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HUBUNGAN LINGKAR PINGGANG DENGAN GLUKOSA DARAH PUASA PADA WANITA MENOPAUSE DI SEMARANG Keyasa, Magnalia Morena Ruth; Widyastuti, Nurmasari; Margawati, Ani; Dieny, Fillah Fithra
Journal of Nutrition College Vol 10, No 3 (2021): Juli
Publisher : Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jnc.v10i3.29168

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Latar Belakang: Wanita menopause biasanya bermasalah dengan peningkatan lingkar pinggang yang disebabkan oleh obesitas. Lingkar pinggang dan kadar glukosa darah puasa berhubungan secara signifikan pada wanita postmenopause.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan lingkar pinggang dengan kadar glukosa darah puasa pada wanita menopause.Metode: Penelitian ini menggunakan rancangan cross sectional pada subjek 55 wanita menopause yang diambil dengan metode simple random sampling. Data lingkar pinggang didapatkan melalui pengukuran antropometri, data asupan diperoleh melalui wawancara semi-quantitative food frequency questionnaire. Analisis kadar glukosa darah puasa menggunakan Spektrofotometer Biolyzer 100. Analisis bivariate menggunakan uji rank spearman. Hasil: Sebagian besar subjek (81,8%) penelitian memiliki kadar glukosa darah puasa normal dengan rerata 108,8±4,2 mg/dl, sedangkan lingkar pinggang terdapat 60% termasuk kategori obesitas. Hasil penelitian ini tidak terdapat hubungan bermakna antara lingkar pinggang dengan kadar glukosa darah puasa pada wanita menopause (r=0,122, p=0,376).Simpulan: Tidak terdapat hubungan antara lingkar pinggang dengan kadar glukosa darah puasa pada wanita menopause.
DEFISIENSI BESI PADA WANITA USIA SUBUR PRANIKAH OBESITAS Fillah Fithra Dieny; Nurmasari Widyastuti; Deny Yudi Fitranti; Choirun Nissa; A. Fahmy Arif Tsani; Firdananda Fikri Jauharany
Media Gizi Mikro Indonesia Vol 10 No 2 (2019): Media Gizi Mikro Indonesia Juni 2019
Publisher : Balai Penelitian dan Pengembangan Kesehatan Magelang

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (277.735 KB) | DOI: 10.22435/mgmi.v10i2.599

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Latar Belakang. Wanita usia subur (WUS) terutama di Indonesia saat ini menghadapi masalah gizi ganda yang kompleks. Obesitas merupakan salah satu masalah gizi yang paling banyak dialami oleh WUS. Anemia merupakan satu sisi lain dari masalah gizi ganda yang banyak dialami di negara berkembang. Obesitas diketahui memiliki hubungan dengan anemia pada WUS. Tujuan. Menganalisis status besi pada WUS pranikah dengan status gizi obesitas dan non obesitas. Metode. Penelitian ini merupakan penelitian observasional dengan desain cross-sectional yang dilakukan pada 50 mahasiswi Universitas Diponegoro, Semarang. Subjek berusia 18-25 tahun dan dipilih dengan metode systematic random sampling. Subjek terdiri dari 25 mahasiswi obesitas dan 25 mahasiswi non obesitas. Status besi diukur melalui serum besi, serum Transferrin Saturation (TSAT), dan Total Iron Binding Capacity (TIBC). Status obesitas dilihat melalui pengukuran antropometri persen lemak tubuh. Uji T tidak berpasangan digunakan untuk mengetahui perbedaan status besi pada WUS pranikah obesitas dan non obesitas. Hasil. Ada perbedaan kadar serum besi (p=0,027), TIBC (p=0,034), dan TSAT (p=0,004) antara kelompok obesitas dan non obesitas. Kadar serum besi kelompok obesitas lebih rendah, ditunjukkan dengan rerata sebesar 83,99±20,66 μg/dl pada kelompok obesitas, sedangkan kelompok non obesitas sebesar 99,2±26,03 μg/dl. Kadar TIBC kelompok obesitas lebih tinggi dilihat dari reratanya sebesar 420,98±47,22 μg/dl, sedangkan kelompok non obesitas 389,94±53,35 μg/dl. Pengukuran TSAT menunjukkan kelompok obesitas memiliki kadar yang lebih rendah ditunjukkan dengan reratanya 20,13±5,27%, sedangkan kelompok non obesitas memiliki rerata sebesar 25,99±7,92%. Kesimpulan. Kelompok obesitas memiliki rata-rata kadar serum besi dan TSAT lebih rendah serta rata-rata kadar TIBC lebih tinggi.
Perbedaan konsumsi makanan jajanan kemasan mengandung monosodium glutamat dan status gizi pada remaja urban dan sub urban di Kabupaten Semarang Atika Putri Widia Anggraeni; Nurmasari Widyastuti; Rachma Purwanti; Deny Yudi Fitranti
Darussalam Nutrition Journal Vol 4, No 2 (2020): Darussalam Nutrition Journal
Publisher : University of Darussalam Gontor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21111/dnj.v4i2.3980

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Latar belakang: Konsumsi MSG secara berlebihan dapat menyebabkan masalah kesehatan seperti status gizi berlebih (overweight) hingga Obesitas. Tujuan: Mengetahui perbedaan konsumsi makanan jajanan kemasan mengandung MSG dan status Gizi pada remaja SMA usia 15-17 tahun urban dan sub urban di Kabupaten Semarang. Metode: Penelitian observasional dengan rancangan deskriptif analitik dengan pendekatan cross sectional. Subjek penelitian sebanyak 47 orang remaja urban dan 47 remaja sub urban di Kabupaten Semarang. Uji statistik yang digunakan Chi Square. Hasil:Umur remaja urban dan sub urban antara 15-17 tahun yang terdiri dari jenis kelamin laki-laki (53,2%) dan perempuan (46,8%). Lebih dari separuh remaja urban mempunyai uang saku > Rp. 15.000 (53,2%), sedangkan pada remaja sub urban lebih dari separuhnya (57,4%) memiliki uang saku < Rp 15.000. Terdapat perbedaan frekuensi konsumsi jajanan kemasan mengandung MSG pada remaja urban dan sub urban (p=0,004a). Persentase remaja sub urban dengan frekuensi konsumsi sering (³7x/minggu) sebesar 34,0% lebih tinggi dibandingkan dengan remaja urban yaitu sebesar 27,7%. Simpulan: Ada perbedaan konsumsi jajanan  kemasan mengandung MSG pada remaja urban dan sub urban. Frekuensi konsumsi jajanan kemasan mengandung MSG pada remaja sub urban lebih tinggi dari pada remaja urban.Background: Overconsumption of MSG can effect to increased health problems like overweight to obesity. Objectives: to determine the differences in consumption of packaged snacks containing MSG and nutritional status between 15 – 17 years old urban and suburban senior high school students at Semarang Regency. Methods: This observational study using a descriptive-analytic design and cross-sectional approach. Samples of this study were 47 urban and 47 suburban adolescents in the Semarang Regency. Statistical analysis included univariate and bivariate tests using Chi-Square. Results: Urban and suburban adolescents were between 15-17 years old which consist of Male (53.2%) and females (46.8%). More than half the percentages of the urban group had more than IDR 15,000 (53.2%) allowance while more than half the percentages of the suburban groups had less than IDR 15,000 (57.4%). There was difference in the frequency of packaging snack consumption between urban and suburban groups (p = 0.004a). Sub urban adolescent with high frequency of packaging snack consumption (³7x/week) were 34.0% more than urban adolescent (27.7%). Conclusion: There was a difference in the consumption frequency of packaged snacks between urban and suburban groups. Suburban group had higher consumption frequency of packaged snacks than urban group.
Asupan makan, sindrom metabolik, dan status keseimbangan asam-basa pada lansia Nurmasari Widyastuti; Muhammad Sulchan; Andrew Johan
Jurnal Gizi Klinik Indonesia Vol 9, No 4 (2013): April
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.18366

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Background: Metabolic syndrome prevalence increases with age and obesity. The metabolic syndrome is associated with alterations in renal function. Low urine pH has been described as a renal manifestation of the metabolic syndrome. Urine pH is a simple and inexpensive method for determining acid-base status. Recent studies suggest that acid-base status is associated with dietary intake.Objective: To examine relationship between dietary intake, components of metabolic syndrome and urine pH among the elderly.Method: Subjects of this cross-sectional study consist of 49 elderly that were collected consecutively. Height, weight, waist circumference (WC), dietary intake, blood pressure (BP), fasting blood glucose and urine were obtained. Rank Spearman correlation test was used to examine the correlation of components of metabolic syndrome and dietary intake with urine pH. Mann-Whitney test was used to compare the urine pH of the metabolic syndrome group and the normal group. Chi-Square/fisher test was used to calculate prevalence ratio (PR) of metabolic syndrome components to low urine pH. Multivariate analysis was done by multiple linear regression.Results: The mean urine pH of the metabolic syndrome group was 6,06 and significantly lower than the normal group (6,50). WC was the only component of metabolic syndrome that related to urine pH (r=-0,325; p=0,023). Abdominal obesity significantly increases the risk of low urine pH (RP=1,6; p=0,023; CI=1,005-2,442). Urine pH was negatively associated with protein intake and proportion of protein on diet. In multivariate analysis, WC is the most significant factor that predicted urinary pH.Conclusion: Urine acidification is a characteristic of abdominal obesity and the metabolic syndrome. Protein intake and proportion of protein on diet contribute to urine pH.
Asupan lemak jenuh dan serat pada remaja obesitas kaitannya dengan sindrom metabolik Nurmasari Widyastuti; Fillah Fithra Dieny; Deny Yudi Fitranti
Jurnal Gizi Klinik Indonesia Vol 12, No 4 (2016): April
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.22756

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Background: There is an emerging global increase of metabolic syndrome prevalence due to increasing of obesity. Obesity and metabolic syndrome beginning in childhood progressing into adulthood.  Dietary saturated fat and fiber intake play a role in etiology in obesity.Objective: This study was to examine the associations between dietary saturated fat intake, fiber intake and components of metabolic syndrome among obese adolescents.Method: A cross-sectional study was conducted to 57 obese students aged 13-15 years old of SMP Nasima and SMP Kesatrian 2 Semarang, based on body mass index for ages. Subjects of this study were collected consecutively. Data were collected through waist circumference and blood pressure measurements, fasting biochemical serum analysis and dietary intake assessment.  Rank Spearman and Pearson correlation test was used to examine the associations between of dietary saturated fat and fiber intake to components of metabolic syndrome.Results: There were 46 subjects (80,7 %) had metabolic syndrome and 11 subjects (19,3 %) had the pre-metabolic syndrome. There was no association between dietary saturated fat intake and waist circumference, HDL cholesterol, triglyceride, fasting blood glucose levels and blood pressure. Fiber intake was negatively associated with blood triglyceride levels (r = -0.340; p = 0.01).Conclusion: There was no association between dietary saturated fat intake and components of metabolic syndrome. There was an association between dietary fiber intake with blood triglyceride levels. Dietary fiber intake has an important role in lipid metabolism.
Sindrom metabolik pada remaja obes: prevalensi dan hubungannya dengan kualitas diet Fillah Fithra Dieny; Nurmasari Widyastuti; Deny Yudi Fitranti
Jurnal Gizi Klinik Indonesia Vol 12, No 1 (2015): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.22830

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Background: The increasing prevalence of adolescents obesity in the last decade have an impact on the increased prevalence of adolescents metabolic syndrome (MetS). Diet quality is one of the determining factors in the incidence of adolescents obesity, so it can also be a factor for MetS.Objective: To analyze the relationship between diet quality and MetS risk factors in obese adolescents.Method: A cross-sectional study was conducted on the 57 obese students in 7th and 8th grades of Nasima and Kesatrian Junior High School in Semarang. Blood pressure (BP) and waist circumference (WC) measurements, as well as blood samples for measurement of fasting blood glucose (FBG), triglyceride (TG) and HDL cholesterol (HDL-C), were conducted to determine the number of risk factors experienced by the subject. Diet quality was measured through assessment of food consumption using a food frequency questionnaire (FFQ). Pearson and Spearman's test was used to determine the correlation between diet quality and MetS risk factors.Results: The majority of obese adolescents (96.5%) had a low-quality of diet. There were 31.6% subjects experienced pre-metabolic syndrome and 68.4% had MetS, with the prevalence of MetS, was higher in male subjects. The diet quality, variety, adequacy scores and fiber intake of the pre-metabolic syndrome group were higher than MetS group. Variety and adequacy scores had significant negative correlation with TG (r = -0.374, p=0.004; r = -0.357, p=0.006, respectively). There was no significant relationship between diet quality score and the number of MetS risk factors (p=0.538), although they had a negative correlation (r = -0.083).Conclusion: Prevalence of pre-metabolic syndrome and MetS was 31.6% and 68.4%. Though there was no significant relationship, diet quality had a negative correlation with the number of MetS risk factors. Variety and adequacy scores had a significant relationship with triglyceride levels.
Keseimbangan asam-basa tubuh dan kejadian sindrom metabolik pada remaja obesitas Firdananda Fikri Jauharany; Nurmasari Widyastuti
Jurnal Gizi Klinik Indonesia Vol 14, No 1 (2017): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.24811

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Background: The prevalence of metabolic syndrome increased in young population, indicated by the rise in obesity among children and adolescent. The Western dietary pattern was one of the causes. A Western diet rich in animal protein can produce acid during the metabolic process and may cause an acid-excess in the body (dietary acid load). This process was contributed to acid-base balance through the metabolism of sulfur-containing amino acids (cysteine and methionine) which produce H+ ions as well as lowering the pH.Objective: To examine the association between acid-base balance and components of metabolic syndrome among obese adolescent.Method: A cross-sectional study was conducted on 40 obese adolescents in Semarang high school. We measured Potential Renal Acid Load (PRAL) score and pH urine as an acid-base indicator. MetS are defined ≥ 3 following risk factors: waist circumference ≥90th percentile, blood pressure ≥90th percentile, triglycerides ≥110 mg/dl, HDL levels ≤40 mg/dl, and fasting blood glucose levels ≥110 mg/dl. Normality test used the Shapiro-Wilk test (n <50). The bivariate analysis used Pearson test, Rank-Spearman test, and Chi-Square test. The multivariate analysis used Multivariate Linear Regression analysis of Backward.Results: PRAL score was associated with waist circumference (r=0,347; p=0,028), sistolic blood pressure (r=0,590; p=<0,001), diastolic blood pressure (r=0,668; p=<0,001), and triglyceride levels (r=0,362; p=0,022). pH urin was not associated with any risk factors of MetS.Conclusion: High dietary acid load may be a risk factor for the development of MetS.
Lingkar pinggang dan lingkar leher dengan kadar kolesterol total pada wanita usia subur obesitas Rifial Ramadhan Manik; Nurmasari Widyastuti; Choirun Nissa
Jurnal Gizi Klinik Indonesia Vol 15, No 3 (2019): Januari
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.38171

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Waist circumference, and neck circumference correlated to total cholesterol among reproductive-age women with obesityBackground: Dyslipidemia is a metabolic disorder condition that is closely related to cholesterol and obesity. The prevalence of obesity in reproductive-age women (>18 years) in Indonesia increased dramatically. Reproductive age women with obesity are at greater risk of hypercholesterolemia compared with non-obese. Waist circumference (WC), mid-upper arm circumference (MUAC), and neck circumference (NC) can be used as a marker of higher or low cholesterol levels. Objective: This study aimed to determine the relationship between WC, MUAC, and NC with total cholesterol. Methods: The study design was cross-sectional with several subjects were 54 women of reproductive-aged 18-29 years. Subject with obese category (BMI ≥25kg/m2) was measured the WC, MUA, and NC as an independent variable and total cholesterol as the dependent variable, and dietary intake (total fat, cholesterol, and saturated fat) as confounding variables. The bivariate analysis used the Pearson correlation test. Multivariate analysis used multivariate linear regression. Results: Bivariate analysis showed there was a significant relationship between WC and NC to total cholesterol (p=0.006 and p=0.001), but not on MUAC (p=0.063). In multivariate analysis, NC is the most significantly related to total cholesterol (β=0.367; p=0.004; Adjusted R Square 24%) than WC. Conclusions: There is a significant relationship between WC and NC to the total cholesterol in women of reproductive age obesity. NC more significantly related to total cholesterol.
Kadar gula darah atlet sepak bola remaja setelah pemberian diet beban glikemik Rahma Wati Dwi Lestari; Deny Yudi Fitranti; Nurmasari Widyastuti; Ahmad Syauqy; Binar Panunggal; Fillah Fithra Dieny; Hartanti Sandi Wijayanti; Dewi Marfu&#039;ah Kurniawati
Jurnal Gizi Klinik Indonesia Vol 17, No 4 (2021): April
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.58277

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Effect of diets with glycemic load arrangement on blood glucose levels in young soccer athletes Background: Carbohydrate arrangement considering the glycemic index (GI) and glycemic load (BG) are important to support the performance of athletes.Objective: To examine the effect of diets with glycemic load arrangement on blood glucose levels in young soccer athletes.Methods: Quasi-experimental study on 14 male young soccer players aged 15-18 years old at Terang Bangsa Soccer School. Each subject completed 4 trials separated by at least 7 days as a washout period. Diets provided consist of high GI with high GL diet (H-H), low GI with high GL diet (L-H), high GI with low GL (H-L), and low GI with low GL diet (L-L). Collected data were fasting blood glucose level (BGL 0), blood glucose level one hour after intervention (BGL 1), blood glucose level two hours after intervention (BGL 2), and blood glucose level after exercise (BGL 3).Results: The results of paired t-test analysis showed that there were differences between fasting blood glucose level and blood glucose level one hour after intervention, blood glucose level one hour after intervention and blood glucose level two hours after intervention, blood glucose level two hours after intervention and blood glucose level after exercise in the H-H and L-H diet group. In the L-L diet group, there were differences between BGL 2 and BGL 3. One-Way ANOVA analysis showed that there were no significant differences in blood glucose levels one hour after the intervention, blood glucose level two hours after intervention, and blood glucose level after exercise between groups.Conclusions: High glycemic load diets influence the increase in blood glucose levels at 1 hour postprandial and after exercise. Low glycemic load diets influence the increase in blood glucose levels after exercise. Diets with the arrangement of glycemic index and glycemic load did not affect blood glucose levels between diet groups. 
Korelasi Aktivitas Fisik dan Persen Lemak Tubuh dengan Indikator Sarkopenia Pravita Dewi Suhada; Nurmasari Widyastuti; Aryu Candra; Ahmad Syauqy
Amerta Nutrition Vol. 5 No. 1 (2021): AMERTA NUTRITION
Publisher : Universitas Airlangga, Kampus C, Mulyorejo, Surabaya-60115, East Java, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/amnt.v5i1.2021.15-22

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Latar Belakang: Sarkopenia erat kaitannya dengan aktivitas fisik dan komposisi tubuh terutama persen lemak tubuh. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan aktivitas fisik dan persen lemak tubuh dengan indikator sarkopenia.Metode: Penelitian ini merupakan studi cross sectional dengan 40 subjek usia 50-59 tahun yang dipilih dengan metode consecutive sampling pada warga penghuni rumah susun Karangroto. Subjek diukur tinggi badan dan berat badan untuk mengetahui status gizi. Indikator sarkopenia diamati dengan mengukur massa otot, kekuatan otot dan performa fisik. Massa otot dan persen lemak tubuh diukur dengan Bioelectrical Impedance Analysis (BIA), kekuatan otot diukur dengan Electronic Hand Dynamometer, performa fisik diukur dengan tes Time Up and Go (TUG), aktivitas fisik diukur dengan kuesioner self-report International Physical Activity Questionnaire (IPAQ) Short Form, dan asupan makanan diukur dengan kuesioner semi kuantitatif Food Frequency Questionnaire (FFQ). Analisis data menggunakan Tes Mann Whitney U, korelasi Pearson Product-Moment dan Rank Spearman.Hasil: Sebesar 62,5%; 47,5%; 52,5%; 52,5%; 2,5%; 40%; 5% subjek secara berurutan memiliki Indeks Massa Tubuh kategori obesitas, persen lemak kategori obesitas, aktivitas fisik sedang, asupan lemak lebih, massa otot rendah, kekuatan otot rendah dan performa fisik rendah. Terdapat perbedaan signifikan pada massa otot dan kekuatan otot antara laki-laki dan perempuan (p<0,001). Aktivitas sedentary berkorelasi negatif dengan massa otot (r -0,434; p 0,005), serta persen lemak dengan massa otot (r -0,356; p 0,024).Kesimpulan: Terdapat hubungan yang signifikan antara aktivitas sedentary dan persen lemak tubuh dengan indikator sarkopenia yaitu massa otot pada penghuni rumah susun Karangroto, Semarang.
Co-Authors A Fahmy Arif Tsani Abyyudha, Dany Adriyan Pramono Agita, Viony Vira Ahmad Syauqy Andani, Sofia Arum Andrew Johan Ani Margawati Anjani, Gemala Anjarsari Retno Utami, Anjarsari Retno Arifani, Rochanisa Sita Aristanti, Aprilia Aryu Candra Astuti, Anak Agung Ayu Fuji Dwi Atika Putri Widia Anggraeni Ayu Rahadiyanti Beti Dwi Suryandari, Beti Dwi Binar Panunggal Choirun Nissa Choirun Nissa Deny Yudi Fitranti Destikasari, Widya Dewi Kurnia Sandi Dewi Marfu’ah Kurniawati Dewi, Arini Citra Dhea Aghestya Enny Probosari Etika Ratna Noer Etisa Adi Murbawani Fauzia, Ria Fillah Fithra Dieny Hartanti Sandi Wijayanti Hermawan, Febriyanti Jauharany, Firdananda Fikri Keyasa, Magnalia Morena Ruth Kusumastuti, Evi Lestari, Rahma Wati Dwi Lilis Endang Wijayanti, Lilis Endang Manik, Rifial Ramadhan MARTHA ARDIARIA Masruroh, Zulfatul Monikasari, Monikasari Muhammad Sulchan Muhammad Sulchan Mursid Tri Susilo Nabila, Rumaisha Nidya Witosari Nissa, Choirun Nur Aini, Fadhilah Nurhidayati, Lisa Rosyida Pravita Dewi Suhada Purbosari, Enny Puspasari, Indah Rachma Purwanti Rahma Wati Dwi Lestari Rahmadani, Prita Ady Rani Pramesti Renata, Maria Dolorosa Sus Retno Tri Wulandari Rifial Ramadhan Manik Rika Purwani, Rika Rosha, Putri Tiara Rujiantina, Ahaddini Septian Sahara, Mailina Prima Sandi, Dewi Kurnia Septamarini, Risna Galuh Setiawan, Muhamad Irwan Siringoringo, Ester Theresia Suwito, Maria Rebecca Tantri, Ignas Fawwaz Teddy Wahyu Nugroho, Teddy Wahyu Triyanto, Bagaskara Putra Tsani, A Fahmy Arif Tzani, Niza Iana Wanty, Wanty Wardana, Ruliansyah Kusuma Widya Destikasari Widyanti, Alfreda Sabrina Zana Fitriana Octavia