Madarina Julia Bagian Ilmu Kesehatan Anak Fakultas Kedokteran UGM Kita sering membicarakan kaitan antara stunting dan sindroma metabolik/ penyakit kardiovaskular tetapi mungkin kita belum begitu jelas, kaitannya itu sebenarnya bagaimana Sebelum kita mulai Saya perlu menjelaskan di depan bahwa saya TIDAK MENGATAKAN bahwa stunting menyebabkan sindroma metabolik Semua bermula dari teori ini
Barker Hypothesis Daerah berwarna hitam: (1901-1910): angka kematian bayi tinggi dan (1959-78) angka kematian akibat penyakit jantung koroner tinggi Pada musim dingin tahun 1944, pasokan makanan ke Belanda terputus akibat blokade Jerman
Lebih dari 10,000 orang mati akibat kelaparan
dan kedinginan pasca pra Bagaimana pengaruh pertumbuhan pada awal kehidupan. Pola pertumbuhan anak dengan berat badan lahir rendah Perbedaan tinggi badan pada usia 20 tahun di Perancis (Leger et al, 1997; France)
mean (SD) height SGA: 174.5(6.7) cm, AGA: 178.9(6.3)
cm (men); p=0.0001 mean (SD) height SGA: 159.6(5.4) cm, AGA: 162.3(4.8) cm (women) p=0.0001; Prevalensi Gangguan Pertumbuhan Bocca-Tjeertes, 2013 At 4 years: stunted 30.4% in preterm, 9.1% in fullterms General Pediatric Clinic vs. Comprehensive Care Clinic on the rate of catch up growth (57% >P5 for GPC vs. 87% for CCC after one year follow up) Bryson et al. 1997 Apakah kita menginginkan catch up growth? Fasting insulin and HOMA IR Fasting insulin AND HOMA-IR are significantly higher in CUG SGA compared NCUG SGA or AGA (Deng et al. 2011) Fasting insulin and HOMA IR Fasting insulin AND HOMA-IR are significantly higher in CUG SGA I (BMI > 0) compared NCUG SGA or AGA (Deng, 2012) Ponderal Index at birth and BMI at 11 yo
Erriksson, et al 1999 Small at birththin at 2 yearsbig at 11 years merupakan faktor risiko penyakit jantung koroner
(Barker et al 2005) Insulin Resistance Syndrome in 8-year-old Indian Children: Small at birth, Big at 8 yrs, or both?
Bavdekar et al. Diabetes 1999; 48: 2422
Pola pertumbuhan sampai usia 11 tahun anak yang nantinya mengalami penyakit jantung koroner (Barker et al 2005)
girls boys Bagaimanakah mekanismenya? The Barker Hypothesis - basic version
Maternal Undernutrition
Fetal Growth Retardation
Poor Childhood Structural Change Metabolic and
Growth within Organs Endocrine Dysfunction
Disease In Later Life
Growth of SGA vs. AGA
Dullo et al., 2006
Mechanisms of Programming?
Nutritional Influence Altered Cell Number or intracellular organization
Reorganisation of organ structure Metabolic Differentiation
Abnormal early cell-cell interactions? DNA Control? (altered cell specific gene regulation) DNA Environment? (altered DNA binding proteins) Altered DNA methylation? Obesity and diabetes genes are associated with being SGA Morgan AR, BMC Med Genetics 2010; 11:125
Results from the Auckland Birthweight Collaborative
study Polymorphisms in genes associated with obesity and/or diabetes Genetic variation of KCNJ11, BDNF, PFKP, PTER, SEC16B was more prevalent in SGA This may be an underlying cause of SGA Thrifty genotype hypothesis (Neel 1962): periodic famines in past selected for alleles that maximize metabolic efficiency, lipid storage,and food-searching behaviors
In modern environments, these alleles are maladaptive as
they lead to diabetes and obesity. Epigenetics Which mechanism causes IR
