Tesis

Korelasi Asupan Selenium terhadap Perubahan Indeks Massa Bebas Lemak dan Kekuatan Genggam Tangan pada Pasien Kanker Kepala dan Leher yang Menjalani Terapi Kemoradiasi = Correlation between dietary selenium intake and changes in fat free mass index and handgrip strength in head and neck cancer patients undergoing chemoradiation therapy.

Latar Belakang: Pada pasien dengan kanker kepala leher (KKL) dapat terjadi perubahan metabolisme yang meningkatkan risiko malnutrisi yang ditandai penurunan indeks massa bebas lemak (IMBL) dan penurunan kapasitas fungsional. Terapi kemoradiasi dapat menyebabkan penurunan asupan energi, protein, dan selenium. Selenium adalah mikronutrien penting yang dalam fungsi muskuloskeletal. Kadar selenoprotein rendah dapat meningkatkan sitokin inflamasi (IL-6) yang menyebabkan kelemahan otot dan kerusakan oksidatif. Tujuan penelitian ini adalah mengetahui pengaruh asupan selenium terhadap IMBL dan kekuatan genggam tangan (KGT) pada pasien KKL saat terapi kemoradiasi. Metode: Penelitian ini merupakan studi kohort prospektif observasional pada pasien KKL setelah menjalani 2 minggu terapi kemoradiasi di unit Radioterapi di Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo. Data asupan selenium didapatkan dengan menggunakan SQ-FFQ, IMBL diperiksa menggunakan BIA seca mBCA 525, dan KGT diperiksa dengan hand grip Jamar digital. Analisis menggunakan korelasi Spearman. Hasil: Terdapat 53 subjek dengan median usia adalah 49 (20-59) tahun dan sebagian besar berjenis kelamin laki-laki. Lokasi kanker terbanyak adalah pada nasofaring sebanyak 62,3%, dan sebagian besar telah berada di stadium IV. Asupan selenium pada laki-laki 84,7 (30-372,4) μ/hari, sedangkan asupan selenium pada perempuan 65,2 (31,1 - 218,8) μ/hari, pada semua subjek telah memenuhi rekomendasi AKG. Rerata IMT didapatkan sebesar 21,1 ± 4,5 kg/m2 dan sebanyak 50,9 % pasien berada pada status gizi berat badan normal. Terjadi penurunan IMBL dan KGT pada semua subjek selama dua minggu terapi. IMBL pada pasien selama dua minggu terapi didapatkan penurunan sebanyak 0,5 (0,1 -3,5) kg/m2. Penurunan KGT tangan aktif adalah sebesar 1,7 (0,2-9,6). Sedangkan untuk penurunan KGT tangan tidak aktif adalah sebesar 1 (0,1 -6,2) kg. Tidak ada korelasi antara asupan selenium dengan perubahan IMBL (r =-0,168, p =0,229), asupan selenium dengan perubahan KGT tangan aktif (r =-0,360, p =0,798), namun terdapat korelasi lemah antara asupan selenium dengan KGT tangan tidak aktif(r =0,276, p =0,045). Kesimpulan: Tidak terdapat korelasi antara asupan selenium dengan perubahan IMBL serta KGT tangan aktif, dan terdapat korelasi lemah antara asupan selenium dengan KGT tangan tidak aktif pada pasien KKL selama dua minggu terapi kemoradiasi.
Kata kunci: asupan selenium; kanker kepala leher; kekuatan genggam tangan; indeks massa bebas lemak; kemoradiasi.


Background: In patients with head and neck cancer (HNC), metabolic changes can occur that increase the risk of malnutrition, characterized by a decrease in fatfree mass index (FFMI) and decreased functional capacity. Undergoing chemoradiation therapy can cause decreased energy, protein, and selenium intake. Selenium is an important micronutrient in musculoskeletal function. Low selenoprotein levels can increase inflammatory cytokines (IL-6) which cause muscle weakness and oxidative damage. The purpose of this study was to determine the effect of selenium intake on FFMI and handgrip strength (HGS) in HNC patients undergoing chemoradiation therapy. Methods: There were 53 subjects with a median age of 49 (20-59) years and most of them were male. The most common cancer location was in the nasopharynx at 62.3%, and most of them were in stage IV. The median selenium intake in men was 84.7 (30-372.4) μ/day, while the median selenium intake in women was 65.2 (31.1-218.8) μ/day, all subjects had met the RDA recommendations. The average BMI was 21.1 ± 4.5 kg/m2 and 50.9% of patients were in normal weight nutritional status. There was a decrease in FFMI and HGS in all subjects during two weeks of therapy. FFMI in patients during two weeks of therapy decreased by 0.5 (1-3.5) kg/m2. The decrease in active hand HGS was 1.7 (0.2-9.6). Meanwhile, the decrease in inactive hand HGS was 1 (0.1-6.2) kg. There was no correlation between selenium intake and changes in FFMI (r = -0.168, p =0.229), selenium intake with changes in active hand HGS (r =-0.360, p =0.798), but there was a weak correlation between selenium intake and inactive hand HGS (r = 0.276, p = 0.045). Results: There were 53 subjects with a median age of 49 (20-59) years and most of them were male. The most common cancer location was in the nasopharynx at 62.3%, and most of them were in stage IV. The median selenium intake in men was 84.7 (30-372.4) μ/day, while the median selenium intake in women was 65.2 (31.1-218.8) μ/day, all subjects had met the RDA recommendations. The average BMI was 21.1 ± 4.5 kg/m2 and 50.9% of patients were in normal weight nutritional status. There was a decrease in FFMI and HGS in all subjects during two weeks of therapy. FFMI in patients during two weeks of therapy decreased by 0.5 (0.1-3.5) kg/m2. The decrease in active hand HGS was 1.7 (0.2-9.6). Meanwhile, the decrease in inactive hand HGS was 1 (0.1-6.2) kg. There was no correlation between selenium intake and changes in FFMI (r =-0.168, p =0.229), selenium intake with changes in active hand HGS (r =-0.360, p =0.798), but there was a weak correlation between selenium intake and inactive hand HGS (r =0.276, p =0.045). Conclusion: There was no correlation between selenium intake and changes in IMBL and active hand HGS, and there was a weak correlation between selenium intake and inactive hand HGS in HNC patients during two weeks of undergoing chemoradiation therapy.
Keywords: selenium intake; head and neck cancer; changes in handgrip strength; changes in fat-free mass index; chemoradiation therapy.