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"Latar Belakang: Kanker primer tahap lanjut dapat bermetastasis ke sistem saraf pusat (SSP) yaitu otak dan spinal, maupun ke selain SSP. Perbedaan gejala klinis antara metastasis SSP dan tanpa keterlibatan SSP adalah defisit neurologis pada metastasis SSP. Kedua metastasis tersebut dapat berisiko menyebabkan indeks massa otot skeletal yang rendah akibat gejala klinis dan peningkatan metabolisme akibat kanker. Namun, belum diketahui perbedaan di antara keduanya. Tujuan penelitian ini untuk mengetahui perbedaan appendicular skeletal muscle index (ASMI) pada pasien metastasis dengan dan tanpa keterlibatan SSP. Metode: Penelitian ini adalah studi potong lintang pada subjek berusia 18-65 tahun. Karakteristik subjek berupa usia, jenis kelamin, indeks massa tubuh, status gizi berdasarkan ASPEN, lokasi tumor primer, lokasi metastasis, waktu terdiagnosis metastasis, defisit neurologis, asupan energi dan protein, Karnofsky Performance Scale, kemoterapi, terapi glukokortikoid, dan nilai ASMI. Analisis bivariat digunakan untuk menilai perbedaan nilai ASMI antara metastasis SSP dan tanpa keterlibatan SSP. Hasil: Terdapat 59 subjek dengan nilai ASMI rendah. Rerata nilai ASMI pada metastasis SSP lebih rendah (3,81±1,19 kg/m2) dibandingkan dengan metastasis tanpa keterlibatan SSP (3,97±0,93 kg/m2) dengan perbedaan tidak signifikan pada kedua kelompok (p = 0,568). Terdapat perbedaan bermakna antara ASMI rendah dengan jenis kelamin (p=0,000), asupan energi (p=0,012), disfagia (p=0,027), nyeri kepala (p=0,033), dan gangguan kognitif (p=0,032). Kesimpulan: Tidak ditemukan perbedaan bermakna antara subjek yang memiliki ASMI rendah pada metastasis SSP dan tanpa keterlibatan SSP. Perbedaan bermakna ditemukan antara ASMI dengan karakteristik subjek yaitu jenis kelamin, asupan energi, disfagia, nyeri kepala, dan gangguan kognitif.

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Background: Advanced primary cancer can metastasize to the central nervous system (CNS), namely the brain and spinal cord, or to other than the CNS. The difference in clinical symptoms between CNS metastases and those without CNS involvement is the neurological deficit in CNS metastases. Both metastases may be at risk for low skeletal muscle mass index due to clinical symptoms and increased metabolism due to cancer. However, the differences between them are unknown. The aim of this study was to determine the difference of appendicular skeletal muscle index in metastatic patients with and without CNS involvement. Methods: This study was a cross-sectional study on subjects aged 18-65 years. Subject characteristics included age, gender, body mass index, nutritional status based on ASPEN, primary tumor location, metastasis location, time of metastasis diagnosis, neurological deficits, energy and protein intake, Karnofsky Performance Scale, chemotherapy, glucocorticoid therapy, and ASMI value. Bivariate analysis was used to assess the difference in ASMI value between CNS metastasis and without CNS involvement Results: There were 59 subjects with low ASMI values. The mean ASMI value in CNS metastasis was lower (3,81±1,19 kg/m2) compared to metastasis without CNS involvement (3,97±0,93 kg/m2) without significant difference in both groups (p=0,568). There was a significant difference between low ASMI and gender (p=0,000), energy intake (p=0,012), dysphagia (p=0,027), headache (p=0,033), and cognitive impairment (p=0,032). Conclusion: No significant difference was found between subjects who had low ASMI in CNS metastasis and without CNS involvement. Significant differences were found between ASMI and subject characteristics such as gender, energy intake, dysphagia, headache, and cognitive impairment."

"Latar Belakang: Diperkirakan 20-40% pasien kanker mengalami metastasis ke sistem saraf pusat (SSP). Kondisi inflamasi sistemik pada kanker yang dimediasi sitokin berkaitan dengan penurunan massa otot. Pada kondisi inflamasi, sel hepatosit terstimulasi untuk memproduksi protein fase akut c-reative protein (CRP). Kadar CRP di sirkulasi mengalami peningkatan pada lebih dari 50% pasien keganasan. CRP diperkirakan berhubungan dengan penurunan massa otot dan menjadi prediktor dini dalam kehilangan jaringan lean. Penelitian ini dilakukan untuk mengetahui hubungan kadar CRP dengan indeks massa otot skeletal (skeletal muscle mass index, SMI) pada pasien metastasis SSP. Metode: Penelitian ini adalah studi potong lintang pada pasien kanker dengan metastasis SSP di RSCM. Karakteristik subjek berupa usia, jenis kelamin, tipe metastasis, lokasi tumor primer, defisit neurologis, status performa Karnofsky, penyakit komorbid, penyakit infeksi, terapi glukokortikoid, sedang menjalani kemoterapi, radioterapi, dan tindakan bedah, indeks massa tubuh (IMT), status gizi berdasarkan IMT dan kriteria ASPEN, asupan energi, asupan protein, kadar CRP, dan nilai SMI. Dilakukan analisis hubungan kadar CRP dengan SMI.Hasil: Terdapat 57 pasien yang mengalami metastasis SSP. Mayoritas subjek perempuan (56,1%). Median usia 47 tahun. Lokasi metastasis lebih banyak ditemukan di otak (56,1%), tipe metastasis berdasarkan lokasi susunan saraf terbanyak adalah sinkronus (86%), seluruh subjek merupakan oligometastasis, dan lokasi tumor primer mayoritas berasal dari nasofaring (17,5%), payudara (15,8%), dan paru (14%). Defisit neurologis terbanyak yaitu nyeri kanker (68,4%), nyeri kepala (56,1%), dan kelemahan anggota gerak (43,9%). Kelemahan anggota gerak mayoritas hemiparesis (22,8%). Sebagian besar status performa Karnofsky pasien terganggu sedang (45,6%), 63,2% subjek tidak memiliki penyakit komorbid, 68,4% tidak memiliki penyakit infeksi, 52,6% tidak dalam terapi glukokortikoid, 75,4% subjek tidak sedang menjalani kemoterapi, masing-masing 1,8% subjek sedang menjalani radioterapi dan tindakan bedah. Rerata IMT estimasi 21,28 kg/m2 dan mayoritas status gizi berdasarkan IMT estimasi adalah berat badan normal (43,9%). Berdasarkan kriteria ASPEN, mayoritas termasuk malnutrisi sedang (49,1%) dan berat (31,6%). Rerata asupan energi 19 kkal/kgBB dan median asupan protein 0,6 g/kgBB. Median kadar CRP 46,6 mg/L dan 96,5% subjek mengalami peningkatan kadar CRP. Rerata SMI seluruh subjek yaitu 6,17 kg/m2, rerata SMI laki-laki 7,2 kg/m2 sedangkan rerata SMI perempuan 5,4 kg/m2. Terdapat korelasi negatif lemah (r=-0,373) yang bermakna secara statistik (p=0,005) antara kadar CRP dengan SMI pasien metastasis SSP .Kesimpulan: Terdapat korelasi yang bermakna antara kadar CRP dengan SMI pada pasien metastasis SSP.

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Background: It is estimated that 20-40% of cancer patients experience metastases to the central nervous system (CNS). Systemic inflammatory conditions in cancer mediated by cytokines are associated with a decrease in muscle mass. In inflammatory conditions, hepatocyte cells are stimulated to produce the acute-phase protein called c-reactive protein (CRP). Circulating CRP levels increase in over 50% of cancer patients. CRP is believed to be related to a decrease in muscle mass and serves as an early predictor in lean tissue loss. This study was conducted to determine the relationship between CRP levels and the skeletal muscle mass index (SMI) in patients with CNS metastases. Methods: This study is a cross-sectional study on cancer patients with CNS metastases at RSCM. Subject characteristics include age, gender, metastases type, primary tumor location, neurological deficits, Karnofsky performance status, comorbidities, infectious diseases, glucocorticoid therapy, undergoing chemotherapy, radiotherapy, and surgery, body mass index (BMI), nutritional status based on BMI and ASPEN criteria, energy intake, protein intake, CRP levels, and skeletal muscle mass index (SMI). An analysis of the relationship between CRP levels and SMI was conducted.

Results: There were 57 patients with CNS metastases. Most subjects were female (56.1%). The median age was 47 years. Metastases was more commonly found in the brain (56.1%), and the most common type of metastasis based on the nervous system location was synchronous (86%). All subjects had oligometastasis, and most primary tumor locations were in the nasopharynx (17.5%), breast (15.8%), and lungs (14%). The most common neurological deficits were cancer pain (68.4%), headaches (56.1%), and limb weakness (43.9%). Most limb weakness was hemiparesis (22.8%). Most Karnofsky performance status was moderately impaired (45.6%), 63.2% had no comorbidities, 68.4% had no infectious diseases, 52.6% were not on glucocorticoid therapy, 75.4% were not undergoing chemotherapy, and 1.8% each were undergoing radiotherapy and surgery. The estimated mean BMI was 21.28 kg/m2, with the majority having a normal weight (43.9%). According to ASPEN criteria, the majority were moderately malnourished (49.1%) and severely malnourished (31.6%). The mean energy intake was 19 kcal/kgBW, and the median protein intake was 0.6 g/kgBW. The median CRP level was 46.6 mg/L, with 96.5% of subjects experiencing an increased CRP level. The mean SMI for all subjects was 6.17 kg/m2, with male subjects having a mean SMI of 7.2 kg/m2 and female subjects having a mean SMI of 5.4 kg/m2. There was a weak negative correlation (r=- 0.373) that was statistically significant (p=0.005) between CRP levels and SMI in patients with CNS metastases.

Conclusion: CRP levels are correlated with SMI in patients with CNS metastasis. Higher CRP levels are associated with lower SMI in patients with CNS metastases."

"Latar Belakang: Stroke merupakan penyebab kematian kedua dan penyebab disabilitas ketiga di dunia. Stroke menimbulkan ketidakmampuan dan kelemahan yang berakibat pada penurunan kemampuan fungsional. Kemandirian aktivitas hidup sehari-hari pasien stroke sangat penting karena dapat meningkatkan kualitas hidup. Dari tahun 1990 hingga 2019, telah terjadi peningkatan kejadian stroke sebesar 70%. Selanjutnya stroke sendiri akan menyebabkan peningkatkan angka kematian sebesar 43% dan disability adjusted lifeyears (DALY) sebesar 143%. Penelitian ini bertujuan untuk mehilat hubungan antara kadar vitamin D serum terhadap massa otot bebas lemak pada kedua ektremitas pada pasien stroke dan luaran klinis dengan pada pasien stroke.Metode: Penelitian menggunakan desain potong lintang pada subjek berusia diatas 18 tahun yang menjalani perawatan di RSUPN Dr. Cipto mangunkusumo dan RS Universitas Indonesia Depok. karakteristik demografi meliputi usia, jenis kelamin, status gizi, jenis kulit, jenis pakaian , asupan vitamin D, pemakaian tabir surya, Indeks Barthel, asupan energi total, asupan protein, asupan lemak, asupan karbohidrat, skor pajanan sinar matahari dan kadar vitamin D serum. Dilakukan analisis hubungan kadar vitamin D serum dengan ASMI dan Indeks Barthel Hasil: Sebagian besar subjek rerata berusia 59 tahun, dengan jenis kelamin perempuan terbanyak. Status gizi 33,3% mengalami obesitas derajat 1 dan 13,3% obesitas derajat 2. Karakteristik subjek memiliki jenis kulit tipe 4 (moderate brown), dan hampir seluruh subjek sebanyak 83,3% tidak memakai tabir surya. Untuk kecupukan asupan, bebagian besar subjek 81,7% memiliki asupan energi total yang cukup, 50% subjek mengalami asupan protein yang kurang, 5% subjek memiliki asupan lemak yang kurang, dan hanya 1,7% subjek yang mengalami asupan karbohidrat yang kurang, disamping itu didapatkan 65% yang mengalami kurangnya asupan bahan makanan sumber vitamin D. Skor pajanan sinar matahari pada hampir seluruh subjek sebesar 81,7% termasuk dalam kategori rendah. Hasil penelitian ini juga didapatkan gambaran 30% sebagian subjek tergolong defisiensi vitamin D, dan 58,3% subjek yang mengalami insufisiensi vitamin D. Sebagian besar subjek pada hasil pemeriksaan ASMI menunjukkan gambaran 83,3% mengalami ASMI yang rendah, dengan proporsi pada subjek laki-laki sebanyak 86,2% dan perempuan sebanyak 80,6%. Untuk Indeks Barthel didapatkan 48,3% subjek mengalami ketergantungan sedang dalam menjalani akitivitas sehari-hari. Kesimpulan: Terdapat korelasi yang bermakna antara kadar vitamin D serum dengan ASMI dan Indeks Barthel.

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Background: Stroke is the second leading cause of death and the third leading cause of disability in the world. Stroke causes disability and weakness which results in decreased functional ability. Independence of daily living activities of stroke patients is very important because it can improve the quality of life. From 1990 to 2019, there has been a 70% increase in the incidence of stroke. Furthermore, stroke itself will cause an increase in mortality by 43% and disability adjusted lifeyears (DALY) by 143%. This study aims to investigate the relationship between serum vitamin D levels and fat-free muscle mass in both extremities in stroke patients and clinical outcomes with stroke patients.

Methods: The study used a cross-sectional design on subjects aged over 18 years who underwent treatment at Dr. Cipto Mangunkusumo Hospital and University of Indonesia Hospital Depok. Demographic characteristics include age, gender, nutritional status, skin type, clothing type, vitamin D intake, sunscreen use, Barthel Index, total energy intake, protein intake, fat intake, carbohydrate intake, sun exposure score and serum vitamin D levels. The association of serum vitamin D level with ASMI and Barthel Index was analyzed.

Results: Most of the subjects had an average age of 59 years, with the most female gender. The subjects had a skin type of type 4 (moderate brown), and almost all subjects as much as 83.3% did not wear sunscreen. For intake adequacy, most subjects 81.7% had sufficient total energy intake, 50% of subjects experienced insufficient protein intake, 5% of subjects had insufficient fat intake, and only 1.7% of subjects experienced insufficient carbohydrate intake, besides that 65% experienced insufficient intake of food sources of vitamin D. The sun exposure score in almost all subjects of 81.7% was in the low category. The results of this study also obtained a picture of 30% of subjects classified as vitamin D deficiency, and 58.3% of subjects who experienced vitamin D insufficiency. Most subjects in the ASMI examination results showed a picture of 83.3% experiencing low ASMI, with a proportion in male subjects as much as 86.2% and women as much as 80.6%. For the Barthel Index, 48.3% of subjects experienced moderate dependence in carrying out daily activities.

Conclusion: There is a significant correlation between serum vitamin D levels with ASMI and Barthel Index."

"Latar Belakang: Laparotomi merupakan pembedahan mayor yang dapat menyebabkan penurunan massa otot rangka dan kapasitas fungsional, seperti kekuatan genggam tangan (KGT). Berbagai studi membuktikan penurunan KGT pascaoperasi menimbulkan komplikasi pascaoperasi, serta KGT berkorelasi erat dengan appendicular skeletal muscle index (ASMI). Pengaruh ASMI praoperasi terhadap KGT pascaoperasi belum banyak dilakukan penelitian, sehingga penelitian ini bertujuan menilai korelasi ASMI praoperasi dengan KGT pascaoperasi.Metode: Studi observasional prospektif dilakukan pada subjek berusia 18 – 65 tahun di RS pendidikan tersier, RSUPN Dr. Cipto Mangunkusumo, yang dirawat untuk laparotomi elektif pada Maret sampai Juni 2023. Pengukuran ASMI praoperasi menggunakan bioimpedance analysis (BIA) multifrequency seca® mBCA 525 dengan cutoff laki-laki > 7,0kg/mg2 dan perempuan >5,7 kg/m2. Pengukuran KGT pada tangan kanan dan kiri pascaoperasi pada hari ke-6 pascaoperasi (POD-6) dengan dinamometer tangan spring-type CAMRY® dengan cutoff laki-laki >28 kg/m2 dan perempuan >18 kg/m2. Analisis bivariat dan multivariat digunakan untuk menilai hubungan variabel bebas dan terikat, serta mengidentifikasi faktor perancu yang berhubungan dengan KGT pascaoperasi.Hasil: Pada 85 subjek penelitian, sebanyak 98,82% subjek memiliki ASMI praoperasi rendah, 72,94% subjek memiliki KGT pascaoperasi tangan kanan menurun, dan 80% subjek memiliki KGT pascaoperasi tangan kiri menurun dari cutoff. Didapatkan hasil signifikan pada korelasi ASMI praoperasi dengan KGT pascaoperasi tangan kanan (r=0,444, p<0,001) dan kiri (r=0,423, p<0,001). Analisis lanjutan dengan regresi linier untuk faktor perancu didapatkan indeks massa tubuh (IMT) adalah faktor paling signifikan meningkatkan KGT tangan kanan dan kiri pascaoperasi.Kesimpulan: Terdapat hubungan yang bermakna secara statistik pada korelasi ASMI praoperasi dengan KGT pascaoperasi laparotomi elektif.

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Background: Laparotomy is a major surgery that can lead to a decrease in skeletal muscle mass and functional capacity, such as handgrip strength (HGS). Various studies have shown that HGS is decreasing after surgery can result in postoperative complications, and HGS is closely correlated with the appendicular skeletal muscle index (ASMI). Research on the preoperative influence of ASMI on postoperative HGS is limited, so this study aims to assess the correlation between preoperative ASMI and postoperative HGS.

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Methods: A prospective observational study was conducted on subjects aged 18-65 years at the tertiary education hospital, RSUPN Dr. Cipto Mangunkusumo, who underwent elective laparotomy from March to June 2023. Preoperative ASMI measurements were taken using multifrequency bioimpedance analysis (BIA) with seca® mBCA 525, with a cutoff for males > 7.0 kg/m2 and females > 5.7 kg/m2. Postoperative HGS measurements for the right and left hands on postoperative day 6 (POD-6) were conducted using a spring-type hand dynamometer CAMRY® with a cutoff for males > 28 kg/m2 and females > 18 kg/m2. Bivariate and multivariate analyses were employed to assess the association between independent and dependent variables, as well as to identify confounding factors associated with postoperative HGS.

Results: In 85 research subjects, 98.82% had low preoperative ASMI, 72.94% experienced a decrease in postoperative right HGS, and 80% had a decrease in postoperative left HGS from the cutoff. Significant results were obtained in the correlation between preoperative ASMI and postoperative right HGS (r=0.444, p<0.001) and left HGS (r=0.423, p<0.001). Further analysis with linear regression for confounding factors revealed that body mass index (BMI) was the most significant factor in increasing postoperative HGS for both right and left hands.

Conclusion: There is a statistically significant in the correlation between preoperative ASMI and postoperative HGS in elective laparotomy."

"Latar Belakang: Obesitas merupakan salah satu kondisi yang sering ditemukan pada penduduk dewasa di Indonesia, di mana 29,3% di antaranya adalah perempuan. Individu obesitas dapat mengalami penurunan massa otot yang disebabkan oleh inaktivitas dan penumpukan lemak yang menghambat proses sintesis otot. Jika tidak ditangani, obesitas dapat menyebabkan berbagai komplikasi, salah satunya adalah sarkopenia obesitas. Sarkopenia obesitas adalah kondisi yang ditandai dengan obesitas dan penurunan fungsi dan massa otot, terdiagnosis dengan  IMT >25 kg/m2, skeletal muscle index (SMI) yang menurun, dan kekuatan genggam tangan atau status performa yang rendah. Sarkopenia lebih sering terdeteksi pada lansia, namun penurunan massa otot sudah dapat terjadi sejak usia dewasa. Penelitian ini melihat apabila perempuan dewasa dengan obesitas sudah memiliki tanda-tanda sarkopenia obesitas seperti penurunan massa otot, SMI, dan hubungannya terhadap kekuatan genggam tangan.Metode: Studi ini merupakan studi potong lintang yang dilakukan pada 64 karyawati obesitas RSUPN Dr. Cipto Mangunkusumo. Massa otot diukur menggunakan body impedance analysis dan skeletal muscle index dihitung menggunakan massa otot dibagi dengan tinggi badan (m2). Kekuatan genggam tangan dihitung menggunakan dinamometer tangan. Analisis hubungan massa otot dan skeletal muscle index dengan kekuatan genggam tangan dihitung menggunakan uji korelasi Pearson.Hasil: Dari 64 subjek perempuan dewasa obesitas, 85,7% di antaranya memiliki massa otot yang rendah, dengan korelasi yang positif terhadap kekuatan genggam tangan kiri (p < 0,05, r = 0,354) dan tangan kanan (p < 0,05, r = 0,401). Namun hasil juga menunjukkan bahwa SMI subjek tidak memiliki korelasi dengan kekuatan genggam tangan mereka (p > 0,05), yang dapat disebabkan karena tinggi badan subjek yang lebih pendek dibandingkan standar tinggi sesuai usia.Kesimpulan: Hasil penelitian ini mendukung hipotesis bahwa perempuan obesitas memiliki kadar massa otot yang rendah, yang jika menetap dapat menyebabkan penurunan kekuatan genggam tangan, sehingga meningkatkan kerentanan mereka untuk mengidap sarkopenia obesitas.

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Background: Obesity is a condition prevalent in Indonesian adults, in which 29,3% of them are women. Obesity may come with decreased muscle mass due to inactivity and inhibition of protein synthesis by fat. In women, decreased muscle mass may also be caused by reduced estradiol. Obesity may lead to complications such as diabetes mellitus type 2, heart disease, stroke, osteoarthritis, and sarcopenic obesity. Sarcopenic obesity is a condition characterized by obesity and a decrease muscle mass and function, seen through body mass index of > 25 kg/m2, reduced skeletal muscle index (SMI), and reduced handgrip strength or physical performance. Sarcopenia is more prevalent in the elderly, but previous studies have proven that decreases in muscle mass begins earlier. This study was done to see if adult obese female workers in Dr. Cipto Mangunkusumo hospital have already experienced a decrease in muscle mass, SMI, and their correlation with handgrip strength.

Method: This cross-sectional study was done on  64 obese female adult workers in Dr. Cipto Mangunkusumo hospital. Their muscle mass was measured using body impedance analysis and their skeletal muscle index was calculated by their muscle mass divided by their height (m2). Their handgrip strength was measured using a hand dynamometer. Analysis of the correlation of muscle mass and skeletal muscle with their handgrip strength was done using Pearson correlation.

Result: Of 64 obese female subjects, 85,7% of them have decreased muscle mass. Their muscle mass has positive correlation with both their left handgrip strength (p < 0,05, r = 0,354) and right handgrip strength (p < 0,05, r = 0,401). However, this study shows that SMI of subjects are not correlated with their handgrip strengths (p > 0,05). This can be caused by the subjects’ height being lower than the national age-standardized height.

Conclusion: Therefore, the results of this study supports the hypothesis that obesity is associated with lower muscle mass which could subsequently reduce handgrip strength, which increases their risk of having sarcopenic obesity."

"Tumor sistem saraf pusat (SSP) dapat menurunkan massa otot dan massa bebas lemak akibat defisit neurologis yang terjadi serta efek sistemik karena keganasan. Penurunan massa bebas lemak dan massa otot dengan inflamasi saling memengaruhi serta dikaitkan dengan prognosis yang buruk. Penelitian ini bertujuan untuk mengetahui korelasi indeks massa bebas lemak (FFMI) dengan indeks inflamasi imun sistemik (SII) pada pasien tumor SSP. Studi ini merupakan studi potong lintang pada pasien dewasa dengan diagnosis tumor SSP di RSUPN Dr. Cipto Mangunkusumo. Pengukuran FFMI menggunakan bio impedance analysis (BIA). Nilai SII didapatkan dari hasil pemeriksaan laboratorium darah perifer lengkap. Terdapat 74 pasien tumor SSP dengan mayoritas perempuan (59,5%) dan lokasi tersering adalah tumor di otak (79,7%). Proporsi jenis tumor primer maupun sekunder adalah sama (50%). Median indeks massa tubuh (IMT) yaitu 22,85 kg/m2 (11,99–37,60 kg/m2) dengan kategori IMT terbanyak adalah berat badan normal (33,8%). Rerata FFMI yaitu 16,05±3,12 kg/m2 dengan 51,4% pasien memiliki FFMI yang rendah. Median SII sebesar 1140,9 (103,6–8745,6). Tidak didapatkan korelasi antara FFMI dengan SII pada pasien tumor SSP. Pada analisis tambahan didapatkan korelasi negatif bermakna antara FFMI dengan SII pada wanita (r=- 0,351; p=0,019), sebaliknya pada pria tidak ditemukan adanya korelasi (r=-0,096; p=0,613).

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Central nervous system (CNS) tumors can reduce muscle mass and fat-free mass due to neurological deficits and systemic effects of malignancy. Decreased fat-free mass and muscle mass with inflammation are mutually influential and associated with poor prognosis. This study aimed to determine the correlation between fat-free mass index (FFMI) and systemic immune inflammation index (SII) in patients with CNS tumors. This is a cross-sectional study of CNS tumors adult patients at Dr. Cipto Mangunkusumo National General Hospital. FFMI measurements were obtained using bioimpedance analysis (BIA). SII values obtained from complete peripheral blood laboratory examination results. There were 74 patients with CNS tumors, with the majority being female (59.5%), and the most common location was brain tumors (79.7%). The proportion of primary and secondary tumor types was equal (50%). The median body mass index (BMI) was 22.85 kg/m2 (11.99– 37.60 kg/m2), with the majority falling under the normal weight category (33.8%). The mean FFMI was 16.05±3.12 kg/m2, with 51.4% of patients having a low FFMI. The median SII was 1140.9 (103.6–8745.6). There was no correlation between FFMI and SII in patients with CNS tumors. In additional analysis, a significant negative correlation was found between FFMI and SII in women (r=-0.351; p=0.019), whereas in men, no correlation was found (r=-0.096; p=0.613)."

"Latar Belakang: Tumor sistem saraf pusat (SSP) merupakan salah satu penyebab utama morbiditas di seluruh dunia yang menyebabkan disabilitas dan penurunan kualitas hidup. Tumor SSP menyebabkan defisit neurologis dan berisiko terjadinya kaheksia. Kaheksia dihubungkan dengan penurunan respons pengobatan dan penurunan kesintasan. Peradangan sistemik merupakan ciri khas kaheksia. Rasio neutrofil limfosit (RNL) merupakan penanda inflamasi sistemik yang mudah dan rutin diperiksa dengan harga yang tidak mahal. Belum diketahui hubungan antara RNL dengan kejadian kaheksia pada tumor SSP.Metode: Studi potong lintang ini dilakukan pada subjek berusia 18–65 tahun di RSUPN Dr. Cipto Mangunkusumo, yang dirawat dengan diagnosis tumor SSP pada bulan November hingga Desember 2023. Nilai RNL diambil dari pemeriksaan darah perifer lengkap dan dilakukan penegakan diagnosis kaheksia berdasarkan kriteria Evans. Dilakukan analisis hubungan RNL dengan kejadian kaheksia.Hasil: Terdapat 50 subjek dengan diagnosis tumor SSP. Median RNL adalah 4,13 (1,26; 23,22). Nilai RNL secara signifikan lebih tinggi pada kelompok subjek yang mengalami kaheksia (median RNL 7,19 (1,26; 23,22)) dibandingkan tanpa kaheksia (median RNL 3,10 (1,40; 8,48)) (p<0,001).Simpulan: RNL berhubungan dengan kejadian kaheksia pada tumor SSP. Subjek yang mengalami kaheksia memiliki RNL yang lebih tinggi dibandingkan dengan yang tidak kaheksia.

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Background: Central nervous system (CNS) tumors are one of the leading causes of morbidity worldwide, causing disability and decreased quality of life. Central nervous system tumors cause neurological deficits and are at risk of developing cachexia. Cachexia is associated with decreased treatment response and reduced survival. Systemic inflammation is the hallmark of cachexia. Neutrophil lymphocyte ratio (NLR) is a systemic inflammation that included in routine laboratory examination and inexpensive. The association between NLR and the incidence of cachexia in CNS tumors remain unknown.

Methods: This cross-sectional study was conducted on subjects aged 18–65 years old at RSUPN Dr. Cipto Mangunkusumo Hospital, who were admitted with CNS tumor diagnosis from November to December 2023. The NLR value was taken from the complete peripheral blood examination and the diagnosis of cachexia was based on Evans criteria. The relationship between NLR and the incidence of cachexia was analyzed.

Results: There were 50 subjects with CNS tumor diagnosis. The median NLR was 4,13 (1,26; 23,22). The mean NLR was significantly higher in the group of subjects with cachexia (median NLR 7,19 (1,26; 23,22)) than without cachexia (median NLR 3,10 (1,40; 8,48)) (p<0,001).

Conclusion: NLR is associated with the incidence of cachexia in CNS tumors. Subjects with cachexia had higher NLR compared to those withoit cachexia."

"Latar Belakang: Tumor sistem saraf pusat (SSP) meningkatkan tekanan intrakranial dan menyebabkan berbagai gangguan neurologis yang dapat memengaruhi status gizi pasien. Status gizi memengaruhi imunitas bawaan dan adaptif. Pada hampir semua jenis keganasan kadar asam amino rantai cabang (AARC) didapatkan rendah. Asam amino rantai cabang meningkatkan imunitas dengan meningkatkan fagositik neutrofil, proliferasi limfosit, sintesis protein, menjaga jalur pensinyalan yang sensitif terhadap nutrisi. Rasio neutrofil limfosit (RNL) menggambarkan keseimbangan sistem imunitas dengan inflamasi. Peningkatan RNL dihubungkan dengan penurunan respon imun tubuh, terapi, harapan hidup dan prognosis. Penelitian ini dilakukan untuk mengetahui hubungan asupan AARC terhadap RNL pada pasien tumor SSP.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor SSP yang dirawat di RSCM. Karakteristik subjek berupa usia, jenis kelamin, jenis tumor, defisit neurologis, status performa karnofsky, indeks massa tubuh (IMT), status gizi berdasarkan ASPEN, penyakit komorbid, status infeksi, kemoterapi, radiasi, dan atau kemoradiasi, terapi glukokortikoid, asupan energi dan protein, asupan AARC, serta nilai RNL. Dilakukan analisis hubungan antara dua kelompok asupan AARC yang dibagi sesuai median populasi penelitian terhadap RNL.Hasil: Terdapat 66 subjek penelitian dengan median usia 48 tahun, mayoritas subjek perempuan (56,1%), dengan jenis tumor sekunder sebanyak 38 subjek (57,6%). Defisit neurologis tertinggi berupa nyeri kepala (60,6%), proporsi status performa karnofsky terganggu sedang-berat (60,6%). Proporsi IMT estimasi normal sebanyak 34,8%, rerata IMT 23,46 ± 4,95 kg/m2, dengan mayoritas malnutrisi (54,5%) berdasarkan kriteria ASPEN. Mayoritas subjek tidak memiliki komorbid (65,2%), tidak infeksi (80,3%), tidak menjalani kemoterapi, radiasi dan atau kemoradiasi (84,8%), serta tidak mendapat glukokortikoid (71,2%). Rerata asupan energi 1519 kkal, protein 65 g/hari, median AARC 9 g/hari. Terdapat perbedaan bermakna nilai RNL (p=0,047) pada kelompok asupan AARC <9 g/hari (median RNL 4,9); pada kelompok asupan AARC ≥9 g/hari (median RNL 3,1).

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Background: Central nervous system (CNS) tumors increase intracranial pressure and cause various neurological disorders that can affect the nutritional status of patients. Nutritional status influences both innate and adaptive immunity. In almost all malignancies, low levels of branched-chain amino acids (BCAA) are observed. Branched-chain amino acids enhance immunity by increasing neutrophil phagocytosis, lymphocyte proliferation, protein synthesis, and maintaining nutrient-sensitive signaling pathways. The neutrophil lymphocyte ratio (NLR) reflects the balance of the immune system with inflammation. An elevated NLR is associated with decreased body immune response, therapy outcomes, life expectancy, and prognosis. This study aims to determine the relationship between BCAA intake and NLR in CNS tumor patients.

Method: This is a cross-sectional study on CNS tumor patients treated at RSCM. Subject characteristics include age, gender, tumor type, neurological deficits, Karnofsky performance status, body mass index (BMI), nutrition status based on ASPEN, comorbidities, infection status, chemotherapy, radiation, and/or chemoradiation, glucocorticoid therapy, energy, and protein intake, BCAA intake, and NLR values. The analysis examines the relationship between two groups of BCAA intake divided according to the study population's median with NLR.

Results: There were 66 study subjects with a median age of 48 years, mostly female subjects (56,1%), with 38 subjects (57,6%) having secondary tumors. The highest neurological deficit was headache (60,6%), and the majority have a moderately to severely impaired Karnofsky performance status (60,6%). The proportion of estimated normal Body Mass Index (BMI) was 34.8%, with a mean BMI of 23,46 ± 4,95 kg/m2, and the majority were malnourished (54,5%) based on ASPEN criteria. Most subjects had no comorbidities (65,2%), no infections (80,3%), did not undergo chemotherapy, radiation, and/or chemoradiation (84,8%), and did not receive glucocorticoids (71.2%). The mean energy intake was 1519 kcal, protein intake 65 g/day, and the median BCAA was 9 g/day. There was a significant difference in the NLR values (p=0,047) between the group with BCAA intake <9 g/day (median NLR 4,9) and the group with BCAA intake ≥9 g/day (median NLR 3,1).

Conclusion: BCAA intake is related to NLR values in CNS tumor patients. Higher BCAA intake is associated with lower NLR values."

"Latar Belakang : Inflamasi kronik berhubungan dengan tumor dan menyebabkan prognosis yang buruk pada pasien kanker. Salah satu penanda inflamasi yang meningkat pada tumor adalah C-Reactive Protein (CRP). Kadar CRP meningkat pada lebih dari 50% pasien keganasan. Peningkatan CRP berhubungan kuat dengan keparahan penyakit pada beberapa kanker. Salah satu zat gizi dalam inflamasi adalah asam lemak omega-3. Asam lemak omega-3 dapat meningkatkan pembentukan specialized pro-resolving mediators (SPM) yang berfungsi meningkatkan mediator antiinflamasi, melindungi blood brain barrier, menurunkan sitokin proinflamasi, menurunkan apoptosis neuron. Penelitian ini bertujuan untuk menilai hubungan asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Metode : Studi potong lintang ini dilakukan pada subjek berusia 18-65 tahun di RSUPN Cipto Mangunkusumo pada bulan November hingga Desember 2023. Pengukuran CRP menggunakan metode immunoturbidimetric assay. Pengambilan asupan asam lemak omega-3 menggunakan Food Frequency Questionnaires semikuantitatif. Analisis bivariat digunakan untuk menilai hubungan antara variabel bebas dan terikat.Hasil : Dari total 63 subjek penelitian, sebanyak 35 subjek (55,6%) pada kelompok asupan asam lemak omega-3 < 2 g/hari dan 28 subjek (44,4%) pada kelompok asupan asam lemak omega-3 ≥ 2 g/hari. Nilai median CRP 8,3 (0,6 – 71,5) mg/L. Tidak terdapat hubungan yang bermakna (p = 0,714) antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.Kesimpulan : Tidak terdapat hubungan bermakna antara asupan asam lemak omega-3 dengan CRP pada pasien tumor sistem saraf pusat.

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Background: Chronic inflammation is associated with tumors and causes poor prognosis in tumor patients. One of the inflammatory markers that increase in tumors is C-Reactive Protein (CRP). CRP levels are elevated in more than 50% of patients with malignancies. Elevated CRP is associated with disease severity in some cancers. One of the nutrients in inflammation is omega-3 fatty acids. Omega-3 fatty acids can increase the formation of specialized pro-resolving mediators (SPM) which function to increase anti-inflammatory mediators, protect the blood brain barrier, reduce pro-inflammatory cytokines, reduce neuron apoptosis. This study aims to assess the relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Methods: This cross-sectional study was conducted on subjects aged 18-65 years at Cipto Mangunkusumo Hospital from November to December 2023. CRP measurement using immunoturbidimetric assay method. Omega-3 fatty acid intake was collected using semiquantitative Food Frequency Questionnaire. Bivariate analysis was used to assess the relationship between independent and dependent variables.

Results: From the total 63 research subjects, 35 subjects (55,6%) in the omega-3 fatty acid intake group < 2 g/day and 28 subjects (44,4%) in the omega-3 fatty acid intake group ≥ 2 g/day. The median CRP value was 8.3 (0.6 - 71.5) mg/L. There was no significant relationship (p = 0,714) between omega-3 fatty acid intake and CRP in patients with central nervous system tumors.

Conclusion: There is no significant relationship between omega-3 fatty acid intake and CRP in patients with central nervous system tumors."