Hertanto Wahyu Subagio
Bagian Ilmu Gizi Fakultas Kedokteran UNDIP Semarang

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Journal : MEDIA MEDIKA INDONESIANA

Pajanan Pestisida Sebagai Faktor Risiko Hipotiroidisme pada Wanita Usia Subur di Daerah Pertanian

MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Pesticide exposure as a risk factor for hypothyroidism in women at childbearing age in agricultural areasBackground: Hypothyroidism in women at childbearing age (WCA) will cause reproduction disorder, i.e. infertility, spontaneous abortion, impaired growth and development of foetus, placental abruption, and preterm delivery. Pesticide exposure is suspected to cause hypothyroidism. The research objective is to prove that pesticide exposure is a risk factor for hypothyroidism among WCA in agricultural areas.Methods: Case-control studies were used as study designs. Study subjects were 44 WCA as cases and 45 WCA as controls. Pesticide exposure was measured by asking WCA’s involvement in agricultural activities using structured questionnaire and by checking their levels of cholinesterase. Hypothyroidism was determined based on the results of TSH, FT4, and T3 level. Confounding variables were also measured. These variables were age, body mass index (BMI), participation in hormonal contraception, liver function, urinaryiodine excretion, urinary thiocyanate level and blood lead level. Chi-square test, OR (95% CI), and multivariate logistic regression were implemented to test the hypothesis.Results: Pesticides exposure is a risk factor for hypothyroidism (crude-OR=3.04; 95% CI=1.20-7.81; nilai p=0.033 and adjusted OR=3.31, 95% CI=1.25 to 8.78, p=0.016). The higher the degree of exposure, the greater the risk of having hypothyroidism.Conclusion: Pesticides exposure is a risk factor for hypothyroidism among WCA in agricultural areas.Keywords: Pesticide exposure, risk factor, hypothyroidism, women at childbearing age, agricultural areaABSTRAKLatar belakang: Hipotiroidisme pada kelompok wanita usia subur (WUS) dapat menyebabkan gangguan reproduksi, seperti infertilitas, abortus spontan, gangguan tumbuh-kembang janin, dan kelahiran prematur. Pajanan pestisida dapat mengganggu fungsi tiroid. Tujuan penelitian adalah membuktikan bahwa pajanan pestisida merupakan faktor risiko hipotiroidisme pada WUS di daerah pertanian.Metode: Desain penelitian yang digunakan adalah kasus-kontrol. Subyek penelitian adalah 44 WUS sebagai kasus dan 45 sebagai kontrol. Pajanan pestisida diukur menggunakan kuesioner dan pemeriksaan kadar kolinesterase. Kejadian hipotiroidisme diukur menggunakan parameter kadar TSH, FT4 dan T3. Variabel perancu yang diukur meliputi umur, indeks massa tubuh (IMT), penggunaan KB hormonal, fungsi hati, ekskresi yodium urin, kadar tiosianat urin, dan kadar Pb darah. Uji hipotesis yang digunakanadalah uji Chi-square, uji OR (95%CI), dan regresi logistik multivariat.Hasil: Pajanan pestisida merupakan faktor risiko hipotiroidisme pada WUS di daerah pertanian (crude-OR=3,04; 95%CI=1,20- 7,81; nilai p=0,033 dan adjusted OR=3,31; 95%CI=1,25-8,78; p=0,016). Semakin tinggi derajat pajanan pestisida, semakin besar risiko terjadinya hipotiroidisme.Simpulan: Pajanan pestisida merupakan faktor risiko kejadian hipotiroidisme pada WUS di daerah pertanian.

Hipotiroidisme pada Wanita Usia Subur (WUS) di Daerah Pertanian: Penelitian di Kecamatan Kersana Kabupaten Brebes

MEDIA MEDIKA INDONESIANA 2010:MMI VOLUME 44 ISSUE 1 YEAR 2010
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Background: Hypothyroidism can cause infertility, spontaneous abortion, fetal growth-development disorders, placental abruption and prematurity. Exposure to pesticides, both of organochlorines and organophosphate, can cause hypothyroidism. The aim of the study was to examine the prevalence of hypothyroidism in WCA in agricultural areas.Methods: A cross-sectional study was conducted in two hundred and eight women of WCA who were randomly selected from four villages and TSH levels were examined. The TSH cut-off point for the diagnosis of hypothyroidism was 4.5 μIU/mL. In a sub-sample, fT4 levels, UEI and thiocyanate in urine, were also examined. Result: The mean level of TSH was 3.66 (±5.330) μIU/mL, the lowest value was 0.05, and the highest was 60 µIU/mL; the median was 2.38 μIU/mL; the mean FT 4 (n=89) was 16.207±3.0438 pmol/L; UEI median value (n=41) was 288.0 mcg/L; while the mean of urinary thiocyanate levels (n=41) was 1.468±1.25 mcg/mL. There were 47 WCA (22,6%) with hypothyroidism, 46 of which (97.9%) are sub-clinical hypothyroidism.Conclusion: The prevalence of hypothyroidism in WCA was 22.6% and almost all women had sub-clinical hypothyroidism. Pesticide exposure is suspected as a risk factor for hypothyroidism in this population.ABSTRAKLatar belakang: Hipotiroidisme merupakan keadaan, di mana kelenjar tiroid tidak dapat memproduksi hormon cukup untuk memenuhi kebutuhan tubuh. Pada WUS, hipotiroidisme dapat menyebabkan infertilitas, abortus spontan, gangguan tumbuh-kembang janin, placental abruption dan bayi lahir sebelum waktunya. Pajanan pestisida, baik dari golongan organoklorin maupun organofosfat, dapat menyebabkan hipotiroidisme. Penelitian ini bertujuan mengkaji berapa besar prevalensi hipotiroidisme pada WUS yang bertempat tinggal di daerah pertanian.Metode: Penelitian ini menggunakan desain cross-sectional. 208 WUS dipilih secara acak dari empat desa dan dilakukan pemeriksaan kadar TSH. Diagnosis hipotiroidisme ditegakkan berdasarkan kadar TSH 4,5 µIU/mL. Pada sebagian WUS (sub-sampel) dilakukan pemeriksaan kadar fT4, UEI dan kandungan tiosianat dalam urin. Hasil: Rerata kadar TSH adalah 3,66 (±5,330) µIU/mL, nilai terendah 0,05, nilai tertinggi 60 µIU/mL sedangkan median TSH 2,38 µIU/mL; rerata fT 4 (n=89) adalah 16,207±3,0438 pmol/L; nilai median UEI (n=41) adalah 288,0 µg/L; rerata kadar tiosianat urin (n=41) adalah 1,25±1,468 µg/mL. Didapatkan 47 WUS (22,6%) dengan hipotiroidisme, 46 di antaranya (97,9%) adalah hipotiroidisme sub-klinik.Simpulan: Prevalensi hipotiroidisme pada WUS sebesar 22,6%, hampir semuanya hipotiroidisme sub-klinik. Pajanan pestisida patut dicurigai sebagai faktor risiko pada WUS di daerah pertanian yang diteliti ini.

Hipertensi pada Obesitas Masa Anak

MEDIA MEDIKA INDONESIANA 2010:MMI VOLUME 44 ISSUE 1 YEAR 2010
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Background: The prevalence of obesity in children increased rapidly in recent years. One of the comorbidity of obesity is the premature onset of cardiovascular risk factors such as hypertension. The objective of the study is to describe the relationship between obesity and the elevated of blood pressure in children.Method: The population for this cross-sectional study was students in one of the junior high school in Semarang with the mean age of 13.5 years. The anthropometric and blood pressure data were taken in 2006. BMI was measured with bioelectrical impedance analysis (BIA) Omron Karada Scan and classified based on International Obesity Task Force according to CDC 2000 graphs. The blood pressure was measured by using Omron Digital type SEM-1 and classified based on national high blood pressure education program (NHBPEP). Anova, Spearman correlation and chi-square test were performed to analyze the data.Result: Of 1.129 students (50.7% boys and 49.3% girls), 185 (16.4%) were overweight and 160 (14.2%) were obese. Hypertension was detected in 304 students (26.9%). There were significant correlation between systolic blood pressure with BMI (r=0.466) and diastolic blood pressure with BMI (r=0.337). The risk to hypertension in overweight was 2.8 times greater (OR=2.79; 95% CI 1.97-3.96 p<0.001) and in obesity was 6.6 times greater (OR=6.61; 95% CI 4.59-9.52 p0.001) than normoweight children. Chinese race has 1.4 times greater risk to have hypertension than native Indonesian children.Conclusion: Overweight and obeis children have greater risk for hypertension than normal children. AbstrakLatar belakang: Prevalensi obesitas pada anak meningkat pesat dalam beberapa tahun terakhir. Salah satu komorbiditas obesitas yang terjadi sejak dini adalah penyakit kardiovaskuler seperti hipertensi. Tujuan dari penelitian ini adalah mengetahui hubungan antara obesitas dengan peningkatan tekanan darah pada anak.Metode: Desain penelitian adalah belah lintang dengan populasi adalah siswa sebuah SLTP di kota Semarang dengan rerata umur 13,5 tahun. Pengambilan data antropometri dan tekanan darah dilakukan tahun 2006. Indeks massa tubuh (IMT) diukur Bioelectrical Impedance Analysis (BIA) Omron Karada Scan dan status gizi ditetapkan berdasarkan kriteria International Obesity Task Force dengan memakai grafik CDC 2000. Tekanan darah diukur dengan Omron Digital type SEM-1 dan ditetapkan berdasarkan klasifikasi National High Blood Pressure Education Program (NHBPEP), dinyatakan hipertensi bila tekanan darah >persentil ke-90. Data dianalisis dengan Anova, Spearman correlation dan chi-square. Hasil: Dari 1.129 siswa (50,7% laki-laki dan 49,3% perempuan), 185 (16.4% adalah gizi lebih dan 160 (14,2%) obesitas. Didapatkan 304 siswa (26,9%) dengan hipertensi. Terdapat korelasi signifikan antar IMT dengan tekanan darah sistolik (r=0,466) dan tekanan darah diastolik (r=0,337). Risiko untuk terjadi hipertensi meningkat 2,8 kali (OR=2,79; 95% CI 1,97-3,96 p<0,001) pada anak dengan gizi lebih dan 6,6 kali (OR=6,61; 95% CI 4,59-9,52 p0,001) pada anak dengan obesitas. Ras Tionghoa mempunyai risiko 1,4 kali lebih tinggi untuk terjadi hipertensi dibandingkan pribumi.