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Introduction
Diabetes is an increasing metabolic problem that contributes to almost 4.2 million of global deaths in 2019.1 The worldwide prevalence of diabetes was predicted to be 10.2% in 2030.2 In 2018, 2.0% of adults were diagnosed with diabetes in Indonesia.3 In addition, around 19.7% of the population were estimated to have impaired glucose tolerance according to 2018 Indonesia's Basic Health Research (Riskesdas).3
Type 2 diabetes mellitus (DM) has been widely studied as a major risk factor for cardiovascular diseases (CVD), which is currently the number one cause of mortality worldwide.4 In 2018, the prevalence of CVD in Indonesia was 1.5%.3 CVD accounts for 52% of deaths in Type 2 DM and 44% in Type 1 DM.5 Adults with type 2 diabetes mellitus are more than twice as likely to develop CVD than adults without diabetes mellitus.6 It is estimated that more than 70% of individuals with diabetes mellitus will die from CVD.6 Among many predictors, lipid markers are the most commonly used indicator of CVD risk.7
In terms of diet therapy for chronic disease and diabetes management, there is a growing trend in the use of natural compound or food with bioactive properties to help improve metabolic conditions.8 Functional food refers to food with basic nutritional impact, which also has beneficial effects on one or more functions of the human organism; it either improves the general and physical conditions and/or decreases the risk of the evolution of diseases.9
Chayote or Sechium edule, a plant from the Cucurbitaceae family, is known for its economic value for trade and for its culinary applications in many countries due to its nutritional content.10 Chayote is also used for medicine and complementary treatment, such as for hypertension or dissolving kidney stones.11 The administration of chayote extract was reported to lower blood glucose and improved lipid profile in diabetic rats.12,13 Chayote juice has also been reported to significantly reduce starch-induced postprandial glycemic load even in the absence of carbohydrate digestive enzymes' inhibitory activities.14 Feeding rats with chayote juice for 3 months along with sucrose or fructose-sweetened beverages not only decreased the progression of impaired glucose tolerance but also significantly prevented development of...