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"Luka bakar berat dapat menyebabkan respons hipermetabolisme dan hiperkatabolisme persisten dan berkepanjangan. Pasien luka bakar yang dirawat di rumah sakit (RS) sering memiliki komorbid, seperti obesitas, diabetes melitus tipe 2 (DMT2), dan hipertensi. Inflamasi kronik akibat obesitas dan komorbid pada luka bakar berat berperan di dalam terjadinya fenomena second hit yang dapat memperberat respons hipermetabolisme. Terapi medik gizi pada pasien luka bakar berat dengan obesitas dan penyulit metabolik bertujuan untuk mencegah penurunan berat badan, mempertahankan massa otot, mengurangi respons hipermetabolisme, menjaga kontrol glikemik dan tekanan darah, meningkatkan sistem imun, membantu penyembuhan luka, memerbaiki kapasitas fungsional, sehingga meningkatkan luaran klinis serta menurunkan risiko morbiditas dan mortalitas. Empat pasien serial kasus dengan luka bakar berat, derajat II-III, 29-38% luas permukaan tubuh (LPT), disebabkan oleh api dan listrik, memiliki status obes I serta komorbid DMT2 dan hipertensi. Terapi medik gizi pada pasien diawali dengan nutrisi enteral dini dalam waktu 24 jam pertama pasca luka bakar, sesuai dengan rekomendasi The European Society for Clinical Nutrition and Metabolism (ESPEN) serta Society of Critical Care Medicine (SCCM) dan American Society for Parenteral and Enteral Nutrition (ASPEN). Terapi medik gizi berdasarkan rekomendasi tersebut disesuaikan kondisi klinis, toleransi asupan, dan hasil laboratorium pasien. Target pemberian nutrisi menggunakan formula Xie, dengan komposisi seimbang, terdiri atas protein 1,5-2 g/kg BB ideal/hari, lemak 25-30%, dan karbohidrat 45-65%. Mikronutrien yang diberikan berupa vitamin B kompleks 3x1, asam folat 1x1 mg, vitamin C 2x250 mg, dan seng 1x20 mg. Keempat pasien serial kasus mengalami perbaikan kondisi klinis, penyembuhan luka baik, tidak ada infeksi dan komplikasi selama perawatan, tekanan darah dan kontrol glikemik baik, penurunan BB<10%, perbaikan kapasitas fungsional, dan lama rawat pasien lebih singkat. Keempat pasien dipulangkan untuk rawat jalan.Terapi medik gizi yang optimal dapat memerbaiki luaran klinis serta menurunkan angka morbiditas dan mortalitas pasien luka bakar berat dengan obesitas dan penyulit metabolik.

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Severe burn injury can cause a persistent and prolonged hypermetabolism and hypercabolism response. Severe burn injury patients treated in hospitals generally have comorbidities, such as obesity, DMT2, and hypertension. Chronic inflammation due to obesity and comorbidities in severe burn injury contributes to a second hit phenomenon in terms of augmenting the hypermetabolic response. Medical nutrition therapy in severe burn injury patient with obesity and metabolic disease is required in order to prevent weight loss, maintain muscle mass, reduce hypermetabolism response, maintain glycemic control and blood pressure, improve the immune system, help wound healing, improve functional capacity, therefore increasing clinical outcome and reduce the risk of morbidity and mortality. The case series consists of four patients with severe burn injury, degree II−III, 29−38% total body surface area, caused by fire and electricity, nutritional status obese I with DMT2 and hypertension. Medical nutrition therapy was initiated with early enteral nutrition within the first 24 hours after burn injury, according to ESPEN, SCCM and ASPEN recommendations and also adjusted based on clinical conditions, nutritional tolerance, and laboratory results. The nutrition target was calculated using Xie formula, with a balanced composition, consists of protein 1.5−2 g/kg ideal body weight/day, fat 25−30%, and carbohydrate 45−65%. Micronutrients supplementation given to these patients includes vitamin B complex 3x1 tablets, folic acid 1x1 mg, vitamin C 2x250 mg, and zinc 1x20 mg. Four patients had improvement in clinical condition and wound healing, no infections and complications during treatment, controlled blood pressure and glycemic, decreased body weight <10%, improvement in functional capacity, and shortened length of hospital stay. All four patients were discharged for outpatient care. Optimal medical nutrition therapy can improve clinical outcomes and reduce the morbidity and mortality rates in severe burn injury patients with obesity and metabolic disease."

"Vitamin D memiliki efek mempertahankan fungsi endovaskular dan mengatur aktivitas inflamasi dalam dinding pembuluh darah. Lemak viseral, disebutkan sebagai prediktor risiko yang baik untuk penyakit vaskular karena berperan aktif secara metabolik serta bersifat meningkatkan pengeluaran sitokin proinflamasi Kedua hal ini berpengaruh dalam peningkatan risiko kejadian stroke akut. Sampai saat ini penelitian yang membahas korelasi antara kedua faktor tersebut masih inkosisten. Studi potong lintang dilakukan pada subyek berusia >18 tahun dengan stroke akut yang menjalani perawatan di RSUPN Dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Pengukuran kadar lemak viseral menggunakan bioelectrical impedance analysis bedridden multifrekuensi. Penilaian kadar serum vitamin D (25 (OH)D) menggunakan metode chemiluminescent immunoassay. Terdapat total 73 subyek penelitian, sebanyak 55 subyek (75,3%) dengan insufisiensi dan 15 subyek (20,5%) mengalami defisiensi vitamin D, dengan nilai rerata di 17,08±7,85 ng/mL. Sejumlah 78,1% subyek memiliki kadar lemak viseral yang tinggi. Terdapat korelasi negatif (r= -0,271) yang signifikan (p <0,021) antara kadar lemak viseral dan kadar vitamin D serum pada stroke akut. Dilakukan analisis multivariat lanjutan, didapatkan kadar lemak viseral dan jenis pakaian (pakaian tertutup) menjadi faktor paling signifikan dalam menilai kadar vitamin D serum.Terdapat korelasi yang signifikan antara kadar lemak viseral dengan kadar vitamin D 25 (OH) pada pasien stroke akut.

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Vitamin D has effects in maintaining endovascular function and regulating inflammatory activity in the vascular wall. Visceral fat is said to be a good risk predictor for vascular disease because it plays a metabolically active role and increases the release of pro-inflammatory cytokines, both of which are influential in increasing the risk of acute stroke events. Studies that discuss the correlation between these two factors are still inconsistent.  A cross-sectional study was conducted on subjects aged >18 years with acute stroke who underwent treatment at Dr. Cipto Mangunkusumo Hospital and University of Indonesia Hospital. Measurement of visceral fat levels using bioelectrical impedance analysis bedridden multifrequency. Assessment of serum vitamin D (25(OH)D) levels using chemiluminescent immunoassay method.  In a total of 73 subjects, 55 (75.3%) subjects had vitamin D insufficiency and 15 (20,5%) subject had deficiency, with mean values at 17.08±7.85 ng/mL. A total of 78.1% of subjects had high visceral fat levels. There was a significant (p<0.021) negative correlation (r= -0.271) between visceral fat and serum vitamin D levels in acute stroke. In a further multivariate analysis, visceral fat content and type of clothing (concealing clothing) was found to be the most significant factor in assessing serum vitamin D levels. There is a significant correlation between visceral fat levels and 25 (OH) vitamin D levels in acute stroke patients."

"Pasien kanker dan infeksi rentan mengalami malnutrisi. Malnutrisi berat merupakan faktor risiko dari sindrom refeeding, suatu pergeseran cairan dan elektrolit yang berat akibat nutrisi yang diberikan pada pasien malnutrisi dan menimbulkan gangguan metabolik. Deplesi mineral intrasel (hipofosfatemia, hipomagnesemia, hipokalemia), gangguan cairan tubuh (refeeding edema), defisiensi tiamin, aritmia, gagal nafas, dan gagal jantung kongestif merupakan tanda dan gejala sindrom refeeding yang dapat meningkatkan morbiditas dan mortalitas. Dilaporkan empat pasien malnutrisi berat dengan tuberkulosis (TBC) paru dan karsinoma nasofaring (KNF) yang mengalami sindrom refeeding saat dirawat di rumah sakit. Terapi medik gizi dengan pemberian energi awal kurang dari 20 kkal/kgBB/hari lalu ditingkatkan bertahap, kadar elektrolit darah yang rendah dilakukan koreksi melalui oral atau intra vena, juga diberikan suplementasi tiamin dan mikronutrien lain. Pemantauan ketat klinis, tanda vital, keseimbangan cairan, dan kadar elektrolit darah dilakukan minimal 24 jam selama nutrisi diberikan. Pada akhir perawatan, terdapat perbaikan gejala dan tanda sindrom refeeding, serta kadar elektrolit darah. Lama perawatan pasien di rumah sakit 11-27 hari. Terapi medik gizi yang benar dan sesuai dapat mengurangi keparahan sindrom refeeding, memperbaiki klinis dan kadar elektrolit darah pasien.

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Patients with cancer or infection disease are vulnerable to malnutrition. Severe malnutrition is a risk factor for refeeding syndrome, profound shifts of fluid and electrolytes that is developed from refeeding and causes metabolic disturbances. Intracellullar mineral depletion (hypophosphatemia, hypomagnesemia, hypokalemia), body water imbalance (refeeding edema), thiamine deficiency, arrhythmia, respiratory failure and congestive heart failure are the signs and symptoms of refeeding syndrome which can increase morbidity and mortality. We report four severe malnutrition patients with pulmonary tuberculosis and nasopharyngeal carcinoma who developed refeeding syndrome while being treated for their underlying illness in hospital. Medical nutrition therapy started with energy less than 20 kcal/kg/day and increased slowly, low blood electrolytes levels were supplemented with oral or intravenous electrolytes. Patients were also given thiamine and another micronutrient supplementation. Patients were monitored closely for clinical conditions, vital signs, water balances and blood electrolytes levels minimum every 24 hours. Before discharge, improvement was seen in signs and symptoms of refeeding syndrome, and blood electrolytes levels. Hospital length of stay was 11 to 27 days. Appropriate medical nutrition therapy can reduce refeeding syndrome severity, give clinical and blood electrolytes levels improvement."

"Ileostomi merupakan tindakan pembedahan pembuatan lubang (stoma) antaraileum dan dinding abdomen, bertujuan untuk pengalihan feses. Ileostomi umumnyadibuat pada pasien yang menjalani penanganan kanker kolorektal, neoplasmastadium lanjut dengan infiltrasi usus halus, maupun peradangan saluran cerna.Ileostomi high output (produksi stoma ileum >1500 mL/hari) dapat menyebabkangangguan keseimbangan cairan dan elektrolit, maupun malnutrisi pada pasien. Saatini belum ada pedoman tata laksana nutrisi komprehensif untuk pasien ileostomihigh output. Serial kasus ini bertujuan untuk mendukung terapi, mengatasimalnutrisi, menunjang perbaikan klinis, sehingga dapat menurunkan morbiditasdan mortalitas pasien ileostomi high output. Empat pasien ileostomi high outputdengan rentang usia 42 hingga 50 tahun mendapatkan terapi medik gizi selamaperawatan di rumah sakit. Tiga kasus merupakan kasus kronik dengan keganasan,sementara satu kasus lainnya merupakan kasus akut yaitu adhesi dan perforasiakibat hernia femoralis strangulata. Keempat kasus tersebut merupakan ileostomihigh output onset awal, yaitu yang terjadi kurang dari tiga minggu pasca pembuatanstoma. Berdasarkan kriteria malnutrisi American Society for Parenteral andEnteral Nutrition (ASPEN), keempat pasien ini tergolong malnutrisi berat. Terapimedik gizi diberikan dengan prinsip pemberian makanan dan minuman porsi kecilnamun sering, restriksi cairan hipotonik, pemberian minuman berupa larutanelektrolit-glukosa, pemberian medikasi anti motilitas, serta koreksi cairan danelektrolit menurut kebutuhan dan kondisi klinis pasien. Target asupan energi danprotein pada keempat pasien dapat tercapai selama perawatan. Selama pemantauan,keempat pasien mengalami penurunan output ileostomi, serta perbaikankeseimbangan cairan dan elektrolit darah. Satu pasien mengalami perburukan klinisdan meninggal akibat sepsis pada hari perawatan ke-18. Tiga pasien pulang dengankondisi klinis perbaikan. Satu pasien mengalami peningkatan output ileostomi saatperawatan di rumah, kemudian dirawat kembali sepuluh hari setelah pulang karenakomplikasi anemia gravis dan ketidakseimbangan elektrolit, dan pada akhirnyameninggal. Terapi medik gizi dapat menurunkan produksi stoma, memperbaikikadar elektrolit darah, serta memperbaiki keseimbangan cairan pada pasienileostomi high output.

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Ileostomy is a surgical procedure to divert the ileum onto an artificial opening inthe abdominal wall, aimed for fecal diversion. Ileostomy is commonly created inpatients undergoing treatment for colorectal cancer, advanced neoplasms withintestinal 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 nutritionmanagement guideline for high output ileostomy patients. This case series aimedto support therapy, prevent malnutrition, improve clinical condition, as well as toreduce the morbidity and mortality of high output ileostomy patients. Four highoutput ileostomy patients, with a range of age 42 to 50 years old received medicalnutrition therapy during their hospital stay. Three cases were chronic cases inmalignancy, while the other case was an acute case of adhesion and perforation dueto strangulated femoral hernia. All four cases were early onset high outputileostomy, occurring in three weeks after stoma creation. Based on the AmericanSociety for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, thesefour patients were classified as severe malnutrition. Medical nutrition therapy wasadministered according to a set of principles: small frequent feeding and drinking,hypotonic fluid restriction, oral electrolyte-glucose solution administration, antimotilitymedication administration, as well as fluid and serum electrolytecorrection, according to patients' needs and clinical conditions. The target of energyand protein intake in all patients were achieved during hospital stay. During hospitalmonitoring, decreased ileostomy output as well as improvement in fluid andelectrolyte balance were observed in all patients. One patient clinically worsenedand died due to sepsis on the 18th day of hospital stay. Three patients showedimprovement in clinical condition and were discharged. One patient experienced anincrease in ileostomy output at home, and then readmitted ten days after hospitaldischarge due to severe anemia and electrolyte imbalance and subsequently died.Medical nutrition therapy may decrease output as well as improve fluid andelectrolyte balance in patients with high output ileostomy."

"Pada penderita kanker paru terjadi inflamasi sistemik dan dapat dilihat dengan peningkatan rasio netrofil limfosit di mana pemeriksaan ini lazim dilakukan di Rumah Sakit. Inflamasi sitemik dapat menyebabkan anoreksia sehingga asupan pada penderita kanker paru menurun dan memengaruhi status gizinya.  Penelitian ini bertujuan untuk mengetahui hubungan antara status gizi dengan rasio netrofil limfosit pada pasien kanker paru di RSUP Persahabatan. Penelitian ini menggunakan desain cross-sectional. Data diambil dari wawancara, pemeriksaan fisik, pemeriksaan laboratorium, dan dari rekam medis pasien poliklinik onkologi RSUP Persahabatan (n=52). Pada penelitian ini subjek sebagian besar berjenis laki-laki (61,5%), rentang usia terbanyak antara 50-60 tahun (38,5%), memiliki riwayat merokok (55,8%) dengan indeks Brinkman berat (30,8%). Lebih dari 50% subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Sebagian besar subjek penelitian berisiko malnutrisi atau malnutrisi sedang (38,5%) dan sebanyak 67,3% mengalami malnutrisi. Sebagai kesimpulan tidak terdapat hubungan antara status gizi dengan rasio netrofil limfosit pada penelitian ini (p = 0,35).

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Systemic inflammation in patients with lung cancer can be seen by the increase in the neutrophil lymphocyte ratio where these examinations are common in hospitals. Systemic inflammation can cause anorexia, with the result that nutrition intake of patients with lung cancer decreases and affects their nutritional status. This study aims to determine the association between nutritional status and the ratio of lymphocyte neutrophils in patients with lung cancer at Persahabatan Hospital. This is a cross-sectional study. Data were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology clinic of Persahabatan Hospital (n = 52) The subjects of the study were mostly male (61.5%), the largest age range was between 50-60 years (38.5%), had a history of smoking (55.8%) with a severe Brinkman index (30.8%). More than 50% of the subjects with energy and protein intake were below the recommended intake for cancer patients. Most of the study subjects were at risk of malnutrition or moderate malnutrition (38.5%) and 67.3% of them were experiencing malnutrition. In conclusion, there was no relationship between nutritional status with the ratio of neutrophil to lymphocytes in this study (p = 0.35)."

"Latar Belakang: Penurunan massa bebas lemak dan status fungsional akan mempengaruhi prognosis pada pasien kanker kepala leher. Pembentukan massa bebas lemak dipengaruhi berbagai hal termasuk nutrisi. Salah satu zat gizi yang berperan dalam adalah asam amino rantai cabang. Karnofsky Performance Scales (KPS) adalah salah satu parameter status fungsional yang dinilai secara rutin untuk pasien kanker Penelitian ini bertujuan untuk melihat korelasi antara asupan asam amino rantai cabang dengan massa bebas lemak dan status fungsional pada pasien kanker kepala dan leher.Metode: Studi potong lintang ini dilakukan pada subjek dewasa dengan kanker kepala leher secara consecutive sampling method di poliklinik radioterapi RSCM. Wawancara dilakukan untuk mengumpulkan data karakteristik dasar, data asupan zat gizi dan penilaian status fungsional. Pengukuran komposisi tubuh massa bebas lemak dengan alat bioimpedance analysis single Frequency. Pengukuran status fungsional dengan KPS.Hasil: Sebanyak 77 subjek penelitian dengan rerata usia 52 tahun, dengan sebagian besar berjenis kelamin laki-laki, 61 % berpendidikan menengah dan sebagian besar bekerja. Lokasi kanker terbanyak pada nasofaring dengan jenis karsinoma sel skuamosa dan stadium IV. Rerata subjek memiliki status gizi normal. Penilaian 3 x24-h Food Recall didapatkan dengan rerata asupan energi 27,44 kkal/kgBB dan protein 1,33 g/kgBB. Penilaian rerata asupan AARC dengan FFQ semi kuantitatif pada subjek penelitian didapatkan sebesar 10,99 gram. Pada penelitian ini didapatkan rerata nilai massa bebas lemak 42,10 kg dengan sebanyak 46 % subjek penelitian laki- laki memiliki index massa bebas lemak < 17 kg/m2 sedangkan pada subjek penelitian wanita terdapat 16 % dengan index massa bebas lemak <15 kg/m2 Status fungsional dengan menggunakan KPS subjek penelitian dengan median 90 dengan nilai minimum 40. Sekitar 11,6% subjek penelitian yang memiliki nilai KPS kurang dari sama dengan 70. Terdapat korelasi lemah antara asupan asam amino rantai cabang dengan massa bebas lemak (r=0,238, p=0,037).Tidak terdapat korelasi antara asupan AARC dengan status fungsional (r=0.147; p>0.05)Kesimpulan: Terdapat korelasi bermakna yang lemah antara asupan AARC dengan massa bebas lemak dan tidak terdapat korelasi antara asupan AARC dengan status fungsional pada subjek kanker kepala leher

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Background: Decreased fat-free mass and functional status will affect the prognosis in head and neck cancer patients. The formation of fat-free mass is influenced by various things including nutrition. One of the nutrients that play a role in is branched chain amino acids. Karnofsky Performance Scales (KPS) is a functional status parameter that is routinely assessed for cancer patients.

Methods: This cross-sectional study was conducted on adult subjects with head and neck cancer by consecutive sampling method at the radiotherapy polyclinic RSCM. Interviews were conducted to collect data on basic characteristics, data on nutrient intake and assessment of functional status. Measurement of body composition fat-free mass using a single Frequency bioimpedance analysis tool. Functional status measurement using the KPS.

Results: A total of 77 study subjects with an average age of 52 years, with most of them being male, 61% having secondary education and most of them working. Most cancer locations in the nasopharynx with the type of squamous cell carcinoma and stage IV. On average, the subjects had normal nutritional status. The 3 x24-h Food Recall assessment was obtained with an average energy intake of 27.44 kcal/kgBW and protein 1.33 g/kgBW. The assessment of the average BCAA intake with semi-quantitative FFQ on research subjects was 10.99 grams. In this study, the average fat-free mass value was 42.10 kg with as many as 46% of male research subjects having a fat-free mass index <17 kg/m2 while in female research subjects there were 16% with a fat-free mass index <15 kg/m2. Functional status using KPS of research subjects with a median of 90 with a minimum value of 40. Approximately 11.6% of study subjects had a KPS value of less than 70. There was a weak correlation between intake of branched-chain amino acids and fat-free mass (r=0.238, p=0.037. There was no correlation between BCAA intake and functional status (r=0.147; p>0.05)

Conclusion: There is a weak significant correlation between BCAA intake and fat-free mass and there is no correlation between BCAA intake and functional status in head and neck cancer subjects

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"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.

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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."