RINI SEKARTINI
KONSULTAN TUMBUH KEMBANG ANAK
TENTANG SAYA
Saya adalah seorang ibu, dengan
3 anak, lahir di Jakarta 2 Juni
1965. Selain kegiatan mengajar
dan membimbing mahasiwa,
hobi saya main sepeda, nonton
film action dan travelling.
Jl. Kelapa Sawit IX blok K3/1
Pondok Kelapa, Jakarta 13450
rsekartini@yahoo.com
rini.sekartini@ui.ac.id
(021) 3907743
08129272702
PENGALAMAN KERJA
Dokter Puskesmas Kampung Dalam – Kotamadya
Pontianak, Kalimantan Barat (1990 – 1993)
Dokter kontingen PON Kalimantan Barat tahun 1993
Staf Departemen Ilmu Kesehatan Anak FKUI – RSCM
PENDIDIKAN
• Lulus Dokter umum FKUI tahun 1990
• Lulus Dokter Spesialis Anak FKUI tahun 1998
• Pendidikan “Maternal & Child Health” Tokyo tahun 2000
• Konsultan Tumbuh Kembang–Pediatri Sosial tahun 2006
• Lulus Program Doktor Ilmu Kedokteran tahun 2008
• Guru besar FKUI tahun 2017
ORGANISASI
• Ketua IDAI Jaya 2014 – 2020
• Sekretaris Koperasi Anak Mandiri Sejahtera
KONSULTASI
Kencana RSCM
RSIA Bunda – Jakarta
Klinik Tumbuh Kembang Lalita – Sumarecon, Bekasi
Gut-brain Axis for Growth
and Development : the
Role of Probiotic
Rini Sekartini
Pokok bahasan

• Definisi Gut-Brain axis, teori yang berkembang

• Teori hubungan antara perkembangan saluran cerna

dan susunan saraf pusat

• Studi terkait Gut-brain axis

Tumbuh Kembang Anak Jangka Panjang:
• Ditentukan oleh kualitas perkembangan otak selama
periode kritis di awal kehidupan
• Saat ini: berkembang konsep “Gut-Brain-Axis”

Pembentukan struktur dan fungsi otak

terkait dengan kesehatan saluran cerna
Konsep Gut-Brain-Axis:
• Fungsional: diperankan oleh mikrobiota saluran cerna

“[Microbiota]-Gut-Brain-Axis”

• Mikrobiota saluran cerna mempunyai peran dalam

regulasi pembentukan dan fungsi otak à memengaruhi
perjalanan jangka panjang pertumbuhan dan
perkembangan anak (Mu, 2016)
Dalam hal tumbuh kembang anak,
mikrobiota saluran cerna berperan
penting dalam mekanisme:

PERTUMBUHAN:
– malnutrisi
– obesitas

PERKEMBANGAN:
– Gangguan perilaku (Autisme,
gangguan kecemasan, dsb)
(Luna, 2016; Ochoa-Repáraz, 2016)

Keterkaitan antara mikrobiota saluran cerna

dengan berbagai sistem tubuh dalam konsep
microbiota-gut-brain-axis (Schroeder, 2016)
TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”

GUT - BRAIN
AXIS

GENETIK
OTAK
Saluran
Nutrisi
Cerna

EPIGENETIK

Stimulasi Organ Indera

Sensoris
OTAK
LINGKUNGAN

Persarafan
Indera
TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”
Brain Development in Early Age and Longterm Developmental Outcomes
FUTURE CHALLENGES

Gut [Microbiota] - brain - axis paradigm

 Brain Development in Early Age and Longterm Developmental Outcomes
FUTURE CHALLENGES

Gut [Microbiota] - brain - axis paradigm

GUT MICROBIOTA Maturation - Establishment

Early
Sterile colonization
 Brain Development in Early Age and Longterm Developmental Outcomes
FUTURE CHALLENGES

Gut [Microbiota] - brain - axis paradigm

Cognitive/
Behaviour

LINK
??

GUT MICROBIOTA Maturation - Establishment

Early
Sterile colonization
TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”

• Fakta: perubahan komposisi mikrobiota di setiap tahapan

perkembangan anak
Brain Development in Early Age and Longterm Developmental Outcomes
FUTURE CHALLENGES

Gut [Microbiota] - brain - axis paradigm

 Brain Development in Early Age and Longterm Developmental Outcomes
FUTURE CHALLENGES

Gut [Microbiota] - brain - axis paradigm

39
Review
The Science behind the Probiotic Strain
Bifidobacterium animalis
subsp. lactis BB-12®

• BB-12® has proven its beneficial health effect in

numerous clinical studies within gastrointestinal health
and immune function.
• Clinical studies have demonstrated survival of BB-12®
through the gastrointestinal tract and BB-12® has been
shown to support a healthy gastrointestinal microbiota.

Microorganisms 2014, 2, 92-110; doi:10.3390/microorganisms2020092

 Gut-Brain Psychology: Rethinking
Psychology From the Microbiota–Gut–
Brain Axis
• According to gut-brain psychology, the gut microbiota is a
crucial part of the gut-brain network, and it communicates with
the brain via the microbiota–gut–brain axis.
• The gut microbiota influences various normal mental
processes and mental phenomena, and is involved in the
pathophysiology of numerous mental and neurological
diseases.
• The effects of gut microbiota on the brain and behavior are
fulfilled by the microbiota–gut–brain axis, which is mainly
composed of the nervous pathway, endocrine pathway, and
immune pathway.

Front. Integr. Neurosci. 12:33. doi: 10.3389/fnint.2018.00033

TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”

• Implikasinya: kolonisasi mikrobiota saluran cerna di

masa awal kehidupan anak à pembentukan sirkuit otak
anak pada periode kritis

• Berbagai bukti riset: mengkaitkan komposisi mikrobiota

saluran cerna dengan tahapan perkembangan anak.
(Borre et al., 2014; Stilling et al., 2014)
TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”

TAHAPAN JANGKA PANJANG

TUMBUH KEMBANG ANAK

Pertumbuhan Fisik
BB – TB/PB – LK

Kognitif (Kecerdasan)
Sekolah

Perilaku - Emosi
Motorik Kasar
Motorik Halus
Bicara - Bahasa
Sosialisasi - Kemandirian
TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”

IQ Intelligence Quotient
Kemampuan individu yang hanya
bertautan dengan aspek kognitif
individu tersebut.

EQ Emotional Quotient Kognitif (Kecerdasan)

Kemampuan mengontrol emosi,
mengendalikan dan menyesuai- Sekolah
kan diri dengan lingkungan
Perilaku - Emosi

SQ Spiritual Quotient
Kemampuan menempatkan
perilaku dalam konteks makna
yang lebih luas
TUMBUH KEMBANG ANAK
PERSPEKTIF TEORI “GUT-BRAIN AXIS”

IQ Intelligence Quotient
Kemampuan individu yang hanya
bertautan dengan aspek kognitif
individu tersebut.

EQ Emotional Quotient
Kemampuan mengontrol emosi, KARAKTER & KEPRIBADIAN
mengendalikan dan menyesuai- Anak
kan diri dengan lingkungan

SQ Spiritual Quotient
Kemampuan menempatkan
perilaku dalam konteks makna
yang lebih luas
ROLE’S OF PROBIOTIC
Impact of Bifidobacterium on Growth and Development
Clinical Evidence
DEVELOPMENT

in stools at the age of 3 months

Mean Bifidobacterial count

Overweight Normal-weight

Weight status
At the age of 10 years
Impact of Bifidobacterium on Growth and Development
Clinical Evidence
GROWTH DEVELOPMENT

Effects of probiotics on child growth: a

systematic review
Onubi et al. (2015) Journal of Health, Population and Nutrition 34:8

12 studies (10 RCT)

2757 children (1598 from developing countries)

The studies varied in:

• type and quantity of probiotics given
• duration of interventions
• characteristics of participants
• setting and units of outcome measures.
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Effects of probiotics on child growth: a

systematic review
Onubi et al. (2015) Journal of Health, Population and Nutrition 34:8

12 studies (10 RCT)

2757 children (1598 from developing countries)

5 Developing countries
Significant
4 under-nourished
Positive Effect
1 well-nourished

No Significant
7 Developed countries
Effect
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Effects of probiotics on child growth: a systematic review

Onubi et al. (2015) Journal of Health, Population and Nutrition 34:8

Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

A possible link between early probiotic intervention and the

risk of neuropsychiatric disorders later in childhood:
A randomized trial.
Erika Isolauri, et al. Pediatr Res. 2015 doi: 10.1038/pr.2015.51

Behaviour

M M M M
B 3w 3m 6m 13y

Probiotics ADHD / AS 0%

P = 0.008

Placebo ADHD / AS 17.1% 34

Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

A possible link between early probiotic intervention and the

risk of neuropsychiatric disorders later in childhood:
A randomized trial.
Erika Isolauri, et al. Pediatr Res. 2015 doi: 10.1038/pr.2015.51

Behaviour

M M M M
B 3w 3m 6m 13y

Bifidobacterium sp. >>> ADHD / AS 0%

P = 0.03 P = 0.008

Bifidobacterium sp. <<<< ADHD / AS 17.1% 34

Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

A possible link between early probiotic intervention and the

risk of neuropsychiatric disorders later in childhood:
A randomized trial.
Erika Isolauri, et al. Pediatr Res. 2015 doi: 10.1038/pr.2015.51

Behaviour

M M M M
B 3w 3m 6m 13y

Our preliminary study suggests both

Bifidobacterium sp. >>> ADHD an
/ AS 0%
intriguing
P = 0.03 link between gut microbiota and behavior Pand= 0.008
a potential treatment target
Bifidobacterium sp. <<<< ADHD / AS 17.1% 34
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. (2019) JAMA Network Open. 2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905

OBJECTIVE:
To study associations between:

the gut microbiome Development at

in infants preschool age
by the Ages and Stages
Questionnaire, 3rd ed. (ASQ-3).
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. (2019) JAMA Network Open. 2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. JAMA Network Open. 2019;2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. JAMA Network Open. 2019;2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. JAMA Network Open. 2019;2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. JAMA Network Open. 2019;2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905
Impact of Bifidobacterium on Growth and Development
Clinical Evidence

GROWTH DEVELOPMENT

Association of the Infant Gut Microbiome

With Early Childhood Neurodevelopmental Outcomes
An Ancillary Study to the VDAART Randomized Clinical Trial
Sordillo et al. JAMA Network Open. 2019;2(3):e190905. doi:10.1001/jamanetworkopen.2019.0905
Targeting gut microbiome: A novel
and potential therapy for autism

• The gut microbiome might promote the symptoms of

ASD through microbial metabolites, immune
regulation and direct interaction with the brain.
• Roles of gut microbiome in the pathology of ASD are
still unclear, and thus studies investigating
mechanisms, such as the contributions of immune,
neural, and endocrine pathways in microbiome-brain
communications, are significant.
• Moreover, the disputed microbial alterations seen in
ASD patients need to be examined deeply.

Life Sciences 194 (2018) 111–119

 Can probiotics benefit children
with autism spectrum disorders?

• Gastrointestinal symptoms in children with autism are

common and are often linked to the children’s abnormal
behavior and social interactions.
• Probiotics are hypothesized to positively impact gut
microbial communities and alter the levels of specific
potentially harmful metabolites in children with ASD.
• Whether probiotics improve behavior and these markers
has yet to be determined.

World J Gastroenterol 2016; 22(46): 10093-102

 Faktor-faktor yang
memengaruhi
Mikrobiota usus

Physiol Rev , 2019;99: 1877–2013

Penyakit-penyakit yang
terkait microbiota saluran
cerna
Impact of Bifidobacterium on Growth and Development
FINAL THOUGHT
 Ringkasan
• Gangguan saluran cerna di usia dini:
o Berdampak terhadap pertumbuhan dan perkembangan anak
o Berdampak jangka panjang terutama untuk kecerdasan dan
o perilaku anak

• Gangguan perkembangan kecerdasan dan perilaku:

o à Mengakibatkan ketidak-seimbangan IQ – EQ – SQ
o à Memengaruhi pembentukan karakter dan kepribadian anak
• Studi intervensi pemberian probiotic, dapat bermanfaat
dalam aspek tumbuh kembang, dan perilaku anak