Understanding the pubertal, psychosocial, and cognitive developmental trajectories of stunted and non-stunted adolescents: protocol of a multi-site Indonesian cohort study.

Background: The prevalence of stunting among Indonesian children aged 5-12 years decreased from 30.7% in 2013 to 23.6% in 2018 but has remained among the highest rates worldwide. Furthermore, Indonesian children were shorter than the standard reported by the World Health Organization and experienced obesity. The Indonesian government has created many programs to reduce stunting in children under the age of 5 years. An early preventive strategy is necessary because stunting can manifest within the initial 1,000 days of life, including during pregnancy. Therefore, a newer perspective, such as that achieved by addressing stunting in adolescents, has been deemed useful, given that adolescents are in their pubertal stage and are undergoing lifestyle changes. This cohort study was designed to measure these factors comprehensively in stunted and non-stunted children as they pass through adolescence. Methods: For the prospective cohort, 560 individuals will be recruited from DKI Jakarta, DI Yogyakarta, and East Java. The participants will be categorized into stunted and non-stunted groups, then undergo annual examinations in which key objectives, such as weight, height, and body mass index ,will be assessed for the growth profile; waist circumference, middle-upper arm circumference, hand-grip strength, body fat percentage, and food intake will be evaluated in a nutritional assessment; psychosocial and mental issues will be evaluated according to behavioral problems, symptoms of depression, quality of life, sleep patterns, anxiety disorders, and parenting style through the use of specific questionnaires; and pubertal stage will be assessed using a self-report questionnaire. Some cross-sectional data, such as cognitive performance, hair zinc levels, vitamin D levels, bone mineral density, and bone age, will also be included. All the outcomes will be analyzed in accordance with the variable types. Discussion: This study provides a thorough dataset of Indonesian adolescents encompassing several elements, such as growth, nutrition, psychosocial wellbeing, mental health, and pubertal development, for both stunted and non-stunted individuals. The data acquired from this study can be used to formulate policies to prevent stunting through targeted interventions for adolescents. Finally, a better understanding of adolescent health could lead to improved strategies to decrease the number of stunted individuals in the next Indonesian generation.

Changes in Mature Human Milk Macronutrient Composition over 45 years in an Urban Population in Indonesia.

BACKGROUND: With improvement in a population's welfare, its food consumption patterns may change, including those of nursing mothers. This, in turn, could influence their human milk composition. RESEARCH AIM: To investigate the secular trend in macronutrient composition of mature human milk from mothers of healthy, full-term infants in urban populations in Indonesia from 1974 and 2019. METHOD: We compared the macronutrient composition of mature human milk of healthy full-term infants from 1974 and 2019. The data from 2019 used the Human Milk Analyzer MIRIS to quantify the milk's carbohydrate, fat, and protein content, while the historical data used methods available at that time, that is, methods described by Benedict, Gerber and Kjeldahl, respectively. RESULTS: There were no significant differences in carbohydrate, protein and fat content across categories of maternal nutritional status in the respective periods. However, the fat content of human milk from 2019 was significantly higher than that of 1974 (4.7 g/dl, SD = 1.7 g/dl vs. 3.3 g/dl, SD = 1.1 g/dl; p < 0.001), while its carbohydrate content was significantly lower (6.2 g/dl, SD = 2.1 g/dl vs. 7.1 g/dl, SD = 0.2 g/dl; p < 0.001). There was no difference in the protein content between the two periods (1.4 g/dl, SD = 0.5 g/dl vs. 1.6 g/dl, SD = 0.3 g/dl; p = 0.491). CONCLUSION: The mature human milk from 2019 has a higher fat and total energy content but lower carbohydrate content than those observed 4 decades ago. The protein content remained the same.

What Are the Various Comprehensive Treatment Models to Improve Self-Efficacy and Self-Management in Adolescents with Diabetes Mellitus? A Scoping Review.

Background: This review aimed to synthesize intervention models involving the role of adolescent and family support as part of comprehensive care to improve self-efficacy and self-management among adolescents with Diabetes Mellitus (DM). Methods: A review was conducted to conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We searched PubMed, Research Gate, Science Direct, Cochrane Library databases, and grey literature. We included articles exploring family intervention models on improving self-efficacy and self-management among adolescents with DM, published from January 1, 2009, to June 30, 2022, and in English. Articles were declared eligible, reviewed critically, and then synthesized narratively. Results: We identified 487 abstracts and title records from the initial search and excluded 409 irrelevant studies. Sixty-six full-text articles were screened, and nine were included in the synthesis. Five articles presented findings from using models focusing on child and adolescent intervention, while in the remaining four articles, the intervention models involved adolescents and their caregivers or parents. Only two models provide comprehensive care that requires collaboration among healthcare providers, patients, and families. Adolescent self-efficacy and self-management schemes as intermediary variables are closely related to everything that can influence health behavior, metabolic control, and quality of life for adolescents, which requires support from a multidisciplinary collaborative team. Conclusion: Excellent comprehensive care team collaboration involving family support is essential to increase the self-efficacy and self-management of adolescents with DM.

Serum apolipoprotein A1 and B are associated with 6-month persistent and incident diabetic macular oedema in type 2 diabetes.

AIMS: To investigate the associations of baseline apolipoprotein A1 (ApoA1) and B (ApoB) levels with persistent and incident diabetic macular oedema (DMO) after 6 months of follow-up. METHODS: This is a prospective cohort study of patients aged ≥30 years with untreated diabetic retinopathy. Examinations, fundus photography and spectral domain optical coherence tomography (SD-OCT) were assessed at baseline, 1, 3 and 6 months. Serum lipids and apolipoproteins were analysed at a pathology laboratory. DMO was confirmed using SD-OCT, classified as (1) incident DMO, (2) persistent DMO and (3) regressed DMO. Eye-specific data were used, controlling for covariates and cluster effect. RESULTS: We recruited 53 patients but only 38 completed the study [(62 eyes), 20 eyes (32.3%) with DMO]. Higher quartile of ApoA1 was associated with lower risk of persistent/incident DMO (p for trend 0.02), while higher ApoB/A1 was associated with higher risk of persistent/incident DMO (p for trend 0.02). Every 10 mg/dL increase in ApoA1 levels was associated with lower risk of persistent/incident DMO (OR 0.69; 95% CI 0.49 to 0.92; p value 0.016), whereas every 0.2 increase in ApoB/A1 was significantly associated with higher risk of persistent/incident DMO (OR 1.4; 95% CI 1.1 to 1.9; p value 0.013) at the end of the study. CONCLUSION: Individuals with diabetes with higher ApoA1 had lower risk of persistent/incident DMO and those with higher ApoB/A1 had higher risk of persistent/incident DMO at the end of 6 months. These suggest that serum ApoA1 and ApoB/A1 levels may be important risk factors for DMO and could be predictive of persistent/incident DMO despite anti-vascular endothelial growth factor treatment.

Survival of Rheumatic Heart Disease in Indonesian Children.

Background: Rheumatic heart disease (RHD) remains a preventable cause of cardiovascular deaths in children in low- and middle-income countries. However, long-term outcome data of children with RHD is still lacking in Indonesia. Objective: To investigate the long-term outcomes of RHD, particularly the survival rates and the predictors. Methods: A retrospective cohort study was done in children aged less than 18 years old admitted with RHD at a tertiary hospital (Dr. Sardjito Hospital, Indonesia) from 2011-2021. Survival time was estimated from the date of first diagnosis of RHD to the survival endpoint (date of mortality or censoring). Kaplan-Meier curves, log-rank test and Cox-regression analysis were used for survival analysis and the predictors. Results: A total of 155 patients admitted with RHD during the study period. Of these, 14 (9.0%) deaths were reported as RHD related mortality with the mean age ± standard deviation of 11.9 ± 2.9 years. Median follow up period was 16 months. The survival rate at 1, 4, and 8 years were 93%, 86.1% and 60%, respectively. Survival was lower in patients with severe valve lesions and NYHA functional class III-IV at the time of diagnosis. Multivariate Cox-regression analysis showed the significant predictors for mortality were poor adherence to penicillin and congestive heart failure, HR 12.7 (95%CI 1.4-113.5) and 18.6 (95%CI 1.8-185.0) respectively. Conclusion: Approximately, only six in 10 children are able to survive at eight years after diagnosis. Poor adherence to penicillin and congestive heart failure were predictors for death. This study emphasizes the needs to improve the adherence of children with RHD and early detection of subclinical carditis in children.

Vitamin D deficiency in South-East Asian children: a systematic review.

OBJECTIVE: To describe the prevalence and determinants of vitamin D deficiency (VDD) among healthy children aged between 0 and 18 years living in South-East Asia (SEA). DESIGN: We systematically searched Ovid MEDLINE and Ovid EMBASE for observational studies assessing VDD among healthy children in the SEA region as the primary or secondary outcome from database inception to 6 April 2021. PubMed was used for e-pubs and publications not indexed in Medline. Publications that included abstracts in English were included. We performed a systematic review to describe the prevalence of VDD in SEA children. RESULTS: Our initial search identified 550 publications with an additional 2 publications from manual screening. Of those, 21 studies from 5 different countries (Thailand, Indonesia, Vietnam, Malaysia and Cambodia) were summarised and included in forest plots. The prevalence of VDD (<50 nmol/L) ranged from 0.9% to 96.4%, with >50% of newborns having VDD, and severe VDD (<30 nmol/L) ranged from 0% to 55.8%. Female sex and urban living were the most common determinants of VDD. CONCLUSIONS: VDD among healthy children living in the SEA region is common. Efforts to detect VDD and the implementation of preventive measures, including education on safe sun exposure and oral vitamin D supplementation or food fortification, should be considered for key target groups, including adolescent females and pregnant and lactating women to improve the vitamin D status of newborns. PROTOCOL REGISTRATION NUMBER: This study is registered with PROSPERO (CRD42020181600).

Hybrid learning method based on feature clustering and scoring for enhanced COVID-19 breath analysis by an electronic nose.

Breath pattern analysis based on an electronic nose (e-nose), which is a noninvasive, fast, and low-cost method, has been continuously used for detecting human diseases, including the coronavirus disease 2019 (COVID-19). Nevertheless, having big data with several available features is not always beneficial because only a few of them will be relevant and useful to distinguish different breath samples (i.e., positive and negative COVID-19 samples). In this study, we develop a hybrid machine learning-based algorithm combining hierarchical agglomerative clustering analysis and permutation feature importance method to improve the data analysis of a portable e-nose for COVID-19 detection (GeNose C19). Utilizing this learning approach, we can obtain an effective and optimum feature combination, enabling the reduction by half of the number of employed sensors without downgrading the classification model performance. Based on the cross-validation test results on the training data, the hybrid algorithm can result in accuracy, sensitivity, and specificity values of (86 ± 3)%, (88 ± 6)%, and (84 ± 6)%, respectively. Meanwhile, for the testing data, a value of 87% is obtained for all the three metrics. These results exhibit the feasibility of using this hybrid filter-wrapper feature-selection method to pave the way for optimizing the GeNose C19 performance.

The association between dietary intake and cardiometabolic risk factors among obese adolescents in Indonesia.

BACKGROUND AND OBJECTIVE: Poor diets, characterized by excess fat, sugar and sodium intakes, are considered to be one of the most important modifiable risk factors for cardiovascular disease. Diet patterns and intakes during adolescence may persist into adulthood and impact on risk for chronic disease later in life. We aimed to evaluate the dietary intake of obese adolescents and its relationship to cardiometabolic health including lipid status and glycemic control. METHODS AND STUDY DESIGN: This was a cross-sectional study of obese children aged 15 to < 18 years in Yogyakarta, Indonesia. All children had a medical history performed including a physical examination and fasting blood sample. Dietary intake was assessed using a semi-quantitative recall food frequency questionnaire. Multivariable linear regression model was performed to determine the relationship between dietary intakes and cardiovascular disease risks and to adjust for potential confounders. RESULTS: Of 179 adolescents, 101 (57.4%) were male and median age was 16.4 (15.0-17.9) years. The majority of adolescents (98%) had inadequate intake of fibre and exceeded intakes of total fat (65%) and total sugar (36%). There was statistically significant correlation found in the multivariable linear regression analysis between fibre intake and HDL cholesterol after adjusting for potential confounders (ß = 0.165; p = 0.033). CONCLUSIONS: This study demonstrates that there is a high proportion of obese Indonesian adolescents with poor dietary intakes. There was relationship observed between intake of nutrients of concern (fibre) and cardiometabolic risk factor among this sample of obese adolescents. Future research should examine overall dietary patterns in more detail among this population to elucidate the role of poor diet intakes in development of cardiovascular disease risk factors in young people transitioning into adulthood.

Secular trends in Javanese adult height: the roles of environment and educational attainment.

BACKGROUND: Since its independence in 1945, Indonesia has undergone rapid socioeconomic development. The fastest changes occurred in Java, which is the main island where more than half of the Indonesian population lives. OBJECTIVE: This study aimed to analyze the secular trend in the height of adults living in Java born between 1953 and 1995 by comparing their residence (rural, small city, or large city) and considering factors that contribute to adult height. METHODS: The analysis used the following data: birth year, body height, weight, body mass index, sex, educational attainment, share of household food expenditures, and residence of 20- to 40-year-old men and women collected by the Indonesia Family Life Survey (IFLS) waves 1 to 5. Multiple linear regression was conducted to analyze several factors that influence adult height. Significance was set at p < 0.05 with a 95% confidence interval (CI). RESULTS: The study included 30,656 measurements of individuals born between 1953 and 1995 (54.9% female). Positive secular trends (95% CI) were observed for men and women: 1.3 (1.1-1.4) cm and 0.9 (0.8-1.0) cm per decade, respectively. Multiple linear regression analyses showed that, in addition to the year of birth, the adult height of both males and females was independently associated with level of education and share of household food expenditure. Stratifying the data into residence in rural areas, small cities, and large cities showed that education levels influenced the adult height of men and women living in all regions, whereas the influence of birth year and share of household food expenditure differed between areas and genders. CONCLUSIONS: We observed positive secular trends in the height of adults living in Java who were born between 1953 and 1995. The birth year, educational attainment, and share of household food expenditure significantly influenced adult height. A higher education level was consistently associated with taller adult height in both men and women living in rural areas, small cities, and large cities.

Growth of exclusively breastfed small for gestational age term infants in the first six months of life: a prospective cohort study.

BACKGROUND: Compared to their appropriate-for-gestational-age (AGA) peers, small-for-gestational-age (SGA) infants are prone to growth deficits. As the first 6 months of exclusive breastfeeding is generally recommended, it is essential to understand how this intervention might impact SGA infants' growth. This study aims to assess growth of exclusively breastfed SGA term infants in the first 6 months of life. METHODS: A prospective cohort study was conducted on term infants born in Dr. Sardjito General Hospital and two private hospitals in Yogyakarta, Indonesia. SGA was defined as birth weight less than the 10th percentile according to Fenton criteria. Weight, length, and head circumference (HC) were measured at birth and monthly until 6 months old. RESULTS: A total of 39 AGA and 17 SGA term infants who were exclusively breastfed in their first 6 months were included and followed. In SGA compared to AGA, birth weight, length, and HC (mean ± SD) were significantly lower (p < 0.001). During the first 6 months, the SGAs grew in weight and length in parallel with the AGAs. At sixth months of age, the weight and length (mean ± SD) of the SGAs were significantly lower compared to the AGAs (p < 0.001). However, HC (mean ± SD) of SGAs grew significantly faster than the AGAs (p < 0.005). At sixth months of age, there were no significant differences in HC between the two groups (p = 0.824). CONCLUSIONS: In the first 6 months, exclusively breastfed SGA term infants, in contrast to weight and length, only show catch up growth in HC, leading to HC comparable to their AGA peers at the age of 6 months.

Sex differences in the association of vitamin D and metabolic risk factors with carotid intima-media thickness in obese adolescents.

BACKGROUND: It has been shown that vitamin D is associated with obesity and the development of atherosclerosis. Less is known about this association among adolescents with obesity. OBJECTIVES: To determine the association of vitamin D level and metabolic risk factors with carotid intima-media thickness (CIMT) among obese adolescents. METHODS: We conducted a cross-sectional study among obese children aged 15 to 17 years in Yogyakarta, Indonesia. The association of vitamin D and other metabolic risk factors (triglyceride, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), and insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR)) with CIMT was explored by multivariable linear regression models. RESULTS: Out of 156 obese adolescents, 55.8% were boys. Compared to girls, boys had higher BMI z-score, waist circumference, and HDL-cholesterol. After adjustment for age, sex and second-hand smoke exposure, high HOMA-IR, total cholesterol, LDL-cholesterol and triglyceride levels were associated with higher odds of elevated CIMT. In analyses stratified by sex, a similar trend was observed in boys, while none of the risk factors were associated with CIMT in girls. We observed no association between vitamin D and CIMT. CONCLUSIONS: Hyperinsulinemia, higher total cholesterol and LDL cholesterol were associated with greater odds of elevated CIMT among obese adolescent boys.

Maternal and Neonatal Factors Affecting Bone Mineral Content of Indonesian Term Newborns.

Background: Interactions between the genome and intrauterine environment can affect bone mineralization in newborns and even in adult life. Several studies show that intrauterine fetal bone mineralization or early postnatal bone condition influences the risk of osteoporosis in later life. Objectives: To determine whole body bone mineral content (WB BMC) and factors that influence neonatal WB BMC in Indonesian term newborns. Subjects/Methods: A cross-sectional study was conducted in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 45 term, appropriate for gestational age (AGA) newborns were included in this study. BMC was assessed by dual-energy x-ray absorptiometry (DXA) in the first week of life. Weight (g), length (cm) and head circumference (cm) were measured at birth. Data on maternal characteristics were obtained from the maternal health records or reported by the mothers. Results: WB BMC measured in the present study (mean ± SD: 33.2 ± 9.3 g) was lower than WB BMC of similar populations in developed countries. Multiple linear regression showed that birth weight, birth length, and gestational age had a positive association with WB BMC (p = 0.048, 0.017, and <0.001, respectively), while maternal cigarette exposure had a negative association with WB BMC (p = 0.012). Male infants had significantly higher of WB BMC than female (p = 0.025). These determinants contribute to 55% variability of WB BMC. Conclusions: WB BMC in Indonesian term newborns is lower than populations in developed countries. Birth weight, length, gestational age, sex, and maternal cigarette exposure during pregnancy are significantly associated with WB BMC observed in Indonesian newborns.

Stunting as a Synonym of Social Disadvantage and Poor Parental Education.

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

Patterns of Body Mass Index, Percentage Body Fat, and Skinfold Thicknesses in 7- to 18-Year-Old Children and Adolescents from Indonesia.

BACKGROUND: Body mass index (BMI) and skinfold thickness are widely used to evaluate body composition. Information on patterns of skinfold thickness may help to understand changes in body composition during growth. The objectives of this study were to observe patterns of BMI, percentage body fat (%BF), and skinfold thicknesses of Indonesian children and adolescents aged 7-18 years. METHODS: Weight, height, and four skinfold thicknesses were measured in 2104 school children (924 boys, 1,180 girls) aged 7-18 years from Yogyakarta between 2015 and 2018. BMI and ratios between central and peripheral skinfold thicknesses were determined. %BF was predicted using the equation of Slaughter et al. Data were analyzed using analysis variance (ANOVA), independent sample t-test, and partial correlation (SPSS version 20.0). RESULTS: At 7-18 years, boys and girls showed a comparable gain in BMI. The comparable gain in %BF between boys and girls only occurred till age 10 and total skinfolds till age 11 years. While, %BF and skinfold thicknesses were higher in girls at 12-17 years, central to peripheral skinfold ratio were higher in boys. Partial correlation analyses showed that all skinfold thickness parameters and %BF were significantly correlated with BMI (P < 0.001; r = 0.19-0.87). CONCLUSIONS: The gain in BMI and skinfold thickness between the ages of 7 and 18 years occurred in age- and sex-specific patterns. Instead of comparable BMI, girls showed higher means of total skinfold thickness from age 12 years, while boys had higher central to peripheral adiposity ratio.

Long-term exposure to PM2.5 and fasting plasma glucose in non-diabetic adolescents in Yogyakarta, Indonesia.

BACKGROUND: Indonesia is facing serious air pollution. However, very few studies have been conducted to examine the health risks of air pollution in Indonesia, particularly for adolescents. OBJECTIVE: To assess the association between long-term exposure to ambient particles with a diameter of <2.5 µm (PM2.5) and fasting plasma glucose (FPG) in adolescents. METHODS: A cross-sectional study was conducted in 482 adolescents aged 14-18 years in Yogyakarta, Indonesia in 2016. We finally included 469 (97.30%) participants who had no missing data for data analysis. We collected individual data on socio-demographics, behavioral habits, and health information through standardized questionnaires. Satellite-based PM2.5 concentrations from 2013 to 2016 were assigned based on participants' residential addresses. The association between PM2.5 and FPG was examined using a generalized linear regression model while FPG was modeled as a continuous variable. An ordered logistic regression model was used to assess the relationship between PM2.5 and FPG categories. RESULTS: Every 1 µg/m³ increase in PM2.5 was associated with a 0.34 mg/dL [95 confidence interval (95% CI): 0.08 mg/dL, 0.59 mg/dL] increase in FPG levels. Comparing with the low FPG level (under 86 mg/dL), every 1 µg/m³ increase in PM2.5 was associated with a 10.20% (95% CI: 1.60%, 19.80%) increase in the odds of impaired fasting glucose (IFG) (100-125 mg/dL). Stratified analyses indicated greater effects on participants with hypertension [odds ratio (OR) = 1.30, 95% CI: 1.09, 1.57] and those had higher physical activities (OR = 1.36, 95% CI: 1.09, 1.57). Adolescents' sex, obesity status and different cutoff points of FPG did not modify the association between the exposure to PM2.5 and FPG levels. CONCLUSION: Long-term exposure to PM2.5 was associated with increased FPG levels in Indonesian non-diabetic adolescents.

Risk of metabolic syndrome and early vascular markers for atherosclerosis in obese Indonesian adolescents.

Background: The prevalence of childhood obesity has increased in low- and middle-income countries, including Indonesia. It is important to identify risk factors for cardiovascular disease in obese adolescents in this region.Aim: To assess the risk of metabolic syndrome and early vascular markers for atherosclerosis in obese Indonesian adolescentsMethods: A cross-sectional study was undertaken in obese high school students aged 15-<18 years in Yogyakarta, Indonesia. All eligible adolescents were interviewed about their medical history, were physically examined and had a fasting blood sample taken. Arterial stiffness was measured during systole and diastole blood pressure, endothelial dysfunction was estimated using flow-mediated dilation (FMD) and arterial wall thickness using carotid artery intima-media thickness (CIMT).Results: A total of 4268 students were screened, 298 (7%) of whom were classified as obese. Of those, 229 had blood samples taken, 173 had FMD performed and 156 had CIMT examination. Adolescents with a higher body mass index or BMI Z-score (>3.0) had a significantly poorer lipid profile, insulin level and homeostasis model assessment of insulin resistance (HOMA-IR) than those with a lower BMI Z-score. There were no significant differences for early vasculature markers for atherosclerosis between these two groups.Conclusion: The prevalence of risks of cardiovascular disease in obese adolescents was significant. The higher the BMI Z-score, the higher the risks of cardiovascular disease. Interventions to reduce obesity and its cardiovascular disease morbidities are urgently needed in low- and middle-income countries.Abbreviations: BMI; body mass index; CIMT, carotid artery intima-media thickness; CDC, Centers for Disease Control and Prevention; FMD flow-mediated dilation; HDL high-density lipoprotein cholesterol; HbA1c haemoglobin A1c; HOMA-IR, homeostasis model assessment of insulin resistance; IOTF, International Obesity Task Force; LDL, low-density lipoprotein cholesterol; WHO, World Health Organization.

Study of NT-proBNP and Hs-Troponin I biomarkers for early detection of children's heart function of proteinenergy malnutrition.

The Protein Energy Malnutrition (PEM) is the condition of a lack of carbohydrate and protein stores in the body that trigger chronic failure nutrient intake and body maintenance function caused to impact the heart functions. The NT-pro-BNP and Hs- Troponin I proteins were found as the indicator of cardiac dysfunction. The sixty subjects of PEM, analyzed by standard of Indonesia Healt Ministry as well as nutritional status. The blood electrolytes examined by laboratory assay and the levels of Hs-Troponin 1 and NT-Pro-BNP were analyzed by Immune-Chromatography method. Assessing of the ventricular mass with the seeing the peak of the diastolic flow rate of left ventricular that estimated by the curve of the receiver operating characteristic and the area under the curve (P<0.05). The result has shown that the PEM decreased in the left ventricular mass for impaired heart function and systolic disorder. The Hs- Troponin I (90.9%) has better sensitivity than NT-pro-BNP (85.5%) if the merger of those markers possesses the lowest sensitivity (81.8%). These proteins have good biomarkers in heart function, mainly in cases where PEM is present.

What information and the extent of information research participants need in informed consent forms: a multi-country survey.

BACKGROUND: The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. METHODS: This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). RESULTS: Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be 'moderately important' to 'very important' for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively). CONCLUSIONS: Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF.

Effect of FTO rs9939609 variant on insulin resistance in obese female adolescents.

OBJECTIVES: FTO rs9939609 variant has been shown to be associated with insulin resistance in Caucasian children. However, studies in Asia show inconsistent findings. We investigated the association between FTO rs9939609 polymorphisms and insulin resistance in obese female adolescents in Indonesia, a genetically distinct group within Asia. RESULTS: A total of 78 obese female adolescents participated in this study. The risk allele (A) frequency of FTO rs9939609 variant in Indonesian obese female adolescence was 44.2%. The frequency of insulin resistance was higher in the subjects with AA (54.6%) or AT (59.6%) than the subject with TT genotype (50%), but did not statistically different (p = 0.81 and p = 0.47, respectively). The insulin resistance rate was also higher in the risk allele (A) than the non-risk allele (T) subjects (0.58 vs. 0.55), but did not statistically different (p = 0.75). There was no association between FTO rs9939609 variant and body mass index, fasting glucose level, fasting insulin level, homeostatic model assessment of insulin resistance, and waist circumference (p > 0.05). In conclusion, FTO rs9939609 variant may not be associated with insulin resistance in Indonesian obese female adolescents. A multicenter study with a larger sample size is needed to clarify these findings.