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"Sugar Sweetened Beverages (SSBs) merupakan cairan yang dimaniskan dengan berbagai bentuk gula tambahan seperti corn syrup, dekstrosa, fruktosa, glukosa, sukrosa, madu dan gula yang secara alami terdapat di dalam bahan pangan namun telah dipekatkan, jika dikonsumsi secara berlebihan maka akan menyebabkan kejadian obesitas dan mengakibatkan faktor risiko lain seperti penyakit tidak menular yaitu diabetes dan penyakit kardiovaskular. Tujuan dari penelitian ini untuk mengetahui perbedaan proporsi konsumsi Sugar Sweetened Beverages (SSBs) berdasarkan konsumsi fast food, screen time, karakteristik individu, karakteristik lingkungan pada mahasiswa Universitas Indonesia tahun 2023. Penelitian ini menggunakan desain studi cross sectional dengan jumlah sampel 185 orang. Data diambil melalui pengisian kuesioner online secara mandiri oleh responden. Data akan dianalisis secara univariat dan bivariat. Hasil penelitian menunjukkan bahwa sebanyak 61,6% mahasiswa Universitas Indonesia mengonsumsi SSB dalam tingkat tingi (≥ 200 kkal). Hasil analisis bivariat menunjukkan bahwa terdapat perbedaan proporsi yang signifikan antara ketersediaan SSBs p-value 0,045 dan odds ratio OR 2,057 (1,068-3,963), pengaruh media sosial p-value 0,025 dan odds ratio OR 2,273 (1,159-4,457), konsumsi fast food p-value 0,049 dan odds ratio OR 0,514 (0,277-0,954), dan screen time p-value 0,044 dan odds ratio OR 1,986 (1,066-3,699) terhadap konsumsi SSBs. Peneliti menyarankan konsumen untuk memperhatikan konsumsi SSBs dan memilih alternatif lain agar tidak mengonsumsi SSBs berlebihan saat melakukan kegiatan luar bersama dengan teman maupun keluarga. Produsen SSBs disarankan untuk mencantumkan label gizi pangan terkait jumlah gula yang ada di produk SSBs terutama SSBs yang berbentuk warlaba. Peneliti juga menyarankan Badan Pengawas Obat dan Makanan (BPOM) dapat mencantumkan infromasi nilai gizi dalam bentuk traffic light atau penggunaan warna yang berbeda untuk membedakan kandungan zat gizi yang rendah, sedang dan juga tinggi seperti warna hijau untuk kandungan zat gizi yang rendah, warna kuning untuk kandungan zat gizi yang sedang dan warna hijau untuk kandungan zat gizi yang tinggi.

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Sugar Sweetened Beverages (SSBs) are liquids that are sweetened with various forms of added sugar such as corn syrup, dextrose, fructose, glucose, sucrose, honey, and sugar which are naturally found in foodstuffs but have been concentrated, if it consumes in excess, it will cause an obesity and lead to other risk factors such as infectious diseases diabetes and cardiovascular disease. The purpose of this study is to determine the differences in the proportion of consumption of Sugar Sweetened Beverages (SSBs) based on consumption of fast food, screen time, individual characteristics, environmental characteristics among the students at University of Indonesia in 2023. This study used a cross-sectional study design with a sample size of 185 respondents. Data was collected by filling online questionnaires independently by respondents. Data will be analyzed univariately and bivariate. The results showed that 61.6% of University of Indonesia students consumed high levels of SSB (≥ 200 kcal). The results of the bivariate analysis showed that there was a significant proportion difference between the availability of SSBs p-value 0.045 and odds ratio OR 2.057 (1.068-3.963), social media influence p-value 0.025 and odds ratio OR 2.273 (1.159-4.457), consumption of fast-food p -value 0.049 and odds ratio OR 0.514 (0.277-0.954), and screen time p-value 0.044 and odds ratio OR 1.986 (1.066-3.699) for consumption of SSBs. Researchers suggest consumers to pay attention to consumption of SSBs and choose other alternatives to avoid heavy consumption of SSBs when doing outdoor activities with friends or family. SSBs producers are advised to put food nutrition labels related to the amount of sugar in SSBs products, especially SSBs in the form of franchises. Researchers also suggest that the Food and Drug Monitoring Agency (BPOM) can put nutritional value information in the form of traffic lights or the use of different colors to distinguish low, medium, and high nutrient content such as green for low nutrient content, yellow for medium nutrient content and green for high nutrient content."

"Konsumsi sugar sweetened beverages secara rutin dapat menyebabkan terjadinya obesitas, diabetes, penyakit kronis, dan kematian dini. Di Indonesia terjadi peningkatan perkembangan industri sugar sweetened beverages secara khusus untuk jenis minuman boba drinks yang mengalami peningkatan pemesanan sampai lebih dari 8.500% pada tahun 2018. Tujuan dilakukannya penelitian adalah untuk melihat gambaran frekuensi konsumsi boba drinks dan menganalisis faktor yang berhubungan khususnya pada remaja akhir. Penelitian ini merupakan penelitian kuantitatif dengan menggunakan desain studi cross sectional. Data penelitian dikumpulkan secara primer pada bulan Mei hingga Juni tahun 2020 pada Mahasiswa FKM UI, Depok, Jawa Barat dengan jumlah responden 262 orang. Data yang terkumpul dianalisis secara univariat dan bivariat menggunakan uji chi-square dengan bantuan perangkat lunak IBM SPSS Statistics 20. Hasil penelitian menemukan adanya hubungan signifikan antara konsumsi boba drinks dengan aksesibilitas online, pengetahuan terkait sugar sweetened beverages, sikap terhadap sugar sweetened beverages, pengaruh teman, dan pengaruh keluarga namun belum dapat menunjukkan hubungan signifikan antara konsumsi boba drinks dengan jenis kelamin, pengeluaran untuk konsumsi, aksesibilitas langsung, pengaruh media massa, dan status gizi. Hasil penilitian menyarankan dilakukannya edukasi gizi serta penyediaan informasi gizi jajanan yang tersedia di lingkungan FKM UI. Peneliti juga menyarankan dilakukannya kampanye gizi yang melibatkan mahasiswa secara langsung.

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Regular consumption of sugar sweetened beverages contribute to the development of obesity, diabetes, chronic disease, and early death. In Indonesia, the sugar sweetened beverages industry has been developing drastically, especially for boba drinks which sales increase for more than 8.500% on 2018. The purpose of this study is to see the consumption pattern of boba drinks and associated factors especially on late adolescent. This study is a quantitative study using cross-sectional design. The data for this study was collected from May until June, 2020 on Student of Public Health Faculty, Universitas Indonesia, Depok, West Java with 262 sample. The data was statistically analyzed in univariate and bivariate with the help of IBM SPSS Statistics 20 software. This study found a significant relation between boba drinks consumption with online accessibility, knowledge regarding sugar sweetened beverages, attitude towards sugar sweetened bevarages, friends/peers influence, and family influence but can’t find any significant relation between boba drinks consumption with sex, food expenses, direct accessibility, mass media influence, and nutritional status. The result from this study suggests to hold nutrition education and providing nutritional information for snacks sold around Public Health Faculty Universitas Indonesia. Researcher also suggests to hold a nutrition campaign involving students."

"Radiocarbon dating method is applied to date samples which are not exceeding 50.000 years in age (Quatemary)....."

"Trade policy does not only affecting the sugar cane at macro level through the price mechanism of output change. The prices increases in 3 scenarios, that are the sugar price at producer price from IDR 3,410 to IDR 1, 461,3 for the A scenario, to IDR 2, 270 for C scenario...."

"Tujuan : Mengetahui keadaan metabolisme penderita obesitas setelah menjalani diet rendah kalori seimbang selama 14 hari, dengan mengukur resting energy expenditure (REE) dan kadar T3 serumTempat : Rumah Sakit Sumber Waras, Jakarta BaratMetodologi: Dilakukan penelitian pada 37 orang perempuan obes yang memenuhi kriteria penerimaan dan penolakan serta bersedia mengikuti penelitian ini. Penelitian ini merupakan studi quasi eksperimental pra dan pasca perlakuan. Setiap subjek menjalani diet rendah kalori seimbang 1000 kkal selama 14 hari. Pemeriksaan antropometri, REE dan kadar T3 serum dilakukan pada awal, hari ke 7 dan akhir perlakuan. REE diukur dengan kalorimetri tak langsung (REE ukur) dan dihitung dengan menggunakan persamaan Harris-Benedict (REE hitung).Hasil: Pada akhir perlakuan terjadi penurunan yang bermakna (p <0,05) pada berat badan, massa lemak, massa bebas lemak, REE ukur dan REE hitung masing-masing dari 71,22±8,63 kg menjadi 69,15±8,37 kg (penurunan 2,9%), dari 35,32J2,58% menjadi 33,94,58% (penurunan 1,38%), dari 45,96±4,89 kg menjadi 45,544,82 kg (penurunan 0,92%), dari 1815,0822,37 kkal menjadi 1718,97±269,50 kkal (penurunan 5,29%) dan dari 1428,07+84,02 kkal menjadi 1408,25 1,52 kkal (penurunan 1,39%). Penurunan kadar T3 serum yang bermakna terjadi pada hari ke 7 (p = 0,001), dari 0,9005±0,1530 ng/mL menjadi 0,836210,1611 mg/mL (penurunan 7,1%). Pada akhir penelitian, dibandingkan dengan hari ke 7, terjadi pertingkatan T3 yang tidak beramakna. Pada hari ke 7 terdapat korelasi positif bermakna (r = 0,349; p = 0,034) antara perubahan REE ukur dengan perubahan T3. Pada hari ke 15 terdapat korelasi positif bermakna (r = 0,401; p = 0,014) antara perubahan REE ukur dengan perubahan massa bebas lemak. Perubahan T3 pada hari ke 7 mempunyai korelasi positif bermakna (r = 0,385; p = 0,019) dengan perubahan berat badan pada minggu pertama dan dengan perubahan massa bebas lemak pada minggu pertama (r = 0,345; p = 0,036). Pads penurunan berat badan sebesar 2,9% terdapat penurunan REE ukur dan REE hitung masing-masing 5,29% dan 1,39%. Rata-rata REE ukur lebih besar 27% daripada REE hitung.Kesimpulan : Setelah terjadi penurunan berat badan dengan diet rendah kalori seimbang, penderita obesitas berada dalam kondisi hipometabolisme yang ditandai dengan penurunan RFE ukur, REE hitung dan kadar T3 serum.

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Objective: to determine the metabolic state of obese females after treatment with balanced low-calorie diet for 14 days by measuring resting energy expenditure (REE) and serum T3 level as indicators.

Location : Sumber Waras hospital , West Jakarta

Methods : The study was carried out on 37 obese females who have been recruited based on inclusion and exclusion criteria. This study is a quasi experimental study with a pre and posttest treatment design. Every subject received a balanced low-calorie diet (LCD) of 1000 kcal/day for 14 days. Antropometric measwrements, REE and serum T3 levels were examined at the beginning, at day 7 and at the end of study. REE were measured and calculated by indirect calorimetry (measured-REE) and using Harris-Benedict equation (calculated-REE) respectively.

Result : Balanced LCD given for 14 days significantly (p <0.05) decreased body weight (BW) , fat mass, fat free mass, measured-REE and calculated-REE from 71.22±8.63 kg to 69.15±8.37 kg (decreased 2,9%), from 35.32.58% to 33.94±2.58% (1,38%), from 45.96±4.89 kg to 45.54±4.82 kg (0,92%), from 1815.0822.37 kcal to 1718.97±269.50 kcal (5,29%), and from 1428,.7±84.02 kcal to 1408.25±81.52 kcal (1,39%) respectively. There was a significant decrease (p = 0.001) in serum T3 leveI at day 7 from 0.9005±0.1530 ng/mL to 0.836210.1611 nglmL (decrease 7,1%). At the end of the study, serum T3 levels increased not significantly compared to day 7. At day 7, there was a significant positive correlation (r = 0.349; p = 0.034) between the change in measured-REE and the change in serum T3 levels. At day 15, a significant positive correlation (r = 0.401; p = 0.014) was found between the change in measured-REE and the change in fat free mass. The changed of serum T3 levels at day 7 had significant positive correlation (r = 0,385; p = 0,019) with the changed of BW in the first week. The changed of serum T3 levels at day 7 had significant positive correlation (r = 0,345; p = 0,036) with the changed of fat free mass in the first week. After reduction of BW by 2.9%, there was a decrease of measured-REE and calculated-REE, 5.29% and 1.39%, respectively. The measured-REE was 27% higher than calculated-REE.

Conclusion : Weight-reduced obese subjects with balanced LCD were in hypometabolic state indicated by a reduction in measured and calculated-REE, and serum T3 levels."

"Tujuan : Mengetahui pengaruh diet rendah kalori seimbang terhadap resting energy expenditure (REE), respiratory quotient (RQ) dan profil lipid serum untuk menurunkan morbiditas dan mortalitas penderita obesitas.Tempat : Rumah Sakit Sumber Waras JakartaBahan dan cara : Penelitian merupakan suatu eksperimental pra dan pasca pemberian diet rendah kalori seimbang 1000 Kkal dengan komposisi 55 % karbohidrat, 20 % protein dan 25 % lemak selama 14 hari terhadap 38 subjek perempuan obes (19-55 tahun) yang telah memenuhi kriteria penerimaan dan penolakan. Data yang dikumpulkan meliputi data karakteristik sosial demografi, data asupan energi dan makronutrien, antropometri, REE, RQ, kadar kolesterol total, trigliserida, kolesterol LDL dan kolesterol HDL serum.Hasil : Setelah pemberian diet 1000 kkal selama 14 hari pada perempuan obes terjadi penurunan bermakna dari berat badan sebesar 2,64% (p= 0,001), penurunan IMT 2,77% (p= 0,001), penurunan persentase massa lemak tubuh 1,44% (p= 0,001), peningkatan persentase massa bebas lemak 1,36% (p= 0,001), penurunan rasio Lpi-Lpa 2,5% (p= 0,001), penurunan tidak bermakna dari REE 4,41% (p= 0,071), penurunan bermakna dari RQ 4,78% (p= 0,036), penurunan kolesterol total 6,67% (p= 0,001), penurunan trigliserida 22,92% (p= 0,001), penurunan kolesterol LDL 4,22% (p 0,027) dan penurunan kolesterol HDL serum 5,54% (p= 0,004).Simpulan : Pemberian diet rendah kalori seimbang sebesar 1000 Kkal/hari selama 14 hari terbukti dapat menurunkan secara bermakna berat badan, IMT, persentase massa lemak, meningkatkan persentase massa bebas lemak, menurunkan rasio Lpi-Lpa, RQ, kolesterol total, trigliserida, kolesterol LDL dan kolesterol HDL serum, tetapi tidak menurunkan secara bermakna REE pada perempuan obes.

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Objective : To identify the effect of balanced low calorie diet on REE, RQ and serum lipid profile of obese women in reducing morbidity and modality of obese people.

Place : Sumber Waras Hospital, Jakarta.

Materials and Methods : The study was an experimental, pre and post balanced low calorie diet (1000 Kcals/day, 55% carbohydrate, 20% protein and 25% fat) for 14 days. Thirty eight obese women, 19.-55 years old had been selected as subjects according to inclusion and exclusion criteria The data that had been collected were social and demographic characteristics, the energy and macronutrient intake, anthropometric, REE, RQ, level of total serum cholesterol, triglyceride, LDL cholesterol and HDL cholesterol.

Results : After 14 days balanced low calorie diet , there were significant reduction of body weight 2,64% (p= 0,001), body mass index 2,77% (p= 0,001), percentage of fat mass 1,44% (p= 0,001), increarnent percentage of fat free mass 1,36% (p= 0,001), reduction of waist to hip ratio 2,5% (p= 0,001), insignificant reduction of REE 4,41% (p= 0,071), significant reduction of RQ 4,78% (p= 0,036), level of total serum cholesterol 6,67% (p= 0,001), triglyceride 22,92% (p= 0,001), LDL cholesterol 4,22% (p= 0,027) and HDL cholesterol 5,54% (p= 0,004).

Conclusion : Balanced low calorie diet was had been shown to reduce body weight, body mass index, percentage of fat mass, to increase percentage of fat free mass, to reduce waist to hip ratio, RQ, level of total serum cholesterol, triglyceride, LDL cholesterol and HDL cholesterol of obese women significantly, but didn't reduce REE significantly."

"ABSTRAKTujuan : Untuk mengetahui nilai pembatas indikator kelebihan lemak tubuh pada lansia.Tempat : Puskesmas Kecamatan Kotamadya Semarang yang mempunyai program lansia binaan.Bahan dan cara : Studi cross-sectional pada lansia 60 tahun ke atas(69 pria dan 173 wanita), subyek penelitian dipilih secara acak sederhana pada tingkat Puskesmas. Data yang dikumpulkan meliputi : data non nutrisi, data nutrisi, antropometri, kadar lipid serum data gula darah puasa .Penetapan nilai pembatas indikator kelebihan lemak tubuh (IMT, Lpe, rasioLPe/Lpa ,ML) ditetapkan pada nilai median. Sedangkan nilai indikator metabolik sebagai faktor risiko PJK ditetapkan pada batas diwaspadai (berdasarkan Konsensus Nasional Dislipidemia Indonesia, 1993).Hasil : Profil kol. total dan kol. HDL serum subyek wanita lebih tinggi daripada subyek pria (p = 0,001). Prevalensi faktor risiko PJK seperti dislipidemia pada subyek wanita lebih tinggi dibandingkan subyek pria (p < 0.05). Nilai-nilai pembatas indikator kelebihan lemak tubuh yang diperoleh pada penelitian ini yaitu IMT (pria 21 kg/m2; wanita 23 kg/m2 ), LPe (pria 79 cm; wanita> 80 cm), rasio LPe-LPa (pria) 0,91; wanita > 0,85), massa lemak tubuh (pria > 22 %; wanita > 35 %). Sensitifitasnya dikaitkan dengan profit lipid sebagai faktor risiko PJK yaitu 40 - 60 %, sedangkan spesifisitasnya 70 - 80 %. Terdapat perbedaan determinan komposisi tubuh terhadap gangguan metabolik pada subyek pria dan wanita. Pada subyek pria nilai pembatas indikator kelebihan lemak tubuh berkorelasi dengan TG dan GDP, sedangkan pada subyek wanita berkorelasi dengan kol. HDL, kol. total, kol. LDL dan TO.Kesimpulan : Nilai-nilai pembatas indikator kelebihan lemak tubuh yang didapat pada penelitian ini cenderung memberi spesifisitas yang lebih tinggi dibanding dengan sensitifitasnya (dikaitkan dengan dislipidemia). Pada subyek pria indikator kelebihan lemak tubuh lebih terkait pada TG den GDP. Sedangkan pada subyek wanita indikator kelebihan lemak tubuh lebih terkait pada dislipidemia.

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ABSTRACT

The Cut Off Point Determination Of Overfatness In Relation to Selected CHD Risks In Elderly In Semarang

Objective :

To determine cut off points of overfatness in the elderly using CHD risks factors as the end points.

Place :

Seven public health centers with elderly clubs in Semarang municipal.

Materials and Methods :

This cross-sectional study involved 242 elderly individuals (69 males & 173 females), aged 60 years and over. Simple random sampling was applied at the PHC level. Structured questionnaires were used to collect information on sosiodemography, life styles, food habits and practices Anthropometric assessments were done to estimate body compositional status. Serum lipids and fasting blood glucose were measured to identify metabolic disorders. High body mass index, high abdominal circumference, high abdominal hip ratio and high fat mass values were used as overfatness indicators. The Indonesian National Consensus on Dyslipidemia was used to identify dyslipidemic cut off values.

Results :

Mean serum total cholesterol and high density lipoprotein (HDL) cholesterol in females were higher than those in males (220.99 ± 46.66 vs 199.31 ± 35.71, p = 0.001 and 51.17 ± 11.58 vs 45.22 ± 12.52, p = 0.001, respectively). The prevalence of CHD risks (dyslipidemic profiles) in females were also higher than that in males (p < 0.05). With respect to CHD risks, cut-off points for overfatness using BM1 values were > 21 kglr2 and ) 23 kglm2 for males and females respectively. Cut off points for other overfatness indicators were AC) 79 cm and ) 80 cm; AHR > 0.91 and ) 0.85 and percent body fat 3 22% and ) 35% for males and females, respectively. Using these cut off values, the sensitivity ranged from 40 -- 60% and the specificity ranged from 70 -- 80%. There were gender differences in the determinants of metabolic disorders. In males, overfatness was more related to TG and fasting blood glucose values. On the other hand, in females, overfatness was more related to total cholesterol, HDL cholesterol, LDL cholesterol and TG.

Conclusion :

This study supports the findings reported by other investigators that cut off values for overfatness, in relation to metabolic disorders, are more specific than sensitive. Gender differences in the determinants of metabolic disorders indicate that interpretation on body compositional disorders in the elderly should be taken cautiously."

"ABSTRAKLatar Belakang: Leptin yang diketemukan oleh Zhang dan Friedman pada tahun 1994, dihasilkan oleh adiposit dan berhubungan dengan obesitas. Pada hewan coba, selain mempengaruhi homeostasis berat badan, leptin juga mempengaruhi metabolisme lipid pada jaringan perifer, seperti lipolisis dan lipogenesis. Peningkatan lipolisis dan penurunan lipogenesis menyebabkan peningkatan asam lemak bebas, yang kemudian diikuti oleh peningkatan konsentrasi trigliserida. Pada saat konsentrasi trigliserida tinggi, terjadi pembentukan small dense LDL, yang merupakan komponen dari dislipidemia aterogenik, terutama pada individu obes. Penelitian ini berusaha memperlihatkan perbedaan antara konsentrasi leptin dan profil lipid pada obes dan non-obes, dan terdapatnya hubungan antara leptin dan small dense LDL pada obesitas.Subyek: Berhasil dikumpulkan 297 laki-laki subyek penelitian, yang terdiri dari 205 subyek dengan obesitas sentral dan 92 subyek non-obes, yang presentase terbesar berusia antara 30-59 tahun. Variabel yang diamati pada penelitan ini antara lain, Indeks Massa Tubuh (IMT), lingkar perut, konsentrasi leptin, trigliserida, asam lemak bebas, kolesterol LDL, ApoB, ratio kolesterol LDL dan ApoB, kolesterol HDL, glukosa puasa dan insulin.Metodologi: Penelitian ini menggunakan disain potong lintang, Hubungan antara leptin dengan variabel-variabel seperti IMT, lingkar perut, leptin, trigliserida asam lemak bebas, kolesterol LDL, ApoB, kolesterol HDL dan insulin dianalisis dengan unpaired Nest, dibandingkan antara kelompok obes sentral dan non-obes. Sedangkan hubungan antara leptin dan small dense LDL dianalisis dengan menggunakan regresi logistik.Pemeriksaan laboratorium dari tiap variabel dilakukan dengan metode antara lain, konsentrasi trigliserida dan asam lemak bebas diukur dengan metode kolorimetri enzimatik, kolesterol LDL dan kolesterol HDL diukur dengan metode homogenisasi. Konsentrasi insulin diukur dengan metode ELISA, kadar leptin diukur dengan metode immunoassay.Hasil dan Pembahasan: Terdapat perbedaan karateristik antara kelompok obes dan non-obes, antara lain plasma leptin lebih tinggi pada kelompok obes sentral dibandingkan dengan kelompok normal; 9,71 (1,92) ng/mL vs. 2,63 (2,09) ng/mL, (P<0,001); rerata trigliserida 159,1 (6,97) mg/dL vs. 119,4 (4,8) mg/dL; (P<0,001), asam lemak bebas 0,42 (0,01) mmol/L vs. 0,36 (0,02) mmol/L; (p=0,001), apoB 108,05 (21,1) mg/dL vs. 101,4 (20,4) mg/dL(p=0,012) juga lebih tinggi pada kelompok obes dibandingkan non-obes, kolesterol HDL lebih rendah pada kelompok obes yaitu 40,6 (1,2) mg/dL vs. 46,2 (1,2) mg/dL; (P<0,001). Sedangkan rerata kolesterol LDL tidak berbeda bermakna antara kelompok obes dan non-obes 138,9 (32,2) mg/dL vs. 137,8 (31,9) mg/dL; (P=0,792). Pada subyek dengan Inleptin < 7,5 pg/mL (1,8 ng/mL) peningkatan kemungkinan didapatkannya small dense LDL sebesar 5,92 kali dibandingkan dengan subyek dengan lnleptin > 9,87 pg/mL (19,34 ng/mL).Penentuan indeks massa tubuh sebagai kriteria obesitas; penelitian ini memperkuat pendapat untuk menggunakan kriteria Asia Pasifik (1MT > 25 kg/m2) sebagai klasifikasi indeks massa tubuh (IMT) untuk populasi orang Indonesia.Hubungan lingkar perut dengan small dense LDL, leptin, IMT, dan HOMA-IR; Lingkar perut mempunyai korelasi yang baik dan bermakna secara statistik dengan konsentrasi leptin (r=0,72 dan P<0,05) dan HOMA-IR (r~0,53 dan P<0,05). Lingkar perut pada subyek dengan dan tanpa small dense LDL berbeda bermakna (P=0,016).Nilai normal konsentrasi leptin bagi IMT normal adalah 2,04 ng/mL dengan kisaran: 0,45 - 9,26 ng/mL. dan rerata konsentrasi leptin pada subyek obes sentral adalah 9,71 ng/mL dan subyek non-obes : 2,63 ng/mL.Resistensi dan defisiensi leptin pada obesitas; pada obesitas sentral dapat terjadi resistensi leptin atau defisiensi leptin dan mungkin ambang terjadinya resistensi leptin pada subyek penelitian ini lebih rendah (< 20 ng/mL) dibandingkan etnik Kaukasia.Peran enzim lipase hepatik (HL) pada pembentukan small dense LDL; hubungan peningkatan konsentrasi leptin dengan didapatkannya small dense LDL dapat dihubungkan dengan efek enzim lipase hepatik. Bila pengaruh leptin terhadap didapatkannya small dense LDL terjadi dengan bantuan enzim lipase hepatik (HL) sebagai katalisator dapat dibuktikan, maka akan memperkuat bukti adanya hubungan antara leptin dengan didapatkannya small dense LDL.Hipotesis baru penelitian ini adalah, leptin mempunyai efek inhibisi terhadap enzim lipase hepatik di hati, atau analog dengan efek inhibisi insulin terhadap enzim HSL pada adiposit.Hasil penelitian dibandingkan dengan penelitian lipid sebelumnya; hasil penelitian ini dapat membuktikan perbedaan leptin dan profil lipid, yaitu konsentrasi asam lemak bebas, trigliserida dan kolesterol HDL pada kelompok subyek obesitas sentral dan subyek non-obes. Beberapa penelitian sebelumnya memberikan hasil yang berbeda.Simpulan: Penelitian ini adalah penelitian pertama yang membandingkan konsentrasi leptin dan hubungannya dengan small dense LDL pada kelompok obes dan non-obes pada populasi di Indonesia maupun di dunia. Hasil penelitian ini memperlihatkan bahwa konsentrasi leptin lebih tinggi secara bermakna pada kelompok obes sentral dibandingkan dengan kelompok non-obes, serta berhubungan secara bermakna dengan konsentrasi trigliserida, asam lemak bebas, apoB dan kolesterol HOL. Lebih jauh lagi, penelitian ini juga memperlihatkan hubungan antara leptin dan didapatkannya small dense LDL, di mana makin rendah leptin akan makin meningkatkan kemungkinan terdapatnya small dense LDL, Pada laki-laki dengan obesitas sentral, leptin berhubungan dengan prediksi didapatkannya small dense LDL. Leptin secara independen mempunyai efek protektif terhadap didapatkannya small dense LDL.

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ABSTRACT

Background: Leptin which is discovered by Zhang and Friedman (1994) is secreted by adipocytes and associated with obesity. In animals it has been shown that beside its effect on weight homeostasis, leptin also exerts peripheral effects that include lipid metabolism, i.e. lipogenesis and lipolysis. The results of studies on humans are conflicting. The increased lipolysis and decreased lipogenesis resulted in an increase synthesis of fatty acids which is followed by triglycerides. At a certain level of triglycerides, small dense LDL formation occur, an established component of atherogenic lipoprotein phenotype (ALP). Leptin has been implicated in this process especially in central obese individuals. The aim of the study is to show that leptin and lipid levels are higher in central obese as compared to non-obese individuals and to investigate the relationship between leptin levels and small dense LDL in central obese individuals.

Subjects: A total of 297 male subjects comprising 205 central obese and 92 nonobese age 30-59 years were enrolled in the study. Variables under study includes body mass index (BMI), serum leptin, triglyceride, free fatty acids, LDL-cholesterol, apoB, LDL-cholesterollapoB ratio, HDL-cholesterol and insulin levels.

Methods: This is a cross sectional study. The correlation between leptin and some variables, such as body mass index (BMI), triglycerides, free fatty acids, LDL-cholesterol, apoB, LDL-cholesterollapoB ratio, HDL-cholesterol and insulin levels was analyzed by unpaired t-test. Correlation between leptin and small dense LDL was analyzed by logistic regression. Plasma tryglycerides and free fatty acids were measured by enzymatic colorimetry method; apoB by immunoturbidimetry, LDL-cholesterol and HDL-cholesterol by homogenous method, insulin level by enzym-linked immunosorbent assay (BLISA), Plasma leptin was measured by immunoassay.

Results & Discussion: The characteristics between obese and nonobese subjects were different, such as mean plasma leptin levels were significantly higher in central obese than in nonobese individuals 9.71 (1.92) ng/mL vs. 2.63 (2.09) ng/mL, (P<0.001); mean triglycerides 159.1 (6.97) mg/dL vs. 119.4 (4.8) mg/dL; (P<0.001), free fatty acids 0.42 (0.01) mmol/L vs. 0.36 (0.02) mmol/L; (P=0.001), apoB 108.05 (21.1) mg/dL vs. 101.4 (20.4) mg/dL (P=0.012) were also higher in central obese than in nonobese individuals, and HDL-cholesterol is lower 40.6 (1.2) mg/dL vs. 46.2 (1.2) mg/dL; (P<0.001). LDL-cholesterol 138.9 (32.2) mg/dL vs. 137.8 (31.9) mg/dL (P=0.792). Among subjects with lnleptin < 7.5 pg/mL (L8 ng/mL) the risk of having small dense LDL increases by 5.92 times compared to subjects with lnleptin 9.87 pg/mL (19.34 ng/mL).

In regard to body mass index and the classification of obesity, the present study is in favor with the Asia Pacific classification and criteria for obesity, i.e. BMI > 25 kg/rn2 to be used for Indonesian population.

Relationship between waist circumferences, small dense LDL, leptin, BMI, dan HOMA-IR. There is a statistically significant strong relationship between waist circumference and leptin (r=0.72; P<0.05) and HOMA-IR P<0.05). Furthermore, mean of waist circumference differ significantly between subjects with and without small dense LDL (P=0.016).

Normal leptin levels for subjects with normal BMI is 2.04 ng/mL (range 0.45-9.26 ng/mL); and mean leptin levels for obese and nonobese were 9.71 and 2.63 ng/mL, respectively.

In regard to leptin resistance and leptin deficiency in obese subjects. Both leptin resistance and leptin dificiency is found in obese subjects, and the result indicate that leptin resistance in this population developed at lower leptin level (<20 ng/mL) as compared to Caucasian.

The possible role of hepatic lipase in small dense LDL formation. The relationship of increased leptin levels and the presence of small dense LDL could possibly be due to hepatic lipase (HL) effect. If the effect of leptin on small dense LDL formation is by way of HL as catalysator can be proven, this finding will then support the evidence of relationship between leptin and small dense LDL.

The hypothesis generated from the present study is that leptin inhibits the effect of HL in the liver in analogy with the inhibitory effect of insulin on HSL in the adipocyte.

Results arising from the present study support the view that leptin levels and lipid profile, i.e. free fatty acids, triglycerides, dan HDL cholesterol in obese differ from nonobese subjects, whereas other studies give different results.

Conclusion: This is the first study that compare leptin levels and determine the relationship between leptin and small dense LDL in central obese and nonobese male Indonesian subjects. The results showed that leptin levels are significantly higher in central obese as compared to nonobese individuals, and is correlated with triglycerides, free fatty acids, apoB and HDL-cholesterol in central obese individuals. Furthermore, this study also showed a relationship between leptin levels and small dense LDL in central obese individuals, in which lower leptin levels carries a higher probability of having more small dense LDL. Leptin has an independent protective effect for the occurrence of small dense LDL."

"Obesitas telah menyerang dengan kekuatan penuh dan dampaknya adalah meningkatnya prevalensi di seluruh dunia seiring dengan meningkatnya angka kematian dan penyakit yang berhubungan dengan obesitas. Faktor genetik, hormonal dan lingkungan berinteraksi satu sama lain menyebabkan obesitas. Diet rendah kalori dan gaya hidup aktif secara fisik adalah cara utama untuk menangani obesitas. Penanganan tambahan adalah melalui intervensi farmakologis, menggunakan dua obat baru, yaitu cyclobutane methanamine HCl dan tetrahidrolipstatin, yang potensial untuk pengaturan obesitas. Cara terakhir untuk memecahkan masalah ini adalah dengan melakukan pembedahan. Akhir kata, pasien harus berkonsultasi dengan dokternya dalam memutuskan metode mana yang paling efektif untuk mencari solusi terhadap obesitas. (Med J Indones 2003; 12: 53-62)

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Obesity has struck with all its might and the results are the increased world-wide prevalence along with increased mortality rate and other obesity-related diseases. Genetic, hormonal and environmental factors interact to cause obesity. Very low calorie diet and physically active lifestyle are the primary means to treat obesity. Additional intervention is by pharmacological treatment, using two new drugs, namely cyclobutane methanamine HCl and tetra hidrolipstatin that are potential for the management of obesity. Another way to solve this problem is by performing a surgery. In conclusion, patients should consult their physicians in order to decide which methods are the most effective to find a solution to combat obesity. (Med J Indones 2003; 12: 53-62)"

"Obesity is performed by genetic, environmental, and complex interaction between genetic and environmental factors.Fatness levels in obese children are indicative of increased risk for elevated blood pressure, cholesterol, and lipoproteinratios children and adolescents. Serum cholesterol and blood pressure are related to raise atherosclerotic lesion. Certaincardiovascular disease risk factors in obese children are related to the earliest stages of atherosclerosis disease. Obesechildren have the high risk factors of certain cardiovascular disease. Genetic factors affecting metabolic rate can besuccessfully managed by the introduction of environmental factors such as decrease caloric intake and increase physicalactivity. The treatment of obesity and of atherosclerotic patients should include dietary restriction (protein sparingmodified fast and hypocaloric balanced diet), nutrition education, increased physical activity, behavior modification, andfamilial support. Success fully management of obesity can improve the quality of life and reduce the risk of morbidityand mortality associated with obesity."