IJCNP (INDONESIAN JOURNAL OF CLINICAL NUTRITION PHYSICIAN)

The PHASE ANGLE AND ITS CLINICAL RELEVANCE TO MALNUTRITION AND LOW-GRADE INFLAMMATION AMONG HEMODIALYSIS PATIENTS: A CROSS-SECTIONAL PERSPECTIVE

ESTI WIDIASIH — 2025-08-02

Background: Patients with chronic kidney disease (CKD) undergoing routine hemodialysis are prone to chronic inflammation and malnutrition, two interrelated conditions that worsen clinical outcomes. The phase angle obtained from bioelectrical impedance analysis (BIA) reflects cell membrane integrity and nutritional status and is suspected to correlate with inflammatory biomarkers such as TNF-α.

Objective: To analyze the relationship between phase angle and Dialysis Malnutrition Score (DMS) on TNF-α levels in routine hemodialysis patients.

Methods: A cross-sectional analytical study was conducted on 50 routine hemodialysis patients in a clinic in Semarang. Data collected included age, sex, duration of hemodialysis, BMI, skeletal muscle mass (SMM), DMS, phase angle, and TNF-α levels. Data were analyzed using Pearson correlation and multiple linear regression.

Results: The average age of participants was 52.38 years, and the average phase angle was 5.05. Pearson correlation showed a significant negative correlation between phase angle and TNF-α levels (r = -0.587; p = 0.000), while DMS showed a positive correlation (r = 0.368; p = 0.009). In the regression model, only phase angle was a significant predictor of TNF-α (β = -0.471; p < 0.001).

Conclusion: Phase angle has a significant negative correlation with TNF-α levels, suggesting its potential as a non-invasive marker for inflammation monitoring in hemodialysis patients. DMS was not significant in the multivariate model. Further studies are recommended to explore causal relationships and longitudinal assessments.

Keyword : Hemodialysis, Phase Angle, TNF-α, Malnutrition, DMS, Chronic Inflammation

THE EFFECTS OF VITAMIN D SUPPLEMENTATION ON DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATHOSUS PATIENTS: AN EVIDENCE-BASED CASE REPORT

Santri Dwizamzami Faridahanum — 2025-09-28

Background: Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by the production of autoantibodies and multisystem involvement, predominantly affecting women of reproductive age. Vitamin D is known to have immunomodulatory effects, including inhibition of T and B cell activation and suppression of pro-inflammatory cytokine production. Objectives: This evidence-based case report aims to evaluate the effect of vitamin D supplementation on disease activity in SLE. Methods: A literature search was conducted using PubMed, Scopus, and Cochrane. Medical Subject Headings (MeSH) terms and relevant keywords based on the clinical question components were applied. All retrieved literature was screened using predefined eligibility criteria, followed by a critical appraisal of eligible studies. Results: One meta-analysis of randomized controlled trials (RCTs) and two RCTs met the eligibility criteria. Almost all of the included studies recruited patients with SLE who had vitamin D deficiency/insuficiency. The methodological validity of all three studies was considered acceptable. The studies demonstrated heterogeneity in terms of baseline disease activity levels among their study populations. The meta-analysis and one of the RCTs reported non-significant results, while the other RCT showed a significant improvement in disease activity following vitamin D supplementation. Conclusion: Current evidence is insufficient to recommend vitamin D supplementation as an adjuvant therapy for improving disease activity in patients with SLE and further research is needed.

PERIOPERATIVE MEDICAL NUTRITIONAL THERAPY IN A SEVERELY MALNOURISHED PATIENT WITH AMPULLA OF VATER CARCINOMA POST WHIPPLE PROCEDURE: A CASE REPORT

I Putu Prayoga Ratha — 2025-12-24

Abstract

Background : The ampulla of Vater carcinoma is a rare gastrointestinal malignancy but has a better prognosis than pancreatic cancer. Severe malnutrition is common in patients with gastrointestinal cancer and worsens clinical outcomes. Objective: To report the implementation of structured perioperative nutrition therapy in a severely malnourished patient with carcinoma of the ampulla of Vater. Methods: Case report of a 51-year-old woman with severe malnutrition and obstructive jaundice, who underwent a Whipple procedure . Nutritional status assessment was performed using Subjective Global Assessment (SGA), anthropometry, and hand grip strength (HGS). Perioperative nutritional therapy was carried out in stages, with clinical and laboratory monitoring. Results: Nutrition therapy was started preoperatively with the ERAS method and continued gradually postoperatively through enteral and parenteral routes, until the patient was able to accept a full oral diet and vitamin supplementation. The target energy of 1840 kcal and protein 78 g/day was achieved within 7 days. Clinical status and physical function improved during treatment. Conclusion: Appropriate perioperative nutritional therapy supports metabolic recovery, improves nutritional status, and enhances clinical outcomes in patients with advanced gastrointestinal cancer undergoing major surgery.

Keywords : severe malnutrition, ampullary carcinoma , perioperative nutritional medical therapy, Whipple procedure

The Role Of Synbiotic Supplementation In Improving Bowel Movement Frequency In A Burn Patient With 32% Total Body Surface Area And Constipation: A Case Report

Cindy Herno Chrysela — 2025-12-24

Background: Severe burns cause microbiota dysbiosis, impaired intestinal motility, and constipation, worsening patient conditions and prolonging hospitalization.

Research Objective: To evaluate the effectiveness of synbiotic supplementation in improving bowel movement frequency in burn patients.

Case Illustration: A study conducted in the Burn High Care Unit at RSUPN Cipto Mangunkusumo involved a 42-year-old male patient with 32% TBSA burns and a history of kidney transplantation. Treatments included debridement, skin grafts, electrolyte correction, and synbiotic supplementation starting on day 6. During 29 days, energy intake, fiber intake, bowel movement frequency, and clinical status were monitored, showing significant improvements until discharge.

Discussion: The 42-year-old male patient with 32% TBSA burns experienced impaired intestinal motility and constipation consistent with microbiota dysbiosis and decreased SCFA due to severe burns. The patient received enteral nutrition and Rillus® synbiotic supplementation from day 6, theoretically enhancing beneficial bacterial colonization and intestinal motility. Bowel movement frequency improved from day 7, indicating synbiotic-related benefits. Micronutrient supplementation according to ESPEN supported wound healing and immunity. Clinical condition and nutritional status improved with significant wound healing until discharge on day 30.

Conclusion: Synbiotic supplementation effectively increased bowel movement frequency and improved intestinal function in severe burn patients with constipation.

Keywords: Severe burn, microbiota dysbiosis, synbiotic, constipation, intestinal motility, bowel movement frequency.

THE EFFECT OF PROBIOTIC ADMINISTRATION ON THE GUT–LUNG AXIS IN REDUCING THE INCIDENCE OF PNEUMONIA: A SYSTEMATIC REVIEW

puput fiohana — 2025-12-22

Introduction: Pneumonia is a major cause of illness and death, especially in critically ill patients. Probiotics have been proposed as a supportive intervention to enhance immune function, maintain gut microbial balance, and strengthen the intestinal barrier against inflammation. Research objectives: The aim of this review is to systematically identify relevant evidence regarding the relationship between probiotics and pneumonia. Methodology: The article employs a systematic review as its methodology. A comprehensive literature search was conducted across PubMed, Google Scholar, and Scopus. The selection of articles for the review was based on established inclusion and exclusion criteria, adhering to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Result: Based on 50 articles, 10 articles were filtered that met the inclusion criteria. The reviewed studies indicated that probiotic supplementation may reduce the severity of pneumonia, particularly ventilator-associated pneumonia (VAP), and improve immune response in critically ill patients. Other research supports that probiotic administration can reduce ICU stays and improve overall good immunity. However, other studies have shown that probiotic administration does not affect the length of stay or therapy in the ICU for pneumonia patients. Conclusion: The administration of probiotics in pneumonia patients provides multiple benefits, particularly by enhancing immunity through the modulation of macrophages within the gut–lung axis.

Key words: immune system, pneumonia, probiotik, systematic review