TYPEClinical Trial
PUBLISHED08 April 2024
DOI10.3389/fnut.2024.1291580
OPEN ACCESS
EDITED BY
Emmanuel Cohen,
UMR7206 Eco Anthropologie et Ethnobiologie
(EAE), France
REVIEWED BY
Diana Nur Afifah,
Diponegoro University, Indonesia
Khamarrul Razak,
University of Technology Malaysia, Malaysia
*CORRESPONDENCE
Fatmah Fatmah
[email protected]
RECEIVED09 September 2023
ACCEPTED26 March 2024
PUBLISHED08 April 2024
CITATION
Fatmah F (2024) E ectiveness of mangrove
sword bean food bar addressed to older
people of landslide disaster victims.
Front. Nutr.11:1291580.
doi: 10.3389/fnut.2024.1291580
COPYRIGHT
©2024 Fatmah. This is an open-access article
distributed under the terms of theCreative
Commons Attribution License (CC BY). The
use, distribution or reproduction in other
forums is permitted, provided the original
author(s) and the copyright owner(s) are
credited and that the original publication in
this journal is cited, in accordance with
accepted academic practice. No use,
distribution or reproduction is permitted
which does not comply with these terms.
E ectivenessofmangrovesword
beanfoodbaraddressedtoolder
peopleoflandslidedisaster
victims
Fatmah Fatmah*
Disaster Management Study Program, School of Environmental Science Universitas Indonesia, Jakarta,
Indonesia
Background:Older people require extra attention due to their reduced ability to
prepare for disasters, as they adequately possess distinct needs. These groups
necessitate uncomplicated, readily consumable, and palatable food options that
fulfill their micronutrient needs. The objective of this research was to assess the
e ects of a snack bar enriched withapi-apimangrove (Avicennia marina) and
sword bean (Canavalia ensiformis) on the body weight and Body Mass Index (BMI)
of older people individuals a icted by a landslide event.
Methods:A non-randomized pre-post-intervention study was undertaken,
involving 31 senior participants. The intervention group consisted of 15 seniors
who were provided with a mangrove sword bean snack bar, while the control
group comprised 16 seniors who received a sword bean food bar during15
days. All study participants received education on maintaining abalanced diet for
older people individuals. The data analysis involved usingunivariate and bivariate
analyses, explicitly applying the independentt-test and dependentt-test.
Results:In the hedonic evaluation, the mangrove sword bean food bar had
superior average attributes in terms of scent, flavor, texture, and color compared
to the sword bean food bar. The consumption of snack bars made from
mangrove sword beans resulted in a significant rise in weight (0.2 kg), energy
intake (240.8 kcal), protein content (5.8 g), carbohydrate content (40.06 g), and fat
content (4.4 g). Carbohydrate can significantly increase weight inthe treatment
subjects. Furthermore, the provision of comprehensive nutrition education has
the potential to enhance the post-study knowledge score, as seenby the
observed increase of 40.6. A significant disparity was observed between the mean
carbohydrate consumption and understanding of balanced nutrition among the
intervention and control groups.
Conclusion:Api-apimangrove sword bean snack bars have been identified as
a viable and ecient substitute for emergency food provisions, particularly in
disaster-stricken communities. These food bars have demonstrated a significant
capacity to contribute to the weight gain of individuals within such groups, thus
addressing the nutritional needs of impacted populations inthe aftermath of
natural calamities. Subsequent investigations may include employing pregnant
women as participants to explore the issue above.
Clinical Trial Registration:Clinicaltrials.gov, identifier: NCT05897892.
KEYWORDS
older people, landslide, disaster, weight, mangrove-sword bean food bar
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Fatmah 10.3389/fnut.2024.1291580
Introduction
Post-hydrometeorological disasters present a substantial
problem in meeting the dietary requirements of vulnerable groups,
particularly older people. To solve this matter, it is recommended
that Complete Emergency Food Products (EFP) be made readily
accessible for immediate consumption as the principal means of
sustenance for 15 days, starting from the moment of evacuation
(1,2). In Indonesia, emergency food formulations include food
bars created from a combination of brand and maize flours (3),
cookies prepared with Moringa leaf flour (4), cookies made from
sweet potato flour, banana flour, and mung bean flour (5), as well as
a snack bar consisting of soybean, broccoli, and mangrove fruit (6).
The exploration of utilizingapi-apimangrove (Avicennia
marina) in producing food bars has yet to be previously
investigated, despite its potential as a suitable alternative to rice
and wheat flour. Based on a study conducted by researchers (7),
it has been shown that theapi-apimangrove demonstrates a
greater energy density in comparison to rice and corn. The api-
api mangrove is more energy-dense (371 kcal) than wheat flour
(365 kcal) (7), rice (360 kcal), and corn (307 kcal) (8,9). Api-
api mangrove is commonly found in coastal tropical countries,
including Indonesia. It is a plant species that is widely distributed
throughout Indonesia and is abundant from Sabang to Merauke.
Avicennia marinais a type of mangrove that can thrive in
environments with minimal light and temperature, in brackish
areas with high salinity levels, and is commonly found in coastal
and mangrove habitats. They can also be found in freshwater
swamps and muddy coastal areas with high salt content (10,11).
Food bars produced from this specific wheat variety require
additional lipids, carbohydrates, proteins, zinc, and vitamin C.
Canavalia ensiformis(sword bean) flour has been selected to
enhance geriatric nutrition. The snack bar has characteristics that
render it a viable choice for dissemination among individuals
affected by calamities. The compact and sturdy design facilitates
convenient portability and manipulation. Furthermore, the
creation of this product can be customized to include a wide
variety of locally sourced food items, hence increasing its versatility
and accessibility in various geographical areas. Furthermore,
this substance can be ingested orally without needing any pre-
treatment, and it exhibits a significant quantity of carbs and
proteins. Similarly, when comparing food bars to cookies or
pastries, it is essential to note that they can withstand higher
amounts of pressure due to their partially dry composition (8). A
comparative analysis was conducted in 2020 to assess the suitability
of lindur fruit (Bruguiera gymnorrhiza) flour, broccoli flour, and
soy flour as potential ingredients in a bar snack. During 15 days,
a total of 33 older people who were relocated due to flooding in
Depok City ingested the snack bars provided to them. During this
particular time frame, it was noted that the average weight of the
aforementioned retired individuals rose by 0.2% (6).
The primary objective of this study was to analyze a specific type
of edible film-forming product (EFP) in the form of snack bars. The
EFP was composed ofapi-apimangrove flour and sword bean. The
api-apimangrove was chosen for examination due to its few studies
compared to the lindur mangrove. Carbohydrates are present in
this specific type of mangroves, albeit at a lower concentration (9).
The nutritional makeup of 100 g ofapi-apimangrove is as follows:
the liquid sample is composed of 21.43 g of carbohydrates, 10.4 g of
protein, 0.043 g of fat, and 22.24 mg of vitamin C per milliliter (12).
The study conducted by mangrove sword bean food bars reveals
that their product has 55 g of carbohydrates, 24 g of protein, and
3 g of fat per 100 g (13). Food bars that utilizeapi-apimangrove
flour have the potential to be a feasible and nourishing alternative
to wheat flour (7). However, incorporatingapi-apimangrove flour
in producing baked goods such as cookies and biscuits is not
commonly practiced. The daily caloric needs of older women and
men, total 1,900 kcal, were met by consuming four snack bars of a
specific type, each weighing 100 g resulting in a total caloric intake
of 2,000 kcal.
This research aimed to examine the possible impact of a snack
bar made fromapi-apimangrove (A. marina) and sword bean (C.
ensiformis) on the weight and Body Mass Index (BMI) of older
people afflicted by landslides. The snack bars can also be used as
emergency food in case of various other types of natural disasters
such as floods, earthquakes, volcanic eruptions, etc. Several research
have been conducted to investigate emergency food formulations in
Indonesia. Numerous research investigations have been conducted
in Indonesia to investigate emergency food compositions. These
investigations had examined the feasibility of utilizing various
ingredients, such as white millet and red bean flour, in producing
food bars (8). Researchers have also explored the potential of
incorporating moringa flour into cookies (14) and investigated the
viability of combining sweet potato flour, banana flour, and mung
bean flour in emergency food formulations (5). Nevertheless, the
combination ofapi-apimangrove flour andkoro pedangbean flour
has yet to be utilized thus far in developing food bars. However,
theapi-apimangrove flour has been recognized as a prospective
alternative to rice and wheat flour in manufacturing biscuits. This
is attributed to its elevated energy content surpassing rice and
maize. The inclusion ofkorosword nut flour results in an elevation
in the levels of lipid content, carbs, protein, zinc, and vitamin
C. The inclusion of koro sword nut flour results in an elevation
of lipid content, carbs, protein, zinc, and vitamin C levels. The
potential impact of snack bars comprising a combination ofapi-
apimangrove flour andkoro pedangbean flour on the nutritional
wellbeing of young children and older people affected by landslides
remains unexplored in existing research. The potential effectiveness
of snack bars is composed of a combination ofapi-api.
Materials and methods
Research design
A non-randomized pre-post intervention study was conducted,
involving a sample of 31 older individuals who were divided
into treatment and control groups. These participants were
affected by the landslide catastrophe (15). Ethical approval
(No. 089/KEPPKSTIKSC/VII/2022) was obtained by the Health
Research and Development Ethics Committee (KEPPK) of Sint
Carolus, College of Health Sciences, Jakarta. Before commencing
the 2-week study period from August 10 to August 25, 2022.
The intervention lasted only 2 weeks because emergency food is
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provided for refugees or victims of natural disasters for 15 days
from the time a disaster is experienced (16). All eligible participants
provided their informed consent by signing a formal document at
the onset of August 2022. The signing event occurred as part of the
introductory activities of the study, and theposbinducadres and the
research team witnessed it.
Subject and population
The study sample comprised older people impacted by
the landslide calamity in Cihanjuang Village, Cimanggung
Subdistrict, Sumedang District, West Java Province, Indonesia. The
geographical location of this village falls within the administrative
boundaries of the West Java Province in Indonesia. The present
study utilized the following criteria to determine the eligibility
of older persons for inclusion: the study’s inclusion criteria
encompassed individuals aged 60 years or older, of both genders,
who lived in Cihanjuang Village, who were directly affected by
the landslide incident, and who exhibited normal, under, or over-
nutrition statuses. To be eligible for the study, individuals were
required to have no pre-existing chronic or degenerative disorders
and demonstrate a desire to abstain from snacks other than snack
bars and plain water.
The researchers employed the formula for the hypothesis
test of paired mean difference (17) to determine the minimum
required sample size. The above conclusion was deduced based
on an observed augmentation in body weight of 0.2 kg within
the older demographic, accompanied by a standard deviation of
0.1 (6). A significance level of 0.05 was selected for conducting
bilateral hypothesis testing during this inquiry. Therefore, to attain
a statistical power of 90%, it was essential to possess a sample
size (n) of 15. The nutritional status of all eligible participants,
who were older persons, was evaluated based on the established
inclusion criteria. An anthropometric assessment was conducted
from August 2 to August 6, 2022. These assessments encompassed
the measurement of weight and height, as well as the application
of the Mini Nutritional Assessment (MNA) tool. Food bars were
supplied to all participants for 2 weeks (18), specifically from
August 10 to August 25, 2022. The assignment of individuals to
treatment and control groups was chosen based on the residential
neighborhoods they inhabit.
Instrument
At the initiation of the inquiry, the investigators assessed the
participants’ weight, height, and Mid-Upper Arm Circumference
(MUAC). A digital scale with a precision of 0.1 kg was utilized
for the three weigh-ins at the beginning, week 1, and week 2
of the study. At the onset of the investigation, a solitary height
measurement was acquired utilizing a microtoise device possessing
a precision level of 0.1 cm. Mid-upper arm circumference (MUAC)
was measured at the baseline using a midline tape, with a
single measurement being acquired. The researchers assessed
the subjects’ malnutrition likelihood using the Mini Nutritional
Assessment (MNA) (19). The evaluation of an individual’s degree
of autonomy can be enhanced by employing various instruments,
such as the Basic Activity Daily Living (BADL) and Instrument
Activity Daily Living (IADL) scales ( 20). A Mini-Mental State
Examination (MMSE) was employed as a standardized screening
technique to determine the existence of dementia or possible
cognitive decline (21). During the preliminary stage of the research
project, data was gathered on the participants’ levels of autonomy,
vulnerability to malnourishment, and degree of cognitive decline.
The research team created instructional resources, including a
brochure and flipchart, to disseminate information regarding a
well-balanced diet.
Subject selection
During the study, a cohort of 31 older people actively
participated. The study included 31 senior participants who
completed the study, with 16 persons assigned to the control
group and 15 individuals assigned to the intervention group with
a non-random method. The intervention group comprised of older
people from three neighborhoods: 1, 2, and 3. The control group
consisted of older people from the neighborhoods 4, 5, and 6.
At the initiation of the research endeavor, there existed a total
of 34 individuals classified as seniors in each of the two groups
who satisfied the stipulated criteria for inclusion in the study.
However, three participants of advanced age withdrew from the
study due to sore throat disease, a modification in the coloration
of their feces to a dark shade, and experiencing nausea after
consuming the snack bars (Figure 1)—the aforementioned adverse
effects manifested after the ingestion of the snack bars by the
individuals. The list of older people who perished in the landslides
was obtained from the leader of the integrated health program
for older people,posbindu. Anthropometric measurements were
conducted at variousposbindusites to obtain preliminary data
regarding the nutritional status of the subjects. The prospective
participant was also invited to attend the study’s inaugural event
15 days before their intended involvement.
Nutritional intervention and monitoring
For the 15-day study period, individuals assigned to the
intervention group consumed mangrove sword bean food bars,
whereas those in the control group consumed sword bean food
bars (Figure 2). Due to the provision of emergency food assistance
to victims of natural disasters and refugees for 15 days following
the occurrence (18), the intervention time was limited to 2 weeks.
As a component of this experimental study, it is anticipated that
each participant within every group will be required to regularly
ingest a snack bar with a weight of 50 g. Based on the data
presented inTable 1, it can be observed that a 50-g mangrove
sword bean snack bar contains a total of 234.2 calories, 24.7 g of
carbohydrates, 5.8 g of protein, and 12.5 g of fat. The enumerators
used the baseline questionnaire to interview all older people
individuals to understand their sociodemographic characteristics
comprehensively. These characteristics encompassed age, marital
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FIGURE 1
Research scheme of older people.
FIGURE 2
Mangrove sword bean food bar(A)and sword bean food bar(B).
status, educational attainment, occupation, and cohabitation
arrangements within their households.
Furthermore, the survey assessed the participant’s
understanding of balanced nutrition, encompassing topics such as
a selection of nutritious foods, the advantages of carbohydrates,
proteins, vitamins, and minerals, the definition of healthy food,
the concept of balanced nutrition, the importance of weight
measurement, the purpose of stable or reduced weight, including
its underlying causes and consequences, and strategies aimed
at weight gain. The participants in a group received balanced
nutrition education twice for 30 min in the first and second weeks
of the study. Because practically all of the participants did not
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TABLE 1Nutrient content per 50 g of food bar.
Type of
food bar
Energy
(kcal)
Carbohydrate
(g)
Protein
(g)
Fat (g)
Mangrove-
sword
bean
234.2 24.7 5.8 12.5
Sword bean 230.4 26.5 3.9 12.1
Nutritional content for results inTable 1were examined at the Saraswanti Laboratory,
Bogor City.
understand the Indonesian language, the nutrition education
materials that were presented to the Sundanese population by
the local enumerators, except the questionnaire, MNA, and
MMSE tools.
The data collected at the endpoint of the study were acquired
after the administration of instructional interventions to assess
the extent to which modifications in balanced nutrition and
macronutrient intake had occurred before selecting the mangrove-
sword bean-food bar as the Emergency-Friendly Product (EFP) for
older people, a hedonic assessment was conducted. The objective of
the experiment was to ascertain the relative popularity of different
combinations ofapi-apimangrove and sword bean in food bars.
To complete the organoleptic test, a cohort of 20 individuals of
advanced age, lacking any specialized expertise, was selected from
diverse geographical locations and assigned to designated study
sites. Ten to 20 people is the ideal number of panelists for a panel
that is not informed (21). Due to the inherent possibility of bias,
specific panelists with less training declined to participate in the
study. The many attributes of the snack bar, such as its color, aroma,
flavor, and texture, might impact individuals’ compliance with and
adoption of the food. The smell, texture, color, and taste of a snack
bar were assessed using a four-point hedonic scale, with ratings
ranging from 1 (indicating great hate) to 4 (displaying strong liking)
(21,22).
Monitoring for adherence to consumption
regulations in food bars
During the duration of the research, the dietary habits of
older people were monitored through regular home visits and
anthropometric measures (weight) taken atposbinduevery week
during the study. Weight gain over 2 weeks was used as an indicator
of adherence to consuming snack bars. During each household
visit, detailed records were documented about the consumption
of food items, the allocation of cookies, the remaining quantity
of cookies, and the consequences following the consumption
of cookies. At the onset, one older people individual expressed
experiencing a headache due to consuming cookies, while another
older people individual reported experiencing difficulties in bowel
movements after consuming cookies. These remarks were made
regarding the adverse effects associated with the consumption of
cookies. Subsequently, the enumerators proceeded to elucidate to
the participants that the detrimental repercussions observed in the
initial stages were indicative of an early adaptation.
Furthermore, the adverse effects will diminish after the body
has acclimated to the medicine. During food bar distribution,
proficient enumerators conducted household visits to collect data
on individuals’ food intake records. The frequency of these visits
was scheduled at a rate of three times each week. Anthropometric
data was collected during the initial and subsequent weeks of the
study to check compliance with food bar intake among the older
people participants. Furthermore, food recalls were documented
weekly, namely at intervals of 24 h, 3 days, and 7 days.
Food bar preparation technique
The food bar known as theapi-apimangrove sword bean
bar is composed ofapi-apimangrove flour and sword bean flour,
melted butter, poultry eggs, refined white sugar, a modest quantity
of wheat, and chocolate, strawberry or orange paste. The food
bar was fabricated employing a digital oven, a mixer, a 20 cm
×15 cm alumunium brownie mold, a digital scale, a food bar
dough-cutting equipment, and a dough mill. The following are the
prescribed protocols for preparing food bars: the process involves
the combination of melted butter and white refined sugar. The
dough underwent mixing using a mechanical device for 5 min,
resulting in a state of uniformity. Incorporate theapi-apimangrove
flour into the mixture, and afterward, add the sword bean flour, egg
yolks, and pasta. Combine the dough with a sizable wooden spatula
until it achieves a consistent and homogeneous texture. Transfer
the batter onto a rectangular baking dish designed for brownies
and cook it in a digitally controlled oven for 30 min, maintaining
a temperature of 180
◦
C.
Data analysis
To analyze the frequency distribution of the food bar
organoleptic test, a univariate analysis was conducted using SPSS
Version 22. The socio-demographic attributes considered in this
analysis included age, gender, marital status, most recent education
level, most recent position, living arrangement of family status,
nutritional status, and knowledge of balanced nutrition among
older people. The MNA, BADL, IADL, MMSE, and MUAC are
all administered in a manner that is similar to the previously
stated method. The Nutri Survey Program was employed to analyze
the data acquired on food consumption for 2 weeks. The data
analysis aimed to compare the consumption amounts for the four
macronutrients (energy, carbohydrate, fat, and protein) before and
after the study using 3 days of 24 food recall (at the first, middle, and
end of weeks). Bivariate analysis, and pairedt-tests were employed
to assess the alterations in mean weight, BMI, macronutrient
consumption (specifically energy, carbohydrate, protein, and fat),
and comprehension of balanced nutrition throughout the study. In
all investigations involving two opposing perspectives, ap-value of
0.01 was deemed statistically significant.
Results
The color, aroma, taste, and texture were the four factors
that were considered in the study to determine whether the
mangrove-sword bean food bar was preferred. In comparison to
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TABLE 2Organoleptic test of mangrove-sword bean and sword-bean
food bars by older people.
Parameter Mangrove-sword
bean food bar
Sword bean
food bar
Color 3.7±0.7 (like) 3.0±0.6 (like)
Aroma 3.5±0.8 (like) 2.2±0.1 (dislike)
Taste 3.5±0.7 (like) 2.0±0.5 (dislike)
Texture 3.0±0.7 (like) 2.1±0.4 (dislike)
1=very dislike; 2=dislike; 3=likes; 4=very like.
the sword bean food bar, the mangrove-sword bean food bar
produced a significantly higher mean score for color, scent, taste,
and texture when evaluated by older individuals (Table 2).Table 3
shows the socio-demographic parameters, nutritional status, level
of independence, and cognitive function of older people. The
study participants in the intervention group were mostly men,
while the women in the control group were mostly married. The
intervention group’s mean age was slightly older than the control
group. Almost all participants in the two groups had a low level of
formal education, lived with their children and grandkids, and had
retired. The majority of people in both groups had normal nutrition
status (62.4% in the control group and 66.7% in the intervention
group), normal MUAC (more than 23.0 cm), independence level
for basic daily and instrumental activities, and normal cognitive
performance. However, there were members in both groups who
had cognitive impairment and, most likely, cognitive decline
(Table 3).
Body Mass Index (BMI) was used to determine the nutritional
status of older people. The intervention group’s older participants
experienced a slightly larger average weight gain than the control
group. During the 15-day intervention, the BMI indicator revealed
identical results. Positive significant differences in post-study
weight and BMI were identified within the intervention group,
but not between groups (Table 4).Table 5displays the variations
in energy, carbohydrate, protein, and fat consumed by older
people before and after the study. The mangrove-sword bean food
bar consumption was associated with increased macronutrient
consumption, specifically carbohydrates, in the intervention group
(p0.02). In contrast, the groups had no significant difference
regarding the average amounts of energy, protein, and fat. Balanced
nutrition knowledge rose after the study (p=0.001), and there
were variations between pre-and post-test scores among the
older people.
Discussion
The objective of research was to investigate the potential effects
of a snack bar composed of api-api mangrove (A. marina) and
sword bean (C. ensiformis) on the weight and BMI of older
people affected by landslides. Despite its potential as a suitable
alternative to rice and wheat flour, the possibility of utilizing api-
api mangrove (A. marina) to produce food bars has yet to be
previously investigated. According to a study by researchers (7),
api-api mangrove has a greater energy density than rice and corn.
Older people are prone to moderate to high risk during a crisis due
to sensory abnormalities, physical restrictions, and degenerative
disorders (23). The likelihood of surviving a natural disaster is
influenced by various factors, including physical mobility, hearing
impairment, limited physical mobility, poor vision, and memory
deficits (24,25). The issue of insufficient provision of sustenance
for individuals affected by disasters should be considered. The
nutritional status of individuals may experience deterioration
after a natural catastrophe due to many factors, such as reduced
access to health services, disruptions in food delivery routes,
and insufficient sanitation (26). It is confident that there will be
a heightened demand for healthcare and sustenance in regions
impacted by disasters. Hence, all relevant parties must prioritize the
effective administration of response strategies, particularly those
that address the nutritional wellbeing of individuals affected by
disasters. The unmet nutritional needs of older people at post-
disaster are susceptible to infectious diseases and malnutrition (27).
Following a devastating event, the issue of restricted availability
of healthcare services and enough nourishment arises. In contrast,
older people must have a diet rich in essential nutrients to fulfill
their daily nutritional requirements and carry out their daily tasks.
Many individuals exhibit a typical nutritional status at the
commencement, while a subset presents with excessive weight
or obesity. The average MUAC of both groups exceeded 21 cm,
a widely accepted value within the normal range (28). During
instances of emergency, such as natural catastrophes, the use
of Mid-Upper Arm Circumference (MUAC) proves to be an
appropriate screening tool for evaluating the nutritional condition
of older people adults. According to the MNA findings, the vast
majority of individuals in both groups had a normative nutritional
status. MNA has been widely employed as a convenient method for
assessing the nutritional status of older people (28,29).
Upon the study’s conclusion, it was observed that the
intervention group exhibited a slightly higher degree of weight
gain and BMI alteration than the control group. Mangrove sword
bean food bars in the diet impacted the development of nutritional
indicators due to carbohydrates in these food bars (8,9). The
intervention group exhibited a higher mean consumption of these
food bars than the control group. Carbohydrates are classified
as a macronutrient that facilitates energy production, leading to
an elevation in calorie intake and BMI (30). Approximately 11%
of older people can meet their daily carbohydrate requirements
by regularly consuming 50 g of mangrove sword bean snack.
According to a study (31), theapi-apimangrove flour has a fat
content of 0.04 percent, protein content of 10.4 percent, and
carbohydrate content of 21.4 percent per 100 g. The findings of the
current study on the weight gain experienced by older people align
with those observed in a similar study conducted on older people
flood victims in Depok City (6).
According to the study conducted by Fatmah et al. (6), there
was a recorded weight gain of 0.2 kg for 15 days following
the intervention. The investigation findings are corroborated
by a study on food and nutrition assistance for older people
after an earthquake disaster (32). Upon the study’s conclusion,
it was observed that there existed a notable disparity in the
level of knowledge of balanced nutrition among the senior
participants of each respective group. The study’s outcomes suggest
that the nutritional knowledge of aged persons was statistically
consistent with previous research, which indicated that their
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TABLE 3Socio-demographic characteristics, nutritional status, independence level, and cognitive performance of older people subjects.
Indicator Control Intervention Total
n % n % n %
Sex
Male 7 43.7 8 53.3 15 48.4
Female 9 56.3 7 46.7 16 51.6
Marital status
Married 8 50.0 9 60.0 17 54.8
Widow/widower 8 50.0 6 40.0 14 45.2
Age (y.o)
Mean±DS 65.3±5.4 70.2±9.2 67.7±7.8
60–65 10 62.5 8 53.4 18 58.0
66–74 4 25.0 2 13.3 6 19.4
≥75 2 12.5 5 33.3 7 22.6
Final education level
Low 15 93.7 13 86.6 28 90.3
Moderate 1 6.3 2 13.4 3 9.7
Staying at home
Alone 1 6.3 3 20.0 4 12.9
Husband/wife 1 6.3 2 13.3 3 9.7
Spouse/children/grandchild 3 18.7 5 33.3 8 25.8
Children/grandchild 11 68.7 5 33.4 16 51.6
Working type
Laborer 4 25.0 4 26.7 8 25.8
Private 1 6.3 1 6.7 2 6.5
No Job 11 68.7 10 66.6 21 67.7
Body mass index (BMI) kg/m
2
Underweight (<18.5 kg/m
2
) 0 0.0 1 6.7 1 3.2
Normal (18.5–24.9 kg/m
2
) 10 62.4 10 66.7 20 64.5
Overweight (25.0–29.9 kg/m
2
) 3 18.8 3 20.0 6 19.4
Obesity (≥30.0 kg/m
2
) 3 18.8 1 6.7 4 12.9
Mean±DS 25.2±4.1 22.9±4.5 24.1±4.4
Mid upper arm circumference (MUAC)
Mean±DS 26.3±2.8 25.2±3.5 25.8±3.1
Independence level
Basic activity daily living (BADL)
Independently 15 93.8 15 100.0 30 96.8
Light dependence 1 6.2 0 0.0 1 3.2
Instrumental activity daily living (IADL)
Independently 13 87.5 12 80.0 25 80.6
Need help now and then 3 12.5 3 20.0 6 19.4
Need help all the time 0 0.0 0 0.0 0 0.0
Mini nutritional assessment (MNA)
(Continued)
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Fatmah 10.3389/fnut.2024.1291580
TABLE 3(Continued)
Indicator Control Intervention Total
n % n % n %
Normal 16 100.0 14 93.3 30 96.7
At risk malnourished 0 0.0 1 6.7 1 3.3
Mini mental state examination (MMSE)
Normal 8 50.0 10 66.7 18 58.1
Probably cognitive deterioration 5 31.3 3 20.0 8 25.8
Cognitive deterioration 3 18.7 2 13.3 5 16.1
DS, deviation standard.
TABLE 4The mean dierence of weight and BMI of older people at pre-post study.
Indicator Intervention Control Dierent #p
Mean DS Mean DS
Weight (kg)
At 1st week 57.2 9.5 52.6 9.1 4.6 0.177
At 2nd week 57.4 9.4 52.7 9.1 4.7 0.167
Difference 0.3 0.4 0.2 0.4 0.1 0.505
95% CI of different (0.0 to 0.5) (−0.0 to 0.4)
p
∗
0.03
flfl
0.150
BMI (kg/m
2
)
At 1st week 25.1 4.1 22.9 4.5 2.2 0.155
At 2nd week 25.2 4.1 22.9 4.5 2.3 0.147
Different 0.1 0.2 0.1 0.1 0.1 0.408
95% CI of different (0.0 to 0.2) (−0.0 to 0.2)
p
∗
0.022
flfl
0.152
#
p, Independen t-test.
∗
p, Dependent t-test.
flfl
p<0.05 at significant level.
CI, confidence interval; DS, deviation standard.
overall understanding of a balanced diet improved following
nutrition education (33). In the aftermath of a disaster, nutrition
management activities are implemented during rebuilding and
rehabilitation to enhance and sustain the nutritional wellbeing
of those affected by the event (34). The unique nutritional
requirements that mean the need for energy decreases, but the need
for protein remains of older people in the aftermath of a disaster
have not been well addressed.
The provision of nourishing food and nutrition education
has the potential to effectively mitigate malnutrition among older
people individuals in the aftermath of natural calamities while
also alleviating food insecurity. Food insecurity can be alleviated
through emergency food assistance programs. The enhancement
and preservation of the nutritional and health condition of
individuals affected by a disaster can be achieved by implementing
nutrition management strategies. These strategies encompass
surveillance measures such as anthropometric assessment of older
people and nutrition awareness initiatives involving nutrition
education and the utilization of snack bars. These activities respond
to and build upon the information gathered from public health
service endeavors. The ability of individuals and institutions to
cultivate a localized safety culture can enhance resilience in the
aftermath of a disaster. Maintaining a constant state of readiness
involves planning to ensure individuals, families, and communities
are prepared for all types of disasters that may impact the
community. The steps include preparing for emergencies, creating
a disaster plan, and staying informed about potential threats
using traditional local wisdom such as poetry, fairy tales, and
construction of house on stilts ( 35). Integrating food security into
post-disaster recovery initiatives is crucial to uphold the nutritional
and health wellbeing of populations particularly susceptible to the
impacts of disasters, such as older people. The Sendai Framework
emphasizes the mitigation of catastrophe risk within people of older
individuals (36). The post-disaster recovery process is impacted by
heightened community engagement by observing emergency food
consumption protocols.
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Fatmah 10.3389/fnut.2024.1291580
TABLE 5Comparison of mean macronutrient intake and nutrition
knowledge of older people.
Indicator Intervention Control p
Mean±DS Mean±DS
Energy (kcal)
At 1st week 1,173.9±5,20.7 1,162.8±370.1 0.946
At 2nd week 1478.3±629.9 1,403.6±529.3 0.724
p
∗
0.072
flfl
0.112
Carbohydrate (g)
At 1st week 179.2±80.9 188.7±56.7 0.709
At 2nd week 238.9±100.6 229.8±94.5 0.797
p
∗
0.020
flfl
0.071
Protein (g)
At 1st week 38.6±18.5 36.4±14.4 0.728
At 2nd week 41.3±24.1 42.2±16.3 0.905
p
∗
0.645 0.283
Fat (g)
At 1st week 35.1±22.8 30.5±20.0 0.562
At 2nd week 39.9±23.5 34.9±17.3 0.502
p
∗
0.601 0.503
Total consumption
of food bar (g)
643.8±25 640.0±38.7 0.749
Balanced nutrition knowledge
Pre-study 30.6±16.1 26.6±14.6 <0.001
flfl
Post-study 64.2±14.3 67.2±13.9 <0.001
flfl
#
p, independent t-test.
∗
p, dependent t-test.
flfl
p<0.05 at significant level.
DS, deviation standard.
Conclusion
Following a natural disaster, older individuals were provided
with a dietary supplement in the form of a snack bar containing
mangrove sword beans for 15 days. As a result, these individuals
saw a modest increase in body weight, with an average gain
of 0.2 kg. Consumption of carbohydrates in mangrove sword
bean snack bars directly impacts weight when used as a dietary
supplement. While the BMI of older individuals did not exhibit
a noteworthy rise, a notable disparity in weight was observed
following the consumption of theapi-apimangrove and sword
bean snack bar compared to their pre-bar weight. Due to its
nutritional composition and structural attributes, the snack bar
remains a viable choice for emergency sustenance options during
and following a crisis. Education regarding appropriate nutrition is
crucial in disaster relief initiatives, particularly when considering
particularly susceptible demographics such as older people and
children underfive.
Further investigation utilizing a more expansive cohort and
an extended temporal scope is imperative to generate empirical
data on the effects of emergency sustenance, such as snack
bars, on the nutritional wellbeing of displaced individuals in the
aftermath of catastrophic events. This assertion holds particular
significance for populations that are considered vulnerable, such
as older people, children below the age of five, lactating women,
and expectant mothers. The present research endeavors to
comprehensively address various nutritional statuses observed
in the older people population, including persons who are
underweight, of average weight, overweight, and obese. In addition,
Law 24 of 2007 on Disaster Management in Indonesia is a
suitable legal reference for disaster management in Indonesia.
However, it does not adequately protect older people group
prone to disasters. Therefore, it is recommended that specific
provisions for older people for disaster management be included
in the draft of the Older People Law. Government policy
to conduct rapid nutrition and health assessments of older
people to identify nutritional problems during emergencies
and post-disasters.
Data availability statement
The original contributions presented in the study are included
in the article/supplementary material, further inquiries can be
directed to the corresponding author.
Ethics statement
The studies involving humans were approved by the
Ethics Commission for Health Research and Development
(KEPPK) of the Sint Carolus, College of Health Sciences,
Jakarta (No.089/KEPPKSTIKSC/VII/2022). The studies were
conducted in accordance with the local legislation and institutional
requirements. Written informed consent for participation in this
study was provided by the participants’ legal guardians/next of kin.
Author contributions
FF: Conceptualization, Data curation, Formal analysis, Funding
acquisition, Investigation, Methodology, Resources, Supervision,
Validation, Visualization, Writing – original draft, Writing – review
& editing.
Funding
The author(s) declare financial support was received for
the research, authorship, and/or publication of this article.
This work was supported by The PUTI Q1 Scopus Grant
of University of Indonesia Year 2022 (grant number: NKB-
524/UN2.RST/HKP.05.00/2022).
Acknowledgments
The author wishes to thank The PUTI Q1 Scopus Grant
of University of Indonesia Year 2022 (grant number: NKB-
524/UN2.RST/HKP.05.00/2022) and the appreciation to all
Frontiers inNutrition 09 frontiersin.org
Fatmah 10.3389/fnut.2024.1291580
individuals who contributed to the successful implementation of
the study. This encompasses the entire population of older people
individuals who participated in the study, as well as the personnel
of theposbindudedicated to serving the older people population in
Cihanjuang Village, Cimanggung subdistrict, Sumedang District,
and all individuals responsible for data collection in the field.
Conflict of interest
The author declares that the research was conducted
in the absence of any commercial or financial relationships
that could be construed as a potential conflict
of interest.
Publisher's note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed or
endorsed by the publisher.
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