KFI Newsletter

Indonesian Nutrition Foundation for Food Fortification (KFI)
KFI Newsletter
Fortifikasi Pangan untuk Perbaikan Gizi
March 2014 - Volume 8
Foreword
Role of Micronutrients in The First 1000 Days
of Life
The 20th International Congress of
Nutrition (ICN) was held in Granada,
Spain,in 15-20 September 2014
was named by Prof. Angel Gil, the
congress’ president as “The Olympic
Games of Nutrition”, held every 4
years in different countries. One
issue discussed at ICN was about
Childhood Stunting and Micronutrients, presented in a plenary
session by Ladsy Allen, a world expert of micronutrients. Her
lecture was about Micronutrient Research Program and Policy:
From Meta-Analysis to Metablolics”. In her lecture Landsy Allen
suggested that in dealing with stunted prevention we should
focus our research on the the affect of micronutrients in the
physiology, metabolic, and immunilogic aspects of stunting.
Her suggestion was elaborated by Anang Otoluwa, - a doctoral
Melindungi 1000 HPK:
Cegah Kerusakan DNA
(Preventing DNA Damage)
Anang S Otoluwa, Kandidat Doktor di Fakultas Kedokteran
Universitas Hasanuddin
Kompas, Kamis 6 Februari 2014
Pada 20th International Congress of Nutrition di Granada,
Spanyol, pertengahan September 2013, Landsy Allen dalam
kuliah umum bertajuk Micronutrient Research, Program
and Policy: from Meta analyses to Metabolomics mengajak
peneliti untuk lebih fokus meneliti dampak zat gizi terhadap
aspek fisiologi, metabolik, ataupun imunologi.
Menurut Allen, selama ini zat gizi terbukti dapat memperbaiki
anemia, mencegah bayi berat lahir rendah, serta mengatasi
stunting (tubuh pendek). Namun, bagaimana hal tersebut
bisa terjadi, perlu penjelasan dan bukti metabolik yang kuat.
Bukti tersebut akan membuat hasil penelitian tidak
ditinggalkan oleh pengambil kebijakan, dan implementasi
kebijakan/program gizi akan selalu aktual.
student at the Medical School, of the Hasanuddin University,
Makassar, Indonesia - in his article at Kompas 6 February
2014 : Cegah Kerusakan DNA (Prevent DNA Damage). With his
permission, his article is reproduced in this number (in bahasa
Indonesia). Anang wrote that the role of nutrition in the First
1000 days of life is to provide sufficient multiple-micronutrients
to prevent damage of DNA of pregnant mother that could lead
to pregnancy complication. “ By understanding the biological
mechanism of pregnancy complication coupled with the most
updated nutrition research on micronutrients, as presented
by Landsy Allen in IUNS congress 2013, would encourage us to
correct the inadequacy of the ongoing program of maternal and
child health to effectively protect the First 1000 days of Life” Anang said
Jakarta, March 2014
KFI-News Letter
Prof. Soekirman (Em.), Bogor Agriculture University (IPB),
Chairman of KFI
Komplikasi kehamilan
Di tengah upaya pemerintah Indonesia menurunkan angka
kematian ibu, himbauan Allen di atas terasa relevan. Studi
tentang penyebab kelainan outcome kehamilan telah
menyentuh tingkat molekuler. Komplikasi kehamilan ternyata
didasari oleh kerusakan genom. Kerusakan deoxyribonucleid
acid (DNA) dapat memengaruhi berbagai proses fisiologis
yang berhubungan dengan kehamilan, mulai dari tahap awal
seperti pematangan sel telur atau produksi sperma, sampai
akhir proses perkembangan plasenta dan janin.
Wiktor (2004) membuktikan bahwa ibu hamil yang mengalami
pre-eklampsia (PE) atau mengalami gangguan pertumbuhan
janin mempunyai kadar 8 hydroxydeoxyguanosine, yakni
penanda kerusakan DNA, yang lebih tinggi dibandingkan
dengan ibu yang hamil normal.
Penelitian Furness (2010) menemukan, ibu hamil 20 minggu
yang mengalami kerusakan DNA mempunyai potensi lebih
besar mengalami gangguan PE dan intra uterine growth
restriction (IUGR). Peningkatan jumlah kerusakan DNA telah
nyata terlihat sebelum gejala klinis PE atau IUGR muncul.
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KFI NewsLetter March 2014 - Volume 8
Peran zat gizi mikro
Bagaimana kerusakan DNA dapat memengaruhi kejadian
komplikasi kehamilan diduga berkaitan dengan iskemia
(keadaan kekurangan darah dalam jaringan) atau hipoksia
plasenta. Kerusakan DNA pada ibu hamil dapat menyebabkan
terhambatnya pembelahan sel, perlambatan siklus sel, serta
kematian sel (apoptosis) berlebihan yang menyebabkan
gangguan invasi sel trofoblas pada saat pembentukan arteri
spiralis.Padahal, invasi trofoblas diperlukan untuk membantu
memperlebar arteri spiralis yang berperan mengirimkan
darah ke plasenta. Jika arteri spiralis tidak terbentuk secara
optimal, pasokan oksigen dan zat gizi akan terganggu, serta
inilah yang menyebabkan komplikasi seperti PE dan IUGR.
Peran zat gizi mikro
Zat gizi mikro, yakni vitamin dan mineral, sangat penting
untuk menjaga keutuhan DNA karena perannya sebagai
kofaktor enzim pada sintesis (pembentukan) dan perbaikan
DNA, pencegahan kerusakan DNA akibat oksidasi, serta
memelihara proses metilasi DNA. Setiap zat gizi mikro
dibutuhkan dalam jumlah yang cukup untuk mencapai hasil
metabolisme maksimal. Kekurangan zat gizi mikro akan
mengganggu metabolisme normal dan pada akhirnya akan
menyebabkan kerusakan DNA.
Hubungan antara kerusakan DNA dan defisiensi zat gizi mikro
telah terbukti melalui berbagai studi. Kekurangan zat besi,
magnesium, seng, vitamin B6, vitamin C, asam folat, dan biotin,
menyebabkan peningkatan kerusakan DNA. Kerusakan DNA
dapat terjadi jika kita mengalami kekurangan zat besi, seng,
folat, vitamin B12, dan kolin, meskipun dalam jumlah sedikit.
Adapun untuk selenium, tembaga, kalsium, niasin, dan kolin,
kerusakan DNA terjadi jika tubuh mengalami defisiensi berat.
Kekurangan seng diketahui dapat menyebabkan peningkatan
pro-oksidan yang akan menyebabkan putusnya rantai DNA
(single-strand breaks).
Selain berperan dalam sintesis DNA, zat gizi mikro mempunyai
peran sebagai kofaktor dalam perbaikan kerusakan DNA.
Tugas ini dilakukan oleh seng dan magnesium sebagai kofaktor
untuk polymerase DNA. Kekurangan seng dan magnesium
menyebabkan kegagalan pada perbaikan double strand breaks
DNA yang kemudian bisa berakibat putusnya kromosom.
Pemberian zat gizi mikro telah terbukti dapat mengurangi
kerusakan DNA. Thomas P (2011) dalam sebuah kajian melaporkan
bahwa suplementasi vitamin antioksidan dan vitamin B
dapat menurunkan kerusakan DNA. Studi lain menemukan
bahwa kerusakan DNA secara signifikan berhubungan dengan
kekurangan kadar vitamin B12 dalam serum (Fenech, 1998).
Smolkova (2004) melaporkan, suplementasi dengan antioksidan
mempunyai efek yang signifikan dalam mengurangi kerusakan
DNA sejumlah 39 persen.
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DNA sangat sensitif terhadap kekurangan zat gizi mikro.
Kekurangan seng dalam 6 minggu menyebabkan peningkatan
DNA strand breaks. Kerusakan DNA yang ditimbulkan oleh
kekurangan asam folat dan B12 sama besarnya, bahkan lebih
besar, dibandingkan dengan tingkat kerusakan DNA akibat
paparan bahan kimia, radiasi ultraviolet, atau radiasi ion.
Penurunan konsentrasi asam folat yang masih dalam batas
fisiologis dapat menginduksi tingkat kerusakan DNA yang
setara dengan yang ditimbulkan oleh paparan radiasi sinar X.
Jika defisiensi ringan untuk satu jenis zat gizi mikro saja dapat
menyebabkan kerusakan DNA yang hebat, bisa dibayangkan
kerusakan yang timbul akibat kekurangan multizat gizi mikro.
Implikasi program
Dari hasil-hasil penelitian di atas tampak bahwa multizat gizi
mikro sangat dibutuhkan oleh ibu hamil untuk mencegah
kerusakan DNA yang pada akhirnya diharapkan dapat
mencegah komplikasi kehamilan/persalinan. Kebutuhan
itu tidak terbatas pada zat besi (Fe) atau asam folat saja
sehingga pemberian tablet tambah darah tidak cukup.
Hasil penelitian di Lombok (2008) membuktikan, suplemen
multizat gizi mikro lebih efektif dalam menurunkan kejadian
komplikasi kehamilan seperti abortus dan kelahiran mati,
dibandingkan tablet tambah darah. Selain itu, terungkap bahwa
ibu hamil anemia di negara-negara berkembang mengalami
kekurangan bukan hanya zat besi saja, melainkan zat gizi mikro
lain. Karena itu, program pemberian tablet tambah darah sudah
saatnya dikaji, dan perlu dipertimbangkan untuk diganti dengan
multizat gizi mikro.
Hal lain yang perlu dikaji adalah kapan saat yang tepat
untuk memberikan suplemen. Secara nasional, tablet tambah
darah diberikan kepada ibu hamil. Namun, efektivitasnya mulai
KFI NewsLetter March 2014 - Volume 8
Micronutrient Research Program
and Policy: From Meta-analyses to
Metabolomics
ICN Daily News IUNS 20th International Congress of
Nutrition, Granada Exhibition and Congress Centre
Prof. Landsy Allen at 20th IUNS
Conggress, Granada 2013
diragukan karena hingga saat ini prevalensi anemia tetap tinggi.
Demikian pula, jika suplemen ini dimaksudkan untuk memperbaiki
kerusakan DNA, saat pemberian yang tepat adalah sebelum hamil
karena kerusakan DNA telah terjadi pada 8 minggu kehamilan.
Akan lebih tepat jika pemberian suplemen menjadi bagian dari
pelayanan perempuan sebelum hamil (preconception care).
Pemahaman yang baik tentang mekanisme biologis terjadinya
komplikasi kehamilan/persalinan serta adanya hasil riset mutakhir
di bidang gizi dapat membantu kita untuk berani melakukan
koreksi terhadap program kesehatan ibu secara mendasar.
Harapannya, pencegahan di sektor hulu akan terlaksana sesuai
harapan guna mempercepat turunnya angka kematian ibu
menjadi 102 per 100.000 kelahiran hidup pada 2015
Stunting: The Face of Poverty
Sri Mulyani Indrawati
Source: http://blogs.worldbank.org/voices/stunting-face-poverty
Globally, 165 million children under
age 5 suffer from chronic malnutrition
– also known as stunting, or low
height for age. Much of this damage
happens in pregnancy and the first two
years of a child’s life. It means a child
has failed to develop in full and it is
essentially irreversible – which means
that the child will have little hope of ever achieving her
full potential.
What will it take to end child stunting? The good news is
that we already have many of the answers. We know that
it is not just about getting more food, but ensuring that
mothers and young children get the right foods with the
right vitamins and minerals at the right times during the
critical growth window between pregnancy and age 2. The
latest evidence published in The Lancet also tells us with
greater certainty that the roots of child malnutrition can
even be traced to the health and nutritional well-being of
adolescent girls before pregnancy.
The evidence tells us that malnutrition costs lives,
perpetuates poverty, and slows economic growth. We
now know that nearly half of all child deaths globally are
attributed to malnutrition. I have seen in my own country,
Indonesia, how stunting caused by malnutrition has
diminished too many children’s futures before they even
begin. Malnourished children are more likely to perform
poorly in school and drop out earlier than their betternourished peers, limiting their future earnings. Data from
Guatemala show that boys who had good nutrition before
age 3 are earning nearly 50% more as adults, and girls had
a greater likelihood of having an independent source of
income and were less likely to live in poor households.
We estimate the annual price tag of providing a set of
13 high-return direct interventions to prevent and treat
undernutrition at approximately $12 billion per year, with
an estimated $10.3 billion gap that needs to be filled from
sources other than affected households.
Malnutrition diminishes not only the futures of individuals,
but also of nations. Recent estimates suggest that as much
as 11% of gross national product in Africa and Asia is lost
annually to the impact of malnutrition. To end extreme
poverty and promote shared prosperity, the world must
commit to end child stunting due to malnutrition. I will be
joining leaders from around the world in London this week
to focus on this critical challenge.
At the World Bank Group, we plan to triple our support
for maternal and early childhood nutrition programs
in developing countries in 2013-14 to $600 million, up
from $230 million in 2011-12. An estimated 90% of this
new funding ($540 million) is from the International
Development Association (IDA), the Bank’s fund for the
poorest. During the past decade, from 2002-12, IDA helped
at least 52 million vulnerable mothers and young children
receive life-saving and life-changing nutrition services.
Ending child stunting is a multi-sectoral challenge. Water
and sanitation investments have a huge potential to
improve nutrition outcomes. Today, about 1.1 billion
people do not have access to safe drinking water, and
about 2.6 billion – or half of the developing world – lack
a simple but adequate latrine. Safety nets and cash3
KFI NewsLetter March 2014 - Volume 8
transfers conditioned on good nutrition behaviors also
have improved nutrition outcomes in Mexico, and have the
potential to do so in Africa and Asia.
of all GAFSP projects explicitly address undernutrition.
Food and nutrition security must go hand in hand. Global
food prices are forecast to remain volatile at least until 2015.
In the poorest countries, where people spend up to twothirds of their daily income on food, rising prices further
threaten the nutrition of the most vulnerable, especially
women and young children. 60% of the world’s hungry
are women, and in the face of food price hikes, families
substitute lower-quality foods along with reducing food
intake overall.
Empowering women is also key, by giving women increased
control over income and household decision-making.
According to the U.N. Food and Agriculture Organization,
if women had equal access to the full suite of agricultural
services including land, technology, financial services, and
markets, it would reduce the number of hungry people in
the world by 100 million to 150 million. Gender-sensitive
business and government policies can also make a big
difference in better nutrition – for example, maternity
leave as well as child care that allows for continued
breastfeeding when mothers return to work.
Amid continuing global food price volatility, the Bank
Group will review our agriculture activities with a view
toward improving nutrition outcomes. We have already
seen excellent progress through the Global Agriculture
and Food Security Program (GAFSP), where more than half
We know what it will take, and where the gaps remain.
Ending childhood malnutrition and stunting is an issue
of equity and of development effectiveness. We can, and
must, end the scourge of stunting and ensure that every
child – and every nation – can reach their full potential
PRESS RELEASE (KFI, Ministry of Health, GAIN)
months, who likely benefited through improved vitamin A
intake of their mothers during pregnancy and breastfeeding.
Vitamin A Fortification Of Cooking Oil Shows
Improvement In Mothers And Children’s “After fortification, vitamin A content in breast milk of lactating
Nutrition – Promising Results From West Java mothers increased by more than half. The research showed
Jakarta, 28 February 2014 – Vitamin A deficiency remains a
public health problem in Indonesia, especially in children
and women, which periodic vitamin A supplementation and
diet-based approaches have not resolved. However, a recent
study has shown that fortification of cooking oil with vitamin
A improved intakes amongst vulnerable populations without
any increase in cooking oil consumption.
A year-long study conducted amongst low income households
in 24 villages in Tasikmalaya and Ciamis districts in West Java
showed that consumption of fortified cooking oil resulted in
improved vitamin A intakes among young women, lactating
mothers, children 12-59 months as well as 5-9 years, bringing
these target groups much closer to their daily required
nutritional intake. The first survey was done in June 2011 just
before fortification started and the second one was concluded
a year later to compare changes of vitamin A levels among test
groups. In all groups, vitamin A levels in blood were better in
2012 than in 2011. This impact also extended to infants 6-11
that across all groups, the prevalence of vitamin A deficiency
fell markedly from 6-18 percent to 0.5-6 percent, a 67 percent
to 96 percent reduction,” explained Prof. Soekirman, Executive
Director of Indonesian Nutrition Foundation for Food
Fortification (KFI) who conducted the research.
“The research was carried out to support the Ministry of
Industry policy in July 2012 on the voluntary fortification
guidelines for unbranded palm cooking oil (SNI 7709:2012),
which was based on a request from the Ministry of Health to
increase health outcomes amongst Indonesian populations”
said Ir. Doddy Izwardi, MA, Director of Community Nutrition
(Bina Gizi ) of the Ministry of Health.
“The results show that fortification of cooking oil with vitamin
A is a viable non-intrusive way to increase vitamin A intakes,
including amongst in the most vulnerable population, “said
Ravi Menon, Global Alliance for Improved Nutrition (GAIN)
Country Manager, which supported the endline survey
Credits:
Concept: Prof.(Em.) Soekirman Creative: Harimawan Latif Writing: Ifrad DDS
Picture Editor: Habibie Yukezain
Published By
Indonesian Nutrition Foundation for Food Fortification (KFI),
Address: KFI c/o Komplek Bappenas A1, Jl. Siaga Raya Pejaten, Jakarta 12510, Indonesia,
Phone: +62 21 7987 130, Fax: +62 21 7918 1016,
Website: www.kfindonesia.org, Email: [email protected]
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The KFI Newsletter is part of KFI-GAIN project.
Supported by: SAFO - GFP