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Abstrak :
Penelitian sebelumnya telah membuktikan adanya korelasi negatif antara kadar asam lemak trans (TFA) dan DHA ASI. Penelitian pada fibroblas manusia menunjukkan bahwa TFA dapat menurunkan availabilitas DHA dengan menghambat proses biosintesis DHA dari alpha-linolenic acid dan inkorporasinya pada lemak membran, termasuk ASI. Penelitian ini dirancang untuk mengetahui korelasi asupan TFA ibu menyusui terhadap kadar DHA ASI. Studi potong lintang dilakukan dengan menggunakan consecutive sampling yang melibatkan 80 orang subjek ibu menyusui sehat pada 1-6 bulan postpartum berusia 20-35 tahun di Puskesmas Cilincing, Jakarta Utara, dan Puskesmas Grogol Petamburan, Jakarta Barat, pada bulan Februari-April 2019 Asupan asam trans, DHA, asam lemak jenuh, dan asam lemak omega-3 dinilai dengan menggunakan food frequency questionnaire semi kuantitatif dan dihitung rasio asupan TFA-DHA. Spesimen ASI diambil secara post-feed pada pagi hari. Kadar DHA ASI diukur dengan menggunakan gas kromatografi tandem spektrometri massa. Korelasi TFA terhadap kadar DHA ASI dianalisis dengan uji korelasi Spearman. Hasil penelitian menunjukkan median asupan TFA adalah 167 (29-849) mg/hari atau >0,08 (0,01-0,38)% total energi. Asupan TFA seluruh subjek masih memenuhi rekomendasi American Heart Association (< 1% total energi). Median asupan DHA adalah 158,5 (13,9-719,7) mg/hari, 67,5% subjek berada dibawah rekomendasi Food and Agriculture Organization (200 mg/hari). Median rasio asupan TFA-DHA adalah 1,08 (0,17-18,06) dan median kadar DHA ASI subjek penelitian adalah >242 (89-865) µmol/l. Tidak didapatkan korelasi antara asupan TFA terhadap kadar DHA ASI (r=0,056, p=0,309), asupan DHA didapatkan memiliki korelasi positif sedang bermakna terhadap kadar DHA ASI (r=0,479, p <0,001), dan terdapat korelasi negatif lemah bermakna rasio asupan TFA-DHA terhadap kadar DHA ASI (r=-0,396, p <0,001). Penelitian ini menyimpulkan bahwa kadar DHA ASI tidak berkorelasi dengan asupan TFA, namun terdapat korelasi negatif lemah antara rasio asupan TFA-DHA terhadap kadar DHA ASI. ......Previous research has shown an inverse correlation between TFA and DHA in breast milk. Experimental data on human fibroblast showed that TFA could decrease the availability of DHA by inhibiting its biosynthesis from alpha-linolenic acid and incorporation to lipid membrane, including human milk. This study was designed to determine the correlation between maternal TFA intake and DHA content of mother's breast milk. This cross-sectional study was conducted at Cilincing Public Health Centre, North Jakarta, and Grogol Petamburan Public Health Centre, West Jakarta, from February to April 2019. Consecutive sampling method was used, 80 healthy lactating mothers at 1-6 postpartum ranging from >20-35 years old, participated in this study. Maternal TFA, DHA, saturated fat, and omega-3 intake was assessed using a semiquantitative food frequency questionnaire, and TFA-DHA intake ratio was calculated. Breast milk specimens were collected post-feed in the morning then breast milk DHA content was analyzed by Gas Chromatography with Mass Spectrometry. Correlation between maternal TFA intake and breast milk's DHA content was assessed using Spearman's test. Data showed the median value of TFA intake was 167 (29-849) mg/day, all subjects TFA intake still below the recommendation of AHA (<1% total energy) Median value of DHA intake was 158.5 (13.9-719.7) mg/day, 67,5% of subject was below Food and Agriculture Organization recommendation (200mg/day). The median value of TFA-DHA ratio was 1.08 (0.17-18.06), and a median value of breast milk's DHA content was 242 (89-865) µmol/l. This study showed no correlation between maternal TFA intake and breast milk's DHA content >(r=0.056, p=0.309), Maternal DHA intake showed a moderate positive correlation with breast milk DHA (r=0.479, p <0.001). There was a weak negative correlation between TFA-DHA intake ratio and breast milk DHA (r=-0.396, p <0.001). This study concluded that the DHA content of the mother's breastmilk was not correlated with maternal TFA intake alone, but it was negatively correlated with TFA-DHA intake ratio.

Abstrak :
Kanker payudara merupakan penyebab kematian tersering pada wanita. Salah satu faktor risiko kanker payudara adalah obesitas. Obesitas merupakan masalah kesehatan global yang diderita 13% populasi dunia. Sekitar 56 % pasien kanker payudara mengalami obesitas. Sebagian besar pasien kanker payudara dengan obesitas mengalami peningkatan berat badan setelah diagnosis dan semakin memberat saat mejalani terapi anti-kanker. Peningkatan massa lemak berperan dalam progresivitas sel kanker dan resistensi kanker terhadap kemoradiasi. Asam lemak omega-3, yaitu eicosapentaenoic acid (EPA) dan docosahexaenoic acid (DHA) merupakan nutrien spesifik dalam terapi medik gizi pasien kanker. Penelitian menunjukkan EPA dan DHA dapat memiliki efek anti-kanker, antiinflamasi, dan anti-obesitas yang dapat menurunkan massa lemak, berat badan, dan meningkatkan sensitivitas terapi anti-kanker. Terapi medik gizi dilakukan pada empat pasien kanker payudara dengan obesitas dengan rentang usia 44–58 tahun. Satu pasien tidak mencapai target asupan energi dan satu pasien melebihi target asupan energi, dengan rentang rerata asupan 23–31 kkal/kgBB. Satu pasien tidak mencapai target asupan protein dengan rentang rerata asupan 1–1,4 g/kgBB. Asupan nutrien spesifik asam amino rantai cabang keempat pasien belum mencapai 10 g/hari dengan rentang rerata asupan 8,3–9,3 g/hari. Asupan EPA dan DHA keempat pasien memiliki rentang rerata 1,8–1,9 g/hari. Tiga dari empat pasien mengalami penurunan berat badan dan free fat mass index (FFMI), satu pasien mengalami peningkatan BB dan FFMI, dan dua dari empat pasien mengalami peningkatan kekuatan genggam. Satu pasien mengalami peningkatan C-reactive protein (CRP) dan satu pasien mengalami penurunan CRP. Keempat pasien memiliki rasio neutrofil limfosit diatas 3,49 yang mengindikasikan peningkatan risiko rekurensi. Keempat pasien mengalami toksisitas akur ringan selama radioterapi. Kendala utama dalam aplikasi terapi medik gizi pada keempat pasien adalah tingkat kepatuhan terhadap preskripsi yang semakin menurun menjelang minggu akhir pemantauan Dibutuhkan tatalaksana gizi lebih lanjut pasca radiasi untuk mencapai target nutrisi disertai peningkatan aktivitas fisik untuk mempertahankan atau meningkatkan massa otot. ......Breast cancer is a leading cause of death in women. One risk factor for breast cancer is obesity, a global health problem affecting 13% of the world's population. About 56% of breast cancer patients are obese. Most breast cancer patients with obesity gain weight after diagnosis and get worse while undergoing anti-cancer therapy. Increased fat mass plays a role in the progression of cancer cells and cancer resistance to chemoradiation. Omega-3 fatty acids, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are specific nutrients in medical nutrition therapy for cancer patients. Research shows that EPA and DHA have anti-cancer, anti-inflammatory, and anti-obesity effects that can reduce fat mass and body weight and increase the sensitivity of anti-cancer therapy. Medical nutrition therapy was done on four obese breast cancer patients aged 44–58. One patient did not reach the energy intake target, and one exceeded the energy intake target, with a mean intake range of 23–31 kcal/kg BW. One patient did not achieve the target protein intake with an average intake of 1–1.4 g/kg BW. The intake of specific nutrients for branched-chain amino acids in the four patients had not yet reached ten g/day with a mean intake range of 8.3–9.3 g/day. The EPA and DHA intakes of the four patients had a mean range of 1.8–1.9 g/day. Three of four patients experienced weight loss and free fat mass index (FFMI), one patient experienced an increase in weight and FFMI, and two of four patients experienced an increase in grip strength. One patient had an increase in C-reactive protein (CRP), and one had a decrease in CRP. All four patients had a neutrophil-lymphocyte ratio above 3.49, indicating an increased risk of recurrence. All four patients experienced mild acute toxicity during radiotherapy. The main obstacle in applying medical nutrition therapy to the four patients was the level of adherence to prescriptions which decreased towards the end of the monitoring week. Further nutritional management after radiation was needed to achieve nutritional targets with increased physical activity to maintain or increase muscle mass.