ABSTRAK Nama : Yulia Novika J Program Studi : Magister Ilmu Kesehatan Masyarakat Peminatan Gizi Judul : Pengaruh ASI Eksklusif dalam Pencapaian Pertumbuhan Linier pada Bayi dengan Panjang Lahir Pendek di Kota Bandar Lampung Pencapaian pertumbuhan linier yang optimal pada bayi lahir pendek dapat dilakukan dengan mencegah peluang terjadinya stunting pada umur berikutnya. Pemberian ASI Eksklusif merupakan makanan ideal bagi bayi selama 6 bulan pertama kehidupan dapat menurunkan peluang terjadi stunting (Fikadu, 2014). Di Indonesia, masalah pendek sudah mulai terlihat pada bayi baru lahir dengan panjang lahir kurang dari 48 cm (20,2%) dan Provinsi Lampung memiliki prevalensi bayi lahir pendek yang lebih besar, yaitu 22,4% (Kemenkes, 2013; Dinkes Lampung, 2015). Penelitian ini menggunakan desain kohort prospektif (longitudinal) untuk mengetahui pengaruh pemberian ASI Eksklusif pada bayi dengan panjang lahir pendek dalam mencapai pertumbuhan linier yang optimal. Sampel adalah bayi yang berumur 3 bulan dengan panjang lahir pendek berjumlah 179 orang dan diamati sampai bayi berumur 6 bulan. Hasil yang diperoleh yaitu lebih dari 90% bayi dengan panjang lahir pendek dapat mencapai panjang badan normal saat umur 6 bulan. Pemberian ASI Eksklusif masih rendah (45.8%). Proporsi bayi lahir pendek yang diberikan ASI eksklusif dan mencapai pertumbuhan linier normal (97.6%) lebih besar dibandingkan dengan bayi yang tidak ASI Eksklusif (93.8%). Pertumbuhan linier bayi yang diberi ASI eksklusif lebih baik dibandingkan bayi yang tidak ASI eksklusif baik pada pertumbuhan normal maupun yang tetap pendek saat umur 6 bulan. Bayi perempuan memiliki pertumbuhan linier yang lebih baik dibandingkan laki-laki. Growth faltering terjadi pertama kali pada bayi yang tidak diberi ASI eksklusif saat periode umur 4-5 bulan dan bayi yang diberi ASI eksklusif mulai mengalami growth faltering saat umur 56 bulan. Hasil analisis regresi logistik terlihat bahwa bayi lahir pendek yang diberi ASI Eksklusif mempunyai peluang dalam mencapai pertumbuhan linier normal sebesar 3.58 kali dibanding bayi lahir pendek yang diberi susu formula setelah dikontrol variabel penyakit infeksi, kenaikan berat minimal, pekerjaan ibu, tinggi badan ibu, dan pemberian MP-ASI dini. Perlu peran aktif dari tenaga kesehatan untuk mempromosikan ASI eksklusif dan dilakukan pemantauan pertumbuhan melalui pengukuran panjang atau tinggi badan pada anak umur 0 – 72 bulan setiap tiga bulan sekali sesuai dengan Permenkes No. 66 Tahun 2014. Hal ini bermanfaat untuk deteksi dini kejadian growth faltering pada anak balita. Kata Kunci : asi eksklusif, panjang lahir, pertumbuhan linier, stunting

ABSTRACT Name : Yulia Novika J Study Program: Magister Program in Public Heatlth Science Title : Influence of Exclusive Breastfeeding on Linear Growth of Stunted Infants from Birth in Bandar Lampung City Growth assessment is an important part of health evaluation of children and as a global effort to improve early childhood growth. Exclusive breastfeeding is the only appropriate food for infant 0-6 months of age, an ideal nutrition for child development and growth. In the region of Bandar Lampung city, the prevalence of stunting is stiil high compared to national data (22.4%; 20.2%). This study aimed to know the effect of excelusive breasfeeding on linear growth infants with stunting from birth in Bandar Lampung city. A quantitative study with prospective cohort design  was carried out in Bandar Lampung city for 3 months since the babies were 3 months of age. A number of 179 mother singleton baby coupled with stunted from birth and exclusive breastfed from birth to six months of age were completed to follow up. Exclusive breasfeeding in Bandar Lampung city is still low (45.8%). Proportion of stunted infants with exclusive breasfeeding achieving normal linear growth (97.6%) up to six months of age. Linier growth of exclusively breast-fed infants is higher than those who are not exclusively breastfed either on normal growth or in infants who remain stunting at 6 months of age and girls grew better than boys. Growth faltering occurred during 4 – 5 months of age in those infants who were not breastfed exclusively while those who breastfed exclusively at 5 – 6 months of age. Growth pattern throughout 3 – 6 months of age were analyzed by logistic regression and plotted in curves compared to WHO standard. Exclusively breastfed infants had 3,58 times better in linier growth compared to formula fed infants. While partial breastfed infants had 1,6 times to achieve normal linier growth compared to infants who were fed by formula after controlling infectious disease exposure, minimal weight gain standar, materbal occupation, maternal height, and early complementary feeding. Thus, active role of health personnel to promote exclusive breasfeeding and growth monitoring, especially linier growth during 072 months of age in every three month according to Minister of Health Permenkes number 66 year 2014 to monitor growth faltering, is required. Kata Kunci : exclusive breastfeeding, birth length, linier growth, stunting

Periode seribu hari pertama kehidupan (1000 HPK) merupakan masa yang sangat rentan terjadinya berbagai masalah gizi yang berdampak terhadap pertumbuhan dan perkembangan anak. Salah satu bentuk gangguan pertumbuhan yang sering muncul pada periode ini adalah stunting. Kelahiran risiko tinggi, khususnya kelahiran “4 TERLALU” (terlalu muda, terlalu tua, terlalu dekat, terlalu banyak) berperan penting dalam meningkatkan risiko morbiditas pada ibu dan anak. Sejumlah studi mengaitkan kelahiran “4 TERLALU” terhadap stunting, namun demikian temuan mengenai hal ini masih terbatas, tidak konsisten, dan umumnya hanya mencakup anak usia balita. Penelitian ini menggunakan data longitudinal Indonesia Family Life Survey (IFLS) tahun 2000, 2007, dan 2014 di 13 provinsi dengan 1.401 anak usia 0–59 bulan yang diikuti hingga usia remaja untuk menilai pengaruh kelahiran 4 TERLALU terhadap status stunting dan perubahan status stunting. Status stunting ditentukan dengan z skor PB/U atau TB/U berdasarkan standar WHO 2007, dan perubahan status dikelompokkan menjadi remained normal, height faltering, catch-up growth, dan remained stunted. Analisis dilakukan menggunakan Generalized Estimating Equation (GEE) untuk menilai dampak kelahiran “4 TERLALU” terhadap status stunting dan multinomial regresi logistik untuk menilai dampak kelahiran “4 TERLALU” terhadap perubahan status stunting di usia sekolah dan usia remaja. Hasil penelitian menunjukkan prevalensi stunting tertinggi pada usia balita (39%), menurun pada usia sekolah (35%), dan mencapai 25% pada remaja. Proporsi kelahiran terlalu muda sebesar 12,7%, terlalu tua 9,6%, terlalu dekat 6,8%, terlalu banyak 16,2%, dengan kelahiran risiko tinggi ≥1 sebesar 36,1% dan ≥2 sebesar 8,7%. Kelahiran terlalu dekat (<24 bulan) secara konsisten meningkatkan risiko stunting sejak balita hingga remaja, sedangkan kelahiran terlalu muda, terlalu tua, dan terlalu banyak tidak menunjukkan hubungan signifikan. Faktor lain yang berpengaruh antara lain usia anak pada saat baseline, berat badan lahir rendah, pendidikan ibu rendah, tinggi badan ibu ≤150 cm, tinggi badan ayah ≤161,9 cm, serta kondisi sosioekonomi dan lingkungan, di mana anak dari keluarga kuintil aset 3 memiliki risiko 21% lebih rendah dibanding kuintil 1. Analisis perubahan status stunting menunjukkan bahwa jarak kelahiran terlalu dekat meningkatkan risiko anak menjadi stunted (height faltering) dan remained stunted. Temuan ini menegaskan bahwa stunting bersifat dinamis dan kelahiran terlalu dekat berkontribusi besar pada gangguan pertumbuhan linier jangka panjang, sehingga diperlukan intervensi gizi, kesehatan reproduksi, dan pemantauan pertumbuhan yang berkesinambungan sejak masa sebelum konsepsi hingga masa remaja.

The first 1,000 days of life (1,000 HPK/Hari Pertama Kehidupan) represents a critical window during which children are highly vulnerable to various nutritional problems that can adversely affect their growth and development. Stunting is one of the most common forms of growth faltering that occurs during this period. Births with high-risk factors, particularly those related to the "4 Too's" (maternal age being too young or too old, a short birth interval, and numerous previous births), greatly increase the likelihood of illness among mothers and their children. Although several studies have linked the "4 Too's" birth characteristics to stunting, the evidence remains limited, inconsistent, and is generally confined to children under five years of age. This study used longitudinal data from the Indonesia Family Life Survey (IFLS) conducted in 2000, 2007, and 2014 across 13 provinces. A cohort of 1,401 children aged 0-59 months was followed through adolescence to assess the influence of the "4 Too's" birth characteristics on stunting status and its longitudinal changes. Stunting status was determined using height-for-age z-scores (HAZ) based on the 2007 WHO standards. Stunting status changes were classified as normal, height faltering, catch-up growth, and stunted persistence. Generalized Estimating Equations (GEE) were used to examine the impact of the 'Four Too' birth factors on stunting, while multinomial logistic regression was employed to investigate their effect on changes in stunting during school age and adolescence. The findings showed that stunting prevalence was most common among 5- year-olds (39%), decreased to 35% during school age, and dropped to 25% in adolescence. The proportions of high-risk births were as follows: 12.7% to mothers who were too young, 9.6% to mothers who were too old, 6.8% with a short birth interval, and 16.2% with high parity. The prevalence of births with at least one risk factor was 36.1%, while 8.7% had two or more risk factors. A birth interval of less than 24 months was constantly linked to an elevated risk of stunting from early childhood through adolescence, while no noteworthy correlation was found between births to mothers of young or older age and those of high parities. The other significant risk factors were the child's age at baseline, low birth weight, low levels of maternal education, maternal height of 150 cm or less, and paternal height of 161.9 cm or less. Socioeconomic factors also played a role, with children from the third asset quintile having a 21% lower risk of stunting than those from the first quintile. Analysis of the changes in stunting status revealed that short birth intervals increased the risk of a child experiencing height faltering or remaining stunted. These findings affirm the dynamic nature of stunting and highlight that a short birth interval is a major contributor to long-term linear growth faltering. Consequently, sustained nutritional and reproductive health interventions, along with continuous growth monitoring, are imperative from the pre-conception period through adolescence to break the intergenerational cycle of stunting.