PERBEDAAN KADAR HIGH DENSITY LIPOPROTEIN (HDL) PADA

TIKUS PUTIH JANTAN (Rattus norvegicus) Galur Wistar YANG

DIBERI HIGH FAT DIET DENGAN PEMBERIAN PERASAN LEMON

FINO (Citrus limon fino) DAN JERUK NIPIS (Citrus aurantifolia)

TUGAS AKHIR

Untuk Memenuhi Persyaratan

Memperoleh Gelar Sarjana Gizi

Oleh:

Nadia Magdalena

NIM 135070300111042

PROGRAM STUDI ILMU GIZI

FAKULTAS KEDOKTERAN

UNIVERSITAS BRAWIJAYA

MALANG

2017

DAFTAR ISI

Halaman

Judul ............................................................................................................ i

Halaman Pengesahan ................................................................................. ii

Pernyataan Keaslian Tulisan ....................................................................... iii

Kata Pengantar ............................................................................................ iv

Abstrak ........................................................................................................ vi

Daftar Isi ...................................................................................................... viii

Daftar Gambar ............................................................................................. xii

Daftar Tabel ................................................................................................. xiii

Daftar Singkatan .......................................................................................... xiv

BAB I PENDAHULUAN

1.1 Latar Belakang Masalah .................................................................... 1

1.2 Rumusan Masalah ............................................................................ 4

1.3 Tujuan Penelitian ............................................................................... 4

1.3.1 Tujuan Umum ........................................................................ 4

1.3.2 Tujuan Khusus ....................................................................... 5

1.4 Manfaat Penelitian ............................................................................. 5

1.4.1 Manfaat Akademik ................................................................. 5

1.4.2 Manfaat Praktis ...................................................................... 5

BAB II TINJAUAN PUSTAKA

2.1 Lemak ............................................................................................... 6

2.1.1 Definisi lemak ........................................................................ 6

2.1.2 Klasifikasi lemak .................................................................... 6

2.1.3 Definisi lipoprotein .................................................................. 7

2.1.4 Klasifikasi lipoprotein.............................................................. 7

2.1.5 Metabolisme Lemak ............................................................... 10

2.1.6 Metabolisme lipoprotein ......................................................... 11

2.2 Dislipidemia ....................................................................................... 14

2.2.1 Definisi Dislipidemia ............................................................... 14

2.2.2 Prevalensi Dislipidemia .......................................................... 15

2.2.3 Etiologi Dislipidemia ............................................................... 16

2.2.4 Patofisiologi Dislipidemia ....................................................... 17

2.2.5 Manifestasi Dislipidemia ......................................................... 18

2.2.6 Terapi Dislipidemia ................................................................ 18

2.3 Lemon ............................................................................................... 19

2.3.1 Taksonomi Lemon (Citrus limon fino) ..................................... 19

2.3.2 Definisi dan Ciri-Ciri Lemon.................................................... 19

2.3.3 Kandungan Lemon ................................................................. 23

2.3.4 Pengaruh Lemon terhadap Profil Lipid ................................... 25

2.4 Jeruk Nipis ........................................................................................ 27

2.4.1 Taksonomi Jeruk Nipis (Citrus aurantifolia) ............................ 27

2.4.2 Definisi dan Ciri-Ciri Jeruk Nipis ............................................. 27

2.4.3 Kandungan Jeruk Nipis .......................................................... 28

2.4.4 Pengaruh Jeruk Nipis terhadap Profil Lipid ............................ 29

BAB III KERANGKA KONSEP DAN HIPOTESIS

3.1 Kerangka Konsep Penelitian ............................................................. 32

3.2 Penjelasan Kerangka Konsep Penelitian ........................................... 33

3.3 Hipotesis ........................................................................................... 35

BAB IV METODOLOGI PENELITIAN

4.1 Rancangan Penelitian ....................................................................... 36

4.2 Populasi dan Sampel......................................................................... 37

4.2.1 Subjek Penelitian ................................................................... 37

4.2.2 Kriteria Inklusi ........................................................................ 37

4.2.3 Kriteria Eksklusi ..................................................................... 38

4.2.4 Drop out ................................................................................. 38

4.2.5 Perhitungan Sampel .............................................................. 38

4.2.6 Randomisasi Sampel ............................................................. 39

4.2.7 Penentuan Perlakuan............................................................. 42

4.3 Variabel Penelitian ............................................................................ 43

4.3.1 Variabel Bebas....................................................................... 43

4.3.2 Variabel Terikat ...................................................................... 43

4.3.3 Variabel Terkendali ................................................................ 43

4.4 Lokasi dan Waktu Penelitian ............................................................. 43

4.4.1 Lokasi Penelitian .................................................................... 43

4.4.2 Waktu Penelitian .................................................................... 43

4.5 Bahan dan Alat/Instrumen Penelitian ................................................. 44

4.5.1 Alat Penelitian ........................................................................ 44

4.5.2 Bahan Penelitian .................................................................... 45

4.5.2.1 Bahan Pakan Tikus .................................................. 45

4.5.2.2 Bahan Bius Tikus ..................................................... 46

4.5.2.3 Bahan Pemeriksaan HDL ......................................... 46

4.6 Definisi Operasional .......................................................................... 47

4.7 Prosedur Penelitian dan Pengumpulan Data ..................................... 48

4.7.1 Perlakuan pada Tikus Percobaan .......................................... 48

4.7.2 Pembuatan Pakan Standar .................................................... 50

4.7.3 Pembuatan Perasan Lemon dan Cara Pemberian ................. 51

4.7.4 Pembuatan Perasan Jeruk Nipis dan Cara Pemberian .......... 51

4.7.5 Penentuan Volume Pemberian Lemon dan Jeruk Nipis ......... 51

4.7.5.1 Volume Pemberian Perasan Lemon (Citrus limon fino)

................................................................................. 52

4.7.5.2 Volume Pemberian Perasan Jeruk Nipis (Citrus

aurantifolia) .............................................................. 52

4.7.6 Pembuatan Suspensi Simvastatin .......................................... 52

4.7.7 Penentuan Dosis Simvastatin ................................................ 53

4.7.8 Proses Pembuatan dan Cara Pemberian Pakan Tinggi

Lemak (High Fat Diet) pada Tikus Wistar ............................... 53

4.7.9 Pemeriksaan Kadar High Density Lipoprotein (HDL) .............. 54

4.8 Analisis Data ..................................................................................... 55

BAB V HASIL PENELITIAN DAN ANALISIS DATA

5.1 Karakteristik Sampel ......................................................................... 57

5.2 Perubahan Berat Badan Tikus ........................................................... 68

5.3 Asupan Pakan Tikus ......................................................................... 61

5.3.1 Jumlah Asupan Pakan Tikus .................................................. 61

5.3.2 Jumlah Asupan Energi Tikus Selama Penelitian .................... 62

5.3.3 Jumlah Asupan Lemak Tikus Selama Penelitian .................... 63

5.3.4 Jumlah Asupan Protein Tikus Selama Penelitian ................... 64

5.3.5 Jumlah Asupan Karbohidrat Tikus Selama Penelitian ............ 65

5.4 Kadar High Density Lipoprotein Tikus Selama Penelitian .................. 67

BAB VI PEMBAHASAN

6.1 Karakteristik Subjek Penelitian .......................................................... 69

6.2 Perubahan Berat Badan Tikus ........................................................... 70

6.3 Asupan Energi, Lemak, Protein, dan Karbohidrat Antar Kelompok

Perlakuan .......................................................................................... 72

6.4 Kadar Kadar High Density Lipoprotein (HDL) Tikus Selama

Penelitian .......................................................................................... 72

6.4 Keterbatasan Penelitian .................................................................... 77

BAB VII PENUTUP

7.1 Kesimpulan ....................................................................................... 79

7.2 Saran ................................................................................................ 79

DAFTAR PUSTAKA ..................................................................................... 80

Lampiran 1. Randomisasi Tikus Percobaan ............................................... 89

Lampiran 2. Diagram Alur Pembuatan Perasan Lemon dan Jeruk Nipis .... 91

Lampiran 3. Diagram Alur Pembuatan Larutan Simvastatin ....................... 92

Lampiran 4. Diagram Alur Pembuatan Pakan Diet Normal ........................ 93

Lampiran 5. Diagram Alur Pembuatan Pakan Diet Tinggi Lemak (High Fat

Diet) ....................................................................................... 94

Lampiran 6. Komposisi Bahan dan Energi Pakan Diet Normal .................. 95

Lampiran 7. Komposisi Bahan dan Energi Pakan Diet Tinggi Lemak (High

Fat Diet) ................................................................................. 96

Lampiran 8. Hasil Analisis Statistik ............................................................ 97

Lampiran 9. Prosedur Pemeriksaan Kadar HDL ........................................ 103

Lampiran 10. Tabel Konversi Perhitungan Dosis ......................................... 104

Lampiran 11. Dokumentasi Perawatan Hewan Coba ................................... 105

Lampiran 12. Master Data ........................................................................... 107

Lampiran 13. Kelayakan Etik ...................................................................... 115

DAFTAR GAMBAR

Halaman

Gambar 2.1 Metabolisme Lemak .............................................................. 11

Gambar 2.2 Jalur Metabolisme Lipoprotein Endogen Dan Eksogen ......... 14

Gambar 2.3 Lemon Eureka ....................................................................... 21

Gambar 2.4 Lemon Lisbon ....................................................................... 21

Gambar 2.5 Lemon Meyer ........................................................................ 22

Gambar 2.6 (a) Lemon Fino Belum Matang .............................................. 23

(b) Lemon Fino Sudah matang .............................................. 23

(c) Penampakan Vertikal Lemon Fino ................................... 23

(d) Penampakan Horizontal Lemon Fino ............................... 23

Gambar 2.7 Jeruk Nipis ............................................................................ 28

Gambar 4.1 Pembagian Kelompok Perlakuan ........................................... 36

Gambar 4.2 Desain Lay Out Rancangan Acak Lengkap Percobaan ......... 41

Gambar 5.1 Rata-Rata Peningkatan Berat Badan Tikus (gram) ............... 59

Gambar 5.2 Rata-Rata Asupan Pakan (gram) .......................................... 61

Gambar 5.3 Rata-Rata Asupan Energi (kkal) ............................................ 62

Gambar 5.4 Rata-Rata Asupan Lemak (gram) .......................................... 63

Gambar 5.5 Rata-Rata Asupan Protein (gram) ......................................... 64

Gambar 5.6 Rata-Rata Asupan Karbohidrat (gram) .................................. 65

Gambar 5.7 Rata-Rata Kadar HDL (mg/dl) ............................................... 67

DAFTAR TABEL

Halaman

Tabel 2.1 Komposisi Lipoprotein ........................................................... 8

Tabel 2.2 Kadar Profil Lipid ................................................................... 10

Tabel 2.3 Perbedaan Kandungan Zat Gizi Lemon dan Jeruk Nipis ....... 29

Tabel 4.1 Pengulangan Perlakuan ........................................................ 37

Tabel 4.2 Pangkat atau Ranking dari 40 Angka Acak ........................... 40

Tabel 4.3 Volume Pemberian Perasan Buah Lemon (Citrus limon fino) 52

Tabel 4.4 Volume Pemberian Perasan Jeruk Nipis (Citrus aurantifolia) 52

Tabel 4.5 Komposisi Pakan Tinggi Lemak (High Fat Diet) .................... 54

Tabel 5.1 Karakteristik Sampel ............................................................. 57

Tabel 5.2 Peningkatan Berat Badan Tikus (gram) ................................. 58

Tabel 5.3 Kadar HDL Pre-Test dan Post-Test (mg/dl) ........................... 68

DAFTAR SINGKATAN

ACAT : Cholesterol acyltransferase

APO B : Apolipoprotein B

EDTA : Ethylenediaminetetraacetic Acid

HDL : High Density Lipoprotein

HFD : High Fat Diet

HMG Co-A : 3-hydroxy-3-methylglutaryl Coenzim A

HOMA-IR : Homeostatic Model Assesment for Insulin Resistance

IDL : Intermediate Density Lipoprotein

LDL : Low Density Lipoprotein

MTP : Microsomal Transfer Protein

NADPH : Nicotinamide Adenine Dinucleotide Phosphate

PCSK9 : Proprotein Convertase Subtilisin/Kexin Type 9

PKV : Penyakit Kardiovaskuler

TG : Trigliserida

TLC : Therapeutic Lifestyle Change

VLDL : Very Low Density Lipoprotein

i

ABSTRAK

Magdalena, Nadia. 2017. Perbedaan Kadar High Density Lipoprotein (HDL) pada Tikus Putih Jantan (Rattus norvegicus) Galur Wistar yang Diberi High Fat Diet dengan Pemberian Perasan Lemon Fino (Citrus limon fino) dan Jeruk Nipis (Citrus aurantifolia). Tugas Akhir, Program Studi Ilmu Gizi, Fakultas Kedokteran Universitas Brawijaya. Pembimbing : (1) Dr. dr. Nurdiana, M.Kes., (2) Olivia Anggraeny, S.Gz., M.Biomed

Pola makan yang mengandung makanan yang tinggi lemak dapat memicu terjadinya dislipidemia. Terapi non-farmakologi yang sering digunakan untuk mengatasi dislipidemia adalah dengan mengonsumsi perasan lemon. Alternatif lain adalah jeruk nipis yang harganya lebih murah dan mudah didapatkan. Penelitian ini bertujuan untuk mengetahui adanya perbedaan pada kadar HDL tikus yang diberi high fat diet dengan pemberian perasan lemon dan jeruk nipis. Penelitian ini menggunakan 32 ekor tikus putih galur wistar jantan yang terbagi menjadi 8 kelompok perlakuan, yaitu kelompok dengan pemberian high fat diet, kelompok dengan pemberian high fat diet dan simvastatin, kelompok dengan pemberian high fat diet dan perasan lemon fino, dan kelompok dengan pemberian high fat diet dan perasan jeruk nipis dengan volume pemberian 1 ml/ekor/hari, 2 ml/ekor/hari, dan 3 ml/ekor/hari. Statin, perasan lemon dan jeruk nipis diberikan melalui sonde selama 5 minggu. Kadar HDL diukur menggunakan alat Lipid Pro Lipid Profile Test Strips. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan kadar HDL antar kelompok perlakuan (p=0,400). Kesimpulan dari penelitian ini adalah tidak terdapat perbedaan kadar HDL pada kelompok yang diberikan perasan lemon maupun jeruk nipis. Kata kunci: HDL, simvastatin, lemon, jeruk nipis

2

ABSTRACT

Magdalena, Nadia 2017. Difference in High Density Lipoprotein (HDL) Levels in Male Rat (Rattus norvegicus) Wistar Strains Given High Fat Diet with Lemon Fino Juice (Citrus limon fino) and Lime Juice (Citrus aurantifolia). Final Assignment, Science of Nutritition Study Program, Faculty of Medical, University of Brawijaya. Guidance of (1) Dr. Dr. Nurdiana M.Kes, (2) Olivia Anggraeny, S.Gz, M.Biomed

Dietary habit contains high fat food can trigger the occurrence of

dyslipidemia. Non-pharmacological therapy that often used to treat dyslipidemia is by consuming lemon juice. Another alternative is the lime which is cheaper and easier to obtain. This study aims to determine the HDL levels of rats given high fat diet with lemon juice and lime juice. This research used 32 male rats which were divided into 8 group of treatment; treatment group that was given high fat diet, treatment group that was given high fat diet and simvastatin, treatment group was given high fat diet and lemon juice and treatment group which was given high fat diet and lime juice with 1ml/rat/day, 2 ml/rat/day, and 3 ml, rat/day given volume. Statin, lemon juice and lime juice are given through sonde for 5 weeks. HDL level after the treatment are measured using Lipid Pro Profile Test Strips. The result shows that there is no difference of HDL levels among treatment groups (p=0,400). The conclusion from this research is there is no difference of HDL levels in the group given lemon juice or lime juice.

Keyword: HDL, simvastatin, lemon, lime