5,03%, sedang yang paling rendah terdapat di SMA Negeri 10, yaitu 1,48%. Hasil penghitungan rata-rata berat badan, tinggi badan dan indek masa tubuh,

ABSTRAK Sindroma metabolik (SIMET) adalah suatu istilah untuk kelompok faktor resiko penyakit jantung dan tipe-2 diabetes meilitus (DM). Faktor resiko tersebut terdiri dari dislipidemia atherogenik, naiknya tekanan darah, naiknya plasma glukosa, keadaan protrombotik, dan keadaan pro-peradangan. Sindroma metabolik diprediksi menyebabkan kenaikan 2 kali lipat resiko terjadinya penyakit jantung dan 5 kali lipat pada penyakit DM tipe2. Meningkatnya angka kejadian SM terjadi akibat peningkatan kasus obesitas. Laporan dari National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) menunjukkan peningkatan prevalensi 3M remaja dari periode 1988-1992 ke periode 1999-2000, yaitu dari 4,2% menjadi 6,4%. Prevalensi laki-laki yang mengalami SM ternyata lebih besar dibanding perempuan, yaitu 9,1% dibanding 3,7%. Remaja dengan Indek Masa Tubuh (IMT) persentil ke 595 32,1% mengalami SM, sedang yang mempunyai IMT antara persentil ke 85-95 didapatkan angka kejadian SM sebesar 7% (Duncan, 2004). Prevalensi SM pada remaja Cina Indonesia yang obesitas di Jakarta Utare dan Selatan sebesar 19,14% untuk laki-laki dan 10,63% untuk perempuan (Sibarani, 2006). Penelitian SM pada orang dewasa pernah dilakukan di Surabaya dengan rnenggunaknn kriteria ATP III didapatkan prevalensi sebesar 32% (Tjokroprawiro, 2007). Tujuan umi'm penelitian ini adalah menjelaskan pengaruh polimorfisme gen penyandi resepto." adrenergik p3 dan komposisi asupan makan remaja mempengaruhi timbulnya sindrcma metabolik pada remaja?. Tujuan umum dicapai melalui beberapa tujuan khusus. Tujuan tahun I: Mengidentifikasi prevalensi remaja obesitas di kota Malang, menetapkan status sindroma metabolik pada remaja, menjelaskan pengaruh komposisi asupan makan terhadap komponen sindroma metabolik pada remaja. Tujuan tahun II: Menjelaskan pengaruh polimorfisme gen penyandi resoptor adrenergik p 3 terhadap sindroma metabolik pada remaja, menjelaskan pengaruh polimorfisme gen penyandi reseptor adrenergik (33 yang sama, komposisi asupan makan yang berbeda terhadap timbulnya sindroma metabolik pada remaja. Guna mencapai tujuan tersebut dilakukan penelitian menggunakan pendekatan epidemiologi molekuler dengan rancangan studi kasus kelola. Untuk mencari prevalensi obesitas pada remaja diambil 20 sekolah secara random dari 190 sekolah di kota Malang dengan rincian 10 sekolah SMP dan 10 sekolah SMA. Kriteria obesitas ditentukan melalui Indek Masa Tubuh (IMT) kemudian dipakai kriteri dari Center Disease of Control (CDC). Dari remaja yang obesitas ditentukan status sindroma metabolik dengan kriteria International Diabetes Federation (IDF), yaitu meningkatnya kadar trigliserida, menurunnya kadar HDL serta lingkar pinggang > 80 cm untuk perempuan dan > 90 cm untuk laki-leki. Sampe! diambil sebesar 150 remaja dengan rincian: 73 kelompok kasus sindroma metebolik dan 77 remaja kelompok kontrol bukan sindroma metabolik. Kriteria sampel diterima dalam penelitian ini adaleh: remaja dengan umur 13-19 tahun pada saat dilakukan p&nelitian, dan bertempat tinggal di wilayah Malang Raya, remaja bukan penderita asma bronchiale (pengobatan dengan kortikosteroid), nephrotic syndrom, cushing syndrcm pada saat dilakukan penelitian, tidak merokok, bersedia sebagai responden untuk diambil sampel darahnya dengan menandatangani persetujuan (inform consent) dari orang tua. Hasil penelitian didapatkan prevalensi obesitas pada remaja sebesar 3,32%, jenis kelamin laki-iaki lebih banyak mengalami obesitas dibandingkan dengan wanita, yaitu 54,1% : 45,9%. Dari seluruh sekolah ternyata SMP Negeri 5 mempunyai prevalensi paling tinggi, yaitu

5,03%, sedang yang paling rendah terdapat di SMA Negeri 10, yaitu 1,48%. Hasil penghitungan rata-rata berat badan, tinggi badan dan indek masa tubuh, laki-laki mempunyai rata-rata tinggi badan dan berat badan lebih tinggi dibandingkan dengan wanita, tetapi setelah dihitung rata-rata indeks masa tubuh ternyata wanita lebih tinggi dibandingkan dengan laki-laki. Setelah dilakukan penghitungan dengan menggunakan uji i ternyata didapatkan perbedaan bermakna pada komponen sindroma metabolik dalam lal berat badan, tinggi badan, indeks masa tubuh, lingkar pinggang, trigliserida dan HDL, _DL, total kolesterol, tekanan darah sistole, tekanan darah diastole, Adiponektin dan Apo 3-100 antara remaja sindroma metabolik dan bukan sindroma metabolik, akan tetapi gula darah puasa dan gula darah 2 jam postprandrial perbedaan tersebut tidak bermakna. lraktor asupan makan lemak, karbohidrat dan kalori total secara simultan berpengaruh lerhadap komponen IMT sebesar R2 =.0,224 atau 22,4%, lingkar pinggang sebesar R2 -.0,238 atau 23,8%, trigleserida sebesar R2 =.0,251 atau 25,1%, HDL sebesar R2 =.0,251 iitau 25,1%, LDL sebesar R2= 0.256 atau 25,6%, GDP sebesar R2= 0.067 atau 6.7%, GD ;!jamPP sebesar R2= 0,037 atau 3,7%, Adiponectin sebesar R2= 0.184 atau18.4%, Apo B-' 00 sebesar R2= 0,043 atau 4,3%. Semua komponen ini merupakan faktor resiko terjadinya penyal.it jantung. Kesimpulan dari penelitian tahap I ini adalah prevalensi remaja obesitas pada remaja cli Kota Malang sebesar 3,32%, remaja laki-laki lebih banyak yang mengalami obesitas Cibanding dengan wanita dengan perbandingan 54,1% dibanding 45,9%, terdapat perbedaan besmakna antara kelompok sindroma metabolik dan bukan sindroma netabolik dalam hal BB, TB, IMT, LP, trigliserida, HDL, LDL, total kolesterol, tekanan oarah sistole, tekanan dareh diastole, Adiponektin dan Apo B-100, akan tetapi gula darah puasa dan gula darah 2 jam postprandrial perbedaan tersebut tidak bermakna. Dari hasil uji statistik ternyata asupan karbohidrat lebih berpengaruh apabila dibandingkan denganasupan lemak dan kalori total. Sehingga disarankan adanya pengaturan diet yaitu dengan pembatasan asupan karbohidrat selain lemak, agar tidak terjadi sindroma metabolik, diperlukan penelitian lebih lanjut untuk menentukan faktor penyebab lain pada remaja sindroma metabolik, antara lain memperhitungkan faktor genetik.

ABSTRACT Me*abolic syndrome is a cluster of cardiovascular disease and type 2 diabetes mellitus risk factors. The risk factor consists of atherogenic dyslipidemia, increased blood pressure, inci eased plasma glucose, pro-thrombotic state and pro-inflammation states. Metabolic syndrome is predicted for causing two fold and fivefold increase of cardiovascular disease and type 2 diabetes mellitus, consecutively. The number of metabolic event increased due to the case of obesity. National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) report shows an increasing number of adolescence metabolic syndrome in the period 1988-1992 and 1999-2000 from 4.2% to 6.4%. The prevalence of male adolescence with metabolic syndrome is higher than of female's, i.e. 9.1% compared to 3.7%. 32.1% of adolescence with Body Mass Index (BMI) on the > 95th percentile are having metabolic syndrome, while only 7% from those of 85-95 th percentile are having metabolic syndrome (Duncan, 2004). The prevalence of metabolic syndrome for obese Chinese Indonesian in Northern and Southern Jakarta are 19.14% for males and 10.63% for females (Sibarani, 2006). From a study on adult's metabolic syndrome held in Surabaya using ATP III criteria, the prevalence reached 32% (Tjokroprawiro, 2007). The general objection of this study is to identify the effect of p3-adrenergic receptor signaling gene polymorphism and the composition of food intake in affecting the occurrence of metabolic syndrome in adolescence. General objection is accomplished through several specific objections. 1st year objection: To identify the prevalence of adolescence obesity in Malang, to determine the state of metabolic syndrome in adolescence, and to associate the effect of food composition to the adolescence metabolic syndrome. 2 nd year objection: To identify the effect of p3-adrenergic receptor signaling gene polymorphism to the adolescence metabolic syndrome, the similar p3-adrenergic receptor signaling gene polymorphism, and the effect of different food composition to the occurrence of adolescence metabolic syndrome The study used an approach of molecular epidemiology with the design of case study management. To get the prevalence, 20 schools, specifically 10 junior high schools and 10 senior high schools, were randomly taken from 190 schools in Malang. The obesity criteria assessed using Body Mass Index (BMI) and Center Disease of Control (CDC) criteria. The state of metabolic syndrome defined using International Diabetes Federation (IDF) criteria; increased triglyceride level, decreased HDL level and waist circumference of >80 cm for males and >90 cm for female. The sample taken was 150 adolsscences consist of a case-group of 73 metabolic syndrome adolescences and a control-group of 77 non-metabolic syndrome adolescences. The accepted criteria for this study are: aqe of 13-19 years old when the study undergone, resided in the area of Malang, not having asthma bronchial (with corticosteroid medication), nephrotic syndrome and Cushing syndrome when the study undergone, not smoking, and willing to participate as a respondent whose blood is to be taken with the parents' agreement (inform consent). The study resulted in obesity prevalence of 3.32% with specification of higher male percentage than of female, i.e. 54.1% : 45.9%. Throughout the schools, SMP Negeri 5 is likely to have the highest prevalence (5.03%) while the lowest is SMA Negeri 10 (1.48%). The means of male weight and height is higher than of female's, but the mean of male BMI is actually a lower one. Using t test, a significant difference is obtained in the metabolic syndrome components like weight, height, BMI, waist circumference, triglyceride and HDL, LDL, total cholesterol, systole

blood presure, diastole blood presure, Adiponectin and Apo B-100 between metabolic and nonmetabolic adolescences. However, the difference is not significant for fasting and 2h postprandial blood glucoses. Fat, carbohydrate and total energy intakes simultaneously influence BMI components (R2 = .0,224 or 22.4%), waist circumference (R2 =.0.233 or 23.8%), triglyceride (R2 =.0.251 or 25.1%) and HDL (R2 =.0.251 or 25.1%), LDL (R2= 0.256 or 25%), fasting blood glucose (R2= 0.067 or 6.7%), postprandial blood glucose (R 2= 0.037 or 3.7%), Adiponectin (R2= 0.184 or 18.4%), and Apo B-100 (R2= 0.043 or 4.3%). All of these components are the risk factors of cardiovascular event. In conclusion, the prevalence of adolescence obesity in the first stage of study in Malang was 3.32% with obese male's prevalence is higher than female's (54.1%:45.9%). There was a significant difference between metabolic and non-metabolic groups in weight, height, BMI, waist circumference, triglyceride, HDL, total cholesterol, systole blood pressure, diastole blood pressure, adiponectin, and ApoB-100. The difference is not significant for and 2h postprandial blood glucoses. Statistical test suggest that carbohydrate intakes affects more than fat and total calorie. Hence, it if suggested to manage a diet with a limitation in carbohydrate and fat intakes in order to prevent metabolic syndrome. A further study is needed to determine other factors, like genetic factor, that cause adolescence metabolic syndrome.

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