Tjaronosari et al IJSRE Volume 05 Issue 11 November 2017 Page 7700
Volume||5||Issue||11||November-2017||Pages-7700-7705||ISSN(e):2321-7545 Website: http://ijsae.in Index Copernicus Value- 56.65 DOI: http://dx.doi.org/10.18535/ijsre/v5i11.01
Dish Suitability With Casein Free Gluten Free Diet In Permata Ananda Autism School
Authors
Tjaronosari1, Herawati2, Waryana3, Ikha Nurtinaningtyas4,
1,2,3
Lecturer in Nutrition Department Poltekkes Kemenkes Yogyakarta 4
Student of Nutrition Department Poltekkes Kemenkes Yogyakarta Email: [email protected]
ABSTRACT
Children with autism need specific diet which called Casein Free Gluten Free (CFGF) Diet. CFGF Diet can prevent intestinal disorder and decrease hyperactivity. Determine dish suitability with CFGF Diet in Permata Ananda Autism School’s dormitory.
This is a survey research in dormitory of Permata Ananda Autism School Unit II. 100 dishes in 2 menu cycles (20 days) which were served are chosen as sample. Research variable are dishes for breakfast, morning snack, lunch, afternoon snack, dinner and dish suitability with CFGF diet. Chi square test was done to test the hypothesis.
There are 100 dishes for breakfast, morning snack, lunch, afternoon snack and dinner in 2 menu cycles and 55 (55%) dishes are not suitable with CFGF Diet. Unsuitability in breakfast (fried rice, fried bihun, tempe, abon (shredded meat)), morning snack (carabikang, apem), lunch and dinner (soto, tempe, semur meat) because it contains additives in soy sauce, yeast, wheat flour, instant seasoning and food coloring. Result shows there is no significant relation between dishes which were served with CFGF diet suitability. On two cycles with 100 dishes, it was identified that type of menu which were served are similar and 55% are not suitable with CFGF diet.There is no significant relation between dishes which were served and CFGF Diet. Keywords: Autism, Autism Diet, Suitability, CFGF.
BACKGROUND
Children with autism need suitable food which is called Casein Free Gluten Free (CFGF) Diet. This diet can help to cure intestinal disorder and decrease hyperactivity. Some research shows that 68.24% autism children can decrease hyperactivity level after given CFGF diet. Other research shows that 61.5% dishes for CFGF Diet are not suitable. In USA, the prevalence of autism is increasing into 1:50 on March 2013 since previous year. The prevalence of autism is 15-20 cases per 10.000 children in the world. In Indonesia, if the natal number is 6 million per years, autism also increasing 0.15% or 6.900 per children every years.1
Dishes for autism have to suitable for them to prevent malnutrition. Diet that is suitable for autism is Casein Free Gluten Free (CFGF) Diet which no yeast/ fermentation and another intolerant food such as addition, coloring food and instant seasoning. Permata Ananda Autism school have implement CFGF Diet for students in dormitory, due to that condition it is needed to do research to evaluate the suitability between served dishes and CFGF Diet.
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METHOD
This is a survey research on autism dormitory management. 100 dishes that served on 2 menu cycles on 20 days in Permata Ananda Autism School Unit II Yogyakarta are chosen as sample. Research Variables are dishes for breakfast, morning snack, lunch, afternoon snack, dinner and dish suitability with CFGF diet. Chi square test was done to test the hypothesis.
RESULT
Permata Ananda Autism School Unit II located in Pacing, Karangrejek, Semanu, Gunungkidul Regency, D.I Yogyakarta. This school serves 3 dishes and 2 snacks for students which cooked and served by 2 cook helper. Management decides to use 10 days menu cycle. Menu evaluation and change was done every 3 or 4 months once. Since 2016 there were 3 times menu changes.
Served Dishes Characteristic 1st Cycle
Served dishes on 1st cycle are available in table 1. Table 1. Served Dishes on 1st Menu Cycle
1st Cycle Number
Dishes Served Dishes Keterangan
Breakfast 10 rice + animal side dish+
plant side dish + vegetable
Fried rice*, abon, tempe, fried bihun *
Morning Snack 10 cake/ snack carabikang and
apem
Lunch 10
rice + animal side dish+ plant side dish + vegetable +
fruit
semur meat*, soto (instant seasoning),
abon, fried bihun * Afternoon
Snack 10 Cassava chips
Dinner 10 rice + animal side dish+
plant side dish + vegetable
semur meat*, soto (instant seasoning), abon, fried goreng*
Total 50
*information = using soy sauce
Table 1 shows soy sauce usage in breakfast and dinner on menu fried rice, fried bihun, semur meat. Another unsuitability are the usage of instant seasoning on menu soto, yeast in carabikang and additive in abon.
2nd Cycle
Served dishes on 2nd menu cycle are served in Table 2. Table 2. Served Dishes on 2nd Menu Cycle
2nd Cycle Number
Dishes Served Dishes
Keterangan
Breakfast 10 rice + animal side dish+ plant side
dish + vegetable
Fried rice*, abon, tempe
Morning Snack 10 cake/ snack Carabikang, tofu meatball and apem
Lunch 10 rice + animal side dish+ plant side
dish + vegetable + fruit
semur egg and meat*, abon
Afternoon Snack 10 Cassava chips
Dinner 10 rice + animal side dish+ plant side
dish + vegetable
semur egg and meat*, abon
Total 50
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unsuitability are the usage of yeast in carabikang and additive in abon.
Served Dish Suitability
Dishes suitability on 1st menu cycle with CFGF Diet
Dishes suitability on 1st menu cycle with CFGF Diet is available in Table 3. Table 3. Dish Suitability on 1st Menu Cycle with CFGF Diet
Day
Dishes on 1st Menu Cycle
Breakfast Morning
Snack Lunch
Afternoon
Snack Dinner
1 US (soy sauce)* US (wheat,
coloring)* S S S
2 S S US (instant
seasoning)* S
US (instant
seasoning)*
3 US(yeast)* S US(yeast)* S US(yeast)*
4 US(yeast)* S US (soy sauce)* S US (soy sauce)*
5 US(yeast)* S S S S
6 US(abon)* S US (soy sauce, abon,
yeast)* S
US (soy sauce, abon, yeast)*
7 US (soy sauce, abon,
yeast)* S S S S
8 US(yeast)* US(yeast)* US(yeast, soy sauce)* S US(yeast, soy
sauce)*
9 US(abon)* S US(yeast)* S US(yeast)*
10 S US (wheat,
coloring)* US(yeast)* S US(yeast)*
RESULT
S 2 7 3 10 3
% S 4% 14% 6% 20% 6%
Dishes Suitability with CFGF Diet =
Information: * Cause of Unsuitability
There are 25 (50%) from 50 dishes on 1st menu cycle that unsuitable with CFGF Diet. Unsuitability on menu fried rice (soy sauce), tempe (yeast), abon (additive), soto (instant seasoning), semur meat (soy sauce). On morning snack the unsuitability is in apem (yeast) and carabikang (wheat and coloring food). Afternoon snack is suitable because cassava chip is suitable with CFGF diet.
Dishes suitability on 2nd menu cycle with CFGF Diet.
Dishes suitability on 2nd menu cycle with CFGF Diet is available in Table 4. Table 4. Dish Suitability on 2nd Menu Cycle with CFGF Diet
Day
Dishes on 2nd Menu Cycle
Breakfast Morning
Snack Lunch
Afternoon
Snack Dinner
1 US
(yeast)* S S S S
2 S US
(yeast)*
US
(instant seasoning)* S
US
(instant seasoning)*
3 S S US
(yeast)* S
US (yeast)*
4 US
(yeast)*
US (yeast)*
US
(yeast)* S
US (yeast)*
5 US
(soy sauce)*
US (wheat)*
US
(soy sauce)* S
US
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6 US
(soy sauce)*
US (wheat)*
US
(soy sauce)* S
US
(soy sauce)*
7 US
(abon)*
US (yeast)*
US (soy sauce, abon,
yeast)* S
US (soy sauce, abon, yeast)*
8 US (soy sauce,
abon, yeast)*
US (yeast)*
US
(soy sauce)* S
US
(soy sauce)*
9 US
(yeast)* S S S S
10 US
(soy sauce)* S
US
(yeast)* S
US (yeast)* RESULT
S 2 4 2 10 2
% S 4% 8% 4% 20% 4%
Dishes Suitability with CFGF Diet =
Information: * Cause of Unsuitability
There are 30 (60%) from 50 dishes on 2nd menu cycle that unsuitable with CFGF Diet. Unsuitability on menu fried rice (soy sauce), tempe (yeast), abon (additive), soto (instant seasoning), semur egg and meat (soy sauce). On morning snack the unsuitability is in tofu meatball, because tofu meatball contains wheat which is not suitable with CFGF diet
Served Dish Suitability with CFGF Diet
Table 5. Served Dishes on 1st and 2nd Menu Cycle with CFGF Diet
Served Dishes S US Amount p value
1st menu cycle 25
(50%)
25 (50%)
50 (50%)
0,318
2nd menu cycle 20
(20%)
30 (30%)
50 (50%)
45 (45%)
55 (55%)
100 (100%)
55 served dishes (55%) from 100 served dishes are not suitable with CFGF Diet. 55 dishes from 25 dishes (25%) in 1st menu cycle and 30 dishes (30%) on 2nd menu cycle. Statistical test shows p value 0.318, it means there is no significant relation between served dishes with CFGF Diet.
DISCUSSION Served Dishes
Table 1 and Table 2 shows served dishes for breakfast are; staple food, animal side dish/ plant side dish and vegetable. Fried rice was served 4 times on 2 menu cycles. Preparation for breakfast is limit, so it is possible to make menu which is practical and fast for serving.2
Morning snack that served are traditional snack and cassava chips. Criteria of healthy snack is contains vitamin, protein and dietary fiber. It is better to substitute morning snack with fruits.3
Lunch that served is staple food, animal side dish, plant side dish, vegetable and fruit. Not all of served dishes for launch are complete menu. Launch is primary time for eating, so it has to serve complete menu. Dishes for dinner are same as dishes for launch to make it efficient. It is permitted to serve same dishes for launch and dinner.2
Served Dishes Suitability
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Department as healthy food but abon contains additive. Commonly autism children have allergic and hypersensitive on additive. It is better to substitute abon with fresh fish/ meat using proper cook. Soto, bihun, semur contain food material that allowed for CFGF Diet, but the food processing by giving additive, instant seasoning make them unsuitable with CFGF Diet.
Unsuitability on snack is identified in morning snack 2nd menu cycle, because carabikang contains wheat and coloring food. It is better to substitute carabikang with other snacks which using natural coloring or fruits. Besides carabikang, apem contains yeast for fermentation process.4
Most of unsuitability is caused by tempe and soy sauce. Wheat and milk is not permitted for autism children, but fermentation product such as tempe, soy sauce is limited for 3 days once. In this case, management serves tempe more than 3 times each menu cycle.5
Relation Served Dishes with CFGF Diet
Result shows there is no significant relation between served dishes with CFGF Diet. In 1st menu cycle there are 25 dishes and in 2nd menu cycle there are 30 dishes and totally 55% dishes are not suitable with CFGF Diet. Both in 1st and 2nd menu cycle have similar dishes that served and more than half is not suitable with CFGF Diet.
Children with autism are described as picky eaters or very selective on choosing foods.6 Most of them will choose what they want to eat and prefer to reject new menu. This is one of factors influence research results. It influences limit type of dishes that consumed by children with autism. This limit dishes can be a serious problem, because it is related with their nutrition intake and nutrition status as impact of food limitation.7 Children with autism usually reject dishes, picky eaters and difficult to accept new menu.8
Unsuitability can be caused by cook helper as external factor, because there are 2 people for serving students. Cook helper have responsibility to prepare food materials until serving dishes for students and management every day. This condition can influence the probability of human error on serving dishes such as dishes variance, taste and dish appearance.
This unsuitability between served dishes and CFGF diet is related with research in Bandung that 85% parents not serving CFGF Diet and it influence children with autism’s behavior.9 In the other side, other research shows CFGF doesn’t influence autism’s behavior in Makassar.10
Moreover, this unsuitability is usually occurs because parents doesn’t give more attention on their autism children diet. Other research shows almost 100% parents are not obedient with CFGF Diet.11
Nutrition therapy for children with autism has to be implemented, though this result shows there is no significant relation. Nutrition therapy with CFGF Diet belongs to biomedical therapy or biomedical treatment. Gluten is protein from wheat and casein is protein from dietary product or milk based. Gluten and casein is not permitted for children with autism because it is hard to digest.6 Children with autism and common children have similar nutrition needs, the difference on type food materials. Food materials that not permitted for autism have to be concerned and not served for them. Those food materials have to be substituted with other nutritious food material which similar and without decreasing nutrition content.12
CONCLUSION
25 dishes (50%) on 1st menu cycle is not suitable with CFGF Diet. It’s unsuitability due to fried rice (soy sauce), fried bihun (soy sauce), tempe (yeast), abon (additive), carabikang (wheat, coloring), soto (instant seasoning) and semur (soy sauce).
30 dishes (30%) on 2nd menu cycle is not suitable with CFGF Diet. It’s unsuitability due to tempe (yeast), fried rice (soy sauce), fried bihun (soy sauce), abon (additive), carabikang (wheat, coloring), soto (instant seasoning) and semur (soy sauce).
55 dishes (55%) is not suitable with CFGF Diet.
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Recommendation
Result shows there is no significant relation between served dishes with CFGF Diet, because of that it is needed to develop another research related with the topic from other perspective such as dishes variation, cook helper’s knowledge and skill to process foods for children with autism.
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