Leptin levels in childhood tuberculosis and its correlation with body mass index, IFN-γ, and TNF-α in an Indonesian population

BACKGROUND

Leptin plays a key role in the regulation of energy and inflammation in tuberculosis (TB). However, its correlation in children with TB remains unclear. Therefore, this study aimed to evaluate the correlations between body mass index, IFN-γ, TNF-α, and leptin levels in children with TB.

METHODS

This was a cross-sectional study of children aged 2-14 years with TB. Sputum examination, chest radiography, and tuberculin skin test findings and clinical symptoms were considered for TB diagnosis. Data on body weight; height; mid-upper arm circumference (MUAC); body mass index (BMI); food intake; and IFN-γ, TNF-α, and leptin levels were collected and analyzed.

RESULTS

Of the 64 diagnosed TB subjects, 2 subjects had positive bacteriological results. The median age was 6 (2-14) years, body weight was 17.7 (9.45-55) kg, height was 114 ± 21.46 cm, and Z score BMI was -0.85 ± 1.14 kg/m2. Malnourished was observed in 17.2% of the subjects. The median calorie intake was 1448.5 (676-4674) kcal, carbohydrate intake was 182.5 (63-558) g, protein intake was 57.9 (15.8-191.0) g, and fat intake was 81.6 (23.6-594.1) g. The median leptin level was 1.2 (0.2-59) ng/mL, IFN-γ was 2.5 (0.9-161) pg/mL, and TNF-α was 13.0 (5.7-356) pg/mL. Correlations were observed between leptin and MUAC (r = 0.251, p = 0.02), Z score (r = 0.453, p = 0.00), and IFN-γ (r = 0.295, p = 0.018).

CONCLUSION

There were positive correlations between BMI and leptin levels, whereas IFN-γ and MUAC showed weak correlations.

Study of the importance of protein needs for catch-up growth in Indonesian stunted children: a narrative review

Stunting is a chronic nutritional deficiency due to various adverse cross-sectoral environmental conditions, including food intake. This influences the linear growth and development of children's brains and their cognitive function. Providing interventions to meet stunted children's protein needs tends to prevent the further abnormal development of cognitive functions. High-protein foods are supplied from various edible local commodities in Indonesia. Therefore, this study aims to demonstrate the importance of feeding stunted children with high-protein diets and provide insight that local food ingredients in the country have growth-promoting potential. Through Google Scholar, PubMed, Science Direct, and Nature, 107 articles were obtained with keywords related to stunting, such as protein intake, catch-up growth + stunting, and adverse effect + catch-up growth. The preferred citations randomized-controlled trials and systematic reviews relevant to the study question were compiled using Mendeley version 1.19.8. Based on the literature review results, stunting is hereditary and affects the quality of generations. The adequacy of protein needs is closely related to growth and development, hence, foods containing a high amount of the nutrient facilitate catch-up growth in stunted children. This conclusion is expected to provide information to policymakers and health agencies in the country concerning the education related to high nutritional local food, which can be reached by the community. Interventions with high-protein-containing local foods ought to be tailored to dietary needs and accompanied by monitoring for the presence or absence of unreasonable weight gain to prevent overweight or obesity.

Correlation of maternal dietary intake with breast milk composition and infant growth

Background: Maternal dietary intake during the period of lactation has an impact on infants growth. Macronutrients in breast milk are affected by several factors such as maternal dietary intake and maternal nutritional status. This study aims to prove the association between maternal protein and fat intake with the composition of breast milk and growth of infants (age 0-6 months). Methods: Prospective study was conducted for 6 months in 41 mother-infant pairs who were exclusively breastfed, and visited to hospitals or health centres. The mothers age is <40 years old with normal and single pregnancy. The breast milk was collected and analyzed using Human Milk Analyzer. Results: There was a negative correlation between maternal protein intake and breast milk composition at 3 months old infants (p = 0.042), between fat intake with HAZ score at 2 weeks (p = 0.048), and between protein intake with HAZ score at 3 months (p = 0.049). Finally, there was a significant increase in WAZ and HAZ score in all sample groups. Although the maternal protein intake of our subjects were only at 83% of Indonesian's RDA average, the protein composition of breast milk and the growth of the infants was sufficient. Conclusion: There is correlation between maternal dietary intake with the composition of breastmilk and infant growth. Even though the calories and protein intake of the mother is lower than the RDA, the breast milk is still sufficient for the growth of infants aged 0-6 months who are exclusively breastfed.

Cytochrome b-245 Alpha Chain Gene Variants and Arterial Function in Indonesian Short Stature Children

Background

The association between short stature, undernutrition and the risk to cardiovascular disease has been clinically established. Genetic factor, particularly the variants in cytochrome b-245 alpha chain (CYBA) gene, which alter the formation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase level, might affect arterial function. This study aimed to observe the association between single nucleotide variants (SNVs) of the CYBA gene and the arterial function of short stature children to understand the reason why some people with short stature develop cardiovascular disease.

Methods

A total of 142 genomic deoxyribonucleic acid (DNA) samples have been collected from short stature children in Brebes, Central Java, Indonesia. Four common single-nucleotide polymorphisms (SNPs): C242T (rs4673), A640G (rs1049255), -930A>G (rs9932581) and *49A>G (rs7195830) in the CYBA gene were examined using TaqMan allelic discrimination assay. The arterial function was measured using transthoracic echocardiography and described as aortic stiffness and distensibility index. Statistical analysis was done to find a significant difference in arterial function between genotypes of each SNV.

Results

A P-value of < 0.05 was considered significant. In rs9932581 (-930A>G) of CYBA gene, the subjects with GG genotype were found to have significantly lower arterial stiffness and higher distensibility compared to AA and AG genotypes. No significant difference was found in the other SNVs.

Conclusion

The GG genotype in rs9932581 of the CYBA gene might have a protective effect on cardiovascular disease in short stature children.

High sensitivity C-reactive protein level in various manifestations of tuberculosis in children

Background Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Of all TB patients, 40-50% are children. C-reactive protein (CRP) is produced during the inflammation process and is an indicator of active TB disease. High sensitivity CRP (hs-CRP) test has higher accuracy and sensitivity to detect CRP at lower levels. Objective To compare hs-CRP in children with TB infection, pulmonary TB, and extra-pulmonary TB. Methods This cross-sectional study of children with tuberculosis was conducted at Dr. Kariadi Hospital and the Semarang Community Health Center, Semarang, Central Java, from January 2020–February 2021. Inclusion criteria were patients aged 1–18 years with suspected TB (contact with adult TB patient or clinically suspected to have TB). Results From 95 study subjects, 19 had TB infection, 51 had pulmonary TB, and 25 had extra-pulmonary TB. There was a significant increase in hs-CRP level based on prolonged fever (P<0.001), enlarged lymph glands (P=0.004), joint swelling (P=0.006), low WHZ or BMI for age (P=0.048), positive bacteriological evidence (P<0.001), and negative/not done tuberculin skin test (P=0.001). There was a significant difference of hs-CRP level based on TB status, with the highest hs-CRP level in extra-pulmonary TB [14.3 mg/l (0.16–321.5)], followed by pulmonary TB [0.8 mg/l (0.3–129.1)], and TB infection [0.7 mg/l (0.3–20.2)]. The highest hs-CRP level for extra-pulmonary TB was found in abdominal TB [84.5 mg/l (0.6–321.5)]. Conclusion  Children with extra-pulmonary TB have significantly higher hs-CRP than children with TB infection or pulmonary TB.

Asupan Zat Besi Berhubungan dengan Perkembangan Anak Stunting Usia 6 - 36 Bulan di Semarang

Latar belakang. Salah satu masalah gizi pada anak yaitu stunting (pendek). Salah satu faktor penyebab stunting yakni asupan zat gizi. Salah satu akibat stunting dapat mempengaruhi perkembangan anak. Ibu berperan penting pada asupan gizi serta perkembangan anak. Skrining pada usia dini berperan dalam mengetahui ada tidaknya gangguan perkembangan pada anak stunting.Tujuan. Mengetahui hubungan asupan gizi dengan perkembangan anak stunting usia 6—36 bulan di wilayah Semarang SelatanMetode. Desain penelitian cross sectional yang dilaksanakan di 8 puskesmas di wilayah Semarang Selatan. Data diperoleh dengan cara interview kuesioner serta pemeriksaan perkembangan dilaksanakan dengan instrumen Capute Scales pada bulan September - November 2020. Analisis multivariat regresi linier digunakan untuk mengetahui hubungan perkembangan dengan variabel dengan mengontrol variabel luar (usia, jenis kelamin, status stunting) Hasil. Subjek berjumlah 71 anak stunting. Subjek memiliki asupan energi (63,1%) dan zat besi (66,2%) yang rendah. Terdapat 33,8% anak stunting mengalami suspek gangguan perkembangan, 9,9% gangguan komunikasi dan 11,3% suspek disabilitas intelektual. Uji multivariat regresi linier menunjukkan bahwa asupan zat besi berhubungan positif dengan perkembangan anak stunting (p 0,05).Kesimpulan. Terdapat hubungan signifikan antara asupan zat besi dengan perkembangan anak stunting.

Insulin-like growth factor-1 and growth in infants 0-6 months of age

Background During infancy, growth is affected by many factors, including hormones. Insulin-like growth factor-1 (IGF-1) is a hormone with an important role in regulating somatic growth and organ development. Objective To analyze for possible correlations between IGF-1 levels and infant growth from 0-6 months of age. Methods A prospective study was conducted on 38 infants from birth to 6 months of age. Inclusion criteria were full-term newborns with normal birth weight and singleton birth. Serum IGF-1 was measured twice, from umbilical cord blood at birth and at 6 months of age. Anthropometric measurements were made every three months. Paired T-test was used to analyze mean IGF-1 among time points, and Pearson’s correlation test was used to analyze IGF-1 levels and growth. Results Mean IGF-1 level decreased from birth to 6 months of age (89.6 ng/mL vs. 48.3 ng/mL, respectively; P<0.001). Delta IGF-1 had positive significant correlations with delta weight at 3 months (r=0.347; P=0.033) and 6 months (r=0.386; P=0.017), as well as delta head circumference at 3 months (r= 0.356; P=0.028) and 6 months (r=0.357; P=0.028). However, there were significant negative correlations between umbilical cord IGF-1 with delta body weight (r= −0.459; P=0.004) and delta length at 6 months (r= −0.414; P=0.010). Conclusions.  There iss a decrease in IGF-1 levels at the first 6 months of life. Umbilical cord IGF-1 level has negative correlations with the weight and length increment at the age of 6 months.

The Relationship between Pesticide Exposure and Umbilical Serum IGF-1 Levels and Low-birth Weight: A Case-control Study in Brebes, Indonesia

BACKGROUND

Birth weight is very important for long-term physical, mental, health, and brain development. Pesticide exposure is thought to interfere with fetal growth, among others, through disruption of the function of the insulin-like growth hormone-1 (IGF-1) hormone.

OBJECTIVE

To analyze the relationship between exposure to pesticides during pregnancy and low-birth weight (LBW) through the disruption of the IGF-1 hormone.

METHODS

In a case-control study, babies born with LBW (birth weight <2500 g) and those born later with normal birth weight (=2500 g) at 2 hospitals in Brebes were chosen as cases and controls, respectively. Maternal pesticide exposure was measured by interview using a questionnaire. Umbilical serum IGF-I level was tested using the ELISA method.

RESULTS

There was a significant relationship between pesticide exposure during pregnancy and LBW (OR 6.8; 95% CI 2.0 to 22.9) and low umbilical serum IGF-1 levels (OR 3.6; 95% CI 1.2 to 11.1). There was a significant relationship between low umbilical serum IGF-1 levels and LBW (OR 8.9; 95% CI 2.4 to 32.1).

CONCLUSION

There was a significant relationship between pesticide exposure during pregnancy and LBW through the umbilical serum IGF-1 reduction pathway.

Effects of low glycemic index diet on insulin resistance among obese adolescent with non-alcoholic fatty liver disease: a randomized controlled trial

BACKGROUND Obesity is strongly correlated with insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). Some studies suggest that dietary intake with low glycemic index (GI) may prevent IR and reduce the incidences of NAFLD. This study was aimed to determine the effects of low GI diet on IR among obese adolescents with NAFLD. METHODS This study was a randomized controlled trial conducted in two JuniorHigh Schools in Semarang, Indonesia. The subjects were 12–14 years obese students with NAFLD, which divided into intervention and control groups according to schools using block random allocation. The intervention group received nutrition education and lunch diet (low energy, low GI, and low fat); meanwhile, the control group only received nutrition education for 12 weeks. The biochemical evaluation included fasting blood glucose (FBG) and insulin levels. IR was assessed using homeostatic model assessment-insulin resistance (HOMA-IR). RESULTS Thirty-two subjects were enrolled in this study, 16 of which were assigned to the intervention group and the other to the control group. After 12 weeks, the energy and carbohydrate intake reduced in the intervention group (p < 0.05), FBG remained unchanged, and HOMA-IR increased (4.9 [3.7]–7.2 [3.5]) compared to the control group (6.4 [4.9]–5.5 [2.8]) (p < 0.05). Meanwhile, within the control group, there were no significant differences in the energy and carbohydrate intake as well as biochemical variables. CONCLUSIONS Low GI modification diet alone may not reduce IR in the obeseadolescents with NAFLD.

Effect of tuberculosis treatment on leptin levels, weight gain, and percentage body fat in Indonesian children

PURPOSE

Tuberculosis (TB) remains a problem in the community. TB patients usually experience malnutrition, which is characterized by both decreased body weight (BW) and body fat percentage (BFP). Leptin, an important regulator of BW, also plays an important role in cellular immunity, which is integral to defense against Mycobacterium tuberculosis infection. We analyzed the effect of an anti-TB treatment regimen on the leptin level, BW, and BFP of children with TB.

METHODS

The design of this study was a group interrupted time series. The subjects were children with probable TB according to clinical criteria based on an Indonesian scoring system adopted from the Consensus of Expert Panel. BW; BFP; energy intake; fat and protein intake; and leptin levels before, 2 months after (intensive phase), and 6 months after (continuation phase) anti-TB treatment, were measured. About 40 children, aged 5-14 years, participated in this study.

RESULTS

The BW, BFP and leptin level increased from before treatment to after completion of the intensive phase and still showed an increased during the continuation phase: BW 18.65 kg, 19.75 kg, and 20.85 kg; BFP 18.3%, 19.5%, and 20.2%; and leptin level 1.9 mg/dL, 3.07 mg/dL, and 3.4 mg/dL, respectively (P<0.01).

CONCLUSION

Leptin level, BW, and BFP increased throughout the course of anti-TB treatment, compared with pretreatment values. Further research is needed to compare the results with data for healthy children.

Pemberian Diet Formula Tepung Ikan Gabus (Ophiocephalus striatus) pada Sindrom Nefrotik

Latar belakang. Pemberian diet dengan protein seimbang pada sindrom nefrotikbertujuan untuk meningkatkan kadar albumin serum. Ikan gabus merupakan ikan airtawar yang banyak dijumpai di Indonesia dan memiliki kadar protein lebih tinggidibandingkan ikan lainnya.Tujuan Penelitian. Penelitian ini bertujuan untuk mengevaluasi pemberiansuplementasi formula tepung ikan gabus terhadap peningkatan kadar albumin serumpasien sindrom nefrotik.Metodologi. Penelitian uji klinik terbuka dilakukan di Bangsal Anak RS Dr. KariadiSemarang, pada 36 anak dengan sindrom nefrotik kelainan minimal, yang terbagi dalamkelompok perlakuan dan kelompok kontrol. Kelompok perlakuan mendapatkansuplementasi ikan gabus, dengan cara mengganti 25% kebutuhan protein dengan tepungikan gabus. Suplemntasi ikan gabus diberikan setiap hari selama 21 hari, dengan jumlahprotein total yang diberikan sama dengan kelompok kontrol. Indeks masa tubuh (IMT),protein total, albumin dan globulin serum diukur setiap minggu, sedangkan akseptabilitastepung ikan gabus dinilai setiap hari. Analisis statistik menggunakan uji t independent.Hasil. Pada kedua kelompok didapatkan peningkatan IMT, kadar protein total danalbumin serum pada akhir penelitian dibandingkan dengan data awal. Tidak didapatkanperbedaan kadar protein total dan globulin pada akhir penelitian antara kelompokperlakuan dan kelompok kontrol. Selisih kenaikan kadar albumin pada kelompokperlakuan (2,04 ± 1,47 g/dl) lebih tinggi secara bermakna dibandingkan dengan kelompokperlakuan (1,47 ± 0,82 g/dl) dengan nilai p = 0,018.Kesimpulan. Pemberian suplementasi tepung ikan gabus selama 21 hari pada pasiensindrom nefrotik kelainan minimal dapat meningkatkan kadar albumin serum.

Maternal perception of sickness as a risk factor of stunting in children aged 2-5 years

Background<br />Stunting in children is caused by past nutritional problems, adversely affects the physical and mental characteristics of children and is a well-established child-health indicator of chronic malnutrition. Socio-cultural factors can affect parenting, thereby indirectly affecting child growth. The objective of this study was to determine socio-cultural factors and parental short stature as risk factors of stunting in children aged 2 to 5 years.<br /><br />Methods<br />The study used a quantitative approach with case control design and a qualitative approach with in-depth interview. The study subjects were children aged 2-5 years, consisting of 45 cases of stunting and 45 controls (normal subjects). Socio-cultural data were obtained through interviews with the mothers, while height was measured with a stadiometer. Data were analyzed using chi square and logistic regression tests to calculate the odds ratio (OR).<br /><br />Results<br />The logistic regression test showed that maternal perception of sickness as a curse (OR=7.43; 95% CI: 2.37-23.21), stopping breastfeeding at &lt;24 months (OR=6.01;95% CI: 1.83-19.69) and low household expenditure for food (OR=5.78;95% CI: 1.28-26.01) were risk factors of stunting incidence with a probability of 73.8%. The most dominant risk factor of stunting was maternal perception of sickness (OR=7.43 95% CI: 2.37-23.21). <br /><br />Conclusion<br />Maternal perception of sickness was the most dominant risk factor of stunting in children 2-5 years of age. A multidisciplinary approach is needed to address the range of raised issues and so combat stunting in children.

Status Gizi, Eosinofilia dan Kepadatan Parasit Malaria Anak Sekolah Dasar di Daerah Endemis Malaria

Latar belakang. Interaksi antara infeksi, status gizi dan imunitas telah lama diketahui, tetapi penelitiantentang interaksi ini di daerah endemis malaria masih terbatas.Tujuan. Bertujuan untuk mengetahui hubungan kepadatan parasit malaria dengan status gizi, kadarhemoglobin dan respon eosinofilia pada anak sekolah dasar di daerah endemis malaria.Metode. Penelitian belah lintang pada anak SD yang dipilih secara cluster random sampling di KabupatenSumba Timur Nusa Tenggara Timur pada tahun 2003. Diambil data status gizi, kadar hemoglobin,kepadatan parasit malaria dan jumlah eosinofilia dari darah subjek.Hasil. Dari 137 anak (57 laki-laki dan 83 perempuan) dengan rerata umur (11,5 ± 1,37) tahun, didapatkangizi kurang 63,6%. Tiga belas persen anak terdapat parasit malaria pada sediaan darah, eosinofilia pada32,9% anak. Kepadatan parasit malaria tinggi 7,9%. Kepadatan parasit malaria tidak berhubungan denganjenis kelamin, suku bangsa dan status gizi, tetapi kepadatan parasit malaria tinggi meningkatkan risikoanemia 2,1 kali (RP 2,1; 95% KI 1,6-2,8 ; p=0,006) dan tidak terjadinya respon eosinofilia 2,9 kali (RP2,9; 95% KI 1,9-4,2 ; p=0,001) .Kesimpulan. Sebagian besar anak mempunyai status gizi kurang. Kepadatan parasit malaria tidakberhubungan dengan jenis kelamin, suku bangsa dan status gizi. Tetapi kepadatan parasit malaria yangtinggi akan meningkatkan risiko anemia 2,1 kali dan tidak adanya respon eosinofilia 2,9 kali. 

Pengaruh Intervensi Diet dan Olah Raga Terhadap Indeks Massa Tubuh, Lemak Tubuh, dan Kesegaran Jasmani pada Anak Obes

Latar belakang. Obesitas telah berkembang menjadi epidemi baik di negara maju maupun negaraberkembang. Diduga bahwa intervensi diet dan olah raga dapat menurunkan risiko obesitas.Tujuan. Mengetahui pengaruh intervensi diet dan olah raga terhadap indeks massa tubuh, lemak tubuhdan kesegaran jasmani pada anak obesMetode. Uji intervensi one group pre and post test design pada anak SD usia 9–10 tahun di SD BernardusSemarang pada bulan Juni-September 2009. Intervensi diet berupa konseling pada anak dan orangtua.Intervensi olahraga tiga kali 45 menit per minggu selama 8 minggu. Pengambilan data pada awal danakhir penelitian berupa data antropometri dengan menggunakan timbangan Tanita BC 545 Inner ScanBody Composition dan tingkat kesegaran jasmani diukur menggunakan 20 meter shuttle run test, kemudiandilakukan analisis data dengan t-test berpasangan dan analisis multivariat.Hasil. Dua puluh subjek (17 laki-laki dan 3 perempuan) menyelesaikan penelitian. Didapatkan penurunanrerata indeks massa tubuh 0,6 kg/m2 (p=0,006) dan peningkatan rerata tingkat kesegaran jasmani sebesar1,66 ml/kg/menit (p=0,000), tetapi tidak didapatkan perbedaan secara bermakna terhadap lemak tubuh.Asupan diet harian berkurang 421,3 kkal/hari. Berdasarkan analisis multivariat, asupan makanan merupakanvariabel yang lebih berpengaruh dibandingkan dengan olahraga (rsquare=0,33, p=0,018).Kesimpulan. Intervensi diet dan olahraga selama 8 minggu menurunkan indeks massa tubuh, meningkatkantingkat kesegaran jasmani, tetapi tidak didapatkan pengaruh yang signifikan terhadap lemak tubuh. Asupandiet merupakan variabel yang paling berpengaruh.

Hubungan Fungsi Tiroid dengan Energy Expenditure pada Remaja

Latar belakang. Hormon tiroid adalah hormon yang dihasilkan oleh kelenjar tiroid yang berfungsi untukmensintesis hormon tiroksin (T4) dan 3,5,3 triodotironine (T3). Tiroid diatur oleh thyroid stimulatinghormone (TSH), glikoprotein yang diproduksi dan disekresi kelenjar hipofisis anterior. Dilaporkan bahwahormon TSH meningkat pada obesitas, sedangkan FT3 dan FT4 masih menjadi perdebatan.Tujuan. Mengetahui hubungan fungsi tiroid dengan energy expenditure pada remaja obesitas dan normal.Metode. Penelitian dilakukan pada anak SMP usia 12-13 tahun di Semarang pada tahun 2008 denganmetode potong lintang. Semua subyek diperiksa komposisi tubuh (indeks masa tubuh / IMT dan persentaselemak tubuh) dengan menggunakan Tanita BC 545, total energy expenditure (TEE) dengan akselerometer danresting energy expenditure (REE) dihitung berdasarkan rumus WHO. Data dianalisis menggunakan tes t tidakberpasangan dan uji korelasi Spearman.Hasil. Subyek penelitian 75 remaja (37 obesitas dan 38 normal), dengan rerata umur 13,2 tahun. FT4 danTSHs remaja laki-laki obesitas lebih tinggi dibanding subyek normal. Terdapat korelasi negatif (r=-0,29)antara FT3 dengan persentase lemak tubuh, korelasi positif antara TSHs dengan IMT (r=0,30) dan persentaselemak tubuh (r=0,34). Tidak didapatkan korelasi antara hormon tiroid dengan REE, tetapi FT3 berkorelasinegatif dengan TEE (r=–0,29), dan TSHs berkorelasi positif dengan TEE (r=0,25).Kesimpulan. Didapatkan korelasi positif antara TSHs dengan komposisi tubuh dan TSHs dengan TEE.Kadar TSHs pada laki-laki obesitas lebih tinggi dibanding normal walaupun hasilnya tidak signifikan secarastatistik.

Pengaruh Intervensi Konseling Feeding Rules dan Stimulasi Terhadap Status Gizi dan Perkembangan Anak di Posyandu Kabupaten Jayapura

Latar belakang. Kesulitan makan dalam jangka waktu lama dapat menimbulkan gagal tumbuh dan keterlambatan perkembangan anak.Tujuan. Mengkaji dampak intervensi (konseling gizi dengan metode feeding rules dan stimulasi) terhadap status gizi dan perkembangan anak di Posyandu Kabupaten Jayapura.Metode. Penelitian quasi experiment pre post test group dilakukan pada anak usia 6-24 bulan dengan kesulitan makan, di 6 Posyandu Kecamatan Sentani Kabupaten Jayapura. Konseling dengan metode feeding rules dan stimulasi dengan SDIDTK (Stimulasi, Deteksi dan Intervensi Dini Tumbuh Kembang) selama 4 bulan (Agustus-Desember 2012), diberikan oleh kader Posyandu terlatih kepada ibu /pengasuh dan anaknya. Status gizi setelah intervensi diukur berdasarkan skor WAZ (Weight for Age z-score), HAZ (Height for Age z-score), dan WHZ (Weight for Height z-score) sedangkan perkembangan diukur dengan data skor KPSP (kuesioner pra skrining perkembangan) diuji dengan menggunakan uji t berpasangan dan uji Wilcoxon.Hasil. Subyek berjumlah 119 anak (58,8% laki-laki), 83,2% di antaranya mengalami kesulitan makan kategori inappropriate feeding practice. Peningkatan bermakna skor WAZ -0,59 (SB 0,93) menjadi -0,45 (SB 0,66) (p=0,010), HAZ -0,59 (SB 1,01) menjadi -0,49 (SB 0,83) (p=0,021), dan WHZ -0,38 (SB 0,94) menjadi -0,28 (SB 0,77) (p=0,014), dan skor KPSP dari 8,76 (SB 1,00) menjadi 9,11 (SB 0,72) (p=0,002) antara sebelum dan sesudah intervensi.Kesimpulan. Terdapat peningkatan secara bermakna status gizi dan perkembangan pada anak dengan kesulitan makan usia 6-24 bulan setelah diberikan konseling gizi dengan metode feeding rules dan stimulasi SDIDTK selama 4 bulan di Posyandu.

Event Free Survival Enam Bulan Kejadian Tumor Cachexia Syndrome pada Anak dengan Keganasan

Latar belakang. Jumlah kasus kanker pada anak dengan komplikasi tumor cachexia syndrome (TCS) terusmeningkat. Penyebab TCS bersifat multifaktorial, yaitu asupan makanan yang kurang, malabsorbsi, dansitokin oleh tumor. Pengelolaan pasien anak dengan keganasan di rumah sakit tidak hanya dari terapi antikanker tetapi juga nutrisi. Nilai event free survival (EFS) terhadap kejadian TCS merupakan salah satuindikator keberhasilan pengelolaan kanker di rumah sakit.Tujuan. Menentukan EFS 6 bulan terhadap kejadian TCS pada pasien anak dengan keganasan.Metode. Desain kohort retrospektif berdasarkan catatan medik pasien anak dengan keganasan yang dirawatdi RSUP Dr. Kariadi Semarang pada bulan Januari 2007 - Desember 2012. Kriteria inklusi adalah pasienusia 0-14 tahun, dengan diagnosis keganasan baik tumor padat maupun hematologi, dan tidak mengalamikakeksia pada saat diagnosis ditegakkan. Dilakukan pengamatan secara klinis dan laboratoris tiap bulanselama 6 bulan untuk menentukan terjadinya TCS. Analisis statistik menggunakan uji Kaplan Meier.Hasil. Didapatkan 83 subjek dengan keganasan, rerata umur pada kelompok tumor padat 61,2 (SD48,37) bulan, dan keganasan hematologi 79,9 (SD 48,37) bulan p=0,032. Empatbelas dari 40 (35%) anaktumor padat dan 10 dari 43(23,3%) anak dengan keganasan hematologi mengalami TCS. Kejadian TCSdidapatkan mulai pengamatan bulan kedua. Rerata terjadi TCS pada tumor padat 4,4 bulan dan padakeganasan hematologi 4,9 bulan. Event free survival 6 bulan kejadian TCS pada tumor padat 65% dankeganasan hematologi 76,7%, p= 0,207.Kesimpulan. Event free survival 6 bulan kejadian TCS pada pasien tumor padat lebih rendah daripadakeganasan hematologi, tetapi tidak berbeda secara statistik

Kadar Kortisol Serum sebagai Indikator Prognosis Sepsis pada Anak

Latar belakang. Salah satu respon utama terhadap stres adalah aktivasi aksis hipotalamus-hipofisis-adrenal, diketahui denganpeningkatkan produksi kortisol.Tujuan. Membuktikan kadar kortisol dapat digunakan sebagai prediktor luaran sepsis.Metode. Penelitian prospektif, dilakukan di RSUP Dr. Kariadi Semarang. Sepsis didiagnosis menurut Konsensus Konfrensi Sepsispada Anak tahun 2005, dikelompokkan sebagai luaran perbaikan dan perburukan. Kortisol serum dianalisis dengan metode ELISA.Uji Mann-Whitney U digunakan untuk menganalisis perbedaan kadar kortisol pada luaran sepsis anak. Kadar kortisol dianalisislebih lanjut menggunakan ROC dan ditentukan titik potong yang optimal.Hasil. Sejumlah 30 anak dengan diagnosis sepsis diikutsertakan dalam penelitian. Kadar kortisol serum subyek berkisar 64,62 – 836,15ng/mL, menunjukkan peningkatan (normal 24 – 229) ng/mL. Median kadar kortisol pada luaran perbaikan 187,05 (64,62-509,08)ng/mL dan pada luaran perburukan 740,91 (299,45-836,15) ng/mL. Terdapat perbedaan bermakna kadar kortisol serum pada luaranperbaikan dan luaran perburukan (p<0,001). Luas area di bawah kurva ROC 0,958, dengan titik potong kadar kortisol 323 ng/mL,RR 48,0 (IK95%:4,304–535,256; p<0,001)Kesimpulan. Kadar serum kortisol lebih dari 323 ng/mL merupakan prediktor luaran perburukan pada sepsis anak.

The influence of intensive nutritional counseling in Posyandu towards the growth 4-18 month old children

Introduction Under 5 years is a critical period for child growth,when growth faltering often occurs. Periodical growth monitoringand nutritional counseling can detect growth faltering earlier, de-termine the cause, and find alternatives to solve such problems.Objective To determine the benefit of nutritional counseling onknowledge, attitude, practice of mothers, and child growth.Methods A randomized controlled trial was conducted inSendangguwo, Semarang on 143 children of the treatment groupand 135 children of the control group. Nutritional counseling wasgiven to mothers in the treatment group by trained health volun-teers. Changes of weight for age Z-score (WAZ), height for age Z-score (HAZ), and weight for height Z-score (WHZ) were analyzedrepeatedly by using ANOVA. The differences of ΔWAZ, ΔHAZ, andΔWHZ between groups were compared by student t-test. GEE (gen-eralized estimating equation) analysis was used to analyze theeffect of confounding variables on the changes of WAZ.Results After 6 months of counseling, knowledge, attitude, andpractice of nutrition in the treatment group significantly increasedcompared to that of the control group (P<0.001). The WAZ, HAZ,and WHZ curves in the control group decreased. However, in thetreatment group, WHZ increased and there was stabilization ofWAZ. At the end of the study, treatment group had significantlyimproved their WAZ (P<0.001), HAZ (P=0.004), and WHZ(P<0.001) compared to that of the control group.Conclusion Nutritional counseling can improve knowledge, atti-tude, and practice of mothers, and has beneficial effects on childgrowth by WAZ, HAZ, and WHZ

The effect of soybean formula and formula 100 supplementation on the growth of preschool children

Background Preschool children are vulnerable in growth. Soy-bean formula (SF) and formula-100 (F100) are supplementary foodswhich contain of high energy and are available at low price; how-ever, they are not widely used for preschool children.Objectives To investigate the effect of SF compared to F100 onthe growth of preschool children.Methods A cross-over trial was conducted on 96 preschool chil-dren aged 4-7 years. Subjects were randomly divided into 2 groupswhich received 200 ml soybean formula (n=49) or F100 (n=47) for1 month and crossed-over after a six-week wash-out period. Bodyweight was measured weekly. Body height and food analysis by 3-day food recall were measured at the beginning and the end of thestudy. The criteria of the acceptability of the formula was eithergood or poor.Results Supplementation with SF as well as F100 induced catchup growth as shown by the increase of Δz-score. There were nosignificant difference of Δ weight for age z-score, Δ height for agez-score, and Δ weight for height z score between groups duringthe first and second phases of the trial. The acceptability of F100was significantly better than that of SF at the beginning; neverthe-less, the difference was not significant at the second phase trial.Conclusions Soybean formula and F100 given for a one monthperiod can induce catch-up growth in preschool children. Soybeanformula as an alternative health food can be accepted by preschoolchildren

Effect of maternal health education on physical activity and body mass index of overweight children

Background The percentage of overweight children in Bengkulu (16.4%) is higher than the national percentage (11.9%). High energy intake and low physical activity are two factors that cause overweight.Objective To assess the impact of maternal health education on changes in maternal behavior, as well as energy intake, physical activity level, and body mass index (BMI) z-scores in overweight children aged 3-6 years.Methods This study was a quasi-experiment with non-randomized, pre-post test control group, conducted in Bengkulu, Indonesia from January to April 2014. Subjects consisted of 48 mothers with overweight children, who were selected purposively and divided into 2 groups (treatment and control). Subjects’ parents kept records of their children’s food intake and daily activity. These records were used to measure energy intake and physical activity. Health education in the treatment group was conducted 6 times in 12 weeks, while the control group received health education only once at the beginning of the study.Results In the treatment group, the child physical activity level [0.04 (SD 0.01)] increased, while the % RDA for energy [-3.4 (SD 13.26)%] and BMI z-score [-0.57 (SD 0.26)] decreased. Significant differences were observed between the treatment and control groups in terms of maternal attitude, and children’s % RDA for energy, physical activity level, and BMI z-score after intervention (P <0.05).Conclusion Health education for mothers effects a positive change in maternal attitude, as well as increased physical activity level, decreased energy consumption relative to their need, and BMI z-score in overweight children.

The role of uncoupling protein 2 and 3 genes polymorphism and energy expenditure in obese Indonesian children

AIM

Uncoupling protein (UCP) genes, which may contribute to energy metabolism in mitochondria, may be involved in the pathogenesis of obesity. We analyzed the differences in energy expenditure between single nucleotide polymorphisms (SNPs) UCP3-55C/T, UCP3 Y210Y, and UCP2 A55V among Indonesian children.

METHODS

The study included 76 schoolchildren (36 obese and 40 healthy; mean age, 12.8 years) in Semarang, Indonesia. Body composition was measured by bioelectrical impedance analysis; resting energy expenditure (REE) by indirect calorimetry; physical activity by uniaxial accelerometer; and total energy expenditure (TEE) by the equations extrapolated from REE and physical activity. UCP3-55C/T, UCP3 Y210Y, and UCP2 A55V were examined by restriction length fragment polymorphism analysis.

RESULTS

The TEE of the subjects with the T/T genotype at UCP3-55C/T after adjusting for fat-free mass (63.2±7.2 kcal/kg/day) and T/T at UCP2 A55V (62.8±5.6 kcal/kg/day) was lower than that of the subjects with the C/C and C/T genotypes (p<0.05). The REE of the subjects with these T/T genotypes tended to be lower than that of the subjects with C/C and C/T (p≥0.05). No significant differences in REE or TEE were found between the UCP3 Y210Y genotypes.

CONCLUSIONS

The subjects with the T/T genotypes of UCP3-55C/T or UCP2 A55V had lower TEE than those with other genotypes.

Aspartate aminotransferase-platelet ratio index and body mass index in children with fatty liver

Background Obesity in children is becoming a global epidemic.Non􀀷alcoholic fatty liver disease (NAFLD) is a highly prevalentand potentially serious complication of childhood obesity. Theearly identification of fibrosis is important in children v.ith NAFLDin order to prevent the development of liver disease in adulthood.One non􀀷invasive procedure to predict liver fibrosis is the aspartateaminotransferase (AST)􀀷platelet ratio index (APRI).Objective The purpose of our study was to assess a correlationbetween APRI and body mass index (BMI) in obese childrenwith fatty liver.Methods A cross􀀷sectional study was conducted from August toSeptember 2007. Subjects were obese children from one juniorhigh school in Semarang. Complete blood count, transaminaseenzyme measurement, and abdominal ultrasound (USG) wereperformed on each subject. Only subjects with bright liver onUSG underwent APRI analysis. Spearman's correlation was usedfor statistical analysis.Results Of 3 7 obese children, 19 children had bright liver on USG.Their mean APRI was 0.16 (SD 0.119). Only one obese subject(1137) with bright liver had an APRI > 0.5. APRI was significantlycorrelated to alanine amino transferase (ALT) levels (r = 0.62),but not significantly correlated to weight and BMI.Conclusion There was no correlation between APRI and BMI.Only lout of 37 obese children with fatty liver had APRI levelsindicating the presence of liver fibrosis. [Paediatr Indones.2012;52:181-4].