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ABDUCENS AC A D E M I C B U N D L E O F C R E AT I O N S P CC E A M S C 2 0 1 9 - BY A M SA U N H AS

SCIENTIFIC

PAPER

Type 2 Diabetes Mellitus: An Ethnicity Based Analysis On Daily Glycemic Load Arief Abdurrazaq Dharma, Imam Amriadi A.S, Andi Muhammad Zharfan, Eddy Zulfikar DISTRICT 6 WINNER FOR SCIENTIFIC PAPER

TYPE 2 DIABETES MELLITUS: AN ETHNICITY BASED ANALYSIS ON DAILY GLYCEMIC LOAD Asian Medical Students’ Association Universitas Hasanuddin

Written By: Arief Abdurrazaq Dharma Imam Amriadi A.S Andi Muhammad Zharfan Eddy Zulfikar

ASIAN MEDICAL STUDENTS’ ASSOCIATION UNIVERSITAS HASANUDDIN MAKASSAR 2018

INTRODUCTION Diabetes prevalence has been rising more rapidly in middle and low-income countries. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 (World Health Organization [WHO], 2017). Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes (American Diabetes Association [ADA], 2015). T2DM mostly happens because the pancreas doesn’t produce enough insulin in amount of the body needs and/or the insulin that is produced does not work correctly (insulin resistance) (British Dietetic Association [BDA], 2018). Insulin itself is a hormone that regulates blood sugar, which helps glucose enter the body cells. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012 (WHO, 2017). Carbohydrates are the dietary components that have the greatest effect on blood glucose concentrations. Because carbohydrates differ in their ability to increase blood glucose, the concept of Glycemic Index (GI) was introduced in the early 1980s. The GI is a ranking of carbohydrates according to their effect on postprandial glycemia (Fiona, Kaye, & Jennie, 2008). Although the GI can effectively rank foods on the basis of their blood glucose response, it does not account for the amount of carbohydrate in a typical serving. Therefore, the new concept of Glycemic Load (GL) was developed as the product of the GI and the amount of carbohydrate in a serving (Livesey G et al., 2013). Three meta-analyses (Barclay, 2008; Dong, 2011; Livesey, 2013) of prospective cohort studies found a higher risk of T2DM with higher GI and GL. Furthermore, three large prospective cohorts of US men and women conducted by Shilpa et al (2014), succeed to prove a positive association between GI, GL, and the risk of T2DM. On their research, Shilpa et.al found that participants who consumed a combination diet that was high in GI or GL and low in cereal fiber had an approximately 50% higher risk of T2DM compared with those whose diets were high in cereal fiber and low in GI or GL. Several physiologic mechanisms have been proposed to explain the positive association of GI and GL with T2DM (Ludwig, 2002; Willet, 2002). High-GI and -GL diets are known to stimulate the increased production of insulin, resulting in a state of hyperinsulinemia, which, in turn, can induce insulin resistance. The consumption of highGI and -GL diets for several years can increase the demand on β-cells and lead to β-cell exhaustion and failure (Pawlak, Kushner, & Ludwig, 2004). Furthermore, because high-GI and -GL diets increase concentrations of blood glucose and free fatty acids (Thomas & Elliott, 2010), chronic exposure to these elevated concentrations can also induce β-cell

failure. The biological plausibility of an association between GI and T2DM is evident from results of metabolic and intervention studies. In a meta-analysis of 12 randomized controlled trials that comprised 612 subjects, low-GI diets reduced glycated hemoglobin by 0.4% (95% CI: −0.7%, −0.2%) over that produced by the control diets (Thomas & Elliott, 2010). Furthermore, the Study to Prevent NonInsulin Dependent Diabetes Mellitus (STOP-NIDDM) trial, which showed that acarbose, an oral α-glucosidase inhibitor, which effectively converts the diet to a low-GI/GL diet, reduced T2DM risk by 25% over a mean follow-up of 3 y provides a proof-of-concept for low-GI diets (Chiasson et al., 2002). Unfortunately, in Indonesia, based on the data from RISKESDAS, about 53.1% of the population aged over 10 years, was known to have excess sugar consumption habits (Riset Kesehatan Dasar [RISKESDAS], 2013), no exception for South Sulawesi. Makassar is a capital city of South Sulawesi, which is dominated by Buginese ethnics (Ciptakarya 2004). Common foods of Buginese Makassarese that are mostly found including coto makassar, jalangkote, beppa tori, pallu butung, pisang ijo, sup saudara and sup konro which are identical with high sugar and fat content. In a study conducted by Wahyu Rizky Kartikasari (2014) about Analysis of Community Eating Habits Around Waduk Cirata, Bogor, by comparing eating habits of Buginese with Sundanese population which living around, it is known that the tea consumption of Buginese is higher than Sundanese. In depth, there are differences in the way of serving the tea between the two. The Buginese are used to drinking tea by adding sugar, while the Sundanese are used to drinking plain or tasteless tea. Furthermore, in Wahyu Research, stated as many as 92.9% of Bugis people are known to have a habit of frequent consumption of snacks. Snacks that are usually eaten are more likely high-carbohydrate snacks such as biscuits, sukro beans, fried foods, banana chips and cassava chips. This kind of habits led to the presentation of the high rate of obesity in Buginese (50%) compared to the Sundanese (34.4%). This is in line with the research of Burhan et al. (2013) who found that in Jeneponto, South Sulawesi, factors that were proven to influence the incidence of central obesity were high intake of sucrose sugar, fat, and low intake of fruit and vegetable. This can be a major problem of society because people whose living with obesity have a 7.14 times greater risk of developing diabetes mellitus than individuals who are not obese in the future (Kurnia & Setyorogo, 2013). This is proven by data from RISKESDAS 2013 that the prevalence of diabetes mellitus diagnosed by doctors or symptoms in South Sulawesi, is the third highest in Indonesia, namely 3.4%, after Central Sulawesi (3.7%) and North Sulawesi (3.6%). This is four times higher than the previous data on RISKESDAS in 2007, whose prevalence is only around 0.8%.

It is concluded that eating habits are formed from the beginning of life, so that high consumption of sugar in children still become a major concern. Parents are determinants of their children's nutrition up to 70% of what they eat (Dallacker, Hertwig R, & Mata J, 2017). Therefore, reducing sugar consumption in children is a parent's decision regarding food (Hertwig & GrĂźne-Yanoff, 2017). The behavior of one's food consumption, in this case the parents and their children, is influenced by knowledge and other factors such as the socio-cultural background in which they live (Aminuddin, 2016). Indonesia is a country that has diverse cultures, and South Sulawesi province is one of them. The population of South Sulawesi consists of 4 major ethnic groups, namely Buginese, Makassarese, Toraja, and Mandar (Ubbe, 2005). Until now, there have been no studies related to the influence of local culture on consumption behavior. Therefore, based on the problem, researchers are interested in knowing more about the consumption culture in South Sulawesi, associated with the increasing risk of types 2 diabetes mellitus.

METHOD This was a descriptive study using consecutive sampling. This study focusing on housewives from four major ethnicities in South Sulawesi (Buginese, Makassarese, Mandar, and Toraja). The housewives included in this study should be at least have one child and made their own dishes for their family. Total number of household in Sulawesi Selatan from Badan Pusat Statistik becoming the parameter of population to be used in Slovinâ€™s formula to get the number of sample for this study. From the total population of 1.976.250 household with 10% of error value, 100 number of sample were accounted in this study. This total number of sample then divided equally into four representing of the four major ethnicities in South Sulawesi. The data then collected by using an online questionnaire which contain fifteen kinds of food that have high level of Glycemic Index. This questionnaire aimed to know how the pattern of food intake given by the housewives to their children, especially in daily carbohydrate content of the food per person. The result then used to assess the Glycemic Load that each children consume daily based on the assessment standard of Glycemic Load used by the former research conducted by Rozanska et al (2016). The final data then analyzed through IBM SPSS 23 software before finally transformed into tables and chart.

RESULT

Table 1. Age category

Valid

Frequency Percent

Valid Percent

Cumulative Percent

17-25

1.0

26-35

3.0

4.0

36-45

38.0

42.0

46-55

51.0

93.0

56-65

6.0

99.0

>65

1.0

100.0

Total

100

100.0

Among 100 eligible subjects, the age of the study participants ranged from 18 to 67 years with a mean and median age of 46.42 and 47.00 respectively. The age category is divided based on the Republic of Indonesia Ministry of Healthâ€™s decision from 17-25, 2635, 36-45, 46-55, 56-65, and >65 where the frequencies are 1(1%), 3 (3%), 38 (38%), 51 (51%), 6 (6%), and 1 (1%) (Table 1).

Table 2. Descriptive distribution of daily glycemic load for each ethnicity Ethnicity

Mean

Median

Max

Min

Buginese

244.8025738

201.9625105

940.6887288

90.566995

Makassarese

256.3505613

212.8594409

860.17585

120.8799048

Toraja

202.1371256

168.8267355

458.714

53.71225314

Mandar

202.0179253

162.0084821

743.068

83.93212986

Table 2 Showed that Mean data of daily glycemic load was highest in Makassarese, followed by Buginese, Toraja, and Mandar Ethnicity and this type of order was applied to Median data of glycemic load as well. Moreover, maximum value of daily glycemic load was highest in Buginese, Followed by Makassarese, Mandar and Toraja ethnicity. Minimal value of daily glycemic load was lowest in Toraja, and followed by Mandar, Buginese and Makassarese Ethnicity.

According to previous research by Rozanka et. al (2016), Glycemic Load (GL) of daily food ration (DFR) were calculated by summing GL values of consumed foods. GL of 80 g or below was considered low, a GL of 80-120 g was considered medium, and a GL of 120 g or above was considered high. It is stated in Shilpa (2014) research, the more the food has high in GI or GL and low in cereal fiber content, it has 50% higher risk of developing T2DM. Using that kind of classification, we found that Makassarese is an ethnic group that has a highest risk of developing diabetes with 25 peoples (100%). Compared to the Toraja ethnic group, where 23 people have a high risk and only 2 people have moderate to low risk. While for Buginese and Mandar ethnic groups, 22 of them have a high risk and 3 have moderate to low risk. For more detail, look at the figure 1 below.

Figure 1. Distributon of daily glycemic load for each ethnicity

DISCUSSION South Sulawesi is one of major provinces in Indonesia. It has 45 764,53 km2 area which include 21 regencies and 3cities. In those liveable space, there are four major ethnics dominating the population, which are Makassar, Bugis, Toraja and Mandar (Ubbe 2005). Based on the daily glycemic load (GL) classification from Rozanka et. al (2016), we found that the Mean data of daily glycemic load of the four ethnics group (Makassar, Bugis, Toraja, Mandar) considered as high, thus all the four major ethnics have the greater risk of developing Types 2 Diabetes Mellitus. It might due to the condition that all those four ethnics live in the close area one to another, which leads to similiar altitude, geographical condition, land and climate profile. Most of the regencies in South Sulawesi classify as a low land that vary from 20- 3.469 m from sea level. Just like the city in Indonesia in general, climate found in South Sulawesi is only dry (June to September) and rainy (December to March) season. All of those factors caused the crops, fruits, vegetables, and main meals produced in South Sulawesi are mostly the same. Rice is still the main food consumed by the four ethnicities in South Sulawesi. South Sulawesi is one of the national rice barns. In 2009, rice production of Sulawesi Selatan was 4 324 178 tons harvested from the 862 017 hectares of rice field, which meant that the productivity was about 5,02 tons per hectare. According to Purwantini (2012), the rate of rice consumption in South Sulawesi reported to reach 98%. South Sulawesi is the highest producer of food crops in the east region of Indonesia. Besides the rice commodity as an item of trade, another food crops of South Sulawesi are corn, cassava, Sweet Potatoes, Soyabeans, Peanuts, and small green pea. Production of Vegatables mostly dominated by red onion, garlic, French beans, carrot, potatoes, cabbage, and tomatoes. Otherwise avocado, orange, pineapple, mango, banana, and jack fruit are the dominant fruit found in this province (BPS, 2010). The current study somehow shoed that eventhough the four ethnicity groups had a quite high daily glycemic load, there is still a litter difference between those ethnicities. 100% of Makassarese involved in this study were reported to be in high risk. Compared to the Toraja ethnic group, where 23 people have a high risk and only 2 people have moderate to low risk. While for Buginese and Mandar ethnic groups, 22 of them have a high risk and 3 have moderate to low risk. This diversity was due to several factors, including socioeconomic factor such as level of education, occupation, income, family scope, culture, and knowledge about nutrition. People who had higher level of education tends to understand more about nutrition. This knoledge of nutrition will ease people to choose what kind of food they want to eat based on nutritional guidance. Therefore, the higher level of education people have, the better they will accept, process, interpret, and use the

information (Contento, 2007). Moreover, the current study focusing more on the level of knowledge of the mother, since knowledge about nutririon owned by a mother will determine the nutritional status of the whole family (Suhardjo, 1989). Environment will play a big role on eating habit. People are forced to adapt with their living environment in order to survive life. Moreover, culture also plays a very important role to eating habit for several cultures even prohibit their followers to eat particular foods especially those who are in the period of pregnancy, lactation, baby or even toddler (Rizki wahyu, 2014). Lack of food variety that is consumed might due to the low level of income which impacting family’s ability to buy foods. The better the occupation is, the bigger income a family will get (Megiyawati, 2004).

CONCLUSION All four ethnicities group in South Sulawesi (Makassar, Bugis, Toraja, Mandar) considered as high risk of type 2 Diabetes mellitus based on their daily glycemic load.

REFERENCES 1. World Health Organization. (2017). Diabetes Key Fact. http://www.who.int/newsroom/fact-sheets/detail/diabetes 2. Fiona S. Atkinson, Kaye Foster-Powell, & Jennie C. Brand Miller. (2008). International tables of glycemic index and glycemic load values. Diabetes care, 31, 12, 2281-2283. 3. Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, BrandMiller JC. (2008). Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies. Am J Clin Nutr, 87, 627–37. 4. Dong JY, Zhang L, Zhang YH, Qin LQ. (2011). Dietary glycaemic index and glycaemic load in relation to the risk of type 2 diabetes: a meta-analysis of prospective cohort studies. Br J Nutr, 106, 1649–54. 5. Livesey G, Taylor R, Livesey H, Liu S. (2013). Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies. Am J Clin Nutr, 97, 584–96. 6. Shilpa N Bhupathiraju, Deirdre K Tobias, Vasanti S Malik, An Pan, Adela Hruby, JoAnn E Manson, Walter C Willett, and Frank B Hu. (2014). Glycemic index, glycemic load, and risk of type 2 diabetes: results from 3 large US cohorts and an updated meta-analysis. Am J Clin Nutr, 100(1), 218–232.

7. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI (2013). Laporan Hasil Riset Kesehatan Dasar 2013. Jakarta, Indonesia: Riskesdas. 8. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. (2007). Laporan Hasil Riset Kesehatan Dasar 2013. Jakarta, Indonesia: Riskesdas. 9. Dallacker M., Hertwig R., & Mata J. (2017). Parents’ considerable underestimation of sugar and their child’s risk of overweight. International Jurnal of Obesity. 10. Hertwig R., Grüne-Yanoff T. (2017). Nudging and boosting: steering or empowering good decisions. Perspect Psychol Sci. 11. Aminuddin M. (2016). Hubungan antara pengetahuan dan sikap dengan perilaku konsumsi jajanan sehat. FKM Unair. 12. Ubbe A. (2005). Perkembangan hukum adat di propinsi sulawesi selatan. Departemen hukum dan hak asasi manusia. Badan pembinaan hukum nasional. 13. Ludwig DS. (2002). The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287, 2414–23. 14. Willett W, Manson J, Liu S. (2002). Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr, 76, 274S–80S. 15. Pawlak DB, Kushner JA, Ludwig DS. (2004). Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals. Lancet, 364, 778–85. 16. Thomas DE, Elliott EJ. (2010). The use of low-glycaemic index diets in diabetes control. Br J Nutr, 104, 797–802. 17. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. (2002). Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet, 359, 2072–7. 18. American Diabetes Association (ADA). (2015). Facts About Type 2. http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html 19. British Dietetic Association (BDA). (2018). Food fact sheet: Diabetes Type 2. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=r ja&uact=8&ved=2ahUKEwitlZW73JLeAhXJLI8KHYtpBG8QFjABegQICBAC &url=https%3A%2F%2Fwww.bda.uk.com%2Ffoodfacts%2Fdiabetestype2.pdf& usg=AOvVaw2wwtdgXWugY-jkxfaovbW4 20. Kurnia, S., & Setyorogo, S. (2013). Faktor resiko kejadian diabetes mellitus tipe II. Jurnal Ilmiah Kesehatan.

21. Ciptakarya. (2004). Profil Kabupaten/Kota [Internet]. [diunduh 2018 okt 12]. Can

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http://ciptakarya.pu.go.id/profil/profil/timur/sulsel/makassar.pdf 22. Burhan Z, Sirajuddin S, Rahayu I. (2013). Pola Konsumsi Terhadap Kejadian Obesitas Sentral pada Pegawai Pemerintahan di Kantor Bupati Kabupaten Jeneponto

[Internet].

[diunduh

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okt

12].

Tersedia

pada:

http://repository.unhas.ac.id/handle/123456789/5440 23. Wahyu Rizky Kartikasari (2014). Analisis Kebiasaan Makan Masyarakat di Sekitar Waduk Cirata, Kecamatan Ciranjang, Kabupaten Cianjur. Departemen Gizi Masyarakat Fakultas Ekologi Manusia Institut Pertanian Bogor. 24. Suhardjo. (1989). Sosio Budaya Gizi. Bogor (ID): Institut Pertanian Bogor. 25. Badan Pusat Statistik. Sulawesi Selatan dalam Angka, (2010). 26. Baliwati YF, Khomsan A, dan Dwiriani CM. 2004. Pengantar Pangan dan Gizi. Jakarta (ID): Penebar Swadaya. 27. Contento IR. (2007). Nutritional Education: Linking Research, Theory, and Practice. Canada (US): Jones and Bartlett Publisher. 28. Megiyawati S. (2004). Pola Makan dan Status Gizi Anak Usia 1-6 Tahun di Kampung Naga Kabupaten Tasikmalaya Provinsi Jawa Barat [skripsi]. Bogor (ID): Institut Pertanian Bogor.

Type 2 Diabetes Mellitus: A Descriptive Analysis On Knowledge and Attitude Of Those In Risk Muh. Khairil Hasyim, Indah Nurul Khairunnisa, Trixie Nathania Zelig, Nurul Fadhilah

Type 2 Diabetes Mellitus: A Descriptive Analysis On Knowledge And Attitude Of Those In Risk Asian Medical Student Association Hasanuddin University

Written By: MuhKhairil Hasyim Indah Nurul Khairunnisa Trixie Nathania Zelig Nurul Fadhilah

ASIAN MEDICAL STUDENTSâ€™ ASSOCIATION INDONESIA 2018

INTRODUCTION Diabetes is a common and increasingly prevalent disease worldwide. There are 382 million people livingwith DM in the world, and is expected toincrease to 592 millionin 2035. Among 382 million people living with diabetes, 175 million of them were untreated and led to complicationswithout any efforts of prevention(International Diabetes Federation, 2013). Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin (Type 1) or when the body cannot effectively use the insulin it produces (Type 2). Diabetes is a disease that is strongly associated with both

microvascular

and

macrovascular

complications,

including

retinopathy,

nephropathy, and neuropathy (microvascular) and ischemic heart disease, peripheral vascular disease, and cerebrovascular disease (macrovascular), resulting in organ and tissue damage in approximately one third to one half of people with diabetes. (Cade, 2008) Type 2 Diabetes Mellitus (T2DM) is the most common form of DM, which accounts for 90% to 95% of all diabetic patients (R John, Srivastava 2014). T2DM develops through abnormal insulin action and insulin secretion that characterized by insulin insensitivity as a result of insulin resistance, declining insulin production, and eventual pancreatic beta-cell failure. This leads to a decrease in glucose transport into the liver, muscle cells, and fat cells. There is an increase in the breakdown of fat with hyperglycemia (Fujioka K, 2013). Based on World Health Organization (WHO) National diabetic group criteria for diagnosing, is a single raised glucose reading with symptoms (polyuria, polydipsia, polyphagia and weight loss), otherwise raised values on two occasions, of either fasting plasma glucose 7.0 mmol/L (126 mg/dL) or with an oral glucose tolerance test (OGTT), two hours after the oral dose a plasma glucose Âł11.1 mmol/L (200 mg/dL). The risk factors for T2DM are better known with predisposing factors that consist of modifiable and non modifiable factors. One of modifiable factors is lifestyle, includinglack of physical activity, poor diet, stress, and others. (Williams Textbooks of Endocrinology. 12th edition 1371-1435). Diabetes keeps a steady increase in developed countries which possibly caused byrapid technological development and instantaneous lifestyle (Weigensberg MJ, Goran MI I 2015.) There are several factors related to the incidence of T2DM, including sociodemographic factors that given the risefor occupation. In this 21stcentury,

peoplemostly spendtheir time pursuing their professions which subconsciously lead them to

T2DM.

After

conducting

pre-research

literature

study

using

several

journals(Adikusuma, Perwitasari, & Supadmi, 2014; Bertalina, 2016; Dini, Sabila, Habibie, & Nugroho, 2017; Lubis & Susilawati, 2017; Srikartika, Cahya, & Hardiati, 2016)we found out that there are several professions that show their tendency to T2DM includingPrivate employees, Housewives,and Government employee (Figure 1).

35 Health Journal vol VII no 3 of Indonesia November 2016

30 25

Indonesian Journal Of Human Nutrition, Desember 2017 Vol 4 No 2

Journal of Management and Pharmaceutical services Vol 6 No 3 September 2016

15 10

Pharmaceutical Media Vol 11 N0 2 September 2014

5 Vocational Health Journal Vol 2 No 2 November 2017

0 Housewifes

Private Employees

Goverment Employee

Figure 1. The number of T2DM cases for each profession in five studies.

Correlationof Lifestyle and Occupation to the silent killer T2DM In 4.0 Revolutionary era, the vast majority of society is being pampered by the existence of technology that has an impact on consumptive and instantaneous characteristic of human nature. In line with the freedom that is received, this also causes various problems in everyday life. Instant things can give more probability for people to suffer from a disease namely as Type 2 Diabetes Mellitus. Facilities which aimed to ease us to work will somehow becoming the reason for us to have less physical movement but still need to face a high level of stress at work. This combination of less physical movement and high level of stress will significantly lead to T2DM. Physical activity is another important part of diabetes management plan proven in several studies. While

doing our daily activities, the muscles will use sugar (glucose) as the source of energy. Regular physical activity also helps our body to use insulin more efficiently. These factors will sequentially work together to lower the level of blood sugar. The more strenuous workout done, the longer the effect lasts. Another factor related to the risk of T2DM is the level of stress. We live in a very stressful society which is constantly putting us underpressure. Stress is a potential contributor to chronic hyperglycemia in diabetes. Stress has long been shown to have major effects on metabolic activity. Energy mobilization is a primary result of the fight or flight response. Stress stimulates the release of various hormones, which can result in elevated blood glucose levels. Although this is of adaptive importance in a healthy organism, in diabetes, as a result of the relative or absolute lack of insulin, stress-induced increases in glucose cannot be metabolized properly. Furthermore, regulation of these stress hormones may be abnormal in diabetes. (Guariguata L, Whiting DR, Hambleton I2013). Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is sadly still unclear. This can be due to misconceptions, misinformation, or a lack of current information about diabetes. Therefore, it is really important to make a reasearch about the influence of knowledge on T2DM for people at risk for it, as well as their behavior to face such risks. The outcome of this research is expected to give wider perspective for government and any stakeholders that are willing to create a healthy lifestyle that improves active movement and seeks solutions to stress levels that can prevent T2DM.

METHOD This was a descriptive study using random sampling method. There are three occupations included in the study; housewives, private employees, and government employee. Each occupations becoming the parameter of population to be used in Slovinâ€™s formula before finally proceeded to randomization process. Finally, there were 106, 107, 108 number of samples for housewives, private employees, and government employee, respectively. There were 2 sections of questionnaireused in the study. The questionnaires were distributed to people staying at Makassar, South Sulawesi, Indonesia. The first section was aimed to know the workerâ€™s knowledge on diabetes mellitus, by measuring the specific knowledge on etiology, risk factors, symptoms, management, and the complication of diabetes mellitus. The second section of the questionnaire was aimed to

assess the respondents about their attitude towards their risky occupation, either being ignorant or positively aware to it. The data was analyzed trough IBM SPSS Statistics 23 before finallytransformed to tables and charts.

RESULT Demography Data Table 1.Demographic data Demographic data

Gender

Male Female Total

106 215 321

33.0 67.0 100.0

Age

20-29 30-39 40-49 50-59 60-69 Total

120 91 62 46 2 321

37.4 28.3 19.3 14.3 0.6 100.0

Level of Education

Elementary Junior High Senior High Bachelor degree Master degree Doctoral degree D3 Total

8 12 63 150 74 5 9 321

2.5 3.7 19.6 46.7 23.1 1.6 2.8 100.0

Occupation

Government employee Housewife Private employee Total

108 106 107 321

33.6 33.0 33.3 100.0

Source: Primary data This study involving 321 people of nondiabetic population where 106 (33.0%) of them are male and 215 (67.0%) are female.The age range of participants are vary from 20-29, 30-39, 40-49, 50-59, and 60-69 range of age where the frequencies are 120 (37.4%), 91 (28.3%), 62 (19.3%),46 (14.3%),and 2 (0.6%), respectively.33.6% of

participants aregovernment employee, 33.0% are housewives, and 33.3% are private employees (Table 1).

Figure1. Knowledge about diabetes

Figure 1 showed that among 108 government employee or government employees,104 of them already knowledgeable and just 4 of them considered as less knowledgeable. Moreover, among 106 of housewives, 102 of them already knowledgeable and only 4 of them considered as less knowledgeable. Finally, among 107 of private employees, 105 of them are knowledgeable and only 2 of them are less knowledgeable.

Figure 2. Attitude towards diabetes Figure 2 showed that among 108 of government employees, 61 of them considered as having positive attitude while 47 of them are negative attitude towards diabetes.Moreover, among 106 ofhousewives, 51 of them considered as having positive attitude while 55 of them are negative attitude towards diabetes.Finally, among 105 of government employees, 44 of them considered as having positive attitude while 63 of them are negative attitude towards diabetes.

Figure 3. Attitude towards the level of knowledge

Figure 3 showed that among 311 participants who are knowledgeable for diabetes, 152 of them had positive attitude and 159 had negative attitude toward diabetes. Moreover, among 10 participants who are less knowledgeable for diabetes, 4 of them had positive attitude and 6 had negative attitude toward diabetes respondent know how to prevent and 159 respondent still arenâ€™t know the prevents, and about 10 respondents who less knowledge about diabetes.

Figure 4.Number of people who know they are in risk

Figure 4 showed that most of the participants don’t know that they are in risk for having diabetes. Among 108 of government employees, 21 of them already know that they are in risk, and 87 didn’t know at all. Moreover,among 106 housewifes, 17 of them already know that they are in riskwhile 89 of them didn’t. Finally, from 107 of private employees, 19 of them already know that they are in risk and surprisingly 88 of them didn’t even know that they are in risk.

DISCUSSION Type 2 Diabetes Mellitus is a commonly found preventable disease which can lead to several complications. Knowledge and attitude are of all factors associated with the incidence of diabetes mellitus. Those factors also can be influenced by the type of occupation people working in. This study aimed to know the occupational-based correlation between knowledge and attitude toward diabetes in Makassar, South Sulawesi, Indonesia.

Out of 321 participants, majority of them are 20-29 years old age range, and the majority of the respondents are female (67%). Regarding the level of education, 46,7% last education is bachelor degree. Occupation was found to be in line with knowledge on diabetes mellitus. This study showed that majority of participants in all study groups; government employee, private employee, and housewife are knowledgeable (96,8%). This result is even higher than the number of knowledgeable participants in previous studies done in South East Ethiopia (55,9%) and Sri Lanka (>75%). (Naveena, 2016)This might be because the current study only covered groups of government employee, private employee, and housewife, where most of them have high level of education which was presumed to be the factor that contributed to the ability of participants in answering the questions provided in the study(Ong, Chua, & Ng, 2014). A better educated person be more inquisitive and more open while being informed or educated in diabetes. Not only that, working population would have the chance to get different information to contented materials, media and other source of information, including radio, magazine, and internet which mke the more knoeledgeable about diabetes mellitus(Gautam, Bhatta, & Aryal, 2015) Attitude was observed to be more positive in the group of Government employee (56,4%)and on the other hand it tended to be more negative in the group of private employee (41,9%)as well as housewives(48,1%). The finding was consistent with the study conducted in Bangladesh in which the attitude score was significantly lower in housewives respondents than the respondents of other occupations because in developing countries, female tend to left behind compared tomale in every aspect (Ong et al., 2014)Many participants were found to be ignorance to seek for medical services and to regularly check the blood glucosebecause of they have to work hours and did not have time to get medical chec up. Not only that, being anxiety of the possible bad result is one of the reason to4 not seek for medical chec up, because the result might backfired them and make them more depressed which led to more negative attitudes(Islam et al., 2014). This explains why housewivesgave more negative attitude compared to others because housewives are having more anxiety (Kassahun & Mekonen, 2017) which support the result of current study. It is different with government employee, that even if they feel anxiety about of the possible bad result, they still have to do the medical check up as the part of their job that has been rule by government that is why more positive attitude could

be see in this occupation. Even though the majority of our respondents had good knowledge (96,8%), yet it was not in line with the result of attitude which showed the tendency to be more negative, proving that most of them still not aware about the risk and complications of T2DM or even don’t have any abilities to stay away from it. This might be because attitude is not just affected by person’s knowledge, but beliefs, emotions, environment, or even the presence of other person while answering the questionnaire. This finding is consistent with the results reported by H. M.M. Herath in Sri Lanka owing to the fact that most of diabetes health promotion efforts are presented in uncoordinated strategy and this lead to false beliefs among general public. (Mumu, Saleh, Ara, Haque, & Ali, 2014)As for the environment, in developing countries like Indonesia, many myth remains still and affects people’s beliefsfor there’s still a lot of people in the community who thinks checking their health and knowing their true condition would making them weak and disturbing their daily activities(Herath, Weerasinghe, Dias, & Weerarathna, 2017). One the other hand, most of respondents were found to be less knowledgeable regarding the risk of their occupation towards diabetes (82,24%). This concerning situation happen because occupation are rarely reviewed as one ofrisk factors of diabetes, there are limited source of literature and study that talking specifically on a particular occpuation that lead to diabetes mellitus (Herath et al., 2017). That is why when we do pre research by searching the data of diabetic patient’s occupation, unfortunately majority of endocrinology outpatient clinic did not register the occupation of diabetic patient, where in fact occupation is one determination of diabetic risk factor due to high stress level that they get at workplace which have a mojor effect on releasing various hormones that act to imbalance the metabolism and glycemic status in established(Harris et al., 2017). On the other hand to cath up the working load, people have to undergo sedentary lifestyle that lead to less physical activity and ended up as imbalance on energy intake and expenditure that will contribute to the occurence of diabetes mellitus (Colberg et al., 2010)

CONCLUSION

This study concluded that majority of people who work as either housewife, government or even private employee already been knowledgeable enough for any information about type 2 diabetes mellitus, yet this level of knowledge unfortunately not in line with their attitude which tended to show less aware even more to ignorant for the risk of diabetes they are facing because of their occupations. Further studies in a bigger community are needed to analyze more on the analytic correlation of knowledge and attitude toward type 2 diabetes mellitus to give better understanding, particularly for the risky occupations.

REFERENCES Adikusuma, W., Perwitasari, D. A., & Supadmi, W. (2014). Evaluasi kepatuhan pasien diabetes melitus tipe 2 di Rumah Sakit Umum PKU Muhammadiyah Bantul, Yogyakarta [in Bahasa Indonesia]. Media Farmasi, 11(2), 208–220. https://doi.org/10.3406/arch.1977.1322 Bertalina. (2016). Hubungan Pengetahuan Terapi Diet Dengan Indeks Glikemik Bahan Makanan Yang Dikonsumsi Pasien Diabetes Mellitus. Jurnal Kesehatan, VII(3), 345–513. Cade, W. T. (2008). Diabetes Special Issue Diabetes-Related Microvascular and Macrovascular Diseases in the, 1322–1335. https://doi.org/10.2522/ptj.20080008 Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., … Braun, B. (2010). Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement. Diabetes Care, 33(12). https://doi.org/10.2337/dc10-9990 Dini, C. Y., Sabila, M., Habibie, I. Y., & Nugroho, F. A. (2017). Asupan Vitamin C Dan E Tidak Mempengaruhi Kadar Gula Darah Puasa Pasien DM Tipe 2. Indonesian Journal of Human Nutrition, 4(2), 65–78. Gautam, A., Bhatta, D. N., & Aryal, R. U. (2015). Diabetes related health knowledge, attitude and practice among diabetic patients in Nepal. BMC Endocrine Disorders,

15(1), 1–8. https://doi.org/10.1186/s12902-015-0021-6 Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PLoS ONE, 12(2), 1–13. https://doi.org/10.1371/journal.pone.0172126 Herath, H. M. M., Weerasinghe, N. P., Dias, H., & Weerarathna, T. P. (2017). Knowledge, attitude and practice related to diabetes mellitus among the general public in Galle district in Southern Sri Lanka: a pilot study. BMC Public Health, 17(1), 1–7. https://doi.org/10.1186/s12889-017-4459-5 Islam, F. M. A., Chakrabarti, R., Dirani, M., Islam, M. T., Ormsby, G., Wahab, M., … Finger, R. P. (2014). Knowledge, attitudes and practice of diabetes in rural Bangladesh: The Bangladesh Population based Diabetes and Eye Study (BPDES). PLoS ONE, 9(10). https://doi.org/10.1371/journal.pone.0110368 Kassahun, C. W., & Mekonen, A. G. (2017). Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study. PLoS ONE, 12(2), 1–18. https://doi.org/10.1371/journal.pone.0170040 Lubis, I. K., & Susilawati. (2017). Analisis Length Of Stay ( LOS ) Berdasarkan Faktor Prediktor Pada Pasien DM Tipe II di RS PKU Muhammadiyah Yogyakarta. Kesehatan Vokasional, 2(2), 161–166. Mumu, S. J., Saleh, F., Ara, F., Haque, M. R., & Ali, L. (2014). Awareness regarding risk factors of type 2 diabetes among individuals attending a tertiary-care hospital in Bangladesh: A cross-sectional study. BMC Research Notes, 7(1). https://doi.org/10.1186/1756-0500-7-599 Naveena, T. (2016). Variations in prevalence of diabetes in various occupations : a quantitative and qualitative review, 3(10), 2705–2708. Ong, W. M., Chua, S. S., & Ng, C. J. (2014). Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: A qualitative study. Patient Preference and Adherence, 8, 237–246. https://doi.org/10.2147/PPA.S57567

Srikartika, V. M., Cahya, A. D., & Hardiati, R. S. W. (2016). Analisis Faktor Yang Memengaruhi Kepatuhan Penggunaan Obat Pasien Diabetes Melitus Tipe 2. JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice), 6(3), 205â€“212. https://doi.org/10.1038/jcbfm.1993.4

PUBLIC POSTER

EAT MORE TO LOSE MORE Azizah Pridayanti Septiman, Nurul Fadhilah, Amy Trybato Arifin, Muh. Arham Harun, DISTRICT 6 WINNER FOR PUBLIC POSTER

EAT MORE TO LOSE MORE , Azizah Pridayanti Septiman, Nurul Fadhilah, Amy Tryabto Arifin, Muh. Arham Harun Fakultas Kedokteran Universitas Hasanuddin (AMSA-Unhas)

The famous technique of losing weight is by drastically reduce your daily intake. Cutting your meals is not a good strategy to lose weight. The truth is, in order to lose weight you need to eat more food in several intake. Eating more is about eating more of the right kind of food. In order to lose weight, you need to eat protein (whole eggs, fish, beef), fat (butter and coconut oil), and low-carb vegetables (broccoli, tomatoes, and spinach). First you need to know and count what your body needs. Then, divide your needs to several portion of meals. You can absolutely eat more than three times and have a view healthy snacks. Snacks are easily prepared food like fruits or yoghurt. This poster aimed to inform people that it is possible to lose weight by eating more of wellmanaged meals.

Losing weight isn't about skipping meals it's about eating right amount, on the right time.

K 1

SNACK

EAT MORE TO LOSE MORE.

ASIA DIABETES: THE WHITE RICE YOU EAT THAT MATTER Amy Trybato Arifin, Muh. Arham Harun, Azizah Pridayanti Septiman, Nurul Fadhilah

ASIA DIABETES : THE WHITE RICE YOU EAT THAT MATTER , Amy Tryabto Arifin, Muh. Arham Harun, Azizah Pridayanti Septiman, Nurul Fadhilah Fakultas Kedokteran Universitas Hasanuddin (AMSA-Unhas)

More than 90% of rice is produced and consumed in Asia. In terms of food consumption, what distinguishes Asia from the rest of the world is its great dependency on rice: it is the basic staple for the majority of the population. A meta-analysis of seven cohort studies following 350,000 people for up to 20 years found that higher consumption of white rice was associated with a significantly increased risk of type 2 diabetes, especially in Asian populations. They estimated each serving per day of white rice was associated with an 11 percent increase in risk of diabetes. Consuming excess amount of white rice will lead you to certain problems. White rice has a high glycemic index which it is easily broken down into simple sugars in the body and raises the blood sugar level of the body. The simplest solution of the problem is to control the portion of the rice. Our poster shows you that by doing simple thing such as take a spoon and cut a small amount of the rice will gradually changes â€œyour shapeâ€?. By doing it continuously, you will not only gain a better shape, but also a better health.

CONSUME LESS , CONTROL YOUR DIABETES.

White rice consumption in asia are three times higher than the nutritionistâ€™s recommendation.

WHERE THERE IS AWARENESS, THERE IS HOPE! Nurul Fadhilah, Amy Trybato Arifin, Muh. Arham Harun, Azizah Pridayanti Septiman

WHERE THERE IS AWARENESS, THERE IS HOPE! Nurul Fadhilah, Amy Tryabto Arifin, Muh. Arham Harun, Azizah Pridayanti Septiman Fakultas Kedokteran Universitas Hasanuddin (AMSA-Unhas)

In 2016, more than 60% of the people with diabetes live in Asia. South-East Asia is home to one fifth (19 %) of the total number of people with diabetes in the world in 2017. Factors such as age, gender, diet and lifestyle changes, including a lack of physical activity caused by modernization and urbanization, are major contributory factors. The maintenance of physical activity are critical focus for blood glucose management and overall health in individuals with diabetes and prediabetes. Physical activity includes all movement that increases energy use, whereas exercise is planned, structured physical activity. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, contributes to weight loss, and improves well-being. This poster aimed to spread the word about how important it is to fight obesity and Diabetes due to the high number of incident found in Asia. One of the act of prevention is by maintain physical activities as simple as walking, jogging, cycling, and swimming.

Therefore by this awareness, we hope people will be able to start doing exercise, little by little, and together workout against obesity and Diabetes because every bit sweat and action counts.

TURN FAT INTO FIT.

There is a healthy person inside just dying to get out.

ITâ€™S CALLED HAM-BURGER Andi Azizul Nukita, Nadhifhah Nurul, Nurul Khairurrizki

ITâ€™S CALLED HAM-BURGER Andi Azizul Nukita, Nadhifah Nurul, Nurul Khairurrizki Faculty of Medicine, Hasanuddin University â€“ Makassar, Indonesia

Obesity is overweight or excess weight due to excessive accumulation of body fat. An estimated 1.7 billion people on this earth are overweight. Obesity is one of the risk factors for degenerative diseases, such as cardiovascular disease, diabetes mellitus, several types of cancer, etc. One of the risk factor of it is by comsuming junk food.

One problem with junk foods is that they're low in satiation value that is, people don't tend to feel as full when they eat them which can lead to overeating by that it can cause obesity. Another problem is that junk food tends to replace other more nutritious foods. By that it can interfere with the balance in the body, and if it is disturbed the person will get sick more easily.

We aim to spread the effect of consuming junk food towards people by this poster and send the knowledge that junk food. Reducing consumption of junk food can reduce the incidence of obesity which is one of the diseases with a high mortality rate such as, reducing the habit of consuming junk can prevent people for cardiovascular disease, which is the disease with the highest mortality rate.

HACKING DIABETES: THE POWER OF ARTIFICIAL PANCREAS Gabrielle Natasha Sutanto, Leony Octavia, Liani Elisabeth Enggy, Firshan Makbul

ABSTRACT

HACKING DIABETES : THE POWER OF ARTIFICIAL PANCREAS Author : Gabrielle Natasha Sutanto, Leony Octavia, Liani Elisabeth Enggy, Firshan Makbul Hasanuddin University, Makassar

Background : Diabetes Type 2, or more commonly known as diabetes mellitus, is a disease caused by the inability of pancreas to produce insulin to control the sugar level in the blood in a long time. It is one of the leading cause of death, and has been increasing significantly especially in middle and low-income countries. The current tool that is used for detecting blood glucose level is glucometer, and the patient have to inject the insulin by his/herself. As the medicinal technology grows along technological development, thereâ€™s a new technology, not quite talked about in public, named artificial pancreas device system. It impersonates the work of healthy pancreas. It uses a computer-controlled algorithm that connects to the continuous glucose monitoring (CGM) system and the insulin infusion pump to allow continuous communication between the two devices. If the CGM detects low blood glucose level, it will notify the insulin infusion pump to pump insulin to the blood, to control the blood glucose level. It can prevent low and high blood glucose level with little or no input from the patient.

Objectives : To inform other people about these brand new technology, that can save lives from the complication of diabetes mellitus, either because of negligence or unaware. We hope that by promoting this new, automated technology, we can save loved ones that are currently battling through their diabetes, and help create a better life

References : http://www.who.int/news-room/fact-sheets/detail/diabetes https://www.joslin.org/info/10_Things_You_Might_Not_Know_About_Diabetes.html

https://www.fda.gov/medicaldevices/productsandmedicalprocedures/homehealthandconsumer/consumerp roducts/artificialpancreas/ucm259548.htm https://www.diabetes.org.uk/about_us/news/artificial-pancreas-type-2

OBESITY: THE ULTIMATE TIME BOMB TO DEFUSE Suandih Zulkarnain, Akhmad Alya Maulana, Muh. Nur Cholis, Ahmad Ezra Saleh

OBESITY: THE ULTIMATE TIME BOMB TO DEFUSE Suandih Zulkarnain, Akhmad Alya Maulana, Muh. Nur Cholis, Ahmad Ezra Saleh Hasanuddin University

ABSTRACT: Although genes play a role in body weight, there are other factors involved. In Indonesia, there are plenty of nutrient-rich food to eat and easy access to fattening fast foods and sweets. Also, because of modern lifestyles, we are not as active as we once were. The end result: We're eating more calories than we can burn. Being overweight or obese can cause a whole cascade of health problems, from heart disease, until diabetes. Body mass index has a strong relationship to diabetes and insulin resistance. In obese individuals, the amount of nonesterified fatty acids, glycerol, hormones, cytokines, proinflammatory markers, and other substances that are involved in the development of insulin resistance, is increased. The pathogenesis in the development of diabetes is based on the fact that the Î˛islet cells of the pancreas are impaired, causing a lack of control of blood glucose. The development of diabetes becomes more inevitable if the failure of Î˛-islet cells of the pancreas is accompanied by insulin resistance. Weight gain and body mass are central to the formation and rising incidence of type 1 and type 2 diabetes. These diseases can seriously impact a person's quality of life and slowly lead to premature death.

Junk Food: The New Addictive Drug Andi Nurul Azizah Maruddani, Dhiya Muthiah Ghaffari, Ismi Nuranggraeni Guntur, Anis Ammar Mihdar

Junk Food : The New Addictive Drug Andi Nurul Azizah Maruddani, Dhiya Muthiah Ghaffari, Ismi Nuranggraeni Guntur, Anis Ammar Mihdar Hasanuddin University, Indonesia.

Nowadays, Junk food is leading us to a whole new level of bad impact. Not only being a risk factor of overweight and obesity but also becoming an addictives. We usually think of food and drugs as distinct categories. But they have a lot of similarities. They're both substances you put in your body, and many people find it hard not to go overboard. Also, Studies have shown that junk foods flood the reward system in the brain with dopamine, stimulating the same areas as drugs of abuse like cocaine.1 Furthermore, Everyone knows that junk food and drugs are unhealthy but still unable to control their consumption. Cravings are a common symptom when it comes to both junk foods and addictive drugs. The obsessive nature and thought processes are identical. Otherwise, studies have shown that both food and drug cues activate the same brain regions when people crave either junk food or drugs.2, 3 Through this poster, we would like to gain people awareness that we are becoming unconscious of being addicted and still enjoy junk food, and it is the time for us to break our habit. So, still lovinâ€™ it? We are quitting it.

References : 1. Luis Hernandez, Bartley G. Hoebel. Food reward and cocaine increase extracellular dopamine in the nucleus accumbens as measured by microdialysis. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/0024320588900367 2. Blumenthal DM, Gold MS. Neurobiology of food addiction. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20495452 3. Gene jack wang et al. Imagine of Brain Dopamine Pathways Implications for Understanding

Obesity.

Retrieved

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098897/

from

LIMIT THE FAST FOOD OR OTHERWISE IT WILL BE THE LAST FOOD Liani Elisabeth Enggy, Gabrielle Natasha Sutanto, Leony Octavia, Firshan Makbul

LIMIT THE FAST FOOD OR OTHERWISE IT WILL BE THE LAST FOOD Author : Liani Elisabeth Enggy, Gabrielle Natasha Sutanto, Leony Octavia, Firshan Makbul Hasanuddin University, Makassar

Background : Junk food is a generic term for all kinds of foods which are rich in energy, because they contain a lot of fat and sugar, as well as salt, but are relatively low in other important nutrients such as protein, fiber, vitamins, and minerals. However, fast food is extremely attractive to most children because of the taste, comparatively lower price, and doesnâ€™t require any cooking or preparation. Since children typically do not understand how this kind of food negatively impacts their health, it can be quite addictive. Globally, an estimated 3.4 million deaths, 3.9% years of life lost, and 3.8% of Disability Adjusted Life Years (DALYs) are related to overweight and obesity. Parents of young children face an increasingly complex world the ever increasing availability of prolific marketing, confusing product labels and misleading health claims create an environment that promotes unhealthy food and drink choices. We must change the environment to make the healthy choice the easy choice for parents and their children.

Objectives : We would like to inform and increase society awareness regarding to particularly relating to disturbances in junkfood, and how the consequences of such exposures can promote weight gain and obesity. Therefore, promoting a healthy life style such as education for parents and environment behavioural for children are essentials. Refrences https://ije-blog.com/2018/03/06/junk-food-in-childhood-contributes-to-socioeconomic-inequalitiesin-overweight-and-obesity/ https://healthyeating.sfgate.com/junk-food-affects-children-5985.html Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980â€“2013: a systematic analysis for the global burden of disease study 2013

Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries:epidemiology, determinants, and prevention. Endocrine Review. 2012

Would You Dare To Eat Them? Vania Noviantika, Siti Nur Djaalna, Rifqi Wardana

Would You Dare To Eat Them? Authors: Vania Noviantika, Siti Nur Djaalna, RifkiWardana Hasanuddin University, Makassar, South Sulawesi

The World Health Organization (WHO) declares obesity as a global epidemic problem. Globally, obesity is a health crisis that's greater than hunger and a major cause of death also disability in the world. Meanwhile in 2015, diabetes was the direct cause of 1.6 million deaths. International Diabetes Federation states 425 million people suffer from diabetes in the world, will increase to 183 million in 2045. There are more than 10,276,100 cases of diabetes in Indonesia in 2017. This rising number of obesity and diabetes are correlated with the skyrocketing consumption of junk food.Junk food refers to fast food, which loads of saturated fats and MSG (Flavoring). Excess of saturated fat and MSG in diet has been shown to cause obesity. Most of the fast foods have exceeding levels of sugar which are associated with diabetes. Obesity, preferentially of visceral as well as ectopic fat depots, is specifically associated with insulin resistance leads diabetes. Diabetes leads diseases such as heart disease, stroke, and blindness. 90% cases of those terrors are caused by junk food. Therefore,we would like to gain the public awareness about the harmful of junk food. Based on those facts, would you still dare to eat them?

REFERENCES International Diabetes Federation. Ministry of Healt Republic of Indonesia, 20 januari 2017 Shilpa N. Bhupathiraju and Frank B. Hu.Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Retrieved from :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887150/ World Health Organization.Retrieved from: http://www.who.int/news-room/fact-sheets/detail/diabetes Bhaskar

Rajveer

and

Ola

Monika.

Junk

Food:

Impact

Health.

Retrieved

from:

https://www.researchgate.net/profile/Rajveer_Bhaskar2/publication/308384822_JUNK_FOOD_IMPACT_ON_HE ALTH/links/5849941608ae686033a76842/JUNK-FOOD-IMPACT-ON-HEALTH.pdf?origin=publication_detail

Let the gadget help your diet Anis Ammar Mihdar, Ahmad Taufik Fadillah Zainal, Dhiya Muthiah Ghaffari, Ismi Nuranggraeni Guntur

Let the gadget help your diet. Anis Ammar Mihdar, Ahmad Taufik Fadillah Zainal, Dhiya Muthiah Gaffari, Ismi Nuranggraeni Guntur Hasanuddin University, Indonesia. Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese.1 The truth is obesity, as well as their related noncommunicable diseases, are largely preventable. Supportive environments and communities are fundamental in shaping peopleâ€™s choices, by making the choice of healthier foods and regular physical activity the easiest choice (the most accessible, available and affordable), and therefore preventing obesity.2 Surprisingly, there are tens of thousands of health-related gadget applications (apps), including hundreds of diet apps, are effective to control your consumption and physical activity.3 The apps can track your daily foods and activities that will improve your health behaviours. Beside of that, you can access your apps anytime and anywhere. Not only accessible, but also cost-effectiveness through the free apps. with all the benefit on diet apps, you can prevent yourself, your friend and your family from obesity and contribute to WHO campaign about save the world from obesity. Through this poster, we would like to inform the people that your gadget can save yourself, your friends, and your family from obesity by tracking daily foods and activities in accessible, available and affordable way. References : 1. WHO. 10 Facts on obesity. Retrieved from http://www.who.int/features/factfiles/obesity/en/ 2. WHO.

Obesity

and

overweight.

Retrieved

from

http://www.who.int/news-room/fact-

sheets/detail/obesity-and-overweight 3. Brian Yoshio Lainget al. Effectiveness of a smartphone application for weight loss compared to usual care in overweight primary care patients: a randomized controlled trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422872/

SPOIL YOUR KIDS, NOT THEIR HEALTH Muh. Arham Harun, Azizah Pridayanti Septiman, Nurul Fadhilah, Amy Trybato Arifin,

SPOIL YOUR KIDS, NOT THEIR HEALTH Muh. Arham Harun, Azizah Pridayanti Septiman, Nurul Fadhilah, Amy Tryabto Arifin, Fakultas Kedokteran Universitas Hasanuddin (AMSA-Unhas)

For many years type 2 diabetes was seen only in adults but it has begun to occur in children. It was once considered a rare condition in the pediatric population, now accounts for about 15% to 45% of all newly diagnosed cases of diabetes in children and teenagers. High intake of sugar-sweetened beverages, which contain considerable amounts of free sugars, increases the likelihood of being overweight or obese, particularly among children. Early childhood nutrition affects the risk of type 2 diabetes later in life. Parents have a direct role in encouraging the child to control their food intake and give them knowledge about healthy eating. There are many levels of intervention required to prevent overweight in children, one critical intervention target is the parent. Because childrens equipped with a biological set of taste predispositions: they prefer sweets, salty tastes and energy-dense foods, parents have the role to control their intake by limit sugar-sweetened beverages and junk foods, provide more vegetables and fruits, and serve reasonably-sized portions. This poster aimed to spread the role of parents on prioritizing actions to prevent their children becoming overweight and obese by control the childrenâ€™s intake and give them exposure about healthy eating habits in order to prevent Diabetes.

No Kid Dreams of

Becoming an Adult

obesity !

GRAB Right & Be HEALTHY

JUIC

ICE JU

WARNING

Children canâ€™t stop it, but you can

SCIENTIFIC

POSTER

THE PROTECTIVE EFFECT OF OBESITY IN CORONARY ARTERY DISEASE Iin Fadhilah Utami, Khairil Hasyim, Ilham Akbar Rahman DISTRICT 6 WINNER FOR SCIENTIFIC POSTER

THE PROTECTIVE EFFECT OF OBESITY IN CORONARY ARTERY DISEASE IIN FADHILAH UTAMI1, KHAIRIL HASYIM 1, ILHAM AKBAR RAHMAN, MD1 1

Faculty of Medicine Hasanuddin University

Introduction: Although for decades there has been controversy regarding the relationship between obesity and coronary artery disease (CAD), it has been assumed that high body mass index (BMI) is a risk factor for CAD. However, the findings of some recent studies were paradoxical. Aim: The aim of this study was to analyze deeper about BMI as well as its correlation with severity of coronary artery disease. Material and Methods: This is observational study with cross sectional approach. The samples taken were 131 patients of coronary artery disease from August 2015 to Januari 2016, then were assessed with coronary angiography in Cardiac Center of Wahidin Sudirohusodo Hospital, Indonesia Results: Of 131 coronary artery disease patients examined 40 (30,5%) were normal, 34 (26,0%) were overweight, 46 (35,1%) obese stage 1 and 11 (8,4%) were obese stage 2. The profil of coronary artery disease patients examined using coronary angiography with gensini scoring system showed that 47 (35,9%) were mild coronary artery disease, 31 (23,7%) were moderate coronary artery disease and 53 (40,5%) were severe coronary artery disease. Among mild coronary artery disease patients, 37 (78,7%) of them were overweight/obese. With p value 0,027 and -3<r<0, our results found that the severity of coronary artery disease was negatively correlated with body mass index. The lipid profile of the patients showing about 111 (84,7%) of the patients had dislipidemia status and among 111 patients with dislipidemia, 81 (73%) were overweight or obese. With p value 0,037 our results showed that there was significant correlation with BMI and dislipidemia. The gender distribution of patients were 100 (76,3%) with male and 31 (23,7%) with female. From 31 of female, approximately 20 (64,5%) of them were obese. While for male, among 100 male, only 37 (37%) of them were obese. With p value 0,002, our results showed that there was significant correlation with gender and body mass index. Conclusion: . The severity of coronary artery disease is negatively correlated with patientâ€™s body mass index. High body mass index has protective effect in coronary artery disease patients. We concluded that obesity is associated with less severe coronary arter disease.

Keywords: Coronary Artery Disease (CAD), Body Mass Index (BMI), Gensini Scoring System (Severity of CAD), Dyslipidemia, Gender

The TheProtective ProtectiveEffect Effectof of Obesity Obesityin inCoronary Coronary Artery ArteryDisease Disease

IIN IIN FADHILAH FADHILAH UTAMI UTAMI11,, KHAIRIL KHAIRIL HASYIM HASYIM 11,, ILHAM ILHAM AKBAR AKBAR RAHMAN, RAHMAN, MD MD11 11AMSA Hasanuddin University AMSA Hasanuddin University

METHODS

INTRODUCTION

This was observational study with cross sectional approach. The samples taken were 131 patients of coronary artery disease from August 2015 to Januari 2016, then were assessed with coronary angiography in Cardiac Center of Wahidin Sudirohusodo Hospital, Indonesia

Although for decades there has been controversy regarding the relationship between obesity and coronary artery disease (CAD), it has been assumed that high body mass index (BMI) is a risk factor for CAD. However, the findings of some recent studies were paradoxical. Therefore, the aim of this study was to analyze deeper about BMI as well as its correlation with severity of coronary artery disease.

RESULTS Of 131 coronary artery disease patients examined 40 (30,5%) were normal, 34 (26,0%) were overweight, 46 (35,1%) were obese stage 1 and 11 (8,4%) were obese stage 2. The profile of coronary artery disease patients examined using coronary angiography with gensini scoring system showed that 47 (35,9%) were mild coronary artery disease, 31 (23,7%) were moderate coronary artery disease and 53 (40,5%) were severe coronary artery disease. Among mild coronary artery disease patients, 37 (78,7%) of them were overweight/obese. With p value 0,027 and -3<r<0, our results found that the severity of coronary artery disease was negatively correlated with body mass index. The lipid profile of the patients showing about 111 (84,7%) of the patients had dislipidemia status and among 111 patients with dislipidemia, 81 (73%) were overweight or obese. With p value 0,037 our results showed that there was significant correlation with BMI and dislipidemia. The gender distribution of patients were 100 (76,3%) with male and 31 (23,7%) with female. From 31 of female, approximately 20 (64,5%) of them were obese. While for male, among 100 male, only 37 (37%) of them were obese. With p value 0,002, our results showed that there was significant correlation with gender and body mass index.

Diagram 1. The Severity Profile of Coronary Artery Disease Patients

60 50 40 30 20 10

0 Mild Coronary Artery Disease Moderate Coronary Artery Disease Severe Coronary Artery Disease

Table 1. BMI Profile of Coronary Artery Disease Patients Number of Cases

BMI

30.5

Overweight

26.0 35.1

Obese 1

Obese 2

8.4

Total

131

100.0

Table 2. Gender Distribution of CAD Patients Gender

Table 3. The Correlation of BMI and Severity of Coronary Artery Disease

Normal BMI

p value : 0.004 (<0.05) Normal Overweight BMI Obese 1 Obese 2 Total

Count % within BMI % within Severity Count % within BMI % within Severity Count % within BMI % within Severity Count % within BMI % within Severity Count % within Severity % of Total

Mild 10 25.0% 21.3% 8 23.5% 17.0% 21 45.7% 44.7% 8 72.7% 17.0% 47 100.0% 35.9%

Severity Moderate 16 40.0% 51.6% 7 20.6% 22.6% 7 15.2% 22.6% 1 9.1% 3.2% 31 100.0% 23.7%

Obese

Severe 14 35.0% 26.4% 19 55.9% 35.8% 18 39.1% 34.0% 2 18.2% 3.8% 53 100.0% 40.5%

Total 40 100.0% 30.5% 34 100.0% 26.0% 46 100.0% 35.1% 11 100.0% 8.4% 131 100.0% 100.0%

Total

Male

Female

Count

% within BMI

85.1%

14.9%

100.0%

% within Gender

63.0%

35.5%

56.5%

Count

% within BMI

64.9%

35.1%

100.0%

% within Gender

37.0%

64.5%

43.5%

Count

100

131

% within Gender

100.0%

% of Total

76.3%

23.7%

100.0%

Table 4. The Correlation of BMI and Dyslipidemia Dyslipidemia

p value : 0,037 (<0.05) Normal

DISCUSSION

Overweight

Our findings suggest that obese patients have a paradoxically lower CAD burden compared to their non-obese comparators. Although it seems logical that obesity or adiposity should be accompanied by more accumulation of fat cells everywhere in the body, including vascular walls (atherosclerotic plauques), it must be clarified that first of all, obesity per se is not adiposopathy, and second, the process of atherosclerosis is not a simple process of fat accumulation but is as a result of adipose tissue dysfunction, or sick fat. This is in line with study conducted by Rubinshtein (2006), in their study on 923 patients with CAD, showed that obesity had an inverse relationship with the severity of CAD.3 Greater metabolic reserves, less cachexia, younger presenting age, more aggressive diagnostic and revascularization procedures, and increased muscle mass have been proposed as possible mechanisms of protection effect.2 Our results also suggest that female patients tend to have lower (mild) in severity of coronary artery disease then male. Female was associated with higher body mass index (overweight/obese), meanwhile male was associated with normal body mass index. According to the landmark “Women’s Ischemia Syndrome Evaluation (WISE) Study”2 they indicated that normal-weight women with the metabolic syndrome have a significantly increased cardiovascular risk. Similarly, overweight and obese women with normal metabolism have a relatively low cardiovascular risk.3

Percent

Normal

BMI Obese 1

Obese 2

Total

Yes

Total

Count

% within BMI

75.0%

25.0%

100.0%

% within Dyslipidemia

27.0%

50.0%

30.5%

Count

% within BMI

85.3%

14.7%

100.0%

% within Dyslipidemia

26.1%

25.0%

26.0%

Count

% within BMI

91.3%

8.7%

100.0%

% within Dyslipidemia

37.8%

20.0%

35.1%

Count

% within BMI

90.9%

9.1%

100.0%

% within Dyslipidemia

9.0%

5.0%

8.4%

Count

111

131

% within Dyslipidemia

100.0%

% of Total

84.7%

15.3%

100.0%

CONCLUSION The severity of coronary artery disease is negatively correlated with patient’s body mass index. High body mass index has protective effect in coronary artery disease patients. We concluded that obesity is associated with less severe coronary artery disease.

REFERENCES REFERENCES

1. Khan, H.S., Javed A, Azis S, Alli J. (2011). Relationship Between BMI and Severity of Coronary Artery Disease in Female Population of Pakistani Origin. Pakistani Heart Journal Vol 44 No 1-2. 2. Gregory A.B., Lester K., Gregory D, Twells L, Midodzi W, and Pearce N. (2017). The Relationship between Body Mass Index and the Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography. Cardiology Research and Practice Vol 2017. 3. Chiha J, Mitchell P, Gopinath B, Plant A, Kovoor P, and Thiagalingam A. (2015). Gender Differences in the Severity and Extent of Coronary Artery Disease. IJC Heart and Vasculature 161-166.

East EastAsian AsianMedical MedicalStudents’ Students Conference Conference

(EAMSC (EAMSC 2019) 2019)

CORRELATION OF CHRONIC COMPLICATIONS OF TYPE II DIABETES MELLITUS AND PHARMACOLOGY TREATMENT PATTERN IN RSUP. DR WAHIDIN SUDIROHUSODO IN INDONESIA Karina Jesslyn Sung, Valentina Febriani Tando, Andi Sitti Nurul Haerunnisa, Vania Noviantika

CORRELATION OF CHRONIC COMPLICATIONS OF TYPE II DIABETES MELLITUS AND PHARMACOLOGY TREATMENT PATTERN IN RSUP. DR WAHIDIN SUDIROHUSODO IN INDONESIA Karina Jesslyn Sung1, Valentina Febriani Tando1, Andi Sitti Nurul Haerunnisa1, Vania Noviantika1 1Faculty

of Medicine Hasanuddin University (AMSA-Unhas)

Background: Type II Diabetes Mellitus is a metabolic disease with the characteristics of hyperglycemia that occurs due to a progressive loss of -cell insulin secretion frequently on the background of insulin resistance, insulin performance or both. In 2014 there were 8.5% or about 422 million people over the age of 18 had Type II Diabetes mellitus which can cause macrovascular and microvascular complications. Aim: To analyze the incidence of chronic complications in type II DM patients and an analysis of the relationship between chronic complications in type II Diabetes Mellitus patients with pharmacological therapy undergoing treatment. Material and Methods: A cross-sectional study was conducted among 325 medical records at the Endocrine Polyclinic of the Wahidin Sudirohusodo Makassar General Hospital in Indonesia from January 1st 2017 to June 30th 2017. Results: The complications of diabetes in the form of peripheral artery disease didnâ€™t show a significant relationship to the selection of type 2 pharmacological therapy for diabetes mellitus (p> 0.05). Meanwhile, disease complications that have a relationship with pharmacological patterns of type 2 diabetes mellitus are cardiovascular disease (V = 0.279, p <0.001), cerebrovascular disease (V = 0.246, p <0.05), diabetic nephropathy (V = 0.172, p <0.05) and diabetic neuropathy (V = 0.228, p <0.05), diabetic foot (V = 0.181, p <0.001), diabetic retinopathy (V = 0.344, p <0.001). Peripheral arterial viewers do not have a relationship with the choice of therapeutic pattern (p> 0.05).

Conclusion: The most patients suffering diabetic neuropathy complications. This study has a complication of disease in the form of cardiovascular disease has a relationship with the pattern of pharmacological therapy with a moderate level of correlation strength. While cerebrovascular disease, diabetic nephropathy, diabetic neuropathy, diabetic foot and diabetic retinopathy have a significant relationship with weak correlation strength. Keywords: chronic complication, Type II Diabetes Mellitus, pharmacology, treatment

ABSTRACT

Introduction: Type 2 Diabetes Mellitus (T2DM) is a common and increasingly preventable

disease worldwide. There are many factors that contribute to the occurrence of T2DM , the modifiable and non-modifiable, the modifiable are less activity and stress, and they are affected by occupation , after conducting a pre-research literature study using several journal , we found government employee, housewifes and private employee are the occupation that have most T2DM. Objective: This study aimed to know the knowledge and attitude of non-diabetic subjects particularly those in risk of it. Methods:method involving 321 participants from three groups of occupation; housewives, private employees, and government employee/civil servants. There were 2 section of questionnaire where the first section was aimed to know the workerâ€™s knowledge on diabetes mellitus andthe second one was aimed to assess the attitude of respondents towards their risky occupation, either being ignorant or positively aware to it. Finally, we also analyzed the link of knowledge and attitude in the context of preventing T2DM. The data was analyzed trough IBM SPSS Statistics 23 before finally transformed into tables and charts. Result:Among 108 subjects from government employee group, 104 were found to be knowledgeable and 47 had negative attitude towards diabetes. Moreover, among 106 subjects of housewife, 102 were found to be knowledgeable and 55 reported to have negative attitude towards diabetes. Finally, among 107 subjects of private employee, 105 were found to be knowledgeable and 63 sadly showed negative attitude towards diabetes. On the other hand, there were 264 out of 321 participants who werereported to not knowing that they are in risk Conclusion:Majority of people who work as either housewife, government or even private employee already been knowledgeable enough for any information about type 2 diabetes mellitus, yet this level of knowledge unfortunately not in line with their attitude which tended to show less aware even more to ignorant for the risk of diabetes they are facing because of their occupations

TYPE 2 DIABETES MELLITUS: A DESCRIPTIVE ANALYSIS ON KNOWLEDGE AND ATTITUDE OF THOSE IN RISK Muh. Khairil Hasyim, Indah Nurul K., Trixie Nathania Z, Nurul Fadhilah

ABSTRACT

Introduction: Type 2 Diabetes Mellitus (T2DM) is a common and increasingly preventable