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"ABSTRAKPenyakit diabetes melitus tipe 2 (DM tipe 2) merupakan penyakit metabolik dengan karakteristik hiperglikemia yang terjadi karena kelainan sekresi insulin, kerja insulin atau kedua-duanya. Faktor yang berkaitan dengan sekresi dan kerja insulin antara lain kebiasaan minum kopi. ToIeransi Glukosa Terganggu (TGT) merupakan suatu prakondisi kejadian DM. Penelitian bertujuan mengetahui pengaruh kebiasaan minum kopi pada kasus TGT terhadap terjadinya DM tipe 2 dan gambaran laju insidensi DM tipe 2 pada kasus TGT serta kesintasannya.Penelitian merupakan Study Kohort Praspektif selama 2 tahun 4 bulan terhadap 289 kasus TGT. Konsumsi kopi dinilai dari jumlah kandungan kafein sesuai frekuensi minuet, jumlah bubuk, dan merk minuman kopi. Kandungan kafein diperiksa dengan alat Spektrofotometer Serapan Atom (SSA) menggunakan metode Kromatografi Cair Kinerja Tinggi (KCKT). Diagnosis DM tipe 2 ditetapkan berdasarkan hasil pemeriksaan klinis dan hasil pemeriksaan kadar glukosa darah puasa ?120 mg/dL danlatau hash pemeriksaan glukosa darah 2 jam sesudah pembebanan glukosa > 200mg/dL. Analisis statistik menggunakan perangkat lunak Stata versi 8.0. Penilaian laju insidensi dengan analisis survival, peranan faktor risiko DM tipe 2 dan TGT dengan analisis multivariat Cox Proportional Hazard Regression dan Multinomial Logistic Regression.Temuan panting dari penelitian ini : (1) Laju insidensi DM tipe 2 adalah 9,3 per I00 kasus TGT per tahun; (2) konsumsi kopi dengan kafein 240 - 359,9 mg per hari hari mempunyai rasio hazard (FIR) 2,33 dan kafein ? 360 mg per hari mempunyai FIR 3,24; (3) faktor lain yang berisiko adalah konsumsi lemak ? 40 gram per hari dengan FIR 2,07, obesitas (IMT ? 25) HR 2,25, obesitas abdominal (RPP L : > 0,95; W: > 0,85) HR 2,28, lama minum kopi (? 10 tahun) HR 1,97, hipertrigliserida (? 200 mg/dL) HR 2,41 dan FFA tinggi (? 0,93 mM) HR. 1,9; (4) mencampur minuman kopi dengan susu atau krim, aktivitas fisik (indeks 120 menitlhari), konsumsi serat ? 25 gram per hari dan konsumsi teh ditemukan mencegah DM tipe 2 masing-masing dengan HR 0,28 0,56, 0,42, dan 0,50; (5) kafein 240 - 359,9 mg mempunyai rasio risiko relatif (rasio RR) tetap mengalami TGT 2,95, kafein ? 360 mg mempunyai rasio RR 3,28;(6) faktor lain yang berisiko TGT adalah konsumsi lemak dengan rasio RR 2,51, obesitas abdominal 2,47 dan hipertrigliserida 2,97; (7) aktivitas fisik dan konsumsi serat ditemukan mencegah TGT masing-masing dengan rasio RR 0,29 dan 0,40; (8) Dari temuan penelitian dihasilkan tiga model sistim skor prediksi DM tipe 2, tiga model untuk memprediksi kejadian tetap TGT dan tiga model untuk memprediksi kejadian normal dengan 4 batasan risiko, dengan probabilitas area ROC model prediksi antara 83,59% -94,73%.Konsumsi kopi pada kasus TGT mempunyai respon dosis dan respon waktu terhadap kejadian DM tipe 2 dan tetap TGT. Sebaliknya terhadap kejadian normal, respon tersebut berbanding terbalik. Jumlah kafein yang terkandung pada minuman kopi meningkatkan FFA mengakibatkan resistensi insulin dan kelelahan sel j3 dalam mengsekresi insulin yang berakhir dengan diabetes. Campuran susu atau krim pada minuman kopi menambah asupan kalsium pada tubuh dan mereduksi kandungan kafein, sehingga mencegah DM tipe 2 pada peminum kopi. Model predisksi dengan sistim skor cukup baik dan praktis untuk memprediksi risiko DM tipe 2, tetap TGT, dan normal. Jika risiko diketahui lebih dini, tindakan pencegahan dapat segera dilakukan dan memberikan hasil penanggulangan lebih baik.

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ABSTRACT

Type 2 Diabetes Mellitus (Type 2 DM) is a metabolic disease characterized by hyperglycemia, due to the abnormal insulin secretion, insulin function, or both. One of the factors related to insulin function and secretion is drinking coffee. Impaired Glucose Tolerance (IGT) is a precondition for the occurrence of Diabetes Mellitus. This research is aimed to study the risk of developing Type 2 DM among impaired glucose tolerant cases that regularly drinks coffee, and to determine the incidence rate of Type 2 DM on IGT cases as well as its survival rate.

This is a cohort prospective study with the duration of 2 years and 4 months among 289 IGT cases. Coffee consumption was assessed by caffeine content according to drinking coffee frequency, weight of coffee powder, and coffee brand's name. The caffeine content was measured by spectrophotometer, used High Performance Liquid Chromatography (HPLC) method. Type 2 DM diagnosis was determined according to ADA 1997 criteria (fasting blood glucose of > 126 mg/dL and/or 2 hours after glucose load of > 200 mg.dL Statistical analysis software used in this study was Stala version 8.0. Assessment of the incidence rate was calculated by survival analysis, while the risk factors of developing Type 2 DM, remained IGT, and reversing to Normal Glucose Tolerance (NGT) were analyzed by multivariate Cox Proportional Hazard Regression and Multinominal Logistic Regression.

Result

Important findings in this research are: (I) The incidence rate of Type 2 DM was 9.3 per 100 cases of IGT person-year; (2) Coffee consumption with caffeine content of 240 - 359,9 mg daily had hazard ratio (HR) of 2.31 and HR for coffee contents > 360 mg caffeine daily was 2.92; (3) Other risk factors for the development Type 2 DM include fat consumption of > 40 g daily, with HR value of 1.99, HR obesity (BMI > 25) was 2.24, and HR for abdominal obesity ( waist hip ratio, men: > 0.95; women: > 0.85) was 2.44, while HR for duration of drinking coffee (? 10 years) was 1.97, for hyper triglyceride (? 200 mg/dL) was 2.74, and for high FFA (> 0.93 mM) was 1.88; (4) Drinking coffee with cream or milk, physical activity (index of 120 minutes/day), and food fiber consumption > 25 gram/day, prevent the development of Type 2 DM with HR value of 0,28, 0.56, and 0.38 respectively; (5) Relative risk ratio (RR) to remain 1GT was 2.95 in drinking coffee with caffeine content of 240 - 359.9 mg, and 3.28 in drinking coffee with caffeine content > 360 mg; (6) Other risk factor of remaining IGT were fat consumption, abdominal obesity, and hyper triglyceride, with RR values of 2.51, 2.47, 2.97 respectively; (7) Physical activity and food fiber consumption prevent reversal to IGT with RR value of 0.29 and 0.40; (8) This study resulted in three prediction score system models for the development of type 2 DM, three prediction score system models for remaining to IGT, and three prediction score system models for reversing to NGT, with the probability of prediction model ROC area between 83.5% to 94.73%.

The incidence rate of Type 2 DM increases every year. Caffeine content in the coffee drinks has linear correlation with increased FFA value, insulin resistance, fasting blood glucose, and two hours after glucose load, as well as the occurrence of DM. Drinking coffee among the IGT cases has dosage and time response relationship to the occurrence of type 2 DM and remaining IGT. On the other hand, the relationship is opposite for the reverse to normal glucose tolerance (NGT). Drinking coffee with cream or milk can prevent the occurrence of type 2 DM. Prediction model with scoring system is good and practical to predict risk of type 2 DM and IGT. If the risk is found earlier, the prevention can be immediately performs and will give better result."

"Peningkatan harapan hidup manusia akan menambah populasi lanjut usia diikuti dengan peningkatan problem, antara lain penurunan fungsi kognitif. Salah satu faktor risiko penurunan fungsi kognitif ialah social engagement yang dipengaruhi oleh lingkungan tempat tinggal. Penelitian dilakukan menggunakan metode cross sectional di kelurahan Jelambar dan Jelambar Baru, Jakarta atas 286 lanjut usia yang tinggal di keluarga dan di panti werdha menunjukkan adanya pengaruh social engagement terhadap fungsi kognitif lanjut usia, terutama di kalangan panti werdha. Social engagement buruk berhubungan dengan gangguan fungsi kognitif setelah dikendalikan oleh aktivitas kognitif, khususnya pada kelompok social engagement buruk dan tinggal di panti; di kelompok lanjut usia perempuan, social engagement buruk berhubungan dengan fungsi kognitif lebih rendah. Komponen social engagement yang paling berperan terhadap fungsi kognitif para lanjut usia adalah aktivitas di masyarakat dan keanggotaan di kelompok masyarakat lain. Kegiatan ke luar rumah dan berbelanja, dan kerja sukarela/amal merupakan komponen aktivitas di masyarakat yang paling berpengaruh. Di kalangan perempuan, komponen social engagement yang paling berpengaruh adalah keanggotaan di kelompok lain. Aktivitas kognitif yang terbesar pengaruhnya adalah masak sendiri dan menonton siaran televisi berita.

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The increase of life expectancy brings a problem of elderly, among others is problem of cogntive decline. One of the risk factors for cognitive decline is social engagement which can be influenced by living environment. This research was done with cross sectional method in kelurahan Jelambar and Jelambar Baru with 286 respondents living in family and institution. Social disengagement was associated with lower cognitive function, especially in institution, influenced by cognitive activity. Among women, social disengagement was associated with lower cognitive function. The most important component of social engagement are to become a member of social club and active in the community, especially outdoor activities and doing shopping for daily needs. Among women, the most important component of social engagement is to become a member of social club. Cognitive activity with biggest influence on cognitve function are self-cooking and watching news in television."

"ABSTRAKPola konsumsi vegetarian menunjukkan peningkatan popularitas yang signifikan. Indonesia Vegetarian Society mencatat peningkatan pesat jumlah anggotanya dari 5.000 orang (1998) menjadi 500.000 (2010). Ibu vegetarian dikuatirkan memiliki status gizi prahamil yang lebih rendah dan berisiko memiliki outcome kehamilan yang rendah yaitu status gizi bayi lahir dan cadangan lemak ibu untuk menyusui rendah. Studi ini bertujuan menganalisis pengaruh vegetarian dan nonvegetarian terhadap status gizi ibu, durasi ASI predominan, dan pertumbuhan bayi selama periode 0-6 bulan. Studi dengan desain kohort longitudinal dilakukan di lima kota di Indonesia (Jakarta, Surabaya, Pontianak, Palembang dan Pekanbaru) dengan populasi vegetarian usia subur terbanyak. Sejumlah 85 ibu-bayi berhasil diikuti selama 6 bulan postpartum.. Berdasarkan data 24 HR food recall, ibu vegetarian secara bermakna mengkonsumsi energi, protein, dan lemak lebih rendah namun karbohidrat lebih tinggi dibandingkan ibu nonvegetarian. Dalam hal zat gizi mikro, ibu vegetarian mengkonsumsi vitamin B12 dan Zn lebih rendah secara signifikan dibandingkan ibu nonvegetarian. Konsumsi saat laktasi pada kedua kelompok signifikan lebih rendah daripada konsumsinya saat hamil. Hasil penelitian menunjukkan bahwa vegetarian tidak mempengaruhi durasi ASI predominan. Konsumsi energi ibu laktasi mempengaruhi durasi ASI predominan pada kelompok nonvegetarian. Secara keseluruhan tidak ada perbedaan IMT postpartum kedua kelompok selama 6 bulan (p value=0,306), tetapi setelah dikontrol durasi ASI predominan (24 minggu) ada perbedaan bermakna (p value=0,047) pada penurunan BB ibu postpartum. Pada kelompok vegetarian faktor yang paling mempengaruhi IMT ibu postpartum adalah IMT postpartum 0 bulan (bulan ke-1 dan ke-2) dan IMT prahamil (bulan ke-3 hingga ke-6), sedangkan pada kelompok nonvegetarian adalah IMT postpartum 0 bulan (bulan ke-1 hingga ke-5) dan durasi ASI predominan (bulan ke-6). Pertumbuhan BB bayi ibu vegetarian lebih tinggi dari nonvegetarian secara bermakna (p value=0,009), tetapi kedua kelompok memiliki PB yang tidak berbeda (p value=0,235). Setelah dikontrol durasi ASI predominan (24 minggu) tidak ada perbedaan pertumbuhan BB dan PB bayi pada kedua kelompok, namun weight loss ibu vegetarian lebih besar (p value=0,047). Faktor yang paling mempengaruhi BB bayi kelompok vegetarian adalah jenis kelamin bayi (bulan ke-1 sampai ke-6), dan pada kelompok nonvegetarian adalah BBL bayi (bulan ke-1 dan ke-2), jenis kelamin (bulan ke-3), dan IMT ibu postpartum 0 bulan (bulan ke-4 hingga ke-6). Faktor yang paling mempengaruhi pertumbuhan PB bayi kelompok vegetarian adalah jenis kelamin bayi (bulan ke-1 hingga bulan ke-5) dan PBL (bulan ke-6), pada kelompok nonvegetarian adalah PBL (bulan ke-1 hingga ke-4) dan jenis kelamin bayi (bulan ke-5 dan ke-6).Hasil penelitian ini mendukung kebijakan pemberian ASI eksklusif 6 bulan, baik pada vegetarian dan nonvegetarian, dengan didukung program gizi dan konsumsi yang cukup pada periode laktasi. Penting menyebarluaskan informasi konsumsi energi dan zat gizi yang cukup pada masa laktasi serta peran aktif pemerintah untuk melakukan suplementasi energi dan zat gizi bagi ibu laktasi. Ibu vegetarian juga perlu mengkonsumsi suplemen zat gizi mikro seperti vitamin B12 dan Zn pada saat laktasi.

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ABSTRACT

Numbers of vegetarian has increased significantly in recent years. Indonesia Vegetarian Society recorded an increase of its member from 5000 in 1998 to 500000 in 2010. Vegetarian mothers were known to have lower pre-pregnancy nutritional status and posing a greater risk to have lower pregnancy outcomes including lower nutrional status of infant at birth and lower maternal fat stores for lactation. This study aimed at analyzing the effect of vegetarian diet on maternal nutritional status, duration of predominant breastfeeding, and infant growth in the period of 0-6 months postpartum. This study is a longitudinal cohort design and conducted in five cities in Indonesia (Jakarta, Surabaya, Pontianak, Palembang and Pekanbaru) with high population of vegetarian childbearing age women. A number of 85 mother-infant pairs consisted of 42 vegetarian and 43 non-vegetarian were followed until 6 month postpartum period. Based on 24 HR food recall, vegetarian mothers consumed lower intakes of energy, protein, and fat but higher intake of carbohydrate. Vegetarian mothers had significant lower intakes of vitamin B12 and zinc. In both groups, nutrient intakes during lactation were significantly lower than intakes during pregnancy. This study shows that vegetarian diet had no influence on predominant breastfeeding duration, but among non-vegetarian mothers, energy intakes during lactation did affect duration of pre-dominant breastfeeding. Overall, no difference was found for 6 months postpartum BMI between the two groups (p value=0.306). However, after controlled by predominant breastfeeding of 24 weeks, significant difference was found for weight loss during postpartum period (p value=0.047). Among vegetarian mothers, the most influencing factor affecting maternal postpartum BMI was 0 month postpartum BMI (affecting BMI 1- and 2-month postpartum), and pre-pregnancy BMI (affecting BMI 3-month postpartum BMI onward). Among non-vegetarian mothers, the most influencing factor affecting maternal postpartum BMI was 0 month postpartum BMI (affecting BMI 1- to 5-month postpartum) and duration of predominant breastfeeding (affecting BMI 6-month postpartum). Weight growth of infants of vegetarian mothers was higher than that of non-vegetarian mothers (p value=0.009), but no difference was found for infant length growth (p value=0.235). After controlled by predominant breastfeeding of 24 weeks, the difference on infant growth were disappeared. However vegetarian mothers had significantly greater weight loss (p value=0.047). Among vegetarian mothers, the most influencing factor affecting infant weight was infant?s sex (affecting infant weight at month 1 to 6 after birth) while among non-vegetarian mothers was infant birthweight (affecting infant weight at month 1 and 2 after birth), infant?s sex (affecting infant weight at month 3 after birth), and maternal 0 month postpartum BMI (affecting infant weight at month 4 to 6 after birth). The most influencing factor affecting infant length among vegetarian mothers was infant?s sex (affecting infant length at month 1 to 5 after birth) and length at birth (affecting infant length at month 6 after birth), while among non-vegetarian mothers the most influencing factor was infant length at birth (affecting infant length at 1 to 4 after birth) and infant?s sex (affecting infant length at 5 and 6 month after birth.

Results of this study supports 6 months exclusive breastfeeding policy for both vegetarian and non-vegetarian, but necessitates nutrition and food consumption related programs during lactation period. It is important to spread information on the importance of adequate energy and nutrient intakes during lactation. Government should take an active role toward supplementation program for lactating mothers. Vegetarian mothers are to balance their diet during lactation period by taking micro-nutrient supplementation such as vitamin B12 and zi"

"Gizi ganda (dual form of malnutrition/DFM) merupakan fenomena kesehatan yang tidak hanya terjadi di tingkat nasional tetapi sudah sampai pada tingkat keluarga. Kondisi ini cukup unik, mengingat anggota keluarga tinggal dalam kondisi yang sama. DFM menjadi tantangan dan masalah kesehatan baru, kedua masalah gizi salah sama penting dan memberikan beban lebih besar pada rumahtangga. Tujuan penelitian adalah mengetahui prevalensi dan determinan DFM di Indonesia dengan menggunakan data Riskesdas 2010. Analisis multilevel modelling digunakan untuk mengidentifikasi determinan DFM di level rumahtangga, wilayah desa/kota dan propinsi. Definisi Dual form of Malnutrition yang digunakan adalah anggota rumahtangga mempunyai status gizi yang berbeda; dipilih pasangan balita kurang gizi (<-2 z-score) dan ibu gizi lebih (IMT>25 kg/m2). Kriteria inklusi adalah rumahtangga dengan pasangan ibu kandung dan balita, usia ibu >18-40 tahun, dan usia balita >=2-5 tahun, sedangkan kriteria eksklusi adalah ibu hamil dan anak masih menyusu. Determinan variabel yang digunakan adalah jumlah anggota rumahtangga, komposisi rumahtangga, sosial ekonomi, Intra Household Food Distribution/IHFD, usia dan jenis kelamin anak, pekerjaan, usia dan pendidikan ibu, wilayah desa-kota, dan kondisi fiskal, akses ke pelayanan kesehatan, kondisi kesehatan propinsi, tingkat kemiskinan, petugas gizi, angka melek huruf yang merupakan proksi indikator kondisi nutrition and epidemiologic transition. Hasil penapisan diperoleh 1899 rumahtangga yang memenuhi syarat. Hasil penelitian menunjukkan prevalensi DFM adalah 29.8% (95%CI 26.5-31.2). ibu berusia diatas 30 tahun OR=1.68;95%CI (0.31-0.72), ibu berpendidikan kurang dari SMA OR=1.63;95%CI(1.23- 1.71), balita mendapatkan alokasi karbohidrat lebih sedikit OR=1.28;95%CI(1.02-1.60), rendahnya distribusi lemak pada anak di level rumahtangga OR=1.24;95%CI(1.02-1.51), dan kondisi kesehatan di masyarakat (IPKM) di level propinsi OR=1.43;95%CI(1.06-1.93). Wilayah desa/kota tidak berhubungan dengan kejadian DFM. Resiko kejadian DFM antara rumahtangga berisiko dengan rumahtangga kurang berisiko adalah 1.33. Level kontekstual propinsi tidak terlalu berpengaruh terhadap perbedaan kejadian DFM di rumahtangga MOR 1.28 (perubahan MOR 3.75%), IOR 0.89-2.29). Penelitian ini menunjukkan bahwa rumahtangga khususnya ibu mempunyai peran yang sangat penting dalam upaya preventif kejadian DFM.

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Dual form of malnutrition/DFM is a health phenomenon that is not only happening at the national level but has reached the lowest level of the family. This condition is quite unique, given the family members living and share the same conditions. DFM is a health challenge and new health problem, of which problem has equal/same important and provide a greater burden to households.

The research objective was to determine the prevalence and determinants of DFM in Indonesia using data Riskesdas 2010. Multilevel modeling analysis used to identify the determinants of DFM in household, urban/rural area and province level. Dual form of malnutrition defined as member of household has an opposite nutritional status; the study used pair of malnourished child (<-2 z-score) and overweight mother (BMI> 25 kg/m2). Inclusion criteria were households with pair child and mother, maternal age> 18-40 years, and child’s age >=2-5years, whereas exclusion criteria were pregnant women and breastfed children. Determinants variable used were the number of household members, household composition, household socio-economic, Intra Household Food Distribution/IHFD, age and gender of children, occupation, age and maternal education, rural and urban areas, and fiscal conditions, access to health care, provincial health condition, poverty level, nutrition workers, literacy rate which are considered as a proxy indicator of nutrition and epidemiologic transition.

The screening result obtained 1899 households are eligible. Results showed the prevalence of DFM was 29.8% (95% CI 26.5-31.2). Mothers aged over 30 years OR =1.68; 95% CI (0.31- 0.72), lower mother’s education (less than senior high school) OR = 1.63, 95% CI (1.23- 1.71), child received lower carbohydrate allocation over the family OR = 1.28, 95% CI (1.02- 1.60), child received lower fat distribution over the family OR = 1.24;95% CI (1.02-1.51), and health conditions in the community (IPKM score) at the provincial level OR = 1.43;95% CI (1.06-1.93. Urban/rural was not associated with DFM. The risk of DFM between households at risk with less risk households is 1.33. Contextual level of provinces do not much affect to the incidence of DFM among households MOR 1.28 (small change of MOR 3.75%) and IOR 0.89-2.29). This study showed that household and particularly mother has a very important role in to prevent DFM events."

"Disertasi ini membahas pengembangan indikator antropometri baru yaitu rasio LiLA terhadap panjang lengan atas (PLA) serta model prediksi risiko Kurang Energi Kronis (KEK) pada wanita usia subur (WUS) suku Melayu. Disain studi cross sectional menggunakan sebagian data Riskesdas 2013 dan data primer. Sampel 1009 WUS berusia 18-49 tahun (tidak hamil) di Kota Makassar dan Kabupaten Tana Toraja, Selawesi Selatan. Hasil studi menemukan formula yang optimal adalah Rasio LiLA/ PLA < 4,25 untuk mendeteksi risiko KEK, lebih baik validitasnya (Sn= 80%; Sp=84%) dibandingkan validitas LiLA menggunakan baku Indeks Massa Tubuh. Prevalensi KEK pada WUS 9,9% (IMT< 18,5); Risiko KEK 22,4 % (Rasio LiLA/ PLA < 4,25). Validitas LiLA < 23,5 cm sudah baik (Sn= 76%; Sp=87,2%), tetapi titik potong optimal untuk skrining adalah <=24,0 cm (Sn= 90%; Sp= 77%) untuk mendeteksi risiko KEK WUS. Faktor risiko KEK: umur, paritas, penggunaan alat kontrasepsi, penyakit infeksi, aktifitas fisik, pekerjaan, status kawin dan sosial ekonomi. Penyakit infeksi berat (POR= 2,79) sebagai faktor risiko dominan; sedangkan faktor protektif dominan adalah penggunaan alat kontrasepsi hormonal (POR= 0,43). Diperlukan komunikasi, informasi, edukasi pada WUS untuk menerapkan pedoman gizi seimbang, pola hidup sehat serta pencegahan penularan penyakit infeksi seperti TB, Malaria dan Hepatitis serta penanganan yang tepat untuk mencegah KEK.

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This study examined the development of new anthropometric indicator was the ratio of MUAC to upper arm length (UAL) and the prediction model of the risk of Chronic Energy Deficiency (CED) in Malay women of reproductive age. Crosssectional study design using part of the data Riskesdas 2013 and primary data. Samples were 1009 women aged 18-49 years (not pregnant) in Makassar and Tana Toraja South of Sulawesi. The study found that the optimal formula was MUAC/ UAL <4.25 to detect a risk of CED, better validity (Sn= 80%; Sp= 84%) compared to MUAC with the gold standard was Body Mass Index (BMI). Prevalence of CED on women of reproductive age 9.9% (BMI <18.5); Risk of CED 22.4% (MUAC/ UAL <4.25). The validity of MUAC <23.5 cm was good but the optimal cut point for screening the risk of CED was <=24 cm (Sn= 76%; Sp= 87.2 %). CED risk factors were age, parity, contraceptive use, infectious diseases, physical activity, job, marital status and socioeconomic. The dominant risk factor was severe infectious disease (POR= 2.79) while the dominant protective factor was the use of hormonal contraceptives (POR= 0.43). It needs communication, information and education to applying balanced nutrition guidelines, healthy lifestyles and the prevention of transmission of infectious diseases such as TB, Malaria and Hepatitis as well as adequate treatment to prevent CED."

"Menarche dini merupakan salah satu faktor risiko kanker payudara yang berhubungan dengan lama pajanan estrogen. Penelitian mengenai faktor-faktor risiko menarche dini belum banyak dilakukan. Penelitian ini bertujuan untuk mengetahui hubungan antara asupan gizi, antropometri dan komposisi tubuh, serta aktivitas fisik dengan kadar estradiol dan menarche dini. Desain penelitian ini adalah potong lintang dengan subjek remaja putri 13-15 tahun di Jakarta, sejak Januari 2014 sampai Januari 2015. Analisis asupan gizi dilakukan dengan metode 24-hour recall dan Food Frequency Questionnaires (FFQ) semikuantitatif. Variabel antropometrik dan komposisi tubuh meliputi berat badan, tinggi badan, indeks massa tubuh (IMT), dan persentase lemak tubuh. Namun ditambahkan pengukuran lingkar lengan atas (LLA) dan lingkar pinggang (LP). Aktivitas fisik dinilai dengan Physical Activity Questionnaire (PAQ). Kadar estradiol serum diukur pada fase folikuler. Menarche dini adalah usia saat menstruasi pertama kali kurang dari 12 tahun. Terdapat 189 remaja putri usia13-15 tahun yang dilibatkan dari 8 SMP di Jakarta. Asupan gizi remaja putri berdasarkan PUGS cukup karbohidrat, kurang protein, tinggi lemak, dan rendah serat. Berdasarkan kriteria z-score IMT/U dari WHO, ditemukan sebanyak 3,2% gizi kurang, 73,5% normal, 18% mengalami overweight dan 5,3% mengalami obese. Lebih dari 90% subjek penelitian memiliki aktivitas fisik rendah. Proporsi menarche dini pada penelitian ini 22,8%. Kadar estradiol berkorelasi positif dengan asupan energi, protein, dan lemak. Berdasarkan kategori asupan, median estradiol berhubungan dengan asupan karbohidrat dan lemak. Terdapat korelasi negatif antara kadar estradiol dan LLA, LP serta z-score IMT/U. Terdapat hubungan antara menarche dini dan variabel-variabel antropometrik LLA dan LP serta z-score IMT/U. Tidak terdapat hubungan antara menarche dini, asupan gizi, aktivitas fisik, dan kadar estradiol. Faktor determinan kadar estradiol adalah asupan energi, protein, lemak dan zscore IMT/U, sedangkan faktor determinan menarche dini adalah LP. Dari hasil penelitian disimpulkan bahwa untuk menurunkan faktor risiko kanker payudara, perlu memperhatikan faktor-faktor yang terkait kadar estradiol dan menarch.

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Early menarche has been known as a risk factor of breast cancer because its association with the length of exposure time to estrogen. There are not much studies has been done on risk factors of early menarche. The aim of this study was to know the association among nutritional intake, anthropometry and body composition, physical activity, estradiol level and early menarche. This was a cross-sectional study involving adolescent girls aged 13-15 years in Jakarta, between January 2014 and January 2015. Interview on nutritional intakes were done by using the 24-hour recall and semiquantitative Food Frequency Questionnaires (FFQ). The anthropometric and body composition variables included body weight, body height, body mass index (BMI) and body fat percentage; however, additional variables were also measured, i.e. mid-upper arm circumference (MUAC) and waist circumference (WC). Physical activity was assessed by using the Physical Activity Questionnaires (PAQ). Serum estradiol levels was measured during follicular phase. Early menarche was defined if the first menstruation occurred before the age of 12 years. There were 189 adolescent girls enrolled in this study from 8 junior high schools in Jakarta.

Based on guidelines of balanced nutrition, nutritiotional intake of adolescent girls were adequate carbohydrate intake, low protein intake, high fat intake, and low fiber intake. based on the WHO z-scores of BMI per age, there was 3,2% underweight, 73,5% normal, 18% overweight and 5,3% obese subjects. More than 90% of the study subjects had mild physical activity. The proportion of early menarche was 22.8%. Estradiol level was positive correlated with the intakes of energy, protein, and fat. Based on the diet intake category, median estradiol level was associate with the intakes of carbohydrate and fat. There was a negative correlation between estradiol level and MUAC, WC, and z-scores BMI per age. There was an association between early menarche and antrophometric measures (MUAC and WC) and z-scores BMI per age. No association was found between early menarche and nutritional intake, physical activity, or estradiol level. Determinant factors of estradiol level were the intakes of energy, protein, fat, and z-score BMI per age; while determinant factor of early menarche was waist circumference. To conclude, in order to reduce breast cancer risk, we should paid attention on factors associated with increased estradiol level and early menarche i.e. fat intake, physical acitivity and normal body weight."

"Kehamilan remaja merupakan kehamilan dengan risiko tinggi yang berhubungan dengan tingginya insiden kelahiran premature, bayi berat lahir rendah (BBLR), dan hasil kehamilan yang buruk lainnya. Kehamilan remaja didefinisikan sebagai usia ginekologi rendah (< 4 tahun sejak menarche) atau sebagai usia kronologis <16 tahun pada saat konsepsi atau persalinan menunjukkan dampak usia muda ibu pada berat lahir.TujuanMengetahui dan mengkaji hubungan usia ginekologis dengan berat lahir dan usia kronologis dengan berat lahir bayi pada ibu remaja di 8 Puskesmas Kota Bekasi dan mengetahui perbedaan kekuatan hubungan antara usia ginekologis dan usia kronologis dengan berat lahir bayi pada ibu remaja di Kota Bekasi.Metode PenelitianPenelitian ini merupakan cross sectional study untuk mempelajari korelasi antara usia ginekologis dan usia kronologis sebagai variabel bebas, dengan berat lahir sebagai variabel terikat. Jumlah sampel yang dibutuhkan dalam penelitian ini dihitung dengan menggunakan rumus uji hipotesis beda proporsi didapat 170 responden. Pengumpulan data primer dan sekunder dilakukan dengan cara wawancara.HasilIbu dengan usia ginekologis < 4 tahun berisiko 4 kali lebih tinggi melahirkan bayi dengan berat < 3000 gram, yang merupakan berat lahir terkait penyakit tidak menular di masa dewasa, dibandingkan dengan ibu usia ginekologis >= 4 tahun, dan ibu dengan usia kronologis < 16 tahun berisiko 2 kali lebih tinggi melahirkan bayi dengan berat < 3000 gram dibandingkan dengan ibu usia kronologis >= 16 tahun. TB pra hamil, IMT pra hamil, penambahan BB selama hamil dan anemia sebagai faktor perancu hubungan usia ginekologis dan usia kronologis dengan berat lahir bayi.KesimpulanUsia ginekologis dan usia kronologis berhubungan dengan berat lahir bayi pada ibu remaja di Kota Bekasi tahun 2015. Usia ginekologis lebih kuat berhubungan dengan berat lahir dibandingkan dengan usia kronologis.SaranDianjurkan untuk menunda kehamilan pertama untuk perempuan Indonesia pada usia setidaknya 18 tahun atau pada usia ginekologis >= 4 tahun. Dilakukannya penelitian lain dengan melihat risiko usia ginekologis dan usia kronologis dengan BBLR dan stunted.

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BackgroundTeenage pregnancy is a high-risk pregnancy associated with high incidences of premature birth, low birth weight (LBW), and other adverse pregnancy outcomes. Teenage pregnancy is defined as a low gynecological age (< 4 years after menarche) or as chronological age < 16 years old at the time of conception or birth of young mothers.Aims1). To know and examine relationships between gynecological age and birth weight and also chronological age and the birth weight among teenage mothers in eight Puskesmas Kota Bekasi. 2). To determine differences in the strength of the above two relationships among the teenage mothers in Bekasi Research methods. This is a cross-sectional study conducted to learn correlations between gynecological age and chronological age as independent variables, and the birth weight as the dependent variable. The number of minimal samples required in this study was 170 respondents, calculated using formula to test different proportions. Primary and secondary data collection was done through interview.ResultCompared to mothers with gynecological age >= 4 years, mothers with gynecological age <4 years were four times at risk of having baby weight of <3000 grams. Mothers with chronological age < 16 years were 2 times at higher risk of giving birth to babies with weight of <3000 grams as compared to mothers with chronological age>= 16 years. Pre-pregnancy height, pre-pregnancy BMI, the increase of body weight during pregnancy and anemia were found to be confounding factors in the relationship between gynecological age and chronological age and the birth weights.ConclusionGynecological age and chronological age were associated with infant birth weight amaong teenage mothers in Bekasi, in year 2015. Gynecological age is more strongly correlated to the birth weight, as compared to the chronological age.RecommendationIt is advisable to delay the first pregnancy for women in Indonesia for at least 18 years of age or gynecological age >= 4 years. Further research could be done to look at the risk of gynecological age and chronological age and the corresponding low birth weight and stunting."

"ABSTRAKSaat ini terdapat perbaikan Angka Harapan Hidup (AHH) penduduk Indonesia dan penambahan populasi penduduk lanjut usia. Pada tahun 2017, AHH mencapai 71,06 tahun, dan jumlah lansia 23,4 juta orang (8,97% dari seluruh penduduk Indonesia). Hal ini berisiko meningkatkan kejadian penyakit degeneratif. Osteoartritis (OA) adalah penyakit yang sering dikaitkan dengan kondisi degeneratif dan mengakibatkan ketidakaktifan fisik. Pada Riskesdas 2013, penyakit Artritis berada di urutan kedua penyakit terbanyak diderita lansia dengan prevalensi 45% (55-64 tahun), 51,9% (65-74 tahun) dan 54,8% (usia >75 tahun). Pengobatan simtomatik dengan OAINS yang berkepanjangan dapat mengakibatkan efek samping yang fatal. Terdapat berbagai faktor risiko berkembangnya OA lutut, di antaranya konsentrasi serum Vitamin D (25(OH)D. Proporsi perempuan lansia dengan defisiensi 25(OH)D pada penelitian di Jakarta dan Bekasi mencapai 35,1%. Terdapat hubungan antara kadar Vitamin D (25(OH)D) yang rendah dengan nyeri lutut dan perubahan kartilago sendi lutut pada OA. Serum Cartilage Oligomeric Matrix Protein (COMP) merupakan produk degradasi penting dari kartilago sendi dan dapat menjadi marker diagnosis untuk OA lutut. Penelitian ini bertujuan mengetahui pengaruh pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu terhadap derajat nyeri berdasarkan indikator WOMAC, dan kondisi obyektif kartilago sendi dengan perubahan marker serum COMP pada penderita OA lutut lansia. Disain penelitian uji klinis teracak, tersamar ganda, dan terkontrol plasebo. Subyek dengan OA lutut simtomatis direkruit secara consecutive sampling dan dilakukan anamnesis, diperiksa kondisi fisik, radiologi lutut, kadar serum Vitamin D (25(OH)D), serum Calcium dan marker COMP. Subyek dialokasikan secara acak (random allocation) pada kelompok perlakuan yang diberikan suplemen Vitamin D (Alphacalcidol) atau kelompok kontrol yang diberikan plasebo. Populasi sumber xviii Universitas Indonesia pada penelitian ini ialah pasien OA lutut lanjut usia yang berobat ke KPKM FKIK UIN Jakarta. Dari hasil pemeriksaan konsentrasi serum Vitamin D 25(OH)D sebelum dilakukan intervensi, 53,4% responden mengalami insufisiensi dan 12,3% responden mengalami defisiensi Vitamin D. Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan derajat nyeri berdasarkan indikator WOMAC pada penderita OA lutut lansia yang bermakna secara statistik dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibanding kontrol sebesar 2,174 (p=0,00). Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan konsentrasi serum COMP pada penderita OA lutut lansia, dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibandingkan kelompok kontrol sebesar 38,15 ng/ml namun tidak bermakna secara statistik (p=0,39)

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ABSTRACTAt present there are improvements in the Life Expectancy (AHH) of the Indonesian population and the addition of the elderly population. In 2017, AHH reached 71.06 yo and the number of elderly people reached 23.4 million people (8.97% of the total population of Indonesia). This has the potential to increase degenerative diseases. Osteoarthritis (OA) is a disease that is often associated with degenerative conditions and physical inactivity. Riskesdas in 2013 stated that Arthritis was the second most common disease suffered by the elderly with a prevalence of 45% (55-64 yo), 51.9% (65-74 yo) and 54.8% (>75 yo). Symptomatic treatment with prolonged NSAIDs can cause fatal side effects. There are various risk factors for developing knee OA, including serum Vitamin D (25(OH)D) concentrations. The proportion of elderly women with 25(OH)D deficiency in studies in Jakarta and Bekasi reaches 35.1%. It has been found an association between low Vitamin D levels (25(OH)D) with knee pain in OA and changes in the knee joint cartilage. Cartilage Oligomeric Matrix Protein (COMP) is an important degradation product of joint cartilage and can be act as a diagnostic marker of knee OA. This study aims to determine the effect of Vitamin D supplementation (Alphacalcidol) for 12 weeks on the degree of pain based on WOMAC indicators, and the objective conditions of joint cartilage with changes in COMP serum markers in patients with knee OA in the elderly. The research design is a randomized, double-blind, and placebo-controlled clinical trials. Subjects with symptomatic knee OA will be recruited by consecutive sampling and continued with history taking, physical conditions examinatons, knee radiology, and blood test for serum vitamin D (25(OH)D), serum calcium and marker COMP. Subjects were then randomly allocated to the treatment group given Vitamin D supplements (Alphacalcidol) or the control group given a placebo. The source population in this study was elderly with knee OA patients xx Universitas Indonesia who went to Primary Health Care Clinic (KPKM) of FKIK UIN Jakarta. We found that before intervention was done, 53.4% of respondents had Vitamin D insufficiency and 12.3% of respondents had Vitamin D deficiency. The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, influenced the decrease in the degree of pain based on the WOMAC indicator in knee OA of elderly patients significantly, with differences in changes in pre and post intervention scores of 2.174 compare with control (p=0.00). The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, affected the decrease in the serum concentration of COMP in knee OA of elderly patients, with differences in changes in pre and post intervention scores in the intervention group compared to the control group of 38.15 ng/ml but not statistically significant (p=0.39)."