Effect of a Local Food–Based Nutrition Intervention Using Moringa oleifera and Arachis hypogaea on Mid–Upper Arm Circumference among Pregnant Women with Chronic Energy Deficiency: A Quasi-Experimental Study
DOI:
https://doi.org/10.55018/janh.v8i1.526Keywords:
Pregnant women, Chronic energy deficiency, Mid-upper arm circumference, Moringa oleifera, Arachis hypogaea, Local food interventionAbstract
Background: Chronic energy deficiency (CED) among pregnant women remains a persistent public health problem in low- and middle-income countries, including Indonesia. Various nutrition programs have been implemented; however, evidence on practical, locally based food interventions—particularly those combining moringa leaves and peanuts in ready-to-consume cookie form—remains limited. This study addresses this gap by evaluating a combined local food–based intervention aimed at improving maternal nutritional status.
Methods: his study used a quasi-experimental design with a non-randomized control group and a pretest–posttest approach, reported according to the TREND guideline. The sample consisted of 100 pregnant women with chronic energy deficiency recruited through consecutive sampling at a primary healthcare center. Inclusion criteria were gestational age 12–28 weeks and MUAC < 23.5 cm, while women with pregnancy complications, chronic diseases, food allergies, or multiple pregnancies were excluded. MUAC was measured using a standard non-stretchable tape by trained midwives. The intervention group received moringa leaf and peanut cookies daily for two weeks in addition to standard antenatal care, while the control group received standard care only. Data were analyzed using paired and independent t-tests, and effect size was calculated using Cohen’s d.
Results: Both groups showed significant improvements in MUAC after the intervention period (p < 0.001). However, the intervention group demonstrated a greater mean increase in MUAC compared with the control group, with a moderate-to-large effect size (Cohen’s d), indicating not only statistical significance but also meaningful clinical improvement. The effect size was moderate-to-large (Cohen's d = 0.65).
Conclusion: The findings indicate that a combined local food–based cookie intervention using moringa leaves and peanuts is more effective than standard antenatal care alone in improving MUAC among pregnant women with CED. This approach supports the integration of culturally appropriate, locally available food interventions into primary healthcare nutrition programs, particularly in low-resource settings.
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References
Aiman, U., Riskika, F., Septiawan, N. A., Syahrani, S., Nurhidaya, I., Fitrasyah, I., Utami Dewi, N., & Hartini, D. A. (2025). A cross-sectional study on determinant factors of Chronic Energy Deficiency (CED) among pregnant women in disaster-prone areas: A case study at Talise Community Health Center, Palu City. Nutrición Clínica y Dietética Hospitalaria, 45(3), 392–401. https://doi.org/10.12873/453aiman
Akbarini, O. F., & Siswina, T. (2022). Factors Affecting the Incidence of Chronic Energy Deficiency (CED) in Pregnant Women. Science Midwifery, 10(5), 3776–3783. https://doi.org/10.35335/midwifery.v10i5.841
Al Maeka, S. M., Kartasurya, M. I., & Pradigdo, S. F. (2025). Impact of maternal chronic energy deficiency on newborns in developing countries: A scoping review. Journal of Holistic Nursing Science, 12(2), 315–325. https://doi.org/10.31603/jhns.v12i2.14001
Alaba, S. K. (2025). Strategies to address food insecurity and improve global nutrition among at-risk populations. International Journal of Science and Research Archive, 14(2), 1657–1680. https://doi.org/10.30574/ijsra.2025.14.2.0564
Alfina, S. T., Setyowati, A. T. W., Wuni, A. A. Z., Andriyanti, A., & Jayanti, R. D. (2024). The Role of Continuity of Care (CoC) in Supporting Pregnant Women at Risk of Chronic Energy Deficiency (CED) in Improving Nutritional Status: A Case Report. International Journal Of Scientific Advances, 5(5), 888–893. https://doi.org/10.51542/ijscia.v5i5.5
Anantasia, G., & Rindrayani, S. R. (2025). Metodologi Penelitian Quasi Eksperimen. ADIBA: Journal Of Education, 5(2), 183–192.
Berti, C., Gaffey, M. F., Bhutta, Z. A., & Cetin, I. (2018). Multiple‐micronutrient supplementation: Evidence from large‐scale prenatal programmes on coverage, compliance and impact. Maternal & Child Nutrition, 14(S5), 1–11. https ://doi.org/10.1111/mcn.12531
Chaman-Ara, K., Sharif, S., Ms, ;, Amin, M., & Phd, B. ; (2018). Challenges and Barriers to Pregnant Women’s Nutrition: Policy Recommendations. Journal of Nutrition and Food Security (JNFS), 3(2), 60–64.
Dinkes Jabar. (2023). Profil Kesehatan Provinsi Jawa Barat Tahun 2023. https://diskes.jabarprov.go.id
Dinkes KBB. (2021). Profil Kesehatan Kabupaten Bandung Barat.
Frianti, N., Arifuddin, S., Hadju, V., Aminuddin, A., Nontji, W., Bahar, B., & Hariati, M. C. (2022). effect of moringa leaf capsules and fe administration to increase hemoglobin levels, weight, and upper arm circumference (LILA) in trimester II pregnant women with chronic energy deficiency (KEK). International Journal of Health Sciences, 6(S3), 12524–12534. https://doi.org/10.53730/ijhs.v6nS3.9600
Habtu, M., Agena, A. G., Umugwaneza, M., Mochama, M., & Munyanshongore, C. (2023). Effect and Challenges of an Integrated Nutrition-Intervention Package Utilization among Pregnant Women and Lactating Mothers in Rwanda: An Exploratory Qualitative Study. Current Developments in Nutrition, 7(1), 100018. https://doi.org/10.1016/j.cdnut.2022.100018
Harna, H., Rahmawati, R., Irawan, A. M. A., & Sa’pang, M. (2024). Prevalence and determinant factors of Chronic Energy Deficiency (CED) in pregnant women. AcTion: Aceh Nutrition Journal, 9(1), 65–73. https://doi.org/10.30867/action.v9i1.1443
Jeukendrup, A. E., Areta, J. L., Van Genechten, L., Langan-Evans, C., Pedlar, C. R., Rodas, G., Sale, C., & Walsh, N. P. (2024). Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist? Sports Medicine, 54(11), 2793–2816. https://doi.org/10.1007/s40279-024-02108-y
Jhaveri, N. R., Poveda, N. E., Kachwaha, S., Comeau, D. L., Nguyen, P. H., & Young, M. F. (2023). Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India. Frontiers in Nutrition, 10(1185696), 1–15. https://doi.org/10.3389/fnut.2023.1185696
Kemenkes RI. (2022, December 13). Gerakan Ibu Hamil Sehat untuk Turunkan Stunting dan Angka Kematian Ibu. Kementrian Kesehatan Indonesia. https://kemkes.go.id/id/gerakan-ibu-hamil-sehat-untuk-turunkan-stunting-dan-angka-kematian-ibu
Legesse, M., Abebe, Z., & Woldie, H. (2019). Chronic energy deficiency and associated factors among older population in Ethiopia: A community based study. PLOS ONE, 14(4), e0214861. https://doi.org/10.1371/journal.pone.0214861
Nasaru, J., Sutiningsih, D., Setiani, O., Sakundarno Adi, M., & Agushybana, F. (2024). Factors Associated with Chronic Energy Deficiency (CED) in Pregnant Women: A Study in North Gorontalo Regency, 2023. In M. I. Kartasurya, J.-H. Han, K.-H. Tsai, S. Nursheena, S. Changrob, N. Lisnawati, A. F. Asna, N. Handayani, & D. Z. Nuridzin (Eds.), BIO Web of Conferences (p. 00003). EDP Science. https://doi.org/10.1051/bioconf/202413300003
Nguyen, P. H., Kachwaha, S., Tran, L. M., Avula, R., Young, M. F., Ghosh, S., Sharma, P. K., Escobar-Alegria, J., Forissier, T., Patil, S., Frongillo, E. A., & Menon, P. (2021). Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation. The Journal of Nutrition, 151(8), 2282–2295. https://doi.org/10.1093/jn/nxab131
Novelia, S., Rukmaini, & Annisa, E. (2021). Factors Related to Chronic Energy Deficiency among Pregnant Women. Nursing and Health Sciences Journal (NHSJ), 1(3), 237–241. https://doi.org/10.53713/nhs.v1i3.54
Nukpezah, R. N., Abanga, E. A., Adokiya, M. N., Aninanya, G. A., Odiakpa, L. O., Shehu, N., Chukwu, N. M., Mahama, A. B., & Boah, M. (2024). Preterm birth, low birth weight, and their co-occurrence among women with preexisting chronic diseases prior to conception: a cross-sectional analysis of postpartum women in a low-resource setting in Ghana. Maternal Health, Neonatology and Perinatology, 10(18), 1–13. https://doi.org/10.1186/s40748-024-00188-2
Nur, N., Sakung, J., & Bima. (2022). Haemoglobin Levels and Mid-Upper Arm Circumference in Pregnant Women Through The Giving of Moringa Biscuits. Journal of Health Science and Prevention, 6(1), 1–7. https://doi.org/10.29080/jhsp.v6i1.632
Park, K., Kittrell, K., & Ewing, R. (2020). Quasi-Experimental Research. In Basic Quantitative Research Methods for Urban Planners (1st ed., pp. 305–318). Routledge.
Prameswari, F. S. P., Marliyati, S. A., & Dewi, M. D. (2020). A Supplementary Protein Food for Pregnant Women with Chronic Energy Deficiency to Improve Fetal Growth. Jurnal Gizi Dan Pangan, 15(1), 1–10. https://doi.org/10.25182/jgp.2020.15.1.1-10
Setyawati, E., Sumarmi, S., Nurasmi, N., Irnawati, I., & Hutagaol, I. O. (2024). Effectiveness of moringa biscuit (Moringa oleifera) and snakehead fish (Channa striata) in improving the nutritional status of pregnant women with chronic energy deficiency. African Journal of Reproductive Health, 28(10s), 41–49. https://doi.org/10.29063/ajrh2024/v28i10s.5
Shah, R., & Bhargava, A. (2020). To Study the Effect of Arachis hypogaea and Cicer arietinum on Serum Calcium Levels of Women between 17-25 years of Age group in Shekhawati region of Rajasthan. EAS Journal of Nutritions and Food Science, 2(4). https://doi.org/https://doi.org/10.36349/easjnfs.2020.v02i04.003
Sudaryati, E., Panjaitan, A. M., Nadeak, T. A. U., Tobing, A. M. L., Masthalina, H., & Keloko, A. B. (2023). The Effect of Pumpkin Biscuits (Cucurbita moschata), Peanut (Arachis hypogaea) andMoringa Leaves (Moringa oleifera) on Hemoglobin Levels and Maternal Upper Arm Circumference (MUAC) of Pregnant Women. Research Suare, 1–11. https://doi.org/10.21203/rs.3.rs-2761631/v1
Utami, N. W., Majid, T. H., & Herawati, D. M. D. (2017). Pemberian minuman formula kacang merah, kacang tanah, dan kacang kedelai terhadap status gizi ibu hamil kurang energi kronis (KEK). Jurnal Gizi Klinik Indonesia, 14(1), 1–9. https://doi.org/10.22146/ijcn.22424
Wati, E. K., Murwani, R., Kartasurya, M. I., & Sulistiyani, S. (2024). Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia. Narra J, 4(1), e742. https://doi.org/10.52225/narra.v4i1.742
Watson, D., Mushamiri, P., Beeri, P., Rouamba, T., Jenner, S., Proebstl, S., Kehoe, S. H., Ward, K. A., Barker, M., & Lawrence, W. (2023). Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS Global Public Health, 3(3), e0000401. https://doi.org/10.1371/journal.pgph.0000401
WHO. (2024, April 26). Maternal mortality. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Wiyono, S., Burhani, A., Harjatmo, T. P., Ngadiarti, I., Prayitno, N., . M., Purbaningrum, R. P., . W., Erowati, D., & Fahira, F. (2020). Study causes of chronic energy deficiency of pregnant in the rural areas. International Journal Of Community Medicine And Public Health, 7(2), 443–448. https://doi.org/10.18203/2394-6040.ijcmph20200412
Wright, C., Barnett, A., Campbell, K. L., Kelly, J. T., & Hamilton, K. (2022). Behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery: A systematic review. Nutrition & Dietetics, 79(1), 110–128. https://doi.org/10.1111/1747-0080.12728
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