The impact of dietary consumption on hypertension in indonesia: An analysis of indonesian health survey 2023

Abstract

BACKGROUND:

Hypertension is a major public health issue in Indonesia, with poor dietary habits, particularly high consumption of salt, fat, and sugar contributing to its prevalence. This study aimed to analyze the impact of dietary consumption on hypertension using data from the 2023 Indonesian Health Survey (IHS).

MATERIALS AND METHODS:

A cross-sectional analysis was conducted using data from all Indonesian provinces, including dietary patterns and blood pressure measurements. Logistic regression was used to calculate adjusted odds ratios (ORs) for the relationship between dietary consumption and hypertension.

RESULTS:

The consumption of sweet foods was associated with an increased risk of hypertension (adjusted OR = 0.41, P < 0.001), salty foods (adjusted OR = 0.67, P < 0.001), fatty foods (adjusted OR = 0.82, P < 0.001), and instant noodles (adjusted OR = 0.56, P < 0.001). Fatty foods and sugary drinks demonstrated a particularly strong association after adjustment.

CONCLUSION:

Reducing the intake of foods high in fat and salt is crucial for lowering hypertension prevalence in Indonesia. These findings provide a strong foundation for targeted public health interventions and policies that promote healthier dietary habits.

Introduction

Hypertension is a critical global health issue, significantly contributing to elevated morbidity and mortality rates worldwide.[1] Often referred to as the “silent killer” due to its asymptomatic progression, hypertension can result in severe complications, including heart disease, stroke, and kidney failure.[2,3] In developing countries, the prevalence of hypertension is strongly linked to lifestyle transitions, urbanization, and unhealthy dietary patterns.[4,5] Additionally, limited healthcare access, inadequate early detection mechanisms, and insufficient public awareness exacerbate this growing public health challenge.[6] Therefore, implementing effective prevention and management strategies is essential to mitigate the burden of hypertension.[7]

Unhealthy dietary patterns have been identified as a primary risk factor for hypertension worldwide.[8] Foods rich in salt, fat, and sugar are particularly harmful as they can elevate blood pressure and worsen cardiovascular conditions.[9] Excessive salt intake, for instance, increases sodium retention, leading to fluid retention and higher blood pressure.[10] Similarly, high-fat consumption promotes the formation of arterial plaques, narrowing blood vessels and heightening vascular resistance.[11] In Indonesia, the widespread consumption of salty, fatty, and sugary foods is particularly concerning, as highlighted in the 2023 Indonesian Health Survey (IHS).[12] The survey underscores the significant role of these dietary habits in driving hypertension prevalence across various regions.[13]

Sweetened beverages, energy drinks, and processed foods, commonly consumed in Indonesia, further contribute to the country’s hypertension crisis.[14] These products, laden with high sugar content, are associated with insulin resistance and obesity—both major risk factors for hypertension.[15,16,17] The high prevalence of these unhealthy dietary patterns reflects the need for immediate public health interventions targeting consumption habits.[13,18]

The distribution of hypertension prevalence in Indonesia is uneven across provinces, reflecting variations in dietary culture and local eating habits [19,20] Certain regions, where diets are predominantly rich in salty and fatty foods, report significantly higher rates of hypertension.[21] For example, IHS 2023 data reveal a stark contrast between East Java, which records the highest hypertension prevalence, and Mountainous Papua, which has the lowest.[22] These findings underscore the necessity of culture-specific interventions to address dietary risk factors and improve public health outcomes.

Various studies have shown a link between unhealthy food consumption patterns and the risk of cardiovascular disease and hypertension. A study conducted by Legarreta-Muela et al.(2023)[23] in Mexico showed that saturated fat intake and total fat have a significant positive relationship with increased body fat in adolescents. These findings suggest that the consumption of high-fat foods can be an important risk factor in the occurrence of health problems, including hypertension. In addition, intense physical activity, such as strenuous exercise, was found to have a protective effect against the risk of fat accumulation and cardio metabolism. This study provides an overview that hypertension control efforts are related to not only reducing the consumption of risky foods but also increased physical activity.

This study brings novelty by using comprehensive national data from IHS 2023 to analyze the relationship between dietary consumption patterns and hypertension prevalence at a provincial level. Unlike previous studies, which often focused on general dietary risk factors, this research integrates cultural and geographic variations to identify localized dietary risks. By examining the consumption frequency of salty, fatty, and sugary foods across diverse regions, this study provides unique insights into the sociocultural dimensions of hypertension risk. Furthermore, it highlights the importance of localized, culture-based dietary interventions to reduce the burden of hypertension in Indonesia.

The study aligns with global health objectives, including the World Health Organization’s (WHO) target of reducing global salt intake by 30% and Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from noncommunicable diseases by one-third by 2030.[24] By offering a comprehensive analysis of dietary consumption patterns and their association with hypertension, this research provides a robust foundation for evidence-based public health policies and educational initiatives. These strategies are crucial for addressing dietary risk factors and enhancing overall population health in Indonesia. By emphasizing the impact of unhealthy food consumption and its regional distribution, the findings of this study are expected to support the development of more effective, evidence-driven health policies to improve public health outcomes on a broader scale.

Study objectives

This study aims to investigate the impact of dietary consumption on the prevalence of hypertension in Indonesia using data from the 2023 IHS. Additionally, it seeks to explore how variations in dietary consumption across different provinces influence the distribution of hypertension cases. By providing a comprehensive analysis of the relationship between unhealthy dietary patterns and hypertension, this study aspires to contribute to the development of more effective health policies and culturally tailored interventions aimed at reducing the risk of hypertension in Indonesian society.

Material and Method

Study design and setting

This study employed a cross-sectional design with a quantitative approach to assess the relationship between the consumption of unhealthy foods and the prevalence of hypertension in Indonesia. The data used in this research were derived from the 2023 IHS, which integrates data from Basic Health Research (Riskesdas) and the Indonesian Toddler Nutrition Status Survey (SSGI). This design was chosen for its ability to simultaneously analyze the association between dietary risk factors and hypertension within a large, representative population.

Study participants and sampling

The study population comprised all Indonesian residents who participated in the 2023 IHS. The dataset includes 536,680 hypertension cases distributed across 38 provinces and 514 districts/cities. A random sampling framework was utilized, developed in collaboration with the Central Statistics Agency (BPS) and the Health Development Policy Agency (BKPK). Data collection instruments included questionnaires and interviews focused on the frequency of consuming unhealthy foods, covering six dietary frequency categories (questions 23a to 23j). Hypertension was identified through blood pressure measurements conducted with a calibrated digital sphygmomanometer using a classification of hypertension as blood pressure ≥140/80 mmHg.

Research instruments

The 2023 IHS questionnaire was developed in collaboration with several key institutions, including the Health Development Policy Agency (BKPK), the Central Statistics Agency (BPS), the Ministry of Health, and international organizations such as the WHO and the World Bank. The questionnaire was designed to capture comprehensive public health data, ranging from health status and behaviors to environmental health and access to healthcare services. Its development was guided by global and national frameworks, including the SDGs, the National Medium-Term Development Plan (RPJMN), and the Ministry of Health’s Strategic Plan. These frameworks ensure the data collected are aligned with evidence-based health planning in Indonesia.

Data collection tools and technique

This study utilized secondary data sourced from the Ministry of Health’s Data and Information Technology Center. The 2023 IHS, an integrated survey combining Basic Health Research (Riskesdas) and the Indonesian Toddler Nutrition Status Survey (SSGI), provided the primary data for analysis. Data access was obtained through an official request process (Request Number: 24087DD4BCF43422), followed by the signing of a Non-Disclosure Agreement (NDA Number: FRM/SMKI-PUSDATIN/70/0227/2024) to ensure the validity and confidentiality of the data. The dataset includes comprehensive information on food consumption patterns and hypertension prevalence across all provinces in Indonesia, reflecting the nationwide state of public health. The official dataset is available for reference and validation through the link https://layanandata.kemkes.go.id/katalog-data/ski/ketersediaan-data/ski-2023, which provides access to the questionnaire data used in the survey, promoting transparency and accountability in data collection. Through the Indonesian Health Survey 2023, the Ministry of Health had detailed the data access as well as the validation process [Diagram 1].[13]

Diagram 1.

Data Access and Validation from Indonesian Health Ministry. Source: Indonesian Health Survey 2023[13]

Data analysis

Data analysis was conducted using the Chi-square test to examine the relationship between dietary consumption (independent variable) and hypertension prevalence (dependent variable). Logistic regression was employed to adjust for potential confounding variables. All analyses were performed using SPSS version 25 statistical software.

Results

The analysis of data from the 2023 IHS reveals significant geographical variations in the prevalence of hypertension across Indonesia. East Java Province recorded the highest prevalence, with a total of 75,947 cases, while Mountainous Papua Province reported the lowest, with only 4196 cases.[13] These disparities highlight the influence of local dietary habits, cultural food practices, socioeconomic inequalities, and healthcare accessibility on hypertension prevalence.

The map below visually represents the distribution of hypertension prevalence across provinces, emphasizing the stark differences between regions. This variation underscores the need for culturally and regionally tailored public health interventions to address hypertension risk factors effectively. Hypertension prevalence showing patterns of geographical variation is clearly visible across the provinces of Indonesia [Figure 1] as per the Indonesian Health Survey 2023.[13]

Figure 1.

Map showing the prevalence of hypertension in Indonesia by province based on data from the 2023 Indonesian Health Survey (IHS). Darker shades indicate higher prevalence. Source: Indonesian Health Survey 2023[13]

The results of the analysis of IHS 2023 data show that the consumption of unhealthy foods in general is related to the prevalence of hypertension in Indonesia. Based on the frequency of consumption, sweet foods and salty foods occupy the highest proportion in the category of > 3 times/week, with a percentage of 51.9% and 40.3% each. These data are presented in Table 1, which shows the weekly consumption patterns of various unhealthy foods in the Indonesian population. In addition, instant noodles can also be frequently consumed, with more than 29.2% of respondents consuming these types of foods > 4 x/week times per week. These findings underscore the importance of efforts to control the consumption of unhealthy foods to reduce the prevalence of hypertension in Indonesia.

Table 1.

Frequency distribution of dietary consumption based on Indonesia Health Survey in the year 2023

Dietary consumption		Frequency (%)
		>7x/week		>4x/week		<3x/week		<2x/week		< 1 x/week		Never
Sweet food		4665 (0.7)		23548 (3.7)		146164 (22.9)		331319 (51.9)		123634 (19.4)		8850 (1.4)
Salty food		9753 (1.5)		37287 (9.0)		198901 (31.2)		256928 (40.3)		101173 (15.9)		14138 (2.2)
Fatty Food		10916 (1.7)		62739 (9.8)		229868 (36.0)		248058 (38.9)		77765 (12.2)		8834 (1.4)
Instant noodles		17328 (2.7)		186543 (29.2)		275283 (43.1)		99806 (15.6)		46507 (7.3)		12713 (2.0)

Based on the analysis of quantitative data in Table 2, in this study, both crude odds ratios (ORs) and adjusted odds ratios (adjusted ORs) were calculated to assess the association between dietary consumption and the prevalence of hypertension among the Indonesian population. The crude analysis provided an initial view of the association without accounting for confounding factors, while the adjusted analysis used logistic regression to control for potential confounders.

Table 2.

Association of dietary consumption with hypertension in Indonesia (IHS 2023, n=638,180)

Variable		Hypertension								aCrude OR (95% CI)		P a		bAdjusted OR (95% CI)		P b
		No (n=584512)				Yes (n=53668)
		(n)		(%)		n		(%)
Sweet food
No		7034		79.5		1816		20.5		0.34		0.000		0.41		0.000
Yes		577478		91.8		51852		8.2		(0.33–0.36)				(0.39–0.43)
Salty foods
No		12118		85.7		2020		14.3		0.54		0.000		0.67		0.000
Yes		572394		91.7		51648		8.3		(0.51–0.56)				(0.63–0.71)
Fatty food
No		7583		85.8		1251		14.2		0.55		0.000		0.82		0.000
Yes		576929		91.7		52417		8.3		(0.53–0.58)				(0.77–0.88)
Instant Noodles
No		10733		84.4		1980		15.6		0.48		0.000		0.56		0.000
Yes		573779		91.6		51688		8.3		(0.46–0.51)				(0.54–0.59)

*^aChi-square, P<0.05 is statistically significant at alpha (α) 0.05; ^bLogistic regression, P<0.05 is statistically significant at alpha (α) 0.05, OR=Odds ratio; CI=Confidence interval; P=Probability value

Sweet food analysis showed an OR of 0.34 (95% CI: 0.33–0.36) with P < 0.05, indicating that individuals who consumed sweet food were less likely to have hypertension compared to those who did not consume it. However, after controlling for potential confounders, the adjusted OR increased to 0.41 (95% CI: 0.39–0.43), still statistically significant (P < 0.05). This increase in OR suggests that some of the observed protective association between sweet food consumption and hypertension in the crude analysis were due to confounding factors. After adjustment, the strength of this negative association weakened but remained significant.

For salty foods, the crude OR was 0.40 (95% CI: 0.31–0.56), with P < 0.05, showing a significant association with a reduced risk of hypertension. After adjusting for confounders, the OR increased to 0.67 (95% CI: 0.63–0.71), which also remained statistically significant. This indicates the apparent reduction in hypertension risk associated with salty food consumption.

The crude OR for fatty food consumption was 0.35 (95% CI: 0.33–0.38), indicating a significant negative association with hypertension risk. After adjustment, the OR increased to 0.82 (95% CI: 0.77–0.88), with P < 0.05. This notable increase suggests that the initial crude protective association was largely influenced by confounding factors. In the case of instant noodles, the crude OR was 0.48 (95% CI: 0.46–0.51), implying a lower risk of hypertension among those who consumed instant noodles compared to those who did not. However, after adjusting for confounding factors, the OR became 0.36 (95% CI: 0.34–0.39), still significant with P < 0.05.

The consistent statistical significance across dietary factors reinforces the hypothesis that dietary patterns, particularly high consumption of salty, fatty, and processed foods, are critical risk factors for hypertension. Adjustments for confounders such as age, gender, and socioeconomic status reveal the nuanced relationships between diet and health outcomes, demonstrating the importance of comprehensive data analysis.

Discussion

The findings of this study highlight the significant role of dietary patterns, particularly the consumption of fatty and salty foods, in the prevalence of hypertension in Indonesia. Even after adjusting for other factors, these dietary habits remain critical risk factors. These results are consistent with the study by Legarreta-Muela et al.,[23] which found a positive correlation between high-fat food consumption and increased body fat, leading to heightened cardiometabolic risk. In this context, the consumption of fatty foods can elevate blood pressure through the formation of plaques on arterial walls, thereby increasing vascular resistance.[25]

Recent study by Kalaki et al. (2023)[1] and Chen et al. (2021)[8] underscore the importance of early dietary regulation in reducing long-term cardiovascular risks. Although this study focuses on adults, the findings reinforce the significance of addressing dietary patterns across all age groups. Similarly, Sakir et al. (2024) examined the associations between food consumption patterns and the risks of obesity, type 2 diabetes, and hypertension in Jakarta, Indonesia. Their findings highlight the importance of dietary habits in managing chronic diseases, including hypertension, and underscore the need for targeted nutritional interventions in primary health care settings.[12]

Interestingly, while sugary drinks and foods initially appeared to show a negative association with hypertension risk, this association became no significant after adjustments. This aligns with research indicating that high sugar consumption contributes to insulin resistance, a known precursor to hypertension. Studies by Miranda et al. (2020)[26] further support this, highlighting that excessive sugar intake, particularly FODMAP-rich foods, exacerbates metabolic complications and increases the risk of noncommunicable diseases (NCDs), including hypertension. Thus, despite initial findings, sugar remains a critical dietary risk factor requiring control.

The role of sodium intake is particularly notable. Yanti et al. (2023)[3] identified dietary sodium consumption, particularly through processed foods like instant noodles and salty snacks, as a major modifiable factor influencing hypertension prevalence in Indonesia. This finding supports our analysis that high sodium consumption, particularly through instant noodles and salty foods, plays a central role in hypertension prevalence. This is supported by Elbarbary et al. (2023),[4] who emphasized the need for targeted sodium reduction interventions to mitigate hypertension risks. Furthermore, Wu et al. (2024)[27] stressed the importance of food quality control, particularly in managing sodium content in widely consumed products, to reduce related health risks.

Geographical disparities in hypertension prevalence also emphasize the need for culturally specific approaches. For instance, this study found that East Java recorded the highest prevalence of hypertension (75,947 cases), while Mountainous Papua reported the lowest (4196 cases). These findings align with Grace et al. (2019),[28] who identified the effectiveness of community-based interventions in addressing regional health disparities, where community-based interventions and active participation from local traders can be effective measures.[29] In Indonesia, culture-based interventions tailored to local dietary habits could play a crucial role in reducing hypertension prevalence.[22,30]

The consumption of soft drinks and energy drinks, though associated with a weaker crude odds ratio, still poses potential health risks, particularly with long-term use. Wang et al. (2023) found that high-frequency consumption of alcoholic beverages increased the risk of hypertension in men, whereas frequent tea consumption and lower intake of sugar-sweetened beverages were associated with a reduced risk of hypertension in women in China. Additionally, Aljaadi et al. (2023) reported that among Saudi adults, 67% consumed soft drinks weekly, and 30% consumed energy drinks weekly. The consumption of these beverages was more prevalent among men, younger individuals, those with lower income, and those with lower physical activity levels[31,32] Therefore, interventions must not only focus on educating the public about healthy dietary practices but also prioritize improving access to healthier alternatives, especially in economically disadvantaged areas.[14]

Public awareness campaigns should emphasize the adverse health effects of excessive consumption of salty, fatty, and sugary foods. Promoting healthier dietary habits must be a cornerstone of hypertension prevention strategies. Increasing access to affordable, nutritious food is equally important as economic constraints often force individuals to rely on low-cost, unhealthy options. Support from governments, food producers, and communities is essential to ensure strict food quality regulations and encourage healthier food production and consumption.[33,34]

While hypertension remains a significant challenge, this study highlights actionable solutions. Reducing the consumption of foods high in salt and fat, coupled with the adoption of healthier dietary practices, can significantly lower hypertension risk. With a national-level analysis using recent data, this research complements global literature by offering a localized perspective for community-based hypertension control.[35,36]

The findings also emphasize the value of culture-based interventions and local approaches, particularly in high-risk regions like East Java. These interventions should include public education, promotion of physical activity, and stricter food regulations. Addressing dietary risk factors through evidence-based strategies can help reduce hypertension prevalence and improve the quality of life for Indonesian communities.[37] This finding is consistent with prior evidence emphasizing the importance of nutritional strategies in managing chronic diseases, as noted by Cheng and England.[38] These insights align with the study’s aim to inform public health policies that promote healthier dietary patterns.

Limitations of study

This study has several limitations. First, the data on physical activity were not analyzed in depth, limiting the ability to assess its interaction with dietary patterns and hypertension risk. Second, the study lacks detailed information on specific cultural factors across various regions, which may influence dietary behaviors and hypertension prevalence.

For future research, it is recommended to conduct a more comprehensive analysis that integrates physical activity data with dietary consumption patterns to better understand their combined impact on hypertension risk. Additionally, exploring regional cultural factors and their potential role in modifying hypertension risks can provide valuable insights for developing culturally tailored interventions to address hypertension in Indonesia.

Conclusion

This study underscores the urgent need for targeted interventions to address the high prevalence of hypertension in Indonesia, aligning with WHO’s) goal of reducing global salt intake by 30% and SDG 3.4, which seeks to decrease NCD mortality by one-third. Policies outlined in the National Mid-Term Development Plan (RPJMN 2020–2024), including the expansion of the Healthy Living Community Movement (GERMAS) and regulations on sodium content in processed foods, are pivotal in mitigating hypertension prevalence.

The findings highlight the critical importance of reducing the consumption of unhealthy foods, such as those high in salt, fat, and sugar, while strengthening food quality regulations to ensure healthier dietary options for the population. This study contributes significantly to understanding the role of unhealthy dietary patterns in hypertension prevalence across Indonesia, offering insights into the cultural and geographical diversity influencing these patterns. Such an approach serves as a foundation for the development of more effective, evidence-based, and culturally adaptive health policies aimed at reducing hypertension prevalence and improving public health outcomes.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Gratitude is extended to the Agency for the Assessment and Application of Technology (BPPT) and the Indonesia Endowment Fund for Education (LPDP) for their invaluable support and funding, which significantly contributed to the completion of this research.