| dc.description.abstract | Prevalenve of obese is rapidly becoming one of the most important medical
and public health problems in countries worldwide, as well as in Indonesia
Epidemiological studies liave reported a progressive increases in incidence of chronic
diseases as hypertension, diabetes, and coronary heart disease with increasing body
mass index. Furthermore, its known that a central distribution of body fat is associated
with a higher risk of morbidity and mortality than a more peripheral distribution of
body fat. Prospective studies have shown a closed relation between the atherogenic
metabolic profile, impaired fibrinolysis and increased susceptibility to thrombosis and
viscerally obese patients. Plasminogen activator inhibitor-I (PAI-I) is the primary
physiological inhibitor of plasminogen activation in vivo. The fact that PAI-1 is
secreted by human adipose tissue and h1ve shown that it is more pronounced in
visceral than in subcutaneous fat. In the regard epidemiological studies suggested that
the elevated expression of PAI-1 as the marker of obesity and elevation in plasma
P AI-1 appear to promote a variety of thrombotic condition.
Soybean-based tempe, a nutritious and healthy food from Indonesia, is
not consumed as raw food but in form of cooked tempe. Research in tempe field has
shown its potential health benefit. During tempe processing, there are valuable
changes not only in the increase of nutritional values of some nutrients in soybeans,
but also in the development of phytochemicals constituent known as isoflavones. The
isoflavone genistein is a phytoestrogen found in high concentrations in soy and soy
products. In addition to estrogenic effects, genistein has effects on protein tyrosin~
kinases, apoptosis, cell proliferation, and angiogenesis and could potentially affect
adipose tissue through these mechanisms. Recent studies also ~howed that isoflavone compound genistein inhibited TNFa - induced PAI-1 production. Furthermore, an
appropiate guideline seems to be reduced calorie intake by introduced low compare
with high GI food, high- fibrous foods, potentially assist in weigh loss and
management of obesity.
The aim of this sti1dy was to conduct evaluation in adult premenopausal obese
women, of the potential lipid-lowering and thrombolytic activity benefit of regular
daily low GI food consumption with soybean-based tempe together. An experimental
randomized crossover design (within-subjects single factor two-level de~i!:,'11) was
conducted at Putri Hijau government hospital in Medan during pt:riod of June 2005
till December 2005, involved pramenopausal healthy obese women with normally
menstrual cycles, working as nurses and staff. The study was approved by Faculty of
Medicine, University of Sumatera Utara Ethics Committee of Research on Health.
BMI dan WC values were obtained using classification for obesity according to Asia
Pacific Region criterion. Body weigh(BW), height and waist circumference (WC)
were measured by Tanita BF 662 (Japan) digital health scale, microtoise Somatometre
inter 16 (London) and special elastic tools (Roche). A 10-h fasting overnight blood
samples was obtained. Total cholesterol, HDL cholesterol, LDL cholesterol, and
triglyceride concentrations were evaluated by using a routine clinical assay
performed on an automatic analyzer (Hitachi). PAI-I antigen and tPA antigen levels
were detennined with specific ELISA
Forty premenopausal women enrolled, seven not complete the protocol because
complete data points over a cycle were not collected due to noncompliance with strict
timing of blood collection (2), inevitable prolonged phase of menstrual cycle during
study (3) or concurrent infection (2). Therefore, 33 subjects completed the entire
study. Clinical characteristics of su~jects showed the mean baseline BMI was 30.21 ±
2.69 kg/m2
, WC 94.3 ± 5.3 cm. Its only 66% subjects were hypercholesterolemia
(more than 200 mg/di), 87 .8 % with LDL-cholesterol levels more than 100 mg/dl,
27.2% with HDL-cholesterol levels below 40 mg/dl, 24.2 % with triglyceride levels
more than 150 mg/dl.Tliere was a significant relation between plasma the PAI-I
antigen and t-PA antigen (r= 0.42, P = 0.01). There were also a significant relation
between WC and total cholesterol, triglycerides, in 21th day (midluteal phase); positive
correlation between WC, PAI-I antigen and t-PA antigen showed in 7th day
(midfollicular phase) of menstrual cycle respectively. All subjects described normal
menstrual cycle duration of29 ± 5 days before study entry. We found some biological
variation both in midfollicular phase (51.8 % for PAI-I antigen, 30.2 % fort-PA
antigen) and midluteal phase (58.11 % for PAI-I antigen, 31.44 % fort-PA antigen)
respectively.
By the four weeks first period of study the subjects consumed their usual home
diets and after randomized procedure they were given treatment allocation as iow
energy (1500-1600 kcal/day) with low glycemic index diet were either consisted of
100 gram cooked soybean-based tempe, Diet T (+) or without soybean-based tempe,
Diet T(-);vice-versa. Blood samples were obtained on 7th and 21st (midfollicular
phase and midluteal phase) of base-line and each of dietary treatment period.
Wilcoxon signed rank test and Mann Whitney U test were used for determined the
effect of diet modification on variables. Non-parametric Speannan's rho correlation
was used to detennine the relation between variables at specific time points during
study. Friedman's test was used to detennine time point differences of fibrinolytic
factors. The primacy finding of the study was that the control diet resulted in clinically
significant decreases more than 6 % of body weights and about 8 % of waist
circumferences measurement (effect of tempe-diet) after 8 weeks period. As expected
lipid and fibrinolytic factors concentrations changed across the menstrual cycle.
When compare to baseline, group data analysis showed the effect of eight weeks
control diet to lowered t-PA antigen (P<0.05) in the midfollicular phase,but not PAI-
1 antigen concentration, meanwhile there was changed relation of the booth
fibrinolytic parameters toward menstrual phases. Despite early decreased of t-P A
antigen levels showed toward control diet and more pronounced by soybean-based
tempe than non-tempe supplement, we assumed this association paralleled either of
body weight decreased, or increases of estrogen levels during the midluteal phase.
There was trends toward increased of the PAI-1 antigen levels with estrogen
concentrations during midluteal phases and expected thrombosis event of subject due
to outlier data showed.There was also trend toward increased of PAI-1 antigen levels
with increased of triglyceride concentrations at the end of study; although soybean-
based control diet have not shown statistical significant effect. In addition, its
suggested that increases concentration of PAI-1 antigen have also been asscociated
with adipose tissue control (body fat) and others factor, although still decreases of
body weight.
As expected, our observation on lipid plasma concentrations showed no
significant effects of control diet on these endpoints. The discrepancy of lipid plasma
concentrations might be either toward to baseline data of subjects which part of
normolipidemia or due to the endogenous female sex steroid cyclical variation during
menstrual cycles, and influences of lower soybean-based tempe portion in control
diet. In conclusion, the high intersubject variability in isoflavone metabolism,
biological variation of menstrual cycles among subjects, preparation portion of
soybean-based tempe, lipid and fibrinolytic factor responses to dietary changes may
have masked a true effect of control diet in this study. We assumed that the low
glycemic diets with 100 gram/day soybean-based tempe might be clinically beneficial
and could slow developing cardiovascular and metabolic risks in adult obese women,
or plays an important role in maintaining nutrition and health overall.
Further studies as to analysed metabolite urine isoflavone concentration
required to determined dose-dependent effect of genistein soybean-based tempe diets
and fibrinolytic factors and lipid plasma in adult obese women | en_US |
