Asupan Asam Lemak Ibu saat Hamil dan Menyusui serta Hubungannya dengan Kandungan Asam Lemak ASI dan Lingkar Kepala Bayi

Abstract

Asam lemak tak jenuh ganda (PUFA) seperti LA dan ALA serta turunanya, yakni long chain-PUFA (LC-PUFA) seperti DHA, EPA, dan ARA berperan penting dalam tumbuh kembang otak bayi (Calder 2015; Moghadasian dan Shahidi 2017). Pertumbuhan dan perkembangan sel otak bergantung pada akumulasi LC-PUFA terutama DHA di otak (Brown 2011; Innis 2014). Kecukupan LC-PUFA ibu selama hamil dan menyusui berpengaruh pada suplai LC-PUFA bagi janin dan bayi (Catena et al. 2019). Sumber utama asam lemak bayi usia 0-6 bulan adalah ASI (Eriksen et al. 2018; Bzikowska-Jura et al. 2018). Kandungan asam lemak ASI diketahui dipengaruhi oleh asupan asam lemak ibu selama hamil dan menyusui (Segura et al. 2015). Selain itu, status gizi ibu juga diketahui berpengaruh pada kandungan asam lemak ASI dan pertumbuhan otak bayi (Breanna dan Lapillonne 2009; Veena et al. 2009; Catalano dan Demouzon 2015). Indikator yang dapat digunakan untuk mengukur pertumbuhan otak bayi adalah lingkar kepala bayi (Catena et al. 2019). Semakin baik tumbuh kembang otak bayi maka semakin baik perkembangan kognitif di masa yang akan datang. Veena et al. (2010) menyatakan bahwa bayi dengan lingkar kepala yang lebih besar memiliki skor IQ lebih tinggi pada usia 9-10 tahun. Penelitian terkait asupan asam lemak ibu serta hubungannya dengan kandungan ASI dan lingkar kepala masih belum banyak dilakukan di Indonesia. Penelitian ini bertujuan untuk menganalisis hubungan asupan asam lemak ibu saat hamil dan menyusui dengan kandungan asam lemak ASI dan lingkar kepala bayi. Penelitian dilakukan menggunakan sebagian data hasil penelitian PUFA oleh BASF–SEAFAST CENTER IPB pada tahun 2018 di Kota Bogor. Subyek adalah ibu hamil dengan kehamilan tunggal yang memiliki usia kandungan 32-40 minggu. Total data yang digunakan sebanyak 79 data ibu dan bayinya. Data penelitian PUFA yang digunakan meliputi data karakteristik ibu (usia, paritas, usia kehamilan), status gizi ibu (IMT pra-hamil), kondisi sosial-ekonomi ibu (pendidikan ibu, pekerjaan ibu, pendapatan keluarga), asupan ibu saat hamil, kandungan asam lemak ASI, dan lama periode kehamilan. Data primer yang digunakan adalah data asupan ibu saat menyusui dan lingkar kepala bayi. Data asupan diperoleh dari kuesioner food recall 2x24 jam saat hamil dan 1x24 jam saat menyusui. Pola konsumsi pangan sumber asam lemak selama hamil diperoleh dari SQ-FFQ. Lingkar kepala bayi diukur saat 5-8 hari postpartum. Pengolahan data dilakukan menggunakan Microsoft Excel 2013. Analisis statistik dilakukan menggunakan SPSS version 16.0 for Windows. Variabel dideskripsikan dalam bentuk frekuensi, persentase, rata-rata, standar deviasi, median, dan jangkauan interkuartil (IQR). Uji beda paired t-test dan Wilcoxon Sign Ranked dilakukan untuk mengetahui perbedaan antara asupan ibu saat hamil dan saat menyusui. Uji hubungan Spearman dilakukan untuk mengetahui hubungan antara 1) asupan ibu saat hamil dan menyusui dengan kandungan asam lemak ASI dan lingkar kepala bayi, 2) IMT pra-hamil dengan kandungan asam lemak ASI dan lingkar kepala bayi, dan 3) kandungan asam lemak ASI dengan lingkar kepala bayi. Pengaruh karakteristik ibu dan kondisi sosial-ekonomi ibu terhadap kandungan asam lemak ASI dan lingkar kepala bayi dianalisis dengan uji regresi logistik. Sebagian besar subyek pada penelitian adalah ibu berusia 20-35 tahun (75,9%), memiliki paritas ≥ 1 (70,9%), tingkat pendidikan tergolong tinggi (53,2%), tidak bekerja atau sebagai ibu rumah tangga (77,2%), tergolong sebagai keluarga tidak miskin (77,2%), dan memiliki status gizi normal (64,6%). Asupan protein, Fe, dan asam folat ibu saat menyusui secara signifikan lebih tinggi dibandingkan saat hamil, namun asupan vitamin D secara signifikan lebih tinggi saat hamil. Meskipun demikian, asupan ibu masih tergolong rendah. Asupan LA, ALA, DHA, EPA, dan ARA ibu saat hamil dan menyusui tergolong rendah (tingkat kecukupan < 80%). Asupan ALA, DHA, dan EPA ibu saat menyusui signifikan lebih tinggi dibandingkan saat hamil, sedangkan asupan ARA ibu signifikan lebih tinggi saat hamil. Asupan asam lemak ibu yang rendah dikarenakan kurang beragam dan rendahnya konsumsi pangan sumber asam lemak. Asupan LA dan ALA ibu banyak berasal dari minyak kelapa sawit, tempe, dan tahu, sedangkan sumber asupan DHA, EPA, dan ARA didominasi daging ayam dan daging sapi. Bayi pada penelitian ini sebagian besar dilahirkan saat usia sudah cukup bulan dengan rata-rata lama periode kehamilan adalah 39,30 ± 1,18 minggu. Rata-rata ukuran lingkar kepala bayi tergolong normal, yakni 34,35 ± 1,41 cm. Median kandungan LA, ALA, DHA, EPA, dan ARA ASI transisi pada penelitian ini masing-masing sebesar 17,82 g, 1,28 g, 0,28 g, 2,63 g, dan 0,25 g per 100 g lemak. Jika dibandingkan dengan kandungan ASI transisi secara global menurut Floris et al. (2019), kandungan LA, ALA, dan EPA ASI subyek lebih tinggi sedangkan kandungan DHA dan ARA ASI subyek lebih rendah. Asupan LA ibu saat menyusui memiliki korelasi positif yang signifikan dengan kandungan LA ASI (p = 0,012), sedangkan asupan ALA saat menyusui secara signifikan berhubungan negatif dengan ALA ASI (p = 0,027). Tidak terdapat hubungan yang signifikan antara asupan ibu saat hamil dan menyusui dengan lingkar kepala bayi (p > 0,05). IMT pra-hamil ibu berhubungan positif secara signifikan dengan lingkar kepala bayi (p = 0,01) namun tidak memiliki korelasi signifikan dengan kandungan asam lemak ASI (p > 0,05). Kandungan asam lemak ASI pada penelitian ini tidak memiliki hubungan signifikan dengan lingkar kepala bayi (p > 0,05). Pendidikan ibu merupakan prediktor kuat untuk kandungan DHA ASI. Ibu dengan tingkat pendidikan tinggi memiliki kandungan DHA ASI 3,3 kali lebih tinggi (p = 0,018; OR = 3,295; 95% CI = 1,225 – 8,865). IMT pra-hamil adalah prediktor kuat kandungan ARA ASI dimana ibu dengan IMT pra-hamil ≥ 25 kg/m2 memiliki kandungan ARA ASI 0,4 kali lebih rendah (p = 0,039; OR = 0,355; 95% CI = 0,133 – 0,951). Perlu dilakukan edukasi mengenai pentingnya PUFA pada ibu hamil dan ibu menyusui dikarenakan asupan PUFA subyek masih sangat rendah. Penelitian lebih lanjut diperlukan untuk mengetahui hubungan yang lebih akurat dikarenakan adanya keterbatasan data dan beberapa kekurangan yang ada pada penelitian ini.

Polyunsaturated fatty acids (PUFA) such as LA and ALA and their derivatives, namely long chain-PUFA (LC-PUFA) such as DHA, EPA, and ARA play an important role in infant brain development (Calder 2015; Moghadasian and Shahidi 2017). The growth and development of brain cells depend on the accumulation of LC-PUFAs in the brain, especially DHA (Brown 2011; Innis 2014). Adequacy of maternal LC-PUFA during pregnancy and lactation affects the supply of LC-PUFA for fetuses and infants (Catena et al. 2019). The main source of fatty acids for infants aged 0-6 months is breast milk (Eriksen et al. 2018; Bzikowska-Jura et al. 2018). The fatty acid content of breast milk is known to be influenced by the maternal intake of fatty acids during pregnancy and lactation (Segura et al. 2015). The maternal nutritional status is also known to affect breast milk fatty acid content and infant brain growth (Breanna and Lapillonne 2009; Veena et al. 2009; Catalano and Demouzon 2015). An indicator that can be used to measure infant brain growth is infant head circumference (Catena et al. 2019). The better of infant brain growth and development, the infant cognitive development would be better in the future. Veena et al. (2010) stated that infant with larger head circumference has higher IQ scores at age 9-10 years. Research related to maternal fatty acid intake and its relationship with breast milk content and head circumference has not been widely conducted in Indonesia. This study analyses the relationship between maternal fatty acid intake during pregnancy and lactation with breast milk fatty acid content and infant head circumference. This research was conducted using part of the PUFA research data by BASF-SEAFAST CENTER IPB in 2018 at Bogor City. Subjects were pregnant women with a single pregnancy with a gestational age of 32-40 weeks. The total data used were 79 data of mothers and their infants. The PUFA research data used included maternal characteristics (age, parity, gestational age), maternal nutritional status (pre-pregnancy BMI), maternal socio-economic conditions (maternal education, maternal occupation, family income), maternal intake during pregnancy, breast milk fatty acid content, and the length of the gestation period. Primary data used are data on maternal intake during lactation and infant head circumference. The maternal dietary intake data obtained from the food recall questionnaire 2x24 hours during pregnancy and 1x24 hours during lactation. The pattern of the fatty acids food sources consumption during pregnancy was obtained from the SQ-FFQ. Infant head circumference was measured at 5-8 days postpartum. Data processing was performed using Microsoft Excel 2013. Statistical analysis was performed using SPSS version 16.0 for Windows. Variables are described in terms of frequency, proportion, mean, standard deviation, median, and interquartile range (IQR). Different test conducted using Paired T-test and Wilcoxon Sign Rank to determine the difference between maternal intake during pregnancy and lactation. The Spearman test was carried out to determine the relationship between 1) maternal intake during pregnancy and lactation with breast milk fatty acid content and infant head circumference, 2) pre-pregnancy BMI with breast milk fatty acid content and infant head circumference, and 3) breast milk fatty acid content with infant head circumference. The effect of maternal characteristics and socio-economic conditions on the breast milk fatty acids content and infant head circumference were analyzed using logistic regression tests. Most of the subjects in the study were mothers aged 20-35 years old (75,9%), had parity ≥ 1 (70,9%), high education level (53,2%), not working or as housewives (77, 2%), are classified as a non-impoverished family (77,2%), and have normal nutritional status (64,6%). The maternal protein, Fe, and folic acid intake during lactation were significantly higher, but the vitamin D intake was significantly lower than during pregnancy. However, maternal intake is still low. Maternal intake of LA, ALA, DHA, EPA, and ARA during pregnancy and lactation is low (adequacy level < 80%). Maternal ALA, DHA, and EPA intake during lactation were significantly higher, whereas maternal ARA intake was significantly lower than during pregnancy. Low maternal fatty acid intake is due to less variety and low consumption of fatty acid food sources. The maternal LA and ALA intake mostly come from palm oil, tempeh, and tofu, while chicken and beef dominate DHA, EPA, and ARA intake sources. In this study, infants were mostly born at full term with an average length of gestation period was 39,30 ± 1,18 weeks. The average infant head circumference is considered normal (34,35 ± 1,41 cm). The median of the LA, ALA, DHA, EPA, and ARA of the transitional breast milk content in this study was 17,82 g, 1,28 g, 0,28 g, 2,63 g, and 0,25 g per 100 g of fat, respectively. When compared with the transitional breast milk content globally according to Floris et al. (2019), the LA, ALA, and EPA content in the subject's breast milk was higher, while the DHA and ARA content of the subject's breast milk was lower. Maternal LA intake during lactation had a significant positive correlation with breast milk LA content (p = 0,012). In contrast, ALA intake during lactation was significantly had a negative association with breast milk ALA content (p = 0,027). There was no significant relationship between maternal intake during pregnancy and lactation with infant head circumference (p > 0,05). Maternal pre-pregnancy BMI was significantly associated with infant head circumference (p = 0,01) but did not have a significant correlation with breast milk fatty acid content (p > 0,05). The breast milk fatty acid content in this study did not significantly correlate with infant head circumference (p > 0,05). Maternal education is a strong predictor of breast milk DHA content. Maternal with higher educational level had a 3,3 times higher breast milk DHA content (p = 0,018; OR = 3,295; 95% CI = 1,225 - 8,865). Pre-pregnancy BMI was a strong predictor of breast milk ARA content where maternal with pre-pregnancy BMI ≥ 25 kg/m2 had a 0,4 times lower breast milk ARA content (p = 0,039; OR = 0,355; 95% CI = 0,133 - 0,951). Education is needed regarding the importance of PUFA in pregnant and lactation women because the subjects PUFA intake is still deficient. Further research is needed to find more accurate associations due to data limitations and some of the weaknesses in this study.