Pengaruh Diet Rendah Protein Dan Diet Rendah Kalori Pada Mencit Dan Keturunannya Terhadap Gambaran Struktur Mikroanatomi Musculus Levator Ani

KHAIRINA HASHIFAH, Dr. dr. Shofwal Widad, Sp.O.G. Subsp. F.E.R.; dr. Agung Dewanto, Sp.O.G. Subsp. F.E.R., Ph.D

2023 | Tesis-Spesialis | OBSTETRI DAN GINEKOLOGI

Latar belakang: Nutrisi selama kehamilan berpengaruh pada perkembangan awal organ janin, termasuk pada pembentukan dan pertumbuhan otot. Musculus levator ani merupakan salah satu otot skelet pada wanita yang penting untuk menyokong organ panggul. Gangguan pada struktur musculus levator ani akan menyebabkan terjadinya disfungsi organ panggul diantaranya inkontinensia urin, inkontinesia fekal dan prolaps organ panggul. Efek diet maternal terhadap perkembangan otot skelet yang lain banyak diteliti, tetapi pengaruhnya terhadap musculus levator ani belum pernah dilakukan. Oleh karena itu, dalam penelitian ini kami akan mengamati pengaruh pemberian diet rendah protein dan diet rendah kalori terhadap struktur mikroanatomi musculus levator ani pada induk mencit dan keturunannya. Metode penelitian: Pada penelitian tahap I, Sebanyak 10 mencit betina (Mus Musculus) galur Swiss-Webster umur 1 bulan dengan kisaran berat badan 20 gram diberikan diet rendah protein (10% kasein), 10 mencit betina diberikan diet rendah kalori (70% kebutuhan kalori) dan 10 mencit betina diberikan diet protein normal (14% kasein) dan kalori normal sebagai kontrol. Setelah perlakuan selama dua bulan, sebanyak 5 ekor per kelompok dimatikan dan diambil musculus levator ani kemudian dianalisis. Pada penelitian tahap 2, keturunan mencit berusia tiga bulan, sebanyak 5 ekor per kelompok dimatikan dan diambil musculus levator ani kemudian dilakukan analisis. Data luas fasikulus, diameter dan luas myofiber, serta luas jaringan ikat disajikan dalam rerata+-SD, kemudian diuji menggunakan ANOVA dan Mann-Whitney Test. Data dinilai bermakna secara statistik jika nilai p<0,05. Hasil penelitian: Pada kelompok induk diet rendah protein dibandingkan dengan kontrol, luas fasikulus lebih kecil (0,14 +- 0,06 mm2 vs 0,25 +- 0,12 mm2), diameter myofiber lebih kecil (76,64 +- 21,69 mcgm vs 77,04 +- 34,72 mcgm), luas myofiber lebih kecil (2.990,18 +- 1.453,53 mcgµm2 vs 3.031,34 +- 2.014,34 mcgm2). Pada kelompok anak diet rendah protein dibandingkan kelompok kontrol, luas fasikulus (0,14 +- 0,07 mm2 vs 0,23 +- 0,09 mm2), diameter myofiber (69,31 +- 22,02 mcgm vs 84,51 +- 26,43mcgm), dan luas myofiber (2.039,39 +- 872,04 mcgµm2 vs 2.661,29 +- 1.447,69mcgm2) lebih kecil. Pada kelompok diet rendah kalori, luas fasikulus lebih kecil dibandingkan dengan kelompok kontrol (0,13 +- 0,03 mm2 vs 0,23 +- 0,09 mm2). Parameter lain diameter myofiber (67,28 +- 20,79 mcgm vs 77,04 +- 34,7 mcgm) dan luas myofiber (2.703,49 +- 1.295,17 mcgm2 vs 2.661,29 +- 1.447,69 mcgm2) lebih kecil dibandingkan dengan kelompok kontrol. Jumlah jaringan ikat pada kelompok induk diet rendah protein dan rendah kalori lebih kecil dibandingkan dengan kelompok kontrol (33,02% vs 34,04%, 32,94% vs 34,04%). Pada kelompok anak, luas jaringan ikat lebih kecil dibandingkan kontrol (28,96% vs 29,47%). Kesimpulan: Luas fasikulus, diameter myofiber, dan luas myofiber musculus levator ani pada kelompok diet rendah protein dan rendah kalori lebih kecil. Luas jaringan ikat lebih kecil pada kelompok diet rendah protein dan diet rendah kalori.

Background: Nutrition during pregnancy has an effect on the early development of fetal organs, including the formation and growth of muscles. Levator ani muscle is one of the skeletal muscles in women that is important for supporting the pelvic organs. Disturbances in the structure of the levator ani muscle will cause dysfunction of the pelvic organs including urinary incontinence, fecal incontinence, and pelvic organ prolapse. The effect of maternal diets on the other skeletal muscles is widely studied, but its effect on levator ani muscle has never been performed. Therefore, in this study, we will observe the effect of giving a low-protein diet and a low-calorie diet on the microanatomical structure of the levator ani muscle in the maternal and their offspring. Methods: In the phase I study, a total of 10 female mice (Mus Musculus) of the Swiss-Webster strain aged 1 month with a body weight range of 20 grams were given a low-protein diet (10% casein), 10 female mice were given a low-calorie diet (70% of caloric needs) and 10 female mice were given a normal protein diet (14% casein) and normal calories as a control. After treatment for two months, 5 mice per group were sacrificed and levator ani muscle was taken and then analyzed. In the phase 2 study, three-month-old mice offspring, 5 mice per group were sacrificed and levator ani muscle was taken and then analyzed. Data on fascicle area, myofiber diameter, myofiber area, and connective tissue area were presented in mean +- standard deviation (SD), then tested using ANOVA and Mann-Whitney test. The data were considered statistically significant when p<0.05. Results: In the maternal group of low-protein diets compared to a normal protein diet, there was a smaller fascicle area (0.14 +- 0.06 mm2 vs 0.25 +- 0.12 mm2), a smaller myofiber diameter (76.64 +- 21.69 mcgm vs 77.04 +- 34.72 mcgm), a smaller myofiber area (2990.18 +- 1453.53 mcgm2 vs 3031.34 +- 2014.34 mcgm2). In the group of offspring on a low-protein diet compared to the normal protein group there was also a smaller fascicle area (0.14 +- 0.07 mm2 vs 0.23 +- 0.09 mm2), a smaller myofiber diameter (69.31 +- 22.02 mcgm vs 84.51 +- 26.43 mcgm), a smaller myofiber area (2039.39 +- 872.04 mcgm2 vs 2661.29 +- 1447.69 mcgm2). In the low-calorie diet group, the fascicle area was smaller than the normal calorie group (0.13 +- 0.03 mm2 vs 0.23 +- 0.09 mm2). The myofiber diameter (67.28 +- 20.79 mcgm vs 77.04 +- 34.7 mcgm) and myofiber area (2703.49 +- 1295.17 mcgm2 vs 2661.29 +- 1447.69 mcgm2) were smaller than the control group. The amount of connective tissue in the in the maternal group of low- protein and low-calorie diets was smaller compared to the control group (33.02% vs 34.04%, 32.94% vs 34.04%). In the group of offspring, the area of connective tissue was smaller than the control (28.96% vs. 29.47%). Conclusions: The fascicle area, myofiber diameter, and myofiber area levator ani muscle in the low protein and low-calorie diet groups were smaller. The area of connective tissue is smaller in the low protein diet and low-calorie diet groups.

Kata Kunci : diet rendah protein, diet rendah kalori, musculus levator ani, mikroanatomi, low protein diet, low-calorie diet, levator ani muscle, microanatomy