Breakfast Practices Among Indonesian Adults: Urban and Rural Differences and Its Associated Factors

Praktik Sarapan pada Orang Dewasa Indonesia: Perbedaan Perkotaan dan Pedesaan dan Faktor yang Berkaitan

Backgrounds: Adults in Indonesia have challenges due to the high prevalence of obesity. Factors that contributed to obesity included unhealthy eating practices. Skipping breakfast habits are linked to health issues such as non-communicable diseases (NCDs). Breakfast practices also reflected the social and cultural dynamics in urban and rural. Socioeconomic and demographic factors could cause differences in breakfast practices between urban and rural areas in Indonesia.

Objectives: This research aimed to examine the differences in breakfast practices among Indonesian adults in urban and rural areas based on various characteristics and to explore the association between socioeconomic and demographic characteristics with breakfast practices.

Methods: This was a cross-sectional study using secondary data from the Indonesia Food Barometer (IFB) in 2018. A total of 770 adults (26–45 years old) were examined to observe the differences in breakfast practices (skipping breakfast, eating together, buying food, cooking food, and activities during meals) in urban and rural areas. Logistic regression analysis was also employed to examine the association between skipping breakfast and modern breakfast practices with socioeconomic and demographic variables.

Results: Chi-square analysis showed significant differences between urban and rural areas in eating alone, eating outside the home, and buying food during breakfast (p-value <0.001). Factors related to skipping breakfast were education level and type of residence (all p-value <0.001), while occupation (p-value = 0.004) and type of residence (p-value <0.001) were related to modern breakfast practices.

Conclusions: There were differences in breakfast practices between urban and rural. Skipping breakfast and modern breakfast practices were more prevalent in urban areas.

INTRODUCTION

Indonesia faced a demographic bonus in 2030, where most of the population consisted of working-age adults. This phenomenon also indicated that the population will begin ageing by 2040, as the elderly population has a higher health risk and vulnerability¹. One health issue in Indonesia was obesity caused by overnutrition. Overnutrition could have led to the loss of Disability-Adjusted Life Years (DALYs) among working-age adults, contributing to Non-Communicable Diseases (NCDs). The 2018 Indonesian Basic Health Research(Riset Kesehatan Dasar/Riskesdas)revealed a progressive rise in the prevalence of overweight among adults, increasing from 11.5% in 2013 and reaching 13.6% in 2018². A comparable trend was observed in the prevalence of obesity, with urban areas exhibiting a higher prevalence compared to rural areas². Furthermore, the implications of adults burdened with obesity led to work limitations, particularly in physically demanding occupations. Reduced mobility and physical endurance hindered employees' abilities to perform certain tasks, necessitating adjustments to job roles or accommodations³. The implications mentioned were caused by poor diet among adults^4;5.

The Global Burden of Diseases Study confirmed the role of poor eating habits as a risk for DALY loss⁴. Various factors have influenced poor eating, such as sociodemographic-economic conditions and eating practices, especially breakfast-related practices⁵. Breakfast consumption has been significantly associated with diet quality and NCDs^6;7;8. Breakfast had been considered a crucial daily meal, breaking the longest fasting period after a meal, especially the overnight fasting period⁶. One lesson from the Balanced Nutrition Guidelines (PGS) was that breakfast was an essential habit for maintaining health⁹. Eating practices, including social and cultural factors like eating with a companion, skipping meals, buying food, and eating outside, had significantly impacted food intake¹⁰. The importance of breakfast practices was nutritionally linked to diet quality¹¹.

Another factor contributing to breakfast practices in society was the distinction between urban and rural areas¹²;¹³. A high population density and infrastructure development typically characterize urban areas. These areas often have advanced amenities, such as paved roads, public transportation, and various commercial, cultural, and recreational facilities. Urban might have diverse populations and are often marked by a more modern and cosmopolitan lifestyle. While for rural areas, on the other hand, are characterized by a lower population density and are often situated away from major cities or urban centers. These areas may have less developed infrastructure and fewer amenities^13;14. Urban and rural were some of the most significant forces influencing food practices and nutritional changes^13;15. Higher urbanization affected food consumption and nutrition changes, impacting consumption habits and practices. Urban areas affected agricultural land, food availability and costs, and the overall environment where food was produced¹⁶. Previous¹⁹studies on eating practices in urban and rural areas in East Java, Indonesia, showed that urban adults are more likely to skip breakfast and have lower diet quality scores than rural areas¹⁷. Breakfast practices were of consuming morning meals, encompassing the evolving nature of these routines in contemporary societies^6;7. The social and physical environment shapes behaviors such as eating out and consuming food prepared away from home, contributing to health and well-being. In Malaysia, the proportion of the 'eating out' phenomenon was positively correlated with modernization^18;19. The previous framework demonstrated the concept of traditional and modern eating practices. People living in urban areas adopted more modern diets than those in rural areas²⁰.

The term of "modern breakfast practices" referred to a diverse array of dietary behaviors influenced by modernization that had an important role similar to traditional norms. These practices might involve changes in food choices, preparation methods, and the overall cultural context of breakfast²¹. A study conducted by Sproesser et al²⁰explaining the term modern eating practices was not only about what people ate but also how people ate. More modern eating can be explained by being more likely to have such eating practices: eating alone, buying food, eating outside, and also screen time or doing other activities during eating. Uncovering the factors influencing modern breakfast practices was crucial for gaining insights into the shifting landscape of dietary habits, especially within sociodemographic characteristics²⁰. This research sought to bridge this gap by delving into the intricate relationships between socio- demographic and economic characteristics and the adoption of modern breakfast practices. Modern breakfast practices might result in a higher likelihood of eating alone, eating outside the home, buying food, and eating with screen time^18;22.

The findings of this study were intriguing, prompting an examination and emphasis on other eating habits during breakfast to determine whether urban and rural areas yielded different results. In conclusion, this research endeavored to unravel the interplay between sociodemographic characteristics and breakfast-eating practices in Indonesian various characteristics, who live in urban and rural. By elucidating these connections, the study aimed to contribute valuable insights for government, health professionals, and individuals striving to promote healthier dietary habits during breakfast.

METHODS

The data used for this quantitative analysis was derived from the Indonesia Food Barometer (IFB) 2018. The IFB 2018 study was conducted with a cross-sectional study design, employing a mixed-model approach that relied on both qualitative instruments (such as one-on-