Lanny C. Gultom1, Sri R.S. Hadinegoro2, Damayanti R. Sjarif2, Herawati A. Sudoyo3, Suzanna Immanuel4, Muchtaruddin Mansyur5, Mexitalia Setiawati6
Background and objective: Lifestyle changes including physical exercise and diet is the management of dyslipidemia before considering the blood lipid-lowering drugs. Genetics factor is often regarded as the cause of the management’s failure in dyslipidemic subjects who had been doing physical exercise obediently and good diet consumption. This article aims: (I) to create the algorithms of dyslipidemia management in obese adolescents including apolipoprotein (apo) E polymorphism with 28 days of physical exercise and National Cholesterol Education Program (NCEP) step II diet interventions in order to start giving the blood-lipid lowering drugs; (II) To determine the apo E genotype’s profiles in subjects who has improved and unimproved lipid profile levels; and (III) To determine the apo E alleles’ roles in improving the lipid profile levels.
Methods: The study designs were cross-sectional and one group pretest and posttest study. Sixty dyslipidemic obese adolescents aged 10-18 years participated in the study. Subjects who met the inclusion criteria received the physical exercise and NCEP step II diet intervention for 28 days, as well as the apo E genotyping.
Results: Total cholesterol, triglycerides, LDL-chol, and HDL-chol level improvements were 51 (85%), 28 (46.7%), 40 (66.7%), and 11 (18.3%). Apo E3/E3 genotype was the largest proportion of genotypes in all subjects who had improved and unimproved lipid profile levels after the interventions. The total cholesterol, triglycerides, and LDL-chol mean levels before and after the intervention showed (I) were not significantly different in the apo E2 allele (P>0.05); and (II) significantly different in apo E3 allele (P<0.001). The total cholesterol and LDL-chol mean levels were significantly different (P<0.001), whereas the triglycerides mean levels was not significantly different (P>0.05) in apo E4 allele.
Conclusions: The profile of apo E genotypes was not evident in dyslipidemic obese adolescents who had improved or unimproved lipid profile levels after receiving the interventions, and apo E3/E3 genotype was the largest proportion of genotypes in both of subjects’ groups. Physical exercise and NCEP step II diet had no role in apo E2 allele, but they played a role in apo E3 allele in improving the total cholesterol, triglycerides, and LDL-chol levels. The interventions also played a role in improving the total cholesterol and LDL-chol levels, however, they did not have a role in improving the triglycerides levels in apo E4 allele. The algorithm of dyslipidemia management could be made in order to treat the dyslipidemia condition in obese adolescents.
