Vitamin D and immune responses: how much is too much?

Vitamin D is a sunshine vitamin that is widely known for bone health. The main source of vitamin D from exposure to ultraviolet B radiation, whereas only 20% from natural and fortified food. Recent studies concluded that vitamin D has a putative role in reducing the risk of viral respiratory infection by suppressing pro-inflammatory cytokines and delaying increasing anti-inflammatory cytokines response. Whereas, vitamin D regulates innate immunity through macrophage and dendrite cell activity as well as an adaptive immune response through lymphocyte T cells response

Medical nutrition therapy in hospitalized patients with pemphigus vulgaris

Dysphagia due to involvement of the oral, pharyngolaryngeal, and esophageal mucosa and increased catabolism due to epidermal shedding can contribute to a decline in nutritional status in pemphigus vulgaris (PV) patients. On the other hand, decreased lean body mass is associated with immune system impairment, increased risk of infection, and delayed wound healing in PV patients, therefore, nutritional screening and assessment are necessary. Medical nutritional therapy in PV patients aims to overcome the metabolic response to the insults, prevent further malnutrition, modulate the immune system, and accelerate wound healing process. An aggressive nutritional support to minimize protein loss during the phase of mucocutaneous lesion healing is needed in patients with PV. Aside from macronutrient adequacy, micronutrients including vitamin A supplementation can be considered to accelerate wound healing process. Medical nutritional therapy including provision of adequate macronutrients, micronutrients, addressing dehydration and electrolyte imbalances should be the cornerstone of multidisciplinary treatment in PV patients

Effect of isoflavone consumptions on the recurrence and survival rate among breast cancer patients: an evidence-based case report

Background: isoflavones possess both anti-estrogenic and estrogenic-like properties. Tempeh is a traditional dish from Indonesia which rich in isoflavone content. It remains controversial whether women diagnosed with breast cancer should be advised to avoid or increase the intake of food products that contain isoflavone to improve survival.Objective: to identify the association between post-diagnosis isoflavone food consumption with the recurrence and survival rate among women with breast cancer. Methods: the search was conducted with advanced searching on PubMed, Cochrane, Scopus, and ProQuest according to the clinical question. The screening of title and abstract using inclusion and exclusion criteria, filtering double, and reading full text led to six useful articles. The selected studies were critically appraised for validity, importance, and applicability.Results: five prospective cohort studies and one meta-analysis were found with comparable validity. Women at the high level of isoflavone intake (>10 mg/day) had a significant reduction in the risk of recurrence and mortality of breast cancer.Conclusion: isoflavone food intake is associated with better survival, low recurrence, and low mortality among breast cancer patients.  

Effect of vitamin D supplementation to prevent acute respiratory tract infection : an evidence-based case report

Background: One of the frequent health problems that regularly occurs in Indonesia, as a tropical country is an acute respiratory tract infection, including influenza. Since immunological benefit of vitamin D already proven, hypothetically, vitamin D can be used as protective agent to prevent influenza or other respiratory tract infections. Objective: This evidence-based case report was focused on the evaluation of protective ability of vitamin D supplementation to prevent influenza or other acute respiratory tract infections.Methods: Literature searching was conducted on PubMed data base and Cochrane Library using the related keyword combinations.Results: Two randomized-clinical trials (RCTs) and a meta-analysis study were fulfilled the eligibility criteria. Vitamin D supplementation did not reduce the incidence of influenza but reduce the incidence of non-influenza infection. High-dose vitamin D supplementation had no effect on the reduction of acute respiratory tract infection incidence. The meta-analysis concluded that vitamin D supplementation reduced the risk for acute respiratory tract infection and the stronger effects occurred on low-levels of vitamin D serum.Conclusion: Vitamin D supplementation may prevent acute respiratory tract infections, especially in subjects with low-levels of vitamin D serum

EFFECTS OF EXTRA VIRGIN OLIVE OIL VERSUS RICE BRAN OIL ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE-2 DIABETES MELLITUS

Objective: The purpose of this study was to determine the effect of extra virgin olive oil (EVOO) and rice bran oil (RBO) on glycemic control and lipid profiles in patients with type-2 diabetes mellitus (T2DM). Methods: Ten patients with T2DM received 15 ml/day of EVOO or RBO. Levels of fasting blood glucose (FBG), postprandial blood glucose (PBG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides (TGs) were measured. RBO or EVOO was administered for 4 consecutive weeks. During a 2-week interval, the treatment was not administered. After this washout period, a crossover design was implemented by exchanging EVOO supplementation with RBO supplementation and vice versa for 4 consecutive weeks. Results: Changes in levels of FBG, PBG, TC, LDL-C, and TGs were not significantly different in the two groups. However, significantly decreased the levels of HDL-C were observed in both groups. Conclusion: RBO and EVOO had no significant influence on levels of FBG or PBG

Correlation of Beta Carotene and Nutrition Status With Malondialdehyde Levels in Breastfeeding Mother

Background : Malondialdehyde (MDA), one of the products of polyunsaturated fatty acid (PUFA) peroxidation detected in breast milk (BM). MDA levels depicted BM’s oxidative status. BM oxidative balance could prevent oxidative stress in babies. MDA could be influenced by antioxidant food source such as beta carotene as well as body mass index (BMI).Objective: To analyze beta carotene intake and BMI and their correlation with BM MDA levels in nursing motherMethods: Eighty breastfeeding mothers who were 20–40 years old, came to Cilincing and Grogol Petamburan Public Health Centre February–April 2019 and had 1–6 months old babies were enrolled in this cross-sectional study. The BM was extracted in the next day. Mothers were asked to empty one of the breast 2 hours prior to extraction. Beta carotene intake was assessed using semi quantitative food frequency (SQ-FFQ). Body weight and height was measured on the first day. The BM MDA levels were assessed using thiobarbituric acid reactive substance (TBARS) assay. The correlation of beta carotene intake and MDA as well as BMI and MDA was assessed using Spearman test with level of significance of p<0.05.Results: Subject’s median age was 27 (20-35) years old, median BMI was 23.21 (15.25-39.55) kg/m2. Beta carotene’s median intake was 8039.8 (1697.7–34028) mg/day with 72.5% of the subjects were considered low intake. BM MDA level’s median was 1.953 (0.739-4.928) nmol/ml. Beta carotene intake (r = 0.247, p = 0.027) and BMI (r = 0.285, p = 0.010[DN4] ) had a weak correlation with BM MDA level.Conclusion: The beta carotene intake and the BMI of the subjects correlate significantly with the BM MDA level. It showed that the mother’s intake and body composition contribute to the oxidant level in BM, therefore influenced the level of oxidative stress transferred to the babies

Body Mass Index And Survival Rate in Nasopharyngeal Cancer Patient: An Evidence-based Case Report

Introduction: Nasopharyngeal cancer is the most common type of head and neck cancer with prevalence of 6.2/100000 population. Recently, study of prognostic factors for nasopharyngeal cancer still becomes one of research focuses. Several studies have tried to find the relationship between nutritional status (body mass index/BMI) and nasopharyngeal cancer patients’ survival rate, but the results are still inconsistent.                    Objective: To find the relationship between nutritional status represented by BMI and nasopharyngeal cancer patients’ survival rate.Methods: Electronic literature searches were performed in Cochrane®, Scopus®, and Pubmed®. Mesh term and title/abstracts were screened based on inclusion and exclusion criteria before relevant journals were reviewed.Results: Two articles were selected based on the eligibility criteria and relevancy to the clinical question. In the study of Huang et al., the subject was nasopharyngeal cancer patient stage III and IV was included as subject of the study. In the study of Lin et al., nasopharyngeal cancer patient with metastases was also included. Patient with higher BMI has better survival rate than underweight BMI category.Conclusion: Increasing BMI in underweight cancer patient simproves nasopharyngeal cancer patient’ survival rate

Comparing the Efficacy of Ketogenic Diet with Low-Fat Diet for Weight Loss in Obesity Patients: Evidenc-Based Case Report

Introduction Obesity is a nutritional disease which is still a health burden particularly in Jakarta. The main treatment for obesity is nutritional intervention. Nowadays, several dietary approaches have been developed, including ketogenic diet, which is still controversial. Methods Literature search had been done within 4 databases including PubMed®, Cochrane®, Google® Scholar, and Science Direct®, using keywords: obesity, ketogenic diet, low-fat diet, and weight loss. Then, Medical Sub Heading (MeSH) was used. The search resulted in two articles which were appraised according to aspects of validity, importance, and applicability Results A randomized-controlled trial study showed similar effect of weight loss with ketogenic diet compared to low-fat diet. On the other hand, a meta-analysis study showed ketogenic diet caused more weight loss than low-fat diet. Both studies showed an increased risk of cardiovascular disease from the ketogenic diet group, which were shown by a decrease of flow-mediated dilatation and an increase of LDL-C. Conclusion Ketogenic diet shows a better long-term effect for weight loss in obese patients than low-fat diet. However, ketogenic diet may increase the cardiovascular event risk significantly

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

Prediction of Post-operative Survival of Colorectal Cancer Patient By Using the Prognostic Nutritional Index: An Evidence-Based Case Report

Background: Colorectal cancer patients may be treated with several modalities and one of them is surgical treatment. Surgery in cancer patients is risky procedure and may not always resulted in prolonged survival. Therefore, before receiving any recommended treatment, the patient’s prognosis has to be assessed and defined properly. Several methods are available to assess the prognosis of cancer patients; one of them is the prognostic nutritional index (PNI).Objective: This study aimed to predict the survival of a colorectal cancer patient post-operatively by calculating the pre-operative PNI score.Method: Literature searching was done using inclusion and exclusion criteria on two databases, i.e. the PubMed and the Cochrane Library. The outcome was survival (disease-free survival, relapse-free survival, or overall survival).Results: Five articles that address the clinical question were retrieved. All indicated that a patient with low PNI score (<44.5) had a shorter overall survival (HR between 1.92 and 3.98 with all p values were <0.05).Conclusion: Pre-operative PNI score can be used to assess the overall survival of a colorectal cancer patient who underwent surgical resection. Patients with a PNI score > 44.5 had better survival than lower PNI score