bahan ajar

Gut : Gut
Hematology/Oncology Clinics of North America : Hematol Oncol Clin North Amer
Human Pathology : Human Pathol
JAMA; Journal of American Medical Association : JAMA
Journal of Allergy and Clinical Immunology : J Allergy Clin Immunol
Journal of Clinical Endocrinology and Metabolism : J Clin Endocrinol Metab
Journal of Clinical Investigation : J Clin Invest
Journal of Clinical Pathology : J Clin Pathol
Journal of Experimental Medicine : J Exp Med
Journal of Immunology : J Immunol
Journal of Infectious Disease : J Infect Dis
Journal of Neurosurgery : J Neurosurg
Journal of Pathology : J Pathol
Journal of Pediatrics : J Pediatr
Journal of Physiology : J Physiol
Journal of Urology : J urol
Lancet : Lancet
Medical Clinics of North America : Med Clin North Amer
Medicine (Baltimore) : Medicine (Baltimore)
New England Journal of Medicine : N Engl J Med
Obstetric and Gynecology : Obstet Gynecol
Pediatric Clinics of North America : Pediatr Clin North Amer
Pediatrics : Pediatrics
Physiological Reviews : Physiol Rev
Postgraduate Medicine : Postgrad Med
Radiology : Radiology
Seminars in Hematology : Semin Hematol
Seminars in Roentgenology : Semin Roentgenol
Surgery : Surgery

36

G. Panduan Pengajuan Etik Penelitian Mahasiswa Politeknik Kesehatan
Kementerian Kesehatan Semarang

Berikut adalah Panduan Mengajukan Etik Penelitian :
1. Pengajuan Sertifikat Ethical Clearance (EC) dapat dilayani pada hari Selasa dan

Kamis, Pukul 13.00 - 15.00 WIB dan atau menyesuaikan.
2. Pengajuan EC hanya melalui website aplikasi DEMO SIM-EPK

(http://keppkn.kemkes.go.id/demo-sim-epk/)
Ketentuan :
a. Berlaku bagi yang belum melakukan pengambilan data
b. Registrasi melalui menu demo pendaftaran peneliti
c. Username dan password harap disimpan untuk login
d. Mahasiswa kemudian melakukan pembayaran
e. Login aplikasi demo = isi identitas, upload bukti bayar, isi protokol dan self

assessment
f. Untuk memantau hasil telaah melalui log in dan klik menu progress protokol.

H. Panduan Penelitian SLR

1. Struktur Penyusunan Tesis dengan Metode Systematic Literature Review
(SLR)/ Systematic Review
Sebagai Gambaran singkat berikut penjelasan mengenai metode SLR:
a. Pengertian Systematic Review adalah tinjauan umum studi primer yang berisi
pernyataan eksplisit tentang tujuan, bahan dan metode dan telah dilakukan
sesuai dengan metodologi yang eksplisit dan dapat direproduksi.
Metode SLR digunakan untuk mengidentifikasi, mengkaji, mengevaluasi, dan
menafsirkan semua penelitian yang tersedia dengan bidang topik fenomena
yang menarik, dengan pertanyaan penelitian tertentu yang relevan. Dengan
penggunaan Metode SLR dapat dilakukan review dan identifikasi jurnal secara
sistematis, yang pada setiap prosesnya mengikuti langkah-langkah atau protokol
yang telah ditetapkan. Dalam hirarki penelitian, systematic review dan
Meta analisis merupakan tingkatan yang paling tinggi.

37

Gambar 1. Hirarki Penelitian.
b. Tipe Review
1) Narrative/ Traditional (overview) review

Digunakan untuk memberikan gambaran umum tentang topik tertentu dan
bermanfaat untuk memahami konsep baru. Metode ini memiliki kekurangan/
kelemahan, diantaranya: jarang komprehensif , tidak mengungkapkan banyak
tentang metodologi mereka , jarang memperhitungkan perbedaan dalam kualitas
studi yang dikaji 4) sering sampai pada kesimpulan yang salah - interpretasi
yang cermat dibutuhkan.
2) Systematic Review/ Systematic Literature Review (SLR)
Meta-analisis merupakan salah satu cara untuk melakukan sintesa hasil secara
statistik (teknik kuantitatif) dan/atau naratif (teknik kualitatif). Metode inilah yang
diijinkan digunakan untuk menyusun tesis karena merupakan studi sekunder
dengan melakukan sintesis dari berbagai hasil penelitian yang relevan, sehingga
fakta yang disajikan lebih komprehensif dan berimbang.
Tabel 1. Perbedaan Systematic Review dengan Traditional Review

38

3) Karakteristik kunci systematic review
a) Fokus pada pertanyaan penelitian yang terdefinisi dengan baik,
b) Judul dan tujuannya jelas,
c) Strategi komprehensif untuk identifikasi semua studi yang relevan,
d) Kriteria inklusi dan eksklusi jelas terjustifikasi,
e) Melakukan penilaian kritis terhadap penelitian,
f) Analisis yang jelas dari hasil studi yang memenuhi syarat (kuantitatif (meta
analisis) dan kualitatif).
g) Laporan terstruktur yang mengandung komponen: Pendahuluan , Kajian
Literatur , Metodologi , Hasil , Diskusi , Kesimpulan.

2. Tahapan penelitian menggunakan metode systematic review
a) Membuat protokol penelitian systematic review
b) Melaksanakan penelitian systematic review

3. Systematic Review Menggunakan PRISMA (Preferred Report Items for
Systematic Reviews and Meta-analyses)
Terdapat 5 tahapan utama dalam melakukan kajian literatur yaitu :
a) Mendefinisikan kriteria kelayakan
Ditentukan dengan Kriteria Inklusi (IC) dimana:
1) IC1: artikel harus merupakan riset asli yang telah dikaji dan dituliskan
dalam bahasa inggris/bahasa indonesia
2) IC2: artikel memiliki tujuan untuk menyelidiki faktor yang mempengaruhi
variabel penelitian yang diinginkan.

39

3) IC3: menentukan secara operasional jenis studi yang akan diambil dan
yang dieliminasi (misalnya, Randomize Controlled Trial (RCT) saja, studi
kuasi eksperimen atau studi kualitatif)

4) IC4: minimal jumlah responden/sampel dalam jurnal yg terpilih.

5) Dan seterusnya.

b) Mendefinisikan sumber informasi
Pencarian literatur dilakukan pada database online yang memiliki repository
besar untuk studi akademis seperti MEDLINE, ABI/Inform Complete, Academic
Search Complete, ACM Digital Library, Elsevier (SCOPUS), Emerald, IEEE
Xplore, ScienceDirect, dan IGI Global, Portal Garuda, Perpusnas. Selain itu,
penelusuran terhadap daftar referensi pada artikel yang masuk dalam kriteria
inklusi juga dilakukan untuk menemukan apakah terdapat studi terkait lainnya
yang berelevansidengan penelitian yang diinginkan.

c) Pemilihan literatur
1) Penentuan kata kunci pencarian,
2) Eksplorasi serta pemilihan judul, abstrak dan kata kunci pada artikel yang
didapatkan dari hasil pencarian berdasarkan kriteria kelayakan yang telah
didefinisikan sebelumnya,
3) Membaca lengkap atau parsial artikel yang belum tereliminasi pada
tahapan sebelumnya untuk menentukan apakah artikel tersebut harus
dimasukkan dalam kajian selanjutnya sesuai dengan kriteria kelayakan,
4) Daftar referensi dari artikel terpilih dikaji kembali untuk menemukan studi
terkaitlainnya.
Artikel yang terdapat pada daftar referensi yang berelasi dengan studi ini akan
dikaji kembali dengan melakukan tahapan c sampai dengan d.

d) Pengumpulan data
Pengumpulan data dilakukan secara manual dengan membuat formulir
ekstraksidata:
1) Tipe artikel
2) Nama jurnal atau konferensi
3) Tahun
4) Topik
5) Judul
6) Kata kunci
7) Negara

40

8) Metode penelitian
9) Dan lain-lain.

e) Pemilihan Item Data (ID)

Dua item data didapatkan dari artikel terpilih yang terdiri dari:

1) Demografi artikel (ID1)
 Distribusi studi terkait variabel penelitian
 Negara yang melakukan studi terkait variabel penelitian
 Distribusi metode penelitian
 Dan lain-lain

2) Faktor-faktor yang mempengaruhi terkait (ID2)

4. Penyusunan BAB IV dan V
a) BAB IV
Pada BAB IV mahasiswa melakukan penjabaran hasil pencarian sampel jurnal
dari metode systematic review. Analisis Flowchart PRISMA dijelaskan di BAB
ini. Jurnal yang akan dianalisis direkap dan dituliskan dalam Tabel karakteristik
jurnal sebagai berikut:

Nama penulis desain studi, populasi intervensi dan hasil
utama, tahun lama studi, perbandingan penelitian
terbit, negara founder (jika
publikasi ada)

b) BAB V
Pada BAB V mahasiswa menuliskan pembahasan dari hasil analisis literatur
yang telah dilakukan untuk menjawab hipotesis penelitian.

41

7
42

Bagan 2. Contoh aplikasi Bagan alur penelitian menggunakan PRISMA

Untuk menilai secara objektif jurnal yang akan dijadikan sampel dalam penelitian
systematic review, berikut daftar pertanyaan untuk penilaian Jurnal menggunakan
metode PRISMA:

Section/topic # Checklist item Reported on page #

TITLE

Title 1 Identify the report as a systematic review,
ABSTRACT meta-analysis, or both.

Structured 2 Provide a structured summary including,
summary as applicable: background; objectives;
data sources; study eligibility criteria,
participants, and interventions; study
appraisal and synthesis methods; results;
limitations; conclusions and implications of
key findings; systematic review registration
number.

INTRODUCTION

Rationale 3 Describe the rationale for the review in the
Objectives context of what is already known.

METHODS 4 Provide an explicit statement of
questions being addressed with reference
to participants,interventions, comparisons,
outcomes, and study design (PICOS).

Protocol and 5 Indicate if a review protocol exists, if and
registration where it can be accessed (e.g., Web
address), and, ifavailable, provide
Eligibility registration information including
criteria registration number.

6 Specify study characteristics (e.g.,
PICOS, length of follow-up) and report
characteristics (e.g.,years considered,
language, publication status) used as
criteria for eligibility, giving rationale.

43

Information 7 Describe all information sources (e.g.,
sources databases with dates of coverage,
contact with studyauthors to identify
Search additional studies) in the search and date
last searched.
Study
selection 8 Present full electronic search strategy for
at least one database, including any limits
Data used, such that it could be repeated.
collection
process 9 State the process for selecting studies
(i.e., screening, eligibility, included in
Data items systematic review, and, if applicable,
included in the meta-analysis).
Risk of bias
in individual 10 Describe method of data extraction from
studies reports (e.g., piloted forms, independently,
in duplicate) and any processes for
Summary obtaining and confirming data from
measures investigators.
Synthesis of
results 11 List and define all variables for which data
were sought (e.g., PICOS, funding
sources) and any assumptions and
simplifications made.

12 Describe methods used for assessing risk
of bias of individual studies (including
specification of whether this was done at
the study or outcome level), and how this
information is to be used in any data
synthesis.

13 State the principal summary measures
(e.g., risk ratio, difference in means).

14 Describe the methods of handling data
and combining results of studies, if done,
including measures of consistency (e.g.,
I2) for each meta-analysis.

44

Section/topic # Checklist item Reported on page #

Risk of bias 15 Specify any assessment of risk of bias that
across studies may affect the cumulative evidence (e.g.,
publicationbias, selective reporting within
Additional studies).
analyses
16 Describe methods of additional analyses
(e.g., sensitivity or subgroup analyses,
meta-regression), if done, indicating which
were pre-specified.

RESULTS

Study selection 17 Give numbers of studies screened,
assessed for eligibility, and included in
the review, withreasons for exclusions at
each stage, ideally with a flow diagram.

Study 18 For each study, present characteristics
characteristics for which data were extracted (e.g., study
size, PICOS,follow-up period) and
provide the citations.

Risk of bias 19 Present data on risk of bias of each study
within studies and, if available, any outcome level
assessment (seeitem 12).

Results of 20 For all outcomes considered (benefits or
individual harms), present, for each study: (a)
studies simple summary data for each
intervention group (b) effect estimates
and confidence intervals, ideally with a
forest plot.

Synthesis of 21 Present the main results of the review. If
results meta-analyses are done, include for each,
confidenceintervals and measures of
consistency.

Risk of 22 Present results of any assessment of risk
bia of bias across studies (see Item 15).

s across studies

45

Additional 23 Give results of additional analyses, if done
analysis (e.g., sensitivity or subgroup analyses,
meta- regression [see Item 16]).

DISCUSSION

Summary of 24 Summarize the main findings including the
evidence strength of evidence for each main
outcome; considertheir relevance to key
Limitations groups (e.g., healthcare providers, users,
and policy makers).
Conclusions
25 Discuss limitations at study and
outcome level (e.g., risk of bias), and at
review-level (e.g.,incomplete retrieval of
identified research, reporting bias).

26 Provide a general interpretation of the
results in the context of other evidence,
and implicationsfor future research.

FUNDING

Funding 27 Describe sources of funding for the systematic
review and other support (e.g., supply of data);
role of funders for the systematic review.

46

N U T R IT IO N R E S E A R C H 5 6 (2 01 8) 1–10

Avai lable online at www.sci e
ncedirec t.com

ScienceDirect

w w w. n rj ou rn al. c om

Review Article

Chromium supplementation does not
improve weight loss or metabolic and
hormonal variablesin patients with
polycystic ovary syndrome:
A systematic review

Vahid Malekia, b, Azimeh Izadia, b, Alireza Farsad-Naeimia, b, Mohammad
Alizadehc,⁎

a Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
b Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences,
Tabriz, Iran
c Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Golgasht St,
Tabriz, Iran

ARTICLE INFO AB S TRAC T

Article history: Polycystic ovary syndro me (PCOS) is the most co mmon e ndocrinopathy in wo me n of
Received 2 June 2017 reproductive age, and recently, chro mium was discussed as an adjuvant way to mana ge it.
Revised 3 April 2018 Herein, a syste matic review was conducted which centered on the effects of chro mium o n
Accepted 8 April 2018 ovarian physiology with a focus on bo dy mass inde x, as well as hormo nal and metabolic
dysfunctions in women suffering fro m PCOS. This review was performed using the guidelines
Keywords: from Preferred Reporting Items for Systematic Reviews. Clinical trials investigating chromium in
Polycystic ovary syndro me wo me n with PCOS with outco me measures related to metabolic and hormo nal status were
Chro mi um included. The search was conducted using PubMed, Scopus, and Google Scholar databases
Body mass index for clinical trials in the English language fro m the inception of the resources until May 2017 with
Ho r mo ne s the terms: chromium, chromium picolinate, CrP, polycystic ovary syndrome, PCOS, and
Syste matic review sclerocystic ovary syndro me. The search resulted in 89 articles, and after inclusion and
Wo me n exclusion criteria were applied, 6 articles were selected for analysis. Two studies that
evaluated the effect of chro mium on body weight or body mass index reported no effect.
Another study reported the beneficial effect of chro mium on weight reduction. It see ms that the
effect of chro mium in the reduction of blood glucose is insignificant, and results are
inconsistent in relation to dyslipide mia. With regard to the effects of chro mium o n
concentrations of sex hormo nes, a longer duration of treat ment is needed to produce
significant changes. The articles reviewed de mo nstrated that chro mium supple me ntation
has li mited effects on weight reduction, glucose control, lipid profile, and hormonal
disturbance of wo men with PCOS; however, more studies are needed due to the clinical
changes observed in patients with PCOS after chro mium supple mentation.

© 2018 Elsevier Inc. All rights reserved.

47

Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; FBS, fasting blood sugar; GnRH, gonadotropin-releasing
hormone; LH, luteinizing hormone; PCOS, polycystic ovary syndrome.

* Corresponding author. Tel.: +98 4133376228; fax: +98 4133340634.
E-mail address: [email protected] (M. Alizadeh).

https://doi.org/10.1016/j.nutres.2018.04.003
0271-5317/© 2018 Elsevier Inc. All rights reserved.

48

2 N U T R IT IO N R E S E A R C H 56 ( 20 1 8) 1–10

Article Outline

1. Introduction.................................................................................................................................................................................................. 20
2. Approach ...................................................................................................................................................................................................... 20

Search strategy and data sources .................................................................................................................................................................... 20

Inclusion and exclusion criteria ...................................................................................................................................................................... 30

Article selection and assess ment of quality.................................................................................................................................................... 30
Data extraction ................................................................................................................................................................................................ 330
3. Findings .......................................................................................................................................................................................................
C hromium and weight changes in PC OS ....................................................................................................................................................... 30

C hromium and glycemic control in PC OS ..................................................................................................................................................... 30

C hromium and ovarian hormones and androgens in PCOS ............................................................................................................................ 40

4. C hromium and dyslipidemia in PC OS ........................................................................................................................................................... 40
5. Discussion .................................................................................................................................................................................................... 50
6.
Knowledge gaps and future directions ........................................................................................................................................................ 7

Conclusions .................................................................................................................................................................................................. 80
Acknowledgment ................................................................................................................................................................................................. 80

References ............................................................................................................................................................................................................ 80

0

0

1. Introduction activity of insulin receptor β, increase the activity of

downstream effectors of insulin signaling pI3-

Polycystic ovary syndrome (PCOS) is the most kinase and Akt, and enhance Glut4 translocation

common female endocrine disorder, with a to the cell surface. Chromium also down-

worldwide prevalence of approxi- mately 5% to regulates protein-tyrosine phosphatase 1B, which

21% in women of reproductive age [1,2]. It is is the negative regulator of insulin signaling, and

characterized by chronic hyperandrogenic alleviates ER stress within the cells, thereby

anovulation or oligoamenorrhea, which leads to rescuing insulin receptor substrate from c-Jun N-

symptoms of hirsutism, acne, androgenic terminal kinases–mediated serine

alopecia, infertility, and increases in circulating phosphorylation and subse- quent ubiquitination.

androgens, such as testosterone [3,4]. The exact Transient up-regulation of AMPK by chromium

etiology of PCOS remains unknown, but it is leads to increased glucose uptake [24,25]. Other

believed to result from complex interactions mechanisms of action of chromium on glucose

between genetic, behavioral, and environmental and lipid metabolisms have been reported [25-

factors. Hyperandrogenism and insulin resistance 28], and although several studies suggest

are the main characteristics in these patients, favorable effects of chromium on blood sugar

which leads to metabolic abnormalities associated levels and insulin resistance in diabetic patients

with obesity, type 2 diabetes, hyperten- sion, [29,30], others failed to show the beneficial effect of

dyslipidemia, inflammation, and subclinical chromium supplementation [31,32].

cardiovascular disease [5-11]. Moreover, women The aim of this systematic review was to

with PCOS exhibit an increased incidence of insulin highlight the information available that focuses

resistance (50%-70%), obesity (30%-75%), and on the influence of chromi- um supplementation

central adiposity, even within the normal body mass with regard to metabolic and hormonal status in

index (BMI) range (50%-70%) [4,12]. patients with PCOS, while also identifying

Insulin resistance is implicated in the etiology of knowledge gaps and providing suggestions for

PCOS, which may explain why the development of future directions.

obesity could be considered

a predisposing factor to reveal the clinical and biochemical

features of PCOS and why PCOS often manifests proposed for improved metabolic profiles in PCOS

during adoles- cence [13,14]. Conversely, women [18-21]. Chromium is an essential element for

improvement of insulin sensitivity in PCOS, either carbohydrate and lipid metabolism. Although its

through drug therapy or through weight loss, results deficiency is reported to be associated with insulin

in improved metabolic profiles, ovulatory function, resistance and diabetes, the mechanisms of action

menstrual regularity, and fertility [13,15,16]. of chromium on glucose and lipid metabolism are

Common PCOS management can only control not well established. However, it has been

symptoms moderately and is not completely postulated that chromium increases the number of

effective in the prevention of complications [17]. insulin receptors and insulin binding at its site of

Recently, micronutrient supplementation was action [22-24]. Chromium has been shown to

enhance the kinase 2. Approach

Search strategy and data
sources

To identify the studies that are eligible for this
systematic review, literature searches were
conducted in electronic databases PubMed,
Scopus, and Google Scholar using Mesh terms
and keywords such as follows: chromium (Mesh)
OR chromium picolinate (Mesh) OR CrP (Mesh)
OR chromium supplementation (Mesh) AND
polycystic ovary syndrome (Mesh) OR PCOS
(Mesh) OR sclerocystic ovary syndrome (Mesh). The
search was limited to clinical trials and English-
language articles published from the inception
date of the resources until May 2017. The review
was conducted according to the PRISMA criteria
and registered with the PROSPERO database of
systematic reviews (registration number:
CRD42017054133).

N UT R IT IO N R E SE AR C H 5 6 (2 0 18) 1–10 3

Inclusion and exclusion on BMI and weight loss of PCOS patents were
criteria investigated in several studies. In one study, the
means of weight and BMI at baseline and after
A screening of titles or abstracts followed by a consumption of 200 μg chromium picolinate for 2
full-text review was performed. Studies were months were not significantly different [34].
considered eligible if they met the following Similarly, no significant change in BMI was
criteria: (1) randomized or quasi-randomized, observed in a study after consumption of 1000 μg
placebo-controlled, blinded, or nonblinded chromium picolinate for 6 months [35]; however,
clinical trials; (2) study population was PCOS another study reported that treatment with 1000
patients; (3) if chromium supple- mentation alone μgchromium picolinate for 6 months resulted in a
was used; (4) published in English-language significant reduction in BMI [36]. In addition, an
journals; and (5) included clinically acceptable Egyptian team [37] found a remarkable reduction in
dosages and durations of chromium BMI among a group of PCOS patients who had
administration on women. Studies were BMIs between 30 and 34.5 kg/m2. With regard to
excluded if (1) chromium was used in the different protocols for treatment, they were not
combination with any other drugs, minerals, or included in the current systematic review;
botanicals; (2) insufficient data were provided; however, because the participants were in a high
(3) the studies were on pregnant women, BMI range, the differences in the findings could be
animals, or vitro models; and (4) the diagnostic relevant. These findings encourage further
criteria were not for eligible study subjects. investigation into the possible role of chromium in
the weight loss of PCOS patients.
Article selection and
assessment of quality Chromium and glycemic
control in PCOS

For this investigation, all titles and abstracts of Molecular studies have postulated possible
the searched articles were compared to the mechanisms of chromium action on cellular
inclusion criteria and critically and independently glucose uptake (Fig. 2). There is near total
assessed by 2 reviewers. To start, all articles that agreement that chromium may activate the
clearly did not meet the inclusion criteria were insulin cell signaling pathway, leading to an
rejected. The articles that were not rejected alleviated insulin resistance [24,25], whereas the
outright were analyzed, and the eligible ones reports on possible effects of chromium
were then identified. This assessment was done supplementation on blood sugar in PCOS
according to a checklist that included aims, patients had similar findings.
research questions, and inclusion and exclusion
criteria. After this, one reviewer assessed the There are no significant beneficial effects of
quality of the included studies according to chromium supplementation on blood glucose in
predefined criteria, including criteria for selection, the populations that had no documented
methods of outcome assessment, and data chromium deficiency. In this regard, previous
analysis. If there was disagree- ment between studies show no statistical significant differences
the 2 reviewers during the process of study in the median chromium concentrations between
selection, the issue was resolved through the patients with PCOS and the control group
discussion among multiple investigators. [38,39]. Similarly, the results of a meta-analysis
conducted by Fazelian et al [40] reported no
Data extraction advantage of chromium in fasting blood sugar
(FBS) among PCOS patients. Furthermore,
Two reviewers extracted the data of the eligible Ashoush et al [36] indicated that chromium
full-text articles on the study characteristics which picolinate is not effective in reducing FBS. In
included mean year; location of study, sample other study populations, a meta-analysis [31] in
size, age, daily dose, and duration of interven- diabetic or nondi- abetic patients also showed no
tion; and the main outcome. If there was significant effect of chromium supplementation.
disagreement between the 2 reviewers during the The authors of a recent study concluded that
process of data extraction, the issue was resolved chromium supplementation is not effective in
through discussion among multiple investigators. popula- tions where chromium deficiency is
unlikely. In this sense, a recent systematic
showed that review and meta-analysis [41] on blood
trace element concentrations in PCOS patients
3. Findings

A flowchart indicating the process for study there are no differences between these patients
selection for the systematic review is shown in and control groups in terms of serum chromium
Fig. 1. In total, 89 articles were retrieved by the levels.
search strategy, 16 of which were duplicates,
thus resulting in 73 nonduplicated publications. Of In the present systematic review, it was found
these, 66 were excluded based on the title or that chromium might moderately reduce insulin
abstract because they did not meet the inclusion resistance when compared with placebo. To the
criteria, whereas one study was excluded best of the authors' knowledge, this is the first
because of lack of sufficient information on the systematic review that assessed the effect of
variables under consid- eration. Only 6 articles chromium supple- mentation on insulin levels in
met the selection criteria and were included in PCOS patients, although some studies have
the qualitative analysis (Table). stated the beneficial effects of chromium supple-
mentation on insulin sensitivity. In a study by
Chromium and weight Jamilian and Asemi [34], it was observed that 200
changes in PCOS μg of chromium picolinate supplementation for 8
weeks resulted in significant improve- ments in
When compared with healthy women, PCOS insulin sensitivity, as reflected by the
patients were more likely to experience obesity that homeostatic model assessment–insulin resistance
further influenced the severity of PCOS [33]. The index. In addition, Ashoush et al [36] indicated that
potential effects of chromium supplementation chromium picolinate is useful in the reduction of
serum fasting insulin. Although Jamilian and Asemi

[34] used a low dose of chromium supplement
and a short duration of intervention, and recruited

a relatively small sample

4 N U T R IT I O N R E S E A R C H 56 ( 20 1 8) 1–10

Identification Records identified through searches (n=89) in electronic Records duplicated (n=16)
databases such as PubMed, Scopus, Google Scholar

Records after duplicates removed (n=73)

Screening Records screened Articles were excluded (n=73) because
(n=73) did not meet inclusion criteria that
Eligibility including:
Full-text articles assessed for
eligibility - Animal study (n=2)
(n =7) - Review study (n=4)
- Chromium in combination

with drugs or supplements
(n=5)
- Non-related studies of chromium
supplementation in patients with
PCOS (n=62)

Full-text article excluded, Due to the lack
of sufficient information about the
variables under consideration (n = 1)

Included Articles included for review
(n=6)

Fig. 1 – Flowchart of the process for selecting articles for the
systematic review.

size (n = 32), it was a controlled trial regarding can increase the ratio of luteinizinghormone (LH)
dietary intakes of energy and macronutrients. In to follicle-stimulating hormone (FSH). For this
contrast, Ashoush et al [36] used a reasonably high
dose (1000 μg daily) for a 6-month duration and reason, it seems that chromium can affect levels of
found a significant weight loss; however, they also ovarian hormones and androgens by increasing insulin
encouraged physical exercise and diet control, sensitivity [42-44].One study [45] demonstrated that
which could have contributed to this weight
difference. Therefore, the exact effects of chromium chromium supplementa- tion for 8 weeks did not
supplementation could not be distinguished in their lead to any significant change inhormonal profiles,
study.
pregnancy rate, and/or alopecia in PCOS

Chromium and ovarian
hormones and androgens in
PCOS

In PCOS, increased levels of androgens can
lead to insulinresistance and hyperinsulinemia.
However, insulin resistance and hyperinsulinemia

women. Similarly, a study carried out by Lucidi et
al [46] showed that chromium picolinate
supplementation in women with PCOS did not
influence hormonal profiles. In addition,
Ashoush et al
[36] did not find any significant impact of
chromium picolinate consumption on serum
testosterone; however, chromium picolinate
significantly increased the chances of
ovulation andregular menstruation after the fifth
month of treatment. Because the effects were
observed after the fifth month of intervention, it
can be hypothesized that a longer duration
may be needed to achieve significant
beneficial effects by chromium picolinate
supplementation. This may explain the
inability of studies to reveal chromium
picolinate efficacy on hirsutism and/or andro-
gen levels in PCOS [36,47].

Chromium and dyslipidemia
in PCOS

According to the National Cholesterol
Education Program guidelines [48],
dyslipidemia is the most common metabolic
abnormality in PCOS, with approximately 70% of
PCOS patients having borderline or high lipid
levels [49]. Both nonobese and

N UT R IT IO N R E SE AR C H 5 6 (2 0 18) 1–10 5

Table – Details about the studies in the articles reviewed

Author, place, Type of study Sample Age (y) Daily Duration Main outcomes
year size dose

M. Jamilian, Iran, Double blinded (RCT ) 64 18-40 200 μg 2 mo Reduce: insulin, HOMA-IR

April 2015 CrP Insignificant: T G, VLDL, T C and FBS,

LDL, HDL

Sh. Egypt, Double blinded (RCT ) 85 20-35 1000 μg 6 mo CrP improved: FSI, B MI; increase: FGIR

December 2014 CrP Insignificant: FB S, free testosterone, an d

ovulation became significantly more

com m on after 4 m o of CrP treatment.

R. Lucidi, Double blinded (RCT ) 10 18-39 200 μg 4 mo Reduce: OGTT 1 h and OGT T 2 h

A meri c an, CrP Insignificant: FB S, ins ulin testosterone,

December 2005 DHEAS, LH, FSH, TG, TC

N. Amr, T he quasi-randomized 35 <18, menarche 1000 μg 6 mo Reduce: oligo/amenorrhea and total

Egy pt, September 2013 trial for at least 2 y CrP number of patients with regular periods

Abbreviations: CrP, chromium picolinate; DHEAS, dehydroepiandrosterone sulfate; FBS, fasting blood sugar; FsSiHgn, iffoicllaicnltel-ystimncurlaetainsgedhowrmitohnter;eHatDmLe,nhtigh-

density lipoprotein; HO MA-IR, homeostatic model assessment–insulin resistance index; LDL, low-density Ilinpsoipgrnoitfeiicna; nLt:HB, MluIt,eaincinzien,gfreheortmesotnoes;teRroCnTe,

rMan.dJoammiizlieadnc,oInrtarno,lled trialD; ToCub, lteotballinchdoeldes(tRerCoTl;)TG,6t0riglycerid e; 1V8L-4D0L, very lo w-d2e0n0s iμtyg lipop2romteoin. Reduce: hirsutism, hs-CRP; increase:

July 2015 CrP prolactin, FSH, LH, free testosterone,

DHEA, 17-OH progesterone

M.L. Lydic, T he quasi-randomized 6 19-42 1000 μg 2 mo Increased: glucose disposal rate

American, 2005 trial CrP Insignificant: weight, LH, FSH, DHEAS,

total testosterone, free testosterone

obese PCOS phenotypes are prone to increases frequency [51,52]. This persistently rapid pulse
in waist-to-hip ratio and have abdominal obesity;
thus, consequently, they are more susceptible to frequency favors increased LH secretion, and low
the development of dyslipidemia [48]. In addition,
a higher postprandial triglyceride response has estrogen levels have also been postulated to
been observed in nonobese PCOS women,
which suggests the existence of an intrinsic lipid enhance the pulsatility of GnRH, thus leading to an
abnormality in these women [49]. Therefore,
using chromium supplementation for the increased LH/FSH ratio. The relative increase in LH
possible management of dyslipidemia, especially
in PCOS patients, has generated significant stimulates the ovarian theca cells to secrete more
interest.
androgens [53,54], and increased androgen and
In this regard, Jamilian and Asemi [34]
assessed the effect of using 200 μg of chromium LH levels cause insulin resistance. In addition,
picolinate supplementation for 8 weeks on the
lipid profile in PCOS. They found no significant hyperinsulinemia acts indirectly to increase serum-
alterations in low-density lipoprotein and high-
density lipopro- tein cholesterol levels. However, free testosterone by inhibiting the hepatic
a trend toward significant reductions of serum production of sex hor- mone–binding protein (Fig.
triglycerides, very low-density lipoprotein, and
cholesterol concentrations was observed after 3) [55,56]. The major concern in the long-term
chromium supplementation. Another study by Lucidi
et al [46] using 200 μg of chromium picolinate management of women with PCOS is the
supplementation for 4 months did not show any
significant change in the lipid profile in PCOS metabolic abnormalities that include insulin
patients as compared with the placebo group.
These findings are similar to those from a study on resistance, dyslipidemia, and central obesity,
diabetic patients [50] that evaluated the effect of
chromium supplementation on lipid profiles but did which constitute a cluster of risk factors for the
not indicate any beneficial effects. Taken
together, these observa- tions suggest that development of cardiovascular disease [42,57].
chromium supplementation may not improve lipid
profiles [34]. This systematic review showed that the effects of

be main- chromium supplementation on body weight and

4. Discussion BMI remains uncertain, and future trials studying

the long-term effects involving assessment of

body composition are warranted.

In a recent meta-analysis, Fazelian et al [40]

reported that chromium supplementation could

significantly reduce BMI; however, Onakpoya et al

[58] concluded that chromium did not generate

statistically significant reductions in

anthropometric parameters, including BMI, waist

circumference, or waist-to- hip ratio. In addition,

Fazelian et al concluded that the magnitude of

the change is small, and the clinical importance

is debatable despite the statistically significant

weight loss by chromium supplementation. In

addition, whether or not such

weight losses after chromium supplementation can

Hyperandrogenism is a key feature in PCOS and tained over longer periods is unclear, as it is
primarily results from excess androgen production possible that they are transient.
in the ovaries that interferes with hypothalamic
sensitivity to negative feedback, thereby Insulin resistance is one of the clinical signs in
increasing gonadotropin-releasing hormone patients with PCOS, and this trait has a cause-
(GnRH) pulse consequence relationship with an increased risk
of type 2 diabetes [59]. Although the exact
mechanisms underlying the beneficial effects of
chromium on

6 N U T R IT I O N R E S E A R C H 56 ( 20 1 8) 1–10

Fig. 2 – The possible mechanism of Cr action on cellular glucose uptake. Cr may be to enhance the
kinase activity of insulin receptor β, increase the activity of downstream effectors of insulin signaling
pI3-kinase and Akt, and enhance Glut4 translocation to the cell surface. Cr also down-regulates
PTP-1B, the negative regulator of insulin signaling and alleviates ER stress within the cells.
Transient up-regulation of AMPK by chromium leads to increased glucose uptake. Cr, chromium;
PI3K, phosphatidylinositol 3-kinase; PKB, protein kinase B; PTP-1B, protein-tyrosine phosphatase 1B;
JNK, c-Jun N-terminal kinases;IRS, insulin receptor substrate; PKB, pyruvate dehydrogenase kinase.

serum insulin are not yet fully understood, it is values may also beage specific [60]. Therefore, high-
suggested that chromium intake increases the quality randomized controlled trials evaluating the
amount of chromium-containing oligopeptide effects of chromium supplements on specific
present in the insulin-sensitive cells, which binds to parameters of insulin resistance in the PCOS
the insulin receptor and significantly increases population are clearly required to further understand
the activity of insulin-stimulated tyrosine kinase its role in glycemic control. In addition, an important
and glucose transporter 4 [26]. These changes in fact is that any intervention associated
turn would result in improved markers of insulin
metabolism. There are several issues that must
be considered for a precise conclusion regarding
beneficial effects of chromium supplementation
on glycemic status in PCOS patients. The present
review focuses on blood sugar and insulin. It is
possible that the use of more complex
procedures for monitoring treatment effects,
including a homeostatic model assessment of
insulin resistance that is often used to describe the
degree of glycemic impairment, would lead to
different results. However, there is currently no
established threshold level to define insulin
resistance in the homeostatic model assessment
of insulin resistance in patients with PCOS, and

with weight loss results in a significant reduction
in blood sugar [61]. Thus, it is reasonable that
chromium supplementation has no effect on the
reduction of blood glucose in this regard. Althuis
et al [62] stated that the effectiveness of
chromium in the reduction of blood glucose in
different populations may be related to the
probability that there is a threshold to how
much blood glucose may be reduced in subjects
who are already withinthe normal range.

The present study indicates that chromium
supplementation has no significant benefit on
sex hormone levels. Supporting these
findings, no beneficial effects of chromium on
serum dehydroepiandrosterone sulfate, FSH,
and LH were found by Fazelian et al [40] in their
meta-analysis, whereas Onakpoya et al
[58] and Ashoush et al [36] suggested that
future trials should be conducted for at least 16
weeks. As mentioned earlier, chromium
supplementation is not helpful in populations
without known chromium deficiency and might
not influence concentrations of sex hormones.
This is why documented cases of chromium
deficiency are uncommon and only reported in
patients completely reliant on parenteral
nutrition [31]. In addition, no difference was
observed between serum chromium levels of
PCOS patients and healthy individuals [41].

N UT R IT IO N R E SE AR C H 5 6 (2 0 18) 1–10 7

Response to chromium supplementation for glycemic control, lipid profiles, and hormonal
lipid profile components is related to the amount status may be affected by changes in the
and form of supplemental chromium, the degree distribution of body composition. Studies have
of dyslipidemia, and the duration of study. Thus, shown that chromium can improve cardiovascu-
the results of the lipid profile evaluation may be, in lar function [66], and patients with PCOS are at
part, explained by the fact that not all the greater risk of cardiovascular disease [57].
patients presented with dyslipidemia. Different Therefore, focusing on the evalu- ation of
study designs and durations used for chromium cardiovascular biomarkers in future studies may
supplementation, together with the characteris- be effective in identifying the effects of chromium
tics of study patients, might explain the on these patients.
discrepancy in the findings. The effect of
chromium intake on dyslipidemia would be an There is a gap in the literature on the
interesting topic for future studies. diagnostically definitive test for chromium
deficiency; thus, identifying deficient subjects is a
chromium status to major challenge. Future research should focus
on the
5. Knowledge gaps and future establishment of a standard for evaluating
directions
identify populations with chromium deficiency and
Patients with PCOS, when compared with the reassess- ment of possible metabolic response
healthy, age- matched individuals, have different to chromium supplementa- tion. It is noteworthy
body compositions and patterns of distribution of that there is no established consensus on the
body fat mass of android. Android obesity is response time to supplemental chromium, as it
associated with insulin resistance, an increased lasts from less than 10 days to more than 3
risk of cardiovascular disease, and other chronic months. However, for clinical changes observed
diseases [63-65]. Therefore, it is suggested that in these patients after administration of
future studies should focus on the effect of chromium, the duration of the intervention should
chromium on body composition, body fat mass, be increased. The safety of chromium supplements
and lean body mass in patients with PCOS. It is another major challenge because not all the
seems that randomized controlled trials studied in the
present review evaluated the adverse effects. In
addition, to

Fig. 3 – The pathophysiologic characteristics of PCOS. The increase in secretion of GnRH hormone
is due to the negative feedback effect of androgens and hyperinsulinemia which leads to the
increased LH/FSH ratio. The relative rise in LH levels stimulates the ovarian theca cells, leading to
the increased secretion of androgens and decreased production of estrogen. Overproduction of
androgens can lead to insulin resistance and hyperinsulinemia. Also, genetic predisposition, obesity,
and its causes can lead to insulin resistance, which affects the liver cells and leads to decreases in
the production of SHBP and increases in androgens. PCOS, Polycystic ovary syndrome; GnRH,
gonadotropin-releasing hormone; LH, luteinizing hormone; FSH, follicle-stimulating hormone; SHBP,
sex hormone–binding protein.

8 N U T R IT IO N R E S E A R C H 56 ( 20 1 8) 1–10

prevent toxic levels, because the tolerable upper adolescents. Pediatrics 2015;136:1154–65.
intake levels of chromium have not been
established, intake from only food sources is [4] Sirmans SM, Pate KA. Epidemiology, diagnosis, and
recommended [67], whereas the rational for management of polycystic ovary syndrome. Clin Epide miol
supplementing diet with chromium is debatable. 2013;6:1–13.

Furthermore, as indicated by Althuis et al [62], [5] Cobin R, Futterweit W, Nestler J, Reaven G, Jellinger P,
there is likely a threshold as to how much blood Ha ndels ma n Y, et al. American Association of Clinical
glucose may respond to supplemental chromium
in individuals already within the normal range. In Endocrinologists position state ment on metabolic and
addition, there are other limitations to be cardiovascular conseque nces of polycystic ovary syndro me.
considered, including the lack of information on Endocr Pract 2005;11:126–34.
the dietary intake and bioavailability of other
minerals (such as magne- sium and zinc) that [6] Hua ng A, Brennan K, Azzi z R. Prevalence of
are known to affect metabolic variables (mainly hyperandro gene mia in the polycystic ovary syndro me
glucose homeostasis) in PCOS. Thus, their
relationships and/or interactions with chromium
need to be investigated.

6. Conclusions

As a whole, chromium supplementation may exert
little benefi- cial effect in decreasing BMI and
FBS, whereas this systematic review indicated
that chromium supplementation does not
remarkably improve weight loss, glycemic control,
dyslipidemia, ovarian hormones, and androgens in
patients with PCOS. Hence, with regard to current
knowledge gaps, more studies are needed to
determine the effects of chromium
supplementation on patients with PCOS and to
evaluate the possible beneficial effects on clinical
conditions, as well as define proper dosage,
duration of supplementation, side effects, and
toxic levels for chromium supplementation.

Acknowledgment

The authors thank the Nutrition Research Center,
Department of Nutrition, Faculty of Nutrition and
Food Science, Tabriz University of Medical Science.
Also, thanks to Sorayya Kheirouri for her help in
providing suggestions to improve the
methodology of this review. This research did not
receive any specific grant from funding agencies
in the public, commercial, or not-for-profit sectors.
The authors declare that they have no conflicts of
interest.

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Stepto NK. Bio markers and insulin sensitivity in wo men with [64] Kirche ngast S, Huber J. Body co mposition characteristics
polycystic ovary syndro me: characteristics and predictive and fat distribution patterns in young infertile wo me n. Fertil
capacity. Clin Endocrinol (Oxf) 2015;83:50–8. Steril 2004;81:539–44.

[60] Costello RB, Dwyer JT, Bailey RL. Chromium supplements for [65] Yucel A, Noyan V, Sagsoz N. The association of serum
glyce mic control in type 2 diabetes: li mited evidence of androgens and insulin resistance with fat distribution in
effectiveness. Nutr Rev 2016;74:455–68.
polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol
[61] Zo mer E, Gurusa my K, Leach R, Tri mmer C, Lobstein T, 2006;126:81–6.
Morris S, et al. Interventions that cause weight loss and the
impact on cardiovascular risk factors: a syste matic review [66] Panchal SK, W anyonyi S, Brown L. Selenium, vanadium, and
and meta-analysis. Obes Rev 2016;17:1001–11. chro mium as micronutrients to i mprove metabolic syndro me.

[62] Althuis MD, Jordan NE, Ludington EA, Wittes JT. Glucose and Curr Hy pertens Rep 2017;19:10.
insulin responses to dietary chro mium supple me nts: a
meta-analysis. Am J Clin Nutr 2002;76:148–55. [67] Trumbo P, Yates AA, Schlicker S, Poos M. Dietary
referenceintakes: vita min A, vita min K, arsenic, boron,
[63] chro mium, copper, iodine, iron, ma nganese, molybde num,

nickel, sili- con, vanadium, and zinc. J Am Diet Assoc
2001;101:294–301.

1

Referensi:

1. Triandini, Evi & Jayanatha, Sadu & Indrawan, Arie & Putra, Ganda & Iswara, Bayu. (2019).

Metode Systematic Literature Review untuk Identifikasi Platform dan Metode Pengembangan
Sistem Informasi di Indonesia. Indonesian Journal of Information Systems. 1. 63.
10.24002/ijis.v1i2.1916.

2. Handayani, Putu Wuri. 2017. Systematic Review dengan PRISMA (Preferred Reporting Items

for Systematic Reviews and Meta-analysis). Work shop Riset Sistem Informasi. Fakultas Ilmu
Komputer UI.

3. Hadisaputro, Suharyo. Systematic Review.
4. http://www.prisma-statement.org/PRISMAStatement/FlowDiagram
5. http://www.prisma-statement.org/PRISMAStatement/Checklist
6. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting

Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7):
e1000097. doi:10.1371/journal.pmed1000097

7. Usman, LS. 2011. Systematic Reviews and Meta-Analyses. J Can Acad Child Adolesc

Psychiatry.20(1): 57–59.

Panduan Penyusunan dan Penulisan Tesis

Page 1

Panduan Penyusunan dan Penulisan Tesis

Page 2

Lampiran 1: Contoh halaman sampul proposal tesis

Contoh sampul depan dan halaman judul
(Ukuran kertas, huruf, dan logo harap disesuaikan ketentuan)

PENERAPAN ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION (ASIR) DAN
WINDOWING TERHADAP KUALITAS CITRA CT SCAN STONOGRAPHY

PROPOSAL TESIS
Disusun untuk memenuhi persyaratan mencapai gelar Strata 2

Imaging Diagnostik Program Magister Terapan

Oleh:
SAIFUDIN
NIM. P1337430415005

PROGRAM STUDI IMAGING DIAGNOSTIK PROGRAM MAGISTER TERAPAN
PROGRAM PASCASARJANA

POLTEKKES KEMENKES SEMARANG
TAHUN 2021

Pedoman Penyusunan dan Penulisan Tesis

Page 1

Lampiran 2 :Contoh halaman persetujuan pembimbing untuk ujian proposal tesis
Contoh:
Pembimbing I : Dr. Suryono, S.Si. MSi,
Pembimbing II: Dr. dr. Hermina Sukmaningtyas, M.Kes, Sp.Rad

(Ukuran kertas dan huruf disesuaikan ketentuan)

HALAMAN PERSETUJUAN

Proposal Tesis dengan judul :
PENERAPAN ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION (ASIR) DAN

WINDOWING TERHADAP KUALITAS CITRA CT SCAN STONOGRAPHY

Oleh:
SAIFUDIN
NIM. P1337430415005

Telah dilakukan pembimbingan proposal tesis dan dinyatakan layak
untuk mengikuti ujian proposal tesis.

Pembimbing I Semarang, 2 Februari 2021
. Menyetujui,

Dr. Suryono, S.Si., M.Si. Pembimbing II
NIP. 197306301998021001
Dr.dr.Hermina Sukmaningtyas,M.Kes, Sp.Rad
NIP. 196706201998022001

Mengetahui,
Ketua Program Studi

Gatot Murti Wibowo, SPd. M.Sc.
NIP. 196606031988031001

Pedoman Penyusunan dan Penulisan Tesis

Page 2

Lampiran 3: Contoh Halaman Pengesahan Proposal Tesis

Contoh: :Dr. Suryono, S.Si. Msi
Pembimbing I :Dr. dr. Hermina Sukmaningtyas, M.Kes, Sp.Rad,
Pembimbing II :Dr. dr. Ari Suwondo, MPH.
Penguji

(Ukuran kertas dan huruf disesuaikan ketentuan)

HALAMAN PENGESAHAN

Proposal Tesis dengan judul :

PENERAPAN ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION (ASIR)
DAN WINDOWING TERHADAP KUALITAS CITRA CT SCAN STONOGRAPHY

Oleh:
SAIFUDIN
NIM. P1337430415005

Telah diujikan pada tanggal……………… dan layak untuk dilanjutkan penelitian
Semarang, 2 Februari 2021

Ketua Penguji

Anggota Penguji I Dr. dr. Ari Suwondo,MPH
NIP.195709291986032001

Anggota Penguji II

Dr. Suryono, S.Si., M.Si. Dr. dr. Hermina Sukmaningtyas, M.Kes, Sp.Rad
NIP. 197306301998021001 NIP. 196706201998022001

Mengetahui,
Ketua Program Studi

Gatot Murti Wibowo, SPd. M.Sc.
NIP. 196606031988031001

Lampiran 4: Contoh halaman sampul seminar hasil penelitian

Pedoman Penyusunan dan Penulisan Tesis

Page 3

Contoh sampul depan dan halaman judul
(Ukuran kertas, huruf, dan logo harap disesuaikan ketentuan)

PENERAPAN PELVIC ROCKING EXERCISE MENGGUNAKAN BIRTH BALL
TERHADAP NYERI PERSALINAN DAN KADAR BETA-ENDORPHINE

SEMINAR HASIL PENELITIAN
Disusun untuk memenuhi persyaratan mencapai gelar Strata 2

Kebidanan Program Magister Terapan

Oleh:
NIKEN WAHYU HIDAYATI

NIM. P1337424716008

PROGRAM STUDI KEBIDANAN PROGRAM MAGISTER TERAPAN
PROGRAM PASCASARJANA

POLTEKKES KEMENKES SEMARANG
TAHUN 2021

Pedoman Penyusunan dan Penulisan Tesis

Page 4

Lampiran 5 : Contoh halaman persetujuan pembimbing untuk seminar hasil penelitian
Contoh:
Pembimbing I : Dr. Runjati M.Mid
Pembimbing II :Dr. Bedjo Santoso, S.SiT, M.Kes

(Ukuran kertas dan huruf disesuaikan ketentuan)
HALAMAN PERSETUJUAN

Seminar Hasil Penelitian Dengan Judul :

PENERAPAN PELVIC ROCKING EXERCISE MENGGUNAKAN BIRTH BALL
TERHADAP NYERI PERSALINAN DAN KADAR BETA-ENDORPHINE

Oleh:

NIKEN WAHYU HIDAYATI
NIM. P1337424716008

Telah dilakukan pembimbingan hasil penelitian dan dinyatakan layak untuk
mengikuti seminar hasil penelitian .

Menyetujui, Semarang, 13 Maret 2021
Pembimbing II
Pembimbing I

Dr. Runjati, M.Mid Dr. Bedjo Santoso, SSiT, M.Kes.
NIP. 197411141998032001 NIP. 197001311990031002

Mengetahui,
Ketua Program Studi

Sri Sumarni, M.Mid.
NIP. 197307291998032001

Pedoman Penyusunan dan Penulisan Tesis

Page 5

Lampiran 6: Contoh Halaman Pengesahan Seminar Hasil Penelitian
Contoh:
Pembimbing I : Dr. Suryono, S.Si, Msi
Pembimbing II : Dr. Melyana N.W.,M.Kes

(Ukuran kertas dan huruf disesuaikan ketentuan)

HALAMAN PENGESAHAN

Seminar Hasil Penelitian Dengan Judul :

PENERAPAN PELVIC ROCKING EXERCISE MENGGUNAKAN BIRTH BALL
TERHADAP NYERI PERSALINAN DAN KADAR BETA-ENDORPHINE

Oleh:

NIKEN WAHYU HIDAYATI
NIM. P1337424716008

Telah diujikan pada tanggal………. dan dinyatakan dapat melanjutkan ujian tesis.

Menyetujui, Semarang, 13 Maret 2021
Pembimbing Anggota
Pembimbing Utama

Dr. Suryono, S.Si., M.Si. Dr. Melyana Nurul Widyawati, SSiT, M.Kes.
NIP. 197306301998021001 NIP. 197909032002122002

Mengetahui,
Ketua Program Studi

Sri Sumarni, M.Mid.
NIP. 197307291998032001

Lampiran 7: Contoh halaman sampul Tesis

Pedoman Penyusunan dan Penulisan Tesis

Page 6

Contoh Sampul Depan dan Halaman Judul
(Ukuran kertas, huruf dan logo disesuaikan ketentuan)

EFEKTIFITAS SUCTION ABOVE CUFF ENDOTRACHEAL TUBE DALAM MENCEGAH
VENTILATOR ASSOCIATED PNEUMONIA PADA PASIEN KRITIS DI RUANG ICU

TESIS
Disusun untuk memenuhi persyaratan mencapai gelar Strata 2

Keperawatan Program Magister Terapan

Oleh:
ARFIYAN SUKMADI
NIM. P1337420815009

PROGRAM STUDI KEPERAWATAN PROGRAM MAGISTER TERAPAN
PROGRAM PASCASARJANA

POLTEKKES KEMENKES SEMARANG
TAHUN 2021

Pedoman Penyusunan dan Penulisan Tesis

Page 7

Lampiran 8 :Contoh halaman persetujuan pembimbing untuk ujian Tesis
Contoh:
Pembimbing I : Dr. Rr. Sri Endang Pujiastuti, SKM, MNS,
Pembimbing II : Dr. Sudirman, MN

(Ukuran kertas dan huruf disesuaikan ketentuan)

HALAMAN PERSETUJUAN

Tesis dengan judul :

EFEKTIFITAS SUCTION ABOVE CUFF ENDOTRACHEAL TUBE DALAM
MENCEGAH VENTILATOR ASSOCIATED PNEUMONIA
PADA PASIEN KRITIS DI RUANG ICU

Oleh:

ARFIYAN SUKMADI
NIM. P1337420815009

Telah dilakukan pembimbingan tesis dan dinyatakan layak untuk mengikuti ujian tesis.

Menyetujui, Semarang, 5 April 2021
Pembimbing II
Pembimbing I
.

Dr. Rr. Sri Endang Pujiastuti, SKM, MNS Dr. Sudirman, BN, MN.
NIP. 1970062919920322002 NIP. 197312151998031003

Mengetahui,

Ketua Program Studi

Mardiyono, MNS, PhD
NIP. 197006121994031002

Pedoman Penyusunan dan Penulisan Tesis

Page 8

Lampiran 9: Contoh halaman pengesahan tesis

(Ukuran kertas dan huruf disesuaikan ketentuan)
HALAMAN PENGESAHAN

Tesis dengan judul :
EFEKTIFITAS SUCTION ABOVE CUFF ENDOTRACHEAL TUBE DALAM
MENCEGAH VENTILATOR ASSOCIATED PNEUMONIA PADA PASIEN KRITIS

DI RUANG ICU

Oleh:

ARFIYAN SUKMADI
NIM. P1337420815009
Telah diujikan pada tanggal ... bulan .... tahun... oleh tim penguji.

Semarang, 5 April 2021

Menyetujui,

Ketua Penguji Anggota Penguji I

Dr. dr. Ari Suwondo,MPH Dr. dr. Suryati Kumorowulan, M.Biotech
NIP.195709291986032001 NIP. 197008182001122002

Anggota Penguji II Anggota Penguji III

Dr. Rr. Sri Endang Pujiastuti, SKM, MNS Dr. Sudirman, BN, MN.
NIP. 1970062919920322002 NIP. 197312151998031003

Mengetahui,

Ketua Program Pascasarjana Ketua Program Studi
Poltekkes Kemenkes Semarang

Prof.Dr.dr.Suharyo Hadisaputro,Sp.PD-KPTI Mardiyono, MNS, PhD
NIDK.8887000016 NIP. 197006121994031002

Pedoman Penyusunan dan Penulisan Tesis

Page 9

Lampiran 10: Contoh Halaman Pernyataan Tesis

DEKLARASI ORISINALITAS

Yang bertanda tangan ini :

Nama : …………………………………………….
NIM : …………………………………………….

PRODI : …………………………………………….

Email : …………………………………………….

Alamat Lengkap : …………………………………………….
(sesuai KTP)

Dengan ini menyatakan bahwa :

a. Karya tulis saya, tesis ini adalah asli dan belum pernah diajukan untuk mendapatkan gelar
akademik (magister), baik di Poltekkes Kemenkes Semarang maupun di perguruan tinggi
lain.

b. Karya tulis ini adalah murni gagasan, rumusan dan penelitian saya sendiri, tanpa bantuan
orang lain, kecuali tim pembimbing dan para narasumber

c. Dalam karya tulis ini tidak terdapat karya atau pendapat yang telah ditulis atau
dipublikasikan orang lain, kecuali secara tertulis dengan jelas dicantumkan sebagai acuan
dalam naskah dengan disebutkan nama pengarang dan judul buku aslinya serta
dicantumkan dalam daftar pustaka.

d. Pernyataan ini saya buat dengan sesungguhnya dan apabila di kemudian hari terdapat
penyimpangan dan ketidak benaran dalam pernyataan ini maka saya bersedia menerima
sanksi akademik berupa pencabutan gelar yang telah saya peroleh, dan sanksi lain
sesuai dengan norma yang berlaku di Poltekkes Kemenkes Semarang.

Semarang, ……………………

Yang membuat pernyataan,
Materai 10.000

NAMA LENGKAP
NIM.

Lampiran 11: Contoh pernyataan formulir pernyataan Academic Property

Pedoman Penyusunan dan Penulisan Tesis

Page 10

PERNYATAAN PERSETUJUAN
HASIL KARYA TESIS UNTUK KEPENTINGAN AKADEMIS

(ACADEMIC PROPERTY)

Sebagai civitas akademik Poltekkes Kemenkes Semarang, saya yang bertanda tangan

dibawah ini :

Nama : TECKY AFIFAH SANTY AMARTHA

NIM : P1337424715020

Program Studi : Kebidanan Program Magister

Terapan

Jurusan : Program Pascasarjana

Jenis Karya : Tesis

Demi pengembangan ilmu pengetahuan, saya menyetujui untuk memberikan kepada
Poltekkes Kemenkes Semarang Hak Bebas Royalti Noneksklusif berupa: Repository, Buku,
HAKI, dan Paten, atas karya ilmiah saya yang berjudul :

Aktivitas Kelistrikan Uterus pada Kontraksi Persalinan Kala I

Beserta perangkat yang ada. Dengan Hak bebas Royalti Noneksklusif ini Program Magister
Terapan Pascasarjana Poltekkes Kemenkes Semarang berhak menyimpan, mengalih media/
formatkan, mengelola dalam bentuk pangkalan data (database) merawat, dan
mempublikasikan tesis saya selama tetap mencantumkan nama saya sebagai
penulis/pencipta dan sebagai pemilik Hak Cipta.

Dibuat di : Semarang
Pada tanggal : 4 Mei 2021

Yang menyatakan

Materai 10.000

Tecky Afifah S.A, S.SiT
NIM. P1337424715020

Pedoman Penyusunan dan Penulisan Tesis

Page 11

Lampiran 12: Contoh Halaman Persembahan

HALAMAN PERSEMBAHAN

Perjuangan merupakan pengalaman yang berharga
Yang dapat menjadikan kita manusia yang berkualitas

Tesis ini kupersembahkan untuk keluargaku
Terima kasih untuk dukungan dan nasehatnya selama ini.

Motto :
# Bersabar, Berusaha, dan Bersyuku
#Bersabar dalam berusaha
#Berusaha dengan tekun dan pantang menyerah
#dan Bersyukur atas apa yang telah diperoleh

Pedoman Penyusunan dan Penulisan Tesis

Page 12

Lampiran 13: Contoh Halaman Riwayat Hidup

RIWAYAT HIDUP
Foto 3x4

Nama :
Tempat, Tanggal lahir :
Agama :
Email :
No Hp :
Alamat lengkap :
(sesuai KTP)
:
Riwayat pendidikan :
Riwayat pekerjaan

Pedoman Penyusunan dan Penulisan Tesis

Page 13

Lampiran 14: Contoh halaman daftar isi tesis i
ii
DAFTAR ISI iii
iv
Halaman judul ........................................................................................... v
Halaman pengesahan ............................................................................... vi
Halaman pernyataan ................................................................................. vii
Halaman persembahan ............................................................................. viii
Riwayat hidup............................................................................................ x
Abstrak ...................................................................................................... xiii
Abstract ..................................................................................................... xiv
Kata Pengantar ......................................................................................... xv
Daftar isi.................................................................................................... xvi
Daftar Tabel ..............................................................................................
Daftar Gambar........................................................................................... 1
Daftar Lampiran......................................................................................... 2
Daftar Singkatan........................................................................................ 2
BAB I PENDAHULUAN 3
4
A. Latar Belakang ............................................................................... 6
B. Perumusan Masalah ......................................................................
C. Tujuan Penelitian ........................................................................... 10
D. Manfaat Penelitian ......................................................................... 12
E. Ruang Lingkup ............................................................................... 15
F. Keaslian Penelitian ......................................................................... 16
17
BAB II TINJAUAN PUSTAKA 20
A. Kehamilan Usia Dini ........................................................................
1. Pengertian ................................................................................ 31
2. Resiko Tinggi pada Kehamilan Usia Muda................................ 40
3. Upaya yang Perlu Dilakukan ..................................................... 50
B. Dukungan Keluarga, Suami dan Tenaga Kesehatan ....................... 52
C. Kerangka Teori................................................................................ 53
55
BAB III METODOLOGI PENELITIAN 60
A. Kerangka konsep ............................................................................ 63
B. Hipotesis ......................................................................................... 65
C. Jenis dan rancangan penelitian ....................................................... 66
D. Populasi dan sampel ....................................................................... 68
1. Populasi.................................................................................... 70
2. Sampel .....................................................................................
E. Definisi operasional .........................................................................
F. Instrumentasi penelitian...................................................................
G. Prosedur penelitian .........................................................................
H. Teknik pengolahan dan analisis data ..............................................
I. Etika penelitian ................................................................................
I. Jadwal penelitian .............................................................................

Pedoman Penyusunan dan Penulisan Tesis

Page 14

BAB IV HASIL

A. Analisis Univariat
1. Karakteristik Responden……………………………………………………

70

2. Pendapatan .............................................................................. 71

3. Pengetahuan ............................................................................ 72

4. Sikap Responden tentang Perawatan Kehamilan ..................... 73

5. Penerimaan Kehamilan............................................................. 75

6. Dukungan Keluarga .................................................................. 77

7. Dukungan Suami ...................................................................... 79

8. Dukungan Tenaga Kesehatan................................................... 81

B. Analisis Bivariat

1. Hubungan Karakteristik terhadap praktik perawatan kehamilan 85

2. Hubungan Pendapatan terhadap Praktik Perawatan Kehamilan

................................................................................................. 88

3. Hubungan Pengetahuan dengan praktik perawatan kehamilan. 88

4. Hubungan antara Penerimaan Kehamilan dengan Praktik

Perawatan Kehamilan................................................................ 90

5. Hubungan antara Dukungan Keluarga dengan Praktik

Perawatan Kehamilan................................................................ 90

6. Hubungan antara Dukungan Suami dengan Praktik Perawatan

Kehamilan.................................................................................. 91

7. Hubungan Dukungan Tenaga Kesehatan dengan Praktik

Perawatan Kehamilan................................................................ 92
C. Analisis Multivariat...............................................................……. 92

BAB V PEMBAHASAN 92
A. Praktik perawatan kehamilan........................................................... 92
B. Karakteristik responden................................................................... 93
1. Umur ........................................................................................... 94
2. Alasan menikah........................................................................... 95
3. Pendidikan .................................................................................. 98
4. Pekerjaan.................................................................................... 100
C. Pendapatan terhadap praktik perawatan kehamilan ........................

BAB VI KESIMPULAN DAN SARAN 110
A. Kesimpulan ................................................................................. 112
B. Saran ..........................................................................................

Pedoman Penyusunan dan Penulisan Tesis

Page 15

Lampiran 15. Contoh Daftar Tabel

DAFTAR TABEL

Tabel 1.1 Jumlah Ibu Hamil Usia Dini, Kematian Ibu dan Bayi .......................... 4
Tabel 1.2 Tabel Keaslian Penelitian .................................................................. 12
Tabel 2.1 Kategori Skala Likert ......................................................................... 47
Tabel 3.1 Variabel Penelitian, Definisi Operasional dan Skala Pengukuran ...... 53
Tabel 3.2 Kisi-kisi Kuesioner Penelitian............................................................. 56
Tabel 3.3 Hasil Uji Validitas Variabel Pengetahuan........................................... 61
Tabel 3.4 Hasil Uji Validitas Variabel Sikap ....................................................... 61
Tabel 3.5 Hasil Uji Validitas Variabel Penerimaan Kehamilan ........................... 62
Tabel 3.6 Hasil Uji Validitas Variabel Dukungan Keluarga................................. 63
Tabel 3.7 Hasil Uji Validitas Variabel Praktik Perawatan Kehamilan ................. 64
Tabel 3.8 Hasil Uji Reliabilitas Semua Variabel................................................. 65
Tabel 3.9 Jadwal Penelitian .............................................................................. 67
Tabel 4.1 Distribusi Frekuensi Umur Responden .............................................. 68
Tabel 4.2 Distribusi Frekuensi Alasan Menikah Responden .............................. 68
Tabel 4.3 Distribusi Frekuensi Pendidikan Responden ..................................... 69
Tabel 4.4 Distribusi Frekuensi Pekerjaan Responden ....................................... 69
Tabel 4.5 Distribusi Frekuensi Pendapatan Responden .................................... 69
Tabel 4.6 Distribusi Frekuensi Tingkat Pengetahuan Responden ..................... 70
Tabel 4.7 Rincian Jawaban Pengetahuan ......................................................... 71
Tabel 4.8 Distribusi Frekuensi Dukungan Keluarga Responden........................ 78
Tabel 4.9 Rincian Jawaban Dukungan Keluarga ............................................... 78
Tabel 4.10 Distribusi Frekuensi Dukungan Suami............................................... 79
Tabel 4.11 Rincian Jawaban Dukungan Suami ................................................... 79
Tabel 4.12 Distribusi Frekuensi Dukungan Tenaga Kesehatan ........................... 81

Pedoman Penyusunan dan Penulisan Tesis

Page 16

Lampiran 16. Contoh Daftar Gambar

DAFTAR GAMBAR

Gambar 2.1 Kerangka Preceed and Proceed Theory........................................... 49
Gambar 2.2 Aplikasi preceed and Proceed Theory terhadap Penelitian............... 50
Gambar 3.1 Kerangka Konsep............................................................................. 51

Pedoman Penyusunan dan Penulisan Tesis

Page 17

Lampiran 17. Contoh Daftar Lampiran

DAFTAR LAMPIRAN

Lampiran 1 Kuesioner Penelitian ....................................................................... 125
Lampiran 2 Uji Normalitas Data ......................................................................... 130
Lampiran 3 Perhitungan Uji Bivariat................................................................... 135
Lampiran 4 Perhitungan Uji Regresi Logistik .................................................... 140
Lampiran 5 Perhitungan Uji Validitas dan Reliabilitas ........................................ 145
Lampiran 6 Surat Permohonan survei awal ....................................................... 150
Lampiran 7 Surat Ijin Studi Pendahuluan ........................................................... 151
Lampiran 8 Surat Tanda Terima Pemberitahuan Penelitian ............................... 152
Lampiran 9 Pemberitahuan Pelaksanaan Penelitian .......................................... 153
Lampiran 10 Informed Consent............................................................................ 154
Lampiran 11 Surat Rekomendasi Penelitian ........................................................ 154
Lampiran 12 Surat pemberitahuan pelaksanaan penelitian.................................. 155
Lampiran 13 Lembar konsultasi ........................................................................... 156

Pedoman Penyusunan dan Penulisan Tesis

Page 18

Lampiran 18. Contoh cover LOG BOOK

LOG BOOK

LAPORAN PERBAIKAN DRAFT TESIS
AKTIVITAS KELISTRIKAN UTERUS PADA KONTRAKSI PERSALINAN KALA I

Oleh:
TECKY AFIFAH
NIM. P1337424715020

PROGRAM STUDI KEBIDANAN PROGRAM MAGISTER TERAPAN
PROGRAM PASCASARJANA POLTEKKES KEMENKES SEMARANG

TAHUN 2021

Pedoman Penyusunan dan Penulisan Tesis

Page 19