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"Kanitis prematur (KP) ialah kondisi dimana individu memiliki minimal 5 helai rambut beruban pada usia kurang dari 25 tahun pada ras Asia. Etiologi KP belum dipahami sepenuhnya dan dianggap sebagai kelainan multifaktorial, salah satunya defisiensi mikronutrien. Vitamin B12 berperan pada proses melanogenesis, sehingga diperkirakan kadar vitamin B12 mencerminkan risiko KP. Pemeriksaan kadar methylmalonic acid (MMA) merupakan indikator defisiensi vitamin B12 yang spesifik. Penelitian ini bertujuan untuk menganalisis perbedaan kadar vitamin B12 dan MMA pada individu KP dibandingkan dengan kontrol dan menganalisis hubungan antara kadar vitamin B12 dan MMA dengan derajat keparahan KP. Penelitian ini adalah studi observasional analitik dengan desain potong lintang. Populasi target penelitian adalah individu KP dan individu dewasa sehat tanpa KP yang direkrut dengan metode consecutive sampling. Data identitas, awitan KP, riwayat KP dalam keluarga, pola diet, dan kebiasaan merokok didapatkan melalui anamnesis. Penilaian derajat keparahan KP dilakukan sesuai metode oleh Shin dkk. Pemeriksaan kadar vitamin B12 dan MMA dengan metode liquid chromatography-mass spectometry (LC-MS). Analisis statistik menggunakan perangkat lunak Stata v.16 (StataCorp). Dari 30 subjek penelitian (SP) kelompok KP, didapatkan 6 orang dengan KP derajat ringan, 15 orang dengan KP sedang, dan 9 orang dengan KP berat. Tidak ditemukan perbedaan karakteristik dasar lain antara kelompok KP dan kontrol. Terdapat perbedaan median kadar vitamin B12 (320 pg/mL vs 360 pg/mL; p<0,001) dan MMA (0,117 mmol/L vs 0,077mmol/L; p=0,0252) yang bermakna pada kelompok KP dibandingkan dengan kontrol. Pada penelitian ini tidak didapatkan hubungan yang bermakna secara statistik antara kadar vitamin B12 (r = 0,0703, p 0,712) dan MMA (r=0,2370, p=0,2074) dengan derajat keparahan KP. Sebagai kesimpulan, Kadar vitamin B12 dan MMA pada kelompok KP lebih rendah dan berbeda bermakna secara statistik dibandingkan kelompok kontrol. Namun tidak ditemukan hubungan yang bermakna secara statistik antara kadar vitamin B12 dan MMA dengan derajat KP.

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Premature canities (PC) is defined as an individual (Asian) aged less than 25 years with at least 5 grey hair strands. The etiology of PC is not completely understood but is thought to be a result of multifactorial abnormalities, one of which is micronutrient deficiency. Vitamin B12 plays a role in melanogenesis, thus it is believed that vitamin B12 level correlate with the risk of developing PC. Methylmalonic acid (MMA) examination is a specific indicator of vitamin B12 deficiency. This study aims to analyze the difference of vitamin B12 and MMA levels among individual with PC and a healthy control, as well as analyzing the correlation between vitamin B12 level and MMA with PC’s degree of severity. This is an analytical observational study with a cross-sectional design. The target population were individuals with PC and healthy individuals recruited by consecutive sampling. Identity of each individual as well as the onset of PC, history of PC among family members, diet, and smoking habit was taken during history taking. The severity of PC was measured using a method developed by Shin et al. Vitamin B12 and MMA level were measured using liquid chromatography-mass spectometry (LC-MS). Statistical analysis was done using Stata v.16 (StataCorp). Among 30 subjects from the PC group, 6 subjects had a mild PC, 15 subjects were moderate PC, and 9 subejcts had a severe PC. Differences among other parameters were found to be not statistically significant. There were statistically significant difference of median Vitamin B12 level ((320 pg/mL vs 360 pg/mL; p<0,001) and MMA level (0,117 mmol/L vs 0,077mmol/L; p=0,0252) between PC and healthy individuals. This study did not find a significant correlation between vitamin B12 (r = 0,0703, p 0,712) and MMA (r=0,2370, p=0,2074) level with the severity of PC. As a conclusion, vitamin B12 and MMA level in group with PC was significantly than the heatlhy individuals. No statistically significant correlations were found between either vitamin B12 or MMA level with the severity of PC."

"Latar Belakang. Sepsis neonatal awitan dini SNAD masih merupakan masalah di Indonesia. Vitamin D memiliki efek pada fungsi imunitas. Neonatus kurang bulan NKB berisiko mengalami defisiensi kadar vitamin D. Hubungan kadar vitamin D dengan kejadian SNAD pada NKB belum jelas.Tujuan. Menganalisis hubungan kadar vitamin D dengan kejadian SNAD pada NKB.Metode. Duapuluh NKB dengan klinis dan pemeriksaan laboratorium menyokong SNAD kelompok kasus dan 20 NKB tanpa hasil laboratorium SNAD kelompok kontrol ikut dalam penelitian ini. Subjek penelitian adalah NKB usia gestasi ge; 28 sampai dengan < 37 minggu dirawat di RSUPN Cipto Mangunkusumo selama bulan Juli - September 2017. Pemeriksaaan kadar vitamin D 25 OH D dengan metode competitive chemiluminescense immunoassay CLIA direk dengan alat Diasorin Liaison.Hasil. Median kadar vitamin D pada NKB dengan SNAD 8,95 4,10 - 16,30 ng/mL dengan rerata usia gestasi 33,25 1,71 minggu dan rerata berat lahir 1863,75 415,06 gram. Median kadar vitamin D tanpa SNAD 11,75 5,80 - 42,80 ng/mL dengan rerata usia gestasi 34,67 1,53 minggu dan rerata berat lahir 2125,0 340,55 gram. Median kadar vitamin D NKB SNAD lebih rendah secara bermakna dibandingkan NKB tanpa SNAD.

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Background. Early onset neonatal sepsis EONS is still a problem in Indonesia. Vitamin D has effect on immune function. Preterm infants have a risk of deficiency of vitamin D levels. The association between vitamin D levels with EONS were unclear.Objective. To determine the association between vitamin D levels with EONS in preterm infants.Methods. Twenty preterm infants with clinical and laboratory finding of EONS study group and 20 preterm infants with no signs of laboratory infection control group were enrolled this study. The subjects were preterm infants of gestational age ge 28 37 weeks in Cipto Mangunkusumo Hospital during July September 2017. Vitamin D 25 OH D levels were measured using Diasorin Liason with competitive chemilunescence immunoassay CLIA technique.Results. Median vitamin D levels with EONS was 8,95 4,10 16,30 ng mL, mean of gestational age and birth weight were 33,25 1,71 weeks and 1863,75 415,06 g, respectively. Median vitamin D levels without EONS was 11,75 5,80 42,80 ng mL, mean of gestational age and birth weight were 34,67 1,53 weeks and 2125,0 340,55 g, respectively. Median vitamin D levels of preterm infants with EONS was significantly lower than without EONS.Conclusion. Vitamin D levels are associated with EONS in preterm infants."

"Latar Belakang: Stroke iskemik merupakan penyebab kematian terbanyak kedua dan penyebab utama disabilitas di seluruh dunia. Beberapa faktor risiko yang sudah diketahui diantaranya pola hidup, penyakit komorbid, usia, jenis kelamin, dan ras. Namun, kadar serum vitamin D yang kurang ternyata juga dikaitkan dengan penyakit neurodegeneratif, serta luaran klinis yang lebih buruk. Penelitian ini dilakukan untuk mengetahui korelasi kadar serum vitamin D dengan derajat keparahan pada stroke iskemik yang dinilai berdasarkan NIHSS. Pada penelitian ini juga akan menilai asupan vitamin D serta pajanan sinar matahari.Metode: Penelitian ini merupakan studi potong lintang pada pasien stroke iskemik di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Karakteristik subjek penelitian berupa usia, jenis kelamin, faktor risiko, penyakit komorbid dengan komplikasi, asupan protein, asupan lemak, asupan vitamin D, pajanan sinar matahari, kadar serum vitamin D, serta derajat keparahan. Dilakukan analisis korelasi kadar serum vitamin D dengan derajat keparahan berdasarkan NIHSS.Hasil: Terdapat 59 subjek dengan diagnosis stroke iskemik dengan rerata usia 63 tahun dan mayoritas laki-laki (62,7%). Faktor risiko terbanyak adalah hipertensi (83,1%), berat badan lebih dan obesitas (64,4%), merokok (57,6%), dan diabetes melitus (42,4%). Penyakit komorbid dengan komplikasi tersering yang ditemukan adalah gangguan jantung (35,6%). Sebanyak 79,7% subjek penelitian memiliki asupan protein yang kurang, sedangkan asupan lemak seluruhnya tergolong cukup. Sebagian besar (52,5%) subjek penelitian memiliki status asupan vitamin D kurang, 5 orang mengonsumsi suplementasi vitamin D secara rutin, derajat pajanan sinar matahari rendah (89,8%). Sebanyak 59,3% memiliki status kadar serum vitamin D defisiensi dengan derajat keparahan terbanyak adalah skor NIHSS 5-15 (76,3%). Terdapat korelasi antara asupan vitamin D dengan derajat keparahan stroke iskemik (r -0,307, p 0,018).Kesimpulan: Kadar serum vitamin D memiliki korelasi dengan derajat keparahan stroke iskemik (r -0,469, p <0,001). Kadar serum vitamin D yang kurang berbanding terbalik dengan skor NIHSS yang didapatkan pada penderita stroke iskemik onset akut.

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Background: Ischemic stroke is the second leading cause of death and the leading cause of disability worldwide. Some of the known risk factors include lifestyle, comorbid diseases, age, gender, and race. However, deficient serum vitamin D levels are also associated with neurodegenerative diseases, as well as worse clinical outcomes. This study was conducted to determine the correlation of serum vitamin D levels with severity in ischemic stroke as assessed by the NIHSS. This study will also assess vitamin D intake and sunlight exposure.

Methods: This study is a cross-sectional study on ischemic stroke patients at RSUPN dr. Cipto Mangunkusumo and University of Indonesia Hospital. Characteristics of the study subjects included age, gender, risk factors, comorbid diseases with complications, protein intake, fat intake, vitamin D intake, sun exposure, serum vitamin D levels, and severity. Correlation analysis of serum vitamin D levels with severity based on NIHSS was conducted.

Results: There were 59 subjects with a diagnosis of ischemic stroke with an average age of 63 years and the majority were male (62.7%). The most common risk factors were hypertension (83.1%), overweight and obesity (64.4%), smoking (57.6%), and diabetes mellitus (42.4%). Comorbid disease with the most common complication found were cardiac disorders (35.6%). A total of 79.7% of the study subjects had insufficient protein intake, while the fat intake was entirely considered adequate. Most (52.5%) of the study subjects had deficient vitamin D intake status, 5 people took vitamin D supplementation regularly, the degree of sun exposure was low (89.8%). A total of 59.3% had vitamin D deficiency serum level status with the most severity being NIHSS score 5-15 (76.3%). There was a correlation between vitamin D intake and ischemic stroke severity (r -0,307, p 0,018).

Conclusion: Serum vitamin D levels have a correlation with ischemic stroke severity (r -0,469, p <0,001). Insufficient serum vitamin D levels are inversely proportional to the NIHSS score obtained in patients with acute onset ischemic stroke."

"ABSTRAKLatar Belakang. Vitamin D diketahui berperan penting dalam memodulasi sistem imunitas. Defisiensi vitamin D sering dihubungkan dengan peningkatan risiko kerentanan dan keparahan terhadap berbagai penyakit infeksi. Penelitian yang meninjau hubungan antara vitamin D dan dengue sangat terbatas. Dengue adalah penyakit dengan beban kesehatan global yang besar, eksplorasi terhadap faktor imunomodulator yang berpotensi untuk menjadi bagian dari upaya pencegahan dan tatalaksana infeksi dengue termasuk vitamin D masih diperlukan.Tujuan. Penelitian ini bertujuan untuk melihat apakah ada perbedaan rerata kadar vitamin D serum pada berbagai derajat keparahan infeksi dengue di masing-masing fase infeksi.Metode. Penelitian potong lintang ini dilakukan dari Oktober 2016-Januari 2018 terhadap 61 pasien dengan infeksi dengue di RSUP dr. Mohammad Hoesin Palembang. Data dikumpulkan melalui rekam medik, hasil pemeriksaan ultrasonografi, kadar 25(OH)D, serta foto rontgen toraks decubitus kanan. Analisis dilakukan dengan uji anova, kai kuadrat, Fisher exact, regresi linear dan logistik dengan interval kepercayaan 95% dan nilai kemaknaan 0.05.Hasil. Rerata kadar vitamin D serum pada infeksi dengue dengan kebocoran plasma (DD) adalah 24.6 ng/ml. Pada infeksi dengue dengan kebocoran plasma (DBD dan SSD) rerata kadar vitamin D pada fase demam adalah 26.66 ng/ml, 21.91 ng/ml pada fase kritis, dan 25.36 ng/ml pada fase konvalesens. Tidak ditemukan adanya perbedaan dan hubungan bermakna antara kadar serta status kecukupan vitamin D dengan derajat keparahan infeksi dengue. Kadar vitamin serum pada fase akut infeksi dengue memiliki korelasi positif dengan hitung trombosit terendah (p=0.03).Simpulan. Kadar vitamin D serum pada berbagai derajat infeksi dengue di masing-masing fase infeksi pada anak tidak berbeda bermakna. Kadar vitamin D serum pada fase demam berhubungan dengan hitung trombosit terendah pada kasus dengue.

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ABSTRACTBackground. Vitamin D has an important role in modulating the immune system. Low level of vitamin D is frequently associated with higher risk of susceptibility and severity to various infectious disease. Studies on dengue infection and vitamin D are still limited. Until today dengue is known to have a high global burden of disease. Therefore, a continouing investigation on potential modulating factors that may be beneficial in the efforts of dengue prevention and management which includes vitamin D is still required.Objectives. The purpose of this study is to evaluate the difference of vitamin D serum values in various levels of dengue infection severity in children in each phase of disease.Methods. A cross sectional study was conducted from October 2016 until January 2018 at Mohammad Hoesin Hospital Palembang. Sixty-one children with dengue infection were included in this study. Data were collected from medical records, ultrasonograpy, 25(OH)D laboratory test, and right lateral decubitus xray. Statistical analysis was calculated with anova, chi-square, fisher exact, linear and logistic regression with 95% confidence interval and 0.05 level of significance.Results. The mean value of 25(OH)D in dengue infection without plasma leakage (Dengeu Fever) is 24.6 ng/ml, while in dengue infection with plasma leakage (Dengue Hemorhaggic Fever and Dengue Shock Syndrome) the mean value are 26.66 ng/ml in febrile phase, 21.91 ng/ml in critical phase, and 25.36 ng/ml in convalescence phase. No significant difference and association were found between the values and status of vitamin D among various level of dengue infection severity. A positive linear correlation was found between the level of vitamin D in the febrile phase dengue infection and thrombocyte lowest count (p=0.03)Conclusions. There are no difference between the value of vitamin D among children with various levels of dengue infection severity in each phase of disease. Vitamin D serum level during febrile phase may have a role in predicting thrombocyte lowest count during dengue infection."

"Latar Belakang: Rambut memiliki berbagai fungsi, salah satunya sebagai perkiraan usia individu. Kanitis, atau uban, merupakan tanda penuaan yang muncul pada rambut yang umumnya terjadi pada dekade ke-4 kehidupan. Kanitis prematur (KP) merupakan istilah munculnya kanitis sebanyak 5 helai rambut sebelum usia 25 tahun pada ras Asia. Etiologi penyakit KP belum sepenuhnya dipahami dan dianggap sebagai kelainan multifaktorial. Defisiensi mikronutrien tertentu, meliputi besi dan seng, diperkirakan berperan dalam munculnya KP. Oleh karena itu, diperkirakan kadar besi dan seng dalam serum dan rambut dapat mencerminkan risiko terjadinya KP pada seseorang.Tujuan: Menganalisis perbedaan rerata kadar besi dan seng rambut dan serum KP dibandingkan populasi sehat dan menganalisis korelasi antara kadar besi dan seng rambut dan serum pasien KP dengan derajat keparahan KP.Metode: Penelitian ini merupakan studi observasional analitik dengan desain kasus kontrol dan dilakukan matching jenis kelamin dan usia. Populasi target penelitian adalah pasien KP dan individu sehat yang diambil dengan metode consecutive sampling berdasarkan kriteria penerimaan dan penolakan. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian. Nilai p<0,05 dianggap signifikan secara statistik.Hasil: Diantara 32 sampel kelompok KP, 7 orang mengalami KP ringan, 14 orang mengalami KP sedang, dan 11 orang mengalami KP berat. Diperoleh perbedaan kadar seng rambut yang bermakna secara statistik antara kelompok KP dengan kelompok sehat (184,03 vs. 231,83; p=0,01). Perbedaan parameter lainnya ditemukan tidak bermakna secara statistik. Tidak ditemukan adanya korelasi yang bermakna secara statistik antara kadar besi dan seng serum maupun rambut terhadap kejadian atau derajat keparahan KP. Data tambahan, ditemukan korelasi positif lemah antara indeks massa tubuh (IMT) dengan derajat keparahan KP (rρ= 0,392; p=0,026). Riwayat KP keluarga merupakan faktor risiko KP (aOR 14,829; 95% IK 3,073–71,566, p=0,001). Setiap penurunan 1 unit (µg/g) kadar seng rambut, kemungkinan mengalami KP meningkat (aOR 1,007; 95% IK 1,001–1,013, p=0,022).Kesimpulan: Kadar seng rambut pada kelompok KP lebih rendah dan berbeda bermakna secara statistik dibandingkan dengan kelompok kontrol sehat, namun tidak ditemukan perbedaan rerata yang bermakna pada parameter lainnya. Tidak ditemukan korelasi antara kadar besi dan seng rambut dengan serum, maupun dengan derajat keparahan KP.

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Background: Hair has various functions, one of which is an estimate of an individual's age. Canities, or gray hair, is a sign of aging that appears on the hair and generally begins to occur in the 4th decade of life. Premature canities (PC) is a term for the appearance of gray hair as much as 5 strands of hair before the age of 25 years in Asian ethnicity. The etiology of PC is not fully understood and is considered a multifactorial disorder. Certain micronutrient deficiencies, including iron and zinc, are thought to play a role in the development of PC. Therefore, it is predicted that iron and zinc levels in serum and hair can reflect a person's risk of developing PC.

Aim: To analyze the difference in mean serum and hair levels of iron and zinc between subjects with PC and healthy controls and to assess their correlation with the severity of PC.

Method: This study is an analytic observational study with a case-control design and matched according to age and gender. The target population of the study was patients with PC and healthy individuals who were recruited by consecutive sampling based on inclusion and exclusion criteria. Appropriate statistical analysis was performed to prove the research hypothesis. A p-value of <0.05 is considered statistically significant.

Results: Among the 32 subjects of the PC group, 7 subjects had mild PC, 14 subjects had moderate PC, and 11 subjects had severe PC. There was a statistically significant difference in hair zinc levels between the PC group and the healthy controls (184.03 vs. 231.83; p=0.01). Differences in other parameters were found to be not statistically significant. There was no statistically significant correlation between serum and hair iron and zinc levels on either the incidence or the severity of PC. A weak positive correlation between body mass index (BMI) and the severity of PC (rρ= 0.392; p= 0.026) was obtained. Family history of PC is a risk factor for PC with an aOR 14,829; 95% CI 3.073–71,566, p=0.001. In addition, for every 1 µg/g decrease in hair zinc levels, the probability of experiencing PC increased (aOR 1.007; 95% CI 1.001–1.013, p=0.022).

Conclusion: Hair zinc levels in the PC group were lower and statistically significant compared to the healthy controls but no significant difference was found in other parameters. There was no correlation between hair iron and zinc levels with serum, nor with the severity of PC.

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"Tujuan: Mengetahui pengaruh suplementasi vitamin B12 400 µg/hari selama enam minggu terhadap kadar vitamin B12 dan homosistein serum pada adventis vegan dewasa. Tempat: Gereja Masehi Advent Hari Ketujuh, Jakarta Barat. Metadologi: Penelitian pro dan pasca perlakuan pada 27 orang subjek, berusia 20-60 tahun. Setiap subjek mengkonsumsi suplemen vitamin B12 400 µg/hari dosis tunggal selama 42 hari. Data yang dikumpulkan meliputi data demografi, antropometri pra dan pasca perlakuan, asupan nutrisi (energi, karbohidrat, protein, dan lemak) dengan metode recall 1 x 24 jam dua kali seminggu pra, pertengahan dan pasca perlakuan. Data asupan vitamin B6, B12 dan asam folat dengan FFQ semi kuantitatif serta data laboratorium meliputi kadar vitamin B12, asam folat, dan homosistein serum pra dan pasta perlakuan. Hasil: Data demografi menunjukkan sebagian besar (81,5%) subjek berpendidikan tinggi dan semua subjek berpenghasilan di atas garis kemiskinan. Data antropometri pada pra dan pasca perlakuan menunjukkan seluruh subjek mempunyai IMT dalam batas normal. Asupan nutrisi selama perlakuan yang meliputi asupan energi, karbohidrat, lemak dan protein tidak mengalami perubahan. Bila dibandingkan dengan AKG tahun 1988 asupan energi, sebagian besar subjek termasuk cukup, asupan karbohidrat, dan protein termasuk kurang; asupan lemak termasuk lebih, Asupan vitamin B6 pada akhir perlakuan tidak menunjukkan penurunan secara signifikan (p=0,6874), sebaliknya dengan asupan vitamin B12 yang menunjukkan peningkatan signifikan (p = 0,021) dan asam folat yang menunjukkan penurunan signifikan (p = 0,0001). Hasil pemeriksaan laboratoriurn pada akhir perlakuan menunjukkan peningkatan signifikan pada kadar vitamin B12 (p = 0,0000) sebesar 202,6%, dari median 127 (58,0-193,0) pg/mL menjadi 376 (183,0-1168,0) pg/mL dan penurunan kadar homosistein yang signifikan (p = 0,0000) sebesar 39% dari median 14,50 (11,1-34,2) } µmol/L menjadi 9,50 (5,6-24,8) µmol/L. Kadar asam folat tidak mengalami penurunan bermakna (p = 0,2960). Kesimpulan: Suplementasi vitamin B12 sebanyak 400 µg/hari selama 42 hari pada vegan terbukti meningkatkan kadar vitamin B12 dan menununkan kadar homosistein.

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The Effect Of Vitamin B12 Supplementation On Homocysteine Level Of Adult VegansObjective: To investigate the effect of 400 µg /day vitamin B12 supplementation for 42 days on serum vitamin B12, and homocysteine levels of 27 adult vegan subjects.

Location: Seventh Day Adventists Church, West Jakarta.

Method: A pre and post test design study was carried out on 27 subjects, aged 20-60 years, who fulfilled the criteria of the selection. Subjects were given 400 µg/day vitamin B12 single dose supplementation for 42 consecutive days. Data collected were demographic, anthropometric, nutritional, and laboratory. The data of energy, carbohydrate, protein, and fat intake were collected using 1 x 24 recall method twice a week at the beginning, within, and the end of the study; whilst vitamin B6, B12 and folk acid intake were obtained with FF0 semi-quantitative method at the beginning and the end of the study. Laboratory data were collected before and after study including serum vitamin B12, folk acid and homocysteine

Results: Demographic data showed that most of the subjects had high formal education level (81.5%) and all subjects had income above the poverty line. Anthropometric data showed that BMI at the beginning and in the end of the study were in normal range. Dietary intake estimation including energy, carbohydrate, protein, and fat, were not significantly changed. Compared to Indonesian RDA 1998, intake of energy was considered adequate, carbohydrate and protein were low, and fat was high. Vitamin B6 intake did not decrease significantly (p = 0.6874) However vitamin B12 intake increased (p = 0.021) and folic acid intake decreased significantly (p = 0.0001). Median value of serum vitamin B12 after supplementation increased significantly (p = 0,0000) by 202.6% from 127 (58.0-193.0) pg/mL to 376 (183.0-1168.0) pg/mL. There was no significant difference in the serum level of folic acid (p = 0.2960). Median value of homocysteine after supplementation decreased significantly (p = 0.0000) by 39% from 14.50 (3.8-34.2) man, to 9.50 (5.6-24.8) µmol/L.

Conclusion: Supplementation of single dose 400 µg vitamin B12 for 42 consecutive days on adult vegan subjects was proven to elevate the level of serum vitamin B12 and decrease the level of homocysteine."

"Nama : Irena UjiantiProgram Studi : Program Magister Ilmu BiomedikJudul Tesis :Dampak Restriksi Vitamin B12 Terhadap Kadar Homosistein, Resistensi Insulin Dan Gambaran NAFLDPembimbing : dr. Imelda Rosalyn Sianipar, M.Biomed, Ph.D dan Dr. dr. Dewi Irawati Soeria Santoso, MS Latar Belakang: Perlemakan hati merupakan penyakit hati kronik terbesar di dunia. Kondisi yang mendasari terjadinya perlemakan hati dimulai dari kondisi resistensi insulin. Salah satu patogenesis terjadinya resistensi insulin adalah gangguan pada pensinyalan insulin oleh zat toksik tertentu yang akan berinteraksi dengan protein yang menyusun jalur pensinyalan insulin. Peningkatan homosistein dikaitkan dengan resistensi insulin. Homosistein akan meningkat sejalan dengan terganggunya jalur metilasi dari siklus metionin. Pemberian diet restriksi vitamin B12 akan memicu terjadinya resistensi insulin lewat jalur stres oksidatif yang ditimbulkan oleh homosistein.Bahan dan Metode: Penelitian ini menggunakan metode eksperimental terhadap 24 tikus Sprague Dawley jantan Rattus norvegicus, 300-350 gram, usia 35-40 minggu , terbagi ke dalam 4 kelompok yaitu kontrol K , Kelompok perlakuan 4 minggu P-1 , Kelompok Perlakuan 8 minggu P-2 dan kelompok perlakuan 12 minggu P-3 . Pada Kelompok kontrol, diberikan diet standar AIN-93M sedangkan kelompok perlakuan diberikan pakan modifikasi restriksi vitamin B12 AIN-93 sesuai usia perlakuan.Hasil: Kelompok perlakuan 8 minggu paling baik dalam menggambarkan kondisi perlemakan hati dibandingkan kelompok kontrol dan perlakuan 4 minggu, sedangkan kelompok perlakuan 12 minggu telah mempresentasikan kondisi NASH Non Alcoholic Steatohepatitis . Hasil ini sejalan dengan kondisi peningkatan homosistein plasma pada kelompok kontrol dan masing-masing usia perlakuan.Kesimpulan: Peningkatan homosistein akibat diet restriksi vitamin B12 mengakibatkan kondisi steatosis dan steatohepatitits pada hati, sebagai akibat dari kondisi resistensi insulin dan kerusakan sebagian dari sel beta pankreas. Kata kunci: Homosistein, Restriksi vitamin B12, NAFLD, Resistensi Insulin

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ABSTRACT Name Irena UjiantiStudy Program Master Program of Biomedical SciencesThesis Title Impact of Vitamin B12 Restriction on Homocysteine Levels, Insulin Resistance and NAFLDCounselor dr. Imelda Rosalyn Sianipar, M.Biomed, Ph.D. dr. Dewi Irawati Soeria Santoso, MS Background The fatty liver is the biggest chronic liver disease in the world. The underlying condition of fatty liver starts from the condition of insulin resistance. One of the pathomechanisms of insulin resistance is the disturbance in insulin signaling by certain toxic substances that will interact with one of the proteins that make up the insulin signaling pathway. Increased homosisteine is associated with insulin resistance. Homosisteine will increase in line with the disruption of the methionin metionin pathway. Dietary vitamin B12 deficiency will trigger insulin resistance through the path of oxidative stress generated by homocysteine.Materials and Methods This study used an experimental method of 24 male Sprague Dawley rats Rattus norvegicus, 300 400 gram, age 7 8 months , divided into 4 groups kontrol K , 4 weeks treatment group P 1 , 8 weeks treatment group P 2 and 12 week treatment group P 3 . In the kontrol group, a standard AIN 93 diet was administered while the feeding group was administered vitamin A deficiency deficiency AIN 93M according to treatment age.Results The best 8 weeks treatment group described the conditions of fatty liver compared to the 4 week kontrol and treatment group, while the 12 week treatment group presented the NASH condition. These results are consistent with the elevated plasma homocysteine conditions in the kontrol group and each treatment age.Conclusion Increased homocysteine due to dietary vitamin B12 deficiency is able to induce the condition of steatosis and steatohepatitits in the liver, as a result of the condition of insulin resistance and beta cell pancrease damage as the underlying patomechanism. Keywords Homocysteine, vitamin B12 Deficiency, NAFLD, Insulin Resistance "

"Diabetes melitus dapat menyebabkan berbagai komplikasi yang menyebabkan hendaya, salah satunya adalah ulkus kaki diabetikum (UKD). Kadar vitamin D diketahui berhubungan dengan penyembuhan luka dan resistensi insulin. Penelitian potong lintang ini bertujuan untuk menentukan hubungan antara kadar vitamin D serum dan derajat keparahan UKD. Tiga puluh pasien UKD dengan nilai ankle brachial index normal dikelompokkan sesuai derajat keparahannya sesuai klasifikasi Wagner diikutkan dalam studi ini. Kadar vitamin D serum diperiksa menggunakan metode immunoassay. Hubungan antara kedua variabel dianalisis. Pasien terdiri dari 18 orang laki-laki (60%) dan 12 orang perempuan (40%) dengan rerata usia 57 tahun. Rerata kadar vitamin D serum adalah 10,58 ng/mL. Korelasi kuat ditemukan antara kadar vitamin D serum dan derajat keparahan UKD (p<0,001, r=0,901). Pemeriksaan penyaring kadar vitamin D serum pada pasien UKD menunjukkan hasil yang rendah dan berkorelasi kuat dengan derajat keparahan UKD

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Diabetes mellitus can cause various disabilitating complications including diabetic foot ulcer (DFU). Vitamin D levels are known to be correlated with wound healing and insulin resistance. This cross-sectional study aimed to determine the correlation between serum level of vitamin D and the severity degree of DFU. Thirty DFU patients with normal ankle brachial index, grouped into degrees according to the Wagner classification, were included in this study. Their serum level of vitamin D were examined using the chemiluminescent immunoassay method. Correlation between these two variables was analyzed. Patients were 18 males (60%) and 12 females (40%) with an average age of 57 years. The average serum level of vitamin D was 10.58 ng/mL. Strong correlation was found between serum level of vitamin D and the severity of DFU (p<0.001, r=0.901). Serum level of vitamin D screening in DFU patients were low and were strongly correlated with the degree of DFU."

"Prevalensi penyakit kardiovaskuler (PKV) meningkat seiring dengan proses penuaan. Aterosklerosis yang menyebabkan terjadinya inflamasi dan diikuti peningkatan kadar C-reactive protein (CRP). Vitamin D merupakan vitamin yang memiliki efek antiinflamasi dan dapat menurunkan kadar hsCRP. Penelitian ini merupakan penelitian dengan desain potong lintang yang bertujuan untuk mengetahui korelasi antara kadar vitamin D dengan kadar hsCRP pada usia lanjut (usila). Penelitian dilakukan di Pusat Santunan Keluarga (Pusaka) 12 di Tomang dan Pusaka 39 di Senen pada pertengahan bulan Desember 2012 sampai bulan Januari 2013. Pengambilan subyek dilakukan dengan cara cluster random sampling, dan didapatkan 71 orang subyek yang memenuhi kriteria penelitian. Data dikumpulkan melalui wawancara meliputi data usia, asupan vitamin D dengan metode Food Frequency Questionnaire (FFQ) semikuantitatif serta total skor pajanan sinar matahari mingguan. Pengukuran antropometri untuk menilai status gizi dan pemeriksaan laboratorium yang meliputi kadar vitamin D dan hsCRP. Didapatkan median usia 69 (60-85) tahun dan 80,3% subyek adalah perempuan. Malnutrisi terdapat pada 71,8 % subyek. Asupan vitamin D menunjukkan 98,6% subyek memiliki asupan vitamin D kurang dari Angka Kecukupan Gizi (AKG) Indonesia. Sebanyak 97,2% subyek memiliki skor pajanan sinar matahari rendah. Nilai rerata kadar vitamin D 38,02±12,94 nmol/L dan 78% subyek tergolong defisiensi vitamin D. Nilai median kadar hsCRP 1,5 (0,1-49,6) mg/L, dan 67,6% subyek tergolong risiko PKV sedang dan tinggi. Didapatkan korelasi positif tidak bermakna antara kadar vitamin D serum dengan kadar hsCRP pada usila (r=0,168, p=0,162).

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The prevalence of cardiovascular disease (CVD) increases in the elderly. Atherosclerosis is a major cause of CVD which stimulate inflammation and followed by increase production of C-reactive protein (CRP). Vitamin D is a vitamin which has anti-inflammatory effects and may reduce level of hsCRP. The aim of this cross sectional study was to find the correlation between serum vitamin D level and hsCRP in elderly. Data collection was conducted during December 2012 to January 2013 on 2 selected Pusaka, Pusaka 12 (Tomang) and Pusaka 39 (Senen). Subjects were obtained using cluster random sampling method. A total of 71 elderly subjects had met the study criteria. Data were collected through interviews including age, vitamin D intake and weekly score of sunlight exposure. Anthropometry measurements to assess the nutritional status and laboratory examination i.e blood levels of vitamin D and hsCRP. Majority of the subjects were female (80,3%), median age was 69 (60-85) years. Malnutrition was occured in 71.8% of the subjects. Intake of vitamin D showed 98.6% of the subjects were less than recommended dietary allowances (RDA). Majority of the subjects had low score of sunlight exposure (97,2%). Mean of vitamin D levels 38,02±12,94 nmol/L, while 78% the of subjects were categorized as vitamin D deficiency. Median of hsCRP levels 1,5 (0,1-49,6) mg/L, while 67,6% subjects were at moderate and high risk of CVD. No significant correlation was found between serum vitamin D levels and hsCRP levels (r=0,168, p=0,162)."

"Respiratory Distress Syndrome (RDS), Feeding Intolerance (FI), dan sepsis merupakan morbiditas yang sering dialami bayi prematur. Salah satu faktor yang memengaruhi morbiditas adalah defisiensi vitamin D. Kadar vitamin D berkorelasi dengan sel Treg pada penyakit inflamasi bayi baru lahir. Sel Treg berperan dalam keseimbangan mikrobiota di usus. Tujuan penelitian ini untuk mengetahui peran vitamin D dengan kejadian RDS, FI, dan sepsis pada bayi sangat prematur dan/atau BBLSR melalui jalur sel Treg dan disbiosis usus. Design penelitian ini adalah kohort prospektif pada bayi sangat prematur dan/atau BBLSR, dilakukan bulan November 2019–Januari 2021 di Unit Neonatal RSCM. Pemeriksaan kadar vitamin D ibu dan bayi menggunakan metode CLIA dan Treg dengan flow cytometry menggunakan Treg detection kit CD4+CD127lowCD25+. Penilaian mikrobiota dengan Real Time PCR dan enteropati dengan Alpha-1 Antitrypsin. Pada penelitian ini didapatkan sebesar 88,3 % ibu defisiensi vitamin D (rerata 12,23 ± 5,07 ng/mL) dan 53% bayi defisiensi vitamin D (rerata 15,79  6,9 ng/mL). Didapatkan korelasi antara kadar vitamin D ibu dan bayi (r = 0,76, p < 0,001). Kadar vitamin ibu dan bayi tidak berhubungan dengan dengan kejadian RDS, FI, dan sepsis. Terdapat hubungan bermakna antara disregulasi sel Treg dengan kejadian FI (p = 0,04) dan sepsis (p = 0,03). Semua bayi mengalami disbiosis. Tidak didapatkan perbedaan komposisi mikrobiota pada RDS, FI, dan sepsis. Terdapat hubungan bermakna antara enteropati dengan kejadian sepsis (p = 0,02). Simpulan : Ibu defisiensi vitamin D akan melahirkan bayi defisiensi vitamin D. Kadar vitamin D tidak berpengaruh terhadap kejadian RDS, FI, dan sepsis. Pada bayi dengan disregulasi sel Treg, kejadian FI dan sepsis lebih tinggi dibandingkan yang tidak. Bayi dengan kondisi disbiosis tidak berbeda untuk terjadinya RDS, FI, dan sepsis. Kondisi enteropati menyebabkan kejadian sepsis lebih tinggi.

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Respiratory distress syndrome, feeding intolerance, and sepsis are the most common morbidities found in premature babies. One of the factors affecting morbidity is vitamin D level. Vitamin D level is correlated with the role of Treg cells in inflammatory neonatal. Treg cells act in balancing microbiota in the intestines. This study aimed to determine the role of vitamin D in increasing the incidence of sepsis, feeding intolerance, and respiratory distress syndrome in very premature and/or very low birth weight babies through Treg cells and intestinal dysbiosis. This is a cohort study conducted on very premature (< 32 weeks) and/or very low birth weight (birth weight < 1,500 g) babies, from November 2019–January 2021 in the Neonatal Unit of RSCM. Vitamin D levels of the mothers and babies were measured using the CLIA and Treg methods with flow cytometry using the Treg detection kit CD4+CD127lowCD25+. Treg was tested from umbilical cords blood. The fecal examination was conducted to determine intestinal bacteria using realtime PCR and Alpha-1 Antitrypsin. Most mothers (88.3%) had vitamin D deficiency with a mean value of 12.33 ± 5.07 ng/mL. The vitamin D level of the umbilical cord was 15.79 ± 6.9 ng/mL. There was a significant correlation between the vitamin D level of mothers and babies (r = 0.76, p < 0.001). There were no difference between maternal and babies vitamin D serum levels with incidence of RDS, FI, and sepsis.There were a significant correlation between Treg cell dysregulation and the incidence of FI (p = 0.04) and sepsis (p = 0.03) but not in RDS. All subjects experienced dysbiosis. There was a significant correlation between enteropathy and the incidence of sepsis (p = 0.02) but not in RDS and FI. Conclusion: Mothers with vitamin D deficiency will give birth to babies with vitamin D deficiency. There were no correlation between vitamin D and the incidence of RDS, FI, and sepsis. In babies with Treg cell dysregulation, the incidence of feeding intolerance and sepsis will be higher. The composition of the microbiota did not affect the incidence of RDS, FI, sepsis. In babies with enteropathy, the incidence of sepsis will be higher."