Hubungan Status Gizi, Asupan dan Kadar Asam Lemak Jenuh Darah dengan Asam Lemak Jenuh Air Susu Ibu

Abstract

Air Susu Ibu (ASI) merupakan makanan ideal bagi bayi yang mengandung zat gizi lengkap sesuai dengan kebutuhan bayi (Andreas et al. 2015). Asam lemak jenuh (ALJ) ASI merupakan jenis lemak dengan proporsi terbesar jika dibandingkan dengan asam lemak tidak jenuh tunggal (ALTJ tunggal) dan asam lemak tidak jenuh ganda (ALTJ ganda). ALTJ ganda menjadi komponen penyusun sel otak yang berhubungan dengan kecerdasan (Benhard et al. 2017) sedangkan besarnya kadar ALJ pada ASI menjadi penting karena menjadi sumber energi bayi pada usia 1 bulan (Antonakou et al. 2013; Innis et al. 2015). Rendahnya ALJ ASI tidak direkomendasikan karena menyebabkan penurunan perbaikan jaringan dan peradangan tak terkendali pada bayi (Sukhotnik et al. 2008; Innis et al. 2015). Salah satu penentu kandungan ALJ ASI adalah asupan ALJ Ibu (Koletzko et al. 2011). Sebuah studi kohor menunjukkan adanya peningkatan asupan ALJ yang berhubungan signifikan dengan peningkatan ALJ ASI (Miliku et al. 2019). Selain asupan, Meneses et al. (2008) menyebutkan kadar ALJ darah menjadi indikator ALJ ASI. Peningkatan ALJ darah diikuti dengan peningkatan ALJ ASI (Siziba et al. 2019). Hal ini menjadi menarik karena pada ibu hamil trimester ketiga terjadi peningkatan asupan ALJ dan perubahan metabolisme lemak yang dapat meningkatkan kadar asam lemak darah yang dapat memengaruhi ALJ ASI (Herrera et al. 2002; Peng et al. 2009; Kawabata et al. 2017). Geraghty et al. (2016), menyebutkan asupan ALJ pada ibu hamil trimester III tidak menunjukkan hubungan dengan peningkatan kolesterol seperti pada ibu trimester I. Asupan ALJ pada ibu hamil trimester III tidak meningkatkan trigliserida darah sehingga tidak berdampak buruk pada tubuh ibu. Penelitian terkait ALJ sangat terbatas, oleh karena itu, perlu dilakukan penelitian yang bertujuan secara umum untuk menganalisis hubungan antara kadar dan jenis ALJ dalam asupan dan darah ibu hamil dengan ALJ ASI. Penelitian ini merupakan bagian dari penelitian longitudinal yang menggunakan data primer dan sekunder. Data sekunder didapatkan dari sebagian data hasil penelitian BASF-SEAFAST CENTER IPB tahun 2018 di Kota Bogor. Subjek pada penelitian ini adalah ibu hamil trimester III berusia 18-45 tahun di wilayah Kota Bogor dengan usia kehamilan 32-40 minggu. Subjek yang diikutkan dalam penelitian ini sebanyak 98 subjek. Data penelitian yang digunakan adalah data primer berupa asupan makronutrient dan ALJ, kadar ALJ pada darah dan ASI sementara data sekunder yang digunakan yaitu karakteristik ibu (usia, usia kehamilan, tingkat pendidikan, pekerjaan ibu dan pendapatan keluarga) dan status gizi meliputi Indeks Masa Tubuh (IMT) sebelum hamil dan Gestational Weight Gain (GWG). Data asupan diolah dari hasil kuesioner food recall 2x24 jam selama hamil. Data IMT dan GWG didapatkan dari wawancara dan catatan medis. Darah diambil dari vena cubital. Data asam lemak jenuh ASI dan darah dianalisis menggunakan metode gas chromatography. Uji korelasi Spearman dilakukan untuk menganalisis hubungan kategori GWG, IMT sebelum hamil, asupan ALJ, kadar ALJ darah dengan ALJ ASI. Kemudian variabel yang memenuhi kriteria uji multivariat dilanjutkan menggunakan uji multiple logistic regression untuk menganalisis variabel mana yang paling berhubungan. Sebagian besar ibu hamil pada penelitian ini berada pada rentang kategori usia 20-35 tahun (74,5%), tingkat pendidikan lulusan SMA/SMK/Sederajat (42,9%), tidak bekerja atau sebagai ibu rumah tangga (75,5%) dan memiliki pendapatan dibawah UMR (81,6%). Ibu hamil memiliki rata-rata IMT 22,85 ± 3,91 kg/m2 dengan kategori IMT normal dan sebagian besar ibu hamil memiliki kategori GWG kurang (42,9%). Sebagian besar ibu hamil memiliki tingkat kecukupan energi sebesar 70%, protein 61%, lemak 91% dan karbohidrat 61%. Asupan asam lemak jenuh ibu didomininasi oleh asupan asam palmitat dan asam laurat. Sumber makanan lemak jenuh berasal dari minyak goreng dan santan. Minyak goreng dan santan dikonsumsi melalui olahan makanan yang digoreng dan bersantan seperti ayam goreng, telur goreng, tempe goreng, gulai, bubur ayam dan soto santan. Ibu hamil memiliki nilai rata-rata kadar ALJ ASI sebesar 0,12 g (asam kaproat), 0,04 g (asam kaprilat), 0,75 g (asam kaprat), 2,63 g (asam laurat), 11,30 g (asam miristat), 15,29 g (asam palmitat), 0,1 g (asam stearat), 0,27 g (asam arakhidat), 0,16 g (asam behenat), 0,08 g (asam lignokerat) dan 30,69 g (total ALJ) per 100 g lemak ASI. Jika dibandingkan dengan rerata kadar ASI transisi pada data global (Floris et al. 2019) didapatkan bahwa asam kaproat, miristat, arakhidat, lignokerat dan kadar ALJ total lebih tinggi sedangkan asam kaprilat, kaprat, laurat, palmitat, stearate dan behenat lebih rendah. Berdasarkan uji korelasi yang dilakukan, tidak terdapat hubungan signifikan antara IMT sebelum hamil dan GWG dengan kadar asam lemak jenuh ASI (p>0,05). Asupan asam laurat dan total ALJ berhubungan positif dengan asam laurat (p=0,014) dan total ALJ ASI (p=0,001) secara signifikan namun tidak terdapat hubungan signifikan untuk jenis asam lemak lainnya (p>0,05). Asam kaprat, miristat, palmitat, stearat, behenate dan lignokerat berhubungan signifikan dengan ALJ ASI terkait (p<0,05). Peningkatan asupan ALJ ASI lebih dari 10% dari total energi mampu meningkatkan kadar ALJ ASI sebesar 3,39 kali.

Breast milk is an ideal food for infants that contains all the nutrients the infant needs (Andreas et al. 2015). Saturated fatty acids (SFAs) consitute a large of the fatty acid in breast milk, followed by monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs). PUFA has evolved into a component of brain cells and has been linked to intelligence (Benhard et al. 2017). While the high amounts of SFAs in breast milk become important since it is a source of energy for newborns (Antonakou et al. 2013; Innis et al. 2015). Breast milk with a low SFAs content is not advised as it results in impaired tissue repair and uncontrolled inflammation in newborns (Sukhotnik et al. 2008; Innis et al. 2015). One of the determinants of SFAs breast milk content is the maternal intake of SFAs (Koletzko et al. 2011). A cohort study showed a significant increase in SFAs intake associated with an increase in SFAs breast milk (Miliku et al. 2019). In addition to intake, Meneses et al. (2008) mentioned blood SFAs levels to be an indicator of SFAs breast milk. An increase in blood SFAS followed by an increase in SFAs breast milk (Siziba et al. 2019). This becomes interesting because in pregnant women in the third trimester there is an increase in SFAs intake and changes in fat metabolism that can increase blood fatty acid levels that can affect SFAs content in breast milk (Herrera et al. 2002; Peng et al. 2009; Kawabata et al. 2017). Geraghty et al. (2016) mentioned that SFAs intake in pregnant women in the third trimester does not show an association with increased cholesterol as in mothers of trimester I. SFAs intake in pregnant women in trimester III does not increase blood triglycerides so it does not adversely affect the mother's body. SFAs- related research is very limited. Therefore, it is necessary to conduct research aimed to analyze the relationship between the levels and types of SFAs in the intake and blood of pregnant women with SFAs content in breast milk. This was a part of longitudinal study which use of those primary and secondary data. Secondary data were derived from BASF-SEAFAST CENTER IPB research which conducted at Bogor City in 2018. The subjects for this study were third-trimester pregnant women aged 18-45 years old from the Bogor City region with a gestational age of 32-40 weeks. The study enrolled 98 individuals. Primary data were obtained from macronutrient and SFAs intake, as well as SFA levels in blood and breast milk, while secondary data were obtained from maternal characteristics (age, gestational age, education level, maternal occupation, and family income). Nutritional status was determined by Body Mass Index (BMI) pre- pregnancy and Gestational Weight Gain (GWG). The data intake were derived from 2 x 24 hours food recall questionnaire throughout third trimester in pregnancy. Interviews and medical records are used to collect data on and gestational weight gain (GWG) data. The blood sample was taken from the cubital vein. Gas chromatography was used to evaluate data on breast milk and blood saturated fatty acids. The Spearman rank test was used to determine the link between the GWG category, pre-pregnancy BMI, SFA intake, SFA levels of blood, and SFA levels in breast milk. The variables that meet the multivariate criterias then continued to logistic regression tests in order to determine which variables are the most associated. The majority of pregnant women in this research were between the ages of 20 and 35 (74.5%), had a high school education level / vocational / equivalent (42.9%), were unemployed or housewives (75.5%), and have less than the UMR 2 (81.6%). Pregnant women have an average BMI of 22.85 ± 3.91 kg/m , which is in the normal BMI range, however the majority of pregnant women in the GWG less than recommendation category (42.9%). The majority of pregnant women have energy sufficiency levels of 70%, protein 61%, fat 91%, and carbohydrate 61%. Palmitic and lauric acids is the majority of the mother's saturated fatty acid intake. Saturated fats mostly found in frying oil and coconut milk. Consumption of cooking oil and coconut milk combine in processed food and fried dishes such as fried chicken, fried eggs, fried tempeh, gulai, chicken porridge, and soto santan. Pregnant women have an average SFA level in breast milk of 0.12 (caproic acid), 0.04 (caprylic acid), 0.75 (capric acid), 2.63 (lauric acid), 11.30 (myristic acid), 15.29 (palmitic acid), 0.1 (stearic acid), 0.27 (arachidic acid), 0.16 (behenic acid), 0.08 (lignoceric acid) and 30.69 (total SFA) g per 100 g of breast milk fat. Comparing to the global data of breastmilk fatty acids composition (Floris et al. 2019) it was found that caproic, myristic, arachidic, lignoceric, and total SFA levels were higher meanwhile caprylic, capric, lauric, palmitic, stearate and behenic acids were lower. Correlation analyses found no significant relationship between pre- pregnancy BMI and GWG with saturated fatty acid (p>0.05). The intake of lauric acid and total SFAs were significantly associated with the intake of lauric acid (p=0.014) and total SFAs in breast milk (p=0.001), but there was no significant association with the intake of other types of fatty acids (p>0.05). Blood levels of capric, myristic, palmitic, stearate. behenate, lignoceric acids were significantly correlated with the corresponding FA in the breast milk (p<0.05). The SFAs intake of breast milk by more than 10% of total energy increased the level of SFAs in breast milk by 3.39 times.