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Abstrak :
[ABSTRAK
Latar balakang. Sekitar 75% kanker leher rahim datang ke rumah sakit dalam stadium lanjut. Terapi utama kanker serviks stadium lanjut adalah radioterapi. Kombinasi terapi radiasi dengan kemoterapi ternyata tidak menghasilkan respons terapi yang lebih baik, tetapi bahkan menimbulkan efek samping yang lebih berat dibandingkan terapi radiasi saja. Perubahan pola makan saat ini, diduga berpengaruh pada respons terapi. Rasio asupan Polyunsaturated Fatty Acids (PUFA) n-6 : n-3 sekitar 1-2 : 1 dapat melawan pertumbuhan kanker. Beberapa publikasi melaporkan bahwa PUFA n-3 (AL n-3) mempunyai efek pro-apoptosis, anti-inflamasi, anti-proliferatif dan anti-angiogenik. Penelitian ini bertujuan untuk mengetahui apakah suplementasi nutrisi tinggi PUFA bersamaan dengan terapi radiasi dapat meningkatkan respons tumor pada kanker serviks stadium lanjut. Metode. Penelitian ini merupakan Randomized Clinical Trial, double blind pada pasien kanker serviks stadium lanjut, jenis karsinoma sel skuama yang hanya mendapat terapi radiasi di Departemen Radioterapi, Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta. Subjek penelitian diambil secara konsekutif, melalui randomisasi dibagi dua kelompok, yaitu kelompok perlakuan dan kontrol. Selama radiasi subjek penelitian mendapat suplementasi nutrisi mengandung isokalori dan isoprotein dengan rasio AL n-6 : n-3 = 1,27 : 1 dan kontrol. Selama perlakuan dilakukan evaluasi setiap lima kali radiasi, meliputi BB dan efek samping radiasi akut. Parameter yang dinilai adalah respons klinis, respons histopatologis serta perubahan kadar PGE2 dan VEGF serum. Hasil. Sebanyak 31 subjek dari 45 subjek dapat menyelesaikan penelitian. Sebelum perlakuan, status sosio-demografi, pola asupan AL n-6 dan n-3, status gizi dan klinis tidak didapatkan perbedaan bermakna. Setelah perlakuan, didapatkan penurunan kadar PGE2 serum pada kelompok perlakuan, sedangkan kelompok kontrol mengalami kenaikan (p = 0,127). Penurunan kadar VEGF kelompok perlakuan lebih besar dibanding kontrol (p = 0,626). Respons klinis dan respons histopatologis kelompok perlakuan lebih baik dibanding kontrol, dengan kemaknaan masing-masing p = 0,172 dan p = 0,169. Secara statistik belum didapatkan perbedaan yang bermakna pada penurunan kadar PGE2 dan VEGF serum, respons klinis dan respons histopatologis, tetapi didapat kemaknaan klinis yang nyata pada kelompok perlakuan dibanding kontrol. Analisis statistik gabungan dari respons klinis, respons histopatologis, kadar PGE2 dan VEGF serum didapatkan respons tumor total yang bermakna (p = 0,048). Kesimpulan. Suplementasi nutrisi tinggi PUFA dengan rasio asam lemak n-6 : n- 3 = 1,27 : 1 pada kanker serviks stadium lanjut bersama terapi radiasi memberikan respons tumor total yang lebih baik.;

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ABSTRACT
Background . Approximately 75% of uterine cervical cancer came to the hospital in an advanced stage. Primary therapy of advanced cervical cancer is radiotherapy. The combination of radiotherapy with chemotherapy did not give better outcomes, but even cause more severe side effects than radiotherapy. Changes in dietary intake at this time, are supposed to influence the response to therapy. The ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) about 1-2: 1 can fight cancer growth. Several publications stated that n-3 PUFA has pro- apoptotic effect, anti-inflammatory, anti-proliferative and anti-angiogenic. This study aimed to examine whether radiotherapy combined with daily nutritional supplements enriched PUFA enhance tumor response in advanced cervical cancer. Method. This study was a double-blind Randomized Clinical Trial (RCT) in patients with advanced squamous cell cervical cancer, received radiation only as control group, and those who received nutritional supplementation containing isocaloric and isoprotein with ratio of n-6 : n-3 PUFA = 1.27: 1 as treatment group. This study was performed in the Department of Radiotherapy Dr. Cipto Mangunkusumo General Hospital (RSUPNCM), Jakarta. Evaluation was done every five times radiation, including Karnofsky Perfomance Scale, body weight and side effects of acute radiation. Parameters assessed were clinical and hematological response, histopathological response and changes in the levels of PGE2 and VEGF serum, Results. A total of 31 subjects from 45 subjects participated the study completely. Prior to treatment, socio-demographic status, patterns of n-6 and n-3 PUFA, clinical and nutritional status were analyzed, no significant differences were noted. After treatment, a decrease in serum PGE2 levels in the treatment group was found, while in the control group increased (P = 0.127). VEGF in the treatment group declined higher than controls (P = 0.626). Treatment group showed significant better clinical response and histopathological responses compared to the control group (p = 0.172 and p = 0.169). No significant differences were found in the reduction of PGE2 and VEGF serum levels, clinical response and histopathological response, although from clinical standpoint there is a better significant response in the treatment group than the control. The combined statistical analysis of clinical response, histopathological response, PGE2 and VEGF serum levels obtained total tumor response (P = 0.048). Conclusion. Nutritional supplementation enriched PUFA (ratio of n-6: n-3 PUFA = 1.27 : 1) in advanced cervical cancer receiving radiotherapy gives better total tumor response.;Background . Approximately 75% of uterine cervical cancer came to the hospital in an advanced stage. Primary therapy of advanced cervical cancer is radiotherapy. The combination of radiotherapy with chemotherapy did not give better outcomes, but even cause more severe side effects than radiotherapy. Changes in dietary intake at this time, are supposed to influence the response to therapy. The ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) about 1-2: 1 can fight cancer growth. Several publications stated that n-3 PUFA has pro- apoptotic effect, anti-inflammatory, anti-proliferative and anti-angiogenic. This study aimed to examine whether radiotherapy combined with daily nutritional supplements enriched PUFA enhance tumor response in advanced cervical cancer. Method. This study was a double-blind Randomized Clinical Trial (RCT) in patients with advanced squamous cell cervical cancer, received radiation only as control group, and those who received nutritional supplementation containing isocaloric and isoprotein with ratio of n-6 : n-3 PUFA = 1.27: 1 as treatment group. This study was performed in the Department of Radiotherapy Dr. Cipto Mangunkusumo General Hospital (RSUPNCM), Jakarta. Evaluation was done every five times radiation, including Karnofsky Perfomance Scale, body weight and side effects of acute radiation. Parameters assessed were clinical and hematological response, histopathological response and changes in the levels of PGE2 and VEGF serum, Results. A total of 31 subjects from 45 subjects participated the study completely. Prior to treatment, socio-demographic status, patterns of n-6 and n-3 PUFA, clinical and nutritional status were analyzed, no significant differences were noted. After treatment, a decrease in serum PGE2 levels in the treatment group was found, while in the control group increased (P = 0.127). VEGF in the treatment group declined higher than controls (P = 0.626). Treatment group showed significant better clinical response and histopathological responses compared to the control group (p = 0.172 and p = 0.169). No significant differences were found in the reduction of PGE2 and VEGF serum levels, clinical response and histopathological response, although from clinical standpoint there is a better significant response in the treatment group than the control. The combined statistical analysis of clinical response, histopathological response, PGE2 and VEGF serum levels obtained total tumor response (P = 0.048). Conclusion. Nutritional supplementation enriched PUFA (ratio of n-6: n-3 PUFA = 1.27 : 1) in advanced cervical cancer receiving radiotherapy gives better total tumor response., Background . Approximately 75% of uterine cervical cancer came to the hospital in an advanced stage. Primary therapy of advanced cervical cancer is radiotherapy. The combination of radiotherapy with chemotherapy did not give better outcomes, but even cause more severe side effects than radiotherapy. Changes in dietary intake at this time, are supposed to influence the response to therapy. The ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) about 1-2: 1 can fight cancer growth. Several publications stated that n-3 PUFA has pro- apoptotic effect, anti-inflammatory, anti-proliferative and anti-angiogenic. This study aimed to examine whether radiotherapy combined with daily nutritional supplements enriched PUFA enhance tumor response in advanced cervical cancer. Method. This study was a double-blind Randomized Clinical Trial (RCT) in patients with advanced squamous cell cervical cancer, received radiation only as control group, and those who received nutritional supplementation containing isocaloric and isoprotein with ratio of n-6 : n-3 PUFA = 1.27: 1 as treatment group. This study was performed in the Department of Radiotherapy Dr. Cipto Mangunkusumo General Hospital (RSUPNCM), Jakarta. Evaluation was done every five times radiation, including Karnofsky Perfomance Scale, body weight and side effects of acute radiation. Parameters assessed were clinical and hematological response, histopathological response and changes in the levels of PGE2 and VEGF serum, Results. A total of 31 subjects from 45 subjects participated the study completely. Prior to treatment, socio-demographic status, patterns of n-6 and n-3 PUFA, clinical and nutritional status were analyzed, no significant differences were noted. After treatment, a decrease in serum PGE2 levels in the treatment group was found, while in the control group increased (P = 0.127). VEGF in the treatment group declined higher than controls (P = 0.626). Treatment group showed significant better clinical response and histopathological responses compared to the control group (p = 0.172 and p = 0.169). No significant differences were found in the reduction of PGE2 and VEGF serum levels, clinical response and histopathological response, although from clinical standpoint there is a better significant response in the treatment group than the control. The combined statistical analysis of clinical response, histopathological response, PGE2 and VEGF serum levels obtained total tumor response (P = 0.048). Conclusion. Nutritional supplementation enriched PUFA (ratio of n-6: n-3 PUFA = 1.27 : 1) in advanced cervical cancer receiving radiotherapy gives better total tumor response.]

Abstrak :

LATAR BELAKANG: Praktik diet yang kurang memadai berdampak negatif terhadap asupan zat gizi dan kejadian penyakit kronis yang berhubungan dengan gizi. Penelitian ini bertujuan untuk mengembangkan Panduan Gizi Seimbang Berbasis Pangan Lokal (PGS-PL) berdasarkan pola makan masyarakat Minangkabau, dalam rangka perbaikan asupan gizi pada wanita usia subur (WUS) penderita dislipidemia. Selanjutnya pada tahap intervensi, dilihat efek promosi PGS-PL terhadap perubahan praktik diet, asupan zat gizi, status gizi dan profil lipid pada WUS Minangkabau dengan dislipidemia.

METODE: Studi tahap pertama menggunakan disain potong lintang, melibatkan 74 WUS suku Minangkabau dengan dislipidemia. Berdasarkan pola makan setempat, identifikasi problem nutrient dan penyusunan PGS-PL dilakukan dengan pendekatan Linear programming, menggunakan tiga dari empat modul pada software Optifood yang dikembangkan oleh WHO. Pada tahap ke dua dilakukan studi intervensi komunitas menggunakan disain pengukuran sebelum dan sesudah dengan kelompok kontrol. Subjek penelitian ditempatkan secara acak yang dikluster ke dalam kelompok PGS-PL (mendapatkan promosi PGS-PL selama 12-minggu) atau kelompok non-PGS-PL (mendapatkan satu kali konsultasi gizi dari pelayanan kesehatan tingkat dasar). Sebanyak 102 WUS (48 pada kelompok PGS-PL dan 54 pada kelompok non-PGSPL) selama 12 minggu. Pada akhir studi, analisis perbedaan antar- dan inter kelompok perlakuan dilakukan untuk melihat perubahan praktik diet, asupan zat gizi, status gizi dan profil lipid darah (kadar kolesterol total, Lipoprotein densitas rendah, Lipoprotein densitas tinggi, dan Trigliserid).

HASIL: Berdasarkan pola makan setempat, ditemukan bahwa asam lemak tidak jenuh (polyunsaturated fatty acid/PUFA, n-3, n-6), serat makanan, zat besi, dan seng merupakan problem nutrient pada WUS suku Minangkabau dengan dislipidemia. PGS-PL yang disusun menekankan penggabungan bahan makanan, kelompok atau sub-kelompok bahan makanan bernilai gizi tinggi yang tersedia secara lokal, untuk meningkatkan asupan problem nutrient tersebut. Promosi PGS-PL dapat meningkatkan skor praktik diet secara bermakna. Peningkatan terutama terjadi pada konsumsi makanan dan sub-kelompok makanan yang dipromosikan (ikan laut, unggas, produk kedelai seperti tahu dan tempe, total sayuran, sayuran hijau, buah-buahan, dan kentang). Tidak ada perubahan bermakna pada konsumsi makanan pokok, makanan selingan, telur, dan makanan yang digoreng pada akhir intervensi. Pengaruh promosi PGS-PL pada asupan zat gizi dapat dilihat pada perubahan yang bermakna pada asupan energi dan karbohidrat, persentase energi dari PUFA dan monounsaturated fatty acid (MUFA), serta rasio PUFA terhadap asam lemak jenuh (saturated fatty acids/SAFA) dalam makanan sehari-hari. Namun, asupan lemak jenuh tidak berubah signifikan. Terdapat perbaikan yang bermakna pada berat badan, indeks massa tubuh, dan lingkar pinggang, namun tidak bermakna terhadap penurunan prevalensi obesitas. Tidak terdapat perubahan profil lipid darah yang bermakna setelah intervensi.

KESIMPULAN: Pendekatan linier programming dapat digunakan dalam menyusun PGS-PL untuk meningkatkan praktik diet dan asupan problem nutrient pada WUS dengan dislipidemia. Promosi PGS-PL secara bermakna berdampak terhadap peningkatan praktik diet, asupan zat gizi, dan status gizi, tetapi belum berpengaruh secara statistik terhadap perbaikan profil lipid WUS dengan dislipidemia.

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BACKGROUND: Given the impact of unfavorable dietary practices is on inadequate nutrient intake and nutrition-related chronic diseases, we sought the problem nutrient in the community habitual dietary practices, and developed an optimized food-based recommendation (FBR) for Minangkabau women of reproductive age (WoRA) with dyslipidemia. Although the effect of the FBR promotion seemed to be potential at planning phase, but this has not been tested in the community setting. Therefore, we conducted a community trial and explored the effect of FBR promotion using locally available foods on dietary practice, nutrient intakes, nutritional status and lipid profile among Minangkabau WoRA with dyslipidemia.

METHODS: The first stage of the study was a cross-sectional study, which involved 74 Minangkabau WoRA with dyslipidemia. Linear programming analysis using three modules of the WHO Optifood software was employed to identify problem nutrients and develop an optimized FBR. The second phase of the study was a community-based trials using pre-post with control group design. The subjects were cluster randomized into either FBR group (receiving 12-weeks of FBR promotion) or non-FBR group (receiving once standard nutritional counseling from primary health care program). At the end, 102 WoRA (48 and 54 WoRA in the FBR group and the non-FBR group, respectively) completed 12-weeks of intervention. We analyzed within- and between group differences on changes of dietary practices, nutrient intakes, nutritional status and lipid profile (serum Total Cholesterol, Low-Density Lipoprotein, High-Density Lipoprotein and Triglyceride levels) at the completion of the study.

RESULTS: Our results identified PUFA, dietary fiber, iron, and zinc as problem nutrients among Minangkabau WoRA with dyslipidemia. The final food-based recommendations emphasized the incorporation of locally available nutrient-dense foods, food groups, and sub-groups that would improve the intake of the identified problem nutrients. The FBRs promotion significantly increased the overall dietary compliance. An increase was predominantly occurred on the consumption of promoted and subgroups food items (sea fish, poultry, soybean products, total vegetables, dark green leafy vegetables, fruits, and potato). There were no significant changes in the consumption of staple food, snacks, eggs, and fatty foods at the end of intervention.  Effect of FBR promotion on nutrient intake was observed through the significant changes in energy and carbohydrate intakes, percentage of energy from PUFA and MUFA, as well as PUFA to SAFA ratio in daily diet. However, intake of saturated fat remained unchanged. Marginal but significant improvements were observed in body weight, BMI, and waist circumference, but the prevalence of obesity was relatively not affected. There were no significant changes of blood lipid profile at the end of intervention.

CONCLUSIONS: Linear programming approach could be potentially used to develop an optimized food-based recommendation based on the identified problem nutrients and locally available nutrient dense foods. The FBRs promotion produced significant improvement in dietary practice, nutrient intakes, and nutritional status, but did not statistically affect blood lipid profile of Minangkabau WoRA with dyslipidemia. 

Abstrak :
Latar belakang: Prevalensi hipovitaminosis D (hypoD) pada penyandang diabetes melitus tipe 2 (DM tipe 2) dengan depresi belum terdokumentasi dan faktor risikonya belum diketahui. Tujuan: Mengetahui prevalensi dan faktor risiko hipovitaminosis D pada pasien diabetes melitus tipe 2 yang juga mengalami depresi. Metode: 118 pasien diabetes melitus tipe 2 yang mengunjungi klinik endokrinologi rawat jalan di Rumah Sakit Nasional Cipto Mangunkusumo antara Desember 2019 dan September 2022 memberikan data untuk studi cross-sectional ini. Data klinis pasien, termasuk indeks massa tubuh, tekanan darah, HbA1C, profil lipid, dan terapi, serta data demografis, termasuk jenis kelamin, usia, status perkawinan, dan latar belakang pendidikan, dikumpulkan. Untuk tujuan mengevaluasi depresi, Beck Depression Inventory-II (BDI-II) digunakan. Kit ELISA digunakan untuk menilai serum vitamin D, variabel dependen. Normal (30 ng/mL), tidak mencukupi (20-29 ng/mL), dan kurang (20 ng/mL) adalah tiga rentang yang digunakan untuk mengkarakterisasi kadar vitamin D serum. Kami menggunakan analisis varian untuk memeriksa faktor antropometrik, klinis, dan biokimia antara ketiga kelompok (ANOVA). Hasil: 118 subyek dengan DM tipe 2. Usia rerata adalah 56 (48, 75-60) tahun, dengan skor BDI II 17 (15-19) dan konsentrasi serum 25 (OH). Tingkat D adalah 18,3 (9,17–29,46) ng/mL. Hanya 21,8% pasien dengan diabetes melitus tipe 2 dan depresi memiliki kadar vitamin D yang cukup. Analisis multivariabel model varians digunakan untuk menguji hubungan usia, skor BDI II, HbA1c, SBP, dan DBP dengan kadar vitamin D. Usia dan skor BDI II keduanya memiliki pengaruh yang signifikan secara bermakna terhadap kadar vitamin D. Kesimpulan: Investigasi cross-sectional ini menemukan bahwa pasien diabetes mellitus tipe 2 dengan depresi memiliki prevalensi hipovitaminosis D yang tinggi (77,7%). Usia dan skor BDI II keduanya secara statistik mempengaruhi perbedaan kadar vitamin D secara bermakna. ......Backgrounds: The prevalence of hypovitaminosis D (hypoD) in type 2 diabetes mellitus (type 2 DM) patients with depression has not been documented, and the risk factors are not known. Objective: To identify the prevalence of and risk factors for hypovitaminosis D in type 2 diabetes mellitus patients who also have depression. Methods: 118 patients with type 2 diabetes mellitus who visited the outpatient endocrinology clinics at Cipto Mangunkusumo National Hospital between December 2019 and September 2022 provided the data for this cross-sectional study. Patients' clinical data, including body mass index, blood pressure, HbA1C, lipid profiles, and therapy, as well as demographic data, including gender, age, marital status, and educational background, were gathered. For the purpose of evaluating depression, the Beck Depression Inventory-II (BDI-II) was utilized. An ELISA kit was utilized to assess serum vitamin D, the dependent variable. Normal (30 ng/mL), insufficient (20-29 ng/mL), and deficient (20 ng/mL) were the three ranges used to characterize serum vitamin D levels. We used analysis of variance to examine anthropometric, clinical, and biochemical factors between the three groups (ANOVA). Results: 118 subjects with type 2 DM. Median of age was 56 (48, 75-60) years old, with a BDI II score of 17 (15-19) and a serum concentration of 25 (OH). D level was 18.3 (9.17–29.46) ng/mL. Only 21.8% of patients with type 2 diabetes mellitus and depression had sufficient levels of vitamin D. A multivariable analysis of variance model was used to examine the associations of age, BDI II score, HbA1c, SBP, and DBP with vitamin D level. Age and BDI II score both had a statistically significant effect on vitamin D levels. Conclusions: This cross-sectional investigation discovered that type 2 diabetes mellitus patients with depression had a high prevalence (77.7%) of hypovitaminosis D. Age and BDI II score both statistically significantly affected differences in vitamin D levels.