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"Tujuan: Mengetahui pengaruh pemberian diet rendah energi seimbang dengan atau tanpa pemberian inhibitor lipase terhadap antropometri dan indikator metabolik pada subyek berat badan lebih.Metodologi: Desain - uji klinis paralel selama 24 minggu, mulai Maret 2002 sampai Maret 2003. Subyek - orang dewasa sehat (berusia >18 sampai 60 tahun) laki-laki dan perempuan, dengan indeks massa tubuh >25 kg/m2. Perlakuan - seluruh subyek mendapatkan diet rendah energi seimbang (defisit 500 kilokalori per hari) mengandung 25% energi dari lemak. Dilakukan randomisasi menjadi 2 kelompok, yaitu kelompok yang mendapat diet saja (kelompok D) dan kelompok diet disertai inhibitor lipase 120 mg 3 kali sehari (kelompok DIL).Hasil: Dari 74 orang yang diskrining, 64 orang (laki-laki 8 orang, perempuan 56 orang) memenuhi syarat sebagai subyek, dilakukan randomisasi menjadi 2 kelompok, masing-masing 32 orang. Pada akhir penelitian, terdapat 13 subyek kelompok D dan 25 subyek kelompok DIL. Indeks massa tubuh kedua kelompok berbeda bermakna (p=0,046). Diet rendah energi menyebabkan penurunan berat badan dan penurunan massa lemak masing-masing sebesar 3,86% dan 2,59%. Perubahan komposisi tubuh tersebut berhubungan dengan perbaikan beberapa faktor risiko terkait obesitas. Kadar gula darah puasa dan kolesterol LDL turun bermakna masing-masing sebesar 8,45% dan 8,75%. Kombinasi diet dan inhibitor lipase memperbesar penurunan berat badan, massa lemak dan lingkar perut masing-masing 4,2+1,2 kg (p=0,001), 3,7+1,4 kg (p=0,014) dan 6,5±2,1 cm (p=0,005). Kombinasi tersebut juga memperbesar penurunan kadar total kolesterol dan HDL kolesterol masing-masing sebesar 20,0+7,2 mg/dL (p=0,008) dan 4,4+2,0 mg/dL (p=0,035). Perubahan pola distribusi lemak tubuh dan rasio LDL/HDL tidak bermakna. Setiap penurunan 1 kg berat badan, massa lemak berkurang 0,8+0,1 kg (p<0,001) ; lingkar perut berkurang 1,0+0,2 cm (p<0,001), ini menunjukkan terjadi pemecahan jaringan lemak intra-abdominal. Setiap penurunan 1 kg massa lemak, kadar gula darah postprandial berkurang 2,2+1,0 mg/dL (p=0,039). Setiap penurunan 1 kg berat badan, kadar total kolesterol berkurang 3,7+0,8 mgldL (p<0,001) ; kadar LDL kolesterol berkurang 2,3+0,8 mg/dL (p=0,008) ; kadar trigliserida berkurang 2,5+1,2 mg/dL (p=0,040). Setiap penurunan 1 cm lingkar perut, kadar HDL kolesterol berkurang 0,4+0,1 mg/dL (p=0,007).Simpulan: Pemberian diet rendah energi seimbang selama 24 minggu menurunkan berat badan, memperbaiki komposisi tubuh dan menurunkan faktor risiko terkait obesitas. Inhibitor lipase sebagai terapi adjuvan diet rendah energi dapat meningkatkan defisit energi, sehingga memperbesar penurunan berat badan, massa lemak, lingkar perut, kadar total kolesterol, dan HDL kolesterol.

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Effects of individualized modest energy deficit diet with or without lipase inhibitor on anthropometric and metabolic indicator in overweight subjects Objectives: To study the effects of weight loss on anthropometric measures and metabolic indicators in overweight subjects consuming low-energy balanced diet with or without lipase inhibitor.Methods: Design - 24 weeks randomized clinical trial study, conducted from March 2002 to March 2003. Subjects - healthy obese adults (>18 to 60 years of age) of both sexes, with body mass index >25 kg/m2. Treatments - all subjects received low-energy diet designed individually to cause an energy deficit of approximately 500 kcal/day (2092 kJ/day) containing 25% of energy as fat. Subjects were randomized to receive diet only (D group) or diet and lipase inhibitor 120 mg 3 times daily (DIL group).Results: A total of 74 subjects screened, 64 subjects (8 males and 56 females) entered the protocol were randomly assigned into 2 groups, each had 32 subjects. At the end of the study, 13 subjects ofD group and 25 subjects of DIL group were evaluated. Lipase inhibitor significantly lowered body mass index (p=0.046). Low-energy diet induced weight loss and fat mass loss up to 3.86% and 2.59% respectively. Improved body composition was associated with improvement in several obesity-related risk factors. Fasting glucose level and LDL cholesterol were lowered by as much as 8.45% and 8.75% respectively.Combination with lipase inhibitor accounted for 4.2+1.2 kg greater weight loss (p=0.001), 3.7+1.4 kg greater fat mass loss (p=0.014), and 6.5+2,1 cm less abdominal circumferences (p=0.005). Lipase inhibitor further reduced total cholesterol and HDL cholesterol up to 20.0±7.2 mg/dL (p=0.008) and 4.4+2.0 mg/dL (p=0.035) respectively. However both groups showed no statistically significant changes of body fat distribution and LDLIHDL ratio. Every 1 kg weight loss caused 0.8+0.1 kg fat mass loss (p<0.001) and 1.0+0.2 cm less abdominal circumference (p<0.001), these changes showed reduction of intra-abdominal fat tissue. One kilogram less fat mass lowered postprandial blood glucose level by 2.2+1.0 mg/dL (p=0.039). One kilogram weight loss also found to reduce total cholesterol, LDL cholesterol and triglyceride level as much as 3.7+0.8 mg/dL (p<0.001); 2.3+0.8 mg/dL (p=0.008) and 2.5+1.2 mg/dL (p=0.040) respectively. One centimetre less abdominal circumference lowered HDL cholesterol by 0.4+0.1 mg/dL (p=0.007).Conclusion: 24 weeks treatment with low-energy diet significantly reduced body weight, improves body composition and some obesity-related risk factor. Lipase inhibitor as adjunctive therapy enhanced energy deficit."

"Obesitas merupakan masalah kesehatan yang sudah mendunia, termasuk di Indonesia. Situasi ini erat kaitannya dengan terjadinya perubahan asupan gizi ditandai dengan penambahan pola makan dimana hal ini dapat menyebabkan penyakit degenerasi. Lingkar pinggang mempakan salah satu faktor prediksi yang kuat pada resistensi insulin, yang merupakan fase dini perkembangan penyakit diabetes melitus. Asupan asam lemak jenuh yang tinggi dapat mcnyebabkan terjadinya resistensi insulin. Data mengenai hubungan antara asam lemak dan resistensi insulin di Indonesia sangat terbatas. Untuk melihat hubungan antara berbagai asupan lemak dengan insulin pada laki-laki dewasa dengan obesitas sentral di Jakarta, maka diadakanlah penelitian dengan metode potongan lintang. Kuesioner semi kuantitaf-frekuensi makanan yang telah divalidasi digunakan untuk memperoleh data asupan lemak pada 126 laki-laki usia 30-50 tahun dengan obesitas sentral di Jakarta yang sebelumnya telah mengikuti prosedur skrining melalui pemeriksaan klinis dan pengambilan darah. Pengukuran antropometrik dilakukan untuk mendapatkan data berat badan, tinggi badan dan lingkar pinggang. Data plasma insulin puasa, plasma glukosa puasa, plasma asam lemak bebas dan profil lemak darah diperoleh melalui pemeriksaan biokimia. Kucsioner global aktivitas tisik dan surveilens penyakit kronik digunakan untuk memperoleh data aktivitas fisik, kcbizmaan merokok, konsumsi alkohol, sayuran dan buah. Asupan lemak total, lemak jenuh, lemak tidak jenuh tunggal maupun ganda (% dari total kalori) diperolch Icbih tinggi dibandingkan rekomendasi PERKENI/NCEP/AHA/ADA (4l.23%, 21.51% and 9.32%), kecuali asupan lemak tidak jenuh ganda berdasarkan PERKENI (6.8?7%). Asupan omega-3 dan omega-6 tidak memenuhi rekomendasi berdasarkan IOM. Hiperkolesterolemia dan hipertrigliseridemia ditemukan pada penelitian ini. Sementara itu, insulin puasa berada dalam nilai nonnal (7.63 u/L). Tidak ditemukan hubungan antara asupan berbagai jenis lemak dengan insulin pada laki-laki dcwasa dengan obesitas sentral, tetapi plasma asam lemak bebas memiliki hubungan positif dengan asupan temak tidak jenuh ganda (% dari total kalori) (rp=0.l90, p<0.05), dan plasma glukosa puasa (r=0.l93, p<0.05). Penelitian kasus-kontrol perlu dilakukan untuk dapat melihat secara jelas hubungan antara asupan berbagai jenis lemak dengan insulin pada seseorang dengan dan tanpa obesitas sentral atau pada seseorang dengan dan tanpa resistensi insulin.

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Obesity is known as the major global health problems, including in Indonesia. This situation is associated with nutritional transitional characterized by changing in dietary patterns, leading to the prevailing degenerative diseases. Waist circumference is strong predictor of insulin resistance, an initial phase for development of type 2 diabetes melitus. High intake of SFA is contributed to insulin resistance. Data on the relations between intake of fatty acids and insulin resistance in Indonesia are very limited. A cross-sectional study was undertaken to examine the association between intake of different fatty acids and insulin level in abdominal obese adult men in Jakarta. Dietary fatty acids was obtained through validated fat SQ-F FQ to |26 men with abdominal obesity aged 30-SO, who pass the screening procedure through clinical and blood assessment. Anthropomethric assessments were done to obtain body weight, height and waist circumference. Biochemichal assessments were undertaken to obtain fasting plasma insulin, glucose, FFA and profile lipid. Global Physical Activity Questionnaire and STEPS questionnaire were used to obtain data on physical activity, smoking habit, alcohol use, fruit and vegetable consumption. Intake of total fat, SFA, MUFA and PUFA (% of total calories) were found higher than that of the PERKENI/NCEP/AI-IA/ADA recommendations (4l.23% , 21.51% and 9.32%), except PUFA intake based on PERKENI (6.87%). Intake of omega-3 and omega-6 PUFA did not meet the requirement suggested by IOM. Hypercholesterolemia and hypertrigliseridemia were found among subjects. Mean fasting plasma insulin was found within desirable range (7.63 ufL). There is no correlation between intakes of different fatty acids and insulin levels in abdominal obese adult men, but FFA plasma were positively correlated with PUFA intake (% of total calories) (rp=0-l90, p<0.05) and fasting plasma glucose (rp=0.l93, p<0.05)- Further study need to be conducted to have clearly understanding of the relationship between intake of different fatty acids and insulin level between abdominal obese and non-abdominal obese or insulin resistance and non insulin resistance using case-control study."

"Gaya hidup masyarakat perkotaan yang difasilitasi dengan ketersediaan dari kemudahan terhadap layanan transportasi berkontribusi pada kurangnya aktivitas bergerak diperkuat dengan kemudahan akses untuk mengkonsumsi makanan tidak sehat berperan sebagai faktor risiko terjadinya obesitas. Intervensi pengaturan pola makan menggunakan piring model T dan aktivitas fisik mempengaruhi pengetahuan dan berhasil menurunkan berat badan sebanyak 2 kilo gram. Diharapkan klien mampu mempertahankan pola makan sehat dengan aktivitas fisik yang teratur untuk mengoptimalkan penurunan berat badan menuju berat badan ideal.

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Combination of Diet Arrangement and Monitoring of Physical Activities as Obesity Management of Adult Family in Depok. The lifestyle of urban communities facilitated by the availability of facilities for transportation services contributes to the lack of moving activities reinforced by easy access to consuming unhealthy foods as a risk factor for obesity. Dieting intervention using plate model T and physical activity affected knowledge and succeeded in losing weight as much as 2 kilograms. It is expected that the client is able to maintain a healthy diet with regular physical activity to optimize weight loss towards the ideal body weight.

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