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"Uji klinis acak tersamar ganda paralel ini merupakan penelitian pendahuluan, bertujuan mengetahui pengaruh suplementasi serat larut dan diet rendah kalori seimbang (DRKS) selama 4 minggu terhadap kadar kolesterol low-density lipoprotein (LDL) serum pada obes I usia 30−50 tahun. Sejumlah 31 subyek dipilih dengan kriteria tertentu dan dibagi menjadi dua kelompok dengan randomisasi blok, 15 orang kelompok perlakuan (KP) dan 16 orang kelompok kontrol (KK). Subyek KP mendapat serat larut psyllium husk (PH) 8,4 g/hari dan DRKS 1200 kkal/hari, sedangkan subyek KK mendapat plasebo dan DRKS 1200 kkal/hari. Data terdiri atas usia, indeks massa tubuh (IMT), asupan zat gizi, serta kadar kolesterol LDL serum. Pemeriksaan kolesterol LDL dilakukan pada awal dan akhir penelitian. Analisis data menggunakan uji t tidak berpasangan dan Mann-Whitney, batas kemaknaan 5%. Karakteristik data dasar dan sebaran subyek kedua kelompok sebanding. Analisis lengkap dilakukan pada 28 subyek (KP dan KK masing-masing 14 subyek). Suplementasi ditoleransi baik dan tidak ditemukan efek samping serius. Median usia subyek KP dan KK berturut-turut 35,0 (30−45) tahun dan 34,50 (30−48) tahun serta rerata IMT 28,0 ± 1,1 kg/m2 dan 27,2 ± 1,4 kg/m2. Rerata kadar kolesterol LDL serum awal KP 137,0 ± 37,0 mg/dL dan KK 134,4 ± 29,1 mg/dL. Defisit energi KP lebih rendah tidak signifikan (p = 0,62) dibandingkan KK, berturut-turut -282,0 ± 482,6 kkal/hari dan -331,8 ± 578,3 kkal/hari. Persentase asupan energi terhadap anjuran KP (94,2 ± 18,5%) lebih tinggi signifikan (p = 0,02) daripada KK (85,4 ± 22,9%). Asupan karbohidrat (KH) total KP (613,1 ± 134,5 kkal/hari) lebih tinggi signifikan (p = 0,02) dibandingkan KK (545,4 ± 161,1 kkal/hari). Asupan protein, lemak total, dan kolesterol KP dan KK sesuai rekomendasi NCEP-ATP III. Pada kedua kelompok, asupan asam lemak jenuh cenderung tinggi, tetapi asupan asam lemak tak jenuh tunggal dan jamak rendah. Asupan serat subyek KP 17,2 ± 2,8 g/hari dan KK 8,6 (5,2−15,2) g/hari. Dengan suplementasi PH tidak tercapai rekomendasi asupan serat. Persentase asupan KH sederhana terhadap energi total KP 11,5±5,4% lebih tinggi signifikan (p = 0,00) dibandingkan KK 6,0 (1,2524,2)%. Penurunan kadar kolesterol LDL serum KP -2,1 ± 16,2 mg/dL lebih sedikit tidak signifikan (p = 0,15) dibandingkan pada KK -10,9 ± 15,3 mg/dL. Penelitian ini belum dapat membuktikan suplementasi PH 8,4 g/hari dan DRKS 1200 kkal/hari selama 4 minggu lebih baik dalam menurunkan kadar kolesterol LDL serum dibandingkan plasebo pada subyek obes I.

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This parallel double blind randomized clinical trial is a preliminary study that aims to investigate the effect of soluble fiber supplementation 8.4 g/day and lowcalorie balanced diet (LCBD) for 4 weeks on serum low-density lipoprotein (LDL) cholesterol level in obese I, aged 30−50 years old. A total of 31 subjects were selected using certain criteria and randomly allocated to one of two groups using block randomization; 15 subjects for treatment (T) group and 16 subjects for control (C) group, respectively. The T group received psyllium husk (PH) 8.4 g/day and LCBD 1200 kcal/day, and the C group received placebo and LCBD 1200 kcal/day. Data include age, body mass index (BMI), intake of energy, macronutrient, and fiber, as well as serum LDL cholesterol level. Serum LDL cholesterol level was examined before and after treatment. Statistical analyses include independent t-test and Mann-Whitney with significance level of 5%. Subjects characteristics of the two groups at baseline was not statistically different. Twenty eight subjects (14 subjects in each group) completed the intervention. Supplementation was well tolerated and there were no serious adverse events. The mean age in T and C group was 35.0 (30.0−45.0) and 34.5 (30.0−48.0) years, respectively, and BMI was 28.0 ± 1.1 and 27.2 ± 1.4 kg/m2, respectively. The pretreatment serum LDL cholesterol level in T and C group was 137.0 ± 37.0 and 134.4 ± 29.1 mg/dL, respectively. Energy deficit in T group was insignificantly lower (p = 0.62) than in C group; -282.0 ± 482.6 and -331.8 ± 578.3 kcal/day, respectively. Percentage of energy intake to recommendation in T group (94.2 ± 18.5%) was significantly higher (p = 0.02) than that in C group (85.4 ± 22.9%). Total carbohydrate (CHO) intake in T group (613.1 ± 134.5 kcal/day) was significantly higher (p = 0.02) than in C group (545.4 ± 161.1 kcal/day). Total protein, fat, and cholesterol intake were similar to the NCEP-ATP III recommendation in both groups. Intake of SAFA was higher than recommended, meanwhile PUFA and MUFA intake were lower than those recommended in both groups. Dietary fiber intake in T and C group was 17.2 ± 2.8 and 8.6 (5.2−15.2) g/day, respectively. During the intervention, PH supplementation did not meet the recommendation. Percentage of simple CHO to total energy in T group 11.5±5.4% was significantly higher (p = 0.00) than in C group 6.0 (1.2524.2)%. PH supplementation decreased serum LDL cholesterol level (-2.1 ± 16.2 mg/dL) lower than placebo (-10.9 ± 15.3 mg/dL), but not significant different (p = 0.15). This study shows that PH supplementation 8.4 g/day in combination with LCBD 1200 kcal/day for 4 weeks in obese I aged 30−50 years old is not proven to decrease the serum LDL cholesterol level."

"Latar belakang: luka bakar berat dapat disertai dengan trauma inhalasi, yang akan memicu respons lokal dan sistemik, sehingga menyebabkan berbagai komplikasi, termasuk systemic inflammatory response syndrome (SIRS) dan sepsis. Berbagai kondisi ini menyebabkan hipermetabolime dan hiperkatabolisme, yang membutuhkan tatalaksana nutrisi adekuat untuk membantu proses penyembuhan pasien. Berbagai kelompok ahli telah memberikan rekomendasi tatalaksana nutrisi pada luka bakar berat dan sakit kritis. Namun, akibat keterbatasan sarana dan prasarana, tidak semua rekomendasi dapat dilaksanakan, sehingga tatalaksana nutrisi diberikan secara optimal. Metode: serial kasus ini terdiri atas empat pasien luka bakar berat, yang disebabkan oleh api, dan disertai trauma inhalasi, yang menyebabkan berbagai komplikasi, sepsis, multiple organ dysfunction syndrome (MODS) dan multiple organ failure (MOF). Tatalaksana nutrisi diberikan secara bertahap sesuai dengan keadaan pasien. Pemberian nutrisi diawali dengan nutrisi enteral dini (NED) dalam waktu 2448 jam setelah luka bakar, sebesar 10 kkal/kg BB, menggunakan drip intermiten. Selanjutnya, nutrisi diberikan sebesar 2025 kkal/kg BB pada fase akut dan 2530 kkal/kg BB/hari pada fase anabolik. Setelah pasien keluar dari intensive care unit (ICU), target kebutuhan energi menggunakan persamaan Xie, dengan protein 1,52,0 g/kg BB/hari, lemak 2530%, dan karbohidrat (KH) 5565%. Mikronutrien diberikan berupa multivitamin antioksidan, vitamin B, asam folat, dan vitamin D. Pasien dalam serial kasus ini juga mendapatkan nutrisi spesifik glutamin sebesar 0,3 g/kg BB/hari, selama 510 hari. Hasil: tiga pasien mengalami perbaikan klinis, kapasitas fungsional, dan laboratorium. Pasien selamat dan dipulangkan untuk rawat jalan. Masa rawat pasien yang selamat berturut-turut 33 hari, 70 hari, dan 43 hari. Seorang pasien mengalami perburukan dan MOF, hingga meninggal dunia setelah dirawat selama 23 hari di ICU. Kesimpulan: tatalaksana nutrisi optimal dapat menunjang penyembuhan luka serta menurunkan angka morbiditas dan mortalitas pasien luka bakar berat dengan trauma inhalasi dan sepsis.

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;Background: severe burn trauma combined with inhalation injury initiates local and systemic response, resulting in various complications such as systemic inflammatory response syndrome (SIRS) and sepsis. These conditions stimulate hypercatabolic process, leading to the increase of nutrition requirement. Adequate nutritional support is necessary in order to control both inflammatory and metabolic response, and also to improve healing process. To date, nutritional recommendations specific for severe burn trauma and critical illness have been established. However, many problems including patient?s condition and lack of resources exist, so optimal nutritional support that fits our settings was delivered. Method: this serial case focused on four severely burned patients caused by flame. Subjects with inhalation trauma and complications such as sepsis, multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF) were included in this study. Nutritional support was delivered according to clinical conditions, patient?s tolerance, and laboratory findings. Early enteral nutrition was initiated within 2448 hours post burns, starting from 10 kcal/kg BW/day with intermittent gravity drip method. Nutrition was gradually increased in order to reach the target of energy for critically ill patients, which is 2025 kcal/kg BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie Equation was used to calculate target of total energy for burned patient. Protein requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were 2530% and 5565% from calorie intake, respectively. Micronutrient supplementation including antioxidants, vitamin B, folic acid, and vitamin D was also provided. Glutamin as specific nutrient was delivered by 0.3 g/kg BW/day in 510 days. Results: improvement of clinical condition, functional capacity, and laboratory parameters was observed in three patients, who could be discharged from hospital and asked to come back for outpatient care. Their lengths of stay were 33 days, 70 days, and 43 days, respectively. However, one patient experienced worsening of condition and died after 22 days of care in Intensive Care Unit (ICU). Conclusions: optimal nutritional support for severely burned patients with inhalation trauma and sepsis is necessary in order to improve healing process, as well as decrease morbidity and mortality."