Prevalence and Factors Related to Hypovitaminosis D in Type 2 Diabetes Mellitus Patients with Depression.

BACKGROUND: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus (T2DM) and depression has not been documented. In addition, the risk factors are unknown. This study aimed to identify the prevalence of and risk factors for hypoD in patients with T2DM who also have depression. METHODS: 118 patients with T2DM who visited the outpatient endocrinology clinics at Cipto Mangunkusumo National Hospital between December 2019-September 2022 provided the clinical and demographic data for this cross- sectional study, including body mass index, blood pressure, glycosylated haemoglobin (HbA1c), lipid profiles, therapy, gender, age, marital status, and educational background. We used The Beck Depression Inventory II (BDI II) to evaluate depression. We used enzyme-linked immunosorbent assay kit to assess the dependent variable: serum vitamin D. We characterized serum vitamin D levels into three groups (normal, 30 ng/mL; insufficient, 20-29 ng/mL; deficient, 20 ng/mL). We also used analyses of variance to examine the anthropometric, clinical, and biochemical factors between the three groups. RESULTS: 118 subjects with T2DM. Their median age was 56 years old (48, 75-60 years old), with a BDI II score of 17 (15-19), and a serum concentration of vitamin D. The D level was 18.3 ng/mL (9.17-29.46 ng/mL). Only 21.8% of patients with T2DM and depression had sufficient levels of vitamin D. We used multivariable analysis of variance model to examine the associations between age, BDI II score, HbA1c, and systolic and diastolic blood pressure with vitamin D level. Age and BDI II score both had a statistically significant effect on vitamin D levels. CONCLUSION: This cross-sectional study discovered that patients with T2DM and depression had a high prevalence (77.7%) of hypoD. Age and BDI II score both affected differences in vitamin D levels with statistical significance.

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.

Proportion of malnourished ambulatory hospitalized patients based on international criteria at Cipto Mangunkusumo Hospital, Indonesia.

OBJECTIVE: Malnutrition is quite prevalent in hospitalized patients, and its diagnosis is particularly important for doctors in order to treat it accordingly. This study aims in finding the frequency of malnutrition in ambulatory hospitalized patients based on three international criteria. METHODS: The subjects of this study were hospitalized patients at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The subjects were investigated for malnutrition using World Health Organization (WHO), American Society for Parenteral and Enteral Nutrition (ASPEN), and the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition. Two hundred and twenty-nine ambulatory hospitalized patients were subject to accurate anthropometry measurements. They were analyzed for their height using Seca-360 and their weight using Seca-869, from which their body mass index could be measured. They were also examined for their handgrip strength using Jamar® Handgrip Dynamometer. The rest of the criteria were fulfilled through subjective history taking. RESULTS: The proportion of malnutrition at Cipto Mangunkusumo hospital was 20.1% when assessed using WHO malnutrition criteria. Meanwhile, about 48.5% of the subjects had malnutrition when assessed using ASPEN criteria. About 42.8% of subjects were categorized as malnutrition according to ESPEN criteria. CONCLUSIONS: The highest proportion of hospital malnutrition is based on ASPEN, followed by ESPEN, and the latter is WHO. ESPEN is more likely to capture malnutrition in chronic conditions, whereas ASPEN is more suitable in acute conditions rather than in chronic ones. ESPEN data would be more accurate when done appropriately according to its guidelines (with the use of a validated instrument).

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.

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.

Obesity risk and preference for high dietary fat intake are determined by FTO rs9939609 gene polymorphism in selected Indonesian adults.

BACKGROUND AND OBJECTIVES: Data suggest that genetic factors are associated with BMI. The fat mass and obesity- associated (FTO) gene modulates adipogenesis through alternative splicing and m6A demethylation. Individuals with FTO rs9939609 gene polymorphism have a preference for energy-dense foods. This study investigates the relationship between FTO rs9939609 and obesity and preference for dietary fat intake among selected Indonesian adults. METHODS AND STUDY DESIGN: A total of 40 non-obese and 40 obese participants aged 19-59 living in Jakarta were recruited. Body composition measurements included body weight, height, BMI, waist circumference, and body fat mass. Dietary intake was assessed using a semiquantitative food frequency questionnaire and food recall over 2 × 24-h periods. Genetic variation was determined using amplification-refractory mutation system polymerase chain reaction. RESULTS: The genotype distribution of the FTO gene (rs9939609) was at Hardy- Weinberg equilibrium (p=1) with minor allele frequency=0.19. Individuals with AT/AA genotypes had 3.72 times higher risk of obesity (p=0.009) and 5.98 times higher dietary fat intake (p=0.02) than those with TT genotype. Obese participants with the AT/AA genotypes had 1.40 times higher dietary fat intake than those with the TT genotype (p=0.016). CONCLUSIONS: These findings suggest that Indonesian adults with AT/AA genotypes of the FTO rs9939609 have higher obesity risks and preferences for high dietary fat intake than those with TT genotype.

The Effect of High Poly Unsaturated Fatty Acid (PUFA) Dietary Supplementation on Inflammatory Status of Patients with Advanced Cervical Cancer on Radiation Treatment.

AIM: to identify the effect of high-PUFA dietary supplementation on inflammatory status of patients with advanced cervical cancer. METHODS: a randomized double-blind clinical trial was conducted in patients with advanced cervical cancer who had undergone external radiation therapy at Department of Radiotherapy, Cipto Mangunkusumo Hospital, Jakarta, between April 2013 and April 2014. The inflammatory status was evaluated based on serum prostaglandin E2 (PGE2) levels using ELISA method. The dietary supplementation was isocaloric, isoprotein and contained PUFA with a ratio of -6: -3 fatty acid = 1.27:1 and supplementation without PUFA. Data were analyzed with statistical tests, including Shapiro-Wilk test, independent T-test and Mann-Whitney test. RESULTS: there was statistically no significant difference on PGE2 level between treatment and control groups (p=0.127). However, there was clinically significant difference, in which the treatment group had reduced PGE2 level by 8.9%; while the control group had increased level by 28.1%. CONCLUSION: dietary supplementation enriched with PUFA can reduce inflammatory status in patients with advanced cervical cancer. Reduced PGE2 level will lower the survival of cancer cells; therefore dietary supplementation enriched with PUFA with a ratio of -6 : -3 fatty acid = 1.27 : 1 along with radiation therapy may improve tumor response to radiation.

Dynamic Changes in Body Composition and Protein Intake in Epithelial Ovarian Cancer Patients Undergoing Chemotherapy: A Preliminary Study.

BACKGROUND: Ovarian cancer patients often face poor nutritional status, with body composition (BC) serving as a significant prognostic indicator. Skeletal muscle mass (SMM) and fat-free mass (FFM) are crucial predictors of both survival and hospitalization duration. Increasing protein intake has been linked to improvements in SMM and FFM. OBJECTIVE: This study aimed to document the alterations in BC parameters among ovarian cancer patients undergoing chemotherapy and correlate these changes with their nutrient intake. METHODS: Twelve female patients with stage III ovarian cancer who received first-line chemotherapy were categorized based on their body mass indices (BMI). BC parameters were assessed using an 8-point bioelectrical impedance analysis with a frequency of 50 Hz-60 Hz and measurement impedance range of 10 Ω-1000 Ω. Nutrient intake (energy, protein, fat, and carbohydrate) was assessed before (T0), during the 3rd (T3), and 6th cycle of chemotherapy (T6) through 24-hour food recall. RESULTS: Significant increases in body weight (BW)were observed in the underweight group (from 40.9 to 46.8 kg, p=0.001), concomitant with enhancements in all BC parameters. While changes were noted in SMM, they were not statistically significant (p=0.105).Among the underweight group, a protein intake above 1.2 g/kg BW led to an uptrend trend in SMM. Conversely, FFM in overweight/obese patients decreased significantly (from 37.6 to 36.4 kg, p=0.005) due to a a reduction in body water. Throughout chemotherapy, fat mass (FM), visceral fat (VAT), and phase angle (PhA) increased in all patient groups, reflecting heightened fat and carbohydrate intake. CONCLUSION: Among stage III ovarian cancer patients, BC undergoes dynamic changes dynamically during the course of chemotherapy, with more pronounced enhancements observed in FFM among underweight patients. Notably, improvements in PhA, SMM or FFM were particularly evident among underweight patients with a protein intake above 1.2 g/kg BW.

Higher peripheral blood mitochondrial DNA copy number and relative telomere length in under 48 years Indonesian breast cancer patients.

OBJECTIVE: Breast cancer is the leading cause of cancer incidence and mortality among Indonesian women. A comprehensive investigation is required to enhance the early detection of this disease. Mitochondrial DNA copy number (mtDNA-CN) and relative telomere length (RTL) have been proposed as potential biomarkers for several cancer risks, as they are linked through oxidative stress mechanisms. We conducted a case-control study to examine peripheral blood mtDNA-CN and RTL patterns in Indonesian breast cancer patients (n = 175) and healthy individuals (n = 181). The relative ratios of mtDNA-CN and RTL were determined using quantitative real-time PCR (qPCR). RESULTS: Median values of mtDNA-CN and RTL were 1.62 and 0.70 in healthy subjects and 1.79 and 0.73 in breast cancer patients, respectively. We found a positive association between peripheral blood mtDNA-CN and RTL (p < 0.001). In under 48 years old breast cancer patients, higher peripheral blood mtDNA-CN (mtDNA-CN ≥ 1.73 (median), p = 0.009) and RTL (continuous variable, p = 0.010) were observed, compared to the corresponding healthy subjects. We also found a significantly higher 'High-High' pattern of mtDNA-CN and RTL in breast cancer patients under 48 years old (p = 0.011). Our findings suggest that peripheral blood mtDNA-CN and RTL could serve as additional minimally invasive biomarkers for breast cancer risk evaluation.

Effect of intermittent fasting 5:2 on body composition and nutritional intake among employees with obesity in Jakarta: a randomized clinical trial.

OBJECTIVE: This study aimed to determine the effect of intermittent fasting 5:2 on body composition in employees with obesity in Jakarta. RESULTS: Fifty participants were included; 25 were allocated to the fasting group and 25 to the control group. There was no significant change in fat mass, fat-free mass, skeletal muscle, and BMI (p > 0.05). Significant in-group changes were observed in body weight (p = 0.023) and BMI (p = 0.018) in the fasting group. Dietary intake was similar before and during the intervention. The reduction in macronutrient intake resulted in a statistically significant difference in carbohydrate, protein, and fat intake in the two groups (p < 0.05). Intermittent fasting 5:2 results in weight loss but does not affect fat mass and fat-free mass reductions. None of the between-group differences were clinically relevant. TRIAL REGISTRATION: ClinicalTrials.gov with ID: NCT04319133 registered on 24 March 2020.

Ramadan fasting reduces high-sensitivity C-reactive protein among HIV-infected patients receiving antiretroviral therapy.

Background: Inflammatory conditions and oxidative stress increase in HIV infection, and inflammation increases the risk of cardiovascular disease. Ramadan fasting is known to reduce inflammation and oxidative stress in diabetic patients. This study examined the effects of Ramadan fasting on high-sensitivity C-reactive protein (hs-CRP) levels and total antioxidant status (TAOS) in HIV patients on antiretroviral therapy (ART). Methods: This was a prospective cohort study comparing HIV-infected patients on stable ART who fasted throughout Ramadan to HIV-infected patients who did not fast during Ramadan. Inclusion criteria were men aged 20-40 years, taking first-line ART for at least 6 months, Muslims intent to fast for Ramadan, no current hospitalization because of acute conditions and not being treated for opportunistic infections. Results: After 2 weeks, hs-CRP had decreased significantly in the fasting group (-0.41 mg/L [IQR = -1; 0.10]) compared to the non-fasting group (0.20 mg/L [IQR = -0.30; 1.50]) (p = 0.004). The linear regression analysis has shown that Ramadan fasting contributed to 10.10% of the variance in hs-CRP value (R 2 = 0.101) and decreased its value by 0.317 points (B = -0.317). Changes in TAOS did not significantly different (p = 0.405) between the fasting group (0.05 mmol/L [IQR = -0.03; 0.12]) and the non-fasting group (0.04 mmol/L [IQR = -0.13; 0.36]). In the fasting group, there were significant changes in polyunsaturated fatty acid consumption (p = 0.029), body weight (p = 0.001), cigarette smoking (p = 0.001), and sleeping duration (p = 0.001). Conclusion: Ramadan fasting reduces hs-CRP concentrations among HIV patients on ART.

The Association Between Triglyceride-Glucose Index as a Marker of Insulin Resistance and the Risk of Breast Cancer.

Background: This study aims to evaluate the association and dose-response between triglyceride-glucose (TyG) index and breast cancer. Method: This is a multicenter case-control study conducted in six public referral hospitals in Indonesia. Cases are individuals aged 19 years or above who were diagnosed with breast cancer within 1 year of diagnosis, based on histopathology and immunohistochemistry. Controls were recruited from corresponding hospitals. TyG index was determined by the formula: ln (fasting TG [mg/dl] × fasting glucose [mg/dl]). Results: There were 212 participants in the breast cancer group and 212 participants in the control group. TyG index was higher in patients with breast cancer (median 8.65 [7.38, 10.9] vs. 8.30 [7.09, 10.84], p < 0.001). When compared with TyG quartile of Q1, Q4 was associated with an OR of 2.42 (1.77, 3.31), p < 0.001, Q3 was associated with an OR of 1.53 (1.21, 1.93), p < 0.001, Q2 was associated with an OR of 1.39 (1.12, 1.73), p = 0.002 for the risk of breast cancer. The dose-response relationship was nonlinear (p < 0.001). On univariate analysis, smoking (OR 2.15 [1.44, 3.22], p < 0.001), use of contraception (1.73 [1.15, 2.60], p = 0.008), alcohol consumption (OR 2.04 [0.96, 4.35], p = 0.064), and TyG Index >8.87 (OR 3.08 [1.93, 4.93], p < 0.001) were associated with risk of breast cancer. Independently associated with increased risk of breast cancer included smoking (OR 1.93 [1.23, 3.01], p = 0.004), use of contraception (OR 1.59 [1.02, 2.48], p = 0.039), and TyG Index >8.87 (OR 2.93 [1.72, 4.98], p < 0.001). Conclusion: TyG index was associated with breast cancer in a nonlinear dose-response fashion.

Profiles of peptide YY and ghrelin, levels of hunger and satiety, and ad libitum intake in obese and non-obese Indonesian women.

INTRODUCTION: The current study aimed to assess profiles of peptide YY and ghrelin, visual analog scales (VAS) for hunger and satiety, and ad libitum intake in obese and non-obese women. METHODS: This open-label non-randomized interventional study involved obese (BMI ≥ 25-35 kg/m2) and non-obese (BMI 18.5-23.0 kg/m2) women subjects. Levels of peptide YY and ghrelin were determined by radioimmunoassay and enzyme-linked immunosorbent assay (ELISA), respectively, while the degrees of hunger and satiety were measured using visual analog scale (VAS) questionnaires. The results were compared in fasting condition and in 15, 60, 120, and 180 minutes after breakfast with balance composition formulation. This study also compared the ad libitum intake within 4 hours after breakfast. RESULTS: As compared to the non-obese group, the obese group have significantly lower levels of peptide YY in fasting, and in 15, 60, 120, and 180 minutes post-prandial, and smaller AUC (Area Under the Curve) of fasting peptide YY. Furthermore, the obese group showed significantly higher ad libitum intake. The obese group also have lower levels of ghrelin and lower VAS for hunger and higher in VAS for satiety as compared to the non-obese group. CONCLUSIONS: There were significant differences in peptide YY level, 4 hours after breakfast ad libitum intake, ghrelin level, and VAS for hunger and satiety, between obese group and non-obese one.

Dysregulation of Kisspeptin and Leptin, as Anorexigenic Agents, Plays Role in the Development of Obesity in Postmenopausal Women.

During the menopausal period, women have a higher tendency to develop obesity and any other metabolic syndromes. Dysregulation of leptin and kisspeptin signaling as anorexigenic agents is believed to be the connection between metabolic disorders and altered reproductive function. Therefore, this study aimed at investigating the association between leptin, soluble leptin receptor (sOBR), free leptin index, kisspeptin concentrations, and body mass index (BMI) in postmenopausal women. A cross-sectional study was carried out among 171 postmenopausal women aged 40-75 years from 2017 to 2018. Subjects were assigned into 2 groups according to their BMIs: obese group (84 subjects) and nonobese group (87 subjects). In addition to anthropometric measurement, blood sample was collected from each subject for leptin, sOBR, free leptin index (FLI), and kisspeptin evaluation. Bivariate and correlation analysis discovered that leptin and FLI were positively correlated with BMI, while sOBR and kisspeptin were negatively correlated with BMI. Among those variables, multivariate analysis found that leptin, sOBR, and kisspeptin were independently associated with obesity. Therefore, it can be concluded that higher serum leptin concentration and FLI, as well as lower serum sOBR and kisspeptin concentrations, are significantly associated with obesity in postmenopausal women.

Comparison of low calorie high protein and low calorie standard protein diet on waist circumference of adults with visceral obesity and weight cycling.

OBJECTIVES: Many individuals with visceral obesity who previously had succeeded in reducing body weight regain and this loss-gain cycle repeats several times which is called as weight cycling. We aimed to evaluate the effect of a low calorie high protein diet (HP) compared to a low calorie standard protein diet (SP) on waist circumference of visceral obese adults with history of weight cycling. RESULTS: In this open-randomized clinical trial, participants were asked to follow dietary plan with reduction in daily caloric intake ranging from 500 to 1000 kcal from usual daily amount with minimum daily amount of 1000 kcal for 8 weeks and were divided in two groups: HP group with protein as 22-30% total calorie intake; and SP group with protein as 12-20% total calorie intake. There was a statistically significant difference (P < 0.001) between waist circumference before and after the dietary intervention among both groups. Meanwhile, there was no statistically significant difference in the mean reduction of waist circumference between HP and SP groups (P = 0.073). Taken together, the protein proportion does not significantly affected waist circumference. Trial registration ClinicalTrials.gov NCT03374150, 11 December 2017.

The effect of breakfast with different macronutrient composition on PYY, ghrelin, and ad libitum intake 4 h after breakfast in Indonesian obese women.

OBJECTIVES: Gut hormones, such as PYY and ghrelin, are associated with appetite control and obesity. Protein is thought to be the most satiating nutrient and could affect the production of several gut hormones. The purpose of the current study was to find the effect of breakfast with different protein composition on PYY, ghrelin, and ad libitum intake 4 h after breakfast. RESULTS: This clinical trial involves 22 obese women participants. Subjects were given three types of breakfast: low protein consumption (12.4% protein), medium protein (23.5% protein), and high protein (40.6% protein). PYY and ghrelin levels were measured at 0, 15, 60, 120, and 180 min after breakfast. Ad libitum meal was given 4 h after breakfast and measured after. This study found that there is no significant difference in PYY and ghrelin level at each measurement time between different type of breakfast. This study also found no significant difference of ad libitum energy intake between different type of breakfast. Trial registration ClinicalTrials.gov NCT03697486, 3 December 2018. Retrospectively registered.

Low vitamin D-25(OH) level in Indonesian multiple sclerosis and neuromyelitis optic patients.

BACKGROUND: Vitamin D deficiency is commonly found in multiple sclerosis (MS) and Neuromyelitis Optic (NMO) patients and can impair the immunological status. As a tropical country, Indonesia has a lot of sunshine throughout the year as a source of vitamin D. The aim of this study was to evaluate and compare the serum vitamin D-25(OH) level in Indonesian MS and NMO patients to healthy individuals. METHODS: A cross-sectional study was conducted in Dr. Cipto Mangunkusumo General Hospital Jakarta from November 2016 to May 2017. Forty-eight patients (29 MS and 19 NMO) and 33 healthy controls were enrolled. We assessed the dietary recall, vitamin D supplementation, sunshine exposure, medication, annual relapse rate, and Expanded Disability Status Scale (EDSS). Vitamin D level was measured using direct competitive chemiluminescence immunoassay. RESULTS: Vitamin D deficiency was found in 48.4% of MS and 56.2% of NMO patients. The serum vitamin D level in MS and NMO groups was not significantly different from the healthy controls. Vitamin D level was not associated with EDSS and the annual relapse rate. Positive significant correlation was observed between sunshine exposure and vitamin D level in healthy control, but not evident in MS and NMO groups. MS and NMO subjects who still treated with corticosteroid had lower vitamin D level. CONCLUSION: Vitamin D deficiency is commonly found in Indonesian MS and NMO patients, but not associated with EDSS and annual relapse rate. Despite living in a country with adequate sunshine exposure, the physician should anticipate low serum vitamin D level, especially in MS or NMO patients who received corticosteroid.

Inadequate dietary α-linolenic acid intake among Indonesian pregnant women is associated with lower newborn weights in urban Jakarta.

BACKGROUND: Omega-3 fatty acid intake during pregnancy has been confirmed to affect newborn birth outcomes in the developed world. However, the association between maternal omega-3 fatty acid intake and birth size is unknown in developing countries. OBJECTIVE: To examine the association of maternal omega-3 fatty acid intake with newborn birth size. METHODS AND STUDY DESIGN: A cross-sectional study was conducted, involving 282 pregnant women aged 19-40 years who had a gestational age of >32 weeks and received antenatal care at 10 health centres and one referral hospital in East Jakarta, Indonesia. Maternal habitual intake of omega-3 fatty acids, including α-linolenic acid, docosahexaenoic acid, and eicosapentaenoic acid, was assessed using a semiquantitative food frequency questionnaire. Birth weight and head circumference were measured using a paediatric weighing scale and tape, respectively, and birth length was obtained from medical records. Multiple linear regression analysis was performed to provide adjusted associations. RESULTS: The median total intake of omega-3 fatty acids, docosahexaenoic acid, eicosapentaenoic acid, and α-linolenic acid was lower than the recommended dietary intake. The newborns of mothers with an α-linolenic acid intake lower than 0.82 g/d had a significantly lower (ß=114, 95% confidence interval=-216, -13.5; p=0.014) weight compared with those of mothers with high α-linolenic acid intake, after adjustment for confounding factors. CONCLUSION: Inadequate maternal intake of α-linolenic acid, but not omega-3 fatty acids, docosahexaenoic acid, or eicosapentaenoic acid, was associated with lower birth weight. Enhanced promotion of consumption of foods rich in essential fatty acids during pregnancy may facilitate attaining optimal infant weight in urban areas.

Effect of cooling of cooked white rice on resistant starch content and glycemic response.

Cooling of cooked starch is known to cause starch retrogradation which increases resistant starch content. This study aimed to determine the effect of cooling of cooked white rice on resistant starch content and glycemic response in healthy subjects. Resistant starch contents were analyzed on freshly cooked white rice (control rice), cooked white rice cooled for 10 hours at room temperature (test rice I), and cooked white rice cooled for 24 hours at 4°C then reheated (test rice II). The results showed that resistant starch contents in control rice, test rice I, and test rice II were 0.64 g/100 g, 1.30 g/100 g, and 1.65 g/100 g, respectively. Test rice II had higher resistant starch content than test rice I, hence used in the clinical study along with control rice to characterize glycemic response in 15 healthy adults. The clinical study was a randomized, single-blind crossover study. In the clinical study, test rice II significantly lowered glycemic response compared with control rice (125±50.1 vs 152±48.3 mmol.min/L, respectively; p=0.047). In conclusion, cooling of cooked white rice increased resistant starch content. Cooked white rice cooled for 24 hours at 4°C then reheated lowered glycemic response compared with freshly cooked white rice.