THE INFLUENCE OF EATING HABITS OF MINAHASAN DISHES ON THE OCCURENCE OF CORONARY HEART DISEASE Grace D. Kandou Post Graduate Department of Public Health University of Sam Ratulangi Manado Department of Public Health Faculty of Medicine University of Sam Ratulangi Manado Email: [email protected] Abstrak: Penyakit jantung koroner (PJK) merupakan masalah kesehatan jantung baik di dunia maupun di Indonesia termasuk Propinsi Sulawesi Utara, dan menempati urutan pertama sebagai penyebab kematian. Penyebab terjadinya PJK multifaktorial; salah satunya adalah kebiasaan makan yang dipengaruhi oleh faktor budaya, adat istiadat, agama dan kepercayaan. Penelitian ini dilakukan untuk mengetahui pengaruh kebiasaan makan makanan etnik Minahasa terhadap kejadian PJK. Metode case control dengan 128 kasus dan 128 kontrol yang diambil dari RSU Prof. Dr. R.D. Kandou. Dilakukan pengumpulan data frekuensi makan dengan menggunakan Food Frequency Quationnaire (FFQ) untuk melihat hubungan ke- biasaan makan dengan PJK. Umumnya makanan etnik Minahasa mengandung asam lemak jenuh 0,01-10,46 % per 100 gramnya. Seseorang yang mengomsumsi jenis makanan berisiko PJK seperti babi putar dengan frekuensi makan ≥ 2 kali/bulan mempunyai kemungkinan terkena PJK 4,43 kali lebih besar dibanding dengan yang mengonsumsi ≤ 1 kali/bulan, setelah dikontrol oleh babi hutan (OR=4,3 95% CI:1,66-11,05), kotey/sa’ut (OR=7,15 95%CI: 1,70- 30,08), merokok (OR=2,76 95% CI: 1,36-5,61), usia (OR=1,96 95%CI: 1,36-2,83), jenis kelamin (OR=2,86 95%CI: 1,41-5,78), dan hipertensi (OR=5,86 95%CI: 2,94-11,66). Berda- sarkan 41 jenis makanan yang dikomposit, seseorang yang mempunyai kebiasaan makan makanan etnik Minahasa dengan frekuensi sering (total skor ≥ nilai mean) mempunyai kemungkinan 5,4 kali lebih besar untuk terkena PJK dibanding dengan yang mempunyai kebiasaan makan jarang (total skor ≤ nilai mean), setelah dikontrol oleh faktor jenis kelamin, riwayat PJK dalam keluarga, dan diabetes. Kata kunci: kebiasaan makan, makanan Minahasa, asam lemak jenuh, penyakit jantung koroner. Abstract: Coronary Heart Disease (CHD) is the leading cause of disability and mortality in Indonesia and North Sulawesi as well as the rest of the world. There are many factors that contribute to the development of CHD. Eating habits are believed to be risk factors and are influenced by culture and religion. This research explores the influence of eating habits of the Minahasans, particularly of the dishes that contain high level of fats contributing to the development of CHD. The methodology of this research involved case controls. The respondents were taken from Prof. Dr. R.D. Kandou General Hospital in Manado, North Sulawesi. The samples were divided into two groups consisting of 128 cases of CHD and 128 cases without CHD for control. Eating frequencies were obtained through Food Frequency Questionnaires (FFQ). The purpose of using these analyses was to obtain the actual effects of the eating habits involving a variety of Minahasan dishes which were believed to have had some contribution to the risks of CHD. Those who ate whole roasted pigs more than twice a month were 4.43 times more susceptible to develop CHD compared to those who ate whole roasted pigs less than once a month, after being controlled by the eating of wild boar (OR=4.3 95% CI: 1.66-11.05), banana heart and stem (OR=7.15 95% CI: 1.70-30.08), smoking (OR=2.76 95% CI: 1.36-5.61), age (OR=1.96 95% CI: 1.36-2.83), gender (OR=2.86 95% CI: 1.41-5.78), and hypertension (OR=5.86 95% CI: 2.94-11.66). Based on the consumption of 169 170 Jurnal Biomedik, Volume 2, Nomor 3, November 2010, hlm. 169-178 41 kinds of Minahasan dishes, those who frequently ate these on a daily bases had a 5.4 higher probability of developing CHD with an eating habit score of ≥ mean value, compared to those who ate less frequently with an eating habit score of ≤ mean value, after being controlled by gender, family history of CHD, and diabetes mellitus. Keywords: eating habit, Minahasan foods, saturated fatty acid, coronary heart disease. Cardiovascular disease is still a hot topic in Around 86% Indonesians (age ≥10) public health issues. It killed over 180,000 consumed fruit less than seven times a people in the United Kingdom and 500,000 week; only 2% consumed fruit ≥ 14 times a people in the United States every year.1-3 week.14 Coronary Heart Disease (CHD) is an Hatma’s research (2001) on four ethnic increasing cause of death in Indonesia with groups (Minangkabau, Javanese, Sunda- an increase from 11th (Survei Kesehatan nese, and Bugis) in Indonesia found that Rumah Tangga/SKRT 1972) to 3rd (SKRT saturated fatty acid was 21% of total energy 1986) and becoming the main cause of consumption.15 Meanwhile, the American deaths (SKRT 1992, 1995, and SKRT 2001, Heart Association (AHA) advised that SKRT 2005).4 Moreover, North Sulawesi, saturated fatty acid consumption should be as one of the thirty provinces in Indonesia, < 10% of total energy intake. It means that has the highest number of deaths caused by the saturated fatty acid consumption of cardiovascular diseases.5,6 According to Indonesians was high.10,15-18 reports from Prof. Dr. R.D. Kandou General Eating habits are influenced by socio- Hospital in Manado, the main reference cultural factors, customs, religions, and hospital in North Sulawesi Province, beliefs, and these habits identify how cardiovascular disease was the main cause individuals or communities satisfy their of deaths.7 nourishment needs.6 CHD is a degenerative disease that is Indonesia has over 500 ethnic groups affected by atherosclerosis manifestated in with various life styles; one of them is the coronary arteries, and other risk factors. Minahasans with a majority living in the There are risk factors that can be controlled North Sulawesi province where they or modified, such as hypertension, comprise the largest ethnic group.19,20 dyslipidemia, smoking, diabetes mellitus, The Minahasans usually celebrate obesity, stress, and physical inactivity. parties with banquets, mostly consisting of Besides that, there are also risk factors that Minahasan dishes derived from animal fat can not be modified such as: age, genetics, (mostly pork). The Minahasans eat pork as gender, and race.8,9 CHD risk was 2.5 times frequently as other Indonesian people eat higher in people with family histories of beef.20 CHD or sudden deaths before age 50 The objective of this research was to compared to people without these find out the influences of Minahasan histories.10-12 Hypertension is closely related consumption of dishes enriched by saturated to CHD, because hypertension increases the fatty acids on CHD, including observations risk of CHD six times higher than such as sedentary life style, smoking, normotension.13 Several studies showed that alcohol consumption, as well as age, sex, diabetes mellitus patients have greater risks family history, and associated diseases (two to three times) to develop CHD (hypertension, obesity, and diabetes compared to normal people. North Sulawesi mellitus). has the highest prevalence of diabetes mellitus in Indonesia.5 METHODS Based on the national census year 2003, about 26% of Indonesians consumed This research was carried out in the vegetables less than seven times a week. Prof. Dr. R.D. Kandou General Hospital, Kandou, The Influence of Eating Habits of Minahasan Dishes on The Occurence... 171 and was designed for non-randomized case n=128 cases and n=128 controls with a total control. Studies were made of new sample number 256. Dietary assessment inpatients and outpatients, based on the was held through Food Frequency hospital medical records. All of them had Questionnaires (FFQ) concerning daily, electrocardiography (ECG) examinations weekly, monthly, and yearly eating habits. and were diagnosed by cardiologists as first Data was processed by using the SPSS time CHD patients (according to AHA version 11(licensed), STATA 8 (licensed), guidelines/PERKI guidelines 2004). As and Windows Vista Basic Premium control group, we took inpatients and Microsoft Excel program. outpatients with no CHD history, but who Eating habit data received from FFQ had had ECG examinations, and had been were categorized in three columns of diagnosed by cardiologists as non CHD frequency: never, seldom, and often. The patients.21 Receiver Operation Curve (ROC) analysis This research was preceded by a survey. was executed to determine the cut off point Its objective was to find out the eating for eating frequencies. The eating habits of the Minahasans living in North frequencies of subjects were obtained for all Sulawesi, especially those who consumed 41 kinds of Minahasan dishes. Univariate certain dishes that were high in saturated analysis for each research variable and fatty acids. Observations were made of bivariate analysis revealed 25 dishes that those dishes that were usual eaten by the were related to the occurrence of CHD. For Minahasans, daily or occasionally, e.g. in logistic regression we used five dishes that parties. had the highest OR values, followed by a Furthermore, samples of food from validiting interaction test for confounding party dishes and daily dishes were analyzed variables. The results showed the effect of for their saturated fatty acid contents. The the kinds of high-risk dishes on the result was a new finding that could be occurrence of CHD after controlling certain included in the list of foods in Indonesia. other factors (sedentary habits, smoking, Saturated fatty acid examinations of 41 alcohol consumption, age, sex, family dishes usually consumed by Minahasans history, hypertension, obesity, and diabetes were performed with gas chromatography mellitus). Then we analyzed combinations by the Food & Nutrient Laboratory in the of several high-risk dishes. Nutrient Research & Development Center The observations of eating habits were of the Health Department of the Republic of based on eating frequency considering the Indonesia in Bogor.