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"Tujuan: Mengetahui pengaruh penurunan berat badan terhadap kadar asam urat plasma dan urin subjek dengan berat badan lebih.Tempat: Sebuah pusat kebugaran di Kelapa Gading, Jakarta UtaraMetodologi: Dilakukan penelitian pada 26 perempuan peserta program penurunan berat badan (BB) yang bersedia mengikuti penelitian ini. Penelitian ini merupakan eksperimen kuasi pra dan pasca perlakuan tanpa pembanding. Tiap subjek mendapat diet rendah kalori seimbang dan olahraga aerobik selama 12 minggu. Diet rendah kalori seimbang diberikan berdasarkan pengurangan kalori sebesar 1000 kkal/hari.Dengan perhitungan keluaran energi selama olahraga aerobik yang diprogramkan berkisar antara 200-400 kkal/hari, diet yang diberikan kira-kira 800-1100 kkal/hari. Sebelum diberikan olahraga aerobik dilakukan tes Cooper untuk menilai kemampuan maksimal tiap subjek dalam berolahraga. Olahraga aerobik diberikan dengan intensitas 60-80% kemampuan maksimal, lama latihan 60 merit; dan frekuensi 5 kali seminggu Pemeriksaan antropometri dan kadar asam urat dilakukan pada awal, minggu ke 2, dan akhir perlakuan.Hasil Terjadi penurunan BB secara signifikan (p<0,05; uji t berpasangan) dan 74,30 ± 10,48 kg menjadi 65,31 ± 8,56 kg (penurunan 12,10%); penurunan indeks massa tubuh (IMT) secara signifikan (p<0,05) dari 29,79 ± 4,28 menjadi 26,19 ± 3,41 kglm2 (pemmman 12,08%); dan penurunan massa lemak (ML) secara signifikan (p<0,05) Bari 36,21 ± 2,80 menjadi 25,97 ±2,94% (penurunan 28,28%). Pada minggu ke 2 terjadi peningkatan kadar asam urat plasma dan urin, masing-masing dari 5,40 ± 1,29 menjadi 5,96 ± 1,44 mg/dL (peningkatan 10,37%) dan dari 542,23 ± 179,39 menjadi 583,15 ± 202,35 mg/dL (peningkatan 7,55%). Setelah perlakuan 12 minim' terjadi penurunan kadar asam urat plasma dan urin yang signifikan (p<0,05) masing-masing dari 5,40 ± 1,29 menjadi 4,39 t 1,21 mg/dL (penurunan 18,70%) dan dari 542,23 ± 179,39 menjadi 479,06 ± 134,73 rng/dL (pemurumn 11,60%). Penurunan berat badan mempunyai korelasi lemah dengan penurunan kadar asam urat plasma (r = 0,32) dan penurunan kadar asam urat urin (r = 0,33) namun tidak signifikan (p >0,05). Dengan uji multivariat didapat korelasi positif atas peningkatan kadar asam urat plasma minggu ke 2 dengan BB awal. Penurunan kadar asam urat plasma pada akhir penelitian mempunyai korelasi positif dengan person ML akhir perlakuan. Penurunan kadar asam carat urin akhir perlakuan berkorelasi positif dengan asupan protein awal, serta berkorelasi negatif dengan clearance asam urat swat.Kesimpulan: Pada proses penurunan berat badan dengan diet rendah kalori seimbang dan olahraga aerobik, kadar asam urat plasma dan urin mula-mula akan meningkat, kemudian menurun mencapai kadar yang lebih rendah daripada kadar awal.

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Effects of Weight Reduction by Balanced Low-Calorie Diet (LCD) and Aerobic Exercise on Plasma and Urinary Uric Acid Levels of Overweight WomenObjective: To investigate the effects of weight reduction on plasma and urinary uric acid levels of overweight subjects

Place: One fitness centre at Ketapa Gading, North Jakarta

Methods: Twenty six overweight women were studied in a pre and posttest, using control group as the same subjects as the treatment group. Subjects received a balanced LCD and aerobic exercise for 12 weeks. Balanced LCD was given based on energy deficit 1000 kcal/day. Energy expenditure from aerobic exercise was 200 to 400 kcal and the subject were given diet of 800-1100 kcallday. All subjects had to undergo Cooper test for designing the aerobic exercise program. The intensity of the aerobic exercise was 60-80% of maximum capacity with duration of 60 minutes 5 days a week Anthropometric measurements and plasma and urinary uric acid were examined at the beginning, second week and after the treatment

Results: Balanced LCD and aerobic exercise given for 12 week significantly (p<0.05; paired t test) decreased body weight (BW), body mass index (BM), and fat mass from 74.30 ± 10.48 kg to 65.31 ± 8.56 kg (decreased 12.10%), from 29.79 ± 4.28 to 26.1.9 ± 3.41 kg/m2 (12.08%), and from 36.21 ± 2.80 to 25.97 ± 2.94% (28.28%) respectively. In the second week, plasma and urinary uric acid levels increased from 5.40 ± 129 to 5.96 ± 1.44 mg/dL (10.7%) and from 542.23 ± 179.39 to 583.15 ± 202.35 mg/dL (7.55%). After 12 weeks of treatment, plasma and urinary uric acid levels decreased significantly (p<0,05) from 5.40 ± L29 to 4.39 ± 1.21 mg/dL (18.70%), and from 542.23 ± 179.39 to 479.06 ± 134.73 mg/dL (11.60%) respectively. There was a weak correlation between weight reduction and plasma (r = 0.32) and urinary uric acid levels (r = 0.33), but not significant (p X0.05). With multivariate analysis, there was a positive correlation between increased plasma uric acid level with BW before treatment There was a positive correlation between decreased of plasma uric acid after treatment with fat mass after treaatment (%). There was a positive correlation between decreased after treatment urinary uric acid level and before treatment protein intake, and had a negative correlation with before treatment uric acid clearance.

Conclusions: In the process of weight reduction with balance LCD and aerobic exercise, plasma and urinary uric acid levels increased in the second week, and decreased to the levels lower than the base line at the end of treatment."

"Tujuan : Mengetahui keadaan metabolisme penderita obesitas setelah menjalani diet rendah kalori seimbang selama 14 hari, dengan mengukur resting energy expenditure (REE) dan kadar T3 serumTempat : Rumah Sakit Sumber Waras, Jakarta BaratMetodologi: Dilakukan penelitian pada 37 orang perempuan obes yang memenuhi kriteria penerimaan dan penolakan serta bersedia mengikuti penelitian ini. Penelitian ini merupakan studi quasi eksperimental pra dan pasca perlakuan. Setiap subjek menjalani diet rendah kalori seimbang 1000 kkal selama 14 hari. Pemeriksaan antropometri, REE dan kadar T3 serum dilakukan pada awal, hari ke 7 dan akhir perlakuan. REE diukur dengan kalorimetri tak langsung (REE ukur) dan dihitung dengan menggunakan persamaan Harris-Benedict (REE hitung).Hasil: Pada akhir perlakuan terjadi penurunan yang bermakna (p <0,05) pada berat badan, massa lemak, massa bebas lemak, REE ukur dan REE hitung masing-masing dari 71,22±8,63 kg menjadi 69,15±8,37 kg (penurunan 2,9%), dari 35,32J2,58% menjadi 33,94,58% (penurunan 1,38%), dari 45,96±4,89 kg menjadi 45,544,82 kg (penurunan 0,92%), dari 1815,0822,37 kkal menjadi 1718,97±269,50 kkal (penurunan 5,29%) dan dari 1428,07+84,02 kkal menjadi 1408,25 1,52 kkal (penurunan 1,39%). Penurunan kadar T3 serum yang bermakna terjadi pada hari ke 7 (p = 0,001), dari 0,9005±0,1530 ng/mL menjadi 0,836210,1611 mg/mL (penurunan 7,1%). Pada akhir penelitian, dibandingkan dengan hari ke 7, terjadi pertingkatan T3 yang tidak beramakna. Pada hari ke 7 terdapat korelasi positif bermakna (r = 0,349; p = 0,034) antara perubahan REE ukur dengan perubahan T3. Pada hari ke 15 terdapat korelasi positif bermakna (r = 0,401; p = 0,014) antara perubahan REE ukur dengan perubahan massa bebas lemak. Perubahan T3 pada hari ke 7 mempunyai korelasi positif bermakna (r = 0,385; p = 0,019) dengan perubahan berat badan pada minggu pertama dan dengan perubahan massa bebas lemak pada minggu pertama (r = 0,345; p = 0,036). Pads penurunan berat badan sebesar 2,9% terdapat penurunan REE ukur dan REE hitung masing-masing 5,29% dan 1,39%. Rata-rata REE ukur lebih besar 27% daripada REE hitung.Kesimpulan : Setelah terjadi penurunan berat badan dengan diet rendah kalori seimbang, penderita obesitas berada dalam kondisi hipometabolisme yang ditandai dengan penurunan RFE ukur, REE hitung dan kadar T3 serum.

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Objective: to determine the metabolic state of obese females after treatment with balanced low-calorie diet for 14 days by measuring resting energy expenditure (REE) and serum T3 level as indicators.

Location : Sumber Waras hospital , West Jakarta

Methods : The study was carried out on 37 obese females who have been recruited based on inclusion and exclusion criteria. This study is a quasi experimental study with a pre and posttest treatment design. Every subject received a balanced low-calorie diet (LCD) of 1000 kcal/day for 14 days. Antropometric measwrements, REE and serum T3 levels were examined at the beginning, at day 7 and at the end of study. REE were measured and calculated by indirect calorimetry (measured-REE) and using Harris-Benedict equation (calculated-REE) respectively.

Result : Balanced LCD given for 14 days significantly (p <0.05) decreased body weight (BW) , fat mass, fat free mass, measured-REE and calculated-REE from 71.22±8.63 kg to 69.15±8.37 kg (decreased 2,9%), from 35.32.58% to 33.94±2.58% (1,38%), from 45.96±4.89 kg to 45.54±4.82 kg (0,92%), from 1815.0822.37 kcal to 1718.97±269.50 kcal (5,29%), and from 1428,.7±84.02 kcal to 1408.25±81.52 kcal (1,39%) respectively. There was a significant decrease (p = 0.001) in serum T3 leveI at day 7 from 0.9005±0.1530 ng/mL to 0.836210.1611 nglmL (decrease 7,1%). At the end of the study, serum T3 levels increased not significantly compared to day 7. At day 7, there was a significant positive correlation (r = 0.349; p = 0.034) between the change in measured-REE and the change in serum T3 levels. At day 15, a significant positive correlation (r = 0.401; p = 0.014) was found between the change in measured-REE and the change in fat free mass. The changed of serum T3 levels at day 7 had significant positive correlation (r = 0,385; p = 0,019) with the changed of BW in the first week. The changed of serum T3 levels at day 7 had significant positive correlation (r = 0,345; p = 0,036) with the changed of fat free mass in the first week. After reduction of BW by 2.9%, there was a decrease of measured-REE and calculated-REE, 5.29% and 1.39%, respectively. The measured-REE was 27% higher than calculated-REE.

Conclusion : Weight-reduced obese subjects with balanced LCD were in hypometabolic state indicated by a reduction in measured and calculated-REE, and serum T3 levels."

"Tujuan: Mengetahui pengaruh suplementasi vitamin B12 400 µg/hari selama enam minggu terhadap kadar vitamin B12 dan homosistein serum pada adventis vegan dewasa. Tempat: Gereja Masehi Advent Hari Ketujuh, Jakarta Barat. Metadologi: Penelitian pro dan pasca perlakuan pada 27 orang subjek, berusia 20-60 tahun. Setiap subjek mengkonsumsi suplemen vitamin B12 400 µg/hari dosis tunggal selama 42 hari. Data yang dikumpulkan meliputi data demografi, antropometri pra dan pasca perlakuan, asupan nutrisi (energi, karbohidrat, protein, dan lemak) dengan metode recall 1 x 24 jam dua kali seminggu pra, pertengahan dan pasca perlakuan. Data asupan vitamin B6, B12 dan asam folat dengan FFQ semi kuantitatif serta data laboratorium meliputi kadar vitamin B12, asam folat, dan homosistein serum pra dan pasta perlakuan. Hasil: Data demografi menunjukkan sebagian besar (81,5%) subjek berpendidikan tinggi dan semua subjek berpenghasilan di atas garis kemiskinan. Data antropometri pada pra dan pasca perlakuan menunjukkan seluruh subjek mempunyai IMT dalam batas normal. Asupan nutrisi selama perlakuan yang meliputi asupan energi, karbohidrat, lemak dan protein tidak mengalami perubahan. Bila dibandingkan dengan AKG tahun 1988 asupan energi, sebagian besar subjek termasuk cukup, asupan karbohidrat, dan protein termasuk kurang; asupan lemak termasuk lebih, Asupan vitamin B6 pada akhir perlakuan tidak menunjukkan penurunan secara signifikan (p=0,6874), sebaliknya dengan asupan vitamin B12 yang menunjukkan peningkatan signifikan (p = 0,021) dan asam folat yang menunjukkan penurunan signifikan (p = 0,0001). Hasil pemeriksaan laboratoriurn pada akhir perlakuan menunjukkan peningkatan signifikan pada kadar vitamin B12 (p = 0,0000) sebesar 202,6%, dari median 127 (58,0-193,0) pg/mL menjadi 376 (183,0-1168,0) pg/mL dan penurunan kadar homosistein yang signifikan (p = 0,0000) sebesar 39% dari median 14,50 (11,1-34,2) } µmol/L menjadi 9,50 (5,6-24,8) µmol/L. Kadar asam folat tidak mengalami penurunan bermakna (p = 0,2960). Kesimpulan: Suplementasi vitamin B12 sebanyak 400 µg/hari selama 42 hari pada vegan terbukti meningkatkan kadar vitamin B12 dan menununkan kadar homosistein.

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The Effect Of Vitamin B12 Supplementation On Homocysteine Level Of Adult VegansObjective: To investigate the effect of 400 µg /day vitamin B12 supplementation for 42 days on serum vitamin B12, and homocysteine levels of 27 adult vegan subjects.

Location: Seventh Day Adventists Church, West Jakarta.

Method: A pre and post test design study was carried out on 27 subjects, aged 20-60 years, who fulfilled the criteria of the selection. Subjects were given 400 µg/day vitamin B12 single dose supplementation for 42 consecutive days. Data collected were demographic, anthropometric, nutritional, and laboratory. The data of energy, carbohydrate, protein, and fat intake were collected using 1 x 24 recall method twice a week at the beginning, within, and the end of the study; whilst vitamin B6, B12 and folk acid intake were obtained with FF0 semi-quantitative method at the beginning and the end of the study. Laboratory data were collected before and after study including serum vitamin B12, folk acid and homocysteine

Results: Demographic data showed that most of the subjects had high formal education level (81.5%) and all subjects had income above the poverty line. Anthropometric data showed that BMI at the beginning and in the end of the study were in normal range. Dietary intake estimation including energy, carbohydrate, protein, and fat, were not significantly changed. Compared to Indonesian RDA 1998, intake of energy was considered adequate, carbohydrate and protein were low, and fat was high. Vitamin B6 intake did not decrease significantly (p = 0.6874) However vitamin B12 intake increased (p = 0.021) and folic acid intake decreased significantly (p = 0.0001). Median value of serum vitamin B12 after supplementation increased significantly (p = 0,0000) by 202.6% from 127 (58.0-193.0) pg/mL to 376 (183.0-1168.0) pg/mL. There was no significant difference in the serum level of folic acid (p = 0.2960). Median value of homocysteine after supplementation decreased significantly (p = 0.0000) by 39% from 14.50 (3.8-34.2) man, to 9.50 (5.6-24.8) µmol/L.

Conclusion: Supplementation of single dose 400 µg vitamin B12 for 42 consecutive days on adult vegan subjects was proven to elevate the level of serum vitamin B12 and decrease the level of homocysteine."

"Tujuan: Menentukan hubungan pengetahuan dan status gizi di kalangan tahun pra-klinis mahasiswa kedokteran dan hubungan antara indeks massa tubuh dan tahun ajaran. Metode: Data dikumpulkan dengan menggunakan kuesioner yang dilakukan antara Mei 2012 hingga Juni 2012 di Kampus Salemba, Fakultas Kedokteran, Universitas Indonesia. Sampel dari penelitian ini adalah dengan menggunakan siswa tahun pra-klinis kelas Internasional Fakultas Kedokteran. Untuk mengukur pengetahuan siswa penelitian ini menggunakan kuesioner yang terdiri dari pengetahuan medis dasar nutrisi dan cara untuk mengatasi atau mencegah data overnutrition.The penelitian ini akan dianalisis dengan menggunakan komputer dengan SPSS 18 program. Tes yang digunakan untuk menganalisis data adalah uji nonparametrik untuk perbandingan kelompok yaitu Chi-square test. Tes lain yang juga digunakan adalah spearman dan uji D Somer itu. Terlebih dahulu data diuji menggunakan KS dan uji shapirowilk untuk homogenitas data. Hasil: Ada hubungan yang lemah tingkat pengetahuan dengan kategori BMI (p = 0,059). BMI cenderung meningkat ketika tingkat pengetahuan cenderung meningkat tapi hampir tidak ada kecenderungan BMI baik untuk meningkatkan atau menurun ketika tingkat pengetahuan meningkat (p = 0,109). Ada hubungan yang sangat lemah tahun batch dengan BMI kategori (p = 0,198). BMI cenderung meningkat saat tahun bets cenderung meningkat. Tapi hampir tidak ada kecenderungan BMI untuk baik kenaikan atau penurunan setiap tahun batch (p = 0,201). Kesimpulan: Tidak ada hubungan antara tingkat pengetahuan dan tubuh kategori indeks massa pada siswa sekolah kedokteran dan juga tidak ada hubungan antara indeks massa tubuh dan tahun batch.

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Aims: Determining the relationship of knowledge and nutrition status among pre-clinical years medical student and relationship between body mass index and batch year.

Methods: The data was collected using a questionnaire that was done between May 2012 to June 2012 at Salemba Campus, Faculty of Medicine, University of Indonesia. The sample from this study is using the pre-clinical years International class students of the Faculty of Medicine. To measure the knowledge of the students this research used questionnaire which comprised of basic medical knowledge of nutrition and ways to overcome or prevent overnutrition.The data of this study will be analyzed using computer with SPSS 18 program. The test used to analyse the data is nonparametric test for group comparison, which is Chi-square test. Another test that also used are spearman test and Somer's D test. Beforehand the data is tested using KS and shapirowilk test for homogeneity of the data.

Results: There's a weak relation of knowledge level with BMI category (p=0,059). BMI tend to increase when knowledge level tend to increase but almost no tendency for BMI to either increase or decrease when knowledge level is increased (p=0,109). There's a very weak relation of batch year with BMI category (p=0,198). BMI tend to increase when batch year tend to increase. But almost no tendency for BMI to either increase or decrease in every batch year (p=0,201).

Conclusion: There's no relation between knowledge level and body mass index category in medical school student and also there is no relation between body mass index and batch year."

"Metode: Data - data didapatkan menggunakan kuesioner frekuensi makan yang dilakukan pada bulan Mei 2012 hingga Juni 2012 di kampus salemba, fakultas kedokteran Universitas Indonesia. Sampel dari studi ini menggunakan data dari mahasiswa kelas internasional tingkat pre klinik, dan sebelumnya didapatkan persetujuan dari masing-masing mahasiwa. Pengukuran yang dilakukan dalam mengukur status gizi adalah Body Mass Index untuk Asia. Data yang didapat di analisa menggunakan program SPSS 11,5 untuk program Windows. Tes Chi-square digunakan untuk menganalisa data. Tes lain yang juga digunakan adalah Spearman dan Sommers'D. Hasil: Dengan total 100 mahasiswa, diantaranya adalah 57 siswa laki-laki (57%), dan 43 siswa perempuan (43%). Dari total populasi hanya 4% dari mereka yang tergolong obesitas, hampir 40% dari mereka tergolong dalam batas normal, dan dengan jumlah yang lebih besar yaitu hampir 50% dari populasi memiliki status gizi kurang dari normal. 8 jenis sumber nutrisi (karbohidrat, protein hewani, protein nabati, lemak, susu, sayuran, buah dan lain-lain) dikategorikan dalam 3 frekuensi yaitu kurang, cukup, dan berlebih. Kategori Sayuran, lain-lain, susu, dan protein nabati memiliki hubungan dengan status gizi (Body Mass Index), dengan p-value diurutkan 0,004; 0,001; 0,001; dan 0,000. Dimana karbohidrat, protein hewani, lemak, dan buah-buahan tidak memiliki hub ungan dengan status gizi (body mass index) Kesimpulan: pola asupan makanan berhubungan dengan status gizi di dalam mahasiswa pre klinik kedokteran. Body Mass Index cenderung meninggi pada mahasiwa yang lebih sering makan. Dimana tidak ada hubungan antara tingkat kuliah mahasiswa dengan obesitas di dalam mahasiwa kedokteran.

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Methods: The data was collected using a food frequency questionnaire that was carried out between May 2012 to June 2012 at Salemba Campus, Faculty of Medicine University of Indonesia. The sample from this study is using the preclinical year’s International Class students of the Faculty of Medicine, and informed consent is filled beforehand. Measurement used in categorizing nutritional status is BMI (Body Mass Index) for Asia. The data was analyzed using computer with SPSS 11,5 for Windows software. Chi-square test was used to analyses the data. Other tests that also used are Spearman and Sommers’D.

Result: In total of 100 students, 57 males (57%) and 43 females (43%). In total population only 4% of them are having obesity, nearly 40% in normal weight range, whereas the bigger percentage by almost 50% have their weight lower than the normal range. 8 kind of source of nutrients (carbohydrate, animal peotein, vegetable protein, fat, milk, vegetable, fruits, and miscelenous) categorized into frequencies (less, good, excess). Vegetable, miscellaneous, milk, and vegetable protein have relation to body mass index, with p-value 0,004, 0,001, 0,001 and 0.000 respectively. Whereas carbohydrates, animal protein, fat and fruits do not have relation to body mass index.

Conclusion: Dietary Pattern is related to nutritional status among medical students. BMI has tendencies to increase as the frquency of the meal taken increse. Whereas there is no relation between the grade among medical students and the obesity among the medical studnets."

"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."

"Latar belakang: Prevalensi obesitas meningkat di seluruh bagian dunia, termasuk juga pada populasi mahasiswa kedokteran. Hal ini disebabkan oleh peningkatan pola diet yang tidak sehat dan kurangnya aktivitas fisik, yang dipengaruhi oleh pengetahuan seseorang.Tujuan: Penelitian ini bertujuan untuk mengetahui penyebaran pengetahuan tentang gizi dan obesitas di mahasiswa kedokteran. Serta pola makan, olahraga, dan praktek gizi pada mahasiswa dalam satu tahun terakhir. Penelitian ini akan menentukan apakah ada hubungan pengetahuan dengan perilaku gizi.Metode: Sebanyak 103 peserta mengisi kuesioner untuk penelitian cross-sectional yang dilakukan pada bulan Juni 2012. Mahasiswa kedokteran pra-klinis dari Kelas Internasional Fakultas Kedokteran Universitas Indonesia dinilai pengetahuan dan perilaku mereka yang berhubungan dengan gizi dan obesitas. Analisis deskriptif dilakukan pada semua data. Uji statistik chi-square dan Spearman’s rank dilakukan untuk menentukan hubungan.Hasil: 32,4% mahasiswa berada dalam kategori overweight (IMT≥23). Dalam penilaian mengetahuan, 14 (13,6%) mahasiswa mendapat nilai Kurang, 87 (84,5%) mendapat Cukup, dan 2 (1,9%) mendapat Baik. Dalam penilaian perilaku, 17 (16,5%) mendapat nilai Kurang, 79 (76,7%) mendapat Cukup, dan 7 (6,8%) mendapat skor Baik. Ada hubungan signifikan tetapi korelasi yang lemah antara pengetahuan dan praktek tentang gizi dan obesitas (rs= 0.262; p=0.008).Kesimpulan: Terdapat hubungan yang signifikan antara pengetahuan dengan perilaku tentang gizi dan obesitas pada mahasiswa pra-klinis Fakultas Kedokteran.

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Background: The prevalence of obesity is increasing in prevalence around the world and the medical students are also affected. The cause lies in increasing unhealthy diet and physical activity pattern that is influenced by the level of knowledge.

Aims: This study aims to know the dissemination of knowledge among medical students about nutrition and obesity, and their nutrition practice in the last one year. This study will determine whether there is a relation between knowledge and the student’s nutrition practice.

Methods: A cross-sectional study was carried out in Jakarta, Indonesia on June 2012, involving 103 pre-clinical medical students from the International Class of Medicine, Universitas Indonesia. Assessment of their knowledge and practice were done with questionnaires. Descriptive analyses were performed on all data and a chi-square and Spearman’s rank statistical test is conducted to determine relationship.

Result: 34,7% of students are overweight (BMI≥23). In the knowledge assessment, 14 (13,6%) students scored Poor, 87 (84,5%) scored Fair, and 2 (1.9%) scored Good. In the practice assessment, 17 (16,5%) scored Poor, 79 (76,7%) who scored Fair, and 7 (6.8%) who scored Good. There is a significant relationship but weak correlation between knowledge and practice (rs= 0.262; p=0.008).

Conclusion: There is a significant relationship between knowledge and practice about nutrition and obesity among pre-clinical medical students."

"Ketoasidosis diabetik (KAD) merupakan komplikasi akut dari diabetes melitus (DM) tak terkontrol, ditandai dengan hiperglikemia, ketosis, dan asidosis metabolik. Pemberian nutrisi sering menjadi masalah, namun menunda pemberian nutrisi dini menyebabkan peningkatan kadar keton darah dan morbiditas pasien. Tujuan penulisan serial kasus ini adalah memulihkan ketosidosis dan memenuhi kebutuhan makro- dan mikronutrien. Pasien berusia antara 18?65 tahun, mengalami KAD dengan DM, dirawat 5?12 hari di Rumah Sakit Umum Tangerang. Pencetus KAD adalah infeksi, ketidakpatuhan pengobatan, dan diet yang tidak tepat. Keempat orang pasien menderita DM dengan penyakit penyerta yang berbeda. Terapi nutrisi diberikan berdasarkan kondisi klinis pasien. Energi diberikan mulai dari kebutuhan basal yang dihitung dengan persamaan Harris-Benedict, atau dimulai dari 20?25 kkal/ kg BB pada kondisi sakit kritis. Makronutrien diberikan sesuai rekomendasi American Diabetes Association dan mikronutrien sesuai dengan kondisi dan kebutuhan pasien. Pemantauan yang dilakukan meliputi toleransi asupan, imbang cairan, antropometri, dan laboratorium (kadar glukosa darah, keton darah, dan elektrolit). Edukasi dan konsultasi nutrisi diberikan setiap hari. Selama pemantauan semua pasien menunjukkan perbaikan klinis dan penurunan kadar keton darah. Semua pasien dapat mencapai kebutuhan energi total dan kadar glukosa darah mendekati normal. Sebelum pulang pasien diberikan edukasi tentang cara mengetahui faktor yang dapat mencetuskan KAD dan mengatasinya, serta edukasi nutrisi untuk mencapai kontrol glikemik optimal dan mencegah KAD.

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Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes, characterized by hyperglycemia, ketosis, and metabolic acidosis. Nutrition intervention may often cause some problems, unfortunately, withholding early nutrition may increase blood ketones concentration and patient morbidity. Aims of this case series are resolve ketoacidosis dan meet macro and micronutrient requirement. Patients aged between 18 to 65 years old, presented DKA with diabetes mellitus, and hospitalized from 5 to 12 days at Tangerang General Hospital. Precipitating factors of DKA include infection, noncompliance to medication, and inproper diet. All patients suffered from DM with different comorbidities. Nutritional therapy was given according to patients clinical condition. The energy was given begin with basal requirement, which calculated using Harris-Benedict equation, or begin with 20?25 kcal/kg body weight (BW) in critically ill condition. Macronutrients were given according to American Diabetes Association recommendation and micronutrients based on patients? condition and requirement. Monitoring includes food intake tolerance, fluid balance, anthropometric, and laboratory results (blood glucose levels, blood ketone, and electrolytes). Education and nutrition consultation were given everyday. During monitoring all patients showed clinical improvements in general condition and blood ketone concentration?s reduction. All patients can meet total energy requirement with blood glucose levels close to normal. Before discharge, patients received education to identify and manage risk factors that may precipitate DKA. Nutrition education was also given to achieve optimal glycemic control and prevent DKA."

"[ABSTRAK Latar belakang: Intestinal failure (IF) merupakan masalah pascabedah denganoutcome yang buruk. Saat ini telah terdapat rekomendasi terapi gizi pada IFberdasarkan etiologinya, namun belum ada laporan serial kasus yang memaparkanaplikasinya.Presentasi Kasus: Pasien dalam serial kasus ini terdiri dari 3 perempuan dan 1laki-laki, berusia 21?42 tahun. Terhadap pasien ditegakkan diagnosis IF denganberbagai etiologi, yaitu 3 pasien dengan fistula enterokutan (FEK) dan 1 pasiendengan short bowel syndrome (SBS) end jejunostomy. Terapi gizi pada pasien IFberdasarkan etiologinya. Pada pasien FEK high output, kebutuhan energi 1,5?2kali resting energy requirement (RER) atau 37?45 kkal/kg BB/hari, protein 1,5?2g/kg BB/hari. Pada FEK low output kebutuhan energi 1?1,5 kali KEB (25?30kkal/kg BB/hari), protein 1?1,5 g/kg BB/hari. Pada pasien FEK yang mendapatterapi konservatif, didapat outcome peningkatan kadar albumin serum dan beratbadan, serta produksi fistel yang berkurang. Pasien FEK dengan persiapanrekonstruksi usus halus terdapat perbaikan keadaan umum dan peningkatan kadaralbumin serum. Pada pasien SBS, terkait kondisi pascabedah maka terapi gizisesuai rekomendasi Enhanced Recovery After Surgery (ERAS), dengankebutuhan energi 25?30 kkal/kg BB/hari dengan komposisi makronutrien yangseimbang. Pada pasien ini dilakukan distal feeding dan pengaturan laju tetesankimus untuk mencegah sindrom dumping. Pasien SBS didapat outcomepeningkatan kadar albumin dan berat badan selama masa perawatan. Kesimpulan: Terapi medik gizi klinik yang adekuat memberikan outcome yang baik pada pasien IF.ABSTRACT Background: Intestinal failure (IF) is a postoperative complication with poor

outcome. Nowadays, many of nutritional management recommendations based on

etiologies of IF, but no report about those application.

Case Presentation: Three female and one male patients were included in this case

series, aged 21?42 years old. Nutritional needs in IF patients are determined by

their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)

and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on

their fistula production. In patients with high output ECF, energy requirement is

in 1.5?2 resting energy requirement (RER) or 37?45 kcal/kg BW/day, protein

1,5?2 g/kg BW/day. In low output ECF, energy requirement is 1?1.5 RER or 25?

30 kcal/kg BW/day hari, protein 1?1.5 g/kg BW/day. In ECF patients given

conservative therapy, serum albumin and body weight increased, while the fistula

production decreased. In patients with preoperative of intestine reconstruction

surgery, there were improvement in general condition with the increase of serum

albumin. In SBS patients, related to the postoperative condition, energy was given

according to Enhanced Recovery after Surgery (ERAS) recommendation 25?30

kkal/kg BW/day with balance of macronutrient composition. In SBS end

jejunostomy patient the food was given through distal feeding with adjusted

chymus drip to prevent dumping syndrome. There were increased in serum

albumin and body weight of the patients.

Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. , Background: Intestinal failure (IF) is a postoperative complication with poor

outcome. Nowadays, many of nutritional management recommendations based on

etiologies of IF, but no report about those application.

Case Presentation: Three female and one male patients were included in this case

series, aged 21–42 years old. Nutritional needs in IF patients are determined by

their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)

and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on

their fistula production. In patients with high output ECF, energy requirement is

in 1.5–2 resting energy requirement (RER) or 37–45 kcal/kg BW/day, protein

1,5–2 g/kg BW/day. In low output ECF, energy requirement is 1–1.5 RER or 25–

30 kcal/kg BW/day hari, protein 1–1.5 g/kg BW/day. In ECF patients given

conservative therapy, serum albumin and body weight increased, while the fistula

production decreased. In patients with preoperative of intestine reconstruction

surgery, there were improvement in general condition with the increase of serum

albumin. In SBS patients, related to the postoperative condition, energy was given

according to Enhanced Recovery after Surgery (ERAS) recommendation 25–30

kkal/kg BW/day with balance of macronutrient composition. In SBS end

jejunostomy patient the food was given through distal feeding with adjusted

chymus drip to prevent dumping syndrome. There were increased in serum

albumin and body weight of the patients.

Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. ]"