The Association of Calcium Intake and Nutritional Status with Bone Density of Elderly Women in Primary Health Center IV South Denpasar, Bali, Indonesia.

(1)

VOL.

1 _,

NO.

1,

zotj

ISSN

No.9772337712005

Joutnal

of

Ageing

and

Development

(2)

LIST

OF

CONTENT

1.

"Explorations

of

Challenging

Issues

for

Japan's

Acceptance

of

Indonesian

and

Filipino

Nurses

and Care Workers:

Outcome

of

Quantitative and Qualitative

Surveys

in

Japan and

the

Sending

Countries"

Shun

Ohno...

...

....1

"Gene

Collagen

I

Alphal

Polymorphism

and Osteoporosis

Risk

in

Indonesian Postmenopausal

Women"

Lindawati

S.

Kusdhany, Elza

lbrahim, Dwi

Anita

Suryandari,

Tri

Budi Rahardjo, EefHogervorst, Christopher

Talbott.

....

. . . . .. ..

.17

"Effects

of Isoflavones in Tempeh on Postmenopausal Syndromes"

Diah

M. Utari,

fumbawan, Hadi Riyadi,

Muhilal,

Purwantyastuti...25

2.

3.

"The

Association

of

Teeth

Mobility"

Farisza

Gita,

Muslita

Elin

Hediana..

...

..

Mandibular

Bone Density

LeYel

with

the Degrec

Indrasari,

Lindawati

S.

Kusdhany,

13

"The Clinical

Profile

of Hospitalized Etderly

Patients

with Delirium

in Immanuel

Teaching

Hospital Bandung"

Vera,

Abram

P.

Tanuatmadja,

Yuvens

Ricardo

Wibowo...40

"The

Association of

Calcium Intake

and

Nutritional

Status

with

Bone

Density

of Density of

Elderly

Women

in

Primary

Health Center

IV

South Denpasar,

Bali, Indonesia"

K.Tresna

Adhi,

D.Puspitasari, W. Weta,

N

K.Sutiari,

N.W.Rapiasih...

46

(3)

The Association ofCalcium Intake... I iADp ,

The Association

of Calcium Intake

and

Nutritional

Status

with

Bone Density of

Elderly

Women

in

Primary

Health Center

IV

South Denpasar,

Bali,

Indonesia

K.Tlesna Adhi, D. Puspitasar i,

N.K.

Sutiari,

N.W. Rapiasih

Abstract

Osteoporosis is a metabolic bone disease which is common and highly co(elated with

age, Ieading to disruption or change in bone shape and increases risk

ofbone

fractures, thereby disrupting

or linliting

daily activities. which catl ultimately include death. This research aims 10 determine the adequacy

ofthe

lcvel

of

calciurn :ntake and nutritional status on bone density in elderly Balincse uomen. The research was observational,

with

a cross-sectional design usirlg simple random sampling.

A

total

of

64 women aged 45

years and above were taken as the study sample. Results showed that 95.3 per cent

ol

elderly women indicated

a

calcium intake less

than

100 per cent

of

Recommended

Dietary

Allowances

(RDA). with a total

calcium

intake

of

an

average

oI

107.76 mg/day. The Body Mass Index

(BMl) of26

in 40.6 per cent ofrcspondents was

normal-Qualitative bonc density measuremcnt indicated

that

having

low

bone dens;ly was

lbund in

4l

(64.1 per cent) respondents. Thcre was a significant relationship between

calcium

intake and nutritional status

with

bone density (p<0.05). Recommendations include

giving

information about consumption

of

high-calcium food sourccs and also increasing physical

activity

and exercisc

to

help absorption

of

nutrients

from

lood consumed to improve bone mineral density.

Keywords: Calciunr Intake, NutritionalStatus, Bonc Density, Eldcrly Women

Abstrak

Osteoporosis adalah penyakit metabolik tulang yang umum dan sangat berkorelasi

dengan

usia, yaog

menyebabkan gangguan

atau

perubahan

bentuk tulang

serta meningkatnya

risiko

patah

tulang,

sehingga mengganggu atau membatasi kegiatan sehari-hari, yang pada akhirnya dapat menyebabkan kematian. Penelitian

ini

bertujuan

untuk

mengetahui

apakah

kecukupan

tingkat

asupan

kalsium

dan

status

Bizi berpengaruh pada kepadatan

tulang

pada perempuan lansia

di

Bali.

Penelitian ini

nrerupakan

penelitian

observasional, dengan desain closs

seclional

menggunakan

simple random sanzpling. Sebanyak

64

perempuan

berusia

45 tahun keatas

dipilih

sebagai sampel penelitian. Hasil penelitian menunjukkan bahwa 95,3 persen perempuan

usia

45

tahun keatas menunjukkan asupan kalsium kurang

dari

100 pers€n Asupan Kecukupan

Gizi (AKG),

dengan asupan kalsium total rata-rata 107,76 mg/hari. Indeks

Massa'lubuh (BMI)

dari

26

di

40,6 persen rcsponden adalah normal. Pengukuran densitas

tulang kualitatif

menunjukkan responden

memiliki

kepadatan tulang yang rendalr, ditemukan pada

4l

(64,1 persen) responden. Ada hubungan signifikan antara asupan kalsium dengan status

gizi

dengan kepadatan tulang (p

<0,05).

Rekomendasi termasuk memberikan infonnasi tentang konsumsi sumber makanan

tinggi

kalsium

(4)

I hc Asoc:,rion olCalcium lnrdke... I lADp

serta mcningkatkan aktivitas

flsik

dan olahraga untuk membantu penyerapan nuirisi

dari rnakanan yang dikonsumsi untuk menirgkatkan kepadatan mineral tulang.

Kata

Kunci:

Konsumsi Kalsium, Status Gizi, Kepadatan Tulang, Lansia Perempuan

Introducfion

According 10

the

Centml

Statistics

Atcncl

(BP5r, the nlmber

ol

elderll

irr

Indonesia

has

increased

significantly.

In

2007 the total

population included

18.96

rnillion

cldrlll

rll.0l

per

(crl

r(siJiJ

in

Bali)

and this number increased by 7.73 per cent in 2009. lndonesian women's life

expectancy

is

longer

than men,

with

a subsequent

higher

frequency

of

elderly

women coinpared

to

lnen.

Life

expectancy

ofthe

population

olBali

in

2000 was 68.1 years

$ith

an increase to approximalely 70.5

years

in

2006.12

This figure is

rvell

above the national figure

of66.2

years.

Based

on

data from

Denpasar

City

Health Office, in 2010 the number

ofelderly

in the city

of

Denpasar counted for as much as 8.39 per cent

ofthe

total

population. In

2011, there was

a 22.32

per

ccnt

increase compared

to

the

year 2010. The

Primary

Health Center

IV

South Denpasar

in

2010 showed that the proportion

ofelderly

people was 8,39 per cent- The proportion

ofelderly

increascd

in

the

years

2011

to

22.36

per cent,

With

an increase irr age. arr increasing

number

of

elderly

affects many aspects

of

life

due

to

tlle

change

in

the

physical.

biological,

psychological,

social, and

the emergence

of

degenerative diseases caused

by

the

ageing

process.

One

of

these

degenerative

morbidilie.

is

6.1q6p6,at1,.

According

to

rhe lnlernarional Osleoporosi.

Foundation

(2007).

osteoporosis

is

a

conditioll

characterized

by

a rapid decrease

in density and thinning

of

bone tissuc. Risk

I-aclors

lor

oseoporo:is

irrchrdc gcnctic..

being a woman, the presence

ofchronic

health

problems.

hormone

deficiency,

alcohol. smoking

and

lack

ol

exelcise.

Calcium

intake

also

contributes

to

maintainine

bone tissue

along

lite, padicularly among the elderly.

Several studies in Indonesia fbund that

the

risk

lactors

tbr

osteoporosis included lack ofexelcise. poor nutritional status

(BMI

<18.5), cafleine intake, calcium intake <70 per cent Reconnnended Dietary Allowances

(RDA)

anci age

2

55 years.6'7 r0

rr'r5-r7 on

this

basis

it

is

important

to

do

research

to

determine

the eflecl

of

calcium

intake and

nutritional status on bonc density ;n Balinese older women.

Methods

This study was an observational study

using

a

cross

sectional

design.

The

population

were 865 clderly

women

\rr'ho cn|ollcd in 2011. Sdmplc

crireri.

ue|r

being women aged 45 years and above enrolled in

the

Primary

Healtlr

Center

IV

South Denpasar

in

2011,

without

abno.malities

of

the spine or paralysis and being

willing

to be

interviewed.

The selected samples werc 64 women aged 45 years and above, using thc sampling technique

of

simple random sampling. The

data

coilection

was

done

by

tracing

the

primary data

collected

through

interviews

about

the

respondents'

characteristics

including nanre, age and educational level. Meanwhile,

to

determine the calcium intake,

qualitative and quantitative interviews were

conducted

usi0g

semi-quantitative

Food Frequency Questionnaire (SQ-FFQ).

Nutaitional status

of

respondents was assessed

by

using

Body

Mass Index

(BMI)

defined as the

weight in

kilograms divided

(5)

The Association oi Calcium tntate-..

i

t,qn,,

I

by

the

square

of

the

height

in

meters (kg/m'?).

Weighl

was assessed using digital

scales

accurate

to

0.1

kg.

Height

was measured

with

microtoice stature meter that

had

0.1 cnr accuracy-

Bone dcnsity was

nreasured

using

the

Bone

Densitometty

Achilles

Express.

Statistical analysis was done using computer soltware and analyzed using

Chi

Square Tests, $'ith a p-value

ol5

per cent to establish significance.

Results

The

research

was

conducted

on

64

wonen

aged 45 yearc and above who were enrolled in the pd$/d77.1r, or who visited the

Primary

llealth

Center

IV

South Denpasar.

Table

I

provides

thc

distribution

of

respondents

based

on

their age

and

edLrcation Ievel.

Table 1. Distributiod of Respondent Characterisdc

Bas€d on Age and Education L€vel

Recommended

Dielao

Allo\^ances (RDA) ot 800

mg/i6y

'

Tabl€ 2. Th€ Distribulion ofCalcium lnlake. Nutritional Statui, and Bone Denlity

alnong Respondents

Calcium Intake Inw (< R-DA)

Normal

(:

RDA)

6l

3

(e5.3) (4.8)

6 (e.4)

5t 179.7) 7 (10.9)

Bone Density

Low(<-r

)

Noflnal

(:

-l

₎

23 (35.9)

4l (64.1)

Table

2

sho$s

that

most

oI

the respondents have

a

normal nulritional status

(79.7 per cent), reflected

by

a

noflnal BMI.

lheir

bonc density was assessed qualitatively using the Bone Densitonetry and showed that most respondents had low bone density (64.1

pl]r cent.). Age

45-59 yr

60-69 ],r

r70)n

Education Level

No schooling

Primary

lunior and senior high school Bachelor Degree

Distribution of

r rJ (2rJ.l) l5 (s4.7)

1t (17.2)

j9 _(60.9)

12 (18.8)

7(n

0) 6 (e.4)

g*

550

540

From the results

of

the dcscriptive analysrs presented

in

Table

I,

it

is

clear

that

most respondents were in in the age group

of

60-69 years (54.7 per cent) with the majority

of

them

not

having

any

schooling (60-9 per

cent).

Measurement

of

dietary

calcium

intake

ol

respondenrs

\\3,

mecJured using

Semi

Quantitative

Food

Frcquency

Questionnaire

(SQFFQ).

For

complete results we reler to Table 2.

The respondents' level ofcalcium intake was mostly

low

(95.3 per cent consumed

it

below the RDA) with an average totalcalcrum intake

of

107.76 mdday, which

is

below

of

Asecteso es (yed)

Figure

l

Dis.ribution ofBone Densi$ Based on Age

Body Mrss Ind€x (BMl)

UndeNeigh(<18.5 ks/N-)

Normal (18.5-25 kg/m:) Overweishl (>25 ks/ntr)

(6)

The Association of Calc;um

Intake.-Figurc

I

shows

the

distribution

of

bone density bascd on respondent's age. 11 shows

that an

increasing age

of

the

respondents increases

the

risk

oi

a

decline

in

bone

den.ir1.

lhi.

change in bone (onrposilion i

thus

a

result

of

the

ageing

process!

ol-alternatively,

depcnds

on thc

particular

lable

J

shor\s

lhdl

lo$

c.rl.iurn

intake cortributes to low bone density where

nonnal level

decreases

the

risk by 68

per cent. For anal),tical purposes, the ntltritional

srctu\

i(

calegorzed

inlo

l*o.

calegorrcs

normal

{BMl:

18.5

-

'5

kg/rn't and

not

normal

(underweight/overweight (BMI:

<18.5 kg/m'?and

>25

kg/m'?,

respeclively)-Chi

square

test

results

showed

that respondents

wilh

low weight were 9.1 limes

more

li(cl)

lo

hir\e

lou

bone

densitl conpared \\,ith respondcnts who had normal nuLntioncl

\lJru\.

lhis

nrean5 Ihal lhcre

i'

a

significant

association between nutritional

status and bone density.

Tabel

3.

Bivarintc

Analysis of Bone Density Based on Calcium

lntakc

and

Nutritional

Status

Bone Density _CI

Variable Nornral

'Total

X)

n

(rer

cent

n

(per

cenl)

n (Per cent)

Low

Up

Calcium Intake

I-ow

4l(

100.0)

20(87.0)

6i(95.3)

0(0.0) 3(13.0)

3(4.7)

5.611 0.018

0.328

0.229

0.470

Normal

4r(r00.0)

23(100.0

Nutritional

StatDs

Not

nornrl

Nornul

2e170.1)

22(9s.7)

5l(79.7)

s.653

0.017 9.103

1.099

75.382

Total 4 r(

r00.0)

23(100.0)

64(100.0)

Discussion

According

to

experts,

to

avoid osteoporosis, one must go through a process that starts

fiom

early prevention.

A

diet that

can lead to

osteoporosis

involves consumption ofless calcium and unbalanced

nulritional

intake.

talcium

d<ficienc1

is

a

situation where

the

concentration

of

total

calcium in scrunr ofless than 8.5

mg/dl

(2-2

mmol/L) or when calcium ion levcls are less

than

1.0

rnmoVL.ra

Calciurn

deficiency occurs during periods

of

rapid bone growth {modelingr

unlil peal

bone mass and

i(

very

influentialon a person's bone

fragility.")

Consuming enough calcium every day

is very impoftant

to

assjst the establishment and maintenance ofstrong bones. Aside

liom

beirrg

a

precursor

of

bone, calcium ts

also

important

for

some

other

body

linctions. lfyou

do

not

consume enough calcium every day as a result, the body

will

take calcium

from the

bones.

This

is

what causes osteoporosis-

In

addition

to

adequate cak iurn intake. rhe

bodl

also needs vilamin

D3, which needs to be sufficienl

for

optimal calcium absorption to take place. This is best synthesized during sun exposure rather than

tte taken in sunlight.

According to a study

that

1

|

minutes a

dc1 of srrn exposure uas qufficienl lo sustain

bone

mass.6

Sports activities such

as

walking. jogging,

aerobics

and

physical exercise

with

weighls

can

also be

used

to

prevent

osteoporosis.

In

people

with

(7)

The Association of Calcium tntake... I Jrule

osteoporosis,

this

can slowdown bone loss, but exercise can also provide the mechanical

stimulation

of

n]uscle contraction

on

the spine and other pads

tlut will

stimulate bone

Less mobility

can

accelerate

and

exacerbate ostcoporosis-

However.

for

patients with osteoporosis

it

is recommended

not

to

exercise exoessively

to

avoid

thc

occurrencc

of

fractures.

Another

factor

affe.ting

lhe

Ie\cl. ot

calcium in plastna

ir

lhc

rario

aa

l

in

lood. ldcall).

calcium intake should be in the same range

with

the

consumption

of

phosphorus

(P),

and

the

ratio

ol'P:

Ca:

I.5:

I

may be acceptable. But

iftlle

ratio is more than 2:1, especially

il

calcilrm intake

is

low. this

will

hav.-negalive influences

which

can cause bone demineralization.e

It

is

estimaled

thal

this

may

be one

important

factor

in

the

development

of

ostcoporosis,

a

phenomenon

that

decreases

bonc

denrit) and

min<ralization.

lhii

is

common

with

an increasing age, especially

in

postmenopausal

women.e

To

prevent

osteoporosis,

smoking,

dlinking

coflee.

alcohol and

soft

drinks should be reduccd. Insterd.

elderl)

shorrld locus L,n consuminB

a

high

calcium-conlaining

foods

such as

anchovies, shrhnp rebon, beans, tempeh or

dri:rking milk.615

Poor

nutritional

status

il]

the

elderlv can be due to:

l.

Decreased

basal

melabolisrn.

where

caloric

needs

decrease resulting in overweight/obesity;

2.

Reduced physical activity resulting in overweight/obesity;

3.

Economic prosperity,

food

con-sumption becomes excessive, the

result tends

to

be

overweight/ obesitYl

4. Taste

loss,

eating

becomes

uncomlortable

and

decreases

appetite, resulting

in

elderly

becoming malnourished (consum-ing less protein energy);

5.

Periodontal disease (teeth),

result-ing

in

difliculty

eating

fiber (vegetables, meat) and

a

tendency

to

eat soft

foods

(high

caloric), resulting in overweight/obesity;

6.

Dccrca'e

in ga'tric

acid secrerion

of

digestive enzymes

and

food,

interferes

with the

absorption {r1' r itamins arrd rnirrrlals. rcsuhing in

deficiency of micro nutdents;

7-

Decreased

bowel

nobility,

resulting in constipation, so elderly

olien

sufler

liom

hemorrhoids

which can cause bleeding and lead

to anemia:

8.

Frequent use

of

drugs

or

alcohol.

this

can

decrease

appetite

tlmt

causes malnutrition and hepatitis or liver canccr;

q.

_Di.orders_ol-moror

slills.

_rc.uking

in

dilficulties

lbr

thc

eldcrll

irr

preparing

their

own

food

and

becoming malnourished;

10.

Less socializing

and

loneliness

r p.1cho

lngical chJnge\i

resuhtng

in

decreased

appetite

and

malnutrition:

I1.

Decreased revenues

(retire),

food

con\unr|lron

i.

louered

result inS

in nralnutrition;

12. Dementia,

rcslrlting

in

i|frequent meals

or

even forgelling

to

eat,

which

can

cause obesity

or

malnutrition.o

t

hcsc problcms in

eldcrl)

alTect lheir

nutritional

status.

that

can

be

obseNed

through body mass index measurement.

In

this

research

there

was

a

significant associalion be.ween nutritional status and

bone density-

These

data

suggested that

clinicians and health service providers need

to

provide intensive information about the

right diet lbod sources, especially foods high in calcium such as anchovies, beans, tempeh

and

milk.

They

should

also

support increased physical

activity

to

prevent ihe decrease

in

bone density

that

will

help sustain a healthy elderly population.

The weakness

ofthis

study is the use

of

dietary

assessment, since none

of

the

dietary

assessment

methods

ploduces accurate nutrient requirements in the elderly

(8)

The Associatior of Calcium lntake...

because

of

memory deficits that can lead to

bias

in

research

resulls.

lrr

addition, measurements

of

nutritional

status

in

this

study have

not

been using height predictor

elde.ly

(fathoms

long/high

knees/seat

height)

lor

the

people aged

60

years and above so

that it

can

resull

in

a

bias

in

the

interpretation

of

nlrtritional

assessment

of

elderly.6

However,

our

data suggest

lhat

a

focus on maintenance

of

the correct weight

by exercising and the correct diet could aid

eldcrll

uomcn

in preventitrg o.teoporosi. in Bali.

Acknowledgernent

Thanks 1o Primary

Heallh

Center

IV

South Denpasar stalfand the ANLENE teani

lor

help and cooperation

in

data collection and inlormation in this study.

PostDenoDausal Osteoporolic Women in North

Wcst

of

lran

Asid Pac

.t

Clin N

r'.

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Dasu

n

Cizi (Bosic

Prnkiple of Ntutitia"). Jakdna:

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l''l'

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I4. RLrjiarro

.^.

Pcryakil Nlctabolisne Klki'nn

(Hiperkdhenia dar Hipokalsni!) dala'n Ku6us

D6a Metabolislrc Kalsiunr daD Penylkil fulanr

PERKIINI (L\) (Calciunr Melabolisn Disease

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li

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18. Seojono CH. Bonc Mehbolism

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I 9. WidiakarF Nalioral Food ard NuLriLion. hdonesiaD R€commended Dielary llos ances

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5 Hcaz J, Mo\kd.rE J. I'olJh S .nd fbEl,imi-Mamaghdi

M.

Nutilion

Status anrong

K.Tresna

Adhi,

D.Puspitasari, W.Weta, and

N.K.Sutiari:

SchoolofPublic

Health, Faculty

olMedicine,

Udayana University

N.W Rapiasih: Sanglah Hospital, Denpasar,

Bali

Corespondence to:

kadek

adhi@yahoo.com