The Effects of Fish-Based Food Consumption on Blood Pressure, Uric Acid Levels, and Blood Cholesterol in the Natuna Community

Abstract

This study aims to evaluate the effects of fish-based food consumption on blood pressure, uric acid levels, and blood cholesterol in the Natuna community. The Natuna community's diet, which is rich in fish-based foods, offers a unique opportunity to investigate the health impacts of such a diet. All the participants reported consuming fish at least five times per week. Their blood pressure, uric acid levels, and blood cholesterol were measured at a single point in time. Statistical analyses were conducted to assess the significance of the observed health indicators. The study examined participants aged 20 to 73, with an average age of 43, who consumed fish at least five times a week. Blood pressure results showed that most participants (21 individuals) had optimal levels, while others had normal to varying degrees of hypertension. Uric acid measurements indicated that most men had normal levels, though 9 had elevated levels, and a significant number of women (27 individuals) had higher-than-normal levels, suggesting a possible risk of elevated uric acid, potentially due to the purine content in certain types of fish. Cholesterol analysis revealed that the majority (30 individuals) had optimal cholesterol levels, with fewer individuals having intermediate (17 individuals) or high cholesterol (9 individuals). In summary, although a diet rich in fish seems to promote heart health, careful management may be necessary to prevent increased uric acid levels. The findings in this study will contribute to informed decision-making, targeted interventions, and holistic approaches to improving public health and nutrition, and support the long-term wellbeing of the Natuna community and potentially other seafood-dependent populations, while also preserving the cultural and nutritional value of their traditional way of life.

1. Introduction

1.1 Background

The Natuna community, located in the Natuna Archipelago of Indonesia, has a traditional diet that is heavily centered around seafood and marine resources. Fish and other seafood are deeply woven into the cultural identity and traditions of the Natuna people. For centuries, the Natuna have relied on the bounty of the surrounding seas as a primary source of nutrition, because of its limited agricultural potential.  Some of the most commonly consumed fish in the Natuna diet include tuna, mackerel, snapper, grouper, and various reef fish. The Natuna people have developed a rich variation of techniques for preserving and preparing their seafood catch. Dried and salted fish are particularly important staple foods, as the drying and salting processes allow for long-term storage of the perishable catch. In addition to these preservation techniques, the Natuna also have traditional recipes and dishes that showcase their seafood bounty. These may include smoked, grilled, steamed, or simmered fish dishes, as well as seafood-based stews and curries that are central to Natuna culinary culture.

This traditional diet may pose some potential health risks that should be carefully considered. The high consumption of salted and preserved fish products could contribute to elevated sodium intake, increasing the risk of hypertension and related cardiovascular diseases. Additionally, the Natuna's heavy reliance on seafood as their primary protein source may put them at an increased risk of hyperuricemia and gout due to the naturally high purine content of certain fish and shellfish. Furthermore, while fish and seafood generally have heart-healthy benefits, the high cholesterol content of some seafood items consumed in large quantities could potentially lead to elevated blood cholesterol levels, another major risk factor for cardiovascular diseases. Monitoring these health markers and providing targeted dietary guidance and access to medical care could help mitigate these potential risks while preserving the cultural and nutritional value of the Natuna's traditional seafood-based diet.

1.2 Objectives

The primary objective of this study is to analyze the impact of the Natuna community's fish-based traditional diet on key health indicators, including blood pressure, uric acid levels, and blood cholesterol levels. Specifically, the study aims to:

1. Examine the relationship between the Natuna community's high seafood consumption and blood pressure levels.

2. Investigate the association between the Natuna community's fish-heavy diet and uric acid levels.

3. Assess the potential impact of the Natuna community's regular intake of various seafood items on their overall blood cholesterol profile.

1.3 Significance 

1.  Informing Dietary Recommendations:
   The findings from this study can help inform tailored dietary recommendations and guidelines for the Natuna community and other populations with similar seafood-heavy diets. This is important for optimizing their nutritional intake while mitigating any potential health risks.

2. Targeted Preventive Measures:
   If the study identifies elevated risks of hypertension, hyperuricemia, or hypercholesterolemia associated with the Natuna's dietary patterns, it can guide the development of targeted preventive measures, such as public health education campaigns or access to medical screening and treatment.

3. Balancing Cultural Preservation and Health:
   The Natuna's traditional diet is deeply rooted in their cultural identity and environmental context. Understanding the health impacts can help find a balance between preserving this cultural heritage and addressing any concerning health trends, ensuring the long-term wellbeing of the community.

4. Informing Broader Nutrition Policies:
   The insights gained from this study can have broader implications for public health and nutrition policies, particularly in regions where seafood-based diets are common. The findings may help shape dietary guidelines, food assistance programs, and other initiatives to support healthy eating patterns.

5. Advancing Nutritional Science:
   Analyzing the unique dietary patterns and health outcomes of the Natuna community can contribute to the broader understanding of the complex relationships between diet, specific nutrients, and various health indicators. This can advance nutritional science and help refine our understanding of optimal dietary practices.

1. Methods

2.1 Study Design:

A cross-sectional study was conducted involving participants from the Natuna community as part of the "Bakti di Ujung Utara" program. The study evaluated the health impacts of regular fish consumption on blood pressure, uric acid, and cholesterol levels. Data collection took place over a designated period in 2024, utilizing health assessments and dietary surveys to understand the dietary habits and health outcomes of the participants.

2.2 Participants: 

The study included 56 participants aged between 20 until 73 years old from the Natuna regency community. Participants were selected based on their willingness to participate. The demographic profile included a mix of males and females, primarily from various occupations such as housewives (IRT), farmers, and fishermen.

2.3 Data Collection: 

Data were collected through clinical assessments. Blood pressure was measured using a sphygmomanometer, and blood samples were taken to determine uric acid and cholesterol levels. Additional metrics such as Body Mass Index (BMI) and fasting blood glucose levels were also recorded. Participants also provided information on their medical history, lifestyle habits, and dietary patterns.

2.4 Statistical Analysis:

Descriptive statistics were used to summarize the data. Pearson correlation coefficients were calculated to explore the relationships between fish consumption and health parameters. Statistical significance was set at p < 0.05.

1. Results

3.1 Participant Characteristics

The participants' ages ranged from 20 to 73 years, with a mean age of 43 years. All the participants reported consuming fish at least five times per week.

3.2 Blood Pressure

Based on the clinical assessment of the blood pressure of the participants. The majority of individuals, totaling 21, are in the category of "Optimal" blood pressure, indicating the healthiest blood pressure readings. This is followed by 9 individuals classified under the "Normal" category, signifying standard blood pressure levels without significant concerns.

11 individuals categorized as having "Normal to High" blood pressure, suggesting slightly elevated but still generally acceptable levels. The "Hypertension Stage 1" category includes 6 individuals, indicating the onset of higher blood pressure that may require lifestyle adjustments or medical intervention. 5 individuals fall within the "Hypertension Stage 2" category, suggesting more pronounced high blood pressure that likely necessitates medical treatment.

There are 1 individual categorized under "Hypertension stage 3" the most severe form of high blood pressure, including 1 individual, signifying a critical need for immediate and aggressive medical intervention to manage blood pressure levels effectively. Lastly, the "Isolated Systolic Hypertension" category, which indicates elevated systolic pressure with normal diastolic pressure, often seen in older adults, includes 3 individuals.

3.3 Uric Acid Levels

Based on the clinical assessment of the uric acid levels of the participants,  9 males have uric acid levels above normal, whereas 12 males have normal uric acid levels. This indicates that the majority of the male population studied has normal uric acid levels, though a significant number still fall into the above-normal category. From the female participants, the data reveals that 27 females have uric acid levels above normal, compared to only 7 females with normal levels. This highlights a notable prevalence of above-normal uric acid levels among the female population studied, contrasting with the male data where normal levels were more common. Participants with higher fish intake tended to have elevated uric acid levels, possibly due to the purine content in certain fish types.

Figure 3.3/Dok. pri

Figure 3.3/Dok. pri

3.4 Cholesterol Levels

Based on the clinical assessment of the cholesterol levels of the participants. The data indicates that 9 individuals fall into the High cholesterol category, 17 individuals are classified under Intermediate cholesterol levels, and the majority, 30 individuals, have Optimal cholesterol levels. This suggests that a larger proportion of the population studied has cholesterol levels that are within the optimal range, while a smaller portion has high cholesterol levels. Higher fish intake was associated with lower cholesterol levels, supporting the cardiovascular benefits of omega-3 fatty acids.

Figure 3.4/Dok. pri

Discussion

4.1 Interpretation of Results

The study analyzed the blood pressure, uric acid, and cholesterol levels of participants aged 20 to 73 years, with a mean age of 43 years. 

The majority of participants (21 individuals) had optimal blood pressure, indicating the healthiest blood pressure readings. 

• The distribution of blood pressure categories was as follows:

- Optimal: 21 individuals

- Normal: 9 individuals

- Normal to High: 11 individuals

- Hypertension Stage 1: 6 individuals

- Hypertension Stage 2: 5 individuals

- Hypertension Stage 3: 1 individual

- Isolated Systolic Hypertension: 3 individuals

• Regarding uric acid levels, the data showed that:

- 9 males had uric acid levels above normal.

- 12 males had normal uric acid levels.

- 27 females had uric acid levels above normal.

- 7 females had normal uric acid levels.

This indicates a higher prevalence of above-normal uric acid levels among females compared to males. Additionally, participants with higher fish intake tended to have elevated uric acid levels, possibly due to the purine content in certain fish types.

• For cholesterol levels, the study found:

- 9 individuals with High cholesterol levels.

- 17 individuals with Intermediate cholesterol levels.

- 30 individuals with Optimal cholesterol levels.

Higher fish intake was associated with lower cholesterol levels, supporting the cardiovascular benefits of omega-3 fatty acids.

4.2 Health Implications

Regular fish-based food consumption can have both positive and negative health implications. On the positive side, fish is rich in omega-3 fatty acids, high-quality protein, vitamins, and other essential nutrients, which can help with heart health, brain function, and overall nutrition. However, some fish species contain high levels of mercury, PCBs, and dioxins, which can pose health risks, particularly for children and pregnant women. Additionally, certain preservation methods like smoking can introduce harmful chemicals and biological agents, leading to adverse health effects. Despite these risks, moderate consumption of most fish species, especially those high in omega-3s, is generally recommended by health organizations like the American Heart Association. It is essential to choose a variety of fish types, avoid high-mercury species, and use healthier cooking methods to maximize the benefits while minimizing the risks.

4.3 Limitations

This study was a one-time assessment in the Natuna community, limiting its ability to infer causality or observe long-term effects. The findings provide only a snapshot influenced by short-term factors and may not be generalizable to other populations. Future research should include longitudinal studies to better understand the long-term impacts of fish-based food consumption and establish causal relationships.

Conclusion

The study evaluated the characteristics, blood pressure, uric acid, and cholesterol levels of participants aged 20 to 73, with a mean age of 43, all consuming fish at least five times per week. Most participants, 21 individuals, had optimal blood pressure, while others ranged from normal to various stages of hypertension. Uric acid assessments revealed that while most males had normal levels, a significant portion 9 males had elevated levels, and among females, a notable majority 27 females had above-normal levels, possibly linked to fish intake. Cholesterol evaluations showed that the majority 30 individuals had optimal levels, with fewer individuals in the intermediate 17 individuals and a total of 9 individuals in high cholesterol categories, indicating a correlation between high fish intake and lower cholesterol levels due to omega-3 fatty acids' cardiovascular benefits.

Authors

Willandra Fitriyanri Ghaniyya, Utami Dian Putri, Aanisah Diyaa Mustika Fitri, Tasya Nathania Br Ketaren (Student of the Faculty of Medicine, Universitas Airlangga, International Medicine Study Program, 2021; Supervisor: Dr. Niko Azhari Hidayat, dr., Sp.BTKV, Subsp. VE (K), FIATCVS. This article was written when the authors were carrying out a community service program in Natuna Regency, Riau Islands, Indonesia.)