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NEWS & UPDATES

How to find malnutrition in Hospital?

Masalah yang biasanya terjadi pada pasien rawat di Rumah Sakit adalah mengalami masalah dalam asupan nutrisi yang sesuai dengan kebutuhannya.[i] Keadaan ini seringkali tidak disadari atau terabaikan oleh tenaga medis yang lebih menekankan penyembuhan melalui pemberian obat berdasarkan penyakit pasien. Kurang tercukupinya asupan nutrisi dapat mengakibatkan menurunnya imunitas pasien [ii] sehingga dapat memperlambat penyembuhan penyakit, meningkatkan kemungkinan terjadinya komplikasi [iii] dan membuat masa perawatan pasien di rumah sakit menjadi lama.[iv]

Chulaporn Roongpisuthipong dari Thailand pada acara APPCN 2015, Kuala Lumpur menampilkan materi mengenai Malnutrition in Hospital yang telah banyak diteliti oleh berbagai negara (USA, Inggris, Itali, Swedia, Skotlandia, Filipina dan Brazil) sejak lama (tahun 1970an) mendapatkan prevalensi angka malnutrisi hingga 50%. Malnutrisi merupakan istilah yang digunakan untuk menggambarkan suatu keadaan dimana terdapat ketidakseimbangan gizi mulai dari kelebihan gizi (overnutrition) hingga kurang gizi (undernutrition). Keadaan overnutrition terdapat pada obesitas sedangkan undernutrition terdapat pada keadaan akut, kronis dan starvasi kronis, dimana semuanya berakibat pada defisiensi makronutrien, mikronutrien dan sindrom metabolik.

Berbagai metode skrining antara lain terdapat pada rekomendasi the European Society of Parenteral and Enteral Nutrition (ESPEN) untuk komunitas: Malnutrition Universal Screening Tool (MUST) pada dewasa, untuk rumah sakit: Nutritional Risk Score (NRS - 2002) dan geriatri menggunakan Mini Nutritional Assessment (MNA). Selain itu termasuk dalam rekomendasi the American Society for Parenteral and Enteral Nutrition (ASPEN) meliputi Birmingham Nutrition Risk Score, Malnutrition Screening Tool (MST), Maastricht Index, Prognostic Nutritional Index, Short Nutrition Assessment Questionnaire, Subjective Global Assessment serta lainnya. [v] Skrining gizi disarankan wajib dilakukan rumah sakit guna mengurangi angka kejadian malnutrisi secara efektif.

Pelaksanaan skrining gizi sebaiknya disesuaikan dengan pelayanan yang dapat diberikan oleh rumah sakit melalui tenaga medis yang tersedia. Skrining gizi yang mudah dan cepat sangat membantu tenaga medis yang langsung berhadapan dengan pasien seperti perawat, bidan, dietrisien dan dokter untuk mendapatkan pasien yang berisiko malnutrisi.[vi]

[i]. Baldwin C, Parson TJ. Dietary advice and nutrition supplements in the management of illness-related malnutrition: a systematic review. Clin. Nutr. 2004;23:1267–1279

[ii]. Chandra RK. Nutrition and the immune system: an introduction. Am. J. Clin. Nutr. 1997;66:460S– 463S

[iii]. Naber TH, Schermer T, deBree A, Nusteling K, Eggink L, Kruimel JW, Bakkeren J, van Heereveld H, Katan MB. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am. J.Clin. Nutr. 1997;66:1232–1239.

[iv]. Braunschweig, C.; Gomez, S.; Sheean, P.M. Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J. Am. Diet. Assoc. 2000, 100, 1316-1322.

[v]. Mueller C, Compher C, Ellen DM, A.S.P.E.N. Clinical Guidelines : Nutrition Screening, Assessment, and Intervention in Adults JPEN J Parenter Enteral Nutr 2011 35: 16-24

[vi]. Marian A.E van Bokhortst-de van der Schueren, Patricia Realino Guaitoli, Elise P Jansma, Henrica C.W. de Ver. Meta-analyse Nutrition Screening Tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014 33: 39 -58.

Fighting Cancer


Penyakit kanker dikenal sebagai silent killer. Penyakit ini dikenal penyakit mematikan nomor satu di dunia. Namun ada cara mencegahnya. Setiap 4 Februari diperingati sebagai Hari Kanker Sedunia. Dimana peringatan itu untuk mengingatkan kita pentingnya hidup sehat. Sebab setiap tahun, penderita kanker terus meningkat.

Dr.dr. Saptawati Bardosono, MSc memberikan informasi cara mencegah terjadinya kanker dengan menjalani hidup sehat. Untuk lebih lengkapnya di menit 3:00

Journal on ESPGHAN 49th Annual Meeting Athens – Greece, 25-28 May 2016


The ESPGHAN 49th Annual Meeting was held in Athens – Greece that was divided into three events, as follows:

  1. Courses on IBD, PG and AHP courses on Wednesday 25 May 2016 in Hilton Hotel (not attended by me)

  2. Working Groups on Wednesday 25 May 2016 in Hilton Hotel (for members only), and

  3. Scientific Program on 26 – 28 May 2016 in Megaron International Center

Amongst the Scientific Program, I am very interested to attend symposia related to the Happy-Tummy or healthy gut presented by Dr. Christina West from Department of Clinical Sciences, Pediatrics at Umea University, Ume, Sweden. She presented her topic on “The Gut Microbiota and Its Role in Allergic Disease” focusing on the following outline:

  1. Development of early life gut microbiota and immune tolerance:

  2. Microbial imprinting may start in utero:

  3. DNA from bacterial taxa in the feto-placental unit

  4. Microbes may travel via the blood stream from the oral cavity to the placenta (Aagand et al, Sci Transl Med, 2014)

  5. Translocation over the gut epithelium also suggested

  6. Transmission of administered labeled bacteria strains from the mother to her offspring in mice (Jumenez et al, Res Microbial 2008).

  7. Postnatal establishment of the gut microbiota as genetic and primary exposure (Salminen S, 2005):

  8. Delivery/birth è caesarian section delivery associated with increased risk of allergic and autoimmune disease (Kristensen K et al, JACI 2016)

  9. Breastfeeding

  10. Weaning

  11. Complementary foods

  12. Predictable micobiome development (Subramania S et al, Cell 2015):

  13. The early gut microbiota abundant in bifidobacteria

  14. Microbes that characterize early stages of development are more capable of metabolizing nutrients associated with breast feeding

  15. Later stages have a gut microbiota enriched in genes that can help digest solid foods

  16. Microbiota establishment is influenced by diet and environmental exposures perinally and in childhood.

  17. Parallels the development of innate and adaptive immune pathways

  18. High biodiversity by short-chain fatty acid production and induction of Treg cells. Low biodiversity /dysbiosis by IgE production and pro-inflammatory responses

  19. Under optimal conditions, postnatal exposures promote tolerance, however modern condition are not optimal and rising immune disese

  20. The development of tolerance is an antigen-driven process:

  21. TLRs expressed on epithelial and endothelial cells, leucocyte subsets in blood.

  23. Sense conserved structural components of microbes

  24. TLR activation can increase or decrease the suppressor activity of Tregs, thus providing link between innate and adaptive immunity.

  25. Dysbiosis in early life microbiota and allergic diseases

  26. Several publications:

  27. Reduced relative abundance (RA) and a diversity of Bacteriodetes in infancy before onset of IgE- associated eczema and asthma (Abrahamsson, Jenmaim et al, JACI 2012 and ClinExp Allergy 2014)

  28. Reduced RA of Ruminococcaceae at 1 yr, 5 times more likely in food-sensitized infants in the CHILD cohort study (Azad, Kozyrsky et al, Clin Exp Allergy 2015)

  29. Reduced RA of Ruminococcaceae at 1 week preceded onset of IgE- associated eczema; the RA of Ruminococcus was inversely correlated with TLR2-induced IL-6 and TNF-α (West, Prescott et al, Clin Exp Allergy, 2015)

  30. Transiety lower RA of Lachnospira, Veillonella, Faecalibacterium and Rothia in infants at risk of asthma; reduced fecal acetate levels, dysregulation of enteroheaptic metabolites (Arrieta et al, Sci Transl Med 2015)

  31. Innate immune responses in allergic disease:

  32. Increase inflammatory responses following TLR-activation (Tullic JACI 2011)

  33. Immature Th1 function (Tulic JACI 2011)

  34. Immature Treg function (Smith JACI 2008, Schaub JACI 2008))

  1. Current evidence on pre/pro/synbiotics for allergy management (prevention and treatment):

  2. Prebiotics, oligosaccharides are the third largest fraction in human milk and confer many potential benefits in breastfed infants. Prebiotics have the potential to promote gut colonization with bifidobacteria, and some studies have demonstrated immune stimulating effects. Increase the production of short-chain fatty acids, with nutritive and anti-inflammatory effects

  3. Synbiotics is combination of pre and probiotics, anticipated to have more global effects on colonization. Meta-analysis eczema treatment, the effect most evident in children >1 yr and if the symbiotic contained a mix of bacterial strains (Chang YS et al, JAMA Pediatr 2016)

  4. Current recommendations:

  5. International expert bodies do not generally recommend pre- pro- or synbiotics for treatment and prevention of allergic disease

  6. Probiotics, there is a likely net benefit from using probiotics resulting primarily from prevention eczema at high risk of allergic disease (WAO guideline panel 2015)

  7. Prebiotics, suggest using prebiotic supplementation in not-exclusively breastfed infants and using prebiotic supplementation in exclusively breastfed infants for allergy prevention (WAO guideline panel 2016).

In conclusions:

  1. The gut microbiota develops to a complex and diverse ecosystem during the first years of life

  2. Aberrant intestinal colonization and reduced biodiversity have been associated with allergic diseases

  3. Pre- pro- and synbiotics have the potential to promote healthy gut colonization and immune maturation in allergic disease

  4. To date, significant heterogeneity between conducted studies precludes general recommendation on their use

I would like to thank you Nestle Indonesia to sponsor me to the event.

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