5th NUTRIMET Prosiding Book

UKK NUTRISI & CABANG BALI
PENYAKIT METABOLIK
Nutrition & Metabolic Disease Working Group

Indonesian Pediatric Society
Supported By
Indonesian Pediatric Society – BALI CHAPTER
PROCEEDING
th
Indonesian Pediatric Nutrition
and Metabolic Disease Update
with the theme

Growing Well in A Changing World
Thursday – Friday, Saturday - Sunday

21 – 22, 23 – 24 July 2022
OFFLINE ONLINE
HYATT REGENCY BALI HTTPS://NUTRIMET.ID/
THURSDAY, 21 JULY 2022 FRIDAY, 22 JULY 2022

ONLINE WORKSHOP http://www.nutrimet.id ONLINE WORKSHOP http://www.nutrimet.id
09.00 – 12.40 WITA 09.00 – 12.40 WITA

(Central Ind Time) (Central Ind Time)
PRACTICAL INBORN ERRORS OF METABOLISM PRINCIPLE OF NUTRITION THERAPY TO
IN DAILY PRACTICE PREVENT AND TREATED STUNTING
OFFLINE WORKSHOP - HYATT REGENCY BALI OFFLINE WORKSHOP - HYATT REGENCY BALI
08.30 – 12.30 WITA 13.00 – 17.30 WITA 13.00 – 17.25 WITA

(Central Ind Time) (Central Ind Time) (Central Ind Time)
PARENTERAL AND POST-DISCHARGE PERIOPERATIVE NUTRITION
ENTERAL NUTRITION NUTRITION FOR
IN CRITICALLY ILL PRETERM BABIES
PATIENTS
SATURDAY - SUNDAY, 23 – 24 JULY 2022

5TH NUTRIMET ON-LINE & VIRTUAL EXHIBITION
09.00 – 14.00
(Central Ind Time)
https://nutrimet.id/annual-conference/
th
with the theme

Growing Well in A Changing World UKK NUTRISI & CABANG BALI
PENYAKIT METABOLIK
Thursday – Friday, Saturday - Sunday Nutrition & Metabolic Disease Working Group - Indonesian Pediatric Society
21 – 22, 23 – 24 July 2022 Supported by
Indonesian Pediatric Society – Bali Chapter
WELCOME MESSAGE
Dear Colleagues,
The COVID-19 crisis is disrupting normal life that is harming health and well-being of children worldwide.
The parents and caregivers may either not be able to afford or get out to buy the food that they normally give
their young children. This may mean adapting habits. Children, although less directly affected by the virus,
are paying a heavy price through the indirect effects of the crisis amongst vulnerable groups. The poor diet,
school closures, social distancing and confinement increase the risk of poor nutrition among children.
The real impact of the COVID-19 pandemic on children extends well beyond that of a viral infection. This
crisis has public health implications that could have life-long consequences on children. It requires effective
and targeted measures mainly for vulnerable children and households to guarantee children’s basic rights
for optimal nutrition to protect their immunity, and to ensure their future growth and development. The 5th
Indonesian Pediatric Nutrition and Metabolic Update (5th NUTRIMET) with the theme “Growing Well in A
Changing World” is aimed at discussing the potential impact of the changing world on children’s nutrition and
lifestyle habits of children.
The 5th NUTRIMET will be held from 21 – 22 & 23 – 24 July 2022 by the Nutrition and Metabolic Disease
Working Group/Indonesian Pediatric Society & Indonesian Pediatric Society – Bali Chapter, is to bring
Pediatricians, Nutritionists, Neonatologists, and experts in child development and other specialists to discuss
the challenges of the interplay between nutrition and growth in the pediatric age group. The 5th NUTRIMET
will be equipped with set-skill tools in fruitful on-line workshops on 21 July 2022, and off-line workshops on
21 – 22 July 2022 at Hyatt Regency Bali-Indonesia, and 23 - 24 July 2022 for online conference and virtual
exhibition at https://nutrimet.id/annual-conference/
We hope the annual conference will enable to share the updated knowledge focusing on nutrition and growth
in nutrition and metabolism field.
We look forward to welcoming you in Goddess Island.
Chairman Chairman
5th NUTRIMET 2022 Nutrition and Metabolic Disease Working Group –
Indonesian Pediatric Society
Dr. dr. I Gusti Lanang Sidiartha, Sp.A(K) Dr. dr. Titis Prawitasari, SpA(K)
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ORGANIZING COMMITTEE
ADVISORY BOARD
Chairman Nutrition & Metabolic Disease Working Group/Indonesian Pediatric Society -
Dr. dr. Titis Prawitasari, Sp.A(K)
Chairman Indonesian Pediatric Society – Bali Chapter –

dr. I Gusti Ngurah Sanjaya Putra, SH., Sp.A(K)
ORGANIZING COMMITTEE
Chairman : Dr. dr. I Gusti Lanang Sidiartha, Sp.A(K)

Secretary : Dr. dr. Meta Hanindita, Sp.A(K)
Treasurer : Dr. dr. I Gusti Ayu Putu Eka Pratiwi, Sp.A(K)
Scientific Committee : Dr. dr. Conny MF Tanjung, Sp.A(K)

dr. Yoga Devaera, Sp.A(K)
Dr. dr. I Gusti Lanang Sidiartha, Sp.A(K)
Event Program : dr. Moretta Damayanti, M.Kes, Sp.A(K)

dr. Winra Pratita, M.Ked (Ped), Sp.A(K)
dr. Romy Windiyanto, MSc., Sp.A
Publication & : dr. Rina Pratiwi, M.Si.Med, Sp.A(K)

Documentation : dr. Made Ratna Dewi, MSc., Sp.A
Secretariat : Global Echo Organizer Convex

Ni Nyoman Mirahayu, SE
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GENERAL INFOMATION
EVENT NAME
5th Indonesian Pediatric Nutrition and Metabolic Disease Update (NUTRIMET)
THEME
“Growing Well in A Changing World”
DATES
Thursday – Friday, 21-22 July 2022 : Workshop Online & Offline
Saturday – Sunday, 23 – 24 July 2022 : 5th NUTRIMET Online
ORGANIZED BY
Nutrition & Metabolic Diseases Working Group/Indonesian Pediatric Society
5th NUTRIMET 2022 ONLINE SYMPOSIUM

5th NUTRIMET 2022 will go online on Saturday – Sunday, 23 – 24 July 2022 at https://nutrimet.id/annual-
conference/ in live online sessions with national expertise and overseas guest speakers.
ON DEMAND VIDEO
The live sessions of 5th NUTRIMET 2022 will be recorded and the output of the recordings (on-demand
video) will available at the end of July at https://nutrimet.id/annual-conference/ and can be accessed by the
registrants until 31 August 2022 to enhance the learning purpose of 5th NUTRIMET 2022.
ONLINE WORKSHOP
https://nutrimet.id/
OFFLINE WORKSHOPS VENUE

Hyatt Regency Bali
LANGUAGE
The official language of 5th NUTRIMET 2022 will be both Indonesian and English (for Overseas Speakers
Session) and applied for e-documents, printing, and presentations.
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FORMAT OF THE PROGRAM

LIVE PRESENTATIONS AND DISCUSSION SESSIONS
Each session featuring a series of lectures in specificic themes highlighting various updates in Nutrition &
Metabolic Disease practices, presented by national and international recognized experts. These live sessions
will be aired online on Saturday to Sunday, 23 – 24 July 2022. See detail Timetable.
Time schedule is in Central Indonesian Time (WITA)
VIRTUAL EXHIBITION
The 5th Indonesian Pediatric Nutrition and Metabolic Disease Update (NUTRIMET) will host a virtual
scientific exhibition from 20 - 24 July 2022 in conjunction with the scientific meetings. The virtual exhibition
will take places in https://nutrimet.id/annual-conference/.
FREE PAPER E-POSTER PRESENTATION

Free Paper Presentations are the opportunities for registrants interested in the field of Nutrition & Metabolic
Disease, coming from all provinces, who are willing to communicate the results of their studies, research, or
experiences.
E-Posters will be displayed in E-Poster Gallery at https://nutrimet.id/annual-conference on 23 – 24 July

2022. All participants of the 5th NUTRIMET 2022 are urged to visit and find the E-Poster Presentation of
their interests and join the authors of E-Poster in interactive discussions via Comment Box or WhatsApp
button that connected directly to the presenters’ whatsapp number.
THE BEST E-POSTER PRESENTERS

The Virtual 5th NUTRIMET will select 3 (three) Best E-Posters presented during the conference. The
announcement of Best E-Poster Presenters and rewards will be held on Sunday, 24 July 2022 during closing
remark at 14.10 WITA. All presenters are expected to join online for the announcement.
ONLINE AND OFFLINE WORKSHOPS

The Virtual 5th NUTRIMET, conducted by experts of Nutrition & Metabolic Disease Working Group/
Indonesian Pediatric Society will update participants on the current state-of-art on developing participants’
skill and management of Pediatric Nutrition & Metabolic Disease in couple of comprehensive Online and
Offline Workshops held on 20-21 July 2022 at https://nutrimet.id/annual-conference/ and Hyatt Regency
Hotel Bali – Indonesia
JOIN THE 5th NUTRIMET 2022

As the new normal in the wake of the COVID-19 pandemic, 5th NUTRIMET 2022 will be present in virtual and
adapt to this fast-emerging trend and integrate it into its functional scientific programmed. 5th NUTRIMET 2022
is making it possible to everyone to attend the conference from anywhere. Enjoy your unique experience in
5th NUTRIMET 2022.
HOW TO JOIN THE 5th NUTRIMET 2022:

- The platform can only be accessed by paid Registrants.
-- LOGIN to https://nutrimet.id/ using your registered Email and Password.
-- Go to ANNUAL CONFERENCE and click EXPLORE VIRTUAL 5th NUTRIMET to enter the Main Hall.
-- Participants are granted a full access to enter all virtual rooms (Conference, Workshops, Exhibition,
E-Poster Gallery)
-- The live sessions will use Zoom® application to live stream the presentation of the conference. Please
download and install Zoom® application on your notebook / computer.
-- Even though it’s mobile friendly, using the Notebook and iPad/Tablet with landscape mode and stable
internet connection is strongly recommended to enjoy the virtual platform optimally.
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ON SITE REGISTRATION
Participants who wish to register after the closing of online registration, can contact the Secretariat on
WhatsApp +62811882080 for back-office assistance.
Registration Fee Includess

• Access to all related programs of 5th NUTRIMET 2022 (Live Scientific Sessions, Virtual Exhibition,
E-Poster Gallery)
• Symposium documents materials: Proceeding Book, along with other digital documents if available.
• E-Certificate of Attendance that has been accredited by Indonesian Pediatric Society for Pediatricians
and Indonesian Medical Association for General Practitioners.
E-CERTIFICATE OF ATTENDANCE
This 5th NUTRIMET 2022 provides the Accreditation of Indonesian Pediatric Society for Pediatricians (IDAI)
for Pediatricians and Indonesian Medical Association (IDI) for General Practitioners. The E-Certificate is
provided upon 70% of accumulative online attendance on 24 July 2022 14.00 WITA (Central Indonesian
Time). The CPD Credits is solely CPD’s Right and discretion upon the list of attendance record and proof
for these online sessions. The Workshop’s E-Certificate will be issued at the end of Workshop. No printing
version of certificate will be provided.
SPEAKERS/MODERATOR GUIDELINES
The Virtual 5th NUTRIMET will use Zoom® application to live stream the presentation of the Webinar. Please
download and install Zoom® application on your notebook / computer.
GENERAL GUIDELINES
1. All speakers and moderators must be familiar with the date and time of their sessions. They are
expected to be ready at least 30 minutes before the sessions commence and connect with our
Remote Operation Team ontime.
2. Moderators are required to follow the runthrough and q-card prepared.
3. Speakers are required to complete their presentation within the time frame allocated. Moderators
and speakers are required to adhere the time limits.
4. Moderators are in-charged for presenting each speaker in their sessions and responsibled to
start and end each session on time.
5. Moderators may read the brief resume of the speaker before the presentation started.
Speakers CV/Resume will be displayed on screen.
6. Moderators are in-charged to lead the discussion on related topic.
FORESEEN & REHEARSAL

The rehearsal for speakers and moderator using Zoom application will be held 30 minutes before the Live
Webinar started. We must be able to connect you using your computer with high-speed internet connection.
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PRE - 5th NUTRIMET
WORKSHOPS

PENYAKIT METABOLIK
Nutrition & Metabolic Disease Working Group Indonesian Pediatric Society

Supported By
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with the theme

https://nutrimet.id/annual-conference
Thursday - Friday, 21-22 July 2022
OFFLINE ONLINE
HYATT REGENCY BALI HTTPS://NUTRIMET.ID/
THURSDAY, 21 JULY 2022 FRIDAY, 22 JULY 2022

ONLINE WORKSHOP http://www.nutrimet.id ONLINE WORKSHOP http://www.nutrimet.id
09.00 – 12.40 WITA 09.00 – 12.40 WITA

(Central Ind Time) (Central Ind Time)
PRACTICAL INBORN ERRORS OF METABOLISM PRINCIPLE OF NUTRITION THERAPY TO
IN DAILY PRACTICE PREVENT AND TREATED STUNTING
OFFLINE WORKSHOP - HYATT REGENCY BALI OFFLINE WORKSHOP - HYATT REGENCY BALI
08.30 – 12.30 WITA 13.00 – 17.30 WITA 13.00 – 17.25 WITA

(Central Ind Time) (Central Ind Time) (Central Ind Time)
PARENTERAL AND POST-DISCHARGE PERIOPERATIVE NUTRITION
ENTERAL NUTRITION NUTRITION FOR
IN CRITICALLY ILL PRETERM BABIES
PATIENTS
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PENYAKIT METABOLIK
ONLINE WORKSHOP:
PRACTICAL INBORN ERRORS OF METABOLISM IN DAILY PRACTICE
THURSDAY, 21 JULY 2022 |09.00 - 12.40 WITA| https://www.nutrimet.id
HOW TO JOIN THE WORKSHOP

- Login to https://nutrimet.id/annual-conference/ using your username (email) and password
- Click “Explore Virtual 5th NUTRIMET” to access the Conference Hall
- Click “Workshop Room” and click “Join Live Session”
- Join the Workshop using the ZOOM Meeting facility, where Participants are expected to fill in their Full
Name and Email according to the registration data
- Registrants must take the Pre-Test before attending the workshop
- Participants who have completed the Workshop must take the Post-Test before obtaining the certificate.
WORKSHOP PROGRAM
ONLINE WORKSHOP: PRACTICAL INBORN ERRORS OF METABOLISM IN DAILY PRACTICE

THURSDAY, 21 JULY 2022 [09.00 - 12.40 WITA]
https://www.nutrimet.id
Course Director: Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
WITA TOPIC FACILITATOR

09.00 - 09.10 Pre Test dr. Klara Yuliarti, Sp.A(K)
09.10 - 09.20 Opening & Introduction Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
INTERACTIVE LECTURE
09.20 - 10.00 Clinical Screening & Prompt Treatment Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
Inborn Errors of Metabolism In Daily
Practice
10.00 - 10.15 Case Demonstration Early Detection dr. Klara Yuliarti, Sp.A(K)
and Prompt Treatment Small Molecule
Diseases
10.15 - 10.30 Case Demonstration Early Detection and dr. Cut Nurul Hafifah, Sp.A(K)
Prompt Treatment Organelle Diseases
CASE BASED DISCUSSION
Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
dr. Klara Yuliarti, Sp.A(K)
dr. Cut Nurul Hafifah, Sp.A(K)
dr. Moretta Damayanti, Sp.A(K), M.Kes
Dr. dr. Lanny C. Gultom, Sp.A(K)
10.30 - 11.30 Case Studies
Dr. dr. Nur Aisiyah Widjaja, Sp.A(K)
dr. Bobby Pambudi, Sp.A
dr. Rina Pratiwi, M.Si.Med, Sp.A(K)
dr. Novitria Dwinanda, Sp.A(K)
Dr. dr. Neti Nurani, Sp.A(K), M.Kes
(11.10 - 11.30) Post Test
11.30 - 12.15 Pleno Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K) &
12.15 - 12.30 Pembahasan Post Test dr. Klara Yuliarti, Sp.A(K)
12.30 - 12.40 Wrap-Up & Closing Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
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ONLINE WORKSHOP:
PRINCIPLE OF NUTRITION THERAPY TO PREVENT AND TREATED STUNTING
FRIDAY, 22 JULY 2022 |09.00 - 12.40 WITA| https://www.nutrimet.id
HOW TO JOIN THE WORKSHOP

- Login to https://nutrimet.id/annual-conference/ using your username (email) and password
- Click “Explore Virtual 5th NUTRIMET” to access the Conference Hall
- Click “Workshop Room” and click “Join Live Session”
- Join the Workshop using the ZOOM Meeting facility, where Participants are expected to fill in their Full
Name and Email according to the registration data
- Registrants must take the Pre-Test before attending the workshop
- Participants who have completed the Workshop must take the Post-Test before obtaining the certificate.
WORKSHOP PROGRAM
ONLINE WORKSHOP: PRINCIPLE OF NUTRITION THERAPY TO PREVENT AND TREATED

STUNTING
FRIDAY, 22 JULY 2022 [09.00 - 12.40 WITA]
https://www.nutrimet.id
Course Director: Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)

09.00 - 09.10 Pre Test Dr. dr. Lanny C. Gultom, Sp.A(K)
09.10 - 09.20 Opening & Introduction Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
INTERACTIVE LECTURE
09.20 - 10.00 Principle of Nutrition Therapy to Prevent Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
and Treated Stunting
10.00 - 10.15 Case Demonstration of Nutrition Therapy Dr. dr. Lanny C. Gultom, Sp.A(K)
to Prevent Stunting
10.15 - 10.30 Case Demonstration of Nutrition Therapy dr. Klara Yuliarti, Sp.A(K)
to Treat Stunting
dr. Cut Nurul Hafifah, SpA(K)
10.30 - 11.30 Breakout Rooms
dr. Novitria Dwinanda, Sp.A(K)
dr. Moretta Damayanti, M.Kes, Sp.A(K)
(11.20 - 11.30) Post Test Dr. dr. Lanny C. Gultom, Sp.A(K)
11.30 - 12.15 Pleno dr. Klara Yuliarti, Sp.A(K)
12.15 - 12.30 Pembahasan Post Test Dr. dr. Lanny C. Gultom, Sp.A(K)
12.30 - 12.40 Wrap-Up & Closing Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K)
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OFFLINE WORKSHOP:
PARENTERAL AND ENTERAL NUTRITION IN CRITICALLY ILL PATIENTS
THURSDAY, 21 JULY 2022 | 09.00 - 12.30 WITA | Hyatt Regency Bali
WORKSHOPS RE-REGISTRATION SERVICES

The Re-Registration services will be available for the registered participants in the Registration Counters –
Hyatt Regency Bali during the opening hours at 08.00 – 15.00 since one day before and during the event
dates.
WORKSHOPS RE-REGISTRATION PROCEDURE

- Display your softcopy or printed registration tickets/receipt when your foreseen at Registration Counter
to obtain your ID & Workshop’s Kit.
- The participant’s ID must be worn throughout the workshops program, entering scientific meetings &
lunch program,
WORKSHOP PROGRAM
OFFLINE WORKSHOP: PARENTERAL AND ENTERAL NUTRITION IN CRITICALLY ILL PATIENTS

Hyatt Regency Bali
Course Director: Dr. dr. Titis Prawitasari, Sp.A(K)

08.30 - 08.45 Opening & Pre Test Dr. dr. Titis Prawitasari, Sp.A(K)
INTERACTIVE LECTURE
08.45 - 09.15 Basic of Nutritional Support in Critically Ill Dr. dr. Titis Prawitasari, Sp.A(K)
Patients
09.15 - 09.45 Parenteral and Enteral Nutrition in dr. Moretta Damayanti, M.Kes, Sp.A(K)
Critically ill: What’s The EBM?
09.45 - 10.00 Coffee/Tea Break
Dr. dr. I Gusti Ayu Putu Eka Pratiwi, M.Kes,
10.00 - 11.30 Case Studies Sp.A(K)
Dr. dr. Meta Herdiana Hanindita, Sp.A(K)
Dr. dr. Conny Tanjung, Sp.A(K)
11.30 - 11.45 Post Test
11.45 - 12.00 Wrap-Up & Closing Dr. dr. Titis Prawitasari, Sp.A(K)
12.00 - 12.30 Lunch
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OFFLINE WORKSHOP:
POST-DISCHARGE NUTRITION FOR PRETERM BABIES
THURSDAY, 21 JULY 2022 | 13.30 - 17.00 WITA | Hyatt Regency Bali

dates.

lunch program,
WORKSHOP PROGRAM
OFFLINE WORKSHOP: POST-DISCHARGE NUTRITION FOR PRETERM BABIES

Hyatt Regency Bali
Course Director: dr. Yoga Devaera, Sp.A(K)

13.00 - 13.30 Lunch & Re-Registration
13.30 - 13.40 Pre Test
13.40 - 13.50 Opening & Introduction dr. Yoga Devaera, Sp.A(K)
13.50 - 14.50 INTERACTIVE LECTURE
-What Growth Chart Should We Use
-Detection and Management of Growth
failure
-Available Enteral Nutrition
14.50 - 15.15 Q and A
15.30 - 16.30 Case Studies
16.30 - 17.00 Pleno Discussion Fasilitator Team
17.00 - 17.15 Post Test
17.15 - 17.30 Wrap-Up & Closing dr. Yoga Devaera, Sp.A(K)
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OFFLINE WORKSHOP:
PERIOPERATIVE NUTRITION
FRIDAY, 22 JULY 2022 | 13.30 - 17.00 WITA | Hyatt Regency Bali

dates.

lunch program,
WORKSHOP PROGRAM
OFFLINE WORKSHOP: PERIOPERATIVE NUTRITION

FRIDAY, 22 JULY 2022 [13.30 - 17.00 WITA]
Hyatt Regency Bali
Course Director: Dr. dr. Titis Prawitasari, Sp.A(K) & Dr. dr. Andi Ade Wijaya, SpAn-KAP

13.00 - 13.30 Lunch & Re-Registration
13.30 - 13.40 Opening & Pre Test Dr. dr. Titis Prawitasari, Sp.A(K)
INTERACTIVE LECTURE
13.40 - 14.10 Perioperative Management: Highlight
Dr. dr. Andi Ade Wijaya, Sp.An-KAP
from Anaesthesiologist
14.10 - 14.40 Perioperative Nutrition Support: What,
When and How
14.40 - 15.00 Discussion Dr. dr. Andi Ade Wijaya, Sp.An-KAP &
Group I
15.15 - 16.45
Dr. dr. Andi Ade Wijaya, SpAn-KAP
Group II
dr. Rizky Amaliah, Sp.BA
16.45 - 16.55 Post Test
16.55 - 17.25 Wrap-Up & Closing Dr. dr. Titis Prawitasari, Sp.A(K)
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LIVE SCIENTIFIC
SESSIONS

PENYAKIT METABOLIK

Supported By
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https://nutrimet.id/annual-conference
Saturday - Sunday, 23-24 July 2022
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PENYAKIT METABOLIK
DAY 1, SATURDAY - 23 JULY 2022

Virtual 5th Indonesian Pediatric Nutrition and Metabolic Update (NUTRIMET)
“Growing Well in A Changing World “
SATURDAY - SUNDAY, 23-24 JULY 2022
WITA DAY 1, SATURDAY 23 JULY 2022 - ENSURING GROWING WELL CHILD

09.00 - 09.20 Opening Remarks
Chairman of Indonesian Pediatric Society - Bali Chapter
dr. I Gusti Ngurah Sanjaya Putra, SH, Sp.A(K)
Chairman of Nutrition and Metabolic Disease Working Group/IPS:
President of Indonesian Pediatric Society:
dr. Piprim Basarah Yanuarso, Sp.A(K)
09.20 - 09.30 HEALTH CARE SYSTEM AND DOCTOR’S WORK ETHIC
Prof. Dr. dr. Aryono Hendarto, Sp.A(K) (Jakarta)
INFANT AND NEWBORN BABY
10” Moderator: dr. Moretta Damayanti, M.Kes, Sp.A(K) (Palembang)
09.40 - 10.00 Nutrition for Late Preterm: What Should We Give
dr. Yoga Devaera, Sp.A(K) (Jakarta)
10.00 - 10.20 Growth Trajectory and Infant Feeding Practice: Impact on Body Composition Later On
Prof. dr. Berthold Koletzko, PhD (Munich)
10.20 - 10.40 Discussion
10.40 - 10.50 Virtual Exhibition & E-Poster Viewing
THE STRATEGY OF PREVENTING STUNTING IN CHILDREN
10” Moderator: Dr. dr. I Gusti Ayu Putu Eka Pratiwi, M.Kes, Sp.A(K) (Denpasar)
11.00 - 11.20 Strategy How to Choose Source of Animal Protein for Stunting Prevention
Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K) (Jakarta)
CHILDREN AND ADOLESCENT
10” Moderator: Dr. dr. Meta Herdiana Hanindita, Sp.A(K) (Surabaya)
11.40 - 12.00 How to Stimulate Oral Motor Development in Infancy
Dr. dr. Luh Karunia Wahyuni, Sp.KFR(K) (Jakarta)
12.00 - 12.20 Obesity: Epidemic in Pandemic Era
Prof. Louise Baur MBBS(Hons), PhD, FRACP (Sydney)
SPECIAL SESSION: HOT TOPIC ON PROCESSED FOOD
10” Moderator: Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K) (Jakarta)
‘13.00 - 13.20 Processed Food and Ultra-Processed Food: What’s the Evidence
Prof. Dr. Ir. Sugiyono, M.AppSc (Bogor)
13.20 - 13.40 Processed Food and Ultra-Processed Food: How’s the Regulation
Yusra Egayanti, Ssi, Apt, MP (Jakarta)
ESSENTIAL AMINO ACIDS FOR OPTIMUM GROWTH
10” Moderator: Dr. dr. Conny Tanjung, Sp.A(K) (Jakarta)
14.10 - 14.30 Dr. dr. Titis Prawitasari, Sp.A(K) (Jakarta)
14.40 - 15.00 Virtual Exhibition & E-Poster Viewing - 13 -
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PENYAKIT METABOLIK
DAY 2, SUNDAY - 24 JULY 2022

Virtual 5th Indonesian Pediatric Nutrition and Metabolic Update (NUTRIMET)
“Growing Well in A Changing World “
SATURDAY - SUNDAY, 23-24 JULY 2022
WITA DAY 2, SUNDAY 24 JULY 2022 - NUTRITION FOR SICK CHILDREN

09.00 - 10.10 ACUTE AND CHRONIC CONDITIONS
10” Moderator: Dr. dr. I Gusti Lanang Sidiartha, Sp.A(K) (Denpasar)
09.10 - 09.30 Nutrients and Immune System Orchestra: Let’s Make Harmony
dr. Rina Pratiwi, M.Si.Med, Sp.A(K) (Semarang)
09.30 - 09.50 Perioperative Nutrition: Implementation of ERAS
Dr. dr. Andi Ade Wijaya, Sp.An-KAP (Jakarta)
INBORN ERRORS OF METABOLISM (IEM)
10” Moderator: dr. Klara Yuliarti, Sp.A(K) (Jakarta)
10.20 - 10.40 MRI and Radiologic Clues to Solve the Mystery of IEM
Marc Engelen, MD, PhD (Amsterdam)
10.40 - 11.00 Manifestation of Cardiovascular System in IEM
dr. Cut Nurul Hafifah, Sp.A(K) (Jakarta)
11.00 - 11.20 Recent Update Management of IEM in Indonesia
Prof. Dr. dr. Damayanti Rusli Sjarif, Sp.A(K) (Jakarta)
IMPORTANCE OF NUTRITION FOR CATCH-UP GROWTH IN DISEASE RELATED & NON-
DISEASE RELATED MALNUTRITION
10” Moderator: Dr. dr. Aidah Juliaty A. Baso, Sp.A(K) (Makassar)
12.00 - 12.20 Dr. Yoga Devaera, Sp.A(K) (Jakarta)
SPECIAL SESSION: INSIGHT ON MULTIPLE CONGENITAL ANOMALY
10” Moderator: Dr. dr. Lanny C. Gultom, Sp.A(K) (Jakarta)
12.40 - 13.00 Diagnosis Algorithm of Multiple Congenital Anomaly in Indonesia
Dr. dr. Yulia Ariani, Sp.A(K) (Jakarta)
STRATEGY TO OPTIMIZE GROWTH FOR CHILDREN
10” Moderator: dr. Winra Pratita, M.Ked (Ped), Sp.A(K) (Medan)
13.40 - 14.00 Compliance of Oral Nutrition Supplements for Undernourished Patients
Prof. Dr. dr. Aryono Hendarto, Sp.A(K) (Jakarta)
14.10 - 14.20 Closing Remark
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INDUSTRY ACKNOWLEDGEMENT
The Nutrition & Metabolic Disease Working Group - Indonesian Pediatric Society and Indonesian Pediatric
Society – Bali Chapter would like to wholeheartedly thank the following patrons, who are entitled to be
recognized as loyal patrons and exhibitors in the 5th NUTRIMET 2022
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21 – 22, 23 – 24 July 2022
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HOW TO STIMULATE ORAL MOTOR DEVELOPMENT IN INFANCY

Luh Karunia Wahyuni
Physical Medicine and Rehabilitation Department
Dr. Cipto Mangunkusumo Hospital–Faculty of Medicine Universitas Indonesia, Jakarta
Pendahuluan
Mulut merupakan jendela dunia bagi bayi karena berbagai reseptor pada rongga mulut bayi seperti
reseptor taktil, suhu, rasa, dan gerak merupakan salah satu bagian tubuh yang berperan penting
pada proses sensori integrasi dan merupakan neuromotor utama untuk eksplorasi dan belajar dari
lingkungan. Kemampuan motorik oral melibatkan fungsi gerak otot wajah, rahang, bibir, pipi, lidah, dan
palatum. Mekanisme oromotor adalah sinkronisasi fungsi mengisap-menelan-bernapas. Sinkronisasi ini
merupakan elemen kritis terhadap perkembangan sensorimotor dan perkembangan kognisi termasuk
perkembangan bicara bahasa, kemampuan mengatur regulasi, mengontrol postur, makan, serta
perkembangan ego. Bayi akan belajar dengan cepat untuk menggunakan mekanisme oromotor untuk
menenangkan diri serta mengatur diri agar terjadi proses ketertarikan serta interaksi sosial. Sistem ini
berkembang terlebih dahulu dibandingkan dengan sistem motorik lainnya dan kematangan fungsinya
baru tercapai saat usia 6 – 7 tahun.
Proses makan bagi bayi pada dasarnya berfungsi untuk pemenuhan kebutuhan nutrisi, serta
mempraktikkan berbagai keterampilan motorik lainnya. Pada saat makan, terjadi proses biopsikososial
yang melibatkan berbagai aspek, seperti aspek sensorimotor, maturasi neurologis, kognisi, emosi, serta
interaksi sosial yang khususnya pada hubungan ibu-anak dan lingkup keluarga yang lebih besar.
Gangguan perkembangan fungsi oromotor terkait dengan fungsi makan akan menyebabkan kesulitan
mengisap, menelan, kesulitan koordinasi isap-telan-napas, berisiko terhadap aspirasi, kesulitan
mengunyah, kesulitan beralih tekstur makanan, makanan diemut yang pada akhirnya menyebabkan
asupan nutrisi tidak adekuat.
Karakteristik Perkembangan Kaitannya Dengan Stimulasi Oromotor
Pola perkembangan dan stimulasi akan memengaruhi fungsi oromotor. Berikut adalah karakteristik
perkembangan yang menjadi dasar stimulasi oromotor yakni:
1. Perkembangan kemampuan menstabilisasi dan mengontrol gerakan dimulai dari tubuh bagian
tengah dan proksimal. Kepala adalah bagian distal, sedangkan leher dan bahu merupakan bagian
proksimal batang tubuh. Jika bagian proksimal tidak stabil, maka seluruh fungsi bagian distal akan
terpengaruh. Konsep kontrol proksimal-distal sangat terkait ketika membicarakan fungsi bagian
mulut. Rahang terletak proksimal terhadap bibir, pipi, dan lidah. Kemampuan untuk menstabilkan
rahang perlu berkembang dahulu sebelum keterampilan gerakan bibir dan lidah berkembang.
2. Perilaku motorik manusia pada awalnya adalah refleks primitif alami berupa respon motorik tubuh
secara menyeluruh. Pada awalnya, rahang dan lidah memiliki gerakan yang kasar dan tidak
terarah karena keterbatasan kontrol gerakan di tengah akibat belum terbentuknya stabilitas internal
rahang. Lidah dan rahang tidak dapat bergerak terpisah karena belum ada disosiasi rahang dan
lidah. Saat stabilitas rahang tercapai, bayi dapat menggunakan keterampilan baru tersebut untuk
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mengeksplorasi cara menggigit dan mengunyah makanan yang lebih sulit karena bayi telah mampu
memisahkan gerakan lidah dari gerakan rahang. Pada tahap selanjutnya, bayi akan mampu untuk
menggerakan lidah secara independen untuk menjilat bibir atau meraih makanan pada rongga pipi
dengan adanya stabilitas rahang.
3. Perkembangan gerak bayi dimulai dari gerakan bidang lurus, sebelum mengembangkan
keterampilan bergerak ke lateral, diagonal, atau berputar. Keterampilan oromotor berkembang dari
bidang tegak, diikuti gerakan lateral dan rotasi. Pertama, rahang membuka dan menutup agar dapat
melakukan ekstensi dan fleksi saat mengunyah. Saat bayi diperkenalkan dengan makanan lunak,
bayi akan melakukan gerakan munching yang merupakan pola gerakan awal pada bidang lurus dari
pola ekstensor (membuka) dan fleksor (menutup) mulut. Selanjutnya, rahang akan terlihat bergerak
ke lateral saat makanan bergerak dari sisi ke sisi di dalam mulut bersamaan dengan perubahan
tingkat keterampilan dan tekstur makanan. Pola gerakan rotasi-sirkular akan muncul saat makanan
berada diantara gigi-gigi molar dan dipindahkan secara halus ke sisi yang berlawanan di dalam
rongga mulut.
4. Perkembangan garis tengah memiliki peran penting pada urutan maturasi normal.
Pada bayi baru lahir, rongga mulut sangat kecil dan seluruhnya terisi lidah. Ragam sentuhan
sensoris pada setiap area permukaan lidah dengan batas rongga mulut memungkinkan lidah
mengalami keseluruhan totalitas batasannya sendiri. Lidah pada awalnya bergerak naik-turun
bersama rahang. Saat proses tersebut terjadi, batas bawah dan lateral lidah menjadi lebih jelas.
Saat bayi berlatih mengangkat ujung lidah akan memperluas sensasi horizontal yang membagi
garis tengah. Saat tekstur makanan yang sedikit kental atau tidak halus diperkenalkan pada bayi,
lidah mulai bergerak ke lateral menuju stimulus makanan tersebut. Sensasi diagonal dan rotasi
pada garis tengah didapatkan dari pengalaman menggigit dan mengunyah akibat terjadi gerakan
berputar terhadap tekstur makanan yang lebih berserat karena membutuhkan proses mengunyah
yang lebih kompleks. Saat bayi mampu mengenali garis tengah oral, mereka akan memiliki sensasi
pusat mulut yang lebih jelas.
5. Bayi memiliki kecenderungan kembali ke pola gerakan sebelumnya saat mempelajari komponen
gerakan yang lebih sulit. Pengembalian ke tahap perkembangan awal pola gerakan primitif dapat
terjadi pada perkembangan keterampilan motorik oral. Bayi dengan pengalaman mengunyah
didominasi oleh makanan lembut akan menggunakan pola mengunyah dengan lateralisasi lidah
minimal. Lateralisasi lidah akan meningkat saat pengalamannya bertambah luas untuk mencapai
ketepatan menggigit makanan. Bayi akan mampu melateralisasikan lidah saat dibutuhkan dan
memindahkan makanan melewati garis tengah vertikal serta pola mengunyah rotasi. Saat makanan
menempel dalam rongga mulut, pola lidah ekstensi-retraksi akan muncul kembali.
6. Input sensoris dari lingkungan dapat memengaruhi arah dan seleksi gerakan, serta tipe respon
motorik oral yang dipilih dan digunakan. Aspek sensoris makanan (misalnya ukuran, suapan,
tekstur, suhu, rasa, keasaman, dan alat makan yang digunakan) akan menentukan gerakan yang
dipilih bayi. Maturasi dan perkembangan keterampilan bayi akan membentuk lebih banyak pilihan
gerakan sehingga mereka dapat memilih cara yang paling efisien untuk menangani jenis makanan
tertentu. Misalnya, ketika bayi mengunyah biskuit akan membutuhkan gerak mengunyah vertikal
untuk melembutkan dan menghancurkan makanan, tetapi saat mengunyah buah yang keras, gerak
mengunyah berputar yang lebih matur diperlukan untuk menghancurkan makanan.
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Input sensoris juga dapat memengaruhi makan menggunakan sendok. Saat makanan dimasukkan
menggunakan sendok ke dalam mulut bayi dan ditarik dengan cepat, bayi tidak akan mampu
menggunakan bibir atas untuk membersihkan sendok. Ketika sendok disuapkan lebih pelan, bayi
akan memiliki waktu untuk memberi respon dengan cara menstabilkan rahang dalam posisi terbuka
serta menggerakan bibir atas ke arah bawah untuk membersihkan makanan pada sendok.
Jika makanan terlalu panas, reaksi oral akan cepat dan mengunyah lebih sedikit sebagai usaha
untuk menelan makanan yang tidak menyenangkan secepatnya. Bayi juga dapat merespon dengan
meludah, menangis, atau tersedak. Menyiapkan makanan dengan suhu tepat memungkinkan anak
memilih respon motorik yang lebih matur.
7. Bayi akan memilih gerakan yang paling efisien dan memerlukan usaha minimal. Jika bayi memiliki
pilihan untuk tetap membuka atau menutup bibir saat mengunyah, bayi akan memilih gerakan yang
lebih kompleks dengan menutup bibir untuk menahan agar makanan tidak jatuh. Namun, jika lidah,
rahang, dan pipi mampu menahan makanan tanpa bantuan bibir, maka gerakan mengunyah dengan
mulut terbuka menjadi lebih dominan. Jika makanan dapat ditelan dengan mengisap, maka bayi
tidak akan mengunyah. Melalui hal ini dapat disimpulkan, saat periode transisi bayi menggunakan
keterampilan oromotor yang memerlukan usaha minimal.
Perkembangan Keterampilan dan Cara Stimulasi Oromotor

Stimulasi oromotor perlu memperhatikan perkembangan kemampuan makan pada bayi. Stimulasi ini
bertujuan untuk mengembangkan koordinasi gerakan mulut, respirasi, dan fonasi untuk komunikasi,
meningkatkan koordinasi oromotor untuk kemampuan makan, memiliki pengalaman sensorik saat
makan, serta meningkatkan pemrosesan sensorik seluruh tubuh.
“Periode kritis” merupakan periode waktu penting untuk memperkenalkan stimulus spesifik untuk
membentuk perkembangan tertentu. Setelah periode kritis lewat, gerakan yang perlu dicapai sudah
tidak dapat dipelajari kembali sehingga terjadi kegagalan maturasi neurologis yang menyebabkan
dampak negatif jangka panjang terhadap berbagai sistem. “Periode sensitif” merupakan waktu yang
optimal untuk memberikan stimulus tertentu. Bila periode ini terlewat, bayi akan lebih sulit mempelajari
gerakan atau perilaku tertentu. Solid foods perlu diperkenalkan kepada bayi pada waktu yang tepat. Jika
terlewat, akan menyebabkan terhambatnya fase perkembangan serta bayi dapat menolak solid foods.
Stimulasi oromotor dapat diberikan secara langsung dan tidak langsung. Stimulasi secara langsung
dapat diberikan berupa oral exercises yang bertujuan untuk stimulasi struktur anatomi yang berperan
(bibir, lidah, pipi, dan rahang) dan meningkatkan pengalaman eksplorasi pada area mulut. Sedangkan
stimulus tidak langsung dapat berupa modifikasi lingkungan sekitar, positioning, komunikasi dengan
bayi, serta perubahan jenis makanan dan cara makan.
1. Positioning
Positioning merupakan faktor penting untuk menstimulasi kemampuan makan. Positioning yang tepat
akan membantu bayi merasa rileks, mampu mengontrol postur tubuh, memungkinkan terjadinya kontrol
gerakan optimal pada wajah, rahang, pipi, bibir, dan lidah, serta palatum. Posisi kepala, bahu, batang
tubuh, dan pinggul perlu dibentuk dalam satu kesegarisan sehingga menciptakan stabilitas postural.
Leher tidak boleh hiperekstensi dan dagu tidak boleh hiperfleksi atau dagu menyentuh dada.
Posisi optimal untuk bayi yang belum mampu duduk adalah posisi fleksi fisiologis yakni bahu pada
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posisi protraksi dan aduksi, siku fleksi, tangan mengarah ke wajah atau mulut; vertebra berada dalam
kesegarisan huruf C, panggul pada posisi fleksi dan tilting ke posterior, lutut fleksi dengan sudut
poplitea 90°, serta kaki dalam posisi netral sedikit dorsofleksi. Memosisikan bayi secara tepat dapat
menstimulasi kemampuan dan kekuatan mengisap bayi secara efisien. Posisi fleksi fisiologis juga akan
memfasilitasi pola oromotor bayi, seperti megisap, lip seal, meningkatkan kemampuan menelan, serta
menjaga patensi jalan napas.
Pada bayi dan anak yang sudah mampu duduk, pada saat duduk untuk makan perlu diperhatikan
posisi panggul dan lutut pada posisi fleksi 90° , beban tumpuan tidak terjadi pada os sacrum dengan
kaki menumpu pada posisi pergelangan kaki netral. Pada posisi ini kontrol gerakan pernapasan yang
dominan adalah diafragma, rahang akan lebih stabil sehingga gerakan bibir dan lidah akan optimal.
2. Stimulasi Oral untuk Meningkatkan Kemampuan Minum pada Bayi

Stimulasi oral didefinisikan sebagai tindakan atau stimulasi sensoris pada bibir, rahang, lidah, palatum
mole, faring, dan otot- otot pernapasan yang bertujuan untuk memengaruhi dasar fisiologis mekanisme
orofaring untuk meningkatkan fungsinya. Program stimulasi oral bertujuan untuk memberikan
pengalaman sensoris oral dan mengembangkan koordinasi oromotor untuk meningkatkan kemampuan
minum agar terhindar dari risiko aspirasi.
Stimulasi oral merupakan variasi dari stroking, tapping, dan stretching secara eksternal oral dan
perioral. Filosofi yang mendasari pendekatan ini adalah perkembangan otak (misalnya organisasi dan
koneksi neuronal) terutama diregulasi dan dipengaruhi oleh input dari lingkungan melalui reseptor
sistem sensoris oral, taktil, kinestetik, vestibular, auditoris, olfaktoris, dan visual untuk mempertahankan
dan memfasilitasi perkembangan ketrampilan.
Dikenal berbagai jenis intervensi oromotor misalnya Fucile Oral Stimulation Program (2002), Boiron
Oral Stimulation Protocol (2007), Beckman Oral Motor Intervention (2012). Semua pendekatan terapi
ini menggunakan filosofi yang sama. Perbedaan satu sama lain adalah pada aspek waktu dan frekuensi
stimulasi, regio yang distimulasi, dan ada tidaknya tata laksana lain seperti oral support atau stimulasi
isapan non-nutritif.
3. Stimulasi Makan Menggunakan Sendok

Makan menggunakan sendok dapat mulai diperkenalkan pada bayi saat usia 4 – 6 bulan ketika bayi akan
mulai makan bubur. Ukuran sendok yang dipilih perlu disesuaikan dengan ukuran mulut bayi. Cekungan
sendok cukup dangkal, kokoh, dan tidak pecah bila digigit. Cekungan sendok juga perlu dipilih yang
tidak terlalu dalam agar bibir dan lidah bayi dapat membuat sedikit cekungan pada tepi sendok. Pilih
sendok yang berwarna-warni dan berbentuk menarik agar bayi tertarik untuk makan menggunakan
sendok, serta gagang sendok yang nyaman saat digenggam oleh anak dan ibu.
Saat memberikan makan menggunakan sendok, arahkan sendok setinggi mulut bayi sehingga bayi
dapat menyiapkan diri untuk menyuap makanan, serta mengurangi gerakan yang tidak diperlukan
(seperti ekstensi leher) sehingga memudahkan proses menelan. Hindari menyendokkan sendok ke
arah gusi atau gigi untuk melepaskan makanan dari sendok karena dapat menyebabkan berkurangnya
kontrol dan partisipasi aktif bayi saat makan, serta mengurangi kesempatan bayi untuk mengembangkan
kemampuan oromotornya. Berikan topangan pada bahu, lengan, atau pergelangan tangan untuk
mendukung anak makan sendiri dengan sendok. Intensitas topangan tersebut dapat dikurangi secara
bertahap, seiring berkembangnya kemampuan kontrol motorik bayi.
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4. Stimulasi Minum Menggunakan Gelas

Minum menggunakan gelas dapat dimulai pada usia 6–7 bulan atau setelah 1 bulan makan
menggunakan sendok. Saat minum menggunakan gelas, cairan akan mengalir dari depan rongga
mulut sehingga memerlukan koordinasi gerak baru yang lebih kompleks antara rahang, bibir, lidah,
dan fungsi pernapasan untuk transportasi aktif cairan ke belakang rongga mulut. Pada awalnya, bayi
akan menggigit gelas, tetapi perlahan pola gerak lidah akan berubah menjadi mampu untuk mengisap
aktif dari gelas. Minum menggunakan gelas bertujuan agar bayi mampu mengatupkan, membuka, dan
menutup bibir secara aktif, meningkatkan kekuatan retraksi lidah, melatih gerakan elevasi dan depresi
pada ujung lidah, dan menggerakan rahang secara terukur.
Stabilitas rahang perlu diperhatikan saat memberikan minum dengan gelas pada bayi. Ibu atau caregiver
dapat berdiri dibelakang bayi dan menopang rahangnya dengan telapak tangan. Bayi juga perlu untuk
menggigit tepi gelas untuk mendukung stabilitas internal. Kontak antara gelas dan bibir bawah perlu
dijaga agar tetap stabil. Jangan mudah melepaskan gelas saat bayi minum, tetap ditahan dahulu walau
bayi berhenti minum.
Gelas kosong dapat diperkenalkan terlebih dahulu pada bayi sebelum minum menggunakan gelas. Bayi
dapat diajarkan untuk berpura-pura minum dengan gelas atau mendemonstrasikannya menggunakan
boneka. Pada tahap awal, gunakan cairan yang telah dikenal oleh bayi sebelumnya. Jenis cairan yang
lain dapat diperkenalkan dahulu dengan menggunakan botol dot sebelum minum menggunakan gelas,
seperti jus apel, wortel, dan tomat. Isi cairan setengah dari kapasitas gelas untuk mencegah tumpahnya
cairan dan mendukung kontrol bayi untuk minum. Hindari pemberian tekanan pada bibir bawah.
Arahkan cairan pada sudut bibir atas, sedikit menyentuh bibir bawah, untuk menghindari masuknya
tertuang langsung ke dalam mulut. Menetapkan ritme pemberian minum dapat membantu bayi untuk
memprediksi dan mengontrol proses minum. Meningkatkan konsistensi cairan minum, contoh jus dan
puree, akan mengembangkan kontrol bayi untuk minum.
5. Stimulasi Kemampuan Mengunyah Makanan

Mengunyah adalah proses memecah makanan padat dengan gerakan lidah ke arah lateral, menyebar,
dan bergulir di antara gigi disertai gerakan memutar oleh rahang. Bayi pada umumya mulai mengunyah
pada usia 6–9 bulan. Mengunyah adalah sebuah kemampuan yang yang harus dipelajari oleh anak
dan bukan merupakan gerakan refleks. Munching/mengunyah dengan gerakan rahang vertikal adalah
kemampuan pertama yang berkembang, yang kemudian melalui proses pengulangan berkala hingga
akhirnya bayi mampu mengunyah dengan gerakan diagonal dan melingkar. Bayi mampu mengunyah
secara efisien saat berusia 18 bulan hingga dua tahun, yaitu pada saat bayi dapat mengendalikan
kemampuan mengigit dengan lip seal yang optimal.
Langkah pertama mengajarkan bayi mengunyah, adalah mengurangi stimulus yang berlebihan dari
lingkungan dan fokus pada struktur anatomi yang terlibat pada gerakan mengunyah yakni gerakan
bibir, lidah, dan rahang. Kemudian persiapkan posisi bayi dengan optimal. Stimulasi kemampuan
mengigit dan mengunyah dapat dilakukan dengan stimulasi proprioseptif otot masseter dan pterigoid
serta stimulasi taktil dan gerakan pada bagian lateral lidah sebelum pemberian makan. Pemilihan
jenis makanan menuju padat sangat penting pada usia pembelajaran mengunyah. Secara bertahap
tingkatkan variasi rasa, suhu, tampilan dan tekstur makanan yang beraneka ragam untuk meningkatkan
input sensoris. Makanan yang kering dan manis dapat menstimulasi produksi saliva. Namun makanan
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yang menghasilkan remahan perlu dihindari karena jika bercampur dengan saliva akan menghasilkan
bolus yang lebih kental sehingga lebih sulit dikunyah. Suhu makanan juga perlu diperhatikan agar tidak
menjadi stimulus yang menganggu pola mengunyah bayi. Sediakan mouthing/stimulasi oral dengan
menggunakan mainan anak yang aman untuk meningkatkan kemampuan mengunyah. Terapkan latihan
secara berkala untuk mendapatkan hasil pembelajaran optimal.
6. Stimulasi Minum Menggunakan Sedotan

Minum menggunakan sedotan secara efisien pada umumnya akan berkembang setelah bayi mampu
minum menggunakan gelas. Tidak ada usia tertentu seorang bayi dapat mulai menggunakan sedotan.
Bayi usia 12 bulan dapat mulai menggunakan sedotan, tetapi tidak jarang pula anak usia 3 tahun
tidak mampu menggunakan sedotan. Pertama kali seorang bayi menggunakan sedotan, mereka akan
memasukkan sedotan hingga beberapa sentimeter masuk ke dalam mulutnya dan melingkarkan lidah
pada sedotan dan mulai mengisap. Seiring dengan bertambahnya usia dan latihan, rahang semakin
stabil, lidah bayi akan lebih mendatar, sehingga bibir dan pipi memliki peranan yang lebih dominan
dalam menciptakan tekanan negatif untuk mengisap. Bayi tidak lagi akan menggigit sedotan dan
dapat minum secara efektif dengan sedikit bagian sedotan yang berada di antara bibir. Minum melalui
sedotan adalah aktivitas oral simetris yang membantu maturasi kemampuan minum dan meningkatkan
kemampuan mengontrol gerakan bibir bagian atas.
Stimulasi minum menggunakan sedotan dapat pula dilakukan dengan menempatkan sedotan di atas
gelas berisi cairan, lalu tekan bagian atas sedotan seperti menekan sebuah selang saat menyiram
tanaman. Hal ini akan menghasilkan sebuah tekanan yang menahan cairan di dasar sedotan, lalu
angkat sedotan dan pindahkan ujung bawah sedotan ke mulut bayi. Kemudian lepaskan tekanan pada
sedotan sehingga cairan yang tertahan di dalam sedotan akan menetes. Ketika bayi mulai mengerti
bahwa terdapat cairan di dalam sedotan, bayi akan belajar untuk menutup bibirnya dan mengisap
cairan melalui sedotan.
Daftar Pustaka
1. Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T. Evidence-based systematic review: effects
of oral motor interventions on feeding and swallowing in preterm infants. Am J Speech-Language Pathol.
2010;19:321–40.
2. Adverson J, Brodsky L. Pediatric swallowing and feeding: assessment and management. 2nd ed. NY:
Thomson Learning; 2002. 390–1,438 p.
3. Fucile S, Gisel EG, Lau C. Effect of an oral stimulation program on sucking skill maturation of preterm
infants. Dev Med Child Neurol. 2005;47:158–62.
4. Klein MD, Delaney TA. Feeding and nutrition for the child with special needs. 1994. 99–101,123,175
p.
5. McCurtin A. The manual of paediatric feeding practice. 1st ed. United Kingdom: Speechmark
Publishing Ltd.; 1997. 35,30–2,82–4,122–3 p.
6. Morris SE; Klein MD. Pre-feeding skills. 2nd ed. Satter E, editor. Tucson: Therapy Skill Builders; 2000.
519,537–42 p.
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IRON - A CRITICAL MICRONUTRIENTS IN PREGNANCY, LACTATION AND INFANCY

Berthold Koletzko Maria Hermoso, Christiane Vollhardt, Karin
LMU – Ludwig-Maximilians-Universität Munich, Division of Metabolic and Nutritional Medicine, Dr. von
Hauner Children´s Hospital, Ludwig-Maximilians-University of Munich Medical Centre, Munich, Germany
Correspondence: Prof. Berthold Koletzko. LMU – Ludwig-Maximilians-Universität Munich, Dr. von

Hauner Children’s Hospital. University of Munich Medical Centre. Lindwurmstr. 4, 80337 Munich,
Germany, Phone: 0049 89 5160 2826. Email: office.koletzko@med.uni-muenchen.de
As part of the European Commission funded EURRECA Network of Excellence, we have previously
reviewed the information on the supply, effects and needs of dietary micronutrients in pregnant women
and their children (1-4), given that he World Health Organisation (WHO) reports that on a global basis, a
large proportion of pregnant women, infants and children suffer from micronutrient deficiencies (5). Here
we try to summarise some of the key findings related to dietary iron supply.
Iron deficiency anemia (IDA) continues to be the most frequent form of anemia in pregnancy. IDA increases
the risk for preterm delivery and low birth weight. Iron is also essential for normal fetal development,
including brain development (6). Therefore, IDA in pregnant women must be prevented. The diet before
and during pregnancy should be rich in bioavailable iron. Although it has been suggested to supplement
all pregnant women with a proven effective iron dose (e.g. 30 to 40 mg ferrous iron) (7), there are concerns
about a lack of adequate benefit of such an approach while there are adverse effects particularly in iron
sufficient women. Therefore, a more desirable option could be targeted supplementation to pregnant
women at risk of IDA, e.g. with serum ferritin levels <70 µg/L.
In infancy and early childhood, iron remains a critical substrate due to the rapid growth, development
and hemoglobin expansion during this period of life. The considerable iron deposited at birth can
become exhausted towards the end of the first half year of life in healthy breastfed infants born at full
term. Human breast milk has a low iron content, and the risk of developing IDA is high form the end of
the first half of the first year of life onwards unless additional iron sources are supplied. It is important
to prevent IDA not only because of the direct consequences of anemia, but also because iron is critical
for brain development and function. IDA deficiency in infancy has been associated with marked adverse
effects on later neurodevelopment in several case control studies (8). In affluent populations such as
in European countries, healthy breastfed infants generally do not need iron supplements, and infant
formulae do not need to provide high iron contents during the first months of life when iron stores are
well filled and iron absorption is low (9). From the 5th to the 7th month of age onwards, a good supply
of well bioavailable iron should be provided with complementary feeding in affluent populations (10),
whereas complementary feeding should not be introduced before the 7th month of life in breastfed
infants in low income countries with a high risk of infectious diarrhoea. Iron supplements should not be
given to iron sufficient infants before the 7th month of age because they may induce adverse effects e.g.
on length growth (11), and the effects of iron supplements on the early development of gut microbiota
and associated effects remain to be elucidated (12). However, iron supplements are regularly needed for
preterm and low birth weight infants and for exclusively breast fed term infants in low income countries,
and one needs to weigh benefits against the reported risks of iron supplementation to infants and
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children in endemic malaria areas where increases morbidity and mortality has been reported (12, 13).
With respect to priorities for further research on perinatal iron supply, data should be collected from
observational studies on iron intake and iron status in pregnant women, infants and toddlers in
Europe, considering modifying factors such as dietary choices, iron absorption, and genetic variation.
The conduct of further randomized clinical trials (RCTs) testing the effects of different doses of iron
supplements to pregnant women on maternal and infant outcomes is considered desirable. The effect
of iron supply and status in breastfed infants and in infants randomized to infant formula with different
iron concentrations (e.g. in the range of 2 to 12 mg/L) in a European setting on outcomes such as motor
and cognitive development, iron deficiency anaemia, gut microbiota, infections and immune response
should be investigated, preferably with a long-term follow-up of subjects up to school age. Moreover,
the effects of different iron supply during the second year of life, e.g. with iron-fortified milk compared to
regular cows’ milk, should be explored, considering similar outcomes as mentioned above for infants.
Future observational and intervention studies should take advantage of modern methods to assess
iron metabolism such as measures of hepticin and non-transferrin-bound iron, to assess gut microbiota
development, metabolomic response, genotype, and epigenetic effects.
Conflict of interest:
The authors declare no conflicts of interest i.e. circumstances that involve the risk that the professional
judgment or acts of primary interest may be unduly influenced by a secondary interest.
Acknowledgements
Funding was obtained by the following sources: European Union projects EURRECA (036196), Early
Nutrition (289346I; European Research Council Advanced Grant ERC-2012-AdG No. 322605, META-
GROWTH project, H2020 Programmes DYNAHEALTH- 633595 und Lifecycle-733206, Erasmus+
Programmes Early Nutrition eAcademy Southeast Asia-573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP
and Capacity Building to Improve Early Nutrition and Health in South Africa-598488-EPP-1-2018-1-DE-
EPPKA2-CBHE-JP, the European Joint Programming Initiative Project NutriPROGRAM, the German
Ministry of Education and Research, Berlin (Grant Nr. 01 GI 0825), and German Research Council (DFH
INST 409/224-1 FUGG).
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REFERENCES
1. Hermoso M, Vollhardt C, Bergmann K, Koletzko B. Critical micronutrients in pregnancy, lactation,
and infancy: considerations on vitamin D, folic acid, and iron, and priorities for future research. Annals
of nutrition & metabolism. 2011;59(1):5-9.
2. Hermoso M, Vucic V, Vollhardt C, Arsic A, Roman-Vinas B, Iglesia-Altaba I, et al. The effect of
iron on cognitive development and function in infants, children and adolescents: a systematic review.
Annals of nutrition & metabolism. 2011;59(2-4):154-65.
3. Iglesia I, Doets EL, Bel-Serrat S, Roman B, Hermoso M, Pena Quintana L, et al. Physiological
and public health basis for assessing micronutrient requirements in children and adolescents. The
EURRECA network. Matern Child Nutr. 2010;6 Suppl 2:84-99.
4. Lohner S, Fekete K, Berti C, Hermoso M, Cetin I, Koletzko B, et al. Effect of folate supplementation
on folate status and health outcomes in infants, children and adolescents: a systematic review. Int J
Food Sci Nutr. 2012;63(8):1014-20.
5. World Health Organization, Food and Agricultural Organization of the United Nations. Guidelines
on food fortification with micronutrients. 2006.
6. Cetin I, Berti C, Mandò C, Parisi F. Placental iron transport and maternal absorption Ann Nutr
Metab. 2011.
7. Milman N. Iron in pregnancy - how do we secure an appropriate iron status in mother and child?
Ann Nutr Metab. 2011.
8. Lozoff B, Beard J, Connor J, Felt B, Georgieff M, Schallert T. Long-lasting neural and behavioral
effects of iron deficiency in infancy. Nutr Rev. 2006;64(5):S34-S43.
9. Domellöf M. Iron requirements in infancy. Ann Nutr Metab. 2011.
10. Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, et al. Complementary feeding:
a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2008;46(1):99-
110.
11. Dewey KG, Domellof M, Cohen RJ, Landa Rivera L, Hernell O, Lonnerdal B. Iron supplementation
affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras.
J Nutr. 2002;132(11):3249-55.
12. Hurrell R. Safety and Efficacy of iron supplements in malaria endemic areas. Ann Nutr Metab.
2011.
13. ESPGHAN-Committee-on-Nutrition, Domellof M, Braegger C, Campoy C, Colomb V, Decsi T, et
al. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014;58(1):119-29.
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PROCESSED FOOD AND ULTRA-PROCESSED FOOD : WHAT’S THE EVIDENCE?

Prof. Dr. Ir. Sugiyono, M.AppSc.
Dept. Ilmu dan Teknologi Pangan
IPB University, Bogor, Indonesia
sugiyono@apps.ipb.ac.id
Pendahuluan
Pangan merupakan salah satu kebutuhan dasar untuk pertumbuhan dan perkembangan
manusia. Pangan memberikan zat gizi yang diperlukan bagi pertumbuhan sel dan proses metabolisme
yang normal dalam tubuh. Zat gizi yang diperlukan mencakup zat gizi makro (protein, lemak, karbohidrat)
dan mikro (vitamin dan mineral).
Konsumsi pangan memengaruhi status kesehatan manusia. Konsumsi pangan yang kurang
menyebabkan kekurangan asupan zat gizi yang berakibat pada marasmus, kwashiorkor, anemia,
gangguan penglihatan, gangguan hormonal, dan lain sebagainya. Sebaliknya, konsumsi pangan yang
berlebihan dapat menyebabkan peningkatan risiko penyakit tidak menular (PTM). Konsumsi energi
yang berlebihan dapat meningkatkan risiko obesitas. Konsumsi lemak yang berlebihan dikaitkan dengan
peningkatan risiko penyakit kardiovaskular. Konsumsi garam yang berlebihan dapat meningkatkan
risiko tekanan darah tinggi (hipertensi) dan konsumsi gula yang berlebihan berhubungan dengan risiko
diabetes.
Tidak diragukan bahwa teknologi pengolahan memengaruhi kandungan dan bioavailabilitas
zat gizi dalam pangan. Teknologi pengolahan pangan diperlukan untuk menghasilkan pangan yang
aman, memenuhi kebutuhan gizi, dalam jumlah cukup, dan ketersediaan setiap waktu. Akan tetapi,
sebagian konsumen memiliki persepsi yang negatif terhadap pangan olahan terkait dengan kandungan
gizi dan dampaknya terhadap kesehatan. Mereka memilih pangan segar atau pangan yang diproses
minimal karena dianggap lebih sehat, padahal pangan tersebut mungkin menimbulkan risiko keamanan
mikrobiologis atau keselamatan lainnya (Sammugam dan Pasupuleti 2019).
Dalam satu dekade terakhir, banyak publikasi yang mengaitkan tingkat pengolahan pangan
dengan peningkatan risiko PTM (misalnya obesitas, diabetes tipe 2, kanker, dan lainnya). Hal ini tentu
menarik perhatian banyak pihak baik peneliti, pakar, organisasi, konsumen, maupun media. Dalam
kaitan ini dikenal istilah ultra-processed foods. Konsumsi ultra-processed foods dinyatakan menjadi
penyebab PTM (Knorr dan Watzke 2019). Tulisan ini membahas tentang istilah yang terkait dan
hubungannya dengan risiko PTM berdasarkan data ilmiah yang ada.
Sistem Klasifikasi Pangan NOVA
Secara konvensional, pangan dapat diklasifikasikan menjadi 2 yaitu pangan segar (fresh)
atau mentah (raw) dan pangan olahan. Sesuai dengan penyebutannya, pangan segar adalah pangan
yang belum diolah, seperti buah dan sayur segar, susu segar, ikan segar, daging segar, telur mentah,
dan sejenisnya. Masih termasuk klasifikasi ini pangan segar yang mengalami perlakuan pendinginan
atau perlakuan minimum misalnya pelapisan, pengupasan, pemotongan, atau penggilingan (disebut
juga minimally processed foods). Pangan olahan adalah pangan yang dihasilkan dari pangan segar
(mentah) yang telah diolah melalui proses pengolahan tertentu misalnya pembekuan, penggaraman,
pengeringan, pengasapan, fermentasi, atau pemanasan (Codex 2019).
Pada tahun 2009 dicetuskan sistem klasifikasi pangan NOVA (Monteiro et al 2019). Klasifikasi
ini didasarkan pada “tingkat” dan tujuan pengolahan yang dilakukan terhadap suatu pangan dan
bukan berdasarkan kandungan zat gizi (Monteiro et al 2017). Menurut klasifikasi NOVA, pangan
dikelompokkan menjadi 4 kategori yaitu 1. unprocessed and minimally processed foods, 2. processed
culinary ingredients, 3. processed foods, dan 4. ultra-processed foods (Tabel 1). Kategori unprocessed
and minimally processed foods mencakup pangan segar seperti di atas dan pangan segar yang telah
mengalami proses pengolahan minimum seperti pengupasan, pemotongan, pengeringan, penggilingan,
penyangraian, perebusan, fermentasi non-alkohol, pasteurisasi, pendinginan, pembekuan, atau
pengemasan. Proses pengolahan tersebut dimaksudkan untuk mengawetkan, memudahkan
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penyimpanan, menjadikan pangan lebih aman dan lebih enak dikonsumsi. Contoh pangan kategori ini
antara lain buah dan sayur segar atau yang dikeringkan, nasi, susu parteurisasi atau susu bubuk, sari
buah pasteurisasi, yogurt plain, teh, kopi, dan air mineral.
Kategori processed culinary ingredients mencakup minyak, lemak, gula, dan garam. Pangan
kategori ini diperoleh dari pangan kategori 1 atau dari alam melalui proses pengepresan, pemurnian,
penggilingan, dan pengeringan. Pangan ini tidak biasa dikonsumsi sendiri, tetapi dikonsumsi bersama
pangan lain atau menjadi ingredien pangan olahan lain (Monteiro et al 2019). Sebagai contoh, minyak
terdapat pada pangan olahan yang digoreng, lemak dan gula digunakan pada produk bakeri (roti,
biskuit, dan sejenisnya). Garam pada umumnya digunakan pada semua jenis pangan olahan.
Kategori processed foods (PF) mencakup pangan olahan yang dikalengkan seperti buah dalam
kaleng dengan medium sirup, sayur dalam kaleng dengan medium air garam, kacang-kacangan yang
diberi garam atau gula, ikan dalam kaleng, daging dalam kaleng, daging atau ikan yang diberi garam,
dikeringkan, dikuring atau diasap, dan roti yang baru dibuat dan tidak dikemas (freshly made unpackaged
breads). Pangan kategori ini dbuat dari pangan kategori 1 dengan penambahan pangan kategori 2.
Proses pengolahannya dilakukan melalui pemasakan/pemanasan, penggaraman, pengasapan, kuring,
atau fermentasi non-alkohol, untuk memperpanjang masa simpan dan memperbiki mutu sensorinya
(Monteiro et al 2019). Pangan olahan kategori ini umumnya mengandung minyak/lemak, gula, dan
garam, bahkan beberapa di antaranya mengandung lemak, gula, atau garam dalam kadar yang relatif
tinggi.
Kategori ultra-processed foods (UPF) merupakan pangan olahan yang diproduksi menggunakan
formulasi bahan baku yang “mostly of exclusive industrial use” melalui serangkaian proses pengolahan
skala industri. Yang termasuk pangan kategori ini di antaranya minuman ringan karbonasi, makanan
ringan manis/gurih dalam kemasan, cokelat, permen, es krim, roti hasil produksi pabrik besar (mass-
produced packaged breads), margarin dan produk olesan lain, biskuit, pastri, cake, bahan campuran
cake, sereal sarapan, cereal bars, minuman energi, minuman susu, yogurt buah, minuman buah,
minuman cokelat, saus instan, pai, pasta, pizza, nuget ayam/ikan, sosis, burger, sup instan, mi instan,
formula bayi, susu lanjutan, dan makanan bayi lainnya (Monteiro et al 2019).
Tabel 1. Sistem klasifikasi pangan NOVA
Kategori Definisi Contoh
1: Unprocessed Edible parts of plants Fresh, squeezed, chilled, frozen, or
Unprocessed (fruit, seeds, leaves, stems, roots, dried fruit and leafy and root vegetables;
and tubers) or of or from animals (muscle, grains such as brown, parboiled or white
minimally fat, offal, eggs, milk), and also fungi, rice, corn cob or kernel, wheat berry or
processed algae, all after separation from nature. grain; legumes such as beans, lentils,
foods Spring and tap water. Minimally and chickpeas; starchy roots and tubers
processed such as potatoes, sweet potatoes and
Unprocessed foods altered by industrial cassava; fungi such as fresh or dried
processes such as removal of inedible mushrooms; meat, poultry, fish and
or unwanted parts, drying, powdering, seafood, whole or in the form of steaks,
squeezing, crushing, grinding, fillets and other cuts; fresh, powdered,
fractioning, steaming, poaching, boiling, chilled or frozen eggs; fresh, powdered or
roasting, and pasteurization, chilling, pasteurized milk; fresh or pasteurized fruit
freezing, placing in containers, vacuum or vegetable juices (with no added sugar,
packaging, non-alcoholic fermentation, sweeteners or flavours); grits, flakes
and other methods that do not add or flour made from corn, wheat, oats,
salt, sugar, oils or fats or other food or cassava; tree and ground nuts and
substances to the original food. other oily seeds (with no added salt or
sugar); herbs and spices used in culinary
preparations, such as thyme, oregano,
mint, pepper, cloves and cinnamon,
whole or powdered, fresh or dried; fresh
or pasteurized plain yoghurt; tea, coffee,
and drinking water.
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2: Substances obtained directly from Vegetable oils crushed from seeds, nuts
Processed group 1 foods or from nature by or fruit (notably olives); butter and lard
culinary industrial processes such as pressing, obtained from milk and pork; sugar and
ingredients centrifuging, refining, extracting or molasses obtained from cane or beet;
mining. Used to prepare, season and honey extracted from combs and syrup
cook group 1 foods. May contain from maple trees; starches extracted
additives that prolong product duration, from corn and other plants; vegetable oils
protect original properties or prevent with added anti-oxidants; salt mined or
proliferation of microorganisms. from seawater, and table salt with added
drying agents.
3: Products made by adding salt, oil, Canned or bottled vegetables and
Processed sugar or other group 2 ingredients legumes in brine; salted or sugared
foods to group 1 foods, using preservation nuts and seeds; salted, dried, cured,
methods such as canning and or smoked meats and fish; canned fish
bottling, and, in the case of breads (with or without added preservatives);
and cheeses, using non alcoholic fruit in syrup (with or without added
fermentation. anti-oxidants); freshly made unpackaged
breads and cheeses.
4 : Ultra- Formulations of ingredients, mostly of Many ready-to-consume products such
processed exclusive industrial use, made by a as carbonated soft drinks; sweet or
foods series of industrial processes, many savoury packaged snacks; chocolate,
requiring sophisticated equipment and candies (confectionery); ice-cream;
technology (hence ‘ultra-processed’). mass-produced packaged breads and
Processes used to make ultra- buns; margarines and other spreads;
processed foods include the fractioning cookies (biscuits), pastries, cakes, and
of whole foods into substances, cake mixes; breakfast ‘cereals’, ‘cereal’
chemical modifications of these and ‘energy’ bars; ‘energy’ drinks; milk
substances, assembly of unmodified drinks, ‘fruit’ yoghurts and ‘fruit’ drinks;
and modified food substances using ‘cocoa’ drinks; ‘instant’ sauces. Many
industrial techniques such as pre-prepared ready-to-heat products
extrusion, moulding and pre-frying; including pies and pasta and pizza
use of additives at various stages of dishes; poultry and fish ‘nuggets’ and
manufacture whose functions include ‘sticks’, sausages, burgers, hot dogs, and
making the final product palatable or other reconstituted meat products; and
hyper-palatable; and sophisticated powdered and packaged ‘instant’ soups,
packaging, usually with plastic and noodles and desserts. Infant formulas,
other synthetic materials. follow-on milks, other baby products;
‘health’ and ‘slimming’ products such as
meal replacement shakes and powders.
Sumber : Monteiro et al (2019)
Dalam sistem klasifikasi pangan NOVA, telah banyak dipelajari tentang kaitan antara
konsumsi UPF dengan kualitas diet dan faktor risiko PTM. Gibney et al (2017) melakukan
penilaian komprehensif dan kritis terhadap sistem klasifikasi pangan NOVA. Definisi UPF sejak
awal kemunculannya telah berubah-ubah, demikian juga dengan contoh-contohnya (Gibney et al
2017, Gibney 2019). Hal ini menunjukkan adanya kesulitan menentukan batasan yang jelas dan
intrepretasinya terhadap batasan tersebut. Sebagai akibatnya, definisi maupun contoh pangannya
menjadi tidak konsisten. Dalam definisi UPF disebutkan istilah “formulasi ingredien” yang membuka
adanya interpretasi yang luas atau berbeda-beda. Semua pangan olahan yang dibuat dari lebih
1 jenis ingredien tentu dengan formulasi tertentu. Konsekuensinya adalah penyebutan contoh
pangannya juga menimbulkan perbedaan pendapat. Gibney et al (2017) menyatakan bahwa istilah
yang digunakan untuk mendefinisikan UPF dan contoh pangannya tidak memenuhi standar normal
dalam sistem klasifikasi pangan. Sistem klasifikasi NOVA tampak terlalu umum dan menimbulkan
perdebatan.
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Steele et al (2016) menyatakan bahwa sistem klasifikasi pangan NOVA membingungkan

bagi ahli teknologi pangan karena penamaan klasifikasinya berdasarkan “tingkat” atau tujuan proses
pengolahan, tetapi klasifikasinya sebenarnya tidak berdasarkan pada hal tersebut. Fardet dan
Rock (2019) menyatakan bahwa sistem klasifikasi pangan NOVA telah dikritik karena hanya bersifat
kualitatif dan dinilai tidak tepat. Demikian juga dengan konsep UPF, telah secara konsisten dikritik
karena menjadi konsep yang terlalu heterogen. Knorr dan Watkze (2019) menyatakan bahwa definisi
dalam sistem klasifikasi NOVA tidak mengacu pada proses pengolahan pangan, tetapi menekankan
adanya formulasi, pengggunaan bahan tambahan pangan (BTP), dan komposisi zat gizi pangan.
Sadler et al (2021) menyatakan bahwa penggunaan sistem klasifikasi pangan NOVA
untuk memprediksi kualitas diet dan dampaknya bagi kesehatan merupakan hal ambigu, tidak
konsisten, dan seringkali mengabaikan bukti ilmiah tentang zat gizi, dan pengaruh proses
pengolahan pangan. Tanpa definisi kategori yang tepat dan kategori yang saling eksklusif,
potensi kesalahan klasifikasi tinggi. Dengan demikian, perlu pendekatan yang lebih holistik dan
realistis dengan mempertimbangkan sifat, kuantitas, fungsi, tingkat pengolahan, dan pengaruh
pengolahan terhadap matrik pangan, sebagai modifikasi dari sistem klasifikasi NOVA (Capozzi
et al 2021).
Processed Foods (PF) dan Ultra-Processed Foods (UPF)

Monteiro et al (2019a) menjelaskan bahwa pada prinsipnya yang membedakan PF dan UPF
adalah bahan baku dan proses pengolahannya. PF dibuat dari bahan baku yang umum digunakan
di rumah tangga, sedangkan UPF dibuat dari bahan baku industri yang “tidak umum” digunakan di
rumah tangga seperti sirup fruktosa, konsentrat sari buah, gula invert, maltodekstrin, dekstrosa, laktosa,
minyak/lemak yang telah mengalami hidrogenasi atau interesterifikasi, protein terhidrolisis, isolat
protein kedelai, gluten, kasein, protein whey, dan serat larut/tidak larut. Gula, minyak/lemak, dan garam
merupakan bahan yang umum digunakan dalam produksi UPF.
Pada produksi UPF juga digunakan BTP seperti pengemulsi, pengental, penstabil, anti-buih,
karbon dioksida, pembentuk gel, bahan pelapis, pemanis, pewarna, perisa, penguat rasa, dan yang
lain untuk menghasilkan pangan olahan yang memiliki rasa enak atau sangat enak (palatable or hyper-
palatable). Monteiro et al (2019) menyatakan bahwa penggunaan BTP tersebut dimaksudkan untuk
menutupi bahan baku yang murah atau memberi produk akhir sifat sensori yang sangat menarik (warna,
tekstur, aroma, rasa).
Monteiro et al (2019) menyatakan bahwa proses pembuatan UPF mencakup proses “fraksinasi”
pangan utuh menjadi ingredien seperti gula, minyak/lemak, protein, pati, atau serat, modifikasi ingredien
tersebut, dan pencampuran ingredien yang telah dimodifikasi dengan ingredien yang belum dimodifikasi.
UPF dikemas dengan kemasan canggih dan pada umumnya menggunakan plastik dan bahan sintetik
lain. Lebih lanjut Monteiro et al (2019a) menjelaskan bahwa UPF memiliki sifat praktis (convenient)
atau siap konsumsi (ready to eat), dan umur simpan lama (awet). UPF diproduksi oleh perusahaan
multinasional dan menggunakan bahan baku yang murah.
Monteiro et al (2019) menjelaskan bahwa cara praktis untuk mengidentifikasi apakah produk
pangan termasuk UPF adalah dengan melihat komposisi bahan yang digunakan pada labelnya. Jika
pada komposisi bahan terdapat BTP yang tidak pernah atau jarang digunakan di rumah tangga atau
BTP yang membuat produk akhir menarik atau enak, maka produk tersebut termasuk UPF. Demikian
juga jika produk tersebut dikemas dalam kemasan canggih dengan bahan sintetis, maka produk tersebut
termasuk UPF.
Bahan-bahan hasil proses “fraksinasi” pangan utuh seperti gula, garam, minyak/lemak, dan
pati merupakan ingredien yang umum digunakan di rumah tangga dan industri kecil dalam proses
pembuatan pangan olahan. Bahkan bahan yang disebutkan oleh Monteiro et al (2017, 2019) “tidak
umum” digunakan dalam rumah tangga seperti sirup fruktosa, lemak terhidrogenasi, isolat protein
kedelai, saat ini dapat diperoleh dengan mudah oleh setiap orang. Demikian juga dengan BTP seperti
bahan pengembang (baking powder atau baking soda), pewarna, perisa, juga sudah umum digunakan
di rumah tangga dan industri kecil pangan. Bahan kemasan plastik juga sudah biasa digunakan pada
pangan yang dikemas, baik pangan produksi rumah tangga, industri kecil atau industri besar. Jika
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menggunakan kriteria UPF yang dinyatakan Monteiro et al (2017, 2019), maka pangan olahan yang
dihasilkan oleh rumah tangga dan industri kecil juga termasuk UPF karena menggunakan bahan-bahan
di atas termasuk BTP dan kemasan plastik. Semua pangan olahan komersial, termasuk yang dihasilkan
oleh industri besar, memenuhi kriteria UPF tanpa melihat kandungan zat gizinya. Sebagai contoh, roti
yang baru dibuat dan tidak dikemas (freshly made unpackaged breads) termasuk PF, sedangkan roti
yang diproduksi oleh industri besar dan dikemas (mass-produced packaged breads) termasuk UPF,
padahal prinsip proses pengolahan dan kandungan zat gizi roti tersebut sama. Contoh lain, yogurt plain
termasuk pangan olahan minimal, tetapi jika ditambah buah atau gula, maka seketika akan berubah
menjadi UPF (Steele et al 2016), padahal proses pengolahannya sama. Hal ini menunjukkan tidak
konsistennya klasifikasi NOVA yang dibuat berdasarkan tingkat pengolahan. Klasifikasi NOVA dinilai
sangat kasar dan dapat menyesatkan, apalagi jika tujuan klasifikasinya untuk menilai kandungan zat
gizi dalam pangan olahan.
Bagi kebanyakan konsumen, sifat UPF yang praktis (convenient) atau siap konsumsi (ready
to eat) dan awet, memang dikehendaki. Sifat tersebut tidak berarti bahwa produk mengandung BTP
pengawet. Sifat tersebut diperoleh melalui proses pengolahan, misal sterilisasi dengan panas. Sifat
tersebut juga tidak ada kaitannya dengan kandungan zat gizinya.
Pada umumnya industri pangan menerapkan spesfifikasi mutu dan keamanan yang ketat
terhadap bahan baku yang digunakan. Hal ini dimaksudkan untuk menghasilan produk yang memenuhi
standar atau spesfikasi mutu dan keamanan yang berlaku. Tidak selamanya bahan baku yang
digunakan oleh industri harganya murah. Banyak bahan baku spesifik yang harganya sangat mahal.
Bahan baku umum yang dibeli oleh industri sangat mungkin harganya murah karena pembeliannya
pada skala besar dan kontinyu. Bahan baku yang murah tidak berarti mutunya tidak baik.
Penggunaan BTP telah diatur dalam Codex General Standard for Food Additives (2019) maupun
Peraturan Badan Pengawas Obat dan Makanan (BPOM) no. 11 tahun 2019 tentang Bahan Tambahan
Pangan. Pada ketentuan tersebut diatur jenis BTP yang diizinkan dan batas maksimum penggunaannya
pada masing-masing jenis pangan olahan. Ketentuan tersebut didasarkan pada kajian keamanan dan
fungsi teknologi. Dengan demikian penggunaan BTP pada pangan olahan sesuai dengan ketentuan
dinyatakan aman. Penggunaan BTP dilarang untuk menutupi cacat/rusak atau penggunaan bahan baku
yang tidak baik mutunya.
Konsumsi UPF dan Profil Gizi Diet (Nutrient Profile of Overall Diet)
Sistem klasifikasi pangan NOVA telah digunakan untuk menilai kualitas diet. Banyak
hasil penelitian yang menghubungkan konsumsi UPF dengan kualitas diet pada suatu populasi
(Tabel 2). Monteiro et al (2019) telah menelaah banyak hasil penelitian yang menyatakan
bahwa konsumsi UPF secara signifikan meningkatkan asupan gula/bebas gula yang berlebih
(di 8 negara yaitu Amerika Serikat, Brasil, Inggris, Chile, Kanada, Kolombia, Australia, dan
Meksiko), lemak jenuh berlebih (di 10 negara), lemak trans berlebih (di 3 negara yaitu Brasil, Chile dan
Australia), natrium berlebih (di Inggris, Australia, dan Belgia), tetapi studi di Chile, Amerika Serikat dan
Kanada menunjukkan tidak ada hubungan antara konsumsi UPF dengan asupan natrium, peningkatan
densitas energi (di Australia, Kanada, Chile, Kolombia, dan Meksiko). Sebaliknya, konsumsi UPF
menyebabkan penurunan asupan protein (di semua negara kecuali Belgia dan Australia), kekurangan
asupan serat (di 8 negara yaitu Amerika Serikat, Brasil, Inggris, Kanada, Chile, Kolombia, Australia, dan
Meksiko), peluang kekurangan asupan kalium (di 7 negara yaitu Amerika Serikat, Brasil, Kanada, Chile,
Inggris, Australia, dan Taiwan), dan asupan fitoestrogen (di Amerika Serikat).
Monteiro et al (2019) juga menyatakan bahwa konsumsi UPF menyebabkan penurunan asupan
beberapa zat gizi mikro yaitu vitamin A, C, D, E, kalsium, magnesium, fosfor dan seng (di Amerika
Serikat), vitamin D, E, B12, niacin, pyridoxine, tembaga, besi, magnesium, fosfor, selenium dan seng
(di Brasil), vitamin A, C, D, E, B12, niacin, thiamine, riboflavin, kalsium, besi, magnesium, fosfor dan
seng (di Kanada), vitamin A, C, D, B6, niacin, thiamine, magnesium, kalsium dan besi (di Taiwan). Akan
tetapi, di Brasil ditemukan data peningkatan konsumsi UPF menyebabkan peningkatan asupan kalsium.
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Di Amerika Serikat, ditemukan hubungan terbalik antara konsumsi UPF dengan asupan pangan
yang sehat yaitu tinggi serat, kalium, magnesium, vitamin C, lebih sedikit gula, dan lemak jenuh. Di
Brasil, terdapat hubungan terbalik antara konsumsi UPF dengan asupan pangan yang sehat yaitu tinggi
protein dan zat gizi mikro, dan less/free sugar. Akan tetapi, terdapat hubungan langsung yang signifikan
antara konsumsi UPF dengan asupan diet tidak sehat yaitu lebih banyak lemak jenuh dan lemak trans,
serta kurang serat (Monteiro et al 2019).
Tabel 2. Hasil penelitian yang menghubungkan asupan UPF dan profil gizi dalam
keseluruhan diet
Peneliti Populasi Zat gizi Temuan penting
yang diteliti
US The dietary share of ultra-processed foods
population was inversely related to the relative diet
aged 2 years content in protein and positively related with
Protein and
Steele et al or total energy intake. Due to the increase in
energy
(2017) older in total energy intake with the increase in ultra-
intake
2009- processed food intake, the absolute protein
2010 (n=9 intake remained relatively constant across
042) quintiles.
Increases in the dietary share of ultra-
Chilean
processed foods were associated with diets
population
higher in added sugar. The upper quintile of
aged
Cediel et al ultra-processed consumption showed three
2 years or Added sugar
(2017) times as many individuals with excessive
older
added sugar intake (≥ten percent of total
in 2010 (n=4
energy intake) compared to the lower
920)
quintile.
Increases in the dietary share or ultra-
UK
Protein, processed foods were associated with diets
population
carbohydrate, higher in free sugars and saturated fat, and
aged 1.5
free sugar, lower in fibre, protein and potassium. The
Rauber et al year or
saturated prevalence of people exceeding the upper
(2018) older in
fat, fibre, sodium, limits recommended for free sugars and
2008-
and sodium increased by 85 percent and 55
2014 (n=9
potassium percent, respectively, from the lowest to the
364)
highest ultra-processed food quintile.
Belgian Increases in the dietary share of ultra-
population processed foods were associated with higher
aged Sodium, saturated risk of diets with excessive content in sodium
Vandevijvere
from 3 to 64 fat and saturated fat.
et al (2018)
years in and trans fat
2014/5
(n=3 146)
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Protein, Increases in the energy intake of ultra-

carbohydrate, processed foods were associated with
total, saturated, diets higher in saturated fat, and lower in
monounsaturated protein, vitamins A, C, D, B1, and B6, niacin,
and potassium, magnesium, calcium, and iron
polyunsaturated as well as with an increased risk of poor
Taiwanese fats, dietary quality (ten percent increase in
adolescents vitamins A, E, D, ultra-processed food intake=OR:1.33; CI 95
Chen et al aged B1, percent 1.16 to 1.52).
(2018) 16-18 years B2, B6, B2, niacin,
in potassium,
2011 (1 274) magnesium,
calcium, iron and
dietary quality
evaluated with the
Youth Healthy
Eating
Index–Taiwan
Colombian Increases in the dietary share of ultra-
population Energy density, processed foods were associated with diets
aged protein, free higher in energy density, free sugars, and
Parra et al
from 1 to 64 sugar, saturated fat, and lower in protein and fibre.
(2019)
years in saturated fat, and
2005 fibre
(n=38 643)
Increases in the dietary share of ultra-
processed foods were associated with higher
energy density, free sugars, sodium, and
Australian Energy density, saturated and trans fats, and lower in fibre
population free and potassium. The prevalence of non-
aged sugar, saturated recommended intake levels of all studied
Machado et
2 years or and nutrients increased linearly across quintiles
al (2019)
older trans fats, fibre, of ultra-processed food intake, notably from
in 2011-2012 sodium, and 22 percent to 82 percent for free sugars, from
(n=12 153) potassium 6 percent to 11 percent for trans-fat, and from
2 percent to 25 percent for dietary energy
density, from the lowest to the highest ultra
processed food quintile.
Mexican Increases in the dietary share of ultra-
population Energy density, processed foods were associated with diets
aged protein, added higher in energy density, added sugars and
Ponce et al
1 year and sugar, saturated fat, and lower in protein and fibre
(2019)
older saturated fat, and
in 2012 fibre
(n= 10 087)
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Chilean Energy density, Increases in the dietary share of ultra-

population free processed foods were associated with
aged sugar, saturated diets higher in energy density, free sugars,
Cediel et al
2 years or and saturated and trans fats, and sodium/
(2020)
older trans fats, fibre, potassium ratio, and lower in fibre and
in 2010 (n=4 sodium, and potassium.
920) potassium
Sumber : Modifikasi dari Monteiro et al (2019)
Secara keseluruhan, banyak penelitian tentang kualitas diet menunjukkan terdapat hubungan
signifikan antara konsumsi UPF dan kualitas diet yang mengarah pada risiko PTM. Kualitas diet yang
dimaksud adalah densitas energi tinggi, kandungan gula tinggi, kandungan lemak jenuh dan lemak trans
tinggi, dan natrium tinggi, tetapi kandungan protein, serat, dan kalium yang tidak mencukupi (Monteiro
et al 2019).
Penelitian yang menghubungkan konsumsi UPF dengan profil gizi diet ternyata tidak selalu
menunjukkan hasil yang konsisten. Tabel 3 menunjukkan hubungan antara tingkat konsumsi UPF
dengan profil gizi diet di Inggris, Brasil, Perancis, Kanada, dan Amerika Serikat. Berdasarkan data
tersebut, Gibney (2019) menyatakan bahwa konsumsi UPF berhubungan dengan asupan gula dan
serat, tetapi tidak ada hubungan dengan asupan lemak total, lemak jenuh, dan natrium. Dalam hal
ini terdapat kecenderungan peningkatan asupan gula ketika konsumsi UPF meningkat, sebaliknya
konsumsi serat cenderung menurun dengan meningkatnya asupan UPF. Hal ini tidak mengejutkan
karena pangan olahan ditambah gula termasuk UPF, sedangkan sumber makanan utama serat (buah
dan sayur segar, kacang-kacangan, serealia utuh, dan lain-lain) tidak termasuk UPF. Asupan lemak
di seluruh kuintil atau kuartil UPF menunjukkan data yang bervariasi. Asupan lemak jenuh tidak
dipengaruhi oleh tingkat asupan UPF. Asupan natrium tidak menunjukkan kecenderungan meningkat
dengan meningkatnya konsumsi UPF, bahkan di Brasil, asupan natrium cenderung menurun dengan
meningkatnya konsumsi UPF.
Negara Q1 Q2 Q3 Q4 Q5
Energi, kkal
Inggris 1732 1766 1784 1776 1763
Brasil 1708 1794 1841 1920 2067
Perancis 1765 1854 1884 1911 NA
Kanada 1936 2031 2109 2120 1911
Amerika Serikat NA NA NA NA NA
Ultra-processed food, %
energi 35 49 57 65 78
Inggris 2 10 18 29 49
Brasil NA NA NA NA NA
Perancis 24 39 49 60 76
Kanada 33 49 58 67 81
Amerika Serikat
Karbohidrat, % energi
Inggris 46 47 49 50 52
Brasil 57 57 56 56 55
Perancis 42 43 43 44 NA
Kanada 49 50 51 53 54
Amerika Serikat 47 49 50 51 53
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Free (f) or added (a) sugars,

% energi
Inggris (a) 9.9 11.3 12.2 13.4 15.4
Brasil (f) 10.9 13.1 15.0 17.6 20.2
Perancis (a) 6.5 7.2 7.9 9.4 NA
Kanada (a) 7.7 11.7 13.4 16.1 19.4
Amerika Serikat (a) 7.7 11.0 13.4 15.7 19.2
Lemak, % energi
Inggris 31 32 32 33 33
Brasil 24 25 27 28 30
Perancis 39 39 40 40 NA
Kanada 31 32 33 33 33
Amerika Serikat 31 32 33 33 33
Lemak jenuh, % energi
Inggris 11.7 12.2 12.2 12.2 12.2
Brasil 7.9 8.5 9.1 10.0 8.9
Perancis 16.4 16.1 16.2 16.1 NA
Kanada 10.2 10.8 10.9 10.9 10.6
Amerika Serikat 10.1 10.7 10.9 10.9 10.9
Serat, g/1000 kkal
Inggris 8.4 8.0 7.8 7.5 6.9
Brasil 13.0 11.9 11.3 10.3 8.9
Perancis 12.3 11.0 10.3 9.7 NA
Kanada 9.7 8.6 8.4 7.8 6.8
Amerika Serikat 9.6 8.9 8.2 7.4 6.7
Natrium, g/1000 kkal
Inggris 1.1 1.2 1.2 1.2 1.3
Brasil 1.9 1.8 1.7 1.7 1.6
Perancis 1.5 1.5 1.5 1.4 NA
Kanada 1.5 1.5 1.5 1.5 1.5
Amerika Serikat 1.7 1.7 1.7 1.7 1.6
Tabel 3. Asupan zat gizi dan pangan berdasarkan kuintil atau kuartil konsumsi UPF di Inggris,
Brasil, Perancis, Kanada, dan Amerika Serikat
Sumber : Rauber et al (2018), Louzada et al (2015), Julia et al (2018), Moubarac et al (2017), Steele
et al (2017)
Monteiro et al (2019) menyatakan bahwa UPF mengandung densitas energi tinggi, lemak tinggi, gula
tinggi, dan garam tinggi, tetapi protein rendah, serat rendah, dan zat gizi mikro rendah. Pernyataan
umum tersebut tentu tidak sepenuhnya dapat dierima. Komposisi zat gizi UPF sangat bervariasi, tidak
selalu densitas energinya tinggi, mengandung lemak tinggi, gula tinggi, garam tinggi, protein rendah,
serat rendah, dan zat gizi mikro rendah. Di samping itu tidak ada nilai batas yang dapat dijadikan acuan
untuk menyatakan kadarnya tinggi. Betapa banyak produk pangan olahan yang dihasilkan oleh industri
dan diklasifikasikan sebagai UPF mengandung energi rendah (low calorie), gula rendah (less sugar)
atau bahkan bebas gula (sugar free or no sugar added), lemak rendah (low fat), garam rendah (less salt
or unsalted), atau protein tinggi (high protein), serat tinggi (high fiber), diperkaya dengan vitamin dan
mineral (fortified with vitamins and minerals).
Formula bayi, susu pertumbuhan, dan makanan bayi lainnya diklasifikasikan sebagai UPF
(Monteiro et al 2019). Komposisi zat gizi produk-produk tersebut diatur dengan sangat ketat sesuai
kebutuhan bayi, yang sangat berbeda dengan UPF lainnya (BPOM 2018). Dengan demikian,
memasukkan produk-produk bayi tersebut sebagai UPF yang dinilai memiliki komposisi gizi yang tidak
“sehat”, tentu tidak tepat.
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Kandungan zat gizi pangan olahan lebih banyak ditentukan oleh ingredien yang digunakan untuk
membuat pangan olahan tersebut. Jika ingredien yang digunakan mengandung energi tinggi, lemak
tinggi, gula tinggi, garam tinggi, maka pangan olahan yang dihasilkan juga memiliki energi tinggi, lemak
tinggi, gula tinggi, dan garam tinggi. Proses pengolahan yang diterapkan tidak mengubah kandungan
zat gizinya. Sebaliknya, jika ingredien yang digunakan mengandung energi rendah, lemak rendah,
gula rendah, dan garam rendah, maka pangan olahan yang dihasilkan memiliki energi yang rendah,
lemak rendah, gula rendah, dan garam rendah. Oleh karena itu proses pengolahan yang sama dapat
menghasilkan pangan olahan dengan kandungan gizi yang “baik bagi kesehatan” atau “tidak baik bagi
kesehatan” bergantung pada ingredien yang digunakan, bukan pada proses pengolahannya. Sebagai
contoh, proses pemanggangan untuk membuat biskuit, dapat menghasilkan biskuit dengan kandungan
serat tinggi dan gula/lemak rendah, tetapi juga dapat menghasilkan biskuit dengan kandungan serat
rendah, dan gula/lemak tinggi.
Dengan demikian penggolongan pangan berdasarkan tingkat pengolahannya, lalu membuat
generalisasi kandungan zat gizi pangan olahan yang dihasilkan merupakan hal yang kurang tepat.
Proses pengolahan tidak selalu menghasilkan pangan dengan densitias energi, lemak, gula, dan garam
tinggi. Sebaliknya, proses pengolahan dapat dirancang untuk menghasilkan pangan dengan densitas
energi rendah, lemak rendah, gula rendah, dan garam rendah, sebagaimana tren yang terjadi.
Beberapa proses pengolahan memang dapat memengaruhi kandungan zat gizi pangan yang
dihasilkan, seperti penggorengan dan pemekatan (evaporasi). Proses penggorengan menghasilkan
pangan olahan dengan kadar minyak 20-40% akibat penggunaan minyak goreng (Fellows 2017).
Proses evaporasi pada pembuatan susu kental manis menghasilkan produk akhir dengan kadar gula
sekitar 50% dan pada pembuatan selai buah menghasilkan produk akhir dengan kadar gula sekitar
65%. Hal ini terjadi karena dilakukan penambahan gula, bukan karena proses pengolahannya.
Proses pengolahan lain yang seringkali dijadikan contoh dalam kaitannya dengan kandungan
zat gizi atau kesehatan adalah proses hidrogenasi parsial pada minyak. Proses hidrogenasi parsial
adalah penjenuhan ikatan rangkap pada asam lemak tidak jenuh untuk meningkatkan titik lelehnya.
Proses ini dilakukan untuk mengubah minyak (cair) menjadi lemak (padat). Lemak hasil proses
hidrogenasi parsial mengandung asam lemak trans. Jika lemak tersebut digunakan dalam pembuatan
pangan olahan seperti margarin dan produk bakeri, maka produk tersebut mengandung asam lemak
trans. Asam lemak trans diketahui memberikan risiko buruk terhadap kesehatan (Pipoyan et al 2021).
Anthony dan Rock (2020) menyatakan terjadi peningkatan konsumsi UPF di seluruh dunia.
Sebagai akibatnya kontribusi UPF dalam asupan energi dan zat gizi populasi menjadi semakin besar.
Gibney et al (2019) menyatakan bahwa konsumsi makanan olahan semakin meningkat sehubungan
dengan meningkatnya pendapatan, urbanisasi, tingkat pekerjaan, munculnya konsumerisme, dan
kelangkaan waktu luang akibat lamanya jam kerja dan sekolah. Terkait dengan kontribusi UPF terhadap
asupan energi, Gibney et al (2017) menyatakan bahwa hal tersebut sebagai akibat dari densitas energi
yang lebih tinggi serta jumlah pangan yang dikonsumsi lebih banyak. Akan tetapi, hal tersebut masih
memerlukan penelitian lebih lanjut.
UPF memiliki kandungan zat gizi dengan variasi yang lebar (Poti et al 2015). Tabel 4 menyajikan
komposisi gizi beberapa biskuit komersial (termasuk UPF). Meskipun sejenis, produk UPF tersebut
memiliki kadar gula, lemak, dan natrium dengan variasi yang lebar. Variasi yang lebih lebar tentu
terjadi pada UPF yang berbeda jenis pangannya. Oleh karena itu, Davidou et al (2020) mengusulkan
modifikasi klasifikasi NOVA dengan menggabungkan 4 grup NOVA dengan 4 subgrup baru. Klasifikasi
ini mempertimbangkan “tingkat” pengolahan, kandungan garam, gula, dan lemak, serta jumlah “penciri”
UPF. Usulan klasifikasi tersebut menghasilkan 8 kategori pangan baru yaitu: unprocessed (A0);
minimally processed foods (A1); culinary ingredients (A2); nutritionally-balanced PF (B1); high-salt,
high-sugar or high-fat processed foods (B2); nutritionally-balanced UPF (C0.1); high-salt, high-sugar or
high-fat UPF (C0.2); dan UPF dengan lebih dari satu “penciri” UPF. Usulan klasifikasi tersebut dinilai
lebih baik karena lebih sesuai dengan kenyataan bahwa tidak semua UPF memiliki kandungan lemak,
gula, dan garam tinggi. Banyak produk UPF yang memiliki kandungan gizi yang baik (seimbang) sesuai
dengan kebutuhan untuk kesehatan.
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Tabel 4. Komposisi gizi beberapa biskuit komersial berdasarkan informasi nilai gizi
Produk Energi (kkal/100g) Lemak (g/100 Gula (g/100 Natrium (mg/100
biskuit kkal) kkal) kkal)
A 529 5.0 4.4 33
B 523 5.5 3.6 50
C 444 3.8 2.5 125
D 478 4.1 4.5 73
E 416 2.9 5.7 129
F 444 3.1 2.5 88
G 533 5.0 3.8 9
H 409 1.7 5.6 6
I 500 25 0* 400
J 500 25 0* 425
*Menggunakan BTP pemanis
Capozzi et al (2021) menyatakan bahwa sebenarnya tidak ada korelasi antara tingkat pengolahan
dengan potensi kesehatan dari pangan yang dihasilkan. Faktanya, ada banyak teknologi pengolahan
baru yang dapat meningkatkan nilai gizi produk pangan, misalnya dengan mengurangi rusaknya zat gizi
dan dilakukan fortifikasi zat gizi. Proses pengolahan dan kandungan zat gizi pangan tidak terkait secara
linier satu sama lain. Produk yang termasuk UPF bisa termasuk produk yang dinilai paling sehat dari
aspek kandungan zat gizi (kadar protein tinggi, serat tinggi, lemak rendah, gula rendah, penambahan
vitamin dan mineral). Menilai semua UPF dianggap tidak baik bagi kesehatan karena kandungan zat
gizinya merupakan suatu kesalahan. Tentu hal ini akan menimbulkan banyak pertanyaan di kalangan
ahli teknologi pangan, gizi, dan kesehatan.
Konsumsi UPF dan Risiko PTM
Terdapat banyak hasil penelitian yang menghubungkan konsumsi UPF dengan risko PTM.
Monteiro et al (2019) telah menelaah banyak hasil penelitian (Tabel 5) yang menunjukkan bahwa
konsumsi UPF meningkatkan risiko terjadinya obesitas atau luaran lain yang terkait obesitas, penyakit
kardiovaskular dan metabolik, kanker payudara, depresi, risiko sindrom iritasi usus besar, dyspepsia
fungsional (the risk of irritable bowel syndrome and functional dyspepsia), risiko sindrom kelemahan
(the frailty syndrome or presence of three or more of the following five phenotypic criteria: exhaustion
after small efforts, muscle weakness, low physical activity, slow walking speed, and unintentional
weight loss), dan risiko kematian dini. Hasil telaah Pagliai et al (2020) menyatakan bahwa peningkatan
konsumsi UPF berhubungan dengan peningkatan risiko penyakit jantung.
Elizabeth et al (2020) menyatakan bahwa konsumsi UPF meningkatkan risiko PTM. Pada
kalangan dewasa, risiko tersebut mencakup kelebihan berat badan, obesitas, risiko metabolik jantung,
kanker, diabetes tipe-2, penyakit kardiovaskular, sindrom iritasi usus besar, depresi dan kondisi
kelemahan (depression and frailty conditions), dan kematian (all-cause mortality). Pada kalangan anak
dan remaja, konsumsi UPF berhubungan dengan risiko metabolik jantung dan asma.
Hall et al (2019) dan Insausti et al (2020) menyatakan konsumsi UPF tinggi berhubungan dengan
insiden abdominal obesity pada kalangan dewasa tua. Hasil telaah yang dilakukan oleh Crimarco et
al (2021) menyatakan bahwa konsumsi UPF berhubungan dengan peningkatan risiko penambahan
berat badan pada orang dewasa dan anak, serta peningkatan risiko adiposity-related co-morbidities
pada orang dewasa. Konsumsi UPF menyebabkan peningkatan asupan energi dan penambahan berat
badan karena UPF cenderung memiliki densitas energi tinggi. Amicis et al (2022) menyatakan konsumsi
UPF secara konsisten dan jangka panjang memengaruhi status gizi dan komposisi tubuh pada anak
dan remaja.
Berdasarkan telaah publikasi hasil penelitian, Monteiro et al (2019) menyatakan bahwa
asupan UPF secara konsisten dikaitkan dengan profil gizi diet yang rentan terhadap risiko obesitas
dan peningkatan risiko PTM. Meskipun demikian, Monteiro et al (2019) menyatakan masih diperlukan
penelitian epidemiologis lebih lanjut untuk mengetahui dampak konsumsi UPF terhadap kesehatan
khususnya PTM yang dikaitkan dengan kualitas diet.
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Hasil telaah yang menghubungkan konsumsi UPF dengan risiko PTM pada umumnya
menemukan bahwa peningkatan konsumsi UPF dapat meningkatkan risiko PTM melalui peningkatan
konsumsi energi, lemak, gula, dan garam. Berdasarkan hal tersebut lalu direkomendasikan bahwa
konsumsi UPF sebaiknya dihindari. Gibney et al (2017) dan Gibney (2019) menyatakan bahwa
rekomendasi ini layak untuk diperdebatkan. Tidak semua UPF memiliki densitas energi tinggi, lemak
tinggi, gula tinggi, dan garam tinggi. Dengan demikian yang lebih tepat adalah menghubungkan risiko
PTM dengan asupan zat gizi, bukan dengan konsumsi UPF. Bahkan Capozzi et al (2021) menyatakan
bahwa menghubungkan konsumsi UPF dan dampaknya terhadap kesehatan karena proses pengolahan
merupakan pernyataan yang sulit dimengerti. Pada sisi lain, proses pengolahan dapat digunakan untuk
menghasilkan pangan yang baik untuk kesehatan. Monteiro et al (2019) sebenarnya juga menyatakan
bahwa proses pengolahan bukan merupakan masalah terkait dengan risiko PTM.
Gibney et al (2017) dan Capozzi et al (2021) mempertanyakan mekanisme hubungan konsumsi
UPF dikaitkan dengan risiko obesitas dan PTM karena adanya hasil penelitian yang tidak konsisten
atau kontradiktif. Sebagaimana dinyatakan oleh Meneguelli et al (2020) bahwa meskipun konsumsi
UPF yang tinggi telah dikaitkan dengan kelebihan berat badan, hipertensi, dislipidemia dan fitur lain dari
sindrom metabolik yang berakibat pada peningkatan risiko PTM dan kematian, tetapi bukti konklusif
yang secara tegas menunjukkan hubungan sebab akibat antara konsumsi UPF dan terjadinya PTM
masih kurang.
Tabel 5. Hasil penelitian yang menghubungkan asupan UPF dengan risiko PTM
Peneliti Populasi yang diteliti Luaran PTM Temuan utama
Each percentage point increase in the
Obesity household availability of ultra-processed
Monteiro et European countries,
prevalence foods resulted in an increase of 0.25 (CI 95
al (2018) 1991-2008 (n=19)
among adults percent 0.05 to 0.45) percentage points in
obesity prevalence.
Pregnant adult dietary share of ultra-processed foods was
Gestational
women followed associated with a 1.3 kg (CI 95 percent 0.3
weight gain,
during pregnancy to 2.4) increase in gestational weight, as
and new-
Rohatgi et al and their new-borns well as with a 0.22 mm (CI 95 percent 0.005
born
(2017) in the US in 2013/4 to 0.4) increase in thigh skinfold, 0.14 (CI
skinfolds and
(n=45) (St. Louis 95 percent 0.02 to 0.3) mm in subscapular
body fat
Women’s Health skinfold, and 0.62 (CI 95 percent 0.04
percentage
Center Study) to 1.2) percentage points of total body
adiposity in the neonate.
French adult
population
A higher dietary share of ultra-processed
Julia et al in 2009-2014 (n=74
Obesity foods was significantly associated with
(2018) 470)
overweight and obesity (P<0.0001)
(French NutriNet-
Santé study)
Participants in the highest quintile of
consumption of ultra-processed foods had
higher BMI (1.61 kg/m²; 95 percent CI 1.11 to
Obesity and 2.10) and waist circumference (4.07 cm; 95
US population aged
Juul et al obesity- percent CI 2.94 to 5.19), and higher odds of
20-64 years in 2005-
(2018) related having obesity (OR: 1.53; 95 percent CI 1.29,
2014 (n=15 977)
outcomes 1.81), excess weight (OR: 1.48; 95 percent
CI 1.25 to 1.76), and abdominal obesity (OR:
1.62; 95 percent CI 1.39 to 1.89) compared
with those in the lowest quintile.
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A ten-percentage point increase in the

relative energy intake from ultra processed
foods increased the odds of being obese
Canadian population Obesity and (OR: 1.05; 95 percent CI 1.01 to 1.08) or
Nardocci et al aged 18 years or obesity- overweight (OR: 1.03; 95 percent CI 1.01
(2019) older related to 1.07). Participants in the highest quintile
in 2004 (n=19,363) outcomes of consumption of ultra-processed foods
had higher odds of being obese (OR: 1.32;
95 percent CI 1.05 to 1.57) compared with
those in the lowest quintile.
Participants in the highest quartile of
Adults aged 18 years consumption of ultra-processed foods had
Incidence of
or older in France a higher risk of developing overall cancer
overall,
with a median follow (1.21; 95 percent CI 1.06 to 1.38) and
Fiolet et al breast,
up of 5 years postmenopausal breast cancer (HR: 1.38;
(2018) prostate and
(n=104,980) (French 95 percent CI 1.06 to 1.81). Additional
colorectal
NutriNet-Santé study analyses show that these associations
cancer
2009/13) remain significant even with adjustment for
total fat, sodium and carbohydrate intake.
High school students
in
There was no significant difference in BMI
Brazil with a median BMI and body
trajectories according to baseline ultra
follow-up of 3 years fat
processed food consumption (p=0.07 for the
Cunha et al (n=1,035) percentage
interaction term between age and quartiles
(2018) (Adolescent trajectories
of ultra-processed food consumption).
Nutritional during follow-
Similar results for body fat percentage
Assessment up
trajectories.
Longitudinal Study -
ELANA 2010/12)
Countries in the
Euromonitor annual
food sales database
and
BMI trajectory Increases in ultra-processed foods volume
with NCD-RisC group
Vandevijvere in sales/capita were significantly and positively
sex-stratified annual
et al (2019) the studied associated with population-level BMI
BMI
period trajectories.
estimates for adults
aged ≥18 years in the
period 2002-2014
(n=80)
Sumber : Modifikasi dari Monteiro et al (2019)
Tabel 5. Hasil penelitian yang menghubungkan asupan UPF dengan risiko PTM (lanjutan)
Participants in the highest quintile of
US adult population ultra-processed food consumption
Steele et al aged 20 years or Metabolic had higher odds of having metabolic
(2019) older in Syndrome syndrome (OR: 1.28; 95 percent CI 1.09,
2009-2014 (n=6,385) 1.50) compared with those in the lowest
quintile.
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Children in Brazil Ultra-processed food consumption at

(n=307) Changes in preschool age was associated with a
aged 3-4 years at anthropometric significant increase in waist
Costa et al
baseline (2001/2) and glucose circumference
(2019)
and 7- metabolism from preschool to school age (β 0.07; P
8 years at follow-up indicators = 0.035), but not with changes in glucose
(2005/6) metabolism.
US adult population
aged 20y or older
Participants in the highest quartile
with a
All-cause and of frequency of ultra-processed food
median follow-up of
Kim et al cardiovascular consumption were at higher risk of all
19
(2019) disease cause mortality (HR: 1.30; 95 percent CI
years (n= 11,898)
mortality 1·08, 1·57). No significant association
(National Health and
was found for cardiovascular mortality.
Nutrition Examination
Survey 1988/94)
Ultra-processed food intake was
Adults (≥ 45y old) in
associated with a higher risk of all-
France with a median
cause mortality (HR for an absolute
Schnabel et follow-up of 7.1 years All-cause
increment of 10 in the percentage of
al (2019) (n=44,551) (French mortality
ultra-processed
NutriNet-Santé study
foods in the diet = 1.14, 95 percent Cl =
2009/17)
1.04 to 1.27).
Adults aged 20-91
years
in Spain with a
Participants in the highest quarter of
median
ultra processed foods consumption were
follow-up of 10.4
at higher risk of all-cause mortality than
Campà et al years All-cause
those in the lowest quarter (HR 1.62, 95
(2019) (n=19,899) mortality
percent CI 1.13 to 2.33). No significant
(Seguimiento
association was found for cardiovascular
Universidad de
and cancer mortality.
Navarra
(SUN) project
1999/2014)
Participants in the highest quarter of
ultra processed foods consumption were
at higher risk of overall cardiovascular
disease (HR: 1.23, 95 percent CI 1.04
Incidence of
to 1.45) than those in the lowest quarter.
Adults (≥18y old) in overall
France with a median cardiovascular
dietary share of ultra-processed foods
Srour et al follow-up of 5.2 years diseases and
results in 1.12 (95 percent CI 1.02
(2019) (n=105,159) (French coronary heart,
to 1.24) higher risk of coronary heart
NutriNet-Santé study and
diseases, and 1.11 (95 percent CI 1.01
2009/18) cerebrovascular
to 1.21) higher risk of cerebrovascular
diseases
disease. Additional analyses show
persistent significant associations with
adjustment for saturated fat, sodium and
sugar intake.
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Adults (≥60y old) in

Spain with a median
follow-up of 3.5 years
ultra-processed foods consumption were
Insausti et al (n=1,822) (Seniors Incidence of
at higher risk of frailty than those in the
(2019) ENRICA – Study on frailty
lowest quintile (OR: 3.67, 95 percent CI
Nutrition and
2.00 to 6.73).
Cardiovascular risk
factors, 2008/2012)
Middle-aged adults in
Spain with a median
follow-up of 10.3
years
ultra-processed foods consumption had
Donoso et al (n=14,907) Incidence of
a higher risk of developing depression
(2019) (Seguimiento depression
than those in the lowest quartile (HR:
Universidad de
1.33; 95 percent CI 1.07-1.64).
Navarra
(SUN) project
1999/2014)
Sumber: Modifikasi dari Monteiro et al (2019)
Tabel 5. Hasil penelitian yang menghubungkan asupan UPF dengan risiko PTM (lanjutan)
ultra-processed foods consumption had
Adults (≥18y old) in a higher risk of developing depressive
France with a median symptoms than those in the lowest
Adjibade et al follow-up of 5.4 years Incidence of quartile (HR: 1.30; 95 percent CI 1.15
(2019) (n=26,730) (French depression to 1.47). Additional analyses show that
NutriNet-Santé study these associations remain significant
2009/18) with adjustment for total fat, sodium and
carbohydrate intake, and a diet quality
index.
consumption of ultra-processed foods
had a greater risk of large weight gain
Adults (≥35y old) in Changes in
(>1.68 kg/year) and waist circumference
Brazil with a median anthropometric
gain (>2.42 cm/year) (RR: 1.30; 95
Canhada et follow-up of 3.8 years indicators
percent CI 1.10 to 1.54, and RR: 1.33;
al (2019) (Longitudinal Study of and incidence
95 percent CI 1.12 to 1.57, respectively),
Adult Health (ELSA of overweight/
and higher risk of developing
Brasil). obesity
overweight/obesity compared to those in
the lowest quartile of consumption (HR:
1.29; 95 percent CI 1.08 to 1.53).
Energy intake was greater during
exposure to the ultra-processed diet (508
US adult voluntaries Daily energy ± 106 kcal/day). Participants gained, on
Hall et al with a mean age of intake, and average, 0.9 ± 0.3 kg during the ultra-
(2019) 31.2 years (n=20) weight and fat processed diet, most being of fat mass.
(NIH study) mass change Participants lost, on average, 0.9 ± 0.3
kg during the
diet with no ultra-processed foods.
Sumber: Modifikasi dari Monteiro et al (2019)
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Kim et al (2019) menyatakan bahwa peningkatan frekuensi konsumsi UPF berhubungan dengan
peningkatan risiko kematian (all-cause mortality), tetapi tidak berhubungan dengan kematian akibat
penyakit kardiovaskular dan kanker (Tabel 6a dan 6b). Hasil penelitian serupa disampaikan oleh Campa
et al (2019) bahwa peningkatan konsumsi UPF meningkatkan risiko kematian (all-cause mortality).
Akan tetapi, konsumsi UPF tidak memiliki kaitan dengan kematin akibat penyakit kardiovaskular (Tabel
7). Hal ini menunjukkan masih diperlukan bukti yang lebih konsisten tentang pengaruh konsumsi UPF
terhadap risiko PTM dan kematian.
Tabel 6a. Hazard ratios and 95% confidence intervals for all-cause mortality
according to quartiles of frequency of UPF intake (times/day) in USA
Quartile of frequency of UPF intake
Quartile 1: Quartile 2: Quartile 3: Quartile 4:

P-trend
(n=2982) (n=2989) (n=2985) (n=2942)
Deaths, n 625 588 617 621
Model 1a 1 [Reference] 0.98 (0.82, 1.16) 1.02 (0.83, 1.24) 1.29 (1.09, 1.53) 0.002*
Model 2 b
1 [Reference] 0.98 (0.83, 1.17) 1.06 (0.85, 1.29) 1.31 (1.09, 1.58) 0.001*
Model 3c 1 [Reference] 0.99 (0.83, 1.18) 1.06 (0.87, 1.30) 1.30 (1.08, 1.57) 0.001*
a
Model 1 was adjusted for age, sex, race/ethnicity, and total energy intake.
b
Model 2 was adjusted for the variables in Model 1 plus poverty level, education level, smoking status,
physical activity, and alcohol intake.
c
Model 3 was adjusted for the variables in Model 2 plus body mass index, hypertension status, total
cholesterol, and estimated glomerular filtration rate.
Sumber: Kim et al (2019)
Tabel 6b. Hazard ratios and 95% confidence intervals for cardiovascular disease mortality
according to quartiles of frequency of UPF intake (times/day) in USA
Quartile of frequency of UPF intake
Quartile 1: Quartile 2: Quartile 3: Quartile 4:

P-trend
(n=2982) (n=2989) (n=2985) (n=2942)
Deaths due to
cardiovascular 174 172 151 151
disease, n
Model 1a 1 [Reference] 1.04 (0.70, 1.54) 0.85 (0.56, 1.28) 1.04 (0.73, 1.50) 0.88
Model 2b 1 [Reference] 1.09 (0.69, 1.74) 0.92 (0.60, 1.41) 1.10 (0.74, 1.67) 0.86
Model 3c 1 [Reference] 1.10 (0.69, 1.76) 0.94 (0.61, 1.45) 1.13 (0.74, 1.71) 0.78
a
Model 1 was adjusted for age, sex, race/ethnicity, and total energy intake.
b
Model 2 was adjusted for the variables in Model 1 plus poverty level, education level, smoking status,
physical activity, and alcohol intake.
c
Model 3 was adjusted for the variables in Model 2 plus body mass index, hypertension status, total
cholesterol, and estimated glomerular filtration rate.
Sumber : Kim et al (2019)
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Tabel 7. Cox proportional hazard ratios (95% confidence intervals) for all cause
mortality of UPF consumption categories in Spain
Sumber : Campa et al (2019)
Rekomendasi untuk menghindari konsumsi UPF berupa produk pangan untuk bayi dan anak
(susu formula, susu pertumbuhan, makanan pendamping air susu ibu atau MP-ASI), serta pangan
kelompok khusus tentu perlu dipertimbangkan dengan seksama. Konsekuensi menghindari produk
tersebut bagi bayi dan anak serta kelompok khusus yang membutuhkan dapat berdampak serius.
Produk-produk tersebut sangat dibutuhkan dalam rangka memenuhi kebutuhan asupan zat gizi. Risiko
kekurangan defisiensi zat gizi bagi bayi dan anak serta kelompok khusus membawa konsekuensi besar
bagi pertumbuhan dan perkembangan sumber daya manusia secara keseluruhan.
Formula bayi, formula lanjutan, formula pertumbuhan, MP-ASI, dan pangan khusus lainnya
telah diatur melalui Peraturan BPOM nomor 1 tahun 2018 tentang Pengawasan Pangan Olahan untuk
Keperluan Gizi Khusus. Pada peraturan tersebut ditetapkan persyaratan mutu dan keamanan produk
dengan sangat ketat.
Pada pangan umum, rekomendasi untuk menghindari konsumsi UPF dapat meningkatkan
risiko defisiensi zat gizi mikro sebagaimana dinyatakan oleh Jones (2019). Hal ini disebabkan karena
banyak UPF yang telah difortifikasi dengan vitamin dan mineral. Banyak juga UPF hasil reformulasi
sehingga memiliki profil gizi yang lebih baik untuk kesehatan (Gibney 2019). UPF tersebut memiliki
densitas energi lebih rendah, rendah/bebas gula, rendah lemak, rendah garam, tinggi serat, dan lain-
lain. Dengan demikian persepsi UPF sebagai pangan tidak baik untuk kesehatan perlu diperbaiki.
Capozzi et al (2021) menyatakan bahwa menilai kualitas pangan berdasarkan kandungan
zat gizi akan lebih baik dibandingkan dengan berdasarkan proses pengolahan. Lebih lanjut Gibney
(2019) juga menyatakan bahwa menilai kualitas pangan berdasarkan proses pengolahan layak untuk
diperdebatkan.
Ludwig et al (2019) menegaskan bahwa pemahaman tentang mekanisme kaitan antara konsumsi
pangan khususnya UPF dan PTM sangat penting untuk diketahui. Fardet dan Rock (2020) menyarakan
dilakukan studi epidemiologis untuk mengaitkan pola diet dengan risiko penyakit kronis dengan
pendekatan yang lebih holistik. Gibney et al (2017) menyatakan bahwa pendekatan studi epidemiologis
untuk melihat dampak asupan pangan terhadap risiko PTM tidak dapat digantikan dengan penggunaan
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klasifikasi NOVA. Capozzi et al (2021) menyarankan dilakukan studi intervensi terkontrol untuk
mengetahui kemungkinan hubungan sebab-akibat antara konsumsi UPF dan risiko PTM. Idealnya, studi
ini harus mempertimbangkan berbagai faktor sosiodemografi dan variabel lingkungan yang diketahui
semakin memengaruhi status kesehatan masyarakat.
Di Indonesia, Intan et al (2021) menganalisis faktor sosiodemografi, perilaku konsumsi, gaya hidup,
tingkat asupan, dan kecukupan zat gizi makro pada orang dewasa (kelompok umur 19-55 tahun) yang
mengalami obesitas berdasarkan data sekunder Riskesdas 2013 dan SKMI 2014 di 5 provinsi (Sulawesi
Utara, DKI Jakarta, Kalimantan Timur, Papua Barat, dan Sumatra Utara). Hasil analisis menunjukkan
bahwa faktor sosiodemografi, perilaku konsumsi, dan gaya hidup berhubungan nyata terhadap obesitas.
Asupan energi dan karbohidrat pada orang dewasa obesitas dan normal tidak berbeda nyata. Asupan
protein dan lemak menunjukkan berbeda nyata yaitu asupan protein dan lemak pada orang dewasa
obesitas lebih tinggi (77.82 g/orang/hari dan 52.49 g/ orang/hari) daripada orang dewasa normal (68.80
g/orang/hari; 45.34 g/orang/hari) (Tabel 8). Hal ini menunjukkan bahwa faktor penyebab obesitas tidak
hanya konsumsi pangan (densitas energi tinggi, tinggi lemak, tinggi gula), tetapi banyak faktor lain yang
memengaruhi. Pada konsumsi pangan sendiri, tidak selamanya pangan densitas energi tinggi, lemak
tinggi, dan gula tinggi yang menyebabkan obesitas.
Tabel 8. Rataan asupan energi dan zat gizi makro pada orang dewasa obesitas dan
normal di 5 provinsi di Indonesia
Zat gizi Rata-rata asupan zat gizi (per orang per hari) Nilai p
Obesitas (n = 1693) Normal (n = 4410)
Energi (kkal) 1759,22 ± 182,84 1690,14 ± 155,11 0,051
Protein (g) 77,82 ± 9,94 68,80 ± 5,59 0,018*
Lemak (g) 52,49 ± 5,22 45,34 ± 4.92 0,002*
Karbohidrat (q) 247,71 ± 26,78 254,60 ± 24,25 0,121
Keterangan: *Terdapat perbedaan signifikan (p < 0.05)
Sumber : Intan et al (2021)
Permanasari dan Julianti (2018) juga menggunakan data Riskesdas 2013 dan
SKMI 2014 untuk menganalisis kaitan antara pola konsumsi dan gaya hidup dengan
prevalensi penyakit kardiovaskular pada tingkat provinsi di Indonesia dengan jumlah
sampel sebanyak 20.183. Prevalensi penyakit kardiovaskular, yaitu jantung dan
stroke, dikelompokkan menjadi kelompok provinsi prevalensi tinggi (prevalensi di atas rerata nasional)
dan prevalensi rendah (prevalensi di bawah rerata nasional). Hasil analisis menunjukkan tidak ada
keterkaitan antara konsumsi zat gizi makro, serat, dan natrium terhadap kejadian penyakit kardiovaskular
pada tingkat provinsi dengan prevalensi rendah maupun tinggi (Tabel 9).
Tabel 9. Rerata konsumsi penduduk umur ≥15 tahun menurut provinsi dengan penyakit
jantung dan stroke prevalensi rendah dan tinggi di Indonesia
Rerata konsumsi Jantung Stroke

Prevalensi Prevalensi Prevalensi Prevalensi
rendah tinggi rendah tinggi
Energi (kalori) 1678 1709 1678 1688
Protein (g) 61,8 66,8 63,0 62,1
Lemak (g) 51,9 49,0 50,6 52,5
Karbohidrat (g) 246,7 256,6 248,4 247,9
Serat (g) 8,4 8,3 8,0 8,8
Natrium (mg) 2668 2657 2625 2711
Sumber : Permanasari dan Julianti (2018)
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Tren Proses Pengolahan Pangan

Tidak diragukan bahwa aplikasi teknologi pengolahan pangan telah menghasilkan produk
pangan yang memiliki sifat lebih aman dikonsumsi, lebih baik sifat sensorinya, lebih awet, lebih mudah
dicerna, lebih tinggi nilai biologisnya karena penurunan faktor/senyawa anti-nutrisi, dan lebih praktis
(convenient). Pada sisi lain, proses pengolahan dapat menurunkan kadar vitamin yang tidak tahan panas
seperti vitamin C dan tiamin (Fellows 2017). Proses produksi pangan pada tingkat industri memungkinkan
pangan olahan terdistribusi di mana-mana dalam jumlah yang memenuhi kebutuhan penduduk yang
jumlahnya semakin banyak. Produk produksi pangan olahan di industri juga memungkinkan biaya
produksi yang lebih ekonomis dan penerapan jaminan mutu dan keamanan yang lebih baik. Pada saat
ini sebagian besar pangan yang dikonsumsi penduduk adalah pangan olahan.
Seiring dengan kemajuan ilmu pengetahuan dan teknologi, semakin banyak perhatian yang
menghubungkan konsumsi pangan dan kesehatan. Pada sisi lain, konsumen juga menghendaki
pangan yang lebih sehat. Sebagai akibatnya terdapat kecenderungan aplikasi teknologi pangan untuk
menghasilkan pangan olahan yang dinilai lebih menyehatkan seperti tinggi serat, rendah energi, rendah
gula, rendah garam, rendah lemak, dan lainnya. Dengan demikian aplikasi teknologi pengolahan di
industri pangan dapat diarahkan untuk menghasilkan UPF dengan nilai gizi dan kesehatan yang lebih
baik (Capozzi et al 2021). Gibney et al (2017) menyatakan bahwa upaya reformulasi untuk menghasilkan
pangan olahan yang lebih rendah densitas energi, kadar lemak, dan kadar gulanya, telah terbukti secara
signifikan berkontribusi pada pengurangan asupan energi dan berat badan.
Kesimpulan
Menurut sistem klasifikasi pangan NOVA, perbedaan PF dan UPF terletak pada “tingkat”
pengolahan dan bahan baku yang digunakan. UPF dibuat melalui proses fraksinasi pangan “utuh”
dan penggunaan bahan tambahan pangan (BTP). Karakteristik UPF adalah densitas energi tinggi,
tinggi lemak, tinggi gula, dan tinggi garam. Padahal pada kenyataannya tidak semua UPF memiliki
karakteristik tersebut, bahkan banyak UPF yang dibuat dengan karakteristik sebaliknya.
Banyak hasil penelitian yang menunjukkan hubungan antara konsumsi UPF dengan risiko
PTM melalui faktor risiko berupa peningkatan konsumsi energi, lemak, gula, garam berlebihan, dan
direkomendasikan untuk menghindari konsumsi UPF. Data yang ada belum menunjukkan bukti yang
konsisten dan konklusif bahwa konsumsi UPF menyebabkan peningkatan risko PTM. Di samping itu,
mekanisme hubungan keduanya masih memerlukan penelitian lebih lanjut. Studi epidemiologi tentang
keterkaitan konsumsi pangan dan risiko PTM lebih penting untuk dilakukan dibandingkan dengan
menilai kandungan zat gizi UPF secara umum. Pernyataan umum bahwa semua UPF memiliki faktor
risiko PTM tersebut perlu dipertanyakan karena pada kenyataannya (dan kecenderungan yang ada)
proses pengolahan UPF dilakukan untuk menghasilkan pangan yang lebih “sehat” dan tidak memiliki
faktor risiko di atas. Menghindari konsumsi UPF yang mengandung zat gizi penting bagi kelompok
tertentu, misalnya bayi, anak dan kelompok khusus, dapat berakibat buruk pada pertumbuhan dan
pengembangan sumber daya manusia ke depan.
Daftar Pustaka
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Regulasi Pangan Olahan Keperluan Gizi Khusus

(Tinjauan regulasi sebagai salah satu processed/ultraprocessed food)
Oleh: Yusra Egayanti, SSi., Apt., MP
(Koordinator Standardisasi Pangan Olahan Keperluan Gizi Khusus, Badan POM)
Berdasarkan Undang-Undang Nomor 18 Tahun 2012 tentang Pangan, pangan didefinisikan sebagai
segala sesuatu yang berasal dari sumber hayati produk pertanian, perkebunan, kehutanan, perikanan,
peternakan, perairan, dan air, baik yang diolah maupun tidak diolah, yang diperuntukkan sebagai
makanan atau minuman bagi konsumsi manusia, termasuk bahan tambahan pangan, bahan baku
pangan, dan bahan lainnya yang digunakan dalam proses penyiapan, pengolahan, dan/atau
pembuatan makanan atau minuman. Pangan merupakan kebutuhan dasar manusia yang paling utama
untuk dapat hidup sehat, aktif, dan produktif dan pemenuhan kebutuhan pangan merupakan bagian
dari hak asasi manusia yang dijamin Undang-Undang Dasar Negara Republik Indonesia Tahun 1945
sebagai komponen dasar dalam pembangunan sumber daya manusia berkualitas.
Pangan yang cukup, aman, bermutu, dan bergizi seimbang harus tersedia serta terjangkau sampai
dengan perseorangan, tidak terkecuali bagi kelompok masyarakat rentan dengan kondisi fisiologis/
medis tertentu. Hal ini sesuai dengan deklarasi Organisasi Pangan dan Pertanian (Food and Agricultural
Organization / FAO) dan Organisasi Kesehatan Dunia (World Health Organization / WHO) Persatuan
Bangsa-Bangsa (1992) yang menekankan bahwa setiap individu mempunyai hak atas pangan yang
bernilai gizi cukup dan aman. Begitu pentingnya aspek keamanan dan mutu ini, maka FAO/WHO
pada tahun 2014, kembali menekankan bahwa adalah hak bagi setiap individu untuk memperoleh
pangan yang aman, cukup dan bergizi. Keamanan dan mutu pangan juga erat berkaitan dengan kualitas
sumber daya manusia dan daya saing bangsa. Karena itu, upaya peningkatan penjaminan keamanan
dan mutu pangan erat kaitannya dengan peningkatan daya saing bangsa, (Hariyadi, P. 2015)
sebagaimana disajikan pada Gambar 1.
Gambar 1. Peningkatan penjaminan keamanan dan mutu pangan akan bermuara pada peningkatan
daya saing bangsa.
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Salah satu jenis pangan yang dikonsumsi dan beredar di Indonesia adalah pangan olahan/processed
food, yang diartikan sebagai makanan atau minuman hasil proses dengan atau tanpa bahan tambahan.
Processed food/pangan olahan diolah menggunakan teknologi pangan, yang telah dikenal sejak zaman
prasejarah, bertujuan untuk mengolah bahan pangan menjadi lebih mudah dimakan, aman dikonsumsi,
memuaskan selera dan awet/memperpanjang umur simpan termasuk kemudahan dalam penyimpanan
dan distribusi. Terkait dengan pengolahan pangan ini, Food and Agriculture Organization (FAO)
menggunakan pengelompokan pangan berdasarkan proses pengolahan yang dikenal dengan NOVA
food definition and classification system yang selanjutnya disebut NOVA system (Monteiro et al. 2016).
Pangan dibagi menjadi empat kelompok:
• Kelompok 1 yaitu kelompok pangan segar, merupakan pangan yang tidak diproses atau hanya
mengalami proses minimal dan dapat langsung dikonsumsi seperti buah dan sayur segar atau
diolah secara sederhana seperti dibekukan, dipotong, digiling, dikupas, divakum seperti daging
beku, buah beku serta produk-produk seperti telur dan susu segar.
• Kelompok 2 adalah pangan olahan kuliner atau pangan olahan antara yang digunakan sebagai
bahan baku untuk diolah lebih lanjut di rumah tangga atau industri. Contoh: krim, mentega, minyak
nabati, tepung, kakao bubuk, garam, pati, gula dan bahan tambahan pangan.
• Kelompok 3 adalah pangan olahan, dimana pangan dapat berasal dari kelompok 1 namun
mengalami proses pengolahan bersama dengan pangan pada kelompok 2 dengan tujuan utama
untuk meningkatkan umur simpan dan kualitas sensori. Contoh: daging atau ikan yang diasinkan
atau diasap, ikan dalam kaleng, keju, yogurt, santan UHT, susu steril, keripik buah, roti, dan buah
dalam kaleng.
• Kelompok 4 adalah ultra-processed food (pangan olahan dengan proses pengolahan yang
komplek), yang terdiri dari berbagai jenis ingridien yang berasal dari kelompok 1 dan kelompok 2
dengan teknologi pengolahan yang lebih komplek dan dapat langsung dikonsumsi oleh konsumen.
Produk kelompok ini biasanya dikemas lebih menarik, kadang-kadang terdapat klaim kesehatan,
dan/atau ditujukan untuk target konsumen tertentu. Contoh: biskuit, makanan instan, es krim,
selai, aneka minuman ringan, aneka makanan ringan (ekstrudat), naget, sosis, burger, dan pangan
untuk keperluat gizi khusus seperti formula bayi, pangan untuk pasien tertentu.
Perkembangan pengolahan pangan, khususnya kelompok 4 selain dipicu oleh perkembangan

teknologi pengolahan pangan, namun juga didorong oleh perubahan gaya hidup, meningkatnya
prevalensi penyakit tidak menular, kebutuhan konsumen karena kondisi fisiologis dan medis tertentu.
Berdasarkan data Badan Pusat Statistik (BPS) tahun 2021, terdapat 30,83 juta anak usia dini
dan 13,56% dari jumlah tersebut berusia < 1 tahun (bayi), dan 57,16% berusia 1-4 tahun. Selain itu,
angka kematian ibu (AKI) Indonesia juga masih tinggi, dan ditargetkan dalam Rencana Pembangunan
Jangka Menengah Nasional (RPJMN) tahun 2020-2024 pada tahun 2024 adalah maksimal 183
per 100.000 kelahiran hidup. Riset Kesehatan Dasar (Riskesdas) 2018 juga menunjukkan prevalensi
29,5% kelahiran prematur serta 3,9% gizi buruk dan 13,8% gizi kurang pada balita. WHO key facts
noncommunicable disease mencantumkan PTM sebagai penyebab 41 juta jiwa meninggal dunia atau
setara 71% kematian di seluruh dunia setiap tahun. Di Indonesia, 73% (atau 1.365.000) kematian
terjadi akibat PTM sebagaimana dilaporkan WHO Noncommunicable Diseases Progress Monitor
2020. Angka ini sejalan dengan hasil Riskesdas 2018 yang menunjukkan kenaikan prevalensi PTM;
seperti kanker, penyakit ginjal kronis, dan diabetes melitus; dibandingkan hasil Riskesdas tahun
2013. Menurut laporan BPJS Kesehatan, pembiayaan kesehatan tertinggi di Indonesia pada tahun
2019 untuk penanganan PTM seperti penyakit jantung (10,3 Triliun rupiah) dan gagal ginjal (2,3 Triliun
rupiah). Masalah kesehatan ini perlu perhatian serius Pemerintah karena merupakan generasi penerus
bangsa yang harus tumbuh dan berkembang dengan baik menjadi manusia Indonesia unggul dan
berdaya saing di masa depan.
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Untuk memenuhi kebutuhan masyarakat baik untuk pencegahan penyakit maupun ditujukan sebagai
penatalaksanaan diet bagi kelompok dengan kondisi fisiologis atau medis tertentu yang merupakan
masalah kesehatan di Indonesia, perlu produk pangan olahan yang berfungsi sebagai dukungan
nutrisi, makanan pengganti atau sebagai terapi nutrisi baik dalam rangka pemenuhan kebutuhan gizi,
pencegahan penyakit, bahkan sebagai pengobatan untuk mempertahankan kualitas hidup maupun
menyelamatkan hidup (life saving). Kondisi ini mendorong perkembangan teknologi pengolahan
pangan untuk menyediakan pangan yang diformulasi secara khusus (ultraprocessing) untuk memenuhi
kebutuhan. Contohnya untuk kelompok bayi/anak, dimungkinkan untuk memberikan breastmilk
substitutes (formula bayi) jika memiliki alasan medis yang dapat diterima. Dalam publikasinya WHO-
UNICEF menekankan bahwa karena kondisi kesehatan bayi atau ibu dapat dianjurkan bahwa bayi
tidak beri ASI baik sementara atau secara permanen. Beberapa alasan yang dapat diterima tersebut
antara lain:
• Bayi yang sama sekali tidak dapat diberi ASI. Misalnya bayi dengan galaktosemia (memerlukan
formula bebas galaktosa), maple syrup urine disease (memerlukan formula bebas leusin, isoleusin
dan valin), fenilketonuria (memerlukan formula bebas fenilalanin), pada beberapa kasus masih
dapat diberi ASI namun dengan pengawasan ketat).
• Bayi yang tetap diberi ASI namun memerlukan tambahan pada selang waktu tertentu. Misalnya
bayi BBLSR (< 1500 g) atau sangat prematur (<32 minggu).
• Ibu dengan kondisi tertentu yang memerlukan pengobatan (misal HIV, mengonsumsi obat tertentu,
menjalani radioterapi/kempoterapi dll) dapat direkomendasikan pemberhentian ASI secara
permanen atau pun sementara, sehingga diperlukan formula khusus untuk bayi.
Dengan berbagai kondisi fisiologis/medis tersebut yang juga terjadi di Indonesia, diperlukan pangan
yang diformulai secara khusus, sebagaimana diatur juga oleh Codex Alimentarius (Lembaga standar
pangan dunia di bawah FAO dan WHO), bahwa produk disebut sebagai Foods for Special Dietary Uses,
dengan batasan bahwa:
… are those foods which are specially processed or formulated to satisfy particular dietary requirements
which exist because of a particular physical or physiological condition and/or specific diseases and
disorders and which are presented as such. The composition of these foodstuffs must differ significantly
from the composition of ordinary foods of comparable nature, if such ordinary foods exist.
Untuk itu, pangan untuk kebutuhan khusus ini, selain harus aman namun juga sesuai untuk
penanganan kondisi fisiologis/medis tertentu. Sehingga dapat disimpulkan bahwa nilai suatu pangan
tidak hanya ditentukan oleh keamanannya, namun ditentukan oleh berbagai faktor mutu lain, termasuk
tujuan/fungsionalitasnya. Secara garis besar, nilai pangan ditentukan oleh dua faktor utama, yaitu faktor
keamanan dan faktor mutu. Faktor keamanan terdiri dari keamanan fisiologis (aman dikonsumsi dari
bahaya kesehatan) dan psikologis (halal, keyakinan). Faktor mutu terdiri dari kesehatan, kenikmatan,
kepraktisan, dan harga. Secara garis besar tren pangan yang bernilai tinggi adalah yang memiliki
manfaat kesehatan dan nilai sensoris yang tinggi, harga yang lebih murah, waktu persiapan yang lebih
singkat serta penanganan yang lebih sederhana. Gambaran nilai pangan seperti diuraikan pada gambar
2. (Hariyadi P, 2018). Pada gambar tersebut terlihat bahwa faktor keamanan merupakan prasyarat
suatu pangan, sedangkan nilai pangan ditentukan oleh banyak faktor. Khusus dikaitkan dengan
pangan untuk kelompok tertentu dengan tujuan kesehatan maka nilai gizi dan fungsionalitasnya
merupakan faktor penentu nilai pangan tersebut.
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Gambar 2. Faktor penentu nilai pangan, Hariyadi P, 2018 (Sumber Gambar: PATPI, Perspektif Global
Ilmu dan Teknologi Pangan)
Pangan yang ditujukan untuk target konsumen tertentu termasuk dalam kategori pangan dengan
tingkat risiko keamanan yang tinggi. Peraturan Pemerintah Nomor 86 tahun 2019 tentang Keamanan
Pangan menyebutkan bahwa penetapan standar atau persyaratan pangan dengan tingkat risiko tinggi
diamanahkan pada Badan POM. Pangan yang mempunyai tingkat risiko Keamanan Pangan yang tinggi
misalnya Pangan Olahan tertentu antara lain formula bayi, Pangan yang diperuntukkan bagi ibu hamil
atau menyusui, Pangan untuk keperluan medis khusus, dan pangan lain yang mempunyai pengaruh
besar terhadap perkembangan kualitas kesehatan manusia.
Menindaklanjuti amanah tersebut, maka telah diatur sejumlah regulasi untuk menjamin keamanan,
mutu, pangan untuk kelompok konsumen tertentu termasuk ketentuan label, cara produksi, cara
distribusi, label dan iklan produk. Pangan untuk kelompok ini dikelompokkan sebagai pangan olahan
keperluan Gizi Khusus (PKGK), yang didefinisikan sebagai pangan olahan yang diproses atau
diformulasi secara khusus untuk memenuhi kebutuhan gizi tertentu karena kondisi fisik/fisiologis dan
penyakit/gangguan tertentu. Berdasarkan Peraturan BPOM No. 1 Tahun 2018 tentang Pengawasan
Pangan Olahan Untuk Keperluan Gizi Khusus (PKGK), yang diubah dengan Peraturan BPOM No. 24
Tahun 2019 dan Peraturan BPOM No. 24 Tahun 2020, PKGK dikelompokkan menjadi 2 yaitu:
1. Pangan Diet Khusus (PDK), yaitu pangan olahan yang diproses atau diformulasi secara khusus
untuk memenuhi kebutuhan gizi tertentu karena kondisi fisik atau fisiologis tertentu.
2. Pangan Olahan Keperluan medis Khusus (PKMK), yaitu merupakan pangan olahan yang diproses
atau diformulasi secara khusus untuk manajemen diet bagi orang dengan penyakit atau gangguan
kesehatan tertentu.
PDK dan PKMK kemudian tersedia untuk memenuhi kebutuhan baik untuk kelompok bayi/anak
maupun untuk kelompok umum/dewasa, seperti pada gambar 3
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Gambar 3. Pengelompokan dan Jenis PKGK
PKMK untuk Kelainan Metabolik bawaan yang telah ditetapkan standar dan persyaratannya antara
lain PKMK untuk pasien Isovaleric Acidemia (bebas asam amino leusin), PKMK untuk Pasien Kelainan
PKMK untuk Pasien Kelainan Metabolik Tirosinemia (bebas asam amino fenilalanin dan tirosin), PKMK
untuk Pasien Kelainan Metabolik Fenilketonuria (bebas asam amino fenil alanin), PKMK untuk Pasien
Kelainan Metabolik Maple Syrup Urine Disease (bebas asam amino leusin, isoleusin, dan valin).
Untuk menjamin produk PKGK aman dikonsumsi sesuai target konsumen, maka ditetapkan sejumlah
persyaratan produk PKGK yang diatur dalam Peraturan Badan POM terkait.
Persyaratan Keamanan
Persyaratan keamanan produk PKGK diatur lebih ketat dibandingkan produk umum lainnya,
mencakup:
• Batas maksimal cemaran: cemaran mikroba (Chronobacter, Salmonella, Listeria, dll), cemaran
logam berat (merkuri, arsen, timbal, dll), cemaran mikotoksin (aflatoksin, okratoksi, fumonisin, dll),
cemaran kimia lainnya (3MCPDe, Dioksin, Akrilamida, dll), cemaran radioaktif dan lain-lain. Produk
tidak boleh melebihi batas maksimal cemaran yang ditetapkan dan dibuktikan dengan pengujian
laboratorium.
• Bahan Tambahan Pangan_BTP: PKGK hanya boleh menggunakan BTP yang diizinkan dan tidak
boleh digunakan melebihi batas maksimal. Terdapat 27 golongan BTP seperti antioksidan, pengaet,
pewarna, perisa, pemanis, penguat rasa, pengental, antikempal, dll. Untuk produk PKGK, BTP
diatur lebih ketat, misalnya pada produk PKGK untuk bayi, antara lain dilarang menggunakan BTP
pengawet, pemanis, pewarna sintetik, perisa sintetik (flavouring).
• Kemasan: produk harus dikemas menggunakan kemasan yang food grade, sesuai ketentuan yang
diatur dalam peraturan Badan POM.
Persyaratan Mutu
PKGK harus memenuhi persyaratan mutu mencakup bahan baku yang aman dan sesuai untuk
kelompok PKGK, kandungan gizi baik zat gizi makro dan mikro (minimal, maksimal), densitas kalori
(untuk beberapa produk tertentu), tekstur (misalnya untuk MP-ASI ada yang tekstur halus, setengah
kasar atau makanan keluarga), osmolaritas (untuk PKMK tertentu), jenis dan jumlah gula yang boleh
ditambahkan, batasan lemak trans, bahan baku. Selain itu penambahan komponen bioaktif/ingredient
baru harus terbukti aman dan memberikan manfaat untuk target konsumen PKGK.
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Persyaratan Produksi dan Distribusi

PKGK hanya dapat diproduksi oleh sarana produksi yang telah menerapkan Good Manufacturing
Practices (GMP). PKGK tertentu seperti formula bayi, PKMK untuk bayi/anak, selain menerapkan GMP
juga wajib menerapkan Hazard Analysis Critical Control Point (HACCP).
Pada distribusinya, PKGK juga harus menerapkan Good Distribution/Retail Practices, agar produk tetap
terjamin mutu dan keamananya di sepanjang rantai distribusi. Khusus untuk PKMK, penggunaannya
harus dengan resep dokter dan hanya dapat diedarkan di apotek, rumah sakit, dan/atau puskesmas,
dan tidak dapat diedarkan melalui ritel umum. Penggunaan PKMK bersifat khusus yang hanya
diperlukan oleh pasien sesuai indikasi dokter dan/atau dibawah pengawasan dokter. Oleh karena itu,.
Penggunaan PKMK di luar pengawasan dokter dikhawatirkan tidak tepat sasaran dan tidak sesuai
aturan penggunaan. Sebagai contoh, penggunaan PKMK secara berlebihan dan/atau dalam jangka
panjang berisiko memperburuk kondisi kesehatan pasien.
Pendekatan yang sama juga dilakukan di negara lain, misalnya di Australia dan New Zealand juga
ditegaskan bahwa PKMK tidak boleh dijual langsung ke konsumen, dan dapat dijual melalui farmasi,
praktek dokter, atau institusi kesehatan.
Persyaratan Label
Informasi/keterangan mengenai produk PKGK wajib dicantumkan pada label. Label harus memuat
informasi nama produk, peruntukan (target konsumen), daftar bahan, informasi alergen, nomor
izin edar, berat bersih/isi bersih, nama produsen/importir, keterangan kedaluwarsa, kode produksi,
keterangan halal, informasi nilai gizi, cara penyiapan, petunjuk penggunaan, peringatan (jika ada),
osmolalitas (untuk yang dikonsumsi menggunakan selang makanan). Untuk produk seperti formula
bayi, harus memuat keterangan tambahan mengenai keunggulan ASI, pemberian MP-ASI sejak usia 6
bulan, termasuk cara penyiapan dengan suhu 70°C. Informasi pada label produk PKGK sebagaimana
terlihat pada gambar 4.
Gambar 4. Ilustrasi label produk PKGK
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Untuk produk PKMK, selain informasi di atas, terdapat informasi tambahan yaitu keterangan HARUS
DENGAN RESEP DOKTER, Peringatan jika PKMK dikonsumsi oleh konsumen dengan kondisi medis
yang tidak sesuai, serta informasi bahwa PKMK dapat digunakan sebagai makanan pengganti atau
sebagai makanan tambahan.
Persyaratan Iklan
PKGK harus memenuhi ketentuan iklan, agar informasi yang disampaikan tidak misleading. Informasi
yang disampaikan melalui iklan, harus sejalan dengan informasi pada label sesuai ketentuan. PKGK
tertentu seperti formula bayi, formula lanjutan dan PKMK tidak boleh diiklankan pada media massa,
namun dapat diinformasikan melalui media khusus kesehatan.
Pengaturan produk PKGK sebagai salah satu produk ultraprocess juga sejalan dengan Codex
Alimentarius. Standar Codex juga diterapkan hampir diseluruh negara anggota Codex yang saat ini
berjumlah lebih dari 180 negara. Hal ini termasuk juga terkait ketentuan PKMK, misalnya di Codex
dan beberapa negara seperti Uni Eropa, Amerika Serikat, Australia New Zealand juga ditegaskan
bahwa PKMK digunakan sebagai manajemen diet bagi pasien dan harus digunakan under medical
supervision. Selain itu Codex juga menekankan bahwa PKMK tidak boleh diiklankan melalui media
massa.
Pengawasan terhadap produk PKGK sebagai pangan ultraprocess dilakukan melalui pemberian
izin edar sebelum produk diedarkan (pre-market control). PKGK hanya dapat diedarkan setelah
mendapatkan izin edar dari Badan POM, setelah memenuhi persyaratan yang mencakup keamanan,
mutu, label, produksi. Sampai saat ini telah terdaftar produk PDK lebih dari 1500 produk (90 Formula
Bayi, 81 Formula Lanjutan, 274 MP-ASI, 337 makanan selingan, 139 minuman khusus bumil busui,
887 Pangan Tambahan Olahraga, 21 makanan kontrol Berat Badan) dan lebih dari 113 produk
PKMK. Setelah produk beredar di pasar, BPOM juga melakukan pengawasan post-market melalui
pemeriksaan, sampling, pengujian, dan penegakan hukum.
Selain itu sosialisasi dan pembinaan kepada pelaku usaha terus dilakukan secara berkesinambungan.
Termasuk melakukan pemberdayaan masyarakat melalui komunikasi, informasi dan edukasi (KIE)
melibatkan pemangku kepentingan, agar masyarakat juga memiliki pemahaman dan pengetahuan
yang baik untuk memilih dan mengonsumsi produk sesuai kebutuhan.
Pustaka:
1. Undang-Undang Nomor 18 tahun 2012 tentang Pangan
2. Peraturan Pemerintah Nomor 86 tahun 2019 tentang Keamanan Pangan
3. Peraturan Pemerintah Nomor 69 tahun 1999 tentang Label dan Iklan Pangan
4. Peraturan Badan POM Nomor 1 tahun 2018 tentang Pengawasan Pangan Olahan Untuk
Keperluan Gizi Khusus (PKGK), yang diubah dengan Peraturan BPOM No. 24 Tahun 2019 dan
Peraturan BPOM No. 24 Tahun 2020
5. Peraturan Badan POM Nomor 31 tahun 2018 tentang Label Pangan Olahan
6. Prosiding Widyakarya Nasional Pangan dan Gizi Bidang 3, Badan POM 2018
7. Hariyadi, P. 2015. Tantangan Ganda Keamanan Pangan di Indonesia: Peranan Rekayasa
Proses Pangan. IPB Press.
8. Hariyadi, P. 2018. Tren perkembangan teknologi pangan di era IR 4.0
9. WHO- UNICEF, 2009. Acceptable medical reasons for use of breast-milk substitutes.
10. [FAO] Food and Agriculture Organization. 1993. Food, Nutrition and Agriculture. Rome: Italy.
11. Monteiro CA, et al. 2016. NOVA The star shines bright. World Nutrition. 7(1-3): 28-38
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12. Kementerian Kesehatan RI. (2018). Hasil Utama RISKESDAS 2018.

13. WHO. (2021). Key Facts Noncommunicable Diseases.
14. WHO. (2020). Noncommunicable Diseases Progress Monitor 2020.
15. BPJS Kesehatan. (2019). Laporan Pengelolaan Program Tahun 2019 & Laporan Keuangan
Tahun 2019 (Auditan).
16. WHO. (2020). Global Action Plan for the Prevention and Control of Noncommunicable Diseases
2013-2020.
17. Codex Allimentarius. CODEX STAN 180-1991. Standard for The Labelling of And Claims For
Foods For Special Medical Purposes.
18. Codex Allimentarius. CODEX STAN 146-1985, Amended 2009. General Standard fortThe
Labelling of and Claims for Prepackaged Foods for Special Dietary Uses
19. COMMISSION DIRECTIVE 1999/21/EC of 25 March 1999 on Dietary Foods for Special
Medical Purposes
20. Food Standard Australia New Zealand. Standard 2.9.5 Food for special medical purposes
21. USFDA: Frequently Asked Questions About Medical Foods; Second Edition Guidance for Industry.
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Supported By
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21 – 22, 23 – 24 July 2022
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E-POSTER FREE PAPER

E-Poster Juries:
• Prof. Dr. dr. Dida Akhmad Gurnida, Sp.A(K), M.Kes
• Dr. dr. Conny Tanjung, Sp.A(K)
• Dr. dr. M. Mexitalia, SpA(K)
NO PRESENTER TOPIC
EP01 Peter Prayogo Hsieh THE RELATIONSHIP BETWEEN SLEEP DURATION AND
OBESITY IN CHILDREN: A SYSTEMATIC REVIEW
EP02 Muhammad Alief MARASMUS AND STUNTING IN 3-MONTHS OLD GIRL
WITH COVID-19, CYTOMEGALOVIRUS INFECTION,
POST COLOSTOMY DUE TO INTESTINAL ATRESIA :
A CASE REPORT
EP03 Jessica Christina MALNUTRITION AS A RISK FACTOR ASSOCIATED WITH
FEBRILE NEUTROPENIA IN ACUTE LYMPHOBLASTIC
LEUKEMIA CHILDREN
EP04 Qeis Ramadhan NUTRITIONAL STATUS OF INFANTS WITH
HIRSCHSPRUNG AFTER ONE-STAGE TRANS-ANAL
ENDORECTAL PULL-THROUGH SURGERY
EP05 Hendra Wardhana SECA IN COMPARISON TO ONEMED AS WEIGHT
SCALES FOR 0-2 YEARS OLD CHILDREN IN DR.
MOEWARDI HOSPITAL
EP06 Ervin Monica VITAMIN D DEFICIENCY IN CHILDREN WITH EXCESS
NUTRITIONAL STATUS : A META-ANALYSIS
EP07 Anna Mariska KWASHIORKOR: THE FORGOTTEN DIAGNOSIS
EP08 Maria Galuh PRETERM BABY BOY WITH SUCCESSFULLY ADEQUATE
Kamenyangan Sari POST DISCHARGE FORMULA – A CASE REPORT
EP09 Arie Falah THE NUTRITIONAL STATUS OF CHILDREN IN RELATION
TO CONGENITAL HEART DISEASE IN DR. MOEWARDI
GENERAL HOSPITAL
EP10 Almira Muthia Deaneva COMPARISON OF NUTRITIONAL STATUS IN INFANTS

WITH HIRSCHPRUNG BASED ON THE AGE OF
TRANSANAL ENDORECTAL PULL-THROUGH SURGERY
EP11 Katherine Richel NUTRITIONAL STATUS OF CHILDREN SUFFERING

Tambunan AMUBA DYSENTRY DURING COVID19 PANDEMIC AREA
EP12 Patricia Vanessa Antolis QUICK AND EASY SCREENING FOR VITAMIN D
ADEQUACY IN CHILDREN: A SCORING SYSTEM TO BE
IMPLEMENTED IN CLINICAL DAILY PRACTICE
EP13 Trias Kusuma Sari THE ASSOCIATION BETWEEN LOCAL ANIMAL SOURCES
FOOD AND CHILDREN’S NUTRITIONAL STATUS IN
COASTAL AREA NAGEKEO FLORES EAST NUSA
TENGGARA
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PENYAKIT METABOLIK
EP14 Peter Fischer John Pandie NUTRITIONAL STATUS OF UNDERFIVE CHILDREN IN

BIAK, PAPUA, COMPARED TO TARGET INDICATORS
OF NUTRITION DEVELOPMENT MINISTRY OF HEALTH
INDONESIA
EP15 Yeni Amalia A NEW EMERGING STUNTING VILLAGE : WHAT
DETERMINANTS LIE BENEATH
EP16 Triyana Dian Dhuha ABNORMAL DESIRE TO EAT NON-FOOD, PICA: A CASE
Akmaly REPORT
EP17 Felynawati Nawati NUTRITIONAL STATUS OF CHILDREN SUFFERING
FEBRILE SEIZURE DURING COVID19 PANDEMIC AREA
EP18 Mike Lauda PLANT-BASED PROTEIN INTAKE AS A RISK FACTOR
FOR STUNTING AMONG CHILDREN UNDER 5 YEARS
OLD: A CASE-CONTROL STUDY
EP19 Zahrifa Riandani Putri PROTEINURIA AND PROGRESSIVE KIDNEY FAILURE IN
A PATIENT WITH SIALIDOSIS
EP20 Zahrifa Riandani Putri REFEEDING SYNDROME IN MALNOURISHED

CHILD WITH ENTEROCUTANEOUS FISTULA AND
HIRSCHSPRUNG’S DISEASE POST DUHAMEL PULL-
THROUGH PROCEDURE
EP21 Della Sabrina Marta GROWTH CONSEQUENCES OF A MINIMUM 1 YEAR
KETOGENIC DIET IN CHILDREN AND ADOLESCENTS
WITH EPILEPSY: A SYSTEMATIC REVIEW
EP22 Amrina Rasyada NEONATAL CHOLESTASIS AS INITIAL MANIFESTATION

OF GAUCHER DISEASE
EP23 Agus Sucianto FORMULA MILK AND WEIGHT GAIN OF INFANTS WITH
CONGENITAL HEART DISEASE IN DR. MOEWARDI
GENERAL HOSPITAL, SURAKARTA: A CROSS
SECTIONAL STUDY
EP24 Fajar Khalis Ananda NUTRITIONAL STATUS OF CHILDREN SUFFERING
ACUTE DIARRHEA DURING COVID19 PANDEMIC AREA
EP25 Enggrajati Moses Hotasi KWASHIORKOR IN ADOLESCENT: AN
Silitonga UNDERESTIMATED CASE
EP26 Gustian Rante Tiballa CORRELATION BEETWEN VITAMIN D LEVEL AND
LEPTIN-ADIPONECTIN RATIO (L/A RATIO) IN OBESE
CHILDREN
EP27 Gustian Rante Tiballa OLIGOARTICULAR JUVENILE IDIOPATHIC ARTHRITIS IN
A 4 -YEAR-OLD GIRL WITH FEEDING PROBLEM
EP28 Jeannie Flynn NEONATAL HEMOCHROMATOSIS TREATED WITH
INTRAVENOUS IMMUNOGLOBULIN (IVIG) AND
ANTIOXIDANT COCKTAIL: A CASE REPORT
EP29 Natharina Yolanda NUTRITIONAL STATUS AND ITS CORRELATION WITH

MORTALITY WITH COVID-19 INFECTION
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EP30 Rizki Nandasari Sulbahri RECURRENT LACTATE ACIDOSIS IN PATIENTS WITH

GLYCOGEN STORAGE DISEASE TYPE IA: A CASE
REPORT
EP31 Putu Ianta Parama Siwi SCURVY IN CHILD PRESENTING WITH WEAKNESS AND
SEVERE ANEMIA: A CASE REPORT
EP32 Novalina Kaban NOMA IN HIV-INFECTED CHILD WITH SEVERE ACUTE
MALNUTRITION: A CASE REPORT
EP33 Tessa Rulianty THE ASSOCIATION BETWEEN TYPE OF MALIGNANCY
AND NUTRITIONAL STATUS IN CHILDREN
EP34 Luciana Intanti Putrijaya MANAGEMENT OF ACUTE METABOLIC

ENCEPHALOPATHY BY PERITONEAL DIALYSIS IN
A NEONATE WITH MAPLE SYRUP URINE DISEASE:
CHALLENGES IN RESOURCE-LIMITED SETTING
EP35 Wiyarni Pambudi CONTRIBUTING FACTORS FOR SUBOPTIMAL
BREASTFEEDING TO IDENTIFY MOTHER WHO NEED
BREASTFEEDING SUPPORT
EP36 Novi Handayani A CASE OF KWASHIORKOR WITH COMPLICATIONS
EP37 Efanrani Stiawan RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND

CHILD DEVELOPMENT DISORDERS
EP38 Bayu Puspita Rani A CASE REPORT: THE DIAGNOSIS AND INITIAL
MANAGEMENT OF STUNTING CASES IN PULMONARY
TUBERCULOSIS CHILDREN AT LIMITED FACILITIES
EP39 Patricia Lukas Goentoro CASE SERIES OF SCURVY IN A TERTIARY HOSPITAL:

THE FORGOTTEN HIDDEN HUNGER
EP40 Jessica Christina MALNUTRITION AS A RISK FACTOR ASSOCIATED WITH
FEBRILE NEUTROPENIA IN ACUTE LYMPHOBLASTIC
LEUKEMIA CHILDREN
EP41 Tisnasari Hafsah ESCAPE FROM KWASHIORKOR AND SEVERE
STUNTING
EP42 Nice Rachmawati Masnadi A CASE REPORT : GAUCHER DISEASE
EP43 St. Rahmah Rahim RELATIONSHIP BETWEEN NUTRITIONAL STATUS WITH
LENGTH OF STAY AND SEVERITY OF COVID 19 IN
CHILDREN AT RSUD DR CHASBULLAH ABDULMADJID,
BEKASI CITY
EP44 Trias Kusuma Sari NUTRITIONAL MANAGEMENT OF LOW BIRTH WEIGHT
INFANTS IN A NEONATAL INTENSIVE CARE UNIT IN A
REMOTE AREA
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EP01. THE RELATIONSHIP BETWEEN SLEEP DURATION AND OBESITY IN CHILDREN: A

SYSTEMATIC REVIEW
Peter Prayogo Hsieh1, Florencia Christina Sindhu, Made Ratna Dewi1, I GustiLanang Sidiartha2
1. Pediatric Department of Wangaya General Hospital, Denpasar City, Bali, Indonesia
2. Pediatric Department of Sanglah General Hospital, Denpasar City, Bali, Indonesia
ABSTRACT
OBJECTIVE: Obesity in children is a serious health problem with a rapidly increasing global prevalence.
Children with obesity are at high risk of developing several metabolic diseases as adults. Studies show
that short sleep duration is a risk factor of obesity. Short sleep duration will affect the diurnal rhythm and
disrupt homeostasis and energy metabolism. This systematic review aims to determine the relationship
between sleep duration and obesity in children.
METHODS: A systematic literature review was carried out by literature searching on PubMed and Google
Scholar using the PRISMA diagram and based on the eligibility criteria in selecting literature. Study
limited to the last five years (2017-2021). Studies that met the criteria were included in the analysis.
RESULTS: There were 17 studies included in the analysis with cross sectional studies, prospective
cohorts and clinical trials study design regarding the relationship between sleep duration and obesity
in children. All studies show a strong association between sleep duration and obesity in children and
adolescents. The underlying mechanism is short sleep duration affects the balance of hormones
controlling hunger and appetite so that appetite increases and causes excess energy intake, resulting
in obesity. Children with short sleep duration are 2-4 times more prone to obesity compared to children
with normal sleep duration.
CONCLUSION: There is a significant relationship between sleep duration and obesity in children and
adolescents. Adequate sleep duration is recommended to prevent obesity and the risk of metabolic and
cardiovascular diseases.
KEYWORDS: adolescents, body mass index, children, obesity, sleep duration

_________________________________________________________________________________
EP02. MARASMUS AND STUNTING IN 3-MONTHS OLD GIRL

WITH COVID-19, CYTOMEGALOVIRUS INFECTION, MICROCEPHAL, POST OP COLOSTOMY ET
CAUSA ATRESIA INTESTINAL
Running Title: Marasmus and stunting With Confirmed Covid 19
Muhammad Alief1, Aidah Juliaty1

1
Department of Pediatrics, Hasanuddin University’s Faculty of Medicine/ Wahidin Sudirohusodo
Hospital, Makassar, Indonesia
E-mail: alief_senator88@yahoo.com
Corresponding Author
Aidah Juliaty,DR.dr. Sp.A(K),Sp.GK, Destya Maulani,dr.M.Kes,Sp.A
Department of Pediatrics, Hasanuddin University’s Faculty of medicine
Jl. Perintis Kemerdekaan km. 10, Tamalanrea 90245, Makassar-Indonesia
E-mail: juliatyaidah07@gmail.com
ABSTRACT
During the pandemic Covid-19, children suffering from malnutrition have an increased risk
of death and affect the growth and development of children. Children with marasmus and stunting
have several risks during the pandemic of Covid-19. The food, financial and health crises during the
Covid-19 pandemic will increase the number of malnourished children. Therefore, it is important to
improve nutrition service programs to reduce child mortality and morbidity during pandemic Covid-19.
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A 3-months old girl is being treated at the Dr. Wahidin Sudirohusodo Makassar Hospital
with diagnose marasmus and stunting with Covid-19, cytomegalovirus infection, microcephal, post
op colostomy et causa atresia intestinal. The diagnosis was made based on history taking, physical
examination, anthropometric examination using the WHO curve, laboratory tests, and PCR. Management
of severe malnutrition according to the guidelines have been given to these patients and anti Covid-19.
The patient was discharged from Hospital after 53th days of treatment. After 6 months follow up, patient
become normal weight, stunted, and good nourished.
Based on this case, the successful management of malnutrition in patients is a unity the
cooperation between the patient’s parents and the doctor. Doctors provide comprehensive management
of malnutrition and are equally important to treat other diseases that accompany it. Through good
education, parents of patients will believe in the doctor’s instructions. They are compliance control,
adherence to taking medication and carrying out all directions from the doctor are the keys to successful
management of malnutrition and stunting. This can be applied to the general public in an effort to reduce
malnutrition and stunting in Indonesia.
Keywords: Malnutrition; Covid-19; Marasmus;Stunting

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EP03. MALNUTRITION AS A RISK FACTOR ASSOCIATED WITH FEBRILE NEUTROPENIA IN

ACUTE LYMPHOBLASTIC LEUKEMIA CHILDREN
Jessica Christina, PriliyanaPuspita, Muhammad Ikhsan

Departmet of Child Health, CiptoMangunkusumo General National Hospital, Jakarta, Indonesia
Background
Febrile Neutropenia (FN) is a frequent complication in children with malignancy. Acute Lymphoblastic
Leukemia (ALL) is the most common malignancy in children.1 Nearly 85%children with malignancy
are malnourished.2 Malnutrition has been associated with impaired immunity and increased risk of
infections.3
Objective
To evaluate malnutrition as a risk factor associated with FN in children with ALL.
Methods
A case control study was conducted to children aged 1 month to 18 years old with ALL at
CiptoMangunkusumo General National Hospital Jakarta between 2019-2020. Study group were children
with FN and control group were children without FN. Bivariate statistical analysis using SPSS was done
to evaluate malnutrition association with FN.
Results
A total of 86 children were enrolled, 43 children in each study and control group. More than half children
were male (54.7%) with overall mean age 6.5+ 5.4 years old. Malnutrition was seen in 32 (37.2%)
children with ALL who participated in this study. Bivariate analysis revealed a significant correlation
between malnutrition and FN in ALL children (p=0.026). Malnourished children aged 1 month to 18
years with ALL risk being febrile neutropenia 2.78 (OR 2.78; 95%CI 1.12–6.89) times greater than well-
nourished children aged 1 month to 18 years with ALL (OR 2.78; 95%CI 1.12–6.89).
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EP04. NUTRITIONAL STATUS OF INFANTS WITH HIRSCHSPRUNG AFTER ONE-STAGE TRANS-

ANAL ENDORECTAL PULL-THROUGH SURGERY
Qeis Ramadhan; Sandi Nugraha
Department of child health of medical faculty of Sebelas Maret University, Surakarta, Central Java,
Indonesia
Background: Hirschsprung is a condition that cause impaired function of absorption and motility of colon
due to inexistence of Meissner and Auerbach’s parasympathetic ganglion that will lead into nutrition
problems. A definitive procedure that has been proven to be effective and safe for this condition is trans-
anal endorectal pull-through (TAERPT). There only few studies that have evaluated the nutritional status
of patient after undergoing the procedure. This research aims to evaluate whether the procedure have
any impact on nutritional status of infant with hirschsprung
Methods: This study is conducted in Dr. Moewardi Hospital with cohort prospective design. There were
48 infants who had undergone the procedure collected from 2019 to 2021. Data were collected in form
of 1 month before and 3 months after the surgery. The data then classified according to World health
organization (WHO) Z-score and analyzed using Friedman Test.
Result: From the data collected and analyzed, we found that there was significant improvement of
nutritional status in our patients (P < 0.001) from 1 month before the surgery and 3 months after the
surgery.
Conclusion: From this research, we found that managing a nutritional status of a patients can be
various, depends on what is the cause of the malnutrition in the first place.
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EP05. SECA IN COMPARISON TO ONEMED AS WEIGHT SCALES

FOR 0-2 YEARS OLD CHILDREN IN DR. MOEWARDI HOSPITAL
Hendra Wardhana, Sandi Nugraha, Pridania Vidya
Department of Pediatrics, Faculty of Medicine, Sebelas Maret University/
Dr. Moewardi Hospital, Surakarta.
Background
Anthropometry is a key point in growth monitoring during the first thousand days of life. Bodyweight
(BW) is one of the anthropometric benchmarks that use a scale as a measuring tool. This study aimed
to compare BW measured by the SECA brand scale with an accuracy of 50 grams to tIs it the difference
he OneMed brand scale.
Methods
We conducted a cross-sectional study in children aged under 2 years old hospitalized at Dr Moewardi
hospital from October 2021 to April 2022. All subjects were scaled without wearing clothes and footwear
by using SECA and OneMed scales. The data were analyzed with ANOVA test and a significance level
was determined with p<0.05.
Results
Thirty-five pediatric patients were included in the study. The mean values of BW measured with SECA
and OneMed were 6.848 kg and, while the OneMed 7.000 kg, respectively. The ANOVA test comparing
both measuring scales obtained the difference of 0.152 kgs (p=0.001).
Conclusion
There is a significant difference between the results of BW measurement using SECA and OneMed.
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EP06. VITAMIN D DEFICIENCY IN CHILDREN WITH EXCESS NUTRITIONAL STATUS: A META-

ANALYSIS
Ervin Monica1, Allyssa Rahmaditta2
1
General Practitioner, North Lombok District General Hospital, West Nusa Tenggara, Indonesia
2
General Practitioner, Jombang Islamic Hospital, East Java, Indonesia
ABSTRACT
Objective: Vitamin D has a pleiotropic effect, one of which is the regulation of the immune system.
Vitamin D deficiency can increase the risk of developing chronic disease. Currently, vitamin D deficiency
often occurs in children with excess nutritional status. The purpose of this study was to determine the
relationship between vitamin D deficiency and excess nutritional status.
Methods: PRISMA guidelines were used to perform this meta-analysis from PubMed, EMBASE, and
the Cochrane Library with categories of vitamin D, children, overweight and obese. Study quality was
assessed with the Newcastle Ottawa Scale and statistically analyzed using RevMan 5.4.1 for Windows.
The inclusion article published in English focuses on vitamin D levels in overweight and obese children,
a cross-sectional study.
Results: From the analysis, 26 articles showed significant vitamin D deficiency in obese children (OR
0.47; 95% CI: 0.39-0.57; I2 82%; p<0.00001) but 10 of them showed insignificant vitamin D deficiency
results in overweight children (OR 0.80; 95% CI: 0.60-1.05; I2 81%; p=0.11). In addition, vitamin D
deficiency was found to be significantly higher in obese than overweight children (OR 0.73; 95% CI:
0.64-0.83; I2 12%; p<0.00001).
Conclusion: Vitamin D levels are inversely proportional to fat mass, so vitamin D supplementation
and weight regulation are needed. However, there are several factors that need to be considered,
including skin pigmentation, ethnicity, sun exposure, and season. Therefore, further research is needed
regarding vitamin D supplementation dosage protocols and appropriate weight regulation for children in
their growth period.
Keywords: Vitamin D, overweight, obese, children
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EP07. KWASHIORKOR: THE FORGOTTEN DIAGNOSIS

Anna Mariska, Maria Mexitalia, Omega Mellyana,Rina Pratiwi
Department of Child Health, Faculty of Medicine, Diponegoro University/Kariadi Hospital, Semarang,
Central Java, Indonesia.
Objective To improve awareness of kwashiorkor, one of the cause general oedema in children
Case Atwo-year-four-month-oldboy with general oedema as his chief complaint. He had oedema on
both legs, then expanded to face and both arms since twomonth prior hospital. According to parents,
children had difficult to eat. Lately only eat 2-3 table spoons three times a day and only drink water.
Patient was brought to General Practitioner, it was said because of poor blood flow, due to the worsening
oedema, parent bought him to hospital. From previous hospital laboratory examination showed anemia
hypochromic microcytic (8.9mg/dL), hypoalbuminemia (1.5mg/dL) he was diagnosed with initial attack
nephrotic syndromereferred to tertiary hospital for further examination. In tertiary hospital physical
examination showed, multiple rampant dental caries, facial swelling, general pittingoedema, cracked
and peeled skin on both legs. Laboratory examination showed anemia hypochromic microcytic (8.9mg/
dL), hypoalbuminemia (2mg/dL), leukocyturia, negative proteinuria, normal liver function test. He was
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diagnosed with kwashiorkor. From further history taking revealed he wasn’t exclusive breastfeeding,
since 1 week until12-month-old he was given condensed milk, 12-month-old until now eat family food
with low protein and drink mineral water only.
ConclusionWe must not forget to think kwashiorkoras one cause ofoedema in children. History taking
and physical examination are important to establish diagnose kwashiorkor in primary health care.
Keywords:kwashiorkor, oedema, nutrition

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EP08. PRETERM BABY GIRL WITH SUCCESSFULLY ADEQUATE POST DISCHARGE FORMULA
– A CASE REPORT
Maria Galuh Kamenyangan Sari; Debby Andina Landiasari; Vita Pramatasari Harti; Irizki Tisna Setiowati
Departement of Child Health of Medical Faculty of Sebelas Maret University, Surakarta, Central Java,
Indonesia
ABSTRACT
Objective: Administering proper nutrition for premature babies is important. Although breastmilk is the
best nutrition for babies, its administration during hospitalization is often below than the recommended
amount. Thus nutrient enriched formula is considered. This case report demonstrates the effect of post
discharge formula on premature baby receiving breastmilk.
Case: A baby girl was born from G2P1A0 mother with GA of 36 weeks. Birth weight, birth length of
and head circumference were measured with Intergrowht-21st chart revealing 1,800 grams (-1.5676
z-score), 42 cms (-1.7169 z-score), and 31 cms (-0.8201), respectively. She was treated in neonatal
HCU for 10 days due to sepsis and congenital pneumonia and given antibiotics. She received enteral
feeding of breastmilk, but she had feeding intolerance, we changed the route to OGT. However there
was no significant weight increment so that we added nutrient enriched formula. Since then her weight
increased significantly from 1,540 grams to 1,860 grams (-2.5924 z-score), length of 43 cms (-2.4702
z score) and head circumference of 33 cms (-0.1133 z-score) at discharge. We asked the mother to
continue giving breastmilk on demand and nutrient enriched formula (22 kcal/30ml) 6x30 ml. Two weeks
after discharged, her weight became 2,050 grams (-2.4861 z-score), length of 44 cms (-2.4995 z-score)
and head circumference of 33 cms (0.695 z-score).
Conclusion: Nutrient enriched formula can be used as an additional nutrient to breast milk for premature
infants who are small for gestational age in order to achieve catch-up growth.
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EP09. THE NUTRITIONAL STATUS OF CHILDREN IN RELATION TO CONGENITAL HEART

DISEASE IN DR. MOEWARDI GENERAL HOSPITAL
Arie Falah, Pridaniya Vidya Ayuningtyas
Department of Child Health, Sebelas Maret University – Dr. Moewardi Hospital, Surakarta, Indonesia
Background: Children have an increased risk of developing malnutrition particularly protein malnutrition
when they have a serious illness. Congenital heart disease (CHD) is a serious condition. Studies show
that CHD account for more infant deaths than all other congenital defects put together. We conducted this
study to analyze the association between the nutritional status and CHD in the Dr. Moewardi Hospital.
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Method: a cross sectional study was performed in 76 pediatric new outpatients with CHD in Dr Moewardi
Hospital, Surakarta, Indonesia from July 2021 until December 2021, data were obtained from medical
record. The inclusion criteria was all new pediatric patients with CHD. We excluded patients with down
syndrome and cerebral palsy. Bivariate analysis used Chi-square test. All data were analyzed statistically
with spss v.25 for windows and P < 0.05 was considered significant.
Results: Out of 76 children diagnosed with CHD who met the inclusion criteria, 59(78%) were acyanotic
and 17(22%) were cyanotic. 26(11%) patients were good nutritional status and 33(89%) were malnutrition
in acyanotic and 2(12%) patients were good nutritional status and 15 (88%) were malnutrition in cyanotic.
Chi square test obtained significant relation between nutritional status and congenital heart disease (p
= 0.014)
Conclusion: there is association between nutritional status and CHD in pediatric population.
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EP10. COMPARISON OF NUTRITIONAL STATUS IN INFANTS WITH HIRSCHPRUNG BASED ON

THE AGE OF TRANSANAL ENDORECTAL PULL-THROUGH SURGERY
Almira Muthia Deaneva; Sandi Nugraha
Department of child health of medical faculty of Sebelas Maret University, Surakarta, Central Java,
Indonesia
Background: Hirschsprung is a congenital disorder characterized by absence of Meissner and

Auerbach’s parasympathetic ganglion leading to nutritional problems. Trans-anal endorectal pull-
through (TAERPT) is a definitive procedure which been proven to be effective for hirschprung disease.
This research aims to evaluate whether age at the time of surgery had impact on the nutritional status
Methods: This study is a cohort prospective conducted in Dr. Moewardi Hospital from 2019-2021 with
48 infants who had undergone the procedure. Data were collected 3 months before and after surgery.
The data then classified according to World health organization (WHO) Z-score and analyzed using
Mann Whitney Test with SPSS 25.0 software to analysis data and p<0.05 was significant.
Result: In 3 months after surgery evaluation found infant ≤ 6 months old tend to have better growth
outcome with 32.1% well nourished (-2 SD to +1 SD); 60.7% moderately malnourished (-3 SD to -2 SD);
3.6% severely malnourished (< -3 SD) and in > 6 months old with 15% well nourished; 45% moderately
malnourished; 35% severely malnourished. We found there was significant improvement of nutritional
status in infant who had gone surgery at ≤ 6 months old (P < 0.027).
Conclusion: According to this research, the surgical procedure done before 6 months old have a better
nutritional improvement.
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EP11. NUTRITIONAL STATUS OF CHILDREN SUFFERING AMUBA DYSENTRY

DURING COVID19 PANDEMIC AREA
Harapan Parlindungan Ringoringo,1*Katherine Richel Tambunan2
1
Department of Child Health, Faculty of Medicine, LambungMangkurat University – RSD
IdamanBanjarbaru, Banjarbaru, South Kalimantan, Indonesia.
2
Mayapada Hospital Tangerang, Banten, Indonesia.
ABSTRACT
OBJECTIVE:Diarrhea is still a health problem in Indonesia. Worldwide, death among children under five
due to diarrhea was 15% or 1600 children under 5 per year. According to the Basic Health Research
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(RISKESDAS) results of the Indonesian Ministry of Health in 2018, the prevalence of diarrhea in children
under 5 was 11%. One of the causes of diarrhea is amoebic dysentery. This study aimed to determine
the nutritional status of patients with amoebic dysentery.
METHOD: This study method is a descriptive retrospective with data from the medical records of patients
with dysentery amoeba in children at IdamanBanjarbaru Hospital from November 2020 - to April 2022.
The sampling technique was carried out using consecutive sampling.
RESULTS: A sample of 18 children, 11 boys, and 7 girls, was obtained in this study. Nutritional status
based on weight for length/height showed that 66.7% of the patients had good nutrition, and 33,3% had
undernutrition. Nutritional status based on weight for age; obtained 66.7% normal, 27.8% underweight.
In addition, nutritional status based on height for age was 66.7% normal and 33.3% short stature.
CONCLUSION: The nutritional status of children affects the prevalence of amoebic dysentery.
KEYWORDS:Amubadysentry, nutritional status, children.

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EP12. Quick and easy screening for vitamin D adequacy in children: a scoring system to be
implemented in clinical daily practice
Vanessa Antolis1, MS Anam2, Maria Mexitalia3, Rina Pratiwi3
1
Pediatric resident, Department of pediatrics, Diponegoro University/ Dr. Kariadi General Hospital,
Semarang, Indonesia
3
Respirology division, Department of pediatrics, Diponegoro University/ Dr. Kariadi General Hospital,
Semarang,Indonesia
2
Nutrition and metabolic division, Department of pediatrics, Diponegoro University/ Dr. Kariadi General
Hospital, Semarang,Indonesia
OBJECTIVE: To find out quick and easy screening for vitamin D adequacy (Vitamin D sufficiency
prediction score, VDSP) in children that can be implemented in clinical daily practice.
METHOD: The subjects in this cross-sectional study were children aged between 2 and 10 years old.
Subjects were taken from primary health care in Semarang. They had examined for 25(OH)D blood
serum level and completed the questionnaire. One point was attributed for each of these items in the
questionnaire: male gender, dry/summer season, often in the open area between 10AM - 2PM, more
than 20% body surface area which was not covered by clothing, frequent used of cotton clothing and
light skin colour. Validity and reliability tests were also performed.
RESULT: Total subjects were 76 children, which 37 children (48.7%) had insufficient vitamin D serum
level and 39 children (51.3%) had sufficient vitamin D serum level. All of the questions were valid (r>0.3)
and reliable (cronbach alpha 0.343). The score of 3 or more was found in 51.3% children, sensitivity/
specificity were 0.66/0.65, while positive and negative predictive values were 0.67/0.65.
CONCLUSION: The implementations of the VDSP scoring were simple, easy, and costless in identifying
adequacy of vitamin D in children but the sensitivity and specificity also PPV and NPV are less than
80%, so this prediction score needs further research. If the result was doubtful, the further examination
of 25(OH)D serum level should be considered when administering vitamin D supplementation in children
properly.
Keywords: vitamin D sufficiency, scoring system, VDSP
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EP13. THE ASSOCIATION BETWEEN LOCAL ANIMAL SOURCES FOOD AND CHILDREN’S
NUTRITIONAL STATUS IN COASTAL AREA NAGEKEO FLORES EAST NUSA TENGGARA
Trias Kusuma Sari, Reza Wea
Aeramo General Hospital, Nagekeo, Flores - East Nusa Tenggara, Indonesia
OBJECTIVE East Nusa Tenggara is one of seven cities in Indonesia with the highest stunting rates.
Nagekeo are close to red status with topography mostly hilly, generally located in coastal area makes
animal source food (ASF) difficult to found. This study aimed to determine the correlation between local
ASF intake and nutritional status in children at coastal area.
METHOD This was a cross-sectional study with total of 68 children in Tonggo Village divided into ages
0-5 y.o (28 children) and > 5 y.o (40 children). Dependent variables were local ASF intake and nutritional
status. Independent variables were living in a coastal area and father occupation. Data were analyzed
by independent Fisher Exact Test, Mann Whitney U test, and T-test.
RESULT The most local ASF are fish (85%) and snail (79,4%) with father’s occupation are fisherman
32.1% and non-fisherman 67.9%. In 0-5 y.o we found 4 children were stunting and 8 children age > 5
y.o were short stature. No correlation between local ASF and nutritional status, but children age 0-5 y.o
who consume fish < 5 times/week are likely to experience stunting by 2.4 higher than those who eat >5
times/week. A significant correlation was found between father’s occupation (fisherman) and nutritional
status (p-value 0.039, OR 0.211; 95%CI). Hemoglobin level < 12 g/dL were found in 69.6% children.
CONCLUSION No correlation has been found related to local ASF and nutritional status, but the
presence of malnourished children, monitoring and feeding assistance of children in the coastal areas
should be considered.
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EP14. NUTRITIONAL STATUS OF UNDERFIVE CHILDREN IN BIAK, PAPUA, COMPARED TO

TARGET INDICATORS OF NUTRITION DEVELOPMENT MINISTRY OF HEALTH INDONESIA
Peter Fischer John Pandie1, Linna1, Windhi Kresnawati2
1. RSUD Biak, Papua 2. RSPAD Gatot Soebroto, Jakarta
Background: National surveillance 2019 showed 30,8% under-five children in Indonesia were stunted.
Undernutrition is a leading cause of morbidity and mortality. Indonesia Government committed to focus
on nutrition program as main goal of health development in 2020-2024. The ministry of health has
set the goal in 2022 to reduce malnutrition to 18,4% stunting, 14% undernutrition, and 7,5% severe
malnutrition. Biak regency, the isolated island in North Papua which rich of seafood and farm products,
should have low malnutrition number.
Aim: to evaluate prevalence of malnutrition in remote and very remote area compared to National target
in 2022.
Method: cross sectional study in remote (Ridge) and very remote (Yawosi) public health center (PHC). All
under-five children in two PHC subjected to anthropometric examination. Nutritional status determined
based on WHO growth chart. Family background were taken through interview with parents.
Results:
Ridge and Yawosi are located di Biak island. Ridge PHC is located in the city center where internet signal
is available and close to public service (0-5 km to hospital / harbor/ airport / traditional market). Yawosi
PHC is located 65 km from the city center, and there is no internet signal. Seventy-four children in Ridge
PHC and 68 children in Yawosi PHC were participated in this study. We found that the prevalence of
stunting, undernutrition and severe malnutrition between Ridge and Yawosi PHC were 9,4% vs 54,4%;
91% vs 23,5%; 0% vs 14,7%. The malnutrition number was very high in both PHC compared to national
target. In very remote area, stunting and severe malnutrition much higher. There is no significant
difference of parent’s job or education level between the two PHC (they are mostly farmers and high
school graduate).
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Conclusion: Malnutrition prevalence in remote and very remote area in Indonesia is still far from
national target, even though food source were available and affordable. We need depth-evaluation and
assessment to find contributing factors of malnutrition so the local program can be made right to the
population.
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EP15. A NEW EMERGING STUNTING VILLAGE: WHAT DETERMINANTS LIE BENEATH

Yeni Amalia, Teddy Panhardyka, Gita Dwi KarismA, Sri Fauziah, Sri Herlina
Fakultas Kedokteran Universitas Islam Malang
OBJECTIVE:
Hundreds of new stunting cases were found in the Baturetno area, which is part of Malang City, the
second largest city in East Java Province. Despite its unusual location, this stunting status is inversely
proportional to the government’s program to reduce child stunting on a large scale. Investigation is
mandatory to identify the determinants. It is hoped that this research can provide crucial data as a basis
for overcoming the stunting and preventing it in the future.
METHOD:
We use the WHO conceptual framework on child stunting to categorize and analyze the determinants.
132 stunting children have been identified using Kartu Ibu dan Anak. Direct interviews with parents were
conducted to obtain data which would then be tabulated and processed using statistics.
RESULT:
Consistent evidence reveals several contextual determinants and proximate causes that give rise to
stunting. Beliefs and norms among the community are the dominant contextual factors. Moreover,
pandemic-triggered poverty, income, and wealth factor also play an important role. The proximate
causes are addressed as maternal factors, poor food quality, inadequate breastfeeding practices and
complementary feeding.
CONCLUSION:
Based on this study, an educational approach is the main solution, followed by steps to improve the
nutritional quality of stunting children. Along with these, the improvement of the economic also needs to
be a concern.
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EP16. ABNORMAL DESIRE TO EAT NON-FOOD, PICA: A CASE REPORT

Triyana Dian Dhuha Akmaly
Department of Child Health, Faculty of Medicine, Brawijaya University, Saiful Anwar Hospital, Malang,
Indonesia
OBJECTIVE: Pica is a persistent consumption of non-food substances with the most reported case
is happen in childhood and adult with intellectual disabilities or psychiatric disorders. Pica can be life-
threatening and lead to serious medical problems. Pica appears to be strongly associated with iron
deficiency anemia and malnutrition, and here we report a case of PICA with iron deficiency anemia and
marasmus malnutrition who was treated at Saiful Anwar Hospital.
CASE: A one-year old boy came with a chief complaint his stomach had been getting bigger since 1
week before he was admitted to the hospital. No complaints of defecation and the last defecation in
the morning, solid consistency but small amounts. Patient had a history of atresia ani post mini PSA.
Patient also had malnutrition marasmus and iron deficiency anemia. From the abdominal examination,
we found a distended abdomen with a belly circumference of 54 cm, deaf percussion, and decreased
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bowel sounds. From BOF examination showed pneumoperitoneum and low-level bowel obstruction.
The patient then performed businasi and evacuation of faecaloma. From the post-spooling evaluation,
we found anal stenosis and faeces were mixed with sand, yarn, and stones.
CONCLUSION: In this case, pica was discovered accidentally after evacuation of the fecaloma due to
complaints of abdominal distension. Proper examination, early recognition, and appropriate management
are needed to prevent further complication. Parents should receive education around good nutritional
practices and be made aware of the potential severity of the condition.
Keywords: PICA, iron deficiency anemia, malnutrition marasmus
Lateral view of patient’s body (Left); abdominal BOF examination (Right)
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EP17. NUTRITIONAL STATUS OF CHILDREN SUFFERING FEBRILE SEIZURE

Felynawati Nawati,1* Harapan Parlindungan Ringoringo2
Inpatient Child Care, Idaman General Hospital, Banjarbaru, South Kalimantan, Indonesia.
1
Department of Child Health, Faculty of Medicine, Lambung Mangkurat University – RSD Idaman
2
Banjarbaru, Banjarbaru, South Kalimantan, Indonesia.
ABSTRACT
OBJECTIVE: Febrile seizures are seizure disorders that often occur in children aged 6 months to 5
years old. The peak incidence at 18 months of age. Febrile seizures are more common in boys than
girls. The incidence of febrile seizures is 2-5%. This study aimed to determine the nutritional status of
patients with febrile seizures.
METHOD: This study method is a descriptive retrospective with data from the medical records of patients
with febrile seizures in children aged six months to five years at Idaman Banjarbaru Hospital from
November 2020 - to April 2022. The sampling technique was carried out using consecutive sampling. In
this study grow charts from WHO use to classify children’s nutritional status.
RESULTS : A sample of 32 children, 20 boys, and 12 girls, was obtained in this study. Nutritional status
based on weight for length/height showed that 90.6% of the patients had good nutrition, and 9.4% had
undernutrition. weight for age data obtained 87.5% normal, 9,4% underweight, 3,1% overweight. In
addition, height for age data show that 62.5% normal and 25% short stature, 12,5% tall stature.
CONCLUSION : This study showed that 90,6% of patient had good nutrition.
Keywords: Febrile seizure, nutritional status, children.
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EP18. PLANT-BASED PROTEIN INTAKE AS A RISK FACTOR FOR STUNTING AMONG CHILDREN
UNDER 5 YEARS OLD: A CASE-CONTROL STUDY
Mike Lauda1, Sekarrini Widyastuti1, Irma Sri Hidayati1, Neti Nurani1

1
Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing,
Universitas Gadjah Mada, Yogyakarta, Indonesia
OBJECTIVE: To assess the risk factors associated with stunting in children under 5 years old.
METHOD: A community-based case-control study was conducted in October 2021 at Genikan village,
Magelang, including 84 children aged 0-60 months old taking by consecutive sampling. Data were
collected by measuring anthropometry, interviewing baseline characteristics and recalling daily food
intake using Semi-Quantitative Food Frequent Questionnaire (SQ-FFQ). Interviewers were blinded to
anthropometry results. Cases were define as stunting according to height-for-age Z-score (HAZ) < -2SD
and condition if weight age < height age < chronological age. Exclusion were made for incomplete
questionnaire data. Data were analyzed using SPSS version 25.0. Bivariate analysis which had p-value
< 0.25 were continued to multivariate analysis using logistic regression.A statistically significant was
declared by adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05.
RESULT: Total of 53 children, 20 cases and 33 controls, were made to data analysis. Bivariate analysis
revealed maternal body height, total siblings, diarrhea episode in last 3 months, daily total protein intake
and daily plant-based protein intake as potential risk factors of stunting (p-value < 0.25). Multivariate
analysis revealed only daily plant-based protein intake (AOR 8.23, 95% CI 1.01-67.17, p-value < 0.05)
and total siblings (AOR 4.79, 95% CI 1.23-18.63, p-value < 0.05) were significantly related to stunting.
CONCLUSION: Higher daily plant-based protein intake and total siblings were associated with higher
risk of stunting for children under 5 years old. Henceforth the type of protein consumption should be
considered wisely.
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EP19. PROTEINURIA AND PROGRESSIVE KIDNEY FAILURE IN A PATIENT WITH SIALIDOSIS
ZahrifaRiandani Putri, KristiaHermawan, Irma Sri Hidayati, Neti Nurani

Department of Pediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing
Objective: Sialidosis, also known as mucolipidosis type I, is a lysosomal storage disorder which results
from defects in the neuraminidase (NEU1) gene on chromosome 6p21. We report a case of sialidosis
type 2 which affected the kidney, manifested as nephrotic syndrome and progressed to kidney failure.
Case: We report a three-years-old boy who was born from the first uncomplicated pregnancy after two
previous miscarriages, without history of parental consanguinity. He initially presented with bilateral
scrotal hernia at 2 months old that required hernia repair procedure. The episode of anemia and
thrombocytopenia were noted at 3 years old, along with the recurrency of bilateral scrotal hernia. On our
first encountered, we found coarse facial features, macroglossia, gingival hypertrophy, paddle-shaped
costae, hepatomegaly, splenomegaly, hypertrophic cardiomyopathy, ventricular septal defect, dysostosis
multiplex in vertebrae, hypotonia, developmental delay and short staturewhich are typical features of
sialidosis. Iduronate sulfatase and α-iduronidaseenzyme were in normal levels. Genetic study revealed
two heterozygous variants in the NEU1 gene. However, parental targeted variant testing has not been
carried out due to financial difficulties. At the age of 3,5 years-old, he developed progressive edema
with nephrotic range proteinuria and hypoalbuminemia, followed by progressive declined of glomerular
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filtration rate. Renal biopsy was not performed due to persistent thrombocytopenia. In addition, this
patient also suffered from recurrent severe anemia refractory to multiple blood transfusion.
Conclusion: Sialidosis involve almost all organs and systems, renal involvement may present as
nephrotic syndrome and rapidly progressed kidney failure.
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EP20. REFEEDING SYNDROME IN MALNOURISHED CHILD WITH ENTEROCUTANEOUS FISTULA

AND HISTORY OF HIRSCHSPRUNG’S DISEASE POST DUHAMEL
PULL-THROUGH PROCEDURE
Zahrifa Riandani Putri, Desy Rusmawatiningtyas, Irma Sri Hidayati, Neti Nurani
Department of Pediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing
Objective: We present a case of refeeding syndrome in a malnourished child with enterocutaneous

fistula and history of Hirschsprung’s disease after Duhamel pull-through procedure, along with clinical
presentation and the management performed.
Case: A seven-year-old boy presented with severe anemia and marasmus type of severe acute
malnutrition. The patient had history of Hirschsprung’s disease and has undergone stoma closure
and Duhamel pull-through on three months before admission. Two months later, he developed
enterocutaneous fistula (ECF) with blood mixed yellowish product. He had significant weight loss from
19 kg to 13 kg in three months. On admission, blood glucose and serum electrolytes were normal. We
managed this malnourished child according to initial phase of severe acute malnutrition treatment with
oral feeding, however he developed high output ECF during rehabilitation phase. Thirty-eight hours after
we combined oral and enteral feeding, he developed respiratory distress with severe hypophosphatemia,
hypomagnesemia, and hypokalemia. There was an episode of seizure and delirium five days later.
Then, he received treatment appropriate for refeeding syndrome in the form of lower calorie intake with
gradual increase, as well as supplementation of phosphate, magnesium, and potassium and eventually
made a safe recovery.
Conclusion: Assessment of risk factors for refeeding syndrome is essential at the start of any nutritional
management, in which feeding must be given gradually along with monitoring of serum electrolytes,
even in children whose appetite has improved.
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EP21. GROWTH CONSEQUENCES OF A MINIMUM 1 YEAR KETOGENIC DIET

IN CHILDREN AND ADOLESCENTS WITH EPILEPSY: A SYSTEMATIC REVIEW
dr. Della Sabrina Marta1, dr. Aditya Putra2, dr. Sagita Pratiwi Sugiyono2,
dr. Ellen Wijaya, Sp.A3, dr. Bobby Pambudi, Sp.A4
1
St. Carolus Hospital, Salemba, Jakarta
2
Faculty of Medicine and Health Science, Catholic University of Indonesia Atma Jaya, Jakarta
3
Department of Pediatric, Faculty of Medicine and Health Science, Catholic University of Indonesia
Atma Jaya, Jakarta
4
Nutrition and Metabolic Disease Division, Department of Pediatric, Sam Ratulangi University/Prof. dr.
R. D. Kandou Hospital Manado
Objective:
Despite the positive outcomes of ketogenic diet (KD) in refractory epilepsy treatment, children’s growth
and development might be a long-term consequence. This study aims to determine the linear-growth
impact of minimum 1 year KD in epilepsy children and adolescents.
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Method:
A systematic review search was conducted using keywords within five databases (Pubmed, Science
Direct, Cochrane, Proquest and EBSCO) with the inclusion criteria: Epilepsy children & adolescent
underwent KD for minimum 1 year. Linear-growth examined with baseline Height for Age Z-score (HAZ)
and after KD intervention. Systematic review was done to analyze pooled data.
Result:
Total of 6 studies (193 subjects) met the criteria, 52% were male, mean aged was 6.14 ± 7.43 years
old. Studies reported a decrease of ≥90% seizure in 70 (41%) subjects. Pooled estimates of mean HAZ
scores were -0.37 ± 2.11 (baseline), -1.04 ± 2.98 (end of study) with mean difference were -0.67 (CI
95% -1.20,-0.14 ; p = 0.01), mean intervention duration was 18.5 months (12-24 months). Decreased
mean HAZ was found in 4 studies (155; 80% subjects); 3 studies with 2 years follow up (107 subjects)
& 1 study with 1 year follow up (48 subjects). Similar mean HAZ on baseline and post-KD were found in
2 studies with 15 months (24; 12% subjects) and 1 year (14; 7% subjects) follow up.
Conclusion:
HAZ of most children and adolescents with epilepsy that underwent a minimum of 1-year KD was found
to decrease after the intervention compared with the baseline score.
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EP22. NEONATAL CHOLESTASIS AS INITIAL MANIFESTATION

OF GAUCHER DISEASE
Amrina Rasyada, Bobby Pambudi, Cut Nurul Hafifah, Klara Yuliarti, Damayanti RusliSjarif
Department of Child Health, Faculty of Medicine University of Indonesia/
CiptoMangunkusumo National General Hospital, Jakarta/Indonesia
BACKGROUND: Neonatal cholestasis may be caused by numerous diseases, including metabolic liver
disease. Even though uncommon, it could be an initial manifestation of Gaucher disease (GD). Early
diagnosis is important to give better management and prognosis.
CASE: A 3 month-old-girl came to CiptoMangunkusumo Hospital with a distended abdomen. At

birth she had ichthyosis. She developed jaundice at three weeks old, experienced growth failure
and developmental delay. She was the second child of non-consanguineous parents. On physical
examination, we found hepatosplenomegaly, dysmorphic face, nystagmus, and ichthyosis. Laboratory
results showed cholestasis (direct bilirubin 4,75 mg/dL), bicytopenia, high ferritin level, and elevation of
liver transaminases. TORCH screening, septic marker, thyroid level, and lipid profile were normal. Bone
marrow puncture was unrepresentative. We suspected GD. Glucocerebrosidase enzyme was low (0,4
nmol/hour/ml) and high chitotriosidase (481,65 nmol/hour/ml), thus we diagnosed her as type 2 GD
due to infantile onset with neurology manifestation. We planned to give enzyme replacement therapy.
However, her condition had deteriorated, and passed away. Genetic counseling was given for the family.
CONCLUSION: Severe type 2 GD may manifest as neonatal cholestasis and ichthyosis. Early recognition
is important to prevent misdiagnosis and unnecessary examinations or treatments.
Keywords: Gaucher, cholestasis, glucocerebrosidase enzyme
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EP23. FORMULA MILK AND WEIGHT GAIN OF INFANTS WITH CONGENITAL HEART DISESASE
IN DR.MOEWARDI GENERAL HOSPITAL, SURAKARTA: A CROSS SECTIONAL STUDY
Agus Sucianto. Pridania Vidya Ayuningtyas

Departement of Child Health, Faculty of Medicine, Sebelas Maret University-Dr.Moewardi General
Hospital, Surakarta, Indonesia
Introduction: The number of patient visit in outpatient pediatric in Dr. Moewardi general hospital 33%
are congenital heart disease (CHD) patients. Infants with CHD may grow more slowly than the normal
infants. The hearts of children with CHD must pump faster because their metabolism are also faster
as compared to healthy children. Therefore these infant require extra calories to maintain their growth.
We conducted this study to determine the relation between formula milk consumption and weight gain
of infants with CHD.
Methods: A cross sectional study was performed in infants with CHD in Dr. Moewardi General Hospital
from January to December 2021. The demographic and clinical data were taken from medical record
of patients. The study population are term infants age 1-24 months who have been diagnosed heart
defects since birth. We included CHD infant patient who were either on breastfeeding or formula milk.
Meanwhile the measurement of weight gain use WHO weight increment curve in three consecutive
months. Then we analyzed the relation with Chi-Square Test. All data were statistically analyzed with
SPSS version 25 for windows, and P-value of < 0.05 was considered significant.
Results: There were 110 infants with CHD. Of these 65 (59%) consumed formula milk and 45 (41%) had
breastmilk. More subjects in formula milk (61,5 %) gained their weight than those receiving breastmilk
did (33%). Chi-Square test revealed a significant reliations between the weight gain of infants with CHD
and formula milk consumption [X2 = 8.46, p = 0.003].
Conclusion: In infant with CHD, formula milk consumption significantly relates to weight gain.
Keyword: infant, congenital heart diseases, formula milk, breastmilk

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EP24. NUTRITIONAL STATUS OF CHILDREN SUFFERING ACUTE DIARRHEA

Fajar Khalis Ananda1
1
Inpatient Child Care, Idaman General Hospital, Banjarbaru, South Kalimantan, Indonesia.
OBJECTIVE: Acute diarrhea is still one of the main problems in Indonesia. Furthermore, many factors
contribute to diarrhea, including poor nutritional problems. Some studies said 278,736 people had acute
diarrhea or 80.22% of the population. According to the data of Riskesdas in 2018, 17.7% of children
under five in Indonesia still have nutritional problems. This study aimed to determine the nutritional
status of patients with acute diarrhea.
METHOD:
This study method is a descriptive retrospective with data from the medical records of patients with
acute diarrhea at Idaman Banjarbaru Hospital from April 2020 to April 2022. The sampling technique
was carried out using consecutive sampling. In addition, this study used WHO grow charts to classify
children’s nutritional status.
RESULTS:
This study involved 54 children consisting of 33 boys and 21 girls. Nutritional status based on weight for
length/height showed that 52% of the patients had good nutrition, 37% had undernutrition, and 11% had
obese. Furthermore, weight for age data showed that 63% were normal, 26% were underweight, and
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11% were overweight. In addition, height for age data showed that 78% were normal, 4% were short
stature, and 18% were tall.
CONCLUSIONS:
This study showed that 51% of patients who suffered from acute diarrhea had good nutrition.
KEYWORDS: Acute diarrhea, nutritional status, children.

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EP25. KWASHIORKOR IN ADOLESCENT: AN UNDERESTIMATED CASE
Enggrajati M. H. Silitonga, Moretta Damayanti, Julius Anzar

Department of Child Health, Faculty of Medicine Universitas Sriwijaya, Mohammad Hoesin General
Hospital, Palembang
Objective: Indonesia is one of the world’s countries with high malnutrition burden. The etiology of
malnutrition is complex and differs between each age group. Commonly, feeding disorder is an important
cause of malnutrition in adolescents. Therefore, this study aims to report a scarce manifestation of
malnutrition in an adolescent.
Case: A 15.5 years old female was admitted to the hospital due to severe edema that started three
months ago. There was no history of prolonged fever or chronic cough. She had anorexia and secondary
amenorrhea and got thinner since studying at a boarding school in Java. She stopped going to school
since the symptoms appeared. We found out her weight was 42.5 kgs, height 148 cm(s), and arm
circumference 13 cm(s). She looked severely wasted with ascites and bilateral pitting edema on both
legs, without lymphadenopathy and organomegaly. The maximum abdominal circumference was 86
cm(s). Ascites fluid analysis showed transudate with normal histopathology findings. She did not have
signs and symptoms of tuberculous infection. Urinary tract infection was suspected from urinalysis
and confirmed with the growth of ESBL producing E. coli. Echocardiography demonstrated dilated
cardiomyopathy. She received pediatric nutrition care, albumin correction, antibiotics, cardiac anti-
failures, and estradiol valerate. She was discharged after 20 days of hospitalization in good condition,
with fully subsided edema.
Conclusion: As a classical form of severe malnutrition, Kwashiorkor might be found in adolescents. The
etiologies could be overlapped with complications and need proper analysis to get a definite diagnosis.
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EP26. CORRELATION BEETWEN VITAMIN D LEVEL AND LEPTIN-ADIPONECTIN RATIO (L/A

RATIO) IN OBESE CHILDREN
Gustian Rante Tiballa, Aidah Juliaty A Baso, Idham Jaya Ganda
Department of Child Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
OBJECTIVE: Obesity is a risk factor for vitamin D deficiency in children and interfereS with the regulation
of adipokines, such as leptin and adiponectin. Vitamin D also influences the synthesis of leptin and
adiponectin through its influence on adipogenesis and regulation of proinflammatory cytokines. The L/A
ratio is an excellent indicator of the risk of metabolic disease, insulin resistance, and vascular disease
compared to measuring these two adipokines separately. The aim of this study is to determine the
correlation between vitamin D deficiency and L/A ratio in obese children.
METHOD: This cross-sectional study was conducted from August 2021 to October 2021 by multistage
cluster random sampling with the target of obesity junior school and high school students in Makassar.
The sample was divided into two groups, the obese children with vitamin D deficiency and without
vitamin D deficiency.
RESULT: The median L/A ratio in the group of obese children with vitamin D deficiency was 1.48, higher
than the group of obese children without vitamin D deficiency, which was 0.13. There was a significant
difference in the median L/A ratio between two groups with p-value = 0.000 (p < 0.05). Vitamin D levels
and L/A ratio showed a negative correlation with p-value = 0.000 and r = 0.808.
CONCLUSION: The L/A ratio was significantly higher in the group of obese children with vitamin D
deficiency and showed significant negative correlation.
Keyword: Vitamin D deficiency, leptin-adiponectin ratio (L/A ratio), obese children
EP27. OLIGOARTICULAR JUVENILE IDIOPATHIC ARTHRITIS IN A 4 -YEAR-OLD GIRL WITH

FEEDING PROBLEM
Gustian Rante Tiballa1, Bahrul Fikri1, Ninny Meutia Pelupessy1, Aidah Juliaty A Baso1
Gustian Rante Tiballa

1
Department of Child Health, Faculty of Medicine, Hasanuddin University/ Wahidin Sudirohusodo
E-mail: gustiantiballa@gmail.com
Corresponding Author
Bahrul Fikri, dr. M.Kes, Sp.A. Ph.D
Department of Child Health, Faculty of Medicine, Hasanuddin University/ Wahidin Sudirohusodo
Jl. Perintis Kemerdekaan km. 10, Tamalanrea 90245, Makassar-Indonesia
E-mail: bahrulfikri@unhas.ac.id
ABSTRACT
Objective. Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease found in
children with unknown causes with the main symptom being arthritis. The etiology and pathogenesis of
JIA are still unclear. The most acceptable and supportive theory is the role of immunological mechanisms
caused by genetic and environmental factors. Feeding problem is one of the causes of Failure to thrieve
in children. It is rare in JIA patients. We report a JIA patient with the presense of feeding problem.
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Case. A 4-year-old girl was hospitalized at the Dr. Wahidin Sudirohusodo Makassar Hospital with
diagnosis of oligoarticular JIA with feeding problem. The diagnosis was made based on history taking,
physical examination, laboratory examination and radiologic examination. Pharmacological management
of this patient with non-steroidal anti-inflammatory drugs (NSAIDs) and supportive therapy resulted a
good outcome. The patient was discharged after 16 days hospitalization.
Conclusion. Understanding the diseases with the appropriate treatments including in JIA patients will
improve the patient’s conditions.
Keywords: Juvenile Idhiopatic Arthritis (JIA), oligoarthricular, feeding problem
EP28. NEONATAL HEMOCHROMATOSIS TREATED WITH INTRAVENOUS IMMUNOGLOBULIN

(IVIG) AND ANTIOXIDANT COCKTAIL: A CASE REPORT
Jeannie Flynn, Nur Aisiyah Widjaja, Meta Herdiana Hanindita
Department of Pediatrics, Dr. Soetomo General Hospital, Surabaya, Indonesia
Objective
To enable pediatricians to clinically recognize Neonatal Hemochromatosis (NH) and plan relevant
investigation and prompt treatment.
Case
A 3-days-old male infant came to the clinic with jaundice. He was lethargic and reluctant to breastfeed.
There was no parental consanguinity but there was history of Intrauterine Fetal Death (IUFD) in previous
pregnancy. Initial laboratory examination was normal except for total/direct bilirubin (15.92/0.48 mg/dl)
and Gamma Glutamyl Transferase (GGT) (287 U/l). Prothrombin time was prolonged (16.8 second) and
International Normalized Ratio (INR) was 1.29. The patient received double phototherapy for 1x24 hours
but the jaundice was only slightly decreased. Screening test for inborn error metabolism was normal.
Serum ammonia and serum Alpha-Fetoprotein (AFP) was increased. Studies for infectious disease
was negative. Iron panel revealed high ferritin levels (1098 ng/mL). Abdominal MRI, liver biopsy, and
salivary glands biopsy have not been performed in this patient. Based on data collection, NH was
diagnosed. Intravenous immunoglobulin was given and ferritin levels was decreased, but begin to
increase thereafter. Therefore, antioxidant cocktail therapy was begun. Ferritin levels begin to decrease
gradually at 27 days of age. Jaundice was improved and the patient was discharged at 29 days of age.
Conclusion
Diagnosis of NH is challenging due to its wide variety of symptoms. Diagnosis can be approached
by excluding other causes of liver failure and detecting iron overload in the body. Early and prompt
treatment with IVIG and antioxidant cocktail therapy may prevent its fast and fatal progression.
EP29. NUTRITIONAL STATUS AND ITS CORRELATION WITH MORTALITY WITH COVID-19
INFECTION
Natharina Yolanda, Ronald Rompies, Bobby Pambudi, Novie Rampengan, Adrian Umboh
Department of Child Health, Faculty of Medicine, Sam Ratulangi University, Manado
Objective
Nutritional status is one of important factors in immune system function and it may have important role
in mortality of Covid-19 infection. The aim of this study was to evaluate the nutritional status and its
correlation with mortality in children diagnosed with Covid-19 infection.
Methods
The body weight and height of children aged 1 – 18 years diagnosed with Covid-19 and hospitalized
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at Kandou General Hospital, Manado, Indonesia were measured. Nutritional status assessed including
weight for age (WFA), height for age (HFA), and weight for height (WFH). Body weight and height was
plotted to WHO growth curve for children below 5 years old and to CDC growth curve for children more
than 5 years old. Correlation between nutritional status and mortality was tested with Pearson analysis.
Results
A total of 85 patients were evaluated. The WFA was normal in 78%; 10% was underweight, 7% was
severely underweight, and 5% was overweight. The HFA was normal in 90%; 8% was stunted and 2%
was severely stunted. WFH was normal in 88%; mild-moderate malnutrition was 8%, severe malnutrition
was 2% and overweight was 2%. Deaths were noted in 3 out of 85 patients (3.5%). In Pearson analysis,
there was no significant correlation between WFA and mortality (LR 1.03, p=0.889, 95% CI 1.01-3.21),
HFA and mortality (LR 1.02, p=0.806, 95% CI 1.0-4.31), and WFH and mortality (LR 2.56, p=0.339, 95%
CI 1.88-5.64).
Conclusion
Undernutrition was present in 10% of children with Covid-19 infection. Nutritional status was not
correlated with mortality in children with Covid-19 infection.
EP30. RECURRENT LACTATE ACIDOSIS IN PATIENTS WITH GLYCOGEN STORAGE DISEASE

TYPE IA: A CASE REPORT
Rizki Nandasari Sulbahri, Moretta Damayanti, Silvia Triratna

Department of Child Health, Faculty of Medicine Universitas Sriwijaya, Mohammad Hoesin General
Hospital Palembang, South Sumatera, Indonesia
OBJECTIVE:
Glycogen Storage Disease (GSD) type Ia, known as Von Gierke disease, is an inherited disorder caused
by deficiencies of glucose-6-phosphate (G6P) enzymes in the glycogen metabolism pathway, impacts
on both gluconeogenesis and glycogenolysis. The inability to convert glucose-6-phosphate (G6P) to
glucose causes severe post absorptive hypoglycemia. Excess G6P is shunted to alternative pathways
including lactate production. We report a case of GSD type Ia presented as recurrent lactate acidosis.
CASE:
A five-months-old boy admitted to hospital with chief complaint shortness of breath for three hours
before admission. It was the third episode in the last three months. He had acute diarrhea without
dehydration. The physical examination showed kussmaul breathing, no rhonchi and no wheezing.
There was sharp-edge liver enlargement. He was stunted with good nutritional status. Normal chest
x ray, echocardiography, and complete blood count were identified. Initial blood gas analysis revealed
pH 7.169 pCO2 18.7 pO2 88.7 SO2 94.5 lactate 19.0 HCO3 6.9 BE -21.9. There was low random
blood sugar with ketonuria. Metabolic profile indicated hypercholesterolemia and hypertriglyceridemia
Complete abdominal ultrasound showed fatty liver with enlargement of bilateral kidney, hydronephrosis
dextra grade II. Therefore, we suspect for glycogen storage disease and checked for genetic mutation
analysis. We managed the patient by giving oxygen through rebreathing mask, intravenous bicarbonate
administration, and nutritional approach with uncooked cornstarch. The genetic mutation analysis
confirmed GSD type Ia.
CONCLUSION:
Glycogen storage disease type Ia may be identified in patient with recurrent lactate acidosis.
KEYWORDS: recurrent lactate acidosis, glycogen storage disease type Ia
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EP31. SCURVY IN CHILDREN PRESENTING WITH WEAKNESS AND SEVERE ANEMIA: A CASE
REPORT
Putu Ianta Parama Siwi, I Gusti Lanang Sidiartha, Dewi Sutriani Mahalini
Department of Child Health Medical School of Udayana University, Sanglah Hospital Denpasar Indonesia
ABSTRACT
Background: Scurvy is a rare and one of the oldest diseases known to mankind. Scurvy is caused by
prolonged severe dietary deficiency of vitamin C. Being rare as compared to other nutritional deficiencies,
it is seldom suspected and this frequently leads to delayed recognition of this disorder. Children with
physical disabilities or abnormal dietary habits are prone to develop this disease. The disease spectrum
of scurvy is quite varied and includes bone and systemic manifestations.
Case: We report a 5-year-old male with hearing impairment, presented to our clinic with a third episode
of weakness and limp. A week prior, he began to have trouble walking, which progressed to complete
refusal to walk because of leg pain. Dietary histories revealed that the patient sharply limited intake of
meat, fruits, and vegetables. Complete blood count showed that he has severe anemia. A diagnosis
of scurvy was assessed on the basis of nutritional history, clinical features, and radiographic findings.
Supplementation of ascorbic acid enabled a prompt resolution of symptoms. .
Conclusion: These clinical manifestations and radiologic findings highlight the importance for doctors
to have a higher index of suspicion for scurvy in nonambulatory children. Our case demonstrates the
importance to emphasizes the necessity of a dietary screening that could potentially reduce extensive
work-up in patients with nonspecific complaints.
Keywords: children, scurvy, deficiency of vitamin C

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EP32. NOMA IN HIV-INFECTED CHILD WITH SEVERE ACUTE MALNUTRITION :

A CASE REPORT
Novalina Kaban, Moretta Damayanti, Yulia Iriani

Department of Child Health, Faculty of Medicine Universitas Sriwijaya/
Mohammad Hoesin Hospital, Palembang, Indonesia
Objective: Noma is orofacial gangrene affecting malnourished children that rapidly destroys and
perforates the soft and hard tissues of the face. Global incidence was 30-40.000 cases annually, with
mortality rate up to 85%. However, there was no publication about Noma in Indonesia. Thus, the objective
of this study was to report a rare case of Noma.
Case: A three-year-old female had been diagnosed with HIV infection and was admitted with severe
acute malnutrition and a lesion on the left corner of the lip. The lesion started as a blister covered with
a white membrane seven days before admission. It rapidly progressed into an ulcer with a five cm(s)
diameter. There were prolonged fever and chronic cough but no history of appropriate treatment. She
lived with her parents in a slum neighbourhood. We found a hole with a grayish-black area, exposed
teeth, and active pus production on physical examination. She looked severely wasted. There were rales
on both lungs. Supporting investigations revealed anemia, confirmed COVID-19 infection, tuberculosis
infection, and very low CD4 level. The pus culture showed Klebsiella Pneumoniae. We managed this
patient according to severe acute malnutrition guidelines and gave proper antibiotics, antituberculosis
and antiretroviral therapy. Her general condition improved on day 25th, the mean weight gain was 20
grams/day, and the lesion size decreased.
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Conclusion: Noma is an abandoned multifactorial disease, and most cases were associated with
malnutrition. Treatment consists of three main elements: proper antibiotics, hydration and nutritional
support, and treatment of concomitant diseases to prevent death.
EP33. THE ASSOCIATION BETWEEN TYPE OF MALIGNANCY AND NUTRITIONAL STATUS IN

CHILDREN
Tessa Rulianty, Moretta Damayanti, Julius Anzar, Dian Puspita Sari

Department of Child Health, Faculty of Medicine/ Moh. Hoesin Hospital
Universitas Sriwijaya, Palembang, Indonesia
Objective: Malnutrition is a common problem in children with cancer. The purpose of the study was
to describe the point prevalence of malnutrition among paediatric patients with malignancy, and its
association with the type of cancer.
Methods: A retrospective study reviewing medical records of all children from 1 month to 18 years of
age with malignancy was conducted from January to March 2022. We used the WHO growth chart
2006 and CDC 2000 to assess the nutritional status, using weight-for-length/height or MUAC if there
was organomegaly or any particular condition. Subjects with moderate and severe malnutrition were
classified as malnourished.
Result: There were 153 subjects, 77 suffered from non-hematologic malignancy, and median age
was 100 (13-205) months. The distribution of nutritional status was as follows: well-nourished 56.2%,
severe malnutrition 14.4%, moderate malnutrition 24.8%, overweight 3.9%, and obese 0.7%. Among
malnourished subjects, female was 59%, 50% were >5 years old, and 90% had short stature. The types
of malignancy were non-hematology (63%) and hematology (36%). Non-hematology malignancies were
osteosarcoma (13%), neuroblastoma (10%), nasopharynx carcinoma (8.3%), non-Hodgkin Lymphoma
(5%), teratoma (5%), Wilms tumor (5%). Meanwhile, 22 subjects had hematology malignancies which
were acute lymphoblastic leukemia (10%), acute myeloid leukemia (10%) and chronic myeloid leukemia
(6.6%). There was significant association between the types of malignancy and nutritional status in this
population (p=0.01, OR 2.392, 95% CI (1,227-4.661)
Conclusion: More than one-third of malignancy children were malnourished, and almost all of them had
short stature. Non-haematologic malignancy patients had higher malnourished prevalence.
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EP34. MANAGEMENT of acute metabolic encephalopathy BY peritoneal dialysis

in A neonate with Maple Syrup Urine Disease:
challenges in resource-limited setting
Luciana Intanti Putrijaya1, Retno Palupi-Baroto2, Cut Nurul Hafifah3 , Damayanti Rusli Sjarif3
Awal Bros Panam Hospital, Pekanbaru, Indonesia

1
Division of Nephrology, Department of Child Health, Faculty of Medicine, Public Health, and Nursing,
2

3
Division of Nutrition and Metabolic Disease, Department of Child Health, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
Objective: Maple Syrup Urine Disease (MSUD), an inborn error of metabolism (IEM), often manifest
with life-threatening acute metabolic encephalopathy at neonatal period. Removal of accumulated toxic
leucine is a key strategy to prevent progressive brain injury or even death. We report a case of MSUD
emphasized on the use of peritoneal dialysis (PD) in the setting where diagnosis and management of
IEM remains challenging.
Case: A previously healthy 8-day-old boy from non-consanguineous parents presented to the hospital
with poor feeding, lethargy, hypotonia, and seizure, then progressed to apnea and coma. Notably, his
two older siblings died at neonatal period with unknown diagnosis. Laboratory examination showed
respiratory alkalosis, elevated lactate and urine ketone. Patient was suspected of IEM with acute
encephalopathy. Supportive therapy included glucose infusion (rate 6-8mg/kg/min), anticonvulsant,
antibiotics, mannitol, and discontinuing protein intake. Three weeks later, amino acid profile revealed
marked elevation of branched-chain amino acid (BCAA) leucine/isoleucine, and the urine organic acid
test revealed increased excretion of 2-hydroxyisovaleric acid and 4-hydroxyphenyllactic acid, thus
confirming MSUD. BCAA-free formula was started. PD was prescribed with dianeal-1.5% 15mL/kg for
2 hours. After 2 weeks of PD, there was a subtle increase of the level of alertness and a remarkable
decrease of plasma leucine/isoleucine (from 2663.82 to 783.3umol/L). Unfortunately, his condition
deteriorated due to sepsis and irreversible brain damage.
Conclusion: PD might be an applicable rescue strategy to remove toxic leucine in MSUD presenting
as neonatal metabolic encephalopathy in resource-limited setting. Prompt recognition and treatment is
important for more favorable outcome.
Keywords: maple syrup urine disease, metabolic encephalopathy, inborn error of metabolism, peritoneal
dialysis
_________________________________________________________________________________
EP35. CONTRIBUTING FACTORS FOR SUBOPTIMAL BREASTFEEDING

TO IDENTIFY MOTHER WHO NEED BREASTFEEDING SUPPORT
Wiyarni Pambudi1,2, Eko Kristanto1, Zenitha Meida Sari2

1
Department of Paediatrics, Faculty of Medicine Universitas Tarumanagara, Jakarta
2
Breasfeeding Task Force Indonesian Pediatric Society
Objective
This study aimed to determine the contributing factors influencing suboptimal breastfeeding to identify
mother who need breastfeeding support.
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Method
A quantitative cross-sectional study was conducted on January 2022. Simple random sampling
technique was applied after taking all registered mothers who join online parenting class. Data from
self-administered questionnaires was analysed using Chi-square or Fisher’s exact test. The outcome of
interest were exclusive breastfeeding and infant growth at 6-month-old.
Result
The recruited sample consisted of 105 eligible mothers with infants aged 6-12 months. Most of the
subjects were aged 20-39 years old (90%), had higher education level (66%), part and full-time workers
(51%), and had household income over minimum regional wages (87%). Sources of breastfeeding
information were obtained from health workers (69%) followed by social media (31%). The proportion
of exclusive breastfeeding was 68% and mode of feeding was 53% direct breastfeeding. Knowledge
was an influential factor in the success of exclusive breastfeeding, with an odds ratio (OR) 3.4.
Adequate weight and length increment was monitored among 71,4% and 51,4% infant, associated
with breastfeeding frequency, infant gender, technique, birth length and weight as contributing factors
of sufficient infant growth during exclusive breastfeeding practices with an adjusted OR of 1.3, 1.4, 1.5,
2,8 and 5.7 respectively.
Conclusion
The finding allowed to identify contributing factors for suboptimal growth of breastfed infant who need
counselling support during the first six month of life. Exclusive breastfeeding success is strongly
influenced by knowledge, but may also need a counselling support for several condition.
Keywords: factor, suboptimal, breastfeeding, support
_________________________________________________________________________________
EP36. A CASE OF KWASHIORKOR WITH COMPLICATIONS
Novi Handayani1, Andrey Setiawan1,2

1
Department of Child Health, Tarakan General Hospital, Jakarta, Indonesia,
2
General Practitioner, Mayapada Hospital Tangerang, Banten, Indonesia
A 15-month-old girl came with pallor, weakness, fever for a month, and cough for two weeks. The
patient has never been to Posyandu and has never been immunized. She was born with the help of a
traditional healer, who did not know her birth weight. Inappropriate feeding practice was found, exclusive
breastfeeding was for 5 months, and got sweetened condensed milk as a substitute. She was given
porridge with gravy for other meals without any side dishes or mashed rice with spinach and tempeh.
From the physical examination, delayed development, edema on palpebrae and both legs, dermatosis,
petechiae, ecchymosis, and baggy pants. She was severely stunted with a length of 65cm (HAZ
-4,62SD) and a weight of 5,5kg (WAZ -4,54SD) hence severely underweight, WHZ -2,91, with an arm
circumference of 11cm, microcephaly (41cm), hair was pale and easily pulled out and a soft liver edge
was also palpable. Mantoux was 0mm.
Further investigations suggested anemia Gravis, leucocytosis, thrombocytopenia, hypoalbuminemia,

prolonged clotting time, altered liver function, electrolyte imbalances (Na 128, K 3.1, Ca 8.1), TSHs
8.319 (hypothyroidism) and urinary tract infection. Echocardiography with ASD 2.5mm. The patient was
admitted to PICU and given inotropic, blood, albumin transfusion, clotting factor, antibiotic, furosemide,
ACE Inhibitor, and Loop Diuretics. After 12 days in PICU, the condition improved, and was transferred
to the ward for monitoring and discharge.
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We should be cautious of severe malnutrition and its complications in Jakarta. The importance
of monitoring and collaborating with Posyandu for anthropometric monitoring, feeding, catch-up
immunizations, and growth and development interventions still needs improvement.
Keywords: kwashiorkor, severe malnutrition, hypothyroidism, microcephaly, baggy pants, atrial septal
defect, anemia gravis, urinary tract infection, inappropriate feeding practice
_________________________________________________________________________________
EP37. RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND CHILD DEVELOPMENT

DISORDERS.
Efanrani Stiawan, Hari Wahyu Nugroho,
Department of Pediatrics, Faculty of Medicine, Sebelas Maret University/ Dr. Moewardi Hospital,
Surakarta, Indonesia.

ABSTRACT
BACKGROUND
The quality of children can be assessed from the process of growth and development. The golden
period is an important phase in the rapid growth and development of children. Nutritional status is
associated with factors that affect the growth and development of children. The purpose of this study
was to determine the relationship between nutritional status and child development disorders.
METHOD
A cross-sectional observational study was conducted on patients at the social pediatric outpatient
clinic at Dr. Moewardi Hospital, Surakarta in February 2022. Diagnose of developmental disorders
was established based on the results of growth and development screening, physical and supporting
examination. Nutritional status was assessed by age-appropriate WHO and CDC growth curves.
Relationship between nutritional status and developmental disorders was analyzed using univariate and
bivariate tests. Limit of significance if p < 0.05 with a 95% confidence interval.

RESULTS
From 45 subjects with a diagnosis of developmental disorders, 28 children (62.3%) were well nourished,
14 children (31.1%) were undernourished and 3 children (6.7%) were overweight. Relationship between
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nutritional status and developmental disorders was analyzed using univariate and bivariate tests. Limit
of significance if p < 0.05 with a 95% confidence interval. statistical test Chi-Square obtained p value of
0.115 with the results of bivariate analysis obtained Contingency Coefficient as big as 0.535 (95% CI)
which means there is no significant relationship between nutritional status and developmental disorders.
CONCLUSION
Nutritional status does not have significant relationship with growth and development disorders.
Keywords: nutritional status, developmental disorders.

_________________________________________________________________________________
EP38. A CASE REPORT:THE DIAGNOSIS AND INITIAL MANAGEMENT OF STUNTING CASES IN

PULMONARY TUBERCULOSIS CHILDREN AT LIMITED FACILITIES
Bayu Puspita Rani
KSM Children’s Health, Pamanukan Medical Center Hospital, Subang-West Java
OBJECTIVE
The period of the first 1000 days of life is a critical period of growth disorders including stunting.
Therefore,the prevention and handling of stunting is one of the important priorities for better child quality.
CASE
Girl aged 19 monthsarived to hospital with complaints of shortness of breath since 1 day before
entering the hospital.Mothersaid there was a history of fever,cough since 3 weeks ago, the child had
no appetite Patients often experience the same complaints from the age of 9months,when the disease
is previously the child is severely malnourished. Current history of the diseaseasthma and Pulmonary
Tuberculosis disangkal.The patienthave history of familywith pulmonary TB without the results of the
BTA examination known,the family has a short stature is refuted.The pregnancy history of the mother
routinely doing ANC regularly in the health facility and the increase in the mother’s weight quite good,a
history complete basic immunization,the histori of foods and drink formula milk from birth to the age of
6months, followed by giving formula milk 1-2 times a day and porridge instant milk up to the age of 12
months, then given food in the form of rice with a familyfood menuand sometimes given formula milk.
Children eat 2-3 meals a day with small portions and with side dishes in the form of side dishes such as
eggs and other instant processedfoods.Children rarely consume meat and vegetables.Nutritional status
is currentlyweight for age -3sd<-2,length for age<-3SD,weight for lenght -2SD to+1SDand at the age of
9 months Weigh for age under <-3- <2SD.
On examination of vital signs obtained pulse 100, breathing 35x i, temperature 36.9 ° C, Spo2
97%, weight 8.4 kg.On physical examination the general condition appeared to be moderately ill, stature
looked short,multiple glands kgb more than 1cm, painless and mobile, the thorax was found to be wet
Ronki in the upper lungs and abdomen of the soepel.
In laboratory examination, Hb 9.2 gr/dl, leukocytes 17,600 μl, eosinophils 6 %.The results of the
X-ray examination obtained a picture of infiltrate in the upper lung and the thickening of the left perihilar
effect: Suggestive active pulmonary TB.With a total scoring TBof 7. Patients in diagnosed bronchiolitis,
pulmonary tuberculosis, and stunting.
Administration of oxygenation therapy2lt/m,nebulationof salbutamol and ipratropium bromide /6 hours
as well.Non-pharmacological therapy is the provision of food given in accordance with energy needs
according to the nutritional adequacy figure of 945 kkal, protein 13.65 gr, total fat 45gr.Afterthe patient
is stable and discharged for outpatient treatment and enjoys providing nutrition and starting to give OAT
starting with the administration of the intensive phase of 2 months. Education on how anthropometric
assessments and their interpretations are conducting evaluations every month.
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When the control to the outpatient child’s appetite began to improve, the child’s BB began to
increase 9kilos,length 74 cm, the 2nd month weight of the child 9.3,lenght 74 cm which was continued
with the Advanced phase in the 3rd month The child’s weight was 10 kilos,lenght 74cm,the appetite was
getting worse, cough complaints were reduced, there was no fever and evaluation of growth until the
age of 3 years.
CONCLUSION
Proper enforcement ofdiagnoses of severe malnutrition andchronic infections in children in their first
1000 days with substandard nutritional status can prevent stunting and other growth failures as well as
monitoring Child growth and development is very important for medicalpersonnel to prevent growth
and development disorders.
EP39. CASE SERIES OF SCURVY IN A TERTIARY HOSPITAL: THE FORGOTTEN HIDDEN HUNGER
Patricia Lukas Goentoro,1 Mega Septiana,1HarsyaPradana Loeis,1 Eka Satya Nugraha,1 Yoga Devaera,1
Titis Prawitasari,1 Klara Yuliarti,1 Cut Nurul Hafifah1
Department of Child Health, Faculty of Medicine Universitas Indonesia- CiptoMangunkusumo Hospital

General Hospital, Jakarta, Indonesia
ABSTRACT
OBJECTIVE: Scurvy is a condition secondary to chronic ascorbic acid deficiency. Scurvy is frequently
misdiagnosed with osteomyelitis or rheumatologic conditions. This study aims to describe our clinical
experience with scurvy, once thought to be non-existent.
METHOD: This study is a retrospective descriptive study. Data were obtained from medical records in
CiptoMangunkusumo Hospital between January 2021 and April 2022
RESULTS: We found 6 cases of scurvy with age ranging from 3 year 4 months to 5 year 11 months. All
of them were males. Five out of six patients had severe malnutrition (MUAC Z-score -3.39 to -3.06). All
patients refused to eat vegetables and fruits, came with painful and swollen knees or ankles, and refused
to walk. One patient complained of stomatitis, another patient manifested with anaemia. Two third of
them showed ascorbic acid levels under 0.1 mg/dL (normal range 0.4 - 2 mg/dL). Plain radiographs of
the lower extremities showed subperiosteal hematoma, soft tissue oedema, sclerotic and irregularity of
the epiphyseal plate. Patients were given vitamin C 300 mg per day divided in 3 doses for 1 month. The
ascorbic acid level and plain radiographs were not yet measured after treatments, however the swollen
legs were significantly improved and they began to walk with aids. Ascorbic acid was then continued
until 3 months.
CONCLUSION: Scurvy should be considered as a differential diagnosis in children with difficulty of

walking and dietary history of vitamin C deficiency. Administration of oral vitamin C gives a good outcome
for the patients.
KEYWORDS: scurvy, malnutrition, swollen legs, subperiosteal hematoma, ascorbic acid
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EP40. MALNUTRITION AS A RISK FACTOR ASSOCIATED WITH FEBRILE NEUTROPENIA IN

ACUTE LYMPHOBLASTIC LEUKEMIA CHILDREN
Jessica Christina, PriliyanaPuspita, Muhammad Ikhsan

Departmet of Child Health, CiptoMangunkusumo General National Hospital, Jakarta, Indonesia
Background
Febrile Neutropenia (FN) is a frequent complication in children with malignancy. Acute Lymphoblastic
Leukemia (ALL) is the most common malignancy in children.1 Nearly 85%children with malignancy
are malnourished.2 Malnutrition has been associated with impaired immunity and increased risk of
infections.3
Objective
To evaluate malnutrition as a risk factor associated with FN in children with ALL.
Methods
A case control study was conducted to children aged 1 month to 18 years old with ALL at
CiptoMangunkusumo General National Hospital Jakarta between 2019-2020. Study group were children
with FN and control group were children without FN. Bivariate statistical analysis using SPSS was done
to evaluate malnutrition association with FN.
Results
A total of 86 children were enrolled, 43 children in each study and control group. More than half children
were male (54.7%) with overall mean age 6.5+ 5.4 years old. Malnutrition was seen in 32 (37.2%)
children with ALL who participated in this study. Bivariate analysis revealed a significant correlation
between malnutrition and FN in ALL children (p=0.026). Malnourished children aged 1 month to 18
years with ALL risk being febrile neutropenia 2.78 (OR 2.78; 95%CI 1.12–6.89) times greater than well-
nourished children aged 1 month to 18 years with ALL (OR 2.78; 95%CI 1.12–6.89).
EP41. ESCAPE FROM KWASHIORKOR AND SEVERE STUNTING:

A CASE REPORT
Tisnasari Hafsah, Rizki Ayu Rizal, Viramitha K Rusmil, Dida A Gurnida, Julistio TB Djais
Department of Child Health, Medical School/Hasan Sadikin Hospital, Bandung, Indonesia
OBJECTIVE
Severe acute malnutrition and chronic malnutrition are still prevalent in Indonesia. However, referral
cases to tertiary hospitals usually come with a complex, difficult diagnosis that is hard to overcome and
achieve complete nutritional recovery. This longitudinal observational case describes a patient with
primary malnutrition and recounts the importance of optimal nutrition care.
CASE
An 8-month-old boy was referred to Emergency Unit Hasan Sadikin Hospital with complaints of swelling
on his legs, shortness of breath, paleness, and feeding problems. His body weight was 5400 grams
(WFA:-4.05 SD), length 57 cm (LFA:-6.14 SD;WFL:0.61 SD), head circumference 44 cm, and mid-upper
arm circumference 12 cm. He looked moderately ill, got crackles on both lungs, slight liver enlargement
and ascites, and bilateral pitting edema on his leg. He was diagnosed as having kwashiorkor,
bronchopneumonia, nutritional anemia, labiopalatoschisis, short stature, and global developmental
delay. Initial treatment was antibiotics, Packed Red Cell and Albumin transfusion, as well as nutritional
support with regular infant formula.
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The patient was born normally, term, 2500 grams. He only got breastmilk for one month because her
mother worked as a foreign worker, then continued with sweetened condensed milk that spent three
cans for one week. Each can contains 370 grams, equal to 1200 kcal, 10 grams of protein.
After six months of follow up, he weighed 9800 grams (WFA: -0.57 SD) and 74 cm (LFA: -2.62 SD) in
length. He was able to walk three steps without help, expressed a wish, and finished his regular meal
and milk offered.
CONCLUSION
High quality and sufficient quantity of nutrition are essential to prevent stunting and other types of
malnutrition.
EP42. A CASE REPORT: GAUCHER DISEASE

Michael Mettafortuna Sephberlian1, Amirah Zatil Izzah1, Nice Rachmawati Masnadi1
1
Pediatrics Department of Medical Faculty Andalas University, RSUP Dr M Djamil, Padang,
West Sumatera, Indonesia
ABSTRACT
Objective: Inherited metabolic disorders are rare, so a high index of suspicion is required to diagnose
them. Gaucher disease is an inherited metabolic disorder caused by deficiency of beta-glucocerebrosidase
enzyme. The definitive diagnosis is by DNA analysis and/or white blood cell enzyme analysis.
Case: A boy aged 6 years and 1 month was referred from Muaro Bungo Hospital with Look pale since 1
week before admission. Left abdomen was enlarged since 3 years ago and has grown rapidly within the
last 2 weeks. Anemic conjunctiva and icteric sclera were found. Abdominal was bloated, liver was palpable
at 5 cm below BAP line and 3 cm below BPX, sharp edges, flat surface, chewy consistency. Spleen at
Schoefner V. Abdominal ultrasonography showed hepatosplenomegaly with ascites. Laboratory showed
pancytopenia with reticulocytosis, elevated bilirubin, SGOT and SGPT. Low beta glucosidase enzyme
test results (1,60 nmol/hr/mL). Erlenmeyer radiography image was found on the femur and Gaucher
cells from bone marrow smear. The patient was planned to receive enzyme replacement therapy.
Conclusion: This patient was diagnosed with Gaucher disease based on clinical manifestations, history
of causality and the findings of pancytopenia, hepatosplenomegaly, Erlenmeyer radiography image,
Gaucher cells and low beta- glucocerebrosidase enzymes.
Keywords: Gaucher disease, clinical manifestations, beta-glucocerebrosidase enzyme.
a. Clinical picture of the patient; b. Bone marrow smear examination showed normocellular, hematopoietic
activity within normal limits, and gaucher cells were found; c. Bone survey obtained Erlenmeyer flask
images of the femur.
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EP43. RELATIONSHIP BETWEEN NUTRITIONAL STATUS WITH LENGTH OF STAY AND SEVERITY
OF COVID 19 IN CHILDREN AT RSUD DR CHASBULLAH ABDULMADJID, BEKASI CITY
St. Rahmah Rahim1, Vania Elvira2, Mas Wishnu Wardhana1 Charles Anthoni Silalahi1, Tommy Harry
Adoe1, Dina Siti Daliyanti1, Tri Yanti rahayuningsih1
1
Pediatric Department of RSUD dr. Chasbullah Abdulmadjid, Bekasi City, Indonesia
2.
Medical Research Doctor, RSUD dr. Chasbullah Abdulmadjid, Bekasi City, Indonesia
OBJECTIVE
Innate immune system provides early first line of defense against pathogens. Malnutrition leads
to decreased immune response, resulting in higher chance of disease to become severe and prolongs
hospital stay. The aim of this study is to investigate the relationship between nutritional status with length
of stay and severity of COVID19 in children.
METHOD
We performed retrospective study following cross -sectional method using the hospital date base of
COVID19 pediatric patients from January 2022 – April 2022. Total of 132 patients were included. Severity
of disease were determined by guideline of COVID19 Management by Indonesia Health Ministry,2020.
Nutritional status were assessed based on weight for length/height of WHO 2006 and CDC 2000 Curve.
One-way ANOVA and Chi-square test were used to analyze the related variabels.
RESULTS
Mean hospital stay was 6 ± 2 with range 5 – 17 days. Our study revealed statistical relation between
variabels. Severe wasted subjects group were found to have highest mean of hospital stay (7.90 ± 2.4,
P =0.000) and contributed to majority cases of severe COVID19 (5/8;62.5%; P=0.02)
CONCLUSION
Malnutrition prolongs the hospital stay and contributes to severity of COVID19. Nutrition status may
be a factor that determines the severity of COVID19 among children. Special attentions are highly
recommended for this group.
Keywords: Nutritional status, Length of Stay, COVID19, Severity
_________________________________________________________________________________
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EP44. NUTRITIONAL MANAGEMENT OF LOW BIRTH WEIGHT INFANTS IN A NEONATAL

INTENSIVE CARE UNIT IN A REMOTE AREA
Trias Kusuma Sari, Stevania Paula Djogo

Aeramo General Hospital, Nagekeo, Flores - East Nusa Tenggara, Indonesia
OBJECTIVE In remote areas mainly Nagekeo city, parenteral nutrition is limited to fulfilling the
needs of lipid and protein, especially in preterm infants. This study aimed to determine the nutritional
management and weight increment in Low Birth Weight (LBW) infants in a remote area.
METHOD All infants with LBW who were survived in NICU at Aeramo hospital included. Preterm
infants are divided into three categories; high-risk (HR) with gestational age (GA) <28 weeks (birth
weight (BW) <1000 g), medium-risk (MR); GA 28-31 weeks or BW 1000-1499 g, and low-risk (LR); GA
32-<37 weeks or BW 1500-2499 g. A mean ± standard deviation (SD) and median interquartile range
[IQR] were calculated.
RESULTS A total of 105 LBW infants were collected (1690.26 ± 275.92 g). Fifty-seven of them were
preterm. One HR infant has GA of 27 weeks, BW 780 g, starts feeding at 2 cc/kg/day, and achieved
full feed target in 1 month of age (BW + 995 g at 3 months). MR infants (26.3%) have started feeding
at 55.51 ± 9.09 cc/kg/day, achieved full feed target in 10.47 ± 3.77day, weight increment 100 [-50 –
200] g. Low-risk infants (71.9%) have started feeding at 62.43 ± 22.42 cc/kg/day, full feed target of
4.76 ± 2.07 day, and weight increment of 0 [-127.5 – 50] g. Term infants were full feed in 3 [3 – 6] days,
weight increment 0 [-85 – 90] g.
CONCLUSION Nutritional management in LBW infants in a remote area is inadequate and requires
continous management and post-discharge follow-up.
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21 – 22, 23 – 24 July 2022
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_______________________________________________________________ SPEAKER/MODERATOR CURICULUM VITAE
Speaker Full Name & Title

Dr. dr. Aidah Juliaty A. Baso, Sp.A(K)
........................................................................................................
Educational Qualifications
• S1, Fakultas Kedokteran Universitas Hasannudin, Makassar (1995)
• SpA, Fakultas Kedokteran Universitas Hasannudin, Makassar (2006)
• Konsultan NPM, Kolegium IKA Indonesia (2013)
• S3, Fakultas Kedokteran Universitas Hasannudin, Makassar (2014)
• Spesialis Gizi Klinik. Fakultas Kedokteran Universitas Hasannudin, Makassar (2014)
Current Position Held

• Staf Pengajar Divisi Nutrisi dan Penyakit Metabolik, Departemen Ilmu Kesehatan Anak, FK UNHAS-
Makassar
• Ketua Program Studi Ilmu Kesehatan Anak FK UNHAS (2017 – sekarang)
• Ketua Departemen Ilmu Kesehatan Anak FK UNHAS (2020 – sekarang

Dr. dr. Andi Ade Wijaya, Sp.An-KAP
........................................................................................................
• Medical Education: FKUI lulus 1996
• Anesthesiologist: FKUI lulus 2004
• Konsultan Anestesi Pediatri: Kolegium Anestesiologi dan Terapi Intensif 2010

• Head of Dept Anesthesiology and Intensive Care FKUI/RSCM/RSUI
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Prof. Dr. dr. Aryono Hendarto, Sp.A(K)
........................................................................................................
• Ph.D Faculty of Medicine, University of Indonesia (2009)
• Paediatric Nutrition Consultant. Faculty of Medicine, University of Indonesia (2002)
• Fellow Pediatric Nutrition, Amsterdam, Netherland (1999-2000)
• Resident at Child Health Department, Faculty of Medicine, University of Indonesia (1990-1996)
• MD. Faculty of Medicine, University of Indonesia (1979-1985)

• Head of Child Health Department, Faculty of Medicine, University of Indonesia – RSUPN Cipto
Mangunkusumo (2013-Present)
• Lecturer for Nutrition Division, Child Health Department, Faculty of Medicine, University of Indonesia
(1996-Present)
• Lecturer in Child Health Department, Faculty of Medicine, University of Indonesia (1996-Present)

Prof. dr. Berthold Koletzko, PhD
........................................................................................................
• Medical School Univ. Münster; Dept. of Pediatrics, Baragwanath Hospital, Johannesburg-Soweto, South
Africa
• Paediatric Dept & Nutrition Rehabilitation Unit, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
• Dept. of Paediatrics, Detmold, Germany
• University Children’s Hospital Düsseldorf, Germany
• The Hospital for Sick Children, Toronto, Ontario, Canada.
• M. D. Thesis (Univ. Münster) 1980,
• Habilitation (PhD equiv.; Univ. Düsseldorf) 1989

• Professor of Paediatrics, Dr. von Hauner Children’s Hospital, Ludwig Maximilians-Univ. Munich, Germany
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........................................................................................................
• Faculty of Medicine, Hasanuddin University, Ujung Pandang, Indonesia (1986-1993)
• Pediatric Department, Indonesian University, Jakarta, Indonesia (2001-2005)
• Nutrition and Metabolic Subspeciality, Indonesian University, Jakarta, Indonesia (2009-2014)
• Fellowship Inborn Errors of Metabolism, Sheffield, United Kingdom (2014)
• Finished PhD degree from University of Indonesia, Jakarta (2016)

• Pediatrician at Pantai Indah Kapuk Hospital
• Secretary of Nutrition and Metabolic Diseases Working Group of Indonesian Pediatric Association (2017-
2020)

........................................................................................................
• 2003 – 2009: Dokter Umum - FKUI
• 2011 – 2015: Dokter Spesialis Anak – FKUI
• 2017 – 2020: Dokter Spesialis Anak Konsultan Nutrisi dan Penyakit Metabolik–FKUI
• 2018 : Clinical Attachment in Inborn Errors of Metabolism – UMC Groningen

• Staf Divisi Nutrisi dan Penyakit Metabolik RSCM/FKUI
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........................................................................................................
• MD; Faculty of Medicine, University of Indonesia (1983)
• Paediatrician; Faculty of Medicine, University of Indonesia (1992)
• Fellowship Pediatric Nutrition; Division of Pediatric Nutrition, Child Health Department, RSCM, Jakarta (1996)
• Clinical Training in Metabolic Diseases; Wilhelmina Children Hospital – Utrecht (2000)
• Clinical Training in Medical Genetics; Clinical Genetics Center – Utrecht (2000)
• Certificate Kinderarts Metaboleziekten, Wilhelmina Children Hospital, Utrecht, The Netherlands (2000)
• PhD; Universiteit Utrecht, The Netherlands (2000)
• Consultant in Paediatric Nutrition and Metabolic Disease; Indonesian Pediatric College, Jakarta (2001)
• Professor in Paediatric Nutrition and Metabolic Disease. Faculty of Medicine, University of Indonesia (2019)

• Ketua Pusat Pelayanan Penyakit Langka Indonesia
• Ketua Human Genetic Research Center (HGRC) IMERI – Fakultas Kedokteran Universitas Indonesia
• Guru Besar Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia – RSUPN Cipto
Mangunkusumo

Dr. dr. I Gusti Ayu Putu Eka Pratiwi, M.Kes, Sp.A(K)
........................................................................................................
• Doctor, Faculty of Medicine – Udayana University (1999)
• Postgraduate Program, Faculty of Medicine – Gadjah Mada University (2005)
• Pediatrician, Faculty of Medicine – Udayana University (2009)
• Ph.D Program, Faculty of Medicine – Udayana University (2016)
• Nutrition and Metabolic Disease Consultant, Faculty of Medicine – Airlangga University (2019)
• Metabolic Fellowship, Women and Children Hospital Adelaide (2019)

• Staff of Nutrition and Metabolic Disease Division, Child Health Department, Faculty of Medicine, Udayana
University/Sanglah General Hospital, Denpasar, Bali (2009 – Now)
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........................................................................................................
• Paediatrician. Faculty of Medicine, Udayana University (2000)
• Paediatric Consultant (2011)
• Ph.D; Faculty of Medicine, Udayana University (2015)

• Head of Nutrition and Metabolic Disease Division, Child Health Department, Faculty of Medicine –
Udayana University/RSUP Sanglah
• Chairman of Indonesian Pediatric Society (IDAI), Bali Branch (2014-2020)
• Board member of Nutrition and Metabolic Disease Working Group, IDAI (2011-2020)

........................................................................................................
• Dokter Umum, Universitas Indonesia (2004)
• Dokter Spesialis Anak, Universitas Indonesia (2010)
• Konsultan Nutrisi dan Penyakit Metabolik, Fakultas Kedokteran Universitas Indonesia (2014)
• Clinical Attachment, Metabolic Medicine, Sheffield Children’s Hospital, Sheffield, United Kingdom (2014)

• Staff Dept. Ilmu Kesehatan Anak, Divisi Nutrisi Metabolik, RSUPN Dr. Cipto Mangunkusumo, Jakarta
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........................................................................................................
• 1994-2000 : Fakultas Kedokteran Universitas Indonesia, Jakarta
• 2002-2006 : Program Pendidikan Dokter Spesialis Ilmu Kesehatan Anak, FKUI, Jakarta
• 2009-2014 : Program Doktoral S3 FKUI, Jakarta
• 2014-2017 : Program Pendidikan Sp-2 Divisi Nutrisi dan Penyakit Metabolik, Departemen Ilmu
Kesehatan Anak FKUI, Jakarta

• 2017-2021 : Anggota Pengurus UKK Nutrisi dan Penyakit Metabolik IDAI
• 2017-2021 : Ketua UK Nutrisi dan Penyakit Metabolik IDAI Jaya
• 2014-2017 : Ketua UK Nutrisi dan Penyakit Metabolik IDAI Jaya
• 2012-sekarang : Anggota Society for the Study of Inborn Errors of Metabolism
• 2018–sekarang : Staf SMF Kesehatan Anak RSUP Fatmawati (Divisi Nutrisi dan Penyakit
Metabolik)

Prof Louise Baur MBBS(Hons), PhD, FRACP
........................................................................................................

• Louise Baur holds the Chair of Child & Adolescent Health at the University of Sydney and is a consultant
paediatrician in Weight Management at the Sydney Children’s Hospitals Network. She has made
research contributions in many aspects of the treatment and the prevention of child and adolescent
obesity and nutrition. Louise is President of the World Obesity Federation and a Founding Fellow of the
Australian Academy of Health & Medical Sciences.
- 96 -
th
with the theme

PENYAKIT METABOLIK
FACULTY RESUME

Dr. dr. Luh Karunia Wahyuni, Sp.KFR(K)
........................................................................................................
• MD; Faculty of Medicine, University of Indonesia (1981-1987)
• Physical Medicine and Rehabilitation; Faculty of Medicine, University of Indonesia (1992-1996)
• Pediatric Rehabilitation Consultant Physical Medicine and Rehabilitation (2010)
• Doctorate in Medicine, Faculty of Medicine University of Indonesia (2019-2022)

• Head of Pediatric Division Medical Rehabilitation Department, RSUPN Cipto Mangunkusumo
(2010-Present)
• Head of Medical Staff of Physical and Medical Rehabilitation, Medical Acupuncture, Occupational
Medicine RSCM (2017-Present)
• Head of Pediatric Division of Physical and Medical Rehabilitation RSCM (2010 Present)
• Teaching Staff at Faculty of Medicine, University of Indonesia (2002-Present)

Marc Engelen, MD, PhD
........................................................................................................
• (Pediatric) Neurologist, Department of Pediatric Neurology, Amsterdam UMC, Amsterdam (2012 –
present)
• Principal Investigator / Associate Professor, Department of Pediatric Neurology, Amsterdam UMC, Amsterdam
(2018 – present)
- 97 -
th
with the theme

PENYAKIT METABOLIK
FACULTY RESUME

Dr. dr. Meta Herdiana Hanindita, Sp.A(K)
........................................................................................................
• Medical Doctor, Airlangga University (2007)
• Pediatrician, Airlangga University (2015)
• Fellowship in Pediatric Metabolic Disease, University of Amsterdam /AMC (2018)
• Consultant in Nutrition and Metabolic Disease, Airlangga University (2019)
• Doctoral, Airlangga University (2021)

• Staff Div. Nutrition and Metabolic Disease, Airlangga University/ Dr. Soetomo General Hospital

dr. Moretta Damayanti, M.Kes, Sp.A(K)
........................................................................................................
• dr, Faculty of Medicine Universitas Sriwijaya (2001)
• SpA, Faculty of Medicine Universitas Sriwijaya (2010)
• M.Kes, Faculty of Medicine Universitas Sriwijaya (2010)
• SpA(K), Faculty of Medicine Universitas Indonesia (2018)

• Staff of KSM Anak RSUP dr. Moehammad Hoesin Palembang
• Lecturer at Faculty of Medicine Universitas Sriwijaya
- 98 -
th
with the theme

PENYAKIT METABOLIK
FACULTY RESUME

dr. Rina Pratiwi, M.Si.Med, Sp.A(K)
........................................................................................................
• Dokter Umum Universitas Diponegoro, lulus 2008
• Magister biomedik, Unibersitas Diponegoro, lulus 2014
• Dokter spesialis anak, Universitas Diponegoro, lulus 2014
• Clinical fellowship inborn error of metabolism, UMCG-Netherland, 2019
• Konsultan Nutrisi dan Penyakit Metabolik, Universitas Indonesia, 2019

• Staf Pengajar Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Diponegoro
• Dokter spesialis anak RS Nasional Diponegoro Semarang
• Dokter spesialis anak RSUP dr.Kariadi Semarang

Prof. Dr. Ir. Sugiyono, M.AppSc
........................................................................................................
• S1 (Food Technology, Bogor Agricultural University, Indonesia) – 1989
• S2 (Biotechnology, University of New South Wales, Australia) – 1996
• S3 (Biotechnology, University of New South Wales, Australia) – 2000

• Head of Food Process Engineering Division – Department of Food Science and Technology, IPB
University Bogor
- 99 -
th
with the theme

PENYAKIT METABOLIK
FACULTY RESUME

........................................................................................................
• Dokter Umum; Fakultas Kedokteran Universitas Indonesia (1996)
• Program Pendidikan Dokter Spesialis Anak (2005)
• Dokter Spesialis Anak Konsultan Divisi Nutrisi dan Penyakit Metabolik (2011)
• Clinical Attachment: Metabolic and Labolatory, Sheffield Children Hospital, Sheffield, UK (2013)

• Staf Divisi Nutrisi & Penyakit Metabolik, Departemen IKA, FKUI/RSCM Jakarta, Indonesia (2005 –
Present)
• Chairman of Nutrition and metabolic Diseases Working Group of Indonesian Pediatric Society (2017 –
Present)

........................................................................................................
• Medical Doctor, FK USU, 2007
• Master Program of Pediatric, FK USU, 2010
• Pediatric Specialist Training Program, FK USU, 2012
• Pediatric Consultant Training Program (Nutrition and Metabolic Diseases), FK UI, 2018
• Clinical Attachment Inherited Metabolic Diseases: Groningen, Netherlands, 2018

• Head of Division, Nutrition and Metabolic Diseases Division, Department of Pediatric, Faculty of
Medicine, Universitas Sumatera Utara.
• Medical Staff, Haji Adam Malik General Hospital and Universitas Sumatera Utara Hospital.
- 100 -
th
with the theme

PENYAKIT METABOLIK
FACULTY RESUME

........................................................................................................
• Dokter Umum; Fakultas Kedokteran Universitas Indonesia 1996
• SpA; Fakultas Kedokteran Universitas Indonesia 2006
• Konsultan Nutrisi dan Penyakit Metabolik 2012

• Kepala Divisi Nutrisi dan Penyakit Metabolik Dept IKA FKUI-RSCM
• Kepala Staf Medis Fungsional RSUI
• Anggota Human Nutrition Research Center IMERI FKUI
• Anggota Satgas Remaja IDAI 2017-saat ini

Dr. dr. Yulia Ariani Aswin, Sp.A(K)
........................................................................................................
• Medical Doctor, Faculty of medicine, Universitas Indonesia (1990 – 1996)
• Pediatrician, Department of Child Health, Cipto Mangunkusumo Hospital Jakarta (2002 – 2008)
• Fellow of Pediatric Nutrition and Metabolic Diseases. FMUI, Jakarta, Indonesia (2016-2019)
• Doctoral program of Biomedical science FMUI, Jakarta, Indonesia (2013-2019)

• Medical team of Center of Excellence for Indonesian Rare Diseases, RSCM-FKUI
• Senior Staff of Human Genetic Center IMERI FKUI
• Research and Working Group Adm. Administrative Coordinator, Faculty of Medicine, Universitas
Indonesia
- 101 -
th
with the theme

PENYAKIT METABOLIK
FACULTY RESUME

Yusra Egayanti, Ssi, Apt, MP
........................................................................................................
• S.Si, Pharmacy - Andalas University (1996)
• Apt, Pharmacy - Andalas University (1997)
• MP, Master of Food Technology IPB University (2017)

• Koordinator Kelompok Substansi Standardisasi Pangan Olahan Keperluan Gizi Khusus, Badan POM (sd
30 Juni 2022)
• Direktur Perumusan Standar Keamanan dan Mutu Pangan, Badan Pangan Nasional (per Juli 2022)
- 102 -
th
with the theme

PENYAKIT METABOLIK
SECRETARIAT
UKK NUTRISI &

PENYAKIT METABOLIK
Nutrition & Metabolic Disease Working

Group - Indonesian Pediatric Society (IDAI)
-4-

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UKK NUTRISI & CABANG BALI

Nutrition & Metabolic Disease Working Group

with the theme

Thursday – Friday, Saturday - Sunday

THURSDAY, 21 JULY 2022 FRIDAY, 22 JULY 2022

09.00 – 12.40 WITA 09.00 – 12.40 WITA

08.30 – 12.30 WITA 13.00 – 17.30 WITA 13.00 – 17.25 WITA

SATURDAY - SUNDAY, 23 – 24 JULY 2022

with the theme

We look forward to welcoming you in Goddess Island.

with the theme

Chairman Indonesian Pediatric Society – Bali Chapter –

Chairman : Dr. dr. I Gusti Lanang Sidiartha, Sp.A(K)

Scientific Committee : Dr. dr. Conny MF Tanjung, Sp.A(K)

Event Program : dr. Moretta Damayanti, M.Kes, Sp.A(K)

Publication & : dr. Rina Pratiwi, M.Si.Med, Sp.A(K)

Secretariat : Global Echo Organizer Convex

with the theme

5th NUTRIMET 2022 ONLINE SYMPOSIUM

OFFLINE WORKSHOPS VENUE

with the theme

FORMAT OF THE PROGRAM

Time schedule is in Central Indonesian Time (WITA)

FREE PAPER E-POSTER PRESENTATION

E-Posters will be displayed in E-Poster Gallery at https://nutrimet.id/annual-conference on 23 – 24 July

THE BEST E-POSTER PRESENTERS

ONLINE AND OFFLINE WORKSHOPS

JOIN THE 5th NUTRIMET 2022

HOW TO JOIN THE 5th NUTRIMET 2022:

with the theme

Registration Fee Includess

FORESEEN & REHEARSAL

UKK NUTRISI & CABANG BALI

Nutrition & Metabolic Disease Working Group Indonesian Pediatric Society

with the theme

THURSDAY, 21 JULY 2022 FRIDAY, 22 JULY 2022

09.00 – 12.40 WITA 09.00 – 12.40 WITA

08.30 – 12.30 WITA 13.00 – 17.30 WITA 13.00 – 17.25 WITA

with the theme

HOW TO JOIN THE WORKSHOP

ONLINE WORKSHOP: PRACTICAL INBORN ERRORS OF METABOLISM IN DAILY PRACTICE

WITA TOPIC FACILITATOR

with the theme

HOW TO JOIN THE WORKSHOP

ONLINE WORKSHOP: PRINCIPLE OF NUTRITION THERAPY TO PREVENT AND TREATED

WITA TOPIC FACILITATOR

with the theme

WORKSHOPS RE-REGISTRATION SERVICES

WORKSHOPS RE-REGISTRATION PROCEDURE

OFFLINE WORKSHOP: PARENTERAL AND ENTERAL NUTRITION IN CRITICALLY ILL PATIENTS

WITA TOPIC FACILITATOR

with the theme

WORKSHOPS RE-REGISTRATION SERVICES

WORKSHOPS RE-REGISTRATION PROCEDURE

OFFLINE WORKSHOP: POST-DISCHARGE NUTRITION FOR PRETERM BABIES

WITA TOPIC FACILITATOR

with the theme

WORKSHOPS RE-REGISTRATION SERVICES

WORKSHOPS RE-REGISTRATION PROCEDURE

OFFLINE WORKSHOP: PERIOPERATIVE NUTRITION

WITA TOPIC FACILITATOR

UKK NUTRISI & CABANG BALI

Nutrition & Metabolic Disease Working Group Indonesian Pediatric Society