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Abstrak :
Latar belakang : Seiring dengan semakin efektifnya terapi Antiretroviral (ARV) pasien HIV memiliki harapan hidup lebih lama, morbiditas dan mortalitas penyakit HIV yang tidak berhubungan dengan Acquired Immunodeficiency Syndrome semakin meningkat. Non-alcoholic Fatty Liver Disease (NAFLD) telah dikenali sebagai penyakit hati tersering yang mempengaruhi lebih dari seperempat jumlah populasi global dan jumlahnya semakin meningkat di Indonesia. Pasien yang terinfeksi HIV memiliki risiko lebih tinggi untuk terkena NAFLD. Penelitian ini bertujuan untuk mendapatkan informasi tentang prevalensi dan faktor yang berhubungan dengan NAFLD pada pasien HIV dalam pengobatan antiretroviral (ARV) tanpa hepatitis viral kronis. Metode: Penelitian ini merupakan studi potong lintang yang melibatkan pasien HIV dalam pengobatan ARV tanpa koinfeksi virus hepatitis yang berobat di poliklinik Kelompok Studi Khusus (POKDISUS) Rumah Sakit Cipto Mangunkusumo Jakarta. NAFLD didefinisikan sebagai perlemakan di jaringan hati yang dibuktikan oleh pemeriksaan imaging transient elastography dengan Controlled Attenuation Parameter (CAP) setidaknya 238 dB/m. Perkiraan faktor-faktor yang berhubungan dengan NAFLD dianalisis dengan regresi logistik bivariat dan multivariat. Hasil: Pada penelitian ini secara keseluruhan didapatkan 105 subyek pasien HIV yang direkrut secara konsekutif. Prevalensi NAFLD didapatkan 52,4% (95% CI ±9,55). Faktor-faktor yang berhubungan dengan NAFLD pada populasi ini adalah hipertensi (PR = 3,755; 95% CI 1,218-11,575; p = 0,021) dan Index Massa Tubuh (IMT) (PR = 1,212 95% CI 1,051-1,396; p = 0,008). Faktor terkait HIV seperti CD4+ nadir, lama mendapat terapi ARV didapatkan tidak terkait NAFLD. Kesimpulan: Prevalensi NAFLD pada pasien HIV di Indonesia tinggi. NAFLD didapatkan berkaitan dengan hipertensi dan IMT, namun tidak dengan faktor-faktor terkait HIV. Penapisan non invasif untuk NAFLD sebaiknya diimplementasikan pada populasi ini untuk intervensi awal dan pencegahan komplikasi. ......Background: As HIV-infected persons experience longer life expectancies, other cause of morbidity and mortality among this group are increasingly being identified. Non-alcoholic fatty liver disease (NAFLD) has been recognized as the most common liver disease affecting more than a quarter of global population and increasing number in Indonesia. HIV-infected persons are at an increased risk of having NAFLD. This study aimed to inform prevalence and factors associated with NAFLD in HIV-infected patients without chronic viral hepatitis on antiretroviral therapy (ARV). Methods: A cross sectional study of HIV-infected person on ARV without hepatitis co-infection was done in HIV Integrated Clinic Cipto Mangunkusumo Hospital, Jakarta. NAFLD was defined as having at least 238 dB/m in transient elastography with associated Controlled Attenuation Parameter (CAP) examination. Bivariate and multivariate logistic regression analysis were applied to estimate factors associated with NAFLD Results: A total of 105 consecutive HIV infected person were included in the study analyzed. The prevalence of NAFLD was 52.4% (95% CI ±9.55). Factors related to NAFLD in this population were hypertension (PR = 3.755; 95% CI 1.218-11.575; p = 0.021) and Body Mass Index (BMI) (PR = 1.212 95% CI 1.051-1.396; p = 0.008). HIV specific variables such as nadir CD4, duration of ARV were not associated with NAFLD. Conclusion : There was a high prevalence of NAFLD among Indonesian person infected with HIV. NAFLD was associated with BMI and hypertension, but not with HIV related factors. Non-invasive screening for NAFLD should be implemented in this populaton to establish early intervention and prevent complication

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ABSTRAK
Aim: to know the effectiveness of probiotic in reducing hepatic inflammation among non-alcoholic fatty liver disease (NAFLD) patients. Methods: we performed literature searching regarding the potential role of probiotic in reducing hepatic inflammation among NAFLD patients. Results: six articles were finally critically appraised. All six studies had good validity and importance. These studies unanimously reported that probiotic is useful in reducing hepatic inflammation, and liver fat content. However, further evidence is needed to show whether or not probiotic is beneficial reducing cirrhosis progression and liver-related mortality. Conclusion: probiotic owns robust potential to treat NAFLD. Probiotic reduce hepatic inflammation, as shown by the reduction of liver aminotransferase, and inflammatory markers. Based on this evidence based report, probiotic is a promising adjunct therapy for NAFLD.

Abstrak :
Background: the risk of Non Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis. Methods: the study was conducted using a cross sectional method in type 2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fishers Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis. Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296 2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117 5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001). Conclusion: prevalence of NAFLD among type 2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD.

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ABSTRACT
Background: non alcoholic fatty liver disease (NAFLD) is known to be associated with some metabolic disorders. Recent studies suggested the role of uric acid in NAFLD through oxidative stress and inflammatory process. This study is aimed to evaluate the association between serum uric acid and NAFLD. Methods: a systematic literature review was conducted using Pubmed and Cochrane library. The quality of all studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). All data were analyzed using REVIEW MANAGER 5.3. Results: eleven studies from America and Asia involving 100,275 subjects were included. The pooled adjusted OR for NAFLD was 1.92 (95% CI: 1.66-2.23; p<0.00001). Subgroup analyses were done based on study design, gender, non-diabetic subjects, non-obese subjects. All subgroup analyses showed statistically significant adjusted OR and most of which having low to moderate heterogeneity. Two studies revealed relationship between increased serum uric acid levels and severity of NAFLD. No publication bias was observed. Conclusion: our study demonstrated association between serum uric acid level and NAFLD. This finding brings a new insight of uric acid in clinical practice. Increased in serum uric acid levels might serve as a trigger for physician to screen for NAFLD.

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ABSTRACT
Background: hypothyroidism is a common concomitant disease of non-alcoholic fatty liver disease (NAFLD). Previous studies regarding the relationship between subclinical hypothyroidism and NAFLD showed conflicting results, ranging from a strong association to not significant one. This case report aimed to investigate the risk of developing NAFLD in subclinical hypothyroidism patients. Methods: literature searching used ScienceDirect, PubMed, ProQuest, and Scopus. Filtering process of titles and abstracts by using inclusion and exclusion criteria yielded 4 eligible articles (1 systematic review, 1 prospective cohort, 1 retrospective cohort, and 1 case-control study) for answering the clinical question. Critical appraisal was conducted by using worksheets from Centre for Evidence-Based Medicine, University of Oxford. Results: the systematic review was considered invalid due to its less comprehensive search for relevant studies, inappropriate article selection to find a causal relationship between diseases, and statistical heterogeneity. The retrospective cohort was decided unimportant because it possessed a relative risk of 0.85 (95% confidence interval [CI], 0.72--1.00) which the upper limit of its CI included 1.00. The rest were valid and had important risk relative and odds ratio (1.27 [95% CI, 1.09--1.47], 3.41 [95% CI, 1.16--9.98]; respectively). The number needed to harm (5 - 17) indicated the clinically meaningful harm of the exposure since only a few patients with subclinical hypothyroidism is needed to obtain one additional NAFLD incidence. Those two articles were also suitable to be applied in our case. Conclusion: patients with subclinical hypothyroidism, compared to euthyroid patients, are at higher risk of developing NAFLD.

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Latar Belakang : Disbiosis mikrobiota usus dianggap berperan pada progresifitas NAFLD. Penelitian mengenai mikrobiota usus pada pasien NAFLD masih sedikit dan menunjukkan hasil yang berbeda. Tujuan : Mengetahui profil mikrobiota usus pada pasien NAFLD dengan derajat fibrosis hati. Metode : Penelitian menggunakan desain potong lintang, dengan menggunakan sampel pasien NAFLD di Rumah Sakit Cipto Mangunkusumo, periode waktu Maret – Juli 2018. Pemeriksaan sampel feses secara konsekutif dilakukan dengan menggunakan alat isolasi DNA (Tiangen) dan quantitative real-time polymerase chain reaction (Fast 7500) untuk menghitung jumlah mikrobiota dinyatakan dalam copy number DNA/gram feses (Bacteroides, Lactobacillus and Bifidobacteria). Sedangkan pemeriksaan fibrosis hati dengan menggunakan alat transient elastography (FibroScan® 502 Touch). Analisis statistik dilakukan menggunakan analisis bivariat dengan menggunakan uji chi-square. Hasil : Dari 60 pasien NAFLD, didapatkan 35 pasien dengan fibrosis non signifikan dan 25 pasien dengan fibrosis signifikan. Kebanyakan pasien merupakan penderita diabetes melitus (85%), dislipidemia (58,3%), obesitas (58,3%), dan obesitas sentral (90%). Didapatkan jumlah Bacteroides (483.000 kopi unit DNA/gram feses) paling banyak dibandingkan dengan Lactobacillus (100.800 kopi unit DNA/gram feses) dan Bifidobacteria  (12.110 kopi unit DNA/gram feses). Dari ketiga mikrobiota tersebut terdapat peningkatan bermakna proporsi Bacteroides pada kelompok fibrosis signifikan (81%) dibandingkan dengan fibrosis non signifikan (19%). Begitupula dengan Lactobacillus yang jumlahnya lebih banyak pada fibrosis signifikan. Sedangkan pada Bifidobacteria, proporsi pada fibrosis signifikan lebih rendah dibandingkan fibrosis non signifikan. Simpulan : Terdapat perubahan komposisi mikrobiota usus pada pasien NAFLD. Proporsi Bacteroides juga meningkat pada kelompok fibrosis signifikan. ......Background: Dysbiosis of the gut microbiota has been considered to have a role in NAFLD progression. However, there is still lack of studies regarding this phenomenon. Aim of the study: To find the difference of gut microbiota profile in NAFLD patient based on the stages of liver fibrosis. Patients and Methods: A cross sectional study was conducted at Dr. Cipto Mangunkusumo Hospital which is the largest tertiary refferal center hepatobiliary outpatient’s clinic. Human fecal samples from NAFLD patients who came to outpatient clinic were collected consecutively. The stool sample examination was performed using isolation DNA kit (Tiangen) and quantitative real-time polymerase chain reaction (Fast 7500) was used to measure total bacterial counts (Bacteroides, Lactobacillus and Bifidobacteria). Clinical and laboratory data, Food Frequency Questionare (FFQ) were also collected. The stage of fibrosis were diagnosed based on transient elastography (FibroScan® 502 Touch). Statistical analysis including bivariate analysis were performed using SPSS version 20. Results: Of 60 human fecal samples, there are 35 patients had non significant fibrosis and 25 patients had significant fibrosis and consist of 46.7% male and 53.3% female with the median age is 56 years old. Most patient have diabetes (85%) dyslipidemia (58.3%), obesity (58.3%), and central obesity (90%).  The Bacteroides count (483000) was higher when compared to Lactobacillus (100800) and Bifidobacteria (12110). Of these three microbiota, the proportion of Bacteroides was higher in significant fibrosis group when compared to non significant fibrosis group. Patient with significant fibrosis was also has a higher proportion of Lactobacillus compared to non significant fibrosis group (7000 vs 2050). In contrast, the proportion of Bifidobacteria was lower in significant fibrosis group (22) when compared to non significant fibrosis group (95). Conclusion: There is a dysbiosis of gut microbiota in NAFLD patients. Bacteroides as a gram-negative microbiota that produces LPS is significantly increased with fibrosis stage, that may play a role in NAFLD progression.

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Obesitas merupakan masalah utama pada kesehatan masyarakat dunia yang diketahui juga sebagai salah satu faktor risiko penyakit perlemakan hati non alkoholik(NAFLD). Sistem penilaian untuk mendeteksi NAFLD telah dikembangkan dan divalidasi di Indonesia. Namun, pola makan orang obesitas yang mungkin memberikan pengaruh terhadap NAFLD masih belum diketahui. Penelitian ini mengevaluasi asupan sukrosa pada obesitas dewasa di Jakarta dan hubungannya dengan skor NAFLD. Ini adalah studi potong lintang berbasis komunitas di antara orang dewasa dengan indeks massa tubuh (BMI)>25 kg/m2 antara September dan Oktober 2018 di Jakarta, Indonesia. Asupan sukrosa dinilai menggunakan food recal l2x24 jam, dihitung berdasarkan tabel komposisi makanan Indonesia dan Amerika dengan menggunakan Nutrisurvey 2007.Skor NAFLD terdiri dari enam faktor risiko, yaitu BMI>25 kg/m2, jenis kelamin laki-laki, usia>35 tahun, trigliserida>150 mg/dL, kadar kolesterol lipoprotein kepadatan tinggi<40 mg/dL untuk pria atau <50 mg/dL untuk wanita, dan kadar alanin aminotrans feraseserum >35 U/L. Dari 102 subjek yang terdaftar, 75 orang(73,5%) adalah wanita. Median dari total skor NAFLD adalah 6,7 dengan rentang dari 3,6 hingga 10,2. Median asupan karbohidrat total adalah 179,6 (54,1-476,8) g/hari, dan median total asupan sukrosa adalah 47,0 (13,7-220,5) g/hari. Asupan sukrosa lebih tinggi signifikan pada responden dengan skor NAFLD >6,7 dibandingkan <6,7. (47,8 vs. 45,3 g; p=0,042; Mann-Whitney U test). Analisis multivariat mengonfirmasi adanya hubungan asupan sukrosa dan skor tinggi perlemakan hati non alkoholik. Kesimpulan: Asupan sukrosa tidak memiliki hubungan bermakna dengan skor NAFLD pada penyandang obesitas dewasa, namun bermakna jika dikaitkan dengan skor tinggi perlemakan hati non alkoholik. Dibutuhkan penelitian lebih lanjut untuk pengembangan variabel tambahan pada skor NAFLD. ......Obesity is a major problem in a world public health which is also known as one of the risk factors of non-alcoholic fatty liver disease (NAFLD). An assessment system for detecting NAFLD has been developed and validated in Indonesia. However, the diet pattern of obese people who might have an effect on NALFD is still unknown. This study evaluated sucrose intake among obese adults in Jakarta and ints association with NAFLD score. This was a community-based cross sectional study among adults with body mass index (BMI) >25 kg/m2 between September and Oktober 2018 in Jakarta, Indonesia. Sucrose intake was assessed using 2x24-hour food recall, calculated based on the Indonesian and American food composition tables using dietary software Nutrisurvey. The NAFLD score consists of six risk factors, i.e. BMI >25 kg/m2, male sex, age >35 years, triglycerides >150 mg/dL, high density lipoprotein cholesterol levels <40 mg/dL for men or <50 mg/dL for women, and serum alanine aminotransferase levels >35 U/L. A total of 102 subjects were recruited; 75 (73.5%) of them were women. The median of total NAFLD scores was 6.7, ranging from 3.6 to 10.2. Median total carbohydrate intake was 179.6 (54.1-476.8) g/day, while the median total sucrose intake was 47.0 (13.7-220.5) g/day. Sucrose intake was significantly higher in patients with NAFLD score >6.7 than <6.7 (47.8 vs. 45.3 g; p=0.042; Mann-Whitney U test). Multivariate analysis confirmed the association of sucrose intake and higher total NAFLD score. Conclusions: Sucrose intake and NAFLD score have no significant association among obese adults. Further research is needed to develop additional variables on NAFLD score.