Faktor-Faktor Yang Mempengaruhi Kejadian Malnutrisi Pasien Dewasa Di Ruang Rawat Inap Rumahsakit
Faktor-Faktor Yang Mempengaruhi Kejadian Malnutrisi Pasien Dewasa Di Ruang Rawat Inap Rumahsakit
ABSTRACT
Background : Nutrient intakes may influence nutritional
status of patients during health care. It was reported that
nutritional status of 75% of hospitalized patients declined
during hospitalization.
Objective: The objectives of this study was to assess
factors that may influence malnutrition among adult
patients in hospital.
Methods: This study was done using a nested case
control study design. Subjects were inpatients of internal
and neurology departments of Sanglah, Sardjito and M.
Jamil hospitals. They were all given oral feeding, in
consciousness condition, cooperative, and non-ascites.
Data on food consumption were obtained using
comstock methods, while nutritional status were
measured using Subjective Global Assessment.
Results: Low energy intake, length of stay, infection,
and special diet were all associated with a higher risk of
hospital malnutrition. Patients with low energy intakes
were 2.4 (OR=2.4, 95%CI= 1.17-4.92) times more likely
to be malnourished than those with sufficient energy
intakes. Patients with length of stay >= 7 days were 8
(OR=8.15, 95% CI =1.87-35.51) times more likely to be
malnourished than those with length of stay < 7 days.
Patients with infectious diseases were 3 (OR= 0.33, 95%
CI= 0.17-0.64) times less likely to be malnourished than
those with non infectious diseases. Lastly, patients with
special diet were 2 (OR=1.96, 95% CI= 1.05-3.68) times
more likely to be malnourished than those without special
diet.
Conclusions: Low energy intake, length of stay, non
infectious diseases, and special diet are risk factors of
malnutrition in adult hospitalized patients.
Key words: Nutrients intake, nutritional status, hospital
malnutrition.
PENDAHULUAN
Pemberian dukungan gizi bagi orang sakit bukan
merupakan tindakan yang berdiri sendiri dan terpisah
dari tindakan perawatan dan pengobatan. Pengaturan
makanan, perawatan penyakit, dan pengobatan
merupakan satu kesatuan dalam proses
penyembuhan penyakit (1). Malnutrisi dapat timbul
sejak sebelum dirawat di rumah sakit karena
penyakitnya atau asupan zat gizi yang tidak cukup,
1
2
3
10
Sampel
(n=318)
Drop Out
(n=25)
Subyek Penelitian
(n=293)
Operasi
(n=1)
Pulang Paksa
(n=22)
Pindah Paksa
(n=2)
Kontrol
(n=223)
Kasus
(n=70)
11
No
Malnutrisi
(n=70)
Karakteristik
1. Jenis kelamin
Laki-laki
Perempuan
2. Umur
< 55 tahun
55 tahun
3. Pendidikan
Rendah
Menengah
Tinggi
4. Kelas Perawatan
Satu
Dua
Tiga
5. Jenis Penyakit
Infeksi
Non infeksi
6. Bentuk Makanan
Mak. biasa
Mak. khusus
Tidak Malnutrisi
(n=223)
(%)
value
38
32
54.29
45.71
117
106
52.47
47.53
155
138
0,07
0,79
48
22
68.57
31.43
151
72
67.71
32.29
199
94
0,89
0,18
24
33
13
34.29
47.14
18.57
51
151
21
22.87
67.71
9.42
75
184
334
10,15
0,06
5
25
40
7.14
35.71
57.15
15
97
111
6.73
43.50
49.77
20
122
151
1,35
0,51
22
48
31.43
68.57
109
114
48.88
51.12
131
162
6,56
0,01*
25
45
35.71
64.29
100
123
44.84
55.16
125
168
1,81
0,18
Tabel 2. Rata-rata Asupan Zat Gizi pada Kelompok Malnutrisi dan Tidak Malnutrisi
Asupan Gizi
Malnutrisi
(Mean SD)
1427,3 343,3
44,4 14,5
Kalori
Protein
Tidak Malnutrisi
(Mean SD)
1548,2 445,4
49,4 14,1
2,08
2,59
0,038*
0,01*
Tabel 3. Asupan Energi dan Protein pada Kelompok Malnutrisi dan Tidak Malnutrisi
Kasus
(n=70)
Asupan Gizi
1. Asupan Energi
80%
< 80%
2. Asupan Protein
80%
< 80%
Kontrol
(n=223)
OR
95% CI
26
44
37,1
62,9
112
111
50,2
48,8
1,7
0,98-2,96
29
41
41,4
58,6
116
107
52,0
48,0
1,5
0,89-2,64
12
7 hari
< 7 hari
Malnutrisi
(n=70)
Tidak Malnutrisi
(n=223)
68
2
97,1
2,9
182
41
81,6
18,4
OR
95% CI
7,7
1,80-32,53
Satu
Dua
Tiga
Malnutrisi
(n=70)
Tidak Malnutrisi
(n=223)
5
25
40
7,1
35,7
57,2
15
97
111
6,7
43,6
49,7
OR
95% CI
0.62
0.84
0.22-1.76
0.30-2.34
13
Infeksi
Non Infeksi
Malnutrisi
(n=70)
Tidak Malnutrisi
(n=223)
22
48
31,4
68,6
109
114
48,9
51,1
OR
95% CI
0,48
0,27-0,85
Biasa
Khusus
Malnutrisi
(n=70)
Tidak Malnutrisi
(n=223)
25
45
35,7
64,3
100
123
44,8
55,2
OR
95% CI
0,79
0,55-1,14
14
Bentuk Makanan
Penyakit
Infeksi
Non-infeksi
Biasa
(n=125)
Khusus
(n=168)
38
87
30.4
69.6
93
75
55.4
44.6
OR
95% CI
2.77
1.70-4.51
Keterangan: :referens
Asupan Energi
Makanan
Cukup
(n=138)
n
Tidak Cukup
(n=155)
%
95% CI
2.03
1.27-3.27
Biasa
72
52.2
53
34.2
Khusus
66
47.8
102
65.8
Keterangan: :referens
OR
15
Odds Ratio
1
2,40
1,17-4,92*
1
1,03
0,51-2,08
1
8,15
1,87-35,51*
1
1,02
0,60-1,74
1
0,33
0,17-0,64*
1
1,96
1,04-3,68*
1
0,66
0,33-1,27
1
0,96
0,52-1,77
1
0,82
0,49-1,37
* = bermakna
16
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RUJUKAN
1.
2.
3.
13.
14.
15.
16. Chima CS, Kathy B, Marci LAD, et al. Relationship nutritional status to length of stay, hospital
costs, and dischange status of patiens hospitalized in the medicine service. J Am Diet Assoc
1997;97:975-80.
17. Almatsier S. Jusat I dan Akmal N. Persepsi
pasien terhadap makanan di rumah sakit (survey pada 10 rumah sakit di Jakarta). Gizi Indonesia 1992;17(1-2):87-96.
18. Wardhana LW. Pengaruh penyakit infeksi dan
noninfeksi terhadap status pulang pasien anak
di bangsal rawat inap [thesis]. Yogyakarta:
Pascasarjana Universitas Gadjah Mada; 2002.
17