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Abstrak :
Homeostasis protein berperan penting dalam memperlambat proses malnutrisi dan dalam mempertahankan massa bebas lemak pasien kanker. Kehilangan signifikan massa bebas lemak terutama massa otot skelet akan mengurangi mobilitas fisik, kapasitas fungsional, dan skor kualitas hidup pasien kanker. Penelitian ini merupakan studi potong lintang yang bertujuan untuk mengetahui korelasi antara asupan protein dengan massa bebas lemak dan kapasitas fungsional pada pasien kanker paru di poli onkologi RS Persahabatan Jakarta. Didapatkan 52 subjek laki-laki dengan rerata usia 55,63 6,77 tahun. Jenis dan stadium kanker yang terbanyak ditemukan adalah adenokarsinoma 63,5, stadium IV 65,4. Status nutrisi kurang berdasarkan IMT ditemui pada 21,2 subjek, dan berdasarkan kadar albumin serum didapatkan 30,8 subjek dengan hipoalbuminemia. Lebih dari 50 subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Pada pemeriksaan komposisi tubuh didapatkan rerata massa bebas lemak 47,20 6,28 kg, dengan 48,1 indeks massa bebas lemak rendah, massa otot rerata 44,74 5,98 kg dengan 40,4 massa otot tergolong kurang. Nilai kapasitas fungsional skala Karnofsky. ......The homeostasis of protein plays an important role in decreasing the process of malnutrition and in maintaining fat free mass in cancer patients. The significant loss of fat free mass, especially skeletal muscle mass could decrease physical activity, functional capacity, and quality of life of cancer patients. This was a cross sectional study aimed to investigate the correlation of protein intake, fat free mass and functional capacity in lung cancer patients in the Oncology Unit of Persahabatan Hospital Jakarta. Obtained 52 male subjects with a mean age of 55,63 6,77 years old. The most cancers type were adenocarcinoma 63,5 and most of subjects were at stage IV 65,4 . Nutritional status of the subjects 21,2 were in undernutrition based on body mass index parameter, and 30,8 of the subjects were in hypoalbuminemia. More than 50 of the subjects had low energy and protein intake. The mean of fat free mass was at 47,20 6,28 kg, that 48,1 of fat free mass index were in low categorized, and 40,4 of muscle mass were also in small categorized, that the mean was at 44,74 5,98 kg. Functional capacity Karnofsky scale of the subjects 26,9 showed less than 70. The data showed that the subjects had nutrition problems. This study showed positive and significant correlations between protein intake with fat free mass index r 0,379, p

Abstrak :
Latar Belakang: Luka bakar berat dengan komorbid diabetes melitus (DM) secara teoritis dapat mengalami fenomena second hit, rentan terhadap peningkatan respon hipermetabolisme karena efek gabungan luka bakar akut dan patofisiologi DM. Implikasi gabungan efek tersebut meningkatkan morbiditas mortalitas, sehingga dibutuhkan tatalaksana nutrisi adekuat untuk melawan respon hipermetabolik dan hiperkatabolik, yang diharapkan memengaruhi perbaikan kontrol glukosa darah. Metode: Serial kasus ini terdiri atas empat pasien luka bakar berat karena api dengan DM tipe 2 yang dirawat di ICU luka bakar. Tatalaksana nutrisi diberikan dengan nutrisi enteral dini dalam waktu 24 jam pertama, secara bertahap diberikan sesuai kondisi klinis dan toleransi asupan, dengan target kebutuhan energi awal 20-25 kkal/kg BB/hari, protein 1,5-2 g/kg BB/hari, lemak 25-30%, dan karbohidrat 55-60%. Hasil: Pemberian nutrisi pada keempat pasien dapat membantu mempertahankan kadar glukosa darah tidak mengalami peningkatan fluktuasi tajam. Interupsi pemberian nutrisi yang disebabkan berbagai kondisi klinis dan tindakan, menyebabkan target energi dan protein harian sulit tercapai pada keempat pasien. Komplikasi sepsis dan syok sepsis terjadi sehingga pada akhirnya keempat pasien meninggal. Kesimpulan: Luka bakar berat, pengendalian infeksi, obesitas, komorbid DM, variabilitas glikemik, serta tatalaksana nutrisi yang tidak adekuat, dapat meningkatkan morbiditas mortalitas pada pasien ini, karenanya masih menjadi tantangan tim terapi medik gizi.

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Background: Severe burns with comorbid diabetes mellitus (DM) can theoretically experience a second hit phenomenon, susceptible to increased hypermetabolic response due to the combined effect of acute burns and DM pathophysiology. The combined implications of these effects increase mortality morbidity, so that adequate management of nutrition is needed to counteract the hypermetabolic and hypercatabolic responses, which are expected to influence improvement in blood glucose control. Method: The cases series consist of four patients with severe burns due to fire with type 2 DM, treated in ICU burns. Nutritional management is given with early enteral nutrition in the first 24 hours, gradually given according to clinical conditions and intake tolerance, with a target of initial energy requirements of 20-25 kcal/kg body weight/day, protein 1.5-2 g/kg body weight/day, 25-30% fat, and carbohydrates 55-60%. Results: Nutrition therapy to all four patients can help maintain blood glucose levels not experiencing sharp fluctuations. Nutritional interruption caused by various clinical conditions and actions, causes daily energy and protein targets difficult to achieve in all four patients. Complications of sepsis and sepsis shock occur and eventually all four patients die. Conclusions: Severe burns, infection control, obesity, comorbid DM, glycemic variability, and inadequate nutritional management, can increase mortality morbidity in these patients, therefore it remains a challenge for the nutritional medical therapy team.