High Prevalence of Prediabetes and Associated Risk Factors in Urban Areas of Pontianak, Indonesia: A Cross-Sectional Study.

Uncontrolled prediabetes can develop into Type 2 Diabetes mellitus (T2DM). The incidence of T2DM among adults in Pontianak, Indonesia was reported remarkably high. Therefore, this study aimed to investigate the risk factors for prediabetes in adults living in urban areas of Pontianak, Indonesia. A cross-sectional study was conducted in 5 subdistricts of Pontianak. A total of 506 adults underwent screening to obtain subjects with fasting blood glucose (FBS) of ≤124 mg/dL and aged >30 years. Blood pressure and body mass index (BMI) were measured. Interview using a structured questionnaire were performed to obtain data on predictor variables (age, sex, education, income, health insurance, tobacco use, history of hypertension, gout, high cholesterol level, frequency of exercise per week, and diabetic education). The prevalence of prediabetes among subjects was significantly high (76.4%). Subjects were predominantly above 40 years, female, had low income, low education level, and had health insurance. About a third of the subjects had a history of hypertension, gout, and high cholesterol level, respectively. The exercise frequency was mostly less than 3 times/week, and the BMI was mainly classified as overweight and obese. The result of spearman's rho correlation showed that age (r = 0.146; p=0.022) and BMI (r = 0.130; p=0.041) significantly correlated with prediabetes incidence. Moreover, the chi-square analysis demonstrated that health insurance ownership (OR = 4.473; 95% CI 1.824-10.972; p ≤ 0.001), history of hypertension (OR = 3.096; 95% CI 1.542-6.218; p=0.001), and history of gout (OR = 2.419; 95% CI 1.148-5.099; p=0.018), were associated with prediabetes incidence. For all these significant risk predictors except BMI, the significant associations were found only among female subjects after specific sex analysis. Moreover, multivariate logistic regression showed that health insurance ownerships (OR = 5.956; 95% CI 2.256-15.661; p ≤ 0.001) and history of hypertension (OR = 3.257; 95% CI 1.451-7.311; p=0.004), and systolic blood pressure (OR = 2.141; 95% CI 1.092-4.196; p=0.027) were the risk factors for prediabetes. It is concluded that the prevalence of prediabetes is probably high especially among urban people in Pontianak, Indonesia. Health insurance ownership and hypertension may have an important role in prediabetes management. The risk factors might be different between male and female.

Effect of zinc and vitamin A supplementation on immune responses in Indonesian pre-schoolers.

BACKGROUND AND OBJECTIVES: Vitamin A and zinc are interrelated, but the effects of zinc on vitamin A supplementation on morbidity are inconsistent and not well understood. We investigated the effects of zinc and vitamin A supplementation on immune responses in Indonesian pre-schoolers. METHODS AND STUDY DESIGN: In a twostage study design, 826 children (2-5year old) were randomly assigned to receive daily zinc supplement (10 mg) or placebo for 4 months. At 2 months, both groups received a 200,000 IU vitamin A capsules through national vitamin A program. Data were collected at baseline, two and four months, resulting in 4 groups for comparisons: - no zinc no vitamin A (Placebo), zinc only, vitamin A only, and zinc plus vitamin A. Hair, blood and saliva samples were collected to measure hair zinc and serum retinol (vitamin A) concentration, ex-vivo IFN-γ, serum IgG and salivary IgA from 81 children selected randomly from each group. RESULTS: At baseline, there were no differences between treatment groups. Zinc supplementation increased ex-vivo IFN-γ production, greatest amongst boys, younger (<3.5 years), normal weight and children with low baseline retinol concentration. Vitamin A supplementation increased IFN-γ only in those with low baseline retinol, with no effect on serum IgG and salivary IgA. After vitamin A supplementation, zinc had an effect on salivary IgA among younger and underweight children. CONCLUSIONS: Zinc supplementation increased IFN-γ (cellular immune responses) and modified the effect of vitamin A supplementation on salivary IgA (mucosal innate immune response) in younger and underweight children.

To What Extent Do Ecological Factors of Behavior Contribute to the Compliance of the Antenatal Care Program in Dumai City, Indonesia?

PURPOSE: Maternal mortality rate (MMR) in Indonesia is still relatively high, at 305 per 100.000 live births (2015). Routine visit to antenatal care is the best way to reduce MMR. Inspite of this, the number of antenatal care visits among pregnant women is still low. This study aimed to measure the influence of behavioral ecological factors with the compliance of pregnant women to visit antenatal care. PATIENTS AND METHODS: Study population was pregnant women living in Dumai City, Indonesia. This study was a quantitative research design with a cross-sectional. We used the cluster system to select participants. A total of 369 subjects participated with a gestation age between >12 until 40 weeks. The data were collected by face-to-face interviews using validated questioners. The analysis was done by bivariate analysis using the Spearman correlation test. Multivariate using multiple linear regression. RESULTS: This study showed that factors of the ecological model of behavior were related to antenatal care compliance (p value<0.05) with a coefficient correlation (0.330-0.569). Multivariate analysis showed that all variables associated significantly (adjusted R2; 0.104-0.311). Five variables were dominant; knowledge, cultural beliefs, family support, friend support, and health facilities with adjusted R2= 0.518. CONCLUSION: Five factors in an ecological model of behavior, such as knowledge, cultural beliefs, family support, friend support, and health facilities, proportion (51,8%) of contributing to antenatal care compliance. We recommend a health district program to make services more accessible to pregnant women. Health education programs need to increase the knowledge of pregnant women and families to provide support in antenatal care compliance. Local governments shall improve antenatal care quality by mapping, planning, and evaluating this program.

Pesticide Exposure and Stunting among Children in Agricultural Areas.

BACKGROUND: The prevalence of growth disorders among school-aged children in Indonesia is high (30.7%). Pesticides have been massively used in Indonesian agricultural areas. OBJECTIVE: To determine if exposure to pesticides is associated with stunting among children in agricultural areas. METHODS: This case-control study included 160 children (48 cases and 112 controls) aged 8-12 years. Exposure to pesticides was measured based on the history of the exposure since perinatal period, infancy, and childhood of the participants. Stunting was determined as a height for age z-score (HAZ) < ­2 SD. Other variables measured were levels of thyroid stimulating hormone (TSH), insulin-like growth factor-1 (IGF-1), hemoglobin, zinc, albumin, nutrient adequacy level (energy and protein), and history of infection, low-birth weight (LBW), and mother's height. RESULTS: There were no significant difference between the cases and controls in terms of in the baseline characteristics, except for the median IGF-1 level; it was significantly (p<0.001) lower in the cases (66.73 ng/mL) than the controls (112.57 ng/mL). High level of pesticide exposure (p=0.029) and low IGF-1 levels (p<0.001) were significantly associated with stunting. After adjusting for confounding variables, these variables were found to be independent risk factors for stunting in children (aOR 3.90, 95% CI 1.15 to 13.26; and aOR 8.35, 95% CI 3.65 to 19.14, respectively). CONCLUSION: Pesticide exposure could be a risk factor for the occurrence of growth disorders in children living in agricultural areas. Necessary actions should be taken to protect children living in agricultural areas from exposure to pesticides.

Iron status and hepcidin levels as potential regulators of haemoglobin homeostasis in overweight and obese women of childbearing age.

OBJECTIVES: Overweight is considered a risk factor for anaemia. However, the mechanisms underlying anaemia development in overweight and obese people remain unclear. This study analysed the correlation of iron status (soluble transferrin receptor [sTfR]/log ferritin ratio) and hepcidin levels with haemoglobin (Hb) levels in overweight and obese women of childbearing age. METHODS: In this cross-sectional study, we recruited 66 women aged 20-29 years with a body mass index ≥23 kg/m2. We gathered data on informed consent, demographic characteristics, questionnaire responses, anthropometric and laboratory values. A Spearman correlation test was performed to determine the correlation. RESULTS: The mean levels of ferritin and sTfR were 10.2 ± 8.12 and 22.2 ± 7.96 ng/ml, respectively, and the mean sTfR/log ferritin ratio was 29.3 ± 17.65 nmol/L. The mean hepcidin levels were 9.0 ± 3.05 ng/ml. In total, 75.8% of subjects had low ferritin levels, high sTfR (51.5%) levels, and a high sTfR/log ferritin ratio (87.9%). The sTfR levels (r = -0.359; p = 0.003) and sTfR/log ferritin ratio (r = -0.375; p = 0.002) were negatively correlated with Hb levels. There was no correlation between the levels of hepcidin and Hb (r = -0.140; p = 0.264), but there was a positive correlation between ferritin and Hb levels (r = 0.350; p = 0.004). CONCLUSION: This study showed a correlation between iron status and Hb levels in overweight and obese women of childbearing age. All the women had erythropoiesis with iron deficiency anaemia. We recommend that overweight and obese women undergo further iron parameters for the detection of early anaemia. In this group, the consumption of foods that enhance iron absorption, such as ascorbic acid, should be encouraged.

The role of uncoupling protein 2 and 3 genes polymorphism and energy expenditure in obese Indonesian children.

AIM: Uncoupling protein (UCP) genes, which may contribute to energy metabolism in mitochondria, may be involved in the pathogenesis of obesity. We analyzed the differences in energy expenditure between single nucleotide polymorphisms (SNPs) UCP3-55C/T, UCP3 Y210Y, and UCP2 A55V among Indonesian children. METHODS: The study included 76 schoolchildren (36 obese and 40 healthy; mean age, 12.8 years) in Semarang, Indonesia. Body composition was measured by bioelectrical impedance analysis; resting energy expenditure (REE) by indirect calorimetry; physical activity by uniaxial accelerometer; and total energy expenditure (TEE) by the equations extrapolated from REE and physical activity. UCP3-55C/T, UCP3 Y210Y, and UCP2 A55V were examined by restriction length fragment polymorphism analysis. RESULTS: The TEE of the subjects with the T/T genotype at UCP3-55C/T after adjusting for fat-free mass (63.2±7.2 kcal/kg/day) and T/T at UCP2 A55V (62.8±5.6 kcal/kg/day) was lower than that of the subjects with the C/C and C/T genotypes (p<0.05). The REE of the subjects with these T/T genotypes tended to be lower than that of the subjects with C/C and C/T (p≥0.05). No significant differences in REE or TEE were found between the UCP3 Y210Y genotypes. CONCLUSIONS: The subjects with the T/T genotypes of UCP3-55C/T or UCP2 A55V had lower TEE than those with other genotypes.

Zinc combined with vitamin A reduces upper respiratory tract infection morbidity in a randomised trial in preschool children in Indonesia.

Zn supplementation has shown inconsistent effects on respiratory morbidity in young children in developing countries. Few studies have focused on upper respiratory tract infection (URTI), a frequent cause of morbidity in this group, and potential benefit from Zn supplementation or factors that influence its efficacy. We investigated the effects of Zn supplementation on URTI before and after vitamin A supplementation. This randomised double-blinded controlled Zn supplementation study was conducted on 826 children aged 2-5 years. Placebo or Zn (10 mg/d) was given in syrup daily for 4 months, with 200 000 IU vitamin A (60 mg retinol) given to all children at 2 months. Health workers visited children every 3 d for compliance and morbidity information. We found that 84 % of children experienced URTI during the study. Zn supplementation reduced the percentage of days with URTI (12 % reduction; P = 0·09), with greater impact following vitamin A supplementation (20 % reduction; P = 0·01). Vitamin A supplementation was associated with a decreased number but an increased duration of URTI episodes. We conclude that Zn combined with vitamin A supplementation significantly reduced the percentage of days with URTI in a population of preschool Indonesian children with marginal nutritional status. The results suggest that vitamin A status modifies the efficacy of Zn supplementation on URTI.