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Abstrak :

Carborxymethyl lysine dalam makanan (dCML), CML plasma (pCML), dan tumor necrosis alpha plasma (pTNF-α) mungkin dapat memengaruhi obesitas. Namun database kandungan CML makanan di Indonesia dan penelitian tentang pengaruh asupan CML terhadap obesitas pada wanita Asia belum pernah dilaporkan sebelumnya.

Penelitian ini bertujuan untuk mendapatkan database CML makanan Indonesia dan menilai efek mediator dCML, pCML, dan pTNF-α terhadap lingkar pinggang (WC), rasio lingkar pinggang terhadap tinggi badan (WHtR), dan indeks masa tubuh (IMT).

Penelitian potong lintang dilakukan terhadap 235 wanita sehat berusia 19-50 tahun, yang bertempat tinggal di daerah pesisir pantai dan pegunungan di Sumatra Barat dan Jawa Barat. Database CML dibuat berdasarkan estimasi dari database CML yang telah dipublikasi dan pemeriksaan secara langsung pada makanan yang diambil dari kedua provinsi tersebut, dengan menggunakan metode liquid chromatography-tandem mass spectrometry. Asupan CML, pCML, dan pTNF-α didapatkan berturut-turut dari 2x24 jam recalls, ultra-performance liquid chromatography-tandem mass spectrometry, and enzyme-linked immunosorbent assay. Perbedaan di antara kelompok dianalisis dengan menggunakan Chi-square atau t-test tidak berpasangan, efek mediator dianalisis dengan structural equation modelling, dan untuk perilaku makan dilakukan dengan wawancara mendalam dan observasi.

Terdapat 161 dari 252 jenis makanan dalam database CML yang telah diidentifikasi kandungan CMLnya secara langsung. Kelompok daging dan kacang-kacangan memiliki nilai rerata kandungan CML tertinggi pertama dan kedua. Geometric means ± SD dari dCML, pCML, dan pTNF-α berturut-turut sebesar 1.7±0.8 mgCML/hari, 22.3±7.9 ng/mL, dan 0.68 ± 0.38 IU/mL. Asupan CML berhubungan langsung dan positif terhadap pCML (β= 0.99 [95%CI: 0.53, 1.78]) demikian pula pCML terhadap pTNF-α (β= 0.12 [95%CI: 0.28, 0.49]). Plasma CML dan pTNF-α berhubungan secara langsung dan positif terhadap WC (β= 0.21 [95%CI: 0.08, 0.33] dengan β= 0.23 [95%CI: 0.11, 0.35]) dan juga terhadap WHtR (β= 0.18 [95%CI: 0.06, 0.31] dengan β= 0.23 [95%CI: 0.11, 0.35]). Pada wawancara mendalam didapatkan bahwa kelompok suku Sunda lebih banyak mengosumsi makanan yang diproses seperti ikan peda goreng, ikan asin goreng dan bakso dibandingkan kelompok suku Minangkabau.

Simpulan: Asupan CML, pCML, dan pTNF-α tampaknya lebih berperan sebagai mediator terhadap WC dan WHtR, dibandingkan terhadap BMI. Pembatasan asupan CML diperlukan untuk menurunkan risiko obesitas sentral pada populasi ini.

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Carborxymethyl lysine in foods (dCML), plasma CML (pCML), and plasma tumor necrosis alpha (pTNF-α) may have an influence on obesity. However, there have been no reports on databases of CML content in Indonesian foods and on studies of the influence of CML intake on obesity in Asian women.

This study aims to develop a database of CML content in Minangkabau and Sundanese foods and to evaluate the mediator effects of dCML, pCML, and pTNF-α on waist circumference (WC), waist to height ratio (WHtR), and body mass index (BMI).

A cross-sectional study was conducted in 235 healthy women aged 19-50 years, who resided in coastal and mountainous areas of West Sumatra and West Java. The CML database was developed based on an estimate from published database and direct measurement of foods obtained from these two provinces, using liquid chromatography-tandem mass spectrometry. The dCML, pCML, and pTNF-α concentrations were obtained from 2x24 hour recalls, ultra-performance liquid chromatography-tandem mass spectrometry, and enzyme-linked immunosorbent assay, respectively. Between-group differences were analyzed by chi-square test or unpaired t-test, the mediator effects by structural equation modelling, and eating behavior by in-depth interviews and observations.

There were 161 of 252 food items of which the CML content was determined. The group of meats and the group of legumes had the highest and second highest mean CML content, respectively. The Geometric means ± SD of dCML, pCML, and pTNF-α were 1.7±0.8 mgCML/day, 22.3±7.9 ng/mL, and 0.68 ± 0.38 IU/mL, respectively. There was a direct positive association between dCML and pCML (β= 0.99 [95%CI: 0.53, 1.78]) and between pCML and pTNF-α (β= 0.12 [95%CI: 0.28, 0.49]). Plasma CML and pTNF-α were directly and positively associated with WC (β= 0.21 [95%CI: 0.08, 0.33] and β= 0.23 [95%CI: 0.11, 0.35]) and WHtR (β= 0.18 [95%CI: 0.06, 0.31] and β= 0.23 [95%CI: 0.11, 0.35]). In eating behavior, it was seen that the Sundanese women consumed more CML from processed foods such as fried fermented fish (ikan peda goreng), fried salted fish (ikan asin goreng) and meatballs (bakso) than Minangkabau women.

Conclusion: Dietary CML, pCML, and pTNF-α apparently had a greater role as mediators in the path from ethnicity to WC and WHtR, than in the path from ethnicity to BMI. Limitation of CML intake is necessary to reduce the risk of central obesity in this population

Abstrak :
Preeklamsia dibagi menjadi preeklamsia awitan dini (PEAD) jika terjadi pada usia kehamilan < 34 minggu dan preeklamsia awitan lanjut (PEAL) pada kehamilan > 34 minggu. Intoleransi imun diduga menyebabkan penolakan imun terhadap fetus di plasenta. Dendritic cell 10 (DC-10) dan sel T regulator CD4+CD25+FoxP3 (Treg) di desidua berperan penting dalam menciptakan lingkungan yang tolerogenik selama kehamilan. Namun, peran spesifik dalam patomekanisme PEAD dan PEAL serta faktor-faktor nutrisi yang berperan dalam regulasi DC-10 dan Treg, yaitu seng, vitamin A, dan vitamin D belum diteliti secara jelas. Penelitian ini bertujuan untuk memahami patomekanisme penolakan imun pada preeklamsia melalui jumlah DC-10 dan sel Treg desidua serta hubungannya dengan vitamin A, vitamin D, dan seng. Desain penelitian ini adalah studi potong lintang komparatif antara kehamilan dengan PEAD, PEAL, dan NT antara Oktober 2019 dan Desember 2021. Subjek penelitian direkrut dari RSUP Fatmawati (Jakarta), RSUPN Cipto Mangunkusumo (Jakarta), dan RSUD Karawang (Jawa Barat). Kriteria penerimaan adalah semua ibu hamil 20–40 minggu yang menjalani persalinan dengan seksio sesaria dan setuju untuk dilibatkan dalam penelitian. Kriteria penolakan meliputi pasien dengan penyulit obstetrik, plasenta previa, memiliki riwayat penyakit kronik, hipertensi sebelum kehamilan 20 minggu, terdiagnosis COVID-19, demam dan leukosit >15.000 /mL pada saat pemeriksaan dan kematian janin dalam rahim. Spesimen desidua diperoleh dengan kuretase tajam setelah seksio sesaria. Jumlah DC-10 dan sel Treg dihitung dengan flow cytometry. Konsentrasi faktor nutrisi diperiksa dengan metode ICP-MS dan LC-MS. Perbandingan median dianalisis dengan uji Kruskal-Wallis, sedangkan koefisien korelasi diperoleh dengan uji korelasi Spearman. Subjek penelitian adalah 14 ibu hamil untuk setiap kelompok (total 42 kasus). Jumlah DC-10 lebih rendah secara bermakna pada PEAD dibandingkan NT (p < 0,001) dan lebih rendah secara bermakna pada PEAL dibandingkan NT (p = 0,015). Sebaliknya, sel Treg FoxP3+CD25+ lebih tinggi secara bermakna pada PEAD dibandingkan NT (p = 0,015). Tidak terdapat korelasi antara faktor nutrisi dan jumlah faktor tolerogenik pada kelompok preeklamsia (PE). Namun, terdapat korelasi sedang antara konsentrasi seng desidua dan DC-10 di kelompok NT (r = 0,656; p = 0,011) dan korelasi kuat antara konsentrasi retinol desidua dan DC-10 juga di kelompok NT (r = 0,746; p = 0,002). Korelasi sedang didapatkan antara konsentrasi vitamin D dan jumlah sel Treg FoxP3+CD25+ di kelompok NT (r = 0,590; p = 0,026). Disimpulkan bahwa jumlah DC-10 pada PEAD lebih rendah dibandingkan dengan kehamilan NT, sedangkan jumlah sel Treg pada PEAD secara bermakna lebih tinggi dibandingkan dengan kehamilan NT. Konsentrasi faktor nutrisi desidua tidak berkorelasi dengan jumlah DC-10 atau Treg desidua pada preeklamsia (PEAD dan PEAL). Namun, pada kelompok NT terdapat korelasi positif antara seng dan DC-10, retinol dan DC-10, serta vitamin D dan jumlah sel Treg desidua. ......Preeclampsia is categorized as early-onset preeclampsia (EOPE) at < 34 week of gestation and late-onset preeclampsia (LOPE) at > 34 week of gestation. Immune intolerance is thought to be the underlying cause of immune rejection to the fetus in the placenta. Decidual dendritic cell-10 (DC-10) and T regulator cell CD4+CD25+FoxP3 (Treg) play important role to create a tolerogenic environment during pregnancy. However, the specific role in the pathomechanism of EOPE or LOPE and nutritional factors that play role in the regulation of DC-10 and Treg, i.e. zinc, vitamin A, and vitamin D have not been widely studied. This study was aimed to know the pathomechanism of immune rejection in preeclampsia through the number of decidual DC-10 and Treg cell and their correlations with vitamin A, vitamin D, and zinc. The study design was cross-sectional comparative among EOPE, LOPE, and NT pregnancies between October 2019 and December 2021. Study subjects were recruited from Fatmawati General Hospital (Jakarta), Cipto Mangukusumo National General Hospital (Jakarta), and Karawang Regional Public Hospital (West Java). Inclusion criteria were all pregnant women between 20–40 weeks of gestation who underwent cesarean delivery and gave their written consent to be included in the study. Exclusion critera were patients with obstetric complications, placenta previa, history of chronic disease, hypertension before 20 weeks of gestation, was diagnosed with COVID-19, fever and leukocyte count of >15.000 /mL at the time of examination and presence of intrauterine fetal death. Decidual specimens were obtained by curettage after the cesarian section. The number of DC-10 and Treg cells were counted using flow cytometry. Concentrations of nutritional factors were assayed using ICP-MS and LC-MS method. Median comparison among groups was analyzed using Kruskal-Wallis test, while correlation coefficient was obtained by using the Spearman correlation test. Study subjects were 14 pregnant women for each group (42 cases in total). The DC-10 was significantly lower in EOPE compared to NT (p < 0.001) and significantly lower in LOPE compared to NT (p = 0.015). On the other hand, Treg FoxP3+CD25+ cells were significantly higher in EOPE compare to NT (p = 0.015). No correlation between nutritional factors and the number of tolerogenic factors in the preeclampsia group. However, there was a moderate correlation between decidual zinc concentration and DC-10 in the NT group (r = 0.656; p = 0.011) and a strong correlation between decidual retinol concentration and DC-10 also in NT group (r = 0.746; p= 0.002). A moderate correlation was found between vitamin D concentration and Treg FoxP3+CD25+ cells in the NT group (r = 0.590; p = 0.026). To conclude, the number of DC-10 in EOPE is lower than NT pregnancy, whereas the number of Treg cells in EOPE is higher than NT pregnancy. Concentrations of dedicual nutritional factors do not correlate with the number of decidual DC-10 or Treg cells in preeclampsia (EOPE and LOPE). However, in NT group, there is positive correlation between decidual zinc and DC-10, retinol and DC-10, and vitamin D and Treg cells.

Abstrak :
Disertasi ini bertujuan untuk mengetahui faktor-faktor yang berpengaruh terhadap terjadinya deviasi positif pertumbuhan sampai usia lima bulan dan mengali perilaku penyimpang positif pada keluarga dengan status ekonomi rendah. Jenis penelitian adalah perpaduan penelitian kuantitatif (kohort prospektif) dengan penelitian kualitatif (Rapid Assesment Procedure). Besar sampel adalah 61 bayi BBLR (2000-2499 gram) yang lahir cukup bulan. Sampel diperoleh dari 5 rumah sakit 7 klinik bidan di Kota Pekanbaru. Hasil menunjukkan bahwa pada usia lima bulan terjadi deviasi positif pertumbuhan sebesar 65,6%. Faktor yang berpengaruh adalah pemberian ASI, kesehatan bayi dan lingkungan pengasuhan. Perilaku positif deviants adalah frekuensi pemberian ASI dalam 24 jam lebih dari 12 kali, memeriksa kesehatan bayi setelah satu minggu dilahirkan, ibu menjaga kebersihan rumah, ayah turut mengasuh bayi, keputusan bersama ibu dan nenek dalam pemberian makanan pada bayi. ......This dissertation aims to determine the factors that influence the occurrence of a positive deviation of growth until the age of five months and experience the positive deviant behavior in families with low economic status. The research type is a combination of quantitative research (prospective cohort) with qualitative research (Rapid Assessment Procedure). The sample size was 61 infants of low birth weight (2000-2499 g) were born at term. Samples were obtained from 5 hospitals 7 midwife clinics in the city of Pekanbaru. The results showed that at the age of five months of positive growth deviation of 65.6%. Factors that influence breastfeeding, infant health and caring environment. Positive Deviants behavior is the frequency of breastfeeding within 24 hours more than 12 times, check the health of babies born after one week, mother to keep the house, father helped care for infants, a decision with his mother and grandmother in infant feeding.