Nutrition Data Center

SUPLEMENTASI YODIUM MENINGKATKAN KADAR BESI ANAK SEKOLAH DASAR PENDERITA GAKY

noreply@blogger.com (Anonymous) — Wed, 20 Jun 2012 13:00:00 +0000

PENDAHULUAN

Masalah anemia defisiensi besi (ADB) dan gangguan akibat kekurangan yodium (GAKY) masih termasuk dalam masalah gizi utama yang serius di Indonesia (1). ADB dan GAKY merupakan masalah gizi terbesar di Indonesia dan sampai saat ini belum nampak menunjukkan titik terang keberhasilan penanggulangannya (2). Prevalensi anemia pada anak sekolah dan remaja sekitar 26,5%. Jenis dan besaran masalah gizi di Indonesia tahun 2001-2003 menunjukkan 8,1 juta anak menderita ADB (3). ADB pada anak sekolah dapat mengganggu perkembangan mental, motorik, kognitif, konsentrasi, serta prestasi belajar (4, 5, 6, 7).

Besi dalam tubuh dapat digambarkan dengan kadar hemoglobin (Hb) dan dapat dipengaruhi oleh multifaktor, salah satunya adalah yodium. Tiroksin yang sintesisnya memerlukan yodium dapat memacu kecepatan proses metabolisme didalam tubuh, termasuk kecepatan metabolisme besi dan sintesis Hb. Hasil penelitian Toruan membuktikan terdapat hubungan antara GAKY dan status anemia (8). Beberapa pustaka juga menyebutkan defisiensi tiroid mengakibatkan gangguan sintesis Hb, atau dengan kata lain terdapat pengaruh yang signifikan antara yodium dengan metabolisme besi dan pembentukan Hb didalam tubuh (9, 10).

Hasil studi pendahuluan (11) menunjukkan Cangkringan merupakkan salah satu daerah endemis GAKY berat dengan prevalensi gondok mencapai 39, 5%. Berdasarkan uraian latar belakang, maka peneliti tertarik untuk melakukan penelitian mengenai iodium meningkatkan kadar besi anak sekolah dasar penderita gaky yang berada di daerah endemis GAKY Kecamatan Cangkringan, Kabupaten Sleman Yogyakarta.

Penelitian ini bertujuan untuk mengetahui pengaruh suplementasi Yodium terhadap perubahan kadar Hb pada anak sekolah dasar (SD) penderita GAKY.

BAHAN DAN METODE PENELITIAN

Penelitian ini merupakan penelitian eksperimental yang dilakukan secara double blind with randomized controlled trial. Rancangan penelitian berupa perbandingan antar kelompok (group comparison) yang dilakukan terhadap siswa SD penderita gaky di Kecamatan Cangkringan pada bulan Mei - Agustus 2010.

Kriteria inklusi penelitian ini antara lain: anak sekolah dasar berusia 8-14 tahun, tercatat sebagai siswa dari SD tempat penelitian dan bersedia ikut dalam penelitian dengan izin orang tua dengan menandatangani proxy consent. Kriteria eksklusinya yaitu tidak menderita GAKY, menderita struma hipertiroid dan penyakit kronis yang dinyatakan oleh dokter. Pemilihan SD sample dilakukan secara purposive dengan prinsip keterjangkauan wilayah dan diambil sample yang telah memenuhi kriteria inklusi. Dari perhitungan besar sampel diperoleh sample minimal sebanyak 36 orang untuk tiap kelompok, karena penelitian ini terdiri dari dua kelompok maka sampel minimal yang diperlukan adalah 72 orang. Sampel dalam penelitian ini dibagi menjadi dua kelompok yaitu: kelompok kontrol dan intervensi yang anggotanya ditentukan secara random. Kelompok intervensi mendapat suplementasi yodium dan telur sedangkan kelompok kontrol mendapatkan plasebo dan telur. Suplemen yodium maupun plasebo diberikan satu kali sedangkan telur diberikan sebanyak 3 butir per minggu selama 3 bulan. Data yang dikumpulkan meliputi data primer yaitu: data karakteristik responden, data recall 24 hours dan data kadar Hb, serta data sekunder yang meliputi: data status GAKY berdasarkan hasil palpasi yang dilakukan oleh petugas Puskesmas Cangkringan, data penyakit malaria dan kecacingan dari Puskesmas setempat, serta data demografi dan geografi wilayah Kecamatan cangkringan Kabupaten Sleman melalui kantor Kecamatan Cangkringan Kabupaten Sleman. Pengolahan data dilakukan dengan program pengolahan data statistik menggunakan metode analisis uji t yaitu paired t-test dan independent t-test serta uji chi-square dengan terlebih dahulu dilakukan uji normalitas untuk mengetahui apakah sebaran data normal atau tidak. Kesimpulan adanya perbedaan atau pengaruh yang signifikan secara statisik menggunakan tingkat kemaknaan (α) 0,05 atau p < 0,05.

HASIL

Kecamatan Cangkringan merupakan Kecamatan di wilayah Kabupaten Sleman dengan ketinggian 400 meter diatas permukaan laut dan berada di kaki Gunung Merapi. Berdasarkan data penyakit Tahun 2010 yang didapatkan dari Puskesmas Cangkringan, Kecamatan Cangkringan bukan merupankan daerah endemis malaria dan kecacingan. Hal ini bisa dilihat dari data penyakit di Kecamatan Cangkringan bulan Januari sampai dengan Agustus 2010. Data tersebut melaporkan jumlah orang yang menderita kecacingan hanya 1 orang dan dilaporkan tidak ada orang yang menderita kecacingan selama 8 bulan tersebut.

Tabel 1. Karakteristik Subyek Penelitian

Variabel	Kelompok suplementasi (N=37)	Kelompok control (N=37)
Pendidikan Ibu
<12 tahun	21 (56%)	28 (76%)
>12 tahun	16 (43%)	9 (24%)
Pendidikan Ayah
<12 tahun	21(56%)	22 (60%)
>12 tahun	16 (43%)	15 (41%)
∑Anggota Keluarga
<5	20 (54%)	23 (62%)
>5	17 (45%)	14 (38%)
Status GAKY
Palpasi
Grade I	5 (13%)	7 (19%)
Grade II	32 (86%)	30 (81%)
EYU
Def. ringan (50-99 µg/L)	7 (18%)	5 (14%)
Cukup (100-200 µg/L)	13 (35%)	24 (65%)
Berlebih (>200 µg/L)	16 (43%)	8 (22%)
TSH*
Normal(0,40-3,00 UI/ml)	31 (84%)	25 (68%)
Hipotiroid (>3,00 UI/ml)	5 (14%)	12 (32%)
Status Anemia
Hb pre	2 (5%)	1 (3%)
Hb post	6 (16%)	3 (8%)

Keterangan: *missing 1.

Hasil uji statistic pada semua karakteristik sampel penelitian tidak ada yang signifikan (p>0,05). Hal ini menunjukkan bahwa sampel antar kelompok telah terdistribusi dengan cukup baik dan homogensehingga semua sampel memiliki kesempatan yang sama dalam penelitian.

Tabel 2. Rerata kadar Hb subyek penelitian pada awal dan akhir penelitian serta perbandingan peningkatan kadar Hb kelompok suplementasi terhadap kelompok kontrol

Variabel	Mean + SD Hb (g/dl)		p^a	Mean ΔHb	p^b
	Awal	Akhir
Kelompok suplementasi (n=37)	13,58+ 0,96	13,33+0,99	0,168	-0,24+1,05	0,148
Kelompok kontrol (n=37)	13,39+ 0,78	13,48+0,88	0,550	0,09+0,90

Keterangan: uji statistic mengguanakan a. paired-sampel T-test, dan b. independen sampel T-test, bermakna jika p<0,05

Hasil uji statistic didapatkan nilai p=0,148, dengan demikian, pada alpha 5% terlihat tidak ada perbedaan yang signifikan perubahan rata-rata kadar Hb sebelum dan setelah perlakuan antara kelompok supelementasi dengan kelompok kontrol.

Tabel 3. Odd Ratio dan Risk Difference antara kelompok suplementasi dan kelompok kontrol

Kelompok Perlakuan	Perubahan Hb		OR	Risk difference
Kelompok Perlakuan	Turun	Naik	(95% CI)	(95% CI)
yodium + telur (n=37)	17	20	O,716	-0,344
placebo+ telur (n=37)	14	23	(0,283-1,810)	(-0,118 to -0,803)

Keterangan: uji statistic mengguanakan chi-square test

Analisis chi-square menunjukkan nilai OR=0,7, dapat disimpilkan bahwa anak yang diberi suplementasi yodium+telur kadar Hb nya turun 1,4 kali dibandingkan anak yang diberi placebo+telur.

Tabel 4. Asupan Zat Gizi Masing-Masing Kelompok

Variabel		Kelompok I (N=37)	Kelompok II (N=37)	P
Asupan Enhancer
Energi	kcal (%AKG)	991,35+319 (49,56%+16,75%)	1123,19+274,39 (56,33%+15,34%)	0,074
Protein	g (%AKG)	33,91+ 19,04 (68,84%+39,5%)	34,63+12,93 (70,49%+27,44%)	0,806
Vit A	re (%AKG)	485,87+ 275,72 (85,90%+50,95%)	546.87+ 290.60 (97.75%+56.19%)	0,345
Vit C	µg (%AKG)	25,58+22,51 (49,74%+42,4%)	29,98+22,70 (61,41%+48,93%)	0,277
Fe	µg (%AKG)	10,14+8,89 (74,94%+74,6)	10,84+ 7,48 (76,71%+53,99%)	0,907
Zink	µg (%AKG)	3,29+2,01 (25,32%+14,75%)	3.88+2.11 (30.4%+16.50%)	0,166
Yodium	µg (%AKG)	13,73+12,25 (10,10%+9,23%)	17,58+16,71 (12,96%+12,99%)	0,278
Asupan inhibitor
Tannin	Mg	3966,99 + 1768,97	4135.84 + 1963.65	0,699
Fitat	Mg	99,95 + 44,52	106.45 + 50.65	0,559
Oksalat	Mg	3,08 + 1,31	3.26 +1.77	0,620

Keterangan: uji statistic dengan independen sampel T-test, bermakna jika p<0,05

Data asupan zat gizi dikumpulkan dengan metode food recall 1x24 jam sebanyak 4 kali selama penelitian berlangsung. Asupan zat gizi yang diperhitungkan hanya berasal dari makanan dan minuman, tidak termasuk zat gizi dari suplemen yang diberikan. Tabel 4 menunjukkan bahwa setelah dianalisis antara variabel luar dan variabel bebas, nilai signifikansi semua enhancer dan inhibitor didapatkan p>0,05, sehingga dapat dikatakan tidak ada perbedaan yang signifikan dalam asupan zat gizi antara kelompok suplementasi dengan kelompok kontrol.

Confounding factor dalam penelitian ini adalah jenis kelamin dan umur sampel penelitian. Analisis Confounding factor dengan menggunakan regresi disajikan dalam Tabel 5.

Tabel 5. Analisis Jenis Kelamin Dan Umur Sebagai Confounding factor

Variabel	r	R²	Koefisien B	P	95% CI
Suplementasi yodium	0,170	0,029	0,332	0,148	-0,121	0,786
Suplementasi yodium*jenis kelamin	0,178	0,032	0,349	0,136	-0,113	0,811
Suplementasi yodium*umur	0,221	0,049	0,340	0,138	-0,112	0,792

Tabel 5 menjelaskan bahwa jenis kelamin dan umur bukan merupakan variabel pengganggu dalam penelitian ini, karena koefisien B tidak berubah secara signifikan. Nilai r=0,17 menunjukkan bahwa hubungan antara suplementasi yodium dengan kadar Hb lemah, kontribusinya janya 2,9%.

PEMBAHASAN

Tabel 1 menunjukkan bahwa sampel yang menderita ADB pada penelitian ini hanya 3 orang (4,1%). Hasil ini sesuai dengan penelitian Paratmanitya (12), Firgasari (13) dan Latifah (14) yang mengemukakan bahwa tidak ada hubungan antara status GAKY dengan status anemia, namun tidak sesuai dengan penelitian Zimmerman dkk (15) yang melaporkan bahwa banyak penderita hipotiroid mengalami anemia di Negara berkembang.

Kondisi sampel setelah tiga bulan perlakuan menunjukkan adanya penurunan rata-rata kadar Hb pada kelompok suplementasi dan peningkatan rata-rata kadar Hb pada kelompok kontrol. Uji paired sampel T-test pada masing-masing kelompok didapatkan nilai p>0,05, menunjukkan perubahan kadar Hb pada masing-masing kelompok perlakuan tidak signifikan.

Untuk melihat pebedaan perubahan antara kedua kelompok tersebut dilakukan uji independen sampel T-test. Hasilnya didapatkan nilai p=148. Angka ini memberikan hasil bahwa hipotesis alternatif pada penelitian ini tidak terbukti.

Kenyataan tersebut menunjukkan suplementasi yodium tidak terbukti berpengaruh dalam meningkatkan kadar Hb sampel penelitian. Hasil penelitian ini sesuai dengan hasil penelitian Wegmuller, dkk (16) yang melaporkan bahwa yodium tidak meningkatkan kadar hemoglobin.

Dalam penelitiannya, Wegmuller dkk (16) melaporkan bahwa anak usia sekolah di Cote d’lvoire yang diberi yodium, status besi mereka yang diukur dengan serum ferritin (SF) dan Transferrin reseptor (TfR) meningkat secara signifikan sehingga prevalensi anemia defisiensi besi turun dari 62% menjadi 38%. Berbeda dengan SF dan TfR, Kadar Hb sampel yang berjumlah 63 orang tidak mengalami peningkatan yang signifikan setelah perlakuan selama enam bulan.

Pada tahun 2002, Zimmerman dkk melakukan penelitian yang serupa di Maroko pada anak usia 6 sampai dengan 15 tahun. Hasilnya pemberian yodium meningkatkan kadar Hb sampel, namun Zimmerman tidak melaporkan nilai p dalam peningkatan kadar Hb sampel pada kelompok ini sehingga tidak diketahui nilai signifikansinya (17).

Perbedaan penelitian ini dengan penelitian yang dilakukan Wegmuller dkk (16) dan Zimmerman dkk (17) adalah bentuk pemberian yodium pada sampel penelitian, durasi penelitian dan prevalensi ADB sampel pada awal penelitian. Penelitian ini memberikan yodium pada sampel berupa suplemen dalam bentuk minyak yodiol, sedangkan Zimmerman dan Wegmuller memberikannya dalam bentuk garam yang telah difortifikasi (iodium salt). Waktu yang digunakan dalam penelitian ini hanya 3 bulan, sedangkan penelitian Wegmuller dilakukan selama 6 bulan dan penelitian Zimmerman dilakukan selama 40 minggu (+10 bulan). Prevalensi ADB pada awal penelitian ini hanya 4,1%, sedangkan pada penelitian Wegmuller prevalensi ADB sampelnya mencapai 62% dan pada penelitian Zimmerman mencapai 36%. Hal ini memberikan dampak bahwa peningkatan kadar Hb pada penelitian ini agak sulit karena rata-rata kadar Hb sampelnya sudah dalam batas normal. Penelitian ini juga tidak mengukur serum ferritin dan transferrin receptor, sehingga simpanan besi tidak dapat diketahui.

Hasil dalam penelitian ini tidak sesuai dengan teori yang menyatakan bahwa hormon tiroid yang sintesisnya memerlukan yodium, dapat meningkatkan kecepatan metabolisme besi dan memperbanyak jumlah dan aktivitas mitokondria sehingga secara tidak langsung dapat mempengaruhi kadar Hb dalam darah. Hormon tiroid juga dilaporkan dapat mempengaruhi absorpsi besi dengan memperluas ukuran mukosa usus dan lambung. Kondisi orang yang menderita hipotiroid dapat menurunkan produksi asam hidroklorat sehingga mengganggu absorpsi besi. Hipotiroid juga dapat menurunkan suhu tubuh sehingga angka eritrosit menjadi berkurang (18, 19).

Nilai normal kadar Hb dan kebutuhan tubuh akan zat gizi termasuk zat besi dan yodium berbeda-beda pada setiap orang. Perbedaan ini dapat dipengaruhi oleh umur dan jenis kelamin. Analisis umur dan jenis kelamin dengan regresi pada penelitian ini didapatkan angka koefisien B tidak mengalami perubahan bermakna sehingga umur dan jenis kelamin bukan merupakan factor pengganggu dalam penelitian ini.

Analisis asupan zat gizi secara bivariat pada masing-masing kelompok juga tidak menunjukkan perbedaan yang signifikan, baik pada asupan enhancer zat besi maupun pada asupan inhibitornya.

Ketidaksesuaian hasil penelitian ini dengan teori yang ada mungkin disebabkan karena beberapa hal, salah satunya adalah rata-rata kadar Hb awal sampel penelitian ini normal, sehingga sulit untuk mengalami kenaikan, meskipun telah diberi suplementasi yodium. pemberian suplementasi yodium juga dapat menjadi pesaing zat besi didalam tubuh, karena kedua zat ini sama-sama membutuhkan yodium dalam metabolismenya. Asupan inhibitor pada sampel juga sangat tinggi, terutama tannin dan fitat yang asupannya melebihi batas minimal untuk terkena anemia. Garrod dalam bukunya ‘Essentials Of Materia Medica and Therapeutics’ menyebutkan bahwa Proporsi yang baik antara yodium dengan zat besi adalah 4 ½ : 1. Kadar zat besi yang berlebih jika direaksikan dengan yodium akan menghilangkan yodium tersebut (20). Fortifikasi ganda antara yodium dengan zat besi juga menggunakan kadar yodium yang lebih tinggi daripada zat besi, yaitu 25 mg dan 2 mg pergram garam (15).

Peningkatan kadar Hb pada kelompok control lebih tinggi daripada kelompok perlakuan dapat disebabkan karena zat besi dalam tubuh mereka tidak ada persaingan dengan yodium, karena kelompok control tidak diberi suplementasi yodium. Peningkatan kadar Hb ini juga dapat disebabkan karena selama 3 bulan, mereka diberi telur, sehingga asupan protein sebagai pembawa zat besi menjadi cukup. Dilihat dari asupan zat gizinya, kelompok kontrol juga rata-ratanya lebih besar daripada kelompok perlakuan suplementasi. Secara bivariat, asupan zat gizi pada masing-masing kelompok memang tidak signifikan, akan tetapi zat gizi didalam tubuh manusia saling berinteraksi, sehingga kekurangan dari salah satu mikronutrien akan mempengaruhi absorpsi, metabolisme, dan atau ekskresi mikronutrien lainnya (21). Metode food recal 4x24 jam dalam penelitian ini memang belum bisa menggambarkan asupan zat gizi sampel sampai asupan mikronutriennya, karena efisiensi mikronutrien dipengaruhi oleh asupan zat gizi dimasa lalu. Idealnya, jumlah minimum metode food recall untuk mengetahui mikronutrien adalah 20 sampai 50 hari dan food frequency untuk mengatahui asupan zat gizi di masa lalu, namun untuk asupan makro seperti energy dan protein, 4x24 jam food recall sudah cukup menggambarkan asupan mereka (22).

SIMPULAN

Suplementasi yodium dan telur tidak berpengaruh terhadap peningkatan kadar besi (Hemoglobin) anak sekolah dasar yang menderita GAKY.

SARAN

Untuk penelitian selanjutnya, sebaiknya diambil sampel yang menderita anemia agar peningkatan kadar Hb dapat dilihat lebih jelas dengan status anemia dapat dianalisis dan sebaiknya serum ferritin dan transferrin reseptor diteliti juga, untuk menggambarkan simpanan dan status besi dalam tubuh sampel penelitian

RUJUKAN

1.Kodyat, B.A., Thaha, A.R. and Minarto. (1998) Penuntasan Masalah Gizi Kurang. Jakarta: Prosiding Widyakarya Nasional Pangan dan Gizi VI 1998.

2.Nugroho, A. (2007) Hubungan Antara Status GAKY Dan Status Anemia Dengan Status Gizi Pada Anak Sekolah Dasar Yang Tinggal Di Daerah Endemik GAKY. Skripsi, Universitas Gadjah Mada.

3.Departemen Kesehatan R.I. (2005) Anemia Gizi Anak Salah Satu Msalah Gizi Utama di Indonesia. Tersedia dalam: <Http://www.MinistryofHealth Indonesia.htm> [Diakses tanggal 28 Juni 2011].

4.Husaini, M.A. (1989) Study Nutritional Anemia and Assesment of Information for Supporting and Formulating National Policy and Program. Jakarta: Direktorat Bina Gizi Masyarakat DepKes RI dengan Pulitbang Gizi DepKes RI.

5.Kodyat, B.A., Thaha, A.R. and Minarto. (1998) Penuntasan Masalah Gizi Kurang. Jakarta: Prosiding Widyakarya Nasional Pangan dan Gizi VI 1998.

6. Thu,B.D, Schultink, W., Dillon, D., Gross, R., Leswara, N.D., Khoi, H.H. (1999) Effect of Daily and Weekly Micronutrient Supplementation on Micronutrient Deficientcies and Growth in Young Vietnamese Children. American Journal Clinical Nutrition. 69.

7.WHO, UNICEF, ICCIDD. (2001) Assesment of Iodine Deficiency Disorder and Monitoring their Elimination, A Guide for Programme Managers. 2^ndEdition. WHO: Conference Jenewa.

8.Toruan, J.L., Kushartanti, W., Widodo, U.S. (2009). Status GAKY, Anemia, EYU, Dan Kesegaran Jasmani Anak Sekolah Dasar Di Kabupaten Dairi Sumatera Utara. Jurnal Gizi Klinik Indonesia. 5 (3) Maret. pp. 114-119.

9.Endang. (2003) Tumbuh Kembang Anak. Konsultasi Ilmiah RS Fatmawati dan Klinik Tumbuh Kembang Anak, Jakarta.

10. Johnson D., Currier J. Women and Anemia (internet). The Body (1999). Tersedia dalam: <http://www.thebody.com/content/art286.html> [Diakses 28 juni 2011]

11. Sudargo, T. (2005). Pengaruh Suplementasi Kapsul Yodium dan Zink terhadap Ekskresi Yodium Urin, Kebugaran Kebugaran Kardiorespiratory Anak Sekolah Dasar dengan Gangguan Akibat kekurangan Yodium. Yogyakarta. Laporan Hibah Dosen Senior. UGM. Dikti.

12. Paratmanitya, Y. (2007) Hubungan Antara Status GAKY Dan Status Anemia Dengan Kesegaran Jasmani Pada Anak Sekolah Dasar Di Daerah Endemis GAKY. Skripsi, Universitas Gadjah Mada.

13. Firgasari, L. (2008) Hubungan Antara Status GAKY Dan Status Anemia Dengan Kemampuan Kognitif Pada Anak Sekolah Dasar Yang Tinggal Di Daerah Endemis GAKY. Skripsi, Universitas Gadjah Mada.

14. Latifah, lenny. 2008. GAKY, Anemia, kecerdasan dan Prestasi Belajar Anak Remaja. Tesis, Universitas Gadjah Mada.

15. Zimmerman, M.B. (2006). The Influence of Iron Status on Iodine Utilization and Thyroid Function, Annu Rev Nutr. (26) pp. 367-389

16. Wegmuller, R., Camara, F., Zimmermann, M.B., Adou, P., and Hurrell, R.F. (2005) Salt Dual-Fortified with Iodine and Micronized Ground Ferric Pyrophosphate Affects Iron Status but Not Hemoglobin in Children in Coˆ te d’Ivoire. (internet). Tersedia dalam: <http.laboratoriumkesehatan. blogspot.com> [Diakses tanggal 28 Juni 2011].

17. Zimmerman, B., Zeder, C., Cnaouki, N., Saad, A., Torresani, T., and Hurrel, R.F. (2002) Dual Fortification of Salt with Iodine and Microencapsulated Iron: A Randomized, Double-Blind, Kontrolled Trial in Moroccan School-children dalam Am. Soc. Clin. Nutr.147. pp. 747-53.

18. Guyton, A.C. (1997). Buku Ajar Fisiologi Kedokteran. 9th . Jakarta: EGC.

19. Hebert, V. (1986) The Blood: Werner’s thyroid, a fundamental n clinical test. Fifth edition. Ingbar and Braverman. Ed. Philadelphia: J.B. Lippincot Company.

20. Farmasi UMS. (2008) Fortifikasi Garam dengan Zat Besi, strategi Praktis dan Efektif Menanggulangi Anemia (internet). Tersedia dalam: <http://farmasi. ums.ac.id/content/artikel/20080412> [Diakses 28 Juni 2011]

21. Zimmermann, M. (2007) Interactions between iron and vitamin A, riboflavin, copper and zinc in the etiology of anemia. In: Badham, J., Zimmermann, M. B., Kraemer, K.eds. The Guidebook Nutritional Anemia. Basel: Sight and Life Press.

22. Willet, W. (1998) Nutritional Epidemiology Second Edition. New York: Oxford University Press

IODINE SUPLEMENTATION INCREASING IRON LEVELS OF ELEMENTARY SCHOOL CHILDREN WITH IDD (IODINE DEFICIENCY DISORDERS)

noreply@blogger.com (Anonymous) — Wed, 20 Jun 2012 12:46:00 +0000

ABSTRACT
Research Background: Iron deficiency anemia (IDA) and iodine deficiency disorders (IDD) are the largest nutrition problem in Indonesia. Hypothyroidism and iron deficiency may influence each other. The most people who have a high risk of suffering from IDD and IDA are school-age children.

Purposes: knowing the effects of iodine on hemoglobin level changes among children of IDD Patient in primary school (SD).

Methods: This research used experimental research which double blind randomized controlled trial design. The subjects were the students of class 3, 4 and 5 of the six primary schools in Cangkringan which is an IDD endemic area. The research subject amount to 74 persons and 37 of them were given iodine + eggs, and 37 others as controls. IDD position measurements palpation and iron levels (haemoglobin) with cyanmethemoglobin method. The datas were analyzed with independent sample t-test and Chi-square, by using some programs of computer.

Results: from 74 subject’s persons which suffering with IDD, 3 subjects of them are anaemic. The result analysis showed that iodine supplementation has no effect to increase the levels of Hb (p > 0.05).
Conclusion: Iodine supplementation has no effect in the increase of Hb

Keywords: iodine, iron, IDD, schoolchildren

Indonesia Occupies the Fifth Rank as The State is Malnutrition in the World

noreply@blogger.com (Anonymous) — Wed, 25 Jan 2012 22:54:00 +0000

Tempo.co

Indonesia Health Minister, Endang Rahayu Sedyaningsih said Indonesia was currently ranked fifth in the nation with global malnutrition. "Ranked fifth for the total population in Indonesia is also the world's fourth largest," Endang said in a press conference after opening a national seminar at Balai Kartini Jakarta, Wednesday, January 18, 2012.

Endang said that the number of children under five who are malnourished in Indonesia is currently around 900 thousand inhabitants. This amount is 4.5 percent of total Indonesian children under five, ie 23 million inhabitants. Malnutrition areas scattered across Indonesia, not only the eastern part of Indonesia.

To resolve this problem, Health Minister invited all stakeholders from governments, international agencies, nongovernmental organizations, universities, and community to give priority to improving food and nutrition in every policy. This step, he said, should be followed by implementation of good and proper evaluation.

Endang also admitted that he would coordinate with other ministries to overcome this problem. "We will ask the Coordinating Minister for People's Welfare to collect the ministries related to the food problem in order to synergize and work together to solve the problem of malnutrition," he said. The Ministry is Endang is Ministry of Agriculture, Ministry of Industry, and Ministry of Maritime Affairs.

Source: Tempo.co

Lose Weight with Red Color

noreply@blogger.com (Anonymous) — Thu, 19 Jan 2012 04:53:00 +0000

intisari-online.com

There are many ways you can do to lose weight. By default, people are advised to diet and exercise, but there are also some unique ways you can do to help us reduce some of the fat in the abdomen.

Would like to lose weight the easy way? Try the advice given by these scientists, "Eat from a dish which is red."

It is said that serves food on the plate is red or drink from a glass of red could reduce the consumption of food and beverages up to 40 percent. This is the result of research conducted by academics from Germany and Switzerland, as reported Dailymail.

According to experts, red color can influence people to not take a snack because this color is often associated with "danger, prohibition, and stop". The findings were published in the journal Appetite.

Experts advise the government and food industry packaging using red for unhealthy foods as a preventive measure. The color can even be used in the café to prevent people from drinking too much.

In their study, the researchers asked 41 male students to drink tea from cups that are labeled in red or blue marks. Apparently they drank 44 percent less than the cup red. In the second part of this study, 109 people were given 10 pretzels on each plate of red, blue, and white. Apparently they only take a few pastries from a red plate.

According to Ursula Arens of the British Association Dietic, "Red possibility is associated with an alarm or something like that."

So, if you want to try to lose weight, there is no harm in trying to replace the dish at home with red plates.

Source: intisari-online.com

DASH Diet, Best Diet of All Time

noreply@blogger.com (Anonymous) — Thu, 19 Jan 2012 04:23:00 +0000

DASH Diet (Dietary Approachs to Stop Hypertension) diet was selected as the best method in the year 2012 according to U.S. News & World Report. This is the second time the DASH diet, which aims to prevent and control the blood pressure category was won as the best diet.

DASH diet is said to be found in the Mediterranean and is now found in many Western countries. DASH offers a total content of dietary fat, cholesterol, saturated fat, and low in salt. In addition, the DASH also provides more potassium, magnesium, calcium, and fiber food.

In this diet, margarine is derived from olive oil or canola oil are rich in MUFA or omega-9 fatty acids. Vegetables and fruits are consumed by more than five doses per day, while the food source of charcoal hydrate mainly selected from cereals and grains (grains) are intact.

To meet the protein needs, preferring DASH intake comes from fish and nuts, beans and legumes instead of meat.

"Although initially geared to lower blood pressure, this diet actually has a very high nutritional value," said Deborah Enos, a nutritionist from Seattle.

In the second place in the ranking of the best diet is the TLC diet (Theraupeutic Lifestyle Changes) which aims to lower cholesterol. In the next sequence is the Mayo Clinic diet is more focused on weight loss.

"TLC is another example of the type of medical diets are becoming popular. But diets that limit the intake of sodium is probably quite difficult for some people to follow," said Enos.

While the big three best diet to lose weight is diet Weight Watcher, The Biggest Loser diet and Jenny Craig diet. According to data consumers, it turns out Weight Watchers diet easier to follow and efektf in weight loss programs in the short and long term.

Selection of type of diet is best done by a panel of experts consisting of 22 experts in the field of diet, nutrition, obesity, food psychology, diabetes expert and cardiologist.

The experts assessed 25 types of diets in 7 categories, namely the ease to run, the ability to lose weight in the short and long term, the completeness of nutrition, safety and the potential to prevent diabetes and heart disease.

Source: Kompas.com

Avoid Drinking Raw Milk Fresh to Stay Healthy

noreply@blogger.com (Anonymous) — Wed, 18 Jan 2012 15:09:00 +0000

shutterstock

Fresh raw milk according to some people more healthful because it contains bacteria and enzymes are better than processed milk. The claim was yet to be proven true. Lately it was found that fresh raw milk is one source of food poisoning.

Centers for Disease Control (CDC) announced the 86 reporting data related to food poisoning outbreaks caused by raw milk between 1998 and 2008. Outbreak was caused 1676 people suffer from ill, 191 have to be hospitalized and two people died.

"Raw milk to be hospitalized cause food poisoning. The amount is three times more than any other food poisoning." said Hannah Gould, a senior epidemiologist at the CDC Enteric Diseases Epidemiology Branch.

That's why now sell fresh raw milk is illegal in most American states.

Raw milk can be easily contaminated by bacteria originating from animal manure, soil, leather, fur or any other equipment on the ranch.

One safe way to kill bacteria is heated to high temperatures, either pasteurized or UHT. This method can be deadly literia bacteria, salmonella and E.coli.

In the US there were two patients who suffered from Guillain-Barre syndrome (which can cause paralysis) after bacterial infection caused by consuming raw milk campylobacteriosis.

Source: CNN

Five Best Foods for Babies

noreply@blogger.com (Anonymous) — Tue, 17 Jan 2012 08:35:00 +0000

Healthy diet is required of all people, including babies. In line with the growth of the baby, parents are obliged to meet all kinds of nutrients needed for baby. Quoted from Ninemsn.com, the following types of food consumed is very good for your child:

1. Broccoli

diettogo.com

The green is useful indeed one super food. Broccoli contains many vitamins, like C vitamin and K vitamin, and minerals that can help to ward off cell damage. Researchers from John Hopskin University that was launched in iloveindia.com, broccoli is also a natural source of folic acid intake may help prevent heart disease.

2. Sweet Potato

robbwolf.com

Sweet potatoes contain potassium, C vitamin, fiber, folate, A vitamin, calcium, and iron. Processing of sweet potatoes are very diverse. From fried, baked, boiled, steamed up, type of food is very tempting offer from the sweet sensation.

3. Cereals

hellobeautiful.com

Type of cereal foods usually become children's favorite dish for breakfast. Cereal foods rich in vitamins, calcium, iron, zinc, and folate are believed to prevent heart disease.

4. Cheese

en.wikipedia.org

Many health food which is derived from milk. One cheese that has an abundance of calcium, protein, and vitamins such as B12 vitamin type. Cheese is very easy to be processed, do not forget to include cheese into your child's school lunch.

5. Yogurt

frozenyogurtcalories.net

One more product derived from milk. Yogurt contains calcium, protein, carbohydrates, B vitamins, zinc and phosphorus. Add pieces of fresh fruit as a friend a cup of yogurt for the baby.

Variety of Vitamins Makes Smooth Skin

noreply@blogger.com (Anonymous) — Sun, 15 Jan 2012 23:19:00 +0000

dailyjuicer.com

There are natural ways to keep skin healthy. One way is to fill it with a variety of vitamins following:

Vitamin A
Vitamin A for skin can be obtained from papaya, peaches, carrots, and green leafy vegetables. In addition to supporting the growth of skin, the nutrients that had also serves to increase endurance.

Vitamin C
This type of vitamin is already very well known both to the skin. In addition to helping in the synthesis of collagen that keep skin cells together, vitamin C also presented skin that looks fresh. Natural sources of vitamin C can be found in oranges, guava, lemon, and green vegetables like spinach.

Vitamin E
Vitamin E content in cereals, grains, almonds, and walnuts make the skin feel soft, smooth, and supple.

In addition to vitamins, you should also add the compound lycopene, as in tomatoes that act as antioxidants that can protect the skin from internal damage.

Donut Day: A Time To Protest Nutrition Efforts?

noreply@blogger.com (Anonymous) — Sat, 04 Jun 2011 02:32:00 +0000

Ready those cop-slash-confectionery punchlines: Today is National Donut Day. And yes, it's a real thing.

The holiday, which was established by the Salvation Army in 1938 to honor women who served doughnuts in World War I, is typically celebrated with deep-fried freebies.

But this year, one group is trying to make it political.

The Competitive Enterprise Institute, a non-profit group that says it stands for free markets and limited government, is calling for people to eat not one, but two doughnuts today. The idea? To protest what it described in a statement as the "government meddling in Americans' nutritional choices."

"Given the growing government attempts to regulate the childhood obesity problem, we thought this deserved some light-hearted attention," said Sam Kazman, general counsel for the group.

Ultimately, however, he said the issue was serious.

In a phone interview, Kazman called out government efforts to curb salt use. He described Michelle Obama's Let's Move initiative as "overreaching" and said it was based on shaky science, citing a recent Task Force on Childhood Obesity report that says the rapid increase in childhood obesity has slowed. But that same report showed that obesity has more than doubled among adults and tripled in children in the last 30 years.

"We're not saying there's not a problem here," Kazman said. "But for the government to be using childhood obesity as the basis for the wholesale reordering of American lifestyles is a constitutional stretch."

Dr. Marion Nestle, a professor in New York University's department of nutrition disagreed, saying that she believes an important function of the government is to advice the public on healthy eating.

"I wonder why people think it's funny to engage in risky health behavior just to show how independent they are," she said in an email. "Eating two donuts once in a while is not going to hurt anyone. But making a daily practice of eating lots of junk food might well lead to problems later on."

Source: www.huffingtonpost.com

The Baby Needs A Nutritious Breakfast Menu

noreply@blogger.com (Anonymous) — Sat, 04 Jun 2011 01:34:00 +0000

id.custom.yahoo.com

Breakfast is very important for the fulfillment of your baby's nutritional needs. With breakfast, little ready spent his days full of activity. Here are some foods that are suitable for your baby.

1. Cereal and milk
This is the most easy and quick breakfast to serve. Even so, the nutrients in it are very complete. Cereals have protein and fiber are very good for children. Meanwhile, the milk has a complete nutritional needs of children every day.

2. Eggs
Besides containing protein, eggs have a variety of nutrients suitable for children's development, such as vitamins A, B, D, iron, calcium and many more. Eggs are also easy to prepare and mixed into the menu like a child. You can cook hard-boiled eggs, scrambled eggs scrambled, cheese egg omelets, egg sandwiches and much more.

3. Wheat bread
Bread wheat has a higher fiber than regular bread, so it can withstand hunger longer in children. In addition, wheat bread also makes the digestive system of the little more smoothly. You can create a variety of wheat bread sandwiches for breakfast child.

4. Fruit juice
Fruit juices can also be a healthy breakfast menu. Especially if you combine it with milk and honey are rich in nutrients. In addition to delicious, fruit juice also practical.

Source: id.custom.yahoo.com

Common sense needed in childhood nutrition guidelines

noreply@blogger.com (Anonymous) — Thu, 26 May 2011 17:49:00 +0000

By Rep. Jean Schmidt (R-Ohio)

We can all agree that childhood obesity in America is a serious problem, and I commend the First Lady for addressing it directly in her “Let’s Move!” campaign to end childhood obesity within a generation. It is a worthwhile and attainable goal and one that I support.

However, lima beans, peas, corn and potatoes predate any kind of childhood obesity epidemic and needlessly attacking them gets us no closer to fixing the issue. What we need is a solution, not a scapegoat.

The United States Department of Agriculture’s “Dietary Guidelines for Americans” serve as the basis for school nutrition standards. The dietary guidelines list potassium, dietary fiber, calcium and vitamin D as “nutrients of concern in American diets,” because people aren’t eating enough of them.

Somebody, somewhere in the USDA, didn’t get the memo.

As a mother and grandmother, I want the best nutrition for my family. As a Member of Congress, I want to be responsible with taxpayer dollars. Fortunately, better nutrition and financial responsibility are not mutually exclusive, especially when it comes to the National School Lunch Program and the School Breakfast Program.

In proposed standards for the school breakfast and lunch programs also issued by USDA in January, a curious thing happened: nutritional recommendations were made that had no basis in science. Instead, recommendations were based on variety and cloaked as nutrition.

How else would you explain the arbitrary limitation of lima beans, peas, corn and potatoes to one cup per week per student in the school lunch program and the complete elimination of them in the breakfast program?

Lima beans are one of the best sources, if not the best source of dietary fiber. Potatoes are the best source of potassium, more than bananas. USDA’s recommendations went beyond those of the National Academy of Sciences’ Institute of Medicine.

One assumption frequently heard that cannot go unchallenged is that all potatoes in schools come in the form of French fries. The truth is they don’t.

Food service technology has made marked improvements over the last decade and most “fries” these days are baked. In fact, of all potatoes served in middle and high schools, only about 15 percent of them are in the form of French fries that are actually fried. In elementary schools, that number drops to about 11 percent. Most school kitchens don’t even have fryers anymore.

At less than $0.05 per serving, the result is an affordable, nutrient-dense food that kids love and that won’t end up in the trash can. Even more, because they are so affordable, serving them allows schools to have greater flexibility for other nutritious menu items.

The proposed changes to the breakfast and lunch programs would have a number of unintended, yet very real consequences. By USDA’s own estimation, the increased costs of the proposed menu changes would be $0.50 per school breakfast and $0.14 per school lunch. Nationwide, this translates to $6.8 billion of increased costs over five years, the bulk of which are associated with this vegetable limitation.

These are real costs that will be only partially offset by the Healthy and Hunger-Free Kids Act passed by the previous Congress that increased the reimbursement rate by $0.06 per meal. The resulting cost difference will be thrust upon the participating schools to make up at a time when they do not have extra funds.

USDA expects that the difference in cost will be bridged by state funds and by raising the price for school meals for those children who do not qualify for free or reduced-price meals. At its core, USDA’s recommendations would amount to an unfunded mandate. Even worse and not acknowledged by USDA, the increased prices for those kids paying the full price of the school meal will result in fewer participants in the breakfast and lunch programs, undermining the original intent to deliver nutrition to those most in need of it.

There is concern that some schools may discontinue the programs — particularly the breakfasts — if the proposed changes are too cost prohibitive.

To remove or limit vegetables from schools that our children and grandchildren actually like and will eat is simply misguided. But to make it more difficult for our schools to provide the best nutrition to those most in need of it is more than misguided, it is irresponsible. Fortunately, there is still time for USDA to do the right thing.

Source: thehill.com

Triathlon training: Nutrition tips for triathletes

noreply@blogger.com (Anonymous) — Thu, 05 May 2011 07:46:00 +0000

D. Benjamin Satkowiak*

Triathlon competition is a physically demanding sport. The body, in effort to keep itself in optimal working condition, relinquishes its precious resources, sapping the life out of even the fittest competitor. Because of this, the nutrition plan of a triathlete must be adequate in conditioning the body, and its systems, for the physical turmoil.

A triathlete can expect to burn anywhere from 4,000-5,000 calories during a single event. During training, the amount is slightly lower, from 2,000 to 3,000 calories, per session. As such, nutritional needs need to be increased accordingly.

The following tips can help improve a triathlete's competition and training, by allowing for greater, more efficient use of energy.

1.) A.M. Nutrition, pt.1: Eat a pre-workout meal at least 2 hours before training, in order to allow for proper digestion.

2.) A.M. Nutrition, pt.2: Approximately 1 hour before your workout, ingest something small, containing carbs, such as an orange or apple, with a handful of nuts or granola.

3.) Hydration: During training or competition conditions, replenishing the body at frequent intervals is necessary. Attempt to drink 4-5 ounces of fluid approximately every 20 minutes, if at all possible.

4.) Avoid Deficits: Approximately every 30-35 minutes, ingest solid calories, such as a sports nutrition or protein bar. If you go too long without substantial amounts of nutrients, your body will become weak and sluggish.

5.) Avoid Painkillers: Many athletes feel the need to take pain relievers, such as Advil or Tylenol, before endeavors, in order to avoid fatigue symptoms. Doing so can cause undue stress on the kidneys.

6.) Stick With The Plan: Stay with what you know. Refuse food and drink you don't normally consume. Never try it on race day.

7.) Carb Loading: The night before an event, store up whole-grain, low-glycemic carbs, such as pasta, or rice. Look to consume several small portions, spread out evenly, every hour for the last 3-4 hours before bedtime.

8.) Fight Waste: Avoid high-fiber meals before events. The last thing you need stomach complications on event day.

9.) After Effects, pt.1: Have a carb-rich meal, within 30-45 minutes of finishing, replacing glycogen stores and replenishing your energy.

10.) After Effects, pt.2: Continue consumption of water and sports drinks. Your body will need several hours to recuperate.

Keep these tips in mind as you train. Never underestimate the importance of diet in triathlon competitions. Treat your body like a Porsche engine and fuel it with the highest-quality ingredients.

*The author, D. Benjamin Satkowiak, is a successful business entrepreneur and personal trainer. All information herein is for educational and entertainment purposes only. Please consult a physician before starting any workout or nutritional program.

source: sports.yahoo.com

Pigeon Peas With Mango

noreply@blogger.com (Anonymous) — Tue, 26 Apr 2011 16:25:00 +0000

This dish is based on a recipe from “660 Curries,” by Raghavan Iyer. I’ve given you the option of using cayenne and sesame seeds instead of Mr. Raghavan’s garam masala, but I encourage you to make the spice mix if you can. You can find pigeon peas and curry leaves in Indian markets. Pigeon peas resemble split yellow peas in color and flavor.

1 heaped cup skinned yellow pigeon peas (toovar or toor dal), preferably the un-oily variety, picked over for stones

1 medium ripe mango, peeled, seeded and chopped

1/2 teaspoon cayenne plus 1 teaspoon ground toasted sesame seeds, or 2 tablespoons Maharashtran sesame-flavored garam masala (see below)

Salt to taste

1/2 teaspoon ground turmeric

10 to 12 curry leaves

2 tablespoons ghee (clarified butter) or canola oil

2 teaspoons cumin seeds

1/4 cup finely chopped cilantro

1. Place the pigeon peas in a medium, heavy saucepan. Cover with 1 inch of water, and roll around the peas. The water will cloud. Drain through a strainer, and return to the pot. Repeat several times until the water is no longer very cloudy when you cover the peas. Drain and return to the pot, then add 3 cups water and bring to a boil over medium-high heat. Skim off and discard any foam. Stir the peas, reduce the heat to medium-low, cover and simmer, stirring from time to time, for 10 minutes. The peas will be partly tender.

2. Add the mango, the garam masala or the cayenne, salt, turmeric, curry leaves and 1 cup water. Bring back to a boil, then reduce the heat again to medium-low. Cover and simmer 20 minutes, stirring occasionally, or until the peas are tender and falling apart.

3. While the peas are simmering, heat the ghee or oil in a small, heavy skillet over medium-high heat. Add the cumin seeds. When they begin to sizzle, turn a reddish brown and smell nutty, remove from the heat. Add the cilantro, and stir until the sizzling stops.

4. When the pigeon peas and mango are very tender, remove the curry leaves and mash the mixture with the back of your spoon. Scrape in the seasoned ghee or oil, and stir together. Cover and simmer five minutes until the flavors are nicely blended. Taste, adjust salt and serve.

Note: For the garam masala, in a small, heavy skillet over medium-high heat combine 2 tablespoons skinned raw peanuts; 1 tablespoon white sesame seeds; 1 1/2 teaspoons coriander seeds; 1/2 teaspoon cumin seeds; 4 to 5 dried red Thai chilies, cayenne chilies or arbol chilies; 1/8 teaspoon freshly grated nutmeg or nutmeg shavings; and 1 blade of mace. Stir until the peanuts are lightly colored in spots and the sesame seeds are a honey-brown color. Immediately transfer to a plate or bowl to cool completely. Add the coconut to the pan, and stir just until almond brown, about 15 seconds. Transfer to the plate or bowl with the spices and nuts. Allow to cool completely. Blend in a spice mill, pulsing the mixture so that the sesame seeds and peanuts don’t heat and grind to butter. Transfer to a jar, and store in a cool, dry place.

Yield: Four servings.

Advance preparation: You can keep this in the refrigerator for two or three days. It will stiffen up. Thin out with water if desired.

Nutritional information per serving: 296 calories; 5 grams saturated fat; 1 gram polyunsaturated fat; 0 grams monounsaturated fat; 20 milligrams cholesterol; 44 grams carbohydrates; 9 grams dietary fiber; 12 milligrams sodium; 12 grams protein

Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Source: www.nytimes.com/

New menu-labeling rules for restaurants

noreply@blogger.com (Anonymous) — Tue, 26 Apr 2011 02:37:00 +0000

Federal experts hope providing nutritional facts
on restaurant menus can decrease the obesity rate.
Keith Hale~Sun-Times

A new federal law will soon make American diners far more aware of just what they are eating — but it might not change what they order.

The law will force chain restaurants to disclose the amount of calories, fat and sodium in diners’ favorite dishes. Many restaurants already are preparing for the changes, calculating calories in their meals, adjusting recipes and adding healthier choices.

At the same time, experts are divided over whether the new information will shock people into ordering protein-packed salmon instead of calorie- and fat-laden fettuccine Alfredo, or if it’s just more meddling by the federal government that takes the pleasure out of eating.

The move is driven by the nation’s growing weight problems. Thirty percent of Americans are classified as being obese, and that number is growing, according to the Centers for Disease Control and Prevention.

Government experts say including nutritional facts can help decrease those rates. Others say it won’t work because only those who already take responsibility for their diet will care.

Starting next year, restaurant chains with 20 or more locations will be required to print calorie counts on menus under the new federal menu-labeling regulation, part of the new health-care law.

The law also requires the chains to make other nutritional information available by request.

A statutory 60-day period for comments began April 1. The Food and Drug Administration expects to publish requirements by the end of this year. The law would take effect six to nine months after the requirements are published.

The federal law is backed by most major chains and the National Restaurant Association, which anticipated that a patchwork of local labeling laws would only get more complicated in the future. And while many restaurant and fast-food chains already post nutritional information on websites or on brochures available on counters, the FDA wants the calories in plain sight.

Americans spend 45 percent of their food budget dining out, according to the Restaurant Association. The CDC and other health experts have linked the nation’s obesity rates to eating out. And being overweight is a driver for chronic diseases and high health-care costs.

“Trying to find the healthy options when dining out can be more difficult than you think. Even a salad can be loaded with hidden fat and sodium,” said U.S. Sen. Tom Harkin (D-Iowa), who co-authored the menu-labeling provisions in the health-care law.

Source: www.suntimes.com

Pre-natal nutrition linked to adult health

noreply@blogger.com (Anonymous) — Mon, 25 Apr 2011 14:37:00 +0000

An expectant mother’s diet during pregnancy can alter her baby’s DNA in the womb, increasing its risk of obesity, heart disease and diabetes in later life, an international study has found.

Researchers said the study provided the first scientific evidence linking pregnant women’s diet to childhood obesity, with major implications for public health.

“This a a major breakthrough because for the first time it gives us the potential to work out the optimal diet a mother should eat,” Peter Gluckman from Auckland University’s Liggins Institute told AFP.

“That’s likely to vary slightly from mother to mother, but it could be a major tool in addressing the obesity epidemic.”

The study, conducted by scientists in Britain, New Zealand and Singapore, showed that what a mother ate during pregnancy could change the function of her child’s DNA through a process calledepigenetic change.

Children with a high degree of epigenetic change were more likely to develop a metabolism that “lays down more fat” and become obese, researchers found.

Such children were around three kilograms (6.6 pounds) heavier than their peers by the time they were aged six to nine, Prof. Gluckman said.

“That’s a hell of a lot of extra weight at that age,” he said, adding that the extra fat was likely to be carried into adulthood, raising the chances of developing diabetes and heart disease.

The researchers used umbilical cord tissue to measure the rate of epigenetic change in 300 babies, then examined whether it was linked to the children’s weight when they were aged six to nine.

“The correlation was very strong, we didn’t believe it at first, so we replicated it again and again,” Prof. Gluckman said.

The study found the effect was not linked to either the mother or the baby’s weight at birth, meaning a slim woman could deliver a small baby which still went on to became obese because of changes triggered by diet in the womb.

Prof. Gluckman said the rate of epigenetic change was possibly linked to a low carbohydrate diet in the first three months of pregnancy but it was too early to draw a definitive conclusion and further studies were needed.

He said one theory was that an embryo fed a diet containing few carbohydrates – which provide the body with energy – assumed it would be born into a carbohydrate-poor environment and altered its metabolism accordingly.

This meant it stored more fat, which could be used as fuel when food was scarce.

Prof. Gluckman said the study, which will be published in the journal Diabetes this week, confirmed long-held suspicions that poor prenatal nutrition could have a major impact on adult health.

Source: www.timesofmalta.com

Balanced Nutrition for Every Age

noreply@blogger.com (Anonymous) — Sun, 17 Apr 2011 01:18:00 +0000

At about 1950 on Indonesia's famous concept of nutritional guidelines called with 4 healthy 5 perfect. The concept was created by prof. Poerwo Soedarmo, also referred to as the father of Indonesian nutrition. But along with the development of science today, then realized that the nutritional needs can not be in the same averaged for every person at every age. In a sense nutrients needed by the children of course are different from adults, as well as nutritional needs for pregnant / lactating and the elderly.
Since 2000, MOH's actually started to introduce new guidelines on nutrition, which is called the "Guidelines for balanced nutrition" (PGS). But because of the lack of socialization, then there are still many people who still do not know about it. Therefore, on January 27, 2011 yesterday, held at Hotel Akmani, Jakarta, organized the event press conference on nutrition in balance and distribution of a book entitled "Healthy and Fit Thanks Balanced Nutrition."
The event is also conducted media education about balanced nutrition for every age group. Present as resource persons were: Prof. Soekirman, SKM, MPS-ID. PhD; Dr. Jus'at & Prof. Idrus. Ir. H. Hardinsyah, MS.PhD.

Ki-ka : moderator; Prof. Soekirman, SKM, MPS-ID. PhD; Prof. Ir. H. Hardinsyah, MS.PhD & Dr. Idrus Jus’at

Prof. Soekirman in his foreword, said his lifestyle changes in society, where people become less frequent physical activity and eating patterns have changed (consume more sweet foods and high fat). So maybe even physically look normal, but if further testing will be visible lack one or more nutrients. In addition, more nutritional problems such as obesity and obesity at this time also began to appear. That is to say when this happens multiple problems in the community is that many cases of malnutrition occur and cases of overweight (overweight / obesity).
Guidelines for balanced nutrition (PGS) itself is a composition of daily food containing nutrients in the type & amount in accordance with the necessities of life, taking into account the 4 principles: (1) variety of food, (2) the importance of clean lifestyle, (3 ) the importance of active lifestyles and sports and (4) monitor ideal weight. In contrast to the concept of Healthy 4 5 Excellent that generalize the nutritional needs of all people, balanced nutrition guidelines principle that every age group, gender, health & physical activity requires a different PGS, in accordance with the conditions of each group.
In addition, PGS also emphasize different proportions for each group, adjusted or balanced by the needs of the body. Another difference is the PGS did not treat milk as a perfect food, but placed a group with other animal protein sources. To facilitate understanding of the PGS, every country in the world has a visualization tailored to each culture. In Indonesia, the principle of PGS visualized in the form of cone with a tray called "Tumpeng Balanced Nutrition" (TGS).

Bentuk Visual Pedoman Gizi Seimbang Indonesia

Tumpeng balanced nutrition (TGS) consists of several pieces of cone, namely: 1 large pieces, 2 pieces of medium, 2 small pieces and at the top there is the smallest piece. The extent of cuts TGS show the portion of consumption per person per day. TGS pieces covered by water, meaning water is the biggest part & nutrients essential for life, a day of white water requirements must be met minimum is 2 liters (8 cups).
On top is a cone shaped piece of large pieces which is a staple food group (carbohydrates). Carbohydrates consumed recommended 3-8 servings / day. Above this section there are groups of vegetables (recommended 3-5 servings / day) and fruit (recommended 2-3 servings / day) as a source of fiber, vitamins & minerals. Then again there are classes on top food sources of protein, which are divided into groups of vegetable and animal protein (consumed recommended 2-3 servings / day). At the top of the cone there are classes of oil, sugar and salt are recommended for consumption as needed.
One of the challenges that must also be considered is about the fulfillment of balanced nutrition in a certain period, which is also known as the window opportunity. That is a brief opportunity to do something beneficial and should be utilized. In the field of nutrition, occasion, ranging from before pregnancy until the child was about 2 years. To prevent the problem of the impact of malnutrition, it should be efforts to improve nutrition in population groups that are included in the window opportunity, namely adolescent girls, pregnant women, nursing mothers and infants to children aged 2 years.
Pregnant women often face multiple health problems, such as excessive nausea and vomiting, anemia and iron deficiency, constipation, hypertension, preeclampsia and eclampsia and gestational diabetes. While the adequacy of pregnant women have a lot of attention due to significantly affect the development of the child. The period of brain development of children's own gold begins in the womb until the child was 2 years old.

medicastore.com

Taburia, Supplement Overcome Malnutrition

noreply@blogger.com (Anonymous) — Sun, 17 Apr 2011 00:15:00 +0000

This supplement contains 12 vitamins and four minerals are essential for child development.

For developing countries like Indonesia, malnutrition remains a serious problem. According to the World Bank reposition Nutrition as Central to Development in 2006, Indonesia including the country where people have problems of nutrition.

Not only is malnutrition due to lack of protein, vitamin A, iron, iodine, but also of excess nutrients that lead to obesity. Data for 2010 calls, there were still 17.9 percent of children suffer from the problem. Malnutrition as much as 4.9 percent and 13 percent severe malnutrition.

Tackle the problem, the government launched a nutritional supplement to improve the standard of nutrition Taburia community, especially in children. These supplements are easily processed. Even just sprinkled on food.

Taburia is in addition to a multivitamin and multimineral to meet the nutritional needs of infants aged 6-24 months. Giving Taburia intended to help children grow and develop optimally, increase endurance, increase appetite, prevent anemia and to prevent nutrient deficiencies.

That's because the first two years of age toddlers are periods in which they develop brain tissue so it is very influential in its growth during life.

Not only practical, Taburia also able to meet the 12 vitamins and minerals much needed four children, namely iodine, zinc, selenium and iron.

Although it can be blended at any kind of food, Taburia not be mixed with watery foods such as milk, tea, soup because it will be lumpy. And can not be mixed with hot foods because of fat that coats the iron will be damaged, and cause discomfort.

However, consumption Taburia can make constipation and black stools so that children are encouraged to drink more water.

Currently, Taburia can be obtained for free at the neighborhood health center-posyandu on 24 districts in North Sumatra, South Sumatra, NTB, NTT, West Kalimantan and South Sulawesi. Taburia giving any priority to children aged 6-24 months from a poor family.

Vivanews.com

Child nutrition program faces cuts

noreply@blogger.com (Anonymous) — Sat, 16 Apr 2011 06:23:00 +0000

Governor Deval Patrick and state lawmakers are proposing to slash more than 20 percent of state money from a decades-old program that helps thousands of low-income mothers afford formula and other basic foods for their children.

The Women, Infants, and Children program, widely known as WIC, is regarded as a pillar of the social safety net, providing 130,000 low-income women in Massachusetts who are pregnant, breast-feeding, or raising young children with supplemental food, health care referrals, and nutrition education.

Despite concerns raised by advocates for the poor, state officials said they have no choice but to make the cuts because of the state’s budget crunch.

“Massachusetts, like all states, continues to feel the impact of the global economic crisis,’’ said Julia Hurley, a spokeswoman for the state Department of Public Health. “No agency wants to have to make these decisions, but sound fiscal management has required tough choices.’’

Hurley said the effects of the proposed cut in state funding for WIC, such as how many families might lose support, remain unclear. State spending would fall from $12.4 million this fiscal year to $9.8 million.

The state also receives federal aid for WIC, which is likely to decline next fiscal year, advocates said. State officials could not say how much the state receives from the federal government for WIC, which provides aid to children until age 5.

Advocates for low-income women, however, said they fear that the consequences of cutting WIC again — it sustained a 9 percent cut in the past three years — will prove devastating.

“This would just make it much harder for poor families,’’ said Valerie Bassett, executive director of the Massachusetts Public Health Association. “It would undermine our effort to make sure that low-income families have access to healthy food.’’

The monthly WIC benefits package can provide a child between the ages of 1 and 4 with a dozen eggs, 16 quarts of milk, and $6 in vouchers for fruits and vegetables, among other foods, according to the US Department of Agriculture.

Administration officials said they need to make such undesirable cuts as they try to close a projected $1.2 billion budget gap. The governor’s proposed $30.5 billion budget for fiscal 2012 called for cutting $570 million, the largest year-to-year cuts in 20 years.

Representative Brian Dempsey, a Haverhill Democrat who serves as chairman of the House Ways and Means Committee, said the WIC cuts represented one of many difficult choices his committee had to make in drafting its budget.

“There are a lot of very important and essential programs that we weren’t able to fund at the appropriate level, and this is one of them,’’ he said.

But Dempsey said he expects an effort to mitigate the WIC reduction. “This is a very difficult cut, and we would like to avoid making it, if we could,’’ he said.

Officials in Senate President Therese Murray’s office said the Senate has yet to decide whether to include the WIC program cuts in its budget, which will not be released until next month.

“We’re still working on our budget recommendations,’’ said David Falcone, a spokesman for Murray.

Organizations such as Horizons for Homeless Children in Boston said nearly all the families they provide services to rely on WIC.

Stacy Dimino, a spokeswoman for Horizons, said some of the children in her program already hoard the food they serve by putting it in their pockets. She said some of the children do not know when their next meal will be.

“If they have to go without WIC, it’s going to be much harder for these families,’’ she said. “These families are already struggling to pay rent, utility payments, and food, and without WIC, I worry they will not make the best nutritional choices. This program is critical.’’

Dr. Sean Palfrey, a professor of pediatrics and public health at Boston University School of Medicine, said about 90 percent of his patients are either eligible for WIC or enrolled in the program, which also provides counseling from nutritionists and referrals for services as diverse as dental care and fuel assistance.

“Without WIC, I wouldn’t know how to help them,’’ he said.

He predicted that many families will turn to food pantries. But he said pantries rarely have the formula and other food needed for pregnant women and newborns.

“WIC ensures that they get quality foods,’’ Palfrey said. “Food pantries aren’t focused on mothers and babies. A baby’s brain development depends on their nutrition. If families are being stretched because they don’t get this, it’s going to hurt.’’

One of his former patients, Sheryl Debarros-Carter, said she relied on WIC to raise her two children when she lived in Roxbury two decades ago. It allowed her to buy milk, juice, cereals, eggs, and other necessities.

“It was a blessing to me,’’ said Debarros-Carter, now 49 and living in Malden. “The foods they supplied I would have probably bypassed. I just couldn’t have afforded it all.’’

She said too many poor families rely on fast foods like pizza as a substitute for the fruits, vegetables, and other vitamin-rich nutrients their children need.

www.boston.com

Michael C. Latham, Expert on Nutrition in Developing World, Dies at 82

noreply@blogger.com (Anonymous) — Sat, 16 Apr 2011 06:15:00 +0000

Michael C. Latham, an expert on international nutrition and tropical health who waged a long campaign against the use of infant formula and for the practice of breastfeeding in developing countries, died on April 1 in Boston. He was 82 and lived in Newfield, N.Y.

The cause was pneumonia, his son Mark said.

Dr. Latham, who directed the Program in International Nutrition at Cornell University for 25 years, first encountered the problems of nutrition in the developing world while practicing medicine as a young doctor for the British colonial service in Tanganyika (now Tanzania).

After the country had gained its independence, he stayed on and was appointed the director of the nutrition unit of the public health ministry. He became alarmed at efforts by Western companies to expand their marketing of infant formula to underdeveloped countries, where high birth rates promised a growing consumer base, and he became one of the first and most forceful public health scientists to sound a warning.

In many poor countries, he pointed out, mothers mixed powdered baby formula with contaminated water, leading to diarrheal diseases. To make the formula last longer, they often used too little of the powder, depriving their babies of vital nutrients.

Bottle feeding was “incredibly difficult and extremely bad,” Dr. Latham wrote in a 1976 report with Ted Greiner, but “the media onslaught is terrific, the messages are powerful and the profits are high.”

“High also is the resultant human suffering,” they wrote.

Dr. Latham’s cause, taken up by several health groups, led the World Health Organization in 1981 to develop a set of guidelines, the International Code of Marketing of Breast-milk Substitutes, which was intended to govern the behavior of private companies. He was a prominent figure in the boycott of Nestlé, a leading manufacturer of infant formula, which agreed in 1984 to abide by the marketing code.

The ideal food for infants, Dr. Latham argued, was breast milk. Its benefits, he wrote, were not limited to improved physical and mental development. It could also potentially curb population growth, he argued, since parents who were confident that their children would thrive would be more likely to have smaller families. In 1991, he helped found the World Alliance for Breastfeeding Action to explain and promote the benefits of breastfeeding around the world.

Michael Charles Latham was born on May 6, 1928, in Kilosa, Tanganyika, where his father was a doctor in the British colonial service. After earning a medical degree from Trinity College, Dublin, in 1952, he worked in hospitals in Britain and the United States before returning to Tanganyika to practice medicine in rural areas. During intermittent leaves, he earned a diploma in tropical public health from the London School of Hygiene and Tropical Medicine in 1958.

After leaving Tanzania in 1964, he taught nutrition at Harvard, where he received a degree in public health in 1965. In 1968 he was recruited by Cornell as a professor of international nutrition. He turned the university’s small Program in International Nutrition into one of the world’s largest training centers for nutritionists, many of whom went on to work in international agencies and public health departments around the world.

His research led to improved programs on infant nutrition, the control of parasitic diseases in humans, and the supply of micronutrients to poor populations.

Dr. Latham often did consulting work in Africa, Asia and South America for organizations like the World Health Organization, the United Nations Food and Agriculture Organization, Unicef and the World Bank.

In addition to his son Mark, of Somerville, Mass., he is survived by his second wife, Dr. Lani Stephenson, and another son, Miles, of Trumansburg, N.Y.

He was the author of two important books on international nutrition, “Human Nutrition in Tropical Africa” (1965) and “Human Nutrition in the Developing World” (1997), as well as a family memoir, “Kilimanjaro Tales: The Saga of a Medical Family in Africa” (1995), which drew on the journals kept by his mother, Gwynneth Latham.

www.nytimes.com

National Action Plan for Food and Nutrition 2011-2015

noreply@blogger.com (Anonymous) — Fri, 15 Apr 2011 03:25:00 +0000

Nutritional state of society has shown a trend that is getting better, this is shown by the lower prevalence of malnutrition among children under five or infants with low weight. Cases of malnutrition among children under five as measured by the prevalence of underweight children under five, and malnutrition are used as an indicator of hunger, because it has strong links with the state of food insecurity in society. Another indicator of hunger is an average rate of energy consumption in the population under 70 percent of the nutritional adequacy. These conditions have a significant impact on the achievement of other goals, such as child mortality and access to education.

This action plan aims to become a guide in implementing food and nutrition development for government agencies, nongovernmental organizations, private institutions, society and actors at national, provincial and district / city. Minister of Planning / Head of Bappenas stated there are five pillars of food and nutrition development, including: (1) Improvement of public nutrition (2) the accessibility of food, (3) quality and food safety, (4) clean and healthy lifestyle behaviors (PHBS); and (5) institutional food and nutrition. Furthermore, the provincial government will develop regional action plan for food and nutrition (RAD-PG) with the district and the city this year as a follow-PG preparation of the NPA.

www.bappenas.go.id

Confused By Food Labels? Read the Fine Print!

noreply@blogger.com (Anonymous) — Mon, 11 Apr 2011 05:27:00 +0000

Even though nutrition info is slapped on all packaged foods and

many restaurant items, people are heavier than ever.

Use this advice to improve your label literacy.

By Amy Paturel, M.P.H., Women’s Health

Twenty years ago, no one scrutinized cereal boxes to compare calories in competing brands. They couldn’t–prior to the Nutrition Labeling and Education Act (NLEA) of 1990, that info wasn’t on most packages. And forget about finding calories on restaurant menus.

Yet the country’s obesity rate back then was about 14 percent lower than it is now. Labels, it seems, may be doing more harm than good. That’s why the Institute of Medicine (IOM), a nonprofit health advisory, is taking a fresh look at labeling policies in an effort to make the facts clearer and harder to ignore. Here’s how not to be duped.

Food Fakers

One of the biggest problems with labels is that while the NLEA specified what nutrition data should be shown, and even the typeface and size it had to be printed in, the legislation didn’t dictate where it should be placed. Consequently, most manufacturers will bury a product’s fact panel and ingredients list on the back or side of the package, while filling the front with such eye-catching words as sensible, smart, and healthy–claims that sound good and sell well but are often misleading.

“Many manufacturers and supermarkets seem to be creating their own proprietary ways of highlighting attributes on the front of packages,” says Nancy Childs, Ph.D., a professor of food marketing at St. Joseph’s University in Philadelphia. “With this proliferation of front-of-the-box babble, it’s very hard for a consumer to make sense of what’s in a particular food.”

Indeed, studies at Cornell University’s Food and Brand Lab show that consumers tend to lowball the number of calories in foods whose packaging features words such as low-fat. This miscalculation leads them to eat more of the product, even when the marketing buzzwords have nothing to do with calories. Cookies, for instance, were thought to have 40 percent fewer calories just because the word organic was printed somewhere on the label.

The assertions themselves may be true, but that doesn’t make them any less confusing.

“You’ll see no cholesterol labels on products that never had cholesterol in them,” says Marisa Moore, R.D., a national spokesperson for the American Dietetic Association. “The food might be filled with sugar or saturated fat, but a person who has high cholesterol might think, ‘Oh, I can eat this,’ without understanding that saturated fat increases cholesterol levels.”

Reform Package

Earlier this year, manufacturers of packaged foods took a step in the right direction by rolling out a voluntary front-of-package labeling system called Nutrition Keys. But critics say the system, like the Smart Choices program that came before it (which has been discontinued), is no less confusing to consumers.

“There’s still a need for awareness and education about how to interpret the information to answer important questions such as how many calories is enough? Or too many?” says Moore.

A preliminary report by the IOM addresses some of these issues and recommends that front-of-package nutrition information be standardized and emphasize the items of most concern: calories, salt, saturated fat, and trans fats.

The IOM is also rallying for more reasonable serving sizes. For example, a can of nuts may boast “150 calories!” on the front, but flipping it over reveals there are actually 150 calories per serving, and that the small package holds seven servings.

Nutrition information is likely to start showing up in more places too. As part of the new health reform bill, restaurant chains with 20 or more locations nationwide are required to post calorie information for all the food they sell, which is important legislation given how often American families eat out.

Of course, knowledge may be power, but it isn’t willpower. There will always be people who see that a food contains an astronomical amount of calories, shrug, and wolf it down anyway. Nothing you put on a label will change that. But experts are optimistic that the proposed mandates will make manufacturers and restaurants sit up and take notice.

“It’s clear that being required to display nutrition information prominently will sensitize food companies and restaurants to the calorie content of their foods,” says Michael Jacobson, Ph.D., cofounder of the Center for Science in the Public Interest, a Washington, D.C.-based public advocacy group. “This will hopefully put pressure on them to cut calories and reformulate their products.”

Some companies already have. Retail giant Walmart recently announced its plan to slash the salt, sugar, and fat in its own brand of packaged foods over the next five years, making it the largest manufacturer to do so. If this trend continues, your waistline will benefit–no matter which cereal you choose.

www.care2.com

US restaurants may soon have nutritional facts printed on menu

noreply@blogger.com (Anonymous) — Mon, 11 Apr 2011 05:02:00 +0000

The US FDA (Food and Drug Administration) is keen to have manufacturers show the nutritional facts on restaurant menus.

In response to the growing concerns with respect to health issues, the US FDA has issued two proposed regulations regarding calorie-labelling on menus and menu boards in chain restaurants, retail food establishments, and vending machines.

"These proposals will ensure that consumers have more information when they make their own food choices," said department of health and human services secretary Kathleen Sebelius.

"Giving consumers clear nutritional information makes it easier for them to choose healthier options that can help fight obesity and make us all healthier," she added.

Specifically, consumers would see calories listed in restaurants and similar retail food establishments that are part of a chain with 20 or more locations doing business under the same name and offering for sale substantially the same menu items.

According to the proposal, these establishments will include fast food joints, bakeries, coffee shops and certain grocery and convenience stores. Movie theatres, airplanes, bowling alleys, and other establishments whose primary purpose is not to sell food will not be subject to this proposed regulation. Additionally, the proposal has invited the public to comment on whether more types of food establishments should or should not be covered by the new rule. A companion rule proposes calorie posting for food sold in vending machines. The FDA is accepting comments on both proposed rules.

"Americans now consume about one-third of their total calories on foods prepared outside their home," said Margaret A Hamburg, MD, FDA Commissioner, "While consumers can find calorie and other nutrition information on most packaged foods, it's not generally available in restaurants or similar retail establishments. This proposal is aimed at giving consumers consistent and easy-to-understand nutrition information."

The initiative, under the Affordable Care Act, requires the disclosure of calorie and other nutrition information in certain food establishments and for certain foods sold in vending machines.

Additionally, on menus and menu boards, statements would be posted concerning suggested daily calorie intake and indicating that additional nutrition information is available on request. Under the proposal, this information would be displayed clearly and prominently on menus and menu boards, including menu boards in drive-through locations; and for individual foods on display. Consistent with the law, the agency is proposing that the following statement on daily caloric intake be on menus and menu boards to help consumers understand the significance of the calorie information in the context of a total daily diet: "A 2,000 calorie diet is used as the basis for general nutrition advice; however, individual calorie needs may vary."

www.fnbnews.com

Egg Nutrition

noreply@blogger.com (Anonymous) — Sun, 10 Apr 2011 14:59:00 +0000

Egg is a food that is very familiar with our daily lives. Eggs as a source of protein has many advantages, among others, the most complete amino acid content compared to other foodstuffs such as fish, meat, chicken, tofu, tempeh, etc.. Eggs have a delicious flavor, so favored by many people. Eggs are also functioning in a variety of food processing. In addition, egg protein include food sources are relatively inexpensive and easy to find. Almost all people need eggs.

Nutritional value of eggs
Actually, any content in an egg? Here is the nutritional value of table eggs in 100 grams of food. (100 salt, about 2 eggs free-range chicken).

However, be careful in consuming eggs. Because in addition to a fairly high fat bladder, eggs also contain sizable amounts of cholesterol than other foods. Cholesterol content in 100 grams of eggs is about 424 mg. Wow, pretty much yes. While we are encouraged to consume less than 300 mg of cholesterol per day. So, should consume enough eggs about 2 eggs per week. Hose-animal dishes interspersed with other food ingredients to enhance the variety of food. In accordance with a message of general guidelines for balanced nutrition (PUGS) that eat a varied diet, because no one food that has a complete nutritional content.

Tips on choosing eggs

1. Choose eggs with the skin intact, not cracked or broken, clean and no stains.

2. When viewed from the contents, the egg is fresh air cavity has a small yag, located in the middle yellow, egg-white solid. Eggs which had long been stored, will have a large air cavity so that it can float if the egg is inserted into the water.

3. Eggs are a good quality marked by the absence of sound (beat) the time the egg is shaken.

(No. 4 and 5 to determine the quality of eggs after the split and requires a rather complicated calculation.) I think if mothers spend, not gonna have time to calculate it first ... .. hehehehe

4. The quality of eggs can also be measured by Haugh unit, namely the measurement of height and thick egg white
egg weight. A fresh egg has a Haugh Unit: 100, good eggs: 72 eggs damaged and less than 50.

5. Index Index egg yolk and egg white can also determine the quality of eggs. Yolk index (IKT) is a high ratio of egg yolk with a diameter as measured after being separated from their eggs. IKT normal value is 0.33 to 0.50. The average egg have IKT 0.42. The longer eggs are stored, the smaller the value IKT due to migration of water.

While the egg white index (IPT) is a high ratio of eggs condensed with an average diameter of the long and short. IPT value of fresh eggs is 0.050 to 0.174. The average egg have IPT 0.090 to 0.120. The longer eggs are stored, the smaller the IPT ovomucin accelerated degradation due to the increase of pH.

IODINE AND GOITER: A CONSEQUENCES DURING PREGNANCY

noreply@blogger.com (Anonymous) — Sun, 10 Apr 2011 13:33:00 +0000

By: Anie Kurniawan, MD, MSc 1), and Eman Sumarna, MSc 2)
1) Chief, Sub Directorate of Clinical Nutrition
2) Staff, Sub Directorate of Clinical Nutrition
Directorate of Community Nutrition MOH-RI

I. The Patho Physiology of Goiter

Goiter or as colloid nodular goiter is thyroid gland enlargement, which is usually caused by too little iodine in the body. Lack of iodine intake from the diet, is the primary cause of iodine deficiency, however goitrogens (substances in the diet which produce goiter due to action on the thyroid gland), such as thiocyanates can enhance the effect of iodine deficiency. Iodine is mineral essential for the normal metabolism of cells, which is a necessary nutrient for production of thyroxin hormones and normal thyroid function. The healthy human adult body contains 15–20 mg of iodine of which 70-80 percent is in the thyroid gland, which weight only 15-25 gr. Thyroid gland consisted of three lobes, which located in the neck two lobes were located behind the throat, with one lobe as conjunction between each lateral lobes.

Iodine exists in the thyroid gland as in organic iodine, that are 1) In the form of iodine containing amino acids; Monoiodotyrosine (MIT), Diodotyrosine (DIT), Thyroxin (T4) and Tri-iodothyronine (T3), 2) In the form of polypeptides containing thyroxin and 3) In the form of thyroglobulin. Thyroglobulin is the main constituent of the colloid, which fills the thyroid follicle, as the storage form of thyroid hormones, and make up 90 percent of the total iodine in the gland. Iodine exists in the blood as Thyroxin (T4) and Triodothyroxin (T3) and as in organics iodine. The level of inorganic iodine falls in iodine deficiency and rises with increase of iodine intake. The dissemination of free T4 is important to assess the thyroid status and to diagnose hypo or hyper thyroids. When iodine intake is deficient, the thyroid gland is unable to produce sufficient thyroid hormone, it may attempt to compensate by enlarging of thyroid gland, which is called colloid nodular goiter. In otherwise, when the thyroid is then reexported to iodine, the nodules may produce thyroid hormone, but occasionally, the nodules may produce too much thyroid hormone causing thyrotoxitosis, which usually accompanied by enlargement of thyroid gland, called a toxic nodular goiter. Colloid nodular goiter is also known as endemic goiters and are usually caused by inadequate iodine in the diet. Endemic goiter tends to be occurred in certain geographical areas with iodine-depleted soil away from the sea cost.

In Indonesia, endemic goiter occurred mainly in volcanic and mountain area affecting among population living in this area, such as pregnant women, newborn babies, under fives and school children. Mapping survey among elementary school children in 1998 showed that 334 sub districts categorized as severe endemic area (Total Goiter Rate/TGR > 30%), 278 from 4028 sub districts as moderate endemic area (TGR 20-24%) and 1167 sub districts as mild endemic area (TGR 5-19,9%). It revealed that around 45% of sub districts in Indonesia were risk to have goiter cases. The latest data showed that TGR among elementary school children, was little bit increased to 11.1% of national rate, but there was decreased TGR in the severe endemic areas significantly. The National IDD Evaluation Survey (2003) showed 50 districts had increased to the better status, while 68 districts had decreased to the worse status and 150 districts in stable condition.

II. The Causes of Goiter

Lack of iodine in the diet is the majority cause of endemic goiter, where the loss of iodine from the soil due to glaciating, erosion, high rain fall, snow and flooding leads to a low iodine content of all food grown in it. The husbandry and agriculture production was also lack of iodine content, which will be in appropriate resources when people in that area consumed it. Inadequate dietary iodine leads to reduce synthetics of thyroid hormones (T3 and T4). While the lower level of T4 in the blood stimulates the pituitary gland to secrete Thyrotrophin Stimulating Hormone (TSH) from the blood to fulfill the production of thyroid gland hormones. In other word, TSH increases the rate of pumping iodine by the thyroid from the blood, followed with hyperplasia of the thyroid gland, as resulted as goiter. Enlargement is regarded as significant in the human when the size of lateral lobes is greater than terminal phalanx of the thumb of the person examined.

Thyroid enlargement whether as form of a single small nodule or massive enlargement is typically symptoms of goiter, which occasionally accompanied with breathing and swallowing difficulties, cause of the compression of the trachea and esophagus. Neck vein distention and dizziness are occurred when the size of the thyroid gland rose above the head (large goiter). Chronic severe iodine deficiency is associated with thyroid hyperplasia. The prevalence of goiter increased, with the severity of the iodine deficiency and becomes almost universal in a population when the iodine intake less than 10 μg per day.

Iodine in the food stuff is widely available in seafood, such as “tenggiri” (cod) sejenis “ikan sungai” (sea bass), nama “ikan laut” (haddock) and ikan “air tawar berduri” (perch). Kelp or “lumut laut” is the most vegetable seafood that is a rich source of iodine. Dairy product and plants grown soil that is rich in iodine are also a good sources of iodine. The risk factors to become goiters are female, people older than forty, having an adequate dietary intakes, which living in an endemic area and having a family history of goiter.

III. Iodine Deficiency in Pregnancy

The term of “goiter” had been used in the past. Presently, the new term of “Iodine Deficiency Disorders (IDD)”, now been generally adopted as international health and nutrition environment. The effect of IDD is due to the impact of hypothyroidism with reduced of T4 levels, and often accompanied with normal T3 levels and raised TSH levels.

The spectrum of IDD affected among vulnerable groups that are fetus, neonates, infancy, childhood and adult. The most common effect of IDD in adults is goiters, while pregnant women who suffered from IDD will had an impact to their children. In iodine deficient areas, there is an increase rate of spontaneous abortions and stillbirths in humans, which can be reduced by correction of the deficiency. Thyroid treatment in pregnant women who are hypothyroid, also had similar benefits on reducing the abortus and stillbirths. (Mc. Michael et al, 1980). Study in Zaire and New Papua Guinea indicated that an increase of stillbirth and infant mortality could be reduced by controlled with iodine oil injection given during pregnancy. Recent evidence indicated that the effects of iodine deficiency on the occurrence of abortion, stillbirth, congenital anomalies, cretins, neonatal goiter and hypothyroidism, probably arise when mother suffered from iodine deficiency. Thus, it was indicated that the major impact of IDD among pregnant women is on child survival (Hetzel BS, 1991). The effect of pregnant women with IDD on their children, continued up to child and adolescent period, however the children had been supplied with sufficient iodine intake. This condition is due to the impairment of brain development of the children, which is depending on inadequate supply of thyroxin since earlier during conception. About one third of normal brain development occurred before birth and the rest is completed in the first two years of life. Normal brain development had to be maintained with normal level of thyroxin hormones that is important both during and after pregnancy, especially among the first two years of life. Thus prevention of goiter especially among pregnant women is important, in order to avoid the iodine deficient during pregnancy toward reducing the impact of IDD on pregnancy outcomes.

IV. Prevention of Goiter

Iodine supplementation is an effective approach to prevent and control goiter and IDD rapidly. However, commonly the thyroid gland cannot become smaller, particularly in person who had a big size of thyroid gland. In fact Iodine oil capsule supplementation targeted to women at reproductive age including pregnant women living in endemic area, are recommended to supply the iodine intake fulfill their requirement.

As known that people living in endemic area are risk to have IDD, more over in pregnant women, who are higher requirement of iodine rather than non-pregnant women. Two capsules, which contain 200 mg iodine for each capsule, should be taken once in year by non-pregnant mother, and adding with one capsule during pregnancy and one capsule during lactation. These supplements are sufficient to meet the minimum daily requirement of iodine, which only 100-150 μg per day.

Fortification of salt with iodine is widely used in the world to improve the iodine intake of the community. It was mandatory that instead of supplementation, the content of iodine in salt should be more than >30 ppm KJO3, and all salt producers have to follow that regulation. The advantage of iodine salt distribution and marketed throughout the country is, that iodine salt supplied can reach all level of social economic status in the community.

V. Conclusion

Pregnant women are risk to have goiters because the requirement of iodine is increased during pregnancy. Lack of iodine intake will cause iodine deficiency disorder (IDD), which result goiters when the deficiency are chronically. IDD in pregnant women will give a harmful effect among their children due to the congenital anomalies, neurological cretinism, myxoedematous, cretinism, which influence the quality of human resources in the future generation.

Therefore, iodine oil capsule distributed to women at reproductive age including pregnant women living in endemic area of goiter have to be implemented in order to eliminate their child growth impairment. Further more, the salt producers should distribute and market the iodized salt particularly in the community who living in endemic area goiter.

Last but not least, every pregnant woman have to visit the health services routinely for antenatal care, so the enlargement of thyroid gland can be detected earlier and then they will have an appropriate treatment.

References
1. Mc Michael, AxJx, Potter, JD and het ind Bys. Iodine Deficiency, thyroid function and reproductive failure. In endemic goiter and endemic cretinism. (eds JB Stanbury and BS Hetzel) pp 445-60 Willey, New York-1980)
2. Hetzel BS. The story of iodine deficiency. An international challenge in nutrition, pp 284-101, Oxford University Press. Oxford 1991
3. Health Encyclopedia: Iodine in diet Adam, p 1-2, 2004
4. Health Encyclopedia, Colloid nodular goiter, Adam p.1-3, 2004
5. American Map Corporation,1984.
6. Iodine Deficiency Disorders (IDD) control program in Indonesia, MOH RI, 2002

gizi.net/

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