Biomedical subjects

S Kardjati

Publications and source records attributed to S Kardjati.

14 recordsLinked to original sources

PubMed1992

Energy supplementation during pregnancy and postnatal growth.

The effect of improving maternal nutrition during pregnancy on growth of the child has not been assessed, since previous studies supplemented the diets of children as well as mothers. In a controlled randomised trial in Madura, East Java, pregnant women received a high (HE) or low (LE) energy supplement that provided 1950 kJ (465 kcal) or 218 kJ (52 kcal), respectively, in the last trimester of pregnancy. The effect of this intervention on the children's growth was assessed longitudinally for the first 5 years of life. Only the children of mothers who had complied for at least 90 days were included. Infants entered the study at birth and their growth was measured at 4-week intervals until 12 months old; thereafter they were measured every 3 months. Growth curves were calculated from a mathematical model, based on the best fit of actual measurements and the age-related growth velocity. Up to the age of 24 months, HE children were significantly heavier than LE children (p less than 0.05). HE children were also taller throughout the first 5 years (p less than 0.005 from 15 to 48 months, p less than 0.05 at both 3-12 and 60 months). Weight-for-height by age was similar in both groups, but stunting (height-for-age) was less prevalent in HE children. In a community characterised by chronic energy deficiency among women of reproductive age, energy supplementation of women for the last 90 days of pregnancy was effective in the promotion of postnatal growth and reduction in malnutrition of preschool children.

Body Height↗

PubMed1992

Reproduction and maternal nutrition in Madura, Indonesia.

The prevalence and severity of chronic energy deficiency (CED) among women of reproductive age as well as its consequences on the newborn and the mother were assessed in a longitudinal study. More than 40% of the mothers had a Body Mass Index (BMI) less than 18.5 before pregnancy, a level below which CED is considered to exist. Weight gain during pregnancy was low, on average 6.6 kg. Taking the difference between 4 week postpartum weight and pre-pregnant weight as net weight gain during pregnancy, mothers with a BMI less than 18.5 before pregnancy gained weight while those with a higher BMI lost weight. This observation suggests that the partitioning of energy to the fetus and the mother depends on the energy reserves of the mother before pregnancy. The functional significance of BMI as an indicator of CED is illustrated by its relation with birth weight. Similarly, 4 week postpartum, weight and BMI were predictive for the weight changes in the mother in the first 12 months after delivery. The groups with the lowest values gained weight, while the heaviest mothers lost weight. In view of the negative effects of CED among women of reproductive age on the infant and the mother, maternal undernutrition should receive the same attention as malnutrition among preschool children.

Body Weight↗

PubMed1991

Nutritional transition during infancy in East Java, Indonesia: 1. A longitudinal study of feeding pattern, breast milk intake and the consumption of additional foods.

Infant feeding pattern was studied longitudinally from birth to 52 weeks among all infants born in the period September 1982-December 1984 in three villages in Madura, East Java (n = 687). Genuine demand breast-feeding was practised but it is the custom to force-feed infants from as early as the third day after birth until about 16 weeks. In a sub-sample the intake of breast milk and additional foods were measured, longitudinally in 76 infants and cross-sectionally in 77 infants. Breast milk intake ranged from 745 g per 24 h in the first month to 640 g per 24 h in the 12th month. Force-feeding did not have a negative influence on breast milk intake. The main constraint in infant feeding is the low intake of additional foods, which remained at 180 kcal and 3 g protein per day from the age of 16 weeks onwards.

Breast Feeding↗

PubMed1991

Nutritional transition during infancy in East Java, Indonesia: 2. A longitudinal study of growth in relation to the intake of breast milk and additional foods.

Weight and length of infants, born in two villages in Madura, East Java were measured longitudinally from birth to 12 months (n = 391). In a sub-sample (n = 76) the intake of breast milk and additional foods during 48 h were also measured. The shape of the weight curve of Madurese infants is comparable to that of healthy, exclusively breast-fed infants in the UK and US during the first 6 months of life, in spite of the custom to force-feed from as early as the first week. The use of a more 'appropriate' growth curve of exclusively breast-fed, healthy infants instead of the NCHS reference failed to define more accurately the age at which growth faltering starts. It is recommended to use weight increments as an indicator of the onset of growth faltering. Breast milk intake correlated significantly with attained weight. However, it explains only a small percentage of the variation in weight, viz. 12-24 per cent. There was no correlation between energy or protein intake from breast milk and additional foods and weight gain.

Breast Feeding↗

PubMed1991

Patterns of variability in the nutrient intake of nutritionally vulnerable pregnant women.

Intra/inter-individual variance ratios for energy, protein, fat and retinol-equivalent intake during the third trimester of pregnancy were calculated. Data were collected on 743 pregnant women from rural Indonesia between 1982 and 1984. Food intake of these women was directly weighed for three consecutive days per month during months 6-9 of pregnancy, yielding 7139 observations for analysis. Ratios were calculated separately for a single month of pregnancy and for the last trimester of pregnancy. The intra/inter-individual variance ratio for kilocalorie and protein intake was less than 1.0 for a single month; it was greater than 1.0 for the trimester. This suggests that women varied their intake of kilocalories and protein more over the course of their pregnancy than they did during one month of their pregnancy. Both the monthly and trimester variance ratios for fat and retinol-equivalent intake were greater than 1.0. Our findings suggest that usual mean intake during the third trimester of pregnancy can be measured with relative precision with two replicates per individual. However, more measurements are needed for regression analyses: measurement error greatly attenuated the coefficients, even though data were collected by the direct weighing method. Thus the number of measurements per individual needed in a study of nutrition and pregnancy depends on the nutrient, the period of 'usual intake' that is of interest, as well as the analytical strategy.

Dietary Fats↗

PubMed1990

Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry.

The effect of prenatal energy supplementation on maternal anthropometry was assessed in a controlled, randomized trial in Madura, East Java. At 26-28 wk of gestation women were either given 465 kcal/d (HE group) or 52 kcal/d (LE group). Two hundred seventy-six women were enrolled in the HE group and 266 women, in the LE group. Supplement intake was variable. Testing of effect by treatment and compliance was thus done by subcategories (HE 1-3 and LE 1-3, corresponding to less than 45, 45-89, and greater than or equal to 90 packets of supplement consumed). Analysis of variance did not show significant differences among the six subcategories in third-trimester weight gain, sum of skinfold thicknesses, 4-wk postpartum weight, or body mass index. In this population energy supplementation for the short duration of the last 90-110 d of pregnancy was not sufficient to improve maternal nutrition as judged by anthropometry.

Analysis of Variance↗

PubMed1990

Breast feeding protects infants in Indonesia against illness and weight loss due to illness.

The authors tested the hypothesis that breast feeding modifies the effect of morbidity on growth by examining, at different levels of breast feeding: 1) number of days ill; and 2) the relation between morbidity and weight change. A total of 200 observations made at 3-weekly intervals between 1983 and 1984 on 33 breast-fed infants from a rural village on the island of Madura, Indonesia were used. Levels of breast feeding were defined as quartiles (Q1-Q4) of proportion of household visit time spent breast feeding. Regression analysis and analysis of variance were used and within child effects examined. Number of days ill from respiratory tract illness decreased significantly (p = 0.01) as quartile of breast feeding increased. Weight change was not affected by respiratory tract illness in Q2-Q4 but was significantly and negatively affected by such illness in the lowest quartile, Q1 (beta = -22.5 +/- 4.8 g/day ill). The slopes of Q2-Q4 were not significantly different from each other but were significantly different (p = 0.0094) from the Q1 slope. The authors examined whether measurement, reverse causality, or confounding bias changed the interpretation of findings; they did not. The authors conclude that breast feeding protects infants against the nutritional consequences of illness by decreasing the number of days with respiratory tract illness and protecting against weight loss due to this form of illness. However, this protective effect of breast feeding is attained only when levels of breast feeding are adequate, because at the lowest level of breast feeding, illness had a negative impact on weight performance.

Breast Feeding↗

PubMed1989

Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on breast-milk output.

Breast-milk output was measured in women who during the last trimester of pregnancy consumed a high- or low-energy supplement (53 and 55 women, respectively). Infant and mother pairs were enrolled at 2 or 6 wk postpartum. Test weighings were done four times at 8-wk intervals. Mean breast-milk output ranged from 682 to 744 g/d in the age period of 2 wk to 7 mo. There was no difference in milk output between the two experimental groups. In all cohorts, breast-feeding frequency influenced milk output positively. Only at age 18-22 wk did the mothers' prepregnancy or 4-wk postpartum body mass index play an additional role. The results confirm that breast-milk output of mildly undernourished women is comparable with that of well-nourished women. Short-term energy supplementation during pregnancy did not increase breast-milk output, probably because the sample studied was not at nutritional risk.

Adult↗

PubMed1989

Infant mortality in Madura, Indonesia. Implications for action.

Infant mortality by age at death and birth weight was assessed in a prospective, population-based study in Madura, East Java. Even after elimination of neonatal tetanus by vaccination during pregnancy as a major cause of death, the infant mortality rate was high, viz. 121 per 1000 live births. The majority of live born infants died in the first 6 months of life. Birth weight was the best practical indicator of survival. The implications for Primary Health Care are discussed.

Adolescent↗

PubMed1988

Energy supplementation in the last trimester of pregnancy in East Java: I. Effect on birthweight.

The effect of two levels of energy supplementation in the last trimester of pregnancy on birthweight was tested in a controlled randomized trial in three villages in Madura, East Java. The high and low energy supplements provided 1.95 MJ (465 kcal) and 218 kJ (52 kcal) per day respectively. In the baseline period the home diet provided on average 6.28 MJ (1500 kcal) (SD 2.1 MJ (499 kcal] and 41 g (SD 13 g) of protein. The mean birthweight was 2835 g and the rate of low birthweight 12.2%. In the experimental period the home diet was better. The average intake ranged from 6.45 to 7.19 MJ (1541-1717 kcal) and 41.4-44.2 g per day, depending on the degree of compliance. Mean birthweight increased by 100 g and the rate of low birthweight dropped to 9.5%. There was no difference between the high and low energy supplemented group as a whole, probably due to the masking effect of the better home diet in the experimental period. It is likely that a positive effect of energy supplementation on birthweight was restricted to the group of pregnant women with the lowest home dietary intake and/or a low prepregnant weight. In this community targeting of supplementation to lean seasons and/or to women with a low prepregnant weight may be cost-effective.

Birth Weight↗

PubMed1979

Nutrition and nutritional status of rural women in East Java.

In the rural parts of nine regencies of the province of East Java Indonesia, in the dry seasons of 1975 and 1976 extensive nutrition surveys were carried out. So designated surplus, marginal and minus areas were included. Social and hygienic features of the household were recorded. The reproductive characteristics of the mother population were noted. Anthropometric data were collected. Their diet, including consumption frequency of staple and secondary foodstuffs, was registered by interview. Of a total of 3,828 mothers of children 0--15 years old 37% were lactating and 6.7% were pregnant. Of the latter some 10% were still nursing a child. The number of live children per family was rather small (2.0--3.4) and the percent of those who had died was high (10--31%). Average height of the mothers was 149 cm and weight 42 kg. A cross-sectional calculation of weight gain during pregnancy resulted in 5.0--7.4 kg. Lactating mothers showed a higher weight-height ratio than non-lactating or pregnant. Taking 90% of the Indonesian standard of weight-for-height as cut-off point for an acceptable nutritional status, 18--24% of the nonpregnant non-lactating, 13--35% of the lactating and 33--57% of the pregnant mothers fell below that standard. Considerable and rather unexpected differences existed between regencies. Low percentages of illiteracy and highest of child survival were found in an area designated as 'minus' for per capita income and food production. Only in Sidoarjo was rice the most frequently consumed staple food. In Trenggalek (south coast) and in Sampang (Madura) it was cassava. In Blitar (south coast) it was rice, maize and cassava mixed or varying according to season. In the remaining six regions a mixture of rice and maize was the common food.

Adolescent↗

PubMed1978

Feeding practices, nutritional status and mortality in pre-school children in rural East Java, Indonesia.

During the dry season of 1975 and 1976 two nutrition surveys were carried out in nine regencies of the province of East Java, Indonesia. The objective was to assess the geographical prevalence, magnitude and severity of nutritional deficiencies, especially among mothers and children. In this paper childfeeding practices, nutritional status of pre-school children and child mortality are reported. In the rural areas surveyed breastfeeding is commonly practiced for a prolonged period. In the regencies along the south and north coast of East Java 90%, respectively 94% of children aged 19-24 months were still breastfed; in Sidoarjo, a relative 'surplus' area, the corresponding figure was 73% and on the island of Madura 51%. Even in age-group 25-47 months 34% still were nursed in Blitar-Trenggalek regency, 54% in Tuban-Lamongan, 23% in Sidoarjo and 15% in Madura. The variation in the breastfeeding period between the regencies is a matter of further investigation. In these rural areas the roles as competitor of powdered milk is a minor one. It was intriguing that 9% of the pregnant women still nursed their youngest child. Supplementary food was introduced at a very early age, i.e. in the first week. This was, however, insufficient to maintain adequate growth after the age of six months. According to weight-for-age severe malnutrition was diagnosed in respectively 1%, 4% and 10% of age-groups 0-5 months, 6-11 months and 1-3 years. The anthropometric data suggest that lack of calories is more influential than the deficit in protein. Age-specific mortality, according to age at death was about 21% in the perinatal and 16% in the neonatal period; from 1-11 months (inclusive) it was 31%, from 1.5 years 19% and till 12 years 8%.

Age Factors↗

PubMedDate not supplied

When does growth faltering start?

Three indicators were used to assess the onset of growth faltering: (a) average weight - and length - for - age as percentage of the NCHS references or (b) the Cambridge references based on breastfed infants and (c) incremental growth over 4 weeks in which "faltering" was defined as a weight increment less than minus 2 standard deviations, calculated by Waterlow from USA and British data or no gain in length. The population covered were singleton infants born in two villages in Madura in September 1982 through December 1984 (N = 391). Weight and length were measured at 4 week intervals. The first two indicators did not properly identify the age period at which growth became unacceptable according to weight or length increments. This was mainly due to the large variation and the skewed distribution of weight and length of Madurese infants. Arbitrarily a magnitude of 20% weight falterers was used as a cut-off point for the onset of growth faltering. Among Madurese infants it would be at or before 3-4 months. It is recommended to analyse weight increments from data, generated by growth monitoring at POSYANDUS for mapping of the age period at risk throughout Indonesia.

Age Factors↗

PubMedDate not supplied

Low birth weight babies under village conditions: feeding pattern, growth and motor development.

Feeding, growth and motor development of low birth weight babies (LBW) were assessed among infants born from September 1982 through December 1984 in 3 villages in Madura. Mean birth weight of Madurese infants ranged from 2850-2950 g and the incidence of LBW from 9.5-12.2%. A larger percentage of the very small LBW babies (birth weight 2.0-2.2 kg) received breastmilk as the sole food in the first 6 months. Yet, force-feeding was also practiced for LBW babies. Infants remained in their growth channel according to birth weight, however, relative to the NCHS centiles at birth, LBW infants grew better in the first 6 months than normal birth weight (NBW) infants. Growth deteriorated conspicuously in the second half of infancy, irrespective of birth weight. There was no difference in motor development between LBW and NBW infants. Once they had survived, LBW infants appeared to do as well as NBW under village conditions.

Birth Weight↗