BAB VI SIMPULAN DAN SARAN
B. Saran
Dengan mempertimbangkan hasil penelitian, Penulis memberikan saran sebagai berikut :
1. Perlu dilakukan sosialisasi yang lebih mendalam kepada masyarakat mengenai efek negatif perubahan toleransi glukosa yang mengarah ke insiden DM tipe II pada orang dengan obesitas sentral.
2. Tingginya prevalensi obesitas pada hasil penelitian ini, kepada warga Perumahan Griya Binangun Asri yang telah dijadikan sampel, perlu dilakukan penyuluhan mengenai perubahan gaya hidup dengan diit dan olahraga yang teratur.
3. Perlunya diterapkan pengukuran antropometri RLPP pada pasien yang berkunjung ke pusat-pusat pelayanan kesehatan sebagai skrining awal adanya obesitas sentral dan faktor risiko kardiometabolik yang disebabkan oleh obesitas tersebut.
4. Perlu dilakukan penelitian dan kajian mendalam untuk menentukan metode pengukuran antropometri tubuh yang paling baik dalam
memprediksikan kemungkinan kejadian faktor risiko kardiometabolik pada obesitas.
5. Dapat memanfaatkan hasil penelitian ini sebagai bahan acuan pada penelitian lanjut yang berkaitan dengan pendalaman masalah resistensi insulin.
DAFTAR PUSTAKA
Basu R, Pajvani UB, Rizza RA, Scherer PE. 2007. Selective downregulation of the high–molecular weight form of adiponectin in hyperinsulinemia and type 2 diabetes. Differential regulation from nondiabetic subjects. Diabetes 56:2174–2177.
Bigaard J, Frederiksen K, Tjønnelan A, Thomsen BL, Overvad K, Heitmann BL, Sørensen TI. 2004. Waist and hip circumferences and all-cause mortality: usefulness of the waist-to hip ratio. International Journal of Obesity 28:741–747.
Bray GA, Lovejoy JC, Smith SR, DeLany JP, Lefevre M, Hwang D, Ryan DH, York DA. 2002. Recent advances in nutritional sciences. The influence of different fats and fatty acid on obesity, insulin resistance, and inflammation. J Nutr 132:2488–2491.
Cani PD, Amar J, Iglesias MA. 2007. Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes care 56:1761–1772.
Chan DC, Watts GF, Barrett PH, Burke V. 2002. Waist circumference, waist-to-hip ratio, and body mass index as predictors of adipose tissue compartments in men. Q J Med 441–447.
Chandran M, Phillips SA, Ciaraldi T, Henry RR. 2003. Adiponectin : More Than Just Another Fat Cell Hormone ?. Diabetes Care 26:2442-2450.
Dahlan MS. 2005. Statistika untuk Kedokteran dan Kesehatan. Jakarta: PT. Arkans
Daniels SR, Steinberger J. 2003. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: An american hearts association scientific statement from the atheroclerosis, hypertensy, and obesity in the young committee (council and nutrition, physical activity, and metabolism). Circulation 107:1448–1453.
Daniels SR. 2009. The use of BMI in the clinical setting. Pediatrics 124:S35–S41.
Departemen Kesehatan Republik Indonesia. 2007. Tahun 2030 prevalensi diabetes melitus di Indonesia mencapai 21,3 juta orang. http://www.depkes.go.id/index.php. (15 Maret 2010)
Després J. 2006. Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk. European Heart Journal Supplements 8:B4–B12.
Eckel RH and Bonow RO. 2003. Diet, obesity, and cardiovascular risk. N Engl J Med 348:2057–2058.
Esqueda A, Aguilar-Salinas CA, Velazquez-Monroy O, Gómez FJ, Rosas PM., Mehta R et al. 2004. The body mass index is a less-sensitive tool for detecting cases with obesity-associated co-morbidities in short stature subjects. International Journal of Obesity 28:1443–1450.
European Health Risk Monitoring. 2002. Recommendation for indicators, international collaboration, protocol and manual of operations for chronic disease risk factor surveys. EHRM.
Eyben VF, Mouritsen E, Holm J, Montvilas P, Dimcevski G, Sucius G et al. 2003. Intra-abdominal obesity and metabolic risk factors: a study of young adults. International Journal of Obesity 27 : 941–949.
Froguel P. 2004. Obesity: mechanisms and clinical management. N Engl J Med 350:1691–1692.
Gandasoebrata R. 2006. Penuntun laboratorium klinik. Jakarta : Dian Rakyat, pp: 7-8.
Grundy SM. 2004. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab 89(6):2595–2600.
Grundy SM, Chair, Cleeman JI, Daniels SR, Donato KA, Eckel RH et al. 2005. Diagnosis and management of the metabolic syndrome. Circulation 112: e285-e290.
Hossain P, Kawar B, and El Nahas M. 2007. Obesity and diabetes in the developing world–a growing challenge. N Engl J Med 356:213–215.
Huxley R, Mendis S, Zheleznyakov E, Reddy S, and Chan J. 2010. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature. European Journal of Clinical Nutrition 64 :16–22.
James PT, Lear SA, KO GT, and Kumanyika S. 2010. Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. European Journal of Clinical Nutrition 64:42-61.
Janghorbani M, Amini M, Rezvanian H, Gouya MM, Delavari A, Alikhani S et al. 2008. Association of body mass index and abdominal obesity with marital status in aduts. ArchIranian Med 11:274–281.
Kahn R, Buse J, Ferannini E, and Stern M. 2005. The metabolic syndrome: time for a critical appraisal. Diabetes Care 28:2289-2304.
Ketel IJ, Volman MN, Seidell JC, Stehouwer CD, Twisk JN, and Lambalk CB. 2007. Superiority of skinfold measurements and waist over waist to hip ratio for determination of body fat distribution in a population-based cohort of Caucasian Dutch adults. European Journal of Endocrinology 156:655–661.
Labib M. 2003. The investigation and management of obesity. J Clin Pathol 56:17-25.
Lang P, Van Harmelen V, Rydén M, Kaaman M, Parini P, Carneheim C et al. 2008. Monomeric tartrate resistance acid phophatase induces insulin sensitive obesity. PLoS ONE 3(3):e1713.
Lear SA, Humphries KH, Frohlich JJ, and Birmingham CL. 2007. Appropriateness of current thresholds for obesity-related masures among Aboriginal people. CMAJ 177:1499–1505.
Liubov ,Noun B , and Laor A. 2003 Relationship of Neck Circumference to Cardiovascular Risk Factors. Obesity Research 11:226 –231.
Lteif AA and Mather KJ. 2005. Obesity, insulin resistance, and the methabolic syndrome. Determinants of endothelial dysfunction in whites and blacks. Circulation 112:32–38.
Mahan, Adair, and Popkin BM. 2002. Ethnic differences in the association betwen body mass index and hypertension. Am J Epidemiology 155:346-353.
Marques BG, Hausman DB, and Martin RJ. 1998 Association of fat cell size and paracrine growth factors in development of hyperplastic obesity. Am J Physiol 275:R1898–R1908.
Matereau. 2010. Pemeriksaan darah hemoglobin dan glukosa darah.
http://materiuas.wordpress.com/2010/01/26/pemeriksaan-darah-hemoglobin-dan-glukosa-darah-2/. (5 April 2010).
McLaughlin T, Abbasi F, Lamendola C, Liang L, Reaven G, Schaaf P et al. 2002. Differentiation between obesity and insulin resistance in the association with C-Reactive protein. Circulation 106:2908–2912.
Merentek E. 2006. Resistensi insulin pada diabetes mellitus tipe 2. Cermin Dunia Kedokteran 150:38-41.
Mirmiran P, Ezmaillzadeh, and Azizi F. 2004. Detection of cardiovascular risk factors by anthropometric measures in Tehranian adults: receiver operating characteristic (ROC) curve analysis. European Journal of Clinical Nutrition 58:1110–1118.
Misra A. 2003. Revisions of cutoffs of body mass index to define overweight and obesity are needed for the Asian-ethnic groups. International Journal of Obesity 27:1294–1296.
Nygaard HA. 2008. Measuring Body Mass Index (BMI) in nursing home residents: the usefulness of measurementof arm span. Scandinavian Journal of Primart Health Care 26:46–49.
Ogden CL, Yanovski SZ, Carrol MD, and Flegal KM. 2007. The epidemiology of obesity. Gastroenterology 132: 087–2102.
Perseghin G, Petersen K, Shulman GI. 2003. Cellular mechanism of insulin resistance: potential links with inflammation. International Journal of Obesity 27:S6–S11.
Poston C, Walker S, and Foreyt JP. 2002. Body mass index: uses and limitations. Strength & Conditioning Journal 24:15–17.
Priyanto. 2004. Analisa gas darah. www. Priyantoblogspot.com. (5 April 2010).
Reaven GM. 2006. The metabolic syndrome: is this diagnosis necessary? Am J Clin Nutr 83:1237–1247.
Riset Kesehatan Dasar. 2007. Tinjauan Nutrisi. [email protected] (4 April).
Sacher RA, Mcpherson RA. 2004. Tinjauan Klinis Hasil Pemeriksaan Laboratorium. Edisi 11. Jakarta : EGC, pp : 519-520.
Sampei MA, Novo NF, Juliano Y, Colugnati FA, and Sigulem DM. 2003. Anthropometry and body composition in ethnic Japanese and Caucasian adolescent girls: considerations on ethnicity and menarche. International Journal of Obesity 27:1114–1120
Sastroasmoro S. 2008. Dasar-Dasar Metodologi Penelitian Klinis. Bagian Ilmu Kesehatan Anak FK UI. Jakarta: Binarupa Aksara.
Schneider HJ, Glaesmer H, Klotsche J, Böhler S, Lehnert H, Zeiher AM et al. 2007. Accuracy of anthropometric indicators of obesity to predict cardiovascular risk. J Clin Endocrinol Metab 92:589–584.
Snijder MB, Heine RJ, Seidell JC, Bouter LM, Stehouwer CD, Nijpels G et al. 2006. Associations of adiponectin levels with incident impaired glucose metabolism and type 2 diabetes in older men and women. Diabetes Care 29:2498–2503.
Steinberger J and Daniels SR. 2003. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an american heart association scientific statement from the atherosclerosis, hypertension, and obesity in the young committee and the diabetes committee. Circulation 107;1448-1453.
Susilowati. 2008. Pengukuran status gizi dengan antropometri gizi. Cimahi: Sekolah Tinggi Ilmu Kesehatan.
Tataranni PA. 2002. Pathophysiology of obesity-induced insulin resistance and type 2 diabetes mellitus. European Review for Medical and
Pharmacological Sciences 6: 27-32.
Terauchi Y, Matsui J, Kamon J, Yamauchi T, Kubota N. Komeda K et al. 2004. Increased serum leptin protects from adiposity despite the increased glucose uptake in white adipose tissue in mice lacking p85α phosphoinositide 3-kinase. Diabetes 53:2261–2270.
Trujillo ME and Scherer PE. 2005. Adiponectin–journey from an adipocyte secretory protein to biomarker of the metabolic syndrome. Journal of Internal Medicine 257:167–175.
Vasquez G, Duval S, Jacobs DR, and Silventoinen K. 2007. Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev 29:115–128.
World Health Organization. 2002. Report workshop on obesity prevention and control strategies in the pacific. Manila: World Health Organization Regional Office for the Western Pacific
World Health Organization. 2004. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163.
World Health Organization. 2010. Obesity and overweight: programmes and project of global strategy on diet, physical activity and health. Geneva, Switzerland : WHO document production services. p: 1
Lampiran 1. Lembar Persetujuan Sampel
LEMBAR PERSETUJUAN MENJADI SUBYEK PENELITIAN
Saya yang bertanda tangan dibawah ini : Nama :
Usia : Alamat :
Menyatakan bersedia untuk menjadi sampel dalam penelitian dengan judul “Hubungan Indeks Massa Tubuh dan Rasio Lingkar Pinggang Pinggul ( RLPP) dengan Kadar Gula Darah Puasa’’ secara sukarela dan tanpa paksaan.
Pengasih, … Mei 2010
Lampiran 2. Hasil Uji Statistik
Distribusi Data
Descriptive Statistics
N Range Minimum Maximum Mean Std. Deviation
UMUR 42 33 25 58 43.90 8.658 IMT 42 18.62 15.80 34.42 23.5950 3.39461 RLPP 42 .21 .77 .98 .8838 .06484 GDP 42 80 76 156 106.86 20.473 Valid N (listwise) 42 Variabel IMT
Case Processing Summary
Indeks Masa Tubuh
Cases
Valid Missing Total
N Percent N Percent N Percent
Kadar Gula darah puasa 1 26 100.0% 0 .0% 26 100.0%
2 16 100.0% 0 .0% 16 100.0% Tests of Normality Indeks Masa Tubuh Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Kadar Gula darah puasa 1 .154 26 .115 .919 26 .042
Hasil transformasi data Tests of Normality Indeks Masa Tubuh Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
trans_gdp 1 .157 26 .099 .923 26 .054
Independent Samples Test
t-test for Equality
T Df Sig. (2-tailed) Mean Difference
Std. Error Difference
trans_gds Equal variances assumed -1.134 40 .264 -.02829 .02495
Equal variances not assumed
-1.254 39.862 .217 -.02829 .02256
Variabel RLPP
Case Processing Summary
Rasio Lingkar PP
Cases
Valid Missing Total
N Percent N Percent N Percent
Kadar Gula darah puasa 1 12 100.0% 0 .0% 12 100.0%
2 30 100.0% 0 .0% 30 100.0% Tests of Normality Rasio Lingkar PP Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Kadar Gula darah puasa 1 .135 12 .200* .966 12 .861
Independent Samples Test
t-test for Equality
T Df Sig. (2-tailed)
Mean
Difference Std. Error Difference Kadar Gula darah puasa Equal variances assumed -8.183 40 .000 -32.800 4.008 Equal variances not assumed -11.892 38.840 .000 -32.800 2.758 Uji Korelasi Correlations Indeks Masa Tubuh Kadar Gula
darah puasa Rasio Lingkar PP
Indeks Masa Tubuh Pearson Correlation 1 .146 .279
Sig. (2-tailed) .356 .073
N 42 42 42
Kadar Gula darah puasa Pearson Correlation .146 1 .791**
Sig. (2-tailed) .356 .000
N 42 42 42
Rasio Lingkar PP Pearson Correlation .279 .791** 1
Sig. (2-tailed) .073 .000
N 42 42 42