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"Latar Belakang: Psoriasis merupakan penyakit inflamasi kronik yang dimediasi sistem imun, menyebabkan lesi kulit dan dapat mengenai sendi. Kondisi inflamasi sistemik meningkatkan risiko berbagai non-transmissible chronic disease dan menyebabkan kehilangan nutrien akibat hiperproliferasi dan deskuamasi epidermis, sehingga dapat menurunkan kualitas hidup. Terapi medik gizi dengan menjaga indeks massa tubuh dalam rentangan normal dan memenuhi kebutuhan vitamin A, E, C, D, dan asam folat, serta pemberian asam lemak omega-3 dapat menurunkan stres oksidatif dan inflamasi. Terapi diet, pengaturan aktivitas fisik, dan modulasi respons inflamasi sistemik menjadi tujuan terapi yang penting dan terintegrasi. Kasus: Pasien psoriasis berbagai tipe dengan penyulit, terdiri atas 3 orang laki-laki dan seorang perempuan, rentangan usia 28–64 tahun. Pasien pertama dengan SIDA, artritis dan hipoalbuminemia, pasien ke-2 hipoalbuminemia, pasien ke-3 artritis, dan pasien ke-4 dengan obesitas. Terapi medik gizi yang diberikan meliputi diet cukup energi, protein tinggi, dan lemak sedang sesuai kodisi pasien, serta beberapa vitamin. Pemantauan dilakukan minimal selama 6 hari meliputi keluhan subjektif, keluaran klinis, hasil laboratorium, antropometri, kapasitas fungsional, dan analisis asupan 24 jam. Nutrisi ditingkatkan bertahap sesuai keluaran klinis dan toleransi. Mikronutrien yang dapat diberikan adalah vitamin B kompleks, C, dan asam folat. Semua pasien mendapat edukasi gizi. Hasil: Asupan energi keempat pasien dapat meningkat bertahap hingga mencapai KET saat pulang. Peningkatan kadar albumin tanpa koreksi infus albumin terjadi pada 2 pasien, penurunan albumin pada 1 pasien, dan pada 1 pasien tidak dilakukan pemeriksaan ulang. Kapasitas fungsional semua pasien mengalami perbaikan saat pulang. Tidak terjadi perubahan berat badan pada 3 pasien, namun 1 pasien mengalami penurunan selama dirawat. Kesimpulan: Terapi medik gizi yang adekuat menunjang proses penyembuhan, serta memperbaiki parameter laboratorium dan kapasitas fungsional.

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Background: Psoriasis is a chronic inflammatory disease mediated by the immune system causing skin lesions and may also affect the joints. Systemic inflammatory conditions increase the risk of various non-transmissible chronic diseases, loss of nutrients through hyperproliferation and desquamation of the epidermis that may reduce quality of life. Medical therapy in nutrition by maintaining body mass index within normal range and fulfillment the requirement of vitamins A, E, C, D, and folic acid, and supplementation of omega-3 fatty acids can reduce oxidative stress and inflammation. Dietary therapy, management of physical activity, and modulation of systemic inflammatory responses are the important and integrated therapeutic goals.

Case: Psoriasis patients of various types and complications with the range of age 28–64-years-old, consist of 3 males and 1 female. The first patient with HIV-AIDS arthritis and hypoalbuminemia, the second with hypoalbuminemia, the third with arthritis, and the fourth with obesity. The medical therapy in nutrition include diet that sufficient in energy, high protein, and moderate fat corresponding to the patients’ condition with supplementation of some vitamins. Monitoring was carried out for at least 6 days that include subjective complaints, clinical outcomes, laboratory results, anthropometric, functional capacity and 24-hour dietary intake analysis. Nutritional intake was gradually increased according to the clinical outcomes and tolerance. Micronutrients that can be given were vitamins B complex, C, and folic acid. All patients received nutrition education.

Results: Nutritional intake of all patients increased gradually and achieved the total energy requirement before discharged from the hospital. There were increased of albumin levels without albumin infusion in 2 patients, decreased in 1 patient, and no albumin levels’ reexamination in 1 patient. Functional capacity improved in all patients before discharged from the hospital. There were no changes in the body weight of 3 patients. However, 1 patient experienced decreased of body weight during hospotalisation.

Conclusion: Adequate medical therapy in nutrition supports the healing process, and improves laboratory parameters and functional capacity."

"Latar Belakang: Penuaan merupakan proses fisiologis yang terjadi pada semua organ tubuh. Usia lanjut dan sejumlah komorbid yang terjadi seperti hipertensi, penyakit jantung koroner, diabetes melitus, penyakit paru obstruktif kronik dan penyakit ginjal kronik, merupakan faktor risiko mayor gagal jantung kongestif. Pasien usia lanjut dengan gagal jantung kongestif berisiko tinggi readmisi rumah sakit, malnutrisi, defisiensi mikronutrien, dehidrasi atau kelebihan cairan, dan mengalami penurunan ambang rasa. Pada tata laksana gagal jantung kongestif, penting untuk membatasi asupan natrium dan cairan yang dapat menyebabkan penurunan asupan nutrisi, sehingga terapi nutrisi diperlukan sejak awal perawatan. Metode: Laporan serial kasus ini memaparkan empat kasus pasien usia lanjut dengan gagal jantung kongestif, berusia 65-78 tahun dengan minimal satu penyakit komorbid yaitu hipertensi, penyakit jantung koroner, penyakit ginjal kronik, penyakit paru obstruktif kronik, dan diabetes melitus. Semua pasien memerlukan dukungan nutrisi. Dua pasien mengalami malnutrisi, satu pasien berat badan lebih dan satu pasien obes I. Masalah nutrisi yang didapatkan antara lain asupan makronutrien dan mikronutrien tidak adekuat dan komposisi nutrisi tidak seimbang selama sakit dan 24 jam terakhir, gangguan elektrolit, hiperurisemia, hiperglikemia, peningkatan kadar kolesterol LDL dan gangguan keseimbangan cairan. Terapi nutrisi gagal jantung kongestif diberikan pada semua pasien disesuaikan dengan penyakit komorbid masing-masing. Suplementasi mikronutrien dan nutrien spesifik diberikan pada keempat pasien. Pemantauan meliputi keluhan subyektif, hemodinamik, tanda dan gejala klinis, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Keempat pasien menunjukkan peningkatan asupan nutrisi, perbaikan klinis berupa penurunan tekanan darah dan frekuensi nadi, serta peningkatan kapasitas fungsional. Kesimpulan: Terapi nutriso yang adekuat dapat memperbaiki kondisi klinis pasien usia lanjut dengan gagal jantung kongestif dan berbagai penyakit komorbid.

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Background: Aging is a physiological process, which is occurs in all organs. Elderly people and various comorbidities, such as hypertension, coronary artery disease, diabetes mellitus, chronic obtructive pulmonary disease and chronic kidney disease, are major risk factors of congestive heart failure. Elderly patients with congestive heart failure are at high risk of hospital readmission, malnutrition, micronutrients deficiency, dehydration or fluid overload and decreased sense of taste. In the congestive heart failure therapy, fluid and sodium intake restriction is important, however it may result in decreased nutrition intake so that is necessary to provide early adequate nutrition therapy.

Method: This serial case report describes four cases of congestive heart failure with various comorbidities in the elderly patients, aged 65-78 years old, with at least one comorbid, such as hypertension, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus. All patients required nutrition support. Two patients classified as malnutrition, one overweight and one obese I. Nutrition problems in this serial case report are macromicronutrients intake, and nutrition composition imbalance during ill and 24 hours before hospitalized, electrolyte imbalance, hyperuricemia, hyperglycemia, elevated LDL cholesterol levels, and fluid imbalance. Nutrition therapy for congestive heart failure was given to all patients, and adjusted to the comorbidities in each patient. Micronutrients and specific nutrients supplementation were given to all patients. Monitoring include subjective complaints, hemodynamic, clinical signs and symptoms, analysis and tolerance of food intake, laboratory results, anthropometric, fluid balance, and functional capacity.

Result: During monitoring in the hospital, all patients showed improved food intake, clinical outcomes, such as decreased of blood pressure, heart rate and increased of fungcional capacity.

Conclusion: Adequate nutrition therapy an important role in improving clinical conditions in the elderly patients with congestive heart failure and various comorbidities."