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"Tujuan: Mengetahui pengaruh pemberian nutrisi enteral dini (NED) terhadap stres metabolisme pada penderita luka bakar, dalam rangka mencari alternafif penatalaksanaan nutrisi pada penderita luka bakar. Tempat: Unit Luka Bakar RSUPN Cipto Mangunkusumo. Bahan dan cara: Penelitian ini merupakan uji klinik pada penderita luka bakar berusia 18 - 60 tahun dengan luka bakar derajat dua seluas 20 - 60% luas permukaan tubuh (LPT). Sepuluh subyek perlakuan diberi Nutrisi Enteral Dini/NED mulai ≤8 jam pasca trauma, sedangkan 10 subyek kontrol diberi nutsisi enteral/oral 24 jam pasca trauma. Stres metabolisme dideteksi dengan pemeriksaan kadar hormon kortisol serum, glukosa darah dan nitrogen urea urin (NUU). Sampel darah untuk pemeriksaan kortisol dan glukosa diambil pada hari ke 1, 7 dan 12. Urin untuk pemeriksaan NUU di kumpulkan selama 24 jam pada hari ke 3, 7 dan 12. Uji statistik yang digunakan adalah uji Mann Whitney U untuk kadar kortisol, NUU dan glukosa darah. Batas kemaknaan yang digunakan 0,05. Hasil: Hasil penelitian menunjukkan tidak terdapat perbedaan bermakna pada kadar kotisol dan NUU, namun demikian pada hari ke 12 tampak penurunan kadar NUU lebih tajam pada kelompok perlakuan. Pada kelompok kontrol justru meningkat Kadar glukosa darah pada hari 12 menunjukkan perbedaan bermakna (p = 0, 04). Kesimpulan: Pemberian NED berhasil menekan stres metabolisme yang terjadi pada penderita luka bakar derajat dua berdasarkan parameter glukosa darah.

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Objective: To investigate the effect of early enteral nutrition (EEN) on the metabolic stress in burned patients, in respect to looking for the alternative of nutrition management in burned patients.

Place: Burn Unit RSUPN Cipto Mangunkusumo.

Materials and methods: This study was randomized clinical trial was conducted on 18 - 60 years subjects with 20 - 60% total body surface area (FBSA) of second degree burned. Ten subjects were given enteral nutrition started g 8 hours post burn, while 10 control subjects were given enteral/oral nutrition 24 hours post burn. Metabolic stress was detected by measuring of serum cortisol, blood glucose level, and urinary urea nitrogen (UUN) level. Blood samples for cortisol and glucose level were taken on day 1, 7 and 12 Twenty four hours collected urine for UUN level were taken on day 3, 7 and 12. Statistical analysis was performed with Mann Whitney U test for cortisol level, NUU and glucose level. The level of significance was 0, 05.

Results: There were no significant differences between the two groups based on serum cortisol and UUN levels, however, the level o UUN of the day 12 decreased in the study group, while it increased in the control group. A significant difference was found of blood glucose between these two groups (p = 0, 04) on day 12.

Conclusion: The administration of EEN reduced the metabolic stress of second degree burned patients express by blood glucose parameter."

"Latar belakang. Obesitas merupakan masalah kesehatan masyarakat dunia dengan prevalensi yang semakin meningkat. Obesitas meningkatan risiko sindrom metabolik dan penyakit kardiovaskular, yang diyakini akibat inflamasi dan stres oksidatif. Penurunan berat badan (BB) dengan cara diet dan olahraga merupakan strategi dasar dalam manajemen obesitas. Penyandang obesitas seringkali mengalami peningkatan dan penurunan BB yang dikenal sebagai weight cycling (WC). Penelitian menunjukkan risiko sindrom metabolik dan penyakit kardiovaskular meningkat pada WC dibandingkan dengan penyandang obesitas pemula [first encounter obesity (FEO)]. Penelitian ini bertujuan untuk menilai pengaruh program penurunan BB terhadap komposisi tubuh, petanda sindrom metabolik, petanda inflamasi dan stres oksidatif pada penyandang obesitas WC dibandingkan dengan FEO.Metode. Penelitian ini merupakan uji klinis terbuka selama delapan minggu yang dilakukan di Balai Kota DKI Jakarta. Subyek penelitian diambil secara konsekutif dan diklasifikasikan menjadi kelompok WC dan FEO. Kedua kelompok diberikan program penurunan BB yang terdiri dari pengurangan asupan energi sebesar 1000 kkal/hari dan olah raga intensitas ringan - sedang tiga kali seminggu selama 45 menit. Pengukuran antropometri dan komposisi tubuh (BB, indeks massa tubuh/IMT, massa lemak/ML, massa bebas lemak/MBL, massa otot/MO, rating lemak viseral, intracellular water /ICW yang merupakan indikator anabolisme protein ), petanda sindrom metabolik (kadar trigliserida/TG dan LP), petanda inflamasi (high sensitivity C-reactive protein/hs-CRP, interleukin/IL-6), dan stres oksidatif (F2-isoprostan) dilakukan pada awal penelitian, minggu ke-4 dan pada akhir penelitian (minggu ke-8).Hasil. Dari total 73 subyek (34 subyek kelompok WC dan 39 subyek kelompok FEO) didapatkan karakteristik yang setara dalam hal usia, riwayat obesitas pada keluarga, asupan makanan, proporsi komposisi makronutrien, dan aktivitas fisik, namun tidak terdapat kesetaraan dalam hal distribusi subyek laki-laki dan perempuan, riwayat lamanya obes. Kelompok WC memiliki ML yang lebih tinggi , MBL, MO dan ICW yang lebih rendah, serta petanda inflamasi yang lebih buruk dibanding kelompok FEO, sebaliknya kelompok FEO memiliki kadar TG, F2-isoprostan lebih tinggi daripada WC. Setelah intervensi diet dan olah raga selama 8 minggu, penurunan BB, IMT, ML, MBL, MO, rating lemak viseral dan kadar ICW pada kelompok WC cenderung lebih rendah daripada kelompok FEO (p >0,05). Penurunan LP pada kelompok WC cenderung lebih rendah daripada kelompok FEO (p = 0,23). Kadar TG pada kelompok WC meningkat, sedangkan pada kelompok FEO terjadi penurunan kadar TG, namun perbedaannya tidak bermakna (p = 0,055). Penurunan kadar hs-CRP dan IL-6 pada kelompok WC cenderung lebih besar daripada FEO (p >0,05). Penurunan kadar F2-isoprostan lebih tinggi pada kelompok FEO daripada kelompok WC (p = 0,017).Kesimpulan: Penyandang obesitas WC memiliki ML yang lebih tinggi dari FEO, disamping itu memiliki anabolisme protein yang lebih rendah, oleh karena itu program diet dan olahraga pada WC harus mempertimbangkan modalitas yang mampu meningkatkan anabolisme protein.Penyandang WC memiliki petanda inflamasi yang lebih buruk dibanding FEO, sedangkan setelah menjalani program diet dan olahraga selama 8 minggu pada penelitian ini tidak didapatkan perbedaan perubahan BB, komposisi tubuh, petanda sindrom metabolik, dan petanda inflamasi, kecuali perubahan petanda stres oksidatif yang lebih baik pada penyandang FEO.

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Background. The worldwide prevalance obesity is increasing rapidly and has become serious health burden globally. Obesity increases risks of metabolic syndrome and cardiovascular diseases which may partly caused by inflammation and oxidative stress. Effective weight loss programs include diet and exercise,and these interventions are considered as first line strategy of obesity management. Obese individuals often experience repeated cycles of weight loss followed by weight regain, which is recognized as weight cycling (WC). Several studies demonstrated that weight cycler has higher risk of metabolic syndrome and cardiovascular diseases than individuals with first encounter obesity (FEO). This study aimed to assess the effect of weight loss programs using diet and exercise on body composition, selected markers of metabolic syndrome, inflammation, and oxidative stress in obese subjects with WC and FEO.

Methods.This study was an 8-week open clinical trial held at Balai Kota DKI Jakarta. Subjects were recruited consecutively and classified into WC and FEO groups. All subjects were assigned to receive weight loss programs with the following goals: 1,000 Kcal reduction of total energy intake/day and 45-minute mild-to-moderate intensity exercise, three times a week. Antropometric and body composition (body weight/BW, body mass index/BMI, fat mass, fat free mass, muscle mass, visceral fat rating, intracellular water/ICW as indicator of protein anabolism), markers of metabolic syndrome (triglyceride/TG levels and waist circumference), inflammation (high sensitivity C-reactive protein/hs-CRP, interleukin/IL-6), and oxidative stress(F2-isoprostane)were measured at baseline, week 4, and the end of study (week 8).

Results. A total of 73 subjects consisting of 34 subjects with WC (WC group) and 39 subjects with FEO (FEO group). Both groups had similar characteristics in age, family history of obesity, dietary intakes, macronutrient composition, and physical activities; meanwhile, gender and duration of obesity were significantly different between groups. WC group had more body fat, less fat free mass, muscle mass and ICW, higher markers of inflammation than FEO group. On the other hand, TG and F2-isoprostane levels in FEO group were higher than WC group. Following 8-week intervention with diet and exercise, the reduction in BW, BMI, fat free mass, muscle mass, visceral fat rating, and ICW in WC group was comparable with FEO group (p>0.05). The reduction of waist circumference in WC group tended to be lower than FEO group (p = 0.23). Triglyceride levels in WC group increased, but it declined in FEO group. However, these differences were not statistically significant(p= 0.055). The decline in hs-CRP and IL-6 levels in WC group tended to be higher than FEO group (p>0.05). Meanwhile, the decrease in F2-isoprostane levels in FEO group was significantly higher than WC group (p=0.017).

Conclusion.Obese subjects with WC had more body fat but lower protein anabolic capacity than those with FEO. These results suggest that diet and exercise program for weight cycler should consider effective ways to enhance protein anabolism.In addition, obese subjects with WC had higher inflammatory process than those with FEO.Using the current model of 8-week intervention with diet and exercise, this study was not able to demonstrate differences between WC and FEO groupsin the magnitude of changes in body composition and inflammation indicators, except oxidative stress indicator."