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Abstrak :
Latar Belakang: Pasien dengan keganasan gaster berisiko tinggi mengalami malnutrisi. Terapi kuratif utama pada pasien keganasan gaster adalah tindakan operasi, sehingga diperlukan dukungan terapi medik gizi perioperatif yang dapat menunjang perbaikan status gizi, kapasitas fungsional, dan kualitas hidup. Metode: Pasien pada serial kasus adalah dua laki-laki dan dua perempuan, berusia 34-64 tahun, dengan diagnosis tiga pasien dengan karsinoma gaster, dan satu pasien gastrointestinal stromal tumor gaster stadium lanjut. Terapi medik gizi praoperasi diberikan dalam bentuk oral dan parenteral. Pada enam jam sebelum tindakan operasi, dua pasien mendapatkan nutrisi parenteral, dan dua pasien mendapatkan nutrisi oral. Pasien pascaoperasi juga mendapatkan nutrisi enteral dini dalam 48 jam pertama. Hasil: Pasien pasca gastrektomi selama mendapatkan nutrisi perioperatif, tiga pasien mengalami proses penyembuhan luka yang baik, sedangkan satu pasien mengalami komplikasi pascaoperasi berupa fistula enterokutan yang kemudian mengalami pemulihan, dan satu pasien mengalami hiperglikemia dipengaruhi oleh tindakan pankreatektomi distal. Lama masa rawat inap pasien antara 21-31 hari. Semua pasien pascaoperasi mengalami peningkatan kapasitas fungsional. ......Background: Patients with gastric malignancy have high risk of malnutrition. The main curative therapy in patients with gastric malignancies is surgery, so it requires the support of perioperative nutritional therapy which could support the improvement of nutritional status, functional capacity, and quality of life. Methods: Patients in this case series were two men and two women, aged 34-64 years, and the diagnosis of three patients are advanced gastric carcinoma, and one patient with advanced gastric gastrointestinal stromal tumor. Preoperative nutritional therapy was given in oral and parenteral route. At six hours before surgery, two patients received parenteral nutrition, and two patients received oral nutrition. All patients also got early enteral nutrition in the first 48 hours after surgery. Results: Patients after gastrectomy during obtaining perioperative nutrition, three patients experienced a good wound healing process, while one patient experienced postoperative complications in the form of enterocutaneous fistula which later recovered, and one patient experienced hyperglycemia that affected by distal pancreatectomy. The length of stay for patients was between 21-31 days, after surgery all patients had increased functional capacity. Conclusion: Perioperative nutritional therapy in gastric malignancies patients undergoing gastrectomy could help improve the nutritional status and functional capacity.

Abstrak :
Latar Belakang: Laparotomi merupakan pembedahan mayor yang dapat menyebabkan penurunan massa otot rangka dan kapasitas fungsional, seperti kekuatan genggam tangan (KGT). Berbagai studi membuktikan penurunan KGT pascaoperasi menimbulkan komplikasi pascaoperasi, serta KGT berkorelasi erat dengan appendicular skeletal muscle index (ASMI). Pengaruh ASMI praoperasi terhadap KGT pascaoperasi belum banyak dilakukan penelitian, sehingga penelitian ini bertujuan menilai korelasi ASMI praoperasi dengan KGT pascaoperasi. Metode: Studi observasional prospektif dilakukan pada subjek berusia 18 – 65 tahun di RS pendidikan tersier, RSUPN Dr. Cipto Mangunkusumo, yang dirawat untuk laparotomi elektif pada Maret sampai Juni 2023. Pengukuran ASMI praoperasi menggunakan bioimpedance analysis (BIA) multifrequency seca® mBCA 525 dengan cutoff laki-laki > 7,0kg/mg2 dan perempuan >5,7 kg/m2. Pengukuran KGT pada tangan kanan dan kiri pascaoperasi pada hari ke-6 pascaoperasi (POD-6) dengan dinamometer tangan spring-type CAMRY® dengan cutoff laki-laki >28 kg/m2 dan perempuan >18 kg/m2. Analisis bivariat dan multivariat digunakan untuk menilai hubungan variabel bebas dan terikat, serta mengidentifikasi faktor perancu yang berhubungan dengan KGT pascaoperasi. Hasil: Pada 85 subjek penelitian, sebanyak 98,82% subjek memiliki ASMI praoperasi rendah, 72,94% subjek memiliki KGT pascaoperasi tangan kanan menurun, dan 80% subjek memiliki KGT pascaoperasi tangan kiri menurun dari cutoff. Didapatkan hasil signifikan pada korelasi ASMI praoperasi dengan KGT pascaoperasi tangan kanan (r=0,444, p<0,001) dan kiri (r=0,423, p<0,001). Analisis lanjutan dengan regresi linier untuk faktor perancu didapatkan indeks massa tubuh (IMT) adalah faktor paling signifikan meningkatkan KGT tangan kanan dan kiri pascaoperasi. Kesimpulan: Terdapat hubungan yang bermakna secara statistik pada korelasi ASMI praoperasi dengan KGT pascaoperasi laparotomi elektif. ......Background: Laparotomy is a major surgery that can lead to a decrease in skeletal muscle mass and functional capacity, such as handgrip strength (HGS). Various studies have shown that HGS is decreasing after surgery can result in postoperative complications, and HGS is closely correlated with the appendicular skeletal muscle index (ASMI). Research on the preoperative influence of ASMI on postoperative HGS is limited, so this study aims to assess the correlation between preoperative ASMI and postoperative HGS. Top of Form Methods: A prospective observational study was conducted on subjects aged 18-65 years at the tertiary education hospital, RSUPN Dr. Cipto Mangunkusumo, who underwent elective laparotomy from March to June 2023. Preoperative ASMI measurements were taken using multifrequency bioimpedance analysis (BIA) with seca® mBCA 525, with a cutoff for males > 7.0 kg/m2 and females > 5.7 kg/m2. Postoperative HGS measurements for the right and left hands on postoperative day 6 (POD-6) were conducted using a spring-type hand dynamometer CAMRY® with a cutoff for males > 28 kg/m2 and females > 18 kg/m2. Bivariate and multivariate analyses were employed to assess the association between independent and dependent variables, as well as to identify confounding factors associated with postoperative HGS. Results: In 85 research subjects, 98.82% had low preoperative ASMI, 72.94% experienced a decrease in postoperative right HGS, and 80% had a decrease in postoperative left HGS from the cutoff. Significant results were obtained in the correlation between preoperative ASMI and postoperative right HGS (r=0.444, p<0.001) and left HGS (r=0.423, p<0.001). Further analysis with linear regression for confounding factors revealed that body mass index (BMI) was the most significant factor in increasing postoperative HGS for both right and left hands. Conclusion: There is a statistically significant in the correlation between preoperative ASMI and postoperative HGS in elective laparotomy.

Abstrak :
Ileostomi merupakan tindakan pembedahan pembuatan lubang (stoma) antara ileum dan dinding abdomen, bertujuan untuk pengalihan feses. Ileostomi umumnya dibuat pada pasien yang menjalani penanganan kanker kolorektal, neoplasma stadium lanjut dengan infiltrasi usus halus, maupun peradangan saluran cerna. Ileostomi high output (produksi stoma ileum >1500 mL/hari) dapat menyebabkan gangguan keseimbangan cairan dan elektrolit, maupun malnutrisi pada pasien. Saat ini belum ada pedoman tata laksana nutrisi komprehensif untuk pasien ileostomi high output. Serial kasus ini bertujuan untuk mendukung terapi, mengatasi malnutrisi, menunjang perbaikan klinis, sehingga dapat menurunkan morbiditas dan mortalitas pasien ileostomi high output. Empat pasien ileostomi high output dengan rentang usia 42 hingga 50 tahun mendapatkan terapi medik gizi selama perawatan di rumah sakit. Tiga kasus merupakan kasus kronik dengan keganasan, sementara satu kasus lainnya merupakan kasus akut yaitu adhesi dan perforasi akibat hernia femoralis strangulata. Keempat kasus tersebut merupakan ileostomi high output onset awal, yaitu yang terjadi kurang dari tiga minggu pasca pembuatan stoma. Berdasarkan kriteria malnutrisi American Society for Parenteral and Enteral Nutrition (ASPEN), keempat pasien ini tergolong malnutrisi berat. Terapi medik gizi diberikan dengan prinsip pemberian makanan dan minuman porsi kecil namun sering, restriksi cairan hipotonik, pemberian minuman berupa larutan elektrolit-glukosa, pemberian medikasi anti motilitas, serta koreksi cairan dan elektrolit menurut kebutuhan dan kondisi klinis pasien. Target asupan energi dan protein pada keempat pasien dapat tercapai selama perawatan. Selama pemantauan, keempat pasien mengalami penurunan output ileostomi, serta perbaikan keseimbangan cairan dan elektrolit darah. Satu pasien mengalami perburukan klinis dan meninggal akibat sepsis pada hari perawatan ke-18. Tiga pasien pulang dengan kondisi klinis perbaikan. Satu pasien mengalami peningkatan output ileostomi saat perawatan di rumah, kemudian dirawat kembali sepuluh hari setelah pulang karena komplikasi anemia gravis dan ketidakseimbangan elektrolit, dan pada akhirnya meninggal. Terapi medik gizi dapat menurunkan produksi stoma, memperbaiki kadar elektrolit darah, serta memperbaiki keseimbangan cairan pada pasien ileostomi high output.

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Ileostomy is a surgical procedure to divert the ileum onto an artificial opening in the abdominal wall, aimed for fecal diversion. Ileostomy is commonly created in patients undergoing treatment for colorectal cancer, advanced neoplasms with intestinal infiltration, or gastrointestinal inflammation. High output ileostomy (stoma output >1500 mL per day) can cause imbalance of fluid and electrolytes, and malnutrition in patients. At present, there is no comprehensive nutrition management guideline for high output ileostomy patients. This case series aimed to support therapy, prevent malnutrition, improve clinical condition, as well as to reduce the morbidity and mortality of high output ileostomy patients. Four high output ileostomy patients, with a range of age 42 to 50 years old received medical nutrition therapy during their hospital stay. Three cases were chronic cases in malignancy, while the other case was an acute case of adhesion and perforation due to strangulated femoral hernia. All four cases were early onset high output ileostomy, occurring in three weeks after stoma creation. Based on the American Society for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, these four patients were classified as severe malnutrition. Medical nutrition therapy was administered according to a set of principles: small frequent feeding and drinking, hypotonic fluid restriction, oral electrolyte-glucose solution administration, antimotility medication administration, as well as fluid and serum electrolyte correction, according to patients' needs and clinical conditions. The target of energy and protein intake in all patients were achieved during hospital stay. During hospital monitoring, decreased ileostomy output as well as improvement in fluid and electrolyte balance were observed in all patients. One patient clinically worsened and died due to sepsis on the 18th day of hospital stay. Three patients showed improvement in clinical condition and were discharged. One patient experienced an increase in ileostomy output at home, and then readmitted ten days after hospital discharge due to severe anemia and electrolyte imbalance and subsequently died. Medical nutrition therapy may decrease output as well as improve fluid and electrolyte balance in patients with high output ileostomy.

Abstrak :
Cedera kepala merupakan penyebab utama kematian dan kecacatan pada populasi dunia berusia di bawah 45 tahun. Cedera kepala sedang (CKS) dan berat (CKB) biasanya memerlukan perawatan intensif dan pendekatan medis-bedah. Pasien dengan cedera kepala mengalami peningkatan laju metabolisme sehingga memerlukan tatalaksana medik gizi yang sesuai. Pemenuhan kebutuhan energi yang tidak adekuat dapat menyebabkan peningkatan angka morbiditas, risiko infeksi, dan komplikasi lainnya. Pemberian nutrisi enteral dini dalam kurun 24-48 jam setelah masuk Intensive Care Unit (ICU) dapat memperbaiki luaran klinis pasca cedera. Serial kasus ini bertujuan untuk melaporkan peran tatalaksana medik gizi pada status gizi, lama pemakaian ventilator, tingkat kesadaran dan kapasitas fungsional pada pasien kritis dengan CKS dan CKB. Empat pasien laki-laki dengan rentang usia 25-46 tahun diobservasi selama perawatan di ICU RS Cipto Mangunkusumo, dua pasien dengan diagnosis CKS dan sisanya dengan diagnosis CKB. Status gizi berdasarkan indeks massa tubuh, dua pasien memiliki berat badan (BB) normal, satu pasien BB lebih dan satu pasien obesitas II. Tingkat kesadaran berdasarkan skor Glascow Coma Scale (GCS) pasien pada saat masuk ICU adalah 6-11. Selama perawatan keempat pasien mendapat nutrisi enteral dini dan pemberian nutrisi ditingkatkan bertahap. Pada seluruh pasien, kebutuhan energi dapat dipenuhi sesuai target 25-30 kkal/kg BB. Kebutuhan makronutrien dapat dipenuhi sesuai target, yaitu protein 1,2-2 g/kg BB, lemak 20-30%, dan karbohidrat minimal 100 g/hari. Pada dua pasien dengan CKB, diberikan nutrien spesifik berupa glutamin sebesar 0,2 g/kgBB/hari dan mikronutrien berupa vitamin C, vitamin B kompleks, asam folat, dan seng. Hingga akhir pemantauan status gizi pada dua pasien CKS dapat dipertahankan, sedangkan dua pasien dengan CKB mengalami penurunan berat badan. Dua pasien CKS hanya menggunakan ventilator selama 4-5 hari, sedangkan dua pasien dengan CKB menggunakan ventilator lebih lama yaitu 12 dan 31 hari dengan disertai komorbiditas pneumotoraks dan ventilator-associated pneumonia. Tingkat kesadaran seluruh pasien mengalami perbaikan. Skor GCS pasien pada akhir perawatan di ICU adalah 7-15. Kapasitas fungsional berdasarkan Indeks Barthel juga mengalami perbaikan pada tiga pasien, yaitu dari ketergantungan total menjadi ketergantungan sedang atau berat. Dapat disimpulkan bahwa tatalaksana medik gizi dapat berperan dalam mempertahankan status gizi, menurunkan lamanya pemakaian ventilator, memperbaiki tingkat kesadaran dan kapasitas fungsional pada pasien sakit kritis dengan CKB dan CKS. Tingkat keparahan cedera kepala dan komorbiditas dapat memengaruhi luaran klinis dan harus dipertimbangkan dalam memberi tatalaksana medik gizi. ...... Traumatic brain injury (TBI) is a leading cause of death and disability in the global population under 45 years old. Moderate and severe TBI usually require intensive care and a medical-surgical approach. Patients with TBI experience an increase in metabolic rate and therefore require appropriate medical nutrition therapy. Inadequate energy intake can cause an increase in morbidity, risk of infection, and other complications. Early enteral nutrition within 24-48 hours after ICU admission has been shown to improve clinical outcome. This case series aims to report the role of medical nutrition therapy on nutritional status and clinical outcomes of critically ill patients with moderate and severe TBI. Four male patients aged 25-46 years were observed during their stay at the ICU of Cipto Mangunkusumo Hospital. Based on body mass index, two patients were normoweight, one patient was overweight and one patient was class II obese. The Glascow Coma Scale (GCS) scores of the patients on ICU admission were ranged 6-11. Two of the four patients were classified as moderate TBI and the other two patients were as classified as severe TBI. On monitoring four patients received early enteral nutrition and the nutrition was gradually increased to reach the target of 25-30 kcal/kg body weight (BW). Enteral formula were targeted to achieve protein intake of 1.2-2 g/kgBW, fat intake of 20-30% of energy intake, and carbohydrate intake of at least 100 g/day. Two patients with severe TBI were given specific nutrients in the form of glutamine as much as 0.2 g/kgBW/day and micronutrients in the form of vitamin C, vitamin B complex, folic acid, and zinc. Two patients with moderate TBI received mechanical ventilation for 4 and 5 days, while two patients with severe TBI received mechanical ventilation for 12 and 31 days. In two patients with severe TBI, prolonged use of mechanical ventilation may be associated with the comorbidities of pneumothorax and ventilator-associated pneumonia. At the end of monitoring, the levels of consciousness were improved in all patients. The patients GCS score at the end of treatment in the ICU were ranged 7-15. Functional capacity based on the Barthel Index also improved in three patients, from total dependence to moderate or severe dependence. Weight loss was experienced in two patients with severe TBI, possibly due to severe and prolonged catabolism in severe TBI. Patients with severe TBI may have higher energy requirements to maintain their nutritional status. It can be concluded that medical nutrition therapy may play a role in improving the level of consciousness and functional capacity in critically ill patients with moderate and severe traumatic brain injury.

Abstrak :
Latar Belakang: Obesitas merupakan kondisi inflamasi kronik yang dapat mengakibatkan penurunan massa otot dan kekuatan genggam tangan. Salah satu nutrisi yang berperan untuk meningkatkan sintesis protein dan menurunkan degradasi protein, yaitu eicosapentaenoic acid (EPA). Penelitian ini bertujuan untuk melihat korelasi antara asupan EPA dengan massa otot dan kekuatan genggam tangan pada karyawan kantoran dengan obesitas. Metode: Penelitian potong lintang ini dilakukan pada subjek karyawan kantoran dengan obesitas. Asupan EPA dinilai dengan food frequency questionnaire semi kuantitatif. Massa otot diukur dengan menggunakan multifrequency bioelectrical impedance analysis. Sedangkan, kekuatan genggam tangan diukur menggunakan electric dynamometer. Hasil: Penelitian ini mencakup 41 subjek penelitian yang memiliki median usia 35 (21-56) tahun dengan jumlah subjek perempuan lebih banyak dibandingkan dengan subjek laki-laki. Subjek penelitian dengan obesitas derajat 1 sebanyak 16 orang (39%) dan obesitas derajat 2 sebanyak 25 orang (61%). Subjek memiliki rerata asupan EPA sebesar 152,3±64,64 mg. Subjek penelitian memiliki median massa otot sebesar 19,8 (15,3-46,5) kg dan median kekuatan genggam tangan sebesar 24,5 (17,8-42,9) kg. Penelitian ini mendapatkan nilai koefisien korelasi cukup dan signifikan antara asupan EPA dengan massa otot (r=0,335, p=0,032). Sedangkan, tidak didapatkan korelasi yang bermakna antara asupan EPA dengan kekuatan genggam tangan. Kesimpulan: Terdapat korelasi bermakna antara asupan EPA dengan massa otot pada karyawan kantoran dengan obesitas. Namun, tidak didapatkan korelasi antara asupan EPA dengan kekuatan genggam tangan. ......Background: Obesity is a chronic inflammatory condition that can lead to decrease muscle mass and handgrip strength. One of the nutrients that plays role in increasing protein synthesis and reducing protein degradation is eicosapentaenoic acid (EPA). This study aims to investigate the correlation between EPA intake with muscle mass and handgrip strength in office workers with obesity. method: This cross-sectional study was conducted on the subject of office workers with obesity. EPA intake was assessed with semi-quantitative food frequency questionnaire. Muscle mass was measured using a multifrequency bioelectrical impedance analysis. Meanwhile, handgrip strength was measured using a electric dynamometer Results: This study included fourty one subjects with a median age of 35 (21-56) years old, mostly were female subjects. There were 16 people with obesity grade 1 (39%) and 25 people with obesity grade 2 (61%). Average EPA intake was 152,3±64,64 mg. The subjects had a median muscle mass of 19,8 (15,3-46,5) kg and median handgrip strength of 24,5 (17,8-42,9) kg. There was adequate correlation between EPA intake and muscle mass (r=0,335, p=0,032). There was no significant correlation between EPA intake and handgrip strength Conclusion: There was a significant correlation between EPA intake muscle mass in office workers with obesity. However, there was no correlation between EPA intake and handgrip strength.