The Relationship between Nutritional Status and Central Obesity with

Low Density Lipoprotein (Ldl) Cholesterol Level in Coronary Heart

Disease Patients at Rsudza Banda Aceh

Egi Atika Handayani

, Husnah

, Muhammad Ridwan

edical

aculty, Universitas Syiah Kuala, Banda Aceh, Indonesia

2) Department of Nutrition, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Indonesia

3) Department of Cardiovascular, Medical Faculty, Universitas Syiah Kuala-dr.Zainoel Abidin Hospital,

Banda Aceh, Indonesia

Keywords: CHD, Nutritional Status, Abdominal Obesity, LDL Cholesterol

Abstract: Coronary Heart Disease (CHD) is one of the chronic diseases mainly causing death in developing countries.

Obesity is one of the factors predisposing an increase in LDL cholesterol level. General obesity is assessed

using body mass index (BMI), while abdominal obesity by waist circumference (WC). This study aims to

assess whether nutritional status and abdominal obesity was associated with LDL cholesterol level in

patients with CHD at RSUDZA Banda Aceh. This is an analytic observational study with cross-sectional

design using quota sampling design of non-probability sampling method. Data collected start from October

16 to October 26, 2017. There were 140 patients that meets the inclusion criteria which have been measured

body weight, height, waist circumference, and the LDL cholesterol level obtained from the laboratory

results. The respondents consisting of 77 males and 63 females. 57 respondents (89.1 %) of 64 respondents

with Obese Class 1 (≥25-<30 kg/m

) and 120 respondents (88.9%) of 135 respondents with abdominal

obesity have high LDL cholesterol level. Using Spearman test, the result of this study reveals a significant

association between nutritional status and LDL cholesterol level in CHD patients with p value = 0,000

(p<0,05) and moderate positive relationship (r = 0.29) and between abdominal obesity and LDL cholesterol

level in CHD patients with p value = 0.000 (p<0,05) and moderate positive relationship (r = 0.31).

Nutritional status and abdominal obesity are associated with the LDL cholesterol level in CHD patients at

RSUDZA Banda Aceh.

1 INTRODUCTION

Coronary Heart Disease (CHD) is one of the leading

causes of death and one of the chronic diseases in

developing countries

(Amani R. 2010). According to

World Health Organization (WHO), cardiovascular

disease is a disease with worldwide death and

disability, and each year is estimated at 17.3 million

people die from cardiovascular disease where a total

of 7.3 million people occurred due to heart disease

and 6.2 million people due to stroke (WHO 2011).

Coronary heart disease is a non-

communicable disease with impaired heart function

because of blood deficiency to the heart muscle due

to the constriction of coronary artery. Based on the

Basic Health Research Indonesia (RISKESDAS)

2013, the prevalence of CHD in Indonesia is the

seventh of 12 diseases. The prevalence of coronary

heart disease based on a doctor's diagnosis is 0.5

percent and based on symptoms is 1.5 percent.

Coronary heart disease increases with age

(RISKESDAS 2013). The prevalence of coronary

heart disease in Aceh Province based on doctor’s

diagnosis is 0.7 percent and based on symptom is 2.3

percent (Balitbangkes 2013).

Coronary heart disease is characterized by

abnormal accumulation of lipids or fatty and fibrous

tissue in the walls of blood vessels. High-fat foods

(cholesterol) can raise cholesterol in the blood.

Cholesterol and other fatty elements are not soluble

in the blood, but bind to proteins to form soluble

compounds called lipoproteins. The cholesterol

contained in the body slightly binds to lipoproteins

132

Handayani, E., Husnah, . and Ridwan, M.

The Relationship between Nutritional Status and Central Obesity with Low Density Lipoprotein (Ldl) Cholesterol Level in Coronary Heart Disease Patients at Rsudza Banda Aceh.

DOI: 10.5220/0008789701320137

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 132-137

ISBN: 978-989-758-438-1

 2020 by SCITEPRESS – Science and Technology Publications, Lda. All r ights reser ved

are Low Density Lipoprotein (LDL) (AlMatsier S

2007).

Cholesterol is transported to the blood in the

form of lipoproteins, 75% LDL cholesterol and 20%

HDL cholesterol. Low LDL cholesterol levels have

a good role in CHD, but excessive LDL cholesterol

will accumulate in the arteries. Cholesterol deposits

in the arteries over time cause narrowing and

stiffening of the arteries, usually called

atherosclerosis, which is a major problem in

coronary heart disease (Joewono S 2013).

Based on Ali Cem's research in 2017, there is

a relationship between body mass index and waist

circumference on coronary heart disease in

Uzunköprü State Hospital, Turkey. The relationship

between abdominal circumference and coronary

heart disease has a stronger correlation. From 292

people with an abdominal circumference > 90 cm,

66 people experienced coronary heart disease. Body

mass index, abdominal circumference and

dyslipidemia are parameters for pathogenesis of

coronary heart disease (Yekdeş 2017).

Research by Karunia in 2015 reveals that

there is a relationship between nutritional status with

HDL and LDL cholesterol levels. There were 50%

of overweight subjects had high serum LDL / HDL

levels. The increasing of LDL cholesterol is

associated with body fat that resides in the adipose

tissue. The adipose tissue will release high levels of

free fatty acids into the portal circulation, thus

disrupting the liver metabolism and stimulating the

liver to produce Very Low Density Lipoprotein

(VLDL), then VLDL particles will be converted into

LDL particles and affect the LDL / HDL ratio

(Agustin K 2015).

Based on research by Medika in 2015, there

is a relationship between abdominal circumference

with LDL cholesterol. As many as 20 people

(54.1%) with abnormal abdominal circumference

have high LDL levels. People with abnormal

abdominal circumference has a 2.64 chance of

having LDL levels (Prasetya M 2015) .The main

cause of elevated LDL cholesterol in the blood is

high saturated fat intake and obesity. Visceral fat

(central obesity) is strongly associated with

metabolic syndrome disorders than total body fat

(general obesity) (Ayu IG 2017).

Obesity has an increased risk of cardiovascular

disease and metabolic diseases such as coronary

heart disease, atherosclerosis, hypertension,

dyslipidemia, diabetes and heart failure (Wilson P

2002). According to the American Heart Association

(AHA), obesity is a major modifying risk factor for

coronary heart disease (Krauss R 2012). Obesity is a

state of increasing total body fat both or in certain

body parts. Obesity can be measured by

anthropometric measurements such as Body Mass

Index (IMT) and abdominal circumference. The

negative effects of excess body weight on blood

cholesterol contribute about 45% in increasing the

risk of CHD(Wilson P 2002). (Widyastuti 2006).

2 METHOD

The study was observational analytic with cross-

sectional design in Polyclinic of Cardiology at

RSUDZA Banda Aceh in October 2017. The

population was all patients with Coronary Heart

Disease diagnosis in Polyclinic of Cardiology at

General Hospital dr. Zainoel Abidin Banda Aceh

2017, the sample was taken by quota sampling and

met the inclusion criteria. The sample was chosen by

non probability sampling method. The primary data

collected by measuring body weight, height and

abdominal circumference, and secondary data

obtained from laboratory results of LDL cholesterol

levels of CHD patients. Statistical analysis with

univariate analysis was used for frequency

distribution and Correlation Spearman Test for

bivariate analysis.

3. RESULTS AND DISCUSSION

Table 1 General Characteristics of CHD Patients

General

n=140

(

)

Characteristics

Sex

Men

77 55,0

Women

63 45,0

Age (years)

17-25

2 1,4

26-35

7 5,0

36-45

19 13,6

46-55

42 30,0

56-65

56 40,0

>65

14 10,0

Educational level

No school

0,7

Elementary school

10,7

Junior Hi

h School

17,9

Senior Hi

h School

33,6

Bachelo

36,4

iste

0,7

The Relationship between Nutritional Status and Central Obesity with Low Density Lipoprotein (Ldl) Cholesterol Level in Coronary Heart

Disease Patients at Rsudza Banda Aceh

133

Occu

ational

Unem

ment

1 0,7

Housewife

44 31,4

Entre

reneu

48 34,3

Teacher/Lecture

5 3,6

Employee

34 24,3

Retirement

7 5

College student

1 0,7

Based on Table 1 the CHD patients was dominantly

men were 77 people (55,0%). Group of age 55-65

years were 56 people (40%). Bachelor, dominantly

in educational level, were 51 people (36,4%).

Entrepeneur was themost patients’ occupation, were

48 people (34,3%).

Table 2 The distribution of nutritional status of CHD

patients

Nutritional status (n=14

(%)

Underweight

0,7

Normal

35 25,0

Overweight

37 26,4

Obesity I

64 45,7

Obesity II

3 2,1

Table 2 indicates CHD patients were dominantly

have obesity grade 1, were 64 people (45,7%),

subject with underweight were 1 people (0,7%).

Table 3 The distribution of Central Obesity of

CHD patients

Abdominal Circumference

n=140

(%)

Normal

Men

2 1,4

Women

3 2,1

Abnormal

Men

75 53,6

Women

60 42,9

Table 3 reveals that the highest central obesity is

found in men, were 75 people (53.6%).

Table 4 Laboratory results of CHD patients, were

obtained LDL cholesterol levels.

LDL cholesterol level

n=140

(%)

Near optimal

0 0

Optimal

0 0

Borderline high

5 3,6

High

124 88,6

Very high

11 7,9

Table 4 reveals that 124 respondents (88,6%) have

high LDL cholesterol.

Table 5 The relationship between nutritional status and LDL cholesterol level of CHD Patients

Nutritional

Status

LDL Cholesterol Level

Borderline high High Very high Total

P-Value

Underweight 1

100 00 0

0 1 100

Normal 4

11,4 228 80

8,6 35 100

Overweight 0

0 337 100

0 37 100

0,000 0,29

Obesity I

0 557 89,1

10,9 64 100

Obesity II

0 22 66,7

33,3 3 100

Based on table 5, indicates form 35 respondents with normal nutritionl status,there were 28 people (80%) had

high LDL cholesterol level, from 37 people (100%) had high LDL cholesterol level, from 64 respondents with

obesity I, there were 57 people (89.1%) had high LDL cholesterol levels and from 3 respondents with obesity

II, 2 people (66,7%) had high LDL cholesterol level. The result revealed p value=0.000(p<0,05), there is

coreelation between nutritional status and LDL cholesterol level of CHD patients in polyclinic of cardiology

in RSUDZA Banda Aceh, and correlation coefficient value (r=0,291) means the strength of relation both

variable is enough.

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

134

Tabel 6 The relationship between central obesity and LDL cholesterol level of CHD patients

Central

Obesity

LDL Cholesterol Level Total

-value

Borderline

High Very high

n % n % n % n %

Normal 1

20.0

80.0

0.0 5 100.0

Abnormal 4

3.0 120

88.9

8.1 135 100.0

0,000 0,31

Based on Table 6, indicates that of 135 central obesity respondents, 120 people (88.9%) had high LDL cholesterol and

11 people (8.1%) had very high cholesterol levels. The result of p value = 0.000 (p

<0,05) shows that there is correlation between central obesity and LDL cholesterol level of CHD patients in

Polyclinic of Cardiology in RSUDZA Banda Aceh,

correlation coefficient value (r = 0,31) means the strength of relation both variables is enough.

4. CONCLUSION

The study results obtained 64 people (45.7%) with obesity

I and 3 people with obesity II (2.1%). This study coincides

with study by Mohammad Ifard 2013 in Iran on 12,416

respondents of CHD patients average on BMI 25.6 kg/m

have obesity status.(Mohammadifard N 2013). Obesity is

a major modifying risk factor for CHD disease. (Krauss

R 2012).

The negative effects of excess weight on blood

pressure and blood cholesterol contribute about 45% in

increasing the risk of CHD and there is an independent

increase of significant risk of the factor. Study by

Iskandar 2017 also find that although there is a slight

increase in body weight above normal, it can increase the

risk of CHD (Hadil A 2017).

The study results of the study found that 135

people (96.5%) of CHD patients had central obesity.

Central obesity is an indicator of cardiovascular

diseases(Sugondo 2009). This The relationship between

nutritional status and LDL cholesterol level of CHD

patients study is in line with research by Ratih 2015,

Women with abdominal circumferences >80 cm will

have 1.5 times risk affected by CHD compared to women

whose abdominal

circumference <80 cm(

Oemiati R 2015).

Obesity central is

influenced by unbalanced energy intake

and lack of physical activity so fat accumulation is more

prevalent in the abdomen because fat cells in the abdomen

are larger. Excess fat is stored in the form of triglycerides

fatty

tissue,

addition, lifestyle modernization, high

caloric intake, low physical activity is also a result of

increased central obesity which is a risk factor of

CHD (Dewi A 2013).

The study results obtained 124 people (88.6%)

with high LDL cholesterol levels. study coincides

Ma'rufi

2014, the percentage of patients with

LDL> 130 mg / dL

in the CHD group was 65.6% (Ma’rufi 2014). If foods

containing saturated fats consumed in excess amounts can

cause an increase of blood cholesterol, usually called

hypercholesterolaemia

(Dewi A 2013).

Increased levels

LDL cholesterol is one of the risk factors for coronary

heart disease. The high levels of LDL cholesterol that

accumulate on the

subendothelial

layer,

LDL cholesterol

is atherogenic which can lead to atherosclerosis (Ma’rufi

2014).

The Spearman Correlation test results obtained p

value = 0.000 (p <0.05) with correlation coefficient value

(r = 0.29). This suggests that there is a relationship

between nutritional status and LDL cholesterol levels in

CHD patients with the strength of relation is enough.

From 64 respondents who have obesity I, there were 57

people (89.1%) had high LDL cholesterol levels. It

signifies that the increasing of nutritional status in a

person tends to affect the increasing of LDL cholesterol

levels. This result is in line with the research of Ali Cem

2017 conducted in Turkey, there were 66 respondents who

experienced CHD had high cholesterol levels with obesity

nutritional status (p-value = 0,049 (Yekdeş 2017).

Obesity is a state of increased total body fat or in

certain body parts. Overweight and obesity have a

relationship with other risk factors in CHD, one of them is

dyslipidemia. LDL cholesterol will be carried to the

tissues including arteries that over time will lead to the

accumulation of fatty plaque in the arteries. If the fatty

plaques accumulate in coronary artery, often called

atherosclerosis, which is the initial cause of coronary heart

disease(Blu DI 2012).

This research is not in line with Tracey's research

2012 at BLU / RSUP. Prof. Dr. R.D.Kandao Manado,

from 62 cases with normal BMI, there were 5 people

normal without CHD (29,4%), and experienced CHD

were 12 people (70,6%). Patients with obesity I, There

were is 2 people normal without CHD (8.7%) and

suffering CHD were 21 people (91.3%). The study

showed p value = 0,135 which means p> 0,05), there is no

relationship between obesity and coronary heart disease.

The absence of a significant association in this study may

be there was the number of other risk factors for

unrecoverable CHDs such as heredity or genetics, age and

sex factors, as well as other factors related to behaviors

such as smoking, alcohol consumption and other history

of diseases such as diabetes melitus, hypertension,

improper diets or infectious diseases that strike attack the

blood and blood vessels (Blood NHL 2011)

The

relationship between central obesity and LDL cholesterol

level of CHD patients.

The study results in Polyclinic of Cardiology in

RSUDZA found that there is the relationship between

central obesity with LDL cholesterol levels of CHD

patients. From 135 respondents who had central obesity,

there were 120 people (88.9%) had high LDL cholesterol

The Relationship between Nutritional Status and Central Obesity with Low Density Lipoprotein (Ldl) Cholesterol Level in Coronary Heart

Disease Patients at Rsudza Banda Aceh

135

levels. The Spearman Correlation test results obtained p =

0,000 (α <0.05) with correlation coefficient value (r =

0.31). The result is in line with research by Medika 2015

in Dr. M. Djamil Padang Hospital. It was obtained there

were 20 people (54,1%) with abnormal abdominal

circumference and high LDL level (p = 0,02) which mean

there is difference of proportion of high LDL level

between abnormal abdominal abdominal respondent with

high LDL level with OR = 2, 64, meaning people with

abnormal abdominal circumference has a 2.64 chance of

having high LDL levels compared to respondents with

normal abdominal circumference (Prasetya M 2015).

The direct effects of excessive fat in the abdomen,

causing a person to have central obesity (Ayu IG 2007).

High intake of saturated fat diet also increase plasma

cholesterol levels with an increase about 15% -25%. This

is because there is a fat deposit in the liver which then

causing the increase of acetyl-koA in the liver to produce

cholesterol (Guyton A 2007). The high levels of LDL

cholesterol in the blood can cause the lack of antioxidants

in the blood vessels so that endothelias are more

susceptible to have endothelial injury that can cause

atherosclerosis in CHD patients (Sudoyo A 2009).

5. SUGESTION

The Nutritional status of CHD patients in the Polyclinic of

Cardiology in RSUDZA Banda Aceh are more

predominantly patients with obese I (45.7%). CHD

patients in Polyclinic of Cardiology in RSUDZA Banda

Aceh are more dominant had central obesity (96.5%).

LDL cholesterol levels of CHD patients were more

dominantly high (88.6%). There is a relationship between

nutritional status and central obesity with LDL cholesterol

levels in CHD patients in Polyclinic of Cardiology in

RSUDZA Banda Aceh.

For related institutions, better to always measuring

abdominal circumference to patients on a regular basis in

order to evaluate LDL cholesterol levels of CHD patients.

For other researchers, it is expected to conduct further

research on other factors that affect LDL cholesterol levels

that also have a high risk for CHD and aggravate CHD

with a larger number of respondents.

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