Incorporating locally available food using linear programming to improve food-based recommendation for preelderly diabetic patients

Abstract

Background:

Dietary adherence is essential for glycemic control in diabetic patients, yet cultural preferences, availability, and affordability often hinder acceptance of recommended foods. Thus, it requires food-based recommendations (FBRs) tailored to local contexts.

Aim:

This study identified locally available foods to develop FBR using linear programming (LP) in WHO Optifood for preelderly diabetic patients.

Methods:

A descriptive cross-sectional study was conducted on 174 type 2 diabetic patients aged 50–64 years in Malang, Indonesia, selected through multistage random sampling. Dietary data were collected over seven days using a 24-h recall, a one-day estimated food record, and a five-day food tally to capture habitual intake patterns. Optifood analysis incorporated demographic data, commonly consumed local foods, and nutrient targets based on Perkeni and Indonesian RDA. Dietary adequacy assessment used a modeled scenario using the 65% Recommended Nutrient Intake (RNI) threshold in the worst-case intake analysis.

Results:

Several nutrients showed dietary inadequacy in the modeled analysis, rather than actual individual deficiencies. Protein, fiber, vitamins A, C, E, B12, iron, and omega-3 could be optimized to exceed 65% of the RNI using local foods such as tempeh, corn rice, moringa leaves, tongkol, kepok banana, and koro beans. However, calcium, vitamin B6, and zinc did not meet the 65% adequacy threshold.

Conclusion:

Locally available food was successfully incorporated into dietary recommendations, fulfilling eight key nutrients. Nevertheless, vitamin B6, calcium, and zinc remained below the recommended thresholds in worst-case modeling, highlighting the need for additional interventions such as food fortification or dietary diversification.

Keywords

Diabetic patient food recommendation linear programming locally available food pre-elderly

Get full access to this article

View all access options for this article.

References

Aas

A-M

Axelsen

Churuangsuk

, et al. (2023) Evidence-based European recommendations for the dietary management of diabetes. Diabetologia 66(6): 965–985.

Al-Salmi

Cook

D’souza

(2022) Diet adherence among adults with type 2 diabetes mellitus: A concept analysis. Oman Medical Journal 37(2): e361.

Alaofè

Mahdavimanshadi

Mizéhoun-Adissoda

, et al. (2024) Precision nutrition for type 2 diabetes in Benin: Leveraging linear goal programming to optimize diets with emphasis on adequacy, affordability, accessibility, and culture. Frontiers in Nutrition 11: 1400594.

Badan Pusat Statistik (BPS) Kota Malang (2023) Kota Malang dalam Angka 2023. Kota Malang.

Belobrajdic

Regina

Klingner

, et al. (2019) High-amylose wheat lowers the postprandial glycemic response to bread in healthy adults: A randomized controlled crossover trial. The Journal of Nutrition 149(8): 1335–1345.

Briend

Darmon

Ferguson

, et al. (2003) Linear programming: A mathematical tool for analyzing and optimizing children's diets during the complementary feeding period. Journal of Pediatric Gastroenterology and Nutrition 36(1): 12–22.

Chiș

Noubissi

Pop

O-L

, et al. (2023) Bioactive compounds in Moringa oleifera: Mechanisms of action, focus on their anti-inflammatory properties. Plants 13(1): 20.

Cole

Florez

(2020) Genetics of diabetes mellitus and diabetes complications. Nature Reviews Nephrology 16(7): 377–390.

Dhoruri

Lestari

Ratnasari

(2017) Sensitivity analysis of goal programming model for dietary menu of diabetes mellitus patients. International Journal of Modeling and Optimization 7(1): 7.

10.

do Prado

Pagnoncelli

MGB

de Melo Pereira

, et al. (2022) Fermented soy products and their potential health benefits: A review. Microorganisms 10(8): 1–24.

11.

Donkor

Essien

Afrifah

(2023) A systematic review of linear programming techniques as applied to diet optimisation and opportunities for improvement. Journal of Optimization 2023: 1–17.

12.

Fauziah

Arsin

Ridwan , et al. (2021) The influence of brown rice and corn rice on blood glucose levels in people with type 2 diabetes mellitus at Antang Health Center Makassar. NVEO - NATURAL VOLATILES & ESSENTIAL OILS Journal | NVEO 8(4): 15436–15441.

13.

Ferguson EL, Darmon N, Briend A, et al. (2004) Food-based dietary guidelines can be developed and tested using linear programming analysis. The Journal of Nutrition 134(4): 951–957.

14.

Ferguson

Darmon

Fahmida

, et al. (2006) Design of optimal food-based complementary feeding recommendations and identification of key “problem nutrients” using goal programming. The Journal of Nutrition 136(9): 2399–2404.

15.

Ferguson

Watson

Berger

, et al. (2019) Realistic food-based approaches alone may not ensure dietary adequacy for women and young children in South-East Asia. Maternal and Child Health Journal 23: 55–66.

16.

Frias

Lee

Carter

, et al. (2023) A microbiome-targeting fibre-enriched nutritional formula is well tolerated and improves quality of life and haemoglobin A1c in type 2 diabetes: A double-blind, randomized, placebo-controlled trial. Diabetes, Obesity and Metabolism 25(5): 1203–1212.

17.

Gao

Yang

Zurbau

, et al. (2023) The effect of food is medicine interventions on diabetes-related health outcomes among low-income and food-insecure individuals: A systematic review and meta-analysis. Canadian Journal of Diabetes 47(2): 143–152.

18.

García-Martínez

Ruiz-Ramos

Pedraza-Chaverri

, et al. (2023) Effect of resveratrol on markers of oxidative stress and sirtuin 1 in elderly adults with type 2 diabetes. International Journal of Molecular Sciences 24(8): 1–15.

19.

Giuntini

Sardá

FAH

de Menezes

(2022) The effects of soluble dietary fibers on glycemic response: An overview and futures perspectives. Foods (Basel, Switzerland) 11(23): 1–26.

20.

Gusnedi

Fahmida

Witjaksono

, et al. (2022) Effectiveness of optimized food-based recommendation promotion to improve nutritional status and lipid profiles among Minangkabau women with dyslipidemia: A cluster-randomized trial. BMC Public Health 22(1): 21.

21.

Hashemi

Mehdizadeh Khalifani

Rahimlou

, et al. (2020) Comparison of the effect of dietary approaches to stop hypertension diet and American Diabetes Association nutrition guidelines on lipid profiles in patients with type 2 diabetes: A comparative clinical trial. Nutrition & Dietetics 77(2): 204–211.

22.

Joo

Liu

(2021) Experience of culturally-tailored diabetes interventions for ethnic minorities: A qualitative systematic review. Clinical Nursing Research 30(3): 253–262.

23.

Kannaiyan

Bagthasingh

Vetri

, et al. (2019) Nutritional, textural and quality attributes of white and dark muscles of little tuna (Euthynnus affinis). Indian Journal of Geo-Marine Sciences 48(2): 205–211.

24.

Kashyap

Kumar

Riar

, et al. (2022) Recent advances in drumstick (Moringa oleifera) leaves bioactive compounds: composition, health benefits, bioaccessibility, and dietary applications. Antioxidants 11(2): 402.

25.

Kementerian Kesehatan

(2020) Tabel Komposisi Pangan Indonesia.

26.

Khashim

Rajikan

(2019) Development and acceptance of healthy and balanced diet for diabetes mellitus patients among UKM staff using linear programming. Pakistan Journal of Nutrition 18(6): 571–578.

27.

Landa-Anell

Melgarejo-Hernández

García-Ulloa

, et al. (2020) Barriers to adherence to a nutritional plan and strategies to overcome them in patients with type 2 diabetes mellitus; results after two years of follow-up. Endocrinología, Diabetes y Nutrición (English ed.) 67(1): 4–12.

28.

Magliano

Boyko

(2021) IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS [Internet]. 10th ed. Brussels: International Diabetes Federation, 35914061.

29.

Mathias

Halemani

Lobo

, et al. (2025) Interventions to improve vitamin and mineral inadequacies among children in India: A scoping review. Journal of Human Nutrition and Dietetics 38(1): e13384.

30.

Mohammed

Sharew

(2019) Adherence to dietary recommendation and associated factors among diabetic patients in Ethiopian teaching hospitals. Pan African Medical Journal 33: 1–11.

31.

Munteanu

Schwartz

(2022) The relationship between nutrition and the immune system. Frontiers in Nutrition 8(9): 1082500.

32.

Salis

Virmani

Priyambada

, et al. (2021) ‘Old is gold’: How traditional Indian dietary practices can support pediatric diabetes management. Nutrients 13(12): 4427.

33.

Sari

Amartasari

Ayuntyas

, et al. (2024) The effect of a nurse's home visit intervention on knowledge, dietary salt adherence, and blood pressure in hypertensive patients at primary health care. Jurnal Keperawatan 15(2): 165–175.

34.

Sebai

Deaconu

Mobetty

, et al. (2024) Measurement of diet quality among First Nations peoples in Canada and associations with health: A scoping review. Nutrition Reviews 82(5): 695–708.

35.

Sinha

Haque

Lugova

, et al. (2023) The effect of omega-3 fatty acids on insulin resistance. Life (Chicago, Ill) 13(6): 1322.

36.

Soelistijo

Lindarto

Decroli

, et al. (2021) Pedoman Pengelolaan Dan Pencegahan Diabetes Melitus Tipe 2 Dewasa Di Indonesia 2021 .

37.

Strydom

Muchiri

Delport

, et al. (2025) Adherence to personalised nutrition education based on glycemic and food insulin index principles and their association with blood glucose control in individuals with type 2 diabetes mellitus. International Journal of Environmental Research and Public Health 22(6): 925.

38.

Chen

, et al. (2023a) The effects of using tempeh as a supplement for type 2 diabetes. Food Science & Nutrition 11(6): 3339–3347.

39.

, et al. (2023b) Moringa oleifera Lam.: A comprehensive review on active components, health benefits and application. RSC Advances 13(35): 24353–24384.

40.

Tan

WSK

Chia

PFW

Ponnalagu

, et al. (2020) The role of soluble corn fiber on glycemic and insulin response. Nutrients 12(4): 1–11.

41.

Vorster

Love

Browne

(2015) Development of food-based dietary guidelines for South Africa – The process. 2001(January 2001).

42.

Wakeman

Archer

(2020) Metformin and micronutrient status in type 2 diabetes: Does polypharmacy involving acid-suppressing medications affect vitamin B12 levels? Diabetes, Metabolic Syndrome and Obesity 13: 2093–2108.

43.

Wilson

Diji

AKA

Marfo

, et al. (2024) Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study. PLoS One 19(5): e0302914.

44.

Yang

Liang

, et al. (2021) Mediating role diet self-efficacy plays in the relationship between social support and diet self-management for patients with type 2 diabetes. Archives of Public Health 79(1): 14.

45.

Yera

Alzahrani

Martínez

, et al. (2023) A systematic review on food recommender systems for diabetic patients. International Journal of Environmental Research and Public Health 20(5): 4248.

46.

Zahra

Chandra

Mansyur

, et al. (2023) Designing optimal food-based recommendations and nutrient-dense canteen menu for oil and gas workers using linear programming: A preliminary study in oil and gas worksite in East Kalimantan, Indonesia. Nutrients 15(19): 4132.