ABSTRAK
Pola konsumsi vegetarian menunjukkan peningkatan popularitas yang signifikan. Indonesia Vegetarian Society mencatat peningkatan pesat jumlah anggotanya dari 5.000 orang (1998) menjadi 500.000 (2010). Ibu vegetarian dikuatirkan memiliki status gizi prahamil yang lebih rendah dan berisiko memiliki outcome kehamilan yang rendah yaitu status gizi bayi lahir dan cadangan lemak ibu untuk menyusui rendah. Studi ini bertujuan menganalisis pengaruh vegetarian dan nonvegetarian terhadap status gizi ibu, durasi ASI predominan, dan pertumbuhan bayi selama periode 0-6 bulan. Studi dengan desain kohort longitudinal dilakukan di lima kota di Indonesia (Jakarta, Surabaya, Pontianak, Palembang dan Pekanbaru) dengan populasi vegetarian usia subur terbanyak. Sejumlah 85 ibu-bayi berhasil diikuti selama 6 bulan postpartum.. Berdasarkan data 24 HR food recall, ibu vegetarian secara bermakna mengkonsumsi energi, protein, dan lemak lebih rendah namun karbohidrat lebih tinggi dibandingkan ibu nonvegetarian. Dalam hal zat gizi mikro, ibu vegetarian mengkonsumsi vitamin B12 dan Zn lebih rendah secara signifikan dibandingkan ibu nonvegetarian. Konsumsi saat laktasi pada kedua kelompok signifikan lebih rendah daripada konsumsinya saat hamil. Hasil penelitian menunjukkan bahwa vegetarian tidak mempengaruhi durasi ASI predominan. Konsumsi energi ibu laktasi mempengaruhi durasi ASI predominan pada kelompok nonvegetarian. Secara keseluruhan tidak ada perbedaan IMT postpartum kedua kelompok selama 6 bulan (p value=0,306), tetapi setelah dikontrol durasi ASI predominan (24 minggu) ada perbedaan bermakna (p value=0,047) pada penurunan BB ibu postpartum. Pada kelompok vegetarian faktor yang paling mempengaruhi IMT ibu postpartum adalah IMT postpartum 0 bulan (bulan ke-1 dan ke-2) dan IMT prahamil (bulan ke-3 hingga ke-6), sedangkan pada kelompok nonvegetarian adalah IMT postpartum 0 bulan (bulan ke-1 hingga ke-5) dan durasi ASI predominan (bulan ke-6). Pertumbuhan BB bayi ibu vegetarian lebih tinggi dari nonvegetarian secara bermakna (p value=0,009), tetapi kedua kelompok memiliki PB yang tidak berbeda (p value=0,235). Setelah dikontrol durasi ASI predominan (24 minggu) tidak ada perbedaan pertumbuhan BB dan PB bayi pada kedua kelompok, namun weight loss ibu vegetarian lebih besar (p value=0,047). Faktor yang paling mempengaruhi BB bayi kelompok vegetarian adalah jenis kelamin bayi (bulan ke-1 sampai ke-6), dan pada kelompok nonvegetarian adalah BBL bayi (bulan ke-1 dan ke-2), jenis kelamin (bulan ke-3), dan IMT ibu postpartum 0 bulan (bulan ke-4 hingga ke-6). Faktor yang paling mempengaruhi pertumbuhan PB bayi kelompok vegetarian adalah jenis kelamin bayi (bulan ke-1 hingga bulan ke-5) dan PBL (bulan ke-6), pada kelompok nonvegetarian adalah PBL (bulan ke-1 hingga ke-4) dan jenis kelamin bayi (bulan ke-5 dan ke-6).Hasil penelitian ini mendukung kebijakan pemberian ASI eksklusif 6 bulan, baik pada vegetarian dan nonvegetarian, dengan didukung program gizi dan konsumsi yang cukup pada periode laktasi. Penting menyebarluaskan informasi konsumsi energi dan zat gizi yang cukup pada masa laktasi serta peran aktif pemerintah untuk melakukan suplementasi energi dan zat gizi bagi ibu laktasi. Ibu vegetarian juga perlu mengkonsumsi suplemen zat gizi mikro seperti vitamin B12 dan Zn pada saat laktasi.
ABSTRACT
Numbers of vegetarian has increased significantly in recent years. Indonesia Vegetarian Society recorded an increase of its member from 5000 in 1998 to 500000 in 2010. Vegetarian mothers were known to have lower pre-pregnancy nutritional status and posing a greater risk to have lower pregnancy outcomes including lower nutrional status of infant at birth and lower maternal fat stores for lactation. This study aimed at analyzing the effect of vegetarian diet on maternal nutritional status, duration of predominant breastfeeding, and infant growth in the period of 0-6 months postpartum. This study is a longitudinal cohort design and conducted in five cities in Indonesia (Jakarta, Surabaya, Pontianak, Palembang and Pekanbaru) with high population of vegetarian childbearing age women. A number of 85 mother-infant pairs consisted of 42 vegetarian and 43 non-vegetarian were followed until 6 month postpartum period. Based on 24 HR food recall, vegetarian mothers consumed lower intakes of energy, protein, and fat but higher intake of carbohydrate. Vegetarian mothers had significant lower intakes of vitamin B12 and zinc. In both groups, nutrient intakes during lactation were significantly lower than intakes during pregnancy. This study shows that vegetarian diet had no influence on predominant breastfeeding duration, but among non-vegetarian mothers, energy intakes during lactation did affect duration of pre-dominant breastfeeding. Overall, no difference was found for 6 months postpartum BMI between the two groups (p value=0.306). However, after controlled by predominant breastfeeding of 24 weeks, significant difference was found for weight loss during postpartum period (p value=0.047). Among vegetarian mothers, the most influencing factor affecting maternal postpartum BMI was 0 month postpartum BMI (affecting BMI 1- and 2-month postpartum), and pre-pregnancy BMI (affecting BMI 3-month postpartum BMI onward). Among non-vegetarian mothers, the most influencing factor affecting maternal postpartum BMI was 0 month postpartum BMI (affecting BMI 1- to 5-month postpartum) and duration of predominant breastfeeding (affecting BMI 6-month postpartum). Weight growth of infants of vegetarian mothers was higher than that of non-vegetarian mothers (p value=0.009), but no difference was found for infant length growth (p value=0.235). After controlled by predominant breastfeeding of 24 weeks, the difference on infant growth were disappeared. However vegetarian mothers had significantly greater weight loss (p value=0.047). Among vegetarian mothers, the most influencing factor affecting infant weight was infant?s sex (affecting infant weight at month 1 to 6 after birth) while among non-vegetarian mothers was infant birthweight (affecting infant weight at month 1 and 2 after birth), infant?s sex (affecting infant weight at month 3 after birth), and maternal 0 month postpartum BMI (affecting infant weight at month 4 to 6 after birth). The most influencing factor affecting infant length among vegetarian mothers was infant?s sex (affecting infant length at month 1 to 5 after birth) and length at birth (affecting infant length at month 6 after birth), while among non-vegetarian mothers the most influencing factor was infant length at birth (affecting infant length at 1 to 4 after birth) and infant?s sex (affecting infant length at 5 and 6 month after birth.Results of this study supports 6 months exclusive breastfeeding policy for both vegetarian and non-vegetarian, but necessitates nutrition and food consumption related programs during lactation period. It is important to spread information on the importance of adequate energy and nutrient intakes during lactation. Government should take an active role toward supplementation program for lactating mothers. Vegetarian mothers are to balance their diet during lactation period by taking micro-nutrient supplementation such as vitamin B12 and zi |
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