Pengembangan Produk RUTF (Ready to Use Therapeutic Food) Berbahan Serealia dan Kedelai Bagi Balita dengan Malnutrisi Akut Berat

Abstract

Masalah kekurangan gizi pada kelompok umur balita masih menjadi masalah penting bagi Indonesia sebagai negara berkembang. Kejadian malnutrisi akut merupakan salah satu masalah gizi serius yang masih banyak dialami oleh balita di Indonesia. Berdasarkan data Riset Kesehatan Dasar, sebanyak 10.4% balita di Indonesia mengalami malnutrisi akut dengan 3.5% diantaranya tergolong malnutrisi akut berat (Kemenkes 2018). Anak yang mengalami malnutrisi akut berat (gizi buruk) ditandai dengan nilai z-score BB/TB <-3SD. Kondisi ini menyebabkan rendahnya berat badan terhadap tinggi badan sehingga anak cenderung kurus (Kemenkes 2020). Konsekuensi malnutrisi akut berat pada balita dapat terjadi dalam jangka pendek seperti morbiditas dan mortalitas, maupun jangka panjang yang akan berdampak pada kemampuan fisik dan kesehatan dimasa mendatang (UNICEF 2013b). Oleh karena itu, permasalahan malnutrisi akut berat ini perlu diperhatikan dan diselesaikan dengan baik. RUTF merupakan makanan pemulihan yang sudah terbukti efektif dalam menanggulangi masalah malnutrisi akut berat. Akan tetapi, pemberian RUTF belum menyeluruh dan belum di produksi secara lokal di Indonesia, sehingga perlu adanya inovasi dalam mengembangkan RUTF dengan memanfaatkan pangan lokal. Beras, jagung, kedelai dan tempe merupakan pangan serealia dan kacang-kacangan yang dapat diproduksi di Indonesia, umum dikonsumsi sehari-hari, mudah didapat, serta harganya terjangkau. Beras dan jagung juga merupakan pangan sumber energi dengan kandungan karbohidrat yang unggul, yaitu sebesar 77.1 g/100 g pada beras dan 72 g/100 g pada jagung (TKPI 2017 dan Suarni 2011), sementara kedelai dan tempe kaya akan sumber protein, yaitu masing-masing sebesar 40.4 g dan 20.8 per 100 g (TKPI 2017). Penambahan susu skim sebagai protein hewani ke dalam formulasi dapat meminimalisir zat antigizi dan meningkatkan mutu protein (Oakley 2010). Penggunaan minyak sebagai sumber lemak memberikan kontribusi energi yang cukup besar, yaitu 9 kkal/g. Minyak kelapa memiliki sifat terapeutik, yaitu mudah dicerna, diserap dan dimanfaatkan oleh tubuh, serta tidak memberatkan saluran pencernaan (Mikołajczak 2017). Oleh karena itu, penelitian ini bertujuan untuk mengembangkan dan menganalisis produk pasta RUTF (Ready to Use Theurapetic Food) berbahan dasar beras, jagung, kedelai dan tempe guna menanggulangi masalah malnutrisi akut berat pada balita. Desain dari penelitian ini adalah eksperimental menggunakan Rancangan Acak Lengkap Faktorial dengan dua kali ulangan. Perlakuan yang diberikan terdiri dari dua faktor, yakni perbedaan jenis tepung serealia (Faktor A) dan jenis tepung kacang-kacangan (Faktor B). Masing-masing faktor terdiri dari dua taraf, yaitu beras dan jagung pada Faktor A serta kedelai dan tempe pada Faktor B. Terdapat empat formula yang diperoleh pada penelitian ini, yaitu A1B1= tepung beras dan tepung kedelai, A2B1= tepung jagung dan tepung kedelai, A1B2= tepung beras dan tepung tempe, A2B2= tepung jagung dan tepung tempe. Setiap formula dirancang untuk memenuhi komposisi zat gizi RUTF yang direkomendasikan oleh WHO. Tahapan penelitian ini meliputi formulasi, pembuatan pasta RUTF, uji organoleptik (uji hedonik, uji ranking, mutu hedonik), analisis kandungan dan daya cerna protein, penentuan formula terpilih, analisis formula terpilih meliputi sifat fisik (viskositas), sifat kimia (proksimat, serat pangan, Fe, Ca, profil asam amino dan aktivitas air), perhitungan kontribusi formula terpilih terhadap AKG Balita dan estimasi harga produk per kemasan pada formula RUTF terpilih. Hasil uji hedonik dan ranking menunjukan bahwa secara keseluruhan skor penilaian tertinggi terdapat pada formula A1B1. Kandungan protein pasta RUTF berkisar (14.35-14.78 g/100 g), keempat formula tersebut telah memenuhi standar kandungan protein yang telah direkomenasikan oleh WHO. Sementara nilai daya cerna pasta RUTF berkisar (90.72-95.47%). Daya cerna protein keempat formula tersebut tergolong tinggi, karena memiliki nilai ≥80% (Sediaoetama 1991). Formula dengan perpaduan tepung beras dan tepung kedelai (A1B1) dipilih sebagai formula terbaik berdasarkan hasil uji organoleptik, kandungan protein dan daya cerna protein in vitro. Formula terpilih ini memiliki karakteristik mutu warna cenderung coklat muda, tingkat kekuningan cenderung kuning muda dan tidak terlihat berminyak, aroma langu lemah, rasa pahit lemah, rasa cenderung manis dan creamy, tekstur cenderung kental, agak berpasir dan tidak terasa berminyak dimulut, aftertaste cenderung lemah dan produk mudah ditelan. Hasil analisis kandungan zat gizi terpilih memiliki kadar air sebesar 1,87%, aktivitas air 0,266 aw, abu 2,8%%, protein 14,35%, lemak 32,5%, karbohidrat 45,29%, serat pangan 3,19%, energi 531 kkal, zat besi 13,99%, kalsium 395,73% dan daya cerna in vitro 95,47%. Profil asam amino pada formula (A1B1) memiliki skor asam amino pembatas pada triptofan, yaitu sebesar 80. Nilai tersebut menunjukan bahwa asam amino yang dapat diserap dan dimanfaatkan oleh tubuh maksimum hanya 80%. Sifat fisik yang dianalisis pada formula terpilih adalah viskositas. Hasil analisis menunjukan nilai viskotas pada A1B1 sebesar 4013 cp, yaitu tergolong sangat kental (Matta et al. 2006). Satu kemasan pasta RUTF memiliki berat bersih sebesar 50 g. Adapun dosis yang diberikan disesuaikan dengan berat badan anak, yaitu berkisar 150-220 kkal/kgBB/hari. Usia balita diklasifikasikan menjadi 3 kelompok umur. Satu kemasan pasta RUTF memberikan kontribusi zat gizi yang berbeda-beda pada setiap kelompok umur. Kontribusi energi satu kemasan pasta RUTF terpilih terhadap AKG balita usia 6-11 bulan, 12-36 bulan dan 37-59 bulan berturut-turut sebesar 33%, 19,7% dan 19%. Persentase tersebut mencukupi sekitar 19-33% atau hampir sepertiga kebutuhan energi harian balita pada setiap kelompok umur. Estimasi harga produk pasta RUTF terpilih adalah sebesar Rp 5 229 per kemasan (50 g). Secara keseluruhan, kandungan gizi formula terpilih (A1B1) telah memenuhi standar komposisi zat gizi RUTF sesuai rekomendasi WHO. Oleh karena itu, formula dengan perpaduan tepung beras dan tepung kedelai berpotensi sebagai alternatif produk RUTF untuk menanggulangi masalah malnutrisi akut berat pada balita. Sebagai saran pada penelitian selanjutnya perlu dilakukan uji daya terima dan uji efikasi produk kepada sasaran. Selain itu, analisis umur simpan produk secara spesifik dan daya cerna protein in vivo juga direkomendasikan untuk diteliti lebih lanjut.

Undernourished among children under five years still become crucial problem for Indonesia as a developing country. Acute malnutrition is one of serious nutrition issues that still frequently occur for children in Indonesia. The data from Riset Kesehatan Dasar (Kemenkes 2018) shows as many as 10,4% of children under five years in Indonesia experience acute malnutrition which 3,5% of them classified in severe acute malnutrition. Children with severe acute malnutrition were characterized by weight-to-height z-score (WHZ) index under -3SD. This condition leads to their low weight compared to their height, so they tend to be wasting (Kemenkes 2020). In the short term, severe acute malnutrition in children under five years can occur have consequences as morbidity and mortality, as well as in the long term which will have an impact on physical abilities and health in the future (UNICEF 2013b). Therefore, the problem of severe acute malnutrition needs to be considered and resolved properly. RUTF is a therapeutic food that has proved effective to overcome severe acute malnutrition problem. However, RUTF allocation is not completed yet and not locally produced in Indonesia, so innovation is important to develop RUTF by utilizing local food. Rice, corn, soybeans and tempeh are local crops in Indonesia, commonly consumed daily and have an affordable price. Rice and corn are also energy sources that rich in carbohydrate content, which are 77,1 g/100 g for rice and 72 g/100 g for corn (TKPI 2017 and Suarni 2011), while soybeans and tempeh are sources of protein, which each contain 40,4 g and 20,8 per 100 g, respectively (TKPI 2017). The addition of skim milk as animal protein into the formulation can minimize anti-nutrients and improve protein quality (Oakley 2010). The use of coconut oil as a source of fat contributes considerable energy, which is 9 kcal/g. Coconut oil has therapeutic properties, which are easily digested, absorbed and utilized by human body, and doesn’t put a load on the gastrointestinal tract (Mikołajczak 2017). Thus, this study aims to develop and to analyze RUTF (Ready to Use Theurapetic Food) paste using selected local crops i.e rice, corn, soybeans and tempeh to overcome the malnutritional problems of children under five years with severe acute malnutrition. The design of this study was experimental using a completely randomized factorial design with two replications. Treatments used in this experiment consisted of two factors, which based on different types of cereal flour (Factor A) and bean flour (Factor B). Each factor consists of two levels, namely rice and corn in Factor A as well as soybean and tempeh in Factor B. Four formulas were obtained in this study, which were A1B1 used rice flour and soybean flour, A2B1 used corn flour and soybean flour, A1B2 used rice flour and tempeh flour and A2B2 used corn flour and tempeh flour. Each formula was designed to fulfill RUTF nutritional recommendation from WHO. The research stages included formulation, RUTF paste production, organoleptic test (hedonic test, ranking test, hedonic quality test), analysis of protein content and in vitro protein digestibility, determination of selected formula, analysis of the selected formula includes physical properties (viscosity), chemical properties (proximate, edible fiber, Fe, Ca, amino acid profile and water activity), calculation the contribution of selected formula to RDA of children under five years and estimated price per package of the selected RUTF formula. The results of the hedonic and ranking tests showed that overall the highest scoring score generated from A1B1 formula. The protein content of RUTF paste was around (14.35-14.78 g/100 g), all formulas had fulfilled the standard of protein regarding WHO. Meanwhile, in vitro protein digestibility of RUTF pasta was around (90.72-95.47%). The protein digestibility of all formulas were categorized as high, since it had a value ≥80% (Sediaoetama 1991). RUTF formula with mixture of rice and soybean was selected based on sensory evaluation result, protein content and in vitro protein digestibility. This selected formula had browniness characteristics which tended to be light brown, the level of yellowness tended to be light yellow and didn’t look oily, beany aroma was weak, bitter taste was weak, the taste tended to be sweet and creamy, the texture tended to be thick, slightly gritty and didn’t feel greasy in the mouth, the aftertaste tended to be weak and product was easy to swallow. The nutrient content analysis showed that selected formula contained 1,87% moisture, 2,80% ash, 14,35% protein, 32,50% fat, 45,29% carbohydrate, 531 kcal energy, 3,19% edible fiber, 13,99 mg/100 g Fe, 395,73 mg/100 g Ca and 95,47% in vitro protein digestibility. The amino acid profile in the formula (A1B1) had a limiting amino acid score on tryptophan, which was 80. This value indicates that the maximum amount of amino acids that can be absorbed and utilized by the body is only 80%. The physical property that was analyzed in the selected formula is viscosity. The results showed that the viscosity value of A1B1 is 4013 cp, which is classified as very thick (Matta et al. 2006). One sachet of RUTF paste has a net weight of 50 g. Furthermore the dose given should be adjusted by children’s weight, which is in the range of 150-220 kcal/kgBB/day. Children under five years is classified into 3 age groups. One sachet of RUTF paste contributes different nutrients in each age groups. The energy contribution of one sachet of selected RUTF paste to the RDA for children aged 6-11 months, 12-36 months and 37-59 months was 33%, 19.7% and 19%, respectively. The percentage is sufficient with approximately 19-33% or almost a third of daily energy requirements of children in each age group. The estimated price of the selected RUTF paste product is IDR 5 229 per sachet (50 g). Overall, the nutritional content of the selected formula (A1B1) has fulfilled the requirements of RUTF nutritional composition regarding WHO guidance. Thus, the formula with mixture of rice and soybeans has the potential as an alternative RUTF products to overcome severe acute malnutrition problem in children under five years. For suggestions on further research, it is necessary to test the acceptability and efficacy of products to the target, which is children under five years. In addition, specific analysis of product shelf life and protein digestibility in vivo is also recommended to be investigated.