Hasil Pencarian  ::  Simpan CSV :: Kembali

Hasil Pencarian

Ditemukan 16001 dokumen yang sesuai dengan query
cover
Guntur Darmawan
Association between serum uric acid and non-alcoholic fatty liver disease: A meta-analysis
"Background: non alcoholic fatty liver disease (NAFLD) is known to be associated with some metabolic disorders. Recent studies suggested the role of uric acid in NAFLD through oxidative stress and inflammatory process. This study is aimed to evaluate the association between serum uric acid and NAFLD. Methods: a systematic literature review was conducted using Pubmed and Cochrane library. The quality of all studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). All data were analyzed using REVIEW MANAGER 5.3. Results: eleven studies from America and Asia involving 100,275 subjects were included. The pooled adjusted OR for NAFLD was 1.92 (95% CI: 1.66-2.23; p<0.00001). Subgroup analyses were done based on study design, gender, non-diabetic subjects, non-obese subjects. All subgroup analyses showed statistically significant adjusted OR and most of which having low to moderate heterogeneity. Two studies revealed relationship between increased serum uric acid levels and severity of NAFLD. No publication bias was observed.
Conclusion: our study demonstrated association between serum uric acid level and NAFLD. This finding brings a new insight of uric acid in clinical practice. Increased in serum uric acid levels might serve as a trigger for physician to screen for NAFLD.
Latar belakang: perlemakan hati non-alkoholik (PHNA) berhubungan dengan berbagai penyakit metabolik. Penelitian terbaru menunjukkan peranan asam urat pada PHNA melalui proses oksidatif dan inflamasi. Laporan ini bertujuan mengevaluasi hubungan antara kadar asam urat serum dengan PHNA.
Metode: tinjauan pustaka sistematik dilakukan dengan menggunakan Pubmed dan Cochrane library. Kualitas dari setiap studi dikaji dengan menggunakan the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Semua data dianalisis dengan menggunakan REVIEW MANAGER 5.3.
Hasil: didapatkan 11 studi dari Amerika dan Asia yang secara keseluruhan melibatkan 100.275 subjek. Pooled adjusted OR untuk NAFLD adalah 1,92 (95% CI: 1,66-2,23; p<0,00001). Analisis subgroup dilakukan berdasarkan desain studi, gender, subjek non diabetes, subjek non obese. Semua analisa subgroup menunjukkan adjusted OR yang bermakna secara statistic dan heterogenitas yang rendah hingga sedang pada mayoritas analisis subgrup. Dua studi menunjukkan hubungan antara kenaikan serum asam urat dengan tingkat keparahan PHNA. Bias publikasi tidak ditemukan pada laporan ini.
Kesimpulan: laporan ini menunjukkan hubungan antara kadar serum asam urat dengan PHNA. Temuan ini dapat memberikan pandangan yang baru terhadap asam urat dalam praktik klinis. Peningkatan kadar serum asam urat dapat menjadi pemicu bagi dokter untuk melakukan skrining PHNA."
Jakarta: University of Indonesia. Faculty of Medicine, 2017
616 UI-IJIM 49:2 (2017)
Artikel Jurnal  Universitas Indonesia Library
cover
Ignatius B. Prasetya
Prevalence and profile of fibrosis in diabetic patients with non-alcoholic fatty liver disease and the associated factors
"Background: the risk of Non Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis.
Methods: the study was conducted using a cross sectional method in type 2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fishers Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis.
Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296 2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117 5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001).
Conclusion: prevalence of NAFLD among type 2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD.
Latar belakang: risiko non-alcoholic fatty liver disease (NAFLD) meningkat pada pasien dengan diabetes melitus (DM) tipe 2. Prevalensi dan faktor-faktor yang berhubungan dengan peningkatan risiko NAFLD pada populasi DM di Indonesia belum pernah diteliti. Profil derajat fibrosis pada populasi ini juga masih belum diketahui. Tujuan penelitian ini mengetahui perbedaan profil pasien DM dengan atau tanpa NAFLD serta derajat fibrosisnya. Metode: penelitian dikerjakan secara potong lintang terhadap pasien DM tipe 2 dewasa yang berobat di poliklinik endokrin metabolik RSCM. Pengambilan sampel dilakukan secara konsekutif. Data yang dikumpulkan mencakup usia, lama diabetes, indeks masa tubuh (IMT), lingkar pinggang, kadar HDL, trigliserida, dan HbA1C. Ultrasonografi abdomen dikerjakan pada semua pasien untuk menentukan adanya NAFLD. Pasien dengan NAFLD lalu menjalani pemeriksaan elastografi transien untuk menilai derajat fibrosis. Uji Chi Square atau Fischer’s-Exact digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat. Hasil: sebanyak 186 pasien dianalisis dalam studi ini, dengan 84 pasien (45,2%) terbukti mengalami NAFLD. Elastografi transien berhasil dikerjakan pada 68 pasien NAFLD, dengan 17 pasien (25,0%) terbukti mengalami fibrosis berat. Analisis univariat menunjukan perbedaan signifikan IMT (PR=1,878; 95% CI= 1,296-2,721; p<0,001) dan lingkar pinggang (PR=2,368; 95% CI= 1,117-5,017; p=0,018) antara kelompok NAFLD dan tidak. Namun pada uji multivariat, IMT merupakan satu-satunya faktor yang berbeda bermakna antara kedua kelompok (OR=2,989; 95%CI=1,625-5,499; p<0,001).
Kesimpulan: prevalensi NAFLD pada pasien DM tipe 2 di RSCM mencapai 45,2%, dengan 25,0% di antaranya mengalami fibrosis berat. IMT merupakan satu-satunya komponen dalam studi ini yang berhubungan dengan kejadian NAFLD"
Jakarta: University of Indonesia. Faculty of Medicine, 2017
616 UI-IJIM 49:2 (2017)
Artikel Jurnal  Universitas Indonesia Library
cover
Sharon Sandra
Korelasi kadar asam urat dengan nilai elastografi transien dan controlled attenuation parameter penyakit perlemakan hati non alkoholik = The correlation between serum uric acid level and the steatosis and fibrosis degree of non alcoholic fatty liver disease evaluated using controlled attenuation parameter - transient elastography
"Latar belakang. Hiperurisemia merupakan salah satu parameter metabolik yang diperkirakan mempunyai peranan dalam perjalanan non-alcoholic liver disease NAFLD . Studi mengenai peranan asam urat dalam progresivitas penyakit hati masih terbatas.Tujuan. Mengetahui korelasi antara kadar asam urat dengan nilai Elastografi Transien ET dan Controlled Attenuation Parameter CAP pasien NAFLD.Metode. Penelitian ini merupakan studi potong lintang dengan menggunakan data sekunder yang melibatkan 113 pasien NAFLD dewasa. Dilakukan uji korelasi antara kadar asam urat dengan nilai ET dan nilai CAP. Lalu dilakukan analisis tambahan dengan membagi pasien menjadi 2 kelompok berdasarkan nilai ET dan CAP. Nilai titik potong ET untuk fibrosis signifikan sebesar ge; 7 kPa dan nilai CAP ge; 285 dB/m digunakan untuk membedakan steatosis ringan dan steatosis sedangberat. Faktor metabolik yang mempengaruhi derajat steatosis dan fibrosis dianalisis dengan menggunakan uji chi-square dan dilakukan analisis regresi logistik.Hasil. Terdapat 45 pasien dengan steatosis sedang-berat dan 34 pasien yang mengalami fibrosis signifikan. Tidak terdapat korelasi antara kadar asam urat dengan nilai CAP koefisien korelasi r = 0,2 dan p=0,026 maupun nilai ET r = 0,151 dan p = 0,110 . Terdapat perbedaan rerata kadar asam urat antara kelompok steatosis ringan dibandingkan steatosis sedang-berat 6,31 1,44 mg/dL vs 6,94 1,62 mg/dL, p = 0,03 . Tidak terdapat hubungan independen antara hiperurisemia dan derajat steatosis. Sedangkan faktor yang berhubungan secara independen dengan derajat fibrosis signifikan adalah hiperurisemia OR 2,450; 95 IK 1,054- 5,697 dan kenaikan kadar glukosa puasa OR 3,988 1,105-14,389 . Kelompok fibrosis signifikan mempunyai nilai rerata kadar asam urat yang lebih tinggi 6,89 1,60 mg/dL vs 6,42 1,50 mg/dL walau tidak bermakna secara statistik nilai p = 0,145 .Kesimpulan. Tidak terdapat korelasi antara kadar asam urat dengan nilai ET dan CAP
Background. Hyperuricemia is one of metabolic parameter which has been considered to play an important role in NAFLD. There is still lack of studies or evidence about correlation between serum uric acid level with liver disease progression.Aim of the study. To know the correlation between serum uric acid level and the steatosis and fibrosis degree of non alcoholic fatty liver disease evaluated using Controlled Attenuation Parameter CAP Transient Elastography TE examination.Methods. This study is a cross sectional study using secondary data of 113 NAFLD. Correlation between uric acid level and the degree of steatosis and fibrosis were also evaluated. Cutoff value for significant liver fibrosis ge 7 kPa. Mild and moderate severe steatosis diagnosed with a cutoff value of ge 285 dB m. Each metabolic factors were analyzed using chi square test. Univariate and multivariate analysis were performed using logistic regression test.Results. Of 113 NAFLD patients, there were 45 patients with moderate severe steatosis and 34 patients with significant fibrosis. There was no correlation between uric acid level and CAP correlation coefficient 0.2, P 0.026 and ET correlation coefficient 0.151, P 1,110 value were found. The difference of uric acid level mean value was found between mild steatosis and moderate severe steatosis 6.31 1.44 mg dL vs. 6.94 162 mg dL, P 0,03 . Hyperuricemia was not independent risk factor of moderate severe steatosis. High level of fasting blood glucose OR 3.98, 95 CI 1.105 14.389 and hyperuricemia OR 2.501, 95 CI 1.095 5.714 were found to be independent risk factors for significant liver fibrosis. Significant liver fibrosis group tends to have a higher mean value of uric acid level 6.89 1.60 mg dL vs. 6.42 1,50 mg dL with a p value 0,145.Conclusion. There was no correlation between uric acid an CAP TE value"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Yoppi Kencana
Titik Potong Rasio Hitung Neutrofil dan Limfosit untuk Memprediksi Derajat Steatosis dan Fibrosis Penyakit Perlemakan Hati Non Alkoholik = Diagnostic Value of Neutrophil to Lymphocyte Ratio in Non-Alcoholic Fatty Liver Disease evaluated using Transient Elastography (TE) with Controlled Attenuated Parameter (CAP)
"ABSTRAK
Non-alcoholic fatty liver disease (NAFLD) adalah penyakit hati kronik yang ditandai dengan akumulasi lemak berlebihan di hati. Elastografi Transien (ET) dan metode Controlled Attenuation Parameter (CAP) merupakan metode pemeriksaan non-invasif untuk menilai derajat fibrosis dan steatosis, namun tidak tersedia di seluruh rumah sakit di Indonesia. Rasio Neutrofil Limfosit (RNL) merupakan penanda peradangan sederhana yang berpotensi memprediksi luaran penyakit. Tujuan : Mengetahui nilai diagnostik RNL sebagai indikator derajat keparahan steatosis dan fibrosis NAFLD. Metode : Penelitian ini adalah studi potong lintang menggunakan data sekunder dari data rekam medis tahun 2016-2018. Analisis statistik deskriptif dan analitik berupa uji korelasi, Receiver Operating Curve (ROC) dan Area Under The Curve (AUC) dipakai untuk mengetahui luaran studi. Hasil : Dari 106 subjek penelitian, kebanyakan pasien adalah perempuan (62,3%) berusia rata-rata 57,29 tahun dan menderita sindrom metabolik (77,4%). Sebagian besar pasien memiliki derajat steatosis sedang-berat (66%) dengan rerata ET 6,14 (2,8-18,2). Terdapat korelasi antara nilai CAP (r=0,648; p<0,001) dan ET (r=0,621; p<0,001) dengan RNL. Penggunaan RNL untuk menilai derajat steatosis sedang-berat memiliki titik potong 1,775 dengan sensitivitas, spesifisitas, NDP dan NDN sebesar 81,5%, 80,6%, 89,1%, dan 69,1%; titik potong 2,150 untuk menilai fibrosis signifikan dengan sensitivitas, spesifisitas, NDP dan NDN berurutan sebesar 92,3 %; 87,5%; 70,6%; dan 97,2%. Simpulan : RNL memiliki korelasi positif dan signifikan terhadap derajat steatosis (CAP) dan fibrosis (ET) dengan sensitivitas dan spesifisitas yang cukup tinggi.
ABSTRACT
Non-alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease with excessive fat accumulation in the liver. Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) is a device and method to examine the degree of fibrosis and steatosis. However, this device is not widely available across Indonesia. Neutrophil and Lymphocyte Ratio (NLR) is a simple marker for inflammation which has a potency to predict disease outcome. This study aims to know the diagnostic value of NLR as the indicator of steatosis and fibrosis severity. Methods: This was a cross-sectional study with consecutive sample collection. We used secondary data from medical record, starting from 2016-2018. A descriptive and analytic statistic, including correlation test, multivariate linear regression, t test, Receiver Operating Curve (ROC) and Area Under the Curve (AUC) were done to know the outcome of the study. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Version 20.0 (SPSS Inc, Chicago, Illinois). A P value <0.05 was considered as statistically significant. Results: Out of 106 subjects, 62.3% patients were women with the mean of age 57.29 years old and 77.4% had metabolic syndrome. Most patients had moderate to severe steatosis degree (66%) with the mean of ET mean 6.14 (2.8-18.2). There was a positive correlation between CAP and TE compared with NLR with r=0.647 (p<0.001) and r=0.621 (p<0.001) respectively. The use of RNL to assess moderate-severe steatosis has a cutoff point of 1.775 with sensitivity,  specificity, PPV and NPV respectively at 81,5%, 80,6%, 89,1%, and 69,1%; cutoff point 2,150 to assess significant fibrosis with sensitivity, specificity, PPV and NPV of 92.3 %, 87.5%, 70.6%, and 97.2% respectively. Conclusion: NLR has a positive and significant correlation with the degree of steatosis and fibrosis with high sensitivity and specificity in comparison with TE/CAP."
2019
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Sepreka Mirly
Hubungan antara Metabolic associated Fatty Liver Disease (MAFLD) dengan Kelelahan Kerja pada Pelaut Kapal Tugboat = The Relationship Between Metabolic associated Fatty Liver Disease (MAFLD) and Work Fatigue in Tugboat Seafarers
"Latar belakang: Indonesia merupakan negara maritim yang berhubungan erat dengan industri pengiriman dan kekayaan laut yang berdampak pada sosio-ekonomik negara. Kesehatan pelaut berperan penting dalam mempertahankan manajemen ini dan perlu mendapat perhatian khusus. Pelaut memiliki risiko mengalami MAFLD, kelelahan saat bertugas, atau kombinasi keduanya. Penelitian ini bertujuan untuk mengetahui hubungan antara MAFLD dengan kelelahan kerja pada Pelaut tugboat.

Metode: Penelitian ini menggunakan metode potong lintang dengan data sekunder hasil MCU karyawan Perusahaan X. MAFLD didefinisikan sebagai fatty liver berdasarkan hasil USG ditambah dengan adanya obesitas atau overweight. Kelelahan diukur menggunakan kuesioner SOFI yang telah divalidasi dalam bahasa Indonesia. Hubungan antara MAFLD dengan kelelahan dianalisis menggunakan uji regresi logistik untuk mendapatkan nilai signifikansi (P), odds ratio (OR) dan interval kepercayaan (IK) 95%.

Hasil: Prevalensi pekerja yang mengalami kelelahan sedang sebanyak 64 orang (23,5%). Kelelahan kerja secara statistik berhubungan signifikan dengan MAFLD (aOR 5,05; IK 95% 2,65-9,60; p <0,001) dan kurangnya aktivitas fisik/olahraga (aOR 2,79; IK 95% 1,17-6,68; p 0,021).

Kesimpulan: Hampir seperempat dari total jumlah pelaut tugboat mengalami kekelahan sedang saat bekerja. Kelelahan tersebut berhubungan signifikan dengan MAFLD dan kurangnya aktivitas fisik/olahraga

Background: Indonesia is a maritime nation closely associated with shipping industry and oceanic wealth that impacts the country's socio-economic status. The health of sailors plays a crucial role in maintaining this management and requires specific attention. Sailors are at risk of experiencing MAFLD, on-duty fatigue, or a combination of both. This research aims to investigate the relationship between MAFLD and work-related fatigue among tugboat sailors.

Methods: This study used a cross-sectional method with secondary data from the Medical Check-Up (MCU) results of Company X's employees. MAFLD was defined as fatty liver based on ultrasound results combined with the presence of obesity or overweight. Fatigue was measured using the validated SOFI questionnaire in the Indonesian language. The association between MAFLD and fatigue was analyzed using logistic regression to obtain significance values (P), odds ratios (OR), and a 95% confidence interval (CI).

Results: The prevalence of workers experiencing moderate fatigue was 64 individuals (23.5%). Statistically, work-related fatigue was significantly associated with MAFLD (aOR 5.05; 95% CI 2.65-9.60; p <0.001) and insufficient physical activity/exercise (aOR 2.79; 95% CI 1.17-6.68; p 0.021).

Conclusion: Nearly a quarter of the total number of tugboat sailors experience moderate fatigue while working. This fatigue is significantly associated with MAFLD and insufficient physical activity/exercise."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Anggilia Stephanie
Korelasi kadar trigliserida dengan derajat steatosis menggunakan controlled attenuation parameter pada pasien nonalcoholic fatty liver disease = The correlation between triglyceride levels and steatosis degree using controlled attenuation parameter on nonalcoholic fatty liver disease patients
"ABSTRAK
Sebagai salah satu penyebab terbanyak peningkatan enzim hati, dan sirosis, NAFLD perlu dinilai derajat steatosisnya. Trigliserida sebagai salah satu komponen sindrom metabolik diketahui mempunyai pengaruh terhadap terjadinya nonalcoholic fatty liver disease NAFLD , namun korelasinya dengan derajat steatosis pada pasien NAFLD belum diketahui. Studi ini bertujuan untuk mendapatkan korelasi antara kadar trigliserida dengan nilai Controlled attenuation parameter CAP pada pasien NAFLD, serta mendapatkan nilai titik potong trigliserida yang optimal untuk memprediksi derajat steatosis sedang-berat pada pasien NAFLD. Studi potong lintang dilakukan pada pasien NAFLD dewasa di poliklinik Penyakit Dalam RSCM, yang direkrut secara konsekutif. Pasien dengan sirosis hepatis dieksklusi dari penelitian. Diagnosis NAFLD dilakukan dengan menggunakan USG, sementara derajat steatosis ditentukan dengan metode CAP menggunakan alat Fibroscan. Sampel darah puasa diambil untuk pemeriksaan trigliserida. Korelasi antara kadar trigliserida dengan nilai CAP dianalisis dengan uji Pearson. Sebanyak enam puluh dua subyek, dengan median usia 55 rentang 21 ndash; 78 tahun. Median nilai IMT 26,1 rentang 19-38 kg/m2, lingkar pinggang 96,6 SB: 8,49 cm, kadar trigliserida 160,3 SB: 65,5 mg/dL, kolesterol LDL 147,8 SB: 38,2 mg/dL, kolesterol HDL 48,5 SB:11,1 mg/dL dan nilai CAP 268,5 SB: 46,8 dB/m. Obesitas sentral didapatkan sebanyak 94,8 . Komorbid didapatkan berupa hipertensi 46,8 , DM tipe 2 54,8 , dan sindrom metabolik pada 72,6 . Didapatkan adanya korelasi yang lemah antara TG dengan derajat steatosis r=0,272; p= 0,033 . Dari kurva ROC didapatkan kemampuan TG dalam memprediksi derajat steatosis kurang baik AUC 0,66 IK 95 0,48 ndash; 0,83 , sehingga tidak dilanjutkan untuk mencari titik potong. Didapatkan adanya korelasi lemah antara kadar trigliserida dengan derajat steatosis pada pasien NAFLD. Saat ini kadar trigliserida tunggal tidak dapat digunakan untuk mendeteksi derajat steatosis sedang-berat.ABSTRACT As one of the most common cause of elevated liver enzymes and cirrhosis nowadays, steatosis degree need to be evaluated in NAFLD cases. Triglyceride, one of metabolic syndrome components, is known to be associated with NAFLD. However, correlation between the triglyceride levels and steatosis degree, has not yet understood. This study aim to find correlation between triglyceride level with Controlled Attenuation Parameter CAP value in NAFLD patients, and also gain optimal cut off point of triglyceride for predicting moderate to severe NAFLD. A cross sectional study on adult NAFLD patient in RSCM Internal Medicine Clinic, recruited consecutively in four months. Patients with liver cirrhosis was excluded. Diagnosis of NAFLD using Ultrasound, meanwhile steatosis degree was assessed using CAP in Fibroscan. Blood samples were taken for Triglycerides examination. The correlation between triglyceride levels with CAP values were analyzed by Pearson test. Sixty two NAFLD subjects, with a median age of 55 range 21 78 years. Median value of BMI was 26.1 range 19 38 kg m2, mean for waist circumference, levels of LDL and HDL cholesterol was 96.6 SD 8.49 cm, 147.8 SD 38.2 mg dL, 48.5 SD 11.1 mg dL , respectively. Mean for triglyceride was 160.3 SD 65.5 mg dL, and CAP value 268.5 SD 46.8 dB m. Central obesity found in as many as 94.8 of subject. Comorbidities such as hypertension and type 2 diabetes was found at 46.8 and 54.8 respectively, and metabolic syndrome 72.6 . In this study, we found a weak correlation between triglyceride values and CAP r 0.272 p 0.033 . From the ROC we find the TG capability of predicting steatosis degree was not good enough AUC 0.66, 95 CI 0.48 to 0.83 . Therefore cut off point of TG was not assessed. As a conclusion, there is a weak correlation between triglyceride levels and degree of steatosis in patients with NAFLD. Triglyceride level cannot be used solely for assessment of steatosis degree. "
Fakultas Kedokteran Universitas Indonesia, 2017
T55689
UI - Tugas Akhir  Universitas Indonesia Library
cover
Yoga Fitriakusumah
Hubungan Small Intestinal Bacterial Overgrowth (SIBO) dengan perlemakan hati non-alkoholik (Non-Alcoholic Fatty Liver Disease/NAFLD) = Association between Small Intestinal Bacterial Overgrowth (SIBO) with Non-Alcoholic Fatty Liver Disease/NAFLD)
2018
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Johana Titus
Hubungan aupan nutrisi dengan metabolisme energi dan estimasi Kebutuhan energi pada penderita sirosis hati = The relationship between nutritional intake, energy metabolism and the estimation of energy requirements of decompensated liver cirrhotic patients
"ABSTRAK
Tujuan: Mengetahui status metabolisme penderita SHD rawat inap di rumah sakit, dan memperoleh rumus untuk menentukan kebutuhan energi yang sesuai dengan status metabolisme penderita.
Tempat: Bagian Gizi dan Bagian Penyakit Dalam Rumah Sakit Sumber Waras, Jakarta.
Metode Penelitian didisain Cross Sectional, pada 49 subyek SHD laki-laki atau perempuan 30-80 tahun yang diseleksi secara konsekutif, dan 40 kontrol sehat yang diseleksi secara random dari karyawan RSSW. Data REE diperoleh dari hasil pemeriksaan konsumsi O2 dan CO2 yang dikeluarkan tubuh, dengan mempergunakan Kalorimeler Indirek. Asupan makanan dicatat selama 3 hari berturut-turut sebelum pemeriksaan REE. Data antropometri (LLA, TLLBK, KAOLA, TB, dan BB) dan pengumpulan urin dilakukan satu hari sebelum pemeriksaan REE, pengambilan darah untuk pemeriksaan IGF-l dan GH dilakukan setelah pemeriksaan Kalorimetri Indirek. Uji Statistik: Univariat mempergunakan tes Kormogorov Smimov, Bivarial mempergunakan uji t tidak berpasang, uji Mann Whitney dan Korelasi Pearson. Uji multivariat mempergunakan uji regresi linier ganda.
Hasil dari 49 subyek SHD yang masuk RS karena komplikasi: hematemesis (34,69%), malaria (46,94%), ikterus (55,1%), dan yang terbanyak asites (87,76%). Dari jumlah tersebut 67,35% tergolong Child C, sisanya Child B. Ditemukan 63,27 % subyek SHD mengeluh mual dan 75,52% anoreksia. Rerata asupan energi subyek SHD secara bermakna lebih rendah dari kontrol sehat (1282,04 ± 229,85 vs 1448,71 ± 325,56; p = 0,006), dan mempunyai korelasi dengan derajat penyakit. Proporsi asupan terhadap kebutuhan energi subyek SHD hanya mencapai 79,49% ± 17,60% REE. Proporsi asupan terhadap kebutuhan energi lebih besar pada subyek SHD yang tanpa keluhan mual dan anoreksia. Penelitian ini menemuken 73,57 % dari subyek SHD daiam keadaan malnutrisi, dan 58,26 % diantaranya (42,86% total subyek SHD) dalam keadaan muscle wasting (AOLA pada persentil < 5) dan menunjukkan korelasi dengan asupan energi (p=0,007). Meningkatnya mobilisasi lemak dan oksidasi substrat lemak ditandai oleh TLLBK pada lebih dari 67% subyek SHD pada persentil < 15 dan RQ = 0,7 ± 0,08, serta menunjukkan korelasi yang bermakna dengan kurangnya asupan energi (p = 0,005). Meningkatnya mobilisasi lemak dan lipolisis diduga mempunyai hubungan dengan rendah IGF-1 dan tingginya GH dalam darah. Walaupun oksidasi lemak diduga untuk mencegah berlanjutnya katabolisme otot, penelitian ini menunjukkan katabolisme otot berlanjut, hal ini ditandai dengan; imbang nitrogen negatif, rasio NUU/K.AOLA subyek SHD bermakna lebih tinggi dari kontrol sehat, dan RQ sekitar 0,43-0,86. Namun, pada penelitian ini tidak didapatkan perbedaan yang bermakna REE subyek SHD dengan kontrol sehat; hal ini disebabkan oleh menurunnya massa otot, dan meningkatnya oksidasi substrat lemak sehingga konsumsi oksigen dan REE rendah. Data menunjukkan rasio REE/K.AOLA bermakna lebih tinggi dari kontrol sehat. Keadaan ini menujukkan subyek SHD dalam kondisi hipermetabolisme disertai penyimpangan metabolisme yang dapat ditandai oleh berlanjutnya mobilisasi lemak; oksidasi substrat lemak (tak sempurna); dan oksidasi substrat protein berlangsung bersama. Asupan nutrisi, komposisi tubuh, dan status metabolisme penderita SHD telab diidentifikasi merupakan acuan penting untuk menentukan REE. Dengan menggunakan variabel; rerata asupan energi, komposisi tubuh (TB, BB, AOLA, dan lainnya) dan derajat penyakit (skor Child-Pugh, albumin, dan NUU) sebagai variabel independen. Melalui uji regresi linier ganda (metode STEPWISE) penelitian ini menemukan 3 variabel merupakan determinan kuat REE yaitu TB, AOLA dan kadar albumin. Dan uji tersebut diperoleh persamaan model yang merupakan model REE estimasi SHD yang reliabel, sehingga dapat direkomendasikan sebagai rumus estimasi REE atau kebutuhan energi penderita SHD yaitu :
kebutuhan energi = -270,40+17,26*AOLA - 217,83*Albumin + 11,42*TB.
Kesimpulan Pada penderita SHD, keadaan hipermetabolisme tidak dapat ditentukan hanya dengan indikator REE. Hipermetabolisme pada subyek SHD menjadi nyata dengan menentukan REE/K.AOLA dan NUU/K.AOLA. Nasib oksidasi makronutrien pada SHD berbeda dengan pada starvasi. Pada subyek SHD lerjadi rangsangan mobilisasi lemak, oksidasi substrat lemak, katabolisme protein otol, dan oksidasi substrat protein secara bersama. Keadaan yang membuktikan adanya penyimpangan metabolisme. Dengan uji regresi limier ganda (metoda STEPWISE), AOLA, albumin dan tinggi badan ditemukan sebagai determinan kuat dari REE atau kebutuhan energi pada penderita SHD rawat inap di RS.
ABSTRACT
Objective: To study the metabolic status of the Decompensated Liver Cirrhotic (DLC) patients who were hospitalized, and to formulate the equation of energy requirements equal to their metabolic status.
Places: The Department of Nutrition and the Department of Internal Medicine at Sumber Waras Hospital (SWH), Jakarta.
The cross sectional study was carried out on 49 DLC subjects, aged 30-80 years, selected consecutively, and on 40 healthy control subjects, selected at random, from SWH staff. The REE data was determined by assessing the Oz consumption (V02) and CO2 production (VCO2] using an Indirect Calorimeter. Food intake was recorded for 3 consecutive days before determining REE. The anthropometrics data (AC, TSF, C.AMA, Height and Weight) and urine samples were assessed one day prior to determining REE. The blood samples for determining IGF-1 and GH were taken after the Indirect Calorimetric assessment (REE data). The statistical tests: Univarian (using Kormogorof-Smimov), Bivarian (using unpaired T-tests, Mann-Whitney and Pearson Correlation), Multivariate (using multiple linear regression).
Results The 49 DLC subjects were hospitalized mainly due to complications of ascites (87.76%); many also suffered with hematemesis (34.69%), melena (46.94%), or icterus (55.1%). Of the 49 subjects, 67.35% were classified as Child C, the rest were Child B. The subjective findings were nausea (63.27%) and/or anorexia (75.52%). The mean energy intake of DLC subjects was significantly lower than the control (healthy volunteers) (1282.74 229.85 vs. 1448.71 * 325.56; p = 0.006), and had a correlation to the degree of disease, Their intake had only been 79.49 17.60% of REE. The proportion of food intake to energy requirements was larger in the DLC subject who had no symptoms of nausea and anorexia. This study has proved that 73.57% of DLC subjects had malnutrition, and 58.26 % of them (42.86 % of all DLC subjects) were in a muscle wasting condition (the percentile of AMA < 5). Il showed a correlation to a decrease in the energy intake (p = 0.007). The increase of fat mobilization and lipid substrate oxidation were shown by the DLC subjects' TSF of more than 67% with a percentile of less than 15 and the mean RQ = 0.7 ± 0.08. This also had a significant correlation to a decrease in the energy intake (p = 0.005). The increase of fat mobilization and lipolysis was assumed to have a correlation with the low level of blood IGF-1 and the high levels of blood GH. The increase of lipid substrate oxidation was assumed to prevent the subsequent of muscle catabolism, however this study showed that the process of muscle catabolism does not end, which was marked by a negative nitrogen balance, a significantly higher the UNUIC.AMA than the control and a RQ of 0.43 - 0.86. In this study, there was no significant difference between the REE of the DLC subjects and the control; this was due to the decrease of muscle mass and the increase of lipid substrate oxidation. This caused a low V02 consumption and a low REE. This study showed REEIC.AMA of the DLC subjects was significantly higher than the control. This condition indicated that the subjects were hyper metabolic with several abnormalities in metabolism such as: continued stimulation causing lipid mobilization from adipose tissue; incomplete oxidation of fatty acid and protein substrate oxidation running together. Energy intake, body composition, the metabolic status of DLC patients was an important reference for the identification of the REE. By using variables which influenced REE, i.e. the mean energy intake, body composition (height, weight, C.AMA, etc.) and the degree of disease severity (Child-Pugh score, albumin, and UNU), which were tested by the multiple linear regression of STEPWISE method, the equation model has been formulated and tested The final equation for estimating energy requirement is:
Energy requirements = -270.40 + 17.26*AOLA - 217.83*Albumin + 11.42?Height.
Conclusion RITE is not the only indicator of hyper metabolism in DLC patients. Hyper metabolism can be identified in DLC patients using REFIC.AMA and UNUIC.AMA. This study has proved abnormalities in metabolism of DLC patients as follows: continued stimulation causing lipid mobilization from adipose tissue; oxidation of fatty acid; muscle protein catabolism; and protein substrate oxidation running together. Through multiple linear regression analysis (the STEPWISE method), AMA, albumin level and height have been found as strong determiners of REE or determiners of energy requirements for DLC subjects."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2003
D476
UI - Disertasi Membership  Universitas Indonesia Library
cover
Ayu Diandra Sari
Hubungan asupan sukrosa dengan skor perlemakan hati non alkoholik pada penyandang obesitas dewasa = Association between sucrose intake and non-alcoholic fatty liver disease score among obese adults
"Obesitas merupakan masalah utama pada kesehatan masyarakat dunia yang diketahui juga sebagai salah satu faktor risiko penyakit perlemakan hati non alkoholik(NAFLD). Sistem penilaian untuk mendeteksi NAFLD telah dikembangkan dan divalidasi di Indonesia. Namun, pola makan orang obesitas yang mungkin memberikan pengaruh terhadap NAFLD masih belum diketahui. Penelitian ini mengevaluasi asupan sukrosa pada obesitas dewasa di Jakarta dan hubungannya dengan skor NAFLD. Ini adalah studi potong lintang berbasis komunitas di antara orang dewasa dengan indeks massa tubuh (BMI)>25 kg/m2 antara September dan Oktober 2018 di Jakarta, Indonesia. Asupan sukrosa dinilai menggunakan food recal l2x24 jam, dihitung berdasarkan tabel komposisi makanan Indonesia dan Amerika dengan menggunakan Nutrisurvey 2007.Skor NAFLD terdiri dari enam faktor risiko, yaitu BMI>25 kg/m2, jenis kelamin laki-laki, usia>35 tahun, trigliserida>150 mg/dL, kadar kolesterol lipoprotein kepadatan tinggi<40 mg/dL untuk pria atau <50 mg/dL untuk wanita, dan kadar alanin aminotrans feraseserum >35 U/L. Dari 102 subjek yang terdaftar, 75 orang(73,5%) adalah wanita. Median dari total skor NAFLD adalah 6,7 dengan rentang dari 3,6 hingga 10,2. Median asupan karbohidrat total adalah 179,6 (54,1-476,8) g/hari, dan median total asupan sukrosa adalah 47,0 (13,7-220,5) g/hari. Asupan sukrosa lebih tinggi signifikan pada responden dengan skor NAFLD >6,7 dibandingkan <6,7. (47,8 vs. 45,3 g; p=0,042; Mann-Whitney U test). Analisis multivariat mengonfirmasi adanya hubungan asupan sukrosa dan skor tinggi perlemakan hati non alkoholik.
Kesimpulan: Asupan sukrosa tidak memiliki hubungan bermakna dengan skor NAFLD pada penyandang obesitas dewasa, namun bermakna jika dikaitkan dengan skor tinggi perlemakan hati non alkoholik. Dibutuhkan penelitian lebih lanjut untuk pengembangan variabel tambahan pada skor NAFLD.
Obesity is a major problem in a world public health which is also known as one of the risk factors of non-alcoholic fatty liver disease (NAFLD). An assessment system for detecting NAFLD has been developed and validated in Indonesia. However, the diet pattern of obese people who might have an effect on NALFD is still unknown. This study evaluated sucrose intake among obese adults in Jakarta and ints association with NAFLD score. This was a community-based cross sectional study among adults with body mass index (BMI) >25 kg/m2 between September and Oktober 2018 in Jakarta, Indonesia. Sucrose intake was assessed using 2x24-hour food recall, calculated based on the Indonesian and American food composition tables using dietary software Nutrisurvey. The NAFLD score consists of six risk factors, i.e. BMI >25 kg/m2, male sex, age >35 years, triglycerides >150 mg/dL, high density lipoprotein cholesterol levels <40 mg/dL for men or <50 mg/dL for women, and serum alanine aminotransferase levels >35 U/L. A total of 102 subjects were recruited; 75 (73.5%) of them were women. The median of total NAFLD scores was 6.7, ranging from 3.6 to 10.2. Median total carbohydrate intake was 179.6 (54.1-476.8) g/day, while the median total sucrose intake was 47.0 (13.7-220.5) g/day. Sucrose intake was significantly higher in patients with NAFLD score >6.7 than <6.7 (47.8 vs. 45.3 g; p=0.042; Mann-Whitney U test). Multivariate analysis confirmed the association of sucrose intake and higher total NAFLD score.
Conclusions: Sucrose intake and NAFLD score have no significant association among obese adults. Further research is needed to develop additional variables on NAFLD score.
"
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
T57776
UI - Tesis Membership  Universitas Indonesia Library
cover
Ghafur Rasyid Arifin
Perubahan gambaran histopatologi perlemakan hati non alkoholik pada tikus sprague dawley yang diinduksi diet restriksi vitamin B12 = Histopathological changes of non-alcoholic fatty liver disease in sprague-dawley rats induced with vitamin B12 restriction diet
"ABSTRACT
Latar Belakang: Defisiensi vitamin B12 belum diketahui secara jelas insidensi dan prevalensinya di seluruh dunia dan hanya terdapat penelitian di daerah-daerah tertentu. Terdapat indikasi defisiensi asam folat dan vitamin B12 menjadi masalah kesehatan masyarakat dalam beberapa negara. Dalam beberapa penelitian, ditemukan bahwa kadar vitamin B12 yang rendah berhubungan dengan terjadinya perlemakan hati. Kondisi perlemakan hati memiliki spektrum yang luas, dari perlemakan hati sederhana, steatohepatitis, fibrosis, hingga sirosis hati. Tujuan: Penelitian ini bertujuan untuk mengetahui perubahan gambaran histopatologi perlemakan hati pada tikus dengan diet restriksi vitamin B12 dalam durasi waktu tertentu. Metode: Penelitian dilakukan dengan 18 ekor tikus Sprague-Dawley yang terbagi dalam 3 kelompok: (1) kelompok kontrol dengan diet normal selama 16 minggu; (2) kelompok perlakuan dengan diet restriksi vitamin B12 selama 8 minggu; dan (3) kelompok perlakuan dengan diet restriksi vitamin B12 selama 16 minggu. Setelah masa perlakuan selesai, hewan coba didekapitasi dan diambil jaringan hati dan dilakukan pemeriksaan histopatologi dengan pewarnaan Hematoxylin-Eosin untuk diamati perlemakan hati yang terjadi.Hasil: Ditemukan steatosis mikrovesikular pada ketiga kelompok. Hanya sedikit ditemukan steatosis markovesikular, inflamasi lobular, dan pembengkakan hepatiosit pada kelompok perlakuan. Pemberian diet restriksi vitamin B12 menunjukkan perbedaan yang bermakna ketika dilihat melalui persentase pelemakan hati yang terjadi (p=0,001). Analisis post-hoc dilakukan dan didapatkan hasil yaitu terdapat perbedaan perlemakan hati yang bermakna pada kelompok kontrol dibandingkan kelompok perlakuan 8 minggu dan pada kelompok kontrol dibandingkan kelompok perlakuan 16 minggu. Kesimpulan: Diet restriksi vitamin B12 menunjukkan adanya perbedaan gambaran perlemakan hati yang bermakna yang terlihat pada gambaran histologi jaringan hati setelah perlakuan 8 dan 16 minggu.
ABSTRACT
Introduction: Vitamin B12 deficiencys incidence and prevalence throughout the world are still unknown  and studies only found in certain areas. There is an indication that folate and vitamin B12 deficiency will be global health problem in some countries. In some research, it was found that low level of serum vitamin B12 was associated with non-alcoholic fatty liver disease (NAFLD). NAFLD has a broad spectrum, from simple steatosis, steatohepatitis, fibrosis, until cirrhosis. Objective: This research aimed to investigate the histopathological changes of steatosis in rats induced with vitamin B12 restriction diet within observation period. Method: This experimental study was conducted with 18 Sprague-Dawley rats that were divided equally in 3 groups: (1) control group with normal diet for 16 weeks; (2) treatment group with vitamin B12 restriction diet for 8 weeks; and (3) treatment group with vitamin B12 restriction diet for 16 weeks. After observation period was finished, decapitation was performed to obtain rats liver tissue. Liver tissue then stained with Hematoxylin-Eosin to observe the steatosis percentage. Result: Microvesicular steatosis was observed in all groups. There were a little macrovesicular steatosis, lobular inflammation, and hepatic ballooning in treatment group. Steatosis percentage showed significant result when all groups were compared (p=0,001). Post-hoc analysis then performed; there was significant difference of steatosis percentage of control group compared with 8 weeks treatment group and control group compared with 16 weeks treatment group. Conclusion: Vitamin B12 restriction diet showed significant difference of steatosis showed in liver tissue after 8 and 16 weeks of treatment."
2019
S-Pdf
UI - Skripsi Membership  Universitas Indonesia Library
<<   1 2 3 4 5 6 7 8 9 10   >>