Comparisons of Characteristics and Nutritional Inadequacies in Indonesian Older Adults Consuming or Refraining from Dairy Products

Esthika Dewiasty, Siti Setiati, Rina Agustina, Rahmi Istanti, Arya Govinda Roosheroe, Murdani Abdullah, Hamzah Shatri, Edy Rizal Wahyudi, Ikhwan Rinaldi, Pradana Soewondo, Rudy Hidayat, Yudo Murti Mupangati, Nove Zain Wisuda, Lisette CPGM de Groot


Background: Milk consumption in the Indonesian elderly population is among the lowest in the world, and two-thirds of the population are lactose intolerant. This might have an impact on energy and nutrient intakes. However, data on the prevalence of nutrient intake inadequacies in dairy users versus non-dairy users, as well as population characteristics, are lacking. Therefore we obtained data comparing nutritional inadequacies and characteristics of Indonesian older adults consuming or refraining from dairy products. Methods: A cross-sectional study was conducted in 2021 as a part of the INA LACTASE study, involving 194 community-dwelling older adults in the outpatient geriatric clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We collected data on demographic and clinical characteristics as part of a routinely performed comprehensive geriatric assessment. A structured questionnaire was developed to categorize participants as dairy-or non-dairy users based on habitual dairy intake. Food records were collected to assess nutrient intakes. The prevalence of inadequacies of energy, macronutrients, and a selection of micronutrients (calcium, vitamin D, and vitamin B12) was calculated by comparing the reported mean intakes to the recommended dietary intakes of the Indonesian population (Indonesian RDA). Prevalence ratios were calculated to measure the association between dairy product consumption and the prevalence of nutrient inadequacies. Results: We recruited 194 eligible participants. This study found that dairy users had a higher proportion of women, a higher monthly income, but a lower proportion of hypertension, diabetes mellitus, and dyslipidaemia in older adults consuming dairy products. We observed wide variability in energy and nutrient intakes, as well as a high prevalence of inadequacies for all dietary intake parameters, particularly micronutrients. Dairy users had a lower prevalence of micronutrient inadequacies than non-dairy users. The prevalence of vitamin D inadequacies in dairy users versus non-dairy users was 91.6% vs. 99.3% in men and 71.9% vs. 98.0% in women, respectively. Inadequate vitamin B12 intake was found in 60.6% of dairy users vs. 89.4% of non-dairy users in men and 65.5% vs.. 68.4% of women, respectively. The most pronounced difference was found in the prevalence of calcium intake inadequacies in dairy users vs. non-dairy users, which was 64.8% vs. 99.5% in men and 89.9% vs. 99.8% in women. We found statistically significant differences in the prevalence of calcium, vitamin D, and vitamin B inadequacies between dairy and non-dairy users. Conclusion: This study identified that dairy users had a higher monthly income and had a lower proportion of hypertension, diabetes mellitus, and dyslipidemia. In addition, we discovered a high prevalence of nutrient intakes inadequacies in Indonesian older adults, particularly among non-dairy users. Micronutrient inadequacies are major sources of concern, with statistically significant difference in calcium, vitamin D, and vitamin B12 prevalence of inadequacies.


characteristics; nutrient intakes; the prevalence of inadequacies; older adults; Indonesia


Pusat Data dan Informasi Kementerian Kesehatan RI. Situasi dan analisis lanjut usia [Internet]. Jakarta: Kementerian Kesehatan RI; 2014 [cited 17 Nov 2020]. Available from:

Badan Pusat Statistik. Statistik penduduk lanjut usia 2019 [Internet]. Jakarta: Badan Pusat Statistik; 2019 [citied 17 Nov 2020]. Available from:

Marshall TA, Stumbo PJ, Warren JJ, Xie XJ. Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly. J Nutr. 2001;131(8):2192–6.

Hong X, Yan J, Xu L, Shen S, Zeng X, Chen L. Relationship between nutritional status and frailty in hospitalized older patients. Clin Interv Aging. 2019; 14:105–11.

Dodds R, Sayer AA. Sarcopenia and frailty: new challenges for clinical practice. Clin Med. 2016;16(5):455–8.

Setiati S, Laksmi PW, Aryana IGPS, et al. Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition. BMC Geriatr. 2019;19(1):182.

Yang Du, Chorong Oh, Jaekyung No. Advantage of dairy for improving aging muscle. J Obes Metabol Syndr. 2019;28:167-74.

Cuesta-Triana F, Verdejo-Bravo C, Fernández-Pérez C, Martín-Sánchez FJ. Effect of milk and other dairy products on the risk of frailty, sarcopenia, and cognitive performance decline in the elderly: A systematic review. Adv Nutr. 2019;10 (suppl_2):S105–19.

Singh GM, Micha R, Khatibzadeh S, et al. Global, regional, and national consumption of sugar-sweetened beverages, fruit juices, and milk: a systematic assessment of beverage intake in 187 countries. PLoS One. 2015;10(8):e0124845.

Dewiasty E, Setiati S, Agustina R, Roosheroe AG, Abdullah M, Istanti R, de Groot LC. Prevalence of lactose intolerance and nutrients intake in an older population regarded as lactase non-persistent. Clin Nutr ESPEN. 2021; 43:317-21.

Ada YR, Musfiroh M, Priyo D, Wiyono VH. [Gambaran kemandirian ekonomi pada lansia. Placentum Jurnal Ilmu Kesehatan dan Aplikasinya]. 2019:7(2):16-23.

Kementerian Kesehatan RI. [Juknis Instrumen pengkajian paripurna pasien geriatri (P3G)]. Jakarta: Kementerian Kesehatan Republik Indonesia (The Indonesian Ministry of Health); 2017.

Fatmah F. Diagnostic test of predicted height model in Indonesian elderly: a study in an urban area. Med J Indones. 2010;19(3):199e204.

Wijnhoven HAH, van Bokhorst-de van der Schueren MAE, Heymans MW, et al. Low mid-upper arm circumference,calf circumference, and body mass index and mortality in older persons. J Gerontol Ser A. 2010;65A (10):1107e14.

Charrondiere UR, Stadlmayr B, Haytowitz D, Oseredczuk M, Ireland J, Wolmarans P, Rittenschober D, Selley B, Puwastien P, Reykdal Ó. FAO/INFOODS guidelines for checking food composition data prior to the publication of a user table/database version 1.0. Rome: Food and Agriculture Organization of the United Nations; 2012.

Nguyen Bao KL, Sandjaja S, Poh BK, et al. The consumption of dairy and its association with nutritional status in the south east Asian nutrition surveys (SEANUTS). Nutrients. 2018;13;10(6):759.

[Angka Kecukupan Gizi yang Dianjurkan untuk Masyarakat Indonesia. Permenkes Nomor 28 Tahun 2019]. The Indonesian Ministry of Health Regulation no.28, 2019.

Slater B, Fisberg DLMR. Estimating prevalence of inadequate nutrient Intake. Rev Saude Publica. 2003;38(4):1-6.

Roman Viñas B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, de Groot LC, van’t Veer P, Matthys C, Serra Majem L. Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab. 2011;59:84–95.

Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington DC: The National Academies Press; 1998.

Setiati S, Harimurti K, Dewiasty E, et al. Profile of food and nutrient intake among Indonesian elderly population and factors associated with energy intake: a multi-centre study. Acta Medica Indones. 2013;45(4):265–74.

Ribeiro AG, Mill JG, Cade NV, Velasquez-Melendez G, Matos SMA, Molina MDCB. Associations of dairy intake with arterial stiffness in Brazilian adults: the Brazilian longitudinal study of adult health (ELSA-Brasil). Nutrients. 2018;10(6):701.

Ong S, Woo J, Parikh P, et al. Addressing nutritional requirements of ageing consumers in Asia-recommendations from an expert workshop. Asia Pac J Clin Nutr. 2019;28(2):204-13.

Best RL, Appleton KM. The consumption of protein-rich foods in older adults: an exploratory focus group study. J Nutr Educ Behav. 2013;45:751-5.

Ubrežiová I, Urbánová M, Kozáková J, Kráľová T. Gender differences in consumer preferences when buying dairy products in Slovakia and Russia. Potr S J F Sci. 2019;1(13):720-29.

Lukito W, Malik SG, Surono IS, Wahlqvist ML. From “lactose intolerance” to “lactose nutrition.” Asia Pac J Clin Nutr. 2015;24 Suppl 1: S1-8.

Wolfe RR. Update on protein intake: importance of milk proteins for health status of the elderly. Nutr Rev. 2015;73(1):41–7.

ter Borg S, Verlaan S, Hemsworth J, et al. Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review. Br J Nutr. 2015;113(8):1195–206.

Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10-47.

Warzecha M, Czerwinski E. Calcium consumption in diet of elderly patients- literature review. Post N Med. 2016; 29(10):777-80.

Zhang R, Naughton DP. Vitamin D in health and disease: current perspectives. Nutr J. 2010;8(9):65.

Nugroho P, Lydia A, Suhardjono S, Harimurti K. Association of BsmI polymorphisms in the vitamin D receptor gene among Indonesian population with diabetic kidney disease. Acta Med Indones. 2021;53(2):149-55.

Watanabe F, Yabuta Y, Bito T, Teng F. Vitamin B12-containing plant food sources for vegetarians. Nutrients. 2014;6(5):1861–73.

Godos J, Tieri M, Ghelfi F, et al. Dairy foods and health: an umbrella review of observational studies. Int J Food Sci Nutr. 2020;71(2):138-51.

Schwingshackl L, Hoffmann G, Lampousi AM, et al. Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2017;32(5):363-75.

Lordan R, Tsoupras A, Mitra B, Zabetakis I. Dairy fats and cardiovascular disease: do we really need to be concerned? Foods. 2018;7(3):29.

Grosso G. Dairy in human health and disease across the lifespan. Philadelphia: Elsevier Inc; 2017. p. 385-93.

van Staveren WA, Steijns JM, de Groot LC. Dairy products as essential contributors of (micro-) nutrients in reference food patterns: an outline for elderly people. J Am Coll Nutr. 2008;27(6):747S-54S.

Hoes AW, Grobbee DE. Clinical epidemiology: principles, methods, and applications for clinical research. Sudbury: Jones and Bartlett Publishers; 2009.

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