Impact of Online Eating Behavior Changes on Nutritional Status of Elementary School during Pandemic

Introduction: COVID-19 pandemic has had a huge impact on education in Indonesia necessitating distance learning from home via online methods. Learning from home change people’s daily life including eating behavior. Children’s eating behavior plays an important role in their nutritional status. Methods: We conducted an observational study with a cross-sectional design which included 48 subjects. Data were collected using an online structured questionnaire. Results: The results of the relationship test show a p-value of (0.000) which is smaller than alpha (0.05). The comparison test results show a p-value of (0.000) which is smaller than (0.05). Conclusion: There is an association of changed eating behavior during COVID-19 pandemic with children’s nutritional status .


Introduction
Indonesia faces a dual burden of malnutrition, with high rates of undernutrition and rising obesity.
WHO defines malnutrition as a medical condition caused by inadequate or imbalanced intake or supply of nutrition.Malnutrition is more often associated with insufficient nutrient intake and excessive nutrient intake. 1 The prevalence of nutritional status (IMT/U) according to the 2018 National Riskesdas data report for children aged 5-12 years is as follows: Very thin cases 24%, thin 6.8%, normal 70.8%, overweight 10.8%, and obese 9.2%. (2)In South Sulawesi, the prevalence of nutritional status for children aged 5-12   years in urban areas is as follows: Very thin 3.89%, thin 8.61%, normal 69.40%, overweight 8.92%, and obese 9.18%.In rural areas, the prevalence is as follows: Very thin 2.32%, thin 8.67%, normal 77.30%, overweight 7.05%, and obese 4.66%.From these data, it can be seen that urban areas have a much higher risk of obesity than rural areas in South Sulawesi Province.The highest incidence of obesity in Makassar City ranks first with a prevalence of 11.82.The incidence of obesity in boys is higher than in girls with a prevalence of 7.74% and 5.27%, respectively. 3ting behavior is the most important behavioral state that can influence nutritional quality.In general, the eating behavior of elementary school children is influenced by parents and schools, which will shape the eating behavior of children. 4 School-age children need good nutrition from their parents and from their environment.If the nutrients they receive are not complete, it will affect physical growth, structure, and decreased brain function, which will cause lack of attention and concentration in learning, and behavioral deviations. 5e COVID-19 pandemic was first identified in Wuhan, Hubei, China, on December 1, 2019.The virus spread rapidly to the rest of the world, including Indonesia.WHO declared a COVID-19.On March 3, 2020, Indonesia first reported a COVID-19 case.Indonesia's government issued a policy to maintain social distancing at the community level and avoid crowds, which also affected learning at the elementary and secondary school levels.As a result, schools in Indonesia, specifically in Makassar City, had to be closed and switched to online learning.This was done by the government as one of the anticipations of the impact of the pandemic to break the chain of distribution of COVID-19 in Indonesia.
During the COVID-19 pandemic, Indonesians experienced a change in eating habits by 62.5 %, an increase in food consumption diversity by 59 %, an increase in eating frequency by 54.5 %, an increase in the amount of food consumed by 51 %, and an increase in body weight by 54.5 %. 6 Several studies have shown that changes in eating behavior and physical activity occur when people spend more time at home.These changes include a decrease in physical activity (38.0 %) and an increase in sitting time (28.6 %), an increase in the frequency of eating and snacking, and consumption of unhealthy foods, compared Green Medical Journal Vol.5 Issue: 3 (December, 2023)  Green Medical Journal e-ISSN: 2686-6668 Volume 5 Issue 3 to before the COVID-19 pandemic. 7sed on the above, the researchers were interested in conducting a study to analyze the changes in eating behavior during online learning on the nutritional status of elementary school-aged children during the COVID-19 pandemic at SD. Inp.Todopuli 1 Kota Makassar.

Methods
The study design used in this study is an observational analytic with a cross-sectional research approach.This study was conducted to determine the relationship between eating behavior and nutritional status of elementary school-aged children during online learning during the COVID-19 pandemic.The study was conducted at SD. Inp.Todopuli 1 Makassar City from June to July on 2021.The population in this study was all grade 4 students and parents (mothers) who attended SD.Inp.Todopuli 1, a total of 92 students.The number of samples was 48 samples.This study was by using purposive sampling technique that had met the inclusion and exclusion criteria.
The data used in this study were primary data obtained from respondents.The questionnaire was distributed to respondents through Google forms, then the respondents filled out the Google forms with the assistance of the researchers.Data were processed using the SPSS (Statistical Package for the Social Sciences) program, using univariate analysis to determine the frequency distribution of the variables studied.Bivariate analysis using the Person Chi-square test to see the relationship between eating behavior and the nutritional status of children during online learning and using the Man-Whitney-U test to see the comparison of children's eating behavior before and during online learning during Covid-19 pandemic.

Result
Univariate Analysis Volume 5 Issue 3

Characteristics of respondents based on child gender
The results of the study showed that the number of male respondents was 25 (52.1%), which was higher than the number of female respondents, which was 23 (47.9%)Based on the results of the study, respondents with good nutritional status had the highest frequency of 36 respondents (75%), while the lowest frequency was in the overweight status of 3 respondents (6.3%).Based on the results of the study, moderate and good eating patterns were applied to 14 respondents (29.7%), 12 respondents (25%) with a very good eating pattern, 5 respondents (10.42%) with a bad eating pattern, while others there were 3 respondents (6.25%) with a very bad eating pattern.Based on the results of the study, it was found that a good eating pattern was applied to 23 respondents (47.9%), 11 respondents (22.9%) with a moderate eating pattern, 9 respondents (18.8%) with a very good eating pattern, 4 respondents (8.3%) with a bad eating pattern, while others there was 1 respondent (2.1%) with a very bad eating pattern.The results of the study, the highest educational level of the respondents was with a S1 education of 26 respondents (54.2%), while the lowest frequency was at the SMP level of 2 respondents (4.2%).The results of the study, the most dominant type of work for respondent is housewife as many as 26 people (54.2%), civil servants there are 10 respondents (20.8%), private employees 4 respondents (8.3%), entrepreneurs 6 respondents (12.5%), students/students 1 respondents (2.1%), and others as many as 1 respondents (2.1%).

Bivariate Analysis
1. Relationship between eating habits and child nutritional status before online learning The results of the relationship test showed a p-value of 0.625, which is greater than alpha 5 % or 0.
05, so H0 is accepted and H1 is rejected.This can be concluded that there is no significant relationship between eating habits before the pandemic and the nutritional status of the respondents.Results of the relationship test showed a p-value of 0.000, which is less than alpha 5% or 0.05, so H0 is rejected and H1 is accepted.This can be concluded that there is a significant relationship between eating habits during the pandemic and the nutritional status of the respondents.The results show that the average difference between before and during online learning is -28.125

Comparison of eating behavior before and during online learning
with a standard deviation of 20.851, and the difference is between -34.179 and -22.071.The results of the comparison test showed a p-value of 0.000, which is less than 0.05, so it is concluded that there is a significant difference in the average between before and during online learning.Volume 5 Issue 3

Discussion
Diet means a habit of eating about the consumption of food in the form of staple foods, protein sources, vegetables, fruits, and milk.The consumption pattern applied to children is high-energy food but low in fiber. 8During the current pandemic, families tend to improve their nutritious eating patterns compared to before the pandemic.Several studies on eating behavior, show that there are changes in food consumption patterns during the COVID-19 pandemic, where people consume more processed grain, fruit, and milk products. 9sed on the research results in table4, it was found that based on a good eating pattern during online learning, there was 1 respondent with a nutritional status of less than normal, 21 respondents with a nutritional status of normal, and 1 respondent with a nutritional status at risk of overweight.This shows that the eating behavior and nutritional status of grade 4 students are mostly good.The research results obtained are in line with previous research by Aris et al., where it was found that the nutrition of children aged 3-5 years during the COVID-19 pandemic is within normal limits and parental knowledge about the nutrition of children aged 3-5 years during the COVID-19 pandemic is mostly in a good condition. 10ting behavior is closely related to children's eating habit and how parents feed their children to meet their daily nutritional needs.Table 6 shows that the most dominant type of mother's occupation is housewife, with 26 people, and for civil servants or private employees, there are 14 people, including 10 civil servants, 4 private employees, and 6 entrepreneurs.This shows that most of the respondents are housewives, where mothers can monitor their children's eating behavior and accompany their children during online learning.
Based on the results of this research, the highest level of education for parents was a bachelor's degree for 26 people, while 2 respondents had a junior high school education.Determining the menu to provide and feed the family is influenced by education, employment and family income.Mothers who have high knowledge without being accompanied by knowledge about good nutrition will have an impact on their ability to provide food by the balanced nutritional guidelines required the family. 11Research conducted by Dody, 2017 shows that there is a significant relationship between maternal knowledge and parenting patterns and there is a significant relationship between parenting patterns and children's nutritional status.

Conclusion
Based on the results of a study conducted to determine how changes in eating behavior before online learning was poor, such as frequent consumption of snacks sold at school and mothers who were not paying attention to the nutritional intake of their children because they tended to consume fast food or processed food.During online learning was good because mothers were more attentive to their children's food and mothers were more likely to cook their own food because of the Covid-19 pandemic to prevent the spread of Covid-19.The nutritional status during online learning had a higher percentage of good nutritional status.
Then, there was a significant relationship between eating behavior before the pandemic and during online learning in students.

Funding sources
There is no funding sources

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study conducted by Katri Andini et al., 2021 to examine the factors that influence of the eating patterns of elementary school students found that the mother's factors, including age, education, knowledge, employment status, and feeding practices, had a significant impact on the eating patterns of elementary Green Medical Journal Vol.5 Issue: 3 (December,2023)  Green Medical Journal e-ISSN: 2686-6668 Issue 3 snacks or snacks during the COVID-19 pandemic to prevent boredom.While the types of snacks that are often consumed are salty snacks such as chips and fried foods.14,15

Table 1 Distribution of respondent characteristics based on the gender of class 4 elementary school children at SD Inp. Todopuli 1 Makassar City in 2021
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