Stunting di Era Pandemic

Covid 19
Fokus: Peran Nutrisi
Nurpudji A Taslim
Perhimpunan Dokter Gizi Klinik Indonesia
Dept. Gizi fakultas Kedokteran Univ. Hasanuddin
2020
 (KERDIL)

Stunting adalah kondisi gagal

tumbuh pada anak balita akibat
kekurangan gizi kronis sehingga
anak terlalu pendek untuk usianya.

Kegagalan seorang anak untuk tumbuh

dan berkembang secara optimal
disebabkan dampak dari kekurangan
gizi secara kumulatif dan terus menerus
 WHO Indonesia negara tertinggi ke
5 di dunia

Ke-2 tertinggi
SEAR South-East Asia Regional
(SEAR).

Balita stunting di Indonesia (30.8%)

RIKESDA
2018 SULBAR no.2 ( 39.7%)
NTT 51,7%. No.1
penyebab
Stunting
 Penyebab
Terbatasnya layanan kesehatan:
Praktek pengasuhan yang
Kurang baik: a. Kurangnya akses ke makanan bergizi.
a. 2 dari 3 ibu hamil belum b. 1 dari 3 ibu hamil Anemia
mengonsumsi suplemen zat
a. Kurang pengetahuan tentang
besi yang memadai
kesehatan dan gizi sebelum
dan pd masa kehamilan
b. 1 dari 3 anak usia 3-6 thn tdk Kurangnya akses ke air Bersih dan
terdaftar di PAUD Sanitasi:
b. 60% dari anak usia 0 – 6
bulan tidak mendapat ASI a. 1 dari 5 RT masih BAB di ruang terbuka
c. Menurunnya tingkat kehadiran b. 1 dari 3 RT belum memiliki akses ke air
eksklusif
anak di Posyandu minum bersih
c. 2 dari 3 anak usia 0 – 24 bln c. Cuci tangan dengan benar masih
d. Tidak mendapat akses yang rendah
tidak menerima MP - ASI
memadai ke layanan imunisasi
Rikesda, 2018
 Indian government has assured food &
medicine to avoid food insecurity during
Laxman Swaroop Sharma Covid-19 pandemic
Assistant Professor at IIHMR University, Jaipur.

Appropriate nutrition responses with

identify type, degree & extent of
undernutrition

Community-based Acute Malnutriton

(CMAM) is a key child survival intervention
(low-cost evidence-based intervention )
Multiple patch-like shadows
• Polypnea was the most common symptom in severe pediatric
patients in Wuhan, followed by fever & cough
• Common imaging changes was multiple patch-like shadows &
ground-glass opacity
• Cytokine storm was found in patients, more serious in critical
illness

Ground-glass opacity
 Malnutrition/Undernutrition

Altered gut Dysregulation of

Enteropathy ↑ IL-10 ↑ MCP-1 ↓ IL-6 ↓ IL-8
microbiota adipocytokine

Impaired
GALT ↓ mucosal Villus blunting
development barrier ↓ Leptin ↑ systemic Altered macrophage Inhibition of
Inflammation recruitment neutrophil
chemotaxis

↓ production ↓ production ↓ absorption of ↓ Th1 & Th17

of Ig A of lymphocyte nutrients polarization

Immune exhaustion & dysregulation

Bacterial
translocation Worsen malnutrition

Impacted to Impacted to
local infection systemic infection

Depletion of immune system

 Herd/Community Immunity

Natural infection Vaccination

Develop individual Immunity

Infection → Threshold
proportion of population

Immune of population

Incidence of the pathogen will decline

Metcalf CJE et al., Understanding Herd Immunity. Trends in Immunology 2015;

Times of India, 2020
The Role of Nutrition
in Children During
COVID-19 Pandemic
• Diet constitutes a critical determinant of immune status
• Malnutrition: most common cause of immunodeficiency
worldwide
• Protein-energy malnutrition (PEM) associated with:
- Cell-mediated immunity impairment
- Phagocyte function
- Complement system
- Cytokine production
- IgA antibody secretion
• Nutritional status associated with:
- the functioning and maintaining of our immune system
- immunity and host resistance against any infectious agent

• Immune system depend on adequate amounts of nutrients

(macro- and micronutrient)
Carbohydrates Proteins Fats
Carbohydrates
• Abundant in many food
• Including cereals, grains, fruits and vegetables
• Provide 4 kcal/g
• 50-60% of total energy intake
• Monosaccharides (glucose, fructose)
• Disaccharides (sucrose, lactose)
• Polysaccharides (starch)
• Sugar alcohol
Proteins & Amino Acids
• Have structural & functional roles in every cell in the body
• Provide 4 kcal/g
• 10-15% of total energy intake
• Dietary protein intake is required to replenish the
turnover of proteins & to meet amino acid need for
growth
• Also provides energy substrate when in excess orduring
periods of catabolism
• PEM impairs brain,immune system & intestinal
mucosal functions
FATS
• The most calorically dense macronutrient
• Providing approximately 9 kcal/g
• For infants: human milk/formula are the main
dietary sources of fat
• Older children: get fat from animal products,
vegetable oils and margarine
 Vitamins
Minerals
The most important in
Covid-19 pandemic:
Regulatory effects of
micronutrients on
immune response
 Micronutrient
• Zinc • Vitamin A
• Iron • Vitamin C
• Copper • Vitamin D
• Selenium • Vitamin E
• Target cell: T cell, NK cell, B cell
• Deficiency promotes infection, impairs immune
response, ↓ hematopoiesis
• Lymphopenia, dermatitis, enteritis
• ↓ Thymic activity
• ↓ Antioxidant enzyme activity
• Sources: meats, shellfish, legumes, fortified cereals,
whole grains
• Target cell: T cell, monocyte
• Iron deficiency causes ↓ neutrophil oxidative burst activity and
↓IgG4 levels
• Anemia linked with mortality in HIV
• Iron excess causes infection in the genetically susceptible host
• Sources:
➢ Heme sources; meat, poultry, fish
➢ Nonheme sources; dairy, eggs, plant-based foods,
breads,
cereals, breakfast foods
• Target cell: monocyte, T cell, neutrophil
• Deficiency leads to infections
• Deficiency ↓ proliferation, phagocyte activity
• Sources: shellfish, seeds and nuts, organ
meats, wheat- bran cereals, whole-grain
products, chocolate
• Target cell: monocyte
• Deficiency suppresses antigen presentation
• Repletion ↑ proliferation
• Deficiency linked to ↑ HIV infection
• Sources: Brazil nuts, seafoods, organ meats,
muscle meats, cereals and other grains, dairy
products
• Target cell: T cell, NK cell, B cell
• Deficiency causes infections, mortality from
infections, ↓ NK activity
• Repletion improves gut integrity at weaning
• Repletion reduces morbidity, mortality from infections
• Sources: liver, dairy products, fish, dark-colored fruit,
leafy vegetable
• Target cell: phagocyte
• Promotes phagocytic and NK activity
• Reduces stress IL-6 response
• Improves response to streptococcal infection
• Reduces growth of Helicobacter pylori
• Sources: Citrus fruit, tomatoes, tomato juice,
potatoes, Brussels sprouts, cauliflower, broccoli,
strawberries, cabbage, spinach
 1,25- dihydroxy-vitamin d3

• Target cell: T cell, B cell, monocyte, macrophage,

dendritic cell
• Affects differentiation, maturation and function of cells
• Suppresses autoimmune disease in animal models
• Deficiency may promote TB infection
• Sources: fish liver oils, flesh of fatty fish, eggs from
hens that have been fed vitamin D, fortified milk
products, fortified cereals
• Target cell: T cell, B cell, monocyte
• ↑ Proliferative, IL-2 response in vitro
• Improves skin test response
• Deficiency may promote viral virulence
• Sources: vegetable oil, unprocessed cereal
grains, nuts, fruit, vegetables, meat
 Kesimpulan
• Untuk menunjang pertumbuhan dan perkembangan anak,
perlu:
• memenuhi kebutuhan gizi anak --- makro & mikro
nutrient
• pemilihan makanan yang tepat untuk menghindarkan
anak mengalami gizi kurang atau bahkan gizi buruk
• kebersihan lingkungan dan sanitasi kesehatan
Food is
medicine when
you are ill
 Thank you
have a nice day