Changes in Mature Human Milk Macronutrient Composition over 45 years in an Urban Population in Indonesia

BACKGROUND

With improvement in a population's welfare, its food consumption patterns may change, including those of nursing mothers. This, in turn, could influence their human milk composition.

RESEARCH AIM

To investigate the secular trend in macronutrient composition of mature human milk from mothers of healthy, full-term infants in urban populations in Indonesia from 1974 and 2019.

METHOD

We compared the macronutrient composition of mature human milk of healthy full-term infants from 1974 and 2019. The data from 2019 used the Human Milk Analyzer MIRIS to quantify the milk's carbohydrate, fat, and protein content, while the historical data used methods available at that time, that is, methods described by Benedict, Gerber and Kjeldahl, respectively.

RESULTS

There were no significant differences in carbohydrate, protein and fat content across categories of maternal nutritional status in the respective periods. However, the fat content of human milk from 2019 was significantly higher than that of 1974 (4.7 g/dl, SD = 1.7 g/dl vs. 3.3 g/dl, SD = 1.1 g/dl; p < 0.001), while its carbohydrate content was significantly lower (6.2 g/dl, SD = 2.1 g/dl vs. 7.1 g/dl, SD = 0.2 g/dl; p < 0.001). There was no difference in the protein content between the two periods (1.4 g/dl, SD = 0.5 g/dl vs. 1.6 g/dl, SD = 0.3 g/dl; p = 0.491).

CONCLUSION

The mature human milk from 2019 has a higher fat and total energy content but lower carbohydrate content than those observed 4 decades ago. The protein content remained the same.

Growth of exclusively breastfed small for gestational age term infants in the first six months of life: a prospective cohort study

BACKGROUND

Compared to their appropriate-for-gestational-age (AGA) peers, small-for-gestational-age (SGA) infants are prone to growth deficits. As the first 6 months of exclusive breastfeeding is generally recommended, it is essential to understand how this intervention might impact SGA infants' growth. This study aims to assess growth of exclusively breastfed SGA term infants in the first 6 months of life.

METHODS

A prospective cohort study was conducted on term infants born in Dr. Sardjito General Hospital and two private hospitals in Yogyakarta, Indonesia. SGA was defined as birth weight less than the 10th percentile according to Fenton criteria. Weight, length, and head circumference (HC) were measured at birth and monthly until 6 months old.

RESULTS

A total of 39 AGA and 17 SGA term infants who were exclusively breastfed in their first 6 months were included and followed. In SGA compared to AGA, birth weight, length, and HC (mean ± SD) were significantly lower (p < 0.001). During the first 6 months, the SGAs grew in weight and length in parallel with the AGAs. At sixth months of age, the weight and length (mean ± SD) of the SGAs were significantly lower compared to the AGAs (p < 0.001). However, HC (mean ± SD) of SGAs grew significantly faster than the AGAs (p < 0.005). At sixth months of age, there were no significant differences in HC between the two groups (p = 0.824).

CONCLUSIONS

In the first 6 months, exclusively breastfed SGA term infants, in contrast to weight and length, only show catch up growth in HC, leading to HC comparable to their AGA peers at the age of 6 months.

Secular Change in Body Size and Somatotype of Indonesian Children aged 7–15 Years (1999–2019)

BACKGROUND: Secular changes assessment can help identifying the quality of health, wealth, and nutrition among populations and provide suggestions for policymakers. AIM: To examine the secular changes in weight, height, body mass index, and somatotype in Indonesian children between 1999 and 2019. METHODS: This cross-sectional study was conducted in 1999 and 2019 on 2021 children aged 7–15 years in Yogyakarta, Indonesia. Anthropometric measurements including height, weight, humerus and femur breadths, circumferences of upper arm and calf; skinfold thickness of triceps, subscapular, suprailiac, and calf were measured. Body mass index (BMI) was calculated as kg/m2. Somatotype components were defined by the Carter-Heath method. Statistical analyses used were three-ways ANOVA and least significant difference post hoc tests. RESULTS: Significant differences for boys and girls were found for height, weight, BMI, and three components of somatotype across the 2-time points. The boys in period 2019 were the tallest and girls were the heaviest, and for BMI, the highest value was observed in 2019 (girls). The children in the 1999 period had somatotype values 3.3 - 3.3 - 3.7 (boys) and 3.9 - 3.0 - 3.5 (girls), while in the 2019 period the somatotype values for boys were 3.5 - 4.5 - 3.0 and 4.3 - 4.1 - 2.4 for girls. CONCLUSION: In general, based on the order of age, there is a similar pattern between children in the two periods. Among Indonesian children from 1999 to 2019, there were positive trends in weight, BMI, endomorph, and mesomorph components, whereas a negative trend for the ectomorph component.

Maternal and Neonatal Factors Affecting Bone Mineral Content of Indonesian Term Newborns

Background: Interactions between the genome and intrauterine environment can affect bone mineralization in newborns and even in adult life. Several studies show that intrauterine fetal bone mineralization or early postnatal bone condition influences the risk of osteoporosis in later life. Objectives: To determine whole body bone mineral content (WB BMC) and factors that influence neonatal WB BMC in Indonesian term newborns. Subjects/Methods: A cross-sectional study was conducted in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 45 term, appropriate for gestational age (AGA) newborns were included in this study. BMC was assessed by dual-energy x-ray absorptiometry (DXA) in the first week of life. Weight (g), length (cm) and head circumference (cm) were measured at birth. Data on maternal characteristics were obtained from the maternal health records or reported by the mothers. Results: WB BMC measured in the present study (mean ± SD: 33.2 ± 9.3 g) was lower than WB BMC of similar populations in developed countries. Multiple linear regression showed that birth weight, birth length, and gestational age had a positive association with WB BMC (p = 0.048, 0.017, and <0.001, respectively), while maternal cigarette exposure had a negative association with WB BMC (p = 0.012). Male infants had significantly higher of WB BMC than female (p = 0.025). These determinants contribute to 55% variability of WB BMC. Conclusions: WB BMC in Indonesian term newborns is lower than populations in developed countries. Birth weight, length, gestational age, sex, and maternal cigarette exposure during pregnancy are significantly associated with WB BMC observed in Indonesian newborns.

SCHOOL HEALTH PROMOTION: A QUASI-EXPERIMENTAL STUDY ON CLEAN AND HEALTHY LIVING BEHAVIOR AMONG ELEMENTARY STUDENTS IN JAYAPURA, PAPUA, INDONESIA

Background: The Indonesian government has launched a clean and healthy living behavior program as one of the efforts for school health promotion. However, the healthy behaviors of the elementary students remain low. Objectives: This study aimed to examine the effect of audiovisual-based education on the knowledge and attitudes of clean and healthy behavior in elementary students.Methods: This was a quasi-experimental study with a pretest-posttest comparison group design conducted from 1 October to 17 October 2018. A total sample of 272 students was selected using purposive sampling, with 136 assigned in an experimental group (audiovisual group) and a comparison group (poster only group). Knowledge and attitudes of clean and healthy living behavior were measured using validated questionnaires. Data were analyzed using a paired t-test and independent t-test.Results: There was a significant effect of the interventions given in the experimental and comparison group on knowledge and attitude of clean and healthy living behavior (p<0.05). However, the experimental group showed a higher mean score compared to the comparison group in knowledge and attitudes, which indicated that the use of audiovisual-based education was more effective than the use of poster alone in improving the knowledge and attitudes of clean and healthy living behavior.Conclusion: The students who received audiovisual-based education had higher knowledge and attitudes of clean and healthy living behavior than those who only received poster-based education. This study provides input for pediatric and community nurses to provide better health education for the community, specifically for school health promotion.

Long-term growth outcomes in children with Hirschsprung disease after definitive surgery: A cross-sectional study

Background

The growth of children with Hirschsprung disease (HSCR) can be affected by many factors, including the environment, nutrient intake, and surgery. Our study compared the long-term (i.e., at least 3 years of follow-up) growth outcomes in HSCR children after transabdominal Soave and Duhamel and transanal endorectal pull-through (TEPT) surgeries.

Methods

A cross-sectional study was conducted in children <18 years of age diagnosed histopathologically with HSCR who underwent pull-through between January 1, 2012-December 31, 2015 in our institution. The postoperative anthropometric data were obtained prospectively through interviews during the outpatient clinic appointment or by telephone.

Results

We recruited 21 patients (Soave: 7 vs. Duhamel: 4 vs. TEPT: 10; p = 0.06). There were no significant differences between the three surgical methods in terms of preoperative and postoperative nutritional status categories (p = 0.52). Concerning the changes in nutritional status, after Soave surgery, it was improved, steady, and worsened in 28.6%, 57.1%, and 14.3% of the children, respectively. The nutritional status of the Duhamel group was worsened and steady in 25% and 75% of the children, respectively, while in the TEPT group, it was improved and steady in 40% and 60% of the children, respectively. However, these differences were not statistically significant (p = 0.42).

Conclusions

While some HSCR children show an improvement in their nutritional status after Soave and TEPT procedures, the overall nutritional status is similar among different procedures. Further multicenter studies with a larger sample size are important to clarify our findings.

Growth outcomes in Hirschsprung disease patients following pull-through

INTRODUCTION

Despite various definitive methods that are used for treating Hirschsprung's disease (HSCR), there are few studies comparing the effect of different pull-through methods on the growth outcomes of patients. We aimed to compare the effect of three different pull-through methods, namely Duhamel, Soave and transanal endorectal pullthrough (TEPT), on HSCR growth outcomes of patients.

METHODS

Medical records of all HSCR patients who underwent pull-through at the Dr. Sardjito Hospital, Indonesia between January 2010 and August 2016 were reviewed for their growth outcomes before and after the surgery.

RESULTS

We included 64 HSCR patients, 45 males and 19 females, of which 14, 17, and 33 patients underwent Duhamel, Soave, and TEPT respectively. There were no nutritional status differences in HSCR patients after Duhamel, Soave, and TEPT surgery (p=0.07, 0.17, and 0.79, respectively). Z-score average of weight-for-age did not differ between three surgical methods (p=0.77 and 0.15 for preoperative and postoperative, respectively). In addition, the improvement of nutritional status was achieved in 21.2% HSCR patients after TEPT, 14.3% post Duhamel and 5.9% following Soave procedure, but these differences did not reach a significant level (p=0.34).

DISCUSSION

Our study shows no difference in effect on the growth outcomes in HSCR patients following Duhamel, Soave and TEPT procedure. Further study with a larger sample size is important to give valuable long-term growth outcomes for HSCR patients after pull-through.

Patterns of body mass index, percentage body fat, and skinfold thicknesses in 7- to 18-year-old children and adolescents from Indonesia

Background:

Body mass index (BMI) and skinfold thickness are widely used to evaluate body composition. Information on patterns of skinfold thickness may help to understand changes in body composition during growth. The objectives of this study were to observe patterns of BMI, percentage body fat (%BF), and skinfold thicknesses of Indonesian children and adolescents aged 7–18 years.

Methods:

Weight, height, and four skinfold thicknesses were measured in 2104 school children (924 boys, 1,180 girls) aged 7–18 years from Yogyakarta between 2015 and 2018. BMI and ratios between central and peripheral skinfold thicknesses were determined. %BF was predicted using the equation of Slaughter et al. Data were analyzed using analysis variance (ANOVA), independent sample t-test, and partial correlation (SPSS version 20.0).

Results:

At 7–18 years, boys and girls showed a comparable gain in BMI. The comparable gain in %BF between boys and girls only occurred till age 10 and total skinfolds till age 11 years. While, %BF and skinfold thicknesses were higher in girls at 12–17 years, central to peripheral skinfold ratio were higher in boys. Partial correlation analyses showed that all skinfold thickness parameters and %BF were significantly correlated with BMI (P < 0.001; r = 0.19–0.87).

Conclusions:

The gain in BMI and skinfold thickness between the ages of 7 and 18 years occurred in age- and sex-specific patterns. Instead of comparable BMI, girls showed higher means of total skinfold thickness from age 12 years, while boys had higher central to peripheral adiposity ratio.

Anthropometry to assess body fat in Indonesian adults

BACKGROUND AND OBJECTIVES

Anthropometric equations are widely used to estimate body composition however, are only appropriate for use in populations in which they have been developed and validated. The present study developed anthropometric prediction equations for Indonesian adults and cross-validated them with selected equations used in this population.

METHODS AND STUDY DESIGN

Six hundred Indonesian adults aged between 18- 65 years (292 males and 308 females) were divided equally into development and validation groups. Stature, body weight, skinfold thickness at eight sites, girth at five sites, and bone breadth at four sites were measured. Stepwise multiple regression analysis was used to propose percentage body fat (%BF) prediction equations using measured variables and %BF from the deuterium oxide dilution technique as the reference. The proposed prediction equations were then cross-validated using the validation group and %BF estimated from several existing equations.

RESULTS

Proposed prediction equations showed r ranged from 0.82 to 0.86 and Standard Error of the Estimate (SEE) from 4.7 to 5.4%. Cross-validation analysis showed bias with the reference %BF between 0.2 and 3.3% and Pure Error (PE) between 2.8 and 4.0%. Among the existing equations, the Durnin and Womersley equation was applicable in females whilst the equation by Davidson et al. underestimated %BF by 6.3-6.6% and the equation by Gurrici et al overestimated by 2.0-3.4% in both genders (p<0.01).

CONCLUSION

The proposed prediction equations provide better options for accurate prediction of %BF in Indonesian adults.

Determination of new anthropometric cut-off values for obesity screening in Indonesian adults

BACKGROUND AND OBJECTIVES

Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) have increasingly been used as screening tools for obesity. However, optimal cut-off values may be different between populations. The current study determined the optimum cut-off values for BMI, WC, WHR, and WSR for obesity screening in Indonesian adults using receiver-operating characteristic (ROC) analysis.

METHODS AND STUDY DESIGN

Stature, body weight, waist and hip circumferences were measured on 600 Indonesians aged 18-65 years (males, n=292; females, n=308) and BMI, WHR, and WSR calculated. Percentage of body fat (%BF) was determined using the deuterium isotope (D2O) dilution technique. Some existing cut-off points for obesity determination were evaluated for sensitivity and specificity.

RESULTS

The existing cutoff values showed low sensitivity in our sample (between 18.4 and 71.1%) and new proposed cut-offs increased the sensitivity to reach 66.7 to 88.5%. The new cut-offs for BMI, WC, WHR, and WSR for determination of obesity were 21.9 (kg/m2), 76.8 (cm), 0.86, and 0.48, respectively, for males and 23.6 (kg/m2), 71.7 (cm), 0.77, and 0.47, respectively, for females.

CONCLUSIONS

WC and WSR are the most predictive both for males and females, and therefore are considered as better screening tools for obesity in this population.

Body mass index and weight status misperception among a sample of college students in Yogyakarta, Indonesia

Background: Weight status perception associates with objective weight status and is important in the management of weight control. To date, perception of weight status among Indonesian youths has not been reported.Objectives: This study aimed to examine the association between body mass index and weight status perception in a sample of college students in Yogyakarta Province.Materials and Methods: A sample of 209 boys and 269 girls of college students in Yogyakarta Province were measured for their stature and body weight. Body mass index was calculated (BMI). Data of demographic, exercise, and diet were collected. Weight status perception was based on participant responses to a question regarding how they classified their own body size as underweight, normal, overweight, or obese. Ordinal regression analysis was performed to evaluate factors associated with weight status misperception among boys and girls.Results: Overall, 43.5% of boys and 37.5% of girls misclassified their own weight status by actual BMI. Of particular note, 75.9% of obese boys and 78.6% of obese girls underestimated their weight status as overweight or normal weight. Whereas, 9.1% and 23.4% of normal weight boys and girls respectively, overestimated their weight status. Ordinal regression analysis revealed that, weight status misperception from others was significantly contributed (p<0.01) to misperception of weight status among boys and girls with OR of 10.31 and 8.13 respectively. Diet practicing was significantly correlated with weight status misperception in boys (p<0.05) with an OR of 19.57.Conclusions: Weight status misperception was prevalent among normal weight and obese students. Obese students of both gender and normal weight boys tended to underestimate their weight status, whereas normal weight girls were likely to overestimate their weight status.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.225-232

Development and validation of anthropometric prediction equations for estimation of body fat in Indonesian men

Body composition of 292 males aged between 18 and 65 years was measured using the deuterium oxide dilution technique. Participants were divided into development (n=146) and cross-validation (n=146) groups. Stature, body weight, skinfold thickness at eight sites, girth at five sites, and bone breadth at four sites were measured and body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) calculated. Equations were developed using multiple regression analyses with skinfolds, breadth and girth measures, BMI, and other indices as independent variables and percentage body fat (%BF) determined from deuterium dilution technique as the reference. All equations were then tested in the cross-validation group. Results from the reference method were also compared with existing prediction equations by Durnin and Womersley (1974), Davidson et al (2011), and Gurrici et al (1998). The proposed prediction equations were valid in our cross-validation samples with r=0.77- 0.86, bias 0.2-0.5%, and pure error 2.8-3.6%. The strongest was generated from skinfolds with r=0.83, SEE 3.7%, and AIC 377.2. The Durnin and Womersley (1974) and Davidson et al (2011) equations significantly (p<0.001) underestimated %BF by 1.0 and 6.9% respectively, whereas the Gurrici et al (1998) equation significantly (p<0.001) overestimated %BF by 3.3% in our cross-validation samples compared to the reference. Results suggest that the proposed prediction equations are useful in the estimation of %BF in Indonesian men.