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DAFTAR PUSTAKA
1. Departemen Kesehatan RI. Petunjuk Teknis Pemantauan Status Gizi Orang
Dewasa dengan Indeks Massa Tubuh (IMT), Jakarta; [internet] 2003. [cited 14 Desember 2013] Available from: http://www.depkes.go.id/index.php.
vw=2&id=A-137
2. Ganong, W.F. Buku Ajar Fisiologi Kedokteran. 22nd. ed. Novrianti A, Dany
F, Resmisari T, Rachman LY, Muttaqin H, Nugroho AW, et al editors. Jakarta: EGC; 2008. p. 325.
3. WHO. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO consultation. Geneva, Switzerland: WHO; 2000. p. 11.
4. Kementerian Kesehatan Republik Indonesia. Katalog dalam Terbitan
Kementerian Kesehatan RI Indonesia: Pusat Data dan Informasi Profil
Kesehatan Indonesia 2012, Jakarta: Kementerian Kesehatan RI; 2013. p. 69.
5. Low S, Chin MC, Deurenberg-Yap M. Review on epidemic of obesity. Ann
Acad Med Singapore [PDF file]. 2009; 38: 57-65.
6. Badan Penelitian dan Pengembangan Kesehatan Depkes RI.Laporan Nasional
Riset Kesehatan Dasar 2007. Jakarta: Balitbangkes Depkes RI; 2008. p. 37.
7. Arisman. Gizi dalam Daur Kehidupan: Buku Ajar Ilmu Gizi. 2nd. ed. Suryani, editor. Jakarta: EGC; 2008. p. 232.
67
8. Gutierrez-Fisac JL, Lopez E, Banegas JR, Graciani A, Rodriguez-Artalejo F.
Prevalence of overweight and obesity in elderly people in Spain.Obesity. 2004; 12: 710-15.
9. Asmadi. Konsep Dasar Keperawatan. Mardella EA, editor. Jakarta: EGC;
2008. p. 209.
10.Jakicic JM, Otto AD. Physical activity considerations for the treatment and prevention of obesity. Am J Clin Nutr. 2005; 82: 9S-226S.
11. Risérus U, Ingelsson E. Alcohol intake, insulin resistance, and abdominal obesity in elderly men. Obesity. 2007; 15:1766 -73.
12.Guallar Castillon P, Rodríguez-Artalejo F, Fornés NS, Banegas
JR, Etxezarreta PA, Ardanaz E, et al. Intake of fried foods is associated with obesity in the cohort of Spanish adults from the European prospective investigation into cancer and nutrition. Am J Clin Nutr. 2007; 86:198-205. 13. Roemmich, JN, Jasmine R. Smith, Leonard H. Epstein, Maya Lambiase
.Stress Reactivity and Adiposity of Youth. Obesity a research Journal. 2007; 15(9): 2303–10.
14. Wajchenberg, B.L. Subcutaneous and Visceral Adipose Tissue: Their Relation to the Metabolic Syndrome, Endocrine Reviews. 2000; 21 (6):697-738.
15.Pangkahila. Anti Aging Medicine: Memperlambat Penuaan Meningkatkan Kualitas Hidup. Dharmawan B, editor. Kompas; 2007. p. 94-99.
16.MB Snijder, M Visser, J M Dekker, J C Seidell, T Fuerst, F Tylavsky, et al.
68
elderly: a comparison with computed tomography and anthropometry. International Journal of Obesity [PDF file]. 2002; 26: 984–93.
17.Mohan Anjana, Sreedharan Sandeep, Raj Deepa, Karani Santhanakrishnan
Vimaleswaran, Syed Farooq, and Viswanathan Mohan. Visceral and Central Abdominal Fat and Anthropometry in Relation to Diabetes in Asian Indians.
Diabetes Care. 2004; 27(12): 2948-53.
18.Mlinar B, Marc J, Janez A, Pfeifer M. Molecular mechanisms of insulin resistance and associated diseases. Clinica Chimica Acta.2007; 375: 20-35.
19.Wang JJ, Wang HJ, Liu JS, Ma J. The association between body mass index, waist circumference with body fat percent, and abdominal fat rate in overweight and obese pupils. Zhonghua Yu Fang Yi Xue Za Zhi. 2013; 47(7) :603-7.
20.Janssen I, Heymsfield SB , Allison DB , Kotler DP , Ross R. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr. 2002; 75(4) :683-8.
21.Kuk JL, Janiszewski PM, Ross R. Body mass index and hip and thigh circumferences are negatively associated with visceral adipose tissue after control for waist circumference. Am J Clin Nutr. 2007; 85(6): 1540-4.
22.Arisman. Obesitas, Diabetes mellitus,& Dislipidemia. Mahode AA, Astuti NZ,
editor. Jakarta: EGC; 2011. p. 162-5.
23.Kantachuvessiri A, Sirivichayakul C, KaewKungwal J, Tungtrongchitr R,
69
waterworks authority. Southeast Asian J Trop Med Public Health. 2005; 36:1057-65.
24.Hill JO. Obesity: Etiology in Modern Nutrition in Health and Disease. Lippincot Wilkins. USA [internet]. 2006 [cited 2013 December 12]. Available
from http://www.itd.unair.ac.id/files/ebook/html
25.Abramowitz, M. Diseases and Disorder: Obesity. Smith GS, editor. Lucent Books.USA; 2004. p. 44.
26.Health and Development through Physical Activity and Sport. [internet]
World Health Organization. 2003. [cited 23 Januari 2013] Available from:
http://whqlibdoc.who.int/ hq/2003/WHO_NMH_NPH_PAH_03.2.pdf
27.Geneva, Switzerland: The WHO Document Production Services.CDC.gov
[internet]. USA Government. [updated: 13 September 2011; cited 23
November 2013] Available from: http://www.cdc.gov/healthyweight/
assessing/bmi/adult_bmi/index.html
28.WHO.int [internet]. World Health Organization, c2006 [update: 23 Januari
2014; cited 23 Januari 2013]. Available from: http://apps.who.int/bmi/
index.jsp?introPage=intro_3.html
29.CDC.gov [internet]. USA Government. [updated: 13 September 2011; cited
23 November2013] Available from : http://www.cdc.gov/healthyweight/
assessing/bmi/childrens_bmi/about_childrens_bmi.html
30.K.M Robert, Daryl KG, Victor WR. Biokimia Harper. 27th. Ed. Wulandari N,
Rendy L, Dwijayanthi L, Liena, Dany F, Rachman LY, editors. Jakarta: EGC;
70
31.Balisteri CR, Caruso C, Candore G. The Role of Adipose Tissue and Adipokines in Obesity-Related Inflammatory Diseases. Mediators of Inflamation. 2010; 2010. p.1. DOI :10.1155/2010/802078.
32.Badan Penelitian dan Pengembangan Kesehatan Depkes RI. Riset Kesehatan
Dasar: Pedoman Pengukuran dan Pemeriksaan Jakarta. Jakarta: Balitbangkes
Depkes RI; 2007. p. 21.
33.M, Eickemberg , Oliveira CC, Roriz AK, Fontes GA, Mello AL, and Sampaio
LR . Bioelectrical impedance and visceral fat: a comparison with computed tomography in adults and elderly. Endocrinol Metabol. 2013 ; 57(1): 27-32.
34.R, Sjahriar Rasad. Radiologi Diagnostik. 2nd. Ed. Ekayuda I, editor. Jakarta:
Badan Penerbit FKUI; 2005. p. 13.
35.Ida M, Hirata M, Hosoda K and Nakao K. Abdomen specific bioelectrical impedance analysis (BIA) methods for evaluation of abdominal fat distribution. Nihon Rinsho. 2013 ; 71(2): 262-5.
36.Fernandes RA, Rosa CS, Buonani C, Oliveira AR, Freitas Júnior IF. The use of bioelectrical impedance to detect excess visceral and subcutaneous fat. J Pediatr (Rio J). 2007 83(6):529-34.
37.Ryo M, Maeda K, Onda T, Katashima M, Okumiya A, Nishida M, et al. A New Simple Method for the Measurement of Visceral Fat Accumulation by Bioelectrical Impedance. Diabetes Care. 2005; 28(2): 451-2.
71
39.M, Patrick, Paul Poirier, Philippe Pibarot, Isabelle Lemieux and Jean-Pierre Després.
Relationship Between Inflammation, Hypertension and Cardiovascular Disease. American Heart Association, Inc . 2009; 53: 577.
40.Rohman, M S. Patogenesis dan Terapi Sindroma Metabolik. J Kardiol Ind:
2007; 28: 160-8.
41.Oktavia Lilyasari. Hipertensi Dengan Obesitas: Adakah Peran Endotelin-1?. J
Kardiol Ind 2007; 28: 460-75.
42.Mlinar B, Marc J, Janez A, Pfeifer M. Molecular mechanisms of insulin resistance and associated diseases. Clinica Chimica Acta.2007; 375: 20-35.
43. Sam S, Haffner S, Davidson MH, D?Agostino RB, Feinstein S, Kondos G. Relationship of Abdominal Visceral and Subcutaneous Adipose Tissue With Lipoprotein Particle Number and Size in Type 2 Diabetes. Diabetes. 2008; 57: 2022-7.
44.Kang HW , Kim D , Kim HJ , Kim CH , Kim YS , Taman MJ , ete al .
Visceral obesity and insulin resistance as risk factors for colorectal adenoma: a cross-sectional, case-control study. Am J Gastroenterol. 2010; 105:178-87. 45.Demerath EW, Sun SS, Rogers N, Lee M, Reed D, Choh AC et al. Anatomical
patterning of visceral adipose tissue: race, sex, and age variation. Obesity.
2007; 15: 2984-93.
72
47.Chiolero Et Al, F. D., Paccaud F, Cornuz J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. American Journal Clinical Nutrition. 2008; 87: 801-809.
48.Mustelin L, Silventoinen K, Pietiläinen K, Rissanen A, and Kaprio J. Physical activity reduces the influence of genetic effects on BMI and waist circumference: a study in young adult twins. Int J Obes. 2009; 33: 29-36. 49.Williams PT, Satariano WA. Relationships of age and weekly running
distance to BMI and circumferences in 41 582 physically active women.
Obesity. 2005; 13: 1370-80.
50. Kyrou I ,Tsigos C. Hormon stres: stres fisiologis dan regulasi metabolisme. Curr Opin Pharmacol. 2009; 9: 787 - 93.
51.J. Marniemi, E. Kronholm, S. Aunola, T. Toikka, C.-E. Mattlar,M.
Koskenvuo, Et Al. Visceral fat and psychosocial stress in identical twins
discordant for obesity. Journal of Internal Medicine. 2002; 251(1): 35–43.
52.Wei Ping JIA, Jun-Xi, Kun-San Xiang, Hui-Juan LU, Lei Chen. Prediction of Abdominal Visceral Obesity From Body Mass Index, Waist Circumference and Waist-hip Ratio in Chinese Adults: Receiver Operating Characteristic Curves Analysis. Biomedical Land Environmental Sciences. 2003; 16: 206-211.
53.Singgih Santosa. Statistik Multivariat. Jakarta: PT Gramedia; 2010. p. 58.
54.Muhammad Zen Rahfiludin, Praba Ginandjar. Tidak ada perbedaan respon
imun perokok berat dan perokok ringan karena asupan mikronutrien. J Gizi
73
55.Aisyiyah. Hubungan Tingkat Pengetahuan Ibu Tentang Makanan Sumber
Protein dengan Frekuensi Pemberian Makanan Sumber Protein pada Anak
Balita Usia 1-2 Tahun di Desa Purwosari Kecamatan Comal Kabupaten
Pemalang. [internet] 2011 [cited 6 Januari 2014] Available from:
http://digilib.unimus.ac.id/gdl.php?=browse&op=read&id=jtptunimus-5971
56.Panduan Kesehatan Olahraga Bagi Petugas Kesehatan [internet] 2002.
[cited 2014 Feb 2] Available from: http://www.depkes.go.id/downloads/
Panduan%20Kesehatan%20Olahraga.pdf
57.Sumner AE, Farmer NM, Tulloch-Reid MK, Sebring NG, Yanovsk
JA, Reynolds JC, et al. Sex differences in visceral adipose tissue volume among African Americans.Am J Clin Nutr. 2002; 76(5 ): 975-9.
58.Altan Onat, Erkan Ayhan, Gülay Hergenç, Günay Can, M. Metin Barlan,
Smoking inhibits visceral fat accumulation in Turkish women: Relation of visceral fat and body fat mass to atherogenic dyslipidemia, inflammatory markers, insulin resistance, and blood pressure. Metabolism. 2009; 58: 963– 970.
59.Sarah M. Camhi1, George A. Bray1, Claude Bouchard1, Frank L. Greenway1,
William D. Johnson1, et al. The Relationship of Waist Circumference and BMI to Visceral, Subcutaneous, and Total Body Fat: Sex and Race Differences, Obesity (2011) 19, 402–408.
60. Steven E. Riechman, Robert E. Schoen, Joel L. Weissfeld, F. Leland Thaete
74
61. C. Gollisch ,Josef Brandauer ,Niels Jessen , Taro Toyoda , Ali Nayer ,Michael
F, Katja et al. Effects of exercise training on subcutaneous and visceral adiposetissue in normal and high fat diet fed rats. American Journal of Physiology Endocrinology and Metabolism. 2009; 297: E495-E504
62.Susanne B, Rebecca S.M, Daniel A.D, Christina Koutsari, and Michael D.
Jensen.Meal. Fatty Acid Uptake in Visceral Fat in Women. Diabetes. 2007; 56:2589–2597.
63.Yasmeen R, Reichert B, Deiuliis J, Yang F, Lynch A, Meyers J, et al.
Autocrine function of aldehyde dehydrogenase 1 as a determinant of diet- and sex-specific differences in visceral adiposity. Diabetes. 2013; 62(1): 124-36. 64. Cris A. Slentz , Lori B. Aiken , Joseph. Houmard , Connie W. Bales , Johanna
L. Johnson , Charles J. Tanner , et al. Inactivity, exercise, and visceral fat.
STRRIDE: a randomized, controlled study of exercise intensity and amount.
Journal of Applied Physiology. 2005; 99: 1613-1618.
65.I. Giannopoulou, L. L. Ploutz-Snyder, R. Carhart, R. S. Weinstock, B.
Fernhall, S. Goulopoulou, et al. Exercise Is Required for Visceral Fat Loss in Postmenopausal Women with Type 2 Diabetes. J Clin Endocrinol Metab. 2005; 90: 1511–1518.
66.Brian E Saelens, Randy J Seeley, Kelly van Schaick, Lane F Donnelly, and
Kendall J O’Brien. Visceral abdominal fat is correlated with whole-body fat
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LAMPIRAN
76
77
Lampiran 3
PERNYATAAN KESEDIAAN MENJADI SUBJEK PENELITIAN
(INFORMED CONSENT) Yang bertanda tangan di bawah ini, saya :
Nama :
Umur/TTL :
Alamat :
No. Handphone :
Bersedia dan mau berpartisipasi menjadi subjek penelitian yang berjudul
“Hubungan antara Indeks Massa Tubuh (IMT) dengan Nilai Lemak Viseral (Studi
Kasus pada Mahasiswa Kedokteran Undip )” yang dilakukan oleh:
Nama :Adhitya Pradana
Instansi :Program Studi Fakultas Kedokteran Universitas Diponegoro Semarang
Demikian pernyataan ini saya buat dengan sesungguhnya tanpa ada paksaan dari siapapun.
Mengetahui Semarang, 2014
Peneliti Subjek penelitian
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Lampiran 4
Penjelasan mengenai penelitian dengan judul:
HUBUNGAN ANTARA INDEKS MASSA TUBUH (IMT) DENGAN NILAI LEMAK VISERAL
(Studi kasus pada mahasiswa kedokteran Undip)
Saya (Adhitya Pradana) sedang melakukan penelitian dengan judul
“Hubungan Antara Indeks Massa Tubuh (IMT) dengan Nilai Lemak Viseral
(Studi kasus pada mahasiswa kedokteran Undip)”, maka saya sebagai peneliti memohon kesediaan Saudara/Saudari untuk menjadi subjek penelitian dalam kegiatan penelitian ini. Penelitian ini bertujuan untuk mencari dan menganalisis hubungan antara IMT dengan nilai lemak viseral pada mahasiswa kedokteran Undip.
Metode penelitian
Apabila Saudara/Saudari setuju berpartisipasi dalam penelitian ini, saya akan melakukan beberapa pengukuran diantaranya :
1. Pengisisan data subjek penelitian.
2. Pengukuran lemak viseral menggunakan Tanita BC-601 yang berbasis metode bioelectrical impedance analysis (BIA).
3. Indeks massa tubuh (IMT) melalui pengukuran berat badan dan tinggi badan.
4. Pengisian kuesioner meliputi kebiasaan merokok, kebiasaan konsumsi alkolhol, kebiasaan konsumsi makanan berlemak dan aktifitas fisik(olahraga).
5. Waktu pemerikssaan kurang lebih 15 menit.
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Semua keterangan yang diperoleh dari penelitian ini akan diperlakukan secara rahasia. Saudara berhak menolak ikut serta dalam penelitian ini dan berhak mengundurkan diri selama penelitian berlangsung. Selama penelitian Saudara tidak dibebani biaya apapun, tetapi harus mengisi surat persetujuan mengikuti penelitian.
Peneliti,
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Lampiran 5
KUESIONER
HUBUNGAN ANTARA INDEKS MASSA TUBUH (IMT) DENGAN NILAI
LEMAK VISERAL
( Studi Kasus Pada Mahasiswa Kedokteran Undip )
Identitas subjek penelitian
2. Berapa batang rokok sehari yang dihabiskan? Sebutkan: ...
3. Apakah rutin melakukan aktivitas seperti olahraga? Ya / Kadang / Tidak
4. Berapa sering olahraga perminggu?
5. Berapa menit setiap kali melakukan olahraga?
Kuesioner Kebiasaan konsumsi alkohol
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Kuesioner Frekuensi Makan Makanan
berlemak
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Lampiran 6
BUKU PETUNJUK INNER SCAN TANITA BC-601
MONITOR LEMAK TUBUH / TIMBANGAN
a. Pemrograman Umum
Alat akan menuntun anda dalam pengaturan. Tampilan akan menunjukkan menu-menu utama dan alat akan berbunyi tiap kali langkah-langkah telah dilaksanakan. Gunakan tombol naik atau turun (Up/down) untuk memilih nomor data pribadi. Gunakan tombol set untuk menyimpan data.
b. Pilih nomor data pribadi
Nomor data pribadi menyimpan data-data pribadi dan gunakan tombol naik atau turun (up/down) untuk memilih umur. Tekan set.
c. Pilih Pria atau Wanita (Male atau Female)
Pria dan Wanita. Standar atau atlet dewasa (baca definisinya dalam buku manual)
d. Gunakan tombol naik atau turun (up/down) untuk menentukan tinggi badan. Tekan set.
e. Alat akan berbunyi dua kali dan layar akan menampilkan data tiga kali untuk konfirmasi pemrograman. Power kemudian akan mati secara otomatis.
f. Lakukan pengukuran
Setelah memprogram data pribadi, anda melakukan pengukuran.
Tekan tombol tanda panah “Up” untuk mengaktifkan alat.
Tekan tombol tanda panah “Up”/Down untuk memilih nomor data pribadi.
Tekan tombol set. Alat akan menyala dan naiklah ke atas pijakan.
g. Berat tubuh akan muncul dahulu .Teruskan berdiri di atas timbangan . Hasil pengukuran akan ditampilkan secara bergantian sebanyak 3 kali. h. Pahami hasil pengukuran
Monitor lemak tubuh anada secara otomatis membandingkan hasil pengukuran lemak tubuh dengan batas lemak tubuh sehat.
Peringatan
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Lampiran 7
Hasil crosstabulasi
Indeks Massa Tubuh * Nilai Lemak Viseral
Crosstab
Nilai Lemak Viseral Total
Berlebih Sehat Berlebih
Indeks Massa
b 1 cells (25,0%) have expected count less than 5. The minimum expected count is 2,50.
Symmetric Measures
Spearman Correlation ,315 ,114 2,927 ,004(c)
Interval by Interval Pearson's R ,315 ,114 2,927 ,004(c)
N of Valid Cases 80
a Not assuming the null hypothesis.
84
Jenis kelamin * Nilai Lemak Viseral
Crosstab
Nilai Lemak Viseral Total
Berlebih Sehat Berlebih
Jenis kelamin Laki-laki Count 6 39 45
b 2 cells (50,0%) have expected count less than 5. The minimum expected count is 3,50.
Symmetric Measures
Spearman Correlation ,126 ,101 1,122 ,265(c)
Interval by Interval Pearson's R ,126 ,101 1,122 ,265(c)
N of Valid Cases 80
a Not assuming the null hypothesis.
85
Kebiasaan merokok * Nilai Lemak Viseral
Crosstab
Nilai Lemak Viseral Total
Berlebih Sehat Berlebih
Kebiasaan
b 2 cells (50,0%) have expected count less than 5. The minimum expected count is ,50.
Symmetric Measures
Spearman Correlation ,258 ,177 2,360 ,021(c)
Interval by Interval Pearson's R ,258 ,177 2,360 ,021(c)
N of Valid Cases 80
a Not assuming the null hypothesis.
86
Kebiasaan konsumsi makanan berlemak * Nilai Lemak
Viseral
Crosstab
Nilai Lemak Viseral Total
Berlebih Sehat Berlebih
Kebiasaan konsumsi
b 2 cells (50,0%) have expected count less than 5. The minimum expected count is ,30.
Symmetric Measures
Spearman Correlation -,154 ,175 -1,372 ,174(c)
Interval by Interval Pearson's R -,154 ,175 -1,372 ,174(c)
N of Valid Cases 80
a Not assuming the null hypothesis.
87
Aktifitas fisik * Nilai Lemak Viseral
Crosstab
Nilai Lemak Viseral Total
Berlebih Sehat Berlebih
Aktifitas
b 1 cells (25,0%) have expected count less than 5. The minimum expected count is 2,80.
Symmetric Measures
a Not assuming the null hypothesis.
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Diskriptif nilai lemak viseral menurut jenis kelamin Descriptives
Uji normalitas pada nilai lemak viseral menurut jenis kelamin
Tests of Normality
a Lilliefors Significance Correction
Test of Homogeneity of Variance
Levene
Statistic df1 df2 Sig.
Nilai lemak viseral Based on Mean 6,387 1 78 ,014
Based on Median 5,959 1 78 ,017
Based on Median and with
adjusted df 5,959 1 74,323 ,017
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Perbedaan Nilai lemak viseral
Uji Mann-Whitney Test
Ranks
JK N Mean Rank Sum of Ranks
Nilai lemak viseral Laki-laki 45 45,84 2063,00
Perempuan 35 33,63 1177,00
Mann-Whitney U 547,000
Wilcoxon W 1177,000
Z -2,379
Asymp. Sig. (2-tailed) ,017
a Grouping Variable: JK
90
a Constant is included in the model. b The cut value is ,500
Variables in the Equation
B S.E. Wald df Sig. Exp(B)
Step 0 Constant 2,197 ,373 34,760 1 ,000 9,000
Variables not in the Equation
Score df Sig.
Step 0 Variables IMT(1) 7,919 1 ,005
KM(1) 5,333 1 ,021
Overall Statistics 12,649 2 ,002
Omnibus Tests of Model Coefficients
Chi-square df Sig.
Step 1 Step 10,665 2 ,005
Block 10,665 2 ,005
91
a Estimation terminated at iteration number 6 because parameter estimates changed by less than ,001.
Hosmer and Lemeshow Test
Step Chi-square Df Sig.
1 ,157 1 ,692
Contingency Table for Hosmer and Lemeshow Test
Nilai Lemak Viseral = Berlebih
Nilai Lemak Viseral =
Sehat Total
Observed Expected Observed Expected Observed
Step 1 1 2 2,000 3 3,000 5
Variables in the Equation
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Lampiran 8
Pelaksanaan penelitian
93
Lampiran 9
Biodata Mahasiswa
Nama : Adhitya Pradana
NIM : 22010110120064
Tempat/tanggal lahir : Cilacap / 4 Juli 1992
Jenis kelamin : Laki-laki
Alamat : Jl. H Agus Salim 18 Yogyakarta
Nomor Telepon : -
Nomor HP : 081392142470
e-mail : [email protected]
Riwayat Pendidikan Formal
1. SD : SD N NGABEAN I Yogyakarta
2. SMP : SMP N 8 Yogyakarta
3. SMA : SMA N 1 Yogyakarta