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"ABSTRAKPasien kanker umumnya mengalami penurunan berat badan terkait kaheksia. Patofisiologi kaheksia kanker multifaktorial, termasuk efek sitokin pro inflamasi dan inflamasi sistemik. Profil asam amino plasma pada pasien kanker mengalami perubahan. Deplesi protein dapat terjadi akibat asupan yang menurun atau efek langsung dari tumor. Penelitian ini bertujuan untuk mengetahui profil dan hubungan antara asam amino serum, status nutrisi dan sitokin-sitokin pro-anti inflamasi, serta sel T helper 17 pada pasien kaheksia kanker paru. Penelitian potong lintang dengan consecutive sampling pada pasien kanker paru dengan kaheksia ini mengambil subjek berusia lebih dari 18 tahun dan belum diterapi atau sudah selesai terapi lebih dari 2 bulan di Rumah Sakit Kanker Dharmais. Analisis asupan dilakukan dengan food frequency questionnaire semikuantitatif dan 24-hours food recall. Pemeriksaan asam amino serum dengan metode spektofotometri, Sel T helper-17 dengan metode flowcytometry, dan C-reactive protein dengan metode latex agglutination, serta kadar IL 17, IL 6 dan TNFα dengan metode ELISA. Data yg didapat kemudian di analisis dengan uji T atau Mann Whitney untuk melihat hubungan dan untuk menganalisis hubungan dalam tabel digunakan uji Chi-Square atau Fischer Exact, sedangkan untuk korelasi digunakan uji Pearson atau Spearman. Asam amino triptofan, asparagin, glutamin, valin, lisin dan sistein berkorelasi positif dengan sitokin anti-inflamasi dan status nutrisi, sebaliknya negatif dengan sitokin pro inflamasi. Asam amino fenilalanin, treonin, dan glutamat berkorelasi positif dengan sitokin pro-inflamasi dan berkorelasi negatif dengan status nutrisi dan sitokin anti inflamasi. Khusus aspartat, selain berkorelasi positif dengan sitokin pro inflamasi, juga berkorelasi positif dengan indeks massa tubuh, tetapi menunjukkan korelasi negatif dengan penurunan berat badan. Beberapa asam amino serum terbukti berhubungan dengan status sitokin dan status nutrisi pada subjek kanker paru dengan kaheksia, sehingga perlu menjadi perhatian dalam terapi nutrisi pasien kankerKata kunci: asam amino serum, status nutrisi, sitokin, kaheksia kanker

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ABSTRACTCancer patients generally experience weight loss associated with cancer cachexia. The pathophysiology of cancer cachexia is multifactorial, including the effects of pro inflammatory cytokines and systemic inflammation.. The plasma amino acid profile was found to significantly undergo changes in cancer patients. Protein depletion can occur due to decreased intake or direct effects of tumors on protein metabolism. This study aimed to determine the profile and relationship between serum amino acids, nutritional status and pro-anti-inflammatory cytokines, and T helper 17 cells in lung cancer cachexia patients. This cross-sectional study with consecutive sampling in lung cancer patients with cachexia took subjects over the age of 18 years and who had not been treated or who had finished therapy for more than 2 months at the Dharmais Cancer Hospital. Dietary intake analyses were carried out with semiquantitative food frequency questionnaire and 24-hour food recalls. Blood tests were carried out in the form of serum amino acids, cytokines, C-reactive protein and T helper 17 cells. Data obtained were then analyzed by the T or Mann Whitney test to see the relationship and to analyze relationships in the table used chi-square or Fischer Exact, while for correlation used Pearson or Spearman test. The amino acids tryptophan, asparagine, glutamine, valine, lysine and cysteine were positively correlated with anti-inflammatory cytokines and nutritional status, and negatively correlated with pro-inflammatory cytokines. Phenylalanine, threonine and glutamate amino acids were positively correlated with pro-inflammatory cytokines and negatively correlated with nutritional status and anti-inflammatory cytokines. Aspartate showed a positive correlation pro inflammatory cytokines and body mass index, but a negative correlation with weight loss. Some serum amino acids have been shown to be related to cytokines and nutritional status in lung cancer cachexia patients, so it should be a concern in nutritional therapy for cancer patients"

"Tujuan: Mengoptimalkan tumbuh kembang anak dengan mengetahui hubungan antara pola pemberian ASI dan MP·ASI dengan stunting pada bayi usia 6-12 bulan dan mengkatkan kadar seng serum bayi usia 6-12 bulan. Metode : Penelitian ini menggunakan desain nested case control. Subyek penelitian adalah bayi stunting dan tidak stunting. Hasil: Jumlah subyek 90 bayi usia 6-12 bulan, 30 kasus, 60 kontrol. Kelompok kasus diambil secara purposive, sedangkan kelompok kontrol adalab bayi tidak stunting dengan matching jenis kelamin dan usia dalam rasio satu banding dua yang diambil acak sederhana. Subyek terdiri atas 45 bayi perempuan dan 45 bayi Iaki-laki. Sebagian besar (73,3%) subyek berusu.9-12 bulan. Berat badan lahir <-1 SD ditemukan pada 24,4% subyek dan panjang badan lahir <-1 SD pada 15,9% subyek (n= 44). Responden, yaitu ibu subyek, sebagian besar (87,8%) berusia antara 17-'15 lahun dan 58,9"10 berpendidikan rendah. Hampir seluruh subyek (96,7%) mendapat asupan seng di bawah AKG 2004. Pada penelitian ini didapatkan BB lahir <-1 SD merupakan faktor risiko yang bennakna (OR =1,51; P < 0,001) Untuk stunting. Uji statistik menuujukkan pola pemberian ASI dan MP-ASI kalegori tidak baik meningkatkan risiko stunting (OR = 1,122; 95% CI 0,351-3,581), walaupun seeara statistik tidak bermakna. Dengan analisis tambahan didapatkan tidak dilanjutkanya ASI setelah mendapat MP-ASI merupakan faktor risiko bermakna Untuk stunting (p ~0,039; OR 5,8). Rerata kadar seng serum bayi stunting 12,4 ± 1,7 umoL, yaitu termasuk dalam rentang marjinaI (10,7-<13 umol/L). Sebanyak 56,1% subyek stunting mempunyai kadar seng serum di bawah niIai normal (13 umol/L) dan 20% mempunyai kadar seng serum rendah «10,7 umol/L). Uji kore1asi menunjukan tidak ada hubungan antara kadar seng serum dengan asupan seng dan panjang badan untuk usia. Kesimpulan: Pola pemberian ASI dan MP-ASI kategori tidak baik meningkatkan risiko stunting. Rerata kadar seng serum bayi stunting pada peneitian ini berada dalam rentang marjinal.

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Objective: Aim of the study was to optimize child grosth by investigating the relationship between breastfeeding and complementary feeding practice and stunting among 6-12 mo infants, and to examine the zinc status of 6-12 months old stunted infants.

Method : A "nested" case-control design was used in this study. Subjects were stunted and nonstunted infants.

Results : A total of90 subjects of 6-12 mo infants in Tangerang participated in this study (30 cases and 60 _Is). Purposive sampling was used to obtain cases, while simple random sampling was used among matched controls (by gender and age). Gender were equally distributed in both groups. Mostof1he subjects (733%) were between 9-12 mo. Birth weight <-1 SD were found in 24.4% and length (n = 44) <-I SO in 15.9% subjects. Respondents, the subjects'mothers; mostly (87.8%) were between 17-35 yr and 58.9% were low educated.. Almost all (96.7%) subjects had zinc intake below Indonesian RDA 2004. This study demonstrated that birth weight <-1 SD was a significance risk factor (p<0.001; OR = 7.57) fur stunting. Statistical analysis showed that inappropriate breastfeeding and complementary feeding practice increased 1he risk fur stunting (OR= 1.122; 95% Cl 0351-3587), although statistically not significant. Further analysis showed that not continuing breastfeeding was a significant risk further for stunting (OR = 5.8 and p = 0.039). Mean serum zinc levels of 1he stunted subjects was 12.4 ± 1.7 umol/L (marginal levels 10.7-<13 pmollL). Serum zinc levels of 56.7% stunted subjects were under be normal levels (13 umol/L) and 20% hail low serum zinc levels <10.7 umol/L). Serum zinc levels did not show relationship with zinc in lake and height for age Z-score.

Conclusion : inappropriate feeding practice increased 1he risk for stunting. Mean serum zinc levels of stunted subjects in this study were in marginal range."

"Studi kasus serial ini bertujuan untuk menganalisis tatalaksana nutrisi yang adekuat pada pasien diabetes melitus (DM) dalam mencegah, memperlambat dan memperbaiki komplikasi kronis dengan memberikan tatalaksana nutrisi sesuai kondisi klinis, laboratoris dan status gizi pasien. Hiperglikemia kronis terkait dengan kerusakan jangka panjang, disfungsi, dan gagal organ, khususnya mata, ginjal, syaraf, jantung dan pembuluh darah. Tatalaksana kadar gula darah yang baik dapat menurunkan risiko, menunda onset, dan menurunkan tingkat keparahan dari komplikasi kronis. Komplikasi kronis dari DM terbagi dalam dua kategori, yaitu komplikasi makrovaskular dan mikrovaskular. Ke-empat kasus yang dipaparkan merupakan pasien DM berusia 37-64 tahun yang menderita DM dengan komplikasi makrovaskular dan mikrovaskular. Pemberian kalori pada pasien-pasien kasus serial ini dihitung dengan menggunakan rumus Harris Benedict. Protein diberikan sesuai ada tidaknya nefropati dan tingkat nefropati. Pemberian lemak 25% dari total kalori dengan komposisi sekitar SAFA 7%, PUFA 8% dan MUFA 10%. Kombinasi tatalaksana nutrisi sesuai kebutuhan bersamaan dengan pemberian insulin atau obat antidiabetes mampu mengontrol kadar gula darah mendekati normal. Pemberian protein sesuai dengan kemampuan fungsi ginjal mampu mengontrol kadar ureum dan kreatinin dengan status gizi pasien tetap terjaga. Kesimpulannya : Penatalaksanaan nutrisi pada pasien DM harus bersifat individual, untuk mempertahankan status kesehatan dan memperlambat, bahkan menghindari timbulnya komplikasi DM. Tatalaksana nutrisi harus di-evaluasi secara berkala sesuai dengan kondisi klinis pasien.

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This case serial study is aim to know the effect of adequate nutrition therapy on diabetic mellitus patient in preventing, slowing and overcome chronic complication. Nutrition therapy was according to their clinical condition, laboratory and nutrition status. Chronic hyperglycemia is related to long term organ damage, organ dis-function and failure. This is especially affect the eye, kidney, nerve, heart and vascular. Glucose control near to normal range will be able to decrease the risk, onset and morbidity of chronic complication. Diabetic chronic complication is divided into two categories, macrovascular and micro-vascular.

The four diabetic mellitus patients in this case series were 37 to 64 years old with macro-vascular and micro-vascular complication. Calories for these patients were calculated using Harris Benedict equation. Protein was given according to kidney function and if there is nephropathy, then protein was given according to the level of nephropathy. Lipid were provided 25% from total calories, with a composition around 7% of SAFA, 8% PUFA and 10% MUFA. A combination of nutrition therapy and insulin or oral anti-diabetic drugs is able to maintain glucose control near to normal range. Protein provision according to kidney function was able to control urea and creatinine level along with maintaining nutrition status.

Conclusion : Nutrition therapy in diabetic patient must be prescribe individually, according to anamnesis, physical examination, laboratory finding and other supporting examination. Nutrition therapy is targeted to maintain health status, to slowdown, and hopefully to prevent diabetic complication. Nutrition therapy must be evaluated periodically according to patient clinical status."