Ketahanan Pangan Rumah Tangga dan Konsumsi Daun Bavoa (Cleome sp.) untuk Peningkatan Produksi ASI pada Ibu Menyusui Suku Kaili

Abstract

Menyusui merupakan salah satu strategi paling efektif untuk meningkatkan kesehatan dan kelangsungan hidup bayi dan anak. Namun, praktik menyusui sering terhambat oleh kuantitas ASI yang dirasakan ibu rendah dan kerawanan pangan rumah tangga. Akan tetapi, ibu dapat meningkatkan produksi ASInya dengan mengonsumsi pangan tertentu yang mengandung laktagogum. Secara tradisional, ibu menyusui suku Kaili telah memanfaatkan beragam pangan lokal, seperti daun bavoa (Cleome sp.), daun kelor (Moringa oleifera), dan daun pucuk labu sebagai sayur dan mengonsumsinya pascamelahirkan karena dipercaya dapat memperlancar ASI. Di antara tanaman tersebut, daun bavoa (Cleome sp.) menarik perhatian khusus. Meskipun merupakan tanaman liar yang telah lama digunakan secara empiris untuk meningkatkan laktasi dan mengobati berbagai penyakit, khasiatnya belum terverifikasi secara ilmiah dan perlu dikaji lebih lanjut. Penelitian ini bertujuan untuk menganalisis ketahanan pangan rumah tangga dan konsumsi daun bavoa (Cleome sp.) untuk peningkatan produksi ASI pada ibu menyusui suku Kaili. Secara khusus penelitian ini bertujuan menganalisis hubungan antara ketahanan pangan rumah tangga dan kebiasaan konsumsi pangan laktagogum terhadap persepsi kecukupan ASI, menganalisis kandungan zat gizi dan komponen bioaktif daun bavoa, serta mengevaluasi pengaruh pemberian tepung daun bavoa terhadap peningkatan produksi susu, kadar hormon prolaktin dan kadar retinol serta retinoic acid pada induk tikus. Penelitian ini dilaksanakan pada Februari hingga Desember 2024, terdiri dari tiga tahap: (1) studi eksplorasi ketahanan pangan dan kebiasaan konsumsi pangan laktagogum pada ibu menyusui suku Kaili; (2) analisis kandungan zat gizi dan komponen bioaktif daun bavoa (Cleome sp.); dan (3) studi praklinis untuk uji efikasi daun bavoa pada hewan coba. Tahap 1, dilakukan di Kabupaten Sigi, Sulawesi Tengah, menggunakan desain mixed-methods cross-sectional. Data kualitatif dikumpulkan melalui observasi (5 ibu menyusui; 25–30 menit/sesi), wawancara mendalam (10 ibu menyusui, termasuk yang diobservasi; 30–45 menit/sesi), dan focus group discussion (FGD) dengan 36 informan (45–60 menit/sesi). Total 46 informan terlibat dalam tahap kualitatif, dipilih menggunakan teknik purposive sampling dengan pertimbangan pengetahuan komunitas dan keterlibatan mereka dalam kesehatan ibu dan anak. Sementara itu, data kuantitatif dikumpulkan dari 337 rumah tangga ibu menyusui suku Kaili menggunakan multistage random sampling. Penelitian tahap 2 dilaksanakan di Pusat Bioteknologi (Biotech Center) IPB University dan di Laboratorium Penguji Balai Besar Industri Agro (BBIA) untuk analisis kandungan zat gizi daun bavoa; serta di Advanced Research Laboratory IPB University untuk analisis kualitatif komponen bioaktif daun bavoa. Penelitian tahap 3 di Laboratorium Biofarmaka (pemeliharaan hewan coba dan pengukuran produksi susu), dan di Pusat Studi Satwa Primata IPB University (analisis kadar prolaktin) serta di PT Saraswanti Indo Genetech (analisis kadar retinol dan retinoic acid) menggunakan desain pre post with control group experimental study. Jumlah sampel sebanyak 20 ekor tikus Sprague Dawley (5 ekor/kelompok) dirandomisasi menjadi empat kelompok perlakuan: kontrol (N: CMC 5 mL/kg BB oral), kontrol positif (KP: domperidone 2,7 mg/kg BB oral), intervensi D1 (tepung bavoa 600 mg/kg BB oral), dan intervensi D2 (tepung bavoa 1200 mg/kg BB oral). Setiap induk tikus menyusui 6 ekor anak. Analisis data tahap 1 menggunakan NVivo 12 untuk kualitatif, serta Microsoft Excel dan IBM SPSS versi 27 untuk kuantitatif. Validitas konstruk dianalisis menggunakan confirmatory factor analysis (CFA) berbasis Partial Least Square (PLS) dengan SmartPLS 4. Uji normalitas dilakukan menggunakan Kolmogorov-Smirnov. Analisis data kuantitatif, uji Chi-Square diterapkan pada data kategorik, uji Spearman pada data numerik, dan regresi logistik untuk menganalisis faktor-faktor yang memengaruhi persepsi kecukupan ASI dengan kontrol terhadap confounding factors. Data tahap 3 dianalisis menggunakan ANOVA untuk mengetahui signifikansi perbedaan antar kelompok perlakuan, dilanjutkan uji Tukey. Semua analisis statistik, nilai p < 0,05 dianggap signifikan. Sebagian besar ibu menyusui suku Kaili memiliki kebiasaan mengonsumsi pangan laktagogum antara lain bavoa, daun labu, daun ubi jalar, dan jantung pisang; dengan jumlah yang tergolong cukup dan frekuensi yang sering. Berdasarkan metode HFIAS, sebagian besar (34,3%) ibu menyusui suku Kaili tergolong rumah tangga tahan pangan yang berhubungan signifikan (p < 0,05) dengan persepsi kecukupan ASI. Jumlah konsumsi pangan laktagogum berhubungan signifikan (p < 0,05) dengan persepsi kecukupan ASI. Kandungan energi dan zat gizi tepung daun bavoa, meliputi abu (16,27 g), karbohidrat (41,00 g), lemak (3,00 g), protein (31,79 g), b-karoten (383 mg/kg), Vitamin C (72,20 mg/kg), Vitamin E (5,15 mg/100 g), zat besi (191 mg/kg), kalsium (22317 mg/kg), dan zink (49,20 mg/kg). Sementara itu, beberapa komponen bioaktif yang teridentifikasi pada daun bavoa yang diprediksi berperan sebagai laktagogum, diantaranya fenilalanin dan rutin. Pemberian tepung daun bavoa secara signifikan meningkatkan produksi susu pada induk tikus. Peningkatan produksi susu mencapai puncaknya pada hari ke-14. Pemberian tepung daun bavoa juga berpengaruh signifikan terhadap kadar prolaktin, retinol, dan retinoic acid pada induk tikus. Perlakuan tepung daun bavoa 1200 mg/kg BB menunjukkan kadar prolaktin lebih tinggi secara nyata dibandingkan kelompok lainnya. Sementara itu, tidak ditemukan perbedaan signifikan antara perlakuan tepung daun bavoa 600 mg/kg BB dengan 1200 mg/kg BB pada produksi susu, kadar retinol, dan retinoic acid. Kebiasaan konsumsi pangan laktagogum pada ibu menyusui suku Kaili perlu dipertahankan untuk mendukung keberhasilan praktik pemberian ASI eksklusif. Uji praklinis dalam penelitian ini memiliki relevansi yang cukup kuat sebagai langkah awal untuk membuktikan secara biologis efek laktagogum dari daun bavoa, yang sebelumnya telah teridentifikasi dalam konteks budaya dan konsumsi masyarakat suku Kaili. Menjadi dasar pengembangan produk tepung bavoa sebagai laktagogum untuk diuji lebih lanjut secara klinis. Jumlah konsumsi daun bavoa segar sebanyak 50 g/orang/hari atau setara 0,833 g/kgBB/hari dapat menjadi jumlah yang direkomendasikan untuk meningkatkan produksi ASI.

Breastfeeding is one of the most effective strategies to improve the health and survival of infants and children. However, breastfeeding practices are often hindered by perceived low breast milk production and household food insecurity. Nevertheless, mothers can enhance milk production by consuming certain foods containing galactagogues. Traditionally, breastfeeding mothers of the Kaili tribe group have utilized a variety of local foods, such as bavoa leaves (Cleome sp.), moringa leaves (Moringa oleifera), and pumpkin shoots, consuming them as vegetables during the postpartum period because they are believed to promote breast milk production. Among these plants, bavoa leaves (Cleome sp.) have gained particular attention. Although they are wild plants that have long been used empirically to enhance lactation and to treat various ailments, their efficacy has not yet been scientifically verified and requires further investigation. This study aimed to analyze household food security and the consumption of bavoa leaves (Cleome sp.) to enhance breast milk production among breastfeeding mothers of the Kaili tribe. Specifically, the study examined the relationship between household food security and galactagogue food consumption with perceived breast milk sufficiency, analyzed the nutrient and bioactive components of bavoa leaves, and evaluated the effects of bavoa leaf flour on milk production, maternal prolactin levels, and maternal levels of retinol and retinoic acid in animal models. The study was conducted from February to December 2024, consisted of three phases: (1) an exploratory study of food security and galactagogue food consumption habits among breastfeeding mothers of the Kaili tribe; (2) analysis of the nutritional and bioactive components of bavoa leaves (Cleome sp.); and (3) a preclinical study to test the efficacy of bavoa leaves in animal models. Phase 1, conducted in Sigi District, Central Sulawesi, using a mixed-methods cross- sectional design. Qualitative data were collected through observations of five breastfeeding mothers (25–30 minutes per session), in-depth interviews with ten breastfeeding mothers (including the five observed mothers; 30–45 minutes per interview), and focus group discussions (FGDs) with 36 informants (45–60 minutes per session), totaling 46 informants selected purposively based on their knowledge and involvement in maternal and child health. Quantitative data were collected from 337 households of breastfeeding mothers using a multistage random sampling. Phase 2 was conducted at the Biotech Center of IPB University and the Laboratory of the Agro Industrial Research and Standardization Center for nutrient analysis of bavoa leaves, and at the Advanced Research Laboratory of IPB University for qualitative analysis of bioactive components. Phase 3 was conducted at the Biofarmaka Laboratory (animal care and milk production measurement), the Primate Research Center of IPB University (prolactin analysis), and PT Saraswanti Indo Genetech (retinol and retinoic acid analysis), using a pre-post experimental design with a control group. A total of 20 lactating female Sprague Dawley rats (5 per group) were randomized into four treatment groups: control (N: CMC 5 mL/kg BW orally), positive control (PC: domperidone 2.7 mg/kg BW orally), intervention D1 (bavoa flour 600 mg/kg BW orally), and intervention D2 (bavoa flour 1200 mg/kg BW orally). Each dam rat nursed 6 pups. Data from phase 1 were analyzed using NVivo 12 for qualitative data and Microsoft Excel and IBM SPSS version 27 for quantitative data. Construct validity was analyzed using confirmatory factor analysis (CFA) based on Partial Least Squares (PLS) with SmartPLS 4. Normality was tested using the Kolmogorov-Smirnov test. Quantitative analyses included Chi-square for categorical variables, Spearman’s correlation for numerical data, and logistic regression to examine factors influencing perceived breast milk sufficiency while controlling for confounders. Phase 3 data were analyzed using ANOVA, followed by Tukey’s post hoc test. A p-value < 0.05 was considered statistically significant. Most breastfeeding mothers of the Kaili tribe habitually and frequently consume galactagogue foods in adequate amounts, particularly bavoa (Cleome gynandra L.), pumpkin leaves (Cucurbita spp.), sweet potato leaves (Ipomoea batatas L.), and banana blossom (Musa spp.). Based on the HFIAS method, 34.3% of these mothers were classified as living in food-secure households, and household food security was significantly associated with the perception of sufficient breast milk (p < 0.05). Moreover, the amount of galactagogue food consumption showed a strong and significant association with the perception of sufficient breast milk (p < 0.05). The nutrient composition of bavoa leaf flour included ash (16.27 g), carbohydrate (41.00 g), fat (3.00 g), protein (31.79 g), ß-carotene (383 mg/kg), vitamin C (72.20 mg/kg), vitamin E (5.15 mg/100 g), iron (191 mg/kg), calcium (22.317 mg/kg), and zinc (49.20 mg/kg). Meanwhile, several bioactive compounds identified in bavoa leaves are predicted to act as lactagogues, including phenylalanine and rutin. Administration of bavoa leaf flour significantly increased milk production in lactating rats, with the peak observed on day 14. Supplementation with bavoa leaf flour also had a significant effect on prolactin, retinol, and retinoic acid levels in lactating rats. The treatment with 1200 mg/kg BW bavoa leaf flour resulted in significantly higher prolactin levels compared to other groups. Meanwhile, no significant differences were found between the 600 mg/kg BW and 1200 mg/kg BW treatments in terms of milk production, retinol, and retinoic acid levels. The practice of consuming galactagogue foods among breastfeeding Kaili mothers should be preserved to support the success of exclusive breastfeeding. The preclinical trial in this study provides strong relevance as an initial step to biologically validate the galactagogue effect of bavoa leaves, which had previously been identified in the cultural and dietary context of the Kaili community. This serves as the basis for developing bavoa leaf flour as a galactagogue product for further clinical testing. The consumption of fresh bavoa leaves at 50 g/person/day, equivalent to 0.833 g/kg BW/day, may be recommended to enhance breast milk production.