DOI: https://doi.org/10.14710/jgi.12.2.115-125

The effect of flexitarian diets on high-densit- lipoprotein (HDL) serum in obese female students

Departement of Nutrition Science, Faculty of Medicine, Universitas Diponegoro, Semarang, Jawa Tengah, Indonesia

Received: 21 Dec 2023; Revised: 17 May 2024; Accepted: 21 May 2024; Available online: 28 Jun 2024; Published: 28 Jun 2024.

Citation Format:
Abstract

Background: Obesity in female students affects metabolic profiles and reproduction. Consuming a plant-based diet can inhibit the synthesis of fatty acids and cholesterol, thereby reducing the risk of obesity. The lipid profile plays a crucial role in metabolism and includes high-density lipoprotein (HDL), which has a protective effect against cardiovascular disorders, obesity, hypertension, and dyslipidemia.

Objective: To analyze the effect of flexitarian diets on changes in serum HDL levels in obese female students.

Methods: A quasi-experimental design with pre-post-test control group was employed. Twenty-two female students aged 19-25 years were selected using consecutive sampling. The subjects were divided into intervention and control groups. The intervention group received a flexitarian diet for 4 weeks consisting of three meals and two snacks totaling 1500 calories per day. Both groups were provided with educational leaflets about obesity and balanced nutrition. Food intake was assessed using a 3x24-hour food recall, while physical activity was measured using the IPAQ-SF questionnaire. Serum HDL levels were analyzed enzymatically before and after the intervention. Statistical analysis was conducted using SPSS 25, including the Shapiro-Wilk test for normality, paired t-tests, independent t-tests, and the Mann-Whitney test.

Results: There was a significant decrease in serum HDL levels in the intervention group (2.00 ± 2.83 mg/dL), while serum HDL levels in the control group increased (3.27 ± 8.25 mg/dL), although this increase was not statistically significant. There was no significant difference between the two groups in terms of the mean change in HDL levels (p > 0.05).

Conclusion: A flexitarian diet for 4 weeks can lead to a significant reduction in serum HDL levels.

Fulltext View|Download
Keywords: Flexitarian Diets; Female Students; Serum HDL; Obesity

Article Metrics:

Article Info
Section: Articles
Language : EN
Recent articles
The effect of soy milk on haemoglobin levels in pregnant women with anaemia Anthropometric markers for fat obesity in Indonesian children aged 7 to 12 years in Yogyakarta Province, Indonesia Additional vitamin D supplementation does not affect muscle strength in the older women: A double-blind randomized controlled trial More recent articles
Most cited articles
Back-Matter Kadar seng dan kadar malondialdehyde pada penderita multi drug resistant tuberculosis dan tuberkulosis sensitif Front-Matter Determinan kejadian stunting pada bayi usia 6 bulan di Kota Semarang Estimasi potensi kerugian ekonomi akibat wasting pada balita di indonesia More cited articles
  1. World Health Organization (WHO). Overweight and obesity. Published 2015. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. Kementerian Kesehatan RI. Riset kesehatan dasar 2018. Jakarta : Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI
  3. Hruby A, Hu F. B. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673-689. doi: 10.1007/s40273-014-0243-x
  4. Rachmi C. N, Li M, Alison Baur L. Overweight and obesity in Indonesia: prevalence and risk factors—a literature review. Public Health. 2017;147:20-29. doi: 10.1016/j.puhe.2017.02.002
  5. Dinas Kesehatan Provinsi Jawa Tengah. Profil kesehatan Provinsi Jawa Tengah
  6. Dieny F. F, Widyastuti N, Fitranti D. Y. Sindrom metabolik pada remaja obes: prevalensi dan hubungannya dengan kualitas diet. Jurnal Gizi Klinik Indonesia. 2015;12(1):1-11. doi: 10.22146/ijcn.22830
  7. Meldrum D. R. Introduction: obesity and reproduction. American Society for Reproductive Medicine. 2017;107(4):831-832. doi: 10.1016/j.fertnstert.2017.02.110
  8. Azkia F. I, Miko Wahyono T. Y. Hubungan pola konsumsi makanan berisiko dengan obesitas sentral pada wanita usia 25-65 tahun di Bogor tahun 2011-2012. Jurnal Epidemiologi Kesehatan Indonesia. 2019;2(1). doi: 10.7454/epidkes.v2i1.1675
  9. Mahan L. K, Raymond J. L. Krause’s Food & the Nutrition Care Process. 14th ed. Elsevier Inc.; 2017
  10. Kurdanti W, Suryani I, Syamsiatun NH, et al. Faktor - faktor yang mempengaruhi kejadian obesitas pada remaja. Jurnal Gizi Klinik Indonesia. 2015;11(4):179. doi: 10.22146/ijcn.22900
  11. Dieny F. F, Widyastuti N, Fitranti D. Y, Nissa C, Tsani A. F. A, Jauharany F. F. Defisiensi besi pada wanita usia subur pranikah obesitas. Media Gizi Mikro Indonesia. 2019;10(2):101-110. https://doi.org/10.22435/mgmi.v10i2.599
  12. Fernando M. L. Gambaran citra tubuh pada wanita dewasa awal. Jurnal Ilmiah Psikologi Terapan. 2019;07(01):101-118. doi: 10.22219/jipt.v7i1.6369
  13. Widiawati S, Novayanti M, Ismiyati. Diet pada wanita usia subur (WUS) obesitas. In: Pameran Poster Ilmiah Pencegahan Penyakit Tidak Menular. Poltekkes Kemenkes Banten; 2019:37-41
  14. Mamat, Sudikno. Faktor-faktor yang berhubungan dengan kadar kolesterol HDL (Analisis data of the Indonesian family life survey 2007/2008). Jurnal Gizi Indonesia. 2010;33(2):143-149
  15. Mahbuba S, Mohsin F, Rahat F, Nahar J, Begum T. Descriptive epidemiology of metabolic syndrome among obese adolescent population. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Published online 2018:6-11. doi: 10.1016/j.dsx.2017.12.026
  16. Sigit F. S, Tahapary D. L, Trompet S, Sartono E, Dijk K. W. Van. The prevalence of metabolic syndrome and its association with body fat distribution in middle-aged individuals from Indonesia and the Netherlands : a cross-sectional analysis of two population‑based studies. Diabetology & Metabolic Syndrome. 2020;12(2):1-11. doi: 10.1186/s13098-019-0503-1
  17. Rose S, Dieny FF, Nuryanto, Tsani AFA. The correlation between waist-to-height ratio (WHtR) and second to fourth digit ratio (2D:4D) with an increase in metabolic syndrome scores in obese adolescent girls. Electronic Journal of General Medicine. 2020;17(3):1-9. doi: 10.29333/ejgm/7872
  18. Woudberg N. J, Goedecke J. H, Blackhurst D, et al. Association between ethnicity and obesity with high-density lipoprotein (HDL) function and subclass distribution. Lipids in Health and Disease. 2016;15(1):1-11. doi: 10.1186/s12944-016-0257-9
  19. Erwinanto E, Santoso A, Putranto J. N. E, et al. Panduan Tata Laksana Dislipidemia Tahun 2017. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia; 2017. http://jki.or.id
  20. Guevara-Cruz M, Flores-López AG, Aguilar-López M, et al. Improvement of lipoprotein profile and metabolic endotoxemia by a lifestyle intervention that modifies the gut microbiota in subjects with metabolic syndrome. Journal of the American Heart Association. 2019;8(17):e012401. doi: 10.1161/JAHA.119.012401
  21. Derbyshire E. J. Flexitarian diets and health: a review of the evidence-based literature. Frontiers in Nutrition. 2017;3(55):1-8. doi: 10.3389/fnut.2016.00055
  22. Blatner D. J. The Flexitarian Diet : The Mostly Vegetarian Way to Lose Weight, Be Healthier, Prevent Disease and Add Years to Your Life. McGraw-Hill; 2009. doi: 10.1036/0071549579
  23. Kent L, Morton D, Rankin P, et al. The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels and the implications for metabolic syndrome status - a cohort study. Nutrition and Metabolism. 2013;10(1):1-6. doi: 10.1186/1743-7075-10-58
  24. Najjar R. S, Moore C. E, Montgomery B. D. A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications. Clinical Cardiology. 2018;41(3):307-313. doi: 10.1002/clc.22863
  25. Horikawa C, Kodama S, Yachi Y, et al. Skipping breakfast and prevalence of overweight and obesity in Asian and Pacific regions: A meta-analysis. Preventive Medicine. 2011;53(4-5):260-267. doi: 10.1016/j.ypmed.2011.08.030
  26. Dunaief DM, Fuhrman J, Dunaief JL, Ying G. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Open Journal of Preventive Medicine. 2012;02(03):364-371. doi: 10.4236/ojpm.2012.23053
  27. Goldberg A. M. Farm animal welfare and human health. Current Environmental Health Reports. 2016;3(3):313-321. doi: 10.1007/s40572-016-0097-9
  28. Willett W, Rockström J, Loken B, et al. Food in the anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019;393(10170):447-492. doi: 10.1016/S0140-6736(18)31788-4
  29. Forestell C. A. Flexitarian diet and weight control: healthy or risky eating behavior? Frontiers in Nutrition. 2018;5(July):1-6. doi: 10.3389/fnut.2018.00059
  30. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Wadsworth; 2017. doi: 10.1016/0307-4412(92)90040-s
  31. Zhou Q, Wu J, Tang J, Wang J. J, Lu C. H, Wang P. X. Beneficial effect of higher dietary fiber intake on plasma HDL-C and TC/HDL-C ratio among Chinese rural-to-urban migrant workers. International Journal of Environmental Research and Public Health. 2015;12(5):4726-4738. doi: 10.3390/ijerph120504726
  32. World Health Organization (WHO). The Asia - Pacific Perspective : Redefining Obesity and Its Treatment.; 2000. doi: ISBN0957708211
  33. Grundy SM, Stone NJ, Bailey AL, et al. 2018 guideline on the management of blood cholesterol : a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019;73(24):e285-e350. doi: 10.1016/j.jacc.2018.11.003
  34. Magkos F, Tetens I, Bügel S. G, et al. A Perspective on the transition to plant-based diets: a diet change may attenuate climate change, but can it also attenuate obesity and chronic disease risk. Advances in Nutrition. 2020;11(1):1-9. doi: 10.1093/advances/nmz090
  35. Tang Y, Liu Y, Xu L, et al. Validity and reproducibility of a revised semi-quantitative food frequency questionnaire (SQFFQ) for women of age-group 12-44 years in Chengdu. Journal of Health, Population and Nutrition. 2015;33(1):50-59. doi: 10.3329/jhpn.v33i1.3194
  36. Fogelholm M, Malmberg JJ SJ. International physical activity questionnaire. Critical Reviews in Physical and Rehabilitation Medicine. 2006;38(4):753-760. doi: 10.1249/01.mss.0000194075.16960.20
  37. Yokoyama Y, Levin SM, Barnard ND. Association between plant-based diets and plasma lipids: A systematic review and meta-analysis. Nutrition Reviews. 2017;75(9):683-698. doi: 10.1093/nutrit/nux030
  38. Campbell EK, Fidahusain M, Campbell TM. Evaluation of an eight-week whole-food plant-based lifestyle modification program. Nutrients. 2019;11(2068):1-12. doi: 10.3390/nu11092068
  39. Wang F, Zheng J, Yang B, Jiang J, Fu Y, Li D. Effects of vegetarian diets on blood lipids: A systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association. 2015;4(10). doi: 10.1161/JAHA.115.002408
  40. Michalczyk MM, Maszczyk A, Stastny P. The effects of low-energy moderate-carbohydrate (MCD) and mixed (MixD) diets on serum lipid profiles and body composition in middle-aged men : a randomized controlled parallel-group clinical trial. International Journal of Environmental Research and Public Health. 2020;17(1332):1-15. doi: 10.3390/ijerph17041332
  41. Yuliantini E, Sari A, Nur E. Hubungan asupan energi, lemak dan serat dengan rasio kadar kolesterol total-HDL. Penelitian Gizi dan Makanan (The Journal of Nutrition and Food Research). 2015;38(2):139-147. doi: 10.22435/pgm.v38i2.5543.139-147
  42. Hicks T. M, Knowles S. O, Farouk M. M. Global provisioning of red meat for flexitarian diets. Frontiers in Nutrition. 2018;5(50). doi: 10.3389/fnut.2018.00050
  43. Guyenet SJ SM. Regulation of food intake, energy balance, and body fat mass : implications for the pathogenesis and treatment of obesity. Journal Clinical Endocrinology Metabolism. 2018;97(5):745-755. https://doi.org/10.1210/jc.2011-2525
  44. Soelistijo SA, Lindarto D, Decroli E, et al. Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia 2019. Perkumpulan Endokrinologi Indonesia. Published online 2019:1-117. https://pbperkeni.or.id/wp-content/uploads/2020/07/Pedoman-Pengelolaan-DM-Tipe-2-Dewasa-di-Indonesia-eBook-PDF-1.pdf
  45. Päivärinta E, Itkonen S. T, Pellinen T, Lehtovirta M, Erkkola M, Pajari A. M. Replacing animal-based proteins with plant-based proteins changes the composition of a whole nordic diet—a randomized clinical trial in healthy Finnish adults. Nutrients. 2020;12(4):1-16. doi: 10.3390/nu12040943
  46. Santos F, Esteves S, Pereira A, Yancy Jr W NJ. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factor. Obesity Review. 2012;13:1048-1066. doi: 10.1111/j.1467-789X.2012.01021
  47. Chawla S, Silva FT, Medeiros SA, Mekary RA, Radenkovic D. The effect of low-fat and low-carbohydrate diets on weight loss and lipid levels: A systematic review and meta-analysis. Nutrients. 2020;12(12):1-21. doi: 10.3390/nu12123774
  48. Rachmawati S, Sulchan M. Asupan lemak dan kadar high density lipoprotein (HDL) sebagai faktor risiko peningkatan kadar C-reactive protein (CRP) pada remaja obesitas dengan sindrom metabolik. Journal of Nutrition College. 2014;3(3):337-345. doi: 10.14710/jnc.v3i3.6586
  49. Trajkovska K. T, Topuzovska S. High-density lipoprotein metabolism and reverse cholesterol transport: Strategies for raising HDL cholesterol. Anatolian Journal of Cardiology. 2017;18(2):149-154. doi: 10.14744/AnatolJCardiol.2017.7608
  50. Barnard ND, Goldman DM, Loomis JF, et al. Plant-based diets for cardiovascular safety and performance in endurance sports. Nutrients. 2019;11(1):1-10. doi: 10.3390/nu11010130
  51. Thaochalee C, Sarikaputi A, Bumrungpech A, Chalermchai T, Nararatwanchai T. Anti-inflammatory effects of plant-based thai diets in overweight and obese individuals. Songklanakarin Journal of Science and Technology. 2021;43(3):840-846. doi: 10.14456/sjst-psu.2021.111
  52. Rondanelli M, Giacosa A, Morazzoni P, et al. MediterrAsian diet products that could raise HDL-cholesterol: A systematic review. BioMed Research International. 2016;2016. doi: 10.1155/2016/2025687
  53. Palazón-Bru A, Hernández-Lozano D, Gil-Guillén VF. Which physical exercise interventions increase HDL-cholesterol levels? a systematic review of meta-analyses of randomized controlled trials. Sports Medicine. 2021;51(2):243-253. doi: 10.1007/s40279-020-01364-y
  54. De Munter J, Van Valkengoed IG, Stronks K, Agyemang C. Total physical activity might not be a good measure in the relationship with HDL cholesterol and triglycerides in a multi-ethnic population: a cross-sectional study. Published online 2011. doi: 10.1186/1476-511X-10-223
  55. Mansoor N, Vinknes KJ, Veierød MB, Retterstøl K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Published online 2015. doi: 10.1017/S0007114515004699
  56. Trautwein EA, McKay S. The role of specific components of a plant-based diet in management of dyslipidemia and the impact on cardiovascular risk. Nutrients. 2020;12(9):1-21. doi: 10.3390/nu12092671

Last update:

No citation recorded.

Last update: 2024-12-21 07:56:06

No citation recorded.