Gds 138 Slide Pemaparan Bahan Aktif Yang Mempengaruhi Tumbuh Kembang Anak

7/28/2019 Gds 138 Slide Pemaparan Bahan Aktif Yang Mempengaruhi Tumbuh Kembang Anak

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Pemaparan bahan aktif yangmempengaruhi tumbuh

kembang anak

Aznan Lelo, Datten BangunDep. Farmakologi & Terapeutik,

Fakultas Kedokteran

Universitas Sumatera Utara

Novmber 2008 KBK-GDS FK USU1

Anak

Anak merupakan suatu amanah dariAllah YMK,

setiap orang tua menginginkan anak-anaknya tumbuh menjadi anak yang

soleh, cerdas, sehat dan masa depanyang cerah

Tumbuh kembang anak harus ditanganidengan seksama

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Kecacatan bayi

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Pemaparan bahan aktif yang mempengaruhi

tumbuh kembang anak

Bahan aktif pada ibu hamil dan menyusui

Paparan pada janin

Paparan pada ASI

Bahan aktif yang ditambahkan pada obat-obatan untuk anak

Bahan aktif yang ditambahkan pada susutambahan

Bahan aktif yang ada di lingkungan anak

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Bahan aktif pada ibu hamil dan

menyusuiPaparan pada janin & Paparan pada ASI

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Homocysteine

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Kadar homocysteine

Kadar homocysteine

meningkat menurut

usia

Kadar homocysteine

berbeda menurutgender

o Hormon

o Otot

o Gaya hidup

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Homocystinurias

Mostly due to inborn error of metabolism;

= transmitted as autosomal recessive traits

= can be diagnosed in the foetus by assaying

appropriate enzymes in cultured amniotic

cells

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Homocysteine metabolism

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Homocysteine dan .

Makin tinggi kadar homocysteine makin jelekrangking di sekolah (Borjel A, dkk.)Increasing homocysteine levels were strongly

associated with reducing grades (p=0.004).

Makin tinggi kadar homocysteine makin

depresi (Ingvar dkk.)homocysteine level above 15 mol/L confers a 2

fold risk for depression.

Makin tinggi kadar homocysteine makin nyatagejala tanda gila schizopreni (Levine J dkk.)schizophrenic patients (16.3 M) compared with

in healthy subjects (10.6 M). 9

Kecacatan jiwa yang berkaitan denganpeningkatan kadar homocysteine

Alcoholism Age-related memory decline Alzheimers disease Autism Dementia

Depression, severe (especially in women) Downs syndrome (children low, mothers high) Epilepsy in children and adults Mental retardation Migraine headaches Parkinsons disease Schizophrenia

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Kecacatan jasmani yang berkaitan dengan

peningkatan kadar homocysteine

Penyakit pembuluh darah otak

Penyakit pembuluh darah jantung

Penyakit pembuluh darah tepi

Trombosis vena dalaman

Dementia/pelupa Patah tulang (paha/pinggul)-----osteoporosis

Neurotoxicity (> 14 mol/L

Dislocated lenses

Sering keguguran

KECACATAN BAYI11 12


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Bahan aktif yang TIDAK BOLEH ditambahkanuntuk / dikonsumsi IBU

Teratogenic

Thalidomide

Fetal death

NSAID (in particular COXIB) at late semester or in

delivery time Early closing ductus arteriosus

Mother intoxication

Alcohol

Psychotropic (XTC, cocaine, morphine, etc)

Smoking 13

Importance of Micronutrient

Balance During Pregnancy

Examples : vitamin A, vitamin D, folic acid, iron, calcium,zinc

Folic acid and iron deficiency are risk factors for pretermbirth, anemia, and infant mortalityFolic acid and iron supplementation are the most widely used

nutritional interventions during pregnancy Omega-3 fatty acid supplementation ensures appropriate

fetal and neonatal developmentBrain growth and central nervous systems (CNS) maturation

Deficiency can be especially dangerous to mother and fetus Impaired maternal/fetal immunity, vision disturbance,

osteoporosis, hypertensionStillbirth, birth defects, decreased cognitive development

1. Bartley KA et al. Am J Clin Nutr. 2005;81:1188S-1198S.2. Holick MF. South Med J. 2005;98:1024-1027.3. Lips P. Prog Biophys Mol Biol. 2006;92:4-8. 14


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Importance of Macronutrient BalanceDuring Pregnancy

Fats, protein, carbohydrates, water Adequate intake essential to healthy

pregnancy

Excessive intake may cause maternal obesityand associated morbidity

Hypertension, gestational diabetes Maternal obesity also linked to birth defects1

NTDs, congenital heart disease, intestinalmalformations

Bartley KA et al. Am J Clin Nutr. 2005;81:1188S-1198S.NTDs=neural tube defects

Eating for 2 does NOT mean doubling intake

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Dose-Response Relationship BetweenFolic Acid and Reduced Incidence of NTDs

-100

-80

-60

-40

-20

0

0 0,2 0,4 0,8 1,0 4,0 5,0

Increase in Daily Folic Acid Intake (mg)

Riskreduction(%)

23%

36%

57%

82%85%

Wald NJ et al. Lancet. 2001;358:2069-2073.

Wald NJ. N Engl J Med. 2004;350:101-103.NTDs=neural tube defects 16


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The Role of Omega-3 Fatty Acids Vital to human development and healthNecessary components of cell membranes and tissues Involved in human reproductive, brain, and visual function

Cannot be synthesized by the body Maternal fatty acid levels tend to fall

Supplementation during pregnancy is important for maternalhealth, fetal development, and early childhood development

Conversion of ALA is minimal and variable Only 0.2%-15% of ALA is converted

to DHADHA is a major fat of CNS, important to brain, heart, eye health,

but the bodys conversion is inefficient

ALA conversion to EPA is better, but still not sufficient to maintainadequate recommended levels

Hornstra G. Am J Clin Nutr. 2000;71(suppl):1262S-1269S.Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.

ALA = alpha-linolenic acid; EPA = eicosapentaenoic acid;

DHA= docosahexaenoic acid 17

EPA dan DHA omega-3 fatty acids

EPA (eicosapentaenoic acid) and

DHA (docosahexaenoic acid)

are important for child growth anddevelopment and associated with a lower

risk of heart disease later in life ALA's dietary recommendations for children

aged 2 years and older stress a diet thatprimarily relies on fish, fruits andvegetables, whole grains, low- fat dairyproducts, beans and lean meat

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Maternal Omega-3 Supplementation AugmentsChildrens Mental Processing

105103

109

106102

99

106102

80

90

100

110

120

130

Mental Processing Composite Sequential Processing Simultaneous Processing Nonverbal Abilities

Omega-3s (DHA, EPA) Omega-6s

P=0.049P=0.098 P=0.11 P=0.17

K-ABC

scores(mean[SD])

Helland M et al. Pediatrics. 2003;111:e39-e44.19

Bahan aktif yang ditambahkan pada

obat-obatan untuk anak

2Sweeteners

Flavors

Dangerous agents

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Bahan aktif yang ditambahkan pada obat-obatan untuk anak

Obat racikan

Saccharum lactis

Obat jadi

Syrup

Flavors

Alkohol

Tablet kunyahFlavors

Pemanis rasa 21

Dangerous agents added to medicines

Alcohol, as a solvent Fluoride Thimerosal in vaccinations

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Halogenated organic compounds andchild's growth:a growing public health problem

Halogenated organic compounds (HOCs) suchaspolychlorinated biphenyls (PCBs) and

dichlorodiphenyl dichloroethylene (DDE) may

interfere with normal hormonal function and,thereby, affect growth and maturation.

two outcomes, easily observed and frequently linked toHOCs, are birth size and post-natal height and growth.

toxicants were termed endocrine disruptors

Halogenated organic compounds (HOCs) such

as polychlorinated biphenyls (PCBs) and

dichlorodiphenyl dichloroethylene (DDE) may

interfere with normal hormonal function and,thereby, affect growth and maturation.

two outcomes, easily observed and frequently linked to

HOCs, are birth size and post-natal height and growth.

toxicants were termed endocrine disruptors

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BahanBahan aktifaktif yangyang ditambahkanditambahkan padapada

susususu tambahantambahan

Nutrient

Supplement

Food additives

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Bahan aktif yang ditambahkan pada susutambahan

Calcium

Vitamin D

EPA dan DHA

Food additivesExcitotoxins MSG

Aspartame

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Neurotransmitters: Excitation and Inhibition

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Excitotoxin Substances that cause an excess of excitatory

neurotransmission in the brain.If inhibitory neurotransmission is lacking, the

excess excitation may lead to neuronal death.

Neuronal death leads to chronic inflammation in

the brain. Excitotoxins MSG

Aspartame

Eksitotoksisitas proses patologi dimananeuron menjadi rusak atau mati akibat

stimulasi berlebihan 27

MSG = monosodium glutamate

It is believed to cause headaches, vomiting,

severe bleeding, loss of consciousness and

convulsions, inflammation to the womb, and

eventually death.

Some items are believed to enter the breastmilk and cause diarrhea and fever in the baby.

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Kerusakan otak akibat penggunaan MSG, area putihpada gambar kanan adalah neuron yang telah mati

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The link between MSG and obesity Potato chips and others aren't health foods

They're made withfried fats,

hidden toxic chemicals (acrylamides), and

monosodium glutamate (MSG).

This is basically a recipe for obesity. How does MSG cause obesity?

Like aspartame, MSG is an excitotoxin, asubstance that overexcites neurons to thepoint of cell damage and, eventually, celldeath. 30


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The link between MSG and obesity Humans lack a blood-brain barrier in the

hypothalamus, which allows excitotoxins to enter

the brain and cause damage

MSG creates a lesion in the hypothalamus thatcorrelates with abnormal development, including

obesity,short stature and

sexual reproduction problems

One characteristic of the obesity induced byexcitotoxins is that it doesn't appear to depend on

food intake.31

Bahan aktif yang ada di

lingkungan anak

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Bahan aktif yang ada di lingkungan anak Di badan

Pewangi yang ada di bedak, pakaian

Di kamarSemprotan pestisida obat nyamuk (organofosfat)

Di rumah

Gas buangan kenderaan bermotor (carbon monoxide)Makanan yang tidak sehat (MSG)

Obat-obatan

Bahan keperluan lain seperti LEM

Di sekolahPewangi aceton (pencyclidin) yang ada pada penghapus,

pinsil, dsb33

Were SurroundedIt is in the air Coal-fired power plants spew

sulfates, nitrates and mercuryinto the airlinked to >20,000premature deaths each year

10% of women carry mercuryconcentrations high enough

for fetal damage Manufacturing,

transportation, electricitygeneration and other humanactivities are taking its toll onour health and environment

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Home Sweet Womb

Even before were born

Mother exposed = Fetus at risk

Average newborn has 200 different

industrial chemicals, pollutants & pesticides

in blood

Carcinogens

Toxic to brain & nervous system

Abnormal development

Urban air pollution linked to chromosomal

abnormalities in infants35

Exposed to the Elements Environmental metals:

Cadmium, Copper, Cobalt, Nickel, Lead, Mercury, Tin & Chromiumlinked to breast cancer

Cadmium & Mercury found in breast milk of nursingmothers

Cause of early puberty and altered mammary glanddevelopment in animals

FluorideFluorinated drinking water linked to Osteosarcoma &

Hypothyroidism

VaccinationsThimerosal causes autism in children

Radiation Increased radiation exposure contributed to rising incidence of

breast cancer between 1950 & 199136

Gds 138 Slide Pemaparan Bahan Aktif Yang Mempengaruhi Tumbuh Kembang Anak

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