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"Latar Belakang: Kontak tubuh manusia dengan arus listrik dapat mengakibatkan trauma luka bakar. Pada Pasien luka bakar listrik, derajat keparahan trauma yang dialami pada organ dalam tidak sebanding dengan luka bakar di permukaan tubuh, sehingga dapat dikategorikan sebagai luka bakar berat. Terapi nutrisi merupakan bagian integral dalam tata laksana luka bakar sejak awal resusitasi hingga fase rehabilitasi. Saat ini sudah terdapat rekomendasi untuk tata laksana nutrisi luka bakar berat. Namun, belum terdapat rekomendasi yang spesifik mengenai tata laksana pada luka bakar listrik.Metode: Laporan serial kasus ini menjelaskan empat pasien kasus luka bakar listrik. Pasien mengalami berbagai penyulit yang kemudian mempengaruhi tata laksana nutrisi yang diberikan. Pasien pertama dengan trauma servikal, pasien kedua mengalami AKI dan penurunan fungsi hati, pasien ketiga mengalami syok sepsis, dan pasien keempat mengalami sepsis dan amputasi. Pemberian nutrisi dimulai sesuai dengan kondisi pasien. Target pemberian energi dihitung dengan menggunakan persamaan Harris-Benedict untuk kebutuhan basal, ditambah faktor stres 1,5-2. Protein diberikan 1,5-2 g/kg BB/hari hingga terjadi perbaikan. Karbohidrat dan lemak berturut-turut 60-65% dan <35%. Pemberian nutrisi diutamakan melalui oral dan enteral, sedangkan jalur parenteral hanya digunakan bila diperlukan untuk pemenuhan energi. Mikronutrien yang diberikan berupa multivitamin antioksidan, vitamin B kompleks dan asam folat.Hasil: Tiga pasien mengalami perbaikan klinis, kapasitas fungsional, dan laboratorium hingga diperbolehkan rawat jalan. Lama perawatan ketiga pasien tersebut berturut-turut 17 hari, 60 hari, dan 20 hari. Satu orang pasien meninggal akibat penyulit yang dialaminya yaitu syok sepsis yang menyebabkan gagal multi organ setelah dirawat selama 14 hari.Kesimpulan: Tatalaksana nutrisi yang optimal dan tepat sesuai dengan kondisi klinis pasien dapat menurunkan morbiditas dan mortalitas pasien dengan luka bakar listrik.

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Background: Contact to electricity can inflict burn injuries in human. In electrical burn injuries, the damages of the internal organs are not comparable to the burn injuries in the body's surface. Nutrition therapy is an integral part in burn management from the beginning of resuscitation to rehabilitation phase. Currently there have been several recommendations of nutrition management in severe burn injury. However there is still no recommendation that specifically recommend for nutrition management in patients with electrical burn injury.

Methods: The serial case report describes four patients with electrical burn injury. All patients had various complications that affected the nutrition management. First patient with cervical trauma, second patient had AKI and decreased liver function, third patient had septic shock, and fourth patient had sepsis and amputation. Nutrition was given individualy according to the patient clinical condition. Target of energy given calculated by Harris-Benedict equation for basal requirement with added stress factor 1,5-2. Protein was given 1,5-2 g/kg BW/day except patient with AKI protein restricted to 0,8-1 g/kg BW/day until improvement of renal function. Carbohydrates and lipids were given 60-65% and <35%, respectively. Oral or enteral nutrition was preferred while parenteral nutrition only given if required to meet the energy requirements. Micronutrients supplementation such as antioxidant vitamins, vitamin B complex, and folic acid were provided to patients.

Results: Three patients had the improvement in clinical condition, functional capacity, and laboratory results that allowed them to be discharged and had outpatient treatment. Length of stay of the patients were 17, 60, 20 days respectively. One patient died due to septic shock compilation that lead to multiple organ failure after 14 days of hospitalization.

Conclusion: Optimal and appropriate nutrition management adjusted to patient's clinical condition can reduced morbidity and mortality rate in the electrical burn injury patients."

"Aging is closely associated with physical disability that mostly causes by the onset of degenerative diseases. Due to the increasing mean age in most of the societies, the relationship between nutrition and aging is growing interest. The study aims to investigate the association of diet and biological age. A cross sectional study was conducted amongst male elderly (60 years and over) living in Jakarta. Eighty-four subjects were selected randomly. Biological age was determined by measuring skin wrinkling using skin microtopograph and serum dehydroepiandrosterone sulfate (DHEAS). Data collection was done using interviewer-administrated structured questionnaire and semi quantitatvive food frequency questionnaire (FFQ). After adjustment for age, elderly with high sosioeconomic status had higher energy, protein, meat, fish, and egg intakes. Low sosioeconomic class ad more extensive hand skin wrinkling and although not significant, arm sites. Serum DHEAS level was similar, respectively for high and low socioeconomic class. Serum DHEAS was positively correlated with the vitamin c intake and negatively correlated with cereal consumption. Skin wrinkling was positively collerated with cereal consumption. Since the design of this study was cross sectional, further studies are recommended to elaborate the protective effect of vitamin C and damaging effect of high cereal consumption on biological age as indicated by serum DHEAS levels and skin wrinkling."

"ABSTRAKLatar Belakang: Prevalensi penyakit ginjal kronik (PGK) meningkat pada usia lanjut. Berdasarkan Riskesdas 2013, prevalensi PGK lebih tinggi pada usia 55-75 tahun dibandingkan usia kurang dari 55 tahun. Pada usia lanjut terjadi perubahan struktur dan fungsi ginjal, serta adanya riwayat penyakit komorbid seperti diabetesmelitus (DM), hipertensi, penyakit jantung dan pembesaran prostat, menjadi faktor risiko yang meningkatkan terjadinya PGK. Komplikasi yang dapat timbul pada penderita PGK antara lain frailty dan protein energy wasting, yang menyebabkan penurunan kapasitas fungsional dan kualitas hidup, serta peningkatan morbiditas dan mortalitas. Terapi nutrisi yang adekuat berperan penting untuk mencegah protein energy wasting dan komplikasi lain yang dapat timbul pada PGK.Metode: Laporan serial kasus ini memaparkan empat kasus PGK pada pasien usia di atas 60 tahun. Dua pasien memiliki penyakit komorbid DM dan hipertensi, dandua lainnya hanya hipertensi. Keempat pasien dalam serial kasus ini termasuk PGK derajat IV dan V. Pada dua kasus dilakukan hemodialisis, sementara pada dua lainnya belum dilakukan. Masalah yang timbul pada keempat kasus adalahterdapat gejala-gejala sindroma uremia yaitu mual, muntah, anoreksia, lemas, sesak, dan anemia sehingga asupan makanan tidak adekuat dan terjadi penurunankapasitas fungsional. Kebutuhan energi pasien dihitung dengan menggunakan persamaan Harris-Benedict ditambah faktor stres dan pemberian protein disesuaikan dengan sudah atau belum dilakukan hemodialisis. Komposisikarbohidrat dan lemak disesuaikan dengan rekomendasi theurapeutic lifestyle changes (TLC) dan American Diabetes Association (ADA). Suplementasi mikronutrien diberikan sesuai dengan kondisi pasien. Pemantauan pasiendilakukan setiap hari dengan memperhatikan perubahan gejala klinis, tanda vital, imbang cairan, kapasitas fungsional, analisis dan toleransi terhadap makanan,serta hasil pemeriksaan laboratorium.Hasil: Pemantauan yang dilakukan pada empat pasien selama perawatan di rumah sakit menunjukkan terjadi perbaikan gejala klinis serta peningkatan asupan makanan dan kapasitas fungsional.Kesimpulan: Terapi nutrisi dapat mendukung terapi utama pada penderita PGK usia lanjut dalam memperbaiki keadaan klinis dan kapasitas fungsional, serta mencegah komplikasi lebih lanjut

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ABSTRACT

Background: The prevalence of chronic kidney disease (CKD) increases in the elderly. Based on Riskesdas 2013, the prevalence of CKD is higher in the age of 55-75 years old compared to below 55 years of age. In the elderly, there are alterations in kidney structure and function, as well as history of comorbidities include diabetes mellitus, hypertension, heart disease and prostate hypertrophy that increase the factor CKD. Complication that may occur in patients with CKD including frailty and protein energy wasting, which can cause decreased

functional capacity and quality of life, and increased morbidity and mortality. Adequate nutrition therapy plays an important role in preventing protein energy wasting and other complications that may arise in CKD.

Methods: This case series report describes four cases of CKD in patients aged above 60 years old. Two patients have comorbid disease diabetes mellitus and hypertension and the others have only hypertension. The four patients in this case series are in CKD stage IV and V. Two cases with hemodialysis, while in the others has not done yet. Problems arising in all cases are uremic syndrome

symptoms such as nausea, vomiting, anorexia,fatigue, dypsnea, and anemia causing inadequate food intake and decreased functional capacity. Energy requirements of the patients calculated using the Harris-Benedict equation added by stress factor and the amount of protein depends on whether the hemodialysis has or has not been applied. Carbohydrate and fat composition appropriated to the

theurapeutic lifestyle changes (TLC) and the American Diabetes Association (ADA) recommendations. Micronutrients supplementation was given in

accordance to patient's condition. Patient monitoring is carried out every day by observing changes in clinical symptoms, vital signs, fluid balance, functional

capacity, dietary analysis and food tolerance, and laboratory resultsResults: Monitoring conducted in the four patients during treatment at the hospital showed the improvements in clinical symptoms, and increased in food

intake and functional capacity."

"Latar Belakang: Penyakit keganasan urogenital merupakan spektrum penyakit yang luas, dengan penatalaksanaan mulai dari observasi dan pemantauan ketat hingga pembedahan ekstirpatif mayor. Risiko malnutrisi praoperatif akibat kanker dan pascaoperatif akibat stres pembedahan akan meningkatkan risiko morbiditas dan mortalitas. Terapi nutrisi perioperatif yang adekuat bertujuan untuk menunjang perbaikan klinis dan status nutrisi, mendukung proses pemulihan, menurunkan risiko komplikasi pascaoperasi, serta menurunkan lama rawat di rumah sakit. Metode: Laporan serial kasus ini menyajikan empat kasus kanker urogenital, terdiri dari dua kasus kanker buli, satu kasus kanker ginjal, dan satu kasus kanker penis. Tiga kasus termasuk kaheksia kanker, dan satu kasus termasuk pra-kaheksia. Seluruh pasien menjalani pembedahan urologi mayor dengan anestesi umum dan epidural. Terapi nutrisi perioperatif yang diberikan antara lain carbohydrate loading, nutrisi enteral dini pascaoperasi, serta pemberian nutrisi secara bertahap berdasarkan kondisi klinis. Dilakukan pemantauan yang meliputi keluhan klinis, antropometri, pemeriksaan fisik, hasil laboratorium, dan analisis asupan. Hasil: Dua pasien mengalami ileus paralitik pascaoperasi dengan satu pasien di antaranya membutuhkan nutrisi parenteral total, dan dapat teratasi dalam 7 hari pascaoperasi. Satu pasien mengalami hiperglikemia reaktif dan diberikan terapi insulin, dapat teratasi dalam 7 hari pascaoperasi. Satu pasien mengalami perlambatan penyembuhan luka dan memiliki masa rawat pascaoperasi paling lama. Pasien yang mengalami ileus paralitik membutuhkan waktu lebih lama untuk mencapai target kalori 80 , namun seluruh pasien telah dapat mencapai target tersebut dalam 7 hari pascaoperasi. Lama perawatan pascaoperasi bervariasi, sekitar 10-27 hari. Kesimpulan: Terapi nutrisi perioperatif yang diberikan pada keempat pasien menunjang perbaikan klinis dan status nutrisi, mendukung proses pemulihan, menurunkan risiko komplikasi pascaoperasi, serta menurunkan lama rawat di rumah sakit.

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Background: Genitourinary malignancy represents a broad spectrum of disease, with treatments ranging from watchful waiting to major extirpative surgery. The risk of preoperative malnutrition due to cancer and postoperatively due to surgical stress will increase the risk of morbidity and mortality. An adequate perioperative nutrition therapy aims to support clinical and nutritional status improvement, hasten the recovery process, reduce the risk of postoperative complications, and decrease the length of hospital stay.

Method This case series report presents four cases of genitourinary cancers, consist of two cases of bladder cancer, one case of kidney cancer, and one case of penile cancer. Three cases are classified into cancer cachexia, and one case of pre cachexia. All patients had undergone major urological surgery under general and epidural anesthesia. Perioperative nutrition therapy provides carbohydrate loading, postoperative early enteral nutrition, as well as gradual nutrition based on clinical conditions. The monitoring given included clinical complaints, anthropometric measurement, physical examination, laboratory test results, and intake analysis.

Result Two patients had postoperative paralytic ileus with one patient requires total parenteral nutrition, and resolved within 7 days after surgery. One patient had reactive hyperglycemia and treated with insulin therapy, resolved in 7 days postoperative. One patient experienced impaired wound healing and had the longest postoperative care period. Patients with paralytic ileus may take more days to achieve 80 calorie target, yet all patients have been able to achieve the target in 7 days postoperative. The length of hospital stay after surgery was varied between 10 to 27 days.

Conclusion Perioperative nutrition therapy given to four patients in this case series leads to the clinical and nutritional status improvement, supports the recovery process, decreases the risk of postoperative complications, and shortens the hospital stays."

"Latar Belakang: Gagal jantung kongestif merupakan penyakit tahap akhir yang disebabkan oleh multifaktor. Pada gagal jantung kongestif terjadi perubahan metabolisme dan perubahan neurohormonal, yang dapat menyebabkan asupan tidak adekuat. Selain itu, akibat obat-obatan yang sering digunakan, terjadi gangguan elektrolit. Terapi nutrisi sejak dini, dapat mendukung proses penyembuhan pasien dan mencegah terjadinya malnutrisi. Kasus: Dalam serial kasus ini terdapat empat kasus pasien gagal jantung kongestif dengan berbagai faktor risiko, diantaranya obesitas, diabetes melitus, hipertensi, dan acute on chronic kidney disease. Pada awal pemeriksaan didapatkan asupan pasien yang kurang dari kebutuhan, kadar glukosa darah yang tidak terkontrol, gangguan elektrolit dan penurunan kapasitas fungsional. Terapi nutrisi diberikan sesuai dengan klinis, hasil laboratorium, dan asupan terakhir masing-masing pasien. Hasil: Tiga pasien mencapai kebutuhan energi total dan satu pasien mencapai 85 kebutuhan energi total, kadar glukosa darah terkontrol, terdapat perbaikan kapasitas fungsional pada semua pasien. Kesimpulan: Terapi nutrisi yang adekuat dan sesuai dengan kondisi pasien gagal jantung dapat mendukung perbaikan klinis pasien, perbaikan kadar glukosa darah, perbaikan kapasitas fungsional, sehingga dapat mempercepat lama rawat di rumah sakit dan mencegah terjadinya malnutrisi.

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Background: Congestive heart failure is an end stage disease caused by a multifactor. In congestive heart failure changes in metabolism and neurohormonal changes, which can cause inadequate intake. In addition, due to frequently used drugs, electrolyte disorders occur. Early nutrition therapy, can support the process of healing the patient and prevent the occurrence of malnutrition.

Case: In this case series there are four cases of patients with congestive heart failure with various risk factors, including obesity, diabetes mellitus, hypertension, and acute on chronic kidney disease. At the beginning of the examination was obtained less patient intake of the need, uncontrolled blood glucose levels, electrolyte disorders and decreased functional capacity. Nutritional therapy is given in accordance with clinical, laboratory outcomes, and the patient's final intake.

Result: Three patients achieved total energy requirements and one patient achieved 85 of total energy requirements, controlled blood glucose levels, and improved functional capacity in all patients.

Conclusion: Adequate nutritional therapy appropriate to the condition of patients with heart failure can support patient clinical improvement, improvement of blood glucose levels, functional capacity improvement, so as to accelerate hospital stay and prevent malnutrition."

"ABSTRAKAngka kejadian karsinoma kolorektal cukup tinggi mencapai 1,3 juta kasus dengan angka kematian sebesar 694.000 per tahun. Sekitar 30 hingga 87 pasien kanker mengalami malnutrisi sebelum menjalani terapi kanker. Terapi medik gizi bertujuan untuk mencegah atau memperbaiki keadaan malnutrisi, mencegah kehilangan massa otot, mengurangi efek samping terapi kanker, meningkatkan kualitas hidup, dan mempercepat penyembuhan luka. Pasien serial kasus ini berjumlah empat orang, berusia 33 hingga 60 tahun. Tiga orang pasien memiliki diagnosis adenokarsinoma rektum dan satu orang didiagnosis dengan adenokarsinoma kolon asendens dengan stoma double barrel setinggi ileum terminal dan kolon desenden. Keempat pasien memiliki status gizi kaheksia kanker. Pemantuan dilakukan setiap hari meliputi penilaian subjektif dan objektif meliputi tanda vital, kondisi klinis, antropometri, kapasitas fungsional, analisis asupan dan laboratorium. Pada saat dipulangkan, kondisi klinis keempat pasien mengalami perbaikan yang dilihat dari produksi stoma yang semakin padat dan toleransi asupan oral baik. Keempat pasien juga mengalami perbaikan kapasitas fungsional. Pemberian kebutuhan energi pada kasus ini rata-rata sebesar 30-39 kkal/kg/hari. Pemberian nutrisi memperhatikan jenis stoma, bagian usus yang vital, kondisi klinis, dan parameter biokimia. Pemberian terapi medik gizi yang adekuat dapat mendukung proses penyembuhan luka pasca tindakan pembedahan dan kapasitas fungsional.

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ABSTRACT<>br>The incidence of colorectal carcinoma is quite high, estimated at 1.3 million cases with 694,000 deaths per year. About 30 to 87 of cancer patients are malnourished before undergoing cancer therapy. Medical nutrition therapy aims to prevent or improve the state of malnutrition, prevent muscle mass loss, reduce the side effects of cancer therapy, improve quality of life, and accelerate wound healing. Patients in this case series involve four subject, aged 33 to 60 years. Three patients had a diagnosis of rectal adenocarcinoma and one person was diagnosed with ascending colon adenocarcinoma with double barrel stoma as high as the terminal ileum and descending colon. All patients had nutritional status of cancer cahexia. Daily monitoring includes subjective and objective assessments including vital signs, clinical conditions, anthropometry, functional capacity, intake analysis, and laboratory analysis. At the time of discharge, the clinical condition of all four patients got improvement from solid stoma production and tolerance of oral intake. The four patients also experienced improved functional capacity. In providing nutrition therapy, we should consider to the type of stoma, vital part of the intestine, clinical conditions, and biochemical parameters. Adequate medical nutrition therapy can support post surgical wound healing and functional capacity."

"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."

"Pasien kanker kepala-leher berisiko tinggi mengalami malnutrisi disebabkan oleh perubahan metabolisme, lokasi tumor, serta gejala toksisitas akut akibat kemoradiasi. Terapi medik gizi secara dini sejak pasien terdiagnosis kanker untuk mencapai asupan energi dan protein yang adekuat, didukung asupan branched-chain amino acid (BCAA) dan eicosapentaenoic acid (EPA) sesuai target, serta aktivitas fisik dapat menjaga massa otot dan status gizi pasien. Acute kidney injury (AKI) merupakan efek toksisitas obat kemoterapi berbasis platinum yang sering dialami pasien. Kondisi tersebut dapat menghambat optimalisasi pemberian nutrisi khususnya protein pada pasien kanker. Tiga dari empat pasien serial kasus sudah mengalami penurunan berat badan drastis, juga pre-kaheksia atau kaheksia sebelum mendapat terapi medik gizi. Selama menjalani kemoradiasi, asupan keempat pasien mengalami penurunan akibat gejala toksisitas akut yang semakin memberat mulai minggu ke-2 radiasi, sehingga tiga dari empat pasien tidak dapat mencapai target asupan energi dan protein pada sebagian besar pemantauan, dengan kisaran antara 6–41 kkal/kgBB/hari dan 0,3–1,6 g/kgBB/hari. Pemberian oral nutrition supplements (ONS) dan nutrisi enteral melalui nasogastric tube (NGT) membantu pemenuhan makronutrien, mikronutrien, serta nutrien spesifik. Berbagai studi menyatakan bahwa pasien yang mendapat terapi medik gizi disertai konseling nutrisi rutin mengalami penurunan berat badan lebih sedikit selama menjalani kemoradiasi. Keempat pasien serial kasus ini mengalami penurunan berat badan >10% selama menjalani kemoradiasi, terutama dari penurunan massa otot. Pasien juga mengalami penurunan kapasitas fungsional dan kualitas hidup. Dua orang pasien yang mendapat terapi medik gizi sejak sebelum kemoradiasi disertai asupan nutrien spesifik sesuai target, dengan rentang asupan BCAA 3,5–16,2 g/hari dan EPA 1–1,38 g/hari, mengalami penurunan berat badan dan kualitas hidup relatif lebih sedikit dibanding dua pasien lainnya. Dibutuhkan asupan energi ≥30 kkal/hari dan asupan protein ≥1,2 g/hari disertai peningkatan aktivitas fisik untuk mempertahankan atau meningkatkan massa otot. Penurunan asupan masih dapat terjadi hingga beberapa minggu pascakemoradiasi, sehingga pemberian terapi medik gizi juga harus dilanjutkan setelah terapi kanker selesai.

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Patients with head and neck cancer are at risk of malnutrition as a result of the metabolic alteration, site of their cancer, also acute toxicity following chemoradiation therapy. Early nutrition intervention consisted of adequate energy, protein, BCAA, and EPA intake, including physical activity initiated immediately after diagnosis was made, may maintain skeletal muscle mass and nutritional status. Platinum-based chemotherapy drug-induced nephrotoxicity can hinder the optimization of protein intake in cancer patients. Three out of four patients in this case series had experienced severe weight loss, also pre-cachexia and cachexia before initiation of nutrition intervention. Energy and protein intake of three patients remained insufficient until the end of chemoradiation therapy, ranged from 6–41 kcal/kg/day and 0,3–1,6 g/kg/day. These inadequacies were mainly caused by acute radiation toxicities that worsen as radiation went on. Oral nutrition supplements and enteral tube feeding may help to achieve adequate macronutrient, micronutrient, and specific nutrient intake. A number of studies demonstrated that regular dietary counseling during chemoradiation was associated with less weight loss. All patients in this case series suffered from weight loss >10%, mainly from skeletal muscle loss. Functional status and quality of life during chemoradiation therapy were also reduced. Better quality of life and less weight loss were seen in two patients who received early nutrition intervention and reached the daily intake target of specific nutrient, ranged from 3,5–16,2 g/day for BCAA and 1–1,38 g/day for EPA. Energy intake ≥30 kcal/day and protein intake ≥1,2 g/day combined with increased physical activity are needed to maintain or increase muscle mass. Side effects of radiation can last for months after treatment; therefore, nutrition intervention should be continued to maintain good nutrition after radiation therapy."

"ABSTRAK

Gagal jantung kongestif merupakan penyakit kronis dengan tingkat morbiditas dan mortalitas yang tinggi. Perubahan metabolisme dan aktivasi sistem neurohormonal turut berperan terhadap terjadinya malnutrisi, yang dapat memperburuk prognosis pasien dengan gagal jantung kongestif. Dalam serial kasus ini, dipaparkan empat kasus pasien gagal jantung kongestif dengan berbagai faktor risiko, diantaranya adalah penyakit jantung koroner, diabetes melitus, hipertensi, dan obesitas. Pada awal pemeriksaan didapatkan adanya defisiensi asupan makro- dan mikronutrien, hiperglikemia, tekanan darah di atas normal, retensi cairan, penurunan kapasitas fungsional dan kualitas hidup. Terapi medik gizi diberikan secara individual, sesuai dengan kondisi klinis, hasil pemeriksaan laboratorium, dan analisis asupan terakhir. Seluruh pasien mengalami peningkatan asupan, perbaikan kondisi klinis, dan kapasitas fungsional. Status nutrisi pasien tidak mengalami perburukan selama perawatan, sedangkan perbaikan kualitas hidup didapatkan pada satu dari empat pasien. Terapi medik gizi yang adekuat pada pasien gagal jantung kongestif dapat mempertahankan status nutrisi pasien dan mendukung perbaikan kondisi klinis, kapasitas fungsional, serta kualitas hidup pasien.

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ABSTRACTCongestive heart failure is a chronic disease with high morbidity and mortality. Metabolic changes and activation of neurohormonal system cause malnutrition that worsened prognosis in patient with congestive heart failure. Decreased functional capacity and quality of life commonly experienced by patient with congestive heart failure. Early medical nutrition therapy supports the recovery phase of patient with congestive heart failure. Four patients in this case series presented with various risk factors for congestive heart failure, including coronary heart disease, diabetes mellitus type-2, hypertension, and obesity. At the first examination, patient presented with inadequate macro- and micronutrient intake, hyperglycemia, high blood pressure, fluid retention, decreased functional capacity and quality of life. Nutritional therapy tailored based on clinical presentation, laboratory results, and previous nutritional intake. All patients showed increase of intake with improvement of clinical condition and functional capacity. Nutritional status during hospitalization remained the same, on the other hand only one patient experienced improvement of quality of life. Adequate medical nutrition therapy in patients with congestive heart failure aids the recovery process of patient with congestive heart failure."