Disertasi

Effects Of Probiotic and Omega 3 Fatty Acid Supplementations On Maternal Anthropometry And Gut Hormones = Efek Suplementasi Probiotik dan Asam Lemak Omega 3 Terhadap Antropometri Ibu Hamil dan Hormon Usus.

Background: A combination of probiotics and omega-3 fatty acids supplementation during pregnancy and postpartum is expected to increase short-chain fatty acid (SCFA) production thereby stimulating L-cells to secrete more GLP-1 and PYYto influence maternal weight during pregnancy- post-partum period and post-partum central obesity. Method: This double-blinded randomized controlled trial is a part of the BRAVE (Brain PRobiotic and n-3 LC-PUFA (OmegA-3) Intervention for Optimum Early Life) study. The intervention group received probiotic capsules containing Lactobacillus rhamnosus (LGG), Lactobacillus acidophilus (LA-5), Bifidobacterium lactis (BB-12), and omega-3 fatty acid, while participants in the control group got identical placebo capsules and lower dose omega 3 fatty acids as their standard needs. The outcomes of this study were gestational weight gain, postpartum weight, waist circumference, waist-height ratio, and fasting plasma GLP-1- PYY level changes. The observation period started from the second trimester up to 6 months postpartum. Results: A total of 214 out of 314 pregnant women who enrolled in BRAVE study who have outcomes data were analyzed in this study. The intervention group had slightly higher gestational weight gain (6.92± 3.70 vs 5.85± 3.36) kg during the second and third trimesters, lower postpartum weight loss (-1.9± 4.5 vs -2.4± 4.6) kg, more waist circumference reduction (-5.7± 6.5 vs -5.1± 6.1) cm, and higher waist for height ratio reduction (-0.037± 0.042 vs - 0.033± 0.041). However, the differences were not statistically significant. The proportion of high-level GLP-1 and PYY between the intervention and control group during pregnancy and the postpartum period was comparable. The PYYlevel during pregnancy was extremely higher than in the postpartum period. The incidence of inadequate, adequate, and excess gestational weight gain was not significantly different between intervention and control groups, (26.7; 25.0; 48.3 vs 33.3; 31.5; 35.2) percent, respectively. Conclusion: The probiotic strains LGG, LA-5, and BB-12 combined with omega-3 fatty acids supplementation did not affect maternal anthropometry and gut hormone changes during pregnancy and the postpartum period. This study was underpowered, therefore the findings should be interpreted with caution.
Keywords: Probiotic, L. rhamnosus, L. acidophilus, B. lactis, Omega-3 fatty acid, GLP-1, PYY, gestational weight, postpartum weight loss, postpartum central obesity, randomized controlled trial.


Latar Belakang: Kombinasi suplementasi probiotik dan asam lemak omega-3 selama masa kehamilan dan pasca salin diharapkan dapat meningkatkan produksi asam lemak rantai pendek (SCFA) yang selanjutnya dapat merangsang sel enteroendokrin L untuk mensekresi lebih banyak hormon GLP-1 dan PYY sehingga dapat mempengaruhi perubahan berat badan selama masa kehamilan dan pasca salin, serta obesitas sentral pasca salin. Metode: Uji terkontrol acak tersamar ganda ini merupakan bagian dari penelitian BRAVE (Brain PRobiotic and n-3 LC-PUFA (OmegA-3) Intervention for Optimum Early Life). Kelompok perlakuan menerima kapsul probiotik yang mengandung Lactobacillus rhamnosus (LGG), Lactobacillus acidophilus (LA-5), Bifidobacterium lactis (BB-12), and asam lemak omega-3, sementara subjek pada kelompok kontrol mendapatkan kapsul plasebo dan asam lemak omega-3 dosis lebih rendah sesuai kebutuhan standar saat hamil. Variabel tergantung pada penelitian ini adalah kenaikan berat badan kehamilan, perubahan berat badan, lingkar perut, dan rasio lingkar pinggang-tinggi badan pasca salin, serta konsentrasi GLP-1 dan PYY plasma puasa. Periode pengamatan dimulai sejak trimester kedua sampai 6 bulan pasca salin. Hasil: Total 214 dari 314 ibu hamil yang terdaftar pada penelitian BRAVE dan memiliki satu atau lebih data variabel tergantung, dianalisis dalam penelitian ini. Subjek di kelompok perlakuan mengalami kenaikan berat badan kehamilan sedikit lebih tinggi (6.92± 3.70 vs 5.85± 3.36) kg, penurunan berat badan pasca salin lebih rendah (-1.9± 4.5 vs -2.4± 4.6) kg, pengecilan lingkar pinggang lebih banyak (-5.7± 6.5 vs -5.1± 6.1) cm, dan penurunan rasio lingkar perut/ tinggi badan lebih banyak (-0.037± 0.042 vs -0.033± 0.041) dibandingkankan kelompok kontrol. Namun perbedaannya tidak signifikan secara statistik. Proporsi subjek yang memiliki konsentrasi GLP-1 dan PYY plasma puasa tinggi tidak berbeda antara kedua kelompok. Konsentrasi PYYplasma puasa selama kehamilan jauh lebih tinggi daripada pasca salin. Insiden kenaikan berat badan kehamilan yang kurang, cukup, dan berlebih tidak berbeda secara signifikan antara kelompok intervensi dan kontrol (26.7; 25.0; 48.3 vs 33.3; 31.5; 35.2) persen. Kesimpulan: Suplementasi probiotik strain LGG, LA-5, dan BB-12 yang dikombinasikan dengan asam lemak omega-3 tidak mempengaruhi perubahan antropometri ibu dan hormon usus ibu selama masa kehamilan dan pasca salin. Penelitian ini memiliki power rendah, sehingga hasil penelitian harus diinterpretasikan dengan hati-hati.
Kata Kunci: Probiotik, L. rhamnosus, L. acidophilus, B. lactis, asam lemak Omega-3, GLP- 1, PYY, berat badan kehamilan, berat badan pasca salin, obesitas sentral pasca salin, uji coba terkontrol acak.