Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKIt is well known that iron and zinc deficiencies have negative consequences on growth and development; therefore combined iron and zinc supplementation has been proposed to be applied at community level. However, studies on zinc supplementation and infant's growth have shown inconsistent results. While physiological factors may partly explain the variation in findings, contribution of care specifically psychosocial care to the outcomes has been less discussed. This study aims to investigate whether effect of micronutrient (zinc, iron, vitamin A) supplementation in improving infants' growth and developmental outcomes is modified by levels of psychosocial care. The main hypothesis of the study is that zinc and iron supplementation improves growth and developmental outcomes of the infants and that the effect is improved with more favorable psychosocial care. The study involved 800 infants aged 3-6 months living in the rural area of East Lombok, West Nusa Tenggara. The main study was a double-blind community intervention study where syrup -consisting of zinc alone, Z (10 mg/d), zinc+iron, ZF (10 mg of each/day), zinc+ iron+ vitamin-A, ZFA (10 mg/d for each zinc and iron, 1,000 IU for vitamin-A), or placebo-- were given in daily dose for six months. The measured outcomes were growth, index on mental (MDI) and psychomotor (PDI) development using Bayley Scale of Infant Development II (BSID II), and micronutrient status (hemoglobin, serum zinc, ferritin, and retinol). Psychosocial care was assessed using Home Observation for Measurement of the Environment (HOME) Inventory scale. Other data included morbidity, food intake, childcare practices, resources for care, and socio-economic condition. Significant effect on serum zinc was observed in Z, ZF and ZFA groups and on serum retinol in ZFA group (p<0.05). Prevalence of anemia and low iron storage (ferritin <10 µg/L) remained the same in ZF and ZFA groups while increased (p<0.01 for hemoglobin, p<0.05 for ferritin) in Z and placebo groups. In general there was no significant effect of the supplementation on growth (HAZ, WHZ, WAZ). However, positive response on linear growth (HAZ) was observed among initially stunted infants, especially stunted boys who receive both zinc and iron (ZF and ZFA groups, p<0.05). There was an improvement of mental development in all groups, but only significantly in ZF group (p<0.05). In addition, subjects whose anemia remained uncorrected had significantly lower mental scores than those who were not/ no longer anemic (p<0.05). Better psychosocial care was associated with better growth, and the difference in growth among upper and lower levels of psychosocial care is minimal in the infants who received iron-zinc supplementation, suggesting that both supplementation and psychosocial care had an effect on growth. However, during the six-month supplementation, combination of both supplementation and better psychosocial care was not more significant than interaction of iron-zinc supplement and male sex (for HAZ) or levels of psychosocial care alone (for WAZ). Growth is determined not only by micronutrient intake and status but also by the contributing role of psychosocial care. Psychosocial care affected growth indirectly through better nutrient intake and health practices, and possibly through direct mechanism, which was not yet identified. The effect of zinc+ iron supplementation on mental development was stronger when combined with better psychosocial care and higher hemoglobin level. Accelerated mental performance was also observed in placebo, suggesting that factor(s) other than nutritional factor(s) may influence mental performance. On the other hand, psychomotor outcome was more predicted by nutritional status (WAZ), age, nutrient intake and illness. Results from this study concluded that mental development was determined both by micronutrient status and psychosocial care. Psychosocial care affected mental development partly through better initial mental performance, but mainly direct suggesting that environmental factor(s) had a stronger role than initial status in determining mental performance. Six months after the supplement was no longer given, growth (HAZ, WAZ, WHZ) remained better in infants having better psychosocial care. The association between growth (HAZ, WAZ) and HOME score at six months after the end of supplementation became stronger than during the intervention period, whereas positive benefit of the supplementation on -HAZ among boys -as observed by the end of the 6-month supplementation- was no longer maintained at this point of time. During the six-month supplementation, the subsequent six months, and over the total 12-month period, nutrient intake together with illness and psychosocial care were significant determinants of nutritional status (HAZ and WAZ). Results of this study suggest that incorporating care elements including encouragement of psychosocial care in supplementation/nutritional programs should improve its effectiveness and sustainability. The study also recommends further study to investigate more optimal iron: zinc ratio (probably more than 1:1) when given to anemic, iron deficient subjects and to investigate the mechanism connecting psychosocial care and nutrition/ health outcomes. "

"Nowadays, many children in developing countries are suffering from micro nutrient deficiencies (Lartey et at., 2000b; Zhao et al., 1998; van Stuijvenberg et al, 1999; Sempertegui et at, 1995). And the most prevalent ones are VAD (Vitamin A Deficiency), IDA (Iron Deficiency Anemia), IDD (Iodine Deficiency Disorder), and lately is zinc deficiency (Sandstead, 1991).The causes of micro nutrient deficiencies are varied and include inadequate dietary intakes (Robert et al, 2000), repeated infections (Khanum et al, 1998) and poor bioavailability from foods due to the presence of inhibitors or inadequate intake of dietary enhancers (Berdanier, 1998; Lunnerdal, 2000; de Pee et al, 1998; Donnen et al, 1996; Lartey et al, 2000a).Due to the roles of micronutrients in metabolic process, immune competence and taste acuity (Golden, 1995), previous findings showed that micronutrient deficiencies might impaired growth (Allen, 1994b; Rosado, 1999; Krieger et al, 1986; Simondon et al, 1996; Hambidge, 2000; Golden & Golden, 1981) and immune system (Black, 1998; Khanum et al, 1998; Semba et al, 1993). The reversibility of impairments caused by micronutrient deficiencies depends on the severity, duration, and stage of development. In some cases, micronutrient supplementation can correct the impairment right after a certain period of supplementation. Ninh et al (1996) stated that zinc deficiency among nutritionally deprived children may limit growth because the growth stimulating effects of zinc might be mediated through changes in circulating insulin-like growth factor (IGF). And after 5 months supplementation with daily-10 mg zinc, weight and height of growth-retarded children in supplemented group significantly increased compared to those of placebo group. In Uganda, zinc supplementation had a short-term effect (within 3 months) on weight gain and MUAC increment only among children from the school with the highest socioeconomic status (Kikafunda et al, 1998). Clinical vitamin A deficiency has been associated with poor child growth (Tarwotjo et al, 1992). Study in Zaire among moderately malnourished preschoolers found that high dose vitamin A supplementation (60 mg of oily solution of retinal palmitate, 30 mg if aged <12 months) increased MUAC and weight significantly compared to control group although without deforming at baseline (Donnen et al, 1998). In Indonesia, the intervention using vitamin A-monosodium glutamate did not merely result on increment of serum vitamin A level, but it also increased the linear growth of supplemented children compared to children in control group at every age (Muhilal et al, 1988). Similar with zinc and vitamin A, iron deficiency may also lead to slowing of growth in regarding to the increment of iron demands during periods of rapid growth and the adverse effects of morbidity. "

"This randomized double-blind placebo-controlled trial aimed to compare the efficacy of daily iron supplementation and multi-micronutrient supplementation both daily and weekly basis on increasing iron status among 284 apparently healthy Indonesian infants aged 6-12 mo. Infants were randomly assigned to receive either daily 1 RDA multi micronutrient supplement (n = 72), weekly 2 RDA multi micronutrient supplement (n = 70), daily ferrous sulphate 10 mg (n = 72), or placebo (n = 70) for wk. Blood hemoglobin, plasma ferritin, plasma zinc, and plasma C-reactive protein concentrations were measured prior to intervention and after 23 wk of supplementation. At baseline, 58.1% of subjects were anemic, 28.2% were iron deficient, and 11.2% were zinc deficient. After 23 wk of supplementation, both daily 1 RDA multi micronutrient and iron supplemented groups had significantly increased blood hemoglobin and plasma ferritin concentration, furthermore reducing the percentage of anemia and iron deficiency. However, the changes of hemoglobin were not significantly different among the treatment groups. Changes of hemoglobin were significantly higher in daily 1 RDA multi micronutrient group than in placebo group when initial blood hemoglobin was low. The change of plasma ferritin concentration in both daily 1 RDA multi micronutrient and iron groups was significantly higher than in other groups. Hemoglobin and ferritin concentrations of weekly 2 RDA multi micronutrient group were not significantly increase, but there were significantly increased in the subjects with low concentration of blood hemoglobin or plasma ferritin. Proportion of infants with zinc deficiency was increased significantly in iron group Daily I RDA multi micronutrient and daily iron supplementation are efficacious in improving the concentration of blood hemoglobin and plasma ferritin and reducing the percentage of infants with anemia and iron deficiency of Indonesian infants aged 6-12 months in a rural community. However, there was an increasing proportion of infants with zinc deficiency in daily iron supplementation. The efficacy of daily 1 RDA multi micronutrient supplementation was higher among the children with blood hemoglobin < 110 g/L Efficacy of weekly 2 RDA multi micronutrient supplementation on the concentration of blood hemoglobin and plasma ferritin of all subjects was not found, but it affected in children with low concentration of blood hemoglobin or plasma ferritin."

"ABSTRAKTujuan Penelitian ini bertujuan menilai adanya perubahan kadar mikronutrien besi folat zinc dan selenium pada wanita hamil setelah pemberian multivitamin dan multimineral Metode Wanita hamil trimester 1 yang melakukan antenatal care di poliklinik Fetomaternal Rumah Sakit Cipto Mangunkusumo periode Juli hingga Oktober 2011 masuk sebagai subjek penelitian Intervensi dilakukan dengan memberikan multivitamin dan mineral yang dikonsumsi 1 tablet perhari selama 3 bulan Pengukuran kadar besi folat zinc dan selenium serum sebelum dan sesudah pemberian multivitamin dan multimineral menjadi keluaran penelitian Analisis statistik menggunakan uji T berpasangan dan uji Wilcoxon Hasil Sebanyak 28 wanita hamil trimester 1 yang bersedia ikut dalam penelitian dan menjalani pemeriksaan kadar mikronutrien sebelum dan sesudah pemberian multivitamin dalam periode penelitian Sebelum pemberian multivitamin kadar besi dan zinc di bawah normal kadar selenium dalam batas normal dan kadar folat di atas normal Pasca suplementasi multivitamin dan multimineral kadar zinc di bawah normal kadar besi dan selenium dalam batas normal dan kadar folat di atas normal Didapat penurunan kadar zinc dan peningkatan kadar folat pasca suplementasi yang bermakna secara statistik p 0 009 p 0 003 Didapat penurunan kadar besi dan peningkatan kadar selenium yang tidak bermakna secara statistik p 0 295 p 0 333 Kesimpulan Terdapat penurunan kadar zinc dan peningkatan kadar folat pasca suplementasi multivitamin dan multimineral Kata Kunci Mikronutrien suplementasi multivitamin dan multimineral

---

ABSTRACTAbstract Objective To measure changes of serum iron folate zinc and selenium level on pregnant woman after multi micronutrient supplementationMethod First trimester pregnant woman whom attended Maternal Fetal Policlinic at Cipto Mangunkusumo Hospital from July 2011 till October 2011 was considered into the study The intervention was consumption of multi micronutrient tablet once a day for three months period Measurements of serum level of iron folate zinc and selenium before and after supplementation were our outcomes We used paired T Test and Wilcoxon test for statistical analysis Results We had a total of 28 pregnant women of first trimester whom participated in the study and had measurement of micronutrient serum level before and after supplementation during the time period Before supplementation Serum iron and zinc level were below normal Serum selenium level was normal with higher than normal serum folate level After supplementation serum zinc level was found to be below normal Both level of serum iron and selenium increased to normal Serum folate level was higher than normal We found a decrease of serum zinc level with an increase in serum folate level that was statistically significant p 0 009 p 0 003 respectively We found slight decrease of serum iron level and an increase of serum selenium level that were not statistically significant p 0 295 p 0 333 Conclusion There is a decreased level of serum zinc with an increase in serum folate level after multi micronutrient supplementationKeywords Multi micronutrient supplementation"