Faktor Risiko Kualitas Diet dan Non-Diet Kejadian Diabetes Melitus Tipe II: Studi Kasus Kontrol pada Studi Kohor
Date
2021Author
Husnul, Nisatami
Briawan, Dodik
Tanziha, Ikeu
Sudikno
Metadata
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Perubahan gaya hidup dan kualitas diet yang semakin tidak sehat pada penduduk usia dewasa mengakibatkan bertambahnya kejadian penyakit tidak menular (PTM), salah satunya yaitu diabetes melitus tipe 2 (DMT2) dengan jumlah penderita yang terus meningkat setiap tahunnya. Kualitas diet memiliki peran yang sangat besar sebagai faktor yang dapat dimodifikasi dalam kejadian DMT2. Kejadian DMT2 diawali dengan munculnya gangguan pada produksi hormon insulin dan terdapat kondisi kelainan yang kompleks ditandai dengan obesitas sentral, dislipidemia, hipertensi dan hiperglikemia atau biasa disebut dengan sindrom metabolik. Kualitas diet dapat dinilai menggunakan instrumen Alternative Healthy Eating Index (AHEI). Salah satu tujuan penggunaan instrument AHEI yaitu untuk memprediksi kejadian PTM.
Data pada studi kohor/longitudinal dapat dimanfaatkan salah satunya untuk mengetahui faktor risiko PTM menggunakan metode kasus-kontrol, yaitu studi dengan pemilihan subjek kelompok kasus ditentukan berdasarkan subjek yang baru terpapar penyakit selama periode pemantauan studi. Kemudian kelompok kontrol dipilih dari subjek yang tidak terpapar penyakit pada populasi dan periode pemantauan yang sama. Pada satu-satunya Studi Kohor PTM di Indonesia yang dilakukan oleh Pusat Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI di wilayah Kota Bogor, sudah diteliti beberapa faktor determinan kejadian DMT2 namun kualitas diet belum dianalisis lebih dalam.
Penelitian ini bertujuan untuk menganalisis hubungan kualitas diet dengan kejadian DMT2. Tujuan khusus peneitian ini yaitu: 1) Mengidentifikasi karakteristik subjek pada kelompok kasus dan kontrol, 2) Menganalisis perbedaan kualitas diet antara kelompok kasus dan kontrol, 3) Menganalisis perbedaan variabel non-diet antara kelompok kasus dan kontrol, 4) Menganalisis hubungan kualitas diet dengan kejadian DMT2, 5) Menganalisis faktor risiko yang berperan terhadap kejadian DMT2. Desain penelitian ialah nested case-control pada studi kohor, menggunakan data sekunder dari “Studi Kohor Faktor Risiko Penyakit Tidak Menular (FRPTM)”. Penelitian kohor ini dilaksanakan oleh Badan Penelitian dan Pengembangan Upaya Kesehatan Masyarakat, Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI. Data yang dianalisis yaitu hasil pemeriksaan dua tahun kesatu/follow up 1 (FU 1), dua tahun kedua/follow up 2 (FU 2) dan penentuan subjek berdasarkan kasus baru DMT2 pada dua tahun ketiga/follow up 3 (FU 3). Kelompok kasus yaitu subjek yang baru terdiagnosa DMT2 pada FU 3, kelompok kontrol yaitu subjek yang tidak terdiagnosa DMT2 mulai baseline (FU 0) sampai dengan FU 3 dengan karakteristik jenis kelamin, usia, status gizi dan aktivitas fisik sama dengan kelompok kasus. Setiap titik pemantauan (FU 1 dan 2) subjek diamati kemunculan faktor risiko diet (data food recall 1 x 24 jam) dan non diet (pemeriksaan fisik klinis seperti pengukuran tekanan darah dan pemeriksaan profil lipid darah). Kualitas diet dinilai menggunakan AHEI modifikasi yang disesuaikan dengan Pedoman Gizi Seimbang. Data dianalisis menggunakan uji beda Chi-Square, t-test independen, Mann-Whitney dan Regresi Logistik.
Subjek yang terpilih sebanyak 192 subjek terdiri dari 76 perempuan (79.2%) dan 20 laki-laki (20.8%) pada tiap kelompok. Rentang umur subjek terbanyak antara tahun 40-59 tahun (67.7%), dengan umur termuda yaitu 33 tahun dan tertua 67 tahun. Aktivitas fisik pada subjek masuk dalam kategori cukup pada kelompok kasus dan kontrol. Status gizi subjek berdasarkan indeks massa tubuh sebagian besar yaitu obesitas (68.8%), begitu pula berdasarkan indikator lingkar perut mayoritas berisiko obesitas sentral (77.1%). Kejadian DMT2 pada kelompok kasus terjadi pada FU 3 dengan perjalanan kejadian mulai FU 0 terdapat 42.7% mengalami pradiabetes yang terus meningkat hingga 70.8% pada FU 2. Pada kelompok kontrol terdapat 14.6% subjek mengalami pradiabetes pada FU 0 higga menjadi 51.0% pada FU 3.
Skor komponen kualitas diet antara kelompok kasus dan kontrol relatif sama, tidak terdapat perbedaan diantara kedua kelompok baik pada skor tiap komponen dan total skor (p>0.05). Terdapat kecenderungan kualitas diet yang lebih baik pada kelompok kasus dibanding kontrol. Rata-rata skor kualitas diet kelompok kasus lebih tinggi dibanding kelompok kontrol pada FU 1 (60.8 poin vs. 58.9 poin) dan FU 2 (58.6 poin vs. 57.8 poin). Berdasarkan uji beda chi-square, variabel non-diet antara kelompok kasus dan kontrol berbeda signifikan (p<0.05) pada variabel riwayat keluarga (33.3% vs. 1.7%), hipertensi (25.0% vs. 4.2%), kadar trigliserida tinggi (40.8 vs. 17.7%), dan kadar HDL rendah (43.3% vs. 25.0%). Sedangkan variabel kolesterol total tinggi (71.1% vs. 60.4%) dan kadar LDL tinggi (59.2% vs. 58.3) tidak berbeda signifikan antar kelompok (hasil uji beda chi-square p>0.05).
Kualitas diet pada penelitian ini tidak berhubungan dengan kejadian DMT2 (Analisis multivariate, Odds Ratio [OR] = 0.6, 95%CI 0.1-3.0, p=0.642). Sedangkan variabel non-diet yaitu hipertensi (OR 7.1, 95%CI 2.2-22.5, p=0.001) dan hipertrigliserida (OR 2.7, 95%CI 1.3-5.6, p=0.001) berhubungan dengan kejadian DMT2. Pedoman Gizi Seimbang dan isi piringku belum secara keseluruhan diaplikasikan sehari-hari oleh sebagian besar subjek. Kejadian DMT2 harus dicegah dengan cara memperbaiki gaya hidup melalui diet sehat, yaitu meningkatkan konsumsi pangan tinggi serat (wholegrain, sayur dan buah), kacang-kacangan dan mengurangi konsumsi daging merah dan olahannya, minuman berpemanis dan lemak trans; mempertahankan berat badan normal dan rutin berolahraga sehingga dapat mencegah kejadian DMT2. Changes in lifestyle and quality of diets that are increasingly unhealthy in the adult population have increased non-communicable diseases (NCD), including type 2 diabetes mellitus (T2DM). These sufferers continue to increase every year. The quality of diet has a massive role as a modifiable factor in the incidence of T2DM. The incidence of T2DM begins with a disturbance in the production of the hormone insulin, and there are complex disorders characterized by central obesity, hypertension, uncontrolled lipid, and blood glucose or commonly referred to as a metabolic syndrome. Dietary quality can be assessed using the Alternate Healthy Eating Index (AHEI) instrument.
Data in cohort/longitudinal studies can determine the risk factors for PTM using the case-control method. Namely, a study in which case group subject selection is determined based on subjects who have recently been exposed to the disease during the study monitoring period. Then a control group was selected from unexposed subjects in the same population and monitoring period. In the only NCD Risk Factor Cohort Study (FRPTM) in Indonesia conducted by the National Institute of Health Research and Development, the Indonesian Ministry of Health in the Bogor City area, several determinants of the incidence of T2DM have been investigated. Still, the quality of the diet has not been analysed in more depth.
This study aims to analyse the relationship between diet quality and the incidence of T2DM. The specific objectives of this research are 1) to identify the characteristics of the subjects in the case and control groups, 2) to analyse the difference of dietary quality in the case and control groups, 3) to analyse the difference of non-diet variable in the case and control groups, 4) to analyse the association between dietary quality and the incidence of T2DM, 5) to analyse the risk factors that contributes of the incidence of T2DM. The study design was a nested case-control in cohort study, using secondary data from the “Non-Communicable Disease Risk Factor (FRPTM) Cohort Study”. This cohort study is a research conducted by the Public Health Research and Development Agency, the Health Research and Development Agency, the Indonesian Ministry of Health. The data analysed were the results of the examination at first two years/follow up 1 (FU 1), second two years/follow up 2 (FU 2), and the determination of the subject based on new cases of T2DM at third two years/follow-up 3 (FU 3). The case group is the subject who has just been diagnosed with T2DM at FU 3; the control group is non-diagnosed T2DM subjects from baseline (FU 0) up to FU 3 with the same characteristics of sex, age, nutritional status, and physical activity as the control group. At each monitoring point (FU 1 and 2), the subjects were observed for the presence of dietary risk factors (food recall data 1 x 24 hours) and non-diet (clinical physical examination such as blood pressure measurement and blood lipid profile). Diet quality was assessed using modified AHEI. Data were analysed using Chi-Square difference test, independent t-test, Mann-Whitney, and Logistic Regression.
Subjects were selected as many as 192 subjects consisting of 76 women (79.2%) and 20 men (20.8%) in each group. The most extensive age range of subjects was between 40-59 years (67.7%), with the youngest age being 33 years and the oldest being 67 years old. Physical activity in the subject was in the moderate category in the case and control groups. The subjects’ nutritional status based on body mass index was mostly obese (68.8%) and based on the abdominal circumference indicator; most were at central obesity (77.1%). The incidence of T2DM in the case group occurred at FU 3 with a course of incidence from FU 0; there were 42.7% experiencing pre-diabetes, which continued to increase to 70.8% in FU 2. In the control group there were 14.6% of subjects experiencing pre-diabetes at FU 0 to 51.0% at FU 3.
The scores for the case and control groups’ dietary quality components were relatively the same; there was no difference between the two groups in each component’s scores and the total scores (p> 0.05). There is a tendency for better diet quality in the case group than in the control group. The mean diet quality score of the case group was higher than the control group at FU 1 (60.8 points vs. 58.9 points) and FU 2 (58.6 points vs. 57.8 points). Based on chi-square test, non-dietary risk factors in subjects between case versus control groups with a significant difference were family history variables (33.3% vs. 1.7%), hypertension (25.0% vs. 4.2%), high triglyceride levels (40.8 vs. 17.7%), and low HDL levels (43.3% vs. 25.0%). Meanwhile, the variable high total cholesterol (71.1% vs. 60.4%) and high LDL levels (59.2% vs. 58.3) did not differ significantly between groups (chi-square test result p>0.05).
The dietary risk factors in this study were not related to T2DM incidence (Multivariate analyses, Odds Ratio [OR] = 0.6, 95% CI 0.1-3.0, p = 0.642). Meanwhile, non-diet risk factors, such as hypertension (OR 7.1, 95% CI 2.2-22.5, p = 0.001) and hypertriglyceridemia (OR 2.7, 95% CI 1.3-5.6, p = 0.001) were associated with the incidence of T2DM. Pedoman Gizi Seimbang and the contents of “Isi Piringku” have not been entirely applied daily by most subjects. The incidence of T2DM must be prevented by improving a lifestyle through a healthy diet. Increasing consumption of high-fiber foods (wholegrain, vegetables, and fruits), legumes, and reducing red meat and processed meat, sugar-sweetened beverages, and trans-fats. Maintaining normal body weight and exercising regularly to prevent the incidence of T2DM.
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