Disertasi

Hubungan Kualitas Diet dengan Permeabilitas Usus dan Respons Antibodi terhadap SARS-CoV-2 pada Remaja dari Tiga Kota Besar di Indonesia = Associations of Dietary Quality with Intestinal Permeability and Antibody Response to SARS-CoV-2 in Adolescents of Three Major Cities in Indonesia.

Pendahuluan. Modulasi permeabilitas usus dengan memperbaiki kualitas diet penting untuk meningkatkan respons imun terhadap SARS-COV-2 dan mendukung kesehatan remaja selama masa pandemi. Penelitian ini bertujuan untuk menginvestigasi hubungan kualitas diet dengan permeabilitas usus dan respons antibodi terhadap SARS-COV-2 pada remaja. Metode. Penelitian potong lintang yang melibatkan 319 remaja berusia 12–17 tahun yang tinggal di Jakarta, Yogyakarta, dan Surabaya dilaksanakan pada bulan Oktober 2022– Februari 2023. Para remaja tersebut sudah mendapatkan dosis lengkap vaksinasi COVID- 19 menggunakan virus yang dilemahkan (Coronavac). Kualitas diet dinilai dengan Healthy Eating Index (HEI) 2015 yang dihitung dari recall 24 jam selama dua hari yang tidak berurutan. Permeabilitas usus dinilai dengan mengukur kadar zonulin dalam serum menggunakan sandwich enzyme-linked immunosorbent assay (ELISA), sementara respons antibodi terhadap SARS-COV-2 dinilai dengan persen inhibisi antibodi netralisasi total terhadap SARS-COV-2 menggunakan competitive ELISA. Regresi linear berganda digunakan untuk menganalisis hubungan kualitas diet dengan permeabilitas usus dan respons antibodi terhadap SARS-COV-2 dengan mengontrol beberapa faktor perancu. Hasil. Rata-rata skor HEI 2015 subjek adalah 48,4 ± 9,2. Hampir 60% subjek memiliki kualitas diet yang buruk. Median (IQR) kadar zonulin dalam serum adalah 155,4 (64,2– 228,0) ng/mL. Kebanyakan subjek memiliki antibodi netralisasi positif terhadap SARSCOV-2 (93,7%) dengan rata-rata 50,4±18,6%. Skor HEI 2015 tidak berhubungan dengan kadar zonulin dalam serum (adjusted β=0.001; 95% CI=-0.003–0.006) maupun persen inhibisi antibodi netralisasi total terhadap SARS-COV-2 (adjusted β=-0.020; 95% CI=- 0.237–0.198), walaupun telah dikontrol dengan faktor-faktor perancu. Hal ini menunjukkan bahwa faktor-faktor selain kualitas diet kemungkinan besar memiliki dampak signifikan terhadap permeabilitas usus dan respons imun. Kesimpulan dan Saran. Skor HEI 2015 tidak berhubungan dengan kadar zonulin dalam serum dan persen inhibisi antibodi neutralisasi total terhadap SARS-COV-2 pada remaja di tiga kota terpilih di Indonesia, setelah dikontrol dengan faktor-faktor perancu. Studi intervensi untuk memodulasi permeabilitas usus dengan suplementasi probiotik dan pendidikan gizi perlu dilakukan.
Kata kunci: Antibodi netralisasi, Healthy Eating Index 2015, kualitas diet, remaja, zonulin


Introduction. Modulation ofintestinal permeability through improvement ofdiet quality is important to enhance immune response to SARS-COV-2 and support overall health of adolescents during the pandemic. This study aims to investigate the associations of diet quality with intestinal permeability and antibody response to SARS-COV-2 in adolescents. Methods. A cross-sectional study involving 319 healthy adolescents aged 12–17 years old living in Jakarta, Yogyakarta, and Surabaya was conducted from October 2022– February 2023. The adolescents had complete COVID-19 vaccination using inactivated virus (Coronavac). Diet quality was assessed by Healthy Eating Index (HEI) 2015 calculated from two non-consecutive days of 24 hours recalls. Intestinal permeability was assessed by serum zonulin level measured using the sandwich enzyme-linked immunosorbent assay (ELISA), while antibody response to SARS-COV-2 was assessed by percent inhibition of total neutralizing antibody to SARS-COV-2 analyzed using competitive ELISA. Multiple linear regression was used to analyze the associations of dietary quality with intestinal permeability and antibody response to SARS-COV-2 while controlling for confounding factors. Results. The average HEI 2015 score of subjects was 48.4 ± 9.2. Almost 60% of subjects had poor diet quality. The median (IQR) serum zonulin level was 155.4 (64.2–228.0) ng/mL. Most subjects had positive neutralizing antibody to SARS-COV-2 (93.7%) with mean of 50.4±18.6%. HEI 2015 score was not associated with both serum zonulin level (adjusted β=0.001; 95% CI=-0.003–0.006) and percent inhibition of total neutralizing antibody to SARS-COV-2 (adjusted β=-0.020; 95% CI=-0.237–0.198), even after accounting for confounding factors. This suggests that factors other than diet quality are more likely to have a significant impact on intestinal permeability and immune response. Conclusion and Recommendation. HEI 2015 score was not associated with serum zonulin level and percent inhibition of total neutralizing antibody against SARS-COV-2 among adolescents in selected three cities of Indonesia, after adjusting for confounding factors. Intervention study to modulate intestinal permeability through probiotic supplementation and nutrition education need to be conducted.
Key words: Adolescents, diet quality, Healthy Eating Index 2015, neutralizing antibody, zonulin