DOI Number: 10.5958/0976-5506.2019.02254.

Pre-Schoolers’ Eating Behavior in Urban Communities: An

Overview

Eka Mishbahatul Marah Has1, Nursalam1, Ferry Efendi1, Yuni Sufyanti Arief1, Dwi Faqihatus Syarifah Has2
1
Faculty of Nursing, Universitas Airlangga, Mulyorejo Street (Kampus C), Surabaya City, East Java,
Indonesia; 2Faculty of Health, Universitas Muhammadiyah Gresik, Sumatera Street No.101, Gresik
Regency, East Java, Indonesia

ABSTRACT
Introduction: Adequate nutrition is needed by preschool-aged children to allow for growth and development
optimally. Eating behavior during the preschool years also shapes lifelong dietary preferences. This study
aimed to describe the pre-schooler eating behavior in urban communities.
Method: The design used was descriptive with a cross-sectional approach. The population consisted of
mothers and preschool-aged children (aged 3-5 years) in Gresik Regency (an urban area in East Java).
The sample size was 90 respondents, taken using a simple random sampling technique. Preschool eating
behavior is defined by energy adequacy level and dietary diversity. The data was collected using food recall
over 24 hours and this was described using frequency and percentage distribution.
Results and Analysis: The results showed that most pre-schoolers had a good energy adequacy level (64.4%).
The most significant contributors to energy were carbohydrates, protein and fat. Most pre-schoolers have
good dietary diversity (75.6%). Most of their food composition consisted of rice, animal and plant protein
and milk. Vegetables and fruits were rarely consumed.
Discussion: It can thus be concluded that the pre-schooler’s eating behavior in urban communities was
good. Further research can use these findings to develop an intervention to enhance the healthy eating
behavior of pre-school children in urban communities.

Keywords: eating behavior, preschool aged-children, urban communities

Introduction during this age is characterized by its “blossoming”

The growth spurt and rapid development occurred
at <5 years of age.1 This represents a time of significant
cognitive and behavioral growth, dominated by the
dynamic and robust progressive process of brain
development that will later be continued with maturation
and experience.2with the initial expression of many
psychological abilities that will continue to be refined
into young adulthood. Likewise, brain development
Corresponding Author:
Eka Mishbahatul Marah Has
Faculty of Nursing, Universitas Airlangga
Mulyorejo Street (Kampus C),
Surabaya City, East Java, Indonesia
Email: eka.m.has@fkp.unair.ac.id
nature, showing some of its most dynamic and
elaborative anatomical and physiological changes. In
this article, we review human brain development during
the preschool years, sampling scientific evidence from
a variety of sources. First, we cover neurobiological
foundations of early postnatal development, explaining
some of the primary mechanisms seen at a larger scale
within neuroimaging studies. Next, we review evidence
from both structural and functional imaging studies,
which now accounts for a large portion of our current
understanding of typical brain development. Within
anatomical imaging, we focus on studies of developing
brain morphology and tissue properties, including
diffusivity of white matter fiber tracts. We also present
new data on changes during the preschool years in
cortical area, thickness, and volume. Physiological brain
development is then reviewed, touching on influential
 2570 Indian Journal of Public Health Research & Development, August 2019, Vol.10, No. 8
results from several different functional imaging and
recording modalities in the preschool and early school-
age years, including positron emission tomography (PET
Thus, there is a need for adequate nutrition to achieve
optimal growth and development.3
Adequate nutrition can be obtained through a
variety of diets in recommended amounts, based on
the body’s dietary needs.4 This refers to frequent
eating, where preschoolers should eat every 3-4 hours
or about 4-6 meals every day. In portions, their plates
should consist of half vegetables and fruits, a quarter
for healthy carbohydrates, and the rest being healthy
proteins, including oils, milk and water.5 When it comes
to choosing a diet, preschoolers still depend on their
mother.6 On the other hand, as their sense of taste develop,
preschool-aged children have their own food preferences
and they become more selective in their choice of food.7
They also are easily attracted by unhealthy snacks in
their environment. Once they have established unhealthy
eating behaviors, it is hard to correct in later life.8 Poor
eating behavior in children is a public health issue. Little
is known about the preschoolers’ eating behavior in
urban communities.
Unhealthy eating behavior in preschool children
can lead to malnutrition.9 Longitudinal research using
Indonesia Family Life Survey’s data found that the
prevalence of stunting and underweight preschoolers
decreased significantly in waves 1 to 4 (stunting
from 50.8% to 36.7%; underweight: from 34.5% to
21.4%). The prevalence of ‘at-risk’, being overweight
or being obese increased significantly from 10.3% to
16.5%.10stunting, and at risk of overweight/overweight
or obesity in Indonesian children aged 2.0-4.9 years; and
b The National Health Survey (RISKESDAS) in 2013
noted that 37% of children aged under 5 years old were
affected by moderate and severe stunting, 12% of children
aged under 5 were affected by wasting (low weight-for-
height) and 12% of children were overweight.11 The
prevalence of malnutrition is decreasing compared
with 2010, but it still cannot achieve the WHO target
on Sustainable Development Goals (SDGs).12 A child
deprived of adequate nutrition may never reach his
full physical or cognitive potential, which can limit his
ability to learn and earn.13 They also have an increased
risk of falling sick and experiencing a greater severity
of disease.14
In developing countries such as Indonesia, the
double burden of malnutrition is more prevalent in
urban areas.15 Urban malnutrition is caused by unhealthy
eating behavior.16 Urban populations tend to consume
more calories and more highly processed foods. They
frequently rely on cheap and convenient street foods.17
However, they also have good access when it comes
to accessing a greater diversity of fresh foods such as
animal-sourced foods, legumes, vegetables and fruits.18
Gresik Regency is categorized as an urban area
that is in the northwest of East Java Province, along the
coastline.19 By 2017, from the 84,696 under five year
old children who came to Posyandu Balita (integrated
health care center for under five-year-old children) in
Gresik Regency, 0.6% were found to be underweight.20
The previous research found that most of the mothers in
the area preferred to buy food from food stalls instead
of cooking themselves. The composition of the food
consumed was often a rice and protein made both from
either animals or plants.21 This study aimed to describe
the preschooler eating behavior in urban communities.
Method
Study design, setting, and sampling: This was
descriptive research with a cross-sectional approach.
The population consisted of mothers and preschool-
aged children (aged 3-5 years) in Gresik Regency
registered as members of a Posyandu Balita. The sample
size was made up of 90 mothers and pre-schoolers in
pairs, who became involved using a simple random
sampling technique. Randomization was conducted by
entering all pre-schooler names into a fishbowl, prior to
their selection. In the case of non-consent, we re-did the
selection process to achieve 90 respondents.
Study variables and data collection: The general
demographic data that was collected included the
mother’s age, the children’s age and the familial monthly
income via a questionnaire completed by the mothers at
the time of recruitment. It is important to describe the
characteristics of a population. A 24-hour dietary recall
(24HR) was used to evaluate the child’s eating behavior.
The 24HR is a structured interview designed to capture
detailed information about all foods and beverages taken
in the past 24 hours. The mother was asked to report and
complete the form on behalf of the children. In order
to make it easier for the mother easier when reporting
their pre-schoolers’ meals, a food model was provided
during the interview. The energy adequacy level was
evaluated by comparing the results of the 24HR with
 Indian Journal of Public Health Research & Development, August 2019, Vol.10, No. 8 2571

the Recommended Dietary Allowance (RDA) for Conted…

preschool-aged children in Indonesia, according to
Family monthly <IDR 3.867.874 68 75.6
Widyakarya Nasional Pangan dan Gizi. The data was
income ≥IDR 3.867.874 22 24.4
then categorized as 1) Good ≥100% RDA, 2) Fair >80-
99% RDA, 3) Less 70-80% RDA and 4) Deficit <70%
RDA. Dietary diversity was evaluated by assessing Table 2: Frequency and percentage distribution of
the variety of food consumed by the pre-schoolers the respondents based on the variables (n = 90)
which should consist of healthy carbohydrates, animal
or plant protein, vegetables, fruits, healthy oil, dairy Variables Category n %
and water. The data then categorized as 1) Good (all Good 58 64.4
food components were fulfilled) or 2) Not good. All Energy adequacy Fair 27 30.0
prospective respondents were given information about level Less 5 5.6
the study. Written informed consent was obtained from Deficit 0 0
all participating mothers. The respondents completed Good 68 75.6
the informed consent form while waiting for service at Dietary diversity
Not good 22 24.4
Posyandu Balita.

Data Analysis: Descriptive statistics were used for all of Discussion

the data represented. The collected data was described
using frequency and percentage distribution.
Results
Table 1 presents the characteristics of the respondents.
It shows that most of the mothers were classified as
young adults (21-40 years old), by as many as 95.6%
mothers. More than half of the pre-schoolers were three
years old, as many as 55.6%. Most of the respondents
were living in a family with a monthly income that was
less than the regional minimum wage (IDR 3.867.874),
as many as 75.6%. Table 2 presents the frequency and
percentage distribution of the respondents based on
the variables. It shows that most pre-schoolers have a
good energy adequacy level, as many as 58 respondents
(64.4%). Most pre-schoolers have good dietary diversity
(68; 75.6%). Most of the food composition consisted of
rice, animal and plant protein and milk. Vegetables and
fruits were rarely consumed.
Most pre-schoolers had a good energy adequacy
level. It means that most of them had an adequate
intake for energy. The RDA for Indonesia stated that an
adequate energy intake for a child 1-3 years old is 1,350
kilocalories per day while for a 4-6 year old it is 1400
kilocalories per day.22 The adequate energy intake for the
pre-schoolers was determined by considering a healthy
child’s daily need for energy to support their growth. For
≥4 year old children, correction for physical activities
was added.23
The research results showed that all of the
respondents with a less energy adequacy level were five
years old. As they grow older, preschool-aged children
develop their food preferences.7 Furthermore, most
children began to attend school at five years old. Previous
research found that almost 75% of 5-year-old children
did not meet their estimated energy requirements. The
school environment sometimes exposes preschoolers to
unhealthy food choice or street foods.24

The energy is required for maintenance, growth

Table 1: Demographic characteristics of the mothers
and repairs of the body. Carbohydrates, protein and
and pre-schoolers (n = 90)
lipids are major sources of energy.25 Similar to this
Variables Category n % statement, the research results found that the most
≤20 years old 1 1.1 significant contributors to energy were carbohydrates,
Mother’s age 21-40 years old 86 95.6 protein and fat. The typical Indonesian diet is high in
carbohydrates and starchy foods, with cereals being
≥41 years old 3 3.3
the primary source.26,27 Previous research also found
3 years old 50 55.6
that urban communities tend to consume more calories
Children’s age 4 years old 23 25.6 and more highly processed foods. They frequently eat
5 years old 17 18.8 convenience street foods, which are cheaper and simpler
 2572 Indian Journal of Public Health Research & Development, August 2019, Vol.10, No. 8
than cooking at home.18Affordability is still a barrier for
low and middle-income groups.27 In this research, many
of the respondents with a family monthly income of less
than the local minimum wage had an inadequate energy
intake. On the contrary, there was one preschooler with
a family monthly income that was more than the local
minimum wage who had a less adequate energy level.
Based on the demographic data, the mother was ≤20
years old. Mothers of a younger age usually have a low
level of nutritional knowledge and experience.28
Dietary diversity is a qualitative method used to
measure food consumption that reflects the household’s
access to a variety of foods and it can be a proxy for
the nutrient adequacy of the diet of individuals.29 Most
respondents had good dietary diversity. This means that
the food consumed by the preschoolers consisted of
carbohydrates, animal or plant protein, vegetables, fruits,
healthy oil, dairy and water. A diverse diet is needed
to ensure optimum growth in preschoolers.5 Urban
communities have good access to a greater diversity
of fresh foods such as animal-sourced foods, legumes,
vegetables and fruits compared to rural communities.18This
supports the availability of diverse foods.
Based on a 24HR analysis, most of the food
composition consisted of rice, animal and plant protein
and milk. Vegetables and fruits were rarely consumed.
Many of the respondents still perceive that the most
important thing is the adequate intake of energy,
although the diet itself was not varying in nutrients. Rice
is a staple food of Indonesians that supplies around 70%
of the total energy.30 Because of its location, near to the
coastline, Gresik Regency is abundant in seafood-based
protein.19 People living there mostly have a good protein
intake. Previous research found that more than half of
the children in Indonesia have dietary intakes that are
less than the RDA for vitamins, which can be obtained
by consuming vegetables and fruits.29 Another research
study found although the nutritional value of pre-
schoolers fulfilled their RDA, the nutrient compositions
often did not meet the necessary standards.31 Mothers
were seen of as the key moderator influencing their
dietary intake of vegetables, fruits, and other healthy
foods.32 However, mothers face numerous challenges in
feeding their pre-schoolers vegetables and fruits, such
as the child’s aversion to vegetables (because of their
unpalatable taste), the family environment and the short
shelf life of fresh vegetables and fruits.33
Conclusion
The pre-schoolers’ eating behavior in urban
communities was good. The mothers should gain more
knowledge about nutrition and food composition which
fits with the needs of pre-schooler to allow them to grow
optimally. The mother also should shape the good eating
skills of their pre-schoolers. These findings can be used
to develop an intervention in order to enhance healthy
eating behavior in pre-schoolers in urban communities.
Ethical Clearance: This research has passed the ethical
test conducted at the Ethics Committee of the Gresik
Regency Health Office number 800/1553/437.52/2012.
Source of Funding: This study was a self-funded
research project.
Conflict of Interest: We declare there to be no potential
conflicts of interest with respect to the research and/or
the publication of this article.
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