IJNP (Indonesian Journal of clinical nutrition physician)
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THE EFFECT OF PROBIOTIC ADMINISTRATION ON THE GUT–LUNG AXIS IN REDUCING THE INCIDENCE OF PNEUMONIA: A SYSTEMATIC REVIEW
Full text linkIntroduction: Pneumonia is a major cause of illness and death, especially in critically ill patients. Probiotics have been proposed as a supportive intervention to enhance immune function, maintain gut microbial balance, and strengthen the intestinal barrier against inflammation. Research objectives: The aim of this review is to systematically identify relevant evidence regarding the relationship between probiotics and pneumonia. Methodology: The article employs a systematic review as its methodology. A comprehensive literature search was conducted across PubMed, Google Scholar, and Scopus. The selection of articles for the review was based on established inclusion and exclusion criteria, adhering to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Result: Based on 50 articles, 10 articles were filtered that met the inclusion criteria. The reviewed studies indicated that probiotic supplementation may reduce the severity of pneumonia, particularly ventilator-associated pneumonia (VAP), and improve immune response in critically ill patients. Other research supports that probiotic administration can reduce ICU stays and improve overall good immunity. However, other studies have shown that probiotic administration does not affect the length of stay or therapy in the ICU for pneumonia patients. Conclusion: The administration of probiotics in pneumonia patients provides multiple benefits, particularly by enhancing immunity through the modulation of macrophages within the gut–lung axis.
Key words: immune system, pneumonia, probiotik, systematic revie
THE EFFECTS OF VITAMIN D SUPPLEMENTATION ON DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATHOSUS PATIENTS: AN EVIDENCE-BASED CASE REPORT
Full text linkBackground: Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by the production of autoantibodies and multisystem involvement, predominantly affecting women of reproductive age. Vitamin D is known to have immunomodulatory effects, including inhibition of T and B cell activation and suppression of pro-inflammatory cytokine production. Objectives: This evidence-based case report aims to evaluate the effect of vitamin D supplementation on disease activity in SLE. Methods: A literature search was conducted using PubMed, Scopus, and Cochrane. Medical Subject Headings (MeSH) terms and relevant keywords based on the clinical question components were applied. All retrieved literature was screened using predefined eligibility criteria, followed by a critical appraisal of eligible studies. Results: One meta-analysis of randomized controlled trials (RCTs) and two RCTs met the eligibility criteria. Almost all of the included studies recruited patients with SLE who had vitamin D deficiency/insuficiency. The methodological validity of all three studies was considered acceptable. The studies demonstrated heterogeneity in terms of baseline disease activity levels among their study populations. The meta-analysis and one of the RCTs reported non-significant results, while the other RCT showed a significant improvement in disease activity following vitamin D supplementation. Conclusion: Current evidence is insufficient to recommend vitamin D supplementation as an adjuvant therapy for improving disease activity in patients with SLE and further research is needed
PERIOPERATIVE MEDICAL NUTRITIONAL THERAPY IN A SEVERELY MALNOURISHED PATIENT WITH AMPULLA OF VATER CARCINOMA POST WHIPPLE PROCEDURE: A CASE REPORT
No full textAbstract
Background : The ampulla of Vater carcinoma is a rare gastrointestinal malignancy but has a better prognosis than pancreatic cancer. Severe malnutrition is common in patients with gastrointestinal cancer and worsens clinical outcomes. Objective: To report the implementation of structured perioperative nutrition therapy in a severely malnourished patient with carcinoma of the ampulla of Vater. Methods: Case report of a 51-year-old woman with severe malnutrition and obstructive jaundice, who underwent a Whipple procedure . Nutritional status assessment was performed using Subjective Global Assessment (SGA), anthropometry, and hand grip strength (HGS). Perioperative nutritional therapy was carried out in stages, with clinical and laboratory monitoring. Results: Nutrition therapy was started preoperatively with the ERAS method and continued gradually postoperatively through enteral and parenteral routes, until the patient was able to accept a full oral diet and vitamin supplementation. The target energy of 1840 kcal and protein 78 g/day was achieved within 7 days. Clinical status and physical function improved during treatment. Conclusion: Appropriate perioperative nutritional therapy supports metabolic recovery, improves nutritional status, and enhances clinical outcomes in patients with advanced gastrointestinal cancer undergoing major surgery.
Keywords : severe malnutrition, ampullary carcinoma , perioperative nutritional medical therapy, Whipple procedur
The Role Of Synbiotic Supplementation In Improving Bowel Movement Frequency In A Burn Patient With 32% Total Body Surface Area And Constipation: A Case Report
Full text linkBackground: Severe burns cause microbiota dysbiosis, impaired intestinal motility, and constipation, worsening patient conditions and prolonging hospitalization.
Research Objective: To evaluate the effectiveness of synbiotic supplementation in improving bowel movement frequency in burn patients.
Case Illustration: A study conducted in the Burn High Care Unit at RSUPN Cipto Mangunkusumo involved a 42-year-old male patient with 32% TBSA burns and a history of kidney transplantation. Treatments included debridement, skin grafts, electrolyte correction, and synbiotic supplementation starting on day 6. During 29 days, energy intake, fiber intake, bowel movement frequency, and clinical status were monitored, showing significant improvements until discharge.
Discussion: The 42-year-old male patient with 32% TBSA burns experienced impaired intestinal motility and constipation consistent with microbiota dysbiosis and decreased SCFA due to severe burns. The patient received enteral nutrition and Rillus® synbiotic supplementation from day 6, theoretically enhancing beneficial bacterial colonization and intestinal motility. Bowel movement frequency improved from day 7, indicating synbiotic-related benefits. Micronutrient supplementation according to ESPEN supported wound healing and immunity. Clinical condition and nutritional status improved with significant wound healing until discharge on day 30.
Conclusion: Synbiotic supplementation effectively increased bowel movement frequency and improved intestinal function in severe burn patients with constipation.
Keywords: Severe burn, microbiota dysbiosis, synbiotic, constipation, intestinal motility, bowel movement frequency
The PHASE ANGLE AND ITS CLINICAL RELEVANCE TO MALNUTRITION AND LOW-GRADE INFLAMMATION AMONG HEMODIALYSIS PATIENTS: A CROSS-SECTIONAL PERSPECTIVE
No full textBackground: Patients with chronic kidney disease (CKD) undergoing routine hemodialysis are prone to chronic inflammation and malnutrition, two interrelated conditions that worsen clinical outcomes. The phase angle obtained from bioelectrical impedance analysis (BIA) reflects cell membrane integrity and nutritional status and is suspected to correlate with inflammatory biomarkers such as TNF-α.
Objective: To analyze the relationship between phase angle and Dialysis Malnutrition Score (DMS) on TNF-α levels in routine hemodialysis patients.
Methods: A cross-sectional analytical study was conducted on 50 routine hemodialysis patients in a clinic in Semarang. Data collected included age, sex, duration of hemodialysis, BMI, skeletal muscle mass (SMM), DMS, phase angle, and TNF-α levels. Data were analyzed using Pearson correlation and multiple linear regression.
Results: The average age of participants was 52.38 years, and the average phase angle was 5.05. Pearson correlation showed a significant negative correlation between phase angle and TNF-α levels (r = -0.587; p = 0.000), while DMS showed a positive correlation (r = 0.368; p = 0.009). In the regression model, only phase angle was a significant predictor of TNF-α (β = -0.471; p < 0.001).
Conclusion: Phase angle has a significant negative correlation with TNF-α levels, suggesting its potential as a non-invasive marker for inflammation monitoring in hemodialysis patients. DMS was not significant in the multivariate model. Further studies are recommended to explore causal relationships and longitudinal assessments.
Keyword : Hemodialysis, Phase Angle, TNF-α, Malnutrition, DMS, Chronic Inflammatio
EFFECTS OF VITAMIN D ADMINISTRATION FOR WOUND HEALING IN PATIENTS WITH DIABETIC FOOT ULCERS: EVIDENCE BASED CASE REPORT
Full text linkDiabetes mellitus can cause microvascular and macrovascular complications. Diabetic foot ulcer is the complications that often occur in DM patients, which is as much as 10%-25%. In Indonesia, the incidence of diabetic foot ulcers is 12% and DM patients can be at risk of diabetic foot ulcers as much as 55.4%. The mortality rate that occurs as a result of diabetic foot ulcers can reach around 15-30%. Patients who have diabetic foot ulcers significantly decreased vitamin D levels. This study aims to determine the effectiveness of vitamin D supplementation for wound healing in diabetic foot ulcers
REDUCED BODY MASS INDEX BUT NOT FAT MASS IN ANTHRACYCLINE-BASED CHEMOTHERAPY OF LOCALLY ADVANCED BREAST CANCER PATIENTS
Full text linkBackground: Breast cancer is a cancer disease with the highest proportion of new cases and the proportion of deaths it causes is quite high at 6.9%. Cancer patients who use anthracycline-based chemotherapy experience loss of body weight, muscle, body cell mass, distribution of extracellular fluid expansion and reduced intracellular air. This study was to determine the change of the Body Mass index (BMI) and body composition of patients with locally advanced breast cancer (stage IIIA, IIIB and IIIC) who had undergone anthracycline-based chemotherapy.Methods: This anthracycline-based observational analytical study of pre and post chemotherapy was conducted with a cross-sectional approach. Subjects were measured height by microtoise; weight, body composition, daily calorie intake (DCI) and basal metabolic rate (BMR) as measured by Bioelectrical Impendance Analysis (BIA).Results: 47 locally advanced breast cancer patients underwent anthracycline-based chemotherapy. Based on the Wilcoxon statistical test, 6 variables with a 95% confidence level (p<0.05) showed a decrease in the value 5 variables, namely BMI, total body water (TBW), visceral fat, skeletal muscle mass and skeletal bone mass. Meanwhile, body fat showed a p value=0.224. The changes of variable confounding, DCI decrease (p=0.004), but BMR increase not significantly (p=0.795).Conclusion: There is an effect of chemotherapy on nutritional status of BMI, TBW, visceral fat, skeletal muscle mass and bone mass in patients with locally advanced breast cancer who underwent anthracycline-based chemotherapy, which may the result of the calorie intake decreased, but not on body fa
SUPLEMENTASI ASAM FOLAT PRAKONSEPSI DALAM PENCEGAHAN BIBIR SUMBING : EVIDENCE - BASED CASE REPORT
Full text linkBibir sumbing merupakan kelainan bawaan yang sering dijumpai pada bayi baru lahir, terutama di negara berkembang. Faktor risikonya antara lain paparan terhadap rokok dan bahan kimia, konsumsi alkohol, serta asupan mikronutrien yang tidak memadai selama kehamilan. Dosis suplementasi asam folat yang lebih tinggi pada masa prakonsepsi berhubungan dengan penurunan risiko bibir sumbing. Tujuan: Mengetahui hubungan antara suplementasi asam folat prakonsepsi dengan risiko terjadinya bibir sumbing. Metode: Pencarian literatur dilakukan dengan advanced searching pada Pubmed, Cochrane Library, Scopus, dan ProQuest dengan kriteria eligibilitas yang ditentukan oleh penulis. Hasil: Studi systematic review-meta analisis oleh Jayarajan, et al. (2019) menjelaskan bahwa terdapat hubungan kuat antara suplementasi asam folat dosis tinggi dengan bibir sumbing. Studi kasus-kontrol yang menilai hubungan suplementasi asam folat prakonsepsi dengan penurunan risiko bibir sumbing dilakukan oleh 2 peneliti. Penelitian Xu W, et al. (2021) menjelaskan bahwa suplementasi asam folat prakonsepsi menurunkan risiko bibir sumbing (aOR = 0,52, 95% CI 0,30-0,90), sedangkan penelitian Mendonca VJ, et al. (2019) menjelaskan bahwa untuk mendapatkan efek samping pada 1 pasien diperlukan 71 pasien dengan suplementasi asam folat selama 1 tahun. Kesimpulan: Berdasarkan dua penelitian didapatkan hasil bahwa suplementasi asam folat prakonsepsi dapat menurunkan risiko bibir sumbing, namun diperlukan penelitian lebih lanjut
THE EFFECTS OF CURCUMIN SUPPLEMENTATION ON GLYCAEMIC INDEX IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME: AN EVIDENCE BASED CASE REPORT
Full text linkBackground: PCOS is the most common cause of infertility around the world. PCOS is associated with impaired glucose tolerance and higher tendency to develop type 2 diabetes. Curcumin, which is known for its anti-inflammatory, antioxidant, and antidiabetic properties, may show promising effect in regulating blood glucose.
Objective: This study aims to evaluate the effect of curcumin supplementation on improving glycaemic profile in women with PCOS.
Methods: Literature searching was conducted by advanced searching in Pubmed, Cochrane Library, Scopus, and ProQuest database using MeSH Terms combined with Title/Abstract. After removing duplicates, the literatures were screened based on the eligibility criteria. Critical appraisal and level of evidence of the selected literatures were determined based on Oxford Centre for Evidence-Based Medicine.
Results: Two selected literatures were relevant to answer our clinical question. The first literature is a systematic review/meta-analysis study by Chien et al (2021) and the latter is a randomized controlled trial by Asan et al (2020). Both literatures show that curcumin supplementation is beneficial in improving glycaemic profile in PCOS patients. These effects were marked by lower fasting blood glucose, insulin level, and HOMA-IR in curcumin group compared to the control group.
Conclusion: Curcumin supplementation for at least 6 weeks significantly improve glycaemic profile in women with PCOS. Curcumin supplementation is also considered safe and well tolerable. However, more studies are needed to investigate further regarding the long-term effects of curcumin supplementation.
Keywords: curcumin, turmeric, polycystic ovarian syndrome, glycaemic profil
HUBUNGAN PHASE ANGLE DENGAN TINGKAT KEPARAHAN INFARK MIOKARD
Full text linkLatar belakang : Phase angle (PhA) yang merupakan indikator integritas seluler mungkin berhubungan dengan tingkat keparahan IM yang tercermin dari penanda cedera miosit yaitu kadar troponin.
Tujuan : Menganalisis hubungan PhA dengan tingkat keparahan IM.
Metode : Penelitian observasional, melibatkan 40 subjek dengan IM yang memenuhi kriteria inklusi dan eksklusi. Tingkat keparahan IM diukur dari kadar troponin I, PhA didapatkan dari bioelectrical impedance analysis, dan data komorbid diambil dari rekam medis pasien. Uji hipotesis menggunakan analisis bivariat untuk melihat hubungan phase angle dan beberapa komorbid dengan tingkat keparahan IM.
Hasil : Mayoritas subyek penelitian berjenis kelamin laki-laki (82,5%), rerata usia 56,1 tahun, dan rerata IMT 25,56 kg/m2. Dislipidemia merupakan jenis komorbid yang paling banyak diderita (92,5%) dan 62,5% subyek penelitian memiliki 2 atau lebih komorbid. Hasil analisis bivariat PhA, jenis komorbid, jumlah komorbid, usia, IMT, dan jenis kelamin terhadap kadar troponin I adalah tidak signifikan (p>0,05).
Kesimpulan : PhA, diabetes, hipertensi, dislipidemia, jumlah komorbid, usia, IMT, dan jenis kelamin tidak berhubungan dengan tingkat keparahan IM.
Kata kunci : BIA, komorbid kardiovaskular, phase angle, tingkat keparahan infark miokar