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NUTRISI PERI KONSEPSI UNTUK 1000

NUTRISI PERI KONSEPSI UNTUK 1000 HARI PERTAMA KEHIDUPAN Maisuri T. Chalid Department of Obstetrics and Gynecology,

HARI PERTAMA KEHIDUPAN

NUTRISI PERI KONSEPSI UNTUK 1000 HARI PERTAMA KEHIDUPAN Maisuri T. Chalid Department of Obstetrics and Gynecology,

Maisuri T. Chalid

Department of Obstetrics and Gynecology, Faculty of Medicine

Hasanuddin University

1000 HPK
1000 HPK
1000 HPK
MENGAPA 1000 HARI PERTAMA KEHIDUPAN, PENTING?
MENGAPA 1000 HARI PERTAMA KEHIDUPAN, PENTING?

Dampak jangka pendek

Dampak jangka panjang

Perkembangan

otak

Pertumbuhan massa tubuh dan komposisi badan

Kognitif dan

MENGAPA 1000 HARI PERTAMA KEHIDUPAN, PENTING? Dampak jangka pendek Dampak jangka panjang Perkembangan otak Pertumbuhan massa

Diabetes, Obesitas,

Penyakit jantung dan

  • Prestasi belajar

Gizi pada 1000 hari pertama kehidupan (janin dan bayi 2 tahun)
Gizi pada
1000 hari pertama
kehidupan
(janin dan
bayi 2 tahun)
Mati
Mati

Kekebalan
Kapasitas kerja

Metabolisme glukosa, lipids, protein Hormon/receptor/gen

  • pembuluh darah, kanker, stroke, dan disabilitas lansia

3

Sumber: Short and long term effects of early nutrition (James et al 2000)

Fetal Origins of Adult Disease:

“Barker” hypothesis: programming of function

During early life nutrient exposure sets metabolic behaviour and thereby determines the risk of

chronic disease during adult life.

Fetal Origins of Adult Disease: “Barker” hypothesis: programming of function During early life nutrient exposure sets
Fetal Origins of Adult Disease: “Barker” hypothesis: programming of function During early life nutrient exposure sets

Early Life Origins of Health and Disease

Early Life Origins of Health and Disease Evidence of a relationship between birth weight and risk

Evidence of a relationship

between birth weight and risk of non-communicable disease in adult life:

  • - Type II diabetes

  • - Hypertension

  • - CVD

  • - Obesity

  • - Other …….

Early Life Origins of Health and Disease Evidence of a relationship between birth weight and risk
Potential Mechanisms of Developmental Programming
Potential Mechanisms of
Developmental Programming
Structural Deficits  Reduced Functional Units in Organs
Structural Deficits  Reduced
Functional Units in Organs
Kidney
Kidney

Nephron #

HTN

Potential Mechanisms of Developmental Programming Structural Deficits  Reduced Functional Units in Organs Kidney  Nephron

Pancreas Islet Cell #

Insulin secretion

Glucose

Muscle
Muscle

muscle mass

Basal met rate

Exercise capacity

Heart

myocyte #

Risk CHF

Liver

cells #

 cells # ?  lipid metabolism

? lipid metabolism

New Nephrons Form in Concentric Layers during Gestation Condensing Mesenchyme Comma Shaped Bodies Outer Nephrogenic Layer

New Nephrons Form in Concentric Layers during Gestation

New Nephrons Form in Concentric Layers during Gestation Condensing Mesenchyme Comma Shaped Bodies Outer Nephrogenic Layer
Condensing Mesenchyme Comma Shaped Bodies Outer Nephrogenic Layer
Condensing Mesenchyme Comma Shaped Bodies
Outer Nephrogenic Layer

Glomeruli

Branching Morphogenesis Nephrogenesis

PERTUMBUHAN OTAK PADA PERIODE 1000 HARI PERTAMA KEHIDUPAN
PERTUMBUHAN OTAK PADA PERIODE 1000
HARI PERTAMA KEHIDUPAN

APA DAMPAK KEKURANGAN GIZI KRONIS

DALAM 1000 HARI PERTAMA KEHIDUPAN TERHADAP PERKEMBANGAN OTAK SELANJUTNYA ???
DALAM 1000 HARI PERTAMA KEHIDUPAN
TERHADAP PERKEMBANGAN OTAK
SELANJUTNYA ???

Gambar A menunjukkan otak anak yang mengalami kekurangan gizi kronis dalam 1000 hari kehidupannya dan gambar B menunjukkan otak dengan gizi baik (sehat). Pada otak anak yang sehat hampir tidak ada bagian yang kosong (putih) dan terlihat padat dan banyak lekukan, karena otak berkembang dengan baik. Sedangkan pada gambar A terlihat banyak bagian kosong (putih) dan lekukannya sedikit, karena otak tidak berkembang secara optimal. Kerusakan dan keterlambatan perkembangan otak bersifat menetap sehingga anak tidak bisa mencapai tumbuh kembang yang optimal.

STATUS OF INDONESIAN PREGNANT WOMEN?
STATUS OF INDONESIAN PREGNANT
WOMEN?
PROPORTION OF ANEMIA IN PREGNANT WOMEN VS URBAN/RURAL AREA, 2013
PROPORTION OF ANEMIA IN PREGNANT
WOMEN VS URBAN/RURAL AREA, 2013
50,0 40,0 37,8 37,1 36,4 30,0 20,0 10,0 0,0 Perkotaan Perdesaan INDONESIA
50,0
40,0
37,8
37,1
36,4
30,0
20,0
10,0
0,0
Perkotaan
Perdesaan
INDONESIA

*) Nilai rujukan menurut WHO/MNH/NHD/MNN/11.1,2011 dan Kemenkes,1999 **) Cut off points anemia Ibu Hamil, Hb < 11,0 g/dl

PROPORTION OF WOMEN REPRODUCTIVE AGE WITH CHRONIC

ENERGY MALNUTRITION: 2007 & 2013
ENERGY MALNUTRITION: 2007 &
2013
2007 2013 50,0 50,0 40,0 40,0 30,0 30,0 20,0 20,0 10,0 10,0 0,0 0,0 15-19 20-24
2007
2013
50,0
50,0
40,0
40,0
30,0
30,0
20,0
20,0
10,0
10,0
0,0
0,0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
15-19
20-24 25=29 30-34
35-39
40-44
45-49
Hamil
Tidak Hamil
Hamil
Tidak Hamil
31,3
30,9
23,8
18,2
16,1
13,1
12,7
10,2
12,6
8,9
10,3
7,9
5,6
8,1
38,5
46,6
30,1
30,6
20,9
19,3
21,4
13,6
17,3
11,3
17,6
10,7
20,7
11,8

*) Risiko KEK jika Lingkar lengan atas (LILA)<23,5 cm

Source: Riskesdas 2007, 2013

AGE GROUPS VS ENERGY CONSUMPTION, 2014
AGE GROUPS VS ENERGY
CONSUMPTION, 2014
 

Tingkat kecukupan kalori

Karakteristik

< 70%

70-<100

≥100-

<130%

≥130%

AKK

% AKK

AKK

AKK

0-59 bln

6,8

48,9

27,1

17,1

5-12 thn

29,7

40,1

19,9

10,2

13 18 thn

52,5

30,3

12,2

5,0

19 55 thn

50,0

32,5

12,9

4,6

>55 thn

44,6

33,5

15,5

6,3

Sumber: Studi Diet Total 2014

AGE GROUPS VS PROTEIN CONSUMPTION, 2014

AGE GROUPS VS PROTEIN CONSUMPTION, 2014 Tingkat kecukupan protein Karakteristik < 80% 80%- ≥100 - ≥120%
   

Tingkat kecukupan protein

 

Karakteristik

< 80%

80%-

≥100-

≥120%

AKP

<100% AKP

<120% AKP

AKP

Kelompok Umur

 
  • 0 - 59 bln

23,6

10,6

11,5

54,2

  • 5 - 12 thn

29,3

16,1

14,7

39,9

13-18 thn

48,1

18,1

13,4

20,1

19-55 thn

33,8

17,9

15,1

33,3

>55 thn

45,8

17,4

13,1

23,7

Source: Studi Diet Total 2014

POTENSI INDONESIA
POTENSI INDONESIA
POTENSI INDONESIA Pada 2010 sumbangan protein ikan dalam total asupan protein hewani rakyat Indonesia baru 50
POTENSI INDONESIA Pada 2010 sumbangan protein ikan dalam total asupan protein hewani rakyat Indonesia baru 50

Pada 2010 sumbangan protein ikan dalam total asupan protein hewani rakyat Indonesia baru 50 %, sekarang 62 %.

WINDOW OF OPPORTUNITY Sembilan Tahun I Tahun II bulan kelahiran kelahiran dalam (365 hari) (365 hari)
WINDOW OF
OPPORTUNITY
Sembilan
Tahun I
Tahun II
bulan
kelahiran
kelahiran
dalam
(365 hari)
(365 hari)
rahim
(9x30 hari)
= 270 hari
Program 1000 HPK Fakultas Kedokteran Universitas Hasanuddin

Maternal Protein Deficiency

Maternal Protein Deficiency Asymmetric Growth Restriction in Utero “The Thrifty Phenotype” Impaired Kidney Development # Nephrons
Asymmetric Growth Restriction in Utero “The Thrifty Phenotype” Impaired Kidney Development # Nephrons FOOD (permanent)
Asymmetric Growth Restriction in Utero
“The Thrifty
Phenotype”
Impaired Kidney
Development
# Nephrons
FOOD
(permanent)

CATCH-UP

GROWTH

Maternal Protein Deficiency Asymmetric Growth Restriction in Utero “The Thrifty Phenotype” Impaired Kidney Development # Nephrons

#

Nephrons

Maternal Protein Deficiency Asymmetric Growth Restriction in Utero “The Thrifty Phenotype” Impaired Kidney Development # Nephrons
BODY MASS
BODY
MASS
Maternal Protein Deficiency Asymmetric Growth Restriction in Utero “The Thrifty Phenotype” Impaired Kidney Development # Nephrons
Maternal Protein Deficiency Asymmetric Growth Restriction in Utero “The Thrifty Phenotype” Impaired Kidney Development # Nephrons
BP
BP
MULTIPLE MICRONUTRIENT SUPPLEMENTATION
MULTIPLE MICRONUTRIENT
SUPPLEMENTATION
• Women of reproductive age, especially pregnant women, in developing countries are recognized to be at
• Women of reproductive age, especially pregnant women, in developing countries are
recognized to be at risk of multiple micronutrient deficiencies, such as iron, folic
acid, iodine, zinc, vitamins A and D, riboflavin, B6 and B12, with the likelihood of
adverse effects on the mother and pregnancy outcomes
• Pregnancy represents a state of increased metabolic requirements, and intake of key micronutrients by pregnant
• Pregnancy represents a state of increased metabolic requirements, and intake of key
micronutrients by pregnant women especially in developing countries is usually
inadequate. This inadequate intake and increased requirement further exacerbates
the pre-existing maternal deficiency [7].
PERANAN IONIC CALCIUM, DHA & ANTIOKSIDAN PADA KASUS PRE EKLAMSIA
PERANAN IONIC CALCIUM, DHA & ANTIOKSIDAN
PADA KASUS PRE EKLAMSIA

Teori Disfungsi Endotel

Preeklamsia Disfungsi Endotel
Preeklamsia
Disfungsi Endotel
Stress Oxidative Peningkatan Jumlah Radikal Bebas
Stress Oxidative
Peningkatan Jumlah Radikal
Bebas

Invasi Blastosit ke Uterus

Pembentukan Struktur Fili Remodeling Arteri Spiral (hanya 30-50%) Janin kekurangan oksigen Iskemia Plasenta

Pembentukan Struktur Fili

Pembentukan Struktur Fili Remodeling Arteri Spiral (hanya 30-50%) Janin kekurangan oksigen Iskemia Plasenta
Remodeling Arteri Spiral (hanya 30-50%)
Remodeling Arteri Spiral
(hanya 30-50%)
Remodeling Arteri Spiral (hanya 30-50%)
Janin kekurangan oksigen
Janin kekurangan oksigen
Iskemia Plasenta
Iskemia Plasenta
Iskemia Plasenta
Iskemia Plasenta
Respon inflamasi
Respon inflamasi
Teori Disfungsi Endotel Preeklamsia Disfungsi Endotel Stress Oxidative Peningkatan Jumlah Radikal Bebas Invasi Blastosit ke Uterus

Disfungsi Endotel

Asam Lemak Lipid Peroksidasi Disfungsi Endotel Oksidan Bebas Kerusakan Glomerular Kerusakan pembuluh darah di hati Kerusakan
Asam Lemak
Lipid Peroksidasi
Disfungsi
Endotel
Oksidan Bebas
Kerusakan
Glomerular
Kerusakan pembuluh
darah di hati
Kerusakan sel di
Gangguan Ginjal
hati
Proteinurea
Proteinurea
Enzim hati (SGOT/ SGPT) >>>
Enzim hati (SGOT/
SGPT) >>>
Peningkatan Tromboksan Vasokonstriksi Hipertensi
Peningkatan
Tromboksan
Vasokonstriksi
Hipertensi
Preeklamsia
Preeklamsia

Teori Kalsium

Epidemiologic

data

suggest,

however

an

inverse

correlation between dietary calcium intake and

incidence of PIH in diverse populations

In rural Guatemala, despite the low socioeconomic

status and low

intake

of

protein

and

energy

of

women, the incidence of eclampsia is low (<0.4 per

1000 births)

Dietary calcium in this population is relatively high (<1100 mg/d), in large part because of the incorporation of lime-processed tortillas as a staple component of the diet.

1980 Belizan dan Villar

Calcium Intake

In addition, a low calcium intake is associated with an increased risk of pregnancy-induced hypertension and related obstetric complications,

Calcium

supplementation

has

been

shown

to

reduce the blood pressure of pregnant women and their offspring in some studies

To what extent these effects indicate the correction of a nutritional deficit or the pharmacologic action of calcium independent of customary calcium intake is, as yet, unknown and needs further detailed research.

DA McCarron, unpublished observations, 1998

MEKANISME TERJADINYA

PREEKLAMPSIA

MEKANISME TERJADINYA PREEKLAMPSIA Wanita hamil kekurangan kalsium Stimulasi hormon paratiroid (PTH) Peningkatan kalsium intraselular Otot polos

Wanita hamil kekurangan kalsium

MEKANISME TERJADINYA PREEKLAMPSIA Wanita hamil kekurangan kalsium Stimulasi hormon paratiroid (PTH) Peningkatan kalsium intraselular Otot polos

Stimulasi hormon paratiroid (PTH)

Peningkatan kalsium intraselular Otot polos
Peningkatan kalsium intraselular
Otot polos

Referensi:

Pembuluh darah

MEKANISME TERJADINYA PREEKLAMPSIA Wanita hamil kekurangan kalsium Stimulasi hormon paratiroid (PTH) Peningkatan kalsium intraselular Otot polos

Vasokontriksi

Rahim

MEKANISME TERJADINYA PREEKLAMPSIA Wanita hamil kekurangan kalsium Stimulasi hormon paratiroid (PTH) Peningkatan kalsium intraselular Otot polos

Kontraksi

1. Hofmeyr GJ et al.; Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems; Cochrane Database of Systematic Reviews; 2010

Perbandingan kejadian hipertensi kehamilan pada ibu hamil yang diberikan kalsium dan yang tidak

Women with Hypertensive Disorders Of Pregnancy (%)
Women with Hypertensive Disorders
Of Pregnancy (%)

Week of Gestation

Resiko gangguan hipertensi pada kehamilan secara signifikan lebih rendah pada ibu hamil yang diberikan suplementasi kalsium daripada yang tidak (3)

Referensi:

  • 1. Nitkowski J; The Real Calcium Problem and Solution; NutritionReallyWorks.net; 2011

  • 2. Hofmeyr GJ et al.; Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems; Cochrane Database of Systematic Reviews; 2010

Long-term effect of calcium supplementation

during pregnancy on the offspring's blood pressure during childhood
during pregnancy on the offspring's blood pressure
during childhood

The risk of high systolic blood pressure was also lower in the calcium group than in the placebo group

(relative risk 0.59; 0.39 to 0.90) and particularly

among children in the highest fourth of body mass

index (0.43; 0.26 to 0.71).

Conclusion :

Calcium supplementation during pregnancy is associated with lower systolic blood pressure in the

offspring, particularly among overweight children.

Belizan, 1997. British Medical Journal. 315(7103):281-5

Ionic Calcium as Coral Calcium
Ionic Calcium as Coral Calcium

Ionic Calcium {Ca++} is available as Coral Calcium.

Total molecular weight of ionic calcium is 40.09 mg.

Ionic calcium is 100% calcium.

Scientists

tell

absorbed.

us

that

98%

of

the ionic

calcium is

So for every 1,000 mg of Coral Calcium, a unique organic calcium carbonate compound that dissipates

calcium directly in its ionic form, 40% is ionic calcium

or 400 mg of calcium.

Of this 400 mg 98% is absorbed, or 392 mg of usable

calcium.

98 95 100 90 80 70 60 50 50 40 40 40 39 37 33 40
98 95 100 90 80 70 60 50 50 40 40 40 39 37 33 40
98 95 100 90 80 70 60 50 50 40 40 40 39 37 33 40
98
95
100
90
80
70
60
50
50
40
40
40
39
37
33
40
30
21
20
10
10
10
0
Ionic Coral
Coral Calcium
Ca Carbonate
Ca Citrat
Ca Lactate
Ca Phospate
Calcium
% Kandungan Ca Elemental
% Absorbsi

Omega-3 dan Pencegahan

preeklampsia

Fish oil, yang kaya akan omega-3 (asam lemak tidak

jenuh) diketahui dapat mengurangi kadar trigliserid puasa dan postprandial dan dapat menurunkan

reaktifitas platelet dan leukosit serta dapat juga

menurunkan tekanan darah.

Omega-3 juga dapat merubah karakteristik dinding

pembuluh darah dan reologi darah.

Referensi:

1. A. Williams et al. Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia. Seatlle. 1995.

Referensi: 1 . A. Williams et al. Omega-3 fatty acids in maternal erythrocytes and risk of

Referensi:

1. A. Williams et al. Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia. Seatlle. 1995.

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena: Dapat mengoptimalkan perkembangan otak dan sel

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena:

Dapat mengoptimalkan perkembangan otak dan sel syaraf janin/bayi (1)

Mencegah terjadinya preeklampsia pada saat kehamilan (2)(3)

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena: Dapat mengoptimalkan perkembangan otak dan sel

Omega -3 yang baik tidak mengandung AA, karena AA dapat meningkatkan resiko terjadinya preeklampsia saat kehamilan (4)

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena: Dapat mengoptimalkan perkembangan otak dan sel

Referensi:

Linoleic Acid (LA)

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena: Dapat mengoptimalkan perkembangan otak dan sel

Delta-6 Desaturase (D6D)

γ – Linoleic Acid (GLA)

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena: Dapat mengoptimalkan perkembangan otak dan sel

Elongase

Dihomo-γ – Linoleic Acid (DGLA)

Omega -3 baik dikonsumsi dari awal kehamilan sampai menyusui karena: Dapat mengoptimalkan perkembangan otak dan sel

Delta-5 Desaturase (D5D)

Arachidonic Acid (AA)

Tromboxan (TXA 2 )
Tromboxan (TXA 2 )
  • 1. Morse, Nancy L; Benefits of Docohexanoic Acid, Folic Acid, Vit D and Iodine ond Foetal and Infant Brain Development and Function Following Maternal Supplementation during Pregnancy and Lactation; Nutrients. 2012.

  • 2. Mahomed et al; Erythrocyte Omega-3, Omega-6 and Trans Fatty Acids in Relation to Risk of Preeclampsia among Women Delivering at Zimbabwe; Physiological Research.2007.

Vasokonstriktor

Pro-Inflamasi

Pro-Agregasi

Pro-Aritmia

  • 3. Kulkarni et al; Reduced placental docosahexaenoic acid levels associated with increased levels of sFlt-1 in preeclampsia,2010.

  • 4. Patterson et al; Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids; Journal of Nutrition and Metabolism.2011,

HIS NAME IS TODAY We are guilty of many errors and many faults,
HIS NAME IS TODAY
We are guilty of many errors and many faults,
But our worst crime is abandoning the children,
But our worst crime is abandoning the children,
Neglecting the fountain of life,
Neglecting the fountain of life,
HIS NAME IS TODAY We are guilty of many errors and many faults, But our worst

Many of the things we need can wait, The child cannot wait. Right now is the time his bones are being formed, His blood is being made, And his senses are being developed,

HIS NAME IS TODAY We are guilty of many errors and many faults, But our worst
HIS NAME IS TODAY We are guilty of many errors and many faults, But our worst
HIS NAME IS TODAY We are guilty of many errors and many faults, But our worst
HIS NAME IS TODAY We are guilty of many errors and many faults, But our worst
To him we cannot answer “tomorrow”
To him we cannot answer “tomorrow”
His name is TODAY
His name is TODAY
(Gabriella Mistral, Nobel Prize Poet from Chile)
(Gabriella Mistral, Nobel Prize Poet from Chile)

Program 1000 HPK Fakultas Kedokteran Universitas Hasanuddin