21 bahwa fitosterol dapat menghambat sintesa VLDL. Uji klinis yang dilakukan Plat & Mensink (2009) yang menggunakan plant stanol pada subjek SM mendapatkan hasil yang mendukung mekanisme tersebut. Plat menemukan bahwa plant stanol ester dapat menurunkan konsentrasi VLDL dan TG pada subjek SM dan menduga bahwa penurunan TG ini berasal dari penurunan produksi partikel VLDL-1 yang tinggi TG (TG rich VLDL-1 particles) di hati (Plat & Mensink 2009).
SIMPULAN DAN SARAN Simpulan Intervensi pemberian fitosterol yang ditambahkan pada minyak sawit dan digunakan sebagai minyak goreng telah dilakukan selama 8 minggu dengan melibatkan 30 orang subjek yang terbagi menjadi kelompok perlakuan dan kontrol. Tidak didapatkan drop out maupun keluhan/efek samping pada penelitian ini. Ratarata total konsumsi minyak goreng selama intervensi yaitu 46 ± 23 g/hari sedangkan rata-rata konsumsi minyak yang diperkaya fitosterol pada kelompok perlakuan adalah 38 ± 19 g/hari. Kesimpulan pada penelitian ini adalah dengan konsumsi minyak sawit yang diperkaya fitosterol sekitar 38 g/hari, dapat mencapai asupan fitosterol sebesar 2 g/hari dan memenuhi asupan fitosterol yang dipersyarakan (>1.3 g/hari). Terdapat perbaikan kadar kolestorol total dan TG namun tidak terdapat perbedaan yang signifikan pada kadar kolesterol LDL. Saran Pada penelitian selanjutnya disarankan mengukur efikasi intervensi ini pada subjek dengan jumlah konsumsi minyak goreng normal dan mengukur kadar VLDL untuk melengkapi mekanisme kerja fitosterol
DAFTAR PUSTAKA Alberti KGMM, Zimmet PZ, Shaw J. 2005. Metabolic Syndrome—A New worldwide definition. A Consensus Statement from the International Diabetes Federation. Diabetic Medicine. 23: 469–480 Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WPT, Loria CM, Smith SC jr. 2009. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120: 1640–1645. DOI: 10.1161/CIRCULATIONAHA.109.192644 [Balitbangkes] Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. 2008. Riset Kesehatan Dasar 2007. Jakarta (ID): Kementerian Kesehatan Republik Indonesia.
22 [Balitbangkes] Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. 2010. Riset Kesehatan Dasar 2010. Jakarta (ID): Kementerian Kesehatan Republik Indonesia. Berger A, Jones PJH, Abumweis SS. 2004. Plant sterols: factors affecting their efficacy and safety as functional food ingredients (review). Lipids in Health and Disease. 3:5 Berglund L & Dianne H. 2003. Cholesterol Absorption and the Metabolic Syndrome: A New Look at an Old Area : Editorial. Arterioscler Thromb Vasc Biol. 23:1314-1316. Blair SN, Capuzzi DM, Gottlieb SO, Nguyen T, Morgan JM, Carter NB. 2000. Incremental Reduction of Serum Total Cholesterol and Low-Density Lipoprotein Cholesterol With the Addition of Plant Stanol Ester-Containing Spread to Statin Therapy. American Journal of Cardiology, 86(1):46-42 [BPOM RI] Badan Pengawas Obat dan Makanan Republik Indonesia. 2011. Peraturan Kepala BPOM RI Tentang Pengawasan Klaim Dalam Label Dan Iklan Pangan Olahan Nomor HK.03.1.23.11.11.09909 Tahun 2011 Lampiran IV. Jakarta. Cantrill R. 2008. Phytosterol, Phytostanol and Their Ester: Chemical and Technical Assessment. JECFA Cognis GmBH. 2008. Application and Stability Data of Vegapure® Plant Sterol Esters in Vegetable Oils. Technical Data Sheet (5):1-5 Curtis LH, Hamill BG, Bethel MA, Anstrom KJ, 2007. Cost of the metabolic syndrome in elderly. Diabetes Care 30(10):2553-2558 Demonty I, Knaap RRT, Meijer L, Zock PL, Geleijnse JM, Trautwein EA. 2013. The effect of plant sterols on serum triglyceride concentrations is dependent on baseline concentrations: a pooled analysis of 12 randomised controlled trials. Europe Journal of Nutrition. 52:153–160 Dewi M, Martianto D, Andarwulan N. 2013. Studi efikasi intervensi minyak kelapa sawit yang diperkaya plant sterol untuk memperbaiki profil lipid darah dan status inflamasi pada penderita hiperlipidemia. (laporan penelitian). Institut Pertanian Bogor. Edem DO. 2002. Palm Oil: Biochemical, Physiological, Nutritional, Hematological and Toxicological Aspects: A review. Plant Foods for Human Nutrition. 57:319-341 [FDA] Food and Drugs Administration. 2010. Food Labeling; Health Claim; Phytosterols and Risk of Coronary Heart Disease; Proposed Rule. FDA Grundy SM, Brewer HB, Cleeman JI Smith SC Jr, Lenfant C. 2004. Definition Of Metabolic Syndrome: Report Of The National Heart, Lung, and Blood Institute/American Heart Association Conference On Scientific Issues Related to Definition. Circulation. 109:433–438. Genser B, Silbernagel G, Backer GD, Brucket E. Carmena R, Chapman MJ, Deanfield J, Descamp OS, Rietzschel ER, Dias KC, Marz W. 2012. Plant Sterols and Cardiovascular Disease: A Systematic Review and Meta-analysis. European Heart Journal. 33:444–451 Gupta AK, Savopoulos CG, Ahuja J, Hatzitolios AI. 2011. Role of Phytosterols in Lipid-Lowering: Current Perspectives. QJM: An International Journal of Medicine. 104:301–308 Hardinsyah. 2011. Analisis Konsumsi Lemak, Gula Dan Garam Penduduk Indonesia. Jurnal Gizi Indonesia. 34(2):92-100
23 Hardinsyah, Briawan D. 1994. Penilaian dan Perencanaan Konsumsi Pangan. Bogor : Departemen GMSK, FAPERTA IPB. Hallikainen M. 2001. Role of plant stanol ester and sterol ester-enriched margarines in the treatment of hypercholesterolemia (disertasi). Kuopio University Publications D. Medical Sciences Ho S & Pal S, 2005. Margarine Phytosterols Decrease The Secretion of Atherogenic Lipoproteins from HepG2 Liver and Caco2 Intestinal Cells. Atherosclerosis 182:29–36 Jenkins, David JA, Cyrill W, Kendall C. 1999. Plant Sterols, Health Claims and Strategies to Reduce Cardiovascular Disease Risk. Journal of the American College of Nutrition. 18(6):559-562 Jones PJH, MacDougall DE, Ntanios F, Vanstone CA. 1997. Dietary Phytosterols as Cholesterol Lowering Agents in Humans. Canadian Journal of Physiology and Pharmacology . 75:217-227. Jones PJH, Ntanios FY, Raeini-Sarjaz M, Vanstone CA. 1999. Cholesterol-Lowering Efficacy of a Sitostanol-Containing Phytosterol Mixture With a Prudent Diet in Hyperlipidemic Men. American Journal of Clinical Nutrition. 69:1144–50. Lau VWY, Journoud M, Jones PJH. 2005, Plant Sterols are Efficacious in Lowering Plasma LDL and non-HDL Cholesterol in Hypercholesterolemic Type 2 Diabetic and Nondiabetic Persons. American Journal of Clinical Nutrition 81:1351-1358. Law M. 2000. Plant sterol and stanol margarines and health. BMJ 320:861 – 864. Lees AM, Mok HYI, Lees RS, McCluskey MA, Grundy SM. 1977. Plant sterols as cholesterol-lowering agents: clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atherosclerosis 28:325-338. Lutsey PL, Steffen LM, Stevens J. 2008. Dietary Intake and the Development of the Metabolic Syndrome: The Atherosclerosis Risk in Communities Study. Circulation. 117:754-761 [JECFA] Joint FAO/WHO Expert Committee on Food Additives. 2008. Phytosterols, phytostanols and their esters. In: Compendium of Food Additive Specifications. Joint FAO/WHO Expert Committee on Food Additives (JECFA), 69th Meeting, June 17-26, 2008, Rome, Italy. (FAO JECFA Monographs 5). Rome, Italy. Martianto D, Komari, Soekirman, Soekatri M, Heryatno Y, Mudjajanto ES. 2005. Possibility of Vitamin A Fortification on Cooking Oil in Indonesia: A Feasibility Analysis. Jakarta: Koalisi Fortifikasi Indonesia. Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartiainen E. 1995. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. New England Journal of Medicine. 333:13081312. Mijares AH, Banul C, Jover A, Sola E, Bellod L. Triguero MLM, Lagarda MJ, Victor VM, Rocha M. 2011. Low Intestinal Cholesterol Absorption is Associated With A Reduced Efficacy of Phytosterol Esters as Hypolipemic Agents in Patients With Metabolic Syndrome. Clinical Nutrition 30:604-609 Misra A, Neha S, Lokesh K. 2010. Review : Obesity, the Metabolic Syndrome, and Type 2 Diabetes in Developing Countries: Role of Dietary Fats and Oils. Journal of the American College of Nutrition, 29(3): 289S–301S Mukherjee S & Mitra A. 2009. Health Effects of Palm Oil. Journal of Human Ecology, 26(3): 197-203 [NCEP] National Cholesterol Education Program. 2002. Third Report of The National Cholesterol Education Program (Expert Panel on Detection,
24 Evaluation, and Treatment Of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final report. Circulation. 106:3143–3421. Nelms M, Sucher KP, Lacey K, Roth LR. 2011. Nutrition Therapy and Pathophysiology. USA: Wadsworth Nguyen TT, Dale LC, Bergmann K, Croghan IT. 1999. Cholesterol-Lowering Effect of Stanol Ester on a US Population of Mildly Hypercholesterolemic Men and Women: A Randomized Controlled Trial. Mayo Clin Proc. 74:1198-1206. Orea CS, Gonzalez M, Gea A, Gomez EF, Gortari FJB, Rastrollo MB, 2013. Consumption of fried foods and risk of metabolic syndrome: The SUN cohort study. Clinical Nutrition. 33(3):545-549 [PSF] Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care, September 2004 Update. www.partnershipforsolutions.org Pranoto A, Kholili U, Tjokroprawiro A, Hendromartono, Sutjahjo A, Murtiwi S. 2005 Metabolic syndrome as observed in Surabaya. Abstract. In: Tjokroprawiro A, eds. Surabaya metabolic syndrome update-1. Surabaya 1:245-247. Puspitadewi A, Sekartini R, Pulungan AB. 2013. Prevalence of insulin resistance in obese adolescence. International Journal of Pediatric Endocrinology (Suppl 1):P102 Plat J & Mensink RP. 2009. Plant Stanol Esters Lower Serum Triacylglycerol Concentrations via a Reduced Hepatic VLDL-1 Production. Journal of Nutrition. 139:1143–1149 Plat, J. Onselen ENM, Heugten MMA, Mensink RP. 2000. Effects on Serum Lipids, Lipoproteins and Fat Soluble Antioxidant Concentrations of Consumption Frequency of Margarines and Shortenings Enriched With Plant Stanol Esters. European Journal of Clinical Nutrition. 54(9):671–677 Pollak OJ. 1953 Reduction of Blood Cholesterol in Man. Circulation (7):702-706 Reaven GM. Banting lecture 1988: Role of Insulin Resistance in Human Disease. Diabetes. 37:1595–1607 Sialvera TE, Pounis GD, Koutelidakis AE, Richter DJ, Yfanti G, Kapsokefalou M. 2012. Phytosterols Supplementation Decreases Plasma Small and Dense LDL Levels in Metabolic Syndrome Patients on A Westernized Type Diet. Nutrition, Metabolism & Cardiovascular Diseases. 22:843-848 Salta FN, Kalogeropoulos N, Karavanou N, Nikolaos KA. 2008. Distribution and Retention of Phytosterols in Frying Oils and Fried Potatoes During Repeated Deep and Pan Frying. Eur Food Res Technol. 227:391–400 Simatupang P, A Purwoto. 1996. Konsumsi Minyak Goreng untuk Pangan. B. Amang, P. Simatupang, dan A. Rachman (Eds.). Dalam Ekonomi Minyak Goreng di Indonesia Bogor : IPB Press. 269 – 302 Simonen P, Gylling H, Howard AN, Miettinen TA. 2000. Introducing a New Component of The Metabolic Syndrome: Low Cholesterol Absorption. American Journal of Clinical Nutrition. 72:82–88. Soewondo P. 2005. Prevalence of Metabolic Syndrome as Defined by The ATP III, Asian Modification of ATP III, WHO and IDF Criteria in Depok Population Study. Abstract. JAFES. 23:S99. Soewondo P, Purnamasari D, Oemardi M, Waspadji S, Soegondo S. 2010. Prevalence of Metabolic Syndrome Using NCEP/ATP III Criteria in Jakarta, Indonesia: The Jakarta Primary Non-communicable Disease Risk Factors Surveillance 2006. Acta Medica Indonesian Journal of Internal Medicine 42: Soupas L, Huikko L, Lampi AM, Piironen V. 2005. Esterification Affects Phytosterol Oxidation. European Journal Lipid Science Technology 107:107–118
25 Suleen Ho, 2005. Margarine Phytosterols Decrease The Secretion of Atherogenic Lipoproteins from HepG2 Liver and Caco2 Intestinal Cells. Atherosclerosis 182: 29–36 Trautwein EA, Duchateau GSMJE, Awad AB, Bradford PG. 2006. Phytosterols: sources and metabolism in Nutrition and Cancer Prevention, CRC, Taylor and Francis group 223-241 Vanhanen HT, Kajander J, Lehtovirta H, Miettinen TA. 1994. Serum Levels, Absorption Efficiency, Faecal Elimination and Synthesis of Cholesterol during Increasing Doses of Dietary Sitostanol Esters in Hypercholesterolaemic Subjects. Clinical Sciemce 87:61-67. Vanhanen HT, Miettinen TA. 1992. Effects of Unsaturated and Saturated Dietary Plants Sterols on Their Serum Contents. Clinica Chimica Acta. 205:97-107. Vissers MN, Zock PL, Meijer GW, Katan MB. 2000. Effect of Plant Sterols From Rice Bran Oil and Triterpene Alcohols From Sheanut Oil on Serum Lipoprotein Concentrations in Humans. American Journal of Clinical Nutrition. 72(6):1510– 1515 Wu TFJ, Yang Y, Zhang L, Han J. 2009. The Effects of Phytosterols/Stanols on Blood Lipid Profiles: A Systematic Review with Meta-Analysis. Asia Pacific Journal of Clinical Nutrition 18(2): 179-186 Waloya T, Rimbawan, Andarwulan N. 2013. Hubungan antara Konsumsi Pangan dan Aktivitas Fisik dengan Kadar Kolesterol Darah Pria dan Wanita Dewasa di Bogor. Jurnal Gizi Pangan, 8(1): 9-16 Weidner C, Michel K, Bard JM, Cazaubielm M, Bell N. 2008. Cholesterol Lowering Effect of a Soy Drink Enriched with Plant Sterols in a French Population with Moderate Hypercholesterolemia. Lipids in Health and Disease. 7:35 [WHO] World Health Organization. 2002. The World Health Report 2002. Reducing Risks, Promoting Healthy Life. WHO, Geneva, Switzerland. [WHO] World Health Organization. 2003. WHO Technical Report Series 196. Diet, Nutrition and The Prevention of Chronic Diseases, Report of a Joint WHO/FAO Expert Consultation. Geneva, Switzerland. [WHO] World Health Organization. 1999. Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Report of a WHO consultation 1999. Winarno, FG. 1999. Minyak Goreng dalam Menu Masyarakat. Jakarta: Balai Pustaka. Winkler JK & Warner K. 2008. The Effect of Phytosterol Concentration on Oxidative Stability And Thermal Polymerization of Heated Oils. European. Journal of Lipid Science &. Technology. 110:455–464
