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"Latar Belakang: Meningkatnya populasi geriatri membuat sindrom frailty akan banyak ditemui di praktik klinik sehari-hari. Fenotip frailty dikaitkan dengan rendahnya massa otot secara teori, namun masih terdapat perbedaan hasil di antara penelitian yang ada. Tujuan: Mengetahui rerata indeks massa otot pada populasi geriatri di rawat jalan dan hubungannya dengan status frailty. Metode: Penelitian menggunakan desain potong lintang terhadap pasien berusia ≥60 tahun di poliklinik Geriatri Rumah Sakit Cipto Mangunkusumo, periode waktu April-Juni 2018. Dilakukan pengambilan data antropometri, pengisian kuesioner Cardiovascular Health Study (CHS) dan pengukuran indeks massa otot dengan dual energy X-ray absoprtiometry (DXA). Parameter indeks massa otot diukur berdasarkan appendicular lean mass (ALM) yang disesuaikan dengan tinggi badan (ALM/TB2) dan indeks massa tubuh (ALM/IMT). Hasil: Didapatkan proporsi subjek frail, pre-frail dan robust berdasarkan skor CHS berturut-turut adalah 29,17%, 58,33% dan 12,5%. Terdapat perbedaan rerata indeks massa otot dengan parameter ALM/TB2 antara pasien yang frail dan yang tidak (6,54 (1,01) Kg/m2 vs 7,03 (0,91) Kg/m2; p=0,01), namun tidak halnya dengan ALM/IMT (p=0,72). Tidak terdapat hubungan yang bermakna baik antara kejadian sindrom frailty dengan indeks massa otot ALM/TB2 (PR 2,03; 95% IK 0,80-5,15; p=0,13) maupun ALM/IMT (PR 5,09; 95% IK 0,45-58,06; p=0,2). Dari analisis multivariat faktor perancu didapatkan hubungan bermakna antara nutrisi (PR 3,67; 95% IK 1,59-8,49; p=0,02) dan status fungsional (PR 4,94; 95% IK 2,01-11,75; p=0,00) dengan kejadian sindrom frailty. Simpulan: Indeks massa otot yang rendah saja tidak dapat dijadikan faktor prediktif terjadinya sindrom frailty, melainkan perlu digabungkan dengan parameter lain seperti kualitas atau fungsi otot, status fungsional dan nutrisi. Penggunaan indeks massa otot dengan parameter ALM/TB2 lebih disarankan.

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Background: Population ageing worldwide is rapidly accelerating along with development of frailty syndrome. A theoretical link between frailty and low lean mass has been established, and low lean mass as frailty predictor, but studies conducted show inconclusive result. Objectives: To obtain appendicular lean mass values among geriatric outpatients and its association with frailty status. Methods. Cross-sectional study conducted to elderly patients (≥60 years old) in the Geriatric Outpatient Clinic of Cipto Mangunkusumo National Referral Hospital in April-June 2018. Each subject underwent anthropometric measurement, frailty evaluation using Cardiovascular Health Study (CHS) questionnaire dan lean mass measurement using dual energy X-ray absoprtiometry (DXA). Appendicular lean mass (ALM) measured was adjusted by height squared (ALM/ht2) and BMI (ALM/BMI) Results: The proportion of frail, pre-frail and robust according to CHS were 29,17%, 58,33% and 12,5% respectively. We found significant difference in ALM/ht2 between frail dan non-frail subjects (6.54 (1.01) Kg/m2 vs. 7.03 (0,91) Kg/m2; p=0.01) but nonsignificant result for ALM/BMI (p=0.72). No association was found between frailty and muscle mass index of ALM/ht2 (PR 2.03; 95%CI 0.80-5.15; p=0.13) or ALM/BMI (PR 5.09; 95% CI 0.45-58.06; p=0.2). From multivariate analysis, there was significant association between nutritional status (PR 3,67; 95% CI 1,59-8,49; p=0,02), functional status (PR 4,94; 95% CI 2,01-11,75; p=0,00) and frailty. Conclusion: Low lean mass alone cannot be used as predictive factor for frailty syndrome, further analysis using another parameter such muscle's quality or function, nutritional status and functional status are needed. This study supports ALM/ht2 as chosen muscle index."

"Kanker kolorektal diketahui berhubungan dengan massa otot yang rendah. Massa otot yang rendah dihubungkan dengan luaran klinis yang buruk. Telah diketahui bahwa asupan protein adalah salah satu faktor yang berperan dalam mempertahankan massa otot. Namun, studi-studi yang ada mengenai efek pemberian protein tinggi pada pasien kanker kolorektal terhadap massa otot belum dapat disimpulkan karena kurangnya bukti dari penelitian berkualitas baik dan intervensi pada studi yang berbeda-beda. Tujuan dari penelitian ini adalah untuk mengetahui korelasi antara asupan protein dengan indeks massa otot skelet pada pasien kanker kolorektal yang dirawat inap di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo (RSCM). Penelitian menggunakan desain potong lintang pada subjek dewasa kanker kolorektal yang dirawat inap di RSCM. Asupan protein dinilai menggunakan multiple 24 hour recall. Indeks massa otot skelet didapatkan dari pengukuran massa otot skelet dalam kilogram menggunakan BIA multifrequency, lalu dibagi dengan tinggi badan dalam meter yang dikuadratkan. Sebanyak 52,5% subjek berjenis kelamin perempuan dan 50% subjek berada pada stadium IV. Terapi yang paling banyak telah dijalani subjek adalah kombinasi pembedahan dan kemoterapi (n=16, 40%). Tidak ditemukan korelasi antara asupan protein dan indeks massa otot skelet (r = -0,04, P=0,795).

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Colorectal cancer is known to be associated with low muscle mass. Low muscle mass is associated with poor clinical outcome. It is known that protein intake is one of the factors that play a role in maintaining muscle mass. However, the existing studies on the effect of administering high protein in colorectal cancer patients on muscle mass have not been definitively concluded due to the lack of evidence from good quality studies and differences of intervention in existing studies. The purpose of this study was to determine the correlation between protein intake and skeletal muscle mass index in colorectal cancer patients who were hospitalized at the RSUPN Dr. Cipto Mangunkusumo (RSCM). The study used a cross-sectional design on adult subjects with colorectal cancer who were hospitalized at RSCM. Protein intake was assessed using multiple 24 hour recalls. Skeletal muscle mass index was obtained from the measurement of skeletal muscle mass in kilograms using BIA multifrequency, then divided by height in meters squared. A total of 52.5% of the subjects were female and 50% of the subjects were in stage IV. The most common therapy that the subject had undergone was a combination of surgery and chemotherapy (n=16, 40%). No correlation was found between protein intake and skeletal muscle mass index (r = -0.04, P=0.795)."

"Latar Belakang: Sarkopenia dan obesitas sering ditemukan pada populasi lanjut usia (lansia). Kombinasi sarkopenia dan obesitas, yaitu obesitas sarkopenia, memiliki morbiditas dan mortalitas lebih tinggi dibandingkan salah satu entitas saja. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara obesitas perifer dan sentral dengan komponen sarkopenia. Metode: Studi potong-lintang ini memakai data sekunder dari penelitian validasi skor Sarcopenia Quality of Life (SARQoL) terhadap lansia ≥60 tahun di Poliklinik Geriatri Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia, periode April–Juni 2018. Analisis multivariat dilakukan terhadap obesitas (indeks massa tubuh [IMT] dan lingkar pinggang [LP]) dan komponen sarkopenia (kekuatan genggam tangan [KGT], indeks massa otot [appendicular skeletal muscle mass per tinggi badan kuadrat, ASMM/TB2], dan kecepatan berjalan) untuk disesuaikan dengan perancu (usia, diabetes melitus, dan aktivitas fisik). Nilai potong diagnostik masing-masing komponen sarkopenia memakai panduan the Asian Working Group on Sarcopenia (AWGS) 2019. Hasil: Rerata usia dari 120 subjek adalah 71,89 (6,11) tahun, dengan proporsi wanita 61,70%. Seluruh subjek menunjukkan rerata IMT 22,48 (4,60) kg/m2; median LP 91,48 (65,40-113,00) cm; rerata ASMM/TB2 6,88 (0,96) kg/m2; median KGT 20 (10,00-40,00) kg; dan rerata kecepatan berjalan 0,76 (0,23) meter/detik. KGT rendah ditemukan lebih sedikit pada kelompok obesitas perifer dibandingkan nonobesitas perifer (adjusted odds ratio OR 0,419; interval kepercayaan IK 95% 0,183-0,959; p=0,040). ASMM/TB2 rendah lebih sedikit pada kelompok obesitas sentral dibandingkan nonobesitas sentral (adjusted OR 0,087; IK 95% 0,029-0,262; p <0,001). Simpulan: Terdapat efek protektif obesitas perifer dan sentral terhadap sarkopenia, tetapi hubungan ini terbatas pada IMT <30 kg/m2.

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Background: Increasing number of elderly is accompanied by increasing prevalence of sarcopenia and obesity. Combination of sarcopenia and obesity, which is called as sarcopenic obesity, associated with higher morbidity and mortality compared to either obesity or sarcopenia alone. Objectives: This study aimed to determine the association between obesity profiles and sarcopenia components.

Methods: This cross-sectional study was using data from the validation study of Sarcopenia Quality of Life (SARQoL) score, of which conducted in geriatric outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Multivariate analysis between obesity (body mass index [BMI] and waist circumference [WC]) and sarcopenia components (handgrip strength [HGS], muscle mass index [appendicular skeletal muscle mass/ height square, ASMM/h2], and gait speed was adjusted to age, diabetes mellitus, and physical activities.

Results: Out of 120 subjects, there was 61.70% women. All subjects had mean of age 71.89 (6.11) years old; mean of BMI 22.48 (4.60) kg/m2; median of WC 91.48 (65.40-113.00) cm; mean of ASMM/h2 6.88 (0.96) kg/m2; median of HGS 20 (10.00-40.00) kg; and mean of gait speed 0.76 (0.23) meter/second. Low HGS was found statistically significant in lower proportion for peripheral obesity group than non-peripheral obesity group (adjusted odds ratio OR 0.419, 95% confidence interval CI 0.183-0.959, p=0.040); and low muscle mass index was lower in central obesity group than non-central obesity group (adjusted OR 0.087, 95% CI 0.029-0.262, p <0.001).

Conclusion: There were protective effects of peripheral and central obesity against sarcopenia"

"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."