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"Cardiovascular disease has become the first cause of death. Highest morbidity is found in the age, and among cardiovascular diseases, prevalence of hypertension is the highest. Many studies on the relationship between nutritional factors and hypertension have been done, but studies to observe determinants of hypertension in Indonesia are lacking. Therefore, there is an urgent need to elaborate information on various hypertension risk factors in the Indonesian elderly, which will allow the policy makers to provide appropriate intervention programs.

The primary purpose of this study was to investigate various determinants of hypertension in the Indonesian elderly with different nutritional status.

A cross sectional study was undertaken in Jakarta and 5 other cities with total sample of 1261 elderly using multistage random sampling. Subjects were recruited from elderly population in Jakarta, Padang, Bandung, Jogyakarta, Denpasar and Makasar. Data were collected through interview using structured questionnaires, anthropometrics measurements, biochemical blood and urine analysis, and blood pressure measurements. Daily nutrients intake was analyzed using WorldFood2 Dietary Assessment Program. Data were analyzed by using SPSS programs for Windows version 7.5; General Linear Model, Multiple linear regression and logistic regression analysis were performed to determine the predictive power of independent variables for outcome variables. Prevalence of hypertension found in the study was quite high, more than 50% of the study population for both men and women. This study showed significant differences of determinant and predictive factors of blood pressure between elderly with Body Mass Index (BMI) < 25 kg/m2 and BMI? 25 kg/m2. Prevalence of systolic and diastolic hypertension was higher in the elderly with BMI < 25 kg/lm2 than in the elderly with BMI 25 kg/m2. BMI was a significant determinant for diastolic blood pressure in elderly with BMI > 25 kg/m2. There was a positive association between blood pressure and Waist to hip ratio (WHR) irrespective of BMI value.

Plasma LDL cholesterol >160 mg/dl increased the risk of having systolic hypertension 1.5 to 2 times in the elderly with BMI < 25 kg/m2 after the age of 65 years and increased the risk of having diastolic hypertension 1.5 times. Plasma triglycerides > 200 mg/dl increased the risk of having systolic hypertension 1.7 and 2.5 times in elderly with BMI 25 kg/m2 and in elderly with BMI? 25 kg/m2 respectively, after the age of 65 years and increased the risk of having diastolic hypertension Ft, 1.7 times. Ratio of total cholesterol to HDL cholesterol > 5 increased the risk of having hypertension 1.8 times in elderly with BMI? 25 kg/m2. Plasma HDL cholesterol < 35 mg/dl in elderly with BMI < 25 kg/m2 increased the risk of hypertension approximately 2.4 times. In elderly with BMI < 25 kgmm2, monounsaturated fatty acid (MUFA) had negative correlation (protecting effect) with diastolic and systolic blood pressure. Saturated fatty acid (SFA) had positive correlation with diastolic blood pressure and systolic blood pressure. Cholesterol intake had positive correlation with diastolic blood pressure. Multivariate analyses in this study did not find significant correlation between energy intakes with blood pressure. Although no significant correlation was found between protein intakes with blood pressure, this study showed that arginine intake had protecting effect against hypertension. The study also showed that calcium and potassium intake had negative correlation with DBP and SBP respectively in elderly with BMI > 25 kg/m2. In elderly with BMI < 25 kg/m2 sodium intake had positive correlation with SBP. This study also demonstrated that sport index had negative correlation (protecting effect) with diastolic blood pressure.

Nutrition education to elderly group should emphasize healthy nutrients with protecting effect against hypertension and avoid nutrients with positive correlation to hypertension. Suggestion for sodium restriction especially in the elderly with BMI < 25 kg/m2, and proper physical/sport activity as a protecting factor against hypertension is very important for the elderly. Regular check of blood pressure and plasma lipid should be conducted and Public Health Centers equipped with appropriate laboratory facilities, for early detection of hypertensive risk factors. BMI category should be considered in hypertension program since there were differences of determinant factors of hypertension between different categories of BMI. Future studies should be directed on public health and nutrition intervention to the elderly community."

"ABSTRAKLatar Belakang: Nefropati diabetik (ND) merupakan komplikasi mikrovaskular yang berkontribusi terhadap end stage renal disease (ESRD) pada penyandang DMT2. Polimorfisme gen apolipoprotein E (APOE) dihubungkan dengan dislipidemia merupakan faktor risiko untuk timbulnya ND.Tujuan: Mengetahui pengaruh polimorfisme gen APOE terhadap kejadian ND penyandang DMT2 di Palembang dan menganalisis pengaruh polimorfisme gen APOE terhadap perubahan profil lipid penyandang DMT2 dengan ND.Metode: Penelitian kasus kontrol pada penyandang DMT2 di Palembang. Kelompok kasus adalah penyandang DMT2 dengan ND dan kelompok kontrol adalah penyandang DMT2 tanpa ND yang memenuhi kriteria penyertaan.Hasil: Terdapat 37 penyandang DMT2 dengan ND (ACR > 300 mg/g kreatinin) dan 42 tanpa ND (ACR < 30 mg/g kreatinin). Tidak terdapat perbedaan bermakna pada usia, jenis kelamin, lama DM, tinggi badan, tekanan darah sistolik, glukosa darah puasa, HbA1c dan profil lipid. Terdapat perbedaan bermakna pada berat badan, IMT, TD diastolik, hemoglobin, ureum, kreatinin dan eGFR antara kasus dan kontrol. Distribusi genotip tidak berbeda bermakna. Pada kelompok kasus didapatkan peningkatan frekuensi alel gen APOE ε2 dibanding kontrol (62,2 % vs. 37,8 %). Dengan analisis bivariat didapatkan penyandang DMT2 yang mengandung alel gen APOE ε2 2,5 kali lipat dan bermakna (p = 0,023) dibandingkan gen APOE ε3 dalam menyebabkan ND sedangkan alel ε4 0,65 kali lipat dan tidak bermakna (p = 0,37). Profil lipid tidak berbeda bermakna baik pada penyandang DMT2 dengan ND maupun penyandang DMT2 tanpa nefropati.Simpulan: Frekuensi alel gen APOE ε2 lebih tinggi pada penyandang DMT2 dengan ND dibandingkan tanpa ND. Gen APOE ε2 merupakan faktor risiko kejadian ND pada penyandang DMT2. Tidak ada hubungan antara kejadian ND dengan perubahan profil lipid.

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ABSTRACT

Backgrounds. Diabetic nephropathy is microvascular complication, largely contributed to end stage renal disease in T2DM patients. Apolipoprotein E (APOE) genetic polymorphism in association with dyslipidemia have been proposed as one of the risk factors for the development of diabetic nephropathy (DN).

Aim: To examine the effect of apolipoprotein E (APOE) gene polymorphism to DN incidence in patients with T2DM and to analyze the effect of APOE gene polymorphism to lipid profile in DN.

Method. Case control study at Palembang. Case group were T2DM with nephropathy and control group were T2DM without nephropathy.

Results. There were 37 patients with DN (ACR > 300 mg/g creatinine) and 42 patients without nephropathy (ACR < 30 mg/g creatinine). No significant differences in terms of age, sex, duration of DM, height, systolic blood pressure, fasting glucose, HbA1c and lipid profiles between the two groups. There were significant differences in weight, BMI, diastolic blood pressure, hemoglobine, ureum, creatinine and eGFR with p value 0.028, 0.013, 0.017, < 0.001, < 0.001, < 0.003 and < 0.002 respectively. The distribution of APOE genotypes between the two groups are the same. However, there was a significant difference in the allele frequencies, ε2 frequency was significantly higher in case group compared to control group (62.2 % vs. 37.8 %). On bivariate analysis ε2 allele showed 2.50 times to DN risk with p 0.023 while ε4 allele 0.65 times to DN risk. No significant difference in lipid profiles between DN and without nephropathy.

Conclusions. APOE ε2 allele was significantly higher in macroalbuminuria group. These result suggest that ε2 allele may be associated with the development of DN and ε2 allele was risk factor in T2DM patients. There were no correlation between APOE gene polymorphism and lipid profiles."

"Diabetes mellitus (DM) is one of the public health problems worldwide, including in Indonesia. Cardiovascular disease was the main cause of death (75-80%) in DM, three-fourths of this death was caused by coronary heart disease (CHD). Approximately 34.2% of patients with acute coronary syndrome (ACS) receiving care at ICCU of Dr. Cipto Mangunkusumo General Hospital (RSCM) suffered from DM. Mortality rates of ACS in DM patients were still high and ACS prognosis in DM patients were still unfavorable. There are many factors playing a part in atherosclerosis and ACS incidence in DM patients, such as metabolic disorders due to hyperglycemia and the fomration of advanced glycation end product (AGE), oxidative stress, atherogenic dyslipidemia in DM in the form of high triglyceride level and low HDL cholesterol as well as an increase in small dense LDL, and insulin resistance. In addition, other risk factors of CHD frequently encountered with DM were hypertension, obesity, thrombocytc hyperaggregation and hypercoagulation. The management ofthis disease which was based on the control of risk factors was not yet satisfactory.Inflammatory response played an important role in pathogenesis of atherosclerosis, beginning with early lesion up to acute coronary syndrome. Increase in inflammatory responses (hsCRP) could predict cardiovascular event and predict post-ACS prognosis. Studies in DM population showed an increase in inflammation. ln-depth studies on inflammatory responses in ACS DM patients have not yet been reported. In normal condition, there was a balance of proinflammatory and antiinflammatory cytokines. The ratio of proinflammatory and antiinflammatory cytokines in ACS, particularly DM patients has not been studied. The relationship between metabolic factor (blood glucose, glyco Hb and lipid) and inflammatory response in ACS DM patients has not yet also been studied.Currently, the effort to decrease inflammatory response is made, among others, by aspirin, statin hypolipidemic medication and insulin sensitizer. Although aspirin and statin were used routinely in ACS patients and have proved to reduce inflammation, morbidity and mortality rates of ACS patients were still high. Thus, we would like to observe whether an addition of other medications in standard therapy could reduce inflammation better. Curcumin in experimental animals-and humans) showed -hypolipidemic effect (decrease 'in absorption and increase in catabolism) and hypoglycemia (effect on PPAR-7). Curcumin also demonstrated antiinflammatory effect. In this study we would like to observe the effects of curcumin on both metabolic factors and inflammatory responses in ACS patients.PROBLEM IDENTIFICATIONThe above elaboration showed a discrepancy associated with inflammatory response in DM ACS patients. Up to now, the relationship of metabolic factor and inflammatory response in DM ACS has not been clear yet. Likewise, the effects of curcumin on metabolic factor and inflammatory response in ACS have not yet been identified.OBJECTIVESTo evaluate inflammatory responses in DM ACS and its relationship with metabolic factors (glucose, blood; glyco Hb, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride); to evaluate the ratio of proinflammatory and antiinflammatory cytokines (IL-6/IL-10) in ACS DM patients, and to identify the effects of curcumin on metabolic factors and inflammatory responses in ACS patients.SETTINGThe study was conducted at ICCU of RSCM, ICCU of Persahabatan, ICCU of RS MMC and ICCU of Medistra Hospital, Cardiology Polyclinic, Department of Internal Medicine, Faculty of Medicine University of Indonesia! RSCM and Integrated Cardiac Service Poiyclinic of RSCM.STUDY SUBJECTSACS patients (DM and non-DM) and CHD (DM and non-DM).DESIGNThere were two studies: l. Observational design to observe inflammatory responses (hscRP, IL-6, IL-IO, VCAM and ICAM) in DM ACS, non-DM ACS, DM CI-ID, and non-DM CHD; to evaluate the relationship between metabolic factors (fasting blood glucose, blood glucose 2 hours PP, glyco Hb, total cholesterol, LDL cholesterol, HDI.. cholesterol and triglyceride) and inflammatory responses (hsCRP, IL-6, IL-10, VCAM and ICAM) in ACS DM. 2. Interventional study which was a double-blind randomized trial to evaluate the effects of curcumin at escalating doses (low dose 3:-:IS mglday, moderate dose 3x30 mg/day and high dose 3x60 mg/day on metabolic factors (fasting blood glucose. blood glucose 2 hours PP and glyco Hb) and the effects of curcumin at escalating doses on inflammatory responses (hsCRP, ll.-6, VCAM and ICAM) in ACS patients.RESULTSIn observational study, |46 subjects were analyzed, consisting of 84 ACS patients, (30 DM ACS patients and 54 non-DM ACS), and 62 CHD (25 DM CHD patients and 37 non-DM CHD patients). The results of the study in the four groups of patients showed: 1. Inflammatory response in DM ACS was higher than in DM CHD (hsCRP, p=0.00; II..-6, p=0.00; IL-10, p=0.00) and non-DM ACS (ICAM, P=0.03). 2. The ratio of proinflammatory and antiinflammatory cytokines (IL-6/II..-10) in DM ACS did not differ from that of DM CHD (p=0.2l) and non-DM ACS (p=0.5 l). 3. There was a relationship between metabolic factors and inflammatory responses in DM ACS: triglyceride and ll.-6 (r=O.39, p=0.03) and II..-I0 (r=0.37, p=o.o4).In interventional study we performed randomization in 75 ACS patients divided into four groups, consisting of low-dose curcumin group of 15 patients, moderate-dose curcumin group of 15 patients, high-dose curcumin group of IS patients, and placebo group of 30 patients. The results of the study in these four groups showed: l. Low-dose curcumin showed a decrease in hsCRP in one week ofthe first month after intervention, there was a significant difference liom that of placebo (p=0.04). Low-dose, moderate-dose, high-dose curcumin groups showed a decrease in IL-6, but was not significantly different from placebo. Low-dose, moderate-dose, high-dose curcumin did not show a decrease in VCAM and ICAM after intervention of 2 months. 2. Low-dose curcumin group tended to experience a decrease in glyco Hb level after intervention of 2 months (p=0.06); however, it was not significantly different from that of placebo. 3. There was a tendency that low-dose curcumin reduced total cholesterol and LDI. cholesterol; however, it was not significantly different from that of placebo. There was a tendency that low-dose curcumin increased HDL cholesterol; however, it was not significantly different from that of placebo. 4. There was a tendency that the pattern of escalating doses had some effects in inflammatory responses and metabolic factors, in which low-dose curcumin showed the best effects, followed by moderate-dose and finally high- dose curcumin.CONCLUSIONSIn this study, inflammatory responses in DM ACS patients were higher than those in DM CHD and non-DM ACS patients. There was no difference in the ratio of proinflammatory and antiinflammatory cytokines (IL-6fIL-IO) in DM ACS compared with DM CHD and non-DM ACS. ln addition, the present study identified some of the relationships between metabolic factors and inflammatory responses. Low-dose curcumin reduced hsCRP in one week of the first month after the intervention in ACS patients. There was a tendency that low-dose curcumin reduced glyco Hb level in ACS."