The Effect of Vitamin E Supplementation on Lipid Profiles and Adiponectin Levels in Obese Adolescents: A Randomized Controlled Trial

Background: low-grade chronic inflammation in obese individuals contributes to the development of lipid abnormality and insulin resistance. Vitamin E has antioxidant and insulin-sensitizing properties, mediated by adiponectin. In this study, we aimed to evaluate the effect of vitamin E supplementation on lipid profiles and adiponectin levels in obese adolescents. Methods: this was a randomized, double-blind, controlled study. Obese adolescents aged 14-18 years, with no history of taking anti-obesity or antioxidant drugs, were recruited and randomized into two groups: vitamin E and placebo. The dose of vitamin E was 400 IU/day. Intervention was administered for two months. Lipid profiles and adiponectin levels were measured at baseline and after intervention. Primary outcomes were analyzed using the per-protocol analysis principle. Statistical analysis was performed using the independent t-test or the Mann-Whitney U test. Results: a total of 66 subjects completed the intervention study, 34 in the vitamin E group and 32 in the placebo group. Lipid profiles and adiponectin levels at 2 months after intervention did not differ significantly between the two groups. Changes from the baseline level were also not significantly different between the two groups and were inconsistent from one subject to another. Conclusion: in obese adolescents, vitamin E supplementation of 400 IU/day for 2 months does not significantly affect lipid profiles and adiponectin levels

Vitamin D levels in epileptic children on long-term anticonvulsant therapy

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels. Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children. Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjects’ 25(OH)D levels were measured by enzyme immunoassay. Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children. Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epileptic children, but none had vitamin D deficiency

Prevalence and Predictors of Complementary Feeding Practices Among Children Aged 6-23 Months in Indonesia

Objectives: Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Methods: We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children’s Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design. Results: The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali. Conclusions: It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low

Defisiensi Besi dan Anemia Defisiensi Besi pada Anak Remaja Obes

Latar belakang. Remaja merupakan kelompok risiko tinggi untuk mengalami defisiensi besi. Obesitas pada remaja meningkatkan risiko defisiensi besi akibat perbedaan pola asupan dan inflamasi kronik derajat rendah. Tujuan. Mengetahui status besi dan asupan besi remaja obes usia 15 -17 tahun. Metode. Penelitian potong lintang pada remaja usia 15 – 17 tahun di dua SMU Jakarta Pusat pada bulan September – November 2015. Subjek dibagi menjadi 2 kelompok berdasarkan indeks massa tubuh (IMT). Subjek dinyatakan obes bila IMT≥P95 dan non-obes bila IMT ≥P5 - <P85. Kepada subjek dilakukan penilaian status besi, yaitu hemoglobin, mean corpusculus volume (MCV), besi serum, feritin, saturasi transferin, dan total iron bonding capacity (TIBC) serta analisis diet. Hasil. Sebanyak 100 subyek memenuhi kriteria inklusi yang terdiri dari 52 subjek obes dan 48 subjek non-obes. Tidak terdapat perbedaan bermakna proporsi defisiensi besi dan anemia defisiensi besi pada kelompok obes dan non-obes (9,6% vs 16,7%; p=0,295). Tidak terdapat perbedaan bermakna asupan zat besi total kelompok obes dan non-obes ( 8 (2,6 – 95,9) mg/hari vs 10 (1,8 – 83,4) mg/hari; p=0,188). Persentase asupan zat besi hem kelompok obes lebih tinggi dibandingkan kelompok non-obes (31 (0,0 – 95,6)% vs 20 (15,2 – 100,0)%; p=0,029). Kesimpulan. Tidak terdapat perbedaan proporsi defisiensi besi dan anemia defisiensi besi pada remaja obes dan non obes usia 15 – 17 tahun. Tidak terdapat perbedaan rerata asupan zat besi remaja obes dan non-obes usia 15 – 17 tahun

Massa Dan Fungsi Ventrikel Kiri Pada Malnutrisi Energi Protein Tipe Marasmus

Objectives. To determine the left ventricular mass, the left ventricular systolic anddiastolic function of children suffering protein energy malnutrion marasmic type. Material.Pediatric patients suffering protein energy malnutrion marasmic type who came for treatment in Division of Pediatric Metabolic Nutrition, Departement of Child Health, Medical Faculty, Cipto Mangunkusumo Hospital Jakarta between June to August 2007.Methods. A cross-sectional study was conducted to evaluate left ventricular systolic function (EF and FS), left ventricular diastolic function (E, A, ratio E/A and IVRT) and left ventricular mass (LVDDi, LVDSi, LVMi) by Ultrasonography Sonos 4500. The student t-test was used, statistical significant was assumed with a&lt; 0.05 with program SPSS 15.0 version. Results. Out of 25 subjects examined (9 male and 16 female), the left ventricular mass in marasmic patients was lower compared to control. Mean of LVMi (g/m2) marasmic and control each 22.5 (SD 17.7) and 39.1 (SD 41.1); p &lt; 0.02. Systolic and diastolic function in marasmic were lower than the control and the difference was statistically significant. Mean EF in marasmic and control each 56.4% (SD 7.2) and 73.2% (SD 7,7) ; p = 0.001. Mean FS 28.6% (SD 4,9) and 40.4% (SD 8.7) ; p = 0.001. Mean ratio E/A in marasmic and control each 1.79 (SD 0.5) and 1.54 (SD 0.2); p = 0.04Conclusions. The left ventricular mass in marasmic was lower than a child with good nutrition. The left ventricular systolic and diastolic function of marasmic patients were disturbed. The left ventricular diastolic function seen in restrictive pattern.Tujuan. Menilai massa, fungsi sistolik dan fungsi diastolik ventrikel kiri padaanak yang menderitamalnutrisi energi protein (MEP) tipe marasmus. Tempat penelitian. Divisi Kardiologi dan Divisi Gizi Metabolik Anak FK UI/RSCM Jakarta.Subyek penelitian. Penderita malnutrisi energi protein (MEP) tipe marasmus yang dirawat atau yang datang berobat ke Divisi Gizi Metabolik Anak FKUI-RSCM sejak bulan Juni– Agustus 2007. Metode. Dilakukan penelitian observasional dengan rancang bangun cross sectional. Data meliputi fungsi sistolik ventrikel kiri (EF dan FS), fungsi diastolik ventrikel kiri (E, A, rasio E/A, IVRT) danmassa ventrikel kiri ( LVDDi, LVDSi, LVMi) dengan menggunakan mesin ultrasonografi Sonos 4500, transduser 8 MHz. Data diolah dengan SPSS versi 15. Dilakukan uji t. Nilai yang dipakai adalah 0,05. Jumlah subyek minimal yang diperlukan adalah 25.Hasil. Dari 25 subyek marasmus yang diperiksa (9 laki – laki dan 16 perempuan). Massa ventrikel kiri marasmus lebih rendah dibanding kontrol. Rerata LVMi (g/m2) marasmus dan kontrol masing-masing 22,5 (SB 17,7) dan 39,1 (SB 41,1); p&lt; 0,02. Fungsi sistolik dan diastolik marasmus lebih rendah dibanding kontrol dan perbedaan ini secara statistik bermakna. Rerata EF marasmus dan kontrol masing-masing adalah 56,4% (SB 7,2) dan 73,2% (SB 7,7) ; p = 0,001. Rerata FS 28,6% (SB 4,9) dan 40,4% (SB 8,7) ; p = 0,001. Rerata rasio E/A marasmus dan kontrol masing-masing 1,79 (SB 0,5) dan 1,54 (SB 0,2); p = 0,04. Kesimpulan. Massa ventrikel kiri pasien marasmus lebih rendah dari pada anak gizi baik,Fungsi sistolik dan fungsi diastolik pasien marasmus telah mengalami gangguan. Fungsi diastolik ventrikel kiri memperlihatkan pola restriktif

Glucose and Lipid Profiles in Adolescents with Thalassemia Major and Its Association with Iron Overload in Specific Organs

BACKGROUND: Organ damage due to iron toxicity is one factor that increases the risk of getting cardiovascular and metabolic diseases in thalassemia patient. This study aims to determine glucose and lipid profiles in adolescents with thalassemia major and its association with iron overload in pancreas and liver.METHODS: This was a cross sectional study. Subjects were thalassemia major adolescents without any confounding factors that may affect glucose and lipid levels. Blood samples were collected to measure the glucose level, lipid profiles, ferritin level and transferrin saturation. T2-Magnetic Resonance Imaging was used to evaluate the iron overload in organs.RESULTS: From a total of 60 subjects, diabetes mellitus was diagnosed in 1 subject and impaired fasting glucose was diagnosed in 3 subjects. All subjects had high triglycerides/ high density lipoprotein-cholesterol (HDL-C) ratio, 59 subjects (98%) had low HDL-C, 18 subjects (30%) had hypertriglyceridemia, and none had abnormal high level of low density lipoprotein-cholesterol (LDL-C). The majority of subjects had ferritin ≥2,500 ng/mL (70%), mild pancreatic iron overload (56.6%), and moderate hepatic iron overload (43.8%). Degree of hyperferritinemia was not associated with glucose and lipid profiles. Blood glucose profiles were not associated with various degree of pancreatic iron overload. Similar result was also observed between lipid profiles and hepatic iron overload.CONCLUSION: Abnormal glucose and lipid profiles in thalassemia major can be found in adolescence. Normal blood glucose level isn’t necessarily associated with normal pancreatic iron deposition. Hepatic iron overload may worsen dyslipidemia in thalassemia major patients.KEYWORDS: glucose profile, lipid profile, pancreatic iron overload, hepatic iron overload, thalassemia majo

Pewarnaan Gram Urin untuk Diagnosis Infeksi Saluran Kemih pada Anak Usia 2 Bulan hingga 2 Tahun

Latar belakang. Infeksi saluran kemih (ISK) merupakan salah satu penyakit infeksi yang sering ditemukan pada anak usia 2 bulan hingga 2 tahun. Kondisi ini sulit dideteksi karena manifestasi klinis yang tidak spesifik. Kultur urin sebagai baku emas menegakkan diagnosis ISK membutuhkan waktu yang lama dan biaya yang mahal. Pewarnaan Gram urin adalah metode yang mungkin dapat digunakan untuk diagnosis dini ISK pada bayi dan anak. Tujuan. Membandingkan metode pewarnaan Gram dan kultur urin untuk mendiagnosis ISK pada anak usia 2 bulan hingga 2 tahun. Metode. Penelitian ini merupakan uji diagnostik dengan metode potong lintang di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia, dari Mei 2016 -Desember 2017. Penelitian ini melibatkan 59 anak usia 2 bulan hingga 2 tahun yang dicurigai menderita ISK yang direkrut dengan metode consecutive sampling. Sampel urin diambil dengan kateterisasi uretra dan dilakukan pemeriksaan urinalisis, pewarnaan Gram, dan pemeriksaan biakan urin. Hasil. Prevalens ISK didapatkan sebesar 38,9%. Pewarnaan Gram urin memiliki sensitivitas 47,8% (95% IK 26,8-69,4%), spesifisitas 97,2% (95% IK 85,5-99,9%), nilai duga positif 91,7% (95% IK 60,3-98,8%), nilai duga negatif 74,5% (95% IK 60,3-98,8%), LR(+) 17,2 (95% IK 2,4-124,6), LR(-) 0,54 (95% IK 0,36-0,8), dan akurasi sebesar 78%. Kesimpulan. Terdapat korelasi yang baik antara pewarnaan Gram urin dan hasil biakan urin untuk mendiagnosis ISK pada anak usia 2 bulan hingga 2 tahun. Antibiotik dapat segera diberikan setelah pewarnaan Gram menunjukkan hasil positif

Hubungan antara Ukuran Lingkar Pinggang dengan Masa Lemak Tubuh, Profil Lipid, dan Gula Darah Puasa pada Remaja Obese

Latar belakang. Obesitas pada anak masih menjadi masalah dunia, termasuk Indonesia. Obesitas abdominal, yang ditandai dengan besarnya ukuran lingkar pinggang, dapat meningkatkan risiko penyakit kardiovaskular, metabolik, dan kematian. Tujuan. Penelitian ini bertujuan untuk mendapatkan gambaran ukuran lingkar pinggang pada anak obes, serta hubungannya dengan masa lemak tubuh, profil lipid, dan kadar gula darah puasa. Metode. Penelitian ini merupakan studi potong lintang. Subjek penelitian adalah anak usia 14-18 tahun dengan obesitas. Pemeriksaan tinggi badan, berat badan, lingkar lengan atas, lingkar pinggang, dan bioelectric impedance analyzer (BIA) dilakukan untuk memperoleh gambaran antropometri subjek. Pemeriksaan darah puasa dilakukan untuk memperoleh data profil lipid dan gula darah puasa. Hasil. Sebanyak 69 subjek terlibat dalam penelitian ini. Semua subjek mempunyai lingkar pinggang ≥P80, dengan lingkar pinggang terlebar adalah 138 cm. Ukuran lingkar pinggang mempunyai korelasi yang bermakna dengan kolesterol high density lipoprotein (HDL), sedangkan korelasi dengan masa lemak tubuh, profil lipid lainnya, dan kadar gula darah puasa tidak bermakna. Kesimpulan. Obesitas pada anak umumnya disertai dengan ukuran lingkar pinggang yang melebihi P80. Ukuran lingkar pinggang mempunyai korelasi yang bermakna dengan kadar kolesterol HDL. Ukuran lingkar pinggang tidak boleh digunakan secara tunggal untuk memperkirakan masa lemak tubuh, profil lipid di luar kolesterol HDL, dan gula darah puasa

The effect of non-organophosphate household pesticides exposure during pregnancy on infants birth sizes and growth rate: a cohort study

BACKGROUND: To date, there is limited evidence on the effect of antenatal exposure to non-organophosphate household pesticides on infant health. Our hypothesis is that antenatal exposure to non-organophosphate household pesticides will be associated with birth sizes and infant growth rate. METHODS: In this prospective cohort study, 284 mother-infant pairs were studied. Mothers were recruited at the third trimester in two primary care centers and one private hospital in Jakarta, Indonesia. Mothers filled out questionnaires about exposure to non-organophosphate household pesticides at the 3rd trimester of pregnancy. Birth weight and length were measured at birth. Afterwards, the weight, height, and head circumference (HC) were measured at 7 days, 1, 2, 4, and 6 months of age. Linear mixed modeling and linear regression was performed to calculate growth rate of each infant. Multivariable linear regression adjusted for confounders was used to assess the association between household pesticides exposure and birth sizes and infant growth rate. RESULTS: Based on self-report questionnaires, 133 (46.8%) mothers were exposed to household pesticides during pregnancy. The mean HC at day 7 in the exposed group was - 7.1 mm (95%CI -13.1;-1.2) lower than in the non-exposed group. The difference was more prominent in the non-mosquito pesticide group (linear regression coefficient: - 22.1 mm, 95%CI -36.5;-7.6). No material associations were found between antenatal exposure to household pesticides with other growth measures, including weight gain, length gain, HC increment and weight-to-length gain rates. No modification of effects by breastfeeding was found. CONCLUSIONS: Our findings suggest that antenatal exposure to household non-organophosphate pesticides is associated with smaller head circumference at birth

Nutrisi dan Kesehatan Gigi-Mulut pada Anak

Nutrisi dan kesehatan gigi dan mulut memiliki kaitan yang erat terutama pada anak yang memiliki fase tumbuh kembang. Nutrisi yang baik dan tepat penting untuk menunjang kesehatan gigi dan mulut. Sebaliknya, kesehatan gigi dan mulut juga penting untuk asupan nutrisi yang adekuat. Karies gigi merupakan salah satu penyakit infeksi kronis yang paling sering terjadi pada anak dan memiliki kaitan erat dengan nutrisi. Berdasarkan sifatnya dalam memicu karies, bahan makanan dibagi menjadi tiga kelompok, yaitu anti-kariogenik, kariogenik, dan kariostatik. Beberapa penelitian menunjukkan bahwa pemberian ASI tidak terbukti memicu karies. Sebaliknya, kebiasaan konsumsi makanan/minuman berkadar gula tinggi, makanan cepat saji, dan makanan ringan diantara waktu makan meningkatkan risiko karies pada anak. Anak dengan gizi lebih dan obesitas juga memiliki risiko karies yang lebih tinggi. Peran suplemen fluoride dan silitol dalam pencegahan karies masih kontroversial. Sementara itu, konsumsi probiotik terbukti mampu mencegah karies dentis. Pencegahan karies dengan mengurangi kebiasaan konsumsi makanan manis, makanan cepat saji, makanan ringan, minuman soda, mencegah obesitas pada anak, serta didukung oleh kebiasaan menyikat gigi dengan teratur sangat penting dalam menjaga kesehatan gigi dan mulut anak