The science and practice of micronutrient in clinical nutrition : the importance of micronutrient evaluation

Micronutrients play a crucial role in maintaining good health as they are required for various processes within the body. Every individual has different micronutrient needs depending on their metabolic condition. To achieve optimal health, these needs must be met adequately

Immunity as key factors that influence cognitive development on children

Immune cells in the central nervous system (CNS) of the fetus are essential for normal neurodevelopment. Innate immunity-related molecules, including cytokines, toll-like receptors and complement family, are known to be expressed in the brain. Microglia, macrophage-like immune cells that reside in the brain and spinal cord, constitute 80% of all immune cells in the brain, making them the most abundant immune cell type. Acquired immunity-related molecules, such as major histocompatibility complex and antibody receptor, are also known to be expressed in the brain. In addition to this, research has demonstrated that they play important functions in the development of the brain. Neurodevelopmental diseases, including schizophrenia, autism spectrum disorders, autism-like obsessive-compulsive behaviours and social impairment, are characterized by a disruption of a wide variety of processes in the developing brain that depend on the normal function of microglia. Enteric infections and malnutrition in the first two years of life are linked to later cognitive impairment. Multiple studies have shown that bacterial and viral illnesses have direct or indirect impacts on cognitive performance in children. The immune system is in constant communication with the central nervous system and participates in the control of behaviour and a range of other essential neurological activities throughout the lifespan

External validation test of body height estimation on outpatient radiotherapy clinic of Dr. Cipto Mangunkusumo General Hospital

Background : Stature is required to calculate body mass index and determine the energy needs of patients in nutritional medical therapy. Difficulty was found to obtain stature data in patients who are unable to stand. Therefore, there are some height estimation formula to predict the actual height using knee height. This study aimed to validate the Chumlea formula on outpatient clinic of Dr. Cipto Mangunkusumo General Hospital, Indonesia. Methods : This cross-sectional study used 90 respondents selected by consecutive sampling. Actual height, knee height, age and gender data were collected. Estimated height using the three of Chumlea formula. Pearson correlation was used to see the correlation between actual height and estimated height. Paired t-test were used to determine the difference significance. Results : The average age of the subjects was  45±10 years old with actual height 157±10 cm, and knee height 48.8±3.5 cm. A strong positive correlation was found between actual height with all estimated height on male (p=0.000; r > 0.8) and female subjects (p=0.000; r > 0.6). However, comparison between actual height and estimated height showed no significant differences only in Chumlea L1 formula (p=0.087) and Chumlea L3 formula (p=0.824) on the male subjects. Conclusions : Chumlea L1 and Chumlea L3 formula was a valid fomulation for calculating the estimated body height in adult male patients. There was no valid Chumlea’s formulation to estimate body height in female patients

Safety drinking water and risk of stunting in children: Is it related ?

Slum areas are identic with nutritional problems in children including stunted children. Incidence of stunted can be caused by various factors, one of which is dysbiosis. This study aims to analyze the microbiota composition of stunted and non-stunted children in Jakarta slum areas and related contributing factors

Micronutrient forgotten or missed in critically ill patients

There is growing interest in the role of micronutrients (essential trace elements and vitamins) in optimizing health and in the prevention or treatment of some diseases. But we must not forget that micronutrients must also be considered in critically ill patients. There is a big difference

Nutritional management of a malnourished cancer patient with high output ileostomy: A case Report

High output stoma is a complication that may follow ileostomy formation, with an incidence of 23%. There is no general consensus on the limit of ileostomy production to be defined as high output. However, output of more than 2000 mL/day, can cause fluid and electrolyte imbalance, also malnutrition due to reduced nutrient absorption. Delay in recognition and treatment, especially in cancer patient with high risk of malnutrition, can further deteriorate patient’s nutritional status. A 43-year-old malnourished female with ascending colon cancer underwent tumor resection and ileocolostomy surgery. Starting from the third postoperative day, ileostomy effluent drastically increased to 2700 mL/day, causing severe hyponatremia, hypokalemia, and hypomagnesemia. Risk factors of high output stoma identified were routine prokinetic medication use and unresolved malignancy-related retroperitoneal abscess. Moreover, increment of food intake in the first days after surgery, specifically food high in insoluble fiber, was one of the contributing factors. High output stoma was then resolved by abscess drainage, discontinuation of prokinetic agent, and administration of antimotility agent. Hyponatremia and hypomagnesemia improved with correction, whereas hypokalemia needed longer time to resolve. Enteral nutrition was maintained and increased gradually to prevent further malnutrition. Oral hypotonic fluid intake was limited to 1000 mL/day and isotonic solution consumption was advised. High stoma production due to hypersecretory phase after ileostomy was expected, but thorough management would prevent patient’s deterioration that was caused by the fluid, electrolyte, and nutritional imbalances

Effect of probiotic supplementation on wound healing in postoperative patients: A case report and literature review

Background: Delayed wound healing, particularly in chronic wounds, is a significant global public health issue. The World Health Organization (WHO) reports that over 6 million people in the United States experience delayed wound healing annually, resulting in a healthcare cost of $25 billion USD. Probiotics, known for their anti-inflammatory properties, have potential in influencing skin immunity by facilitating the transfer of cytokines and immune cells from Peyer's patches to the skin. Nevertheless, the precise impact of probiotics on postoperative wound healing remains an area with limited research. Objective: Determine the effectiveness of probiotic supplements in wound healing in patients with surgical wounds Method: Literature search is done by advanced searching on Pubmed, Cochrane, Scopus, and EBSCOhost with eligibility criteria determined by the author. Results: There were three articles relevant to clinical questions and eligibility criteria that had been established, consisting of one systematic review article from the randomized controlled trial (RCT) study and two RCT articles. The SR/MA article includes good-quality RCT studies. The SR/MA article showed insignificant results on the effect of probiotic administration on healing. The RCT article showed significant results on the effect of probiotics on surgical wound healing, but the confidence level was low in one of the articles. Conclusion: Probiotic supplementation on wound healing in postoperative patients is not conclusive. This can be affected by the type of probiotic strain, dosage, duration of administration, and location of the surgical wound

The effect of intermittent fasting 5:2 on IL-6 levels in obese male employees in Jakarta

Background: Obesity is a condition of excessive fat accumulation in adipose tissue. This condition causes endothelial damage, increase macrophage infiltration, and inflammation in adipose tissue. Inflammation happens due to the increase of interleukin-6 (IL-6) as a proinflammatory cytokine which responsible for the occurrence of chronic diseases. Intermittent fasting is a potentially effective method for losing weight and suggested can reduce levels of proinflammatory cytokines. Objective: The aim of this study is to determine the effect of 5:2 intermittent fasting on IL-6 cytokine levels in obese employees in Jakarta. Methods: This study used a cross-sectional method conducted on 50 healthy male employees aged 19–52 years with a body mass index (BMI) ≥25 kg/m2. Subjects were divided into two groups, the 5:2 intermittent fasting group and the non-fasting group. Intermittent fasting 5:2 was observed every Monday and Thursday for eight weeks. IL-6 levels were obtained through examination using an enzyme-linked immunosorbent assay (ELISA) method. Statistical analysis was performed by Mann Whitney and Kruskal Wallis test. Results: The results showed that the median of IL-6 levels decreased in fasting group from 5,10 (1.06–9.81) pg/mL to 4.64 (1.00–13.39) pg/mL and increased in non-fasting group from 3.65 (1.17–38.70) pg /mL to 6.35 (2.44–19.86) pg/mL, but the change was not significant. Conclusion: Intermittent fasting 5:2 tend to decrease IL-6 levels in obese male employees in Jakarta although the change of IL-6 level was not significant

Chyme reinfusion therapy using new technology

High output double enterostomies (DES) and disease-related malnutrition (DRM) are features of intestinal failure (IF) that require parenteral nutrition (PN) until surgical re-establishment of intestinal continuity. PN risks include gut and hepatobiliary dysfunction and Intestinal failure associated liver disease (IFALD), defined as hepatobiliary dysfunction with elevated liver function tests (LFT).  Chyme reinfusion therapy (CRT) is a distal feeding technique recommended for restoration of digestive function

Nutrition in paediatric intestinal failure

Children with irreversible intestinal failure can survive and lead good quality of life in the recent 20-30 years. A lot of this advance is due to better understanding of what and how to deliver nutrition (both enterally and parenterally) effectively. This talk aims to provide not only an overview but some practical considerations on how to manage paediatric intestinal failure