Liquid Chromatography with Tandem Mass Spectrometry Analysis of Carboxymethyl Lysine in Indonesian Foods.

There is little data on directly measured carboxymethyl lysine (CML) content in Indonesian foods. This study aimed to generate a database of CML values in foods commonly consumed in West Java and West Sumatra. The results were to be used to update our previous estimated CML values. CML values in food samples were measured using high-pressure liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). Food protein content was analyzed by Kjeldahl's method or inferred from the nutrition facts' label. A total of 210 food samples were examined, with the food groups of meat and poultry (1.06 mg CML/100 g edible food), and starchy foods (0.21 mg/100 g edible food) having the highest and lowest mean CML levels, respectively. We found that the foods with the top three highest CML content were fried starch dough (cimol), fried fish crackers, and chicken gulai. The mean of the estimated values (0.80 mg CML/100 g edible food) was higher than the directly measured values (0.66 mg CML/100 g edible food), [p < 0.035]. Conclusion: This database provides information on CML values in Indonesian foods, and can be further used to make a guide policy for the selection of foods to reduce non-communicable diseases. Further measurements are needed on Indonesian dishes to complete the database.

Distinctive Microbiome Type Distribution in a Young Adult Balinese Cohort May Reflect Environmental Changes Associated with Modernization.

An important public health question is understanding how changes in human environments can drive changes in the gut microbiota that influence risks associated with human health and wellbeing. It is well-documented that the modernization of societies is strongly correlated with intergenerational change in the frequency of nutrition-related chronic diseases in which microbial dysbiosis is implicated. The population of Bali, Indonesia, is well-positioned to study the interconnection between a changing food environment and microbiome patterns in its early stages, because of a recent history of modernization. Here, we characterize the fecal microbiota and diet history of the young adult women in Bali, Indonesia (n = 41) in order to compare microbial patterns in this generation with those of other populations with different histories of a modern food environment (industrialized supply chain). We found strong support for two distinct fecal microbiota community types in our study cohort at similar frequency: a Prevotella-rich (Type-P) and a Bacteroides-rich (Type-B) community (p < 0.001, analysis of similarity, Wilcoxon test). Although Type-P individuals had lower alpha diversity (p < 0.001, Shannon) and higher incidence of obesity, multivariate analyses with diet data showed that community types significantly influenced associations with BMI. In a multi-country dataset (n = 257), we confirmed that microbial beta diversity across subsistent and industrial populations was significantly associated with Prevotella and Bacteroides abundance (p < 0.001, generalized additive model) and that the prevalence of community types differs between societies. The young adult Balinese microbiota was distinctive in having an equal prevalence of two community types. Collectively, our study showed that the incorporation of community types as an explanatory factor into study design or modeling improved the ability to identify microbiome associations with diet and health metrics.

Effectiveness of optimized food-based recommendation promotion to improve nutritional status and lipid profiles among Minangkabau women with dyslipidemia: A cluster-randomized trial.

BACKGROUND: In women of Minangkabau ethnicity, a high prevalence of dyslipidemia, overweight, and obesity is thought to be closely related to poor dietary practices. Promotion of local specific food-based recommendations (FBRs) was previously found to be effective in improving dietary practice and nutrient intakes related to dyslipidemia. This study aimed to describe the effects of the FBR promotion on the nutritional status and lipid profiles of Minangkabau women with dyslipidemia. METHODS: We used a cluster-randomized design with a total subject of 123 Minangkabau women of reproductive age with dyslipidemia. They were recruited from 16 sub-villages and assigned to either the FBR group (n = 61) or the non-FBR group (n = 62). Data on body weight, height, waist circumference, and lipid profiles were collected at the baseline and the end of the trial. Linear mixed model analysis was used to analyze the effect of the intervention on nutritional status and lipid profiles. RESULTS: The mean effect (95% confidence interval) of the intervention on body weight, body mass index, and waist circumference for the FBR group versus the non-FBR group were -1.1 (-1.8; -0.39) kg, -0.43(-0.76; -0.11) kg/m2 and -2.1(-3.7;-0.46) mm respectively (p <0.05). The Castelli's index in the FBR group improved, but there was no significant between-group difference in the change of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides at the end of the intervention. CONCLUSION: The promotion of the FBRs positively impact the nutritional status but did not significantly affect the blood lipid profile of Minangkabau women with dyslipidemia. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov Protocol Registration and Result System (PRS) as NCT04085874, in September 2019.

The prevalence of oral high-risk HPV infection in Indonesian oral squamous cell carcinoma patients.

OBJECTIVES: The objective of this study was to report the integrated observations of high-risk HPV-related oral squamous carcinoma (OSCC) at our national referral center for cancer, the Dharmais National Cancer Hospital (DNCH), Jakarta, from 2003 to 2013. MATERIALS AND METHODS: Seventy-eight formalin-fixed paraffin-embedded specimens obtained from OSCC cases were collected from 2003 to 2013 DNCH archives and were included in this high-risk HPV (HR-HPV) study. Seventy-nine DNA samples from the normal oral mucosa of healthy individuals were obtained from the Oral Biology Laboratory DNA archives from 2001 to 2005. Glyceraldehyde 3-phosphate dehydrogenase was used as a control to ensure the DNA integrity for the subsequent HPV DNA PCR detection. High-risk HPV16/18 DNA amplification was conducted by nested PCR using two pairs of primers that were designed specifically to identify the region of gene L1 HPV16 and the HPV16/18 region. RESULTS AND CONCLUSIONS: A high prevalence of HPV16/18 was detected in OSCC cases (17.9%). HPV18 occurred more often than HPV16 (86%) among OSCC patients who were HPV positive. This result supports high HPV18 prevalence among Indonesian cervical cancer patients studied in 1995 and 2006. The prevalence of high-risk HPV remains low in the normal Indonesian population (3.8%), but HPV16 is consistently more frequently detected in non-cancer populations.

Promotion of optimized food-based recommendations to improve dietary practices and nutrient intakes among Minangkabau women of reproductive age with dyslipidemia.

BACKGROUND AND OBJECTIVES: Using a linear programming approach, an optimized food-based recommendations (FBRs) had been formulated for Minangkabau women of reproductive age with dyslipidemia in Indonesia. This study aimed to assess the effectiveness of the promotion of the FBRs for improving dietary practices and nutrient intakes. METHODS AND STUDY DESIGN: A community-based, clustered-randomized trial was conducted among Minangkabau women of reproductive age (20-44 years) with dyslipidemia. The subjects were assigned either into the FBR group (n=48), or the non-FBR group (n=54). Baseline and end-line dietary data were assessed through interviews using a one-week semiquantitative food frequency questionnaire (SQ-FFQ) and two replicate 24-hour dietary recalls. The changes in dietary practice and nutrient intakes were analysed using ANCOVA test. RESULTS: Significant changes were observed (p<0.005) in the consumption of the promoted food items and subgroups (sea fish, soy protein, dark green leafy vegetables, and potatoes). Significant changes were also observed in nutrient intake, especially energy intake from carbohydrates and unsaturated fatty acids (total PUFA, MUFA, n-3 and n-6 fatty acids), as well as the dietary P/S ratio and fiber intake. CONCLUSIONS: With current dietary practices, intakes of some typical problem nutrients such as n-6, zinc, iron, and fiber still could not achieve 100% of the RNIs, while the intake of SFA still exceeded the recommended intake. Further approaches are needed to expand the population food basket and promote behavioral change to address established cultural food habits, including reducing the use of cooking oil in food preparation and increasing vegetable consumption.

Influence of Micronutrient Consumption by Tuberculosis Patients on the Sputum Conversion Rate: A Systematic Review and Meta-analysis Study.

BACKGROUND: infectious disease is one of the global health challenge in the world, including tuberculosis. Some factors significantly associated with increased treatment success, including the duration of treatment or treatment compliance, use more than three sensitive drugs, individualized regimen, and weight-related to micronutrient. METHODS: a systematic review and meta-analysis study of randomized control trial studies conducted and reported by preferred reporting items for systematic reviews and meta-analyses. The primary data source was online publications, consist of three bases data, which subscribed by Universitas Indonesia, they are Proquest, EBSCO CINAHL, EBSCO Dentistry. Risk of bias was assessed using the Cochrane risk-of-bias tool, and data were analyzed using Review Manager 2015. RESULTS: there were eight full paper rates as relevant studies. There was a significant difference of effect among the intervention group compared the control group (or placebo group). RR of the pooled estimate was 1.12 (95% CI: 1.06 - 1.18) with heterogeneity study 36%. While, the poled calculated based on type of micronutrient from seven studies showed there was no difference of sputum conversion between Vitamin D and placebo group (RR-1.05, 95% CI 0.99 - 1.12) with heterogeneity study 0% and a significant result seems among Zinc and Retinol intervention (RR=1.21, 95% CI 1.09 - 1.35) with heterogeneity study 40%. CONCLUSION: micronutrient intervention during tuberculosis treatment has a positive effect toward to sputum conversion among patient. Zinc and retinol influence sputum conversion while vitamin D did not.

Food-based recommendations for Minangkabau women of reproductive age with dyslipidemia.

BACKGROUND AND OBJECTIVES: Considering the impact of unfavorable dietary practices on inadequate nutrient intake, this cross-sectional study aimed to explore dietary practices, including problem nutrients, and develop local food-based recommendations (FBRs) to improve the intake of problem nutrients among women of reproductive age (WoRA) with dyslipidemia in Minangkabau, Indonesia. METHODS AND STUDY DESIGN: The study was conducted in the Padang township inhabited mostly by the Minangkabau tribe. Accordingly, 74 WoRA with dyslipidemia completed the study. Two replicate 24-h recalls and a 5-day food record were used to assess food consumption patterns. Then, linear programming (LP) analysis using three modules of the WHO Optifood software was employed to identify problem nutrients and develop FBRs. RESULTS: Median (5th and 95th percentiles) weekly consumption frequencies for grain; meat, fish, and eggs; and added fat were 18 (14-27), 11 (6-16), and 15 (7-30), while those for fruits and vegetables were 2 (0-11) and 7 (2-16), respectively. Based on the aforementioned food pattern, PUFA (both n-3 and n-6 fatty acids), dietary fiber, iron, and zinc were identified as typical problem nutrients. The final FBR emphasized on incorporating locally available nutrient-dense foods, as well as food groups and sub-groups, which would improve the intake of problem nutrients. CONCLUSIONS: Minangkabau WoRA have dietary practices that predispose them to dyslipidemia. Moreover, the LP approach is a sensitive tool for identifying nutrient-dense foods that could potentially improve problem nutrient intake, as well as those that need to be limited in the final FBR.

Intake of essential fatty acids in Indonesian children: secondary analysis of data from a nationally representative survey.

Essential fatty acids (EFA) such as α-linolenic acid (ALA) and linoleic acid (LA) are needed for healthy growth and development of children. Worldwide, reliable intake data of EFA are often lacking. The objective of this study was to investigate dietary intake of EFA in Indonesian children. Dietary intake data of 4-12-year-old children (n 45,821) from a nationally representative Indonesian survey were used to estimate median intake and distribution of population fatty acid intake. Missing data on individual fatty acids in the Indonesian food composition table were complemented through chemical analyses of national representative food samples and imputation of data from the US nutrient database. Nutrient adequacy ratios were calculated as a percentage of FAO/WHO intake recommendations. The medians of total fat intake of the children was 26·7 (10th-90th percentile 11·2-40·0) percentage of total daily energy (%E). Intakes of fatty acids were 4·05 (10th-90th percentile 1·83-7·22) %E for total PUFA, 3·36 (10th-90th percentile 1·14-6·29) %E for LA and 0·20 (10th-90th percentile 0·07-0·66) %E for ALA. Median intake of PUFA was 67 % and that of ALA 40 % of the minimum amounts recommended by FAO/WHO. These data indicate that a majority of Indonesian children has intakes of PUFA and specifically ALA that are lower than recommended intake levels. Total fat and LA intakes may be suboptimal for a smaller yet considerable proportion of children. Public health initiatives should provide practical guidelines to promote consumption of PUFA-rich foods.

Decidual dendritic cells 10 and CD4+CD25+FOXP3 regulatory T cell in preeclampsia and their correlation with nutritional factors in pathomechanism of immune rejection in pregnancy.

BACKGROUND: Immune intolerance is thought to be the underlying cause of immune rejection to fetus in preeclampsia. Decidual dendritic cell-10 (DC-10) and T regulator cell (Treg) play important role to create tolerogenic environment during pregnancy. However, their roles on the specific pathomechanism of preeclampsia along with various nutritional factors have not been widely studied. AIM: To determine the number of DC-10 and Treg in preeclampsia and their correlations with decidual nutritional factors. METHOD: This was a cross-sectional study among early onset preeclampsia (EOPE), late onset preeclampsia (LOPE), and normotensive (NT) pregnancies. Decidual specimens were obtained by curettage after caesarean section. The number of DC-10 and Treg cells were counted using flow cytometry. The levels of nutritional factors (zinc, retinol, all-trans retinoic acid, vitamin D) were determined using ICP-MS and LC-MS method. RESULT: A total of 14 subjects for each group were included in the study. The DC-10 was significantly lower in both EOPE and LOPE compared to NT (p < 0.001). Treg cells were significantly higher in EOPE compare to NT (p = 0.015). There was a moderate correlation between zinc level and DC-10 (p = 0.011) and a strong correlation between retinol level and DC-10 (p = 0.002) in the NT group. A moderate correlation was found between vitamin D level and Treg cells in the NT group (p = 0.026). CONCLUSION: There was a lower number of DC-10 and higher number of Treg cells in early preeclampsia. There was no correlation between DC-10 and Treg number with decidual nutritional factors in preeclampsia.

Prevalence of tuberculosis infection and its relationship to stunting in children (under five years) household contact with new tuberculosis cases.

BACKGROUND: Children who inhabit the same house with tuberculosis (TB) patients are at high risk for infection and illness with TB. Nutritional status (stunting) in children is related to the child's ability to withstand MTB (Mycobacterium Tuberculosis). This study aims to estimated the prevalence of tuberculosis infection and its relationship to stunting in children (under five years) with household contact (HHC) with new TB cases. METHODS: A cross-sectional design was implemented. Conducted in July 2018-April 2019 at 13 Public Health Center in Makassar City. The sample size was calculated using one sample situation-about precision formula. Samples were children under five who had contact with new diagnosed TB cases. Tuberculosis infection was measured by TST (tuberculin skin test). Logistic regression with causal model to examine TB infection relationship with stunting and covariate variable, analyzed using Stata/MP 13.0 software. RESULTS: One hundred twenty-six (126) eligible children. Prevalence of tuberculosis infection was 38.10%. Frequency of stunted was 31 children (24.60%). Stunted nutritional status (aPR): 2.36, 95% CI 1.60-3.44), boys (aPR: 1.47, 95% CI 0.96-2.25), not getting BCG immunization (aPR: 1.58, 95%) CI 0.89-2.82), and high contact intensity (aPR: 2.62, 95% CI 1.10-6.22) best predicted the tuberculosis infection in children with TB case household contacts with a model contribution of 64%. CONCLUSION: Stunted nutritional status (moderate and severe), boys, not getting BCG immunization, and high contact intensity are the determinants of TB infection transmission in children HHC with TB. Children under five years of age who have close contact with TB cases should be targeted for priority interventions to prevent the transmission of TB infection and progressing to TB cases.

Prevalence of Blood Lead among Children Living in Battery Recycling Communities in Greater Jakarta, Indonesia.

This study aimed to assess the prevalence of blood lead levels (BLLs) among children 1 to 5 years old who reside near and distant to informally used lead-acid battery (ULAB) recycling locations and examine risk factors for elevated BLLs. A cross-sectional study was conducted in three greater Jakarta neighborhoods where informal ULAB recycling occurs. Venous BLLs among 279 children were analyzed using portable blood lead testing machines. Demographic, child activities, and sources of lead exposure inside and outside homes were assessed. Multivariate analysis was performed to evaluate factors associated with the prevalence of BLLs. Forty-seven percent of children had BLLs ≥ 5 µg/dL and 9% had BLLs ≥ 10 µg/dL. No differences in geometric mean BLLs were observed between children who lived near and distant to ULAB locations. Older child age groups [Prevalence Ratio (PR) 2.14, 95% Confidence Interval (CI) 1.16, 4.18) and low household income (PR 1.58, 95% CI 1.03, 2.40) were associated with BLLs 5-9 µg/dL. Low educational attainment of the child's father (PR 3.17, 95% CI 1.23, 8.16) and frequent outdoor child activity (PR 4.93, 95% CI 1.09, 22.21) were predictors of BLLs ≥ 10 µg/dL. This study shows the association between lead exposure among children and environmental sources. Public health officials can consider expanded surveillance, health care provider education, and development of strategies to reduce lead exposure.

Dietary and Plasma Carboxymethyl Lysine and Tumor Necrosis Factor-α as Mediators of Body Mass Index and Waist Circumference among Women in Indonesia.

Dietary and plasma carboxymethyl lysine (dCML, pCML) and plasma tumor necrosis factor-α (pTNF-α) may be associated with obesity in affluent society. However, evidence in women from low-middle income countries with predominantly traditional diets is lacking. We investigated the mediator effects of dCML, pCML and pTNF-α on body mass index (BMI) and waist circumference (WC) among Indonesian women. A cross-sectional study was conducted among 235 non-diabetic, non-anemic and non-smoking women aged 19-50 years from selected mountainous and coastal areas of West Sumatra and West Java. Dietary CML, pCML, pTNF-α were obtained from 2 × 24-h recalls, ultra-performance liquid chromatography-tandem mass spectrometry and enzyme-linked immunosorbent assay, respectively. Between-group differences were analyzed by the Chi-square or Mann-Whitney test and mediator effects by Structural Equation Modeling. The medians and interquartile-ranges of dCML, pCML and pTNF-α were 2.2 (1.7-3.0) mg/day, 22.2 (17.2-28.2) ng/mL and 0.68 (0.52-1.00) IU/mL, respectively, and significantly higher in the WC ≥ 80 cm than in the WC < 80 cm group, but not in BMI ≥ 25 kg/m2 compared to BMI < 25 kg/m2 group. Plasma CML and pTNF-α were positively and directly related to WC (ß = 0.21 [95% CI: 0.09, 0.33] and ß = 0.23 [95% CI: 0.11, 0.35], respectively). Dietary CML that correlated with dry-heat processing and cereals as the highest contributions was positively related to WC (ß = 0.33 [95% CI: 0.12, 0.83]). Ethnicity, level of education, intake of fat, and intake of energy contributed to dCML, pCML and pTNF-α, and subsequently affected WC, while only ethnicity contributed to BMI through dCML, pCML and pTNF-α (ß = 0.07 [95% CI: 0.01, 0.14]). A positive direct effect of dCML on pCML and of pCML and pTNF-α on WC was seen among Indonesian women. Dietary CML seems to have several paths that indirectly influence the increases in WC if compared to BMI. Thus, intake of CML-rich foods should be reduced, or the foods consumed in moderate amounts to avoid the risk of central obesity in this population.

Oral Contraceptive and Breast Cancer Risks: a Case Control Study in Six Referral Hospitals in Indonesia

Objective: This study aimed to understand the effects of the use of oral contraceptive to breast cancer risk in six referral hospitals in Indonesia. Methods: The research design was hospital based case-control, conducted in 2013. Population was women patients aged 15 years and above in six cancer-referral hospitals in five provinces. Total of 762 people were included in this study consisting of 381 who are diagnosed with breast cancer as confirmed by histopathologic examination in inpatient surgery ward, and 381 people who are not diagnosed with breast cancer based on interview in outpatient surgery ward as control group. A set of data were collected including the use of oral contraceptives, age, early menarche, childbirth status, breastfeeding status, obesity, unhealthy diet, history of benign breast tumors, family history of breast cancer, and age of menopause. Result: Results showed that Odds Ratio (OR) of patients using oral contraceptive <6 years was 1.93 (95% CI 1.23 ­ 3.03) and OR of those using oral contraceptive ≥ 6 years was 2.90 (95% CI 1.65­ 5.09) as compared to people who did not use oral contraceptive. Conclusion: Use of oral contraceptive in patients was indicated to increase the risk of breast cancer. Longer the duration of using oral contraceptive tend to have higher the risk of breast cancer.

From the Millennium Development Goals to Sustainable Development Goals.: The response to the HIV epidemic in Indonesia: challenges and opportunities.

Since the first case was reported in 1981, the Indonesian government and civil society have implemented many initiatives to respond to the HIV/AIDS epidemic. From an historical perspective, the country now has the means to rapidly diagnose cases of HIV infection and provide antiretroviral therapy. The concern expressed by international health agencies about a potential major HIV epidemic in the country has not been confirmed, as evidenced by a slowing down of the number cases. The threat from non-sterile needle sharing has been relatively well controlled through harm-reduction programmes; however, drug trafficking remains a challenge. It has reached worrying levels and involves law enforcement units at the forefront of the battle. In parallel, the level of condom use in high-risk behaviour groups seems unsuccessful in reducing infection rates, especially among heterosexuals. The lack of information and the high mobility of the groups at risk of acquiring HIV infection have created tremendous challenges for outreach programmes. Heterosexual transmission represents the most important route of transmission in the country. When reflecting on the country's 2014 Millennium Development Goals, condom use during high-risk sex only reaches 43.5%, and only 21.3% of young people have a comprehensive knowledge about HIV/AIDS. The 2030 Millennium Development Goal Agenda offers an opportunity to catch up on goals that still need to be achieved. Therefore, efforts are underway to try to halt the epidemic by 2030 and also to ensure that all high-risk populations are included in this effort.

Relationship between intra-household food distribution and coexistence of dual forms of malnutrition.

BACKGROUND/OBJECTIVES: The relationship between food intake and nutritional status has been clearly established. Yet, there are only limited studies on food intake among family members and their nutritional status. The study examined the relationship between intra-household food distribution and coexistence of dual forms of malnutrition (DFM) in the same household. SUBJECTS/METHODS: Households with a malnourished child and overweight mother were categorized as DFM. Intra-household food distribution among family members was reported using ratios, which are a measure of individual intakes as compared to all household member intakes adjusted to RDA. RESULTS: A 1,899 families were included in the study. The prevalence of DFM was 29.8% (95%CI 26.5-31.2). Children consumed lower amounts of energy (OR 1.34; 95%CI 1.06-1.69, P = 0.011), carbohydrates (OR 1.2; 95%CI1.03-1.61, P = 0.022), protein (OR 1.3; 95%CI 1.03-1.64, P = 0.026), and fat (OR 1.3; 95%CI 1.05-1.66, P = 0.016) than their mothers and other family members. In contrast, mothers consumed more carbohydrates than children and other family members (OR1.24; 95%CI 1.02-1.51, P = 0.03). CONCLUSIONS: This study is the first to report on the food distribution among family members and its relationship with occurrence of DFM in Indonesia. The results confirm the occurrence of an unequal food distribution between children and mothers, which increases risk of DFM in the household. The results also demonstrate that nutritional education at the household level is important to increase awareness of the impact of DFM.