Asupan Vitamin D Rendah dan Keparahan Demam Berdarah Dengue pada Anak Usia 1-14 Tahun

Authors

Nur Siyam, Departemen Epiodemiologi dan Biostatistik Jurusan Ilmu Kesehatan Masyarakat Fakultas Ilmu Keolahragaan Universitas Negeri SemarangFollow
Siswanto Agus Wilopo, Departemen Kesehatan Masyarakat Fakultas Kedokteran Universitas Gadjah MadaFollow
Mohammad Hakimi, Departemen Kesehatan Masyarakat Fakultas Kedokteran Universitas Gadjah MadaFollow

Abstract

Demam berdarah dengue (DBD) menimbulkan syok dan kematian. Penderita DBD di Yogyakarta sebagian besar usia 1 - 12 tahun dengan DBD parah. Asupan vitamin D rendah diasumsikan penyebab DBD parah. Asumsi ini perlu dibuktikan dengan menganalisis pengaruh asupan Vitamin D dan keparahan DBD. Rancangan penelitian adalah studi kasus kontrol. Penelitian di bangsal rawat inap anak dan instalasi catatan medik RS Jogja dan RSUP Dr. Sardjito. Kasus adalah anak usia 1 - 14 tahun dengan DBD grade III & IV, kontrolnya DBD grade I & II. Data asupan vitamin D diambil dengan food frequency questionnaire (FFQ). Variabel luar adalah indeks massa tubuh (IMT), usia, status penyakit kronis dan intensitas terpapar matahari pagi. Analisis dengan uji-t dan regresi logistik. Hasil penelitian didapatkan 60 kasus dan 60 kontrol tanpa matching. Cut-off point asupan vitamin D berdasarkan ROC curve adalah 2,7 µg/hari. Penderita DBD parah rata-rata asupan vitamin D 1,10 kali lebih sedikit dibandingkan DBD tidak parah. Rata-rata asupan vitamin D lebih rendah 1 µg/day bersama IMT ≥18,75 kg/m2, penyakit kronis, dan kurang terpapar matahari pagi berpengaruh pada DBD parah (OR=0,47; 95% CI: 0,32-0,71). Cukup Asupan vitamin D disarankan untuk menghindari keparahan DBD. Penyakit kronis dan berat badan lebih perlu menjadi perhatian tenaga medis sebagai kewaspadaan dini terjadinya shock. Dengue hemorrhagic fever (DHF) lead to shock and death. Patient in Yogyakarta mostly aged 1 - 12 years old with severe dengue. A low vitamin D intake is assumed to be the cause of severe dengue. This assumption needs to be proved by analyzing the effect of vitamin D intake and severity of DHF. Study design was a case control study. Research on children’s wards and medical record installation in hospital. Cases were children with DHF grade III and IV, the control of DHF grade I & II. Data vitamin D intake was obtained by FFQ. Outer variables: BMI, age, chronic diseases and intensity morning sun exposure. Analysis by t-test and logistic regression. The results showed 60 cases and 60 controls without matching. Cut-off point vitamin D intake based ROC curve was 2.7 µg/day. Patients with severe dengue average vitamin D intake of 1.10 times less than not severe dengue. The average vitamin D intake lower 1 µg/day with a BMI ³ 18.75 kg/m2, chronic disease, and less exposed to the morning sun effect on severe dengue (OR = 0.47, 95% CI: 0.32 to 0.71). Sufficient vitamin D intake is recommended to avoid the dengue severity. Chronic diseases and more weight should be a concern of medical personnel as early warning shock occurrence.

References

1. Yamshchikov AV, Desai NS, Blumberg HM, Ziegler TR, Tangpricha V. Vitamin D for treatment and prevention of infectious diseases: a systematic review of randomized controlled trials. Endocrine Practice. 2009;15 (5): 438-49.

2. Youssef DA, Miller CW, El-Abbassi AM, Cutchins DC, Cutchins C, Grant WB, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol. 2011; 3(4): 220-9.

3. Beard JA, Bearden A, Striker R. Vitamin D and the anti-viral state. Journal of Clinical Virology. 2011; 50 (3):194-200.

4. Van Belle TL, Gysemans C, Mathieu C. Vitamin D in autoimmune, infectious and allergic diseases: a vital player? Best Practice & Research Clinical Endocrinology & Metabolism. 2011; 25(4): 617-32.

5. Nguyen TH, Lei HY, Nguyen TL, Lin YS, Huang KJ, Le BL, et al. Dengue hemorrhagic fever in infants: a study of clinical and cytokine profiles. The Journal of Infectious Diseases. 2004; 189 (2): 221-32. Epub 2004/01/15.

6. McCarty CA. Sunlight exposure assessment: can we accurately assess vitamin D exposure from sunlight questionnaires? American Journal of Clinical Nutrition. 2008; 87(suppl): 1097S–101S.

7. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, et al. Low vitamin D status despite abundant sun exposure. The Journal of Clinical Endocrinology & Metabolism. 2007; 92 (6):2130 –5.

8. Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M. Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa. Journal of the American Dietetic Association. 2009; 109 (3): 479-85, 85 e1-3.

9. Perez AB, Sierra B, Garcia G, Aguirre E, Babel N, Alvarez M, et al. Tumor necrosis factor-alpha, transforming growth factor-beta1, and interleukin-10 gene polymorphisms: implication in protection or susceptibility to dengue hemorrhagic fever. Human Immunology. 2010; 71(11): 1135-40.

10. Hart PH. Vitamin D supplementation, moderate sun exposure, and control of immune diseases. Immunology. 2012; 73.

11. Paul G, Brehm JM, Alcorn JF, Holguı ´n F, Aujla SJ, Celedo´ n JC. Vitamin D and asthma. American Journal of Respiratory and Critical Care Medicine. 2012; 185.

12. Valdivielso JM, Fernandez E. Vitamin D receptor polymorphisms and diseases. Clinica Chimica Acta. 2006; 371(1–2):1-12.

13. Figueiredo MA, Rodrigues LC, Barreto ML, Lima JW, Costa MC, Morato V, et al. Allergies and diabetes as risk factors for dengue hemorrhagic fever: results of a case control study. PLoS Negleted Tropical Disease. 2010; 4(6): e699.

14. Stephenson JR. Understanding dengue pathogenesis: implications for vaccine design. Bulletin of the World Health Organization. 2005; 83(4): 308-14.

15. Kalayanarooj S, Nimmannitya S. Is dengue severity related to nutritional status? The Southeast Asian Journal of Tropical Medicine and Public Health. 2005;36(2):378-84.

16. Matsuda M, Shimomura I, Sata M, Arita Y, Nishida M, Maeda N, et al. Role of adiponectin in preventing vascular stenosis. The missing link of adipo-vascular axis. The Journal of Biological Chemistry. 2002; 277(40): 37487-91.

17. Cohen SS, Gammon MD, Signorello LB, North KE, Lange EM, Fowke JH, et al. Serum adiponectin in relation to body mass index and other correlates in black and white women. Annual of Epidemiology. 2011; 21(2): 86-94.

18. Guerre-Millo M. Adiponectin: an update. Diabetes & metabolism. 2008;34 (1): 12-8.

19. Wagner A, Simon C, Oujaa M, Platat C, Schweitzer B, Arveiler D. Adiponectin is associated with lipid profile and insulin sensitivity in French adolescents. Diabetes & metabolism. 2008;34(5):465-71. Epub 2008/08/08.

20. Stein EM, Strain G, Sinha N, Ortiz D, Pomp A, Dakin G, et al. Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study. Clin Endocrinol. 2009;August ; 71(2):176–83.

21. Kardas F, Kendirci M, Kurtoglu S. Cardiometabolic risk factors related to vitamin D and adiponectin in obese children and adolescents. International Journal of Endocrinology. 2013; 2013: 1-5.

22. Wang CCL, Pereira RI, Hosokawa P, Dickinson LM, Krantz MJ, Neumar C, et al. Association between 25-hydroxyvitamin D and adiponection levels in hypertensive subjects [online]. North Beauregard Street Alexandria; 2010 [ cited 2013 Dec 29]; Available from: http://professional.diabetes.org/Abstracts_Display.aspx?TYP=1&CID=79769.

Recommended Citation

Siyam N , Wilopo SA , Hakimi M , et al. Asupan Vitamin D Rendah dan Keparahan Demam Berdarah Dengue pada Anak Usia 1-14 Tahun. Kesmas. 2014; 9(1): 87-93
DOI: 10.21109/kesmas.v9i1.461
Available at: https://scholarhub.ui.ac.id/kesmas/vol9/iss1/14