KURIKULUM VITAE

dr IGP SUKA ARYANA, SpPD-KGer, FINASIM

(Staf Pengajar Divisi Geriatri, Bag/SMF Ilmu Penyakit Dalam
FK UNUD /RSUP Sanglah Denpasar, Bali)
Pendidikan
Dokter umum: FK Unud 1997, Spesialis Penyakit Dalam: FK Unud 2005
Visiting research fellow Kobe Jepang 2002,Konsultan Geriatri: 2009, FINASIM
2011, Geriatric emergency course, Singapore 2010
Penghargaan:
Nominator the Best Young Investigator Award AFES Singapura 2003, and Manila
2005, The Best Mustafa-Varon Award for the Best Free Paper On shock and
Critical Care 2005, The Best Young Investigator Award, ASMIHA Surabaya 2005,
The best Scientific Free paper, TIG 2009, Jakarta
Organisasi/Jabatan
Wakil ketua Cabang PAPDI Cab. Bali,
Ketua KOMKORDIK RSUP Sanglah/FK UNUD
Sekretaris TKP PPDS FK Unud, Bali
Ketua Bidang Akreditasi dan Standarisasi, Kolegium Ilmu Penyakit Dalam,
Indonesia
Assessor dan Fasilitator LamPTKes
Instruktur : Perioperatif kolegium Bedah, BT/ACLS 118,
Clinical Emergency, Soft SKill for clinical profesional, Clinical Teacher Training.
BASIC MECHANISM SARCOPENIA IN ELDERLY
ROLE OF MYOKINE

IGP SUKA ARYANA

DIVISI GERIATRI, BAGIAN/SMF ILMU PENYAKIT DALAM
RSUP SANGLAH/FK UNUD, DENPASAR, BALI
 OUTLINE
• BACKGROUND
• DIAGNOSIS OF SARCOPENIA
• BASIC MECHANISM SARCOPENIA
• MYOKINE
• SUMMARY
BACKGROUND
 SARKOPENIA

• Irwin Rosenberg thn 1989  “sarco” daging,

“penia” kekurangan
• Hilangnya massa otot, kualitas, dan fungsi otot
secara progresif
• Prevalensi 30% pada usia > 60 tahun  >50%
pada usia 80 tahun

5
 Faktor risiko Sarkopenia

6
•Cruz-Jentoft A J et al. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010
 DIAGNOSIS SARCOPENIA

• KRITERIA DIAGNOSIS DARI SARKOPENIA ADALAH:

1. PENURUNAN MASA OTOT
2. PENURUAN KEKUATAN OTOT
3. PENURUNAN KEMAMPUAN AKTIFITAS FISIK
• DIAGNOSIS DITEGAKAN BILA ADA KRITERIA 1
DITAMBAH KRITERIA 2 ATAU 3.
 Pendekatan Klinis Diagnosis Sarkopenia

8
•Cruz-Jentoft A J et al. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010
 TEKNIK PENGUKURAN
Variable Penelitian Praktek klinis
Muscle mass Computed tomography (CT) BIA
Magnetic resonance imaging (MRI) DXA
Dual energy X-ray absorptiometry (DXA) Anthropometry
Anthropometry  
Bioimpedance analysis (BIA)
Total or partial body potassium per fat-
free soft tissue

Muscle strength Handgrip strength Handgrip strength

Knee flexion/extension
Peak expiratory flow
Physical Short Physical Performance SPPB
performance Battery (SPPB) Usual gait speed
Usual gait speed Get-up-and-go test
Timed get-up-and-go test
Stair climb power test
 STADIUM SARKOPENIA
Stadium Muscle mass Muscle Performance
strength

Pre-sarcopenia Menurun    
Menurun
Sarcopenia Menurun Menurun
atau
Severe
sarcopenia
Menurun Menurun Menurun
 KLASIFIKASI SARKOPENIA
Primary sarcopenia
-Age-related sarcopenia
- 
Secondary sarcopenia
-Activity-related sarcopenia
 
-Disease-related sarcopenia
 
 
-Nutrition-related sarcopenia
 
 
No other cause evident except ageing
 
Can result from bed rest, sedentary lifestyle,
deconditioning or zero-gravity conditions
Associated with advanced organ failure
(heart, lung, liver, kidney, brain), inflammatory
disease, malignancy or endocrine disease
Results from inadequate dietary intake of
energy and/or protein, as with malabsorption,
gastrointestinal disorders or use of
medications that cause anorexia
BASIC MECHANISM
BODY FAT AND MUSCLE MASS IN AGING

Mu
scle
ma
ss
PATHOPHYSIOLOGY
MECHANISM
DISEASOME OF PHYSICAL
INACTIVITY
MYOKINES
 MYOKINE –MUSCLE CYTOKINES
• EXERCISE HAS BEEN LABELED THE “REAL POLYPILL”
• THE MAJOR EFFECTOR AND TARGET OF EXERCISE
SKELETAL MUSCLE HAS THE UNIQUE CAPABILITY
• THESE MUSCLE DERIVED SECRETORY FACTORS ARE
CALLED “MYOKINES”, A TERM FIRST SUGGESTED OVER
10 YEARS AGO BY THE GROUP OF PEDERSEN FOR INTER-
LEUKIN 6 (IL-6) AND OTHER CYTOKINES PRODUCED BY
SKELETAL MUSCLE
 MYOKINE
• WHO 2020  penyakit kronis 60% dari
keseluruhan penyakit
• Physical inactivity  penyebab utama
penyakit kronis : diabetes melitus, penyakit
kardiovaskular, kanker, demensia, depresi 
diseasome of physical inactivity
• Otot lurik  ORGAN ENDOKRIN  exercise
factor  MYOKINE

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CENTRAL ROLE OF MYOKINE
 Peranan Latihan Fisik pada
Peningkatan Myokine

21
So B et alExercise-induced myokines in health and metabolic diseases. Integr Med Res. 2014
 Peran Latihan Fisik pada Geriatri

• Geriatri  inflamasi kronis  hilangnya

massa otot  disabilitas
• Inflamasi  target intervensi
• Terapi farmakologis  tidak digunakan
• Aktivitas fisik  satu-satunya terapi untuk
memperbaiki fungsi otot

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 Peran Latihan Fisik pada Geriatri

• Studi NHAESIII dan CHS  korelasi terbalik

antara CRP dan aktivitas fisik
• Aktivitas fisik 
– ↓ sitokin aterogenik (interferon γ, TNF α, IL-1)
– ↑ sitokin ateroprotektif (IL-10, IL-4, TGF B1)
• Aktivitas fisik  ↑ myokine

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 Penelitian latihan fisik yang
menginduksi myokine
Myokine Latihan fisik Hasil
IL-6 Latihan kontraksi eksensor lutut ↑ IL-6 (9)
(konsentrik) selama 5 jam
IL-15 Treadmill ↑ serum IL-15 (43)
(70% denyut jantung maksimum, 30
menit)
Latihan resistensi ↑ IL-6, IL-10, IL-1ra, IL-8
(4 set, 10 kali pengulangan, 2-3 (44)
menit istirahat setiap interval)
Latihan resistensi ↑ IL- 15 serum (45)
(3 hari per minggu, 6-10 kali
pengulangan)
BDNF Bersepeda ↑ BDNF MRNA,
(VO2 maksimum 60%, 120 menit) ↑ protein BDNF (17)

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 Penelitian latihan fisik yang
menginduksi myokine
Myokine Latihan fisik Hasil
LIF Latihan resistensi ↑ LIF MRNA hingga 9 kali
Cycle ergometer lipat (25)
(3 jam, VO2 maksimum 60%) ↑ LIF MRNA hingga 4,5 kali
lipat (46)
Irisin Latihan daya tahan tubuh ↑ irisin plasma
(endurance)
(bersepeda, VO2 maksimum 65%, 4-
5 sesi) ↑irisin plasma (47)
Acute exercise
FGF-21 Treadmill ↑ FGF-21 (48)
(Bruce’s protocol 5 hari/2 minggu,
21 menit)
SPARC Acute exercise ↑ SPARC (49)
(bersepeda, VO2 maksimum 70%,
30 menit)
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 MYOKINE

IL-15
• Efek anabolik meningkatkan jumlah dan
diferensiasi miosit
• Korelasi terbalik dengan massa lemak tubuh

• Dihasilkan di otak dan otot lurik

BDNF • Neurotrophine  survival dan pertumbuhan

sel saraf
• Peningkatan oksidasi lemak

IL-8 • ↑ angiogenesis dan proliferasi sel endotel

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 MYOKINE

• Induksi PGC-1α di liver 

FGF-21 mengatur homeostasis energi,
asam lemak, glukoneogenesis

LIF • Mempengaruhi proliferasi sel 

hipertropi dan regenerasi miosit

• Myoblas, myotubes dan serat otot

SPARC • Menghambat adipogenesis,
meningkatkan translokasi GLUT 33
 RINGKASAN
• Mekanisme terjadinya Sarkopenia multifaktor
• Salah satunya melalui peran myokine
• Terapi farmakologis tidak menunjukkan hasil
• Aktivitas fisik  kontraksi otot  myokine 
metabolisme glukosa, FFA, angiogenesis,
neurogeneis  menjelaskan hubungan antara otot,
liver, otak, dan jaringan lemak
• Aktivitas fisik  mengurangi sarkopenia  pada
populasi geriatri
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TERIMA KASIH