Tesis

Korelasi antara Perubahan Asupan Protein dengan Perubahan Indeks Massa Otot pada Kanker Kepala Leher dengan Malnutrisi yang Menjalani Kemoradiasi = Correlation Between Changes in Protein Intake and Changes in Skeletal Muscle Index among Malnourished Head and Neck Cancer Patients Undergoing Chemoradiation.

Latar Belakang: Pasien kanker kepala dan leher (KKL) yang menjalani kemoradiasi mengalami stres metabolik, inflamasi sistemik, dan toksisitas terapi yang menyebabkan penurunan asupan nutrisi dan percepatan katabolisme otot. Asupan protein memegang peran penting dalam mempertahankan massa otot, namun bukti mengenai hubungan perubahan asupan protein dengan perubahan indeks massa otot pada pasien KKL dengan malnutrisi yang menjalani kemoradiasi masih terbatas di Indonesia. Metode: Penelitian kohort prospektif ini melibatkan 53 pasien KKL malnutrisi yang menjalani kemoradiasi di RSUPN Dr. Cipto Mangunkusumo. Asupan protein dinilai menggunakan food recall 2×24 jam pada minggu ke-3 dan minggu ke-5 radiasi. Indeks massa otot diukur menggunakan Bioelectrical Impedance Analysis. Analisis korelasi Spearman digunakan untuk menilai hubungan perubahan asupan protein (gram/hari dan gram/kgBB/hari) dengan perubahan indeks massa otot. Hasil: Dari total 53 subjek, didapatkan didapatkan rerata perubahan asupan protein harian pasien sebesar −4,19 (±23,95) g/hari atau setara dengan −0,17 (−1,49;1,25) g/kgBB/hari. Untuk perubahan indeks massa otot, didapatkan nilai median subjek adalah -0,42 (–5,03;1,4) kg/m2. Tidak ditemukan korelasi antara perubahan asupan protein dengan indeks massa otot, dengan nilai r = 0,062, p = 0,675 untuk perubahan asupan protein per hari dan r = 0,023, p = 0,896 untuk perubahan asupan protein gram per kilogram berat. Kesimpulan: Tidak ditemukan hubungan yang bermakna antara perubahan asupan protein dan perubahan indeks massa otot dalam interval dua minggu pada pasien KKL dengan malnutrisi yang menjalani kemoradiasi.
Kata Kunci: asupan protein, indeks massa otot, kanker kepala dan leher, malnutrisi, kemoradiasi


Background: Head and neck cancer (HNC) patients undergoing chemoradiation experience metabolic stress, systemic inflammation, and therapy toxicity, all of which contribute to reduced nutritional intake and accelerated muscle catabolism. Protein intake plays a critical role in preserving muscle mass; however, evidence regarding the relationship between changes in protein intake and changes in muscle mass index among malnourished HNC patients undergoing chemoradiation in Indonesia remains limited. Methods: This prospective cohort study included 53 malnourished HNC patients undergoing chemoradiation at Dr. Cipto Mangunkusumo National General Hospital. Protein intake was assessed using two non-consecutive 24-hour food recalls during week 3 and week 5 of radiotherapy. Muscle mass index was measured using Bioelectrical Impedance Analysis. Spearman correlation analysis was performed to evaluate the association between changes in protein intake (g/day and g/kg/day) and changes in muscle mass index. Results: Among the 53 subjects, the mean change in daily protein intake was −4.19 (±23.95) g/day, equivalent to −0.17 (−1.49; 1.25) g/kg/day. The median change in muscle mass index was −0.42 (−5.03; 1.4) kg/m². No significant correlation was observed between changes in protein intake and changes in muscle mass index, with r = 0.062, p = 0.675 for changes in protein intake per day and r = 0.023, p = 0.896 for changes expressed in g/kg/day. Conclusion No significant association was found between changes in protein intake and changes in muscle mass index within the two-week interval among malnourished HNC patients undergoing chemoradiation.
Keywords: protein intake, muscle mass index, head and neck cancer, malnutrition, chemoradiation