Efikasi Pemberian Makanan Tambahan (PMT) Biskuit Diperkaya dengan Tepung Protein Ikan Lele Dumbo (Clarias gariepinus), Isolat Protein Kedelai dan Probiotik Enterococcus faecium IS27526 yang Dimikroenkapsulasi pada Balita (2-5 Tahun) Berat Badan Rendah

Abstract

PEM and infectious diseases among under-five children were exist a serious problem which required immediate efforts to overcome. (Riskesdas, 2007). Analysis by Atmarita et al (2006) using SUSENAS data (1989-2005) showed that PEM among children was mainly determined by economic factors, mother education, food availability and infections. The objective of study was to analyze the efficacy of biscuit enriched with catfish protein flour (Clarias gariepinus), soy protein isolate and E. faecium IS- 27526 microencapsulated probiotic at a dose 108 A human intervention study with duration 90 days supplementation biscuit enriched with catfish protein flour (Clarias gariepinus), soy protein isolate and E. faecium IS-27526 probiotic was conducted in Sukabumi District, West Java. The study was applied a Pre-post Randomized Double Blind Placebo Controlled Trial. Initially, there were 5 groups with 18 children each (P0 = control biscuit with control cream; P1 = catfish protein flour and soy protein isolate biscuit with control cream; P2 = control biscuit with probiotic cream; P3 = catfish protein flour and soy protein isolate biscuit with probiotic cream (everyday) and P4 = catfish protein flour and soy protein isolate biscuit with probiotic cream (every two days). Seven children were dropped out during the treatment, therefore, only 83 children were fulfilled the criteria for analysis. Ethical approval was obtained from Research and Development Board of Indonesian Ministry of Health. cfu/day on nutritional status, humoral immune response (sIgA) and morbidity of underweight under-five children. The results showed that after 90 days supplementation, the compliance of biscuit consumption was relatively high (82.8%). Delta WAZ among functional biscuit groups P3 (0.309 ± 0.3) and P4 (0.216 ± 0.3) were significantly higher than control group (P0) and other groups, P1 and P2 (p<0.05). However, HAZ and WHZ among functional biscuit groups and other groups were not significantly different. Delta fecal secretory IgA concentration of functional biscuit groups P3 (0.963 ± 0.8 μg/g) and P4 (0.740 ± 0.4 μg/g) were significantly higher than control (P0) and others groups P1 and P2 (p<0.05). Significantly lower episode of diarrhea (2.17 times/4 months) was observed among all treatment groups (P1, P2, P3, and P4). Probability for reduction of diarrhea episode (<1.64 times/4 months) was 63.48% among functional biscuit groups (P2, P3 and P4), and 51.62% among a high protein biscuit group (P1). No adverse effect was observed during 90 days of supplementation. As a conclusion, supplementation of functional biscuit (biscuit enriched with catfish flour protein (Clarias gariepinus), soy protein isolate and E. faecium IS-27526 microencapsulated probiotic is safe for young children and have a beneficial effect, i.e. improve nutritional status (WAZ), modulate humoral immune response (sIgA), and reduce diarrhea episode) among under-five children.

Masalah gizi kurang pada balita bukanlah merupakan hal yang baru, namun masalah ini tetap aktual, dicerminkan adanya peningkatan prevalensi KEP di daerah kantong kemiskinan. Kondisi ini diperparah dengan adanya bencana alam diberbagai daerah. Laporan Riskesdas (Depkes 2008) menunjukkan di Indonesia periode 2005-2007, telah terjadi perbaikan status gizi balita melampaui target pembangunan jangka menengah (20%), namun masih belum merata dan bahkan masih terdapat 19 propinsi dengan prevalensi gizi buruk dan gizi kurang masih cukup tinggi. Lebih lanjut menurut Jalal (2009) berat badan rata-rata anak balita Indonesia setelah usia 6 bulan, semakin bertambah umur, semakin menjauh dari berat badan rata-rata rujukan WHO 2005. Menggunakan nilai rata-rata Z_skor semakin bertambah umur, tinggi badan anak Indonesia juga semakin menjauhi standar WHO. Disisi lain, Riskesdas (Depkes 2008) melaporkan bahwa di Indonesia penyakit ISPA (>35%) dan diare (16.7%) tertinggi pada usia balita, demikian juga penyebab kematian balita adalah diare dan pnemonia. Menurut Tomkins (2002) masalah kurang gizi merupakan faktor penyebab utama tingginya penyakit infeksi dan menurut WHO dan UNICEF hampir 60% kematian anak diasosiasikan dengan gizi kurang. Program intervensi dalam bentuk makanan tambahan bergizi dan sekaligus upaya penguatan imunitas tubuh balita perlu mendapat perhatian serius agar anak balita tidak mudah jatuh ke keadaan kurang gizi dan mudah sakit. Pengadaan PMT balita selama ini masih terfokus pada kandungan zat gizi konvensional saja dan belum memperhatikan potensi fungsional. Hasil Evaluasi WFP dan FKM UNAIR (2008) menunjukkan PMT biskuit memiliki daya terima yang baik pada balita, sedangkan Boobier et al. (2006) biskuit konvensional yang tinggi lemak dan gula diasosiasikan diet tidak sehat, namun dapat dimodifikasi menjadi produk fungsional. Secara umum penelitian ini bertujuan menganalisis efikasi pemberian makanan tambahan biskuit yang diperkaya dengan protein ikan Lele Dumbo (Clarias gariepinus), isolat protein kedelai dan probiotik Enterococcus faecium IS- 27526 terhadap peningkatan status gizi, respon imun humoral (sIgA) dan morbiditas balita berat badan rendah (BBR).Penelitian ini merupakan penelitian ekspeimental dengan desain Randomized Controlled Trial (RCT) Double Blind Pre-post study. Penelitian di masyarakat dilakukan mulai Juni hingga September 2009 di 4 wilayah kerja Puskesmas di Kabupaten Sukabumi yaitu Kadudampit, Warungkiara, Bantargadung dan Cikaka