Association of Maternal Education With Nutritional Outcomes of Poor Children With Stunting in Indonesia.

The consequences of poverty and food insecurity can indirectly contribute to obesity. Long-term effect of stunting children may be the risk factor for overweight and obesity in the poor in Indonesia. The role of parental education is also associated with overweight and obesity in children. This study aimed to observe the risk of stunted children becoming overweight and obese based on maternal education among poor people in Indonesia. This study involved three cohorts design. Cohort 1 is a 14-year cohort, and two 7-year cohorts for cohorts 2 and 3. We used secondary longitudinal data from Indonesian Family Life Survey (IFLS) 3 (2000), IFLS 4 (2007), and IFLS 5 (2014). After stratification by high maternal education and economic status of the family, there is an increased risk of stunting children becoming overweight and obese, with a risk ratio of 2 in cohort 1 and 1.69 in cohort 2. These results showed that stunted children with high-education mothers and lived in the low-income families have a 1.69 to 2 times higher risk of becoming overweight and obese. Thus, the importance of primary education and health education for women to increase children's health in the future.

Enhancing knowledge of Diabetes self-management and quality of life in people with Diabetes Mellitus by using Guru Diabetes Apps-based health coaching.

Introduction: Virtual diabetes coaching through applications has the potential to improve self-management in people with Type 2 Diabetes Mellitus. However, applications designed for Asian's diabetic have never been studied. Therefore, our study aimed to identify the effect of Guru Diabetes Apps-Based Health Coaching on the level of glycemic hemoglobin, knowledge, and quality of life in Indonesians, as one of Asian ethnicities. Materials and methods: This study used an experimental design. Participants with T2DM were recruited from three primary care health centers. The intervention included 3 months of virtual health coaching through the Guru Diabetes application. The daily monitoring of glycemic blood glucose, blood pressure, body weight, nutrition intake, and activity provided were used as baseline to conduct virtual in-person coaching. The glycemic hemoglobin level, knowledge level, and quality of life were assessed at baseline and post-enrollment. A multilevel modeling approach was used for statistical analysis. Results: A total of 66 respondents were enrolled, and 62 respondents (93.93%) remained in the study at 3 months. After completing the intervention, the HbA1c level decreased in all groups, however it did not differ among the groups. On the other hand, the results indicate significant improvement in the average diabetes self-management knowledge score (pre = 14.97 vs post = 19.07, p < 0.05) and quality of life score (pre = 54.34 vs post = 60.28, p < 0.05), with significant difference among the groups (p < 0.05). Conclusion: Participants in the Android Application-Based Health Coaching experienced a significant improvement in diabetes self-management knowledge and quality of life scores at 3 months. In conclusion, the Guru Diabetes Apps-Based Health Coaching has the potential to support people with T2DM in performing diabetes self-management at home.

Exploring the coach-client interaction of virtual health coaching conducted in patients with type 2 diabetes mellitus: A scoping review.

BACKGROUND AND AIMS: Recent studies reported that virtual health coaching (VHCs) had greater benefits on glycemic control compared to traditional diabetes care. However, VHCs are reported to lack real-time evaluations and personalized patient feedback. To support the intention of developing high quality VHC programs, this review aimed to describe characteristics of the coach-client interaction within VHC that had beneficial impacts on patients with type 2 diabetes mellitus (T2DM) patients. METHODS: We conducted a comprehensive scoping review following the six steps of the framework developed by Arksey and O'Malley. Twelve articles that met the eligibility criteria were retrieved from Medline, ProQuest, Science Direct and Scopus. RESULTS: We found five key concepts regarding the characteristics of coach-client interactions. First, the discussion through smartphones involved individualized feedback and insights, goals setting, barrier identification, facilitation to change behavior, and also clients' clinical, mental, and social conditions. Second, the interactions were supported by in-app features including in-app messaging, email, in-app live video consultation and in-app discussion forums. Third, the most used time of evaluation was 12 months. Fourth, the most commonly delivered topic was lifestyle changes which were predominantly focused on dietary patterns. Fifth, most of health coaches were health liaisons. CONCLUSIONS: The findings highlight the discussion points within interaction through well-planned devices combining an appropriate in-app features contribute to an effective coach-client interactions of VHC. It is expected that future studies can apply these findings as the basis to develop a single set of standards for VHCs which refer to specific patterns of patient-oriented interaction.

Diet or exercise: The role of diet and/or exercise on changes of pro-inflammatory markers during a weight loss program in adult women with overweight.

BACKGROUND AND AIMS: Obesity is associated with increased inflammation leading to a higher risk for non-communicable diseases. There was a controversy about whether exercise has a better influence on reducing inflammation during a lifestyle modification program among individuals with obesity. The objective of this study was to evaluate whether exercise could provide a benefit in reducing inflammatory markers in the context of a weight loss program. METHODS: This is an experimental study with control. Subjects were pre-menopausal adult women with overweight and assigned for low-calorie diet only (LCD) or low-calorie diet and exercise (LCDex) without randomization. We compared the effect of LCDex (n = 36) and LCD (n = 36) on inflammation markers (leptin and interleukin 6/IL6) for 8 weeks. RESULTS: We showed that after the weight loss program, there was a significant increase in IL6 (p = 0.009) but no changes in leptin (p = 0.760) concentration in both groups. There were no difference in changes of IL6 between LCDex and LCD (p = 0.483). CONCLUSIONS: A weight loss program was associated with increased inflammation. Among premenopausal women with overweight, a combination of LCD with exercise does not provide a greater benefit in reducing inflammation than those with LCD alone. TRIAL REGISTRATION: KE/0700/06/2018.

The interaction between energy intake, physical activity and UCP2 -866G/A gene variation on weight gain and changes in adiposity: an Indonesian Nutrigenetic Cohort (INDOGENIC).

The present study aimed to investigate an interaction between energy intake, physical activity and UCP2 gene variation on weight gain and adiposity changes in Indonesian adults. This is a prospective cohort study conducted in 323 healthy adults living in the city of Yogyakarta, Indonesia. Energy intake, physical activity, body weight, BMI, percentage body fat and waist:hip ratio (WHR) were measured at baseline and after 2 years while UCP2 -866G/A gene variation was determined at baseline. We reported that after 2 years subjects had a significant increment in body weight, BMI, body fat and reduction in WHR (all P < 0·05). In all subjects, total energy intake was significantly correlated with changes in body weight (ß = 0·128, P = 0·023) and body fat (ß = 0·123, P = 0·030). Among subjects with the GG genotype, changes in energy intake were positively correlated with changes in body weight (ß = 0·232, P = 0·016) and body fat (ß = 0·201, P = 0·034). These correlations were insignificant among those with AA + GA genotypes (all P > 0·05). In summary, we show that UCP2 gene variation might influence the adiposity response towards changes in energy intake. Subjects with the GG genotype of UCP2 -866G/A gene were more responsive to energy intake, thus more prone to weight gain due to overeating.

The Impact of Weight Loss Program in Metabolic Profile and Body Fat Improvement among Indonesian Young Obese: A Randomized Clinical Trial.

Abdominal obesity is defined as an accumulation visceral fat in abdomen region. It is linked to metabolic disorders that contribute to chronic diseases. Triglyceride (TG) to high-density lipoprotein (TG/HDL) ratio is considered as an insulin resistance (IR) marker. The waist to height ratio (WHtR) has been advocated as an effective and convenient measurement of central adiposity that could potentially be superior instead of BMI in determining cardiometabolic risk. The objective of this study was to investigate the effect of 8-wk-high protein diet and exercise on TG/HDL ratio, waist to height ratio (WHtR), body fat (BF) and body weight (BW). This study was a randomized clinical trial in 43 subjects with BMI >25 kg/m2. Subjects were randomized into 3 groups: High Protein Diet and Exercise (HPDE; n=15) High Protein Diet (HPD; n=15) and Control Group (CG; n=13). The prescribed diet consisted of 1,200 calories; while the exercise was conducted for 5 times/wk for 8 wk. The hypocaloric diet comprised of 55% carbohydrate, 25% protein, and 20% fat. In the end of the study, HPDE group had greater weight loss (-2.3±1.9 kg) than HPD (-1.8±2.2 kg); while CG increased in weight (1.8±1.3 kg). HPDE group had significantly improved TG, HDL, TG/HDL ratio and WHtR by -26.6 mg/dL, 12.7 mg/dL, -1.02, -0.02 respectively (p<0.05). There were significant differences between 3 groups, with ΔTG (p=0.008), ΔHDL (p=0.001), and ΔTG/HDL ratio (p=0.004) and WHtR (p=0.001). In conclusion, t hypocaloric diet combined with exercise has a beneficial effect in weight loss among young obese.

Interprofessional communication in a socio-hierarchical culture: development of the TRI-O guide.

OBJECTIVES: Interprofessional education (IPE) and collaborative practice are essential for patient safety. Effective teamwork starting with partnership-based communications should be introduced early in the educational process. Many societies in the world hold socio-hierarchical culture with a wide power distance, which makes collaboration among health professionals challenging. Since an appropriate communication framework for this context is not yet available, this study filled that gap by developing a guide for interprofessional communication, which is best suited to the socio-hierarchical and socio-cultural contexts. MATERIALS AND METHODS: The draft of the guide was constructed based on previous studies of communication in health care in a socio-hierarchical context, referred to international IPE literature, and refined by focus group discussions among various health professionals. Nominal group technique, also comments from national and international experts of communication skills in health care, was used to validate the guide. A pilot study with a pre-posttest design was conducted with 53 first- and 107 fourth-year undergraduate medical, nursing, and health nutrition students. RESULTS: We developed the "TRI-O" guide of interprofessional communication skills, emphasizing "open for collaboration, open for information, open for discussion", and found that the application of the guide during training was feasible and positively influenced students' perceptions. CONCLUSION: The findings suggest that the TRI-O guide is beneficial to help students initiate partnership-based communication and mutual collaboration among health professionals in the socio-hierarchical and socio-cultural context.

The Interaction between Coffee: Caffeine Consumption, UCP2 Gene Variation, and Adiposity in Adults-A Cross-Sectional Study.

BACKGROUND: Coffee is suggested as an alternative option for weight loss but the relationship between coffee consumption and adiposity in population-based studies is still controversial. Therefore, this study was aimed at evaluating the relationship between coffee intake and adiposity in adults and to test whether uncoupling protein 2 (UCP2) gene variation was able to affect this relationship. METHODS: This was a cross-sectional study conducted in male and female adults living in the urban area of Yogyakarta, Indonesia. Adiposity was determined based on body weight, body mass index (BMI), percent body fat, and waist and hip circumference. Data on coffee consumption and other dietary components were collected using a semiquantitative food frequency questionnaire along with other caffeine-containing beverages such as tea, chocolate, and other beverages. The -866 G/A UCP2 gene variation was analyzed using polymerase chain reaction-restriction fragment length polymorphism. The correlation between coffee intake and adiposity was tested using linear regression test with adjustment for sex, age, energy intake, table sugar intake, and total caffeine intake. RESULTS: In all subjects, coffee intake was inversely correlated with body weight (ß = -0.122, p=0.028), BMI (ß = -0.157, p=0.005), and body fat (ß = -0.135, p=0.009). In subjects with AA + GA genotypes, coffee intake was inversely correlated with body weight (ß = -0.155, p=0.027), BMI (ß = -0.179, p=0.010), and body fat (ß = -0.148, p=0.021). By contrast, in subjects with GG genotype, coffee intake was not correlated with body weight (ß = -0.017, p=0.822), BMI (ß = -0.068, p=0.377), and body fat (ß = -0.047, p=0.504). CONCLUSION: We showed that coffee intake was negatively correlated with adiposity, and this was independent of total caffeine intake. Additionally, we showed that the -866 G/A UCP2 gene variation influences the relationship between coffee intake and adiposity.

Dietary Inflammatory Index Score and Its Association with Body Weight, Blood Pressure, Lipid Profile, and Leptin in Indonesian Adults.

It was previously reported that dietary intake is an important trigger for systemic inflammation and one of the lifestyle factors for the development of cardiovascular diseases. The aim of this study was to evaluate the association between Dietary Inflammatory Index (DII) score and body weight, blood pressure, lipid profile and leptin in an Indonesian population. This was a cross-sectional study conducted in 503 Indonesian adults. The DII score was calculated based on data of 30 nutrients and food components. Anthropometric profile, blood pressure, lipid profile, and leptin were measured. The association of these variables with the DII score was analyzed. The DII score was not associated with body weight, body mass index (BMI), body fat, waist circumference, hip circumference, systolic and diastolic blood pressure, triglycerides, and high-density lipoprotein (HDL) (both unadjusted and after adjustment for covariates). However, plasma leptin concentration was significantly associated with the DII score (B = 0.096, p = 0.020). Plasma leptin also increased significantly across tertiles of the DII score (ANCOVA, p = 0.031). This positive association between the DII score and plasma leptin concentration suggests a role for the inflammatory properties of the diet in regulating adipose tissue inflammation.

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.

The Gene-Lifestyle Interaction on Leptin Sensitivity and Lipid Metabolism in Adults: A Population Based Study.

BACKGROUND: Obesity has been associated with leptin resistance and this might be caused by genetic factors. The aim of this study was to investigate the gene-lifestyle interaction between -866G/A UCP2 (uncoupling protein 2) gene polymorphism, dietary intake and leptin in a population based study. METHODS: This is a cross sectional study conducted in adults living at urban area of Yogyakarta, Indonesia. Data of adiposity, lifestyle, triglyceride, high density lipoprotein (HDL) cholesterol, leptin and UCP2 gene polymorphism were obtained in 380 men and female adults. RESULTS: UCP2 gene polymorphism was not significantly associated with adiposity, leptin, triglyceride, HDL cholesterol, dietary intake and physical activity (all p > 0.05). Leptin was lower in overweight subjects with AA + GA genotypes than those with GG genotype counterparts (p = 0.029). In subjects with AA + GA genotypes there was a negative correlation between leptin concentration (r = -0.324; p < 0.0001) and total energy intake and this correlation was not seen in GG genotype (r = -0.111; p = 0.188). CONCLUSIONS: In summary, we showed how genetic variation in -866G/A UCP2 affected individual response to leptin production. AA + GA genotype had a better leptin sensitivity shown by its response in dietary intake and body mass index (BMI) and this explained the protective effect of A allele to obesity.

Tumour necrosis factor-α and risk of cardiovascular disease among overfat Indonesian adolescents.

BACKGROUND: Overfatness (overweight and obesity) is associated with an increased risk of cardiovascular disease, including elevated blood pressure, dyslipidaemia, and insulin resistance. Chronic inflammation may play a role in mediating these associations. OBJECTIVE: To investigate the association between plasma tumour necrosis factor-α and risk factors for cardiovascular disease among overweight and obese adolescents. METHODS AND STUDY DESIGN: This study was an observational analysis with a cross-sectional design for high school students in Yogyakarta, Indonesia. One hundred and fifteen overweight and obese adolescents (mean age 16.8 years; 48.3% female) were involved in the study. Overfatness was specified by body mass index z-scores. Anthropometric measurements, blood pressure, lipid profiles, and fasting glucose were obtained. Fasting plasma insulin and plasma tumour necrosis factor-α were quantified using enzyme-linked immunosorbent assay. Insulin resistance was represented as the homeostatic model assessment value. Data were analysed using SPSS for Windows, version 23. RESULTS: Plasma tumour necrosis factor-α was significantly associated with total cholesterol (p=0.046) and diastolic blood pressure (p=0.018) among the overweight and obese adolescents. Results from path analyses showed that there were indirect effects of z-score BMI on systolic and diastolic blood pressures, HDL and fasting plasma glucose mediated by plasma tumour necrosis factor-α concentrations. Meanwhile, there were indirect effects of waist circumference on systolic and diastolic blood pressure by age and height percentile and HDL. There was no significant association between plasma tumour necrosis factor-α and insulin resistance. CONCLUSION: The study showed that a proinflammatory marker, plasma tumour necrosis factor-α, is associated with blood pressure, HDL and fasting plasma glucose in overweight and obese adolescents. This indicates that inflammation in overweight and obesity may play a role in increasing the risk of cardiovascular disease.

The development of low glycemic index cookie bars from foxtail millet (Setaria italica), arrowroot (Maranta arundinacea) flour, and kidney beans (Phaseolus vulgaris).

Wholegrain foods are becoming increasingly popular as a high fiber dietary supplement recommended for people with diabetes. In Indonesia, the incidence of diabetes mellitus has almost doubled recently and poses a significant health risk with the high prevalence of obesity and cardiovascular diseases. The present research aimed to develop cookie bars from foxtail millet, arrowroot flour, and kidney beans. The physical, chemical, and sensory properties were evaluated by selecting the best formula to test the glycemic index. Three formulae of cookie bars, which had different percentages of foxtail millet, kidney beans, and arrowroot flour were evaluated. The results showed that the three formulae (F1, F2, F3) had °Hue values of 53.77, 58.46, and 58.31, and breaking force of 8.37, 10.12, and 5.87 N, respectively. While all other nutritional content were significantly different between formulae, the total crude fat was not. The F2 cookie bar was selected and evaluated for the glycemic index because it has the best sensory properties, lowest total sugar and available carbohydrate content. F2 cookie bars that contain 15% foxtail millet, 15% arrowroot flour, and 30% of kidney beans have a glycemic index of 37.6 hence it could be classified as a low glycemic index cookie bar. In conclusion, our findings indicated that F2 cookie bars can be further developed as a suitable diabetic food since it has the best physico-chemical properties, sensory properties, and low glycemic index.

Sexual dimorphism in interleukin 17A and adipocytokines and their association with insulin resistance among obese adolescents in Yogyakarta, Indonesia.

BACKGROUND AND OBJECTIVES: Pro-inflammatory cytokines interleukin 17A (IL-17), leptin, and adiponectin have been associated with obesity and insulin resistance. Moreover, differences in sex and ethnicity as well as plasma concentration of adipocytokines and cytokines have been associated with the risk of insulin resistance. This study was conducted to elucidate whether sex differences exist in the risk of insulin resistance in Indonesian adolescents and to determine how plasma leptin, adiponectin, and IL-17 predict insulin resistance. METHODS AND STUDY DESIGN: The study participants were 69 obese-overweight boys, 53 obese-overweight girls, 59 non-obese boys, and 50 non-obese girls aged 15-18 years. Insulin resistance was determined using the homeostatic model assessment of insulin resistance index. Plasma IL-17, leptin, and adiponectin were measured using ELISA. Data were analysed using one-way ANOVA and linear regression analysis. Odd ratios [ORs; 95% confidence intervals (CIs)] were analysed to estimate the risk of insulin resistance; the significance level was set at 95%. RESULT: The OR (95% CI) for insulin resistance was higher in obese-overweight boys than in obese-overweight girls. The plasma IL-17 was higher in boys, whereas plasma adiponectin and leptin were significantly higher in girls. In all participants, obesity status and plasma leptin were the most efficient predictors of insulin resistance, whereas the IL-17 could not significantly predict insulin resistance. CONCLUSION: Sexual dimorphism exists in IL17 as well as leptin and adiponectin in adolescents. Plasma IL-17 cannot be used to predict insulin resistance in adolescents of both sex.

Dyslipidemia, insulin resistance and dietary fat intake in obese and normal weight adolescents: the role of uncoupling protein 2 -866G/A gene polymorphism.

Obesity in adolescents has been associated with increased cardiovascular risk factors such as dyslipidemia and insulin resistance. Several factors have been proposed to be associated with cardiovascular risk factors in adolescents including dietary habit, physical activity and genetic. This study was aimed to evaluate the interaction between genetic variation and dietary intake on cardiovascular metabolic risk factors in obese and normal weight adolescents. The UCP2 gene was chosen because it was previously correlated with dietary intake and cardiovascular risk factors. This study is a case control study done in 10 senior high school in Yogyakarta. Subjects were obese and normal weight adolescents taken from an obesity screening with age ranged between 16 and 18 years old. Dyslipidemia was observed by measuring total cholesterol, triglyceride, LDL dan HDL level while insulin resistance was determined by calculating fasting glucose and insulin level. Lipid profile, glucose and insulin level were measured after 8 hours of fasting. UCP2 -866G/A gene polymorphism were determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results show that obese adolescents had significantly higher blood pressure, total cholesterol, LDL, triglyceride, insulin level and lower HDL level than their normal weight counterparts (all p<0.001). In obese adolescents, UCP2 -866G/A was associated with blood pressure (p=0.025), total cholesterol level (p=0.025), LDL (p=0.024) level and HOMA IR (p<0.001) but not with dietary fat intake (p=0.386). Additionally, subjects with UCP2 -866G/A gene polymorphism and high dietary fat intake had lower risk on obesity compared to those without UCP2 -866G/A gene polymorphism and low dietary fat intake. We conclude that the UCP2 -866G/A was associated with dyslipidemia, insulin resistance in obese adolescents. Additionally, we also observed the interaction between UCP2 -866G/A gene polymorphism and dietary intake on the risk of obesity.

Association of SNPs in GHSR rs292216 and rs509035 on dietary intake in Indonesian obese female adolescents.

BACKGROUND: Obesity has been linked to high dietary intake and low physical activity. Studies showed that those factors were not only regulated by environment but also by genetic. However, the relationship is less been understood in obese children and adolescents. OBJECTIVE: The objective of this study was to examine the role of SNPs in GHSR rs292216 and rs509035 on dietary intake in obese female adolescents. METHODS: This is an observational study with cross sectional design. Respondents were obese female adolescents enrolled from obesity screening done in six junior high schools in Yogyakarta. Dietary intake was measured using 6 days 24 hours inconsecutive dietary recall. Genotyping of 2 SNPs from GHSR was done using FRLP-PCR. RESULTS: There were 78 obese female adolescents joined this study. We found that no significant association between SNPs GHSR and dietary intake (p < 0.05). In addition, a SNP-SNP interaction analysis shown there is no difference between combination of GHSR rs292216 and rs509035 on dietary intake (p < 0.05). CONCLUSION: We concluded that SNPs on GHSR rs292216 and rs509035 were not related to dietary intake in Indonesian obese female adolescents. Further study is necessary to investigate the effect of those genes on dietary intake in the broader population.