Pengaruh Pemberian Cookies Galohgor Terhadap Biomarker Inflamasi Ibu Postpartum dan Pertumbuhan Bayi

Abstract

Prevalensi stunting di Indonesia terus meningkat. Pemberian Air Susu Ibu (ASI) Eksklusif merupakan salah satu cara mencegah kejadian stunting. ASI mengandung berbagai zat gizi dan komponen aktif salah satunya yaitu insulin-like growth factor-I (IGF-I). Kadar IGF-1 juga berhubungan dengan status vitamin A. Jamu Galohgor sudah dikembangkan menjadi produk cookies Galohgor dan sudah diintervensikan pada ibu postpartum selama 14 hari. Hasil dari penelitian tersebut menunjukkan cookies galohgor dapat meningkatkan β-karoten serum dan memperbaiki kondisi stres oksidatif yang diukur dengan biomarker MDA serum (Ma’rifah et al. 2019) selain itu juga cookies Galohgor berpengaruh terhadap peningkatan berat bayi menurut umur (Nuraelah et al. 2020). Penelitian ini bertujuan untuk menganalisis manfaat cookies Galohgor pada ibu postpartum dengan cara pemeriksaan biomarker inflamasi terhadap pertumbuhan bayi. Desain penelitian yang digunakan adalah desain quasy experimental, menggunakan 2 kelompok perlakuan yaitu: 1) kelompok subjek yang diberikan produk makanan cookies Galohgor; 2) kelompok subjek yang diberikan produk makanan cookies kontrol. Penelitian ini merupakan penelitian lanjutan dari penelitan Roosita et al. (2018) yang berjudul Studi Efikasi Nutrasetikal Galohgor untuk Peningkatan Produksi ASI dan Ekspresi Gen Penanda Laktasi Pada Ibu Penderita Diabetes Melitus Tipe 2. Protokol penelitian ini telah disetujui oleh Komisi Etik yang Melibatkan Subjek Manusia, IPB No. 081/IT3.KEPMSMIPB/SK/2018. Kriteria inklusi subjek yang terlibat pada penelitian yaitu ibu postpartum berusia 26-40 tahun, kehamilan ke-2 hingga kehamilan ke-5, tidak menderita penyakit kronis, tidak merokok, ibu bersedia menjadi subjek penelitian yang ditegaskan melalui persetujuan informed consent, ibu dalam keadaan sadar dan dapat berkomunikasi dengan baik. Kriteria eksklusi, bila bayi lahir prematur atau berat badan lahir kurang dari 2500 g dan persalinan tidak secara normal atau dengan cara operasi sesar. Subjek kelompok cookies Galohgor (n = 9) dan kelompok kontrol (n = 9) diberikan cookies sesuai dengan kelompok perlakuan selama 40 hari. Cookies Galohgor adalah cookies yang mengandung 1 gram Galohgor per keping cookies. Pada hari ke-13 dan 39 dilakukan pengambilan sampel ASI dan hari ke-14 dan 40 dilakukan pengambilan darah. Hari ke-13 dan ke-39 digunakan untuk menilai status gizi, dan tingkat konsumsi. Hasil analisis statistik karakteristik responden yang meliputi usia, paritas, indeks massa tubuh (IMT), lingkar lengan atas (LILA), berat badan bayi, Panjang badan bayi, lingkar kepala bayi, tidak berbeda nyata antara kelompok cookies galohgor dan kelompok kontrol (p>0.05). Kadar TNF-α ibu postpartum hari ke-14 dan hari ke-40 setelah pemberian cookies rata-rata tidak berbeda nyata (p>0.05) antara kelompok kontrol dan kelompok cookies Galohgor. Pada hari ke 40 kadar TNF-α kelompok kontrol tidak ada perubahan rata- rata 22.430±3.047 pg/ml dan pada kelompok cookies mengalami penurunan menjadi 20.668±6.919 pg/ml. Penurunan TNF-α diduga adanya pengaruh β-karoten dari cookies Galohgor. β-karoten menekan aktivitas NF-kB yang penting untuk produksi TNF-α. Hasil analisis ANCOVA kadar retinol dan β-karoten setelah pemberian cookies hari ke-14 dan ke-40 menunjukkan nilai rata-rata tidak berbeda nyata (p>0.05) antara kelompok kontrol dan kelompok cookies Galohgor. Rata-rata kadar retinol kelompok kontrol (1.24±0.25 μmol/L) dan kelompok cookies Galohgor (1.05±0.43 μmol/L) masuk kategori normal. Begitu juga kadar retinol pada hari ke- 40, meskipun mengalami penurunan rata-rata kadar retinol kelompok kontrol (0.90±0.16 μmol/L) dan kelompok cookies Galohgor (0.94±0.13 μmol/L) masih masuk kategori normal. Kadar β-karoten serum ibu postpartum hari ke-14 pada kelompok kontrol (0.11±0.06 μmol/L) dan kelompok cookies Galohgor (0.10±0.07 μmol/L) masuk kategori rendah. Setelah pemberian intervensi sampai hari keempat 40, rata-rata kadar retinol kelompok kontrol (0.10±0.06 μmol/L) dan kelompok cookies Galohgor (0.10±0.02 μmol/L) masih masuk kategori rendah. Kadar TNF-α mengalami peningkatan pada ibu postpartum selama empat minggu pasca melahirkan. Rendahnya β-karoten pada serum darah diduga membantu menetralkan radikal bebas yang terjadi pada ibu postpartum. Hasil analisis ANCOVA pada kadar retinol dan β-karoten ASI ibu menunjukkan bahwa, tidak ada perbedaan yang signifikan antara kelompok kontrol dan kelompok cookies, baik pada hari ke-14 dan hari ke-40. Kadar rata-rata retinol ASI hari ke-14 kelompok kontrol (38.284±6.451mg/kg) dan kelompok cookies Galohgor (41.405±15.438 mg/kg) mengalami peningkatan menjadi 67.312±43.291 mg/kg dan 55.651±33.659 mg/kg. Sedangkan kadar rata-rata β-karoten ASI pada hari ke-14 pada kelompok kontrol (0.953±0.769 mg/kg) mengalami penurunan pada hari ke-40 menjadi 0.472±0.369 mg/kg. Sebaliknya kadar rata-rata β-karoten ASI pada hari ke-14 pada kelompok cookies Galohgor (0.455±0.527 mg/kg) mengalami peningkatan pada hari ke-40 menjadi (0.691±0.462 mg/kg). Kandungan retinol dan β-karoten tidak berbeda nyata diduga karena asupan kedua kelompok tidak berbeda, kandungan retinol dan β-karoten sudah tinggi saat awal-awal melahirkan. Hasil analisis IGF-1 ASI pada hari ke-40 menunjukkan terdapat perbedaan yang signifikan (p<0.05) antara kelompok kontrol dan kelompok cookies. Hasil analisis ANCOVA didapatkan variabel usia ibu berhubungan dengan kadar IGF-1 pada ASI. Kadar IGF-1 ASI kelompok cookies Galohgor lebih tinggi diduga terdapat kontribusi β-karoten dari cookies jamu galohgor. Hasil pengukuran antropometri menunjukkan bahwa terdapat perbedaan signifikan (p<0.05) berat badan bayi hari ke-14 dan hari ke-40 antara ke kelompok kontrol dan kelompok cookies Galohgor. Pada pengukuran lingkar kepala bayi, terdapat perbedaan yang signifikan (p<0.05) lingkar kepala bayi hari ke-14 antara kelompok kontrol dan kelompok cookies galohgor. Berat badan dan lingkar kepala bayi kelompok cookies Galohgor yang lebih besar diduga terdapat peran β-karoten dari cookies Galohgor. Pemberian cookies Galohgor diduga membantu mempertahankan kadar IGF-1 ASI.

The prevalence of stunting in Indonesia continues to increase. Exclusive breastfeeding is one of the ways to prevent stunting. Breast milk contains various nutrients and active components, one of which is insulin-like growth factor-1 (IGF-1). IGF-1 contents are also associated with vitamin A status. Galohgor herb has been developed into a product of Galohgor cookies and it has been intervened in postpartum mothers for 14 days. The finding indicates that Galohgor cookies can increase β-serum carotene and improve the condition of oxidative stress as measured by serum MDA biomarkers (Ma’rifah et al. 2019) in addition, Galohgor cookies affect the increase of baby weight in accordance with age (Nuraelah et al. 2020). The aim of this study was to analyze the benefits of Galohgor cookies on postpartum mothers by examining inflammatory biomarkers on the growth of the infant. The research design used was a quasy experimental design, using 2 treatment groups, namely: 1) the subject group was given the Galohgor cookie food product; 2) the subject group was given a control cookie food product. This study was advanced research from the research of Roosita et al. (2018) entitled The Study of Nutraceutical Efficacy on Galohgor for Increasing Breast Milk Production and Expression of Lactation Marker Genes in Mothers with Type 2 Diabetes Mellitus. This study protocol has been approved by the Ethics Commission Involving Human Subjects, IPB No. 081/IT3.KEPMSMIPB/SK/2018. The inclusion criteria of the subjects involved in the study were postpartum mothers aged 26-40 years, 2nd to 5th pregnancy, did not suffer from chronic diseases, did not smoke, mothers were willing to be research subjects confirmed by informed consent, mothers were in a conscious state and could communicate well. Exclusion criteria, if the baby was born prematurely or birth weight less than 2500 g and childbirth was not normal or by cesarean section. The subjects of the Galohgor cookies group (n = 9) and the control group (n = 9) were given cookies according to the treatment group for 40 days. Galohgor cookies are cookies that contain 1 gram of Galohgor per cookie. On the 13th day, breast milk samples were taken and on the 14th day blood samples were taken. The intervention of giving cookies was continued until the 40th day. On the 39th day, breast milk samples were taken and blood was taken again on the 40th day. On the 13th and 39th days were used to assess nutritional status, and consumption levels. The results of statistical analysis of respondents’ characteristics, which included of age, parity, body mass index (BMI), upper arm circumference (LILA), baby’s weight, baby’s body length, baby’s head circumference, were not significantly different between the Galohgor cookies group and the control group (p> 0.05). The level of TNF- α in postpartum mothers on the 14th and 40th days after administering cookies were not significantly different (p>0.05) between the control group and the Galohgor cookies group. On the 40th day, the level of TNF- α in the control group did not change an average of 22,430±3,047 pg/ml and the cookies group decreased to 20,668±6,919 pg/ml. The decrease in TNF-α was assumed due to the effect of β-carotene from Galohgor cookies. β-carotene suppresses the activity of NF-kB which is essential for the production of TNF-α. The results of ANCOVA analysis of retinol and β-carotene levels after the administration of cookies on the 14th and 40th days pointed out that the average value was not significantly different (p>0.05) between the control group and the Galohgor cookies group. The average of retinol levels in the control group (1.24±0.25 mol/L) and Galohgor cookies group (1.05±0.43 mol/L) were in the normal category. Likewise, retinol levels on the 40th day, even though, the average retinol levels decreased in the control group (0.90±0.16 mol/L) and the Galohgor cookies group (0.94±0.13 mol/L) were still in the normal category. Serum-carotene levels in postpartum mothers on the 14th day in the control group (0.11±0.06 mol/L) and galohgor cookies group (0.10±0.07 mol/L) were in the low category. After administering the intervention until the fourth day of 40, the average retinol levels in the control group (0.10±0.06 mol/L) and Galohgor cookies group (0.10±0.02 mol/L) were still in the low category. TNF-α levels increased in postpartum women for four weeks postpartum. The low of β-carotene in blood serum was assumed to assist neutralize free radicals that occurred in postpartum mother. The results of ANCOVA analysis on retinol and β-carotene levels in maternal milk showed that there was no significant difference between the control group and the cookies group, both on 14th and 40th days. The average levels of retinol in breast milk on 14th day of the control group (38.284±6.451mg/kg) and the Galohgor cookies group (41.405±15,438 mg/kg) increased to 67,312±43,291 mg/kg and 55,651±33,659 mg/kg. Meanwhile, the average level of β-carotene in breast milk on the 14th day in the control group (0.953±0.769 mg/kg) decreased on the 40th day to 0.472±0.369 mg/kg. On the other hand, the average level of β-carotene in breast milk on the 14th day in the Galohgor cookies group (0.455±0.527 mg/kg) increased on the 40th day to (0.691±0.462 mg/kg). The content of retinol and β-carotene was not significantly different, it was presumably because the intake of the two groups was not different, the content of retinol and β-carotene was already high in the early days of childbirth. The results of IGF-1 analysis of breast milk on the 40th day showed that there was a significant difference (p<0.05) between the control group and the cookies group. The results of ANCOVA analysis indicated that maternal age was associated with IGF-1 levels in breast milk. The higher levels of IGF-1ASI in the Galohgor cookies group were assumed to have a contribution of β-carotene from the Galohgor herbal cookies. The results of anthropometric measurements indicated that there was a significant difference (p<0.05) in the baby’s weight on the 14th and 40th days between the control group and the Galohgor cookies group. In the measurement of the infant’s head circumference, there was a significant difference (p<0.05) on the 14th day of the baby’s head circumference between the control group and the galohgor cookies group. The weight and head circumference of infants in the larger group of Galohgor cookies were assumed that there was a role of β-carotene from galohgor cookies. Intervention Galohgor cookies were thought to help maintaining breast milk IGF-1 levels.