World Nutrition Journal (Indonesian Nutrition Association - INA)

Introduction: This study aimed to investigate the relationship between serum adiponectin and metabolic syndrome in adults living in rural Malaysia.Methods: A total of 299 Malay adults (men=124; women = 175) with a mean age 48.8 (11.7) years were recruited. Measurements for waist circumference and blood pressure were taken before drawing an overnight fasting blood samples. Biochemical tests for triglycerides, HDL cholesterol, glucose and serum adiponectin concentration were measured.Results: Our results show that the adiponectin level in the subjects with metabolic syndrome was significantly lower than those without metabolic syndrome (p &lt; 0.05). Among the metabolic syndrome risk factors, adiponectin level was significantly associated with hypertriglyceridemia and reduced HDL cholesterol (p &lt; 0.001).Conclusion: The outcome from this study which highlights the association of hypoadiponectinemia with risk factors of metabolic syndrome in Malay adults, suggests that the reduced level of adiponectin may play a pivotal role in the development of metabolic syndrome in this ethnic group

Isa, Nur Firdaus

Zainuddin, Laila Ruwaida Mohd

Wan Muda, Wan Manan

Mohamed, Hamid Jan B. Jan

English

Association of Serum Adiponectin Levels with Metabolic Syndrome Risk Factors in Malay Adults

Erlinawati, Noor Diah

Oetoro, Samuel

Gunarti, Dwirini Retno

Effect of Rice Bran Oil on the Lipid Profile of Mild-Moderate Hypercholesterolemic Male Aged 19-55 year

Bela, Stella Evangeline

Sutanto, Luciana Budiati

Pandelaki, Jacob

World Nutrition Journal vol.1 No. 1 July 2017 | http://dx.doi.org/10.25220/WNJ.V01i1.0004 
 
13 
Abstract—Introduction: The objective of this study 
was to compare gastric emptying time, hunger 
response, and blood glucose level after drinking 
specific oral nutritional supplements (S-ONS) to tea 
with sugar in healthy adults. 
Methods: This study was a clinical, parallel, random 
allocation, and single-blind trial. This study was 
conducted at Cipto Mangunkusumo General 
Hospital, Jakarta. The subjects were 12 healthy 
adults divided into 2 groups: intervention group (n = 
6) and control group (n = 6). Patients in the 
intervention group received 200 mL S-ONS (200 
kcal, 18% protein, 20% fat and 62% carbohydrate) 
and control group received 200 mL of tea with 10 
grams of sugar (40 kcal). Gastric volume was 
measured using 2D-sonography every 30 minutes. 
Blood glucose level was measured using blood 
peripheral sample. Hunger response was measured 
using visual analog scale (VAS). 
Results: Gastric emptying time in the intervention 
group was <90 minutes, and in the control group <60 
minutes. Blood glucose level was increased in the 
intervention group and decreased in control group. 
Hunger response was decreased in intervention 
group and increased in control group. 
Conclusion: Gastric emptying time after either 
drinking S-ONS and drinking tea with sugar in 
healthy adults subjects were less than 2 hours. 
Patients receiving S-ONS had significantly higher 
blood glucose level and were less hungry than the 
control group. 
 
Keywords: ONS, gastric emptying time, blood-
glucose level, hunger response 
 
INTRODUCTION 
Fasting before medical procedures, such as elective 
surgery, abdominal ultrasound scanning,  endoscopy 
scanning, and intubation, is standard protocol to 
ensure that the stomach is empty and avoid 
pulmonary aspiration.1 Preoperative guidelines state 
that the minimum duration for fasting before surgery 
is two hours for clear fluids and six hours for light 
meal.2-4  The guidelines do not include the provision 
of oral nutritional supplements (ONS), which is more 
complete in nutritional content, able to meet 
nutritional needs, and able to reduce hunger as well 
as maintain blood glucose level.5 The stress of 
surgery may be tolerated by children when they are 
fed up to 2 h before elective surgery.6 A case report 
by Sutanto et al, 20097 concluded that the 
preoperative nutrition management of patient with 
ONS resulted in more satisfaction, less hunger, less 
thirst, and reduced postoperative nausea and 
vomiting compared to the patient not receiving ONS 
during the preoperative period.  
 Oral nutritional supplement could be used as a 
nutritional choice in preoperative fasting guidelines, 
therefore the gastric emptying rate after drinking 
ONS needs to be determined. Research on gastric 
emptying rate after drinking 200 mL of specific ONS 
(S-ONS) with a formula was initiated by Sutanto et 
al in 2010.5 They found that the gastric emptying rate 
after drinking 200 mL of S-ONS with a specific 
formula was less than two hours. The purpose of this 
study was to compare the rate of gastric emptying, 
hunger, and blood glucose levels after consuming 
either S-ONS and tea with sugar. 
METHODS 
The study design was a clinical, parallel, random 
allocation, and single-blind trial. Data was collected 
in Cipto Mangunkusumo General Hospital, Jakarta, 
from May - June 2011 after the proposal was 
approved by the Ethical Clearance Research 
Committee of Faculty of Medicine University of 
Indonesia.   
 The target population was healthy adult 
patients and the subjects were those who met the 
THE EFFECTS OF SPECIFIC ORAL NUTRITIONAL SUPPLEMENTS 
COMPARED TO TEA WITH SUGAR ON GASTRIC EMPTYING TIME, 
BLOOD GLUCOSE LEVEL, AND HUNGER RESPONSE IN HEALTHY 
ADULTS 
†Stella E Bella,1 Luciana B Sutanto,1 Jacob Pandelaki2 
1 Indonesian Nutrition Association, Jakarta, Indonesia 
2 Dept. of Diagnostic Radiology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital 
Jakarta, Indonesia 
World Nutrition Journal vol.1 No. 1 July 2017 | http://dx.doi.org/10.25220/WNJ.V01i1.0004 
 
14 
study criteria.  Inclusion criteria were 19-50 years old 
and agreed to join the study by signing the informed 
consent. Exclusion criteria were patients with nausea 
and vomiting, or on antiemetic and/or promotility 
drugs, with high blood pressure and/or diabetes, 
pregnancy and lactation.  
 Twelve healthy subjects were allocated by 
block randomization into two groups, intervention 
and control groups.  The intervention group received 
200 mL S-ONS (200 kcal, 18% protein, 20% fat, and 
62% carbohydrate) and the control group received 
200 mL of tea with 10 grams of sugar (40 kcal). 
Gastric emptying of subjects in both groups were 
measured using a 2D-ultrasound. This technique has 
been used,7 validated and recommended for gastric 
emptying assessment.8 Gastric volume was 
determined by using π r2 L formula, the same method 
used in a study by Sutanto et al.7 To ascertain the 
stomach was empty before measurement, subjects 
were required to follow the fasting guidelines, ate 
last main meal six hours before and drink clear fluid 
two hours before examination.3 The initial 
examination was considered as empty stomach if the 
gastric volume was less than 80 mL.11 Measurement 
of the gastric volume was done every 30 minutes 
until the stomach was considered to be empty again.   
 Blood glucose level was measured at the initial and 
end when measuring gastric volume. Blood sample 
was taken from peripheral vein.  Hunger response 
was taken at the same time as blood glucose 
measurement, using visual analog scale (VAS) 0-100 
mm interview.   
RESULTS 
Both groups had no significant differences in 
characteristics, as seen in Table 1. The gastric 
volume was measured using 2D-sonography every 
30 minutes,  gastric emptying time of intervention 
group was <90 minutes, and control group was <60 
minutes, therefore gastric emptying time for both 
groups were less than 2 hours, as seen in Table 2. 
Blood glucose level of the intervention group was 
increased, while control group was decreased.  
Subjects received S-ONS had significantly higher 
blood glucose level than control group, as shown in 
Table 3.  
Hunger response in the intervention group 
was decreased, while control group was increased.  
Subjects received S-ONS were significantly less 
hungry than control group, as shown in Table 4. 
DISCUSSION 
The gastric emptying time of all subject were less 
than two hours; gastric emptying time of the 
intervention group was longer than control group, 90 
and 60 minutes respectively.  This result was 
consistent with the study by Sutanto et al, 2010.5 
Their study used the same amount and characteristics 
of ONS as this study although the subject was 
different, i.e. healthy pregnant patients with a 
gestational age of greater than 37 weeks.  It showed 
that gastric emptying after drinking 200 mL S-ONS 
in pregnant women were as fast as non pregnant 
healthy adults.  
 The higher calories cause longer gastric 
emptying time. A study by Gentilcore et al, 200614 
showed that gastric emptying rate was lower in 
patients after having higher calories.  In that study, 
one group consumed 500 mL beef broth soup (12 
kcal) and the other group consumed 300 mL of 
dextrose 25% (314 kcal).  The results of this study 
was consistent with Gentilcore14 in which gastric 
emptying time of the intervention group was longer 
than control, in which the  intervention group 
received 200 kcal S-ONS and the control group 
received 40 kcal. 
World Nutrition Journal vol.1 No. 1 July 2017 | http://dx.doi.org/10.25220/WNJ.V01i1.0004 
 
15 
The amount of calories had an impact on the 
subjects’ blood glucose level and hunger response.  
At the end, mean blood glucose level of the 
intervention group was increased (at minute 90), 
while control group decreased (at minute 90). 
Compared to the control group, mean blood glucose 
level of the intervention group was significantly 
higher.  It meant that S-ONS was better than tea with 
sugar in controlling blood glucose level in patients 
who would have medical procedure.  
Hunger response was decreased from the 
basal value in the intervention group, while it was 
increased in the control group. At the end, hunger 
response was lower in the control group. Compared 
to the control group, the intervention group receiving 
200 mL S-ONS  had lower hunger response. 
 Theoretically, the lower blood glucose level 
will decrease glucose supply for brain metabolism, 
this will stimulate hunger and increase peristalsis.15 
The results of this study corresponded to that theory, 
the control group with lower blood glucose level had 
World Nutrition Journal vol.1 No. 1 July 2017 | http://dx.doi.org/10.25220/WNJ.V01i1.0004 
 
16 
longer VAS which described higher hunger 
response. 
 We concluded that by giving S-ONS before 
medical procedures would help control blood 
glucose level and prevent hunger. Specific Oral 
Nutritional Supplements should be considered as a 
medical drink prior to a medical procedure that 
requires preoperative fasting.  Furthermore, S-ONS 
could be given 2 hours before medical procedure 
because gastric emptying time was less than 2 hours. 
Further studies should be carried out so that S-ONS 
can be included in the existed standard protocol. 
 
Conflicts of Interest 
The authors declare no conflict of interest regarding this 
research. 
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between aspiration and pneumonia following stroke. Top 
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elective procedures a report by American Society 
Anesthesiologist task force on preoperative fasting. In: 
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3. The Canadian Anesthesiologists' Society. In: Guidelines to 
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4. Perkumpulan Ahli Anestesi dan Terapi Intensif 
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The Effect of Specific Oral Nutritional Supplements Compared to Tea with Sugar on Gastric Emptying Time, Blood Glucose Level, and Hunger Response in Healthy Adults

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Association of Serum Adiponectin Levels with Metabolic Syndrome Risk Factors in Malay Adults

Effect of Rice Bran Oil on the Lipid Profile of Mild-Moderate Hypercholesterolemic Male Aged 19-55 year

The Effect of Specific Oral Nutritional Supplements Compared to Tea with Sugar on Gastric Emptying Time, Blood Glucose Level, and Hunger Response in Healthy Adults

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