“Peran Instrumen Skrining Healthy Kids Dalam Deteksi Dini Risiko Obesitas Pada Anak Dengan Acute Lymphoblastic Leukemia.”

Sampurno, Tulus and dr. Prasetya Ismail Permadi, Sp.A(K), M.Biomed, and dr. Susanto Nugroho, Sp.A(K), (2024) “Peran Instrumen Skrining Healthy Kids Dalam Deteksi Dini Risiko Obesitas Pada Anak Dengan Acute Lymphoblastic Leukemia.”. Magister thesis, Universitas Brawijaya.

Abstract

Masalah kesehatan masyarakat yang paling serius di abad ke-21, baik di negara maju maupun negara berkembang, adalah kelebihan berat badan pada masa kanakkanak dan obesitas pada masa kanak-kanak, yang diakui sebagai prediktor risiko obesitas pada masa dewasa. Sementara itu, prevalensi obesitas tampak tinggi pada pasien anak penyintas ALL. Anak dengan ALL memiliki risiko kelebihan berat badan/obesitas di awal pengobatan, yang sering menetap hingga paska selesai pengobatan. Intervensi gaya hidup diperlukan untuk mengendalikan berat badan sejak dini selama pengobatan, terutama untuk pasien yang kelebihan berat badan/obesitas pada saat didiagnosis, dan mereka yang mengalami kenaikan berat badan yang substansial selama pengobatan Kelebihan berat badan/obesitas pada pasien ALL sering dikaitkan dengan penggunaan kortikosteroid selama pengobatan, yang secara nyata meningkatkan asupan energi melalui peningkatan nafsu makan. Studi komprehensif dari Townsend et all, 2018, telah menunjukkan validitas dan realibilitas suatu formulir “Healthy Kids” untuk skrining pola hidup sehat anak untuk risiko obesitas. Masih diperlukan studi yang menguji validitas maupun hubungan dan nilai prediksi instrumen Healthy Kids pada pasien diabetes mellitus tipe 1 maupun keganasan, termasuk ALL di setiap fase pengobatannya. Penelitian ini membantu ahli gizi dan tenaga medis profesional lainnya untuk secara dini mengenali faktor risiko obesitas pada anak dengan pengobatan ALL, dan merencanakan strategi gizi preventif untuk memerangi kelebihan gizi. Subjek penelitian didapatkan secara consecutive sampling pada sejumlah 33 responden anak di bulan Pebruari 2024 – Mei 2024 yang terdiagnosis ALL yang sedang menjalani beberapa fase pengobatan, serta dirawat dalam instalasi rawat inap di Departemen Kesehatan Anak RSUD. Dr. Saiful Anwar, Malang, Indonesia, dari usia 0 hingga 10 tahun. Subjek penelitian didominasi oleh pasien dari golongan ekonomi bawah, yaitu sebesar 66,67% dengan perawatan kelas 3. Skor-Z IMT pasien anak yang sedang menjalani pengobatan, tidak menunjukkan adanya perbedaan distribusi di antara fase induksi, konsolidasi, maupun rumatan. Skor Total Kuesioner tidak menunjukkan adanya perbedaan distribusi pada pasien anak yang sedang menjalani pengobatan, di antara fase induksi, konsolidasi, maupun rumatan. Keseluruhan 19 butir kuesioner dinyatakan valid, serta reliabel atau konsisten. Keseluruhan 19 butir kuesioner juga tidak memiliki tingkat kesukaran yang tinggi. Skor instrumen kuesioner skrining yang tervalidasi menunjukkan adanya asosiasi dengan effect size yang besar dengan kejadian obesitas anak selama menjalani pengobatan ALL. Variabel bebas diketahui secara simultan (bersama-sama) memberikan pengaruh terhadap variabel Skor-Z IMT (BAZ) sebesar 66,5%. Hasil Uji F Simultan menunjukkan bahwa empat belas variabel Butir Kuesioner (dengan eliminasi Skor Total) secara bersama-sama atau simultan berpengaruh terhadap variabel Skor-Z IMT (BAZ), dengan Nilai Sig. sebesar 0,032. Meskipun demikian, penurunan total skor instrumen kuesioner skrining tidak terbukti memiliki korelasi positif dengan skor-Z IMT pada anak dengan ALL selama menjalani fase pengobatan. Terdapat korelasi positif antara skor skala diet (dari enam butir kuesioner) pada instrumen skrining “Healthy Kids” dan skor-Z IMT menurut usia pada anak dengan ALL selama menjalani fase pengobatan. Terdapat korelasi positif antara skor pola tidur (satu butir kuesioner) pada instrumen skrining “Healthy Kids” dan skor-Z IMT menurut usia pada anak dengan ALL selama menjalani fase pengobatan. Skor skala diet tidak terbukti memiliki korelasi terhadap skor perilaku makan orang tua atau keluarga pada instrumen skrining “Healthy Kids” pada anak dengan ALL selama menjalani fase pengobatan.Hasil penelitian ini dapat menghasilkan suatu instrumen kuesioner skrining baru meliputi enam butir kuesioner yang terbukti memiliki pengaruh kuat terhadap perubahan Skor-Z IMT pada pasien ALL yang sedang menjalani beberapa fase pengobatan, yaitu 1). skor skala diet meliputi Butir 5 (Saya selalu menyediakan buah untuk dimakan anak saya), Butir 8 (Saya membelikan sayur-sayuran untuk anak saya), Butir 14 (Anak saya makan permen, roti, atau kue, beberapa kali per hari), Butir 16 (Anak saya makan cemilan, chiki, biskuit, atau keripik beberapa kali), dan Butir 18 (Jika memasak/makan daging, saya potong/ buang lemak/gajih/kulit), serta 2). skor skala aktivitas fisik, waktu penggunaan gawai, serta pola tidur meliputi Butir 3 (Waktu Anak saya tidur malam).

English Abstract

The most serious public health problems of the 21st century, in both developed and developing countries, are childhood overweight and childhood obesity, which are recognized as predictors of obesity risk in adulthood. Meanwhile, the prevalence of obesity appears to be high in pediatric ALL survivors. Children with ALL have a risk of being overweight/obesity at the start of treatment, which often persists until after completion of treatment. Lifestyle interventions are needed to control the body weight as early as starting treatment, especially for patients who are overweight/obese at the time of diagnosis, and those who experience substantial weight gain during treatment. Overweight/obesity in ALL patients is often associated with the use of corticosteroid during treatment, which markedly increases energy intake through increased appetite. A comprehensive study from Townsend et all, 2018, has demonstrated the validity and reliability of a “Healthy Kids” form for children's healthy lifestyles’ screening for the risk of obesity. Studies are still needed to test the validity, relationship, and predictive value of the Healthy Kids instrument in patients with type 1 diabetes mellitus and malignancies, including ALL, at each phase of treatments. This research helps nutritionists and other medical professionals to early recognize several risk factors for obesity in children with ALL treatment, and create preventive nutrition strategies plan to combat overnutrition. Research subjects were obtained by consecutive sampling from 33 child respondents in February 2024 – May 2024 who were diagnosed with ALL, undergoing several phases of treatments, and were being treated in the inpatient installation at the Children's Health Department of the Regional Hospital. Dr. Saiful Anwar, Malang, Indonesia, from 0 to 10 years old of agee. The research subjects were dominated by patients from lower economic groups, namely 66.67% with lowest class of hospitalization. The BMI Z-score of pediatric patients undergoing treatment did not show any differences in distribution between the induction, consolidation or maintenance phases. The Total Questionnaire Score did not show any differences in distribution in pediatric patients undergoing treatment, between the induction, consolidation and maintenance phases. All 19 questionnaire items were declared valid, as well as reliable or consistent. All 19 questionnaire items also do not have a high level of difficulty. Validated screening questionnaire instrument scores show an association with a large effect size with the incidence of childhood obesity during ALL treatment. The independent variables are known to simultaneously (together) have an influence of 66.5%. on the BMI Z-Score variable. The results of the Simultaneous F Test show that the fourteen Questionnaire Item variables (with Total Score elimination) simultaneously influence the BMI Z-Score variable, with a Sig. of 0.032. However, the decrease in the total score of the screening questionnaire instrument was not proven to have a positive correlation with the BMI Zscore in children with ALL during the treatment phase. There was a positive correlation between the diet scale score (from the six questionnaire items) on the “Healthy Kids” screening instrument and the BMI Z-score according to age in children with ALL during the treatment phases. There was a positive correlation between the sleep pattern score (one questionnaire item) on the "Healthy Kids" screening instrument and the BMI Z-score according to age in children with ALL during the treatment phases. Diet scale scores were not proven to have a correlation with parents' or family eating behavior scores on the "Healthy Kids" screening instrument in children with ALL during the treatment phases. The results of this research can produce a new screening questionnaire instrument including six questionnaire items which are proven to have a strong influence on changes in BMI Z-Score in ALL patients who are undergoing several phases of treatments, namely 1). Diet scale scores include Item 5 (I always provide fruit for my childv to eat), Item 8 (I buy vegetables for my child), Item 14 (My child eats candy, bread or cake, several times per day), Item 16 (My child eats snacks, chiki, biscuits or chips several times), and Item 18 (If I cook/eat meat, I cut/discard the fat/salt/skin), and 2). Physical activity scale scores, time using devices, and sleep patterns include Item 3 (When my child sleeps at night).

Item Type:	Thesis (Magister)
Identification Number:	0424060130
Uncontrolled Keywords:	: obesitas, ALL, instrumen skrining, Healthy Kids, deteksi dini
Divisions:	Profesi Kedokteran > Spesialis Ilmu Kesehatan Anak, Fakultas Kedokteran
Depositing User:	Unnamed user with username nova
Date Deposited:	12 Nov 2024 06:35
Last Modified:	12 Nov 2024 06:35
URI:	http://repository.ub.ac.id/id/eprint/232459

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