Irritable bowel syndrome in Indonesian adolescents

Abstract Objective: Irritable bowel syndrome is a frequent functional gastrointestinal disorder. The aims of this study were to investigate its epidemiology, focusing on the role of intestinal mucosal integrity and to evaluate the impact on the quality of life. Methods: A community-based survey applying a comparative cross sectional approach was conducted in six high schools in Palembang. Subjects were recruited using multistage random sampling divided in two groups. Rome III criteria were used to establish a diagnosis of IBS in combination with a questionnaire to determine risk factors. Determination of fecal alpha-1-antitrypsin and calprotectin levels was performed to determine impaired intestinal mucosal integrity. A questionnaire was used to evaluate how quality of life was affected by irritable bowel syndrome. Results: The survey was performed in 454 14−18 years old adolescents, of whom 30.2% fulfilled the Rome III criteria for IBS, with the following subtypes: 36.5% diarrhea, 18.9% constipation, 21.9% mixed, and 22.6% unclassified. Major risk factors were female gender, bullying, age 14-16 years, history of constipation and diarrhea, eating nuts, and drinking coffee, tea, and soft drinks. There was a significant association with intestinal inflammation (p = 0.013). A significantly impaired quality of life was found (p = 0.001). Conclusions: The prevalence of irritable bowel syndrome in adolescents was high, with bullying, female gender, age 14-16 years, constipation and diarrhea, and dietary consumption of soft drinks, coffee, and tea as risk factors. A significant association with intestinal inflammation was found.

Serum folate levels among healthy infants aged 6–8 months: relation to infants’ nutritional status indicators and maternal knowledge-attitude-practice.

Background: Vitamin B12 and folate deficiency can cause anemia which may lead growth and development impairments. This study was aimed to determine serum folate levels among infants aged 6–8 months and the relation to infants’ nutritional indicators and maternal knowledge-attitude-practice about infant feeding. Methods: A cross–sectional design was implemented in infants aged 6–8 months and their mothers as respondents who met the study criteria. Data collected among the infants included sex, age, length, weight, intake of energy, protein and folate (based on a one–month semi–quantitative FFQ and a 24–hour food recall), serum folate and hemoglobin levels. Data collected among the mothers included age, education level, income based on average minimum monthly wage, knowledge, attitude and behavior concerning infant’s feeding, i.e. breast milk and complementary feeding practices. Results: This study found that the median of serum folate levels was 43.05 nmol/L with values ranging from 19.92 nmol/L to 104.24 nmol/L. Serum folate level had a strong positive correlation with its related factors, protein and folate intake. Conclusions: Protein-folate–rich complementay food should be provided to infants aged 6 months and over to maintain serum folate level.

Dietary iron intake, serum ferritin and haemoglobin levels, and cognitive development scores of infants aged 6–8 months.

Background: Iron deficiency during infancy may lead to negative effect on cognitive function and psychomotor development. This study aimed to investigate serum ferritin, haemoglobin level and its relation to cognitive development score in infants aged 6–8 months. Methods: This cross-sectional study was done on 76 infants recruited from several selected community health center in Kampung Melayu Village, Jatinegara Jakarta who had fulfilled the study criteria. Data collected consist of age, weight, height, head circumference, energy, protein and iron intake, serum feritin levels, haemoglobin levels and cognitive development score using Capute Scales method (Cognitive Adaptive Test/ Clinical Linguistic Auditory Milestone Scales/ CAT-CLAMS). Results: Among 74 infants aged 6-8 months, 73% had less dietary iron intake as compared to its RDA (7 mg/d), 18.9% were with serum ferritin less than normal value (20 μg/L), and 56.7% with haemoglobin levels less than normal value (11 mg/dL). In relation to cognitive development score, this study revealed that the CAT score was significantly lower among subjects with hemoglobin value less than 11 mg/dL (p = 0.026). Conclusion: Early prevention of impaired cognitive development is urgently needed by providing iron-rich complementary foods to infants since 6 months (mo) old to maintain the normal level of hemoglobin.

Effect of a six-month iron-zinc fortified milk supplementation on nutritional status, physical capacity and speed learning process in Indonesian underweight schoolchildren: randomized, placebo-controlled.

Aim to evaluated the effect of milk supplementation enriched with iron and zinc on indicators of growth, physical capacity and cognitive performance in underweight school-children. Method Two-armed, randomized controlled double-blind trial was performed in several primary schools in Jakarta and Surakarta, Indonesia. A total of 245 underweight schoolchildren aged 7-9 years living in urban poor areas of Jakarta and Solo were randomly allocated to receive two cups of iron-zinc fortifi ed-milk (n = 121) or non-iron-zinc fortifi ed milk (n= 124) supplementation daily for six months. Biochemical indicators, anthropometric indices, physical capacity and cognitive performance were measured at before and after the supplementation. Results The study shows that between the fortifi ed and non-fortifi ed milk group, there was no signifi cant different in haemoglobin increase (0.01 + 0.96 mg/dL versus 0.17 + 0.81 mg/dL) nor serum ferritin increase (12.77 + 25.50 mcg/dL versus 14.99 + 29.56 mcg/dL). Unexpectedly, decreased in serum zinc was found in both groups (3.01 + 3.24 mMol/dL and 3.12 + 3.71 mMol/dL). There was signifi cant higher increment (P=0.045) in body weight among the fortifi ed milk group (1.31 + 0.69 kg) as compared to the non-fortifi ed group (1.13 + 0.69 kg). Consistently, there was signifi cant increase (P=0.025) in the indicator of underweight (WAZ) among the fortifi ed milk group (1.47 + 0.50) as compared to the non-fortifi ed group (1.33 + 0.47). There was signifi cant improvement (P=0.001) of cognitive performance, i.e. coding test-score among the fortifi ed group (12.74 + 11.76) as compared to the non-fortifi ed group (8.31 + 9.60), but there was no signifi cant difference found in the improvement of physical capacity score in both groups (10323.77 + 9253.83 versus 8435.94 + 8824.55). Conclusion Among underweight schoolchildren aged 7-9 y, supplementation of milk fortifi ed with iron and zinc can provide better growth, and better speed processing of learning ability.

The effect of indigestible dextrin and phytosterol on serum LDL-cholesterol level on hypercholesterolemic subjects.

Aim To investigate the effects of indigestible dextrin 2x2.3g/day and phytosterol 2x0.6g/day provided for 6 weeks in lowering serum LDL-cholesterol levels amongs hypercholesterolemic subjects. Methods A randomized clinical trial, two pararel groups, double blinded and randomly assigned to each different group was done in 16 subjects per-group. Results Before the, intervention the level of LDL cholesterol of both ID and FS group were 158.81 ± 17.74 mg/dL and 176.18 ± 25.31 mg/dL, respectively. After the intervention there was a significant reduction in LDL cholesterol level in both groups, i.e. among the ID group by 20.93 ± 12.65 mg/dL (13.24%) with p value of <0.001, while the reduction of LDL cholesterol level among the PS group was 21.87 ± 28.76 mg/dL (11.21%) with p value of 0.008. However, the reduction of cholesterol level between the two groups did not show any significant difference. Conclusion Consuming indigestible dextrin 2x2.3g/day and 2x0.6g/day phytosterol (PS) for 6 weeks will have the same ability to decrease the serum cholesterol level in hypercholesterolemic subjects.

Relationship between plasma lipid profile and the severity of diabetic retinopathy in type 2 diabetes patients.

This study aimed to determine the relationship between plasma lipid profile and the severity of diabetic retinopathy in type 2 diabetes patients. A cross sectional study was done in Ophthalmologic Clinic, Cipto Mangunkusumo General Hospital, Jakarta for 52 diabetic retinopathy (DR) patients. Data collected were demographic, life style, duration of diabetes, physical and antropometric examinations, fat, fatty acid and cholesterol intake, fasting plasma glucose, A1C, total-, LDL-,HDL-cholesterol and triglyceride level, and fundus examination. Statistical analysis was done using chi-square test to see the associations between plasma lipid profile and DR in type 2 diabetes patients. Subjects comprised of 20 males and 32 females diabetes patients with mean age of 53.8 ± 5.2 years. As much as 53.8% had been diagnosed as DM for >10 years. The mean value of BMI was 24.1 ± 3.3 kg/m2 and 38.5% were classified as obese I and II. The mean value of fasting plasma glucose was 157.5 ± 71.8 mg/dL, and A1C was 9.1 ± 2.4 %. For lipid profile, 40.4% had high total cholesterol level (>240 mg/dL), 34.6% had high and very high LDL-cholesterol level (≥160 mg/dL), and 65.4% had normal HDL-cholesterol (40-60 mg/dL) and triglyceride level (<150 mg/dL). For the severity of retinopathy, 61.6% had severe non-proliferative diabetic retinopahy (NPDR) and proliferative diabetic retinopahy (PDR). In conclusion, there were no significant associations between plasma lipid profile and the severity of diabetic retinopathy.

The effects of phytosterol in low fat milk on serum lipid levels among mild-moderately hypercholesterolemic subjects.

One of the most important risk factors for CHD is dyslipidemia, among others hypercholesterolemia or high LDL-cholesterol. Plant-sterols or phytosterols (PS) are among dietary factors known to lower blood cholesterol as part of therapeutic life-style changes diet. This study was aimed to evaluate the effect of PS properly solubilized in a-partly vegetable oil-filled low fat milk, on serum lipid levels in mild-moderate hypercholesterolemic subjects. Randomized, two-arm parallel control group trial was conducted at Department of Nutrition-University of Indonesia in Jakarta from June to November 2006. Each subject was randomly assigned to receive dietary life-style changes counseling plus 1.2 g phytosterol/day in low-fat milk (PS-group) or control group receiving the counseling alone for six weeks period. There were no significant changes of serum total and LDL-cholesterol of control group after a six week of dietary counseling (respectively 218.3 ± 18.6 mg/dL to 219.6 ± 24.3 mg/dL and 164.7±21.8 mg/dL to 160.0±26.4 mg/dL). There were a significant decreases of serum total and LDL-cholesterol (respectively p=0.01 and p=0.004) among subjects receiving PS after a six weeks observation period (respectively 233.5±24.6 mg/dL to 211.2±30.3 mg/dL and 176.9±24.7 mg/dL to 154.5±24.3 mg/dL). There was a significant difference in the LDL-lowering effects (p=0.024) among the PS-group after a six weeks (22.4±27.9 mg/dL) as compared to the control group (4.7±17.2 mg/dL). No significant changes were found on serum HDL-cholesterol and triglyceride levels in both groups. Although there was no significant difference found in daily nutrients intake between the-2 groups, however, significant reductions in body weight, body mass index and waist circumference were found only in the PS group (p=0.000; 0.000; 0.003, respectively). It is concluded that the lowering of total and LDL-cholesterol in those receiving life-style changes counseling plus 1.2 g PS daily for six weeks was significantly higher as compared to those of receiving counseling alone.

Association between dietary intake of vitamin A, C, and E as antioxidants and cognitive function in the elderly at a nursing home.

As oxidative stress is considered one of the major mechanisms underlying degenerative changes, antioxidants from dietary sources, such as vitamin A, C, and E, may have protective effects against oxidative stress and thus be able to prevent or delay cognitive impairment in the elderly. This cross sectional study was designed to determine the association between dietary intake of vitamin A, C, and E and the presence of cognitive impairment in the elderly, along with other factors. Subjects included 36 residents from a nursing home in Jakarta, Indonesia. The data obtained including daily nutrition intake values one week prior to sampling converted from semi- quantitative food frequency questionnaire (SFFQ) results, Mini Mental State Examination (MMSE) scores, and anthropometrical measurement results. This study showed that while sex, age, education, nutritional status, and macronutrients intake were not significantly associated with presence of cognitive impairment, significant positive correlation existed between education and MMSE score (p=0.036, r=0.351). Higher vitamin A and vitamin C intake were shown to be significantly associated with lower incidence of cognitive impairment (p=0.022 and p=0.045, respectively). Moreover, vitamin C was shown to have significant positive correlation with MMSE score (p=0.031, r=0.359). However, the association between vitamin E and the presence of impairment was not significant (p=0.129). Higher intake of vitamin A and C may delay or prevent cognitive impairment in the elderly. Higher intake of vitamin C may contribute to better cognitive functioning. The findings may be explained by the two antioxidant vitamins’ protective effects against neurode generative processes cause by oxidative stress.