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Parenteral multivitamins in hospitalized patients Niken Puruhita
World Nutrition Journal Vol. 6 No. S1 (2022): Selected conference proceedings of the Nutri Virtual Symposium 2022
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V06.S1.0009

Malnutrition, especially micronutrient malnutrition remain as major problems in hospitalized patients. Micronutrient malnutrition contributes to health status and recovery speed of patients. It may lead to poor wound healing and/or increasing the risk of complication which result in longer hospital stay or even, death. Critically or acutely ill patients who are in total parenteral nutrition therapy for longer period need intravenous micronutrients. Past publications reported Wernickeâ€™s Beri-beri in patient who did not received vitamins along with total parenteral nutrition infusion after 4 weeks passed away regardless the amounts of macronutrients delivered.

HUBUNGAN PHASE ANGLE DENGAN TINGKAT KEPARAHAN INFARK MIOKARD Rosa Kristiansen; Niken Puruhita; Febe Christianto; Hertanto Wahyu Subagio; Enny Probosari
IJCNP : INDONESIAN JOURNAL OF CLINICAL NUTRITION PHYSICIAN Vol 6 No 1 (2023): IJCNP (INDONESIAN JOURNAL OF CLINICAL NUTRITION PHYSICIAN)
Publisher : Perhimpunan Dokter Gizi Klinik Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54773/ijcnp.v6i1.156

Latar belakang : Phase angle (PhA) yang merupakan indikator integritas seluler mungkin berhubungan dengan tingkat keparahan IM yang tercermin dari penanda cedera miosit yaitu kadar troponin. Tujuan : Menganalisis hubungan PhA dengan tingkat keparahan IM. Metode : Penelitian observasional, melibatkan 40 subjek dengan IM yang memenuhi kriteria inklusi dan eksklusi. Tingkat keparahan IM diukur dari kadar troponin I, PhA didapatkan dari bioelectrical impedance analysis, dan data komorbid diambil dari rekam medis pasien. Uji hipotesis menggunakan analisis bivariat untuk melihat hubungan phase angle dan beberapa komorbid dengan tingkat keparahan IM. Hasil : Mayoritas subyek penelitian berjenis kelamin laki-laki (82,5%), rerata usia 56,1 tahun, dan rerata IMT 25,56 kg/m2. Dislipidemia merupakan jenis komorbid yang paling banyak diderita (92,5%) dan 62,5% subyek penelitian memiliki 2 atau lebih komorbid. Hasil analisis bivariat PhA, jenis komorbid, jumlah komorbid, usia, IMT, dan jenis kelamin terhadap kadar troponin I adalah tidak signifikan (p>0,05). Kesimpulan : PhA, diabetes, hipertensi, dislipidemia, jumlah komorbid, usia, IMT, dan jenis kelamin tidak berhubungan dengan tingkat keparahan IM. Kata kunci : BIA, komorbid kardiovaskular, phase angle, tingkat keparahan infark miokard

Nutrition and inflammaging : unveiling the impact of diet on healthy aging Niken Puruhita
World Nutrition Journal Vol. 7 No. S1 (2023): Selected conference proceedings of the Nutri Symposium 2023
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/V07.S1.0013

Aging is a declining process which leads to a poorer state of human health. The process involved immune system, known as immunosenescence, which is a multifactorial and dynamic process, involving both innate and acquired immunity. It is characterized by a progressive reduction in the ability to trigger immune responses against infections and vaccinations and lead to inflammaging. Immunosenescence plays a critical role in most chrocic diseases in older people, therefore, attempts are made to slow down or reverse the process.

Korelasi Status Gizi dengan Phase Angle pada Pasien Gagal Ginjal Kronis yang Menjalani Hemodialisis Hartanto, Okky; Puruhita, Niken; Khairuddin, Khairuddin; Muis, Siti Fatimah; Christianto, Febe
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 1 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i1.795

BACKGROUND: Nutritional problem are often experienced by patients with chronic kidney disease (CKD) undergoing regular hemodialysis. There are various tools that can be used to evaluate nutritional status, such as the 7-point Subjective Global Assessment (SGA), nevertheless, malnutrition in these patients is still underdiagnosed and resulting in worse clinical outcomes. Phase Angle (PhA) as measured by multi-frequency Bioelectrical Impedance Analysis (BIA) may detect nutritional problem in early stage in order to start nutrition therapy early. OBJECTIVE: To analyze correlation between nutritional status and PhA in CKD patients with regular hemodialysis. METHODS: The subject of this study were 39 CKD patients undergoing regular hemodialysis who met the inclusion and exclusion criteria. Nutritional status was evaluated by 7-point SGA, while PhA was measured by multi-frequency BIA. Correlation between variables analyzed by Spearman correlation test. RESULT: Positive correlation was observed between nutritional status and PhA (r = 0,64; p < 0,001). There was a negative correlation between PhA and number of comorbids (r = -0,381, p = 0,017). PhA was not correlated with sex and hemodialysis duration. CONCLUSION: There is positive correlation between nutritional status measured by 7-point SGA and PhA in CKD patients with regular hemodialysis.

Correlation Between Visceral Fat And Lipid Profile in Myocardial Infarction Patients Yuniari, Dwi; Puruhita, Niken; Probosari, Enny; Subagyo, Hertanto Wahyu; Nugrohowati, Annta Kern
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 2 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i2.797

BACKGROUND : Previous studies reported that visceral fat plays an important role in cardiovascular disease, even in non-obese individuals. Bioelectrical impedance analysis (BIA) is a non-invasive and radiation-free method for assessing visceral fat. Not much is known whether visceral fat correlates with lipid profile in myocardial infarction (MI) patients in Indonesian population. PURPOSE : To analyze the correlation between visceral fat and serum lipid profile in MI patients. METHODE : This is a correlational study on 32 MI patients hospitalized at the ICCU of RSUP Dr. Kariadi Hospital recruited with consecutive sampling. Visceral fat was measured by BIA SECA mBCA 525 series, data regarding levels of total cholesterol, triglycerides, low density lipoprotein (LDL), and high density lipoprotein (HDL) were gathered from medical record. The data were normally distributed, then the hypothesis was tested with the Pearson. RESULT : The mean age of the subjects was 55 ± 9.88 years, with 87.5% being male. As many as 81.3% of subjects experienced ST-elevation myocardial infarction (STEMI). The average body mass index (BMI) was 26.2 ± 3.68 kg/m², in which 40.6% of subjects were classified as grade 1 obesity. The majority of subjects (93.8%) had high visceral fat. As many as 68.8% of subjects had high LDL levels with an average of 120.5 ± 38.84 mg/dL. HDL average was 35±13.55 mg/dL with 62.5% of subjects having low HDL levels. More than half of the subjects (56.3%) experienced hypertriglyceridemia with an average of 157.4 ± 55.84 mg/dL. Visceral fat was significantly related to total cholesterol and triglycerides (r=0.40; p=0.02 and r=0.36; p=0.04). CONCLUSION : There is a significant correlation between visceral fat and total cholesterol and triglycerides in MI patients.

Sorghum-Soybean Flour Enteral Formula Reduces Blood Glucose, Cholesterol, Triglycerides, LDL, and Increases HDL and Albumin in Hyperglycemic Rats Probosari, Enny; Dewi, Suci Noviya; Alfadila, Tsania Izza; Handayani, Endah Nur; Rizkita, Maura Sania; Candra, Aryu; Ardiaria, Martha; Puruhita, Niken; Murbawani, Etisa Adi
Molecular and Cellular Biomedical Sciences Vol 9, No 1 (2025)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v9i1.507

Background: Diabetes mellitus prevalence is rising. Liquid feeding in the form of enteral formulas is needed to meet the nutritional needs of patients who cannot consume orally. The development of enteral formulas based on sorghum-soybean flour for diabetes mellitus patients, which has been nutritionally analyzed and adjusted to the requirements of enteral manufacturing, was selected for further in vivo research. This study evaluated the effect of the sorghum-soybean flour formula on fasting blood glucose (FBG), lipid profile levels, and albumin in hyperglycemic rats.Materials and methods: This was a true experimental study with pre–post-test randomized control design. Wistar rats were divided into four groups: negative control group was normal rats and given standard feed only; positive control group was hyperglycemic rats and given standard feed only; treatment (T)1 and T2 groups were hyperglycemic rats given standard feed along with enteral formula at a dose of 4,41 g/day and 5,51 g/day for 28 days. Blood samples were collected to analyze FBG, albumin, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and total cholesterol.Results: There were differences in the levels of FBG, albumin, LDL, HDL, triglycerides, and total cholesterol before and after the intervention in groups T1 and T2. Group T1 showed an 8.12% decrease in FBG, while T2 showed a 29.89% decrease. Triglycerides decreased by 29.22% in T1 and 31.85% in T2; cholesterol decreased by 11.41% in T1 and 13.94% in T2. LDL levels decreased by 29.97% in T1 and 38.44% in T2. Albumin levels increased by 47.90% in T1 and 56.67% in T2. HDL levels increased by 23.94% in T1 and in 35.04% in T2.Conclusion: Administration of an enteral formula based on sorghum-soybean flour can reduce FBG, triglycerides, total cholesterol, and LDL levels, and increase albumin and HDL levels in hyperglycemic rats.Keywords: hyperglycemia, enteral formula, albumin levels, fasting blood glucose, HDL, LDL, total cholesterol, triglycerides

Whey Protein as an Adjuvant Therapy for Wound Healing and Infection Control: A Systematic Review and Meta-Analysis of Clinical and Preclinical Evidence Aliva Nabila Farinisa; Niken Puruhita; Yan Wisnu Prajoko; Felix Setiawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1483

Background: Impaired wound healing and subsequent infections represent a significant clinical and economic burden. Nutritional status, particularly high-quality protein provision, is a critical, modifiable determinant of healing outcomes. Whey protein (WP), a rich source of essential amino acids and unique bioactive components, has emerged as a promising adjuvant therapy. Methods: We conducted a systematic review and meta-analysis adhering to PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from January 2015 to December 2024 for clinical randomized controlled trials (RCTs) and preclinical controlled studies evaluating WP supplementation on wound healing and infection. Rigorous inclusion criteria led to the selection of seven studies (four clinical RCTs, three preclinical) for quantitative synthesis. Data were pooled using a random-effects model to calculate Standardized Mean Differences (SMD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes. Results: The meta-analysis of four clinical RCTs (n=340 patients) demonstrated that WP supplementation significantly accelerated wound healing (SMD = 0.78; 95% CI 0.45, 1.11; p < 0.0001) with moderate heterogeneity (I²=38%). Furthermore, WP significantly reduced the odds of wound infection by 48% (OR = 0.52; 95% CI 0.31, 0.87; p=0.01) with no heterogeneity (I²=0%). Preclinical synthesis (3 studies, n=62 animals) revealed a significant reduction in pro-inflammatory cytokines (TNF-α, IL-6) at the wound site (SMD = -1.15; 95% CI -1.67, -0.63; p < 0.0001). Conclusion: This meta-analysis provides robust quantitative evidence that whey protein functions as an effective adjuvant therapy, significantly enhancing wound repair and providing clinically relevant infection control. These benefits appear to be mediated by a dual mechanism: providing essential anabolic substrates for tissue repair and exerting potent immunomodulatory and antioxidant effects via bioactive components like lactoferrin and cysteine.

Vitamin D in the Breast Cancer Continuum: A Systematic Review and Meta-Analysis of Primary Prevention, Patient Prognosis, and Adjunctive Treatment Response Felix Setiawan; Yan Wisnu Prajoko; Niken Puruhita; Aliva Nabila Farinisa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1486

Background: The role of vitamin D across the breast cancer spectrum remains complex and contested. Compelling preclinical antineoplastic mechanisms contrast with inconsistent clinical findings. Large randomized controlled trials (RCTs) show null effects for primary prevention, while observational studies often link higher vitamin D status at diagnosis with better prognosis. Key conflicts include this prevention-prognosis disconnect, debates over linear versus J-shaped prognostic dose-responses, and a "receptor-status paradox" where estrogen receptor-positive (ER-positive) disease shows prognostic links, but hormone receptor-negative (HR-negative)/triple-negative (TNBC) subtypes derive greater benefit (improved pathological complete response, pCR) from vitamin D intervention during neoadjuvant chemotherapy (NACT). This study systematically synthesizes evidence across these distinct clinical contexts. Methods: Following PRISMA guidelines, we systematically reviewed PubMed, EMBASE, and CENTRAL (January 1st, 2014–September 2nd, 2025) for high-impact RCTs and large prospective cohort studies evaluating vitamin D supplementation or serum 25-hydroxyvitamin D (25(OH)D) levels regarding breast cancer incidence, prognosis (survival/recurrence), or pCR after NACT. Quality was assessed (Cochrane RoB 2; Newcastle-Ottawa Scale). Data were extracted dually. Findings were synthesized stratigraphically (prevention, prognosis, treatment). A random-effects meta-analysis pooled pCR data from NACT RCTs. Results: Six high-quality studies (3 RCTs, 3 cohorts; N=31,026) were included. (1) Prevention: The VITAL RCT (N=25,871; mean baseline 25(OH)D 30.8 ng/mL) found no reduction in incident invasive breast cancer with 2000 IU/day vitamin D3 (HR 1.02, 95% CI 0.79–1.31). (2) Prognosis: Cohort studies (N=4,835) showed higher 25(OH)D linked to better OS (Adj HR T3 vs T1: 0.72). Complexity emerged: one study linked benefit specifically to ER-positive recurrence (Adj HR 0.87), while another reported a J-shaped curve for EFS, with worse outcomes at both low (≤52 nmol/L; Adj HR 1.63) and high (≥99 nmol/L; Adj HR 1.37) levels versus intermediate. (3) Treatment: Meta-analysis of two NACT RCTs (N=310) showed vitamin D supplementation significantly increased pCR rates (38.1% vs 22.6%; Pooled RR 1.69, 95% CI 1.21–2.36; P=0.002; I²=0%). Subgroup data strongly suggested greater benefit in HR-negative/TNBC and baseline-deficient patients. Conclusion: Vitamin D supplementation appears ineffective for primary breast cancer prevention in replete populations. Its prognostic role is complex, suggesting an optimal 25(OH)D range (potentially ~30-40 ng/mL) and possible ER-specific hormonal modulation effects, though causality from observational data remains uncertain. Critically, vitamin D intervention during NACT significantly improves pCR, particularly in HR-negative/TNBC, likely via distinct chemosensitization/immunomodulatory mechanisms. This synthesis provides a framework for understanding these context-dependent roles, supporting vitamin D assessment and potentially adjunctive NACT supplementation, especially in deficient patients with aggressive subtypes, pending necessary validation in larger trials.

Adaptive Radiotherapy (ART) versus Non-Adaptive IMRT for Locoregionally Advanced Nasopharyngeal Carcinoma: A Meta-Analysis of Dosimetric Advantages, Clinical Outcomes, and Organ-at-Risk Sparing Gina Amalia; Yan Wisnu Prajoko; Niken Puruhita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1488

Background: Intensity-modulated radiotherapy (IMRT) is the cornerstone of treatment for nasopharyngeal carcinoma (NPC), offering high dose conformity. However, anatomical variations during the multi-week therapy course can compromise dosimetric accuracy. Adaptive radiotherapy (ART), which adjusts the treatment plan based on intra-treatment imaging, aims to mitigate these effects. This meta-analysis synthesized contemporary comparative evidence (2014–2025) on the efficacy and safety of ART versus non-adaptive IMRT in locoregionally advanced NPC. Methods: Following PRISMA guidelines, PubMed, Embase, Scopus, and Cochrane Library were searched for studies comparing ART with non-adaptive IMRT (cohorts or hybrid/phantom plan comparisons) in locoregionally advanced NPC. Primary outcomes were locoregional recurrence-free survival (LRFS) and overall survival (OS); secondary outcomes included progression-free survival (PFS), distant metastasis-free survival (DMFS), and dosimetric metrics for targets (D98, Conformity Index [CI]) and organs-at-risk (OARs: parotid Dmean, spinal cord Dmax, brainstem Dmax). Hazard Ratios (HR) and Mean Differences (MD) were pooled using random-effects models. Data estimation methods (Tierney, Wan, Cochrane) were employed where necessary. Heterogeneity was assessed using I². Results: Nine studies (2 cohort, 7 dosimetric/anatomical) involving 362 patients (clinical) and 215 datasets (dosimetric) were included. ART significantly improved LRFS compared to non-adaptive IMRT (pooled HR = 0.53, 95% CI 0.32–0.88; I²=0%). No significant differences were found for OS (HR=0.98, 95% CI 0.64–1.50), PFS (HR=0.70, 95% CI 0.45–1.07), or DMFS (HR=0.88, 95% CI 0.48–1.62). Compared to hybrid/phantom plans, ART significantly enhanced target coverage (pooled PTV D98 MD = 2.15 Gy, 95% CI 1.10–3.20 Gy; I²=78%) and conformity (pooled CI MD = 0.05, 95% CI 0.02–0.08; I²=85%). ART significantly reduced OAR doses: parotid Dmean (pooled MD = -3.50 Gy, 95% CI -4.95 to -2.05 Gy; I²=90%), spinal cord Dmax (pooled MD = -3.95 Gy, 95% CI -5.80 to -2.10 Gy; I²=93%), and brainstem Dmax (pooled MD = -2.75 Gy, 95% CI -4.40 to -1.10 Gy; I²=91%). Dosimetric analyses exhibited high heterogeneity. Conclusion: ART significantly improves LRFS in locoregionally advanced NPC compared to non-adaptive IMRT. It provides substantial dosimetric advantages, enhancing target coverage and conformity while critically reducing doses to parotid glands, spinal cord, and brainstem. Despite high dosimetric heterogeneity and no demonstrated OS benefit, the improvements in LRFS and dose delivery support the thoughtful implementation of ART.

Whey Protein as an Adjuvant Therapy for Wound Healing and Infection Control: A Systematic Review and Meta-Analysis of Clinical and Preclinical Evidence Aliva Nabila Farinisa; Niken Puruhita; Yan Wisnu Prajoko; Felix Setiawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1483

Background: Impaired wound healing and subsequent infections represent a significant clinical and economic burden. Nutritional status, particularly high-quality protein provision, is a critical, modifiable determinant of healing outcomes. Whey protein (WP), a rich source of essential amino acids and unique bioactive components, has emerged as a promising adjuvant therapy. Methods: We conducted a systematic review and meta-analysis adhering to PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from January 2015 to December 2024 for clinical randomized controlled trials (RCTs) and preclinical controlled studies evaluating WP supplementation on wound healing and infection. Rigorous inclusion criteria led to the selection of seven studies (four clinical RCTs, three preclinical) for quantitative synthesis. Data were pooled using a random-effects model to calculate Standardized Mean Differences (SMD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes. Results: The meta-analysis of four clinical RCTs (n=340 patients) demonstrated that WP supplementation significantly accelerated wound healing (SMD = 0.78; 95% CI 0.45, 1.11; p < 0.0001) with moderate heterogeneity (I²=38%). Furthermore, WP significantly reduced the odds of wound infection by 48% (OR = 0.52; 95% CI 0.31, 0.87; p=0.01) with no heterogeneity (I²=0%). Preclinical synthesis (3 studies, n=62 animals) revealed a significant reduction in pro-inflammatory cytokines (TNF-α, IL-6) at the wound site (SMD = -1.15; 95% CI -1.67, -0.63; p < 0.0001). Conclusion: This meta-analysis provides robust quantitative evidence that whey protein functions as an effective adjuvant therapy, significantly enhancing wound repair and providing clinically relevant infection control. These benefits appear to be mediated by a dual mechanism: providing essential anabolic substrates for tissue repair and exerting potent immunomodulatory and antioxidant effects via bioactive components like lactoferrin and cysteine.

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