Asupan Natrium, Status Gizi, Tekanan Darah dan Profil Metabolit terkait Hipertensi pada Pria Dewasa

Abstract

Hipertensi merupakan masalah utama kesehatan global seiring dengan peningkatan prevalensinya setiap tahun di seluruh dunia. Prevalensi hipertensi di Indonesia pada tahun 2014 sebesar 25,8% dan meningkat menjadi 34,1% pada tahun 2018. Jawa Barat menduduki peringkat kedua provinsi dengan prevalensi hipertensi tertinggi pada tahun 2018 sebesar 39,60%. Berbagai penelitian menunjukkan bahwa perilaku gaya hidup, indeks massa tubuh, obesitas sentral, dan asupan natrium, berhubungan dengan risiko hipertensi. Berbagai pendekatan dalam penelitian dilakukan untuk mengkaji mekanisme patofisiologi, faktor risiko serta tindakan preventif terkait hipertensi, termasuk melalui pendekatan metabolomik. Penelitian ini bertujuan menganalisis hubungan antara karakteristik individu, status gizi, lingkar perut dan asupan natrium terhadap tekanan darah serta menganalisis senyawa metabolit terkait hipertensi pada kelompok laki-laki dewasa di Desa Sukajadi, Kecamatan Tamansari, Kabupaten Bogor. Penelitian kuantitatif ini menggunakan desain cross-sectional, dilaksanakan di Desa Sukajadi, Kecamatan Tamansari, Kabupaten Bogor, Jawa Barat. Penelitian dilakukan pada bulan November 2022 sampai Maret 2023. Penarikan sampel dilakukan dengan cara purposive sampling. Kriteria inklusi dari penelitian ini adalah subjek laki-laki dari penelitian utama “Growth of rural children in West Java, Indonesia: a twenty-year follow-up study”, berusia 18-49 tahun dan bersedia menjadi subjek penelitian. Total subjek penelitian sebanyak 73 orang. Persetujuan etik (ethical clearance) diperoleh dari Komisi Etik Penelitian yang melibatkan Subjek Manusia IPB dengan nomor 271/IT3.KEPMSM-IPB/SK/2020. Data karakteristik subjek dan asupan dikumpulkan melalui wawancara langsung kepada subjek. Data konsumsi dikumpulkan menggunakan kuesioner semi quantitative food frequency questionnaire (SQ-FFQ) dengan alat bantu buku foto makanan. Data antropometri diperoleh dari pengukuran lingkar perut, penimbangan berat badan dan pengukuran tinggi badan untuk menilai indeks massa tubuh (IMT). Analisis univariat menggunakan uji deskriptif dan analisis bivariat menggunakan uji korelasi Spearman. Analisis metabolomik menggunakan LCMS/MS untuk melihat profil metabolit serum darah subjek. Selanjutnya, senyawa metabolit ditentukan dengan membandingkan profil metabolit serum subjek dengan literatur. Sebagian besar subjek berusia 18-29 tahun yang termasuk dalam kategori dewasa awal. Mayoritas subjek memiliki tingkat pendidikan tergolong rendah dengan kebiasaan merokok aktif. Sekitar 11% subjek tergolong obesitas dan sebanyak 12,3% subjek termasuk dalam kategori obesitas sentral dengan lingkar perut di atas 90 cm. Kebiasaan konsumsi sayur dan buah subjek masih rendah. Rerata total asupan natrium subjek sebesar 2133,9 mg/hari, lebih tinggi dari batas asupan natrium harian yang direkomendasikan. Pangan dari kelompok bumbu dan olahan, seperti garam, bumbu penyedap dan mie instan memberikan kontribusi terbesar pada asupan natrium subjek. Terdapat hubungan yang signifikan (p<0,05) antara status gizi dan lingkar perut dengan tekanan darah. Namun, tidak terdapat hubungan yang bermakna antara kebiasaan merokok, asupan natrium, kalium, magnesium, konsumsi cairan serta kolesterol LDL dengan tekanan darah sistol maupun diastol. Terdapat 39 senyawa metabolit yang berhasil diidentifikasi dalam serum darah subjek menggunakan analisis LCMS/MS. Senyawa metabolit asetikarnitin, isoleusin, fenilalanin, arginin, prolin dan asam urat diketahui menjadi kandidat senyawa yang berhubungan dengan tekanan darah. Pada hipertensi, terjadi peningkatan asetilkarnitin, fenilalanin, dan asam urat, sedangkan, kadar arginin, isoleusin dan prolin diketahui mengalami penurunan akibat kondisi hipertensi. Hasil penelitian ini diharapkan dapat menjadi referensi untuk penelitian lebih lanjut terkait senyawa metabolit yang berperan sebagai biomarker hipertensi.

Hypertension is a major global health problem as its prevalence increases every year throughout the world. The prevalence of hypertension in Indonesia in 2014 was 25.8% and increased to 34.1% in 2018. West Java was ranked second in the province with the highest prevalence of hypertension in 2018 at 39.60%. Various studies show that lifestyle behavior, body mass index, central obesity, and sodium intake are associated with the risk of hypertension. Various research approaches have been carried out to examine pathophysiological mechanisms, risk factors and preventive approaches related to hypertension, including through metabolomics. This study aims to analyze the association between individual characteristics, nutritional status, abdominal circumference, and sodium intake on blood pressure as well as analyzing metabolite compounds related to hypertension in a group of adult men in Sukajadi Village, Tamansari District, Bogor Regency. The quantitative and cross-sectional study design was applied in this study and conducted during November 2022 to March 2023 in Sukajadi Village, Tamansari District, Bogor Regency, West Java Province. The purposive sampling was carried out with inclusion criteria as follows: male subjects from the main research "Growth of rural children in West Java, Indonesia: a twenty-year follow-up study", aged 18-49 years and willing to be participated in this research. The total research subjects were 73 people. Ethical approval (ethical clearance) was obtained from the IPB Research Ethics Commission involving Human Subjects with number 271/IT3.KEPMSM-IPB/SK/2020. Data on subject characteristics and intake were collected through direct interviews with subjects. Consumption data was collected using a semi-quantitative food frequency questionnaire (SQ-FFQ) and supported by a food photo book. Anthropometric data was obtained from measuring abdominal circumference, body weight, and body height to assess body mass index (BMI). Univariate analysis uses descriptive tests and bivariate analysis uses the Spearman correlation test. Metabolomics analysis uses LCMS/MS to view the subject's blood serum metabolite profile. The candidates of metabolite compounds were determined by comparing the subject's serum metabolite profile with the literature. Most of the subjects were aged 18-29 years who were included in the early adulthood category. Most of the subjects' educational level was low and had active smoking habits. Around 11% of subjects were classified as obese and as many as 12.3% of subjects were categorized as central obesity with an abdominal circumference above 90 cm. The subject's fruit and vegetable consumption habits are still low. The total mean sodium intake of the subjects was 2133.9 mg/day, higher than the recommended daily sodium intake limit. Foods from the spice and processed group, such as salt, seasonings, and instant noodles, made the largest contribution to the subject's sodium intake. There is a significant relationship (p<0.05) between nutritional status and abdominal circumference and blood pressure. However, there was no significant relationship between smoking habits, intake of sodium, potassium, magnesium, fluid consumption and LDL cholesterol with systolic or diastolic blood pressure. There were 39 metabolite compounds that were identified in the subject's blood serum using LCMS/MS analysis. The metabolite compounds acetilcarnitine, isoleucine, phenylalanine, arginine, proline, and uric acid are known to be candidate compounds associated with blood pressure. In hypertension, acetylcarnitine, phenylalanine and uric acid were increased, whilst levels of arginine, isoleucine and proline are known to be decreased.