Abstrak: ABSTRACTAtrial septal defect is one of the most common forms of congenital heart disease. Although various M-mode and two-dimensional echocardiographic characteristics of atrial septal defect have been described, these criteria lack sensitivity and specificity. By allowing visualization of blood flow, the demonstration of right-toleft or left-to-right shunting is possible with contrast echocardiography(11-16). The purpose of the first part of this study was to verify the utility of this technique for evaluating patients with atrial septal defect.We observed that contrast echocardiographic shunts may persist long after closure of an atrial septal defect. The aim of the second part of' this study was to determine whether this indicates unsuccessful repair or a hemodynamically important residual shunt.Peripheral venous injection of echocardiographic contrast allows the visualization of blood flow through the right sided cardiac cavities. The purpose of the third part of the study was to determine whether the technique may aid to the diagnosis of some right heart abnormalities by the demonstration of specific blood flow patterns.The patterns of echo contrast appearance in the inferior vena cava after upper extremity injection may be related to right heart hemodynamics(17,18). The purpose of the fourth part of the study was to determine the utility of contrast echocardiography of the inferior vena cava for the assessment of right heart hemodynamics. Since the technique can be used to detect tricuspid regurgitation( 9-21), we also studied whether estimation of its severity is possible,. because this would have important therapeutic and prognostic implications.An intriguing potential .future application of contrast echocardiography is the study of myocardial perfusion. The technique would offer many advantages over the other imaging modalities such as radionuclide techniques, contrast-enhanced computerized transmission tomography, positron emission tomography and nuclear magnetic resonance. Contrast echocardiographic. myocardial perfusion imaging would have a good spatial and temporal resolution and allows direct and simultaneous assessment of both the perfusion and function of the myocardium. It is also much less expensive. However, a good and safe echocardiographic contrast agent for such application in humans is not yet available.

Abstrak: Tujuan penelitian ini adalah untuk mengetahui apakah efek lipemik minyak ikan dibandingkan dengan efek lipemik minyak jagung dapat dipengaruhi oleh komposisi diet basal. Untuk mencapai tujuan ini sejumlah 192 ekor tikus Wistar jantan (Hsd/Cpb:WU) berumur tiga minggu di gunakan dalam empat rangkaian eksperimen. Dalam setiap eksperimen digunakan 48 ekor tikus. Setelah melalui masa aklimatisasi selama enam hari, tikus-tikus dikelompokkan secara acak didasarkan atas berat badan, konsentrasi kolesterol dan trigliserida darah menjadi empat kelompok yang masing-masing terdiri dari 12 ekor tikus. Tikus-tikus tersebut diberi diet eksperimen yang mengandung minyak ikan atau minyak jagung, tetapi berbeda dalam komposisi diet basalnya. Peubah-peubah dari diet basal tersebut adalah jumlah lemak (rendah dibanding tinggi), jenis karbohidrat ( glukosa dibanding sukrosa), jumlah kholesterol (rendah dibanding tinggi), dan jenis protein (casein dibanding protein kedelai).Setiap eksperimen terdiri dari empat kelompok diet, dua di antaranya ditambah minyak ikan dan lainnya minyak jagung. Diet ini mengandung 12% minyak ikan menhaden atau 12% minyak jagung. Minyak ikan menhaden mengandung kurang lebih 14% asam lemak eikosapentanoat (C20:5, n-3) dan 8% asam lemak dokosaheksanoat (C22:6, n-3), sementara minyak jagung mengandung 56% asam lemak linoleat (C18:3, n-3). Diet eksperimen diberikan selama dua minggu untuk tiap percobaan.Hasil penelitian menunjukkan bahwa efek hipotrigliseridemik minyak ikan dibandingkan dengan efek hipotrigliseridemik minyak jagung tidak dipengaruhi oleh komposisi diet basal. Efek kholesterolemik minyak ikan dibandingkan dengan efek kholesterolemik minyak jagung, dipengaruhi oleh komposisi diet basalnya. Penambahan sejumlah minyak kelapa ke dalam diet eksperimen tanpa mengubah kandungan energinya (isokalori), dapat mengurangi efek hipokholesterolemik minyak ikan. Efek hipokholesterolemik minyak ikan dibandingkan dengan efek hipokholesterolemik minyak jagung tidak dipengaruhi oleh macam karbohidrat di dalam diet basal. Penambahan 1% berat kholesterol ke dalam diet eksperimen, baik pada diet basal yang mengandung casein atau protein kedelai, tidak mempengaruhi efek hipokholesterolemik minyak ikan dibandingkan dengan efek hipokholesterolemik minyak jagung. Minyak ikan dibandingkan dengan minyak jagung, memberikan efek pada konsentrasi kholesterol dalam hati tidak sitematis . Pada tikus yang diberi diet minyak ikan, konsentrasi kholesterol dalam hati meningkat + tujuh kali, dan + 10 kali pada tikus yang diberi diet minyak jagung.Dapat disimpulkan bahwa efek lipemik minyak ikan dibandingkan dengan efek lipemik minyak jagung, dipengaruhi oleh komposisi diet basal. Ini berlaku untuk efek hipakholesterolemik, tetapi tidak untuk efek hipotrigliseridemik. Dengan demikian komposisi diet basal perlu diperhatikan bila akan membandingkan efek kholesterolemik minyak ikan dalam suatu penelitian.

---

The objective of the present studies was to find out whether the lipemic effect of dietary fish oil versus corn oil would be affected by the background composition of the diet. For this purpose, a total of 192, male Wistar rats (Hsd/ Cpb:WU) three weeks of age were used in a series of four experiments. In each experiment, 48 rate were divided randomly into four groups of 12 rats each. The rats were fed diets containing either fish oil or corn oil but different background compositions. The variables of the background diet were : the amount of fat (low versus high), the type of carbohydrate (glucose versus sucrose), the amount of cholesterol (low versus high), and the type of protein (casein versus soy protein).Each experiment consisted of four dietary groups, two of which received either fish oil or corn oil in the diets. The diets contained either 12% (w/w) of menhaden oil or corn oil. The menhaden oil contained approximately 14% eicosapentaenoic and 8% docosahexaenoic acid and the corn oil contained about 56% linoleic acid. The experimental diets were given for two weeks in each experiment.It was found that the hypotriglyceridemic effect of fish oil versus corn oil was not influenced by the background composition of the diet. The hypocholesterolemic effect of fish oil versus corn oil did depend on the background composition of the diet. Addition of coconut fat to the diet at the expense of an isocaloric amount of sucrose resulted in a diminished hypocholesterolemic effect of fish oil. The hypocholesterolemic effect of fish oil versus corn oil was not influenced by the type of carbohydrate (glucose versus sucrose) in the background diet. Upon the addition of 1% (w/w) of cholesterol to the diets, irrespective of whether casein or soy protein was the protein source, no cholesterol lowering effect of fish oil versus corn oil was observed.It can be concluded that the lipemic effect of fish oil versus corn oil can be influenced by the background composition of the diet. This conclusion should be qualified it holds for the hypocholesterolemic but not for the hypotriglyceridemic effect of fish oil. This implies that the composition of the background diet should be considered when comparing the cholesterolemic effects of fish oil in various experiments.

Abstrak: Cardiovascular disease has become the first cause of death. Highest morbidity is found in the age, and among cardiovascular diseases, prevalence of hypertension is the highest. Many studies on the relationship between nutritional factors and hypertension have been done, but studies to observe determinants of hypertension in Indonesia are lacking. Therefore, there is an urgent need to elaborate information on various hypertension risk factors in the Indonesian elderly, which will allow the policy makers to provide appropriate intervention programs.The primary purpose of this study was to investigate various determinants of hypertension in the Indonesian elderly with different nutritional status.A cross sectional study was undertaken in Jakarta and 5 other cities with total sample of 1261 elderly using multistage random sampling. Subjects were recruited from elderly population in Jakarta, Padang, Bandung, Jogyakarta, Denpasar and Makasar. Data were collected through interview using structured questionnaires, anthropometrics measurements, biochemical blood and urine analysis, and blood pressure measurements. Daily nutrients intake was analyzed using WorldFood2 Dietary Assessment Program. Data were analyzed by using SPSS programs for Windows version 7.5; General Linear Model, Multiple linear regression and logistic regression analysis were performed to determine the predictive power of independent variables for outcome variables. Prevalence of hypertension found in the study was quite high, more than 50% of the study population for both men and women. This study showed significant differences of determinant and predictive factors of blood pressure between elderly with Body Mass Index (BMI) < 25 kg/m2 and BMI? 25 kg/m2. Prevalence of systolic and diastolic hypertension was higher in the elderly with BMI < 25 kg/lm2 than in the elderly with BMI 25 kg/m2. BMI was a significant determinant for diastolic blood pressure in elderly with BMI > 25 kg/m2. There was a positive association between blood pressure and Waist to hip ratio (WHR) irrespective of BMI value.Plasma LDL cholesterol >160 mg/dl increased the risk of having systolic hypertension 1.5 to 2 times in the elderly with BMI < 25 kg/m2 after the age of 65 years and increased the risk of having diastolic hypertension 1.5 times. Plasma triglycerides > 200 mg/dl increased the risk of having systolic hypertension 1.7 and 2.5 times in elderly with BMI 25 kg/m2 and in elderly with BMI? 25 kg/m2 respectively, after the age of 65 years and increased the risk of having diastolic hypertension Ft, 1.7 times. Ratio of total cholesterol to HDL cholesterol > 5 increased the risk of having hypertension 1.8 times in elderly with BMI? 25 kg/m2. Plasma HDL cholesterol < 35 mg/dl in elderly with BMI < 25 kg/m2 increased the risk of hypertension approximately 2.4 times. In elderly with BMI < 25 kgmm2, monounsaturated fatty acid (MUFA) had negative correlation (protecting effect) with diastolic and systolic blood pressure. Saturated fatty acid (SFA) had positive correlation with diastolic blood pressure and systolic blood pressure. Cholesterol intake had positive correlation with diastolic blood pressure. Multivariate analyses in this study did not find significant correlation between energy intakes with blood pressure. Although no significant correlation was found between protein intakes with blood pressure, this study showed that arginine intake had protecting effect against hypertension. The study also showed that calcium and potassium intake had negative correlation with DBP and SBP respectively in elderly with BMI > 25 kg/m2. In elderly with BMI < 25 kg/m2 sodium intake had positive correlation with SBP. This study also demonstrated that sport index had negative correlation (protecting effect) with diastolic blood pressure.Nutrition education to elderly group should emphasize healthy nutrients with protecting effect against hypertension and avoid nutrients with positive correlation to hypertension. Suggestion for sodium restriction especially in the elderly with BMI < 25 kg/m2, and proper physical/sport activity as a protecting factor against hypertension is very important for the elderly. Regular check of blood pressure and plasma lipid should be conducted and Public Health Centers equipped with appropriate laboratory facilities, for early detection of hypertensive risk factors. BMI category should be considered in hypertension program since there were differences of determinant factors of hypertension between different categories of BMI. Future studies should be directed on public health and nutrition intervention to the elderly community.