 *Corresponding author.

Email: d.nurafifah.dna@fk.undip.ac.id

eISSN: 2550-2166 / © 2020 The Authors. Published by Rynnye Lyan Resources

  Food Research 4 (4) : 1000 - 1010 (August 2020)
  Journal homepage: http://www.myfoodresearch.com

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The effect of processed Tempeh Gembus to triglycerides levels and insulin

resistance status in women with obesity

1Nadia, F.S., 1Wati, D.A., 2Isnawati, M., 1Sulchan, M. and 1,*Afifah, D.N.

1Department of Nutrition Science, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
2Nutrition Science Department, Politeknik Kesehatan Kemenkes, Semarang, Indonesia

Article history:

Received: 11 December 2019

Received in revised form: 4

February 2020

Accepted:  9 February 2020

Available Online: 5 March

2020

Keywords:

Obesity,

Tempeh Gembus,

TG levels,

Insulin resistance status,

HOMA-IR

DOI:
https://doi.org/10.26656/fr.2017.4(4).415

Abstract

Obesity is an increasing weight that exceeds the limits of physical and skeletal needs due

to the excessive backfilling of body fat. Obesity is a predisposing factor for increasing

triglyceride levels (TG) and insulin resistance status. Consumption of fiber, such as

Tempeh Gembus can be an alternative treatment to lower TG levels and insulin resistance

status. This research was aimed to prove the influence of processed Tempeh Gembus to

TG levels and insulin resistance status. This research employed a pre-post randomized

control group. The participants of this research are 40 women with pre-menopausal

obesity which are divided into two groups: the control group which is given the daily

standard diet treatment Isocaloric 30 kcal/kg of BW/day and the treatment group which is

given the daily standard diet Isocaloric 30 kcal/kg of BW/day with the addition of

processed Tempeh Gembus processed as much as 150 g/day for 28 days. The result show,

giving Tempeh Gembus to the treatment group can lower the TG level (p = 0.010) and

insulin resistance status (p = 0.000) significantly. The decreased levels of TG in the

treatment group (-9.3±9.6 mg/dL) were higher compared to the decline in the control

group (-2.90±4.43 mg/dL). Decreased insulin resistance status in the control group (-

0.60±0.51) is lower than the treatment group (-6.90±4.82).  Based on the results above,

consumption of 150 g/day of processed Tempeh Gembus for 28 days can lower TG levels

1. Introduction

Obesity develops resistance to cellular insulin action

which is characterized by reduced insulin ability to

inhibit glucose production from the liver and its ability to

support the uptake of glucose in fats and muscles

(Samuel and Shulman, 2012). Obesity-related insulin

resistance is a major risk factor for cardiovascular

disease and type 2 diabetes (T2D), which that prevalence

has reached epidemic proportions. Studies in human and

animal showed that the change of body weight is

associated with insulin sensitivity which suggests a

causal link between obesity and insulin resistance (Klein

and Romijn, 2016). The link between body weight

changes and insulin resistance may partly determine by

the role of adipose tissue (AT) in obesity (Tchernof and

Després, 2013). The AT is not only storage for lipids, but

also serves as an endocrine organ that secretes various

cytokines and hormones peptides that contribute to body

weight regulation and energy metabolism (Park et al.,

2006).

Food intake is one of an important factor that

determines obesity-related disorders (Martirosyan and

Singh, 2015). Obese people are recommended to reduce

the intake of foods containing saturated fats and consume

foodstuffs that can help raise levels of insulin. Make

Yourfood as medicine is one of the efforts to optimize

eating consumption and functional food to overcome

disease as part of a daily diet, not in the form of pills,

tablets or powders (Martirosyan and Singh, 2015).

Consumption of high-protein fermented foods is

suspected to prevent diabetes mellitus and cardiovascular

disease. Various fermented foods such as natto,

Chungkook-Jang, Doen-Jang, Jeot-Gal, and Tempeh

(fermented food from Indonesia) have been identified as

being able to produce enzymes with high fibrinolytic

activity (Mine et al., 2005; Sugimoto et al., 2007; Afifah,

Sulchan and Syah, 2014; Afifah et al., 2014; Afifah et

al., 2017; Stephani et al., 2017). Tempeh Gembus as one

of Indonesia’s original fermented food has been

suggested to have a potential fibrinolytic enzyme (Afifah

et al., 2014; Afifah et al., 2014). Tempeh Gembus is

made from tofu residue which is fermented by Rhizopus

oligosporus also known as a popular functional food

product consumed by Indonesians (Arini et al., 2019;

https://orcid.org/0000-0001-7229-320X

https://orcid.org/0000-0001-9353-1166

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Afifah et al., 2020; Manullang, 2020).

Fiber is an active substance owned by Tempeh

Gembus, the value of protein content is 3 times more

compared to soybean Tempeh, which is 3.93 g/100 g (Li

et al., 2012; Lu et al., 2013). In addition, the nutritional

content profile in Tempeh Gembus has the value of

amino acids and fatty acids which is better than soybean

does (Damanik et al., 2018). A diet with high fiber (> 25

g of soluble fiber and > 47 g of non-soluble fibers per

day) may decrease the risk up to 50% occurrence of

stroke in the population (Casiglia et al., 2013). In

addition, high fiber intake shows good benefits against

obesity. Fiber Intake (15 – 30 grams/day) can increase

the sensitivity of insulin and can lower the level of TG in

the blood because of the content of hypocholesterolemic

that increases absorption and increase the excretion of

cholesterol in the intestines (Dodevska et al., 2013).

Previous studies have shown that soy protein

consumption at a relatively high rate of 20-25 g for 6

weeks has an impact on decreasing triglyceride levels,

total cholesterol and low-density lipoprotein cholesterol

(LDL-cholesterol) in the participant of

hypercholesterolemia. These results demonstrate an

effect which appears to be in part attributable to the

suppression of triglyceride fatty acid (TGFA)

biosynthesis (Wang et al., 2004; Kusumaningsih et al.,

2006; den Besten et al., 2015; Tokede et al., 2015).

Previous research, indicating that Tempeh Gembus is

safe to be consumed because it has an antimicrobial

activity due to the fermentation process (Noviana et al.,

2018). The purpose of this research is to determine the

role of Tempeh Gembus in the prevention of diabetes

mellitus and cardiovascular disease that is reviewed from

the indicator of triglyceride levels and insulin resistance

status in the blood of obese women.

2. Materials and methods

2.1 Study design and patients

In this study, we included 40 women aged 20-50

years, body mass index ≥ 23 kg/m2, has no history or is

experiencing degenerative diseases (derivatives), not

smoking, willing to participate in this study by signing

informed consent. The participants were recruited based

on consecutive sampling method.

The participants are divided into two groups: one

control group and one treatment group with each of them

consisting of 20 participants. The daily standard diet

intervention of isocaloric 30 kcal/kg BW/day provided as

feeding package by investigators to participants. The

control group (X1) with daily standard diet intervention

of Isocaloric 30 kcal/kg BW/day for 28 days. Treatment

group (X2) with daily standard diet intervention of

Isocaloric 30 kcal/kg BW/day with the addition of

processed Tempeh Gembus as much as 150 grams/day

for 28 days. Food intake restriction intervention is done

by reducing food portions while still paying attention to

the nutritional value (Redman and Ravussin, 2011).

Limitation of food intake is given in stages as much as

30 kcal/kg body weight/day through food menus

provided by the correctional institution which refers to a

low-calorie diet for obesity by considering the gender

and physical activity of the participant (Wahyuningsih,

2013).

2.2 Laboratory, anthropometric and clinical data

collection

The data of the body mass index is obtained based

on weight and height measurements. Nutrient intake data

are obtained through interviews directly using food recall

form and the Comstock method to see the rest of Tempeh

Gembus, then they were analyzed by using Nutrisurvey

software. The data of physical activity level were

obtained through interviews directly using the

International Physical Activity Questionnaires (IPAQ)

form. Then the data were calculated by using the formula

of PAL (Physical Activity Level) WHO with the

category of physical activity level is lightweight (1.40-

1.69 units), moderate (1.70-1.99 units), and weight (2.00

-2.40 units). Triglyceride levels (TG) are measured by

laboratory personnel using the glycerol phosphate

oxidase-p-aminophenazone (GPO-PAP) method. While

insulin resistance status is measured by using the

homeostasis method, a model of assessment of insulin

resistance (HOMA-IR). This study was a pre-post

randomized control group design. The research was

conducted in March 2019. This independent variable of

this research is a restriction of feeding intake, while the

dependent variables are TG levels and insulin resistance

status. Test results of blood analysis were conducted by

certified phlebotomist from clinical laboratory CITO

Semarang Indraprasta (Clinical Laboratory Accreditation

Committee (KALK) of the Ministry of Health.

2.3 Preparation period

2.3.1 Restriction of intake

The restriction of intake is adjusted to the individual

needs of each participant by taking into account the body

condition and activity of the participant so that the

decrease in calorie gradually with a 30 kcal/kg BW/day

Isocaloric diet. This restriction is carried out as a form of

controlling the occurrence of improper diet,

improvement of the BW, increased levels of TG value

and the status of insulin resistance that will eventually

exacerbate the condition of the participant.

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2.3.2 Preparation of Tempeh Gembus treatment

ingredients

Tempeh Gembus that will be given as treatment

materials made by researchers and teams, in the

Laboratory of Food Technology Department of Nutrition

Poltekkes Semarang, the Ministry of Health (Kemenkes),

using tofu pulp obtained from tofu craftsmen in the

region of Cinde-Lamper City Semarang. The yeast of

Tempeh used is the yeast Raprima.

Processed Tempeh Gembus as treatment material is

processed in the Culinary Nutrition Laboratory

Department of Nutrition Poltekkes Kemenkes Semarang.

Tempeh Gembus is processed with 5 kinds of cooking

(Wati et al., 2020) recipes including Bacem, Oseng

Cabai Hijau, Sambal Kacang Bumbu Sate, Pepes Kuning

dan Balado.

2.4 Statistical analysis

The data obtained will be analyzed by statistical test

using SPSS version 16. Each of the data was analyzed to

see the distribution using the Shapiro-Wilk normality test

due to the number of samples of < 50 people. Test the

average difference between each group before and after

the intervention using the test paired T-Test if the data is

normal distribution and Wilcoxon test if the distribution

data is abnormal. Test the average rate between groups

using the independent T-test test if the data is normal

distribution and Mann Whitney test if the data is not

normal distribution.

2.6 Ethical clearance

Request Ethical clearance has been reviewed and

approved by the ethical clearance with the certificate

number 32/I/2019/Bioetic Commission.

3. Results

3.1 Characteristics of participants

Participant characteristics consisting of age, level of

physical activity, Body Mass Index before and after

treatment are presented in Table 1. All participants in the

study were in the age group of 21-50 years. The mean

age in the control group (35.05±8.54 years) was lower

than in the treatment group (36.50± 9.37 years). The

Mann Whitney test showed that there was no significant

difference in age between groups (p = 0.64), so age was

not a confounding variable in the study. The mean level

of physical activity during the study in the control group

(1.52±0.17 units) was higher than the treatment group

(1.48± 0.10 units). The Mann Whitney test showed that

there was no difference in the average level of physical

activity between groups (p = 0.84), so the level of

physical activity was not a confounding variable in the

study. Based on WHO (2011), the level of participant

activity in this study was included in the mild category

(1.40-1.69 unit). Table 1 also shows that the average

Body Mass Index (BMI) before and after the study in the

control group (30.00±5.61 kg/m2; 29.63±5.42 kg/m2)

than the treatment group (28.22±2.49 kg/m2; 27.32±2.50

kg/m2). The Mann Whitney test showed that there was

no difference in mean Body Mass Index before (p =

0.51) and after research (p = 0.16), did not become

confounding in the study.

3.2 Dietary intake before intervention

Table 2 shows data on energy, protein, fat and

carbohydrate intake patterns before the study. The mean

energy intake before the study in the control group

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Characteristics of

participants

  Control
p

Treatment

  Average ±SD Median Min-Max Average ±SD Median Min-Max

Age (year)   35.05±8.54 34.00 21-50 36.50±9.37 39.00 21-48 0.64*

BMI (kg/m2)
Before 30.00±5.61 28.40 25.10-47.67 28.22±2.49 27.73 25.08-33.23 0.51*

After 29.63±5.42 27.99 25.00-47.03 27.32±2.50 27.14 4.15-32.47 0.16*

Level of physical

activity (unit)
During 1.52±0.17 1.42 1.40-1.79 1.48±0.10 1.43 1.40-1.73 0.84*

Table 1. Characteristics of participants before and after treatment

*Mann Whitney test

Diet
Control

p
Treatment

Average ±SD Median Min-Max Average ±SD Median Min-Max

Energy (kcal) 2.306.96±545.24 2284.65 916.4-3.328.10 2.057.70±241.06 1954.68 1.823.6-2.714.50 0.01*

Protein (g) 84.86±19.08 87.90 45.90-118.40 72.59±19.16 71.65 39.50-111.30 0.04**

Fat (g) 86.58±31.84 82.55 26.90-131.30 60.57±18.75 59.41 30.80-109.00 0.00**

Carbohydrates

(g)
296.79±77.45 289.90 22.00-451.10 276.42±35.50 274.33 216.80-364.70 0.29**

Table 2. Dietary intake before intervention

*Independent sample test **Mann Whitney test

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(2306.96±545.24 kcal) was higher than in the treatment

group (2057.70±241.06 kcal), the Mann Whitney test

showed that there were significant differences in energy

intake between groups (p = 0.01) so that energy intake

before the study becomes confounding variable. The

mean protein intake before the study in the control group

(84.86±19.08 g) was higher than the treatment group

(72.59±19.16 g), the independent sample test showed

that there were significant differences in energy intake

between groups (p = 0.04) so that protein intake before it

can become confounding variables. The mean fat intake

before the study in the control group (86.8±31.84 g) was

higher than the treatment group (60.57±18.75 g),

the independent sample test showed that there were

significant differences in energy intake between groups

(p = 0.00) so that fat intake before the study can be a

confounding variable. The mean carbohydrate intake in

the control group (296.79±77.45 g) was higher than the

treatment group (276.42±35.50 g), but the independent

sample test showed no difference in carbohydrate intake

before the inter-group study (p = 0.29) so that

carbohydrate intake before the study did not become a

confounding variable.

3.3 Dietary intake during intervention

Dietary  intake can become confounding variables

when there are significant differences between groups

(p<0.05). The nutritional intake consists of energy

intake, protein, fat, carbohydrate and the intake of

Tempeh Gembus (treatment group). Table 3 presents

food intake data during the study of each group. There is

no difference in energy intake, protein, fat and

carbohydrate in both groups and there is a difference in

the treatment of the Tempeh Gembus. This is because the

differences in interventions conducted during the study,

from the treatment group can increase the level of

consumption of Tempeh Gembus for 28 days

intervention of a minimum value of 35.88% and a

maximum value of 94.90%.

3.4 The effect of processed Tempeh Gembus on

triglycerides levels

TG levels before and after intervention in each group

can be seen in Table 4. The control group’s average level

of TG before the intervention is 144.70±17.84 mg/dL

and the average TG level after intervention becomes

141.80±18.38 mg/dL. In the treatment group, the average

rate of TG before the intervention is 143.95±20.01 mg/

dL and the average TG levels after intervention reach

134.65±20.72 mg/dL. Statistically, there is a significant

difference between the average of TG levels before and

after the intervention in both groups (p = 0.00; p = 0.00).

Average levels of TG before intervention in control

group (144.70±17.84 mg/dL) are higher than treatment

group (143.95±20.01 mg/dL). However, there is no

significant difference in the average of TG levels before

the intervention between the two groups (p = 0.90). The

average rate of TG after intervention in control group

(133.05±21.83 mg/dL) is lower than treatment group

(134.65±20.72 mg/dL), but there is no significant

difference on the average of TG levels after intervention

between the two groups (p = 0.81). Decreased levels of

TG in the control group (-2.90±4.43mg/dL) are lower

than the treatment group (-9.30±9.63 mg/dL). In

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Intake
Control Treatment

p
Average±SD Median Min-Max Average±SD Median Min-Max

Energy (kcal) 1.924.35±218.62 1955.07 1.456.65-.457.00 1.883.817±187.89 1895.40 1.512.81-.299.05 0.53*

Protein (g) 96.21±10.93 97.75 72.83-122.85 94.19±9.39 94.77 75.64-114.95 0.53*

Fat (g) 42.76±4.85 43.45 32.37-54.60 41.86±4.17 42.12 33.62-51.09 0.53*

Carbohydrates

(g)
288.61±32.75 293.26 218.50-368.55 282.54±28.16 284.31 226.92-344.86 0.53*

Gembus Intake

(%)
0.00±0.00 0.00 0.00-0.00 61.37±19.05 56.88 35.88-94.90 0.00*

Table 3. Dietary intake during intervention

*Independent sample test

TG Levels (mg/dL)
Control (n=20) Treatment (n=20)

p
Average ±SD Min - Max Median Average ±SD Min – Max Median

Before 144.70±17.84 111 – 179 146.50 143.95±20.01 110 – 178 146.00 0.90**

After 141.80±18.38 100 – 178 136.50 134.65±20.72 100 – 165 129.50 0.25**

∆ TG Levels 2.90±4.43 -13 – 6.00 -2.00 -9.30± 9.63 33 – 00.0 -6.00 0.01***

p 0.000* 0.000*

Table 4. TG levels before and after intervention on control group and treatment group

*Paired sample test, **Independent sample test, and ***Mann Whitney test

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summary, there is a significant difference in the

reduction of TG post-granting intervention between the

two groups (p = 0.01).

3.5 The effect of processed Tempeh Gembus on fasting

blood glucose (FGB) levels and insulin levels

Based on Table 5, the average FBG rate of the

control group before the intervention is 125.95±18.42

mg/dL whereas after the average FBG rate intervention

becomes 119.25±16.47 mg/dL. In the treatment group,

the average FBG rate before the intervention is

124.20±9.36 mg/dL whereas after the average FBG rate

intervention becomes 82.10±13.61 mg/dL. Statistically,

there is a significant difference between the average FBG

rate before and after the intervention in both groups (p =

0.00; p = 0.00). Although it has not yet reached the

optimal value, there is a statistically significant reduction

in FBG levels in both groups.

In the control group, the average insulin level before

the intervention is 25.81±8.99 µIU/L whereas after the

intervention of the average insulin levels becomes

25.10±8.51 µIU/L. In the treatment group, the average

level of insulin before the intervention is 38.18±16.41

µIU/L whereas after the intervention of the average

insulin levels into 23.99±9.72 µIU/L. Statistically, there

is a significant difference in insulin levels in the

treatment group before and after the intervention (p =

0.00). Although it has not yet reached the optimal value,

there is a statistically significant decrease in insulin

levels in both groups.

The average FBG rate prior to the intervention in the

control group (125.95±18.42 mg/dL) was higher than the

treatment group (124.20±9.36 mg/dL), but there was no

significant difference to the average FBG level before

the two group intervention (p = 0.60). Average FBG

levels after the intervention in the control group

(119.25±16.47 mg/dL) is higher than the treatment group

(82.10±13.61 mg/dL), there is a significant difference in

the FBG rate after the intervention between the two

groups (p = 0.00). The decline in FBG levels in the

control group (-6.70±6.11 mg/dL) is lower than the

treatment group (-42.10±15.00 mg/dL), there is a

significant difference in the decline in FBG levels after

the intervention between the two groups (p = 0.00).

The average insulin level before the intervention in

the control group (25.81±8.99 Μiu/L) is lower than the

treatment group (38.18±16.41 µIU/L), but there is no

significant difference to the average insulin level before

the intervention between the two groups (p = 0.02).

Average insulin levels after an intervention in the control

group (25.10±8.51 µIU/L) is higher than the treatment

group (23.99±9.72 µIU/L), but there is no significant

difference to the average insulin rate after the

intervention between the two groups (p = 0.54).

Decreased levels of insulin in the control group (-

0.70±0.96 µIU/L) are lower compared to treatment

groups (-14.19±13.80 µIU/L), there are significant

differences in the decrease in insulin levels after the

intervention of the two groups (p = 0.00).

3.6 The effect of processed Tempeh Gembus on insulin

resistance status

In the control group (based on Table 6), the average

status of insulin resistance before the intervention is

7.89±2.82 while after the intervention the insulin

resistance status reaches to 7.38±2.56. In the treatment

group, the average status of insulin resistance before the

intervention is 11.77±5.32 while after the intervention of

insulin resistance status reaches to 4.87±2.32.

Statistically, there is a significant difference between the

average status of insulin resistance before and after

intervention in both groups (P = 0.00; p = 0.00).

Although it has not yet reached the optimal value, there

is a decline in insulin resistance status, which is

statistically significant in both groups.

The average status of insulin resistance before the

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FBG Levels (mg/dL)
Control (n=20) Treatment (n=20)

p
Average±SD Min-Max Median Average±SD Min -Max Median

Before 125.95±18.42 103-196 125.00 124.20±9.36 101-140 124.50 0.60**

After 119.25±16.47 110-180 116.50 82.10±13.61 67-120 77.50 0.00**

∆ FBG Levels -6.70±6.11 -20-1 -4.50 -42.10±15.00 -62-(-5) -46.60 0.00**

p 0.00* 0.00*

Insulin Levels µIU/L

Before 25.81±8.99 13.17-5.18 22.61 38.18±16.41 12.11-6.15 37.54 0.023**

After 25.10±8.51 12.10-4.10 22.13 23.99±9.72 10.15-55.78 21.38 0.543**

∆ Insulin Levels -0.70±0.96 -4.20-0.54 -0.60 -14.19±13.80 -51.12-(-40) -12.34 0.000**

p 0.000* 0.000*

Table 5. FBG levels and insulin levels before and after intervention control group and treatment group

*Wilcoxon sample test **Mann Whitney test

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intervention in the control group (7.89±2.82) is lower

than the treatment group (11.77±5.32); so, there is a

significant difference to the average status of insulin

resistance before the intervention between the two

groups (P = 0.02). Average status of insulin resistance

after intervention in the control group (7.38±2.56) is

higher than the treatment group (4.87±2.32): so, there is

a significant difference to the average status of insulin

resistance after intervention between the two groups (P =

0,00). Decreased insulin resistance status in the control

group (-0.60±0.51) is lower than the treatment group (-

6.90±4.82); so there is a significant difference to the

decline of the insulin resistance status after giving inter

intervention in both groups (P = 0.00). Although there is

a significant decline in each group of treatment, the value

of insulin resistance status has not reached the optimal

value.

4. Discussion

There is a significant difference in the decline in the

level of TG post-granting intervention between the two

groups (p = 0.010). Elevated levels of TG or

hypertriglyceridemia are influenced by gene factors and

dietary consumption such as carbohydrates, fats, and

alcohol. The blood TG levels will be able to increase

affected by the low activity of the enzyme LPL

(Lipoprotein Lipase) which serves to hydrate

triglycerides into fatty acids and glycerol (Murray et al.,

2012).

Obesity and saturated fat consumption can activate

JNK. The increase of fat deposition in adipocytes in

obesity leads to the production of pro-inflammatory

cytokines, which include TNF-α and IL-6 that further

activates the JNK and NFκβ lines. Activation of NFκβ

on obesity increasingly adds to the inflammatory

response that weighs insulin resistance (Sah et al., 2016).

In women pre-menopause women experience decreased

estrogen hormones associated with increased body fat

and visceral fat accumulation (Hall, 2015; Mansour et

al., 2017), to prevent the occurrence of excessive

estrogen deficits need to have an incorrect intake setting

the same with consuming Tempeh Gembus. Other studies

show that fibers in the Tempeh Gembus provide

hypercholesterolemia effects and lipid-lowering effects

in hamsters that are fed a high-fat diet achieve 20%/kg

BW for 3 weeks with the results of TG (P<0.05)

(Villanueva et al., 2011). Decreased levels of TG given

to a group have a value of more than 50% with the

administration of 5%/kgBW of a group that is given only

dietary control diet (Nagata et al., 2016). This is in line

with previous research, in the hyperlipidemia group of

women divided into 3 groups, namely the control group,

1 treatment group that got Tempeh Gembus 103 g/day

and 2 treatment groups that got Tempeh Gembus 206 g/

day for 14 days. In the provision of Tempeh Gembus at a

dose of 103 g/day, there is no difference in the influence

of Tempeh Gembus on total cholesterol levels and TG in

the three groups. But, consumption of Tempeh with a

dose of 206 g/day has a significant influence to lower the

total cholesterol levels and has no significant influence to

lower TG levels (Agustina et al., 2018).

Therefore, the food fiber can be concluded, and

protein can be a role to lower lipid plasma and

cholesterol, Tempeh Gembus can improve the nutrients

of other food quality and is a promising functional food

that can be used in Fiber-rich food development. The

research is in line with the previous research,

statistically, there is no significant difference to the

decrease in TG levels, but if it was viewed from the

average value of TG levels in both groups decreased

(144.70±17.84 mg/dL), such as in the control group prior

to the study, (133.05±21.83 mg/dL) in the control group

after research while the average rate of TG

(143.95±20.01 mg/dL) on the treatment group before

research, (134.65±20.72 mg/dL) in the treatment group.

Tempeh Gembus is one form of the fermented Okara,

which has 3 times higher fiber (4.69%) from soybean

Tempeh (1.40%) (Li et al., 2012). The soybean fiber

component of the Tempeh Gembus has a major role in

lowering cholesterol levels and other lipid profile

mechanisms including TG levels. A structurally owned

isoflavone antioxidant compounds similar to estrogen.

Previous research showed a high level of antioxidant

activity with ABTS analysis method (Agustina et al.,

2018). The decrease in TG levels also occurred in the

control group, this is due to changes in the food intake of

participants during the intervention through the

restriction of intake with isocaloric 30 kcal/kg BW. The

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Insulin Resistance Status
Control (n=20) Treatment (n=20)

p
Average±SD Min–Max Median Average ±SD Min-Max Median

Before 7.89±2.82 4.13-14.01 6.82 11.77±5.32 3.99-23.13 11.40 0.02**

After 7.38±2.56 3.20-13.07 6.55 4.87±2.32 2.66-12.40 4.22 0.00**

∆ Insulin Resistance Status -0.60±0.51 -1.97-0.07 -0.55 -6.90±4.82 -18.37-(-0.74) -6.29 0.00**

p 0.00* 0.00*

Table 6. Insulin resistance status before and after intervention control group and treatment group

*Wilcoxon sample test **Mann Whitney test

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average energy intake before research, in the control

group (2306.96±545.247 kcal) is higher than the

treatment group (2057.70±241.062 kcal), while the

average energy intake during research in the control

group (1924.35±218.624 higher than the treatment group

(1883.81±187.897 kcal), there was a decrease in the

participants ' intake of meals before and during the study.

Low-calorie food restriction leads to decreased

lipogenesis activity, and fewer Free Fatty acids (FFA) or

free fatty acid are formed. Furthermore, it was the

mobilization of FFA from fat tissue to the hepar and bind

with glycerol to form triacylglycerol. Thus, the lower the

consumption of calories, the lower the synthesis of

triacylglycerol in hepar and the lower level of TG in the

blood occurs (Hu et al., 2013; Tsalissavrina et al., 2013;

Athyros et al., 2018).

Giving Tempeh Gembus is very effective to lower

the TG level which will be directly related to the increase

in HDL levels. The higher the HDL level, the lower the

cholesterol circulating in the blood that is transported

back to the liver, and the lower the risk of atherosclerosis

will be. Thus, this is in line with this research, where the

decrease in TG levels can also be influenced by a

decrease in fasting blood sugar and insulin levels.

Previous research conducted was by giving Tempeh

directly was able to lower the FBG level, preventing the

increase in total cholesterol levels, TG and LDL levels,

reduce the damage of β-pancreatic cells. Insulin

resistance in Hepar is selective, that is, insulin is not able

to suppress gluconeogenesis, but still stimulates the

synthesis of fatty acids, which manifests as

hyperglycemia and hypertriglyceridemia. Manifestations

of insulin resistance in adipose tissue are glucose

transport disorder and impaired inhibition of lipolysis

(Ismaiel et al., 2017).

Fiber content (Lu et al., 2013) and high protein

(Ahmed et al., 2010) in Okara has the ability to reduce

the FBG level. These fibers contain bioactive

components with high viscosity, these components can

directly slow the discharge of the stomach and

absorption of glucose due to the hypoglycemic effect on

Okara (Sedaghat et al., 2015). The mechanism of fiber to

decrease in blood glucose levels is strongly influenced

by the absorption of carbohydrates in the intestines. The

lower the carbohydrate that is absorbed by the body, the

lower the glucosamal levels will be. In this case, fiber

can decrease the efficiency of carbohydrate absorption

that can cause a decreased insulin response. When the

insulin response decreases, the pancreas's work will be

lighter so that it can improve the function of the pancreas

in producing insulin (Ahmed et al., 2010; Lu et al., 2013;

Sedaghat et al., 2015).

Eating arrangement with isocaloric is not only

limited to the amount consumed but it is also influenced

by food quality and meal frequency that will later affect

the metabolic rate (Franz et al., 2010). Some

physiological reasons in food settings have an inverse

relationship of Anara insulinotropic which relies on FBG

and dietary intake (Franz et al., 2010; Mesas et al., 2012;

Salehi et al., 2014). This leads to a decline in the control

group, isocaloric food restriction is able to lower adipose

tissue in the body so that there is no hyperglycemic,

glucose intolerance in the state of Dyslipidemia and

increased inflammatory response. In addition, isocaloric

is able to lower the AKT phosphorylation in the liver,

preventing insulin resistance and increasing

phosphorylation ratio of IKK-β-total IKK-β in

preventing the occurrence of inflammation of the tissues

(Samuel, 2012; Bretón et al., 2013; Ye, 2013). This

research suggests that food settings are able to help

lower the impairment on FBG which is a reduction risk

of insulin resistance that triggers inflammation in the

muscles and impaired insulin signals in the liver (Jiang

and Messina, 2011; Samuel, 2012; Bretón et al., 2013;

Ye, 2013; Francisqueti et al., 2017).

There is a decline in FBG levels and insulin levels

are able to decrease the occurrence of insulin resistance.

Giving Tempeh Gembus has the ability to decrease

insulin resistance. According to recent studies, high fiber

consumption levels can contribute to the increase in

carbohydrate metabolism in non-pharmacological ways.

In addition, the fiber consumption from Tempeh Gembus

is beneficial reducing postprandial hyperglycemia by

inhibiting Digestion and absorption of carbohydrates, as

well as enhancing a sense of satiety with the effects of

the resultant weight loss (Furukawa et al., 2017). In

individual insulin resistance, fiber consumption can

increase the sensitivity of the peripheral insulin through

short-chain fatty acids, which is produced by the

fermentation of fibers in the intestines (Feder and

Fonseca, 2017). However, there has been no direct

research that proves the influence of Tempeh Gembus

against insulin resistance status. Theoretically, the

mechanism of Tempeh Gembus affecting the status of

insulin resistance can be explained through oxidative

stress reduction pathways by suppressing the formation

of ROS. Another study proved that the feeding of

Tempeh Gembus lowered the MDA levels in the rats that

were fed atherogenic (Kurniasari et al., 2017).

Additionally, the decline also occurs in the control

group. This is due to the restriction of intake that can

suppress the rate of FFA. On the characteristics of

female obesity, pre-menopause increased the levels of

free fatty acids (FFA) plasma. Research in rats and

humans showed the increase of FFA due to triglyceride

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lipolysis of adipose tissue in insulin metabolism

disorder. Food restriction with Isocaloric suppresses the

distribution of fats that interfere with metabolic activity,

especially in gluteal adipose tissue which is protective

against insulin resistance. In contrast, the adipose tissue

of the visceral shows a higher inflammatory increase

compared to subcutaneous and intramuscular adipose

tissues. The visceral adipose tissue rises to the port vein

so that the hepar is directly exposed to high FFA levels

and Adipokine. This leads to insulin resistance

characterized by increased hepatic glucose production

and elevated fasting glucose levels. The emphasizing of

the rate of FFA through calorie restriction can also lower

the deposition of fat in the target tissues of other insulin,

such as skeletal muscle, which is associated with

mitochondrial dysfunction and insulin resistance, which

leads to glucose transport disorder after eating due to the

decreased translocation GLUT-4 (Polonsky and Burant,

2016). Overall, Tempeh Gembus effectively decreases

insulin resistance. This occurs because of a decrease in

the level of TG which is followed by a decrease in FBG

and Insulin.

5. Conclusion

The provision of processed Tempeh Gembus is able

to lower TG levels and Insulin resistance Status for 28

days. The provision of processed Tempeh Gembus is

expected to be applied to pre-menopause women with

obesity. Changes in TG and Insulin resistance status also

occurred in the control group. This is thought to be due

to a standard diet of 30 kcal/kg body BW/day for 28

days.

Acknowledgements

This research involves many participants.  On this

occasion, the authors expressed their gratitude to the: (1)

Correctional Institution of Class II Semarang (2) Women

with pre-menopause and fellows at post-graduate study

of nutrition for their participation and cooperation; (3)

KEMENRISTEK DIKTI of Diponegoro University; and

(4) Directorate of Research and Community service,

Directorate General for Strengthening Research and

Development of fiscal year 2019, number: 285-05/UN7.

P 4.3/PP/2019 that gave the funds for this research.

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