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"ABSTRAKPada lanjut usia terjadi penurunan massa dan kekuatan otot yang memengaruhikapasitas fungsional sehingga meningkatkan risiko sarkopenia. Salah satu faktor yang dinilai dapat memengaruhi penurunan massa dan kekuatan otot pada lansia adalah menurunnya asupan protein dan asam amino rantai cabang (AARC) sehingga akan memengaruhi status protein viseral terutama prealbumin. Tujuan penelitian ini adalah untuk menilai hubungan antara asupan protein, AARC dan kadar prealbumin dengan kekuatan otot pada lansia. Metode penelitian ini adalah studi potong lintang pada 52 lansia dari bulan April-Mei 2016. Data asupan makanan yang meliputi asupan energi, kalori non protein, protein dan AARC didapatkan dari food record 2x24 jam. Pengambilan darah dilakukan setelah subjek berpuasa ± 8 jam dan pengukuran kekuatan otot dengan handgrip dynamometer merk Jamar. Hasil penelitian menunjukan tidak terdapat korelasi yang signifikan antara kekuatan genggam tangan dengan asupan protein (r=0,21 dan p=0,11), asupan AARC (r=0,18 dan p=0,19), dan kadar prealbumin serum (r=-0,05 dan p=0,69). Kesimpulan dari penelitian ini didapatkan bahwa asupan protein yang rendah tetapi disertai dengan asupan energi dan AARC yang cukup akan memengaruhi kadar prealbumin serum dan kekuatan otot tetap berada pada nilai normal, walaupun tidak ditemukan hubungan yang bermakna secara statistik.

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ABSTRACTThe decrease of muscle mass and strength in elderly people will affect thefunctional capacity and increase the risk of sarcopenia. One factor that can affect the loss of mass and muscle strength in elderly is the decrease in protein and branched chain amino acids (BCAA) intakes. This will affect the visceral protein status, especially prealbumin. The purpose of this study is to assess the association between intake of protein, BCAA and serum prealbumin level with muscle strength in elderly people. The methodology of this research is a cross-sectional study with 52 elderly people from April-May 2016. Food intake include energy, non-protein calorie (NPC), protein, and BCAA which is obtained from 2x24 hours food records. Blood sampling was performed after the subjects fasted for ± 8 hours, and muscle strength was measured with a Jamar's handgrip dynamometer. The results show there are no correlation between protein intake with the hand grip strength (r = 0,21 and p = 0,11), as well as AARC intake (r = 0,18 and p = 0,19) and prealbumin serum level (r = -0,056 and p = 0,69). This study concludes that low protein intake but accompanied with sufficient energy intake and BCAA will affect serum prealbumin level and muscle strength will be remained at normal values, however a statistically significant relationship is not found."

"Leukemia limfoblastik akut adalah penyakit keganasan hematologi yang paling sering ditemukan pada anak. Perubahan metabolisme pasien kanker dan pengobatan kemoterapi menyebabkan pasien mengalami anoreksia sehingga dapat mengakibatkan pasien mengalami malnutrisi. Kondisi tersebut dapat menurunkan respons terhadap terapi, rendahnya kualitas hidup, dan tingginya mortalitas. Terapi medik gizi yang adekuat diperlukan untuk mendukung proses penyembuhan anak dengan pasien kanker. Asam amino rantai cabang (AARC) merupakan salah satu zat gizi spesifik yang dapat memperbaiki asupan makan dengan cara berkompetisi dengan triptofan pada transporter di otak pada mekanisme lapar-kenyang sehingga menurunkan efek anoreksigenik. Penelitian sebelumnya menunjukkan efek positif pemberian AARC terhadap asupan makan dan menurunkan kadar triptofan bebas di otak pada pasien kanker. Serial kasus ini memaparkan tiga pasien laki-laki dan satu pasien perempuan, berusia 8-14 tahun dengan malnutrisi, mengalami penurunan asupan makan, dan peningkatan kadar inflamasi. Seluruh pasien mendapatkan terapi medik gizi sejak awal perawatan hingga sebelum pulang dari rumah sakit. Pemberian energi dan protein sesuai fase pada penatalaksanaan gizi buruk dan AARC yang berasal dari bahan makanan sumber serta makanan cair. Asupan energi tertinggi pasien kasus sebesar 54-140 kkal/kgBB dan asupan protein tertinggi sebesar 2-4,7 g/kgBB dengan AARC tertinggi sebesar 8,9-23,4 g. Terdapat penurunan kadar inflamasi pada seluruh pasien kasus. Skala lapar-kenyang terendah sebelum makan 2 dan setelah makan 5, perbaikan tingkat lapar-kenyang pada seluruh pasien kasus diikuti dengan peningkatan jumlah asupan. Satu orang pasien mengalami penurunan berat badan, dua orang tetap, dan satu orang mengalami peningkatan berat badan. Terapi medik gizi yang adekuat dengan pemberian AARC dapat menunjang keberhasilan pengobatan pasien anak malnutrisi dengan lekemia limfoblastik akut yang menjalani kemoterapi.

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Acute lymphoblastic leukemia is the most common hematological malignancy in children. Metabolic changes in cancer patients and chemotherapy cause patients to experience anorexia which can increase the risk of malnutrition. These conditions can reduce the response to therapy, lower quality of life, and high mortality. Adequate nutritional management is needed to support the healing process of children with cancer patients. Branched-chain amino acids(BCAA) are specific nutrients that can improve calorie intake by competing with tryptophan on transporters in the brain on the hunger-satiety center, thereby reducing anorexigenic effects. Previous research has shown a positive effect of BCAAs on improving calorie intake and reducing levels of free tryptophan in the brain in cancer patients. This case series describes three male and one female patient, aged 8-14 years, malnutrition, decreased calorie intake, and inflammation. All patients received medical nutrition therapy from early treatment until before leaving the hospital. Provision of energy and protein according to the phase in the management of malnutrition and specific nutrients, BCAAs derived from food and liquid food. The highest energy intake of patients in the case of 54-140 kcal/kg BW, and the highest protein intake of 2-4.7 g/kg BW with the highest AARC of 8.9-23.4 g. All patients experienced a reduction in inflammation. The level of hunger-satiety is 2 before eating, and it is 5 thereafter. In all cases, patients increase their intake after experiencing improvements in their hunger-satiation levels. Two patients' weights remained the same, one gained weight, and one patient lost weight. Adequate nutritional therapy and AARC supplementation can support the successful treatment of malnourished pediatric patients with acute lymphoblastic leukemia on chemotherapy."

"Latar Belakang: Penurunan massa bebas lemak dan status fungsional akan mempengaruhi prognosis pada pasien kanker kepala leher. Pembentukan massa bebas lemak dipengaruhi berbagai hal termasuk nutrisi. Salah satu zat gizi yang berperan dalam adalah asam amino rantai cabang. Karnofsky Performance Scales (KPS) adalah salah satu parameter status fungsional yang dinilai secara rutin untuk pasien kanker Penelitian ini bertujuan untuk melihat korelasi antara asupan asam amino rantai cabang dengan massa bebas lemak dan status fungsional pada pasien kanker kepala dan leher.Metode: Studi potong lintang ini dilakukan pada subjek dewasa dengan kanker kepala leher secara consecutive sampling method di poliklinik radioterapi RSCM. Wawancara dilakukan untuk mengumpulkan data karakteristik dasar, data asupan zat gizi dan penilaian status fungsional. Pengukuran komposisi tubuh massa bebas lemak dengan alat bioimpedance analysis single Frequency. Pengukuran status fungsional dengan KPS.Hasil: Sebanyak 77 subjek penelitian dengan rerata usia 52 tahun, dengan sebagian besar berjenis kelamin laki-laki, 61 % berpendidikan menengah dan sebagian besar bekerja. Lokasi kanker terbanyak pada nasofaring dengan jenis karsinoma sel skuamosa dan stadium IV. Rerata subjek memiliki status gizi normal. Penilaian 3 x24-h Food Recall didapatkan dengan rerata asupan energi 27,44 kkal/kgBB dan protein 1,33 g/kgBB. Penilaian rerata asupan AARC dengan FFQ semi kuantitatif pada subjek penelitian didapatkan sebesar 10,99 gram. Pada penelitian ini didapatkan rerata nilai massa bebas lemak 42,10 kg dengan sebanyak 46 % subjek penelitian laki- laki memiliki index massa bebas lemak < 17 kg/m2 sedangkan pada subjek penelitian wanita terdapat 16 % dengan index massa bebas lemak <15 kg/m2 Status fungsional dengan menggunakan KPS subjek penelitian dengan median 90 dengan nilai minimum 40. Sekitar 11,6% subjek penelitian yang memiliki nilai KPS kurang dari sama dengan 70. Terdapat korelasi lemah antara asupan asam amino rantai cabang dengan massa bebas lemak (r=0,238, p=0,037).Tidak terdapat korelasi antara asupan AARC dengan status fungsional (r=0.147; p>0.05)Kesimpulan: Terdapat korelasi bermakna yang lemah antara asupan AARC dengan massa bebas lemak dan tidak terdapat korelasi antara asupan AARC dengan status fungsional pada subjek kanker kepala leher

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Background: Decreased fat-free mass and functional status will affect the prognosis in head and neck cancer patients. The formation of fat-free mass is influenced by various things including nutrition. One of the nutrients that play a role in is branched chain amino acids. Karnofsky Performance Scales (KPS) is a functional status parameter that is routinely assessed for cancer patients.

Methods: This cross-sectional study was conducted on adult subjects with head and neck cancer by consecutive sampling method at the radiotherapy polyclinic RSCM. Interviews were conducted to collect data on basic characteristics, data on nutrient intake and assessment of functional status. Measurement of body composition fat-free mass using a single Frequency bioimpedance analysis tool. Functional status measurement using the KPS.

Results: A total of 77 study subjects with an average age of 52 years, with most of them being male, 61% having secondary education and most of them working. Most cancer locations in the nasopharynx with the type of squamous cell carcinoma and stage IV. On average, the subjects had normal nutritional status. The 3 x24-h Food Recall assessment was obtained with an average energy intake of 27.44 kcal/kgBW and protein 1.33 g/kgBW. The assessment of the average BCAA intake with semi-quantitative FFQ on research subjects was 10.99 grams. In this study, the average fat-free mass value was 42.10 kg with as many as 46% of male research subjects having a fat-free mass index <17 kg/m2 while in female research subjects there were 16% with a fat-free mass index <15 kg/m2. Functional status using KPS of research subjects with a median of 90 with a minimum value of 40. Approximately 11.6% of study subjects had a KPS value of less than 70. There was a weak correlation between intake of branched-chain amino acids and fat-free mass (r=0.238, p=0.037. There was no correlation between BCAA intake and functional status (r=0.147; p>0.05)

Conclusion: There is a weak significant correlation between BCAA intake and fat-free mass and there is no correlation between BCAA intake and functional status in head and neck cancer subjects

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"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."