Characteristic Body Mass Index and Nutrition Knowledge of Snack Food School-Age Children Among Elementary School Students at SD Ciawi Jatinangor

Lack of nutrient in school age children in several times had implication in abnormal increasing body weight and height related with their growth. Snack food school –age children had contribute 15-20% from total daily nutrien consumption. Aim of this study is to describe characteristic body mass index and nutrition knowledge about healty snack food school age. Collecting primary data with cross sectional descriptive study comes from questionnaire, measurement of body weight and height.Number of total sampling 33 participants from grade 5 elementary school Ciawi Jatinangor. The questionnaire were asked about characteristics participants, nutritional knowledge and their reasoning and preference for variety of snack food school-age children. It also include question about their self efficacy about their knowledge. The result shows most of participants, male and female in underweight status. The mostly reasoning choice snacking school variety cause of their tastefull, cheaper and umami. Number they pocket money not correlated with their skill to choices variety of school snacking. The present study revealed that, 36% and 39% of boys and girls respectively were having underweight BMI with lack of healthy characteristical knowledge of snack food school aged. Participants tends to show good self efficacy about their snacking food. Changing student food behavior and their efficacy will require cooperation supports between school staff, parents and food vendors at school


Introduction
Growth and Development children in schoolage runs very fast and complexes . Inadequate nutrition may lead malnutrition , growth retardation and reduced productivity. Data in Riskesdas 2015 stated nutrition protein index level decreasing in group 5-12 years old as 29,3%. 1,2 Meanwhile, total consumtion energy in the same level group were 1850-2000kkal/day. 2 It means, in level pre and elementary school, they had lack of nutrition and protein from breakfast to gain their energy during school activity. Previous study stated, packed lunch school meals in elementary school also had composition imbalance nutrient composition. 3,4 Another choice for student which have no brings their meals or no breakfast , their parents usually give them money to buy some food in school. They are purchasing their pocket money snacking at canteen or food stall nearby the school. Snacking during school time has contribute daily nutritional at least 15-20% from total calorie for a day. 2 Lacking nutrient for several times had implication decreasing in their nutritional anthropometry. 5 Nutritional anthropometry is the measurement of human physical dimension at different age level and degrees of nutrition. One of parameters are height, weight, and BMI which classified by WHO guidelines. Aim of this study is to finding characteristic nutritional status and nutritional knowledge of snacking food school aged (Panganan Jajanan Anak Sekolah or PJAS) among children in public elementary school Ciawi Jatinangor.

Methods
This research use cross sectional descriptive study. The data were collected from questionnaires and measurement.

Participants, settigs and recruitment.
Participants were 33 children (11 males and 22 females) ages 10-11 years old enrolled collecting data on 9-10 am in Public

Elementary
School Ciawi Jatinangor. Informed consent has done before data were collected. Grade 5 were chosen because they are not in national final exam, has familier with the school facility including the canteen and food stall sorrounding school and had their own pocket money .
Body mass index (BMI) : measurement of body weight and height. Body weight participants were taken by portable weighing balance with 0,1 kg nearest calibrate. Height was measured using vertical rod, which 0,1 cm nearest accurately. BMI was classified by WHO guidelines.

Measurements of nutritional knowledge.
There are 9 item questionairres which had to fill by their own self. The questionairres has validity and reability tes before.
Characteristical Nutitional knowledge : Preferency, variety ,ingridients,frequency and reasoning of snack food school age children. Children were asked their preferences of snack food school age, selected from 2 respons, "Yes" or "NO". If they asked yes, the question continue with variety of snack food school age. Variety of food choosed from tipe of snacking food which commonly eaten by participants and always served in school canteen and food stall. There are 14 varieties snack food school age :" pancake, Fried sago flour with egg, roasted corn, fried tofu, milk, candy, noodle in cup, kebab, buerger, Steam sago flour, yellow rice, fried meatball and tofu , cakwe and instan noodles. They choose 1 of that items which most likely purchasing. For prior nutritional knowledge, they had question " are you know about the ingridient of that 's snacking food ?". Two options for that, "Yes " or "No". For frequency of snacking, they had 3 item options : " everyday", "2-4 times a week", "once a month", "never". There 7 items for reasoning questions of snacking food : " its taste", " cheaper", " its appearence", " colourfull" , " favourable ", " friends accompany " and " healthy ". Participants had to choose one of the item which most likely appopriate with their reason to purchase the snack food.
Self Efficacy. Self efficacy was using 2 items. The first one related with the prior knowledge of "ingridients" food snack. If participants answer "Yes", the question continue with " if you know there is no healty, will you still purchase the snack ?" the options " Yes " or " No". The second items is the question : " if you know the bad information about the ingridients, will you still continue that information to your friends ?", and the options also same with the question before.
Preference to bring lunch box . Preference to bring packed meal to school was one of the item questionairre. At least 2 weeks before the collecting data.
Total number of pocket money. The range for total number pocket money for a day is : 1-5 IDR, 5-10 IDR, more than 10 IDR, and none.
Data Analysis Analysis by SPSS 2010. Tables were prepared with means , standard deviation and percentage (%) values. Approximately half of the surveyed data of participants were girl (52%) and mostly at 10 years old (67%) in data collected. At least 2 weeks before data collected, 54% participants had already bringing their lunch box, but not yet with 45% participants. Height (cm) 1,37± 0,06 1,36±0,08

Self Efficacy.
Data self efficacy participants shows that 33 participants which like snacking during school time, almost participants (90%) will not continue purchasing the snack food if they know its ingridients not healty and only 10% choose to continue. Almost all participants will transfer the information about "bad ingridients food snack " to their freinds (72%), and rest of the number (28%) participants not have any idea.

Snacking School Frequency Related with Number of Pocket Money
At least 33% participants which have range pocket money less than 5 IDR, purchase food snack shool-age everyday. The same condition (33%) with the participants which have 5-10 IDR pocket money. But not in the participants with the pocket money more than 10 IDR. The fig.2 shows highly frequency snacking during school time in group participants with range pocket money 1-5 IDR and 5-10 IDR.

Disccusion
Chidren with 9-11 age years old is elementary school period with the optimal maturity in terms of preferences food to consumed. In this period, their parents usually gave them some money pocket to buy snacking food. Interaction between school aged children with their family has important to contribute building students food behavior, in terms of preferences variety food consumption. 6 Healthy choices menu food consumption in their family behavior usually influenced the patterns choices kind of snacking food especially snacking food at school. School also has important contribute building student food behavior. 7 Several topic about unhealthy snacking food ingredients could be include in their curriculum in elementary level as trigger point to enhance their level nutritional knowlegde. In this result, shows 36% male participants and 39% female participants with the BMI underweight (below 18,5%), and all the participants has snacking food. Tipe of snacking food mostly from processed wheat flour with the rich synthetic flavor enhancer and low nutrient index which needed in their gowth and maturity level. BMI underweight participants suspected related with their food behavior. Calori index level in food snack assumed not enough to supply optimal calori which required in snack food school aged, 15-20% from total calory for a day. 2 Another study in Makasar from several public elementary school also stated level nutrient index snack food school aged below the nutrient index requirement. 8,9 Almost participants choose the type of varian snacking food because its flavor. Several nutritional study stated that synthetic food flavoring dominant in snack food school aged, especially additional monosodium glutamat (MSG) in its ingredient. 8 Traditional snack food school aged like "cilok, cimol, cireng", usually use carbohydrat as single basic material component and minimal variant with another component (protein or lipid).
Lack of nutrient for several times cause imbalance intake nutrition and metabolism, influence in weight and height especially in child growth and development period. Parents have contribution building children eating behavior. Wrong eating environment can caused disorder of eating behavior. 10 Effect synthetic food flavor in longterm used in brain has significantly proved either in animal research or in human. Nuerotoxic effect of MSG influenced brain function in addiction and memory process. MSG also change taste receptor as savory taste in tongue. Index Snack Food School Aged data from The National Agency of Drug and Food Control of Republic Of Indonesia (NADFC) 2009-2014 only 76,18%, lesser than target scale 90%. 4,11 Several factors contribute that condition, like microbe investation such as Salmonella Sp., excessive additional food synthetic flavor , harmfull ingredients, etc. Selection type variety of food involving several factors as biological mechanism, appetite control, eating behaviour and also social culture value. 11,12 In this study, range number of pocket money in group snacking food aged in SDN Ciawi Jatinangor between 1-10 IDR. Almost participants tend to spend their money to buy 44 Fifi Veronica, Characteristic Body Mass Index some food at stall outside of scholl canteen. Similar results from previous study stated that children with lowest money pocket tends to choose healthy snacking food at school canteen (72%) and vice versa (18%) outside school canteen. 12,13,14 Traditional food like " cireng, cimol, etc" which lack of nutrition usually finding outside of school canteen. Several studies stated, there is no significancy between number of pocket money with preferences of Snack Food School Aged. Otherwise role of friend, parents and number of pocket money has involved its perception significantly. 15 Previous study stated, there is significancy between energy intake school aged with lunch box. In this study, the result show , 54 % participants has lunch box also has snacking food. This condition might be related with the type and variant of lunch box, monotonous and lack of variety. Previous study stated parents are effective building child eating berhavior and preferrences, especially mother is role model for their children eating behavior. Some factors contribute to mother"s eating behavior, such as socioeconomic status, educational level, working status, and level of nutritional knowledge. Contribution parents especially mother significantly higher to improve menu their children lunch box. 6 In this study, self efficacy participants for new information about ingridients healthy snack food are good. They are not continue eating snack food with the unhealthy ingridients. Needs more study to prove their self efficacy.

Conclusion
Nutritional status 5 th grade public elementary school Ciawi Jatinangor, almost half in underweight with lacking characteristical knowledge of healthy snack food school aged. Interestingly, mostly underweight exist on girls group. As describe in previous studies, malnourished status in girls young age will continue and develop through out their life phase (puberty and maternity). 15 Changing student food behavior will require cooperation supports between school staff, parents and food vendors at school .

Human Subjects Approval Statement
This study was approved by Ethical Comittee for the protection of human subject at Padjadjaran University.