The Effect of Yoghurt Yellow Soybean (Glycine max) to the level of Blood

LDL on the smoker Late Adolescence

Sitiayu Anisa Gultom, Choiria Mulyawati, Hasan Murdiman, Triyoga Sulistyaningsih,
Muhammad Murtadho, Darmawati Ayu Indraswari
Medical Faculty of Diponegoro University, Semarang

Abstract
According to World Health Organization (WHO), Cardiovascular disease such as
coronary heart disease and stroke is one out of four main kind of Non Communicable
Diseases (NCD). Cardiovascular disease caused by multifactorial risk factors which is some
of those risk factors can be modified.1 One of risk factors that can be modified is
dyslipidemia.2
This study was a true experimental study with pre and post test Randomized
Controlled Group Design. This study was conducted during thirty days. Samples were taken
from random alocation method from thirty six final teen age smokers. The data were taken by
looking the blood LDL before and after treatment. The analysis of the data by SPSS
Programme 21.0

The analysis of the hypothesis using comparative test showed the significance
differences between LDL pretest and posttest control group (p=0,406) and the unsignificance
differences between LDL pretest-posttest treatment group and control group (p=0,309).

There was a significant decrease in the level of LDL after given milk yoghurt of
Yellow soybean during one month on the smoker late adolescence compared before given
treatment.

There was a significant difference score on the level of LDL between pretest-postest
treatment group compared to the difference of control group.

Key words: LDL, Yoghurt, Isoflavon

Introduction

According to World Health Organization (WHO), Cardiovascular disease such as

coronary heart disease and stroke is one out of four main kind of Non Communicable
Diseases (NCD).1 According to Riskesdas 2013, the prevalence of coronary heart disease in
Indonesia that can be diagnosed by the doctor is for about 0,5% and 1,5% based on diagnosed
doctors or the symptoms. Whereas for stroke disease, the highest prevalence is on the age of
75 years old is 43,1% diagnosed by doctor and 67% based on diagnosed doctors or the
symptoms.3

Cardiovascular disease caused by multifactorial risk factors which is some of

those risk factors can be modified.1 One of risk factors that can be modified is
dyslipidemia.2,4,5 The Data in Indonesia based on Riskesdas 2007 showed that the prevalence
of dyslipidemia according to Total cholestrol > 200 mg/dL is 39,8%. According to Riskesdas
2013, some of the researches indicated the high level of LDL (Low Density Lipoprotein)
suggested as the main reason of coronary heart disease.3 LDL has the high ability on the
plaque formation of artery that can trigger heart disease and stroke.4

Moreover, according to the Guideline of Dyslipidemia, high reduction of the

cardiovascular risk is equals with high reduction of LDL levels, so that the reduction of LDL
levels still as a main target in the abnormality therapy of lipid levels. Other cause that can
related to LDL levels in body is smoking.6

Smoking related to the abnormal metabolism of lipid, which is becomed the risk factor
of cardiovascular disease. Smoking considered can alter the differences of Lipoprotein Serum
profile.7 The research showed smoking can increase Trygliceride serum (TG), cholestrol
total, LDL, and can decrease High density lipoprotein (HDL), all of those indicated
dyslipidemia.8

Survei Kesehatan Rumah Tangga (SKRT) and Riskesdas showed there is increased of
the smokers prevalence aged above 15 years old, 27% (Susenas 1995)’ 31,5% (SKRT 2001);
34,3% (Susenas 2004); 34,7% (Riskesdas 2007) and 36,3 % (Riskesdas 2013).3

Modified risk factors of blood lipid abnormality is through life sylte intervention. The
purpose of lifestyle intervention can descrease LDL levels, tryglyceride consentration, and
increase HDL cholestrol.9 The effort that can be done through dietary supplement. One of
dietary supplement is soy protein. Soy bean contains flavonoid in the group of isoflavon. The
main ingredient of Isoflavon in Yellow soy beans is the highest group of others
hipocotiledon, can reach 4000 μg/g. Isoflavon of soybean seeds had been proven gives many
benefit for healt, one of them is can decrease blood lipid profile especially cholestrol and
triglyceride.10

Based on research that had been done, it is known that soy protein related to the decline
3-5% LDL cholestrol. This is because soy bean contains isoflavon that has role to decrease
the level of blood cholestrol.11 Soybean that contains highest isoflavon is Yellow soybeans.
Research that has been done by Wu et al, processing of yellow soybean through fermentation
will produce high free isoflavon. This free isoflavon resulted from hydrolisis of isoflavon that
can decrease blood cholestrol.12

The previous research reported that yoghurt from yellow soybean that produce through
fermentation and then tested to white male wistar. That research showed there was an effect
of yoghurt yellow soybean to decrease LDL levels on hyperlipidemia white male wistar. The
previous research used yoghurt yellow soybean with the sample white wistar and human but
the effect of yoghurt yellow soybean to the smoker late adolescence has never been done.
Based on this background, the proposer want to propose the product of yellow soybean which
has been known for it’s benefits and the safety to human. So that it will become inovation to
decrease LDL levels to smoker late adolescence as a risk factor of hyperlipidemia.
Tools and Ingredients
The tools that will use to make yoghurt yellow soybean; stove, pan, mixer, spoon, blender,
filter tool, refrigerator, pH indicator and measuring glass, storage container. While the
ingredients are yellow soybean, mineral water, aquadest, sugar, yoghurt starter, 3 kg of LPG.

Yoghurt Production

The production of yellow soybean is using yellow soybean that processed with modified
Illnois method. At that time yoghurt yellow soybean that given to smoker late adolescence,
conducted the measurement on the level acidity of yoghurt yellow soybean, to make sure the
score of its pH is on the range 3,96-5,01, as the quality parameter of yoghurt.

Giving Yoghurt Soybean

This study is a true experimental study with pre and post test Randomized Controlled Group
Design that using smoker late adolescence as a subject for research. The number of sample is
based on formula (Kemas, 2015) so the number of sample in this research is 2x16=32
samples smoker late adolescence that met inclusion criteria, college student aged 18-25 years
old with the BMI condition 18,5-25 kg/m2, the samples has been smoked during 1-5 years,
and the onser of smoking ≥ 3 cigarettes per week. While the exclusion criteria are alcoholic
and obesity.

The dosage of yoghurt yellow soybean based on the yoghurt dosage that has been proven to
decrease serum cholestrol, for about 200 ml/day, based on previous research (Abdolamir
Baroutkoub, 2010) 32 smoker late adolescence with BMI 18,5-25 kg/m2 are divided on two
treatment group.

The treatment that given to two groups : first group as control group, smoker late adolescence
given mineral water as negative control during 30 days. The second group as treatment group,
smoker late adolescence given yoghurt yellow soybean with the dosage 200 ml/day during 30
days. And then measurement of LDL levels before and after given yoghurt yellow soybean.
After that analyze the result of the research.

Table 1 Descriptive Analysis Age Subject

Group Mean N Std. Deviation Median Minimum Maximum

Treatment 21,13 15 1,598 21,00 19 25

Control 21,07 15 1,438 21,00 19 24

Total 21,10 30 1,494 21,00 19 25

Data Analysis
Data analysis involves descriptive analysis, normality test, and hypothesis test.
Descriptive analysis such as numeric described with mean and standar deviation/median.
Normality test using Saphiro-wilk because the number of the sample <50. Normal
distribution of the Data if p>0,05.
Hypothesis test using comparative test for each group, which is using Paired T Test if
the distribution is normal, and Wilcoxon test if the distribution is not normal. The
comparative test using the decline of pretest-postest between treatment and control group
using independent T Test. The significance of p score if p<0,05.

The Result of Research

In this research, there were 30 samples with the highest age is 25 years old, the lowest age is
19 years old. The mean of the age is 21,10 years old. There were 15 samples in each group
(treatment and control group). The standard deviation of the age in this research is 1,494.
The descriptive analysis of LDL pretest and postest, the results is on the below table.

Table 2 Descriptive Analysis of LDL

Statistic Std.
Error
Mean 123,40 4,653
Lower 113,88
95% Confidence Interval for Bound
Mean Upper 132,92
Bound
5% Trimmed Mean 122,65
Median 124,00
Pretest_LDL Variance 649,490
Std. Deviation 25,485
Minimum 85
Maximum 177
Range 92
Interquartile Range 42
Skewness ,236 ,427
Kurtosis -,767 ,833
Mean 115,63 4,475
Lower 106,48
95% Confidence Interval for Bound
Posttest_LD
Mean Upper 124,79
L
Bound
5% Trimmed Mean 115,04
Median 109,50
 Variance 600,723
Std. Deviation 24,510
Minimum 66
Maximum 181
Range 115
Interquartile Range 36
Skewness ,445 ,427
Kurtosis ,507 ,833

From the descriptive analysis the mean of LDL pretest treatment group is 126,27 with
standard deviation is 28,559; the highest score is 177; the lowest score is 120,53. While the
mean postest treatment group is 113,33; with standard deviation is 29,075; the highest score
is 181; the lowest score is 66. The mean of LDL levels on pretest control group is 120,53;
with standard deviation 22,630; the highest score is 161; the lowest score is 85. The mean of
LDL levels on Postest control group is 117,93; with standard deviation is 19,689; the highest
score is 148, the lowest score is 79.
Table 3 Normality Test of LDL level

Kolmogorov-Smirnova Shapiro-Wilk

Statistic Df Sig. Statistic df Sig.

Pretest_LDL ,099 30 ,200* ,961 30 ,325

Posttest_LDL ,124 30 ,200* ,979 30 ,793

The result of normality test for LDL pre and postest using Saphiro-Wilk test get
p>0,05, so it can be concluded the data has normal distribution.

Table 4 LDL levels on Treatment Group

Paired t df Sig. (2-

Differences tailed)

95%
Confidence
Interval of
the
Difference
 Upper

Posttest_LDL - -5,061 -3,524 14 ,003

Pair 1
Pretest_LDL

Comparative test with paired T-test on the treatment group get p<0,05 that is significant. The
result of this test indicated if there is significant differences between LDL after given yellow
soybean compared before given treatment group.

Table 5 T test of Control Group

Paired T df Sig. (2-

Differences tailed)

95%
Confidence
Interval of
the
Difference

Upper

Posttest_LDL - 3,915 -,856 14 ,406

Pair 1
Pretest_LDL

Comparative test of control group with paired T-test get p>0,05, is 0,406. The result
of the test indicated the differences on the levels of LDL control group between pre and
postest is not significant.
Normality test of LDL pretest and postest each group using Saphiro-Wilk test. The
result of the normality test for this data is 0,797; so p>0,05, the distribution is normal.

Table 6 Normality Test of LDL pre-postest

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig. Statistic df Sig.

Delta LDL ,097 30 ,200* ,979 30 ,797

The difference of LDL pretest and postest each group compared to independent t-test.
The result get p=0,039 (p<0,05), it means the difference of LDL decline of treatment group
compared to the decline of LDL control group is significant.
 Tabel 7 The Decline of T-test of LDL pre-postest between two groups

t-test for Equality of Means

Sig. (2- Mean Std. Error

tailed) Difference Difference

Equal variances assumed ,039 -10,33333 4,76422

Delta
LDL Equal variances not ,039 -10,33333 4,76422
assumed

Discussion

Yellow soybean contains flavonoid in the isoflavon group. It is known that isoflavon
in yellow soybean is contains the highest seeds compared to others. Isoflavon is antioxidant
that had been proven to decrease lipid profile especially cholestrol and triglyceride and from
the research it is known that soybean can decrease 3-5% LDL cholestrol.
The research that had been done by Wu et al, the production of yellow soybean
through fermentation will produce high isoflavon that can decrease the levels of cholestrol in
the blood.
Based on comparative test to treatment group that compare between LDL pretest (pre
treatment) with LDL postest (post treatment) obtained decreased levels of LDL with p < 0,05
that indicates LDL levels pretest and postest have significant differences.
The result of comparative test of control group that compares LDL levels pretest and
postest with p>0,05 that indicates there is no significant differences of LDL levels.
The result of the test that compares the decline of LDL pretest and postest for each
treatment get p < 0,05 indicates the decline of LDL pretest and postest each treatment group
showed significant differences.
The result of pretest and postest between treatment and control group, it can be
concluded that yoghurt yellow soybean with dosage of 200 cc per day during 30 days can
decrease LDL profile.
The limitation of this research is the number of the samples that have not been
represent population because time limitation and resource. Moreover, there is no control of
daily diet so there is possibility of diet differences that can affect blood cholestrol level.

Summary
1. There is significant decline of LDL after given yoghurt yellow soybean during 1
month to smoker late adolescence compared before given treatment
 2. There is significant decline of LDL between pretest and postest treatment group
compared to the decline of pretest-postest control group.

Suggestion
The result of this research provide significant result to decrease blood LDL levels to smoker
late adolescence that consumed yoghurt yellow soybean routinely during 1 month, therefore
this product can use as alternative food or drink to decrease LDL levels.
Further development is required to increase production and introduction to community about
yoghurt yellow soybean as alternative food or drink to decrease LDL levels as prevention of
carciovascular disease.

Acknowledgement
The researcher deepest gratitude goes to medical faculty of diponegoro university and
directorat of research and community service- research ministry, technology, and education
that has been support this research.

Refferences

1. WHO. Non Communicable Diseases [Internet]. 2017. p. 4. Available from:

http://www.who.int/mediacentre/factsheets/fs355/en/
2. Downs JR, O’Malley PG. Management of dyslipidemia for cardiovascular disease risk
reduction: Synopsis of the 2014 U.S. department of veterans affairs and U.S.
department of defense clinical practice guideline. Ann Intern Med. 2015;163(4):291–7.
3. Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar
(RISKESDAS) 2013. Lap Nas 2013. 2013;1–384.
4. Siri-tarino PW, Sun Q, Hu FB, Krauss RM. Opinion Saturated fat , carbohydrate , and
cardiovascular disease 1 – 4. 2010;(5).
5. Chow CK, Jolly S, Rao-Melacini P, Fox KAA, Anand SS, Yusuf S. Association of
diet, exercise, and smoking modification with risk of early cardiovascular events after
acute coronary syndromes. Circulation. 2010;121(6):750–8.
6. Erwinanto, Santoso A, Putranto JNE, Tedjasukmana P, Suryawan R, Rifqi S, et al.
Pedoman tatalaksana dislipidemia. J Kardiol Indones [Internet]. 2013;34(4):245–70.
Available from: http://jki.or.id
7. Lee MH, Ahn SV, Hur NW, Choi DP, Kim HC, Suh I. Gender differences in the
association between smoking and dyslipidemia: 2005 Korean National Health and
Nutrition Examination Survey. Clin Chim Acta [Internet]. 2011;412(17–18):1600–5.
Available from: http://dx.doi.org/10.1016/j.cca.2011.05.013
8. Craig WY, Palomaki GE, Haddow JE, Bi-Rong D, Craig W, Palomaki G, et al.
Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of
published data. Bmj [Internet]. 1989;298(6676):784–8. Available from:
http://www.bmj.com/cgi/doi/10.1136/bmj.298.6676.784
9. Grundy SM, Arai H, Barter P, Bersot TP, Betteridge DJ, Carmena R, et al. An
International Atherosclerosis Society Position Paper: Global recommendations for the
management of dyslipidemia - Full report. J Clin Lipidol [Internet]. 2014;8(1):29–60.
Available from: http://dx.doi.org/10.1016/j.jacl.2013.10.001
10. Baiduri I, Murwani H. Pengaruh Pemberian Yoghurt Kedelai Hitam Black Soyghurt)
Terhadap Kadar Kolesterol Ldl Serum Pada Tikus Dislipidemia Artikel. Artik Penelit
Prodi Ilmu Gizi, FK Undip. 2011;
11. Chao WX. Health effects of soy protein and isoflavones in humans. J Nutr [Internet].
2008;138(6):4–9. Available from: http://www.scopus.com/inward/record.url?eid=2-
s2.0-44449100194&partnerID=tZOtx3y1
12. Salim RH, Iswahyudi, Ilmiawan MI. Pengaruh Yoghurt Kacang Kedelai Kuning
Terhadap Kadar Ldl Serum Pada Tikus Putih Jantan Galur Wistar Hiperlipidemia.
Progr Stud Pendidik Dr Fak Kedokt Univ Tanjungpura. 2013;