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Abstrak :
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). ......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).

Abstrak :
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. ......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.

Abstrak :
Latar belakang: Pasien Talasemia Mayor (TM) anak menderita defisiensi nutrisi karena asupan nutrisi yang tidak mencukupi. Penghindaran makanan kaya zat besi seringkali bersamaan dengan pembatasan asupan protein. Asupan mikronutrien termasuk magnesium lebih rendah dibandingkan anak normal. Fungsi otot lebih awal terganggu akibat defisiensi nutrisi daripada massa otot. Penilaian massa otot dan Hand Grip Strength (HGS) menjadi penting untuk mengevaluasi status gizi. Hingga saat ini belum ada penelitian di Indonesia yang mengevaluasi hubungan antara HGS dengan asupan kalori, protein dan magnesium, LILA dan massa otot pasien anak TM. Metode: Penelitian dengan desain studi potong lintang melibatkan 70 pasien TM anak, berusia 6-18 tahun di Pusat Talasemia RSUPN Cipto Mangunkusumo. Status gizi dievaluasi disertai pengukuran lingkar lengan atas (LILA). Asupan kalori, protein dan magnesium diperoleh melalui metode analisis diet semi-kuantitatif Food Frequency Questionnaires (FFQ) dan Magnesium FFQ (MgFFQ). Kadar Mg serum dinilai dengan menggunakan metode enzimatik-kalorimetri. Massa otot diukur menggunakan Bioelectrical Impedance Analysis (BIA) dan HGS dinilai menggunakan Dinamometer tangan Jamar. Hasil: Status gizi berdasarkan LILA/U sebagian besar berstatus gizi baik 42,9% dan malnutrisi 57,1% yakni gizi kurang (30,0%), gizi buruk (25,7%), dan obesitas (1,4%). Rerata kecukupan energi pada anak TM lelaki 100% (SB 17), sedangkan anak perempuan sebesar 112% (SB 27). Rerata asupan protein dan magnesium pada kedua kelompok lebih tinggi dibanding kebutuhan AKG. HGS berkorelasi kuat dengan massa otot (r=0,82), berkorelasi sedang dengan LILA (r=0,60), dan berkorelasi lemah dengan asupan kalori (r=-0,27), protein (r=-0,33) dan magnesium (r=-0,23), serta kadar magnesium (r=0,26). Hipermagnesemia dijumpai pada 23% subyek penelitian. Simpulan: Lebih dari separuh anak Talasemia mengalami malnutrisi walaupun asupan cukup. HGS berkorelasi dengan asupan nutrisi, LILA, dan massa otot. ......Background: Pediatric Thalassemia Major (TM) patients suffer from nutritional deficiencies due to insufficient nutritional intake. Avoidance of iron-rich foods often coincides with limiting protein intake. Micronutrient intake including magnesium is lower than in normal children. Muscle function is impaired earlier due to nutritional deficiencies than muscle mass. Assessment of muscle mass and Hand Grip Strength (HGS) is important for evaluating nutritional status. Until now there has been no research in Indonesia that evaluates the relationship between HGS and calorie, protein, and magnesium intake, LILA, and muscle mass in pediatric TM patients. Methods: This research with a cross-sectional study design involved 70 pediatric TM patients, aged 6-18 years at the Thalassemia Center of RSUPN Cipto Mangunkusumo. Nutritional status is evaluated by measurement of mid-upper arm circumference (MUAC). Calorie, protein, and magnesium intake was obtained through semi- quantitative dietary analysis methods Food Frequency Questionnaires (FFQ) and Magnesium FFQ (MgFFQ). Serum Mg levels were assessed using the enzymatic calorimetric method. Muscle mass was measured using Bioelectrical Impedance Analysis (BIA) and HGS was assessed using a Jamar hand dynamometer. Results: Nutritional status based on LILA/U was mostly good nutritional status 42.9% and malnutrition 57.1%, namely undernutrition (30.0%), poor nutrition (25.7%), and obesity (1.4%). The average energy adequacy for TM boys is 100% (SD 17), while for girls it is 112% (SD 27). The average intake of protein and magnesium in both groups was higher than the RDA requirements. HGS is strongly correlated with muscle mass (r=0.82), moderately correlated with LILA (r=0.60), and weakly correlated with calorie intake (r=-0.27), protein (r=-0.33), and magnesium (r=-0.23), as well as magnesium levels (r=0.26). Hypermagnesemia was found in 23% of study subjects. Conclusion: More than half of Thalassemia children experience malnutrition despite adequate intake. HGS correlates with nutritional intake, MUAC, and muscle mass.