Kaitan Kualitas Konsumsi Pangan Dan Status Gizi Dengan Usia Menarche Dan Premenstrual Syndrome Pada Remaja Putri Di Jambi

Abstract

Remaja saat ini mengalami pertumbuhan dan perkembangan yang lebih cepat termasuk menstruasi pertama (menarche). Berdasarkan hasil Riskesdas 2010 sebanyak 21,3% wanita di Jambi mengalami menarche pada usia =12 tahun. Menarche dini memungkinkan remaja putri lebih cepat bersentuhan dengan kehidupan seksual serta meningkatkan risiko terjadinya kanker terkait hormon dan penyakit kardiovaskular. Gangguan pada siklus menstruasi yang sering dialami remaja adalah premenstrual syndrome (PMS). Konsumsi pangan dan status gizi berperan penting dalam perkembangan organ reproduksi remaja. Oleh karena itu, penelitian ini bertujuan untuk menganalisis kaitan kualitas konsumsi pangan dan status gizi dengan usia menarche dan premenstrual syndrome pada remaja putri di Jambi. Penelitian ini menggunakan desain cross sectional study. Penelitian dilaksanakan di Sekolah Menengah Pertama (SMP) negeri di Provinsi Jambi yang terbagi atas dua wilayah, yakni perkotaan di Kecamatan Sungai Penuh, Kota Sungai Penuh dan perdesaan di Kecamatan Batang Merangin, Kabupaten Kerinci. Penetapan perkotaan dan perdesaan berdasarkan Peraturan Kepala Badan Pusat Statistik Nomor 120 tahun 2020. Penentuan sekolah lokasi penelitian ditetapkan secara purposive. Penelitian dilaksanakan pada bulan September-November 2023 dan telah lolos kaji etik yang dikeluarkan oleh Komisi Etik Penelitian Kesehatan, Fakultas Keperawatan Universitas Airlangga dengan No: 2967-KEPK. Berdasarkan hasil perhitungan didapatkan jumlah minimal subjek sebanyak 100 orang untuk masing-masing wilayah. Oleh karena itu, total keseluruhan subjek adalah 200 orang yang dipilih dengan teknik purposive sampling. Data yang dikumpulkan pada penelitian ini meliputi karakteristik keluarga (pendidikan orang tua, besar keluarga, pekerjaan dan pendapatan orang tua), karakteristik subjek (usia, uang saku, siklus dan lama menstruasi), dan usia menarche yang diperoleh melalui pengisian kuesioner oleh subjek. Data konsumsi pangan meliputi tingkat kecukupan energi dan zat gizi, kualitas konsumsi pangan (Healthy Eating Index/HEI), keragaman pangan (Individual Dietary Diversity Score/IDDS), dan densitas energi konsumsi diperoleh melalui wawancara menggunakan kuesioner food recall 2x24 jam. Data aktivitas fisik diperoleh melalui pengisian kuesioner International Physical Activity Questionnaire Short-Form (IPAQ-SF). Data status gizi meliputi z-score TB/U, z-score IMT/U, dan persen lemak tubuh diperoleh menggunakan stature meter dan timbangan BIA. Data PMS diperoleh melalui pengisian kuesioner Shortened Premenstrual Assessment Form (SPAF). Data prestasi belajar diperoleh dari nilai ujian mata pelajaran Matematika, IPA, Bahasa Indonesia, dan Bahasa Inggris. Analisis data menggunakan SPSS versi 25.0. Analisis data meliputi analisis univariat (uji deskriptif), analisis bivariat (uji beda: Independent t-test, Mann-Whitney, dan Chi-squared test; dan uji hubungan: Pearson dan Spearman test); serta analisis multivariat (regresi logistik). Hasil analisis menunjukkan jika pendidikan orang tua, besar keluarga, pekerjaan orang tua, pendapatan orang tua, dan uang saku subjek signifikan lebih tinggi di perkotaan dibandingkan perdesaan. Meskipun demikian, usia, siklus menstruasi, dan lama menstruasi subjek tidak berbeda signifikan antar wilayah tempat tinggal. Rata-rata tingkat kecukupan energi, karbohidrat, protein, lemak, vitamin B6, zat besi, densitas energi konsumsi, z-score TB/U, z-score IMT/U, dan prestasi belajar signifikan lebih tinggi di perkotaan dibandingkan perdesaan. Meskipun demikian, tingkat kecukupan kalsium, magnesium, vitamin C, kualitas konsumsi pangan (HEI), keragaman pangan (IDDS), aktivitas fisik, dan persen lemak tidak berbeda signifikan antar wilayah tempat tinggal. Rata-rata usia menarche di perkotaan adalah 11,6 tahun sedangkan di perdesaan 12,0 tahun, sehingga usia menarche di perkotaan lebih muda dibandingkan perdesaan. Rata-rata skor PMS di perkotaan dan perdesaan adalah 24,8 dan 22,7, dengan demikian skor PMS tidak berbeda signifikan antar wilayah tempat tinggal, hanya cenderung lebih tinggi di perkotaan dibandingkan perdesaan. Tingkat kecukupan kalsium dan zat besi berhubungan signifikan positif dengan z-score TB/U, sehingga semakin tinggi tingkat kecukupan kalsium dan zat besi maka semakin tinggi z-score TB/U. Tingkat kecukupan energi, karbohidrat, protein, vitamin B6, zat besi, dan aktivitas fisik berhubungan signifikan positif dengan z-score IMT/U, sehingga semakin tinggi tingkat kecukupan energi, karbohidrat, protein, vitamin B6, zat besi, dan aktivitas fisik maka semakin tinggi z-score IMT/U. Tingkat kecukupan vitamin B6 berhubungan signifikan positif dengan persen lemak tubuh, sehingga semakin tinggi tingkat kecukupan vitamin B6 maka semakin tinggi persen lemak tubuh. Z-Score TB/U, z-score IMT/U, dan persen lemak tubuh berhubungan signifikan negatif dengan usia menarche, sehingga semakin tinggi z-score TB/U, semakin gemuk, dan semakin tinggi persen lemak tubuh maka semakin muda usia menarche. Z-Score IMT/U dan persen lemak berhubungan signifikan positif dengan PMS. Namun, usia menarche berhubungan signifikan negatif dengan PMS. Oleh karena itu, semakin gemuk, semakin tinggi persen lemak tubuh, dan semakin dini usia menarche maka semakin tinggi risiko terjadi PMS. Tidak terdapat hubungan signifikan kejadian PMS dengan prestasi belajar. Faktor risiko usia menarche adalah remaja yang tinggal di perkotaan berisiko 2,591 kali mengalami menarche dini dibandingkan dengan yang tinggal di perdesaan (OR: 2,591; 95% CI: 1,415-4,744) dan faktor risiko kejadian PMS adalah remaja dengan persen lemak tubuh tinggi (gemuk) berisiko 2,619 kali mengalami PMS dibandingkan dengan yang persen lemak tubuh normal (OR: 2,619 CI 95%: 1,228-5,586). Oleh karena itu, pihak sekolah dan instansi terkait perlu melakukan edukasi dan promosi gizi untuk meningkatkan pengetahuan dan kesadaran remaja agar dapat mempraktikan pola makan yang baik sehingga memiliki kualitas diet sesuai rekomendasi gizi seimbang berupa mengurangi makanan yang tinggi kalori, gula, dan garam serta meningkatkan konsumsi sayur, buah, protein nabati, dan susu sesuai dengan pedoman gizi seimbang. Selain itu, perlu dilakukan edukasi dalam upaya meningkatkan kesadaran remaja untuk melakukan aktivitas fisik/olahraga minimal 150 menit/minggu, sehingga dapat memperbaiki status gizi dan mengurangi keluhan gejala PMS pada remaja putri di Jambi.

Adolescence is the second fastest growth and development phase, including menstruation (menarche). Based on the results of Riskesdas 2010, 21.3% of women in Jambi experienced menarche at the age of =12 years. Early menarche allows adolescent girls to come into contact with sexual life more quickly and increases the risk of hormone-related cancers and cardiovascular disease. Disorders of the menstrual cycle that are often experienced by adolescents are premenstrual syndrome (PMS). Food consumption and nutritional status play an important role in the development of adolescent reproductive organs. Therefore, this study aims to analyze the association of food consumption quality and nutritional status with age of menarche and premenstrual syndrome in adolescent girls in Jambi. This study used a cross-sectional study design. The study was conducted at public junior high schools in Jambi Province, which are divided into two regions, namely urban in Sungai Penuh Subdistrict, Sungai Penuh City, and rural in Batang Merangin Subdistrict, Kerinci Regency. The determination of urban and rural areas is based on the Regulation of the Head of the Central Statistics Agency Number 120 of 2020. The determination of the research location schools was purposive. The research was conducted in September-November 2023 and has passed the ethical review issued by the Health Research Ethics Commission, Faculty of Nursing, Universitas Airlangga with No. 2967-KEPK: 2967-KEPK. Based on the calculation results, the minimum number of subjects is 100 people for each region. Therefore, the total number of subjects was 200 people selected by purposive sampling technique. The data collected in this study included family characteristics (parents' education, family size, occupation and parents' income), subject characteristics (age, pocket money, menstrual cycle and duration), and age of menarche obtained through filling out a questionnaire by the subject. Food consumption data including energy and nutrient adequacy levels, food consumption quality (Healthy Eating Index/HEI), food diversity (Individual Dietary Diversity Score/IDDS), and energy density of consumption were obtained through interviews using a 2x24 hour food recall questionnaire. Physical activity data was obtained by filling out the International Physical Activity Questionnaire Short-Form (IPAQ-SF) questionnaire. Nutritional status data included HAZ, BAZ, and percent body fat using a stature meter and BIA scales. PMS data were obtained through the Shortened Premenstrual Assessment Form (SPAF) questionnaire. Learning achievement data were obtained from test scores in Mathematics, Science, Indonesian Language, and English. Data were analyzed using SPSS version 25.0. Data analysis included univariate analysis (descriptive test), bivariate analysis (t-test: Independent t-test, Mann-Whitney, and Chi-squared test; and relationship test: Pearson and Spearman tests); and multivariate analysis (logistic regression). The analysis showed that parents' education, family size, parents' occupation, parents' income, and pocket money were significantly higher in urban areas compared to rural areas. However, the age, menstrual cycle, and length of menstruation of the subjects did not differ significantly between regions of residence. The mean adequacy levels of energy, carbohydrate, protein, fat, vitamin B6, iron, energy density of consumption, HAZ, BAZ, and learning achievement were significantly higher in urban than rural areas. However, the adequacy levels of calcium, magnesium, vitamin C, food quality (HEI), food diversity (IDDS), physical activity, and percent fat did not differ significantly between regions of residence. The average age of menarche in urban areas is 11.6 years while in rural areas it is 12.0 years, so the age of menarche in urban areas is younger than in rural areas. The mean PMS scores in urban and rural areas were 24.8 and 22.7, thus PMS scores did not differ significantly between areas of residence, only tending to be higher in urban areas than rural areas. Calcium and iron adequacy levels were significantly positively associated with HAZ, such that the higher the calcium and iron adequacy levels, the higher the HAZ. Energy, carbohydrate, protein, vitamin B6, iron, and physical activity adequacy levels were significantly positively associated with BAZ, such that the higher the energy, carbohydrate, protein, vitamin B6, iron, and physical activity adequacy levels, the higher the BAZ. Vitamin B6 sufficiency was significantly positively associated with percent body fat, such that the higher the vitamin B6 sufficiency level, the higher the percent body fat. HAZ, BAZ, and percent body fat were significantly negatively associated with age at menarche, such that the higher the HAZ, the fatter, and the higher the percent body fat, the younger the age at menarche. BAZ and percent body fat were significantly positively associated with PMS. However, age at menarche was significantly negatively associated with PMS. Therefore, the heavier the weight, the higher the percent body fat, and the earlier the age of menarche, the higher the risk of PMS. There was no significant relationship between the incidence of PMS and learning achievement. The risk factor for age of menarche was that adolescents living in urban areas had 2.591 times the risk of early menarche compared to those living in rural areas (OR: 2.591; 95% CI: 1.415-4.744) and the risk factor for PMS was that adolescents with high body fat percent had 2.619 times the risk of PMS compared to those with normal body fat percent (OR: 2.619 95% CI: 1.228-5.586). Therefore, schools and related agencies need to conduct nutrition education and promotion to increase the knowledge and awareness of adolescents so that they can practice a good diet so that they have a quality diet according to balanced nutrition recommendations in the form of reducing foods that are high in calories, sugar, and salt and increasing consumption of vegetables, fruit, vegetable protein, and milk by balanced nutrition guidelines. In addition, education needs to be carried out in an effort to increase the awareness of adolescents to do physical activity/exercise for at least 150 minutes/week, so that it can improve nutritional status and reduce complaints of PMS symptoms in adolescent girls in Jambi.