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"Kaheksia merupakan sindrom multifaktorial yang menyebabkan gangguan fungsional progresif dan tidak dapat ditangani dengan terapi nutrisi konvensional. Kaheksia dijumpai pada 45% penderita kanker dan bila tidak diatasi dapat menyebabkan kematian 22% pasien kanker. Terapi medik gizi merupakan bagian dari terapi multimodal yang direkomendasikan dalam tatalaksana kaheksia dengan tujuan menjaga atau meningkatkan asupan makan, status gizi, dan kapasitas fungsional. Serial kasus ini melaporkan empat pasien kaheksia pada kanker dengan intake sulit berusia 42-53 tahun. Tiga pasien berstatus gizi normal, sedangkan satu pasien obes berdasakan kriteria World Health Organization (WHO) Asia Pasifik. Terapi medik gizi diberikan sesuai pedoman pada kanker dengan target pemberian energi sesuai Kebutuhan Energi Total (KET) masing-masing pasien yang dihitung dari Kebutuhan Energi Basal (KEB) yang dikalikan dengan faktor stres 1,5. Protein diberikan minimal 1,2 g/kgBB/hari untuk pasien dengan fungsi ginjal normal dan 0,8 g/kgBB/hari untuk pasien dengan penyakit ginjal kronis. Nutrien spesifik asam amino rantai cabang (AARC) dipenuhi melalui pemberian bahan makanan sumber dan oral nutrition supplementation (ONS). Keempat pasien pulang dengan perbaikan asupan makan dan peningkatan kapasitas fungsional. Status gizi keempat pasien dapat dipertahankan selama perawatan. Terapi medik gizi dapat meningkatkan asupan makan, menjaga status gizi, dan meningkatkan kapasitas fungsional pasien kaheksia pada kanker dengan intake sulit.

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Cachexia is a multifactorial syndrome responsible for progressive functional impairment that cannot be overcome with conventional nutrition therapy. Cachexia was found in 45% of cancer patients and will lead to death in 22% cancer patients. Nutrition therapy is a part of multimodal therapy that was recommended in cachexia therapy to maintain or increase food intake, nutritional status, and functional capacity. This case series report four cancer cachexia patients with low intake aged 42-53 years old. Three patients have normal nutritional status, while one patient is obese based on World Health Organization (WHO) for Asia Pacific criteria. Nutrition therapies were given based on cancer guideline with energy target prescriptions according to total energy requirements for each patients. Proteins were given with minimal 1,2 g/kgBW/day for patients with normal kidney function and 0,8 g/kgBW/day for patient with chronic kidney disease.  Specific nutrient branched-chain amino acids (BCAA) requirements are fulfilled by administration of Oral Nutrition Supplementation (ONS). All four patients were discharged with improvements in food intake and functional capacity. No nutritional status were declined during hospitalization. Medical nutrition therapy could improve food intake, maintain nutritional status, and improve functional capacity in cachexia cancer with low intake patients."

"Latar belakang: Kanker sel skuamosa (KSS) lidah adalah keganasan rongga mulut tersering dengan prognosis terburuk. Insiden KSS lidah cenderung meningkat dan semakin banyak pada usia kurang dari 45 tahun. Hampir semua pasien kanker kepala leher mengalami malnutrisi saat didiagnosis kanker. Tiga puluh satu persen pasien KSS kepala leher dengan kaheksia memiliki disease-free survival lebih rendah dibandingkan pasien yang tidak kaheksia. Modalitas terapi KSS lidah seperti radioterapi, kemoterapi, pembedahan, maupun kombinasi ketiganya dapat memperburuk malnutrisi atau kaheksia yang telah terjadi jika tidak ditatalaksana dengan baik. Terapi medik gizi diperlukan pada pasien KSS lidah yang menjalani radioterapi untuk mencegah malnutrisi atau kaheksia.Metode: Pasien KSS lidah berusia 41-53 tahun. Tiga pasien berjenis kelamin perempuan dan satu orang laki-laki. Dua pasien telah menjalani pembedahan, semua pasien menjalani radioterapi bersamaan dengan kemoterapi. Satu pasien memiliki hasil skrining MST kurang lebih 5, dan selebihnya memiliki nilai 4. Pemantauan dilakukan sebelum, saat, dan sesudah radioterapi meliputi keluhan subjektif, kondisi klinis, pemeriksaan laboratorium, antropometri, komposisi tubuh, kapasitas fungsional dan analisis asupan. Keempat pasien mendapatkan edukasi nutrisi, oral nutrition support (ONS), suplementasi vitamin dan mineral serta asam lemak omega-3.Hasil: Keempat pasien dapat meningkatkan asupan makanannya. Pasien mengalami penurunan berat badan, tiga pasien mengalami kenaikan berat badan pasca radioterapi. Dua pasien menggunakan NGT serta memiliki penyulit berupa hipertiroid subklinis dan DM tipe 2. Pasien mengalami anemia, dua di antaranya mengalami perbaikan kadar Hb. Terjadi penurunan massa otot namun terdapat perbaikan kekuatan genggaman tangan dan skor EGOG.Kesimpulan: Terapi medik gizi dapat memperbaiki keluaran klinis, kapasitas fungsional, antropometri, dan laboratorium terutama pada pasien tanpa penyulit

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Background. Squamous cell carcinoma of the tongue (SCCOT) is the most common oral cavity cancer with the worst prognosis. The incidence of SCCOT tends to increase at the age of less than 45 years old. Almost all head and neck cancer patients are malnourished at the time of diagnosis. Thirty-one percent of head and neck SCC cachexia patients have a lower disease-free survival than non cachexia. Modalities of tongue SCC therapy such as radiotherapy, chemotherapy, surgery, or a combination of all three can worsen malnutrition or cachexia that has occurred if it is not managed properly. Early medical nutrition therapy is required in SCCOT patients undergoing radiotherapy to prevent cachexia or malnutrition.

Method. Four SCCOT patients 41-53 years old. Three patients were females and one patient was male. Two patients underwent surgery, and all patients underwent concurrent radio-chemotherapy. One patient had MST score more less than 5, and the rest had a score of 4. Monitoring was carried out before, during and after radiotherapy including subjective complaints, clinical conditions, laboratory examinations, anthropometry, body composition, functional capacity and food intake analysis. Four patients received nutritional education, oral nutrition support (ONS), supplementation of vitamins and minerals and omega-3 fatty acid.

Results. All patients can increase their food intake. Patients experienced weight loss, most of them experienced weight gain after radiotherapy. Two patients used tube feeding and had complications of subclinical hyperthyroidism and type 2 diabetes. Patients had anemia, two of them had improved hemoglobin level. There was a decrease in muscle mass but there was an improvement in the strength of hand grip and EGOG score, especially after radiotherapy.

Conclusion. Medical nutrition therapy can improve clinical outcomes, functional capacity, anthropometry, and laboratory especially in patients without complications."

"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."

"Tatalaksana nutrisi pada beberapa penyakit paru yang disampaikan dalam bentuk serial kasus ini bertujuan untuk mengetahui peran terapi nutrisi yang adekuat pada proses pemulihan penyakit paru Serial kasus ini terdiri dari 1 TB paru aktif dengan basil tahan asam BTA positif 2 Pleuritis TB 3 penyakit paru obstruktif kronik PPOK eksaserbasi akut dengan TB paru relaps dan 4 PPOK eksaserbasi akut suspek kor pulmonale dengan riwayat TB paru Keempat pasien adalah pasien rawat inap di RSUT yaitu salah satu RS jejaring PPDS 1 PSIGK yang mendapat tatalaksana bagi penyakitnya dan diberikan dukungan nutrisi selama kurang lebih delapan hari Pasien pada serial kasus ini berusia antara 17 ndash 72 tahun Umumnya pasien mengalami sesak napas anoreksia penurunan berat badan dan malnutrisi Hasil skrining gizi menunjukkan semua pasien memerlukan tatalaksana nutrisi Pemberian nutrisi sesuai dengan kebutuhan masing masing pasien kalori dimulai dari 80 kebutuhan energi basal dan secara bertahap ditingkatkan hingga mencapai kebutuhan energi total Pemantauan tatalaksana nutrisi dilakukan selama minimal lima hari mencakup toleransi asupan makanan kapasitas fungsional hasil pemeriksaan laboratorium dan antropometrik Hasil tatalaksana nutrisi menunjukkan perbaikan toleransi asupan makanan yang dinilai dari kemampuan pasien menghabiskan makanan Kebutuhan energi total umumnya dapat dicapai pada hari keempat dan kelima perawatan Perbaikan kapasitas fungsional ditandai dengan kemampuan pasien berdiri atau berjalan sendiri Selama perawatan terjadi peningkatan berat badan kecuali satu orang pasien berat badannya menetap Perbaikan hasil pemeriksaan laboratorium tidak dapat dinilai karena tidak dilakukan pemeriksaan ulang Dari serial kasus ini didapat kesimpulan bahwa pemberian nutrisi yang adekuat penting pada tatalaksana penyakit paru Tatalaksana nutrisi yang baik dapat memperbaiki status nutrisi dan imunitas pasien penyakit paru sehingga pemulihan menjadi lebih cepat dan lama rawat lebih singkat Pasien dapat kembali menjalankan aktivitas kehidupannya sehari hari dan mempunyai kualitas hidup yang lebih baik

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The aim of nutritional management in several pulmonary diseases presented in the form of a case series is to determine the role of adequate nutritional therapy in the recovery of the diseases The case series consists of 1 active pulmonary tuberculosis TB smear positive 2 TB pleurisy 3 acute exacerbation of chronic obstruction pulmonary disease COPD with pulmonary TB relapse and 4 acute exacerbation of COPD with suspected of cor pulmonale and a history of pulmonary TB The four patients were inpatients of T hospital one of the teaching hospitals of PPDS 1 PSIGK which were examined and given nutritional therapy for about eight days The age of patients on this case series were between 17 ndash 72 years old In general patients experience shortness of breath anorexia weight loss and malnutrition Based on the results of nutritional screening all patients requiring nutritional management Nutritional management was adjusted to individual nutritional requirement provision calories began at 80 of basal energy requirement and gradually increased to achieve the total energy requirement Nutritional management was monitored for a minimum of five days including tolerance of food intake functional capacity laboratory examination and anthropometric assessment The results showed an improvement of dietary intake assessed by patient rsquo s ability to increase their food intake Total energy requirement can generally be achieved on the fourth and fifth day of treatment Improvement of the functional capacity was shown by their ability to stand or walk without any assistance The weight of all patients increased during treatment except one patient had stable weight Improvement of laboratory test results could not be assessed because there was no re examination It can be concluded from this case series that the provision of adequate nutrition is necessary in the management of pulmonary diseases Proper nutritional management can improve the nutritional status and immunity therefore can speed up patients rsquo recovery faster and shorten length of stay Patients can return to their daily activities and have a better quality of life "

"The Indonesia Regional Hydration Study THIRST pada tahun 2009 melakukan penelitian terhadap 1200 orang di beberapa kota di Indonesia Hasil penelitian tersebut menunjukan bahwa sebanyak 42 5 subjek dewasa mengalami dehidrasi ringan Hal ini diketahui karena 60 remaja dan dewasa tidak mengetahui pentingnya penambahan asupan cairan untuk mencegah dehidrasi ringan Latar belakang ini yang membuat peneliti merasa perlu melakukan penelitian pada subjek perempuan produktif usia 19 49 tahun Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan tingkat pengetahuan dan asupan cairan pada subjek perempuan produktif usia 19 49 tahun Desain penelitian ini adalah cross sectional Data penelitian diambil pada bulan Januari 2012 melalui kuesioner dan lembar asupan cairan pada 66 subjek yang memenuhi kriteria inklusi Hasil penelitian ini menunjukkan bahwa sebagian besar 92 4 subjek berusia 30 49 tahun dan tingkat pendidikan sebagian besar 45 5 adalah lulusan SD Selain itu sebagian besar subjek 43 9 memiliki pengetahuan cukup Secara keseluruhan asupan cairan subjek adalah 2771 52 1111 83 mL hari dan sebagian besar 66 7 memiliki asupan cairan yang adekuat Penelitian ini membuktikan tidak terdapat hubungan p 0 079 antara tingkat pengetahuan dan asupan cairan Sebanyak 52 4 subjek yang berpengetahuan buruk memilki asupan cairan adekuat Hal ini menunjukan terdapat faktor lain disamping pengetahuan yang memengaruhi asupan cairan pada perempuan produktif usia 19 49 tahun Kata kunci asupan cairan perempuan produktif usia 19 ndash 49 tahun tingkat pengetahuan.

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The Indonesian Regional Hydration Study THIRST in 2009 conducted a study of 1200 people in several cities in Indonesia The results revealed that as many as 42 5 of the adult subjects experienced mild dehydration This was known as 60 of the adolescents and adults did not know the importance of the addition of fluid intake to prevent mild dehydration This background motivated researchers to do research on the 19 49 years old productive female The aim is to determine the association between the knowledge level and the fluid intake The design of the study was cross sectional Data were taken in January 2012 through questionnaires and fluid intake sheet on 66 subjects who met the inclusion criteria Results of this study showed that the majority of the subjects 92 4 was 30 49 years old and most education level 45 5 was primary school graduate In addition the majority of the subjects 43 9 had sufficient knowledge Overall fluid intake of the subjects was 2771 52 1111 83 mL day and most of them 66 7 had adequate fluid intake This study proves that there is no association p 0 079 between the level of knowledge and fluid intake A total of 52 4 of the bad knowledge subjects had adequate fluid intake It is revealed that there are other factors besides knowledge level that affecting the fluid intake in 19 49 years old productive femaleKeywords fluid intake 19 49 years old productive female and knowledge level"

"The Indonesia Regional Hydration Study THIRST tahun 2009 melaporkan tingginya prevalensi dehidrasi pada remaja di Indonesia yang mencapai 49 5 Studi tersebut juga menunjukkan rendahnya tingkat pengetahuan remaja mengenai asupan cairan. Penelitian ini bertujuan untuk mengetahui hubungan tingkat pengetahuan dengan asupan cairan pada remaja usia 13 18 tahun. Dengan menggunakan desain penelitian cross sectional pengambilan data dilakukan di Yayasan Kasih Keluarga Pejaten Jakarta Selatan pada bulan Januari 2012. Subyek diberikan kuesioner berisi 10 pertanyaan dan lembar asupan cairan harian 2x24 jam untuk diisi selama hari Jumat dan Sabtu. Analisis statistik dilakukan melalui uji chi square pada SPSS versi 16 Dari 67 subyek 52 8 berjenis kelamin perempuan dan 62 7 merupakan pelajar SMK. Sebanyak 46 3 subyek memiliki tingkat pengetahuan cukup 25 4 memiliki tingkat pengetahuan baik dan 28 3 memiliki tingkat pengetahuan kurang. Nilai median jumlah asupan cairan harian subyek sebesar 2310 720 5 520 ml dan sebagian besar subyek 65 7 memiliki asupan cairan yang adekuat Sejumlah 82 4 subyek berpengetahuan baik dan 71 subyek berpengetahuan cukup memiliki jumlah asupan cairan yang adekuat. Pada kelompok tingkat pengetahuan rendah hanya 42 1 subyek yang memiliki asupan cairan yang adekuat Terdapat hubungan yang bermakna antara tingkat pengetahuan dan asupan cairan subyek p 0 028.

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The Indonesia Regional Hydration Study THIRST in 2009 reported high prevalence 49 5 of dehydration among teenagers in Indonesia. The study also reported poor knowledge level about fluid intake among teenagers. The purpose of this research was to determine the relationship between fluid intake and knowledge level among teenagers 13 18 years old. By using cross sectional research design data collection was conducted in Yayasan Kasih Keluarga Pejaten Jakarta Selatan on January 2012. Subjects were given questionnaire consisted of 10 questions and daily fluid intake sheet 2x24 hours which had to be filled on Friday and Saturday. Statistical analysis was done using chi square test in SPSS version 16 Among 67 subjects 52 8 were female and 62 7 were vocational school students 46 3 subjects have moderate knowledge level 25 4 have good knowledge level and 28 3 have poor knowledge level. The median value of the daily fluid intake is 2310 720 5 520 ml and most of the subjects 65 7 have adequate fluid intake 82 4 subjects with good knowledge and 71 subjects with moderate knowledge have adequate fluid intake. Meanwhile from poor knowledge group only 42 1 subjects have adequate fluid intake There is significant association between fluid intake and knowledge level p 0 028."

"ABSTRAK Imbang nitrogen pada pasien sakit kritis selalu negatif akibat respon stres. Pada lansia perubahan metabolismenya berisiko memperburuk imbang nitrogen. Tujuan penelitian ini adalah untuk mengetahui imbang nitrogen dan hubungannya dengan asupan energi dan protein pada lansia sakit kritis dalam 48 jam pertama di ICU. Penelitian ini menggunakan metode potong lintang, consecutive sampling. Subyek penelitian adalah 26 lansia sakit kritis. Hasil penelitian pada 24 jam I dan II adalah; imbang nitrogen -5,2 (-31,2 − -4,1) g dan -4,5+4,6; asupan energi 78,8+45,0% dan 91,1+50,2% terhadap target; asupan protein 0,57+0,35 g/kgBB/hari dan 0,71+0,37 g/kgBB/hari serta terdapat korelasi positif bermakna antara imbang nitrogen dengan asupan energi; r=0,6 dan r=0,5 dan korelasi positif bermakna antara imbang nitrogen dengan asupan protein; r=0,5 dan r=0,4. Kesimpulan penelitian ini adalah terdapat hubungan bermakna antara imbang nitrogen dengan asupan energi dan protein pada lansia sakit kritis

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ABSTRAK Nitrogen balance in criticaly ill patients tend to be negative due to stress response. In the elderly patients, the metabolic changes risk to worsening nitrogen balance.The aim of this study is to determine nitrogen balance and its relation with energy and protein intake in critically ill elderly patients within 48 hours in ICU. The study was cross sectional, consecutive sampling on 26 subjects. The nitrogen balances were -5.2 (-31.2 − -4.1) g and -4.5+4.6 g; energy intakes were 78.8+45.0% and 91.1+50.2% target; protein intakes were; 0.57+0.35 g/kgBW/d and 0.71+0.37 g/kgBW/d. There were positive correlation between nitrogen balance and energy intake; r=0.6 and r=0.5, and between nitrogen balance and protein intake; r=0.5 and r=0.4 in 24 hours I and II respectively. The conclusion is there were positive correlation between nitrogen balance with energy and protein intakes."

"[ABSTRAKPendahuluan:Pada traumatic brain injury (TBI) dapat terjadi peningkatan metabolisme sehingga pasien rentan mengalami malnutrisi. Tatalaksana nutrisi yang adekuat sesuai dengan kondisi klinis dan komorbiditas berperan dalam mencegah terjadinya malnutrisi, menurunkan morbiditas dan mortalitas, serta mengoptimalkan outcome neurologis.Presentasi Kasus:Keempat pasien dalam serial kasus ini adalah laki-laki berusia antara 31?60 tahun dengan TBI dan berbagai faktor penyulit. Pasien pertama dengan obesitas dan mengalami hiponatremia berulang selama perawatan, pasien kedua memiliki status gizi malnutrisi, pasien ketiga dengan riwayat kemoradiasi pada astrositoma, amiloid angiopati dan disfagia, sementara pasien keempat dengan hipertensi dan fibrilasi atrium. Skrining gizi dengan MST pada keempat pasien menunjukkan skor dua. Pemberian energi pada keempat pasien adalah sebesar 140?150% dari kebutuhan energi basal yang dihitung dengan Harris-Benedict, dengan target pemberian protein sebesar 1,5?1,9 g/kg BB/hari atau setara dengan 20% energi. Selama pemantauan asupan protein pada keempat pasien adalah sebesar 0,55?1,67 g/kg BB/hari atau setara dengan 13,1?19,5% energi. Restriksi cairan dilakukan pada pasien pertama sebagai tatalaksana hiponatremia yang diperkirakan terjadi akibat SIADH. Pemberian natrium pada pasien keempat tidak direstriksi meskipun pasien mengalami hipertensi karena hipertensi adalah salah satu mekanisme kompensasi pada TBI. Pasien ketiga mengalami disfagia jika mengasup air putih sehingga dilakukan latihan menelan. Asupan per oral dimulai pada hari ke 6?15 pasca trauma.Hasil:Keempat pasien menunjukkan perbaikan outcome neurologis yang tampak berdasarkan peningkatan skor GCS disertai peningkatan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien TBI dengan mempertimbangkan komorbiditas pasien diperlukan untuk menunjang penyembuhan dan memperbaiki outcome pasien.

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ABSTRACTBackground:Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.Case Presentation:The four patients included in this serial case were male, 31?60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140?150% of predicted basal energy requirement and target of protein provision were 1,5?1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55?1,67 g/kg BW/day or equal to 13,1?19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6? 15 post trauma.Result:There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient?s outcome. Nutritional management should consider patient?s comorbidities.;Background:Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.Case Presentation:The four patients included in this serial case were male, 31–60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140–150% of predicted basal energy requirement and target of protein provision were 1,5–1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55–1,67 g/kg BW/day or equal to 13,1–19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6– 15 post trauma.Result:There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient’s outcome. Nutritional management should consider patient’s comorbidities., Background:Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.Case Presentation:The four patients included in this serial case were male, 31–60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140–150% of predicted basal energy requirement and target of protein provision were 1,5–1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55–1,67 g/kg BW/day or equal to 13,1–19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6– 15 post trauma.Result:There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient’s outcome. Nutritional management should consider patient’s comorbidities.]"

"[ABSTRAKLatar belakang: Kanker kepala dan leher merupakan salah satu keganasan yang dapat menyebabkan malnutrisi. Radioterapi dan kemoterapi merupakan bagian dari terapi pasien yang dapat menimbulkan berbagai efek samping sehingga dapat memperburuk status gizi pasien. Tujuan tatalaksana nutrisi adalahmeningkatkan asupan pasien, mempertahankan berat badan dan meminimalkan penurunan berat badan selama radiasi dan kemoterapi, meningkatkan kualitas hidup, menurunkan angka mortalitas pasien KKL pasca radioterapi dan kemoterapi. Tatalaksana nutrisi yang diberikan meliputi pemberian makronutrien, mikronutrien, nutrien spesifik serta konseling dan edukasi.Metode: Pasien pada serial kasus ini berjumlah empat orang dan berusia antara 41 hingga 57 tahun. Ketiga pasien menjalani kemoradiasi dan hanya satu pasien yang menjalani radioterapi. Hasil skrining pada semua pasien dengan menggunakan malnutrition screening tool (MST) mendapatkan nilai ≥2. Kebutuhan energi pasien dihitung dengan menggunakan rumus Harris Benedict selanjutnya dihitung kebutuhan energi total dengan faktor stres 1,5. Pemantauan yang dilakukan pada pasien meliputi keluhan subyektif, kondisi klinis, tanda vital, antropometri, kapasitas fungsional, dan analisis asupan. Monitoring dan evaluasi dilakukan secara teratur untuk memantau pencapaian target nutrisi.Hasil: Dukungan nutrisi yang diberikan pada keempat pasien dapat meningkatkan asupan dan menaikkan berat badan pasien ketiga, mempertahahankan berat badan pasien pertama dan keempat, serta meminimalkan penurunan berat badan pasien kedua. Kapasitas fungsional pasien tidak mengalami penurunan.Kesimpulan: Dukungan nutrisi yang diberikan pada pasien kanker kepala dan leher dalam terapi radiasi dapat meminimalkan, mempertahankan, dan meningkatkan berat badan, serta mempertahankan kapasitas fungsional pasien.

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ABSTRACTIntroduction: Head and Neck Cancer is malignant disease associated with malnutrition. Radiotherapy and Chemotherapy will give side effect which can worsen nutritional status. The goal of nutritional management are to maintain or increase nutritional status, improve quality of life, and prolong survival of patients. Nutrition management include provide macronutrient, micronutrient, specific nutrients, counseling, and education. Methode: Patient in this case series were between 41 to 57 years old. Three of patients undergoing chemoradiation and one of patients on radiation therapy. All patients had a screening score ≥2 using a Malnutrition Screening Tool (MST). Nutritional status of patients were obese, normoweight with risk of malnutrition, and normoweight. Basal energy requirement were calculated using Harris Benedict Formula then calculated with stress factor 1.5 for total energy requirement. Monitoring included subjective complaints, clinical condition, vital signs, anthropometric, functional capacity and nutrition analysis. Monitoring and evaluation were done for accomplishment of nutritional targets.Results : Nutritional support could increase intake and weight gain in third patients, weight maintaining in first and fourth patients, and for second patients were minimizing weight loss. There was no decrease in functional capacity.Conclusion: Nutritional support in head and neck cancer with radiotherapy could minimizing, maintaining, and increasing body weight also maintaining functional capacity., Introduction: Head and Neck Cancer is malignant disease associated withmalnutrition. Radiotherapy and Chemotherapy will give side effect which canworsen nutritional status. The goal of nutritional management are to maintain orincrease nutritional status, improve quality of life, and prolong survival ofpatients. Nutrition management include provide macronutrient, micronutrient,specific nutrients, counseling, and education. Methode: Patient in this case series were between 41 to 57 years old. Three ofpatients undergoing chemoradiation and one of patients on radiation therapy. Allpatients had a screening score ≥2 using a Malnutrition Screening Tool (MST). Nutritional status of patients were obese, normoweight with risk of malnutrition,and normoweight. Basal energy requirement were calculated using HarrisBenedict Formula then calculated with stress factor 1.5 for total energyrequirement. Monitoring included subjective complaints, clinical condition, vitalsigns, anthropometric, functional capacity and nutrition analysis. Monitoring andevaluation were done for accomplishment of nutritional targets. Results : Nutritional support could increase intake and weight gain in thirdpatients, weight maintaining in first and fourth patients, and for second patientswere minimizing weight loss. There was no decrease in functional capacity.Conclusion: Nutritional support in head and neck cancer with radiotherapy could minimizing, maintaining, and increasing body weight also maintaining functional capacity.]"