) diet is inversely associated with incidence of insulin resistance in adults: The Tehran lipid and glucose study. Journal of Clinical Biochemistry and Nutrition, 2017;61(2):123-9. https://doi.org/10.3164/jcbn.1... PMid:28955129 PMCid:PMC5612815.
Asnidar A. Pendidikan Kesehatan Berbasis Media Sosial Untuk Mengubah Pengetahuan, Gaya Hidup Dan Indeks Massa Tubuh Remaja Obesitas Di Bulukumba [Social Media Based Health Education to Change Knowledge, Lifestyle and Body Mass Index of Adolescent Obesity in Bulukumba]. Universitas Hasanudin Makasar. 2017.
Lanita U, Sudargo T, Huriyati E. Pengaruh pendidikan kesehatan melalui short message service (sms) dan booklet tentang obesitas pada remaja overweight dan obesitas [The effect of health education by short message service (sms) and booklet about obesity in overweight and obese adolescent]. Jurnal Gizi Klinik Indonesia, 2015;12(1):36-44. https://doi.org/10.22146/ijcn.....
NHLBI. National Institute of Health. National Heart, Lung and Blood Institute. Your guide to lowering your blood pressure with DASH. 2006. https://doi.org/10.1037/e56649....
Kowalski KC, Crocker PR, Donen RM. Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A). Saskatoon: University of Saskatchewan. 2004. Available at: https://www.performwell.org/in....
Mazloomy-Mahmoodabad SS, Navabi ZS, Ahmadi A, Askarishahi M. The effect of educational intervention on weight loss in adolescents with overweight and obesity: Application of the theory of planned behavior. ARYA Atherosclerosis, 2017;13(4):176-83.
Bleich SN, Bandara S, Bennett W, Cooper LA, Gudzune KA, Medical JH. Enhancing the role of nutrition professionals in weight management: A cross sectional survey. Obesity (Silver Spring), 2015;23(2):454-60. https://doi.org/10.1002/oby.20... PMid:25445319 PMCid:PMC4310773.
Spolidoro JV, Pitrez Filho ML, Vargas LT, Santana JC, Pitrez E, Hauschild JA, et al. Waist circumference in children and adolescents correlate with metabolic syndrome and fat deposits in young adults. Clinical Nutrition,2013;32(1):93-7. https://doi.org/10.1016/j.clnu... PMid:22841400.
Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. Journal of Pediatrics, 2006;148(2):188-94. https://doi.org/10.1016/j.jped... PMid:16492427.
Motlagh ME, Shirvani S, Hassanzadeh-Rostami Z, Taheri M, Ghadimi R. Assessment of overweight and obesity in Iranian adolescents: Optimal cut-off values of anthropometric indices. Eastern Mediterranean Health Journal, 2018;24(10):975-87. https://doi.org/10.26719/2018.... PMid:30582140.
Siren R, Eriksson JG, Vanhanen H. Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease. BMC Public Health, 2012;12(1). https://doi.org/10.1186/1471-2... PMid:22877354 PMCid:PMC3490795.
Asma PN, John S, Monica SJ. Dietary pattern and nutrient intake of overweight and normal weight adolescent girls - A cross-sectional study. Asian Journal of Pharmaceutical and Clinical Research, 2018;11(1):264-7. https://doi.org/10.22159/ajpcr....
Dharmade PN, Kale MP. Effect of nutrition education on anthropometric measurements of adolescent girls. International Journal of Home Science, 2017;3(1):136-40. Available at: http://www.homesciencejournal.....
Jaiswal M, Bansal R, Agarwal A. Role of mid-upper arm circumference for determining overweight and obesity in children and adolescents. Journal of Clinical and Diagnostic Research, 2017;11(8):SC05-SC08. https://doi.org/10.7860/JCDR/2... PMid:28969228 PMCid:PMC5620869.
Pandita A, Sharma D, Pandita D, Pawar S, Tariq M, Kaul A. Childhood obesity: Prevention is better than cure. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2016;9:83-9. https://doi.org/10.2147/DMSO.S... PMid:27042133 PMCid:PMC4801195.
Esler M. The 2009 Carl Ludwig Lecture: pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. Journal of Applied Physiology, 2010;108(2):227-37. https://doi.org/10.1152/japplp... PMid:19940096.
Straznicky NE, Grima MT, Eikelis N, Nestel PJ, Dawood T, Schlaich MP, et al. The effects of weight loss versus weight loss maintenance on sympathetic nervous system activity and metabolic syndrome components. Journal of Clinical Endocrinology and Metabolism, 2011;96(3):503-8. https://doi.org/10.1210/jc.201... PMid:21177786.
Juncos LI. Salt intake in childhood and adolescence. Hypertension, 2014;63(5):911-2. https://doi.org/10.1161/HYPERT... PMid:24614219.
Ewald DR, Haldeman LA. Risk Factors in Adolescent Hypertension. Global Pediatric Health, 2016;3:1-26. https://doi.org/10.1177/233379... PMid:27335997 PMCid:PMC4784559.
De La Haye K, D’Amico EJ, Miles JNV, Ewing B, Tucker JS. Covariance among multiple health risk behaviors in adolescents. PLoS ONE, 2014;9(5):1-5. https://doi.org/10.1371/journa... PMid:24858838 PMCid:PMC4032285.
Journals System - logo
Scroll to top