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"Kuantitas dan kualitas asupan protein belum sepenuhnya diketahui perannya terhadap kualitas hidup. Prognostic Nutritional Index (PNI) juga belum diketahui dapat mencerminkan kualitas hidup dan apakah bisa ditingkatkan dengan asupan protein. Penelitian dengan desain potong lintang ini bertujuan untuk mengetahui korelasi antara asupan protein dengan PNI dan kualitas hidup serta korelasi PNI dengan kualitas hidup pada pasien kanker kepala leher dengan radioterapi di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo, Jakarta. Sebanyak 61 subjek didapatkan dari consecutive sampling. Rerata usia subjek adalah 46,3 ± 12,4 dan 65,6% subjek berada pada kanker stadium IV dan mendapatkan terapi kemoradiasi. Sebanyak 32,8% subjek yang memiliki status gizi kurang. Median asupan protein adalah 1,42 (0,26-4,11) g/kg/hari. Nilai PNI pada subjek penelitian memiliki median 45,9 (29,4-54,2). Hasil penelitian menunjukkan adanya korelasi bermakna antara kuantitas asupan protein berdasarkan Food Frequency Questionnaire (FFQ) semikuantitatif dan beberapa aspek gejala pada kualitas hidup yaitu pada aspek pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37;p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). Kualitas asupan protein tidak berkorelasi bermakna dengan kualitas hidup. PNI berkorelasi bermakna terhadap 1 aspek fungsional yaitu physical function (r=0,378; p=0,003) dan 2 aspek gejala yaitu opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Meskipun tidak signifikan secara statistik, namun PNI memiliki arah korelasi yang positif terhadap aspek fungsional lainnya dan memiliki arah korelasi negatif terhadap aspek gejala lainnya yang berarti semakin tinggi PNI maka aspek fungsional semakin baik dan gejala semakin ringan. Studi ini tidak menemukan adanya korelasi bermakna antara asupan protein, baik kualitas maupun kuantitasnya, terhadap PNI. Hasil ini diduga berkaitan dengan penemuan bahwa sebagian besar penderita masih memiliki pola asupan yang mampu mencukupi kebutuhan kalori dan protein harian. Diperlukan studi prospektif yang menelusuri aspek prognostik kanker kepala leher dari segi kualitas hidup untuk mengetahui apakah PNI dapat memprediksi aspek kualitas hidup dengan lebih rinci.

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Quality and quantity of protein intake has not been well understood that it can affect quality of life. Moreover, Prognostic Nutritional Index (PNI) also has not been well studied upon its usage to reflect quality of life of head and neck cancer patients undergoing radiotherapy. This cross sectional study was aimed to determine the correlation between protein intake and PNI and also the correlation between PNI and quality of life in head and neck cancer patients undergoing radiotherapy at Radiotherapy Department, dr. Cipto Mangunkusumo General Hospital, Jakarta. Total of 61 subjects were recruited with consecutive sampling method with mean age of 46,3 ± 12,4 years old and 65,6% subjects were on stage IV cancer and were getting a combination of chemo and radiotherapy. Only 32,8% subjects were on low nutritional status. Median of total protein intake was 1,42 (0,26-4,11) g/kg/day. Median of PNI was 45,9 (29,4-54,2) among subjects. The result of the study showed a significant correlations between quanitity of protein intake based on semiquantitative Food Frequency Questionnaire (FFQ) with several aspects of quality of life, that were pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37; p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). This aspects were all symptomatics. PNI was significantly correlated with 1 functional aspect, which was Physical function (r=0.378; p=0,003) and 2 symptomp aspects, which were opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Although not statistically significant, but there were positive direction of correlation with other functional aspects and negative direction of correlation with other symptomps aspects. This implicates that the higher the PNI, the lower the symptoms and the better the functional status of head and neck cancer patients undergoing radiotherapy. This study did not show a significant correlation between quality and quantity of protein intake with PNI. An adequate intake of calorie and protein in most subjects were found in this study which might explain the result. More studies, preferably prospective one, may be needed to show the usage of PNI to reflect quality of life, especially involving quality of life progresivity."

"Gangguan psikiatri meningkatkan risiko penderitanya mengalami obesitas dan sindroma metabolik akibat interaksi faktor genetik, lingkungan, gejala penyakit psikiatri dan pengobatannya. Pengaturan asupan makan dan perubahan pola hidup tetap menjadi tatalaksana awal pada pasien dengan gangguan psikiatri. Penggunaan metformin telah disarankan dalam studi sebagai adjuvan dalam tatalaksana berat badan pada pasien gangguan psikiatri terutama yang menggunakan obat psikiatri dalam jangka panjang. Empat pasien rawat inap dengan gangguan psikiatri dipantau selama perawatan dan sebulan setelah rawat jalan dengan kontak per minggu. Dilakukan pencatatan masalah subjektif, objektif, riwayat peningkatan berat badan, riwayat pengobatan pola asupan serta pengukuran antropometri dan komposisi tubuh. Pola asupan harian dan 24 jam terakhir dikumpulkan dengan metode FFQ semi kuantitatif dan 24h dietary recall. Perencanaan terapi medik gizi dilakukan dengan restriksi kalori, peningkatan asupan protein, penyesuaian asupan karbohidrat, motivasi melakukan aktivitas fisik yang cukup dan pemberian metformin dengan dosis bertahap. Tiga pasien memiliki status gizi obes 2, 1 pasien memiliki status gizi obes morbid yang disertai massa lemak yang tinggi dan massa otot yang rendah. Seluruh pasien memiliki lingkar pinggang diatas normal, kadar kolesterol total, LDL yang tinggi dan HDL yang rendah. Tiga pasien tidak mematuhi preskripsi selama perawatan. Setelah rawat jalan, dua pasien memiliki caregiver yang memberikan pemantauan dan motivasi yang baik terhadap pasien selama sebulan dan terdapat penurunan berat badan, penurunan lingkar pinggang, dan perbaikan komposisi tubuh. Terapi medik gizi pada pasien dengan gangguan psikiatri membutuhkan kerjasama dengan caregiver agar dapat bermanfaat bagi pasien.

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Patients with psychiatric disorders experienced an increased risk of obesity and metabolic syndrome due to genetic, environmental, disease symptoms and medication factor. Diet and lifestyle modification remained the firstline modalities for management of obesity in patients with psychiatric disorders. Metformin as an adjuvant therapy is recommended for preventing weight gain in patients especially with long-time psychiatric medication usage. Four inpatients with various psychiatric disorders were monitored during hospital stay and one month after discharge with weekly contact for monitoring. Subjective symptoms and objective signs, including history of weight gain, psychiatric medication history, intake pattern, anthropometric and body composition measurements were recorded. Daily intake pattern and 24 hour food intake were recorded and analyzed with semi-quantitative FFQ method and 24h food recall, respectively. Energy restriction, adjustment of protein and carbohydrate intake, physical activity encouragement and oral metformin administration with increasing dose were implemented in all patients. Three patients were grade 2 obese, one patients was morbidly obese with high fat mass and low muscle mass. All patients showed an increased waist circumference, high total cholesterol and LDL level, and low HDL level. Three patients failed to comply with nutrition prescription. After discharge, two patients had a supportive caregivers that gave an adequate monitoring and encouragement. Weight loss, reduced waist circumference, and better body compositition were found in 2 patients with supportive caregivers. Medical nutrition therapy on patient with psychiatric disorder will benefit greatly from supportive caregiver to bring benefit for patients."