| dc.description.abstract | Seribu hari pertama kehidupan (1000 HPK) dikenal dengan window of opportunity karena merupakan periode emas pertumbuhan dan perkembangan yang optimal. Setelah itu, usia sebelum lima tahun juga menjadi kelompok rawan sehingga memerlukan perhatian kecukupan gizi. Jika tidak optimal maka akan menyebabkan masalah kekurangan gizi berupa stunting dan wasting. Prevalensi stunting pada balita mencapai 24,4% dan wasting mencapai 7,1%. Kekurangan gizi menimbulkan dampak jangka panjang terhadap kejadian penyakit tidak menular seperti hipertensi dan diabetes (DeBoe et al. 2014; Kementerian PPN/ Bappenas 2018; Kemenkes RI 2021). Non-communicable diseases menyebabkan hingga 41 juta kematian yang setara dengan 74% dari penyebab kematian secara global. Faktor risiko metabolik terhadap terjadinya NCDs adalah peningkatan tekanan darah yang menyebabkan 19% kematian secara global, kemudian diikuti oleh peningkatan gula darah dan obesitas (WHO 2019). Hipertensi dan Diabetes Melitus sering dikaitkan dengan penyakit pada orang dewasa, namun hasil systematic review dan meta-regression analysis menunjukkan peningkatan tekanan darah sudah mulai terdeteksi pada usia remaja. Masa remaja sering disebut sebagai the second window of opportunity untuk masa dewasa yang lebih baik (Unicef 2017) menjadi titik kritis untuk mengidentifikasi risiko hipertensi dan diabetes untuk pencegahan terjadinya komplikasi saat masa dewasa (Akseer et al. 2020). Penelitian di Indonesia sebagai negara berkembang belum banyak menelusuri perkembangan status gizi individu saat balita kaitannya dengan terjadinya hipertensi dan diabetes pada remaja.
Penelitian ini adalah penelitian kohort retrospektif dengan menggunakan data sekunder Indonesian Family Life Survey (IFLS). Data survei yang digunakan dalam penelitian ini yaitu data survei yang dilakukan pada tahun 1997 (IFLS-2), 2000 (IFLS-3), dan 2014 (IFLS-5). Responden penelitian berjumlah 373 remaja usia 17-19 tahun. Variabel bebas dalam penelitian ini yaitu faktor gaya hidup responden yaitu kebiasaan merokok, aktivitas fisik, kesehatan psikologis, kualitas tidur); frekuensi konsumsi Less Healthy Food and Beverages (LHFB) yaitu konsumsi mi instan, fast food, makanan manis, gorengan, minuman bersoda; konsumsi sayuran dan buah; status gizi; dan perubahan status gizi saat balita. Variabel terikat pada penelitian ini yaitu risiko hipertensi dan risiko Diabetes Melitus. Analisis data yang digunakan meliputi analisis univariat, analisis bivariat menggunakan Chi-squared (X2) test dan bivariate logistic regression serta analisis multivariat menggunakan regresi logistik multinomial dengan nilai p<0,05.
Responden pada penelitian ini yaitu remaja usia 17-19 tahun, sebagian berjenis kelamin laki-laki (50,7%), sebagian besar (62,5%) tinggal di daerah perkotaan. Berdasarkan gaya hidup, sebagian besar (73,7%) bukan perokok, sebagian (50,4%) memiliki aktivitas fisik yang aktif, sebagian (57,1%) memiliki kesehatan psikologis dalam kategori tidak stres, dan sebagian besar (88,5%) memiliki kualitas tidur dalam kategori baik. Berdasarkan konsumsi pangan, sebagian (63,3%) jarang mengonsumsi mi instan, sebagian besar (88,5%) jarang mengonsumsi fast food, sebagian (52,3%) sering mengonsumsi makanan manis, sebagian (52,3%) jarang mengonsumsi gorengan, sebagian besar (84,5%) jarang mengonsumsi minuman bersoda, sebagian besar (68,6%) jarang mengonsumsi sayuran dan sebagian besar (82,8%) sering mengonsumsi buah. Responden sebagian besar memiliki status gizi baik. Perubahan status gizi responden saat balita berdasarkan TB/U dan IMT/U berturut-turut yaitu 38,3% dan 73,4% memiliki status gizi normal selama follow-up.
Berdasarkan risiko hipertensi, 38,1% responden memiliki tekanan darah dalam kategori pre-hipertensi dan sebanyak 4,3% responden mengalami hipertensi. Berdasarkan risiko Diabetes Melitus, sebanyak 12,6% responden termasuk dalam kategori pre-Diabetes dan 15,0% responden mengalami Diabetes. Variabel aktivitas fisik, kesehatan psikologis, konsumsi mi instan, konsumsi fast food, konsumsi minuman bersoda, status gizi, perubahan status gizi saat balita (TB/U) berhubungan dengan risiko hipertensi. Variabel kualitas tidur, konsumsi fast food, konsumsi minuman bersoda, konsumsi sayuran, status gizi, dan perubahan status gizi saat balita (z-score TB/U) berhubungan dengan risiko Diabetes Melitus.
Status gizi balita yang pulih dari stunting menjadi faktor protektif terhadap risiko pre-hipertensi (aOR 0,24 95% CI 0,09-0,59). Faktor risiko terjadinya pre-hipertensi yaitu gizi lebih (aOR 3,43 95% CI 1,47-7,97), kurang aktif (aOR 4,71 95% CI 2,87-7,70), dan sering mengonsumsi fast food (aOR=2,83 95% CI 1,11-7,21). Status gizi saat balita yang pulih dari stunting menjadi faktor protektif terhadap risiko pre-diabetes (aOR=0,19 95% CI 0,04-0,88). Sedangkan status gizi memburuk menjadi faktor risiko diabetes pada remaja (aOR=3,92 95% CI 1,81-8,51). Remaja yang sering mengonsumsi fast food berisiko 4,24 kali lebih besar mengalami diabetes dibandingkan yang jarang mengonsumsi fast food (aOR=4,24 95% CI 1,62-11,13). Sedangkan konsumsi sayuran yang sering menjadi faktor protektif terhadap risiko diabetes pada remaja (aOR 0,36 95% CI 0,17-0,81).
Upaya yang bisa dilakukan untuk mencegah terjadinya hipertensi/diabetes pada remaja dengan memperhatikan 1000 HPK seperti melakukan IMD (Inisiasi Menyusui Dini), pemberian ASI ekslusif, pemberian MP-ASI optimal, PMT (Pemberian Makanan Tambahan), suplementasi mikronutrien, imunisasi dasar lengkap, edukasi gizi, dan program-program lintas sektor lainnya. Upaya pemerintah dalam pencegahan penyakit tidak menular pada remaja di Indonesia yang telah dilakukan melalui PKPR (Pelayanan Kesehatan Peduli Remaja) perlu diperluas dengan lebih konsisten dalam melakukan kegiatan pemantauan berat badan, pemeriksaan gula darah, edukasi gizi terkait faktor risiko hipertensi dan diabetes sehingga deteksi dini risiko hipertensi/diabetes dapat terlaksana. | id |
| dc.description.abstract | The first thousand days of life is known as the window of opportunity because it is the golden period of optimal growth and development. After that, aged before five years is also a vulnerable group and therefore require attention to nutritional adequacy. If it is not optimal, it will cause malnutrition problems in the form of stunting and wasting. The prevalence of stunting in toddlers reached 24.4% and wasting reached 7.1%. Malnutrition has a long-term impact on the incidence of non-communicable diseases such as hypertension and diabetes (DeBoe et al. 2014; Ministry of National Development Planning 2018; Indonesian Ministry of Health 2021). Non-communicable diseases cause up to 41 million deaths, which is equivalent to 74% of causes of death globally. The metabolic risk factor for the occurrence of NCDs is increased blood pressure which causes 19% of deaths globally, followed by increased blood sugar and obesity (WHO 2019). Hypertension and diabetes mellitus are often associated with disease in adults, but the results of a systematic review and meta-regression analysis show that an increase in blood pressure has begun to be detected in adolescence. Adolescence is often referred to as a second window of opportunity for a better adulthood (Unicef 2017) and is a critical point for identifying the risk of hypertension and diabetes to prevent complications in adulthood (Akseer et al. 2020). Only few have studies that trace individuals from childhood to adolescence examined the influence of childhood undernutrition on hypertension and diabetes risk among adolescents.
This research is a retrospective cohort study using secondary data from the Indonesian Family Life Survey (IFLS). The survey data used in this research is survey data conducted in 1997 (IFLS-2), 2000 (IFLS-3), and 2014 (IFLS-5). The research respondents totaled 373 teenagers aged 17-19 years. The independent variables in this study are the respondent's lifestyle factors, namely smoking habits, physical activity, psychological health, sleep quality); frequency of consumption of Less Healthy Food and Beverages (LHFB), namely consumption of instant noodles, fast food, sweet foods, fried foods, fizzy drinks; consumption of vegetables and fruit; nutritional status; and changes in nutritional status during childhood. The dependent variables in this study are the risk of hypertension and the risk of Diabetes Mellitus. Data analysis used included univariate analysis, bivariate analysis using the Chi-squared (X2) test and bivariate logistic regression as well as multivariate analysis using multinomial logistic regression with p value <0.05.
Respondents in this study were adolescents aged 17-19 years, some were male (50.7%), some (62.5%) lived in urban areas. Based on lifestyle, most (73.7%) are non-smokers, some (50.4%) have active physical activity, some (57.1%) have psychological health in the no stress category, and most (88.5%) %) has sleep quality in the good category. Based on food consumption, some (63.3%) rarely consume instant noodles, most (88.5%) rarely consume fast food, some (52.3%) often consume sweet foods, some (52.3%) rarely consume fried foods, the majority (84.5%) rarely consume fizzy drinks, the majority (68.6%) rarely consume vegetables and the majority (82.8%) often consume fruit. Most of the respondents had good nutritional status. Changes in the nutritional status of respondents as toddlers based on HAZ and BMIZ respectively, namely 38.3% and 73.4% had normal nutritional status during the follow-up period.
Based on the risk of hypertension, 38.1% had blood pressure in the pre-hypertension category and 4.3% had hypertension. Based on the risk of Diabetes Mellitus, 12.6% of respondents were included in the pre-Diabetes category and 15.0% of respondents had Diabetes. Variables physical activity, psychological health, consumption of instant noodles, consumption of fast food, consumption of fizzy drinks, nutritional status, changes in nutritional status during toddlerhood (HAZ) which are related to the risk of hypertension. The variables sleep quality, fast food consumption, carbonated drink consumption, vegetable consumption, nutritional status, and changes in nutritional status during toddlerhood (HAZ) are related to the risk of Diabetes Mellitus.
The nutritional status of toddlers who recover from stunting is a protective factor against the risk of pre-hypertension (aOR 0.24 95% CI 0.09-0.59). Risk factors for pre-hypertension are overnutrition (aOR 3.43 95% CI 1.47-7.97), lack of activity (aOR 4.71 95% CI 2.87-7.70), and frequent consumption of fast food serving (aOR=2.83 95% CI 1.11-7.21). Nutritional status when toddlers recover from stunting is a protective factor against the risk of pre-diabetes (aOR=0.19 95% CI 0.04-0.88). Meanwhile, worsening nutritional status is a risk factor for diabetes in adolescents (aOR=3.92 95% CI 1.81-8.51). Adolescents who frequently consume fast food are 4.24 times more likely to suffer from diabetes than those who rarely consume fast food (aOR=4.24 95% CI 1.62-11.13). Meanwhile, frequent consumption of vegetables is a protective factor against the risk of diabetes in adolescents (aOR 0.36 95% CI 0.17-0.81).
The entry point that can be made to prevent the occurrence of hypertension/diabetes in adolescents by paying attention to the 1000 first days of life include early initiation of breastfeeding, exclusive breastfeeding, additional feeding, micronutrient supplementation, complete basic immunization, education nutrition, and other cross-sector programs. The government's efforts to prevent non-communicable diseases in adolescents in Indonesia which have been carried out through adolescents-friendly health service need to be expanded more consistently in carrying out weight monitoring activities, blood sugar checks, nutritional education related to risk factors for hypertension and diabetes so that early detection of risk hypertension/diabetes can be implemented. | id |
