3.1. Daily Consumption Pattern of Bogor Adult Residents
In this study, various foods (270 food items) consumed by Bogor residents were categorized into 11 food groups based on their main ingredients (
Table S5). Although the dishes derived from meat, fish and seafood were not expected to contain flavonoids, those types of food groups may also contribute to the flavonoid intake when considering the presence of other, plant-based ingredients in their composition. The consumption pattern and the contribution of each of the 11 food groups to the total food consumption of Bogor residents is presented in
Table 2. The average food consumption of the residents of Bogor City and District was estimated as 892 g/person/day. The food groups with the largest contribution to the total food consumption were cereals and cereal products (44.6%), followed by vegetables and vegetable products (15.8%) and fruits and fruit products (11.9%). Unlike other food groups, cereals and cereal products were consumed by all respondents (100%). This is related to the common consumption pattern of Indonesian people, who rely on rice (cereals) as the staple food. In addition, this study showed that vegetables and their processed products, fruits and fruit products, legumes and legume products, and snacks were consumed by a high percentage of the studied population, while food supplements were only consumed by 5% of respondents.
The average consumption of fruit and of vegetables and their processed products by the studied population was estimated as 247.1 g/person/day, which is in line with the results reported by Setyowati et al. (2018) for Jakarta residents [
31]. The fruit and vegetables that respondents usually consumed were bananas (local banana), cabbage, spinach, and water cress. The recommended fruit and vegetables intake, excluding potatoes and other starchy tubers, according to the current recommendations of the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO) is a minimum of 400 g (or five 80 g portions) a day [
32].
Such amount of fruit and vegetables in a habitual diet is considered as an important contributor to the prevention of chronic diseases, such as cancers, cardiovascular diseases, diabetes, obesity, as well as for the prevention and alleviation of several micronutrient deficiencies, especially in less developed countries [
32]. The low intake of products from these important food categories by the Bogor population is caused by their limited economic accessibility. High prices of fruits and vegetables (especially fruits) result from (a) inefficient agricultural and horticultural practices, (b) long distances between the location of the main production areas and the target market (high transportation costs), and (c) lack of efficient logistics causing high food losses. It should be pointed that low intake of vegetables and fruit is listed as one of the top ten risk factors for mortality globally. According to the Global Burden of Disease Study [
33], 1.8 million deaths/year worldwide can be attributed to low consumption of vegetables and 3.4 million to diets low in vegetables. Although vegetables and fruit consumption has been extensively promoted worldwide in the recent decades, per capita consumption is still estimated to be 20 to 50% below the minimum daily recommended level of 400 g [
34]. Relevant actions taken to increase fruit and vegetables consumption by the Indonesian population could be therefore considered as important initiatives for improving public health.
The results on the average consumption of each food group by the respondents depending on their area of residence, gender, and age are shown in
Table 3. None of the three factors (area of residence, gender, and age) were shown to significantly affect the total food consumption. The
t-test results on each food group’s consumption also showed that there were no significant differences between Bogor residents representing the two different areas (city vs. district). Gender-related differences were identified in the case of a number of food groups, i.e., female respondents consumed significantly higher amounts of herbs, spices, and condiments, as well as supplements, compared to the male respondents, while male respondents consumed significantly more cereals and cereal products. There was also a trend (
p = 0.083) towards higher consumption of vegetables and vegetable products in the female group. Significant age-related differences were noticed only in the case of cereals and cereal products, which were consumed in higher amounts by two younger (25–40 y and 41–55 y) groups compared to the oldest (56–65 y) respondent group.
Some significant differences were also identified when a more in-depth analysis was carried out for each respondent’s subcategory (
Table S6), i.e., ANOVA results on female respondents representing different age groups showed that women aged 56–65 years old tended to consume significantly lower amounts of food (696.56 g/person/day) than women in the two other age groups (25–40 and 41–55 years old). In Bogor City, the total food consumption of respondents aged 41–55 years old was significantly higher than that of respondents in the 25–40 years old and 56–65 years old groups. This can be due to the tendency of increasing food consumption at the peak of the productive age (age 35–44 years), and a significant decrease when a person has passed the productive age, especially starting from the age of 50 years and over [
35].
Specific observation on the male respondents representing different age groups showed that men aged 41–55 years old consumed significantly higher amounts of beverages than men in other age groups. Moreover, consumption of cereals and cereal products by male respondents was decreasing with age (lowest in the 56–65 years old group), while consumption of vegetables and vegetable products was increasing with age (highest in the 56–65 years old group). Interestingly, in the case of female respondents, the consumption of cereals and cereal products, but also vegetables and vegetable products and snacks was decreasing with age (lowest in the 56–65 years old group). At the same time the consumption of eggs and their processed foods by female respondents aged 41–55 years old was significantly higher than in other age groups of women (but this difference was significant only in the case of district area).
It is important to point that, in case of female respondents, the consumption of products from groups such as vegetables, fruits, legumes, and supplements was decreasing with age (was lowest in the oldest age group—56–65 y), while risk of many diseases is known to be growing, and the bioavailability of many nutrients is considerably decreasing with age [
36]. Thus, people from older age groups should be considered as an important target for actions towards the increase of fruit and vegetables consumption and/or dietary supplementation.
The gender-related differences in the consumption level of different food groups were more evident in the city area compared to the district area of Bogor: females in the city area consumed significantly more beverages; more herbs, spices and condiments; and more supplements, but less cereals and cereal products than males from the same area. Similar, although not as significant trends, were observed in the district area, except for beverages, for which the results recorded for the district and city area were opposite (in the district area the consumption of beverages was significantly higher in the group of males compared to female respondents).
Consumption of meat and meat products by females in the city area was decreasing with age (lowest in the 56–65 years old group). Although there was a similar tendency in the male group in the same area, the difference was not significant. Male respondents aged 56–65 years old in the city area consumed fish and fish products in highest amount compared to men from other age groups.
In the district area, consumption of eggs and egg products was higher in the age group of 41–55 years old (as already described above), but this difference was in fact statistically significant only in the case of female respondents. The men aged 56–65 years old from the district area consumed the highest amounts of legumes and of vegetables and their processed products compared to men from other age groups in the same area, but a similar trend was not observed in the case of women from the same area (
Table S6).
3.2. Estimated Daily Flavonoid Intake of Bogor Adult Residents
Table 4 shows the data sources used for determination of flavonoid and carotenoid contents in 270 food items consumed by Bogor residents. Total flavonoid and carotenoid content of each food category and examples of calculations of their content from multi-ingredient foods are shown in
Tables S7–S10. Some of the food items were assigned as not containing flavonoids (3 food items) or carotenoids (9 food items). The levels of flavonoids and carotenoids contained in several foods could not be determined (27 unknown values for flavonoids and 17 unknown values for carotenoids) due to limited information in the secondary databases. A list of food items with unknown flavonoid and carotenoid content is available in
Tables S11 and S12.
These study results showed that the total consumption of flavonoids by Bogor residents (both city and district) was 149.5 mg/day (
Table 5). As much as 70.7% of the total flavonoids consumed by all respondents were sourced from legumes and legume products. Other food groups significantly contributing to the total flavonoid intake included vegetables and vegetable products (10.1%) and fruits and fruit products (7.3%). At the same time, food groups 6 (fish and fish products) and 10 (supplements) only provided a negligible contribution to the total daily flavonoids intake. Our findings are in accordance with the statement of Bhagwat et al. [
30], affirming that the main sources of flavonoid compounds, besides isoflavones, are vegetables and fruits, while the main sources of isoflavones are legumes, especially soy-based food products.
As already described, according to the data on the consumption patterns of Bogor adults, the foods consumed in the highest amount were cereals and their processed products. However, this group contained relatively low amounts of flavonoids, and thus the contribution of this food group to the total daily intake of flavonoids only reached 2.4%. On the other hand, consumption of legumes and their products only accounted for 9.1% of the total food consumption, but products from this food group were considered to be the main contributors to the flavonoid intake because of their high content of flavonoid compounds. Isoflavones were identified as the most consumed flavonoid compounds (49.4% of the total daily flavonoid intake), followed by flavonols (24.0%), flavanones (9.4%), flavan-3-ols (7.0%), flavones (6.0%), and anthocyanidins (4.2%). The types of food that greatly contributed to the isoflavone intake were tempeh, tofu, and other soy-based products such as, e.g., tauco.
Table 6 shows the daily intake of flavonoid subclasses for different respondents’ categories (based on area of residence, age, gender). The area of residence (city vs. district) was observed to significantly affect the anthocyanidin and isoflavone intake. The isoflavone intake of Bogor City residents was higher than that of Bogor District residents. It was related to the higher intake of legumes and legume products by Bogor City residents.
Fruits and fruit products were considered to be the main contributor to anthocyanidin intake. Although the fruit consumption of Bogor City and District residents did not differ significantly, the significant difference in the anthocyanidin intake could be associated with the different types of fruit consumed by both populations. Grapes, strawberries, blueberries, and dragon fruit are reported to contain high levels of anthocyanidins [
30], so these fruits might have given high contribution to the anthocyanidin intake. Detailed comparison of flavonoid intake between several respondent subcategories are provided in
Table S13.
The daily flavonoid intake may vary by geographical region due to different factors, such as dietary patterns, the flavonoid classes included, the food consumption survey methods, the food composition database used, and the method of expression. Escovar-Cevoli et al. [
10] summarized data on the mean intake of flavonoids worldwide, which ranged between 150–600 mg/day, expressed as aglycones. They also added that the main food items contributing to the daily flavonoid intake included black tea, fruits (i.e., berries, apples), red wine, cocoa, beans, soy, tofu, and vegetables (i.e., onions). Chun et al. [
37] reported the estimated average daily total flavonoid intake of U.S. adults to be 189.7 mg/day, which was mainly from flavan-3-ols (83.5%), followed by flavanones, flavonols, anthocyanidins, flavones, and isoflavones. Food items mainly contributing to the flavonoid intake of U.S. adults included tea, citrus fruit juices, wine, and citrus fruits. These findings were not in accordance with the present study because of the marked differences in the consumption patterns between the two different observed populations. A higher average intake of total flavonoids (428.0 mg/day) was found in the population of European adults, as reported by Vogiatzoglou et al. [
13], with flavan-3-ols as the main contributors. The total flavonoid intakes of the Chinese and South Korean populations were about 225–320 mg/day [
10]. While Sohrab et al. [
16] found that Iranian adults consumed flavonoid compounds in a much higher amount, reaching 1650 mg/day. This high intake is due to the elevated consumption of black tea in those Middle Eastern populations. Currently, the recommended daily intake of total flavonoids or subclasses of flavonoids is still not well defined, therefore, statements regarding the adequacy of daily flavonoid intake of the Bogor adult population cannot be formed yet.
3.3. Estimated Daily Carotenoid Intake of Bogor Adult Residents
The estimated daily carotenoid intake of Bogor residents in this study was 7578 µg/day or 7.6 mg/day. The contribution of each food group to the total carotenoid intake can be seen in
Table 7. Vegetables and vegetable products were observed as the main contributors (53.9%) to the total carotenoid intake, followed by fruits and fruit products (20.2%) and snacks (14.4%). Many vegetables have been recognized as rich sources of carotenoid compounds. Fruits and their processed products, primarily those possessing colors in the yellow to red spectrum, are also known as a good source of carotenoids [
38]. A considerably high contribution of snacks to the estimated total carotenoid intake is related to the fact that many of the snacks consumed regularly by Indonesians are based on/contain fruit and vegetables.
β-carotene was found as the main carotenoid compound consumed by all respondents. As much as 49.9% of total carotenoid intake was from β-carotene, followed by lycopene (19.9%), lutein and zeaxanthin (13.5%), α-carotene (6.9%), and β-cryptoxanthin (2.6%). The main food sources of β-carotene in this study were vegetables and their processed products.
Table 8 shows that total carotenoid intake (and especially β-carotene intake) of Bogor District residents was significantly higher than that of Bogor City residents (
p < 0.05). This can be due to the higher consumption of vegetable-based foods by Bogor District residents. At the same time, the gender and age of the respondents seemed not to significantly influence the total carotenoid intake of the Bogor population. Detailed comparison of carotenoid intakes between several respondent subcategories is provided in
Table S14.
Total carotenoid intake found in this study was lower than reported in some previous reports on the carotenoid intakes of several populations, for example: 14 mg/day by European adults from the UK, Ireland, Spain, France and the Netherlands [
18], 10.69–22.61 mg/day by Irish adults [
19], and 20 mg/day by the Fijian population [
20]. However, the total carotenoid intake of Bogor adults was higher than that of overweight and obese Dominican subjects, which only reached 6.36 mg/day [
22] and the female population in the U.S., who only consumed 6.0 mg of total carotenoids/day [
21]. In line with the present study, several aforementioned studies also reported the role of β-carotene as the main contributor to the daily total carotenoid intake. Carrot was considered to be the main source of β-carotene intake in the European population [
18].
Carotenoids are known as one of the pigment groups found in plants. Three of the carotenoid compounds investigated, namely α-carotene, β-carotene and β-cryptoxanthin, can be converted into retinol, and thus are referred to as provitamin A carotenoids. At the same time lutein, zeaxanthin, and lycopene are considered to be non-provitamin A carotenoids [
14]. The daily intake of provitamin A carotenoids may contribute to the daily vitamin A intake. The recommended dietary allowance (RDA) or adequate intake (AI) for carotenoids is not established yet, but the US Food and Drug Administration (FDA) has set the RDA for vitamin A to be 900 µg retinol activity equivalents (RAE) per day [
39]. Detailed information regarding retinol activity equivalent ratios for preformed vitamin A and provitamin A carotenoids have been provided by Hidgon [
14]. Although provitamin A carotenoids intake can protect consumers from vitamin A deficiency, the deficiency symptoms can be also avoided in people consuming low-carotenoid diets in the case of an adequate vitamin A intake [
40].
As previously described, habitual flavonoid and carotenoid intakes are associated with the reduced risks of several chronic diseases, primarily cardiovascular disease (CVD) and type 2 diabetes mellitus [
11,
13]. Currently, chronic diseases, also termed as non-communicable diseases (NCDs), are reported to be the leading causes (about 71%) of death in the world. Over 85% of those premature deaths occur in low- and middle-income countries [
41]. Indonesia is also experiencing a dramatic escalation in the problem of NCDs. This is evidenced by an increase in the prevalence of NCDs from year to year based on the results of the National Basic Health Research in 2007, 2013, and 2018 [
42]. For example, the results of the National Basic Health Research in 2007 and 2013 showed that the prevalence of stroke increased from 8.3‰ in 2007 to 12.1‰ in 2013. Increased prevalence is also observed in type 2 diabetes mellitus and hypertension, i.e., from 1.1% and 7.6% in 2007, respectively, to 2.1% (diabetes mellitus) and 9.5% (hypertension, only based on medical doctors’ diagnoses) in 2013 [
43]. Coronary heart disease (CHD), stroke, and diabetes mellitus are identified as the main NCDs in Indonesia. In addition, hypertension and obesity are recognized as the main risk factors for the incidence of those three main NCDs. According to the data of the National Basic Health Research in 2013 [
43], the prevalence of diabetes mellitus, hypertension, and CHD were found to be higher in women than men. At the same time, the prevalence of stroke in men and women were similar. The prevalence of CHD, stroke, heart failure, diabetes mellitus, and hypertension tended to increase with age. Furthermore, urban communities tended to have a higher prevalence of diabetes mellitus, CHD, stroke, and hypertension than rural communities. Health profile data of West Java Province, Indonesia in 2012 [
44] showed that the prevalence of diabetes mellitus in Bogor City is higher than in Bogor Regency, while the prevalence of hypertension was found to be higher in Bogor Regency than in Bogor City.
As previously mentioned, some significant differences in the carotenoid intake can be found between respondents from two different areas of residence. Respondents from Bogor Regency (rural area) consumed more carotenoids than Bogor City respondents (urban). In the case of the flavonoid subclasses’ intake, respondents from Bogor city consumed higher amounts of anthocyanidins, flavones, and isoflavones. Furthermore, although not significant, the total flavonoid and carotenoid intake in female respondents tended to be higher than that of male respondents. Even though the results of the National Basic Health Research [
43] show that the prevalence of various NCDs is closely related to the area of residence (rural vs. urban), age (young vs. elderly), and gender (male vs. female), the association between dietary patterns (including total flavonoid and carotenoid intake) and the reported facts regarding the NCDs prevalence in Indonesia has not been clearly seen yet. This can be explained by the fact that the dietary patterns, including the intake of flavonoids and carotenoids, are among a number of factors influencing the development of NCDs [
45], such as, e.g., age, gender, physical (in)activity, and tobacco and alcohol use.