23 Jenis fast food yang sering anda konsumsi (boleh lebih dari 1)

  Lampiran 1.

PERNYATAAN KESEDIAAN MENJADI RESPONDEN

  Yang bertandatangan dibawah ini: Nama : …………………………………………………. Umur : …………………………………………………. Alamat : ………………………………………………….

  Setelah mendapatkan penjelasan tentang penelitian ini maka saya menyatakan

bersedia berpartisipasi menjadi subjek dalam penelitian yang akan dilakukan oleh

saudari Tengku Yenni Febrina mengenai “Faktor Risiko Penyebab Kejadian Gizi

Lebih pada Mahasiswa Akademi Kebidanan Agatha Yayasan Vala Agatha

Pematangsiantar Tahun 2013”.

  Saya menyadari sepenuhnya bahwa penelitian ini sangat bermanfaat untuk

kepentingan ilmiah dan upaya untuk mendukung Program Keselamatan Pasien

Indentitas responden digunakan hanya untuk keperluan penelitian dan akan dijaga

kerahasiaannya.

  Demikian pernyataan ini dibuat dengan sukarela tanpa ada paksaan dari pihak manapun agar dapat dipergunakan sesuai keperluan.

  Medan, ………… 2014 Peneliti Mostro Mijoyo Ambarita

  81

  Lampiran 2.

KUESIONER PENELITIAN

  IDENTITAS RESPONDEN 1. Nama ……………………………………..

  

2. Tanggal lahir/Umur ……………………………./………tahun

  3. Jenis kelamin

  a. Laki-laki b. Perempuan

  4. Angkatan a.2011 b. 2012 c. 2013

  5. Suku

a.

  Jawa

b.

  Batak

c.

Melayu

d.

  Minang

e.

Tionghoa

f.

India

g.

  Lain-lain………………….

  6. Agama

a.

  Islam

b.

  Kristen

c.

Hindu

d.

  Budha

e.

Lain……….

  8 Status tinggal

a.

  Bersama orang tua

b.

  Indekost/Asrama

c.

Numpang di rumah saudara 9. Rata-rata uang saku harian Rp ………………..

  10. Riwayat penyakit keluarga .............................

  (keturunan)

PENGUKURAN ANTROPOMETRI

  11. Berat badan ……………. kg

  12. Tinggi badan ……………. cm

  13. Lingkar perut ……………..cm

KEBIASAAN MAKAN

  14 Apakah setiap hari selalu makan

a.

ya b. Jarang c. Tidak pernah pagi

  15 Berapa kali anda jajan dalam 1

a.

  Setiap hari minggu

b.

  4-6 kali

c.

4-6 kali

d.

  Tidak pernah

  16 Sebutkan 3 jenis makanan favorit

1.

yang paling sering dikonsumsi

2.

sehari-hari dalam 3 bulan terakhir

3.

  17 Berapa kali anda makan dalam

  a. …..kali sehari ?

  18 Dimana anda biasa makan pagi

a.

  Di Asrama b. kantin kampus

b.

  Lainnya. ……………

  82

  19 Dimana anda biasa makan siang

  a. Di Asrama b. kantin kampus c.lainnya. ……………

  20 Dalam satu minggu berapa kali anda

  a. ……kali mengkonsumsi sayuran/buah

  21 Sayuran yang anda sukai dan sering …………………………… dimakan

  22 Berapa kali rata-rata anda jajan fast ………….kali per minggu food …………. kali per bulan

  23 Jenis fast food yang sering anda a.

  Kentucky Fried Chicken konsumsi (boleh lebih dari 1) b.

  Pizza Hut c. Hoka-hoka bento d.

  Texas Chicken e. Dunkin Donat’s f. Lain-lain……………..

AKTIVITAS FISIK

  24 Berapa jarak Asrama ke Tempat …………… km Praktek

  25 Dengan apa anda paling sering pergi …………………….. ke Tempat Praktek dalam 3 bulan terakhir

  26 Berapa jam rata-rata anda di Asrama …………………. jam tiap hari

  27 Apakah anda sering menonton TV

  a. Ya b. Tidak dalam 3 bulan terakhir

  28 Berapa lama rata-rata nonton TV …………………..jam dalam sehari?

  29 Berapa jam rata-rata anda duduk di …………………..jam depan computer/laptop

  30 Apakah anda biasa makan

  a. Ya b. Tidak snack/ngemil sambil nonton/belajar ?

  31 Berapa jam rata-rata anda tidur ? …………………..jam

  32 Apakah anda biasa melakukan olah

  a. Ya b. Tidak raga ?

  33 Berapa kali anda berolah raga ……………..kali dalam 1 minggu

  34 Berapa lama rata-rata setiap ……………..menit berolahraga

  35 Jenis olahraga yang sering ………………….. dilakukan

  

FORMULIR FOOD RECALL 24 JAM

Hari : 1 (hari biasa)

No. Responden : Nama : Umur : Jenis Kelamin :

  Waktu Makan Nama makanan Jenis bahan pangan Jumlah yang dimakan URT (Ukuran Rumah Tangga) Gram Pagi (sarapan) Jam ….. Selingan/jajanan Jam …… Makan siang Jam …… Selingan/jajanan sore Jam …… Makan malam Jam ….

  Keterangan : URT : Ukuran Rumah Tangga, misalnya : piring, mangkok, potong, sendok, gelas,dan lain-lain.

  Nama Pewawancara : Tanggal wawancara :

  

FORMULIR FOOD RECALL 24 JAM

Hari : 2 (hari libur/minggu)

No. Responden : Nama : Umur : Jenis Kelamin :

  Waktu Makan Nama makanan Jenis bahan pangan Jumlah yang dimakan URT (Ukuran Rumah Tangga) Gram Pagi (sarapan) Jam ….. Selingan/jajanan Jam …… Makan siang Jam …… Selingan/jajanan sore Jam …… Makan malam Jam ….

  Keterangan : URT : Ukuran Rumah Tangga, misalnya : piring, mangkok, potong, sendok, gelas, dan lain-lain.

  Nama Pewawancara : Tanggal wawancara :

  

FORMULIR FOOD FREQUENCY

MENURUT JENIS BAHAN-BAHAN MAKANAN

No. Responden : ………………………… Nama :………………………… Umur : ………………………… Jenis Kelamin : …………………………

  Frekuensi Jenis Bahan > 3 x 1 - 3 x > 3 x ≤ 3 x Makanan sehari sehari seminggu seminggu Makanan Pokok Nasi Mie Roti Lauk-Pauk Ikan kering Telur Ayam Daging Tahu Tempe Sayur-sayuran Daun singkong Bayam Kangkung Wortel Kol Kembang Kol Sawi Kacang Buah-buahan Pisang Jeruk Semangka Pepaya Nenas Jajanan Gorengan Fast Food Soft drink

FORMULIR AKTIVITAS FISIK SELAMA 24 JAM

  No. Responden : Nama : Umur : Jenis Kelamin :

  Alokasi waktu No Kegiatan PAL (Jam)

  1 Tidur

  2 Kegiatan pribadi(Mandi, dandan, dll)

  3 Makan

  4 Duduk (kuliah, tutorial, pleno, dll)

  5 Pekerjaan rumah (menyapu, mencuci, mengepel)

  6 Mengemudi

  7 Berjalan

  8 Nonton TV, Game, Chatting dll Total

  24

  Lampiran 3. Master Data Penelitian

  88

  Lampiran 4.

HASIL OLAH DATA

  Status gizi Total Gizi lebih tidak gizi lebih

  44

  92

  b. Computed only for a 2x2 table

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 6.00.

  .000 1 1.000 N of Valid Cases

  1.000 .621 Linear-by-Linear Association

  Exact Sig. (1- sided) Pearson Chi-Square .000 ^a 1 1.000 Continuity Correction ^b .000 1 1.000 Likelihood Ratio .000 1 1.000 Fisher's Exact Test

  (2-sided) Exact Sig. (2- sided)

  Value df Asymp. Sig.

  

Chi-Square Tests

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  44.0

  44.0

  88 Expected Count

  44

  Umur 17-20 tahun Count

  Crosstabs Umur * Status gizi Crosstab

  12.0 % within Status gizi 13.6% 13.6% 13.6% % of Total 6.8% 6.8% 13.6%

  6.0

  6.0

  12 Expected Count

  6

  6

  21-25 tahun Count

  76.0 % within Status gizi 86.4% 86.4% 86.4% % of Total 43.2% 43.2% 86.4%

  38.0

  38.0

  76 Expected Count

  38

  38

  Total Count

  Angkatan * Status gizi Crosstab

  Status gizi Gizi lebih tidak gizi lebih Total

  Angkatan 2013 Count

  7

  7

  14 Expected Count

  7.0

  7.0

  14.0 % within Status gizi 15.9% 15.9% 15.9% % of Total 8.0% 8.0% 15.9% 2012 Count

  23

  23

  46 Expected Count

  23.0

  23.0

  46.0 % within Status gizi 52.3% 52.3% 52.3% % of Total 26.1% 26.1% 52.3% 2011 Count

  14

  14

  28 Expected Count

  14.0

  14.0

  28.0 % within Status gizi 31.8% 31.8% 31.8% % of Total 15.9% 15.9% 31.8%

  Total Count

  44

  44

  88 Expected Count

  44.0

  44.0

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  Chi-Square Tests

  Value df Asymp. Sig. (2-sided) _a Pearson Chi-Square .000 2 1.000 Likelihood Ratio .000 2 1.000 Linear-by-Linear Association .000 1 1.000 N of Valid Cases

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.00.

  Riwayat Keluarga * Status gizi Crosstab

  44

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 19.00.

  .733 1 .392 N of Valid Cases

  .519 .259 Linear-by-Linear Association

  (1-sided) Pearson Chi-Square .741 ^a 1 .389 Continuity Correction ^b .417 1 .519 Likelihood Ratio .742 1 .389 Fisher's Exact Test

  (2-sided) Exact Sig.

  (2-sided) Exact Sig.

  Value df Asymp. Sig.

  Chi-Square Tests

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  44.0

  44.0

  88 Expected Count

  44

  Total Count

  Status gizi Total Gizi lebih tidak gizi lebih

  50.0 % within Status gizi 52.3% 61.4% 56.8% % of Total 26.1% 30.7% 56.8%

  25.0

  25.0

  50 Expected Count

  27

  23

  Tidak Count

  38.0 % within Status gizi 47.7% 38.6% 43.2% % of Total 23.9% 19.3% 43.2%

  19.0

  19.0

  38 Expected Count

  17

  21

  Riwayat keluarga Ya Count

  b. Computed only for a 2x2 table

  Asupan Energi * Status gizi Crosstab

  Total Count

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 21.00.

  4.503 1 .034 N of Valid Cases

  .054 .027 Linear-by-Linear Association

  Exact Sig. (1- sided) Pearson Chi-Square 4.555 ^a 1 .033 Continuity Correction ^b 3.689 1 .055 Likelihood Ratio 4.595 1 .032 Fisher's Exact Test

  (2-sided) Exact Sig. (2- sided)

  Value df Asymp. Sig.

  Chi-Square Tests

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  44.0

  44.0

  88 Expected Count

  44

  44

  46.0 % within Status gizi 40.9% 63.6% 52.3% % of Total 20.5% 31.8% 52.3%

  Status gizi Total Gizi lebih tidak gizi lebih

  23.0

  23.0

  46 Expected Count

  28

  18

  Cukup Count

  42.0 % within Status gizi 59.1% 36.4% 47.7% % of Total 29.5% 18.2% 47.7%

  21.0

  21.0

  42 Expected Count

  16

  26

  Asupan energi Lebih Count

  b. Computed only for a 2x2 table

  Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for Asupan energi (Lebih / 2.528 1.170 5.970 Cukup) For cohort Status gizi = Gizi lebih 1.582 1.028 2.436 For cohort Status gizi = tidak gizi .626 .399 .981 lebih N of Valid Cases

  88 Asupan Protein * Status Gizi

  

Crosstab

  Status gizi Gizi lebih tidak gizi lebih Total

  Asupan protein Lebih Count

  20

  17

  37 Expected Count

  18.5

  18.5

  37.0 % within Status gizi 45.5% 38.6% 42.0% % of Total 22.7% 19.3% 42.0%

  Cukup Count

  24

  27

  51 Expected Count

  25.5

  25.5

  51.0 % within Status gizi 54.5% 61.4% 58.0% % of Total 27.3% 30.7% 58.0%

  Total Count

  44

  44

  88 Expected Count

  44.0

  44.0

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  Chi-Square Tests Asymp. Sig. Exact Sig. Exact Sig.

  Value df (2-sided) (2-sided) (1-sided) _a Pearson Chi-Square .420 _b 1 .517 Continuity Correction .187 1 .666 Likelihood Ratio .420 1 .517 Fisher's Exact Test

  .666 .333 Linear-by-Linear .415 1 .519 Association N of Valid Cases

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 18.50.

  b. Computed only for a 2x2 table

  Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for Asupan protein (Lebih 1.324 .566 3.093 / Cukup) For cohort Status gizi = Gizi lebih 1.149 .758 1.741 For cohort Status gizi = tidak gizi .868 .562 1.341 lebih N of Valid Cases

  88

  Asupan karbohidrat * Status gizi

Crosstab

  44

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 20.00.

  4.531 1 .033 N of Valid Cases

  .053 .027 Linear-by-Linear Association

  (1-sided) Pearson Chi-Square 4.583 ^a 1 .032 Continuity Correction ^b 3.713 1 .054 Likelihood Ratio 4.625 1 .032 Fisher's Exact Test

  (2-sided) Exact Sig.

  (2-sided) Exact Sig.

  Value df Asymp. Sig.

  Chi-Square Tests

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  44.0

  44.0

  88 Expected Count

  44

  Total Count

  Status gizi Total Gizi lebih tidak gizi lebih

  40.0 % within Status gizi 34.1% 56.8% 45.5% % of Total 17.0% 28.4% 45.5%

  20.0

  20.0

  40 Expected Count

  25

  15

  Cukup Count

  48.0 % within Status gizi 65.9% 43.2% 54.5% % of Total 33.0% 21.6% 54.5%

  24.0

  24.0

  48 Expected Count

  19

  29

  Asupan karbohidrat Lebih Count

  b. Computed only for a 2x2 table

  

Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for Asupan karbohidrat 2.544 1.173 6.028 (Lebih / Cukup) For cohort Status gizi = Gizi lebih 1.611 1.016 2.555 For cohort Status gizi = tidak gizi .633 .414 .968 lebih N of Valid Cases

  88 Asupan Lemak * Status Gizi

  

Crosstab

  Status gizi Gizi lebih tidak gizi lebih Total

  Asupan lemak Lebih Count

  27

  17

  44 Expected Count

  22.0

  22.0

  44.0 % within Status gizi 61.4% 38.6% 50.0% % of Total 30.7% 19.3% 50.0%

  Cukup Count

  17

  27

  44 Expected Count

  22.0

  22.0

  44.0 % within Status gizi 38.6% 61.4% 50.0% % of Total 19.3% 30.7% 50.0%

  Total Count

  44

  44

  88 Expected Count

  44.0

  44.0

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  Chi-Square Tests Asymp. Sig. Exact Sig. Exact Sig.

  Value df (2-sided) (2-sided) (1-sided) _a Pearson Chi-Square 4.545 _b 1 .033 Continuity Correction 3.682 1 .055 Likelihood Ratio 4.585 1 .032 Fisher's Exact Test

  .054 .027 Linear-by-Linear 4.494 1 .034 Association N of Valid Cases

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 22.00.

  b. Computed only for a 2x2 table

  Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for Asupan lemak (Lebih / 2.522 1.169 5.950 Cukup) For cohort Status gizi = Gizi lebih 1.588 1.023 2.466 For cohort Status gizi = tidak gizi .630 .405 .978 lebih N of Valid Cases

  88

  Asupan Serat * Status Gizi Crosstab

  44

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 21.50.

  5.440 1 .020 N of Valid Cases

  .032 .016 Linear-by-Linear Association

  (1-sided) Pearson Chi-Square 5.503 ^a 1 .019 Continuity Correction ^b 4.548 1 .033 Likelihood Ratio 5.562 1 .018 Fisher's Exact Test

  (2-sided) Exact Sig.

  (2-sided) Exact Sig.

  Value df Asymp. Sig.

  Chi-Square Tests

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  44.0

  44.0

  88 Expected Count

  44

  Total Count

  Status gizi Total Gizi lebih tidak gizi lebih

  45.0 % within Status gizi 38.6% 63.6% 51.1% % of Total 19.3% 31.8% 51.1%

  22.5

  22.5

  45 Expected Count

  28

  17

  Cukup Count

  43.0 % within Status gizi 61.4% 36.4% 48.9% % of Total 30.7% 18.2% 48.9%

  21.5

  21.5

  43 Expected Count

  16

  27

  Asupan serat Kurang Count

  b. Computed only for a 2x2 table

  

Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for Asupan serat (Kurang / 2.779 1.172 6.591 Cukup) For cohort Status gizi = Gizi lebih 1.662 1.071 2.581 For cohort Status gizi = tidak gizi .598 .381 .938 lebih N of Valid Cases

  88 Aktifitas Fisik * Status Gizi

  

Crosstab

  Status gizi Gizi lebih tidak gizi lebih Total

  Aktifitas fisik Kurang Count

  23

  13

  36 Expected Count

  18.0

  18.0

  36.0 % within Status gizi 52.3% 29.5% 40.9% % of Total 26.1% 14.8% 40.9%

  Cukup Count

  21

  31

  52 Expected Count

  26.0

  26.0

  52.0 % within Status gizi 47.7% 70.5% 59.1% % of Total 23.9% 35.2% 59.1%

  Total Count

  44

  44

  88 Expected Count

  44.0

  44.0

  88.0 % within Status gizi 100.0% 100.0% 100.0% % of Total 50.0% 50.0% 100.0%

  

Chi-Square Tests

Asymp. Sig. Exact Sig. Exact Sig.

  Value df (2-sided) (2-sided) (1-sided) _a Pearson Chi-Square 4.701 _b 1 .030 Continuity Correction 3.808 1 .051 Likelihood Ratio 4.750 1 .029 Fisher's Exact Test

  .050 .025 Linear-by-Linear 4.647 1 .031 Association N of Valid Cases

  88 a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 18.00.

  b. Computed only for a 2x2 table

  

Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for Aktifitas fisik (Kurang 2.612 1.186 6.279 / Cukup) For cohort Status gizi = Gizi lebih 1.582 1.048 2.387 For cohort Status gizi = tidak gizi .606 .372 .987 lebih N of Valid Cases

  88 Logistic Regression _a

Case Processing Summary

Unweighted Cases

  N Percent Selected Cases Included in Analysis 88 100.0

  Missing Cases .0

  Total 88 100.0 Unselected Cases

  .0 Total

  88 100.0 a. If weight is in effect, see classification table for the total number of cases.

  

Dependent Variable Encoding

  Original Value Internal Value

  Gizi lebih tidak gizi lebih

  1 Block 0: Beginning Block _a,b Classification Table Predicted

  Status gizi Percentage

  Observed Gizi lebih tidak gizi lebih Correct Step 0 Status gizi Gizi lebih 44 .0 tidak gizi lebih

  44 100.0 Overall Percentage

  50.0 a. Constant is included in the model.

  b. The cut value is .500

  

Variables in the Equation

  B S.E. Wald df Sig. Exp(B) Step 0 Constant .000 .213 .000 1 1.000 1.000

  

Variables not in the Equation

Score df Sig.

  Step 0 Variables Energi 4.555 1 .033 Karbohidrat 4.583 1 .032 Lemak 4.545 1 .033 serat 5.503

  1 .019 Aktifits 4.701 1 .030

  Overall Statistics 20.406 5 .001

  Block 1: Method = Enter Omnibus Tests of Model Coefficients Chi-square df Sig.

  11

  Lower Upper St ep 1 ^a

  95% C.I.for EXP(B)

  Exp(B )

  

Variables in the Equation

B S.E. Wald df Sig.

  a. The cut value is .500

  76.1

  75.0 Overall Percentage

  33

  77.3 tidak gizi lebih

  Step 1 Step 22.797 5 .000 Block 22.797 5 .000 Model 22.797 5 .000

  10

  34

  Correct Gizi lebih tidak gizi lebih Step 1 Status gizi Gizi lebih

  Status gizi Percentage

  Observed Predicted

  Classification Table ^a

  a. Estimation terminated at iteration number 5 because parameter estimates changed by less than .001.

  Step -2 Log likelihood Cox & Snell R Square Nagelkerke R Square 1 99.197 ^a .228 .304

  Model Summary

  Energi 1.005 .520 2.050 1 .042 2.107 1.160 5.841 Karbohidrat 1.010 .507 2.559 1 .047 2.249 1.133 6.069 Lemak 1.067 .512 4.342 1 .037 2.907 1.265 7.934 serat 1.380 .517 7.117 1 .008 3.973 1.442 10.946 Aktifits 1.015 .505 4.035 1 .045 2.758 1.225 7.423 Constant -5.616 1.905 15.979 1 .000 .000 a. Variable(s) entered on step 1: Energi, Karbohidrat, Lemak, serat, Aktifits.

  Lampiran 5. Dokumentasi Penelitian 106