TINJAUAN SISTEMATIS KOMPREHENSIF PENGARUH GAYA HIDUP SEDENTER TERHADAP RISIKO KEJADIAN STROKE ISKEMIK PADA USIA DEWASA MUDA
Keywords:
gaya hidup sedenter, perilaku duduk berkepanjangan, stroke iskemik, dewasa mudaAbstract
Pendahuluan: Insidens stroke iskemik pada dewasa muda meningkat secara global sejak 2015, berlawanan dengan tren penurunan pada kelompok usia lanjut. Gaya hidup sedenter merupakan perilaku yang sangat lazim pada kelompok usia produktif, namun besar dan bentuk hubungannya dengan stroke iskemik pada dewasa muda belum pernah disintesis secara kuantitatif. Tujuan penelitian adalah mengukur besar asosiasi gaya hidup sedenter dengan risiko stroke serta menguji apakah asosiasi tersebut lebih kuat pada populasi berusia muda. Hipotesis penelitian menyatakan bahwa gaya hidup sedenter berhubungan independen dengan peningkatan risiko stroke iskemik, dengan besar efek yang lebih tinggi pada dewasa muda.
Metode: Tinjauan sistematis dan meta-analisis dilakukan mengikuti pedoman PRISMA 2020. Kriteria inklusi dibatasi pada uji acak terkendali, studi kohort, kasus-kontrol, potong lintang, dan studi observasional lain yang melaporkan estimasi efek terdisesuaikan. Penggabungan menggunakan metode DerSimonian–Laird; heterogenitas dinilai dengan I², τ², dan uji Q; bias publikasi dievaluasi dengan funnel plot, uji Egger, uji Begg, serta trim-and-fill Duval–Tweedie. Risiko bias dinilai dengan Newcastle–Ottawa Scale termodifikasi dan kepastian bukti dengan GRADE.
Hasil: Dua puluh empat studi observasional (1.988.882 partisipan; 16 negara) memenuhi kriteria. Pada luaran primer (20 studi), pajanan sedenter tertinggi dibandingkan terendah berhubungan dengan peningkatan risiko stroke sebesar 42% (RR 1,42; IK 95% 1,30–1,54; p < 0,001; I² = 80,6%). Untuk stroke iskemik, RR 1,86 (IK 95% 1,37–2,51; p < 0,001). Durasi duduk ≥8 jam/hari meningkatkan risiko 53% (RR 1,53; IK 95% 1,26–1,86), dan setiap penambahan 1 jam/hari meningkatkan risiko 8% (RR 1,08; IK 95% 1,04–1,13). Besar efek lebih tinggi pada populasi berusia ≤55 tahun (RR 1,64; IK 95% 1,31–2,06) dibandingkan populasi lebih tua (RR 1,25; IK 95% 1,14–1,37); uji perbedaan antar-subgrup χ² = 4,89; p = 0,027. Kombinasi sedenter berkepanjangan dan inaktivitas fisik memberikan risiko tertinggi (RR 3,82; IK 95% 2,68–5,46; I² = 0%). Uji Egger tidak menunjukkan bias publikasi (p = 0,204) dan estimasi trim-and-fill tetap bermakna (RR 1,37; IK 95% 1,25–1,49).
Kesimpulan: Gaya hidup sedenter merupakan faktor risiko independen dan dapat dimodifikasi untuk stroke iskemik, dengan besar efek yang lebih menonjol pada dewasa muda. Pembatasan durasi duduk di bawah 8 jam per hari, interupsi duduk berkala, dan pemenuhan aktivitas fisik sedang–berat minimal 150 menit per minggu direkomendasikan sebagai komponen baku pencegahan primer stroke pada kelompok usia produktif.
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