Association of dietary intake and physical activity with hypercholesterolemia among prolanis participants
Cholesterol levels are vital indicators of the risk of metabolic disease. However, data on specific lifestyle determinants contributing to hypercholesterolemia within the Chronic Disease Management Program (Prolanis) population remain limited, despite their enrollment in routine monitoring programs. This study aimed to analyze the association between cholesterol intake, fiber intake, and physical activity with cholesterol levels in Prolanis participants. This cross-sectional study involved 42 Prolanis participants aged 42–76 years at the Kedato Community Health Center in Bandar Lampung. Nutrient intake was measured using the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ), physical activity was assessed using the Physical Activity Level (PAL) assessment, and cholesterol levels were measured enzymatically. Bivariate analysis indicated significant associations between cholesterol intake (OR=11.000; 95%CI: 2.366–51.141), fiber intake (OR=5.600; 95%CI: 1.218–25.751), and physical activity (OR=4.750; 95%CI: 1.226–18.406) with cholesterol levels. BMI and central obesity were not significantly associated with each other. However, in the multivariate logistic regression model, physical activity emerged as the sole independent correlate (Adjusted OR 4.848; 95% CI: 1.026–22.909), whereas the associations for dietary variables were attenuated and lost statistical significance. Although dietary factors showed initial associations, physical activity was identified as the most robust independent correlate of cholesterol levels among the Prolanis participants in this study. These findings suggest that emphasizing physical activity is a critical component of strategies to address hypercholesterolemia in this population
Keywords : Cholesterol intake, Cholesterol level, Fiber, Prolanis participants
- Abera, A., Worede, A., Hirigo, A. T., Alemayehu, R., & Ambachew, S. (2024). Dyslipidemia and associated factors among adult cardiac patients: A hospital-based comparative cross-sectional study. European Journal of Medical Research, 29, 1–12. https://doi.org/10.1186/s40001-024-01802-x
- Aggarwal, R., Bhatt, D. L., Rodriguez, F., Yeh, R. W., & Wadhera, R. K. (2022). Trends in lipid concentrations and lipid control among US adults, 2007–2018. JAMA, 328(8), 737–745. https://doi.org/10.1001/jama.2022.12567
- Alahmari, L. A. (2024). Dietary fiber influence on overall health, with an emphasis on CVD, diabetes, obesity, colon cancer, and inflammation. Frontiers in Nutrition, 11, 1510564. https://doi.org/10.3389/fnut.2024.1510564
- Almuraikhy, S., Doudin, A., Dömling, A., Althani, A. A., & Elrayess, M. A. (2024). Molecular regulators of exercise-mediated insulin sensitivity in non-obese individuals. Journal of Cellular and Molecular Medicine, 28, 1–10. https://doi.org/10.1111/jcmm.18015
- Anderson, E., & Durstine, J. L. (2019). Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science, 1(1), 3–10. https://doi.org/10.1016/j.smhs.2019.08.006
- Antoni, R. (2023). Dietary saturated fat and cholesterol: Cracking the myths around eggs and cardiovascular disease. Journal of Nutritional Science, 12, 1–6. https://doi.org/10.1017/jns.2023.82
- Belanger, M. J., Rao, P., & Robbins, J. M. (2022). Exercise, physical activity, and cardiometabolic health. Cardiology in Review, 30(3), 134–144. https://doi.org/10.1097/CRD.0000000000000417
- Bittner, V., Linnebur, S. A., Dixon, D. L., Forman, D. E., Green, A. R., Jacobson, T. A., Orkaby, A. R., Saseen, J. J., & Virani, S. S. (2025). Managing hypercholesterolemia in adults older than 75 years without a history of atherosclerotic cardiovascular disease: An expert clinical consensus from the National Lipid Association and the American Geriatrics Society. Journal of Clinical Lipidology, 19, 215–237. https://doi.org/10.1016/j.jacl.2024.09.005
- Braga, P. G. S., Freitas, F. R., Bachi, A. L. L., Amirato, G. R., Baroni, R. V., Alves, M. J. N. N., Vieira, R. P., Vaisberg, M. W., Aldin, M. N., Kalil Filho, R., Figueiredo Neto, A. M., Damasceno, N. R. T., Tavoni, T. M., Maranhão, R. C., & Damasceno, N. R. T. (2023). Regular practice of physical activity improves cholesterol transfers to high-density lipoprotein (HDL) and other HDL metabolic parameters in older adults. Nutrients, 15(23), 4871. https://doi.org/10.3390/nu15234871
- Brunham, L. R., Lonn, E., & Mehta, S. R. (2024). Dyslipidemia and the current state of cardiovascular disease: Epidemiology, risk factors, and effect of lipid lowering. Canadian Journal of Cardiology, 40(Suppl. 1), S4–S12. https://doi.org/10.1016/j.cjca.2024.04.017
- Carson, J. A. S., Lichtenstein, A. H., Anderson, C. A. M., Appel, L. J., Kris-Etherton, P. M., Meyer, K. A., Petersen, K., Polonsky, T., & Van Horn, L. (2020). Dietary cholesterol and cardiovascular risk: A science advisory from the American Heart Association. Circulation, 141(3), E39–E53. https://doi.org/10.1161/CIR.0000000000000743
- Chan, A. K. Y., Tsang, Y. C., Jiang, C. M., Leung, K. C. M., Lo, E. C. M., & Chu, C. H. (2023). Diet, nutrition, and oral health in older adults: A review of the literature. Dentistry Journal, 11(9), 222. https://doi.org/10.3390/dj11090222
- Chen, X., Tao, L., & Wang, Y. (2025). Association of dietary fiber intake with all-cause and cardiovascular mortality in diabetes and prediabetes. Diabetology & Metabolic Syndrome, 17, 1810. https://doi.org/10.1186/s13098-025-01810-9
- Doewes, R. I., Gharibian, G., Zadeh, F. A., Zaman, B. A., Vahdat, S., & Akhavan-Sigari, R. (2023). An updated systematic review on the effects of aerobic exercise on human blood lipid profile. Current Problems in Cardiology, 48, 101108. https://doi.org/10.1016/j.cpcardiol.2022.101108
- Feingold, K. R., & Chait, A. (2023). Approach to patients with elevated low-density lipoprotein cholesterol levels. Best Practice & Research: Clinical Endocrinology & Metabolism, 37, 101658. https://doi.org/10.1016/j.beem.2022.101658
- Feng, L., Nian, S., Tong, Z., Zhu, Y., Li, Y., Zhang, C., Bai, X., Luo, X., Wu, M., & Yan, Z. (2020). Age-related trends in lipid levels: A large-scale cross-sectional study of the general Chinese population. BMJ Open, 10, e034226. https://doi.org/10.1136/bmjopen-2019-034226
- Franczyk, B., Gluba-Brzózka, A., Ciałkowska-Rysz, A., Ławiński, J., & Rysz, J. (2023). The impact of aerobic exercise on HDL quantity and quality: A narrative review. International Journal of Molecular Sciences, 24(5), 4653. https://doi.org/10.3390/ijms24054653
- Izquierdo, M., Duque, G., & Morley, J. E. (2021). Physical activity guidelines for older people: Knowledge gaps and future directions. The Lancet Healthy Longevity, 2(6), e380–e383. https://doi.org/10.1016/S2666-7568(21)00079-9
- Khalafi, M., Sakhaei, M. H., Kazeminasab, F., Rosenkranz, S. K., & Symonds, M. E. (2023). Exercise training, dietary intervention, or combined interventions and their effects on lipid profiles in adults with overweight and obesity: A systematic review and meta-analysis of randomized clinical trials. Nutrition, Metabolism and Cardiovascular Diseases, 33(8), 1662–1683. https://doi.org/10.1016/j.numecd.2023.05.024
- Kunutsor, S. K., & Laukkanen, J. A. (2024). Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: A narrative review. Expert Review of Cardiovascular Therapy, 22(2), 91–101. https://doi.org/10.1080/14779072.2024.2328644
- Lin, L., Kiryakos, J., Ammous, F., Ratliff, S. M., Ware, E. B., Faul, J. D., Kardia, S. L. R., Zhao, W., Birditt, K. S., & Smith, J. A. (2024). Epigenetic age acceleration is associated with blood lipid levels in a multi-ancestry sample of older U.S. adults. BMC Medical Genomics, 17, 1–12. https://doi.org/10.1186/s12920-024-01914-7
- Liu, J., Jin, X., Feng, Z., & Huang, J. (2023). The association of central and extremity circumference with all-cause mortality and cardiovascular mortality: A cohort study. Frontiers in Cardiovascular Medicine, 10, 1251619. https://doi.org/10.3389/fcvm.2023.1251619
- Markovič, R., Grubelnik, V., Vošner, H. B., Kokol, P., Završnik, M., Janša, K., Zupet, M., Završnik, J., & Marhl, M. (2022). Age-related changes in lipid and glucose levels associated with drug use and mortality: An observational study. Journal of Personalized Medicine, 12(2), 280. https://doi.org/10.3390/jpm12020280
- Mazur, M., Przytuła, A., Szymańska, M., & Popiołek-Kalisz, J. (2024). Dietary strategies for cardiovascular disease risk factors prevention. Current Problems in Cardiology, 49, 102746. https://doi.org/10.1016/j.cpcardiol.2024.102746
- Moraes, E. G., Generoso, G., Bensenor, I. M., Santos, R. D., Santos, I. S., Goulart, A. C., Jones, S. R., Kulkarni, K. R., Blaha, M. J., Toth, P. P., Lotufo, P. A., & Bittencourt, M. S. (2025). Association of obesity and LDL subfractions evaluated by body mass index, waist circumference, and diabetes status: The ELSA-Brasil study. Diabetology & Metabolic Syndrome, 17, 1644. https://doi.org/10.1186/s13098-025-01644-5
- Muscella, A., Stefàno, E., & Marsigliante, S. (2020). The effects of exercise training on lipid metabolism and coronary heart disease. American Journal of Physiology-Heart and Circulatory Physiology, 319(1), H76–H88. https://doi.org/10.1152/ajpheart.00708.2019
- Pandey, M., AlQassab, O., Kanthajan, T., Parikh, A., Francis, A. J., Sreenivasan, C., & Nwosu, M. (2024). Effectiveness of high-fiber, plant-based diets in reducing cardiovascular risk factors among middle-aged and older adults: A systematic review. Cureus, 16, e67660. https://doi.org/10.7759/cureus.67660
- Ragusa, F. S., Tanaka, T., Veronese, N., Mansueto, P., Dominguez, L. J., Barbagallo, M., & Ferrucci, L. (2025). Weight of time: Exploring the link between obesity and aging. Aging Clinical and Experimental Research, 37, 1–20. https://doi.org/10.1007/s40520-025-03106-4
- Shirazi, D., Haudenschild, C., Lynch, D. H., Fanous, M., Kahkoska, A. R., Jimenez, D., Spangler, H., Driesse, T., & Batsis, J. A. (2023). Obesity, multiple chronic conditions, and the relationship with physical function: Data from the National Health and Aging Trends Study. Archives of Gerontology and Geriatrics, 107, 104913. https://doi.org/10.1016/j.archger.2022.104913
- Silva, F. M., Duarte-Mendes, P., Teixeira, A. M., Soares, C. M., & Ferreira, J. P. (2024). The effects of combined exercise training on glucose metabolism and inflammatory markers in sedentary adults: A systematic review and meta-analysis. Scientific Reports, 14, 51832. https://doi.org/10.1038/s41598-024-51832-y
- Sitohang, M. Y. (2023). Understanding ageing populations in high-income countries: Lesson learned for Indonesia. Journal of Indonesian Social and Humanities (JISSH), 13, 65–76. ⚠ DOI/URL tidak tersedia https://ejournal.brin.go.id/jissh/article/view/8873
- Soliman, G. A. (2019). Dietary fiber, atherosclerosis, and cardiovascular disease. Nutrients, 11(5), 1155. https://doi.org/10.3390/nu11051155
- Song, R., Hu, M., Qin, X., Qiu, L., Wang, P., Zhang, X., Liu, R., & Wang, X. (2023). The roles of lipid metabolism in the pathogenesis of chronic diseases in the elderly. Nutrients, 15(15), 3433. https://doi.org/10.3390/nu15153433
- Suresh, A., Shobna., Salaria, M., Morya, S., Khalid, W., Afzal, F. A., Khan, A. A., Safdar, S., Khalid, M. Z., & Mukonzo Kasongo, E. L. (2024). Dietary fiber: An unmatched food component for sustainable health. Food and Agricultural Immunology, 35, 2384420. https://doi.org/10.1080/09540105.2024.2384420
- Syeda, U. S. A., Battillo, D., Visaria, A., & Malin, S. K. (2023). The importance of exercise for glycemic control in type 2 diabetes. American Journal of Medicine Open, 9, 100031. https://doi.org/10.1016/j.ajmo.2023.100031
- Xiao, J., Wei, H., Gao, Z., Chen, L., Ye, W., & Huang, W. (2024). Differential age-specific associations of LDL cholesterol and body mass index with coronary heart disease. Atherosclerosis, 393, 117542. https://doi.org/10.1016/j.atherosclerosis.2024.117542
- Yun, H., Su, W., Zhao, H., Li, H., Wang, Z., Cui, X., Xi, C., Gao, R., Sun, Y., & Liu, C. (2023). Effects of different exercise modalities on lipid profile in the elderly population: A meta-analysis. Medicine, 102(26), e33854. https://doi.org/10.1097/MD.0000000000033854
- Zhang, H. R., Yang, Y., Tian, W., & Sun, Y. J. (2022). Dietary fiber and all-cause and cardiovascular mortality in older adults with hypertension: A cohort study of NHANES. Journal of Nutrition, Health & Aging, 26(5), 407–414. https://doi.org/10.1007/s12603-022-1770-3
- Zhang, T., Liu, Y., Yang, Y., Luo, J., & Hao, C. (2025). The effect and mechanism of regular exercise on improving insulin resistance: Based on the perspective of cellular and molecular levels. International Journal of Molecular Sciences, 26(9), 4199. https://doi.org/10.3390/ijms26094199
- Zheng, Y., Fang, Y., Xu, X., Ye, W., Kang, S., Yang, K., Cao, Y., Xu, R., Zheng, J., & Wang, H. (2023). Dietary saturated fatty acids increased all-cause and cardiovascular disease mortality in an elderly population: The National Health and Nutrition Examination Survey. Nutrition Research, 120, 99–114. https://doi.org/10.1016/j.nutres.2023.10.002
Copyright (c) 2026 Sutrio Sutrio, Arie Nugroho, Endang Sri Wahyuni, Sefanadia Putri

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.