Indonesia’s health and nutrition status:Omega-3s for cardiovascular health

Indonesia’s health and nutrition status:

Omega-3s for cardiovascular health

Dr Fiastuti Witjaksono

Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital

Overall health status in Indonesia

3

Hypertension / high blood pressure Diabetes mellitus Heart Disease Stroke Osteoporosis

0.6 0.70.26

0.8 0.90.39

1.71.3

0.64

3.9

2.11.67

5.5

2.83.3

4.8

3.6

4.61

3.5 3.2

6.7

0

1

2

3

4

5

6

7

8

Diabetes Cor. Heart Disease Stroke

15-24 25-34 35-44 45-54 55-64 65-74 75+

Top 5 health concerns in Indonesia

% of prevalence

Source: Riskesdas 2013

High blood pressure and arthritis are the two major issues in Indonesia

The higher occurrence of these disabilities in elderly may be caused by age or lifestyle

Nutritional prevention can reduce risk factors and fight degenerative disabilities

4

Cardiovascular diseases are the top cause of death by non-communicable diseases in Indonesia

Source: World Health Organization – Non-Communicable Diseases (NCD) Country Profiles - Indonesia, 2014

Source: http://www.thejakartapost.com/news/2014/04/07/world-health-day-heart-disease-still-number-one-killer.html

What is Cardiovascular diseaseDefinition:

A general term that describes a disease of the heart or blood vessels

Types of CVD

• Coronary heart disease

The flow of oxygen-rich blood to the heart is blocked or reduced by a build-up of

fatty material in the coronary arteries

• Stroke

A serious medical condition that occurs when the blood supply to part of the brain is cut off

• Peripheral arterial disease

A blockage in the arteries to your limbs (usually legs).

• Aortic disease

The wall of the aorta becomes weakened and bulges outwards

Years of life lost (YLLs) quantify premature mortality by weighting younger deaths more than older deaths

Institute for Health Metrics and Evaluation. GBD Profile: Indonesia

Indonesia’s Nutritional Profile

Rajwinder K. Harikaa Ans Eilandera Marjan Alssemaa Saskia J.M. Osendarpc Peter L. Zock. Intake of Fatty Acids in General Populations Worldwide Does Not Meet Dietary Recommendations to Prevent Coronary Heart Disease: A Systematic Review of Data from 40 Countries

Mean intake of SFA (intake in descending order) and PUFA in 40 countries

Consumption of total fat and saturated fat

Hardinsyah, Analisis komsumsi lemak, gula dan garam penduduk Indonesia, Gizi Indon 2011

• Pedoman Umum Gizi Seimbang (PUGS) Indonesia recommend to consume fat less than 25 % of total calories (2000 kal-56 g)

• Consumption of saturated fat of WHO recommendation is less than 10%

Cardiovascular diseases risk factors

• Obesity

• Diabetes Mellitus

• High blood pressure

• Hyper- triglyceride

Proportion of obese women (BMI>25) Age >18 years in Indonesia

Indonesia Basic Health Survey (Riskesdas), 2013

Proportion of obese men (BMI>25) Age >18 years in Indonesia


Proportion of abnormal cholesterol according gender and age >15 years in 2013

Men Women Urban Rural Indonesia



Proportion of abnormal fasting glucose according to gender

Prevalence of High Blood Pressure based on measurement


The Role of Omega-3 in Cardiovascular Diseases

What are Omega-3s: Structure of n-3 PUFA

Calder PC. Marine omega-3 fatty acids and inflammatory processes: effects, mechanism, and clinical relevance. Biochimica et Biophysica Acta, 2015: 1851:469-484.

Omega-6 Omega-3 Essential Fatty Acids

The conversion of short chain to long-chain omega-3s is limited.

Route of omega-3s from food to tissue

20

[Schuchardt et al., 2013]

Food Sources of Long-Chain n-3 PUFA

Mozaffarian and Wu. Omega 3 Fatty Acids and Cardiovascular Disease. J Am Coll Cardiol 2011;58:2047–67

Physiological Effects of n-3 PUFA That Might Influence CVD Risk


Clinical Studies on Omega-3s and Heart Health

RCTs of n-3 PUFA and Clinical Cardiovascular Events


The strengthen of ‘Mozaffarian and Wu’ study1. Randomized clinical trial2. Comparing omega-3 and placebo3. Large sample4. Decrease cardiovascular diseases by omega-3

Efficacy of Omega-3 Polyunsaturated Fatty Acids Administration Through Dietary Counseling

Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events. A Systematic Review and Meta-analysis. JAMA, September 12, 2012; 308

Efficacy of Omega-3 Polyunsaturated Fatty Acid Supplements Across Different Outcomes

Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events. A Systematic Review and Meta-analysis. JAMA, September 12, 2012; 308

Dose-Response Effects of n-3 PUFA Consumption on Fasting Plasma Triglycerides in RCTs


Summary: How omega-3s benefit your heart • Lowering of triglycerides

• Reduces resting heart rate

• Reduces systolic and diastolic blood pressure

• Antithrombotic effect

• Improved flow-mediated arterial dilatation (endothelial function)

• Improved cardiac filling and myocardial efficiency

• Enhancing insulin sensitivity

• Anti inflammatory effect

• Anti-arrhythmic effect


Leading Medical Organizations recommend fish intake or EPA/DHA supplements

Regular fish consumption (1-2 servings per week) is protective against coronary heart disease and ischaemic stroke and is recommended. The serving should provide an equivalent of 200-500 mg of eicosapentaenoic and docosahexaenoic acid.

500 mg/day EPA/DHA for adults for cardiovascular health

2 servings of fatty fish per week – for general health

1000 mg/day of EPA/DHA – patients with coronary heart disease

2-4g/day of EPA/DHA – patients with high triglycerides

General population: At least 2-3 servings of fatty fish

Post MI: 1 g/day

Indonesia’s health and nutrition status:Omega-3s for cardiovascular health

Health & Medicine

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