Tesis

Korelasi antara Perubahan Asupan Protein dengan Perubahan Indeks Massa Bebas Lemak dan Albumin pada Pasien Kanker Kepala Leher dengan Malnutrisi yang sedang Menjalani Kemoradiasi = Correlation between Changes in Protein Intake and Changes in Fat-Free Mass Index and Albumin in Malnourished Head and Neck Cancer Patients Undergoing Chemoradiation.

Latar Belakang: Pasien kanker kepala leher yang menjalani kemoradiasi berisiko tinggi mengalami inflamasi, gangguan metabolisme dan malnutrisi yang menyebabkan penurunan indeks massa bebas lemak dan kadar albumin. Kekurangan protein pada kondisi stres metabolik kanker dapat mempercepat katabolisme dan memperberat penurunan indeks massa bebas lemak (IMBL) maupun albumin. Namun, bukti mengenai hubungan antara perubahan asupan protein dengan perubahan indeks massa bebas lemak dan albumin pada kanker dengan malnutrisi yang sedang menjalani kemoradiasi di Indonesia masih terbatas. Metode: Penelitian kohort prospektif pada 56 subjek kanker kepala leher dengan malnutrisi yang sedang menjalani kemoradioterapi di RS Dr. Cipto Mangunkusumo. Asupan protein dinilai menggunakan food recall 2x24 jam pada pra radiasi dan minggu ke-3 radiasi. Dilakukan pemeriksaan IMBL menggunakan Bioelectrical Impedance Analysis dan albumin serum pada saat pra radiasi dan minggu ke-3 radiasi. Analisis korelasi Spearman digunakan untuk menilai hubungan antara perubahan asupan protein dan perubahan albumin dan indeks massa bebas lemak. Hasil: Dari total 56 subjek dengan median usia adalah 49 tahun dan sebagian besar laki-laki. Lokasi kanker terbanyak pada nasofaring dan berada di stadium IV. Asupan energi sebelum radiasi 26 (8;41) kkal/kgBB/hari sedangkan asupan energi pada minggu ketiga radiasi sebesar 22,5 (±7,9) kkal/hari. Terjadi perubahan asupan protein harian dengan median 0 (1;1,2) g/kgBB/hari. Median perubahan IMBL -0,6 (-5,5;5,8) kg/m2. Perubahan albumin, dengan nilai median -0,15 (-1,42;0,78) g/dL Tidak ditemukan korelasi antara perubahan asupan protein dengan perubahan IMBL (r =0,139, p =0,307), namun terdapat korelasi antara perubahan asupan protein dengan perubahan albumin (r =0,316, p =0,01). Kesimpulan: Tidak terdapat korelasi antara perubahan asupan protein dengan perubahan IMBL namun terdapat korelasi antara perubahan asupan protein dengan perubahan kadar albumin selama tiga minggu kemoradioterapi.
Kata Kunci: Asupan protein, indeks massa bebas lemak,albumin, kemoradioterapi, kanker kepala leher


Background: Patients with head and neck cancer undergoing chemoradiotherapy are at high risk of inflammation, metabolic disturbances, and malnutrition, which may lead to a decline in fat-free mass index (FFMI) and serum albumin levels. In the setting of cancer-related metabolic stress, inadequate protein intake can accelerate catabolism and aggravate decreases in FFMI and albumin. However, evidence on the association between changes in protein intake and changes in FFMI and albumin among malnourished cancer patients receiving chemoradiotherapy in Indonesia remains limited. Methods: This prospective cohort study included 56 malnourished patients with head and neck cancer undergoing chemoradiotherapy at Dr. Cipto Mangunkusumo Hospital. Protein intake was assessed using two 24-hour dietary recalls at preradiotherapy and at week 3 of radiotherapy. FFMI was measured using bioelectrical impedance analysis, and serum albumin was assessed at pre-radiotherapy and at week 3. Spearman correlation analysis was used to evaluate the association between changes in protein intake and changes in albumin and FFMI. Results: Among the 56 participants, the median age was 49 years and most were male. The most common cancer site was the nasopharynx, and most patients were stage IV. Energy intake before radiotherapy was 26 (8–41) kcal/kg body weight/day, while at week 3 it was 22.5 (± 7.9) kcal/day. The median change in daily protein intake was 0 (1–1.2). The mean change in FFMI was −0.5 (±2.1) kg/m². The median change in albumin was −0.15 (−1.42 to 0.78). No correlation was found between changes in protein intake and changes in FFMI (r = 0.139, p = 0.307), whereas a correlation was observed between changes in protein intake and changes in albumin (r = 0.316, p = 0.01). Conclusion: There was no correlation between changes in protein intake and changes in FFMI; however, changes in protein intake were correlated with changes in serum albumin during three weeks of chemoradiotherapy.
Keywords: protein intake, fat-free mass index, albumin, chemoradiotherapy, head and neck cance