Hubungan Leaky Gut dan Defisiensi Zinc pada Ibu Hamil terhadap Risiko Stunting: Suatu Tinjauan Sistematik dan Meta-Analisis

Abstract

Stunting is a major public health problem in many developing countries. Evidence suggests that chronic intestinal dysfunction (often referred to as environmental enteric dysfunction/"leaky gut") and maternal micronutrient status during pregnancy—particularly zinc deficiency—may contribute to impaired child growth. This study aimed to conduct a systematic review and meta-analysis of the association between markers of intestinal permeability (leaky gut) and/or maternal zinc deficiency in pregnancy and the incidence of stunting in children. A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar until October 2025 for observational studies, interventions, and related meta-analyses. Inclusion criteria: studies reporting the association between (a) maternal intestinal permeability markers (e.g., zonulin, L/N ratio, REG1B, fecal calprotectin if measured in the maternal context), (b) maternal zinc status (serum/creatin/intake indicators), and child growth outcomes (stunting or height/age). Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane RoB for RCTs. Where homogeneous data were available, we conducted a random-effects meta-analysis to calculate odds ratios (ORs) or standardized mean differences (SMDs). Of the 1,278 publications identified, 12 studies met the inclusion criteria for narrative synthesis. Only a few studies directly assessed maternal gut permeability in relation to stunting, making quantitative meta-analysis impossible. Studies of maternal zinc supplementation have shown mixed results on child growth. Although a direct causal relationship between maternal leaky gut and stunting remains uncertain, the consistency of the biological mechanisms—zinc affecting gut integrity, chronic inflammation, and impaired growth—supports an indirect influence. These findings highlight a strong biological pathway through which maternal zinc deficiency may impact gut integrity and increase the risk of stunting in children.