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Abstrak :
Latar belakang: Kanker saat ini masih menjadi salah satu masalah kesehatan utama di dunia. Insidensi kanker ginekologi di Indonesia masih tinggi. Aspek nutrisi merupakan salah satu aspek yang paling sering mengalami kelainan pada pasien dengan kanker. Patient Generated-Subjective Global Assessment (PG-SGA) merupakan modalitas skrining nutrisi yang mengombinasikan data kualitatif dan semi-kuantitatif. Proses inflamasi sistemik yang terjadi pada pasien kanker dapat mengakibatkan penurunan kadar albumin dan prealbumin. Namun, belum banyak penelitian sebelumnya yang mencari bagaimana korelasi kadar albumin dan prealbumin terhadap skor PG-SGA. Tujuan: Mengetahui parameter yang paling baik dalam mendeteksi malnutrisi untuk pasien dengan onkologi ginekologi di RSUPN Dr. Cipto Mangunkusumo. Metode: Penelitian ini menggunakan metode potong lintang (cross sectional). Subjek dari penelitian ini adalah pasien yang didiagnosis dengan kanker ginekologi yang berobat ke Poliklinik Onkologi Ginekologi RSUPN Dr. Cipto Mangunkusumo dan direncanakan atau telah menjalani terapi pada Oktober 2020 - September 2021. Pasien dengan riwayat keganasan primer selain keganasan ginekologi, menerima terapi kortikosteroid oral atau intravena, riwayat pembedahan saluran cerna yang memengaruhi absorpsi/asupan nutrisi, dan riwayat penyakit liver akut atau kronik dan alkoholisme dieksklusi dari penelitian. Hasil: Didapatkan sebanyak 90 subjek yang diikutsertakan dalam penelitian. Secara keseluruhan, nilai rerata albumin yaitu 4,19 g/dL, rerata prealbumin yaitu 39,1 mg/dL, dan rerata skor PG-SGA yaitu 3 atau kategori A. Terdapat korelasi positif lemah antar kadar albumin dengan prealbumin (r=0,378, p=0,000), Terdapat korelasi negatif lemah antara kadar albumin terhadap skor PG-SGA (r=-0,313, p=0,003), sedangkan tidak terdapat korelasi kadar prealbumin terhadap skor PG-SGA (r=-0,145, p=0,173). Kesimpulan: Didapatkan korelasi antara albumin terhadap skor PG-SGA, namun tidak didapatkan korelasi antara prealbumin terhadap skor PG-SGA. ......Background: Cancer is still one of the major health problems in the world. The incidence of gynecological cancer in Indonesia is still high. Nutritional aspect is one of the most frequent aspects of abnormalities in patients with cancer. Patient Generated-Subjective Global Assessment (PG-SGA) is a nutritional screening modality that combines qualitative and semi-quantitative data. Systemic inflammatory process that occurs in cancer patients can result in a decrease in albumin and prealbumin levels. However, there have not been many previous studies looking at the correlation between albumin and prealbumin levels on the PG-SGA score. Objective: Knowing the best parameters in detecting malnutrition for gynecological oncology patients at RSUPN Dr. Cipto Mangunkusumo. Methods: This study used a cross-sectional method. The subjects of this study were diagnosed with gynecological cancer who went to the Gynecological Oncology Polyclinic of RSUPN Dr. Dr. Cipto Mangunkusumo and planned or already undergoing therapy during October 2020 - September 2021. Patients with a history of primary malignancy other than gynecological malignancy, receiving oral or intravenous corticosteroid therapy, history of gastrointestinal surgery affecting nutrient absorption/intake, and history of acute or chronic liver disease and alcoholism was excluded from the study. Results: There were 90 subjects who were included in this study. Overall, the average level of albumin was 4.19 g/dL, the average level of prealbumin was 39.1 mg/dL, and the average of scored-PG-SGA was 3 or category A. There was a weak positive correlation between albumin and prealbumin levels (r=0.378, p=0.000). This study showed a weak negative correlation between albumin level and scored-PG-SGA (r=-0.313, p=0.003), whereas there was no correlation between prealbumin levels and scored-PG-SGA (r=-0.145, p=0.173). Conclusion: A weak negative correlation was found between albumin and the scored-PG-SGA, but no correlation was found between prealbumin and the scored-PG-SGA.

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ABSTRAK
Background: Community-acquired pneumonia is an acute infection of the lung parenchyma transmitted from the community with a high mortality rate. Predictors of mortality include the Pneumonia Severity Index (PSI) and CURB-65, and the biomarkers procalcitonin and D-dimers. Prealbumin (also known as transthyretin) is a biomarker for protein calorie malnutrition and has shown a positive correlation to negative patient outcomes in several different conditions. This study aims to study how prealbumin can be used as a predictor of mortality in CAP. Method: Articles were identified by searching 4 databases and screened for eligibility; 2 articles were eligible for this study. Assessment was done using the Quality in Prognosis Studies (QUIPS) tools and the Prognosis Critical Appraisal form. Result: The two articles assessed in this study have found that prealbumin is correlated with negative outcomes, particularly mortality. The studies have found that the patients who died had low serum prealbumin levels at admission. Conclusion: Serum prealbumin concentration is the preferred biomarker for protein calorie malnutrition as it is more sensitive compared to other biomarkers. There is a strong correlation between low serum prealbumin concentration upon admission with negative patient outcomes for patients with CAP. Further studies should include a wider range of subjects, specifically in age, and investigate the role of prealbumin as a predictor of malnutrition or inflammation and how it correlates to negative patient outcomes.

Abstrak :
Tujuan : Mengetahui pengaruh pemberian NED terhadap status protein penderita luka bakar derajat II, 20-60% dari luas permukaan tubuh (LPT) dan/atau derajat III ≥ 10% LPT usia 18-60 tahun. Tempat : Unit Luka Bakar RSUPNCM Bahan dan Cara : Penelitian ini merupakan suatu uji klinik dengan randomisasi yang telah disetujui oleh panitia tetap penilai etik penelitian Fakultas Kedokteran Universitas Indonesia. Duapuluh subyek yang memenuhi kriteria penerimaan dan penolakan dibagi 2 kelompok secara randomisasi blok. Sepuluh subyek perlakuan diberi NED mulai ≤ 8 jam pasca luka bakar, sedangkan 10 subyek kontrol diberi nutrisi enteral/oral 24 jam pasca luka bakar. Pengamatan dilakukan selama 12 hari. Status protein ditetapkan dengan pemeriksaan albumin dan prealbumin serum serta nitrogen urea urin (NUU). Sampel darah untuk pemeriksaan albumin dan prealbumin diambil hari ke-l, 7, dan 12. Urin tampung 24 jam untuk pemeriksaan NUU diambil hari ke-3, 7 dan 12. Uji statistik yang digunakan adalah uji t untuk data berdistribusi normal dan uji Mann Whitney U untuk data berdistribusi tidak normal, batas kemaknaan yang digunakan sebesar 5%. Hasil : Penelitian ini menunjukkan pemberian NED tidak menunjukkan perbedaan bermakna terhadap status protein antara kelompok perlakuan dan kelompok kontrol, tetapi pada kelompok perlakuan didapatkan peningkatan kadar prealbumin dan gambaran penurunan kadar NUU yang lebih tajam. Kesimpulan : NED mempunyai kecenderungan dapat memperbaiki status protein walaupun belum dapat dibuktikan secara statistik.

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The Effect of Early Enteral Nutrition (EEN) on Protein Status in Burn Patients at Burn Unit Dr. Cipto Mangun Kusumo Hospital 1999-2000Objective: To know the effect of EEN on protein status in burn patients with 20-60% total body surface area (TBSA) of second degree burned, and/or ≥ 10% TBSA of third degree burned, age 18-60 years old subjects. Place: Burn Unit Cipto Mangunkusumo Hospital Material and Methods The study was a randomized clinical trial, which already certify by the ethical clearance research committee of the Faculty of Medicine University of Indonesia. Twenty subjects were selected by inclusion and exclusion criteria. The subjects were divided into two groups by block randomization. Ten subjects were given enteral nutrition started ≤ 8 hours post burn, while 10 control subjects were given enteral / oral nutrition 24 hours post burn. Observation was done for 12 days. Protein status was determined by the laboratory result of albumin and prealbumin serum and the level of urinary urea nitrogen (UUN). Blood samples for albumin and prealbumin serum were taken on the day 1st, 7th and 12th. Twenty four hours collected urines for UUN examination were taken on the day 3rd, 7th and 12th . Statistical analysis was performed with t-test for data with normal distribution and Mann Whitney U test for data which do not conform to a normal distribution. The level of significance was 5%. Results: The results showed no significant difference between the two groups, except on day 12th the prealbumin level tends to increase and the UUN level tend to decrease in the study group. Conclusion : The EEN tend to be able to increase the protein status although has not statistically proven yet.

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Tujuan : Mengetahui pengaruh pemberian nutrisi enteral tinggi protein pada status protein penderita stroke akut Tempat : Ruang rawat IRNA B, bagian Neurologi Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Jakarta. Metodologi : Penelitian adalah suatu uji klinik paralel yang telah disetujui oleh panitia tetap penilai etik penelitian Fakultas Kedokteran Universitas Indonesia. Sebanyak 36 subyek penelitian stroke hemoragik dan iskemik akut yang memenuhi kriteria dibagi dalam dua kelompok secara randomisasi blok. Sebanyak 18 orang kelompok perlakuan mendapat nutrisi enteral tinggi protein (NETP), sedangkan 18 orang kelompok kontrol mendapat makanan cair racikan rumah sakit. Pengukuran berat badan dan tinggi badar dilakukan pada hari 1. Pemeriksaan albumin dan prealbumin serum dilakukan pada hari ke 1 dan Pemeriksaan NUU dan kreatinin urin dari urin tampung 24 jam pada hari 1, dan 7. Imbang nitrogen diperoleh dengan menghitung asupan nitrogen dan NUU 24 jam Uji statistik yang digunakan adalah uji t untuk data yang berdistribusi normal, dan uji Mann Whitney untuk data yang berdistribusi tidak normal. Batas kemaknaan yang digunakan sebesar 5%. Hasil : Pada kelompok perlakuan didapatkan sedikit peningkatan ni1ai prealbumin yang belum bermakna, yaitu 0,161 (0,104-0,303) menjadi 0,163 (0,043 0,276) g/L, sedangkan pada kelompok kontrol didapatkan penurunan yang bermakna yaitu 0,181 (0,093-0,267) menjadi 0,138 (0,066-0,280). Didapatkan penurunan nilai albumin pada kedua kelompok. Penurunan nilai albumin pada kelompok perlakuan lebih sedikit dibandingkan kontrol, masing-masing yaitu - 0,35 dan - 0,60 g/dL.Pemberia NETP dapat menurunkan ekskresi kreatinin urin secara bermakna, yaitu dari 1019 (300-1530) menjadi 791,50 (246-1524) mg/24 jam), tetapi belum memperbaiki NUU dari imbang nitrogen Kesimpulan : Pemberian NETP pada pasien stroke akut cenderung dapat meningkatkan status protein, walaupun belum dapat dibuktikan secara statistik. ......Effects High Protein Enteral Nutrition on Protein Status in Acute Stroke PatientsObjective To investigate the effects of high protein enteral nutrition on protein status in acute stroke. Location: IRNA B, Cipto Mangunkusumo General Hospital, Jakarta Subjects and Methods : The study was a parallel clinical trial, which was alread} certified by the Ethical Clearance Research Committee of Faculty of Medicine Universit of Indonesia. Thirty six subjects with acute hemorhagic and ischemic stroke wen selected using certain criteria. The subjects were divided into two groups using blocs randomization. Eighteen subjects in treatment group received high protein entera nutrition (HPEN), and the control group received enteral hospital diet. Body weight an( height were assessed on the la day of admission. Albumin and prealbumin were assessed on day 1 and 7. Urinary urea nitrogen (UUN) and urinary creatinine were assessed on da: 1, 4, and 7 using 24-hour urine collection. Nitrogen balance was calculated b: substracting nitrogen intake with urinary urea nitrogen. Statistical analysis was performe+ using t-test for normal distributed and Mann Whitney test for not normal distributed data The level of significance was 5%. Results : In the treatment group, there was a slingtly increased in prealbumin level, bi: not yet significantly : 0,161 (0,104-0,303) to 0,163 (0,043-0,276) g,/L, while in the contra group markedly decreased : 0,181 0,093-0,267) to 0,138 (0,066-0,280) gIL, The albumi level decreased in both groups. Albumin level in the trreatment group decreased less tha the control group, respectively - 0,35 (-1,20-0,60) and - 0,60 (-1,40-0,00). The HPE] decreased urinary creatinine excretion significantly : 1019 (307-15310) to 791,50 (24( 1524), however UUN and nitrogen balance did not show any improvement Conclusion : HPEN tend to be able to increase the protein status although has ni statistically been proven yet.

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ABSTRAK
Pada lanjut usia terjadi penurunan massa dan kekuatan otot yang memengaruhi kapasitas 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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ABSTRACT
The decrease of muscle mass and strength in elderly people will affect the functional 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.

Abstrak :
Penelitian ini dilakukan untuk mengetahui pengaruh pemberian nutrisi enteral tinggi protein pada status protein penderita stroke akut. Subjek penelitian dibagi 2 kelompok secara randomisasi blok, yaitu kelompok perlakuan mendapat nutrisi enteral tinggi protein (NETP) dan kelompok kontrol mendapat nutrisi enteral standar rumah sakit (NERS). Tiga puluh enam subjek dari 60 penderita stroke akut berhasil menjalani 7 hari penelitian ini. Hasil penelitian menunjukkan bahwa pemberian NETP dapat meningkatkan kadar prealbumin serum, menurunkan ekskresi kreatinin urin, dan memperkecil penurunan kadar albumin serum dibandingkan kelompok kontrol. (Med J Indones 2004; 14: 37-43)

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The objective of this study was to determine the effect of high protein enteral nutrition on protein status in acute stroke patients. The subjects were divided into two groups using block randomisation, i.e. the intervention group that received high protein enteral nutrition (HPEN), and the control group that received enteral hospital diet. Thirty six out of 60 acute stroke patients had completed 7 days of follow-up. The results showed that HPEN have increased prealbumin level, decreased urinary creatinine excretion, and decreased the decline of albumin serum compared to the control group. (Med J Indones 2004; 14: 37-43)

Abstrak :
Latar belakang. Pasien sakit kritis berada dalam kondisi katabolik yang menyebabkan ketidakseimbangan sintesis dan pemecahan protein sehingga dibutuhkan asupan protein yang adekuat untuk mempertahankan massa otot, meningkatkan kadar prealbumin, dan imbang nitrogen. Ophiocephalus striatus (OS) mempunyai potensi sebagai sumber protein karena mengandung asam amino, asam lemak, mineral, dan vitamin. Penelitian ini bertujuan untuk menilai efek dari pemberian suplementasi ekstrak OS terhadap luas penampang otot rektus femoris, bisep brakii, kadar prealbumin, dan imbang nitrogen pasien sakit kritis dengan ventilator. Metodologi. Penelitian ini merupakan uji klinis dengan desain uji acak terkontrol yang dilakukan terhadap pasien usia 18-65 tahun yang menggunakan ventilator di intensive care unit (ICU) RSUPN Dr. Cipto Mangunkusumo sejak bulan Juli sampai dengan Oktober 2019 ICU. Sebanyak 42 subjek dirandomisasi menjadi dua kelompok. Kelompok ekstrak (n=19) mendapatkan suplementasi ekstrak OS 15 g/hari, yang diberikan sejak hari kedua sampai dengan hari keenam. Kelompok kontrol (n=23) tidak mendapatkan suplementasi tersebut. Pengukuran luas penampang otot, pemeriksaan kadar prealbumin, dan imbang nitrogen dilakukan pada hari pertama dan hari ketujuh. Hasil. Terjadi peningkatan luas penampang otot rektus femoris pada kelompok ekstrak (p=0,038) dan penurunan pada kelompok kontrol (p=0,006) disertai perbedaan bermakna antara dua kelompok (p=0,001). Terjadi peningkatan luas penampang otot bisep brakii pada kelompok ekstrak (p=0,033) dan penurunan pada kelompok kontrol (p=0,001) disertai perbedaan bermakna antara kedua kelompok (p<0,001). Terjadi peningkatan kadar prealbumin pada kelompok ekstrak (p<0,001) maupun kelompok kontrol (p=0,023) disertai perbedaan peningkatan yang bermakna antara kedua kelompok (p<0,001). Terjadi peningkatan kadar imbang nitrogen pada kelompok ekstrak (p<0,001) maupun kelompok kontrol (p=0,001) disertai perbedaan peningkatan yang tidak bermakna antara kedua kelompok (p=0,685). Kesimpulan. Pemberian suplementasi ekstrak Ophiocephalus striatus secara signifikan dapat meningkatkan luas penampang otot rektus femoris, otot bisep brakii, dan kadar prealbumin pada pasien sakit kritis. ......Background. Critically ill patients are in catabolic conditions that have imbalances in protein synthesis and breakdown. Thus, they require adequate protein intake to maintain the muscle mass and to increase the prealbumin levels and nitrogen balance. Ophiocephalus striatus (OS) is a potential source of proteins since it contains high amount of amino acids, fatty acids, minerals, and vitamins. This study was aimed to measure the effect of OS extract supplementation on cross-sectional area (CSA) of rectus femoris and biceps brachii, prealbumin levels, and nitrogen balance in critically ill patients with ventilator. Methods. This was a randomized controlled clinical trial study involving patients aged 18-65 years old with ventilator in intensive care unit (ICU) Dr. Cipto Mangunkusumo Hospital between July until October 2019. In total, 42 subjects were randomized into two groups. Extract group (n=19) recieved 15 g of OS extract supplementation daily, administered from the second day to the sixth day. Control group (n=23) did not receive the extract. Measurement of CSA of rectus femoris and biceps brachii, prealbumin levels, and nitrogen balance were done in the first and the seventh day. Results. There was an increase of cross sectional area of rectus femoris in extract group (p=0.038) and a decrease in control group (p=0.006) with significant difference between the two groups (p=0.001). There was an increase of cross sectional area of biceps brachii in extract group (p=0.033) and a decrase in control group (p=0.001) with significant difference between the two groups (p<0.001). There was an increase of prealbumin levels in both groups, extract group (p<0.001) and control group (p=0.023), with a significant difference of increase between the two groups (p<0.001). There was an increase of nitrogen balance in both groups, extract group (p<0.001) and control group (p<0.001), with an insignificant difference of increase between the two groups (p<0.685) Conclusion. Administration of Ophiocephalus striatus extract supplementation can significantly increase the cross-sectional area of rectus femoris and biceps brachii, and the prealbumin levels in critically ill patients.

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Latar Belakang: Malnutrisi meningkatkan morbiditas dan mortalitas dan menurunkan kualitas hidup pasien sirosis hati. Untuk memperbaiki status gizi, dianjurkan pemberian late night snack (LNS) dengan 50 gram karbohidrat. Santan mengandung banyak middle chain triacylglicerol, sehingga berpotensi menjadi sumber gizi yang lebih baik dan aman bagi pasien sirosis. Tujuan: Mengetahui manfaat santan untuk memperbaiki status gizi pasien sirosis hati. Metode: Dilakukan uji klinik dengan desain paralel. Subjek adalah pasien sirosis hati Child Pugh A dan B, yang mengalami malnutrisi berdasarkan kriteria IMT modifikasi Campillo, atau mengalami unintentional weight loss. Pasien dibagi menjadi 2 kelompok, kelompok I mendapat LNS berupa 25 gram gula ditambah 50 cc santan, sedangkan kelompok II mendapat LNS berupa 50 gram gula. Status gizi dinilai dari parameter triceps skinfold thickness (TSF), mid arm muscle circumference (MAMC), indeks massa tubuh (IMT), massa lemak tubuh (MLT), kadar prealbumin dan kadar albumin serum. Hasil Penelitian: Terdapat 18 subjek pada kelompok I, dan 17 subjek pada kelompok II yang menyelesaikan penelitian. Kedua kelompok setara dalam proporsi gender, CP A dan B, dan penyebab sirosis. Meskipun rerata usia kelompok II lebih tua dibandingkan kelompok I, namun tidak terdapat korelasi antara usia dengan semua parameter status gizi yang diukur. Didapatkan peningkatan status gizi lebih baik pada kelompok I bila dilihat dari parameter MAMC, MLT dan kadar albumin serum. Pengukuran TSF meningkat setelah pemberian LNS, namun tidak menunjukkan beda perubahan bermakna antara kedua kelompok, Pengukuran IMT dan kadar prealbumin serum tidak dapat mencerminkan perubahan status gizi dengan baik. Kesimpulan: Pemberian LNS dengan kombinasi karbohidrat dan santan lebih unggul dibandingkan LNS dengan karbohidrat saja dalam memperbaiki status gizi pasien sirosis hati, dilihat dari parameter MAMC, MLT dan kadar albumin serum, sedangkan parameter TSF, IMT dan kadar prealbumin serum tidak menunjukkan beda perubahan yang bermakna antara kedua kelompok. ...... Background: Malnutrition caused a decline in quality of life, increased morbidity and mortality in patients with cirrhosis of the liver. It is recommended to give late night snack (LNS) with 50 grams of carbohydrates to improve their nutritional status. Coconut milk contains a lot of middle chain triacylglycerol, it is potentially act as a source of safe, and better nutrition for patients with cirrhosis. Aim: To see the benefit of coconut milk to improve the nutritional status of chirrotic patients. Methods: This study is a clinical trial with parallel design. Subjects were cirrhotic patients with Child-Pugh A and B, who suffered malnutrition using Campillo?s modification of BMI criteria or experience unintentional weight loss. Subjects were devided into 2 groups, groups I received 25 gram of sugar and 50 cc of coconut milk as LNS, group II received received 50 gram sugar as LNS. Nutritional status assessed from triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI), body fat mass (BFM), serum prealbumin and serum albumin levels. Results: There were 18 subjects in group I and 17 subjects in group II. Both groups were similar in proportion of gender, CP A and B, and the cause of cirrhosis. Although the mean age of group II older than group I, but there were no significant correlation found between age and all nutrition parameters. Measurement of MAMC, BFM, and albumin levels showed that cirrhotic patient in group I have improvement of nutritional status better than group II, The TSF was increased after administration of LNS, but no significantly different changes found among both groups,. BMI and serum prealbumin cannot reflect changes in nutritional status well. Conclusion: Late night snack containing carbohydrate and coconut milk, is superior to improving nutritional status in cirrhotic patients compare to carbohydrates alone, as seen from MAMC, BFM, and serum albumin level parameters, whereas TSF, BMI, and serum prealbumin level did not show any difference between two groups.