Introduction. Achievement of energy target in critically ill Covid-19 patients in Intensive Care Unit (ICU) is challenging. This study was aimed to depict the possibility of achieving energy target and its determinants in critically ill Covid-19 patients. Methods. A cross sectional study was conducted in ICU of dr. Kariadi Hospital Semarang, Indonesia. Secondary data were obtained from Covid-19 patients who were in ICU for minimum 3 days, from March to December 2020. Data collected included age, sex, Body Mass Index (BMI), comorbidities, Modified Nutrition Risk in Critically Ill (mNUTRIC) score, energy intake, route of nutrition delivery (enteral or combination of enteral and parenteral nutrition), lactate status, ICU length of stay (LOS), duration of mechanical ventilator and mortality. Risk Prevalence calculations were conducted to measure risks. Variables with significant associations and p< 0.25 were included in multiple logistic regression. Results. A total of 188 subjects were included in the analysis. Most patients were male (62.8%) and obese (61.8%). As much as 56.9% patients were able to achieve energy target of 20 kcal/kgBW on day 3 of ICU stay. Those with low risk mNUTRIC score and nutrition delivery was through enteral and parenteral route were more likely to achieve target energy of 20 kcal/kgBW in the first 3 days in the ICU. Conclusions. Achieving energy target of 20 kcal on day 3 of ICU stay for critically ill Covid-19 patients is feasible. Low mNutric score and nutrition delivery through enteral and parenteral route were two determinants for the achievement.

Prediabetesis is associated with an increase in plasma insulin concentration due to a decrease in insulin sensitivity in insulin target organs. Central obesity is a risk factor for prediabetes. To determine the relationship between muscle mass, body fat mass, and abdominal circumference with insulin resistance. The study was involving 50 young adult subjects aged 15-35 years, 50 subjects who met the inclusion and exclusion criteria. Muscle mass and body fat mass were measured using Bioelectrical Impedance Analysis (BIA). Abdominal circumference was measured using a tapemeter. Hours of sleep were measured using a questionnaire, while physical activity was measured based on the IPAQ-short form. Insulin resistances were measured using HOMA-IR score. Data were analyzed using spearman correlation. The correlation between abdominal circumference using two kinds of measurement and HOMA IR was found in all subjects (r = 0.691 and r 0.659; p = 0.000). After being analyzed separately by gender, it was found that there are positive correlation between body fat mass and HOMA-IR (male r = 0.672 p 0.001 female r = 0.582 p 0.001). There were a negative correlation between skeletal muscle mass and HOMA-IR (male r= -0.653 p 0.002, female r= -0.424, p 0.019), but there was no relationship between physical activity and sleep hours with insulin resistance. There is a relationship between skeletal muscle mass, fat mass, and abdominal circumference on insulin resistance regardless of gender. Further study is needed to determine the cutoff point of HOMA-IR as the predictor of insulin resistance.

Background: Increasing number of the older adults population results in increasing sarcopenia, a geriatric problem that may lead to poor quality of life, susceptibility to disease, malnutrition, and even death. Muscle mass is an important sarcopenia parameter that can be measured by Bioelectrical Impedance Analysis (BIA). Detection of decreased muscle mass can be done by measuring calf circumference, it is expected to provide an early diagnose of sarcopenia so that early intervention can be given and improve the quality of life of the older adults.Objective: To analyze the diagnostic accuracy of calf circumference for decreased muscle mass in older adults to provide simple way in diagnosing sarcopenia.Methods: This study involved 126 older adults, consisted of 57 men and 69 women aged 60-80 years in the community who met the inclusion criteria. Criteria of sarcopenia were defined based on the Asian Working Group for Sarcopenia (AWGS) Consensus, consisted of three components; muscle mass, handgrip strength, and walking speed. This study analyze the diagnostic accuracy of calf circumference for decreased muscle mass measured by single- frequency BIA and calf circumference was measured using a measuring tape. The analysis was carried out according to the receiver operating characteristic (ROC) curve to determine the cut-off point along with the sensitivity (Se) and specificity (Sp) values, positive and negative predictive values (PPV and NPV) of calf circumference as an indicator for low muscle mass.Results: Optimal cut-off point of calf circumference to indicate low muscle mass is 32.9 cm in women (Se 80.8%, Sp 79.1%, PPV 75.9%, NPV 87.5%) and 33.5 cm in men (Se 78.6%, Sp 74.4%, PPV 50%, NPV 91.4%). PPV in men is lower than women. This is due to a lower prevalence of decreased muscle mass in men than women. There were 49 participants with the calf circumference below cut-off point and 40 (31.7%) of the 126 participants had sarcopenia.Conclusion: Calf circumference has a diagnostic accuracy to find decreased muscle mass in  sarcopenia.

Latar Belakang: Prevalensi abses hepar di dunia mencapai 2,3 kasus per 100.000 penduduk.  Keluhan mual, muntah, anoreksia, dan nyeri perut yang merupakan keluhan utama abses hepar tentunya akan menurunkan asupan pasien. Pasien abses hepar sering datang dengan riwayat starvasi lama sehingga berisiko refeeding syndrome Pengobatan abses hepar adalah drainase secara operasi sehingga terapi nutrisi perioperatif menjadi salah satu kunci keberhasilan terapi multidisiplin.   Laporan Kasus: Tn B, 70 tahun, datang dengan keluhan mual, dan muntah setiap kali makan sejak 1 bulan SMRS disertai nyeri perut kanan atas, demam, dan menggigil. Pasien juga mengeluhkan penurunan berat badan dan starvasi sejak 1 bulan. Pemeriksaan fisik abdomen terdapat nyeri tekan kuadran kanan atas (+).  Sebelum diberikan terapi nutrisi, pasien mengalami refeeding syndrome akibat overfeeding yang ditandai dengan deplesi kalium dan magnesium progresif. Pasien diberikan diet mulai dari 10 kkal/kgBB/hari dan untuk terapi refeeding diberikan suplementasi tiamin dan B kompleks serta koreksi MgSO4 dan KCl. Diet mencapai target pada hari ke-5 perawatan. Pasien dilakukan tindakan laparoskopi drainase abses sesuai prosedur ERAS. Pada masa pemulihan pasca operasi, pasien diberikan suplementasi vitamin A, vitamin C, dan zinc. Pasien juga diberikan ONS yang mengandung vitamin A, vitamin E, tembaga dan selenium, omega 3, dan branched chain amino acids. Kesimpulan: Keberhasilan terapi gizi pada pasien ini tampak dari pasien dapat segera ditatalaksana untuk mencegah kondisi fatal akibat refeeding, terjadi peningkatan asupan, berat badan, peningkatan kekuatan genggaman, dan tidak terjadi wound dehiscence selama perawatan di rumah sakit.   Kata kunci: abses hepar, refeeding syndrome, sarkopenia, terapi nutrisi

LATAR BELAKANG: Pasien gagal ginjal kronis (GGK) yang menjalani hemodialisis berisiko mengalami masalah status gizi, yang dapat diperiksa dengan berbagai pemeriksaan seperti 7-point Subjective Global Assessment (SGA). Namun, masalah status gizi masih sering terlambat dideteksi sehingga memperburuk luaran klinis pasien. Phase Angle (PhA) merupakan pemeriksaan yang dapat mendeteksi masalah status gizi pada tahap awal sehingga terapi gizi dapat dimulai seawal mungkin. PhA diharapkan dapat menjadi salah satu alat pemeriksaan status gizi. TUJUAN: Menganalisis korelasi antara status gizi dengan PhA pada pasien GGK yang menjalani hemodialisis. METODE: Penelitian korelasional dilakukan pada 39 pasien GGK yang menjalani hemodialisis yang memenuhi kriteria inklusi dan eksklusi. Status gizi diperiksa dengan 7-point SGA, dan PhA diukur dengan Bioelectrical Impedance Analysis (BIA) multi frekuensi. Uji korelasi Spearman digunakan untuk menganalisis hubungan antar variabel. HASIL: Terdapat korelasi positif antara status gizi dengan PhA (r = 0,64; p < 0,001). Terdapat korelasi negatif antara PhA dengan jumlah komorbid (r = -0,381, p = 0,017). PhA tidak berkorelasi dengan jenis dan lama hemodialisis. SIMPULAN: Terdapat korelasi positif antara status gizi yang diukur dengan 7-point SGA dengan PhA pada pasien GGK yang menjalani hemodialisis.