International Journals
Asia Pacific
Journal of
Clinical Nutrition
Volume 26, Supplement 1
(Juni 2017)
Review Article
1
The Clinical Nutrition Research Agenda in Indonesia and beyond: ecological strategy for food in health care delivery
WIDJAJA LUKITO, LINDAWATI WIBOWO, MARK L WAHLQVIST AND THE SCIENTIFIC ADVISORY GROUP
Original Research Communications
Pregnancy and Lactation
2
Inadequate dietary α-linolenic acid intake among Indonesian pregnant women is associated with lower newborn weights in urban Jakarta
DUDUNG ANGKASA, VICTOR TAMBUNAN, HELDA KHUSUN, FIASTUTI WITJAKSONO AND RINA AGUSTINA
3
Intergenerational effects of maternal birth weight, BMI, and body composition during pregnancy on infant birth weight: Tanjungsari Cohort Study, Indonesia
GAGA IRAWAN NUGRAHA, HERRY HERMAN AND ANNA ALISJAHBANA
4
Hydration status of pregnant women in West Jakarta
ERRY YUDHYA MULYANI, HARDINSYAH, DODIK BRIAWAN AND BUDI IMAN SANTOSO
5
Family support and exclusive breastfeeding among Yogyakarta mothers in employment
DEWI RATNASARI, BUNGA ASTRIA PARAMASHANTI, HAMAM HADI, ANAFRIN YUGISTYOWATI, DEWI ASTITI AND EKA NURHAYATI
6
Programming of infant neurodevelopment by maternal obesity: potential role of maternal inflammation and insulin resistance
MIRA DEWI, SUSAN E CARLSON, KATHLEEN M GUSTAFSON, DEBRA K SULLIVAN, JO A WICK AND HOLLY R HULL
Child and Adolescent Nutrition
7
Sago worms as a nutritious traditional and alternative food for rural children in Southeast Sulawesi, Indonesia
INTAN R NIRMALA, TREES, SUWARNI AND MOCHAMMAD S PRAMONO
8
Tumour necrosis factor-α and risk of cardiovascular disease among overfat Indonesian adolescents
DIAN CATURINI SULISTYONINGRUM, RINA SUSILOWATI, EMY HURIYATI, NI PUTU DIAH WITARI, HARRY FREITAG LUGLIO MUHAMMAD AND MADARINA JULIA
9
Chronic liver disease is a risk factor for malnutrition and growth retardation in children
ARIANI DEWI WIDODO, EVA J SOELAEMAN, NOVITRIA DWINANDA, PRAJNYA P NARENDRASWARI AND BUDI PURNOMO
Women's Health
10
Cooking methods and depressive symptoms are joint risk factors for fatigue among migrant Indonesian women working domestically in Taiwan
KHAIRIZKA CITRA PALUPI, CHUN-KUANG SHIH AND JUNG-SU CHANG
Nutrition and Infection
11
Vitamin D status in under-five children with a history of close tuberculosis contact in Padang, West Sumatra
FINNY FITRY YANI, NUR INDRAWATY LIPOETO, BAMBANG SUPRIYATNO, ERYATI DARWIN AND DARFIOES BASIR
12
Energy regulation in newly diagnosed TB with chronic energy deficiency: free fatty acids and RBP4
NURPUDJI A TASLIM, DEVINTHA VIRANI, NI KETUT SUMARTINI, KARMILA, AGUSSALIM BUKHARI, AMINUDDIN, SURYANI AS’AD, RADEN SATRIONO, HAERANI RASYID AND IRAWATY DJAHARUDDIN
13
Selenium status and fungi in the protein-losing enteropathy of persistent diarrhea
PRAMITA G DWIPOERWANTORO, WIDJAJA LUKITO, DIANA AULIA, JOSIANE ARNAUD AND A-M ROUSSEL
Body Compositional Disorders
14
Pre- and postprandial acylated ghrelin in obese and normal weight men
SRI ANDARINI, FERDY BANGUN KANGSAPUTRA AND DIAN HANDAYANI
The Clinical Nutrition Research Agenda in Indonesia and beyond: ecological strategy for food in health care delivery
WIDJAJA LUKITO, LINDAWATI WIBOWO, MARK L WAHLQVIST AND THE SCIENTIFIC ADVISORY GROUP
Despite progress with the food-associated health agenda in the public health and clinical domains, much remains to be done in Indonesia. There are reasons to be optimistic which include economic development, increasing literacy, progress towards universal health coverage and community organizational arrangements across the archipelago which focus on health through some 10,000 puskesmas. These community health centres are variably
staffed with voluntary cadres from the community, bidans (nurses) and general medical practitioners. For more effective prevention and management of nutritionally-related health problems, innovative community and clinical
nutrition research and expertise is required. With rapid urbanisation, the growth of the digital economy, increasing socio-economic inequity and climate change, there are imperatives for ecologically sustainable, nonemployment dependent livelihoods which provide energy, food, water, education and health care security. A relevant health care workforce will include those who research and practice clinical nutrition. Here we gather together an account of an extensive body of published and emerging literature which makes a case collectively for a more ecological approach to nutrition and health and how it might revitalise the Indonesian and other health care systems.
Key Words: nutrition research methodology, econutrition, ecosystem health disorders, livelihoods, health systems, food systems
Inadequate dietary α-linolenic acid intake among Indonesian pregnant women is associated with lower newborn weights in urban Jakarta
DUDUNG ANGKASA, VICTOR TAMBUNAN, HELDA KHUSUN, FIASTUTI WITJAKSONO AND RINA AGUSTINA
Background: Omega-3 fatty acid intake during pregnancy has been confirmed to affect newborn birth outcomes in the developed world. However, the association between maternal omega-3 fatty acid intake and birth size is
unknown in developing countries. Objective: To examine the association of maternal omega-3 fatty acid intake with newborn birth size. Methods and Study Design: A cross-sectional study was conducted, involving 282
pregnant women aged 19–40 years who had a gestational age of >32 weeks and received antenatal care at 10 health centres and one referral hospital in East Jakarta, Indonesia. Maternal habitual intake of omega-3 fatty acids, including α-linolenic acid, docosahexaenoic acid, and eicosapentaenoic acid, was assessed using a semiquantitative food frequency questionnaire. Birth weight and head circumference were measured using a paediatric weighing scale and tape, respectively, and birth length was obtained from medical records. Multiple linear regression analysis was performed to provide adjusted associations. Results: The median total intake of omega-3 fatty acids, docosahexaenoic acid, eicosapentaenoic acid, and α-linolenic acid was lower than the recommended dietary intake. The newborns of mothers with an α-linolenic acid intake lower than 0.82 g/d had a significantly lower (β=114, 95% confidence interval=−216, −13.5; p=0.014) weight compared with those of mothers with
high α-linolenic acid intake, after adjustment for confounding factors. Conclusion: Inadequate maternal intake of α-linolenic acid, but not omega-3 fatty acids, docosahexaenoic acid, or eicosapentaenoic acid, was associated with lower birth weight. Enhanced promotion of consumption of foods rich in essential fatty acids during pregnancy
may facilitate attaining optimal infant weight in urban areas.
Key words: developing countries, newborn, birth weight, birth length, head circumference, omega-3 fatty acids, pregnancy
Intergenerational effects of maternal birth weight, BMI, and body composition during pregnancy on infant birth weight: Tanjungsari Cohort Study, Indonesia
GAGA IRAWAN NUGRAHA, HERRY HERMAN AND ANNA ALISJAHBANA
Background and Objectives: Infant birth weight might be partly contributed to by maternal nutritional status at birth and maternal nutrition during pregnancy. The objective of this study was to analyze intergenerational ma-ternal birth weight, maternal BMI, weight change during pregnancy, and maternal body composition (FM, FFM, and TBW) changes during pregnancy. Methods and Study Design: We analyzed the associations between the maternal birth weight and body composition of 94 women and infant birth weight by using multiple regression adjusted for socioeconomic and reproductive history. Results: All associations with infant birth weight were pos-itive. The association between infant birth weight and maternal birth weight was 0.28 (95% CI: 0.02–0.54); that for the association between infant birth weight and maternal body weight in the first, second, and third trimesters was 15.1 (95% CI: 4.92–25.3), 13.7 (95% CI: 2.78–24.6), and 16.1 (95% CI: 5.22–27.0), respectively. The asso-ciation between infant birth weight and fat mass in the second and third trimesters were 18.4 (95% CI: 3.38–33.5) and 16.1 (95% CI: 5.23–27.0), respectively, and those for the association between infant birth weight and fat-free mass in the first and third trimesters were 33.6 (6.38, 60.9) and 34.8 (95% CI: 3.47–66.1), respectively. Conclu-sions: This study confirms previous findings that maternal birth weight and body composition during pregnancy are associated with infant birth weight.
Key Words: intergenerational, maternal birth weight, maternal BMI, maternal body composition, infant birth weight
Hydration status of pregnant women in West Jakarta
ERRY ERRY YUDHYA MULYANI, HARDINSYAH, DODIK BRIAWAN AND BUDI IMAN SANTOSO
Background and Objectives: During pregnancy, the body exhibits dynamic changes in fluid composition. More than 50%of women experience nausea and vomiting during the first trimester. Studies of hydration status in pregnant women are limited, and not in tropical countries, like in Indonesia. The objective of this study was to investigate the hydration status and appropriate biomarkers for determination of hydration status in pregnant women in West Jakarta. Methods and Study Design: This study was cross-sectional. A total of 35 pregnant women aged (19-35 years) at the early second trimester of pregnancy was recruited. Urine osmolality, urine specific gravity, and serum osmolality were used to determine hydration status. Subjects then were divided into a hydration group (HG) and a dehydration group (DG). We used independent t tests, chi-square and Spearman
rank correlation coefficient to analyse the data. Results: The population was comparably divided between dehydration and hydration groups (57.1% and 42.9%, respectively). The proportions by age, parity, gestational age,
height, weight, upper arm circumference, waist circumference, pelvic circumference, body temperature, blood pressure, and fundal height did not differ between groups (p≥0.05). There was a relationship between urine colour and hydration status (p<0.05). Differences in hydration biomarker status (urine osmolality and urine specific gravity) were noted between the groups (p<0.05). Conclusions: Dehydration may be common during pregnancy
in tropical Indonesia and can be confirmed by the hydration biomarkers of urinary specific gravity and osmolality. Fluid balance is necessary to prevent health problems and intrauterine growth restriction in pregnant women.
Key Words: hydration status, urine specific gravity, urine osmolality
Family support and exclusive breastfeeding among Yogyakarta mothers in employment
DEWI RATNASARI, BUNGA ASTRIA PARAMASHANTI, HAMAM HADI, ANAFRIN YUGISTYOWATI, DEWI ASTITI AND EKA NURHAYATI
Background and Objectives: Exclusive breastfeeding provides many benefits to both infants and mothers. Despite the introduction of laws aimed at protecting the practice of exclusive breastfeeding, the coverage of exclusive breastfeeding remains low, particularly for working mothers. Methods and Study Design: This crosssectional study recruited working mothers employed in medium and large companies in Bantul District, Daerah
Istimewa Yogyakarta, Indonesia. The study participants were 158 working mothers whose children were aged 6–12 months, and they were selected using the probability proportional to size technique. The data were analyzed
using descriptive statistics, chi-square tests, and multiple logistic regression. Results: Adequate family support for breastfeeding (OR: 2.86; 95% CI: 1.25–6.53) and a high paternal education level (OR: 2.68; 95% CI: 1.11–6.48) were significantly associated with the practice of exclusive breastfeeding among working mothers. However, the infant’s sex and age, parity, and the mother’s age and education level were unassociated with exclusive breastfeeding. Conclusion: Family support and a high paternal education level are crucial in enabling working mothers to practice exclusive breastfeeding. Interventions that promote exclusive breastfeeding should focus on involving the husband and other family members in health care programs related to breastfeeding.
Key Words: exclusive breastfeeding, family support, paternal education level, working mothers
Programming of infant neurodevelopment by maternal obesity: potential role of maternal
inflammation and insulin resistance
MIRA DEWI, SUSAN E CARLSON, KATHLEEN M GUSTAFSON, DEBRA K SULLIVAN, JO A WICK AND HOLLY R HULL
Background and Objectives: Recent studies show that maternal obesity is associated with impaired offspring neurodevelopmental outcomes. The mechanism underlying the association is unclear. However, there is evidence
to suggest a role for intra-uterine exposure to inflammation and insulin resistance (IR). We aimed to determine if maternal IR and inflammation were associated to fetal neurodevelopment as indicated by fetal heart rate variability (HRV), an index of fetal cardiac autonomic nervous system development. Method and Study Design: A total of 44 healthy maternal-fetal pairs (maternal pre-pregnancy BMI distribution: n=20 normal weight, 8 overweight, 16 obese) were analyzed. We assessed maternal inflammation (plasma IL-6 and TNF-α) and IR (HOMA index). Fetal HRV, a proxy for fetal neurodevelopment, was assessed using fetal magnetocardiogram at the 36th week of pregnancy. The relationships between maternal inflammation and IR with fetal HRV (SD1 and SD2) were estimated individually by Pearson bivariate correlations. Results: No correlations were observed between
the fetal HRV components with maternal HOMA-IR and maternal plasma levels of IL-6 and TNF-α (all p<0.05). However, the negative association between maternal TNF-α level and fetal SD2 approached significance (correlation coefficient=-0.29, 95% confidence interval=-0.62,-0.03, p=0.07). Conclusion: Maternal IR and inflammation during pregnancy were not associated with fetal cardiac autonomic nervous system development. Further
studies with a larger sample size and more maternal inflammatory indicators are needed to explore these relationships.
Key Words: maternal obesity, inflammation, insulin resistance, fetal heart rate variability
Sago worms as a nutritious traditional and alternative food for rural children in Southeast Sulawesi, Indonesia
INTAN R NIRMALA, TREES, SUWARNI AND MOCHAMMAD S PRAMONO
Background and Objectives: The sago worm Rhynchophorus ferrugineus is a nutritious food source found in the remaining parts of a sago palm trunk after the removal of sago starch by farmers. The effort to increase sago
worm consumption is investigated in an intervention study among children aged <5 years. Methods and Study Design: Children aged 1–5 years were allocated to a sago worm inclusive diet (n=10) and to a control group eating a usual diet, but without sago worms (n=13). Snacks were served once per day (100 g) for 45 days and designed to contain similar amounts of vegetables (carrots and long beans) and other ingredients including rice,
sticky rice, cassava, sweet potato, banana, or tofu with or without sago worms. Food preference was ascertained by interview. Anthropometric measurements were taken at baseline and the endpoint. Results: After mixing all food stuffs into one product for instance nasi gurih, protein and fat content in the intervention group was higher compared to control group (8.8 g and 7.3 g vs 4.7 g and 0.5 g respectively). In the intervention group receiving complementary feeding with sago worms, children’s height changed minimally as did the control group (0.3 vs 0.2 cm); no difference was observed between the groups regarding weight or height. Conclusions: Sago worm consumption can diversify the diet through usage in various dishes, so improving its overall nutritional quality. Worm addition in an intervention program does not compromise, but maintains nutritional value. Local use adds affordability and sustainability to the food and health systems in a sago-consuming culture, so contributing to food security.
Key Words: Sago worm, nutritious, food security, children under five, Indonesia
Tumour necrosis factor-α and risk of cardiovascular disease among overfat Indonesian adolescents
DIAN CATURINI SULISTYONINGRUM, RINA SUSILOWATI, EMY HURIYATI, NI PUTU DIAH WITARI, HARRY
FREITAG LUGLIO MUHAMMAD AND MADARINA JULIA
Background: Overfatness (overweight and obesity) is associated with an increased risk of cardiovascular disease, including elevated blood pressure, dyslipidaemia, and insulin resistance. Chronic inflammation may play a role in mediating these associations. Objective: To investigate the association between plasma tumour necrosis factor-α and risk factors for cardiovascular disease among overweight and obese adolescents. Methods and Study Design: This study was an observational analysis with a cross-sectional design for high school students in Yogyakarta, Indonesia. One hundred and fifteen overweight and obese adolescents (mean age 16.8 years; 48.3% female) were involved in the study. Overfatness was specified by body mass index z-scores. Anthropometric measurements, blood pressure, lipid profiles, and fasting glucose were obtained. Fasting plasma insulin and plasma tumour necrosis factor-α were quantified using enzyme-linked immunosorbent assay. Insulin resistance was represented as
the homeostatic model assessment value. Data were analysed using SPSS for Windows, version 23. Results: Plasma tumour necrosis factor-α was significantly associated with total cholesterol (p=0.046) and diastolic blood pressure (p=0.018) among the overweight and obese adolescents. Results from path analyses showed that there were indirect effects of z-score BMI on systolic and diastolic blood pressures, HDL and fasting plasma glucose mediated by plasma tumour necrosis factor-α concentrations. Meanwhile, there were indirect effects of waist circumference on systolic and diastolic blood pressure by age and height percentile and HDL. There was no significant association between plasma tumour necrosis factor-α and insulin resistance. Conclusion: The study showed that a proinflammatory marker, plasma tumour necrosis factor-α, is associated with blood pressure, HDL and fasting plasma glucose in overweight and obese adolescents. This indicates that inflammation in overweight and obesity may play a role in increasing the risk of cardiovascular disease.
Key Words: tumour necrosis factor-α, overfatness, adolescents, blood pressures, lipid profile, insulin resistance
Chronic liver disease is a risk factor for malnutrition and growth retardation in children
ARIANI DEWI WIDODO, EVA J SOELAEMAN, NOVITRIA DWINANDA, PRAJNYA P NARENDRASWARI AND BUDI
PURNOMO
Background: Despite distinct advancements in nutritional therapy, malnutrition and growth retardation remain inevitable consequences of chronic liver disease. The global prevalence of chronic liver disease in children is about 3%, with a quarter undernourished. Malnutrition itself is a negative prognostic indicator of survival. Further research is necessary for delivering adequate nutritional support to reduce morbidity and mortality. Objective: To evaluate the nutritional status and growth of children with chronic liver disease and its contributing factors.
Methods and Study Design: Data were gathered about 21 children aged 7 months to 13.3 years diagnosed with chronic liver disease at Harapan Kita Women and Children Hospital between November 2014 and February 2016. Physical growth and nutritional status were evaluated using anthropometric percentiles and z-scores. Laboratory measurements were made on their first visit. Results: The mean age of participants was 43.9±47.4
months. Mean weight was 13.4±9.31 kg, and mean length/height was 88.8±27.7 cm. Ten (47.6%) and 3 (14.3%) patients had moderate or severe undernutrition, respectively, and 38% (8 patients) had growth retardation. Of those with good nutritional status, 62.5% were older than 5 years. Malnutrition was correlated with growth failure, a low serum albumin, and elevated aspartate transaminase (p<0.05 in all cases). Conclusion: Early diagnosis of malnutrition should encourage nutritional support, delay illness progression and increase survival in children with chronic liver disease.
Key Words: malnutrition, growth failure, chronic liver disease, risk factors
Cooking methods and depressive symptoms are joint risk factors for fatigue among migrant
Indonesian women working domestically in Taiwan
KHAIRIZKA CITRA PALUPI, CHUN-KUANG SHIH AND JUNG-SU CHANG
Background and Objectives: Fatigue is a critical occupational health risk among migrant workers. Globally, more than half of migrant workers are women. However, the prevalence rate and risk factors for fatigue in domestically em-ployed migrant women are unknown. Methods and Study Design: In total, 194 Indonesian women migrants aged 20–50 years who were working in Taipei were studied. Self-perceived acculturation, dietary acculturation, BMI and hae-moglobin were evaluated. Fatigue and depressive symptoms were assessed using the Brief Fatigue Inventory and Beck Depression Inventory-II, respectively. Results: The prevalence of fatigue was 27.8%. Depressive symptoms (p<0.0001), cooking methods (p=0.027), and self-perceived feelings of sadness and weakness (p=0.003) were associat-ed with fatigue. After adjustment for covariates, the ORs for depressive symptoms (OR: 5.40; 95% CI: 2.32–12.6), deep frying/stir frying (OR: 5.23; 95% CI: 1.27–21.5), and self-perceived feelings of sadness and weakness (OR: 3.41; 95% CI: 1.26–9.25) remained significant. An interactive analysis revealed that women without depressive symptoms who used deep frying/stir frying as a cooking method had a 3.5-fold (1–12.3) higher risk of fatigue than did those who used non-deep frying and stir frying as cooking methods (which served as the reference) for cooking. By contrast, women with depressive symptoms who used non-deep frying and stir frying had a 6.5-fold (2.8–15.3) higher risk of fa-tigue, and the risk increased sharply to 12.6-fold (1.26–125.8) if they used deep frying and stir frying for cooking. Conclusions: The risk of fatigue among migrant women working domestically is increased when they exhibit depres-sive symptoms and their cooking technique is frying.
Key Words: fatigue, cooking methods, deep frying/stir frying, depressive symptoms, domestic migrant women, Taiwan
Vitamin D status in under-five children with a history of close tuberculosis contact in Padang, West Sumatra
FINNY FITRY YANI, NUR INDRAWATY LIPOETO, BAMBANG SUPRIYATNO, ERYATI DARWIN AND DARFIOES BASIR
Background and Objective: Serum vitamin D influences cellular immunity against Mycobacterium tuberculosis, particularly in under-five children. Vitamin D insufficiency and deficiency as well as tuberculosis (TB) are highly prevalent in Indonesia. This study described the association of serum vitamin D in the incidence of latent TB in under-five children with a history of close TB contact. Methods and Study Design: This cross-sectional study examined 178 under-five children with a history of close TB contact, with 98 index cases from primary health care facilities in Padang. Latent TB was defined based on a positive tuberculin skin test. Serum vitamin D was determined using ELISA method. General characteristics for age, sex, socioeconomic status, contact score, BCG scars, and nutritional status were also collected. Results: Of 168 eligible subjects, 40.5% had latent TB, however no differences between ‘latent TB’ and ‘without latent TB’ were observed in participant characteristics. Vitamin D deficiency, insufficiency, and sufficiency were observed in 23.3%, 43.5%, and 33.3% of children, respectively. In general, the ‘latent TB’ group had lower serum vitamin D than those in the ‘without latent TB’ group, stratified by age, contact score and nutritional status; however, significant differences were observed in children age <1 years (18.02.6 vs 31.210.5, respectively, p=0.013). Nevertheless, no associations between the two groups were observed using multivariate analysis. Conclusion: Vitamin D status was not associated with the incidence of latent TB among under-five children with a history of close TB contact, although this may not obtain in children aged <1 year old.
Key Words: vitamin D status, tuberculosis contact, under-five children, latent tuberculosis
Energy regulation in newly diagnosed TB with chronic energy deficiency: free fatty acids and RBP4
NURPUDJI A TASLIM, DEVINTHA VIRANI, NI KETUT SUMARTINI, KARMILA, AGUSSALIM BUKHARI, AMINUDDIN, SURYANI AS’AD, RADEN SATRIONO, HAERANI RASYID AND IRAWATY DJAHARUDDIN
Background and objectives: Energy metabolism may be dysfunctionally integral between host and infective agent in active tuberculosis, mediated by adipocytokines and free fatty acids (FFA) as the products of triglyceride lipolysis in fat, blood or other tissues. Retinol Binding Protein 4 (RBP4) and asymmetric dimethylarginine (ADMA) are candidate adipocytokines. The possibility of a deleterious metabolic nexus in chronic energy defi-ciency (CED) (BMI <18.5 kg/m2) is explored. Methods and design: Newly diagnosed patients with tuberculosis (n=63) were selected using consecutive random sampling at a Centre for the Care and Treatment of Lung Diseas-es in Makassar, Indonesia. Diagnosis of pulmonary TB required microscopy with Ziehl-Neelsen stain. Anthro-pometric measurements were taken. Venesection allowed glomerular filtration rate, FFA, serum glutamic oxaloa-cetic transaminase and glutamate-pyruvate transaminase to be assessed. Results: CED was evident in 60.3%. For the well and lesser nourished, medians were, respectively, FFA 0.30 and 0.37 mmol/mL (p=0.960); RBP4 199730 ng/mL and 11721 ng/mL (p=0.009); GFR 106 ml/min and 113 ml/min (p=0.673); and ADMA 0.52 ng/mL and 0.51 ng/mL (p=0.172). BMI and serum RBP4 were correlated (ρ=0.52, p<0.001), with odds ratios (OR) 5.8 (CI 1.68-20.3). RBP4 in CED was lower than in better nourished patients. Serum FFA is not evidently associated with BMI in patients with active TB. Conclusions : RBP4 is some 6-fold lower when active TB patients have CED than when BMI >25 kg/m2. However, FFA was not associated with CED in these active TB patients which may be a type 2 error or represent an energy impasse where infection and the host’s metabolic needs are in com-petition.
Key Words: tuberculosis, malnutrition, free fatty acids, retinol binding protein 4, asymmetric dimethylarginine
Selenium status and fungi in the protein-losing enteropathy of persistent diarrhea
PRAMITA G DWIPOERWANTORO, WIDJAJA LUKITO, DIANA AULIA, JOSIANE ARNAUD AND A-M ROUSSEL
Background and Objectives: A vicious cycle of infection, malabsorption, and malnutrition has been implicated in the perpetuation of diarrheal disease. This study examined whether persistent diarrhea is associated with changes in selenium status and stool alpha-1 antitrypsin (AAT) concentration. Methods and Study Design: This cross-sectional study included 30 children aged 1–12 years with persistent diarrhea who were hospitalized in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, and 30 apparently healthy children who were matched by age and sex and lived in a rural area of Jakarta. Clinical examinations, blood routine tests, erythrocyte glutathione peroxidase (GPX) activity and plasma selenium levels as well as AAT in fresh stool samples were performed in all the subjects. Results: Of 30 children with persistent diarrhea, 17 had moderate malnutrition and 13 had severe malnutrition. The mean plasma selenium was significantly lower in children with persistent diarrhea than in children without diarrhea (86.0 g/L [95% CI: 76.1–95.9] vs 110 ɧ#61549;g/L [95% CI: 104–116, p<0.0001). The mean stool AAT concentration was significantly higher in children with persistent diarrhea than in those without diarrhea (115 mg/dL [95% CI: 38.5–191] vs 16 mg/dL [95% CI: 4.0–13.5, p<0.0001]). Selenium correlated with AAT (p=0.05). Fecal fungi were persistently present. Conclusions: Although selenium status in both groups was optimal for the obtained plasma GPX activity, children with persistent diarrhea exhibited lower plasma selenium levels. This study suggests that the decrease in the plasma selenium level may be the consequence of protein loss and that fungi may be involved.
Key Words: malnutrition, enteropathogen, intestinal inflammation, protein-losing enteropathy
Pre- and postprandial acylated ghrelin in obese and normal weight men
SRI ANDARINI, FERDY BANGUN KANGSAPUTRA AND DIAN HANDAYANI
Background and Objectives: The prevalence of obesity in Indonesia has increasing. We have assessed the relationship between plasma acylated ghrelin hormone and self-reported appetite ratings (hunger and desire to eat) in obese and normal weight men. Methods and Study Design: Thirty-two men participated in an experimental study, where acylated ghrelin and self-reported appetite ratings were compared between a test group of 16 obese men and a control group of 16 men with normal body mass indices. The participants were administered isocaloric mixed meals, and measurements were taken at 0 (before eating), 30, 60, and 120 minutes postprandial. Data were analysed using an independent t test, the Mann–Whitney U test, the Pearson correlation, the Spearman rank-order correlation, trapezoidal rule analysis for the area under the curve, and receiver operating curve analysis to determine the optimal cut-off values, sensitivity, and specificity. Results: Acylated ghrelin concentrations were higher in the test group than in the control group at all time points (p<0.01). There were no significant differences in the appetite ratings between the two groups at any time (p>0.05). There was no correlation between the acylated ghrelin concentration and appetite rating. According to the receiver operating curve analysis (sensitivity: 88%; specificity: 100%), the cut-offs for optimal acylated ghrelin immediately before eating and 30 minutes after eating, averaged 2332 pg/mL and 2710 pg/mL, respectively. Conclusions: The effect on obesity will depend on associated changes in deacylated ghrelin. Acylated ghrelin increases in obese individuals pre- and 30, 60, 90 and 120 minutes post prandial.
Key Words: acylated ghrelin, appetite, obesity, energy homeostasis, hunger