Tesis

Hubungan antara Asupan Energi dan Protein dengan Pengukuran Lingkar Lengan Atas pada pasien Intensive Care Unit = Relationship between Energy and Protein Intake with Upper Arm Circumference Measurement.

Latar Belakang: Sakit kritis sering dihubungkan dengan malnutrisi yang disebabkan oleh perubahan metabolisme dan asupan yang menurun. Keadaan hipermetabolik yang tidak disertai dengan dukungan asupan energi dan protein yang adekuat, akan menyebabkan peningkatan konsumsi substrat protein dan energi secara cepat, disfungsi sistem imunitas, serta penurunan fungsi organ. Penilaian status gizi pada pasien sakit kritis sangat penting untuk menatalaksana dan mengevaluasi terapi gizi yang diberikan. Berbagai penelitian telah melaporkan mamfaat pemberian asupan energi dan protein yang cukup terhadap perubahan berat badan, namun pengukuran berat badan seringkali sulit dilakukan pada pasien ICU karena berbagai hal seperti penurunan kesadaran dan imobilisasi. Salah satu pengukuran antropometri yang cukup mudah dilakukan untuk mengevaluasi status gizi yaitu lingkar lengan atas (LLA) yang mencerminkan massa otot sebagai cadangan protein tubuh. Lingkar lengan atas (LLA) direkomendasikan sebagai parameter nutrisi karena sederhana dan indikator yang dapat digunakan untuk menilai malnutrisi. Penelitian ini bertujuan melihat hubungan antara asupan energi dan protein terhadap perubahan LLA pada pasien sakit kritis yang dirawat di ICU. Metode: Penelitian ini merupakan studi prospektif observasional pada pasien sakit kritis di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. karakteristik subjek penelitian meliputi usia, jenis kelamin, tinggi badan, berat badan, indeks massa tubuh (IMT), skor NRS 2002, status gizi berdasarkan kriteria ESPEN, penyakit penyerta, skor SOFA, diagnosis saat dirawat, dan kadar CRP. Dilakukan analisis korelasi antara asupan energa dan protein dengan perubahan lingkar lengan atas (LLA). Hasil: Terdapat 55 subjek dengan rerata subjek berusia 50,58±14.21 tahun. Subjek didominasi oleh laki-laki 42(76%) subjek. Sebagian besar subjek dengan status gizi malnutrisi 33(60%). Rerata berat badan, tinggi badan dan IMT secara berturut-turut adalah sebesar 56,6±15,8 kg, 165 (150-175) cm, dan 21.1±5,6 kg/m2. Berdasarkan skor SOFA, subjek penelitian terbanyak memiliki skor SOFA 0-6 40(72,7%) (risiko rendah). Rerata asupan energi dan protein subjek sebesar 16,51±6,4 kkal/kgBB/hari dan 0.7(0-1.8) g/kgBB/hari. Sebagian besar subjek memiliki asupan energi tidak cukup 46(84%) dan asupan protein tidak cukup 36(66%). Rerata LLA subjek saat admisi adalah 26,6±3,86 cm dan rerata LLA setelah 7 hari perawatan sebesar 25,6±3,61 cm. Terdapat perbedaan bermakna perubahan LLA setelah 7 hari perawatan di ICU (p < 0.001), namun tidak terdapat korelasi antara asupan energi dan asupan protein terhadap perubahan ukuran LLA. Selain asupan, tingkat inflamasi dapat menjadi faktor yang dapat mempengaruhi tingginya katabolisme, namun tidak dilakukan analisis hubungan antara tingkat inflamasi terhadap LLA pada subjek penelitian ini. Kesimpulan: Tidak terdapat hubungan antara asupan energi dan protein selama 7 hari pertama perawatan dengan perubahan ukuran LLA selama 7 hari perawatan.
Kata kunci: Asupan energi, asupan protein, lingkar lengan atas, sakit kritis


Background: Critical illness is often associated with malnutrition due to metabolic changes and decreased intake. A hypermetabolic state without adequate energy and protein support leads to increased protein and energy substrate consumption, immune system dysfunction, and organ impairment. Assessing nutritional status in critically ill patients is crucial for managing and evaluating nutritional therapy. Several studies have reported benefits of adequate energy and protein intake on weight changes, but weighing patients in the ICU is challenging due to factors like decreased consciousness and immobility. One anthropometric measurement that's relatively easy to conduct for evaluating nutritional status is the mid-upper arm circumference (MUAC), reflecting muscle mass as a body protein reserve. MUAC is recommended as a nutritional parameter for its simplicity and usefulness in assessing malnutrition. This study aims to examine the relationship between energy and protein intake and changes in MUAC in critically ill patients treated in the ICU. Methods: This study is a prospective observational study of critically ill patients at RSUPN dr. Cipto Mangunkusumo and RS Universitas Indonesia. Subject characteristics included age, gender, height, weight, body mass index (BMI), NRS 2002 score, nutritional status based on ESPEN criteria, comorbidities, SOFA score, admission diagnosis, and CRP levels. Correlation analysis was performed between energy and protein intake and changes in mid-upper arm circumference (MUAC). Results: There were 55 subjects with a mean age of 50.58±14.21 years. The majority were male, comprising 42 patients (76%). Most subjects were malnourished, totaling 33 (60%). Mean weight, height, and BMI were 56.6±15.8 kg, 165 (150-175) cm, and 21.1±5.6 kg/m2, respectively. Based on SOFA score, most subjects had a SOFA score of 0-6 (40 patients, 72.7%), indicating low risk. Mean energy intake was 16.51±6.4 kcal/kg/day, and mean protein intake was 0.7 (0-1.8) g/kg/day. A majority had inadequate energy intake (46 patients, 84%) and protein intake (36 patients, 66%). Mean MUAC at admission was 26.6±3.86 cm, and mean MUAC after 7 days of treatment was 25.6±3.61 cm. There was a significant decrease in MUAC after 7 days in the ICU (p < 0.001), but no correlation was found between energy or protein intake and changes in MUAC. In addition to intake, inflammation levels could influence high catabolism, but no analysis was performed on the relationship between inflammation levels and MUAC in this study. Conclusion: There was no relationship between energy and protein intake during the first 7 days of treatment and changes in MUAC during 7 days of treatment.
Keywords: Energy intake, protein intake, mid-upper arm circumference, critically ill