association of fat mass and obesity-associated
by Nur Indrawati Lipoeto4
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N P A K I S T A N J O U R N A L OF
UTRITION
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O PEN ACCESS P a k is ta n Jou rn al of N u tritio n ISSN 1680-5194 DOI: 10.3923/pjn.2018.471.479Cross Mark
t esearch ssociation of Fat Mass and Obesity-associated rs9939609 Article Polymorphisms and Eating Behaviour and Food Preferences in Adolescent Minangkabau Girls
’,2Susmiati, 3Nur Indrawaty Lipoeto, 4lngrid 5. Surono and 5Jamsari jamsari
'Doctoral Program of Biom edical, Faculty of Medical, Universitas Andalas, Padang, 25163 W est Sum atra, Indonesia
^Faculty of Nursing, Universitas Andalas. Padang, 25163 W est Sum atra, Indonesia
’Departm ent of Nutrition, Faculty of Medical, Universitas Andalas, Padang, 25163 W est Sum atra, Indonesia
’Departm ent o f Food Technology, Faculty of Engineering, Bina Nusantara University, 11480 Jakarta, Indonesia
’Departm ent of Agroecotechnology, Faculty of Agriculture, Universitas Andalas, Padang, 25163 W est Sum atra, Indonesia
Abstract .
Backgrou nd and Objective: There are pros and cons surrounding the relationship b etw e en a t mass obesity associated (FTO) rs9939609 variants and the occurrence of obesity with regards to ethnicity and race. The Minangkabau ethnicity is unique ce a p a re d to other ethnicities in Indonesia regarding its dietary pattern, in that this ethnic diet is high in fat intake and low in fibre intake. Itiis study aimed to investigate the relationship between FTO rs9939609 variants and eating habits and food preferences among adolescent girls of Minangkabau ethnicity. Methodology: This study was a case control study and 275 adolescent girls (130 obese and 145 normal) were included. Tetra-primer amplification refractory mutation system-polymerasechain reaction (tetra-ARMS-PCR) was employed to examine genetic variants of FTO rs9939609. Eating habits were determined using an eating habits questionnaire and body mass index (BMI) was computed using the BMI Z-score (WHO). Results:This study revealed a significant relationship between genetic variants of FTO rs9939609 (TT.TAand AA genotypes) and higher BMI (p = 0.01). Those with the A allele were found to consume more fried food and have a lower intake of fruit (p<0.05) than those with the TT genotype. In the obese group, subjects with the A allele did not have a preference for a fruit-vegetable diet (p<0.05). Based on cooking method, subjects with the A allele preferred to eat less meat curry than those with TAand TT genotypes (p = 0.01). Conclusion: The genetic variants of FTO rs9939609 are associated with obesity, eating behaviour and food preferences in adolescents of Minangkabau ethnicity.
Key w ord s: FTO rs9939609, ob esity, e atin g b eh avio u r, food preferen ces, ad o lescen ts
R eceived : M arch 24,2018 Accepter.’ Ju ly 10,2018 Published: S e p tem b er 15,2018
Su sm iati, N ur In d ra w a ty Lip o eto , In g rid 5. Surono and Jam sari Jam sari, 2018 A sso ciatio n o f fat m ass and ob esity-associated rs9939609 polym orphism s and eatin g b e h avio u r an d foo t! p referen ces in ad o le sce n t M in an g kab au girls. Pak. J. N utr., 17:471 479.
. 9 ‘ ’ f Su sm iati, Facu lty o f N ursing, U n iversitas A ndalas, Pad an g , 25163 W e s t Sum atra, In d on esia
■
- © 2018 Su sm iati et a/. This is an open access a rtic le d istrib u ted u n d er th e term s o f th e cre a tiv e com m ons attri b utton Licen se, w h ich perm its u n restricted use, d istrib u tio n an d rep ro d u ctio n in an y m edium , p rovid ed th e o rig in al au th o r and sou rce are cred ited .
C o m p etin g in te re s t The au th o rs h ave d e clared th a t no co m p etin g in terest exists.
D ata A v a ila b ly , A ll re le va n t d ata are w ith in th e pap er and its su p p ortin g in form ation files.
Pak J. Nutr., 17(10): 471-479,2018 INTRODUCTION
D espite rigorous effort to prevent obesity by lifestyle ch an g es associated w ith eating habits and exercise, the o ccurrence o f obesity in ail nations is still rising. T he aetiology and pathogenesis of obesity are n o t yet fully understood, w h ich m akes th e ra p y and p revention o f obesity less effective.
T he risk of obesity d ep end s o n intertw in ed factors; i.e., genetic variants (polym orphism s) and enviro nm en tal factors (diet, physical activities)1.
The N ational Basic Health Research4stu dy revealed that in W e st Sum atera, w h ich is p red o m in ate d b y the M inangkabau ethn ic group, th e prevalence of obesity is 10.8%
or similar to th e national prevalence, 8 3 % obese and 2 5 % very obese. In term s of d ietary patterns, Lipoeto et at.1 reported that th e M inangkabau ethnic gro up is unique am o ng other ethnicities in Indonesia w ith diets m ainly consisting of steam ed rice as a source o f carbohydrates, fish, coconut, vegetables an d chili, w ith slight differences b etw een breakfast, lunch and dinner, Alm ost all M inangkabau food item s are cooked w ith coconut milk and spices (garlic, tu rm e ric onion, ginger and chili).
G e n e s can interact with other genes or with external factors (diet) to contribute to increased b od y fat. Previous studies fo un d that genes play a role in nu trien t specific choices and eating preferences4. G e n e tic variations m ay explain individual -specificities in food preferences, nutritional requirem ents and dietary responses am ong individuals-.
T h e occurrence o f obesity tends to be conferred by increased ene rg yin tak e an d increased hunger/reduced satiety instead o jjd ia n g e s to energy o u tflo w or less exercise in hu m an s6. Fa t mass an d obesity-associated protein (FTO) is explicitly fo un d in th e nucleus o f cells in nearly all hum an tissues'. The hypothalam us is the area w h e re its highest expression levels are observed. This appetite-control zone plays an im portant role in sensitivity to satiety, food responsiveness and eating b eh avio u r5.
Tim e for meals, food intake and food preferences are affected by an intricate relationship am ong physiological, psychological, social and g enetic factors’1. Food intake and choices are m ainly determ ined b y food preferences. Food preferences are th e result o f a com plex relationship b etw een g ene tican d e x te rn alfacto rsth atd rive variatio n sin individuals, for instance, children are dubious and picky ab o ut food and their fo o d preferences10. This preference is reinforced b y a clear g enetic stim ulus of ap petite features in ch ild ren’ .
Harbron et a/.'2 found that in a Caucasian group, unhealthy eating habits, such as grow ing h u n g e ran d shyness or em otional scores as w ell as higher fat and carbohydrate
consum ption are related to the risk o f FTO polym orphism alleles. M cCaffery et at:1 found that d ietary patterns and com position can be affected by risk variants that are related to obesity. M ean w h ile, Brunkw all, et a/.'4 suggested that preference for protein and sucrose is related to risk alleles of the FTO g ene and is also related to a high-fat and low-fibre d ie t'1 and th e consum p tio n of carbohydrates and p ro te in 16.
D espite num erous stu d ie g o n g enetic interactions and environm ental variables, the association b etw e en the FTO rs9939609 polym orphism and dietary behaviours in obese a d o le s c e n t » has rarely been com p rehensively studied.
Therefore, this stu dy w as conducted to investigate the relationship b etw e en th e FTO rs9939609 polym orphism and diet patterns and food p references in an obese M inangkabau population.
MATERIALS AND METHODS
Settings and study design: This study was con du cted as a case control study design in four regencies in W est Sum atra Province (i.e., Tanah datar, Pad an g Panjang, Pariam an and Pa d an g ).T h e m ain study population consisted of adolescent girls aged 12-15 years. The subjects w e re recruited from schools after inform ed consent was o btained. Subjects with a history of horm onal disturbances or intestinal diseases w e re excluded from the study. O bese and norm al subjects w ere selected according to b o d y m ass index (BM I). O besity w a s d efin ed as a BM I Z score>+1 SD and non-obese w as defined as -2 SD < BM I Zscore<+1 S D V .
M easurem ent of anthropom etric parameters:
A nthrop om etric param eters w ere m easured by a professional enum erator. B o d y heig ht was m easured using a roll-up m easuring tape (Seca 206, G erm any) w ith a wall attachm ent.
B o d y w e ig h t w as m easured to the nearest 0.5 kg w ith a digital scale (Om ron, H BF 510W, Ja p a n ) w h ile the subjects w ere w earing normal clothing and no shoes. B o d y mass index w as calculated as w ^ g h t d ivid ed by height squared (kg m !). W aist circum ference w as m easured to the nearest 0.5 cm w ith a standard household tap e m easure. B M I was calculated according to the W H O 2007 g ro w th reference. Subjects w ere classified as obese if th e y had a B M I Z score>+2 SD and norm al if 2 SD < BM I Z score<+l SD. All m easurem ents w ere obtain ed in duplicate by a team o f trained persons.
Oenotyping: A professional analyst was em plo yed to collect 5 m L b lo o d specim ens from each re sp o n d g it. A D N A isolation kit (invitrogen, Therm o Fisher Scientific) was u s e d to ex tract
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genom ic D N A from EDTA-anticoagulated w h o le blood specim ens and th e D N A sam ples w e re th e n stored at -20 C.
Tetra-primer am plification refractory m utation system-PCR (tetra-ARMS-PCR) was used to g eno typ e the S N P variant rs9939609. PCR-restriction fragm ent length polym orphism (RFLP) w as em p lo yed to g e n o typ e the rs9939609 variant, aim ed to validate th e results of the tetra ARMS-PCR.
Eating behaviour and food preferences: Food intake was m easured using a semi q u an titative food frequency questionnaire in aface-to face interview w ith an experienced enum erator. The FFQ includes questions on routine consum ption o f 223 fo o d choices for th e last ye ar p rio rto the study. The food choices w ere grouped into 15 categories:
carbohydrates (rice, fried rice, potatoes an d cereal), fresh fish and other seafood, salted fish, meat, poultry, eggs, tofu and tem peh, peanuts and other nuts, fast food, milk and dairy products, vegetables, fruits, snack foods, drinks and beverages. O ther questions asked w e re ab o u t h o w o ften the sub-items w e re eaten, th e w a y the food w a s prepared and any additional inform ation. T h e subjects w e re requested to m em orize the foods they had eaten during the past year.
Several coloured pictures w e re presented to subjects in order to estim ate the serving size o f th e foods. In general, the questionnaire enabled th e approxim ation o f the d aily food intake of th e 223food options b yfu rth e r exam ining sub-items, such as fruits and veg etables, in su pp lem en tary questions.
Data on the nutrient content o f the food items was acquired from th e N utrient C om position o f M inangkabau Foods. An identical p opulation w a s used to validate th e questionnaire.
Eating habits w e re explained as a w a y to choose, consum e and use food by a person or group based on social norm s and customs. The questionnaire used was Eating, drinking and
sm oking h a b its'6. T h e inform ation on diet included th e subjects' preference of food typ e (anim al protein diet, plant protein diet, fruit-vegetarian, w estern and sw eet food).
Ethical approval: All subjects and their parents or guardians signed inform ed co n sent form s that w e re prepared by the enum erators. Ethical approval w a s granted by th e Ethics C o m m ittee o f the M edical Faculty of Andalas University, Padang, Indonesia.
Statistical analysis: SPS S version 20.0 (S PS S In c , Chicago, IL,
I
U SA) was em p lo yed for the statistical analyses. Continuous variables are expressed as the M e a n ± S D and categorical variables are expressed as frequencies (% ). For norm ally distributed variables b etw e en the obese and non obese groups, m ean differences w e re exam ined using a t-test. For non-norm ally distributed variables, the M a n n W h itn e y U test was em ployed. Chi-squared test w as used to assess differences in categorical variables (FTO g e n o typ e frequency) b etw e en the obese and norm al groups. A n analysis w as also co n d u cte d to d eterm ine the relationships am ong BMI, eating habits and FTO g enotyp e. Differences w ere considered significantly different w h e n p<0.05.
RESULTS
Subjects' characteristics: Table 1 show s that an thropom etric m easurem ents (w eight, BMI, w aist circum ference, hip circum ference, systolic and diastolic blood pressure and
% b ody fat) in th e obese group w e re significantly higher than those in the norm al group (p = 0.01). Average total energy intake w a s not significantly different b e tw e e n the tw o g roups (
2649.32±912.52
vs2678.92
±1286.31
;p =0
.26
).Table I: Subjects characteristic
_______________________________________________________________Norm al (n - 145)_____________________________ Obese (n - 128)______________________________ p-value ’ Anthropometries
W eight (kg) 48.14 ±7.1-4 66.14 ±8.22 0,01*
Body mass index (kg m J) 20.82±2.68 28.35 ±2.79 0.01*
W aist circum ference (cm) 69.61 ±6.62 84.3 7 ±6.67 0.01*
Hip circum ference (cm ) 85.82±5.94 100.12±6.63 0.01*
W/H ratio 0.81 ±0.05 0.84 ±0.04 0.01*
Systolic blood pressure (m m Hg) 116.71 ±9.41 'N po+i p
0.01*
Diastolic blood pressure (mmHg) 71.60±8.12 78.00 ±11.07 0.01*
B o d y fa t(% ) 24.26 ± 3.1! 30.62 ± 179 0.01*
Dietary intake
Total energy (kcal day ) 2649.32 + 912.52 2678.92 ±1286.31 0.26
Carbohydrate 30t.76± 110.11 308.92 ±152.06 0.21
F a tO 130.01 ±53.07 131.17±128.51 0.37
Protein 101.42 ±42.64 98.64 ±54.02 0.33
F ib e r(g d a y ') 17.93 ±7.29 14.96 ±8.19 0.20
Values are expressed as th e M ean± SD Independent t test
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Pak. J. Nutrv 17(10): 471-479,2018
Table 3: Association FTO rs 9939609 genotype and eating behaviour
Norm al O bese
Eating behavoiur TT (n = 82) TA (n - 60) AA (n = 3) p-value TT(n =58) TA (n = 56) AA in - 14) p-value
Regular meal
Always 33 (40.2%) 20(33.3% ) 1 (33.3%) 0.69 15(25.9%) 21(37.5%) 3(21.4% ) 0.30
Seldom Breakfast
49 (59.8%) 40(66.7% ) 2 (66.7%) 43 (74.1%) 35 (6 2 .5 « It (78.6%)
Alw ays 41 (50.0%) 21 (35.0%) 1 (33.3%) 0.19 26 (44.8%) 29(51.8%) 11 (78.6%) 0.076
Seldom
Meal frequency/day
41 (50.0%) 39(65.0%) 2 (66.7%) 32 (55.2%) 27 (48.2%) 3(21.4% )
1-2 M S (6.1%) 1 0 .7 % ) 0 (0.0%) 0.40 2 (3.4% ) 1 (1.8%) 0 (0 .0 % ) 0.70
3*4 x/d 77 (93.9%) 59(98.3%) 3 000 .0 % ) 56 (96.6%) 55(98.2%) 14(100.0%)
Snack frequency/day
Always 13(15.9%) 8(13.3% ) 0 (0 .0 « 0.70 7(12.1% ) 6 (10.7%) 1 (7.1%) 0.87
Seldom 69(84.1% ) 5 2 (8 6 7 % ) 3 (1 0 0 .0 « 51 (87.9%) 50 (89.3%) 13 (92.9%)
Fruit frequency/day
Always 24 (29.3%) 25(41.7% ) 0 (0 .0 % ) 0.14 33 (56.9%) 19(33.9%) 6 (42.9%) 0.04
Seldom $8(70.7%) 35(58.3%) 3(100.0%) 25(43.1%) 37 (66.5%) 8 (57.1%)
Vegetable frequency/day
Always 29 (35.4%) 15(25.0% ) 0 (0.0%) 0.21 11 (19.0%) 15(26.8%) 6 (42.9% ) 0.16
Seldom 53 (64.6%) 45(75.0% ) 3(100.0%) 47(81.0% ) 41 (73.2%) 8 (57.1%)
h ie d frequency/day
Always 59(72.0% ) 36(60.0% ) 2 (66.7%) 0.32 48(82.8%) 33 (58.9%) 11 (78.6%) 0.01
Seldom 23 (28.0%) 24(40.0% ) 1 (33.3%) 10(17.2%) 23 (41.1%) 3 (21.4%)
Meal with family
Always 3 5 (4 2 7 «) 24(40,0% ) 2(66.7% ) 076 22 (37.9%) 13(23.2%) 9 (64.3%) 0.86
Seldom 47 (57.3%) 36(60.0%) 1 (33.3%) 36(62.1%) 43 (76.8%) 5 (3 5 .7 «
“Significant differences w ith p-value<Q,05. Chi square test
Table 4: Association FTO rs99396G9 and d ietary preferences
Norm al Obese
FTO genotypes Low High p-value Low High p-value
'Animal protein diet
TT 12(14.6%) 70 (85.4%) 030 5 (8.6%) 5 3 (9 1 .4 «) 0.13
TA 5 (8 5 % ) 54 (9 1 5 % ) 7(12.5% ) 49(87.5% )
AA 1 (3 3 3 % ) 2 (66.7%) 4 (28.6%) 10(71.4%)
W a n t protein (Set
TT 33 (4 0 2 % ) 49 (59,8%) 18(31.0%) 40(69,0% )
TA 16(27.1%) 43 (72.9%) 0.14 14 (25.0%) 42 (75.0%) 0,40
AA
‘Western (Set
2(66.7% ) 1 (3 3 3 % ) 6(42.9% ) 8 (5 7 ,1 % )
IT 25 (3 0 5 % ) 57 (6 9 5 % ) 33 (S6 .9% ) 25 (43.1%)
TA 21 (35.6%) 38 (64.4%) 039 33 (58.9%) 23(41.1% ) 0.83
AA 0 (0 m ) 3 (1006% ) 7 (50.0%) 7 (50.0%)
T ru it-vegetables d ie t
TT 28 (34.1%) 54 (65.9%) 19 (32.8%) 39 (67.2%)
TA 2 2 (3 7 3 % ) 3 ? (62.7%) 050 14(25.0%) 42 (75.0%) 0.01*
AA
•Sweet food
2 (66.7%) 1 (3 3 3 % ) 10(71.4%) 4 (28.6%)
TT 21 (2 5 6 % ) 61 (74.4%) 27 (46.6%) 31 (53.4%)
TA 14(23.7% ) 45 (7 6 3 % ) 025 20(35.7%) 36 (6 4 3 % ) 0.32
AA 2 (6 6 7 % ) 1 (3 3 3 % ) 4 (28.6%) 10(71.4%)
•‘Anim al protein base d iet includes m eat, beef, lamb, chicken, liver, fish, shrim p and egg, “Plan t protein base d iet nut, tofu, tem peh, "W estern base diet includes soft drink, pizza and potato chips and ham burger, 'T ruit veg etab le d iet includes fruit, vegetable and juice, 'S w e et food d iet includes candy, chocolate, ice-cream and soft dri nks, *Chi square test, significant differences w ith p value<0.05
and a w e ig h t excess o f 3 kg has a 1.5 tim es greater risk of freq uently found in Europeans are associated w ith o besity in o be sityth an a person w ith o u t risk alleles.FT O varian tsthatare Chinese p eo p le and M alays living in Singapore20, as found
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elsew here such as in C h in e s e " 21, Rom anian ch ild ren24, Pakistanis25 and South Asians26. How ever, inconsistencies w ere found am ong P a k is ta ig w ith ob esity2’.
Risk variants o f the fat mass and obesity-associated protein (FTO) rs9939609 g e n e have been associated w ith a higher risk ofobesity. Nevertheless, the fact that FTO g eno typ e and food intake are related has yet to be confirm ed. In this study, w e support th e finding th a t there are no significant differences in m acronutrient intake b etw e en FTO genotypes, as previously found by a m f a -analysis study of Livingstone et al2*. Furtherm ore, th e A allele o f the FTO rs9939609 g e n e is associated with o besity via higher energ y intake, i.e, m ainly fatJM0. H ow ever, this finding is inconsistent with the results o f a meta-analysis con du cted for children and adolescents5’ .The A alle le of rs9939609influencedobesity but did not con trib ute to th e g o n tr o l of energ y expenditure.
Instead, this allele could b e involved in th e regulation of food intake and fo o d choices in European children, suggesting a p ath w ay to a h yp e rp h ag icp h e n o type or a preference fo rh ig h calorie food. H o w ever, our study did support this result. This difference was th o u gh t to be d ue to distinction in the studied SNPs, the ag e o f subjects (m ainly children), fe w e r nu m b er of subjects an d variations in the m easurem ents of dietary intake that is incom patible w ith o ur FFQ.
T he fu nd am ental m olecular interactions b etw e en FTO and risk o f obesity are still unclear. Based on studies of hum ans, the appetites and eating habits of children and adolescents are affected by the FTO g e n o typ e 2*. Similarly, the B O g en o typ e influences e ating habits, food selection’3 and food preferences’4. R ecen t research found that the FTO geno typ e is associated w ith a rise in ghrelin ho rm one (hu ng er horm one) levels and a decline in leptin ho rm one (satiety horm one) levels15. The A allele o f FTO m ay disrupt the circulating levels o f th e orexigenic horm one acyl-ghrelin and dim inish postprandial ap petite redu ctio n” .
M a n y n e w genes in th e brain are w ell studied a n d som e genes are specifically found in the hypothalam us, w h ich functions in co njunction w ith central nervous system processes and ha ve an essential role in th e control o f body w eig ht. T he hypothalam us is key in controlling energy hom eostasis and food intake. Dysfunction in the hypothalam ic area m ay cause d ereg u lation o f b od y w e ig h t due to changes in eating b eh avio ur35.
Persons w ith the A allele w ere show n to e a t considerably m ore fried food than those w ith the TT genotype. Moreover, w e also found a significant relationship b etw e en th e A allele and low er fruit intake. I H s finding is in line w ith a study of y o u th in w h ich they had a t least one A allele and consum ed a considerably hi gher p ercen tag e o f e n e rg y from fat tha n theTT
subjects did (p = 0.008}14. The FTO rs9930609 allele is associated with an increase in the consum ption of 5 g d ay ! fat and 25 kJ d ay energ y (based o n a 3 d ay food record) in children3£ Other research has identified a relationship b etw een FTO g e n o typ e and B M I in persons consum ing a diet high in fat and, particularly, satu rated fat35. In Spanish children, the risk allele carriers that consum e m ore than 12.6% SFA (o f total energy) had a higher risk o f obesity than TT carriers” .
G eneticvariatio ns m ayalte r h o w children recognize their preference for fat-rich foods. In adults, there are differences b etw e en persons with o besity and w ith norm al w e ig h t in their preference for fat and for a blend o f sugar and fat*51 and this finding supports a m ech an ism that m ay be contained in the aetiology of the variations. Persons with obesity and th a t are o ve rw e ig h t exhibit a predisposition to preference and selection of high-energy foods th a t could p rom ote these conditions. D espite being an im portant part of food choice, 'liking' o nly contributes to general distinction in food choice and eating behaviours to a reasonable extent4*. Sugar and fat are the tw o m ost favourable ingredients in food by children42.
These results are in line w ith a cohort study in the U nited States in w h ich th e variants o f FTO w e re associated w ith a fried food d iet11. In our study, it was suggested that fried food and fruit intakes could m o dify the relationship b etw e en FTO variants and obesity, particularly in individuals w h o co n sum e m ore fried food or less fruit and have a g enetic risk o fobesity.
There is substantial similarity in children's preferences of food; high-fat and sw eet foods are usually preferred l|g children, b u t vegetables are alm ost universally disliked44. In line w ith th e se results, a study that investigated food patterns across th e FTO g e no typ es found that A allele carriers consum ed a higher nu m b er o f m eals per d ay and ate m ore servings of energy-dense f o o d s J .
In obese subjects, there is an association b etw e en rs9939609 g eno typ e and fruit preference. Participants w ith the AA g eno typ e did no t prefer a fruit-vegetable diet. This finding is in line w ith a p revious study in C hinese Han children and adolescents45. There is an interaction b etw e en FTO variants and fibre intake in those w ith general obesity, an effect that w a s m ore p rom in en t in those w h o consum ed high levels of d ietary fibre and had a high nu m b er o f risk alleles44.
Based o n cooking m ethod, in obese subjects, there was a significant association b e tw e e n FTO geno typ e and a preference for m eat curry. Participants with the A a lle le had a low er intake o f m eat curry than those with o ther genotypes.
M eat curry consists o f m eat (fish, chicken and beef) w ith co con ut and m any spices, especially phenolic com pounds.
Ph eno lic com pounds, as secondary m etab olites in plants, present th e greatest eviden ce o f effective obesity treatm ent.
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Polyphenols m ay p rovide beneficial effects o n adipose tissue under obese conditions by reducing intracellular oxidative stress an d ch ronic low -grade inflam m ation and by suppressing adipogenesis, lipogenesis and the differentiation of preadipo cytes to m ature adipocytes'1'. As one o f the spices in curry, turm eric contains curcum in, w h ich is an active ingredient that can be utilized to reduce w eight.
CONCLUSION
O bese subjects w ith th e A allele co n sum e m ore fried food and less fruit than those w ith th e T allele. Furtherm ore, obese subjects w ith the A allele do not prefer a diet including fruits veg etables and m eat curry. H ig h fried food intake and low fruit, veg etable and curry intake m ay increase obesity prevalence in subjects with the A allele.
T h e strength of this research is th a t th e study has been conducted in num erous samples and various geographic distributions com prising rural and urban subjects. The lim itation o f this study is that the study was a cross-sectional study, w h ich cannot trace causal m echanism s. Based on this limitation, future research will include an intervention study.
SIGNIFICANCE STATEMENT
This research found a relationship b etw e en the FTO rs9939609 polym orphism and obesity. T he results of this study could be used by health care professionals to set w e ig h t m an ag em ent goals and p ro vid e d ietary assistance for people w ith a g enetic te n d e n c y for obesity.
ACKNOWLEDGMENTS
W e express our gratitude to D anone Institute Indonesia for fu nd in g this research (No: 002/D/DII/2014) and Fakultas K ep eraw atan Universitas Andalas (No: 1344/UN.l 6.13.D/PLy FKEP/2017). W e also th an k the Program Ban tuan S em in arLu ar Negeri, Universitas Andalas and our participants, w ith ou t w h o m this study w o u ld not have been possible.
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