Tesis

Pengaruh Suplementasi Santan Terhadap Beberapa Parameter Status Gizi Pasien Sirosis Hati = Effect of Coconut Milk Supplementation on Several Parameters of Nutrinional Status of Liver Cirrhosis Patients.

Latar Belakang: Malnutrisi meningkatkan morbiditas dan mortalitas dan menurunkan kualitas hidup pasien sirosis hati. Untuk memperbaiki status gizi, dianjurkan pemberian late night snack (LNS) dengan 50 gram karbohidrat. Santan mengandung banyak middle chain triacylglicerol, sehingga berpotensi menjadi sumber gizi yang lebih baik dan aman bagi pasien sirosis. Tujuan: Mengetahui manfaat santan untuk memperbaiki status gizi pasien sirosis hati. Metode: Dilakukan uji klinik dengan desain paralel. Subjek adalah pasien sirosis hati Child Pugh A dan B, yang mengalami malnutrisi berdasarkan kriteria IMT modifikasi Campillo, atau mengalami unintentional weight loss. Pasien dibagi menjadi 2 kelompok, kelompok I mendapat LNS berupa 25 gram gula ditambah 50 cc santan, sedangkan kelompok II mendapat LNS berupa 50 gram gula. Status gizi dinilai dari parameter triceps skinfold thickness (TSF), mid arm muscle circumference (MAMC), indeks massa tubuh (IMT), massa lemak tubuh (MLT), kadar prealbumin dan kadar albumin serum. Hasil Penelitian: Terdapat 18 subjek pada kelompok I, dan 17 subjek pada kelompok II yang menyelesaikan penelitian. Kedua kelompok setara dalam proporsi gender, CP A dan B, dan penyebab sirosis. Meskipun rerata usia kelompok II lebih tua dibandingkan kelompok I, namun tidak terdapat korelasi antara usia dengan semua parameter status gizi yang diukur. Didapatkan peningkatan status gizi lebih baik pada kelompok I bila dilihat dari parameter MAMC, MLT dan kadar albumin serum. Pengukuran TSF meningkat setelah pemberian LNS, namun tidak menunjukkan beda perubahan bermakna antara kedua kelompok, Pengukuran IMT dan kadar prealbumin serum tidak dapat mencerminkan perubahan status gizi dengan baik. Kesimpulan: Pemberian LNS dengan kombinasi karbohidrat dan santan lebih unggul dibandingkan LNS dengan karbohidrat saja dalam memperbaiki status gizi pasien sirosis hati, dilihat dari parameter MAMC, MLT dan kadar albumin serum, sedangkan parameter TSF, IMT dan kadar prealbumin serum tidak menunjukkan beda perubahan yang bermakna antara kedua kelompok.
Kata Kunci: Sirosis, late night snack, santan, karbohidrat, skor Child Pugh, triceps skinfold thicness, mid arm muscle circumference, indeks massa tubuh, massa lemak tubuh, kadar prealbumin serum, kadar albumin serum.


Background: Malnutrition caused a decline in quality of life, increased morbidity and mortality in patients with cirrhosis of the liver. It is recommended to give late night snack (LNS) with 50 grams of carbohydrates to improve their nutritional status. Coconut milk contains a lot of middle chain triacylglycerol, it is potentially act as a source of safe, and better nutrition for patients with cirrhosis. Aim: To see the benefit of coconut milk to improve the nutritional status of chirrotic patients. Methods: This study is a clinical trial with parallel design. Subjects were cirrhotic patients with Child-Pugh A and B, who suffered malnutrition using Campillo’s modification of BMI criteria or experience unintentional weight loss. Subjects were devided into 2 groups, groups I received 25 gram of sugar and 50 cc of coconut milk as LNS, group II received received 50 gram sugar as LNS. Nutritional status assessed from triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI), body fat mass (BFM), serum prealbumin and serum albumin levels. Results: There were 18 subjects in group I and 17 subjects in group II. Both groups were similar in proportion of gender, CP A and B, and the cause of cirrhosis. Although the mean age of group II older than group I, but there were no significant correlation found between age and all nutrition parameters. Measurement of MAMC, BFM, and albumin levels showed that cirrhotic patient in group I have improvement of nutritional status better than group II, The TSF was increased after administration of LNS, but no significantly different changes found among both groups,. BMI and serum prealbumin cannot reflect changes in nutritional status well. Conclusion: Late night snack containing carbohydrate and coconut milk, is superior to improving nutritional status in cirrhotic patients compare to carbohydrates alone, as seen from MAMC, BFM, and serum albumin level parameters, whereas TSF, BMI, and serum prealbumin level did not show any difference between two groups.
Keyword: Cirrhosis, late night snack, coconut milk, carbohydrates, Child Pugh score, triceps skin fold thickness, mid-arm muscle circumference, body mass index, body fat mass, serum prealbumin level, serum albumin level.