Low Fiber and High Fat Intake: A Determinants of the Occurrence of

High Blood Pressure in Obese Employees at Jakarta Islamic Hospital

Nabila Jemima Aji, Leni Sri Rahayu and Devieka Rhama Dhanny

Department of Nutrition, Faculty of Health Sciences, University of Muhammadiyah Prof. Dr. Hamka, Jakarta, Indonesia

Keywords: Fiber, Fat, Blood Pressure, Obesity.

Abstract: Obesity can increase several degenerative diseases risk, especially high blood pressure. High blood pressure

in obese can be triggered by various factors. This study aims to determine the relationship between physical

activity, fiber, and fat intake with blood pressure in obese employees at Jakarta Islamic Hospital. This research

is a quantitative study with a cross-sectional design using secondary data obtained from Jakarta Islamic

Hospital. The data collected in this study were blood pressure from Medical Check Up (MCU), physical

activity level from Global Physical Activity Questionnaire (GPAQ), also fiber and fat intake from Semi-

Quantitative Food Frequency Questionnaire (SQ-FFQ) with the number of respondents as many as 41

respondents. The results showed that most of the respondents had normal blood pressure (56.1%), low

physical activity (56.1%), low fiber intake (65.9%), and excessive fat intake (58.5%). Statistical tests show

that there is a relationship between fiber (p-value = 0.002) and fat intake (p-value = 0.002) with blood pressure,

but there is no relationship between physical activity and blood pressure (p-value = 1,000). It is suggested to

respondents be able to increase physical activity, consume enough fiber and reduce fat intake to prevent

obesity which has an impact on high blood pressure.

1 INTRODUCTION

The prevalence of obesity continues to increase quite

rapidly from year to year. Based on Riskesdas in

2013, the prevalence of obesity in Indonesia reached

14.8% and in 2018 it increased to 21.8% (Kemenkes

RI, 2018a). The prevalence of obesity in DKI Jakarta

Province was 29.8%, especially in the Central Jakarta

City area, reaching the highest figure of 33.3% in

2018 (Kemenkes RI, 2018b).

Obesity is a health problem that can increase the

risk of degenerative diseases, one of which is high

blood pressure (WHO, 2019). The prevalence of high

blood pressure (hypertension) in DKI Jakarta

Province was found at 33.4% and in Central Jakarta

City it reached 39.1% in 2018 (Kemenkes RI, 2018b).

Obese patients have a 9 times higher risk of

developing high blood pressure (Kartikasari, 2012).

Obesity conditions with high blood pressure can

increase the risk of heart disease which affects

morbidity and mortality rates (Kemenkes RI, 2013;

WHO, 2016).

High blood pressure in obese patients is a disease

caused by various risk factors, including high fructose

intake (Haris & Tambunan, 2016), low levels of

physical activity (Kartikasari, 2012; Rohkuswara &

Syarif, 2017), low fiber intake (Kartikasari, 2012;

Rohkuswara & Syarif, 2017), low fiber intake.

Ramadhani et al., 2017; Rohkuswara & Syarif, 2017;

Yuriah et al., 2019), high sodium intake (D. M. Sari

& Panunggal, 2013), high fat intake (Ramadhani et

al., 2017; Yuriah et al., 2019), as well as a person's

high level of stress (Gunawan & Adriani, 2020; Suoth

et al., 2014).

Based on the results of Riskesdas 2018, the

prevalence of residents in Central Jakarta who lack

physical activity reached 43.46%, much higher than

the prevalence in Indonesia, which was only 33.5%

(Kemenkes RI, 2018b). Obese patients tend to be low

in activity which causes an increase in heart rate. A

high heart rate will increase blood pressure

(Kartikasari, 2012). According to research, someone

whose physical activity is less at risk is 2 times higher

for suffering from high blood pressure compared to

someone whose physical activity is sufficient

(Rohkuswara & Syarif, 2017).

The prevalence of residents of Central Jakarta

City who consume less fruit and vegetables is very

high, reaching 95.05% according to the results of

Riskesdas in 2018 (Kemenkes RI, 2018b).

Aji, N., Rahayu, L. and Dhanny, D.

Low Fiber and High Fat Intake: A Determinants of the Occurrence of High Blood Pressure in Obese Employees at Jakarta Islamic Hospital.

DOI: 10.5220/0011649600003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 74-81

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

Consumption of vegetables and fruits that are less can

describe low fiber intake. Fiber has an important role

in reducing the risk of high blood pressure in obese

people (Rohkuswara & Syarif, 2017). Low fiber

intake will reduce bile acid excretion so that

cholesterol absorption will increase and it will

accumulate in blood vessels (D. M. Sari & Panunggal,

2013; N. Sari et al., 2016; Thompson et al., 2011;

Yuriah et al., 2019). Lack of fruit and vegetable

consumption has a 1.3 times higher risk of developing

high blood pressure (Rohkuswara & Syarif, 2017).

In addition, it was also found that the prevalence

of consumption of fatty foods >1 serving per day in

the population of Central Jakarta City reached

42.12%, much higher than the prevalence of DKI

Jakarta Province which was only 39.41% according

to the results of Riskesdas in 2018 (Kemenkes RI,

2018b). Someone who is obese tends to like fast food

that contains high fat (Suoth et al., 2014). Excess fat

intake plays a role in the accumulation of cholesterol

which then causes plaque (atherosclerosis). One of

the triggering factors for high blood pressure is a

blockage in the blood vessels (Ramadhani et al.,

2017; WHO, 2013; Yuriah et al., 2019). Excess fat

intake was also found to be 7.51 times more in

patients with grade 2 hypertension than in patients

with grade 1 hypertension (Yuriah et al., 2019).

The level of physical activity, fiber, and fat intake

can affect the nutritional status of the employees of

Jakarta Islamic Hospital. Health workers and

employees in health services must have good health

status so that their performance is always optimal to

continue to improve the quality of health services.

Jakarta Islamic Hospital employees are a group at risk

for high blood pressure with obesity because after a

preliminary study, data obtained that 65.6% (292 of

445) of Jakarta Islamic Hospital employees are obese

(HR RSIJ CP, 2021). In addition, based on the results

of interviews with several employees of Jakarta

Islamic Hospital, it is known that daily activities with

a busy work schedule result in infrequent exercise. An

unfavorable eating pattern was also found in the

results of a 2 x 24-hour recall of food intake which

showed that employees preferred fast food, which

was generally low in fiber and high in fat. Low

physical activity and fiber intake, as well as high fat

intake, can increase the risk of developing high blood

pressure in obese employees. Therefore, researchers

are interested in examining the relationship between

levels of physical activity, fiber, and fat intake with

blood pressure in obese employees at Jakarta Islamic

Hospital.

2 METHOD

This study is a quantitative study using a cross-

sectional study design and Chi-Square statistical test.

The population in this study were all 292 obese

employees at Jakarta Islamic Hospital in October

2021. The sample size in this study was 41 samples

calculated using a two-proportion hypothesis test.

This study is using purposive sampling. The

inclusion criteria for this study are respondents who

are willing to be the research sample and have a BMI

≥27 kg/m

. While the exclusion criteria for this study

were respondents who were on a diet, during

pregnancy and had chronic diseases (chronic kidney

disease and heart disease).

The dependent variable studied was blood

pressure. While the independent variables studied

were physical activity, fiber intake, and the

proportion of fat intake.

Blood pressure is the pressure exerted by

circulating blood on the arterial walls of the body as

measured by nurses using a mercury

sphygmomanometer. Categorized as high if systolic

pressure ≥140 mmHg and/or diastolic ≥90 mmHg and

normal if systolic pressure <140 mmHg and/or

diastolic <90 mmHg (Kemenkes RI, 2013).

Physical activity is a daily activity that includes

frequency and intensity which is divided into three

domains (activities at work, travel, and recreation as

measured by MET (metabolic equivalents) values.

Obtained through a questionnaire with the Global

Physical Activity Questionnaire (GPAQ) interview.

Categorized as low if the MET score is <600 and

sufficient if ≥600 (WHO, 2012).

Fiber intake is the average daily intake of

respondents from food and beverages consumed in

the last 1 month. Obtained through a questionnaire

with the Semi-Quantitative Food Frequency

Questionnaire (SQ-FFQ) interview. Categorized as

less if the intake is <8 grams/day and sufficient if ≥8

grams/day (Sunarti, 2017; PERSAGI, & AsDI, 2019).

The proportion of fat intake is the average daily

intake of respondents from food and beverages

consumed in the last 1 month compared to energy

needs. Obtained through a questionnaire with the

Semi-Quantitative Food Frequency Questionnaire

(SQ-FFQ) interview. Categorized more if >30% and

sufficient if ≤30% of energy needs (PERSAGI, &

AsDI, 2019; Kementerian Kesehatan Republik

Indonesia, 2018).

All data used in this study is secondary data

obtained from Jakarta Islamic Hospital in October –

November 2021. Researchers were involved in the

data collection process with the nutrition installation.

Low Fiber and High Fat Intake: A Determinants of the Occurrence of High Blood Pressure in Obese Employees at Jakarta Islamic Hospital

3 RESULTS

3.1 Respondents Characteristics

Table 1: Distribution of Respondents by Characteristics.

No Variables Total (n) Percentage (%)

1 Gender

Man 11 26,8

Women 30 73,2

2 BMI Classification

Obesity Grade I 7 17,1

Obesity Grade II 34 82,9

3 Blood Pressure

High 18 43,9

Normal 23 56,1

4 Physical Activity

Low (METs <600) 23 56,1

Moderate (METs ≥600 – <3000) 16 39,0

High (METs ≥3000) 2 4,9

5 Fiber Intake

Deficient (<8 grams/day) 27 65,9

Sufficient (≥8 grams/day) 14 34,1

6 The proportion of Fat Intake

Excessive (>30% of energy requirement) 24 58,5

Sufficient (≤30% of energy requirement) 17 41,5

Based on table 1, it is known that most of the

respondents are female, which is 73.2%. In addition,

based on BMI, it is known that most of the

respondents fall into the category of obesity level II,

which is 82.9% with an average BMI of 34.31 kg/m

(27-47 kg/m

). The average age of the respondents

was 42.97 years with the lowest age being 29 years

and the highest being 53 years.

Based on blood pressure data, some

respondent’s blood pressure was included in the

normal category, namely 56.1% with an average

systolic pressure of 131.85 mmHg (99 – 164 mmHg)

and a diastolic pressure of 85.24 mmHg (69 – 108

mmHg). The level of physical activity of some

respondents was included in the low category (METs

<600) which was 56.1% with the average score of the

respondent’s physical activity METs being 761.95 (0

– 3320). The fiber intake of most of the respondents

was included in the deficient category (<8 grams/day)

which was 65.9% with the average fiber intake of the

respondents being 7.33 grams/day (0.53 – 29.44

grams/day). The proportion of fat intake of some

respondents is included in the excessive category

(>30% of the need) which is 58.5% with the average

proportion of the respondent's fat intake being

34.48% of the need (4.69 - 88.39% of the need). The

average proportion of respondent’s fat intake is high

when compared to the proportion of fat intake for

balanced nutrition, which is 25-30%.

3.2 Relationship between Physical

Activity and Blood Pressure

For the analysis of the relationship between physical

activity and blood pressure, the category of moderate

to high physical activity was categorized as sufficient.

Based on table 2, it is known that in respondents with

high blood pressure, as many as 10 (43.5%)

respondents have low levels of physical activity and

8 (44.4%) respondents have sufficient levels of

physical activity. This shows a tendency that

respondents with low or moderate physical activity

have the same proportion of high blood pressure. This

tendency is also reinforced by the results of statistical

ICSDH 2022 - The International Conference on Social Determinants of Health

Table 2: Distribution of Respondents According to Physical Activity and Blood Pressure.

Physical

Activity

Blood Pressure

Total

(95% CI)

P-value

High Normal

n % n % n %

0,978 (0,488

– 1,961)

1,000

Low 10 43,5 13 56,5 23 100,0

Sufficient 8 44,4 10 55,6 18 100,0

Table 3: Distribution of Respondents According to Fiber Intake and Blood Pressure.

Fiber

Intake

Blood Pressure

Total

(95% CI)

P-value

h Normal

n % n % n %

8,815 (1,304

– 59,569)

0,002 Deficient 17 63,0 10 37,0 27 100,0

Sufficient 1 7,1 13 92,9 14 100,0

Table 4: Distribution of Respondents According to Proportion of Fat Intake and Blood Pressure.

The proportion

of Fat Intake

Blood Pressure

Total

(95% CI)

P-value

High Normal

n % n % n %

5,667

(1,495 – 21,473)

0,002

Excessive 16 66,7 8 33,3 24 100,0

Sufficient 2 11,8 15 88,2 17 100,0

tests which show there is no relationship between

physical activity and blood pressure (p-value = 1).

From the analysis results, it was also obtained that the

PR (Prevalence Ratio) value was not significant

because it was <1 and was in the CI range of 0.978

(95% CI: 0.488 – 1.961).

3.3 Relationship Between Fiber Intake

and Blood Pressure

Based on table 3 it is known that respondents with

high blood pressure were found to have more (63%)

who had deficient fiber intake than respondents with

sufficient fiber intake (7.1%). This indicates a

tendency that the lower the fiber intake, the higher the

blood pressure of obese respondents. Based on the

results of statistical tests showed a significant

relationship between fiber intake and blood pressure

(p-value = 0.002). From the results of the analysis, the

PR (Prevalence Ratio) value of 8.815 means that

respondents who consume less fiber have an 8.8 times

chance of experiencing high blood pressure compared

to respondents who consume enough fiber.

3.4 Relationship Between Proportion of

Fat Intake and Blood Pressure

Based on table 4, it is known that respondents with

high blood pressure were found to be more (66.7%)

who had excessive fat intake proportions compared to

respondents with sufficient fat intake proportions

(11.8%). This indicates that there is a tendency that

the higher the proportion of fat intake, the higher the

blood pressure of obese respondents. Based on the

results of statistical tests showed a significant

relationship between the proportion of fat intake with

blood pressure (p-value = 0.002). From the results of

the analysis, it was also obtained that the PR

(Prevalence Ratio) value of 5.667 means that

respondents who have a proportion of excess fat

intake have a 5.6 times chance of experiencing high

blood pressure compared to respondents who have a

sufficient proportion of fat intake.

4 DISCUSSION

4.1 Relationship Between Physical

Activity and Blood Pressure

The level of physical activity is one of the factors that

can affect blood pressure in someone who is obese.

Obesity occurs due to low energy expenditure

compared to the energy consumed. The lower a

person's level of physical activity, the higher their

blood pressure due to a high heart rate when the

person is physically active (Mayoclinic, 2021; WHO,

2016).

The results showed that there was no significant

relationship between physical activity and blood

pressure in obese employees at Jakarta Islamic

Hospital (p-value = 1,000). This is because there are

other causes of increased blood pressure such as

stress conditions, age, and poor diet in obese people

(Putriastuti, 2016). Meanwhile, in this study, the

Low Fiber and High Fat Intake: A Determinants of the Occurrence of High Blood Pressure in Obese Employees at Jakarta Islamic Hospital

increase in blood pressure in obese employees is more

influenced by poor eating patterns such as low fiber

and high fat so the results show that there is no

significant relationship between the level of physical

activity and blood pressure in obese employees at

Jakarta Islamic Hospital in 2021.

This study is not in line with the research of

Rihiantoro and Widodo (2018) which states that there

is a relationship between physical activity and the

incidence of hypertension (high blood pressure) at the

Tulang Bawang I Health Center with a p-value of

0.005 and an OR (Odds Ratio) of 2.255 (Rihiantoro

& Widodo, 2018). This is caused by differences in

characteristics and the number of respondents.

Respondents in Rihiantoro and Widodo's research

(2018) were patients at the Tulang Bawang 1 Public

Health Center where the level of physical activity

tended to vary. While the respondents in this study

were employees of Jakarta Islamic Hospital, most of

whom were nurses. In addition, the number of

respondents in Rihiantoro and Widodo's (2018) study

was more (n = 64) compared to this study (n = 41).

This study is also not in line with Putriastuti's

research (2016) which also states that there is a

significant relationship between exercise status and

the incidence of hypertension (high blood pressure) in

middle age patients (45-59 years) at Kedurus Health

Center Surabaya with a p-value of 0.001. On the other

hand, this study also states that there is no relationship

between the frequency and duration of exercise with

the incidence of hypertension with p-values of 0.068

and 0.710, respectively. The absence of a relationship

between the frequency and duration of exercise with

the incidence of hypertension in patients is also due

to other causes of increased blood pressure such as

stress conditions, age, and poor diet in obese patients

(Putriastuti, 2016).

4.2 Relationship Between Fiber Intake

and Blood Pressure

Fiber has an important role in blood pressure in obese

patients (Khomsan et al., 2004; WHO, 2016). When

a person consumes less fiber, bile acids will absorb

cholesterol resulting in a build-up in the blood vessels

(Gropper et al., 2009; Thompson et al., 2011).

The results showed that there was a significant

relationship between fiber intake and blood pressure

in obese employees at Jakarta Islamic Hospital (p-

value = 0.002). In addition, the PR value (Prevalence

Ratio) of 8.815 means that respondents who consume

less fiber have an 8.8 times chance of experiencing

high blood pressure compared to employees who

consume enough fiber.

This study is in line with the research of Yuriah et

al. (2019) which states that there is a relationship

between fiber intake and blood pressure in

hypertensive patients at the Gondokusuman I Health

Center Yogyakarta with a p-value of 0.03 and an OR

(Odds Ratio) value of 10.24, which means that

patients with stage I hypertension consume fiber

10,24 times more than patients with stage II

hypertension (Yuriah et al., 2019). The research of

Ramadhani et al. (2017) also mentioned that there

was a relationship between fiber intake and systolic

and diastolic blood pressure in adult patients at

Roemani Muhammadiyah Hospital Semarang with p-

values of 0.001 and 0.008, respectively (Ramadhani

et al., 2017). Other studies have also shown a

significant relationship between low fiber intake and

the incidence of high blood pressure (Bertalina &

Muliani, 2016; Kholifah et al., 2015).

4.3 Relationship Between Proportion of

Fat Intake and Blood Pressure

Obese people tend to often consume foods that

contain high fat in large portions (Gandy et al., 2014;

Hardinsyah & Supariasa, 2016). High consumption of

fat, especially saturated fat, is associated with

increased body weight which increases the risk of

high blood pressure. Consumption of saturated fat can

increase cholesterol in the blood. Cholesterol will

clog blood vessels by forming atherosclerosis

(Almatsier, 2016). Clogged blood vessels cause an

increase in blood pressure (WHO, 2013).

The results showed that there was a significant

relationship between the proportion of fat intake and

blood pressure in obese employees at Jakarta Islamic

Hospital (p-value = 0.002). In addition, a PR

(Prevalence Ratio) value of 5.667 was also obtained,

which means that respondents who have a proportion

of excess fat intake have a 5.6 times chance of

experiencing high blood pressure compared to

employees who have a sufficient proportion of fat

intake.

This is in line with Sari's research (2019) which

states that there is a relationship between fat intake

and blood pressure in adults in Lubuk Buaya Padang

with a p-value of 0.000 (J. N. Sari, 2019). The

research of Ramadhani et al. (2017) also mentioned

that there was a relationship between fat intake and

systolic and diastolic blood pressure in adults at

Roemani Muhammadiyah Hospital Semarang with p-

values of 0.000 and 0.004, respectively (Ramadhani

et al., 2017). Other studies have also shown a

significant relationship between high fat intake and

the incidence of obesity and high blood pressure

ICSDH 2022 - The International Conference on Social Determinants of Health

(Susanti, 2015). Patients with level II hypertension

consume 7.51 times more fat than patients with level

I hypertension (Yuriah et al., 2019).

5 CONCLUSIONS

Based on the research results, it can be concluded that

the age of respondents is from 29 to 53 years old, most

of them are female and have grade II obesity. Most of

the respondents have normal blood pressure, low

physical activity and fiber intake, and also excessive

proportion of fat intake. There is no significant

relationship between physical activity and blood

pressure in obese employees at Jakarta Islamic

Hospital. There is a significant relationship between

fiber intake and the proportion of fat intake with

blood pressure in obese employees at Jakarta Islamic

Hospital.

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