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Berusaha memahami

hubungan antara stunting


dan sindroma metabolik

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

Thrifty Phenomenon ( Hales et al 1992)

Poor nutrition in fetus

Changes in fetus Metabolic programming

Ensure Post natal survival


What next

stunting vs. short stature???


cut off for LBW? SGA?
dan masih banyak lagi