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Correlation of Consumption Patterns and Polymorphism Genes of Angiotensin
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Excess intake of sodium salt will increase the extracellular blood volume that affects the onset of hypertension (Mahmudah et al., 2015).
Several studies have suggested the association of ACE gene polymorphism with hypertension. For example, Markus et al. (1995) reported a positive relationship between allele D angiotensin converting enzyme polymorphisms Insertion / Deletion with hypertension. A study done by Azizah (2010) reported that insertion / deletion polymorphism of the ACE gene affects the concentration of ACE in the blood and affects blood pressure.
Hypertension is a disease with various causes. One of the hypertensive risk factors is the geographic location of an area. People who live in coastal areas have a higher risk of hypertension than people living in highland areas (Kartikasari, 2012). The tendency to increase cases of hypertension is influenced by various factors, so it takes an effort to analyze the polymorphism of genes associated with the incidence of hypertension in coastal communities. The purpose of this research was to know the relationship of consumption pattern with Angiotensin Converting Enzyme (ACE) gene polymorphism (deletion / deletion) with incidence of hypertension in coastal community of Kendari City.
Materials and Methods
This study was an observational analysis with molecular biology approach, case-control research design. Research locations were in the coastal area of Kendari City, namely in the work area Public Health Center of Mata, Nambo and Abeli. DNA isolation and PCR examination (please give more details) were performed at Integrated Laboratory, Faculty of Medicine, University of Halu Oleo.
The study was conducted from February to August of 2017, with samples meeting the inclusion and exclusion criteria of 70 samples, consisting of 35 case samples and 35 control samples. Primary data were obtained through direct interviews, using semi-quantitative food frequency questionnaires (FFQ-SQ), to determine diet and laboratory analysis. Secondary data about hypertension based on physician diagnosis of Public Health Center in coastal area of Kendari City.
Results and Discussion Results
The distribution of sample characteristics based on genotype frequencies and allele of ACE I / D genes can be seen in Table 1. The genotype of Insertion-Insersi (II) genotype had the highest percentage (54.3%) as well as the largest allele of ACE Insertion (I) gene (72.9%).
Table 1. Genotype Frequency Distribution and Frequency of Allele ACE I / D genes
Charecteristics
Respondent Categories
Total
Cases Controls
n % n % n %
Genotype ACE genes
II 20 28.6 18 25.7 38 54.3
ID 12 17.1 13 18.6 25 35.7
DD 3 4.3 4 5.7 7 10.0
Alelle ACE genes
I 29 41.5 22 31.4 51 72.9
D 6 8.6 13 18.5 19 27.1
Total 35 50.0 35 50.0 70 100.0
There was a relationship of sodium consumption pattern (p=0,000, OR=6.46, CI 95% = 2.25- 18.54), fat consumption pattern (p=0,002, OR=4.76, CI 95% = 1.73-13.06) with hypertension occurrence.
While the polymorphism of ACE I / D genes was not related to the incidence of hypertension (p=0.631, OR=0.79, CI 95% = 0.31-2.03) (Table 2)
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Table 2. Relationship pattern of sodium consumption, fat consumption and polymorphism of ACE I/D genes with Hypertension occurence on coastal communities of Kendari City
Charecteristics
Hypertension Occurence
Total
p value OR
95% CI Hypertension No Hypertension
LL UL
n % n % n %
Sodium consumption pattern
0.000 6.46 2.25 18.54
Risky 23 32.9 8 11.4 31 44.3
Not Risky 12 17.1 27 38.6 39 55.7
Fat consumption pattern
0.002 4.76 1.73 13.06
Risky 24 34.3 11 15.7 35 50.0
Not Risky 11 15.7 24 34.3 35 50.0
Polymorphism ACE genes
0.631 0.79 0.31 2.03
Risk Factor 15 21.4 17 24.3 32 45.7
Not Risk Factor 20 28.6 18 25.7 38 53.3
Total 35 50.0 35 50.0 70 100.0
Discussion
Based on the results presented in Table 2, it shows that there was a relationship between sodium consumption pattern with hypertension occurence (p=0.000) in the coastal community of Kendari City.
Most respondents have consumed more sodium than the recommended sodium requirement (> 2000 mg / day). The maximum intake of sample sodium intake was 3808.4 mg / day and the minimum intake of sodium sample was 958.6 mg / day. Types of food containing sodium consumed by respondents are soy sauce, sauce, seasonings, and instant noodles.
Sodium elements are usually consumed in the form of salt. Excessive consumption of sodium causes the concentration of sodium in the extracellular fluid to increase (Maria, 2012). When sodium intake is increased, then the kidneys will respond to increase excretion of salt out with urine. But if the effort to excrete sodium exceeds the threshold of kidney ability, the kidneys will retain oxygen so that the intra vascular volume increases. Increased blood volume make the heart contract to drain more blood into the blood vessels and increase blood pressure (Manawan, 2016).
This results of this study is in line with the study done by Aliffian (2013) which shows the correlation between sodium intake to systolic blood pressure (p=0.040) and diastolic (p=0.013) in outpatient hypertension at PKU Muhammadiyah Hospital, Surakarta. Manawan (2016) also found that there was a relationship of sodium intake with the incidence of hypertension (p=0.000) in the Village Tandengan Satu District Eris, Minahasa District.
In contrast, Maria (2012) found no significant relationship between sodium intake and hypertension (p=0.652) at Guido Valadares Hospital Dili East Timor. Mulki's study (2014) also showed no significant association between sodium intake, either with systolic blood pressure (p=0.114), as well as diastolic blood pressure of the sample (p=0.114). The variation of the results can be attributed to individual reactions to the amount of sodium in the body which is different depending on the sensitivity of the response.
Based on results, there was a correlation between fat consumption pattern with hypertension occurrence (p=0.002) at coastal community of Kendari City. Most respondents have consumed more fat than the recommended fat requirement (> 67 g / day). Excessive fat intake was due to the careless of the respondents to food containing fat. The maximum fat intake of the sample was 150.7 g / day and the minimum value was 12.10 g / day. Types of food sources containing fat often consumed by the samples were fresh fish (skipjack, snapper, and single fish), chicken eggs, coconut milk, and biscuits. Saturated fat found in butter, biscuits, meat products, and creams, has been shown to increase blood cholesterol levels.
Cholesterol that is too high in the blood can narrow the arteries that cause blood circulation clog (Siringoringo, 2013).
The high fat consumption of the respondents was due to their less attention to the selection of food sources of fat. Excessive saturated fat intake can lead to dyslipidemia, as a risk factor for atherosclerosis, which can lead to hypertension. This is due to blood vessels that have atherosclerosis. In addition to increased blood vessel wall resistance, there is also a narrowing of the lumen of the arteries, thus triggering an increase in heart rate and increased blood flow volume, resulting in increased blood pressure and hypertension (Lidiyawati, 2014).
The results of this study were in line with a research done by Salman et al (2015) in Banjarbaru which showed a significant relationship between risk factors of fat consumption pattern with the
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occurrence of hypertension (p=0.029). Siringoringo et al (2013) also reported a significant relationship between the habit of consuming saturated fat with the incidence of hypertension in the elderly (p=0.032) in Sigaoi Village Samosir District. Lidiyawati's (2014) study showed that saturated fatty acid intake had significant relationship and hypertensive risk factor in menopausal women (p=0.02, OR=5.76, 95% CI = 1,141-29,078), in Bojongsalaman Village. In contrast, a study done by Masfufah (2015) showed no relationship between fat intake with blood pressure in elderly (p = 0.92) in Blulukan Village of Karanganyar Regency. Also, Ismuningsih (2013) reported no relationship between fat intake with blood pressure in patients with hypertension (p=0.15), outpatient at Hospital PKU Muhammadiyah Surakarta.
According to Ismuningsih (2013), other factors such as sodium intake, age, family history, and the presence of other diseases could increase blood pressure (Ismuningsih, 2013).
There is no correlation between polymorphism of ACE I / D gene and hypertensive incidence (p=0.631) in coastal community of Kendari City. This is in line with research done by Rasyid et al (2012) who found no significant difference in genotypic distribution and allele frequencies between the genotype groups of DD, genotype ID and genotype II (p=0.903). In contrast, there was a significant relationship between ACE I / D gene polymorphism and hypertension in Yogyakarta, Indonesia (Azizah et al 2010). In addition, the results also showed that the frequency of D alleles of the ACE gene in Yogyakarta, Indonesia was very low, based on the analysis of the ACE genotype. Some experiments have shown that although ACE plasma levels are very stable in individuals, there are striking differences between individuals. Population studies linking ACE genes with hypertension need to study ACE gene deviations in the context of ethnicity, age, gender, environmental and geographical factors (Shanmuganathan et al., 2015).
Conclusion
There were a relationship of fat consumption pattern and consumption pattern of sodium with hypertension occurrence. There was no relationship of gene polymorphism Angiotensin Converting Enzyme Insertion / Delesi (ACE I / D) genes, with incidence of hypertension in coastal communities of Kendari City. Need to check serum ACE levels, before laboratory tests with different research designs were performed. People need to check blood pressure regularly to control it properly.
Acknowledgements
The authors would like to thanks to the respondents for their participation and cooperation, to research teams of UHO Medical Faculty, head of health office and head of public health centre, in coastal area of Kendari City for their support throughout the study.
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