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"ABSTRAKModernisasi kota-kota besar di Indonesia terutama Jakarta meningkatkan jumlahperempuan bekerja dengan pcrubahan terhadap gaya hidup terutama dalam jumlahdan komposisi asupan makanan. Hal tersebut bila disertai dengan mulaimeourunnya honnon estrogen pada perempuan di awal masa klimakterlum,dikhawatirkan telah teljadi perubahan profil lipid dan distribusi lemak. Tujuanpcnalitian ini adalah diketahuinya asupan total energi dan asupan makronutrienserta profit lipid karyawati di awal rna.- klimakterium yaitu usia 35-45 tahun,serta hubungannya dengan ukuran lingkar pinggang. Stodi ini adalah studi potonglingtang yang dilakukan di Poliklinik Departemen Kebudayaan dan Pariwisata RJ.Sebanyak 66 orang karyawati menandatangani lembar persetujuan menjadisubyek pcnelitian, dengan 52 orang (78,8%) subyek menyelesaikan studi ini.Pengumpulan data ditakukan dengan wawancara, pcngukuran antropometri danpcaitaian asupan makanan menggunakan merode food record 3x24 jam.Dilakukan juga pemeriksaan tahoratorium untuk mengukur kadar kolesterol LDL,HDL dan trigliserida serum. Rerata ulruran lingkar pinggang subyek adalah 84,8 ±9,42 em dengao sebagian besar subyek (67,3%) tennasuk dalarn kategori lebih.Rerata asupan total energi subyek penelitian adalah 1571 ± 303,2 kkal, dengansebagian besar subyek tennasuk dalarn kategori cukup jika dibandingkan dengankebutoba energi total. Rerata asupan makronutrien untuk karbohidrat adalah 213,7± 40,73 gr (54,7 ± 6,24 o/oE), sera! 11,2 ± 4,52 gr, protein 54,0 ± 13,25 gr (13,7 ±1,89 %E), lemak 56,0 ± 17,76 gr (31,6 ± 5,62 %E), SAFA 25,8 ± 8,84 gr (14,6 ±3,44 %E), MUFA 14,1 ± 5,07 gr (8,0 ± 2,02 %E), PUFA 12,3 ± 5,85 gr (6,9 ±2,84 %E) dan kotesterol 242,2 ± 118,36 mg per hari. Berdesarkan aujuran asupanoleh PERKENI, asupan kaibohidrat, protein, MUF A dan PUF A sebagian besarsubyek dikategorlkan cukup. Sementara asupan lemak, SAP A dan kotesterolsebagian besar subyek dikategorikan lebih dan asupan serat kurang. Kadarkolesterol LDL, HDL dan trigliserida subyek berturut-turut adalah 126,3 ± 29,71m8fdL, 58,2 ± 9,46 mg/dL dan 84,7 ± 35,81 mg/dL. Kadar ko1esterol LDL dantrigliserida serum sebagian besar subyek dalam kategori normal. Kader kolesterolHDL serum seluruh subyek dahun kategori normal. Tidak terdapat hubunganbermakna antara jumlah asupan energi total dan masing-masing makronutrienterhadap ukuran lingkar pinggang. Namun terdepat korelasi derajat lemak antara kadar trigliserida serum dan ukuran lingkar pinggang.

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AbstractModernization on some major cities in Indonesia specially Jakarta bas raised thenumber of working women from year to year, and alter their !!restyle includingtheir total nutrition intake and macronutrient composition. Accompanied withdecreasing estrogen level in early climacteric women, there was big concern thatthere had been alteration on lipid profile and fat distribution among these women.The aim of the study was to evaluate daily intake of total energy, macronutrientsand lipid profile among healthy female government employee on earlyclimacteric phase (aged 35-45 years), and their association with waistcircumference. This cross sectional study took place in Cultural and TourismDepartment of Republic Indonesia. Sixty six women have provided consent,while 52 subjects (78.8%) have completed the study. Data collection wereconducted from interviews, anthropometric measurements and dietary assessmentusing 3 x 24 hours food record. Serum triglyceride, LDL, HDL cholesterol levelwere assessed as well. Mean value of waist circumference was 84.8 ± 9.42 em,and categorized as high, as well as on the majority of subjects (67.3 %).Meanvalue and standard deviation of to!al energy intake was 1571 ± 303,2 kcal, andcategorized as moderate. The mean intake value of carbohydrate was 213,7 ±40,73 g (54,7 ± 6,24 %E), fiber 11,2 ± 4.52 gr, protein 54.0 ± 13.25 g (13.7 ± 1.89%E), fut 56.0 ± 17.76 g (3L6 ± 5.62 %E), SAFA 25.8 ± 8.84 gr (14.6 ± 3.44%E), MUFA 14.1 ± 5.o7 gr (8.0 ± 2.02 %E), PUFA 12.3 ± 5.85 gr (6.9 ± 2.M%E) and cholesterol 242.2 ± 118.36 mg!day. Based on PER.KENIrecommendation for macronutrient intake, majority of subject's intake ofcarbohydrate, protein, MUFA and PUF A were categorized as moderate, the intakeof daily fat, SAFA and cholesterol were high, and all subject's intake of fiber waslow. Subject's serum LDL and HDL cholesterol level were 126.3 ± 29.71 mg/dLand 58.2 ± 9.46 mg/dL respectively, while serum triglyceride level was 84.7 ±35.81 mg!dL. Majority of subject's lipid profile categorized as normal. Nosignificant associations were found among total energy as well as macronutrientswith waist circumference. Nevertheless, there was weak significant associationbetween triglyceride serum level and waist circumference."

"Komplikasi ulkus diabetikum pedis (UDP) terjadi pada 15% pasien DM tipe 2. Seluruh kasus UDP dalam serial kasus ini diawali oleh trauma pedis sehingga menyebabkan luka yang tidak menyembuh disertai demam, kelemahan tubuh, mual, anoreksia, dengan atau tanpa disertai gejala klasik DM. Suatu uji klnis mendapatkan sebanyak 69% penderita DM dengan komplikasi UDP menderita malnutrisi. Tata laksana nutrisi pada serial kasus ini adalah pemberian nutrisi optimal, meliputi makronutrien, mikronutrien, dan nutrien spesifik sesuai kebutuhan untuk memperbaiki dan mencegah malnutrisi, komplikasi lainnya, dan kekambuhan serta mendukung penyembuhan ulkus.Rentang usia pasien pada serial kasus ini adalah 52–70 tahun. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict. Kebutuhan energi total didapat dari perkalian kebutuhan energi basal dengan faktor stres. Pemberian nutrisi dilakukan bertahap sesuai toleransi sampai mencapai kebutuhan total.Makronutrien diberikan dengan komposisi sesuai dengan keadaan pasien.Pemberian protein sesuai dengan fungsi ginjal, pembatasan asam lemak jenuh dan kolesterol, karbohidrat terutama jenis kompleks, dan cukup serat.Garam diberikan sesuai tekanan darah.Diusulkan pemberian mikronutrien berupa vitamin dan mineral sesuai Angka Kecukupan Gizi (AKG) serta nutrien spesifik asam lemak omega-3.Pemantauan dilakukan terhadap perkembangan klinis, toleransi asupan makanan, kapasitas fungsional, status ulkus, laboratorium, dan antropometri.Seluruh pasien membutuhkan insulin dengan dosis yang terus meningkat untuk menjaga kadar glukosa darah dan mengalami penurunan berat badan, namun kebutuhan energi total dapat tercapai, luka membaik dan kapasitas fungsional meningkat. Tata laksana nutrisi yang diberikan harus bersifat individual disesuaikan dengan keadaan umum dan klinis pasien.Edukasi nutrisi selama dan pasca rawat penting diberikan dalam meningkatkan motivasi pasien menjalankan diet yang benar untuk menjaga status gizi. Status gizi dan kontrol glikemik yang baik penting dalam penyembuhan luka, mencegah kekambuhan dan timbulnya komplikasi diabetes melitus yang lain.

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Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals. All patients had pedal trauma as an initiation of their non-healing wounds which were then developed to form ulcers. The ulcers presented with febrile, lethargy, nausea, anorexia, with or without diabetes mellitus classical symptoms. A clinical trial found 69% patients of this disease were malnourished. The goal of medical nutrition therapy on type 2 diabetes mellitus with diabetic foot ulcer is to provide the patients with appropriate nutrition containing macronutrient, micronutrient, and specific nutrient according to the requirement, to reverese and prevent malnutrition, other complications and recurrence, and support the wound healing.

Patient’s age range in this case series was 52–70 years old. Basal energy requirements calculated using Harris-Benedict equation and multiplyit by stress factor for the total energy requirements. Diets were gradually given according patient’s tolerance until total energy requirements were achieved.Macronutrients composition were given according to patient’s condition, with protein adjusted to renal function, limiting saturated fat and cholesterol, complex carbohydrate, sufficient fiber and sodium given according to blood pressure. Micronutrient recommendation was vitamin and mineral sejumlah as much as Recommended Dietary Allowance (RDA) and omega-3 fatty acid. Monitoring was done at clinical status, nutrition intake and tolerance, functional capacity, wound/ulcer status, laboratory and anthropometric assessment.

All patients needed increasing dose of insulin in maintainingglucose control and experienced mild weight loss, total energy requirements were achieved by all patients. Patient’s functional capacities were increased, and had improvement wound status. Nutrition therapy for patients should be given individuallyaccording to general and clinical condition. Nutrition education and motivation during and after hospitalization are important part of this disease’s management to keep the patient’s compliance on nutrition intake as recommended to maintain good nutritional status and glycemic control, prevent other complications and re-ulceration."