Dietary non-compliance among Indonesian patients with diabetes and kidney disease: A focus on risk-associated eating behaviors
Chronic illnesses, such as diabetes mellitus (DM), hypertension, and chronic kidney disease (CKD), are increasingly prevalent in Indonesia, partly due to poor dietary habits. This study aimed to analyze the association between risky food consumption and the occurrence of hypertension and CKD in individuals with diabetes and to explore the factors influencing unhealthy food choices. This cross-sectional study used data from the 2023 Indonesian Health Survey. The analysis included 14,935 adults diagnosed with diabetes mellitus, of whom 143 were identified as having both hypertension and CKD. Stratified random sampling was applied based on census blocks. Data were collected through structured interviews and health assessments of dietary patterns and a history of chronic illness. Chi-square tests and logistic regression were performed to assess the associations, with p < 0.05 considered significant. Hypertension was significantly associated with CKD (OR, 2.16; 95% CI: 1.68–2.77; p < 0.001). Risky dietary patterns, particularly high intakes of salty foods, processed meats, and sugary beverages, were significantly associated with hypertension. The major drivers of unhealthy food consumption include taste, affordability, and lack of health awareness. Risky food intake contributes to hypertension and CKD in patients with diabetes. Targeted public health interventions are required to improve dietary behavior and raise awareness.
Keywords : Diabetes Mellitus, Hypertension, Chronic Kidney Disease, Dietary Behavior
- Ajisuksmo, C. R. P. (2021). Why some adolescents engage in risk-taking behavior. International Journal of Educational Psychology, 10(2), 143. https://doi.org/10.17583/ijep.2021.4258
- Akpan, E., & Ekrikpo, U. E. (2015). Chronic kidney failure: Knowledge of kidney disease, perception of causes and symptomatology in Uyo, Nigeria. Open Journal of Nephrology, 5(3), 91–97. https://doi.org/10.4236/ojneph.2015.53014
- Aljabri, K. S. (2019). Serum lipid profiles in patients with chronic kidney disease in a Saudi population. Endocrinology & Metabolism International Journal, 7(1). https://doi.org/10.15406/emij.2019.07.00239
- Al Rahmad, A. H. (2021). Faktor risiko obesitas pada guru sekolah perempuan serta relevansi dengan PTM selama pandemi Covid-19. Amerta Nutrition, 5(1), 31–40. https://doi.org/10.20473/amnt.v5i1.2021.31-40
- Amoah, A. S., Twumwaa, N. A., Braimah, B. E., & Gadogbe, M. (2024). The role of culinary education in promoting nutritional awareness: A systematic review. American Journal of Multidisciplinary Research and Innovation, 3(1). https://doi.org/10.54536/ajmri.v3i1.2464
- Baaj, T., Botoca, M., Creţu, O., Abu-Awwad, A., Ardeleanu, E., Musta, I., Ţilea, I., Baaj, S., Sima, L., Paunescu, A., Rusmir, A., Latcu, S. C., Plesa, S., Protesi, A. E., & Cumpănaş, A. A. (2020). Biochemical, clinical and prevalence characteristics of chronic kidney disease secondary to arterial hypertension. Revista de Chimie, 71(5), 462–472. https://doi.org/10.37358/rc.20.5.8158
- Cash, T., Desbrow, B., Leveritt, M., & Ball, L. (2014). Utilization and preference of nutrition information sources in Australia. Health Expectations, 18(6), 2288–2295. https://doi.org/10.1111/hex.12198
- Cena, H., & Calder, P. C. (2020). Defining a healthy diet: Evidence for the role of contemporary dietary patterns in health and disease. Nutrients, 12(2), 334. https://doi.org/10.3390/nu12020334
- Chen, X., & Li, X. (2024). Food factors: The role of nutritional clarity in enhancing public health outcomes. SHS Web of Conferences, 183, 02008. https://doi.org/10.1051/shsconf/202418302008
- Coșoreanu, A., Rusu, E., Rusu, F., Stanciu, S., Ungureanu, I., Donici, M., Vișinescu, A., Enache, G., & Radulian, G. (2024). Clinical and metabolic particularities of a Roma population with diabetes—Considering ethnic disparities in healthcare management. Preprints. https://doi.org/10.20944/preprints202405.1059.v1
- Dalmazo, A. L., Fetter, C., Goldmeier, S., Irigoyen, M. C., Pellanda, L. C., Barbosa, E. C. D., Moreira, T. R., & Osório, D. R. D. (2019). Stress and food consumption relationship in hypertensive patients. Arquivos Brasileiros de Cardiologia. https://doi.org/10.5935/abc.20190175
- Ephraim, R. K., Biekpe, S., Sakyi, S. A., Adoba, P., Agbodjakey, H., & Antoh, E. O. (2015). Prevalence of chronic kidney disease among the high-risk population in South-Western Ghana: A cross-sectional study. Canadian Journal of Kidney Health and Disease, 2, 1–7. https://doi.org/10.1186/s40697-015-0076-3
- Fenta, E. T., Eshetu, H. B., Kebede, N., Bogale, E. K., Zewdie, A., Kassie, T. D., Anagaw, T. F., Mazengia, E. M., & Gelaw, S. S. (2023). Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide: A systematic review and meta-analysis. Diabetology & Metabolic Syndrome, 15, 1–15. https://doi.org/10.1186/s13098-023-01202-x
- Gbadamosi, M. A., & Tlou, B. (2020). Modifiable risk factors associated with non-communicable diseases among adult outpatients in Manzini, Swaziland: A cross-sectional study. BMC Public Health, 20, 1–10. https://doi.org/10.1186/s12889-020-08816-0
- Hakami, R., Gillis, D. E., Poureslami, I., & FitzGerald, J. M. (2018). Patient and professional perspectives on nutrition in chronic respiratory disease self-management. HLRP: Health Literacy Research and Practice, 2(3), e147–e159. https://doi.org/10.3928/24748307-20180803-01
- Hale, D. R., & Viner, R. (2016). The correlates and course of multiple health risk behaviour in adolescence. BMC Public Health, 16(1), 1–10. https://doi.org/10.1186/s12889-016-3120-z
- Hustrini, N. M., Susalit, E., & Rotmans, J. (2022). Prevalence and risk factors for chronic kidney disease in Indonesia: An analysis of the National Basic Health Survey 2018. Journal of Global Health, 12, 04074. https://doi.org/10.7189/jogh.12.04074
- Ibrahim, S. L., Jiroutek, M. R., Holland, M. A., & Sutton, B. S. (2016). Utilization of ACE inhibitors and angiotensin receptor blockers in patients with diabetes. Preventive Medicine Reports, 3, 52–56. https://doi.org/10.1016/j.pmedr.2016.01.005
- Jankowski, J., Floege, J., Fliser, D., Böhm, M., & Marx, N. (2021). Cardiovascular disease in chronic kidney disease. Circulation, 143(11), 1157–1172. https://doi.org/10.1161/CIRCULATIONAHA.120.050686
- Kim, H., & Kim, K. (2022). Blood pressure target in type 2 diabetes mellitus. Diabetes & Metabolism Journal, 46(5), 667–674. https://doi.org/10.4093/dmj.2022.0215
- Kim, H.-Y., Lee, J., & Kim, J. (2018). Association between dietary inflammatory index and metabolic syndrome in the Korean population. Nutrients, 10(5), 648. https://doi.org/10.3390/nu10050648
- Kumela, K., Wolide, A. D., Dibaba, F. K., Fufa, F. G., Garedow, A. W., Tufa, B. E., & Bobasa, E. M. (2019). Patient awareness, prevalence, and risk factors of chronic kidney disease among diabetes and hypertensive patients in Ethiopia. BioMed Research International, 2019, 1–8. https://doi.org/10.1155/2019/2383508
- M, D., Thi, D. P., Van, H. H., Thi, T. N., & Khac, T. C. (2023). Knowledge, attitude, and practice of using food labels among medical students. Journal of Public Health and Development. https://doi.org/10.55131/jphd/2023/210323
- Nardocci, M., Polsky, J. Y., & Moubarac, J. (2020). Consumption of ultra-processed foods and obesity, diabetes, and hypertension in Canadian adults. Canadian Journal of Public Health, 111(7), 1325–1335. https://doi.org/10.17269/s41997-020-00429-9
- Nouri, M., Mahmoodi, M., Shateri, Z., Ghadiri, M., Rajabzadeh-Dehkordi, M., Vali, M., & Gargari, B. P. (2023). Carbohydrate quality indices and bone mass density in postmenopausal women. BMC Women’s Health, 23, Article 2188. https://doi.org/10.1186/s12905-023-02188-4
- Oddo, V. M., Maehara, M., Izwardy, D., Sugihantono, A., Ali, P. B., & Rah, J. H. (2019). Risk factors for nutrition-related chronic disease in Indonesian adults. PLOS ONE, 14(9). https://doi.org/10.1371/journal.pone.0221927
- Pathak, J., & Dass, E. (2015). Effects of ARB and ACEI in diabetic nephropathy. Indian Journal of Pharmacology, 47(2), 148–152. https://doi.org/10.4103/0253-7613.153420
- Phillips, C. M., Chen, L., Heude, B., Bernard, J. Y., Harvey, N. C., Duijts, L., … Hébert, J. R. (2019). Dietary inflammatory index and non-communicable disease risk. Nutrients, 11(8), 1873. https://doi.org/10.3390/nu11081873
- Poureslami, I., Nimmon, L., Rootman, I., & Fitzgerald, M. J. (2016). Health literacy and chronic disease management. Health Promotion International, 32(4), 743–754. https://doi.org/10.1093/heapro/daw003
- Ruggieri, S., Drago, G., Panunzi, S., Rizzo, G., Tavormina, E. E., Maltese, S., & Cibella, F. (2022). Sociodemographic factors and dietary patterns in pregnant women in contaminated areas. Nutrients, 14(17), 3489. https://doi.org/10.3390/nu14173489
- Shiferaw, W. S., Akalu, T. Y., & Aynalem, Y. A. (2020). Chronic kidney disease among diabetes patients in Ethiopia: A systematic review. International Journal of Nephrology, 2020, 1–15. https://doi.org/10.1155/2020/8890331
- Simanjuntak, T. D., & Wahyono, T. Y. M. (2021). Type 2 diabetes and CKD in Indonesia (IFLS 5). Jurnal Epidemiologi Kesehatan Indonesia, 4(2). https://doi.org/10.7454/epidkes.v4i2.4037
- Soltani, S., Shirani, F., Chitsazi, M. J., & Salehi‐Abargouei, A. (2016). DASH diet and body composition: A meta-analysis. Obesity Reviews, 17(5), 442–454. https://doi.org/10.1111/obr.12391
- Stamler, J., Chan, Q., Daviglus, M. L., Dyer, A. R., Van Horn, L., Garside, D. B., ... Elliott, P. (2018). Sodium and blood pressure. Hypertension, 71(1), 1–12. https://doi.org/10.1161/HYPERTENSIONAHA.117.09928
- Takase, H., Sugiura, T., Kimura, G., Ohte, N., & Dohi, Y. (2015). Sodium consumption predicts hypertension. Journal of the American Heart Association, 4(9). https://doi.org/10.1161/JAHA.115.001959
- Toiba, H., Noor, A. Y. M., Rahman, M. S., Hartono, R., Asmara, R., & Retnoningsih, D. (2023). Consumer preference toward organic instant noodles in Indonesia. Agris On-Line Papers in Economics and Informatics, 15(1), 127–137. https://doi.org/10.7160/aol.2023.150110
- Wang, J., Liu, W.-J., & Lee, C.-L. (2022). DASH and Mediterranean diet adherence with all-cause mortality. Frontiers in Nutrition, 9, 828792. https://doi.org/10.3389/fnut.2022.828792
- Yamaoka, T., Araki, A., Tamura, Y., Tanaka, S., Fujihara, K., Horikawa, C., ... Sone, H. (2020). Low protein intake and mortality in type 2 diabetes. Nutrients, 12(6), 1629. https://doi.org/10.3390/nu12061629
- Yao, J., Fan, S., Shi, X., Gong, X., Zhao, J., & Fan, G. (2021). ACE inhibitors vs ARBs on insulin sensitivity: Meta-analysis. PLOS ONE, 16(6), e0253492. https://doi.org/10.1371/journal.pone.0253492
- Yunas, S., Setyawati, B., & Rachmawati, R. (2021). Perilaku gaya hidup remaja berisiko terkait PTM di Indonesia. Penelitian Gizi dan Makanan, 44(1), 11–20. https://doi.org/10.22435/pgm.v44i1.3337
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