International Journals

Objective: To examine the association between obese-years and the risk of cardiovascular disease (CVD). Study design: Prospective cohort study. Setting: Boston, USA. Participants: 5036 participants of the Framingham Heart Study were examined. Methods: Obese-years was calculated by multiplying for each participant the number of body mass index (BMI) units above 29 kg/m2 by the number of years lived at that BMI during approximately 50 years of follow-up. The association between obese-years and CVD was analysed using time-dependent Cox regression adjusted for potential confounders and compared with other models using the Akaike information criterion (AIC). The lowest AIC indicated better fit. Primary outcome: CVD. Results: The median cumulative obese-years was 24 (range 2–556 obese-years). During 138 918 personyears of follow-up, 2753 (55%) participants were diagnosed with CVD. The incidence rates and adjusted HR (AHR) for CVD increased with an increase in the number of obese-years. AHR for the categories 1–24.9, 25–49.9, 50–74.9 and ?75 obese-years were, respectively, 1.31 (95% CI 1.15 to 1.48), 1.37 (95% CI 1.14 to 1.65), 1.62 (95% CI 1.32 to 1.99) and 1.80 (95% CI 1.54 to 2.10) compared with those who were never obese (ie, had zero obese-years). The effect of obese-years was stronger in males than females. For every 10 unit increase in obese-years, the AHR of CVD increased by 6% (95% CI 4% to 8%) for males and 3% (95% CI 2% to 4%) for females. The AIC was lowest for the model containing obese-years compared with models containing either the level of BMI or the duration of obesity alone. Conclusions: This study demonstrates that obeseyears metric conceptually captures the cumulative damage of obesity on body systems, and is found to provide slightly more precise estimation of the risk of CVD than the level or duration of obesity alone.

Background: Diabetes Mellitus (DM) triggers an excessive reaction of free-radicals. It increases reactive oxygen species and reduces antioxidants status as well as the β cell damage. Clear kefir was used for DM therapies, however it limited biomolecular exploration of its bioactive roles. Research aimed to investigate the effects of clear kefir on the biomolecular nature of the glycemic status of T2DM in Bandung. Methods: The randomized pretest-posttest control group was conducted by 106 T2DM patients. Research was done in several hospitals in Bandung and Cimahi, West Java from 2012–2013. Samples were divided randomly into three groups: (1) T2DM with HbA1c < 7 was fed a standard diet, supplemented with 200 ml/day of clear kefir, (2) T2DM with HbA1c > 7 fed standard diet and supplemented 200 ml/day by clear kefir, (3) T2DM with HbA1c was fed a standard diet as a control group. Dose response was obtained from a preeliminary vivo study, and then converted to human dosage by year 2011. Intervention was effectively done for 30 days. HbA1c was measured by HPLC. Fasting blood glucose (FBG) and Postprandial blood glucose levels (PBG) were measured by enzymes levels. C Peptide and insulin were measured by Elisa. Data was analyzed by a statictics programme by significance p<0,05. Study was approved by ethic committee. Results: HbA1c was significantly reduced in delta level (p<0.01) and FBG (p<0.015) among kefir groups. PBG was not significantly reduced among groups. C-Peptide was significantly increased in delta level, except in control group (p<0.014). Insulin was reduced significantly, except in control group (p<0.003). Conclusions: Supplementation of clear kefir reduced blood glucose levels (HbA1c, FBG, PBG) and increased c-peptide. Clear kefir’s biomolecular mechanisms and chemistry characterization is a challenge for future studies.

Background: High concentrations of plasma leptin and the release of pro-inflammatory cytokines in leptin-resistance in obesity have been reported to trigger endothelial dysfunction. The objective of this study was to elucidate the role of quercetin in modulating leptin-induced inflammation as assessed by the levels of Ob-Ra expression, ERK1/2 phosphorylation, NF-kappa B activation and TNF-alpha secretion in umbilical vein endothelial cells (HUVECs) in vitro. Findings: HUVECs were exposed to either control levels (0 ng/ml) or 500 ng/mL leptin (L) for 48 hours, followed by control or 125 uM quercetin (Q) for another 6 h. The experimental groups were as follows: L0Q0, L0Q125, L500Q0, L500Q125. The presence of the short chain leptin receptor isoform Ob-Ra in HUVECs was determined by Western blot and immunocytochemistry analyses. Ob-Ra expression, ERK1/2 phosphorylation, NF-kappa B activation and TNF-alpha secretion were quantified by ELISA, and NF-kappa B activationby immunofluorescence staining. Our results showed that Ob-Ra expression, ERK1/2 phosphorylation and NF-kappa B activation increased significantly after 500 ng/mL leptin exposure (1.8x, 1.5x, 6.2x for Ob-Ra, ERK1/2 and NF-kappa B, respectively), but were reduced by addition of 125 uM quercetin (0.7x, 0.3x and 0.4x for Ob-Ra, ERK1/2 and NF-kappa B, respectively), and that quercetin could also partially suppress leptin-induced TNF-alpha secretion (3.8x) by 0.8x. Conclusion: Exposure of HUVECs to leptin up-regulated Ob-Ra expression and elevated ERK1/2 phosphorylation and NFkB activation, and increased TNF-alpha secretion. These effects strongly suppressed by quercetin, with the exception of TNF-alpha which was partially suppressed. The findings might be of clinical significance, as endothelial dysfunction that could lead to cardiovascular disease is preventable, and quercetin is a natural compound found in various plants and fruits.

The objectives of this study were to analyze the macronutrients composition, dietary fiber, and resistant starch in Bestak sweet potato variety; to identify the prebiotic components in sweet potato fiber extract (SPFE); and to evaluate the prebiotic activity of SPFE. Evaluation of prebiotic activity was based on the change in cell biomass after 24 h of growth of the probiotic strain in the presence of SPFE, inulin, fructooligosacharide, or glucose relative to the change in cell biomass of Escherichia coli grown under the same condition. Prebiotic activity was calculated for L. plantarum Mut7 and Bifidobacterium longum JCM 1217. The results showed that ash, starch, and total carbohydrate in SPFE were lower than in the raw sweet potato and its powder. However the crude protein in SPFE was higher than in the raw sweet potato and its powder. SPFE contained 3.50% soluble fiber, 12.17% insoluble fiber, 22.23% resistant starch, and 37.90% total dietary fiber. The increasing cell number of L. plantarum Mut7 was higher in the SPFE substrate (3.21 log CFU/ml), whereas B. longum grew better in FOS substrate (2.19 log CFU/ml). The highest prebiotic activity score was obtained for L. plantarum Mut7 grown on SPFE (1.62), whereas the lowest score was for Bifidobacterium longum grown on inulin (0.47). It can be concluded that Bestak sweet potato variety has potency as prebiotic source because it contains FOS, inulin and raffinose. The SPFE has prebiotic activity score that similar to FOS, but it was higher than inulin.

In some hospitals, soybean porridge is used by nutritionists for children who have diarrhea therapy. This is likely related to the recovery of the immune system, both systemically and in the digestive tract. Rats, fed with black soybean tempe diet for 35 days, had higher T cell proliferation index than standard diet rats. This study aims to determine the potential of black soybean tempe in modulating antioxidant enzyme activity and proliferation of human lymphocytes in vivo. A total of 21 respondents were divided into three groups, namely placebo consumption group, tempe extract capsules consumption and tempe consumption group. Interventions were conducted for 28 days in respondents resident. During the intervention all respondents only consumed provided food by researchers. Each respondent in the treatment group consumed 100 grams tempe per day, while those in soybean extract group consumed 3 capsules. Black soybean tempe consumption in humans could enhance the immune system by increasing T cell proliferation and lymphocytes resistance to hydrogen peroxide. Consumption of black soybean tempe tends to enhance B cell proliferation, enzyme activity of SOD, catalase and glutathione peroxides. It can be concluded that consuming tempe could enhance the immune system , especially the cellular immune system.

Purpose: To examine the effectiveness of multilevel promotion on exclusive breastfeeding (EBF) duration and prevalence. DESIGN: A pretest-posttest control group design, quasi-experiment. Setting: Two public health centers in the Demak District, Central Java, Indonesia. Subjects: A total of 163 families were enrolled, including pregnant mothers, fathers, and grandmothers. Intervention: The multilevel promotion of EBF was conducted at the subdistrict, village, family, and individual levels.This was a complex intervention that modified breastfeeding determinants, integrated multidisciplinary partnerships, and involved community leaders (i.e., voluntary health workers, traditional birth attendants, Muslim scholars, and heads of villages). The strategies applied were advocacy, training, media, and home visit counseling. Measures: EBF duration and prevalence. Analysis: Survival analyses, Cox proportional-hazard model. Results: The duration of EBF increased after the multilevel promotion. The median postintervention duration in the intervention group was 18 weeks compared with .1 week in the control group (p < .001). The prevalence of EBF at 1, 8, 16, and 24 weeks for the intervention versus control groups was 75.3% vs. 28.0%, 64.2% vs. 14.6%, 50.6% vs. 8.5%, and 37.0% vs. 3.7%, respectively (p < .001). Mothers in the control group were three times more likely to stop exclusive breastfeeding per unit of time than were mothers in the intervention group (adjusted hazard ratio 3.01; 95% confidence interval: 1.96, 4.63). Conclusion: Multilevel promotion can prolong the duration and increase the prevalence of EBF.

Introduction: Pregnant women are encouraged to comply with dietary recommendations to meet their own nutritional needs as well as their child. Deficiency of certain nutrients may lead to morbidity of both the mother and child. In this review, information on nutrients intake of pregnant women from studies conducted in Indonesia will be analysed. Methods: A literature search of all possible sources of information was conducted. These included (i) electronic databases of PubMed, Elsevier, Science Direct, EBSCO, and Google Scholar; (ii) archives and records of the Ministry of Health; (iii) library collection in institutions such as health polytechnics, local health offices, non-government organisations and universities in Yogyakarta, Central Java, East Java Province; and (iv) articles on pregnant women's nutrient intake conducted in Indonesia in 2000 - 2010. The results were analysed descriptively by comparing them with the Estimated Average Requirements (EAR) value. Results: Two of four studies showed mean energy intake below EAR. Protein intake was lower than EAR only in two studies, while four are in contrary to the EAR. No study showed low fat and carbohydrate intake. A large number of studies reported low average intake of calcium and iron. Conclusion: The reviewed studies suggest that intake of several nutrients by pregnant women in Indonesia is below the EAR.

Purpose and methodology: This study investigated the effect of plain kefir on glycemic, antioxidants, immune response and pancreatic ? cell regeneration of hyperglycemia Wistar Rats induced by Streptozotocin. Findings: Kefir supplementation 3.6 cc / day affect significantly on blood glucose, antioxidants, lipid peroxidation, and pancreatic ?-cells. Statistical analysis showed reduce of glucose (p<0.001), MDA (p<0.001), level of proinflamatory cytokines (IL1, IL6,) (p<0.001), except of controls. Antioxidant showed increase of catalase, GPx (p<0.001) and SOD (p<0.05). Similarly, there was increased of IL10 (p<0.05) and the normal cells pancreatic (p<0.001), except of control. TNF? reduced no significant (p>0.05), except of control. Ancova test showed MDA and IL10 were the most contributed to the pancreatic β cells regeneration International Journal of Food, Nutrition & Public Health Vol. 5 No. 1/2, 2012 by 91.0% and 9% determined by TNF-α, antioxidants, blood glucose, body weight. Value: Kefir is significantly reduced of glucose, lipid peroxide, level of cytokines (IL1, IL6) and enhanced IL10, antioxidants capacity and normal pancreatic β cell expression. Insulin and kefir descriptively reduced TNF αlevel.

Objective: To explore the factors that encompass maternal self-efficacy in providing food for the home. Methods: In-depth interviews were conducted with 19 mothers of nutritionally at risk children in an urban area of East Jakarta, Indonesia. This study was based on Social Cognitive Theory, Family Stress Models, and Ecological Frameworks. Data collection was coded and analyzed using the Grounded Theory Method. Results: Most mothers felt secure in providing food for their families knowing that their relatives and neighbors would support them if they lacked the money to buy food; however, most of them did not supply appropriate meals in terms of nutrient content, variety, and timing. Conclusions and Implications: Maternal self-efficacy was mainly characterized by practical issues concerning the preparation of food at home and a lack of knowledge of health and nutrition. Family-based interventions are needed to enhance competence in providing nutritious food from available resources.

Children patient suffering from malnutrition and chronic diarrhea, who had been treated with tempe formula improved their health status, recovered from the diarrhea in a relatively shorter period, and gained weight. It is perceived that the quick recovery was due to improvement of the body’s immune system. The aim of the research was to observe the effect of black soybean tempe and it’s ethanol extract on T and B cells proliferation and level of secretory IgA (sIgA) in rat induced with Salmonella typhimurium. A total of 48 rats were divided into four groups, 12 rats each assigned to standard diet, diet plus black soybean tempe flour, diet plus tempe ethanol extract, and diet plus mixture from tempe ethanol extract and flour of black soybean tempe. Body weights were recorded during 35 days of diet treatment, and index stimulation on T and B cells as well as level of secretory IgA were measured after S. typhimurium induction. Result indicated that diet with tempe, diet with ethanol extract and combination of both increased body weight better than that of control. Treatments with tempe and mixture of tempe with its ethanol extract were significantly different from the control in the proliferation of T cell; however, the treatment with tempe ethanol extract did not. The three treatments did not improved proliferation of B cell. Diet with tempe alone significantly increased secretory IgA in the intestinal tract fluid of rats, but the other treatments did not show significant difference with the control (without Salmonella induction).

Resistant starch type 3 (RS3) is retrograded starch which is not digested by human starch degrading enzyme, and will thus undergo bacterial degradation in the colon. The main fermentation products are the Short Chain Fatty Acid (SCFA): acetate, propionate and butyrate. SCFA has signi?cant bene?t impact on the metabolism of the host. The objectives of this research were to study the SCFA pro?le produced by colonic butyrate producing bacteria grown in medium containing RS3. RS3 was made from sago or rice starch treated with amylase, pullulanase and the combination of amylase and pullulanase. Fermentation study was performed by using Clostridium butyricum BCC B2571 or Eubacterium rectale DSM 17629, which has been identi?ed as capable of degradation of starch residue and also regarded as bene?cial bacteria. Experimental result revealed that enzyme hydrolysis of retrograded sago or rice starch was bene?cial to RS formation. RS3 derived from sago contained higher RS (31-38%) than those derived from rice starch (21-26%). This study indicated that C. butyricum BCC B2571 produced acetate, propionate and butyrate at molar ratio of 1.8 : 1 : 1, when the medium was supplemented with RSSA at concentration 1%. In the medium containing similar substrate, E. rectale DSM 17629 produced acetate, propionate and butyrate at molar ratio of 1.7 : 1 : 1.2. High levels of acetate, propionate and butyrate at molar ratio of 1.8 : 1 : 1.1 was also produced by E. rectale DSM 17629 in medium supplemented with RSSP at concentration 1%. The results showed that both bacteria responded differently to the RS3 supplementation. Such result provided insight into the possibility of designing RS3 as prebiotic with featured regarding SCFA released in the human colon with potential health implication.

Nutrition history in Indonesia began in 1887, when Christiann Eijkman discovered the relationship between vitamin B-1 deficiency and beri-beri. In the 1950’s, the socialization of nutrition messages started with the introduction of “Healthy Four Perfect Five” (Empat Sehat Lima Sempurna-ESLS). For the next 25 years after that, ESLS became a favorite in nutrition education and was nationally known. Although the ESLS was never evaluated, food consumption pattern of Indonesians are never balanced. Undernutrition is rampant and overnutrition emerged. In 1995 the Indonesian food-based dietary guidelines was launched by the Ministry of Health, and formally incorporated into the nutrition policy. The Guide has 13 messages. Again, the guidelines were never evaluated; in 2010 undernutrition persists and the prevalence of degenerative diseases increased. Thus, it is urgent for Indonesia to have concrete Nutrition Guidelines (Gizi Seimbang) covering messages like: (1) consume a variety of foods; (2) keep clean; (3) be active, exercise regularly; and (4) monitor body weight. The guidelines shall be developed for all age groups. The guidelines were tested to over 300 audiences and the responses were promising. Dissemination of the messages widely within the formal channels is compulsory. The new Nutrition Guideline messages are an open concept ready to be revised accordingly. It is evident that nutrition sciences and its application had undergone rapid changes over time and Indonesia need to adopt accordingly and timely. Although, outcomes may not be seen in a short time, longer term output will benefit future generations.

Obesity is a major contributor to the global burden of chronic disease and disability. In developing countries like Indonesia, obesity often co-exists with undernutrition. Data from national basic health research 2007 showed that overnutrition was found among all age groups, on a double digit scale, with similar magnitude in urban and rural areas and higher prevalence in adult female. In contrary to 14% undernourished children under the age of 5 years, 12% of their counterparts were overnourished; for 6–14 years 10% vs. 6%; and for 15 years and above 15% vs. 19%. The purpose of the review is to raise awareness on the increasing obesity problem and to set recommendations to prevent obesity. Stunted adults in developing countries are 1.2 times more likely to be overweight than non-stunted adults. Approaches to overcoming obesity in adulthood emphasize dietary changes, increasing physical activity and behaviour modification. It is important for Indonesia to target nutrition intervention for female adolescents, pregnant woman to first 2 years of life, initiate nutrition education for school-age children and disseminate Holistic Healthy Framework Approach with key message ‘Initiate healthier food choices’. Prompt Nutrition Guidelines and the use of lower body mass index cut-off should be considered

Torbangun (Coleus amboinicus Lour) has been used as a breast milk stimulant (a lactagogue) by Bataknese people in Indonesia for hundreds of years. However, the traditional use of torbangun is not well documented, and scientific evidence is limited to establish coleus as a lactagogue. This Focus Group Discussion (FGD) study was conducted to gather information regarding the practice and cultural beliefs related to the traditional use of torbangun as a lactagogue. The main findings of this investigation were: (1) torbangun, which is considered nourishing, is usually given to the mother for one month after giving birth in order to restore her state of balance; (2) in the Bataknese culture, torbangun is perceived to serve several purposes which include enhancing breast milk production and acting as a uterine cleansing agent; and (3) the tradition has been practiced for hundreds of years, and its adherence is still strong. J Hum Lact. 25(1):64-72.

Background. The National Center for Health Statistics/ World Health Organization (NCHS/WHO) reference is considered unsuitable for assessing the nutritional status of breastfed children. It is gradually being replaced by the WHO Child Growth Standards in many countries. Objective. To assess the implications of adopting the WHO Child Growth Standards to classify Indonesian children according to nutrition status. Methods. Data were obtained from two cross-sectional surveys in two districts in Indonesia in 1998. Children under 2 years of age were randomly selected using a two-stage cluster sampling. Z-scores of weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age (WAZ) were calculated based on both the NCHS/WHO reference and the WHO Child Growth Standards. Wasting, stunting, and underweight were defined as z-scores less than ?2.0. Results. We included 1,374 children, of whom 693 (50.4%) were male and 681 (49.6%) were female. Almost all of the children had initiated breastfeeding and were still being breastfed when the data were collected. According to the WHO Child Growth Standards, the prevalence of wasting did not change with age, but the prevalence rates of stunting and underweight rose steadily with age. Although the contribution of wasting to the classification of underweight was relatively constant, the contribution of stunting increased as the children grew. Conclusions. The WHO Child Growth Standards are a better tool for assessing the nutritional status of Indonesian children than the NCHS/WHO reference. However, low WAZ is not a suitable indicator for commencing an extra feeding program, because it reflects stunting instead of wasting. The high prevalence of stunting indicates the need to perform preventive nutritional intervention beginning earlier in life, i.e., in utero.