Eid Al-Fitr or Lebaran is a day that is highly awaited by Muslims, not only in Indonesia, but also all around the world. Eid is identical with a family gathering and also the tradition of eating together with family. Many types of food and drinks are served during Eid. In Indonesia, the usual menus are lontong opor ayam, rendang, meatball soup, Eid cakes, snacks, and sweet drinks.

Some people make Eid or Lebaran as a time of revenge to eat as much as they want, after having fast for about 30 days in the month of Ramadan, within 13-14 hours every day. However, this phenomenon cannot be justified. Why? Because it can cause an unfavorable impact for the body, for example: increasing weight drastically, and also increasing blood sugar and cholesterol levels in our bodies.

There are four tips for maintaining a healthy diet that we need to consider and apply during Eid:

• Limit the Amount of Food Intake and Limit High Calorie Food: Foods Containing Coconut Milk and High in Fat

During Eid, we often feel like we want to taste all the food that is served at the table. It is okay to try all the foods served, but remember to limit the number of the portions. Use small plates to limit the amount of your food intake.

Most of the food served during Eid are identical with coconut milk (santan) and rich in fat. Even though it has such a delicious taste, but we need to limit the portions. If it’s too much consumed, there can be an increase in body weight, cholesterol and blood sugar levels, so that it can increase the risk of cardiovascular disease (1). 

• Increase the Consumption of Vegetables and Fruits

Try to keep consuming vegetables and fruits during Eid. Besides choosing protein-rich foods, don’t forget to tuck in vegetables and fruits on your plate, to meet your micronutrient needs. The World Health Organization (WHO) recommends consuming vegetables and fruits at least 400 grams/person/day (2).

Vegetables and fruit are known to be rich in vitamins, minerals, carotenoids, phytosterols, flavonoids, phenolic compounds, dietary fibers, and antioxidants that have so many benefits for the body (3,4). One of the benefits is that it can maintain our health and also reduce the risks of several diseases (3), such as:

• Cancer
• Cardiovascular diseases: hypertension and chronic health failure
• Diabetes Mellitus
• Arthritis
• Skin diseases
• Overweight and Obesity
• Neurodegenerative diseases: Alzheimer’s and Parkinson’s disease

In addition, consuming enough vegetables and fruits also helps maintain lung function in adults, and also increases bone health to avoid the risk of osteoporosis (3).

• Limit Sugar Intake

Oftentimes, sweet foods and drinks are served during Eid. It’s okay if you want to try various types of Eid cakes or sweet drinks served on the table, but keep an eye on the numbers of the portions. Eating too much sugar increases the risk of dental caries, diabetes, and obesity (5).

Don’t forget to drink enough water after consuming sweet foods and drinks. The Ministry of Health Republic of Indonesia recommends drinking 2 liters of water or 8 glasses every day (6).

• Do Moderate Exercise

Last but not least, take your time to do some exercises. The Ministry of Health Republic of Indonesia recommends exercising for about 30 minutes/day or 150 minutes/week in moderate intensity (7). You don’t have to do sports using special equipment or go to the gym with a personal trainer, but you can do your exercises independently at home. Choose a type of exercise that you can enjoy, so that you don’t feel overwhelmed while doing it.

References:

1. Astrup A, Mangkos F, Bier DM, Brenna T, Otto M, Hill JO, et al. Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations. JACC State-of-the-Art Review. 2020; 76(7).
2. WHO. Healthy Diet. [Online]; 2020 [cited 2022 April 23. Available from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet.
3. Yahia EM, García-Solís P, Celis MEM. Contribution of Fruits and Vegetables to Human Nutrition and Health. In Postharvest Physiology and Biochemistry of Fruits and Vegetables. Cambridge: Woodhead Publishing; 2019. p. 19-45.
4. Varadaraju R, Patel P. Health Benefits of Vegetables. International Journal of Chemical Studies. 2019; 7(2): p. 82-87.
5. WHO. Taxes on sugary drinks: Why do it? (No. WHO/NMH/PND/16.5 Rev. 1): World Health Organization; 2017.
6. Kemenkes RI. Berapa Takaran Normal Air Agar Tidak Kekurangan Cairan dalam Tubuh? [Online]; 2018 [cited 2022 April 23. Available from: http://p2ptm.kemkes.go.id/preview/infografhic/berapa-takaran-normal-air-agar-tidak-kekurangan-cairan-dalam-tubuh.
7. Kemenkes RI. Ayo Bergerak, Lawan Obesitas Jakarta: Kementerian Kesehatan RI; 2017.

The food pattern during fasting is certainly changing. The changes occur when food consumption is limited so that the frequency of eating and the amount of food consumed are more limited. In general, people consume a portion of food three times a day but during fasting it changes to two times a day. Although eating patterns change during fasting, people must maintain optimal and balanced nutritional intake so that their body condition remains healthy and can undergo fasting properly. Therefore, the foods fulfillment with carbohydrates, fiber, vitamins and minerals, fats, and proteins must be considered accordingly.

Several things need to be considered in implementing a healthy diet while fasting. Three tips for maintaining a healthy diet during fasting are:

• Limit Salty Foods Consumption During Suhoor

Consuming salty foods will increase the intake of sodium that enters the body. It can increase urination after consuming drinks during the suhoor (Juraschek et.al., 2020). In addition, it also causes dry mouth and thirst. It is caused when the body improves the ratio of sodium and fluid balance to respond to the sodium increase (Agócs et al., 2020). Therefore, try to limit salt consumption or other high-sodium foods such as sauces, soy sauce, and canned foods during the suhoor.

• Consume Complex Carbohydrates and High Fiber

Consuming food sources of complex carbohydrates and high fiber are recommended at suhoor. Foods such as sweet potatoes, corn, cassava, oatmeal, whole wheat bread, and brown rice will provide a full effect for more than 6 hours. It happens because fiber can slow down the gastric emptying process, so that food absorption takes longer (Akbar et al., 2021). In addition, consuming enough fiber can also maintain a healthy digestive tract and prevent constipation (McRorie et al., 2016).

• Eat Sufficiently and Limit Sweet Foods During Iftar

When breaking the fast, you should consume food gradually. Avoid consuming heavy food immediately, because it can put an extra burden on digestion (Sanvictores et al., 2021). In addition, directly consuming a lot of food can make the stomach feel tight. Therefore, eat gradually, starting with water, then a little sweet food, and main food after an interval of half or an hour are recommended. When breaking the fast, it is also necessary to pay attention to the consumption of sweet foods, but people often consume drinks with high sugar and sweet foods when breaking the fast. Sweet foods have benefits in increasing low blood sugar levels while fasting. However, you need to be careful not to consume excess sugar.

References:

Akbar A, Shreenath AP. High Fiber Diet. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559033/

Agócs R, Sugár D, Szabó AJ. Is too much salt harmful? Yes. Pediatr Nephrol. 2020 Sep;35(9):1777-1785. doi: 10.1007/s00467-019-04387-4. Epub 2019 Nov 28. PMID: 31781959; PMCID: PMC7384997.

Juraschek SP, Miller ER 3rd, Chang AR, Anderson CAM, Hall JE, Appel LJ. Effects of Sodium Reduction on Energy, Metabolism, Weight, Thirst, and Urine Volume: Results From the DASH (Dietary Approaches to Stop Hypertension)-Sodium Trial. Hypertension. 2020 Mar;75(3):723-729. doi: 10.1161/HYPERTENSIONAHA.119.13932. Epub 2020 Jan 20. PMID: 31957521; PMCID: PMC7278848.

McRorie JW Jr, McKeown NM. Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber. J Acad Nutr Diet. 2017 Feb;117(2):251-264. doi: 10.1016/j.jand.2016.09.021. Epub 2016 Nov 15. PMID: 27863994.

Sanvictores T, Casale J, Huecker MR. Physiology, Fasting. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534877/

Certainly it is not an easy thing to hold thirst for more than 12 hours per day. Under normal circumstances, adult body requires ± 2 liters of fluid every day. Lack of fluids can cause disturbances in brain function such as difficulty thinking, headaches, fatigue, and impaired muscle function. Therefore, in this article, we will discuss tips that can be done to keep the body hydrated during fasting.

• Drink enough water

During fasting, our bodies can experience mild dehydration which is characterized by headaches, fatigue, and difficulty concentrating. To prevent excessive thirst, we can divide the time to drink water with the following pattern: 1 glass when breaking the fast, 1 glass after dinner, 1 glass after Isha’ time, 1 glass after Tarawih time, 1 cup before bed, 1 cup after wake up, 1 glass at dawn, and 1 glass before Fajr. The volume of water that is drunk at one time should not be excessive (only about 250 – 300 mL / glass) because the body will not be able to absorb large amounts of water at once. Dairy products such as milk and yogurt are also high in water content so they are good for supplementing daily fluid needs.

• Consumption of fruits and vegetables

Eating fruits and vegetables is also highly recommended, because in addition to containing high water content, they also contain vitamins and minerals that are good for the body. Examples of fruits that contain a lot of water are watermelon, strawberries, oranges, melons, and pineapples. In addition, vegetables that are high in water content include spinach, broccoli, tomatoes, and carrots.

• Avoid caffeine consumption

You should avoid drinking tea or coffee before fasting because the caffeine contained in it is a diuretic. Consumption of tea and coffee will increase the frequency of urination and make our bodies thirsty faster. This will make dehydration worse.

• Take a cold shower

Hot temperatures can increase the release of fluid through the skin pores. Taking a cold shower will keep your body from excreting a lot of fluids. In addition, showering with cold water can also help reduce stress and improve mood.

References:

1. Enhance (2022). Cold Showers and Intermittent Fasting: The Benefits to Your Health. [online]. Available at: enhancenaturals.co.uk
2. Khuraaki (2022). A Guide on Healthy Eating and Hydration During Ramadan. [online]. Available at: https://khuraaki.co.uk.
3. Shadman Z, Akhoundan M, Poorsoltan N (2016). Nutritional Education Needs in Relation to Ramadan Fasting and Its Complications in Tehran, Iran. Iran Red Crescent Med J. 18(8):e26130.
4. UCLA Health (2019). Healthy Tips for Ramadan. [online]. Available at: https://connect.uclahealth.org/2019/05/01/healthy-tips-for-ramadan.

Because of the negative effects, intermittent fasting is not recommended for pregnant women and nursing mothers, children and adolescents under the age of 18, those at risk of hypoglycemia, diabetes, or people with certain chronic diseases. If you have side effects like headaches, nausea, or other symptoms after practicing intermittent fasting, you should consult a doctor. There are several methods that can be used by those who want to start intermittent fasting, including:

1. The 5:2 Diet

This method is used twice a week and involves eating only one portion of food (about 500-600 calories). To keep calories low when fasting, it is highly recommended to eat foods high in fiber and protein. On the other five days of week, you are free to eat normally. If you choose to eat normally every day of the week except Sunday and Monday, for example.

1. The 16/8 method

You have choice of eating for 8 hours and fasting for 16 hours. For example, you may eat from 10 a.m. until 6 p.m. and then fast for the next 16 hours. Some people find it simple to maintain this method over time.

1. Eat-Stop-Eat

This method involves fasting for a full 24 hours once or twice a week. You can fast from breakfast till breakfast the next day, then continue after one day of not fasting. The negative effects of this method might be severe, including weariness, headaches, and hunger.

Reference:

1. Cleveland Clinic (2022). Intermittent Fasting: How It Works and 4 Types Explained. [Online] Available at: https://health.levelandclinic.org/ [Accessed April 6, 2022]
2. Dong, TA, Sandesara, PB, Dhindsa, DS, Mehta, A., Arneson, LC, Dollar, AL, … & Sperling, LS (2020). Intermittent fasting: a heart healthy dietary pattern?.The American journal of medicine,133(8), 901-907.
3. Johns Hopkins Medicine (2022). Intermittent Fasting: What is it, and how does it work? [Online] Available at: https://www.hopkinsmedicine.org/ [Accessed April 6, 2022]
4. Mohamed, AI, Abdi, AM and Abilahi, MM (2020). Ramadan Intermittent Fasting and Its Beneficial Effects of Health: A Review Article. Central African Journal of Public Health, 6(5), 288-292.

Stunting is one of the chronic nutritional problems in Indonesia. The prevalence of stunting in Indonesia is quite high, ranked number 2 in Southeast Asia (1). Based on Riskesdas 2018, the prevalence is 30.8% and it is estimated to decrease to 26.92% in 2020 (2, 3). However, this figure is still within the upper threshold for stunting prevalence which is 20% set by WHO. This is an important problem that needs to be addressed together either by the government or by the community.

Stunting or short toddlers is a condition of failure to thrive that occurs in children under five due to chronic malnutrition, especially in the period of the First 1,000 Days of Life (HPK) (4). Stunting conditions are generally caused by low nutritional intake and health status for a long time, lack of access to sanitation and clean water resulting in repeated infections, and inadequate parenting (4).

Early detection of stunting can be done by monitoring the child’s growth curve regularly. Mothers should regularly monitor their child’s growth and development by visiting the nearest Posyandu in the neighborhood. The cadre will explain how the child’s weight and length/height are based on their age category. Toddlers are categorized as stunted when the Body Length index for Age (PB/U) or Height for Age (TB/U) with a z-score is in the range of less than -2 SD (short) to -3 SD (very short) (4).

Stunting prevention needs to be done as early as possible. Similar to what has been said by Prof. Dr. dr. Nila Djuwita F. Moeloek, SpM(K), that “If we prevent it earlier since we are young girls, the better results will be. Behavior change is needed because preventing stunting is important!”. The government together with the Ministry of Health has also compiled stunting prevention programs to reduce stunting prevalence in Indonesia, such as (5):

1. Giving 90 pieces blood supplementation during pregnancy
2. Providing additional food for pregnant women
3. Handling pregnant women with an expert doctor or midwife
4. Implementation of breastfeeding early initiation
5. Exclusive breastfeeding for babies up to 6 months old
6. Complementary feeding for 2 years old children (from 6 months to 24 months)
7. Immunization and vitamin A supplementation
8. Monitoring growth and development of toddlers through Posyandu activities in the neighborhood
9. Implementing clean and healthy living behavior

If not prevented and handled properly, stunting can have a negative impact on the quality of human resources. 

• Short-term impact: stunting can cause stunted growth in children, impaired brain growth, cognitive and motoric disorders of children, metabolic disorders, and physical size of children’s bodies do not develop optimally according to their age (4,6).
• Long-term impact: stunting can cause children intellectual capacity which has an impact on decreasing learning concentration and difficulty understanding the material presented at school, so that it can affect learning achievement and productivity as an adult, decreased immunity/immune, and the risk of developing degenerative diseases (4,6).

References:

1. Asian Development Bank (ADB). Prevalensi Stunting Balita Indonesia Tertinggi ke-2 di Asia Tenggara. [Online].; 2020 [cited 2022 April 3. Available from: https://databoks.katadata.co.id/datapublish/2021/11/25/prevalensi-stunting-balita-indonesia-tertinggi-ke-2-di-asia-tenggara.
2. Sekretariat Wakil Presiden. Angka Prevalensi Stunting tahun 2020 Diprediksi Turun. [Online].; 2021 [cited 22 Desember 21. Available from: https://stunting.go.id/angka-prevalensi-stunting-tahun-2020-diprediksi-turun/.
3. Kemenkes RI. Hasil Utama Riskesdas 2018. Jakarta; 2018.
4. Kementerian PPN/Bappenas. Pedoman Pelaksanaan Intervensi Penurunan Stunting Terintegrasi di Kabupaten/Kota Jakarta: Kementerian Perencanaan dan Pembangunan Nasional/Badan Perencanaan dan Pembangunan Nasional; 2018.
5. Kemenkes RI. Warta Kesmas: Cegah Stunting itu Penting. [Online].; 2018 [cited 2021 April 3. Available from: https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Warta-Kesmas-Edisi-02-2018_1136.pdf.
6. Adistrie F, Lumbantobing VBM, Maryam NNA. Pemberdayaan Kader Kesehatan Dalam Deteksi Dini Stunting dan Stimulasi Tumbuh Kembang pada Balita. Media Karya Kesehatan. 2018 Desember; 1(2).