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Summary Background & aims Coronavirus disease 2019 (COVID-19) patients are at high risk of malnutrition, and their doctors are part of a multidisciplinary team, including nutritionists. However, adherence to nutritional guidelines may be difficult in the context of capacity constraints during the COVID-19 pandemic. The aim of this study was to investigate barriers to doctors' adherence to nutritional guidelines and the impacts of guideline adherence on the outcomes of hospitalized COVID-19 patients. Methods A multinational electronic survey involving 51 doctors was conducted between November 2020 and January 2021 from 17 COVID-19-designated hospitals in countries with high (Indonesia) and low (Vietnam) numbers of confirmed COVID-19 cases. Results In general, doctors reported concerns related to nutritional practices in patients with Covid-19 which included feeling stress when performing medical nutritional therapy (65%), lacking self-efficacy or confidence in performing nutritional care (49%), lacking clear nutritional guidelines (45%), and experiencing budget limitations (33%). A regression analysis adjusted for age, country, and the number of hospitalized COVID-19 cases revealed that guideline knowledge (β: −1.01 (−1.78, −0.23); p = 0.012) and awareness of guidelines (β: −1.37 (−2.66, −0.09); p = 0.037) were negatively correlated with the length of stay of critically ill COVID-19 patients, but non-significant after adjusting for specialization of the doctor. When stratified according to country, a significant relationship between guideline adherence and length of stay of critically ill patients was only found in Vietnam [guideline adherence: β: −0.55 (−1.08, −0.03); p = 0.038; guideline knowledge: β: −1.01 (−1.9, −0.13); p = 0.027] after adjusting for age, specialty, and number of hospitalized COVID-19 cases. In Indonesia, the significant relationship between guideline adherence and mortality of COVID-19 patients remained strong (β: −14 (−27, −1); p = 0.033) after adjusting for age, specialty, and number of hospitalized COVID-19 cases Conclusions Inadequate nutritional knowledge is a key barrier to guideline adherence, and this was international and may be related to doctors' specialties and the COVID-19 pandemic. Adherence to nutritional guidelines may represent a prognostic factor for survival in COVID-19 patients.

Objective:The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron deficiency (ID) anaemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy BMI (pBMI) and erythropoiesis-related nutritional deficiencies.Design:Anthropometry, blood biochemistry and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion or a vitamin B12 deficiency.Setting:The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017–2019).Participants:We included 1456 women aged 20 to 45 years with singleton pregnancies.Results:Among these pregnant women, 9·6 % were UW, and 29·2 % were either OW (15·8 %) or OB (13·4 %). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95 % CI) for OW subjects (0·6; 95 % CI (0·4, 0·9)) but increased odds for UW (1·2; 95 % CI (0·8, 2·0)) and OB subjects (1·2; 95 % CI (0·8, 1·8)). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight, OB pregnant women had 3·4-fold (3·4; 95 % CI (1·4, 8·1)) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0·3; 95 % CI (0·1, 1·2)). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, Fe and folate intakes, but positive relationship with fat intakes.Conclusion:The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy.

Purpose Study location may cause a different type of socio-demographic, body mass index (BMI), study intensity and food-related behavior. The increasing number of Indonesia students who study abroad to Taiwan is interesting to be examined those factors related. The purpose of this study is to examine the food-related behavior of Indonesian college students in different study location. Design/methodology/approach A descriptive cross-sectional study design was used to administer questionnaires assessing socio-demographic, BMI, study intensity, meal preparations, food access and eating behavior of Indonesian college students (n = 493). Study location took in two cities and different countries (Indonesia and Taiwan). Analysis statistics was using frequency descriptive, Chi-square test, Wilcoxon–Mann–Whitney U test, Kruskal–Wallis test and Logistic regression. Findings The trend showed students who lived in Malang tended to have healthier eating behavior. Students tended to have a higher prevalence of low study intensity, dependent meal preparation and difficult food access in Taipei. There was a significant relationship between study location and study intensity (p < 0.01), study location and BMI (p < 0.01), study location and meal preparation (p < 0.01), study location and food access (p = 0.02). On the other hand, eating behavior had no significant relationship with study location (p = 0.28). Marital status became the most dominant variable in influencing obesity (OR = 0.198). Findings indicate that there are significant differences between study location with marital status, BMI, study intensity, meal preparation and food access, but not eating behavior. Moreover, married status is most influencing to obesity risk. Research limitations/implications The limitations of this research were data of height and weight was not be measured directly. Moreover, the reliability of the instrument was unexpected. In the future, research needs improvement more sample for fixing it. Moreover, to support initiatives to incorporate eating behavior into body weight management strategies may be needed. The implications are to create an effective nutrition education for Indonesian college students. Hopefully, it will be influencing public attitudes and affecting the quality of life. Practical implications Further investigation should consider longitudinal studies to explore the different effects of eating behavior on overweight and obesity. Nutritional education programs should give to young adults not only in developed but also in developing countries. Originality/value This paper shows our findings about the difference study location that may cause a different type of eating behavior. The research subject was Indonesian college students who live and study in two cities, Malang-Indonesia and Taipei-Taiwan. The trend showed students who live in Malang tend to have healthier eating behavior. On the other hand, study intensity, meal preparation and food access were significantly different in both cities. Indonesian college students in Taipei tended to have the higher prevalence of low study intensity, dependent meal preparation and difficult food access. The authors believe that the findings would appeal to a broad audience, especially for improving meal preparation in college students who study abroad.

The nutrition transition in low-middle income countries is marked by rising intakes of highly caloric, low nutrient-dense (junk) foods, decreasing intakes of fruits and vegetables, and sedentary behavior. The objective of this study was to explore interactions among fruit-and-vegetable intake, junk food energy intake, sedentary behavior, and obesity in Indonesian children. We conducted this school-based, case-control study in 2013 in Yogyakarta Special Province, Indonesia. The cases were 244 obese children aged 7&ndash, 12 years having a BMI &gt, 95th percentile of an age- and sex-specific distribution from the Centers for Disease Control and Prevention. The controls (n = 244) were classroom-matched children with a BMI &lt, 85th percentile. Using conditional logistic regression, the relative odds (95% confidence intervals, OR: 95% CI) of obesity given reported frequent fruit-and-vegetable intake (&ge, 3 servings/day), low junk food energy (&le, 1050 kcal/day) intake and low sedentary behavior (&lt, 5 h/day) was 0.46 (0.30&ndash, 0.69), 0.61 (0.37&ndash, 0.98), and 0.18 (0.12&ndash, 0.28), respectively. Effect sizes were dose-responsive and appeared additive. For example, children with low sedentary behavior and frequent fruit-and-vegetable intake were 92% less likely (OR = 0.08, 0.04&ndash, 0.15) to be obese than children not exceeding either of these thresholds. Similarly, children frequently eating fruits and vegetables and reporting a low junk food energy intake were 70% less likely (OR = 0.30, 0.15&ndash, 0.59) to be obese. The findings were unchanged after adjusting for child, maternal, and household covariates. Preventive interventions for child obesity need multiple components to improve diets and raise levels of physical activity rather than just addressing one of the three types of assessed behaviors.

Good nutritional support is crucial for the immune system to fight against coronavirus disease 2019 (COVID-19). However, in the context of a pandemic with a highly transmissible coronavirus, implementation of nutrition practice may be difficult. A multicenter electronic survey involving 62 dieticians was conducted, in order to understand barriers associated with dieticians’ adherence to nutrition guidelines for hospitalized COVID-19 patients in Indonesia. 69% of dieticians felt under stress when performing nutrition care, and 90% took supplements to boost their own immunity against the coronavirus. The concerns related to clinical practice included a lack of clear guidelines (74%), a lack of access to medical records (55%), inadequate experience or knowledge (48%), and a lack of self-efficacy/confidence (29%) in performing nutritional care. Half (52%) of the dieticians had performed nutrition education/counseling, 47% had monitored a patient’s body weight, and 76% had monitored a patient’s dietary intake. An adjusted linear regression showed that guideline adherence independently predicted the dieticians’ nutrition care behaviors of nutrition counselling (ß: 0.24 (0.002, 0.08), p = 0.04), and monitoring of body weight (ß: 0.43 (0.04, 0.11), p = 0.001) and dietary intake (ß: 0.47(0.03, 0.10), p = 0.001) of COVID-19 patients. Overall, adherence to COVID-19 nutrition guidelines is associated with better nutritional management behaviors in hospitalized COVID-19 patients.

OBJECTIVES: In this cross-sectional community-based study, we explored the relationship between TMAO and BMI with metabolic syndrome among middle-aged and elderly adults in Taiwan. METHODS: Population in this study were from a cross-sectional, community-based study in northern Taipei City, Taiwan. Eighty-six adults subject aged over 40 years (men and women) were enrolled. All subjects live near the Shin Kong Hospital. Body mass index (BMI) calculated based on body height and weight data. TMAO measured by enzyme-linked immunosorbent assay (ELISA) according to the manufactory's instruction. Metabolic syndrome was defined based on the 2005 revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The logistic regression, odds ratios (OR) and 95% confidence intervals (CIs) were calculated. RESULTS: This study reported that the metabolic syndrome group had higher TMAO levels (17.62 ng/mL) compare to participants without metabolic syndrome. In a multiple logistic regression, after adjusted with age, gender, weekly red meat consumption, log Hs-CRP, log choline, l-carnitine, and total body fat percentage, TMAO (adjusted OR = 5.89, 95% CI: 1.08–32.37) and BMI (adjusted OR = 1.39, 95% CI: 1.08–1.79) were more likely to increase metabolic syndrome risk. CONCLUSIONS: TMAO and BMI have roles in increasing metabolic syndrome risk. TMAO associated with higher OR of metabolic syndrome than BMI. Therefore, these findings showed that TMAO is a potential biomarker to predict metabolic syndrome risk in middle-aged and elderly adults in Taiwan. FUNDING SOURCES: Indonesia Endowment Fund for Education (LPDP-BUDI LN), the Ministry of Finance, and the Ministry of Research Technology Higher Education, Republic of Indonesia.

Obesity has become a significant problem for developing countries, including Indonesia. High duration of sedentary activity and high intake of unhealthy foods were associated with high risk of overweight and obesity. The objective of this study was to compare the distributions of sedentary activity and dietary behavior with overweight/obesity risks between urban and rural areas among children and adolescents aged 10&ndash, 18 years in Indonesia. This is a cross-sectional study. Data from a national survey in 33 Indonesian provinces (Basic Health Research /Riskesdas 2013) were analyzed. Multiple logistic regression models were used to calculate the odds ratio (OR) adjusted with all variables, such as age, gender, residency, education level, physical activity, and food intake. An urban&ndash, rural residence difference was found in the factors related to obesity. Daily caffeinated soft drinks and energy drinks consumption (OR = 1.12, 95% CI: 1.01&ndash, 1.23) were related to risk of overweight and obesity in urban areas. Daily grilled foods (OR = 1.32, 95% CI: 1.22&ndash, 1.42) and salty food (OR = 1.09, 95% CI: 1.04&ndash, 1.15) consumption were significantly associated with obesity in rural areas but not in urban areas. Furthermore, sedentary activity was correlated with overweight and obesity among those who lived in urban and rural areas. Our findings suggest that education, environmental, and policy interventions may need to specifically target urban settings, where access is high to a wide range of processed and traditional high-sugar, high-fat snack foods and beverages.

Sedentary behaviors and dietary intake are independently associated with obesity risk. In the literature, only a few studies have investigated gender differences for such associations. The present study aims to assess the association of sedentary behaviors and unhealthy foods intake with obesity in men and women in a comparative manner. The analysis presented in this study was based on the data from a population-based, cross-sectional, nationally representative survey (Indonesian Basic Health Research 2013/RISKESDAS 2013). In total, 222,650 men and 248,590 women aged 19&ndash, 55 years were enrolled. A validated questionnaire, physical activity card, and food card were used for the assessments. The results showed that the prevalence of obesity (body mass index of &ge, 27.5 kg/m2) was higher in women (18.71%) than in men (8.67%). The mean body mass index in women tended to be higher than in men. After adjusting for age and education, the gender effect on obesity persisted in women and was more significant than in men. There was also a positive and significant effect on obesity of sedentary behaviors and unhealthy foods intake. Moreover, fatty and fried foods displayed a positive multiplicative interaction, increasing obesity risk in women more than in men and indicating a possible dietary risk in in women in relation to obesity. The study suggests that the implementation of educational programs on nutrition and physical activity is particularly important for promoting a healthy body weight among Indonesian women.

OBJECTIVES: Sedentary behaviors and unhealthy diets are reported to be risk factors of obesity. The present study aims to examine the role of high sedentary activity and low consumption of fruits and vegetables in increasing obesity in Indonesian adult people. METHODS: The analysis presented in this study was based on the data from a population-based, cross-sectional, nationally representative, Indonesian Basic Health Research 2013. In total, 222,650 men and 248,590 women aged 19–55 years were enrolled. A validated questionnaire, physical activity card, and food card were used for assessment. RESULTS: The results showed that prevalence of obesity (body mass index of ≥27.5 kg/m2) was higher in women (18.71%) than in men (8.67%). The prevalence was higher in those with high (≥ 6 hours/day) sedentary activity (17.3%) than in those with low sedentary activity (14.5%). Furthermore, the prevalence was higher in those with low consumption of fruits and vegetables (20.6%) than in those with adequate consumption of fruits and vegetables (15.0%). Overall, people with high sedentary activity were 1.2 times (OR = 1.18, 95% CI: 1.16–1.21) more likely to be obese than those with low sedentary activity, and people with low consumption of fruits and vegetables were 1.5 times (OR = 1.51, 95% CI: 1.22–1.87) more likely to be obese than those with adequate consumption of fruits and vegetables after adjusting for age, sex, and socioeconomic status. The excess odds of being obese attributable to high sedentary activity and low consumption of fruits and vegetables was higher in men than in women. CONCLUSIONS: The present study suggests that promoting physical activity and healthy diets especially adequate consumption of fruits and vegetables could be the keys in preventing obesity in Indonesia. FUNDING SOURCES: Indonesian Ministry of Health, The University of Alma Ata, Taipei Medical University.