SDGS in children during the COVID-19 pandemic in Indonesia

This global pandemic negatively affects many aspects of children and adolescent health in Indonesia, including our journey in achieving SDGs. Even before the pandemic, our country is not yet on the right track in our SDGs journey with no national comprehensive programs. If we do not urgently address the problems in our nation’s health system, the COVID-19 pandemic can be detrimental to our SDGs progress

Childhood Obesity as a Global Problem: a Cross-sectional Survey on Global Awareness and National Program Implementation

INTRODUCTION: The rising global epidemic of childhood obesity is a major public health challenge. Despite the urgency, there is a lack of data on the awareness and implementation of preventative measures. The aim of this study was to identify areas for improvement in the prevention and management of childhood obesity worldwide. METHODS: A cross-sectional electronic survey was distributed to 132 members of national pediatric societies of the International Pediatric Association. RESULTS: Twenty-eight (21.2%) participants, each from a different country across six World Health Organization (WHO) regions completed the survey. Most participants reported that national prevalence data of childhood obesity is available (78.6%), and the number increased during the Coronavirus disease-2019 pandemic (60.7%). In most countries (78.6%), the amount of sugar and salt in children's products is provided but only 42.9% enacted regulations on children-targeted advertising. Childhood obesity prevention programs from the government (64.3%) and schools (53.6%) are available with existing support from private or non-profit organizations (71.4%). Participants were aware of WHO's guidance concerning childhood obesity (78.6%), while fewer were aware of The United Nations International Children's Emergency Fund's (UNICEF) guidance (50%). Participants reported that WHO/UNICEF guidance acted as a reference to develop policies, regulations and national programs. However, progress was hindered by poor compliance. Lastly, participants provided suggestions on tackling obesity, with responses ranging from developing and reinforcing policies, involvement of schools, and prevention across all life stages. DISCUSSION AND CONCLUSION: There are different practices in implementing prevention measures to counter childhood obesity globally, particularly in statutory regulation on food advertising and national programs. While support and awareness was relatively high, implementation was hindered. This reflects the need for prompt, country-specific evaluation and interventions

Stunting as a Synonym of Social Disadvantage and Poor Parental Education

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education

Tata laksana Metformin Diabetes Mellitus Tipe 2 pada Anak Dibandingkan dengan obat Anti Diabetes Oral yang lain

Prevalens dan insidens diabetes mellitus tipe 2 (DMT2) pada anak terus mengalami peningkatan di seluruh dunia. Data di Indonesia menunjukkan prevalens diabetes pada anak di daerah perkotaan Jakarta meningkat dari 1,7% pada tahun 1982 menjadi 5,7% pada tahun 1995, namun sayangnya tidak ada data lebih lanjut mengenai prevalens DMT2. Sampai saat ini, obat anti diabetik oral yang sudah disetujui penggunaannya pada anak oleh oleh Food and Drug Administration (FDA) hanya metformin. Sedangkan obat anti diabetik oral golongan lain masih dalam perdebatan. Dari penelusuran literatur didapatkan bahwa secara umum mekanisme kerja obat-obat tersebut dalam mengontrol kadar gula darah yaitu dengan meningkatkan sekresi insulin seperti obat golongan sulfonylurea, menurunkan resistensi insulin seperti obat golongan biguanid dan menurunkan absorpsi glukosa postprandial seperti obat golongan inhibitor-glucosidase. Keberhasilan terapi dinilai berdasarkan kadar glukosa darah, kadar HbA1c, dan sindrom metabolik yang menyertainya seperti obesitas, hipertensi dan hiperlipidemia. Sampai saat ini belum ada data mengenai efektifitas dan keamanan penggunaan obat anti diabetik oral selain biguanid metformin. Uji klinis mengenai penggunaan obat-obatan anti diabetik oral selain metformin pada anak dengan DMT2 masih perlu dilakukan untuk dapat dijadikan suatu rekomendasi terapi. Selain mengontrol kadar gula darah, tata laksana DMT2 juga meliputi modifikasi gaya hidup dan mengatasi gejala sindrom metabolik yang menyertainya

Prevalence of insulin resistance in obese adolescents

Background Childhood obesity is a global health problem, with the prevalence is differed in each country and affected by many factors, such as lifestyle and physical activity. Insulin resistance (IR) as a basic mechanism of several metabolic diseases in obesity, is related with metabolic syndrome (MetS) along with its long term complications, such as type 2 diabetes mellitus (T2DM). Several factors are known to be associated with IR, and the presence of acanthosis nigricans (AN) has an important meaning in predicting IR. Objectives To assess the prevalence of IR, MetS in obese adolescents and its potentially associated factors, such as gender, signs of AN, and family history of metabolic diseases. Methods A cross-sectional study was performed in obese adolescents, aged 12-15 years, over a two-month period. Fasting blood glucose, insulin, and lipid profiles were measured. Obesity was defined using body mass index (BMI). Insulin resistance was quantified by the homeostasis model assessment for IR (HOMA-IR) . Metabolic syndrome was defined according to the International Diabetes Federation (IDF) 2007 criteria. Results Of92 obese adolescents, IR was found in 38% of subjects, with females predominating (57.2%). Signs of AN were seen in 71. 4% of subj ects and a positive family history of metabolic diseases was found in 82.8% of subjects, including family history of obesity, type 2 diabetes mellitus (T2DM), and hypertension. Less than 10% of subjects were considered to be in a prediabetic state, and none had T2DM. No statistical significance was found between gender, family history, or signs of AN and IR (P>0.05). Metabolic syndromes was found in 19.6% of subjects, with the fo llowing prevalences for each component: 34.8% for hypertension, 78.3% for central obesity, 8.7% for impaired fasting glucose (IFG), 22.8% for low levels of HDL, and 2 1. 7% for high triglyceride levels. A strong correlation was found between IR and IFG with OR= 5 .69 (95%CI 1.079 ~ 29.993, P= D.04). Conclusion We find a high prevalence ofIRin obese adolescents, and IR increases the risk of prediabetes. Thus, prevention strategies are needed to overcome the long term impact of obesity on health