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Carborxymethyl lysine dalam makanan (dCML), CML plasma (pCML), dan tumor necrosis alpha plasma (pTNF-α) mungkin dapat memengaruhi obesitas. Namun database kandungan CML makanan di Indonesia dan penelitian tentang pengaruh asupan CML terhadap obesitas pada wanita Asia belum pernah dilaporkan sebelumnya.

Penelitian ini bertujuan untuk mendapatkan database CML makanan Indonesia dan menilai efek mediator dCML, pCML, dan pTNF-α terhadap lingkar pinggang (WC), rasio lingkar pinggang terhadap tinggi badan (WHtR), dan indeks masa tubuh (IMT).

Penelitian potong lintang dilakukan terhadap 235 wanita sehat berusia 19-50 tahun, yang bertempat tinggal di daerah pesisir pantai dan pegunungan di Sumatra Barat dan Jawa Barat. Database CML dibuat berdasarkan estimasi dari database CML yang telah dipublikasi dan pemeriksaan secara langsung pada makanan yang diambil dari kedua provinsi tersebut, dengan menggunakan metode liquid chromatography-tandem mass spectrometry. Asupan CML, pCML, dan pTNF-α didapatkan berturut-turut dari 2x24 jam recalls, ultra-performance liquid chromatography-tandem mass spectrometry, and enzyme-linked immunosorbent assay. Perbedaan di antara kelompok dianalisis dengan menggunakan Chi-square atau t-test tidak berpasangan, efek mediator dianalisis dengan structural equation modelling, dan untuk perilaku makan dilakukan dengan wawancara mendalam dan observasi.

Terdapat 161 dari 252 jenis makanan dalam database CML yang telah diidentifikasi kandungan CMLnya secara langsung. Kelompok daging dan kacang-kacangan memiliki nilai rerata kandungan CML tertinggi pertama dan kedua. Geometric means ± SD dari dCML, pCML, dan pTNF-α berturut-turut sebesar 1.7±0.8 mgCML/hari, 22.3±7.9 ng/mL, dan 0.68 ± 0.38 IU/mL. Asupan CML berhubungan langsung dan positif terhadap pCML (β= 0.99 [95%CI: 0.53, 1.78]) demikian pula pCML terhadap pTNF-α (β= 0.12 [95%CI: 0.28, 0.49]). Plasma CML dan pTNF-α berhubungan secara langsung dan positif terhadap WC (β= 0.21 [95%CI: 0.08, 0.33] dengan β= 0.23 [95%CI: 0.11, 0.35]) dan juga terhadap WHtR (β= 0.18 [95%CI: 0.06, 0.31] dengan β= 0.23 [95%CI: 0.11, 0.35]). Pada wawancara mendalam didapatkan bahwa kelompok suku Sunda lebih banyak mengosumsi makanan yang diproses seperti ikan peda goreng, ikan asin goreng dan bakso dibandingkan kelompok suku Minangkabau.

Simpulan: Asupan CML, pCML, dan pTNF-α tampaknya lebih berperan sebagai mediator terhadap WC dan WHtR, dibandingkan terhadap BMI. Pembatasan asupan CML diperlukan untuk menurunkan risiko obesitas sentral pada populasi ini.

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Carborxymethyl lysine in foods (dCML), plasma CML (pCML), and plasma tumor necrosis alpha (pTNF-α) may have an influence on obesity. However, there have been no reports on databases of CML content in Indonesian foods and on studies of the influence of CML intake on obesity in Asian women.

This study aims to develop a database of CML content in Minangkabau and Sundanese foods and to evaluate the mediator effects of dCML, pCML, and pTNF-α on waist circumference (WC), waist to height ratio (WHtR), and body mass index (BMI).

A cross-sectional study was conducted in 235 healthy women aged 19-50 years, who resided in coastal and mountainous areas of West Sumatra and West Java. The CML database was developed based on an estimate from published database and direct measurement of foods obtained from these two provinces, using liquid chromatography-tandem mass spectrometry. The dCML, pCML, and pTNF-α concentrations were obtained from 2x24 hour recalls, ultra-performance liquid chromatography-tandem mass spectrometry, and enzyme-linked immunosorbent assay, respectively. Between-group differences were analyzed by chi-square test or unpaired t-test, the mediator effects by structural equation modelling, and eating behavior by in-depth interviews and observations.

There were 161 of 252 food items of which the CML content was determined. The group of meats and the group of legumes had the highest and second highest mean CML content, respectively. The Geometric means ± SD of dCML, pCML, and pTNF-α were 1.7±0.8 mgCML/day, 22.3±7.9 ng/mL, and 0.68 ± 0.38 IU/mL, respectively. There was a direct positive association between dCML and pCML (β= 0.99 [95%CI: 0.53, 1.78]) and between pCML and pTNF-α (β= 0.12 [95%CI: 0.28, 0.49]). Plasma CML and pTNF-α were directly and positively associated with WC (β= 0.21 [95%CI: 0.08, 0.33] and β= 0.23 [95%CI: 0.11, 0.35]) and WHtR (β= 0.18 [95%CI: 0.06, 0.31] and β= 0.23 [95%CI: 0.11, 0.35]). In eating behavior, it was seen that the Sundanese women consumed more CML from processed foods such as fried fermented fish (ikan peda goreng), fried salted fish (ikan asin goreng) and meatballs (bakso) than Minangkabau women.

Conclusion: Dietary CML, pCML, and pTNF-α apparently had a greater role as mediators in the path from ethnicity to WC and WHtR, than in the path from ethnicity to BMI. Limitation of CML intake is necessary to reduce the risk of central obesity in this population

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"ABSTRAKLatar belakang: SOPK adalah gangguan endokrin yang hingga saat ini etiologinya masih belum jelas. Faktor epigenetik metilasi DNA, akhir-akhir ini mendapatkan perhatian dalam patogenesis SOPK. Gen HSD17B1 disebut sebagai "estrogenik" 17β-HSD karena mengkatalisasi langkah terakhir dalam biosintesis estrogen dengan secara istimewa mengurangi estrone, estrogen yang lemah untuk menghasilkan estrogen 17β-estradiol yang kuat. Kami berspekulasi cacat pada metilasi DNA mendorong deregulasi gen sehingga terjadi penurunan ekspresi mRNA HSD17B1, akhirnya menghasilkan estradiol yang tidak cukup pada pasien SOPK.Metode: Kami mengumpulkan total 60 pasien wanita. MSP untuk analisis metilasi DNA, qPCR untuk analisis ekspresi mRNA.Tujuan: Untuk menganlisis metilasi DNA pada kelompok pasien SOPKdan kelompok wanita sehat, ekspresi mRNA pada kelompok pasien SOPK dan kelompok wanita sehat, tingkat estradiol pada pasien SOPK dan kelompok wanita sehat, korelasi antara metilasi DNA dan ekspresi mRNA pada pasien SOPK, korelasi ekspresi mRNA pada pasien SOPKdan kadar serum estradiol.Hasil: Metilasi gen HSD17B1 pada wanita SOPK adalah 42,64% dan kelompok yang sehat menunjukkan 53,80%, p = 0,160 tidak signifikansi antara kedua kelompok. Nilai ekspresi relatif gen HSD17B1 adalah 0,70 kali lebih rendah dibandingkan dengan kelompok wanita sehat, p = 0,003 signifikansi antara kedua kelompok. Estradiol rata-rata pada kelompok SOPK25,78 pg / ml dan kelompok wanita sehat adalah 36,74 pg / ml. Korelasi tingkat metilasi DNA versus ekspresi mRNA pada pasien SOPK, tidak signifikan p = 0,076. Korelasi antara ekspresi mRNA gen HSD17B1 dan kadar serum estradiol, signifikansi p = 0,020. ;Semakin terjadi penurunan ekspresi mRNA, semakin rendah kadar serum estradiol.

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ABSTRACTBackground: PCOS is the most common endocrine disorder but its etiology remains unclear. Lately, epigenetic factors have gained considerable attention in the pathogenesis of PCOS, DNA methylation.  HSD17B1 is referred to as the "estrogenic" 17β-HSD because it catalyzes the final step in estrogen biosynthesis by preferentially reducing the weak estrogen estrone to yield the potent estrogen 17β-estradiol. We speculated defects in DNA methylation promote the deregulation of genes make decrease mRNA expression HSD17B1, finally produces not enough estradiol in PCOS patients.Methods: We collected a total of 60 female patients. MSP for DNA methylation analysis, qPCR for mRNA expression analysis.Aims: To investigate, DNA methylation in PCOS patients group and healthy women group, mRNA expression in PCOS patients group and healthy women group, estradiol level in PCOS patients and healthy women group, the correlation between DNA methylation and mRNA expression in PCOS patients, correlation mRNA expression in PCOS patients and estradiol serum level.Results: Methylated of HSD17B1 gene in PCOS women was 42.64 % and a healthy group showed 53.80 %, p=0.160 not significances between the two groups.  The relative expression value of the HSD17B1 gene was 0.70 fold lower compare with a healthy women group, p=0.003 significance between the two groups. The average estradiol in the PCOS group 25.78 pg/ml and the healthy women group is 36.74 pg/ml. Correlation of DNA methylation level versus mRNA expression in PCOS patients, not significance p=0.076. Correlation between mRNA expression of the HSD17B1 gene and estradiol serum level, significance p=0.020. (More decrease mRNA expression, more lower estradiol serum level)."

"Diet dapat menentukan status seng selama kehamilan. Namun, beberapa penelitian mengenai hubungan antara asupan, pola makan dan kualitas makanan berbasis lokal dengan status seng masih terbatas. Oleh karena itu, penelitian ini bertujuan untuk mengetahui apakah asupan seng, pola makan berbasis lokal PMBL dan kualitas diet berhubungan dengan kadar serum seng pada ibu hamil Minangkabau. Penelitian cross-sectional ini dilakukan dengan melibatkan 360 ibu hamil dengan usia kehamilan antara 16 dan 32 minggu. Semi-quantitative Food Frequency Questionnaire SFFQ digunakan untuk memperolah data asupan makanan, dan PMBL ditentukan berdasarkan hasil principal component analysis PCA . Penelitian ini mengolah 21 kelompok makanan dengan menggunakan PCA menjadi pola makanan bersumber nabati, pola makanan bersumber ikan, ayam dan jeroan, pola makanan bersumber tepung dan pemanis, pola makanan bersumber daging, pola makanan bersumber ikan masak santan, telur dan kacang-kacangan, pola makanan bersumber seafood/hasil laut dan pola makanan bersumber susu. Kualitas diet dianalisis dengan menggunakan Healthy Eating Index HEI 2010. Kadar serum seng diukur dengan menggunakan metode atomic absorption spectrophotometric. Analisis regresi linier multivariat dilakukan untuk menilai asupan seng, PMBL dan kualitas diet dengan kadar serum seng setelah dikontrol oleh faktor perancu. Rerata kadar serum seng adalah 10.1 2.1 mol/L. Asupan seng secara signifikan berhubungan dengan konsentrasi serum seng setelah dikontrol oleh umur, usia kehamilan, asupan energi, asupan serat, lokasi geografis dan pengeluaran rumah tangga adjusted ? = 0,083, 95 CI: 0,003, 0.163, p < 0.05 . Pola makanan bersumber tepung dan pemanis berbanding terbalik dengan kadar serum seng setelah dikontrol oleh umur, usia kehamilan dan pengeluaran rumah tangga adjusted ? = -0.179, 95 CI: -0,335, -0,023, p < 0.05 ; sedangkan PMBL lainnya tidak berhubungan secara signifikan dengan kadar serum seng. Skor total HEI 2010 tidak berhubungan dengan kadar serum seng pada semua responden, tetapi skor HEI 2010 menunjukkan hasil yang berhubungan di daerah pantai setelah dikontrol oleh umur, usia kehamilan, asupan serat dan asupan fitat adjusted ? = 0.186, 95 CI: 0.066, 0.306, p < 0.05 . Secara keseluruhan, antara asupan seng, pola makanan lokal Minangkabau dengan rendah tepung dan pemanis secara positif mempengaruhi kadar serum seng selama masa kehamilan. Meskipun kualitas diet yang dinilai menggunakan HEI 2010 tidak berhubungan dengan kadar serum seng, tetapi kualitas diet menunjukkan hubungan dengan serum seng pada ibu hamil yang tinggal di daerah pantai.Kata Kunci : pola makan; kehamilan; kadar serum seng; Minangkabau; Indonesia

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Diet has consequences on zinc status during pregnancy. However, studies focusing on association of dietary intake, pattern and quality in locally produced foods with zinc status are limited. Therefore, this study aimed to investigate whether zinc intake, local based dietary patterns LBDPs and diet quality are associated with serum zinc concentration among Minangkabau pregnant women. A cross sectional study was conducted involving 360 pregnant women between the 16th and 32nd weeks of gestation. Using dietary data from semi quantitative Food Frequency Questionnaire, LBDPs were identified by principal component analysis PCA . This study extracted 21 food groups into plant sources, fish, chicken and meat organ sources, flour and sweetness source, meats sources, fish with coconut milk, eggs and nuts sources, seafood sources and milk sources patterns by PCA. Dietary quality was analyzed by using the Healthy Eating Index HEI 2010. Serum zinc concentration was measured by using atomic absorption spectrophotometric methods. Multivariate linear regression analysis was performed to assess zinc intake, the LBDPs, and diet quality with serum zinc concentration after adjusted for potential confounders. The mean serum zinc concentration of pregnant women was 10.1 2.1 mol L. Zinc intake significant associated with serum zinc concentration after adjusted for age, gestational age, energy intake, fiber intake, geographic location and household rsquo s expenditure adjusted 0.083 95 CI 0.003, 0.163 p 0.05 . The flour and sweetness sources pattern was inversely associated with serum zinc concentration after adjusted for age, gestational age and household rsquo s expenditure adjusted 0.179 95 CI 0.335, 0.023 p 0.05 while the other LBDPs were not significantly associated with serum zinc concentration. The overall HEI 2010 score was not significantly associated with serum zinc concentration in the total subjects, but it was associated in coastal area after adjusted for age, gestational age, fiber and phytate intakes adjusted 0.186, 95 CI 0.066, 0.306, p 0.05 . In conclusion, zinc intake and local based Minangkabau foods with less in flour and sweetness positively influence serum zinc concentration during pregnancy. Although, the dietary quality assessed by the HEI 2010 did not associate with serum zinc concentration, it clearly associated with zinc serum of pregnant women in coastal area.Keywords dietary patterns pregnancy serum zinc Minangkabau Indonesia."

"Human Milk Oligosaccharides (HMO), adalah kelompok senyawa ketiga terbanyak dalam ASI dan berhubungan dengan pertumbuhan bayi. Studi prospektif longitudinal dilakukan pada 120 pasangan ibu-bayi berusia 0 – 4 bulan dari RS Kemang Medical Care, Puskesmas Cilandak, Mampang, Pasar Minggu dan Tebet di Jakarta Selatan antara Agustus 2021 – Mei 2022.Analisis gen dilakukan dengan Next Generation Sequencing (NGS) dan Sanger. Profil HMO (2'FL, LNFP I, LNT, LNnT, 3'SL dan 6'SL) diperiksa pada usia 0, 2, 4 bulan. Weight for age zscore (WAZ), weight for length z-score (WLZ), dan weight velocity diperiksa setiap bulan. Penelitian ini menggunakan uji korelasi Pearson dan Spearman, uji Anova untuk pengukuran berulang, Friedman tes, regresi logistik dan model linier umum untuk pengukuran berulang dengan nilai p <0,05 dianggap signifikan secara statistik.Sekretor positif dalam penelitian ini sebanyak 58,3% dan 41,7% sebagai Sekretor lemah. Prevalensi Lewis positif sebesar 85% dan 15% adalah Lewis negatif, sama dengan prevalensi Group 1 (Se+Le+) dan Grup 3 (Se+Le-). Kkonsentrasi 2’FL pada kelompok Se+Leberkorelasi negatif dengan WAZ dan berkorelasi positif dengan LNFP I (r0,478) usia dua bulan (r-0,294). 2’FL pada ibu Sekretor positif berkorelasi negatif dengan WAZ bulan kedua (r-0,294). 2’FL, LNFP I dan LNT memiliki hubungan positif dengan indikator pertumbuhan berat badan.

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Human Milk Oligosaccharides (HMOs) are the third most abundant group of compounds in human milk. HMOs can modulate the immune system of the intestinal mucosa, modulate infection and allergy, and link to growth in early infancy. A prospective longitudinal study was conducted among 120 mother-infant pairs aged 0 – 4 months from Kemang Medical Care Women and Children Hospital, Public Health Center in Cilandak, Mampang, Pasar Minggu, and Tebet in South Jakarta between Agustus 2021 – May 2022. The gene analysis for the Secretor and Lewis status of the mother were performed by usung Targeted Next Generation Sequencing (NGS) and Sanger at baseline. The HMOs profiles (2'FL, LNFP I, LNT, LNnT, 3'SL, and 6'SL), breast milk calories, and fat were examined at 0, 2, and 4 months. Weight growth indicators, namely weight for age z-score, weight for length z-score (WAZ, WLZ, and weight velocity), infection episode, and mother's body mass index (BMI) were examined every month. Data were analyzed using Pearson or Spearman correlation test (correlation coefficient), general linear model for repeated measures ANOVA test and Friedman test (mean difference between and within groups, respectively) and logistic regression unadjusted OR (association between dependent and independent variables), with a p-value <0.05 considered statistically significant.

The positive and weak Secretor mothers were 58.3% and 41.7%, respectively. The proportion of Lewis positive and Se+LE+ groups was 85%, while 15% were in Lewis negative and Se+Legroup. At baseline, 2'FL concentration among Se+Le- mothers were negatively correlated with WAZ and LNFP I (r0.478) concentration was positively correlated with infants' WLZ. The 2'FL concentration among Secretor mothers was negatively correlated with infants' WAZ in the second month (r-0.294). Mothers with high 2'FL levels increased the standard deviation of infants' WLZ in the fourth month. Infants' weight velocities were higher among high LNT and 3'SL levels in the second month; and in high 2'FL and LNFP I mothers in the fourth month. HMOs profile (2’FL LNT, LNFP I and 3’SL) of the lactating mothers have a positive relationship with weight growth indicator and innovative intervention to improve HMOs concentration among mothers should be consider as one of the ways to improve infants growth."

"Latar belakang: Enzim methylenetetrahydrofolate reductase (MTHFR) terlibat dalam metabolism asam folat dan tipe allele mempengaruhi aktivitas enzim. Memberikan suplementasi asam folat kepada ibu hamil dapat mempengaruhi perubahan dalam derajat metilasi gen tertentu yang mempengaruhi kesehatan janin. Walaupun sudah banyak penelitian yang mempelajari peran asam folat sebagai donor dalam mekanisme epigenetik, namun penelitian pengaruh suplementasi besi-asam folat pada luaran kehamilan melalui pendekatan interaksi zat gizi-gen dalam desain penelitian longitudinal masih jarang. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar serum asam folat pada ibu dan anak, dan derajat metilasi pada gen pencetak insulin-like growth factor (IGF2) yang dikenal terlibat dalam tumbuh kembang anak dan dapat digunakan sebagai penanda kemunculan penyakit Metode: Di tahun 2018, penelitian longitudinal dilakukan dengan mengunjungi 127 subyek termasuk anak yang dilahirkan dan mengikutsertakannya dalam penelitian. Enam puluh tujuh serum asam folat ibu selama hamil dan pasca melahirkan diperiksa, sementara serum asam folat anak dikumpulkan sebanyak 44 spesimen untuk pemeriksaan penanda darah. Pemeriksaan serum asam folat dengan menggunakan the liquid chromatography-mass spectrometry/mass spectrometry. Untuk pemeriksaan biomolekuler, tipe allele enzim MTHFR 677C>T and 1298A>C menggunakan Taqman polymerase chain reaction. Sementara metode pyrosequencing digunakan untuk menghitung DNA metilasi pada IGF2 pada anak. Hubungan antar variabel dianalisis menggunakan analisis regresi linier multivariat. Hasil:Tidak ada hubungan yang signifikan antara asupan asam folat dan serum asam folat ibu selama hamil, tiga tahun pasca melahirkan dan anak yang dilahirkan (p>0.05). Penelitian ini tidak dapat menunjukkan hubungan antara tipe allel dari MTHFR 677 C>T dan 1298 A>C dan serum asam folat (p>0.05). Serum asam folat selama hamil juga mempengaruhi status serum asam folat tiga tahun pasca melahirkan (p<0.05) dan status serum asam folat anak (p<0.05). Namun penelitian ini tidak dapat menunjukkan pengaruh status serum asam folat anak dengan DNA metilasi IGF2 pada anak (p>0.05). Simpulan: Serum asam folat selama hamil berkontribusi pada serum asam folat tiga tahun pasca melahirkan dan anak. Genotipe dari MTHFR gene at 677C>T and 1298 A>C kemungkinan tidak terlibat dalam metabolism asam folat pada ibu. Serum asam folat selama kehamilan tidak memiliki dampak pada status metilasi dari IGF2 pada wilayah differentially methylated region (DMR) untuk subyek anak. Namun, beberapa hal harus menjadi perhatian karena, secara statistik, jumlah subyek penelitian tidak memadai. Saran: Perlu dilakukan penelitian lanjutan yang melibatkan subyek lebih banyak dan metode yang lebih canggih dalam menentukan MTHFR dan metilasi DNA.

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Background: Methylenetetrahydrofolate reductase (MTHFR) enzyme is involved in folic acid metabolism, and their allele types affected its activity. Providing folic acid supplementation to pregnant mothers may influence the change in methylation level in specific genes that affect the susceptibility of disease of their offspring. Although folic acid's role as a donor in the epigenetic mechanism has been investigated, a longitudinal study exploring the influence of iron-folic acid supplementation on maternal dan birth outcome by the nutrient-gene interaction approach is lacking. Therefore, we investigated the relationship of serum folic acid level among the mothers and the children, and the imprinted insulin-like growth factor 2 (IGF2) methylation level that is known actively involved in growth and development in children and possibly utilized as a surrogate marker for the disease Methods: In 2018, the follow-up study conducted by re-visited 67 subjects and put the mother and their children included in the study. For each group, sixty-seven serums were collected for folic acid measurement for mothers during gestation and three-year post-partum. Furthermore, forty-four serums for children were gathered for biomarker measurement. Serum folics were measured by using liquid chromatography-mass spectrometry/mass spectrometry. Determining the genotype of the MTHFR enzyme in position 677C>T and 1298 A>C was used Taqman Polymerase Chain Reaction (PCR) method. The pyrosequencing method was utilized to quantify the methylation level of the IGF-2 of the children. The relationship analysis between variables using multivariate linear regression. Results: There was no relationship between the folic acid intake during gestation and serum folic acid of the mothers during pregnancy, three-year post-partum, and the children (p>0.05). There was no relationship between the allele type of MTHFR 677C>T and 1298A>C and serum folic acid status of the mother (p>0.05). The serum folic acid during pregnancy had a significant relationship to the serum folic acid three-year post-partum (p<0.05) as well as the serum folic acid of the children (p<0.05). There was no significant relationship between the serum folic acid of the children, serum homocysteine, and the methylation status of IGF2 of the children (p>0.05). Conclusion: The serum folic acid during pregnancy contributed to the serum folic acid three-year post-partum of mother and the children. The genotype of the MTHFR gene at 677C>T and 1298 A>C was possibly not involved in folic acid metabolism in the mother. Serum folic acid during pregnancy could not have an effect on the methylation status of the IGF2 in the differentially methylated region (DMR) area of the children. However, this conclusion needs to be taken in caution due to lack of study power Recommendation: Further cohorts studies with a large sample size and more advanced methods in determining the MTHFR enzyme and DNA methylation. "

"Penelitian ini bertujuan untuk mengetahui pengaruh dari optimized food-based recommendation FBR dan biskuit fortifikasi terhadap performa kognitif siswa sekolah dasar. Cluster randomized controlled trial selama enam bulan pada anak sekolah usia 7-9 tahun n=252 dilaksanakan di 12 sekolah di Kota Nyaundon yang terdiri dari 3 kelompok; kombimasi optimized FBR dan biskuit fortifikasi, optimized FBR, dan kontrol. Performa kognitif, antropometri, dan indicator biokimia diukur sebagai outcome. Pada kedua kelompok intervensi optimized FBR dengan biscuit fortifikasi dan optimized FBR terdapat pengaruh yang significant terhadap performa kognitif, weight-for-age z-scores dan kadar besi serum. Akan tetapi kombinasi optimized FBR dengan biscuit fortifikasi menghasilkan skor performa kognitif yang lebih tinggi dibandingkan optimized FBR saja dengan skor yang lebih tinggi secara signifikan pada daya ingat 1.1 0.1: p-vale

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The study aimed to determine the effect of optimized food-based recommendation FBR and fortified biscuits on cognitive performance of primary school children. A six-month cluster randomized controlled trial among 7-9 years old school children n=252 were conducted at 12 schools in Nyaungdon Township with three intervention groups; optimized FBR with fortified biscuits, optimized FBR, and control. The cognitive performances, anthropometry and biochemical indicators were assessed as outcomes. Analysis of covariance and multiple linear regression analysis were done. Both intervention optimized FBR with fortified biscuits and optimized FBR groups had significant effect on the cognitive performances, weight-for-age z-scores and serum iron status. But combined optimized FBR with fortified biscuits improved cognitive performances higher scores than optimized FBR alone with significantly higher in memory 1.1 0.1: p-vale."