Available at: among http://ejournal.
id/index.
php/IJND Jurnal Gizi dan Indonesian Journal Dietetik of Association Nutrition Indonesia Dietetics of central obesity and smoking with online HDL level indonesian peoples .
Ae 59 year.
101 DOI : http://dx.
org/10.
21927/ijnd.
(Indonesian Vol.
No.
1,Journal 2020: 1-8 of Nutrition and Dietetic.
Vol.
No.
3, 2020: 101-108
Association of central obesity and smoking with HDL level among Indonesian peoples .
Ae 59 year.
Mukhlidah Hanun Siregar1*.
Fatmah Fatmah2.
Ratu Ayu Dewi Sartika3 Department of Nutrition.
Faculty of Medicine.
University of Sultan Ageng Tirtayasa.
Jalan Jenderal Soedirman KM 03 Cilegon.
Banten School of Environment Science.
University of Indonesia.
Jalan Margonda Raya.
Pondok Cina.
Kecamatan Beji.
Kota Depok.
Jawa Barat Department of Nutrition University of Indonesia.
Jalan Margonda Raya.
Pondok Cina.
Kecamatan Beji.
Kota Depok.
Jawa Barat *Corresponding author : mukhlidah.
hanunsiregar@untirta.
ABSTRAK
Latar Belakang : High-Density Lipoprotein (HDL) adalah bagian dari profil lipid yang dianjurkan berada pada level diatas 40 mg/dl.
HDL rendah menjadi salah satu kriteria sindrom metabolik.
Rendahnya HDL dalam darah akan menyebabkan terjadinya aterosklerosis dan berdampak pada peningkatan risiko penyakit cardiovaskular.
Beberapa penelitian menemukan bahwa obesitas sentral, merokok, aktivitas fisik, dan asupan makanan memiliki peran dalam menurunkan kadar HDL.
Tujuan : Tujuan dari penelitian ini adalah untuk mengetahui faktor utama yang berhubungan dengan kadar HDL pada masyarakat Indonesia dengan range usia 18-59 tahun.
Metode : Desain penelitian menggunakan desain cross sectional.
Data penelitian diperoleh dari Riset Kesehatan Dasar tahun 2013.
Total responden setelah dilakukan manajemen data sebanyak 21.
055 orang.
Faktor yang dianalisis adalah usia, jenis kelamin, status menikah, aktivitas fisik, merokok, obesitas sentral, konsumsi buah dan sayur, konsumsi kopi dan konsumsi makanan berlemak.
Data dianalisis dengan uji hipotesis multiple regression logistic for the prediction model.
Hasil : Hasil penelitian menunjukkan bahwa sebesar 26,2% penduduk Indonesia berusia 18-59 tahun memiliki kadar HDL O40 mg/dl.
Setelah dianalisis melalui 4 model, ditemukan bahwa obesitas sentral, merokok, konsumsi makanan berlemak, status menikah, dan jenis kelamin memiliki hubungan secara signifikan dengan kadar HDL .
erurutan berdasarkan nilai OR).
Kesimpulan : Obesitas sentral dan merokok menjadi faktor utama terhadap kadar HDL abnormal setelah dikontrol dengan faktor lain yang berhubungan, dengan nilai OR 1.
p-value<0.
dan 284 .
p-value<0.
Obesitas sentral merupakan faktor utama yang berhubungan dengan penurunan kadar HDL.
Oleh karena itu, penelitian ini menyarankan untuk menjaga lingkar pinggang selalu berada pada batas <80 cm untuk perempuan dan <90 untuk laki-laki dengan melaksanakan pedoman gizi seimbang .
erutama menurunkan konsumsi makanan berlemak dan meningkatkan aktivitas fisi.
, menjauhi merokok, khususnya pada perempuan menikah.
KATA KUNCI: gizi seimbang.
kadar HDL.
obesitas sentral
ABSTRACT
Background: High-Density Lipoprotein (HDL) is a part of the lipid profile and it is recommended to be above 40 mg/dl.
Low HDL is one of the criteria of metabolic syndrome.
Low HDL in the blood will cause atherosclerosis and affect the increased risk of cardiovascular disease.
Some research found that central obesity, smoking, physical activity, and dietary intake have a role in lowering HDL levels.
Objectives: The purpose of this research is to know the main factors associate to HDL levels in Indonesian society with range age 18-59 years.
Methods: Design research was using cross sectional design.
Research data obtained from Basic Health Research in 2013.
Total respondents after doing data management were 21.
055 people.
The analyzed factors are age, gender, married status, physical activity, smoking, central obesity, dietary of fruit and Mukhlidah Hanun Siregar.
Fatmah.
Ratu Ayu Dewi Sartika.
Vol 8 No.
3, 2020: 101-108
vegetable, coffee consumption and dietary of fatty foods.
The data was analyzed by multiple regression logistic for the prediction model.
Result: The results showed that 26.
2% of the Indonesian population aged 18-59 years had HDL levels O 40 mg/dl.
After being analyzed through 4 models, it was found that central obesity, smoking, dietary of fatty foods, married status, and sex associated significantly with HDL levels .
equentially based on OR Central obesity and smoking are becoming a major factor related with abnormal HDL levels after adjustment with other significant associated factors, with OR 1.
p-value < 0.
and 284 .
p-value < 0.
Conclusions: Central obesity was a major factor associated with decreasing levels of HDL.
Therefore, this research suggested to keep the waist circumference always under 80 cm for women and 90 for men, by applied the balanced nutritional guidelines .
ecreasing of fatty foods and increasing physical activit.
, avoiding smoking, especially for married women.
KEYWORDS: balance nutrition.
central obesity.
HDL levels.
Article info:
Article submitted on August 05 , 2020
Articles revised on September 02, 2020
Articles received on September 28, 2020
INTRODUCTION
MATERIALS AND METHODS
HDL (High Density Lipoprotei.
is one of lipoprotein, it is a combination of fat and high protein levels, less triglycerides and phospholipids, has protein general characteristic, found in the blood plasma, and called as Augood fatsAy because it is helping to clean plaque on blood vessels.
Together with obesity, raised triglycerides, raised blood pressure, raised fasting plasma glucose, and reduced HDL cholesterol is a component of the metabolic syndrome/MS .
The manifestation of MS is diabetes mellitus, another effect of low HDL level is trigger an increase of LDL level and become a risk factor for cardiovascular disease .
The population in South Asia showed a trend of increasing triglyceride levels and low HDL levels in different ethnic groups .
Ae.
In 2007, prevalence of low HDL level in Indonesia was 35% and decreased 9% in 2013 .
But, it still a problem to identify the risk factors of low HDL level.
The aims of the present study were to determine the main factors for reduced HDL levels between selected HDL risk factors namely age and sex .
, marital status .
, central obesity .
Ae.
, smoking .
Ae.
, stress .
, physical activity .
, dietary of fatty food .
, dietary of fruit and vegetable.
, and coffee consumption .
All participants were of Indonesian and lived in Indonesia when Basic Health Research 2013 study implemented.
Basic Health Research 2013 study was a survey with cross sectional design to describe the health problems of population in all regions of Indonesia represented by subjects at the national, provinces, and district/city level.
The participants consist of rural and urban populations, total household were 294,959 households and 1,027,763 people consisting of all age ranges.
In this study, the population was people with age range 18-59 years i.
e 310,671 men and 338,954 women .
otal were 649,.
This total was for the measurement of all research variables, and biomedical samples were representing the The inclusion criteria were 18-59 years old, conducting blood sampling for a complete examination of blood lipid profiles, and complete data of all variables.
Total subject we found from Ministry of Health were 28,300, and 21,055 after applied the inclusion criteria.
Sample size was accounting by formula of different categories difference test based on study of HDL level in Indonesia .
, minimum sample were 493.
The implementation of data collection from Basic Health Research 2013 was conducted in May- Association of central obesity and smoking with HDL level among indonesian peoples .
Ae 59 year.
103 June 2013, in 33 provinces and 497 districts/cities.
The enumerator was recruited by the local health department and trained.
There were 3 types of data collection tools namely: Household questionnaire (RKD13.
RT) asked to family head or housewife.
Individual questionnaire (RKD13.
IND) asked to each household member.
and form (BM01-BM.
and a set of field laboratories for the retrieval of blood The enumerator interviewed the household head, then to all the family members, alternately.
Then the measurement of body weight and height and other examinations.
Biomedical examination carried out field laboratories that can be laboratory clinics, hospitals and other facilities are possible.
this study, researcher collected data from Ministry of Health in 2015 and analyzed in the same year.
Basic Health Research 2013 has registered in Ethics Committee from Health Research Ethics Commission (KEPK) National Institute of Health Research and Development (Balitbangke.
of Health Ministry number LB.
01/5.
2/KE.
006/2013.
HDL level was defined according to the criteria containing in the report of National Education Programe (NCEP) Adult Treatment Panel (ATP)-i 2001, which defines as abnormal HDL level (O40 mg/d.
and otherwise as normal.
Age was defined to 4 categories as 18-25 years, 26-35 years, 36-44 years and 45-59 years.
Marital status was defined by living alone .
nmarried or divorce.
or living with couple .
Central obesity was defined at waist circumference (WC) WCOu90 cm in males and WCOu80 cm female, as use in Hoppin and Ministry of Health Recomendation.
A dietary questionnaire was developed on the basis of food habits practiced each day over a period of least 1 week.
Dietary of fatty food was classified as AuyesAy if a person eating it Ou3 times a weeks, otherwise.
AunoAy.
This classification same with consumption of coffee.
Dietary of fruits and vegetables defined at recommendation from Indonesia Ministry of Health.
adequate is eating fruit and/or vegetables Ou5 portion every day in a week.
and otherwise AulowAy.
Smoking was classified as AuyesAy if a person smoked daily or occasionally when Basic Health ResearchAo2013 implementation, and otherwise AunoAy.
Physical activity was classified as AuactiveAy if a person doing heavy and/or moderate activity 3 days over a period of least 1 week.
(The activities was listed in Basic Health ResearchAo2013 questionnair.
otherwise Auless-activeAy.
Last, stress was classified as AuyesAy if a person answer Ou6 from 20 questions with yes.
and otherwise AunoAy.
Data were analyzed using statistical software.
The prevalence of abnormal HDL level were adjusted to the ATP i standard population.
Logistic regression used to investigate the association between HDL level and determine major factor after adjusting .
, age, sex, central obesity, smoking, physical activity, marital status, and dietary of fatty The estimates and 95% confidence interval (CI) of the coefficients were displayed.
A p-value of O0.
05 or 95% CI was considered statistically The factor was considered statistically significant insert to multivariate analyze.
Multivariate analyze to predict the main factor lowering HDL
RESULTS AND DISCUSSIONS
Table 1 shows the prevalence of abnormal HDL level in subject adjusted to NCEP i standard Five thousand five hundred and twelve subjects .
2%) classified as abnormal HDL level with CI 95% .
2 Ae 27.
2%).
In characteristics, women more than men, married more than unmarried/divorced.
In life style, smoker less than non-smoker, but less-active more than active subjects and most of subject was not stress.
dietary, subjects have eaten fatty food more than 3 times a week .
8%), and found mostly subjects have low level in dietary of fruit and vegetable in a week .
9%).
Last, subjects consumed coffee more than 3 times a week were less than others.
Table 2 shows the p-value non-adjusted and adjusted association between factors with HDL In bivariate analysis with Chi-square analysis found that sex, marital status, smoking, physical activity, dietary of fatty food and coffee consumption significantly associated with HDL level.
But when adjusted all factors with p-value>0.
25 into model Mukhlidah Hanun Siregar.
Fatmah.
Ratu Ayu Dewi Sartika.
Vol 8 No.
3, 2020: 101-108
Table 1.
Prevalence of abnormal HDL level among indonesian people .
-59 year.
Variabel HDL level Abnormal Normal Age 45 Ae 59 years 36 Ae 44 years 26 Ae 35 years 18 Ae 25 years Sex Women Men Marital status Unmarried/Divorced Married Central Obesity Yes Normal Smoking Yes Physical Activity Less-active Active Stress Yes Dietary of fatty food Yes Dietary of fruit and Low Adequate Coffee Consumption Yes Total .
=21.
Persentase .
% CI) 2 .
2 Ae 27.
8 Ae 74.
4 Ae 39.
3 Ae 30.
6 Ae 22.
4 Ae 11.
7 Ae 63.
4 Ae 38.
8 Ae 17.
8 Ae 84.
3 Ae 41.
4 Ae 60.
6 Ae 32.
6 Ae 69.
5 Ae 64.
2 Ae 37.
0 Ae 7.
7 Ae 94.
5 Ae 70.
1 Ae 36.
2 Ae 93.
5 Ae 7.
Ae 41.
7 ( 58 Ae 63.
found different p-value in central obesity.
In bivariate analysis, central obesity was not associated with HDL Level .
-value>0.
, but in logistic regression, it was associated and become main factor to predicte HDL level.
Central obesity become the main factor because has highest OR than others .
% CI 1.
p-value=0.
The second was smoking with OR 1.
% CI 1.
p-value=0.
The fourth or the last model found after confounding analysis for all adjusted factors.
HDL Level Preliminary data showed that the average HDL level of subjects was 48.
66 mg/dl (A12.
min-max 10-219 mg/d.
In this study, found that subjects .
-59 year.
with abnormal HDL level is 2% with standar O40 mg/dl for abnormal.
This found higher than population prevalence in Basic Health Research 2013 (>15 year.
9% as abnormal HDL level.
Higher prevalence showed in Mamat as 76.
9% because the standard for abnormal HDL level was <50 mg/dl.
Means, with standard <50 mg/dl, the prevalence of abnormal HDL Level will be higher.
In other study.
Sartika found that 25% subjects have abnormal HDL level with average of 1A10.
The limitation of this study, was used the old standard to define the abnormal HDL level.
If we use the last standard from IDF 2006 -abnormal was < 1.
03 mmol/l or 40 mg/dl in males and < 1.
29 mmol/l or 50 mg/dl in females- we found that prevalence of abnormal HDL level was 43%, higher than before .
Second limitation was data availability of risk We only analyzed the variables available in the Basic Health Research 2013, there were variables not available such as the history of dyslipidemia, energy intake .
arbohydrate, protein, fa.
, consumption of antioxidants (A and C vitamin.
and history of cardiovascular diseases.
So, factors analyzed not represented of all factors were associated with HDL level.
In multivariate analysis, found that sex, marital status, central obesity, smoking and dietary of fatty food was included in prediction model for HDL Level.
Central obesity and smoking were higher OR value and had become risk factor because OR>1.
Than dietary of fatty food, marital status, and sex become protection factor because OR<1.
But, in this study we focused to major risk factors.
Central Obesity Central obesity become the major factors to reduced HDL level in Indonesia adults and older.
Its mean, there were significant association between central obesity with HDL Level adjusted for sex.
Association of central obesity and smoking with HDL level among indonesian peoples .
Ae 59 year.
105 Table 2.
Adjusted coefficient from linier regression analyses of asociation between factors and HDL Level Variables Age*** 45 Ae 59 years 36 Ae 44 years 26 Ae 35 years 18 Ae 59 years Sex Women Men Marital status Unmarried/Divorced Married Central obesity Yes Normal Smoking Yes Physical Activity*** Less-active Active Stress *** Yes Dietary of fatty food Yes Dietary of fruit and vegetable*** Low Adequate Coffee Consumption*** Yes Abnormal .
=5.
HDL Level Normal .
= 15.
OR adjusted .
% CI) 299 .
,261-0,.
0,792 .
,696-0,.
1,948 .
,740-2,.
1,284 .
,127-1,.
0,814 .
,737-0,.
* result from bivariat analyses ** prediction model and confounding analyses from all variabel .
xcept Stress, p>0.
***age exit in fourth model, physical activity in first model, dietary of fruit and vegetable and coffee consumption in in third model, all because change of OR>10%, all factor in last model associated with p-value 0.
marital status, smoking, and dietary of fatty food.
Darmawan and Irfanuddin also found significant association between central obesity with HDLcholesterol level .
In other study found that the inverse association between central obesity .
aist circumference/ WC) with HDL-cholesterol in men with age 24-54 years.
Its mean, bigger WC causes lower HDL level .
Subjects with obesity, especially central obesity, have a disorder in the regulation of fatty acids.
The disorder make increasing the levels of triglycerides and choleethyl ester .
The increasing of triglycerides and choleethyl ester caused lowering of HDL2.
This condition will also be exacerbated by hypertriglyceridemia and insulin resistance .
Central obesity has a significant association with HDL levels after adjusting for other factors.
bivariate analyze, we not found the association.
Our assumption, this was related with marital Hosseinpour-Niazi showed that married Mukhlidah Hanun Siregar.
Fatmah.
Ratu Ayu Dewi Sartika.
Vol 8 No.
3, 2020: 101-108
women have lower HDL level than divorced or unmarried .
In sub-analyze we found the significant association between central obesity with marital status, women subjects with marital status AumarriedAy have more central obesity than unmarried/divorced.
Several cross-sectional and longitudinal studies also have shown that married subjects are more often overweight and obese than unmarried subject .
Ae.
In current study, we concluded from multivariate analyze that central obesity was risk factor for abnormal HDL level and unmarried/divorced was protection factor.
However, this association can be attributed to differences in personal lifestyle and dietary habits of the subjects in the community, cannot be generalizing for all population .
This association are areas that await further investigation.
Smoking The second risk factor was smoking.
Smoking has a significant association in bivariate and multivariate, consistently.
Our result was in line with several studies .
The acute effects of cigarette smoking is disorder in fat metabolism, which increase of total cholesterol and triglycerides .
High triglyceride levels make CETP mediate the transfer of triglycerides to HDL, and formed more large-size HDL.
This large-size HDL is an ideal substrate for lipase enzyme in liver, it was released increasing HDL in liver and decreasing HDL in plasma .
In sub-analyze of smoking, we found that average of cigarettes was 12.
39 per day (SD A 97, min-max 1-.
This finding showed that cigarettes/day were associated with lower HDL level .
<0,.
This was evidenced by Framingham Heart Study, recruited 2000 men and 2000 women aged 20-49 years.
The decrease of HDL level in men was 4 mg/dl and in women 6 mg/dl .
current study finding that an important factor was the number of cigarettes have smoked per day, not length of time have smoked.
This finding was same as found by several studies .
,16,.
However, effect of smoking for HDL level is acute.
In subjects stopped smoking.
HDL level have increased rapidly as found by Nashvilles Vanderbit University that after nicotine abstinence smoking in a week, there was increasing in HDL level as 15% or 7 points .
CONCLUSIONS AND RECOMMENDATIONS
In conclusion, central obesity and smoking were major risk factor for lower HDL level in Indonesia adult and older.
We may be find the confounding in the association of central obesity for HDL level, because central obesity was an effects from other lifestyle i.
e physical activity and dietary habits and further studies should investigate other risk factors.
While, cigarette smoking was direct association and it is strongly recommended to avoid smoking for increasing of HDL level.
REFERENCES