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"Malnutrisi merupakan hal yang umum terjadi pada pasien sirosis hati Tata laksana nutrisi yang optimal bertujuan mempertahankan dan meningkatkan status gizi memperbaiki keadaan klinis dan meningkatkan kualitas hidup pasien Tatalaksana nutrisi pasien sirosis hati mencakup pemberian makronutrien mikronutrien dan nutrien spesifik serta cairan Pasien pada serial kasus ini terdiri atas tiga orang laki laki dan satu orang perempuan dengan rentang usia antara 30 sampai 57 tahun Tiga orang pasien menderita malnutrisi dan satu orang pasien berisiko malnutrisi Berdasarkan skrining seluruh pasien membutuhkan dukungan nutrisi Kebutuhan energi total KET pasien dihitung dengan menjumlahkan kebutuhan energi basal KEB yang didapat dengan menggunakan persamaan Harris Benedict dan faktor stres yang sesuai kondisi klinis pasien Pemberian nutrisi dimulai dengan 80 dari KEB sampai KEB kemudian ditingkatkan secara bertahap hingga mencapai KET Kebutuhan protein dan lemak disesuaikan dengan kondisi pasien Protein yang diberikan mempunyai kandungan asam amino rantai cabang AARC yang tinggi dan lemak jenis medium chain triglyceride MCT trigliserida rantai sedang Makanan diberikan dalam porsi kecil dengan jadwal pemberian sering dan malam hari diberikan late evening snack sebanyak 10 dari asupan harian total mengandung karbohidrat dan AARC Pada pasien dengan hiponatremia dilusional asupan cairan direstriksi Selama pemantauan dengan bertambah baiknya keadaan klinis maka asupan makan pasien dapat mencapai KET Serial kasus ini menunjukkan bahwa pada pasien sirosis hati dengan berbagai komplikasi tata laksana nutrisi yang baik dapat meningkatkan status gizi memperbaiki keadaan klinis dan meningkatkan kualitas hidup pasien

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Malnutrition is common in patients with liver cirrhosis Optimal nutrition support in patients with liver cirrhosis is required to maintain and improve clinical condition nutrition status and quality of life by providing macronutrient micronutrient specific nutrient and fluid according to the recommendation Patients in this case series were three males and one female with age ranged from 30 to 57 years old Three patients were malnourished while one was on risk of being malnourished Based on the screening conducted to these patients while their admission all four patients needed nutrition support therapy Total energy requirements were determined using Harris Benedict equation to calculate basal energy requirements and multiplied by stress factor Nutrition provision initiated from 80 basal energy requirement and increased gradually according to patient rsquo s tolerance until total energy requirements were achieved Protein and lipid were given in accordance with the patients clinical condition with protein contain high branched chain amino acid BCAA and fat which high in medium chain triglyceride MCT The diets delivered in small portion six times per day with late evening snack as much as 10 of total energy intake contained carbohydrate and BCAA Fluid restrictions were applied to patients with dilutional hyponatremia During hospitalization nutrition intake increased as general conditions improved Nutrition status clinical condition and quality of life of liver cirrhotic patients with various complications in this case series were improved by appopriate nutrition support ;Malnutrition is common in patients with liver cirrhosis Optimal nutrition support in patients with liver cirrhosis is required to maintain and improve clinical condition nutrition status and quality of life by providing macronutrient micronutrient specific nutrient and fluid according to the recommendation Patients in this case series were three males and one female with age ranged from 30 to 57 years old Three patients were malnourished while one was on risk of being malnourished Based on the screening conducted to these patients while their admission all four patients needed nutrition support therapy Total energy requirements were determined using Harris Benedict equation to calculate basal energy requirements and multiplied by stress factor Nutrition provision initiated from 80 basal energy requirement and increased gradually according to patient rsquo s tolerance until total energy requirements were achieved Protein and lipid were given in accordance with the patients clinical condition with protein contain high branched chain amino acid BCAA and fat which high in medium chain triglyceride MCT The diets delivered in small portion six times per day with late evening snack as much as 10 of total energy intake contained carbohydrate and BCAA Fluid restrictions were applied to patients with dilutional hyponatremia During hospitalization nutrition intake increased as general conditions improved Nutrition status clinical condition and quality of life of liver cirrhotic patients with various complications in this case series were improved by appopriate nutrition support "

"[ABSTRAKPasien penyakit ginjal kronik derajat 5 mengalami suatu keadaan di mana ginjal sama sekali tidak dapat mempertahankan homeostasis metabolisme tubuh sehingga membutuhkan terapi pengganti ginjal. Terapi pengganti ginjal yang paling sering dipilih oleh pasien PGK derajat 5 adalah hemodialisis. Perubahan metabolik pada PGK derajat 5 dengan hemodialisis dapat disebabkan oleh gangguan fungsi ginjal dan proses hemodialisis. Perubahan metabolik tersebut antara lain gangguan keseimbangan cairan, dan asam basa serta gangguanmetabolisme protein, karbohidrat, dan lemak. Dibutuhkan terapi terintegrasi pada pasien PGK yang terdiri atas terapi farmakologi, terapi pengganti ginjal, terapi nutrisi dan dukungan psikologis. Peran nutrisi dalam menurunkan komplikasi dan meningkatkan kualitas hidup sangat penting dalam tatalaksana pasien PGK. Pemberian nutrisi pada pasien PGK dengan hemodialisis bertujuan untuk mengatasi gejala akibat gangguan ginjal dan mencegah komplikasi akibat progresivitas kerusakan ginjal. Pemberian nutrisi yang tepat dapat dilakukan dengan memahami patofisiologi yang terjadi pada pasien PGK dan proseshemodialisis yang dipilih sebagai terapi pengganti ginjal. Berdasarkan hal tersebut, dilaporkan empat serial kasus pada pasien PGK derajat 5 dengan hemodialisis rutin. Diberikan terapi nutrisi sesuai panduan yaitu energi 30-35 kkal per kg berat badan, protein 1,2 g per kg berat badan, lemak 25-30% energi total, dan karbohidrat 60-65% energi total. Diketahui bahwa penyebab asupan tidak terpenuhi adalah keadaan klinis yaitu sesak, penurunan kesadaran, dan gangguan saluran cerna yaitu mual dan muntah.

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ABSTRACTStage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods that substitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit. Stage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins, carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit., Stage 5 of chronic kidney disease represents total inability of kidneys to maintainbody homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidneytransplantation. The most used method is hemodialysis. Metabolic changes instage 5 of chronic kidney disease can be caused by kidney disease itself and alsohemodialysis treatment. Metabolic complications of chronic kidney disease andhemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complicationand to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are toovercome the symtoms and to prevent the complication that caused by kidneydisease. Nutrition therapy can be done properly by understand thepathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney diseasewith hemodialysis are reported here. The nutrition which is given consist ofenergy 30–35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid25–30 % total energy, and carbohydrate 60–65 % total energy. There isinadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit.]"

"ABSTRAKLatar Belakang : Kolestasis adalah penyumbatan atau terhambatnya aliran empedu dari hati ke duodenum, dibagi menjadi intra dan ekstrahepatik. Kolestatis ekstrahepatik terutama disebabkan oleh obstruksi. Pankreatikoduodenektomi merupakan terapi pembedahan pilihan, dapat menyebabkan perubahan anatomis dan fisiologis saluran cerna. Perubahan ini menimbulkan maldigesti dan malabsorpsi, menyebabkan malnutrisi, serta meningkatkan morbiditas dan mortalitas bila tidak mendapat dukungan nutrisi.Presentasi kasus : Empat kasus kolestasis ekstrahepatik, dengan keluhan ikterus di seluruh badan, nyeri perut. Tiga kasus 1 orang laki-laki dan 2 orang perempuan , disebabkan keganasan dan 1 kasus karena striktura CBD jinak. Semua pasien menjalani pembedahan, dengan lama operasi berkisar antara 3 sampai 9 jam. Pemenuhan protein dan asam amino terutama asam amino rantai cabang, diupayakan maksimal, yang diperoleh dari kombinasi makanan cair polimerik dan putih telur. Lemak dibatasi maksimal 30 dari energi yang diberikan, dengan kandungan medium-chain triglycerides MCT tinggi. Pankreatikoduodenektomi menimbulkan perubahan pada organ saluran cerna, dengan gejala mual dan perut begah setelah makan, dapat diatasi dengan penyesuaian cara pemberian, jumlah dan bentuk nutrisi tiap kondisi pasien. Selama perawatan di RS, secara umum asupan makanan dan kondisi klinis pasien membaik, serta pulang dengan perbaikan kondisi klinis.Kesimpulan: Terapi medik gizi klinik pada pasien dengan kolestasis, dapat membantu terapi bedah dan medikamentosa untuk memperoleh outcome pasca bedah dan memperbaiki kualitas hidup pasien. "

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"ABSTRACTBackground Cholestasis is a blockage or obstruction of the flow of bile from the liver to the duodenum, divided into intrahepatic and extrahepatic. Extrahepatic cholestasis mainly due to the obstruction. Pancreaticoduodenectomy surgery is the treatment of choice, can cause anatomical and physiological changes in the gastrointestinal tract. These changes maldigesti and malabsorption, causing malnutrition, as well as increased morbidity and mortality if not received nutritional support.Case Presentation Four cases of extrahepatic cholestasis, jaundice throughout the body, abdominal pain. Three cases 1 male and 2 female , due to malignancy and 1 case for the CBD benign stricture. All patients underwent surgery, with long operating range from 3 to 9 hours. Fulfillment of protein and amino acids, especially branched chain amino acids, maximum effort, which is obtained from a combination of a polymeric liquid food and egg white. Fat is limited to maximum 30 of the energy supplied, containing medium chain triglycerides MCT high. Pancreaticoduodenectomy cause changes in the organs of the gastrointestinal tract, with symptoms of nausea and abdominal discomfort after eating, can be overcome by adjusting the mode of administration, the amount and form of nutrients each patient 39 s condition. During treatment in hospital, in general, food intake and clinical condition of the patients improved, as well as return to the improvement of clinical conditions.Conclusion The clinical nutrition medical therapy in patients with cholestasis, can help surgical and medical therapy to obtain post surgical outcomes and improve the quality of life of patients."

"Latar belakang: Gagal jantung kongestif atau congestive heart failure CHF dan diabetes melitus DM tipe 2 merupakan dua kondisi yang saling memberatkan, yaitu terjadi gangguan metabolisme yang lebih berat akibat perubahan neurohormonal, dan struktur jantung yang berpotensi memperburuk prognosis. Tatalaksana nutrisi sejak awal diagnosis sangat penting dalam mendukung proses penyembuhan pasien dan mencegah komplikasi lebih lanjut. Kasus: Dalam serial kasus ini terdapat empat pasien CHF dan DM tipe 2 dengan penyulit. Keempat pasien dengan hipertensi dan hiperurisemia, tiga pasien dengan status gizi obes, tiga pasien dengan infark miokard, satu pasien dengan unstable angina pectoris, dua pasien dengan acute kidney injury, dan satu pasien dengan chronic kidney disease. Pada awal pemeriksaan didapatkan defisiensi asupan makro- dan mikronutrien, kontrol tekanan darah dan glukosa darah yang kurang baik, retensi cairan, dan penurunan kapasitas fungsional. Tatalaksana nutrisi disesuaikan secara individual, berdasarkan kondisi klinis, hasil laboratorium dan pemeriksaan penunjang lainnya serta riwayat asupan makanan. Hasil: Seluruh pasien mengalami peningkatan toleransi asupan, perbaikan kondisi klinis, dan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien CHF dan DM tipe 2 dengan penyulit dapat mendukung perbaikan kondisi klinis dan kapasitas fungsional, sehingga dapat menurunkan morbiditas dan mortalitas.

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Background: Congestive heart failure CHF and type 2 diabetes mellitus DM are two mutually aggravating conditions, with more severe metabolic abnormalities due to changes in neurohormonal and cardiac structure which potentially worsen the prognosis. Nutritional management since early diagnosis is very important in supporting the healing process of patients and prevent further complications.

Cases: Four patients were diagnosed with CHF and type 2 DM with complicating conditions. Four patients with hypertension and hyperuricemia, three patients were obese, three patients experienced myocard infarct one patient had unstable angina pectoris, two patients had acute kidney injury, and one patient had chronic kidney disease. Nutritional problems in four patients at assessment were macro and micronutrient deficiencies, uncontrolled blood pressure and blood glucose, fluid retention and declined functional capacity. Nutrition therapy were planned individually including macronutrients, micronutrients and fluid intakes, based on clinical conditions, laboratory findings, other examinations, and previous food intakes.

Result: There were improvements of clinical conditions, intake tolerance, and functional capacity.

Conclusion: Adequate nutrition therapy for CHF and type 2 DM patients with complicating conditions supports the improvements of clinical condition and functional capacity, decreasing morbidity and mortality rates. "

"ABSTRAKPendahuluan: Pasien bedah dengan sakit kritis yang dirawat di ICU cukup sering dijumpai dan menggunakan sumber daya rumah sakit lebih banyak. Sakit kritis dapat menyebabkan pasien menjadi malnutrisi. Malnutrisi pada pasien yang dirawat di ICU akan meningkatkan morbiditas dan mortalitas. Terapi nutrisi untuk pasien sakit kritis pascabedah bertujuan untuk menurunkan stres metabolik, memodulasi respons imun, dan membantu penyembuhan lukaHasil dan Pembahasan: Pemenuhan kebutuhan nutrisi pada pasien sakit kritis pascabedah bergantung pada kondisi klinis pasien. Serial kasus ini menguraikan dua pasien dengan bedah mayor gastrointestinal, satu pasien dengan pembedahan pembuluh darah besar, dan satu pasien dengan pembedahan besar daerah leher sampai mediastinum. Selama perawatan di ICU semua pasien diberikan terapi nutrisi dengan target energi 30 kkal/kg BB dan protein 1,2 ndash;2,0 g/kg BB per hari. Nutrisi diberikan secara optimal sesuai kondisi pasien untuk mendukung perbaikan klinis pasien. Terapi nutrisi secara optimal pada sakit kritis pascabedah dapat menurunkan katabolisme, memodulasi sistem imun, mencegah malnutrisi, serta menurunkan morbiditas dan mortalitasKesimpulan: Terapi nutrisi yang optimal pada pasien sakit kritis pascabedah dapat membantu perbaikan klinis

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ABSTRACTIntroduction Surgical patients with critical illness admittted to the ICU are fairly common and use more hospital resources. Critical illness can cause the patients become malnourished. Malnutrition in the ICU patients will increase the morbidity and mortality rates. Nutrition therapy in critically ill postoperative patients aims to reduce metabolic stress, modulate the immune response, and improve wound healingResults and Discussion Fulfilment of nutrition requirements in postoperative critically ill patients depends on the patient 39 s clinical condition. This serial case describes two patients with major gastrointestinal surgery, one patient with major blood vessel surgery, and one patient with large neck and mediastinum surgery. During treatment in the ICU all patients were given nutrition therapy with the target energy of 30 kcal kg and protein 1.2 ndash 2.0 g kg daily. Nutrition is given optimally adjusted to patients rsquo condition to support the patient clinical improvement. Optimal nutrition therapy in critically ill postsurgical patients can reduce catabolism, modulate the immune system, prevent malnutrition, and decrease morbidity and mortality rates.Conclusion Optimal nutrition therapy in critically ill postsurgical patients can support clinical improvement "

"ABSTRAKLatar Belakang: Stroke hemoragik merupakan penyakit serebrovaskular yang ditandai dengan pecahnya pembuluh darah sehingga terjadi perdarahan pada otak. Penyebab tersering stroke hemoragik adalah hipertensi. Selain itu penyebab lainnya seperti diabetes melitus dan obesitas dapat menjadi penyulit keadaan klinis pasien. Stroke hemoragik dan beberapa penyulit akan menyebabkan disfungsi neurologis dan disfungsi motorik, yang keduanya akan menyebabkan penurunan asupan nutrisi. Penurunan asupan nutrisi dapat disebabkan penurunan kapasitas fungsional dan gangguan proses menelan atau disfagia. Nutrisi yang tidak adekuat dapat menyebabkan kualitas hidup menurun serta risiko serangan stroke berulang. Terapi medik gizi klinis berperan memberi nutrisi optimal, membatasai natrium, mengontrol glukosa darah dan mengatasi defisiensi mikronutrien. Metode:Serial kasus ini terdiri dari empat kasus stroke hemoragik pada pasien perempuan dan laki-laki dengan rentang usia 50 ndash;65 tahun, dengan penyulit seperti disfagia, penurunan kesadaran, dan perdarahan GIT, disertai penyakit penyerta yaitu Hipertensi dan DM tipe 2. Kasus pertama dan kedua mengalami gejala disfagia dan membutuhkan dukungan nutrisi melalui jalur enteral. Kasus ketiga terdapat penurunan asupan makanan karena penurunan kapasitas fungsional yang terjadi. Kasus keempat mengalami penurunan kesadaran dan perdarahan saluran cerna serta membutuhkan dukungan nutrisi secara enteral dan parenteral. Keempat pasien memiliki indeks massa tubuh obes 1. Masalah nutrisi yang dihadapi keempat pasien ini adalah asupan makro dan mikronutrien yang tidak optimal, jalur pemberian nutrisi, kebutuhan nutrisi yang tidak terpenuhi selama sakit. Terapi medik gizi klinik diberikan sesuai rekomendasi stroke hemoragik ddengan hipertensi dan DM tipe 2. Hasil :Kasus pertama hingga kasus ketiga mengalami perbaikan keadaan klinis, antara lain peningkatan kemampuan menelan, perbaikan tekanan darah, kadar glukosa, dan kapasitas fungsional. Kasus keempat meninggal dunia pada hari perawatan ke-8 akibat edema paru dan gagal jantung. Kesimpulan: Terapi medik gizi klinik yang diberikan dapat membantu keadaan klinis dan kapasitas fungsional pada pasien stroke hemoragik dengan Hipertensi dan DM tipe 2.

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ABSTRACT<>br>Background Hemorrhagic stroke is a cerebrovascular disease characterized by rupture of blood vessels resulting in bleeding in the brain. The most common cause of hemorrhagic stroke is hypertension. In addition, other causes such as diabetes mellitus and obesity could worsening the patient's clinical situation. Hemorrhagic strokes and some complications will cause neurologic dysfunction and motoric dysfunction, both of which will lead to a decrease in nutrient intake. Decreased nutritional intake could caused due to decreased functional capacity and impaired ingestion or dysphagia. Inadequate nutrition can lead to decreased quality of life as well as the risk of recurrent stroke. Medical clinical nutrition therapy plays an optimal role in nutrition, restricting sodium, controlling blood glucose and overcoming micronutrient deficiencies. Methods This case series consists of four cases of hemorrhagic stroke in female and male patients with age range 50-65 years, with complications such as dysphagia, consciousness derivation, and gastrointestinal bleeding, accompanied by comorbidities susch as Hypertension and type 2 DM. The first and second cases have symptoms of dysphagia and require nutritional support through the enteral route. The third case there is a decrease in food intake due to decreased functional capacity that occurs. The fourth case has consciousness derivation and gastrointestinal bleeding that requires support of enteral and parenteral nutritions. All of patients had obesity 1 body mass index. Nutritional problems faced by these four patients were unoptimal macro and micronutrient intake, nutritional pathways, unfulfilled nutritional needs during illness. Medical clinical nutrition therapy is given as recommended by hemorrhagic stroke with hypertension and type 2 diabetes mellitus Result The first case to the third case has improved clinical conditions, including increased ability to swallow, improvement of blood pressure, glucose levels, and functional capacity. The fourth case died on the 8th day of treatment due to pulmonary edema and heart failure. Conclusion Clinical nutrition therapy provided could improved clinical and functional capacity in hemorrhagic stroke patients with hypertension and type 2 DM."

"ABSTRAKDiabetes melitus DM merupakan suatu epidemik global. Obesitas merupakan faktor risiko tersering pada terjadinya DM tipe 2. Salah satu komplikasi yang sering dialami oleh penderita DM ialah kaki diabetik. Pada pasien DM dengan obesitas dan kaki diabetik, terapi medik gizi penting untuk mencapai target berat badan, menjaga kadar glikemik, serta mencegah komplikasi DM. Selain itu pemberian nutrisi yang adekuat juga penting untuk mendukung penyembuhan luka. Pasien pada serial kasus ini berusia antara 41 ndash;59 tahun dengan dengan proporsi yang sama antara laki-laki dan perempuan. Keempat pasien memiliki status gizi obes dengan IMT sebesar 26-54,4 kg/m2. Awitan DM pada keempat pasien diketahui bervariasi antara 1-13 tahun. Terapi medik gizi diberikan sesuai dengan klinis, hasil laboratorium, dan asupan terakhir masing-masing pasien. Dari hasil pemantauan didapatkan bahwa dengan terapi nutrisi yang diberikan terjadi penurunan berat badan sebesar 3,2-4,8 kg 3,2-5,8 dan penurunan nilai HbA1c sebanyak 0,3-0,7. Selain itu juga didapatkan ukuran luka yang mengecil dan gejala neuropati berkurang. Pada pasien DM tipe 2 dengan obesitas dan kaki diabetik, terapi medik gizi yang adekuat berkaitan dengan penurunan berat badan, perbaikan kontrol glikemik, dan penyembuhan luka yang baik.

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ABSTRACT<>br>Diabetes mellitus is now a global epidemic. Obesity is a common risk factor in the occurrence of type 2 diabetes. One of the complications that are often experienced by people with diabetes is diabetic foot. In diabetic patients with obesity and diabetic foot, medical nutrition therapy is important to achieve targeted body weight, maintain glycemic levels, and prevent diabetes complications. Good nutrition is also essential for wound healing. This case series consists of four patients who are between 41-59 years old and obese with BMI of 26-54.4 kg/m2. The onset of DM in all four patients is known to vary between 1-13 years. Nutritional therapy is given in accordance with the clinical, laboratory outcomes, and patients' daily intake. It was found that medical nutrition therapy can lead to weight loss of 3.2-4.8 kg (3.2-5.8%) and decreased HbA1c by 0.3-0.7%. It was also observed that the wound size and neuropathy symptoms are reduced. Adequate medical nutrition therapy in type 2 DM patients with obesity and diabetic foot is associated with weight loss, improved glycemic control, and good wound healing."

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Minuman ringan berpemanis adalah minuman ringan yang diberi tambahan gula sederhana yang dapat menambah kandungan energi. Trigliserida merupakan salah satu bentuk simpanan lemak di dalam tubuh. Konsumsi minuman ringan berpemanis dapat meningkatkan kadar trigliserida melalui peningkatan lipogenesis de novo.  Lemak viseral adalah lemak yang terdapat pada rongga abdomen yang diketahui merupakan faktor risiko tinggi untuk penyakit metabolik di kemudian hari. Penelitian ini bertujuan untuk mengetahui korelasi antara frekuensi konsumsi minuman ringan berpemanis dengan kadar trigliserida dan visceral fat rating pada remaja putri. Penelitian ini menggunakan disain potong lintang dengan melibatkan 47 subjek yang direkrut melalui metode consecutive sampling. Frekuensi minuman ringan berpemanis diambil dengan metode FFQ. Sampel kadar trigliserida diambil dari darah tanpa puasa dan diukur menggunakan metode enzymatic colorimetric. Visceral fat rating diukur menggunakan BIA. Uji statistik menggunakan uji korelasi Pearson dan Spearman dengan SPSS. Subjek rata-rata mengonsumsi minuman ringan berpemanis sebanyak 8,91 + 4,71 kali/minggu. Nilai rata-rata kadar trigliserida subjek adalah 110,49 + 41,49 mg/dL. Nilai tengah visceral fat rating subjek adalah 3 (1 – 11) termasuk dalam kategori sehat. Pada penelitian ini didapatkan hasil korelasi positif bermakna dengan derajat sangat kuat (p = <0,001, r = 0,88) antara frekuensi konsumsi minuman ringan berpemanis dengan kadar trigliserida dan korelasi positif bermakna dengan derajat sedang (p = 0,003, r = 0,426) antara frekuensi konsumsi minuman ringan berpemanis dengan visceral fat rating.

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Sugar sweetened beverages are beverages that are given an addition of simple sugar so they can add energy content. Triglycerides are one form of fat deposits in the body. Consumption of sugar sweetened beverages can increase triglyceride levels through increasing de novo lipogenesis. Visceral fat, which is located in the abdominal cavity, is known to be a high risk factor for metabolic diseases in the future. This study aims to determine the correlation between consumption frequency of sugar sweetened beverages with triglyceride levels and visceral fat rating in female adolescence.  This study used a cross-sectional design involving 47 subjects recruited through a consecutive sampling method. The frequency of sugar sweetened beverages is taken by FFQ method. Triglyceride levels were taken from blood without fasting and measured using enzymatic colorimetric method. Visceral fat rating measured using BIA. Statistical test using Pearson and Spearman correlation test with SPSS. The average of subject that consumed sweetened soft drinks as much as 8.91 + 4,71 times / week. The average subject triglyceride levels 110,49 + 41,49 mg / dL. The median of the subject's visceral fat rating are 3 (1 - 11) is included in the healthy range. In this study a significant positive correlation was strongly found (p = <0.001, r = 0.88) between the consumption frequency of sweetened soft drinks and triglyceride levels and a positive correlation with moderate degrees (p = 0.003, r = 0.426) between consumption frequency of sugar sweetened beverages and visceral fat rating.

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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."