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"Latar Belakang: Katabolisme pascalaparotomi menyebabkan imbang nitrogen negatif dan diduga tidak dapat dicegah dengan pemberian nutrisi. Nutrisi parenteral dapat meningkatkan faktor anabolisme. Belum diketahui apakah proporsi asupan energi dan protein dari jalur parenteral terhadap asupan total berkorelasi dengan imbang nitrogen pasien pascalaparotomi elektif.Metode: Studi potong lintang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM) pada pasien pascalaparotomi elektif yang memperoleh supplemental parenteral nutrition (SPN) antara 3 hari pertama pascalaparotomi. Pemeriksaan nitrogen urea urin (NUU) dilakukan terhadap pasien dengan asupan ≥ 12 kkal/kg BB pada hari ketiga pascalaparotomi. Pasien dengan gangguan ginjal dan hati tidak disertakan dalam penelitian.Hasil: Rerata imbang nitrogen hari ketiga pascalaparotomi sebesar -2,8 ± 3,8 g/hari, dengan median asupan energi 19 (12–34) g/kg BB dan protein 0,9 (0,4–1,9) g/kg BB. Proporsi asupan energi dari jalur parenteral sebesar 0,51 ± 0,26 dan protein 0,59 ± 0,28. Tidak ditemukan korelasi signifikan pada proporsi asupan energi dan protein dari jalur parenteral terhadap asupan total dengan imbang nitrogen. Korelasi signifikan ditemukan pada variabel total asupan energi (r = 0,697, p <0,001) dan protein (r = 0,808, p <0,001) dengan imbang nitrogen.Kesimpulan: Pemberian SPN dini penting dalam mencapai total asupan energi dan protein untuk mengimbangi kehilangan nitrogen hari ketiga pascalaparotomi elektif di RSCM meskipun korelasi proporsi asupan nutrisi dengan imbang nitrogen belum tampak pada penelitian ini.

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Background: Post-laparotomy catabolism causes a negative nitrogen balance and is unlikely prevented by nutritional intervention. Parenteral nutrition can increase anabolic factor. It is not known whether the proportion of energy and protein intake from parenteral nutrition to total intake correlates with nitrogen balance in elective post-laparotomy patients.

Methods: A cross-sectional study was conducted at Cipto Mangunkusumo Hospital in elective post-laparotomy patients who received supplemental parenteral nutrition (SPN) within first 3 days after laparotomy. Urine urea nitrogen (UUN) examination was performed on patients with intake ≥ 12 kcal/kg BW on the third day after laparotomy. Patients with renal and hepatic impairment were excluded. Results: The mean nitrogen balance on the third day post-laparotomy was -2.8 ± 3.8 g/day, with median energy intake of 19 (12–34) g/kg BW and protein 0.9 (0.4– 1.9) g/kg BW. The proportion of energy intake from the parenteral route was 0.51 ± 0.26 and protein was 0.59 ± 0.28. No significant correlation was found in the proportion of energy and protein intake from the parenteral nutrition to total intake with nitrogen balance. Significant correlations were found for total energy intake (r= 0.697, p <0.001) and protein (r= 0.808, p <0.001) with nitrogen balance. Conclusion: Early administration of SPN is important in achieving total energy and protein intake to compensate nitrogen loss on the third day after elective laparotomy although the association between the proportion of nutrition intake and nitrogen balance has not been observed in this study."

"ABSTRAKPada pasien sakit kritis, salah satu faktor yang berhubungan dengan angka mortalitas adalah hilangnya protein tubuh, yang digambarkan dengan imbang nitrogen negatif. Imbang nitrogen negatif merupakan akibat penyakit pasien tanpa diimbangi asupan energi dan protein yang adekuat. Berdasarkan hal tersebut, maka dilakukan penelitian ini, yang bertujuan untuk mengetahui korelasi antara asupan energi dan imbang nitrogen pasien sakit kritis di Intensive Care Unit (ICU) dewasa Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM). Metode penelitian yang digunakan adalah studi potong lintang dengan cara mendapatkan sampel consecutive sampling. Kriteria penerimaan adalah pasien ICU dewasa RSUPNCM Jakarta, laki-laki atau perempuan, berusia 20-79 tahun, dan bersedia mengikuti penelitian. Kriteria penolakan adalah pasien yang mengalami gangguan fungsi ginjal atau gangguan fungsi hati. Kriteria pengeluaran adalah pasien tidak dapat mengikuti penelitian sampai selesai atau data tidak lengkap. Data penelitian meliputi asupan energi dan nitrogen, nitrogen urea urin (NUU), serta imbang nitrogen dalam 24 jam awal perawatan. Hasil penelitian menunjukkan pada 30 subyek penelitian terdapat rerata asupan energi 56,3+33,9 % berdasarkan panduan ESPEN. Rerata asupan nitrogen, NUU dan imbang nitrogen masing-masing adalah 3,8+2,7 g, 8,3+4,4 g, dan -8,5+5,5 g. Terdapat korelasi positif kuat bermakna antara asupan energi dan imbang nitrogen, r=0,6, p<0,01. Kesimpulan penelitian ini adalah semakin kurang asupan energi, maka imbang nitrogen akan semakin negatif.

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ABSTRACTHigh protein loss is an important factor in critically ill patients mortality, that is indicated by negative nitrogen balance. Negative nitrogen balance is the result of urinary urea nitrogen (UUN), caused by the severity of the disease, compared to energy and protein intake. This study had been completed, which aimed to determine the correlation between energy intake and nitrogen balance of critically ill patients in adults Intensive Care Unit (ICU) Ciptomangunkusumo general hospital. The method of this study was a cross sectional with consecutive sampling. Inclusion criteria were patients admitted to ICU, aged 20-79 years, and agreed to join this study. Exclusion criteria were patients with kidney or liver diseases. Drop out criteria were patiens who did not complete the study or have complete data. Data collected were energy and nitrogen intake, UUN, nitrogen balance during first 24 hours. There were 30 patients who participated in this study. Energy intake mean was 56,3+33,9 %, based on ESPEN guideline. Mean of nitrogen intake, UUN, and nitrogen balance were 3,8+2,7 g, 8,3+4,4 g, and -8,5+5,5 g, respectively. The correlation between energy intake and nitrogen balance was significantly strong positive correlated. The conclusion of this study is the lower energy intake, the more negative nitrogen balance."

"Pasien rawat inap banyak yang mengalami malnutrisi di rumah sakit (RS). Malnutrisi dihubungkan dengan berbagai komplikasi, seperti risiko yang lebih tinggi mengalami infeksi, memperpanjang masa rawat (length of stay), meningkatkan biaya rawat, serta meningkatkan risiko morbiditas dan mortalitas. Variabilitas prevalensi malnutrisi masih banyak terjadi, akibat banyaknya instrumen skrining dan asesmen serta batas ambang penentuan malnutrisi. Kriteria malnutrisi terbaru menurut Global Leadership Initiative on Malnutrition (GLIM) mengusulkan model dua langkah untuk mendiagnosis malnutrisi di RS. Penelitian ini bertujuan untuk menguji kesahihan kriteria diagnosis GLIM dibandingkan dengan ASPEN dalam mendiagnosis malnutrisi pada pasien rawat inap dewasa. Penelitian menggunakan desain potong lintang pada subjek dewasa yang dirawat inap di RSCM. Setiap pasien didiagnosis menggunakan kriteria GLIM dan ASPEN oleh dokter yang berbeda. Sebanyak 100 subjek penelitian dengan median usia 44,5 tahun, mayoritas perempuan, diagnosis malnutrisi menurut kriteria GLIM paling banyak didapatkan pada pasien penyakit saluran cerna, hepatobilier dan pankreas 69% (20 dari 29 subjek) yang diikuti dengan penyakit keganasan 47% (10 dari 21 subjek). Menurut kriteria ASPEN, terdapat 48% pasien malnutrisi dengan rincian 22% malnutrisi sedang dan 26% malnutrisi berat. Menurut kriteria GLIM, terdapat 63% pasien dengan malnutrisi. Kriteria malnutrisi GLIM memiliki sensitivitas 97,9%, spesifisitas 69,2%, NPP 74,6%, dan NPN 97,3%. Uji chi square menunjukkan adanya perbedaan signifikan (p = 0.000) antara GLIM dan ASPEN. Uji Cohen’s Kappa menunjukkan nilai k = 0,663 dan nilai p = 0.071 yang menunjukkan kesepakatan antara diagnosis GLIM dengan ASPEN dengan tingkat sedang (nilai k = 0,61-0,8) dan tidak signifikan. Median total lymphocyte count (TLC) adalah 1,725/mm3 dengan TLC terendah 340/mm3 dan tertinggi 15,660/mm3. Median kadar albumin adalah 3,85 g/dl dengan nilai terendah 1,1 g/dl dan tertinggi 5,4 g/dl.

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Many inpatients are malnourished in the hospital (RS). Malnutrition is associated with various complications, such as a higher risk of infection, length of stay, increased hospitalization costs, and increased risk of morbidity and mortality. There is still a lot of variability in the prevalence of malnutrition, due to the large number of screening and assessment instruments and the threshold for determining malnutrition. The latest malnutrition criteria according to the Global Leadership Initiative on Malnutrition (GLIM) proposes a two-step model for diagnosing malnutrition in hospitals. This study aimed to examine the validity of the GLIM diagnostic criteria compared to ASPEN in diagnosing malnutrition in adult hospitalized patients. The study used a cross-sectional design on adult subjects who were hospitalized at RSCM. Each patient was diagnosed using the GLIM and ASPEN criteria by a different physician. A total of 100 patients with a median age of 44.5 years participated in the study, the majority were women, the diagnosis of malnutrition according to the GLIM criteria was mostly found in patients with gastrointestinal, hepatobiliary, and pancreatic diseases 69% (20 of 29 subjects) followed by malignancy 47% (10 of 21 subjects). According to ASPEN criteria, there were 48% of malnourished patients, 22% moderate malnutrition and 26% severe malnutrition, meanwhile according to the GLIM criteria, there are 63% of patients with malnutrition. The GLIM malnutrition criteria had a sensitivity of 97.9%, specificity of 69.2%, PPV 74.6%, and NPV 97.3%. The chi square test showed a significant difference (p = 0.000) between GLIM and ASPEN. Cohen's Kappa test showed a value of k = 0.663 and a value of p = 0.071 which indicated a moderate (k = 0.61-0.8) and insignificant agreement between the diagnosis of GLIM and ASPEN. The median total lymphocyte count (TLC) was 1.725/mm3 with the lowest TLC of 340/mm3 and the highest of 15,660/mm3. The median albumin level was 3.85 g/dl with the lowest value 1.1 g/dl and the highest 5.4 g/dl."

"Sakit kritis merupakan suatu kondisi terjadinya gangguan fungsi multiorgan yang menyebabkan homeostasis tubuh tidak dapat dipertahankan tanpa adanya intervensi medis di unit perawatan intensif. Proses hiperkatabolik akibat stres metabolik pada pasien sakit kritis terutama di fase akut sangat tinggi sehingga menyebabkan degradasi protein. Tingkat degradasi ini dapat dilihat salah satunya dengan pemeriksaan kehilangan nitrogen melalui urin 24 jam. Asupan energi dan protein berperan penting dalam memelihara proses metabolisme yang terjadi. Asupan yang tidak adekuat diiringi kehilangan protein yang tinggi akan menghasilkan nilai imbang nitrogen yang negatif. Tujuan penelitian ini untuk melihat korelasi asupan protein selama fase akut terhadap perubahan imbang nitrogen yang dinilai pada hari ke-3 dan ke-7 perawatan. Metode penelitian ini menggunakan desain potong lintang yang dilakukan di Intensive Care Unit Rumah Sakit Universitas Indonesia (ICU RSUI) dengan pengambilan sampel secara consecutive sampling. Kriteria penerimaan adalah berusia 18-60 tahun, mendapatkan asupan protein pertama dalam 48 jam, dan bersedia mengikuti penelitian. Kriteria penolakan adalah produksi urin <0.5 ml/kgBB/jam, gangguan fungsi ginjal dan hati kronis, IMT <18.5 atau ≥30 kg/m², skor APACHE II>30, hamil, dan mendapat norepinefrin >0.3 mcg. Kriteria pengeluaran adalah mendapatkan rerata asupan protein hari ke-3 hingga ke-7 <0.5gr/kgBB/hari, dan meninggal sebelum hari ke-7. Pemeriksaan kadar nitrogen urea urin 24 jam dan perhitungan imbang nitrogen dinilai pada hari ke-3 dan ke-7 perawatan. Hasil penelitian menunjukkan rerata asupan protein dan energi pada 21 subyek adalah 0.8 gr/kgBB/hari dan 78% dari EE pada hari ke-3, lalu rerata asupan pada hari ke-7 adalah 1.1 gr/kgBB/hari dan 110% dari EE. Rerata kadar NUU dan imbang nitrogen hari ke-3 adalah 8.1 gr dan -5.3 gr. Rerata kadar NUU dan imbang nitrogen hari ke-7 adalah 7.2 gr dan -1.5 gr. Rerata perubahan imbang nitrogen bernilai positif yaitu 3.8 gr. Terdapat korelasi positif antara asupan energi maupun protein terhadap imbang nitrogen hari ke-3 (r=0.5, p=0.01; r=0.6, p=0.003). Walaupun terdapat perbaikan imbang nitrogen yang signifikan pada subyek penelitian namun tidak didapatkan korelasi bermakna antara asupan protein terhadap perubahan imbang nitrogen (p=0.1). Kesimpulan penelitian ini adalah asupan energi dan protein berkorelasi positif dengan imbang nitrogen pada early acute phase. Asupan protein pada late acute phase tidak berhubungan dengan perubahan imbang nitrogen pada penelitian ini

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Critical illness is a condition where multiorgan dysfunction occurs which causes body homeostasis that cannot be maintained without medical intervention in the intensive care unit. The hypercatabolic process due to metabolic stress in critically ill patients, especially in the acute phase, is very high, causing protein degradation. This level of degradation can be evaluated by examining nitrogen loss through 24-hour urine. Energy and protein intake plays an important role in maintaining the metabolic processes. Inadequate intake accompanied by high protein losses will result in negative nitrogen balance values. The aim of this study was to analyze the correlation of protein intake during the acute phase with nitrogen balance changes on days 3 and 7 of treatment. The method of this study was cross-sectional with consecutive sampling, conducted in the Intensive Care Unit of the University of Indonesia Hospital (ICU RSUI). Inclusion criteria were 18-60 years old, getting their first protein intake within 48 hours, and willing to take part in the research. Exclusion criteria were urine output <0.5 ml/kgBW/hour, chronic kidney and liver function disorders, BMI <18.5 or ≥30 kg/m2, APACHE II score>30, pregnancy, and receiving norepinephrine >0.3 mcg. Drop out criteria were patients having an average protein intake on days 3 to 7 <0.5 gr/kgBW/day, or dying before the 7^th day. Examination of 24-hour urine urea nitrogen (UUN) levels and calculation of nitrogen balance were assessed on days 3 and 7 of treatment. The results of the study showed that the mean of protein and energy intake in the 21 subjects was 0.8 gr/kgBW/day and 78% of EE on day 3, then the mean intake on day 7 was 1.1 gr/kgBW/day and 110% of EE. The mean ​​of UUN levels and nitrogen balance on day 3 were 8.1 gr and -5.3 gr. The mean of UUN levels and nitrogen balance on day 7 were 7.2 gr and -1.5 gr. Mean of nitrogen balance changes was positive, namely 3.8 gr. There was a positive correlation between energy and protein intake with nitrogen balance on day 3 (r=0.5, p=0.01; r=0.6, p=0.003). Although there was a significant improvement in nitrogen balance in the research subjects, there was no significant correlation between protein intake with nitrogen balance changes (p=0.1). The conclusion of this study is that energy and protein intake were positively correlated with nitrogen balance in the early acute phase. Protein intake in the late acute phase was not associated with nitrogen balance changes in this study."

"Stroke merupakan abnormal fungsi sistem saraf pusat akibat suplai darah ke otak terhenti. Manifestasi klinis yang menyertai pasien stroke adalah disfagia. Penatalaksanan gangguan proses menelan adalah kegiatan mengunyah agar mengembalikan fungsi motorik volunter yang cedera. Tujuan umum mengetahui pengaruh kegiatan mengunyah terhadap asupan nutrisi dan lama perbaikan fungsi menelan pada pasien stroke dengan disfagia. Penelitian menggunakan desain Randomized Control Trial dengan rancangan pretest-posttest with control group. Total sampel adalah 30 responden dibagi atas 2 kelompok. Hasil penelitian dinyatakan ada perbedaan yang signifikan asupan nutrisi dan lama perbaikan fungsi menelan sesudah diberikan kegiatan mengunyah, dengan p value 0,001 (α =0,05). Pemberian kegiatan mengunyah terbukti dapat meningkatkan asupan nutrisi dan mempercepat perbaikan fungsi menelan pada pasien stroke dengan disfagia.

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Stroke is an abnormal function of the central nervous system caused by inadekuat blood supply to the brain. Clinical manifestations that often accompanies stroke patients is dysphagia. Swallowing disorder process, the intervention form of chewing activity. Chewing activities aimed to restoring voluntary motor function.

This study aims to determine the effect of chewing activities to nutrition intake and the time of swallow function recovery of stroke patients with dysphagia. This study uses a Randomized Control Trial design. Total sample used by 30 respondents divided in 2 group. Each group consist of 15 respondents.

Results of this study revealed that there are significant differences intake nutrition and the time of swallow function recovery after chewing activities, with a p value of 0.001 (α = 0,05). Giving chewing activities proven to increase the intake of nutrients and accelerate the improvement of swallowing function of stroke patients with dysphagia."

"Penelitian ini merupakan penelitian kuantitatif yang menggunakan desain cross sectional dan bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan obesitas pada PNS. Populasi penelitian adalah dewasa yang terdaftar sebagai Pegawai Negeri Sipil di Kementerian Koperasi dan Usaha Kecil Menengah dengan sampel sebanyak 122 yang didapatkan dengan metode simple random sampling. Penelitian dilakukan pada 2-19 April 2012 dengan menggunakan instrument berupa kuesioner, microtoise, timbangan seca dan food models.Hasil penelitian menunjukkan 32,8% responden mengalami obesitas. Hasil analisis bivariat menunjukkan bahwa terdapat hubungan yang bermakna antara pengetahuan gizi, pendidikan terakhir, asupan energi, asupan protein, asupan lemak dan asupan karbohidrat dengan kejadian obesitas pada PNS. Sedangkan tidak ada hubungan yang bermakna antara umur, jenis kelamin, status pernikahan dan aktivitas fisik dengan obesitas. Peneliti menyarankan kepada Kementerian Koperasi dan Usaha Kecil Menengah untuk mengadakan edukasi dan penyuluhan mengenai gizi agar terhindar dari risiko penyakit akibat obesitas.The study is a quantitative study using cross sectional design and aims to determine the factors associated with obesity in the PNS. The study population is adults who are registered as civil servant in the Ministry of Cooperatives and Small and Medium Enterprises with a total of 122 samples obtained by simple random sampling method. The study was conducted on 2 to 19 April 2012 by using the instrument in the form of questionnaires, microtoise, Seca scales and food models. The results showed 32.8% of respondents were obese.

The results of bivariate analysis showed that there was a significant association between nutritional knowledge, the latest education, energy intake, protein intake, intake of fat and carbohydrate intake with the incidence of obesity in the PNS. Whereas no significant association between age, sex, marital status and physical activity with obesity. Researchers suggest to the Ministry of Cooperatives and Small and Medium Enterprises to conduct education and counseling on nutrition in order to avoid the risk of disease due to obesity."

"Obesitas anak meningkat dua kali lipat dalam 20 tahun terakhir dan terjadi pada negara berkembang seperti Indonesia Pengaruh pengetahuan gizi terhadap asupan remaja masih dalam perdebatan Penelitian ini bertujuan untuk menelusuri hubungan tingkat pengetahuan gizi dengan asupan energi dan makronutrien Pengambilan data berlangsung pada Februari hingga April 2012 pada salah satu fakultas kedokteran di Jakarta Seluruh mahasiswa berusia 15 18 tahun diikutsertakan dalam penelitian potong lintang ini Pengetahuan gizi diukur melalui kuesioner isian Asupan energi dan makronutrien ditelusuri melalui wawancara gizi dengan panduan kuesioner FFQ Sebanyak 75 subyek ikut serta dalam penelitian dengan 62 di antaranya memiliki tingkat pengetahuan gizi sedang dengan rerata skor 21 00 12 00 27 00 Konsumsi rerata energi karbohidrat protein dan lemak harian responden adalah 2443 60 761 30 ndash 5109 00 kkal 316 10 106 50 ndash 734 20 gram 88 89 37 02 gram dan 82 00 14 80 211 30 gram Proporsi karbohidrat protein dan lemak pada responden adalah 53 97 9 31 13 31 7 67 ndash 22 45 dan 31 95 12 59 ndash 53 47 Laki laki mengonsumsi total energi dan makronutrien yang lebih tinggi tetapi komposisi yang serupa dengan perempuan Tidak ada hubungan antara tingkat pengetahuan gizi dengan asupan energi p 0 415 jumlah dan komposisi karbohidrat p 0 715 p 0 323 protein p 0 634 p 0 387 serta lemak p 0 116 p 0 398 Oleh karena itu peningkatan pengetahuan gizi tidak berhubungan dengan asupan energi dan makronutrien yang lebih baik.

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Adolescent's obesity increased two times in recent two decades and existed in developing countries like Indonesia Effect of nutrition knowledge on nutrition intake is still debated We investigated the relationship between nutrient knowledge levels and energy and macronutrient intake Data was collected from February to April 2012 at a medical school in Jakarta All students aged 15 to 18 years old enrolled in this cross sectional study Nutrition knowledge was assessed by open ended questions Energy and macronutrient intake was estimated by guidance of FFQ in the interview Among 75 subjects out of 62 students scored lsquo average'in nutrition knowledge with mean of 21 00 12 00 27 00 Mean consumption of energy carbohydrate protein and fat were 2443 60 761 30 ndash 5109 00 kcal 316 10 106 50 ndash 734 20 grams 88 89 37 02 grams and 82 00 14 80 ndash 211 30 grams respectively Proportion of carbohydrate protein and fat in the diet were 53 97 9 31 13 31 7 67 ndash 22 45 and 31 95 12 59 ndash 53 47 Males consumed higher energy and macronutrients intake but had similar diet composition There were no significant correlations between nutrition knowledge levels and energy intake p 0 415 number and composition of carbohydrate p 0 715 p 0 323 protein p 0 634 p 0 387 and fat p 0 116 p 0 398 intake Therefore better nutrition knowledge did not correspond to better energy and macronutrient intake."

"Latar belakang : Jumlah kelahiran hidup bayi prematur di RSCM adalah 507 dan 112 diantaranya lahir pada usia gestasi 28-32 minggu atau disebut bayi baru lahir sangat prematur (BBLSP). Data RSCM menunjukkan bahwa BBLSP memiliki angka kesintasan 58,9%. Pemberian nutrisi yang agresif dengan diet tinggi protein pada BBLSP diperlukan untuk mempercepat kejar tumbuh. Diet tinggi protein memberikan beban metabolisme pada ginjal BBLSP yang sedang berkembang. Ginjal BBLSP memiliki jumlah nefron fungsional yang lebih sedikit dan imaturitas yang ditandai dengan rendahnya laju filtrasi glomerulus serta kemampuan pemekatan urin yang rendah. Diet tinggi protein menginduksi hipertrofi ginjal, proteinuria, dan sklerosis glomerular melalui single nephron glomerular hyperfiltration (SNGHF) sehingga menyebabkan cedera glomerulotubular yang dapat dideteksi dengan biomarka Neutrophil gelatinase-associated lipocalin urin (uNGAL). Tujuan : Mengetahui pengaruh asupan protein terhadap cedera glomerulotubular pada BBLSP. Metode : Penelitian ini adalah penelitian pada BBLSP yang dilakukan dengan desain kohort prospektif yang dilakukan di ruang rawat perinatologi Departemen Ilmu Kesehatan Anak RS Cipto Mangunkusumo dan RS Bunda Menteng pada periode 1 Juni 2019 hingga Mei 2020. Pengambilan sampel urin dilakukan sebanyak 3 kali yaitu usia 0-48 jam (T1), 72 jam (T2), dan usia 21 hari (T3). Dilakukan pemeriksaan rasio NGAL dan kreatinin urin (uNGAL/Cr). Cedera glomerulotubular didefinisikan sebagai uNGAL/Cr  1 SB. Data karakteristik subyek dan asupan protein diambil dari rekam medik. Rerata asupan protein enteral dicatat sejak usia 14-21 hari sesuai asupan di rekam medik. Kadar protein di ASI diukur dengan human milk analyzer. Asupan tinggi protein adalah kadar asupan protein 3 g/kg/hari. Hasil : Total subyek penelitian adalah 59 BBLSP pada saat rekruitmen dan terdapat 39 subyek menyelesaikan penelitian hingga usia 21 hari. Proporsi BBLSP yang mengalami cedera glomerulotubular pada pemberian kadar asupan tinggi protein 5/29 subyek, sedangkan pada pemberian kadar asupan rendah protein adalah 4/10 subyek. Kadar uNGAL/Cr pada BBLSP yang mendapatkan kadar asupan tinggi protein dibandingkan rendah protein adalah 3,54 (0,69-89,16) ng/mg dan 6,88 (0,32-66,64) ng/mg. Kadar uNGAL/Cr pada usia 48 jam, 72 jam, dan 21 hari tidak menunjukkan korelasi yang bermakna dengan kadar asupan protein (p=0,80; 0,58; 0,07).Simpulan : Sebanyak 5/29 subyek yang mendapatkan kadar asupan tinggi protein mengalami cedera glomerulotubular. Kadar uNGAL/Cr pada BBLSP yang mendapat asupan tinggi protein maupun rendah protein cenderung meningkat pada usia 72 jam dan menurun pada usia 21 hari. Pemberian asupan tinggi protein pada BBLSP tidak menyebabkan cedera glomerulotubular pada bayi sangat prematur.

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Background: Absolute preterm birth rate in Cipto Mangunkusumo Hospital (CMH) was 507 in 2018, 112 amongst were born very preterm (28-32 weeks of gestational age). The survival rate was approximately 58.9%. Early aggressive nutrition by administration of high protein intake is needed for catch up growth. High protein produces high metabolic load to the kidney. Kidney in the very preterm neonates have fewer amount of functional nephron. Furthermore, the immaturity of the kidney was shown in lower glomerular filtration rate and ability to dilute urine. High protein intake induces nephron hypertrophy,

proteinuria, and glomerular sclerosis through single nephron glomerular hyperfiltration (SNGHF) which lead to glomerulotubular injury. Urine neutrophil gelatinase-associated lipocalin to creatinine ratio (uNGAL/Cr) is a biomarker used to detect glomerulotubular injury.

Aim : To analyze the correlation of high protein intake and glomerulotubular injury in very preterm neonates.

Method: A prospective cohort study was conducted in very preterm infants admitted to neonatology ward of CMH and Bunda Hospital Menteng during 1 June 2019 to May 2020. Urine sample were taken in 3 points of time: age 0-48 hours, 72 hours, and 21 days postnatal. Urine NGAL and creatinine (uNGAL/Cr) were examined. Glomerulotubular injury was defined as uNGAL/Cr level 1 SD. Subject characteristic data and protein intake were obtained from medical record. Enteral protein intake was recorded daily from medical record since age 14-21 days postnatal. Protein level in the breastmilk was measured by using human milk analyzer. High protein intake is recorded if the average intake was  3/kg/day.

Results: This study recruited 59 very preterm neonates and 39 of them survived until the end of the study. Proportion of very preterm neonates who had glomerulotubular injury after high protein intake vs low protein intake was 5/29 vs 4/10 subjects. Median of uNGAL/Cr level in high protein intake group compare to low protein intake group were 3,54 (0,69-89,16) ng/mg and 6,88 (0,32-66,64) ng/mg. Protein intake is not correlated to uNGAL/Cr level at 0-48 hours, 72 hours, and 21 days postnatal age (p=0,80; 0,58; 0,07).

Conclusion: There were 5/29 subjects experienced glomerulotubular injury in high protein intake administration. In very preterm neonates, uNGAL/Cr level was increased at the age of 72 hours and decreased in 21 days on both high and low protein intake group. High protein intake had no correlation to glomerulotubular injury in the very preterm neonates. "

"Perubahan gaya hidup remaja menyebabkan ketidakseimbangan asupan energi dan aktivitas fisik yang berujung pada obesitas, mempengaruhi kesehatanya di usia dewasa. Obesitas dini dapat menyebabkan penyakit degeneratif terjadi secara lebih cepat. Penelitian ini ingin mencari faktor asupan energi dan komposisi makronutrien dalam mempengaruhi status gizi berdasarkan tebal lipatan kulit. Seluruh mahasiswa tingkat pertama usia 15-18 tahun pada juni 2011-Juni 2013 (n=75) diwawancara asupan makanannya dalam satu bulan terakhir, kemudian dicari asupan energi harian, komposisi karbohidrat, protein dan lemaknya. Subjek juga diukur tebal lipatan kulit di empat lokasi (bisep, trisep, subskapula dan suprailiaka), kemudian dicari persentase lemak tubuh dan digolongkan kedalam status obesitas dan tidak obesitas. 25,8% remaja pria dan 38,6% remaja wanita tergolong obesitas dengan kadar lemak tubuh ≥25(♂) dan ≥35%(♀) pada usia 15-18 tahun. Baik remaja dengan obesitas maupun tidak obesitas kebanyakan mengonsumsi asupan energi secara berlebih 2443(761-5109)kkal atau sebanding dengan 104(35-230)% AKG dimana laki-laki lebih banyak dibandingkan perempuan. Asupan gizi rerata dengan komposisi 53.97±9.31% karbohidrat, 13.67±2.65% protein dan 31.41±8.12 % lemak. Kadar lemak pada pria (30,6±3,7%) lebih besar daripada pada wanita (21,4±5,3%). Hubungan antara asupan energi, komposisi karbohidrat, protein dan lemak dengan tebal lipat kulit masing masing dengan p=0,703; p=0,189; p=0,319; p=0,804. Asupan energi yang berlebihan maupun komposisi karbohidrat, protein dan lemak tidak secara langsung berpengaruh terhadap status gizi berdasarkan tebal lipatan kulit. Status gizi berdasarkan tebal lipatan kulit dapat dipengaruhi oleh berbagai faktor lain di luar itu sehingga perlu diperhatikan hal-hal lain dalam memberikan intervensi kesehatan untuk memperbaiki kondisi obesitas.

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Adolescent lifestyle changes led to an imbalance energy intake and physical activity lead to obesity which led to premature degenerative diseases. This study wanted to find energy intake and macronutrient composition as a factor influence skinfold thickness. The entire freshman aged 15-18 years (n=75) on June 2011were interviewed to exam the past month food intake, carbohydrates, protein and fat composition using FFQ questionnaire.

Subject were also had skinfold thickness at four sites examined, those measurement would lead to body fat percentage and had categorized into obesity and non-obesity. 25,8% male and 38,6 female adolescent were classified as obese with body fat percentage ≥ 25 (♂) and ≥ 35% (♀) at the age of 15-18 years. Both adolescents with obese and non-obese mostly consume excess energy intake 2443(761-5109) kcal equivalent to 104(35-230)% RDA, while male consumed 113(65-197)% RDA on average and female 107±39% RDA. The macronutrient diet compositions consist of 53.97±9.31% carbohydrate, 13.67±2.65% protein and 31.41±8.12% fat. Body fat percentages in male (30.6±3.7%) were greater than women (21.4±5.3%).

Relations between energy intake, carbohydrate, protein and fat composition with skinfold thickness is p = 0.703, p = 0.189, p = 0.319, p = 0.804 respectively. Excessive energy intake and carbohydrates, protein and fats composition do not directly affect the nutritional status based on skinfold thickness. Nutritional status based on skinfold thickness could be affected by other factors that need to be considered, especially in delivering health interventions to improve the adolescent obesity condition."