Tesis

Prevalens dan faktor risiko malnutrisi pada anak dengan kolestasis kronik di rumah sakit Cipto Mangunkusumo = Prevalence and risk factor of malnutrition in children with chronic cholestasis at Cipto Mangunkusumo hospital.

Latar Belakang: Anak dengan kolestasis kronik memiliki risiko tinggi mengalami malnutrisi yang memengaruhi pertumbuhan dan perkembangan. Berbagai faktor risiko penyebab malnutrisi pada kolestasis kronik penting untuk diidentifikasi agar penanganan malnutrisi lebih terarah. Tujuan: Studi ini untuk mengetahui prevalens, profil dan faktor risiko yang memengaruhi malnutrisi pada anak dengan kolestasis kronik. Metode: Studi ini menggunakan desain potong lintang pada subyek kolestasis kronik berusia 3 bulan – 5 tahun di klinik rawat jalan gastrohepatologi RSCM. Dilakukan pemeriksaan antropometri, status gizi, pola asupan nutrisi makronutrien dan mikronutrien serta identifikasi faktor risiko malnutrisi. Kemudian dinilai hubungan antara faktor risiko tersebut dengan status gizi. Hasil: Dari 94 subyek didapatkan prevalens malnutrisi 53,3%, prevalens stunting 59,6%, prevalens mikrosefali 59,6%. Persentase subyek dengan riwayat rawat inap 71,1%, riwayat puasa 44,7%, asites sedang-masif 38,3% dan perdarahan saluran cerna 11,7%. Jumlah subyek dengan kekurangan asupan makronutrien: asupan kalori 67,1%, asupan karbohidrat 53,2%, asupan protein 13,8%, asupan lemak 77,7% dan asupan MCT 76,6%. Jumlah subyek dengan kekurangan asupan mikronutrien: vitamin A 56,4%, vitamin D 55,3%, vitamin E 21,3%, vitamin K 24,5%, vitamin B 1 21,3%, vitamin B2 13,8%, vitamin B6 24,5%, vitamin B12 2,1%, vitamin C15,8%, zat besi 69,1%, seng 87,2%, fosfor 3,2% dan magnesium 66%. Faktor risiko yang memiliki hubungan bermakna dengan malnutrisi pada anak kolestasis kronik adalah perdarahan saluran cerna dan asites sedang-masif dengan nilai p 0,001 dan 0,025. Tidak terdapat hubungan yang bermakna antara asupan makronutrien, riwayat durasi rawat inap, riwayat durasi puasa dengan malnutrisi pada anak kolestasis kronik. Kesimpulan: Prevalens dan penyebab malnutrisi pada anak kolestasis kronik cukup tinggi dan bervariasi, dibutuhkan evaluasi status gizi berkala pada anak kolestasis kronik untuk mengatasi dan mencegah malnutrisi. Perdarahan saluran cerna dan asites sedangmasif sebagai faktor risiko yang berpengaruh terhadap malnutrisi harus mendapat penanganan yang komprehensif agar pemberian asupan nutrisi tidak terhambat.
Kata kunci: kolestasis kronik, status gizi, makronutrien, mikronutrien, ascites dan perdarahan saluran cerna.


Background: Children with chronic cholestasis have a higher risk of malnutrition that affect growth and development in life. There are several risk factors that should be identified and managed to reduce the risk of malnutrition. Objective: To know the prevalence of malnutrition, the profile and risk factors that are related to malnutrition in children with chronic cholestasis. Methods: This cross-sectional study involved children age 3 months to 5 years old at pediatrics gastro-hepatology clinic RSUPN Dr. Cipto Mangunkusumo. Methods include standard anthropometric examination, evaluation of nutritional status, pattern of intake nutrition and identification risk factors that are related to malnutrition. Results: Out of 94 subjects, the prevalence of malnutrition is 53.3%, prevalence of stunting is 59.6% and prevalence of microcephaly is 59.6%. 71.1% had history of hospitalization, 44.7% had history of fasting, 38.3% had moderate and massive ascites, and 11.7% had gastro-intestinal bleeding. Insufficient daily macronutrient intake are as follows: calorie 67.1%, carbohydrate 53.2%, protein 13.8%, lipid 77.7% and MCT 76.6%. Insufficient daily micronutrient intake are as follows: vitamin A 56.4%, vitamin D 55.3%, vitamin E 21,3%, vitamin K 24,5%, vitamin B 1 21,3%, vitamin B2 13.8%, vitamin B6 24.5%, vitamin B12 2.1%, vitamin C 15.8% Fe 69.1%, Zinc 87.2 %, P 3.2% and Mg 66%. There were significant relationships between gastro-intestinal bleeding (p value of 0.001) and moderate-massive ascites (p value of 0.025) in nutrition status in children with chronic cholestasis. No relationships were observed among insufficient macronutrient intake, duration of hospitalization and duration of fasting with nutrition status in children with chronic cholestasis. Conclusion: The high prevalence of malnutrition in children with chronic cholestasis and the causes of malnutrition are varied. Although some causes have no specific treatment, all children with chronic cholestasis should have periodic nutritional evaluation to optimized macronutrient and vitamin intake. Comprehensive management moderate – massive ascites and gastro-intestinal bleeding are important to prevent malnutrition in children with chronic cholestasis.
Keywords: Chronic cholestasis, malnutrition, macronutrient, micronutrient, ascites, gastrointestinal bleeding