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"Latar Belakang. Prevalensi sindrom metabolik (SM) semakin meningkat di daerah ruralIndonesia. Kunci patogenesis SM adalah resistensi insulin yang dapat didiagnosis denganHomeostasis Model Assessment of Insulin Resistance (HOMA-IR) dan IndeksTriglyceride/Glucose (TyG). Hingga saat ini, belum ada nilai titik potong optimal untukindeks tersebut di Indonesia.Metode. Sebanyak 1300 subjek orang dewasa berusia 18-60 tahun dari studi Sugarspin diNangapanda, Flores, Indonesia dibagi menjadi dua grup berdasarkan jenis kelamin.Penentuan nilai titik potong HOMA-IR dan Indeks TyG pada setiap grup dilakukan dengankalkulasi persentil 75 (p75) dan 90 (p90) pada populasi sehat dan dengan metode receiveroperating characteristics (ROC) pada populasi SM dan non-SM. Korelasi antara HOMAIRdan Indeks TyG dinilai dengan korelasi Spearman pada subjek laki-laki dan perempuan.Hasil. Berdasarkan kedua metode, titik potong HOMA-IR dan Indeks TyG berbeda-bedaantara laki-laki dan perempuan. Nilai titik potong HOMA-IR berdasarkan persentil padalaki-laki sehat adalah 0,9 (p75) dan 1,242 (p90); sedangkan pada perempuan adalah 1,208(p75) dan 1,656 (p90). Berdasarkan ROC, titik potong HOMA-IR antara populasi SM dannon-SM pada laki-laki adalah 1,185 dan pada perempuan adalah 1,505. Nilai titik potongIndeks TyG pada laki-laki sehat adalah 8,590 (p75) dan 8,702 (p90); sedangkan padaperempuan adalah 8,448 (p75) dan 8,617 (p90). Berdasarkan ROC, titik potong Indeks TyGadalah 8,905 untuk laki-laki dan 8,695 untuk perempuan. Koefisien korelasi HOMA-IRdan Indeks TyG ialah 0,39 pada laki-laki dan 0,36 pada perempuan.Kesimpulan. Nilai titik potong HOMA-IR untuk resistensi insulin pada laki-laki adalah0,9 (p75), 1,242 (p90), dan 1,185 (ROC); pada perempuan adalah 1,208 (p75), 1,656 (p90),dan 1,505 (ROC). Nilai titik potong Indeks TyG pada laki-laki adalah 8,59 (p75), 8,702(p90), dan 8,905 (ROC); pada perempuan adalah 8,448 (p75), 8,617 (p90), dan 8,695(ROC). Didapatkan hasil korelasi yang lemah antara HOMA-IR dan Indeks TyG.

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Background. Metabolic Syndrome (MS) prevalence is increasing in Indonesia's rural area.

The key pathogenetic mechanism of MS is insulin resistance which can be diagnosed by

Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and

Triglyceride/Glucose (TyG) Index. There are no predefined cut-offs for these indexes in

Indonesia.

Methods. As many as 1300 adults aged 18-60 years from Sugarspin study in Nangapanda,

Flores, Indonesia were divided into different groups based on sex. We determined the cutoff

points of HOMA-IR and TyG Index in each group by calculation of the 75th (p75) and

90th percentiles (p90) in healthy subjects and by receiver operating characteristics (ROC)

analysis of MS and non-MS subjects. Correlation between HOMA-IR and TyG Index was

performed in both sexes by Spearman's correlation.

Results. Using both methods, HOMA-IR and TyG Index cut-offs were different between

males and females. The HOMA-IR cut-offs for healthy males were 0.9 (p75) and 1.242

(p90); for healthy females were 1.208 (p75) and 1.656 (p90). By ROC, the HOMA-IR cutoff

for males was 1.185 and for females was 1.505. The TyG Index cut-offs for healthy

males were 8.590 (p75) and 8.702 (p90); for healthy females were 8.448 (p75) and 8.617

(p90). The TyG Index ROC cut-offs were 8.905 for males and 8.695 for females. The

correlation coefficients between HOMA-IR and TyG Index were 0.39 for males and 0.36

for females.

Conclusion. The HOMA-IR cut-offs for males were 0.9 (p75), 1.242 (p90), and 1.185

(ROC); for females were 1.208 (p75), 1.656 (p90), and 1.505 (ROC). The TyG Index cutoffs

for males were 8.590 (p75), 8.702 (p90), and 8.905 (ROC); for females were 8.448

(p75), 8.617 (p90), and 8.695 (ROC). The correlation between HOMA-IR and TyG Index

was weak."

"ABSTRAKSindrom metabolik MetS adalah kumpulan faktor yang kompleks dan saling berhubungan, yang meningkatkan risiko penyakit jantung dan diabetes mellitus tipe 2. Resistensi insulin dan obesitas sentral dianggap sebagai penyebab utama dari sindrom metabolik, sehingga penurunan resistensi insulin menjadi tujuan klinis yang penting saat ini. Beberapa studi menyimpulkan bahwa akupunktur dapat meningkatkan sensitivitas insulin, karena itu efektif untuk mengatasi gangguan metabolik Uji klinis acak tersamar tunggal dengan pembanding dilakukan pada 50 penderita sindrom metabolik yang dibagi secara acak ke dalam dua kelompok, kelompok elektroakupunktur dan medikamentosa n = 25 serta kelompok elektroakupunktur sham dan medikamentosa n=25 . Elektroakupunktur dilakukan 2 kali seminggu sebanyak 10 kali tindakan di titik CV12 Zhongwan, CV4 Guanyuan, ST25 Tianshu, ST36 Zusanli, ST40 Fenglong, SP6 Sanyinjiao, dan MA-IC3 Endokrin. Dilakukan pemeriksaan gula darah puasa dan insulin puasa untuk mengukur HOMA-IR sebagai luaran primer. Hasilnya terdapat perbedaan bermakna secara statistik perubahan HOMA-IR antara kelompok elektroakupunktur dan medikamentosa dengan kelompok elektroakupunktur sham dan medikamentosa -1,66 2,187 dan -0,29 2,388, p = 0,044 . Terapi kombinasi elektroakupunktur dan medikamentosa efektif untuk menurunkan resistensi insulin pada penderita sindrom metabolik.

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ABSTRACTThe metabolic syndrome is a complex disorder defined by a cluster of interconnected factors that increase the risk of cardiovascular diseases and diabetes mellitus type 2. Insulin resistance and central obesity are considered significant factors as the underlying cause of the metabolic syndrome, since reduction of insulin resistance is an important clinical goal today. Several studies have concluded that acupuncture can improve insulin sensitivity, as it is effective against metabolic disturbances. A single blind randomized controlled trial involved 50 patients randomly allocated into two groups electroacupuncture with medication group n 25 or sham electroacupunture with medication group n 25 . Electroacupuncture therapy was given twice a week for ten times at CV12 Zhongwan, CV4 Guanyuan, ST25 Tianshu, ST36 Zusanli, ST40 Fenglong, SP6 Sanyinjiao, and MA IC3 Endocrine. Fasting blood glucose and fasting insulin serum were assessed to measure HOMA IR as the primary outcome. There was a statistically significant difference in changing of HOMA IR between electroacupuncture with medication group and sham electroacupunture with medication group 1,66 2,187 and 0,29 2,388, p 0.044 . Electroacupuncture with medical treatment effectively decreased insulin resistance of metabolic syndrome patients."

"Tujuan: Untuk meneliti korelasi antara penanda biokimia Angptl3, FABP4 dan HOMA-IR pada populasi pria Indonesia dengan kondisi obesitas sentral non diabetes. Metode: Penelitian ini menggunakan metode potong lintang pada 133 individu pria dengan obesitas sentral non diabetes (dengan kriteria lingkar pinggang > 90 cm; konsentrasi glukosa darah puasa < 126 mg/dL; dan tidak adanya keluhan khas diabetes) usia 30-60 tahun yang dilakukan di Jakarta, Indonesia. Penanda biokimia yang ditentukan meliputi Angptl3, FABP4, FFA, insulin puasa, dan glukosa puasa. Di samping itu dilakukan penentuan berat badan, tinggi badan, lingkar pinggang (LP), tekanan darah sistolik (TDS), dan tekanan darah diastolik (TDD). Hubungan antara berbagai penanda biokimia didapatkan melalui uji korelasi Pearson dan Spearman. Hasil: Hasil uji korelasi Pearson dan Spearman menunjukkan adanya korelasi positif yang bermakna antara Angptl3 dan FABP4 (r = 0,319; P = 0,000), Angptl3 dan FFA (r = 0,171; P = 0,049), FABP4 dan HOMA-IR (r = 0,202; P = 0,019), FFA dan FABP4 (r = 0,506; P = 0,000), LP dan HOMA-IR (r = 0,323; P = 0,000), LP dan FABP4 (r = 0,387; P = 0,000), Indeks Massa Tubuh (IMT) dan HOMA-IR (r = 0,270; P = 0,002), serta IMT dan FABP4 (r = 0,362; P = 0,000). Kesimpulan: Adanya korelasi positif yang bermakna antara Angptl3-FABP4, Angptl3-FFA, FFA-FABP4 serta FABP4-HOMA-IR menimbulkan dugaan bahwa Angptl3 memicu lipolisis dalam jaringan adiposa melalui hubungannya dengan FABP4 serta berhubungan dengan peningkatan resistensi insulin pada individu pria obes non diabetes.

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AbstractAim: To reveal the correlation between Angptl3, FABP4 and HOMA-IR among Indonesian obese non diabetic males. Methods: This is a cross sectional study with 133 obese non diabetic males volunteers (characterized by waist circumference > 90 cm; fasting blood glucose < 126 mg/dL; and no diabetic specific symptoms) age between 30-60 years which was done in Jakarta, Indonesia. We measured biochemical markers such as Angptl3, FABP4, FFA, fasting insulin and fasting glucose. We also measured weight, height, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Correlation between each marker was measured using Pearson and Spearman?s analysis. Results: Pearson and Spearman?s correlation analysis showed significant positive correlation between Angptl3 and FABP4 (r = 0.319; P = 0.000), Angptl3 and FFA (r = 0.171; r = 0.049), FABP4 and HOMA-IR (r = 0.202; P = 0.019), FFA and FABP4 (r = 0.506; P = 0.000), WC and HOMA-IR (r = 0.323; P = 0.000), WC and FABP4 (r = 0.387; P = 0.000), Body Mass Index (BMI) and HOMA-IR (r = 0.270; P = 0.002), BMI and FABP4 (r = 0.362; P = 0.000). Conclusion: This study showed positive significant correlations between Angptl3-FABP4, Angptl3-FFA, FFA-FABP4 and FABP4-HOMA-IR. We suggest that Angptl3 can activate lipolysis in adipose tissue (through its correlation with FABP4), and Angptl3 concentration is related to insulin resistance risk among Indonesian obese non diabetic males."

"Sindrom ovarium polikistik (SOPK) adalah salah satu kelainan endokrin yang paling umum terjadi pada wanita usia reproduktif. Patogenenesis SOPK berhubungan langsung dengan resistensi insulin. Beberapa studi menyimpulkan bahwa akupunktur dapat meningkatkan sensitivitas insulin sehingga dapat memperbaiki gejala SOPK. Uji klinis acak tersamar ganda dilakukan pada 44 penderita SOPK yang dibagi secara acak ke dalam dua kelompok, yakni kelompok elektroakupunktur kombinasi medikamentosa (n=22) dan kelompok elektroakupunktur sham kombinasi medikamentosa (n=22). Elektroakupunktur dilakukan 3 kal seminggu, sebanyak 12 kali, selama 4 minggu, pada titik CV3 Zhongji, CV4 Guanyuan, CV6 Qihai, ST25 Tianshu, ST28 Shuidao, ST36 Zusanli, SP6 Sanyinjiao, dan BL57 Chengsan. Pemeriksaan gula darah puasa dan insulin puasa dilakukan untuk mengukur indeks HOMA-IR sebagai luaran primer. Hasil penelitian menunjukkan adanya perbedaan yang bermakna. Median indeks HOMA-IR pada kelompok elektroakupunktur kombinasi medikamentosa sebelum dan sesudah terapi menunjukkan perbedaan bermakna secara statistik (p=0,014). Sedangkan median indeks HOMA-IR pada kelompok elektroakupunktur sham kombinasi medikamentosa sebelum dan sesudah terapi tidak terdapat perbedaan bermakna (p=0,592). Kesimpulan penelitian ini elektroakupunktur kombinasi medikamentosa efektif untuk meningkatkan sensitivitas insulin.

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Polycystic ovary syndrome (SOPK) is one of the most common endocrine disorders in women of reproductive age. The pathogenesis of SOPK is directly related to insulin resistance. Several studies have concluded that acupuncture can increase insulin sensitivity to improve symptoms of PCOS. Double-blind randomized clinical trials were performed on 44 patients with SOPK who were randomly divided into two groups, the electroacupuncture with medication group (n=22) and the electroacupuncture sham with medication group (n=22). Electroacupuncture was given 3 times a week, 12 times, for 4 weeks, at the point of CV3 Zhongji, CV4 Guanyuan, CV6 Qihai, ST25 Tianshu, ST28 Shuidao, ST36 Zusanli, SP6 Sanyinjiao, and BL57 Chengsan. Fasting blood glucose and fasting insulin were performed to measure the HOMA-IR index as the primary outcome. The results showed a significant difference. The median HOMA-IR index in the electroacupuncture with medication group before and after therapy showed statistically significant differences (p = 0.014). While median HOMA-IR index in electroacupuncture sham with medication group before and after therapy there was no significant difference (p = 0.592). The conclusion of this study electroacupuncture combination with medication is effective to improve insulin sensitivity. "

"Latar belakang: Sindrom metabolik merupakan kumpulan gejala abnormalitas metabolik tubuh yang meliputi hipertensi, obesitas sentral, hiperglikemia, resistensi insulin, dan dislipidemia. Hal ini menurunkan kualitas hidup seseorang dan berdampak meningkatnya biaya pengobatan. Salah satu faktor risikonya adalah kebiasaan konsumsi produk instan tinggi fruktosa. Penelitian ini bertujuan membuktikan hubungan antara kebiasaan konsumsi makanan dan/atau minuman yang mengandung fruktosa dengan terjadinya resistensi insulin yang bermanifestasi sindrom metabolik pada subjek di Posyandu Lansia Monjok Kota Mataram.Metode: Penelitian ini merupakan studi cross-sectional. Pengambilan sampel ditetapkan secara consecutive sampling. Subjek penelitian sebanyak 48 orang berusia 45-90 tahun dari Posyandu Lansia Monjok. Data diperoleh dari wawancara subjek, Puskesmas Mataram, dan Posyandu Monjok. Asupan fruktosa dikumpulkan dengan metode food recall 24hour dan dinilai dengan software nutrisurvey. Resistensi insulin ditetapkan dengan metode TyG Index. Sindrom metabolik ditetapkan berdasarkan parameter National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III).Hasil: Hasil penelitian menunjukkan 52.1% subjek di Posyandu Lansia Monjok Kota Mataram mengalami resistensi insulin dan 62.5% sindrom metabolik. Uji Chi-Square menunjukkan terdapat hubungan signifikan antara kebiasaan konsumsi fruktosa dengan terjadinya resistensi insulin (p=0.000) dan sindrom metabolik (p=0.001).Kesimpulan: Sebagian subjek di Posyandu Lansia Monjok Kota Mataram memiliki kebiasaan konsumsi tinggi fruktosa sehingga menyebabkan terjadinya resistensi insulin yang bermanifestasi menjadi sindrom metabolik.

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Introduction: Metabolic syndrome is a collection of symptoms of metabolic abnormalities, including hypertension, central obesity, hyperglycemia, insulin resistance, and dyslipidemia. This matter reduce a person’s quality of life and impact financially due to high treatment costs. One of the risk factors that trigger metabolic syndrome is the habit of consuming instant food or beverages that contain high fructose. This study aims to prove the relationship between the habit of consuming food and/or drinks containing fructose and the occurrence of insulin resistance manifesting metabolic syndrome among subjects at Monjok Elderly Integrated Healthcare Center Mataram.

Method: This study was cross-sectional. Sampling was determined using consecutive sampling. Subjects, as many as 48 people, aged 45-90 years form Monjok Elderly Integrated Healthcare Center Mataram. Data were obtained from subject interviews and data from Mataram Public Health Center and Monjok Integrated Healthcare Center. Fructose intake was collected using a 24-hour food recall method and assessed using NutriSurvey software. Insulin resistance was determined by the TyG Index method. Metabolic syndrome was determined based on the Adult Care Panel of the National Cholesterol Education Program III (NCEP ATP III).

Result: The results showed that 52.1% subjects at Monjok Elderly Integrated Healthcare Center experienced insulin resistance and 62.5% metabolic syndrome. The Chi-Square test showed a significant correlation between fructose consumption habits and the occurrence of insulin resistance (p=0.000) and metabolic syndrome (p=0.001).

Conclusion: Half of the subjects at Monjok Elderly Integrated Healthcare Center had a high fructose consumption habit that cause to insulin resistance manifesting metabolic syndrome."

"Hiperglikemia merupakan gejala metabolik berupa peningkatan glukosa darah melebihi batas normal, yang dikaitkan dengan diabetes melitus (DM). Modifikasi gaya hidup yang lebih sehat, seperti dilakukannya restriksi kalori dengan metode fasting-mimicking diet (FMD) dapat dilakukan sebagai alternatif pendekatan untuk pengendalian DM tipe 2. Penelitian ini bertujuan untuk mengetahui pengaruh FMD berbahan nabati yang tersedia di Indonesia, terhadap kadar glukosa darah dan resistensi insulin. Penelitian dilakukan terhadap tikus jantan galur Sprague-Dawley model hiperglikemia yang dibagi menjadi 4 kelompok perlakuan (n=16), yakni kelompok hiperglikemia (high fat diet[HFD]-streptozotosin[STZ] 35 mg/kgBB dan CMC Na 0,5%), kelompok metformin (HFD-STZ 35 mg/kgBB dan metformin 250 mg/kgBB), kelompok FMD (HFD-STZ 35 mg/kgBB dan FMD), dan kelompok normal diet (ND) (CMC Na 0,5%). Pemberian perlakuan dilakukan selama 28 hari. Tikus dilakukan pengecekan glukosa darah puasa (GDP) dan berat badan setiap minggu perlakuan dan dikorbankan untuk diambil sampel darahnya setelah perlakuan berakhir. Homeostasis model assessment of insulin resistance (HOMA-IR) digunakan untuk mengukur resistensi insulin. Hasil penelitian menunjukkan penurunan kadar GDP dengan adanya pemberian FMD, walaupun tidak terdapat perbedaan signifikan antara GDP pra-perlakuan dengan GDP minggu ke-4 perlakuan (p>0,05). Hasil penelitian juga menunjukkan nilai HOMA-IR kelompok FMD mendekati nilai HOMA-IR kelompok ND dan lebih rendah secara signifikan dibandingkan nilai HOMA-IR kelompok hiperglikemia (p<0,05), yang berarti pemberian FMD pada tikus hiperglikemia menghasilkan tingkat resistensi insulin yang lebih rendah dibandingkan dengan tikus hiperglikemia yang tidak diberikan FMD. Sebagai kesimpulan, pemberian FMD dapat menurunkan GDP dan menghasilkan tingkat resistensi insulin yang lebih rendah pada tikus model hiperglikemia.

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Hyperglycemia is a metabolic symptom in the form of an increase in blood glucose exceeding normal limits, which is associated with diabetes mellitus (DM). Healthy lifestyle modifications, such as calorie restriction with the fasting-mimicking diet (FMD) method, can be used as an alternative approach to controlling type 2 diabetes. This study aims to determine the effect of FMD using plant-based ingredients available in Indonesia on blood glucose levels and insulin resistance. The study was conducted on male rats of the Sprague-Dawley strain model of hyperglycemia, which were divided into 4 treatment groups (n = 16), namely the hyperglycemic group (high fat diet [HFD]-streptozotocin [STZ] 35 mg/kgBW and CMC Na 0.5%), the metformin group (HFD-STZ 35 mg/kgBW and metformin 250 mg/kgBW), the FMD group (HFD-STZ 35 mg/kgBW and FMD), and the normal diet (ND) group (CMC Na 0.5%). The treatment was carried out for 28 days. Rats were checked for fasting blood glucose (FBG) and body weight every week of treatment and sacrificed for blood samples after the treatment ended. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to measure insulin resistance. The results showed a decrease in FBG levels with the administration of FMD, although there was no significant difference between pre-treatment FBG and FBG at the 4th week of treatment (p>0,05). The results also showed that the HOMA-IR value of the FMD group was close to the HOMA-IR value of the ND group and was significantly lower than the HOMA-IR value of the hyperglycemic group (p<0,05), which means that administering FMD to hyperglycemic rats resulted in lower levels of insulin resistance than the hyperglycemic rats that were not given FMD. In conclusion, administration of FMD can reduce FBG and result in lower levels of insulin resistance in hyperglycemic rats."

"Latar Belakang: Selain usia, prevalensi sindrom metabolik (SM) dipengaruhi oleh perbedaan tempat tinggal. Perubahan pola asupan makan yang dipengaruhi laju urbanisasi dipercaya memicu terjadinya inflamasi usus. Lipocalin-2 (LCN-2) merupakan petanda baru yang banyak diteliti dalam inflamasi usus serta penyakit kardiovaskular. Penelitian ini bertujuan membandingkan resistensi insulin (HOMA-IR), sindrom metabolik, dan LCN-2 pada dewasa muda di urban dan rural serta mencari korelasi antara HOMA-IR dan LCN-2. Metode: Penelitian dengan desain potong lintang ini dilakukan tahun 2018-2019 pada 475 mahasiswa berusia 18-20 tahun. Data yang dikumpulkan meliputi antropometri, glukosa darah puasa, insulin puasa, profil lipid dan kadar LCN2 serum. Setelah menjalani wawancara dan pemeriksaan fisik, sampel darah disimpan pada suhu khusus (-800C). Pemeriksaan sampel dilakukan pada satu waktu (2020) untuk mengurangi bias hasil akibat perbedaan waktu dan penanganan sampel. LCN2 diperiksa dengan menggunakan Human Lipocalin-2/NGAL DuoSet ELISA dari R&D systems.Hasil Penelitian: Prevalensi SM di daerah urban dan rural berturut-turut adalah 2,8% dan 0,85%. Sementara itu prevalensi obesitas sentral total, di urban dan di rural masing-masing sebesar 15,4%; 23,1%; dan 7.3%. Kelompok urban memiliki HOMA-IR lebih tinggi (0,99 vs 0,78; p<0,001) dibandingkan kelompok rural. Nilai LCN2 lebih rendah di daerah urban bila dibandingkan dengan daerah rural (161,80 ng/mL vs 246,6 ng/ml, p<0,001). Tidak terdapat korelasi antara HOMA-IR dengan LCN2 (r:-0,75, p:0,110).Kesimpulan: Prevalensi SM pada dewasa muda lebih tinggi pada daerah urban bila dibandingkan dengan daerah rural. Prevalensi obesitas sentral lebih tinggi di urban dibandingkan dengan rural. Rerata HOMA-IR di daerah urban lebih tinggi dibandingkan rural. Rerata LCN2 lebih tinggi di rural dibandingkan urban. Tidak terdapat perbedaan nilai LCN2 pada kelompok SM dan kelompok tanpa SM. Tidak terdapat hubungan antara HOMA IR dan LCN2.

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Background/Objective: The prevalence of metabolic syndrome not only influenced by age but also residency area. The alteration of dietary pattern due to urbanization presumed to initiate gut inflammation. Lipocalin-2 (LCN-2) is a novel marker for gut inflammation and also cardiovascular disease. This study aim to compare insulin resistance (HOMA-IR), metabolic syndrome, and LCN-2 level in late adolescent in urban and rural area. Methods Cross sectional study was done during 2018 and 2019, which included 475 colleague students (18-20 years old) in urban and rural. We measured anthropometric parameter, fasting blood glucose, fasting insulin, lipid profile and LCN2 level. After respondent interview and physical examination, blood sample kept in specific freezer (-800C). The analysis of respondent’s blood sample executed in similar time (2020) to prevent result bias due to the different time of sampling management.

Methods: Cross sectional study was done during 2018 and 2019, which included 475 colleague students (18-20 years old) in urban and rural. We measured anthropometric parameter, fasting blood glucose, fasting insulin, lipid profile and LCN2 level. After respondent interview and physical examination, blood sample kept in specific freezer (-800C). The analysis of respondent’s blood sample executed in similar time (2020) to prevent result bias due to the different time of sampling management.

Results: The prevalence of metabolic syndrome in urban dan rural were 2.9% and 0.8%. Meanwhile the prevalence of central obesity in total, urban and rural were 15,4%; 23,1%; and 7.3%. Urban group has higher HOMA-IR value than rural group (0.99 vs 0.78; p<0.001). LCN2 value was lower in urban compared with rural area (161.80 ng/mL vs 246.6 ng/mL, p<0.001). There was no correlation between HOMA-IR and LCN2 (r: -0.075. p: 0.110).

Conclusions: The prevalence of MS in late adolescent higher in urban compare with rural area. Central obesity prevalence was higher in urban area. HOMA-IR were differed significantly in urban compared with rural in total population and male population. LCN2 value was differed significantly between urban and rural. However, LCN2 was not significantly differed between MS and without MS Group. Furthermore LCN2 and HOMA-IR shows no correlation"

"Latar Belakang: Hibiscus sabdariffa Linn dikenal sebagai herbal yang memiliki efek antioksidan dan antiinflamasi. Inflamasi merupakan salah satu mekanisme terjadinya diabetes mellitus, sebuah penyakit metabolik yang terjadi akibat gangguan pada insulin dan fungsi sel beta pancreas. Penelitian ini bertujuan untuk mengetahui potensi Hibiscus sabdariffa Linn. terhadap kadar HOMA-IR (Homeostasis Model Assessment-Insulin Resistance) dan Interleukin-6 pada kondisi diabetes mellitus. Metode: Dua puluh empat tikus Sprague-Dawley ditempatkan secara acak menjadi enam kelompok; kontrol normal, normal dengan 200mg/kgBB Hibiscus, normal dengan 500mg/kgBB Hibiscus, kontrol diabetes, diabetes dengan 200mg/kgBB Hibiscus, dan diabetes dengan 500mg/kgBB Hibiscus. Hibiscus sabdariffa Linn diberikan selama 5 minggu kepada kelompok Hibiscus, dan sampel darah dari tiap kelompok diambil untuk menilai kadar gula darah, insulin, dan IL-6. Kadar IL-6 diukur menggunakan ELISA. HOMA-IR dicek menggunakan tes non-parametrik Kruskal-Wallis dan IL-6 dicek menggunakan one-way ANOVA untuk menilai signifikansi statistik. Hasil: Tikus di kelompok diabetes yang diberikan 200mg/kgBB dan 500mg/kgBB Hibiscus memiliki nilai HOMA-IR dan kadar IL-6 yang lebih rendah walau tidak ada signifikansi statistik antar kelompok HOMA-IR (p= 0.127) dan IL-6 (p = 0.760). Kesimpulan: Penelitian ini tidak menghasilkan signifikansi statistik terhadap penurunan HOMA-IR dan IL-6.

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Introduction: Hibiscus sabdariffa Linn. is known as one of the herbs that possess antioxidant and anti-inflammatory benefits. Inflammation has been long suggested to be one of the pathophysiology of diabetes mellitus, a metabolic disorder that is rooted from insulin impairment and beta cell dysfunction. This study objective is to explore the antiinflammatory effect of Hibiscus sabdariffa Linn towards HOMA-IR (Homeostasis Model Assessment-Insulin Resistance) and Interleukin-6 in diabetes mellitus condition.

Methods: Twenty four Sprague-Dawley rats were randomly allocated into six different group; normal control group, normal with 200mg/kgBW of Hibiscus, normal with 500mg/kgBW of Hibiscus, diabetic control, diabetic with 200mg/kgBW of Hibiscus, and diabetic with 500mg/kgBW of Hibiscus. Hibiscus sabdariffa Linn. was administered for 5 weeks for the Hibiscus group, and the blood samples of each group are drawn to obtain blood glucose, insulin, and IL-6. IL-6 level was measured using ELISA kit. HOMA-IR statistical significance was checked using non-parametric Kruskal-Wallis test and IL-6 statistical significance was calculated using one-way ANOVA.

Results: Rats in diabetic group that are treated with 200mg/kgBW and 500mg/kgBW had lower value of HOMA- IR and IL-6 although there were no statistical significance between both HOMA-IR (p = 0.127) and IL-6 (p = 0.760) group.

Conclusion: This study does not yield statistically significant decrease of both HOMA-IR and IL-6."

"Obesitas menjadi masalah besar dewasa ini terkait dengan lebih dari 3 juta kematian terjadi akibat komplikasinya. Diet seimbang dengan restriksi kalori, sebagai manajemen obesitas, perlu mempertimbangkan produksi makanan sustainable terkait isu perubahan lingkungan, ketahanan pangan, dan keanekaragaman hayati. Aplikasi seluler berpeluang menjadi strategi baru untuk meningkatkan efektivitas dan keberhasilan manajemen obesitas. Penelitian ini bertujuan menilai efek dari diet seimbang dan sustainable berbasis aplikasi dibandingkan dengan diet seimbang berbasis aplikasi terhadap resistensi insulin. Uji klinis acak tersamar ganda dilakukan terhadap 56 wanita obesitas usia 19 ndash;59 tahun dengan indeks massa tubuh ge;25 kg/m2 yang bekerja atau belajar atau tinggal di Jakarta Pusat dan/atau Kota Depok. Subjek dibagi secara randomisasi berstrata berdasarkan kelompok usia 0.05] dan perubahan asupan lemak [ -5.8 23.9 vs -6.4 22 , p >0.05] antar kelompok. Meskipun ada pengurangan nilai HOMA-IR pada kelompok intervensi, perbedaan rerata perubahan HOMA-IR antar kelompok tidak berbeda bermakna setelah dilakukan penyesuaian dengan Indeks Massa Tubuh [ -0.87 1.27 vs -0.29 1.21 , p >0.05]. Kesimpulan : Intervensi diet seimbang dan sustainable berbasis aplikasi selama 8 minggu tidak mengurangi nilai HOMA-IR dibandingkan dengan diet seimbang berbasis aplikasi. Penelitian lebih lanjut diharapkan dapat dilakukan dengan periode yang lebih lama atau lebih banyak subjek dalam menerapkan diet yang seimbang dan sustainable.

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Obesity is a major problem today related to more than 3 million deaths because of its complications. A balanced diet with caloric restriction, is known as obesity management, requires a novel ways of producing nutritious foods in a sustainable manner because of the issues of environment changes, food security, and biodiversity. Mobile application is a new strategy to improve the effectiveness and success of obesity management. We examine the effect of a balanced and sustainable dietary mobile application compared to a balance diet application on the change of insulin resistance as a common attribute for obesity and type 2 diabetes. A double blind randomized clinical trial was conducted involving 56 obese women aged 19 59 years with body mass index ge 25 kg m2 working or studying or residing in Central Jakarta and or Depok City. Subjects were selected randomly and stratified based on age group 0,05 and fat intake changes 5.8 23.9 vs 6.4 22 , p 0,05 were observed between groups. Although there was a significant reduction of HOMA IR within intervention group, the difference in the mean reduction of HOMA IR after intervention 0.87 1.27 vs 0.29 1.21 , p 0.05 between group was not significantly different after adjusted by Body Mass Index.Conclusion An 8 week of balanced and sustainable dietary application intervention did not reduce elevated HOMA IR level compared with a balanced diet application. Further research is expected to be performed with longer periode or more subject in applying a balanced and sustainable diet."

"ABSTRAK Latar Belakang: Sindrom Ovarium Polikistik (SOPK) merupakan penyebab 40%infertilitas pada wanita usia reproduksi. Resistensi insulin sebagai salah satupatofisiolofi yang mendasari SOPK, berkaitan erat dengan jaringan adiposaviseral dan ditemukan pada 30-50% pasien SOPK dengan indeks masa tubuhnormal serta lingkar pinggang kurang dari 80 cm. Retinol Binding Protein-4(RBP-4) yang disekresi oleh jaringan adiposa viseral diketahui sebagai salah satuadipokin yang menyebabkan resistensi insulin. Pengukuran IMT dan lingkarpinggang tidak dapat mewakili akumulasi jaringan adiposa viseral pada SOPKdengan IMT normal serta lingkar pinggang kurang dari 80 cm. Dengandiketahuinya titik potong optimal kadar serum RBP-4 sebagai penanda jaringanadiposa viseral, diharapkan dapat memprediksi risiko kejadian resistensi insulinyang bermanfaat dalam menentukan penatalaksanaan kasus SOPK dengan IMTnormal terkait strategi pengurangan akumulasi jaringan adiposa viseral. Tujuan: Diketahuinya titik potong optimal kadar serum RBP-4 sebagai penandajaringan adiposa viseral untuk memprediksi risiko kejadian resistensi insulin padapenderita SOPK dengan IMT normal. Metode: Studi observasional dengan desain potong lintang selama periode Juli2014 hingga Maret 2015 di Poliklinik Yasmin, RSCM, Jakarta. Hasil: Sejumlah 40 subjek SOPK dengan IMT normal yang memenuhi kriteriainklusi didapatkan 16 subjek (40%) yang mengalami resistensi insulin dan 24subjek (60%) nir resistensi insulin. Sejumlah 23 subjek (57.5%) memiliki lingkarpinggang kurang dari 80 cm, dimana 6 subjek (26%) diantaranya mengalami resistensi insulin. Kadar serum RBP-4 pada kelompok resistensi insulin bermakna lebih tinggi dibandingkan nir resistensi insulin (p 0.008). Dengan analisis ROCdidapatkan AUC kadar serum RBP-4 78.8% (IK 95% -8445.59 ? -1447.98)dengan nilai p 0.002. Titik potong optimal kadar serum RBP-4 adalah 24133ng/mL dengan sensitivitas sebesar 75% dan spesifisitas sebesar 75%. Dengananalisis regresi logistik biner didapatkan pemeriksaan serum RBP-4 menambahnilai diagnostik dari parameter demografis dan klinis AUC 85.7% menjadi 91.1%. Kesimpulan: Kadar serum RBP-4 sebagai penanda jaringan adiposa viseral dapat digunakan untuk memprediksi risiko kejadian resistensi insulin pada penderita SOPK dengan IMT normal. ABSTRACT Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent

of infertility?s issues on reproductive women. Insulin resistance as one of

important pathophysiology in PCOS, correlates with visceral adipose tissue and is

found on 30-50% PCOS patients with normal body mass index and waist

circumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which is

secreted by visceral adipose tissue, known as one of adipokines that cause insulin

resistance. The measurement of body mass index and waist circumference could

not represent visceral adiposity on PCOS with normal body mass index and waist

circumference less than 80 cm. Determination of serum RBP-4 cut off level as

visceral adipose tissue marker hopefully could predict the risk of insulin

resistance on polycystic ovarian syndrome with normal body mass index,

therefore it will be useful on its management related to reduction of visceral

adiposity.

Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue marker

to predict the risk of insulin resistance on PCOS with normal body mass index.

Method: This was an observational study with cross sectional design conducted at

Yasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.

Result: Fourty PCOS patients with normal body mass index were participated on

this study. There were 16 subjects (40%) who were insulin resistance and 24

subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)

who had waist circumference less than 80 cm, where 6 of them (26%) were

insulim resistance. Serum RBP-4 level was significantly higher on insulin

resistance group (p 0.008). After ROC analysis was performed, AUC of serum

RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level of

serum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. After

logistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. ;Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent

of infertility?s issues on reproductive women. Insulin resistance as one of

important pathophysiology in PCOS, correlates with visceral adipose tissue and is

found on 30-50% PCOS patients with normal body mass index and waist

circumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which is

secreted by visceral adipose tissue, known as one of adipokines that cause insulin

resistance. The measurement of body mass index and waist circumference could

not represent visceral adiposity on PCOS with normal body mass index and waist

circumference less than 80 cm. Determination of serum RBP-4 cut off level as

visceral adipose tissue marker hopefully could predict the risk of insulin

resistance on polycystic ovarian syndrome with normal body mass index,

therefore it will be useful on its management related to reduction of visceral

adiposity.

Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue marker

to predict the risk of insulin resistance on PCOS with normal body mass index.

Method: This was an observational study with cross sectional design conducted at

Yasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.

Result: Fourty PCOS patients with normal body mass index were participated on

this study. There were 16 subjects (40%) who were insulin resistance and 24

subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)

who had waist circumference less than 80 cm, where 6 of them (26%) were

insulim resistance. Serum RBP-4 level was significantly higher on insulin

resistance group (p 0.008). After ROC analysis was performed, AUC of serum

RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level of

serum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. After

logistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. "