Jurnal OCS dan weight gain

8/9/2019 Jurnal OCS dan weight gain

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dr. Achmad Zainudin Arif*

dr. Laksmi Sasiarini, SpPD-KEMD**

* Mahasiswa Program Pendidikan Doker Spesia!is "!mu Pen#aki Da!am $aku!as Kedokeran %ni&ersias 'rawi(a#a

** Saf Di&isi Endokrin 'agian "!mu Pen#aki Da!am $aku!as Kedokeran %ni&ersias 'rawi(a#a)

A s#semaic re&iew of he eec of ora!g!ucocoricoids on

energ# inake, appeie, and +od# weigh in humans

ourna! reading


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"nroducion

• +esi# is a ma(or risk facor forman# serious and de+i!iaing chronicdiseases.

• ra! g!ucocoricoids /S0 areconsidered o ha&e o+esogeniceecs

• Dose-response re!aionship 1

• Associaed risks can +ecommunicaed o paiens

recommendaion


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"nroducion

• shor and !ong erms ani-in2ammaor#properies

– ashma, rheumao!ogic diseases, dermao!ogica!disorders, auoimmune diseases, oherin2ammaor# disorders

• ad&erse eecs 3

– dose dependen

–

ha!f-!ife – $re4uenc#

– ime of da# adminisered

– roue of adminisraion of he drugs


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ra! g!ucocoricoid ad&erseeec

• Shor-erm 3 – insomnia, consipaion, +!oaing, mood changes, and

h#perg!#cemia

• !ong-erm 3

– seoporosis

– +one necrosis

– areria! h#perension

– Dia+ees

– h#poha!amic-piuiar#-adrena! a5is suppression,

– /ushing s#ndrome

– /aaracs

– 6!aucoma

– Skin hinning, eas# +ruising

– musc!e aroph#


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"nroducion

• /ommon /S ad&erse eec 3 – "ncrease +od# weigh '70 and appeie 3 in cancer

paien, dia!#sis paien

• /S ad&erse eecs no ofen repored reca!! and se!f-repored +# su+(ecs posiner&enion

•

'ias oward reporing ad&erse eecs fo!!owing!ong-erm raher han shor-erm iner&enions

• Ad&erse eecs are no in&esigaed as primar#oucomes in /S iner&enion sudies


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+(eci&e

• 8o idenif# c!inica!!# signi9can eecsi:es inc!uding energy intakechanges of greaer han or e4ua! o

; M change in BW andwheher a re!aionship e5iss+eween g!ucocoricoid dose,

duration, and efect size insu+(ecs wih inammatoryconditions and healthy su+(ecs


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"nc!usion


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E5c!uion


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"nc!usion


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"nc!usion


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Ana!#sis

• +(eci&e e&idence demonsraing hag!ucocoricoids ha&e an impac on '7,energ# inake, or appeie is !imied.

• shor-erm /S use is un!ike!# o !ead oincreased energ# inake, a!hough he#ma# increase energ# e5pendiure '7was no signi9can!# increased

• !ong-erm /S use c!inica!!# signi9canincreases in '7 increase in oa! +od#waer


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Ana!#sis

• g!ucocoricoids do no ha&e asigni9can impac on fa and !eanmass in reamen periods !asing ?

da#s or !ess

• 8he !ong-erm sudies inc!uded in here&iew did no e5amine eecs on

+od# composiion


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Ana!#sis

• 7eigh gain and o+esi# occur as aresu! of energ# im+a!ance wheregreaer ki!o(ou!es are consumed han

are e5pended.

• "ncreased energ# inake genera!!#precedes weigh gain and o+esi# as

he conse4uence of an increasedappeie.


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Ana!#sis

• 'od# composiion changes such as heredisri+uion and accumu!aion of fa inhe face and dorsocer&ica! region

!eading o appearance of a @moon faceand +ua!o hump known as!ipod#sroph# ha&e +een repored afer!ongerm use BC monhs0 in su+(ecswih in2ammaor# condiions, dia!#sispaiens, and afer organ ransp!anaion


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Ana!#sis

• Some research sugges ha he mea+o!iceecs of g!ucocoricoids are dosedependen, wih !ow doses e5hi+iing

ana+o!ic eecs and high doses producingcaa+o!ic eecs, associaed wihdecreased '7 and food inake

• /S 3 – simu!ae appeie and diear# inake a !ow

doses

– inhi+i appeie a high doses


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Ana!#sis

• $uure sudies ha measure '7 asan oucome of /S herap# shou!dmeasure diear# inake using

appropriae diear# assessmenoo!s, such as food records, and a!someasure ph#sica! aci&i#, as +oh

are confounders of weigh change.


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Sud# Limiaion

• Di&ersi# of numerous feaures of hesudies under in&esigaion

– sud# popu!aions, aims, sud# design, and

oucome &aria+!es• /hanges in '7 wihou measuring energ#

inake, ph#sica! aci&i#, and energ#mea+o!ism.

• Measuremen of impac of 2uiddisri+uion on '7 changes noconsidered.


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Sud# Limiaion

• here is insucien o+(eci&ee&idence o conc!ude ha shor ermuse of /S causes c!inica!!#

signi9can changes in energ# inake,'7, +od# composiion, or appeie inhea!h# conro!s or su+(ecs wih

in2ammaor# condiions


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/onc!usion

• !ong-erm use of /S ma# conri+ueo c!inica!!# signi9can increases in'7

• $urher sudies are needed in a rangeof paien popu!aions o e!ucidaehe eecs of /S on energ# inake

and e5pendiure, '7, and appeiewih &a!idaed, sensii&e oo!s, inwe!!-designed and ade4uae!#

powered /8s.


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/riica!! Appraisa!

Saemen ).)

8he sud# addresses a c!ear!# de9ned research 4uesion

7h# is his imporan1 7hendoes hissaemenapp!#1

esponse3

+esi# is a ma(or riskfacor for man# seriousand de+i!iaing chronicdiseases.ra! g!ucocoricoids /S0are considered o ha&eo+esogenic eecsDose-response re!aionship

1

A!wa#sapp!ies.

Ges. 7here he research 4uesion isc!ear!# saed. eference o a prooco!,ehics appro&a!, or pre-deermined


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/riica!! Appraisa!

Saemen ).;

A !eas wo peop!e shou!d se!ec sudies and e5rac daa

7ha does hissaemen mean1

7hendoes hissaemen app!#1

esponse3

7hi!e e5racing daa

from sudies ma# +ean o+(eci&e process,here is a!wa#s scopefor error ormisinerpreaion.Ha&ing wo or morepeop!e carr# ou daa

e5racionindependen!# of eachoher reduces he riskof error or +iascreeping in. 8hereshou!d a!so +e a c!ear

mechanism for arri&inga consensus where

A!wa#s

app!ies.

Ges. 8he sud# c!ear!# saes ha

wo or more peop!e were in&o!&edin daa e5racion, and ha he#were working independen!# ofeach oher. A mehod of reachingconsensus is a!so descri+ed.


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/riica!! Appraisa!

Saemen).C A comprehensi&e !ieraure search is carried ou

7ha does his saemenmean1

7hen doeshissaemenapp!#1

esponse3

A s#semaic re&iew mus, +#de9niion, inc!ude a

Icomprehensi&e !ierauresearchJ co&ering a!! !ike!#sources of sudies. De9niionof Icomprehensi&eJ is dicu!as a numer of facorsin2uence he scope of asearch. As a minimum a !easwo ma(or e!ecronicdaa+ases shou!d +e

searched. Ma(or daa+asesinc!ude he /ochrane !i+rar#,Em+ase, and Med!ine. Somesu+(ecs shou!d in&o!&e morespecia!i:ed daa+ases such asAMED, /"AHL.

A!mosa!wa#s.

Ges. fu!! deai!s of he !ieraure search arepro&ided eiher in he re&iew ise!f or in a

separae source ha is a&ai!a+!e o hosee&a!uaing he re&iew eg in an on!inesupp!emen0.

n!# eng!ish aric!e inc!uded


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/riica!! Appraisa!

Saemen ).

8he auhors c!ear!# sae if or how he# !imied heir re&iew +#pu+!icaion #pe


7hendoes hissaemenapp!#1

esponse3

8his comes +ack oinc!usion < e5c!usioncrieria. Auhors wi!!norma!!# ha&e a rangeof c!inica! crieria oconsider, +u ma#decide o impose

addiiona! !imiaions/ommon !imiaionsare sud# #pe,!anguage ofpu+!icaion, andpu+!ished orunpu+!ished !ieraure.

A!wa#sapp!ies.

Ges. A!! crieria used o se!ecsudies are c!ear!# speci9ed..


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/riica!! Appraisa!

Saemen ).=

8he inc!uded and e5c!uded sudies are !ised


7hendoes hissaemenapp!#1

esponse3

A !is of inc!uded ande5c!uded sudiesshou!d +e pro&ided.

A!wa#sapp!ies.

Ges. Sudies inc!uded in here&iew, or e5c!uded fo!!owingapp!icaion of he agreed e5c!usioncrieria, are !ised.


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/riica!! Appraisa!

Saemen ). 8he characerisics of he inc!uded sudies are pro&ided



Score shou!d +e3

"n an aggregaed form

such as a a+!e, daa fromhe origina! sudies shou!d+e pro&ided on heparicipans, iner&enionsand oucomes. 8heranges of characerisicsin a!! he sudies ana!#:ede.g., age, race, se5,

re!e&an socioeconomicdaa, disease saus,duraion, se&eri#, oroher diseases shou!d +erepored.

A!wa#s

app!ies.

Ges. daa from he origina! sudies is

pro&ided in sucien deai! o a!!owassessmen of he compara+i!i# of hesud# popu!aions. oe ha a formaoher han a a+!e is accepa+!e, as!ong as he informaion noed here ispro&ided.


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/riica!! Appraisa!

Saemen ).? 8he mehodo!ogica! 4ua!i# of he inc!uded sudies is assessed anddocumened 7ha does his saemen

mean17hendoes hissaemen app!#1

esponse3

8his is eeci&e!# asking

wheher he auhorsappraised he indi&idua!sudies in a simi!ar wa# ohow #ou are appraisinghe re&iew.

A!wa#s

app!ies.

Ges. 8he auhors repor he appraisa! of

indi&idua! sudies using !e&e! ofe&idence.


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/riica!! Appraisa!

Saemen ).N 8he scieni9c 4ua!i# of he inc!uded sudies was assessed appropriae!#



esponse3

8he mehodo!ogica! rigor

and scieni9c 4ua!i# ofhe indi&idua! papersshou!d +e considered inhe ana!#sis and heconc!usions of he re&iew,and e5p!ici!# saed informu!aingrecommendaions.

A!wa#s

app!ies

Ges. 8he re&iew inc!udes informaion on

indi&idua! sud# 4ua!i# a!ong wihoucome daa and conc!usions fromeach sud#.


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/riica!! Appraisa!Saemen).O

Appropriae mehods are used o com+ine he indi&idua! sud# 9ndings


7hen doeshissaemenapp!#1

esponse3

$or he poo!ed resu!s, a esshou!d +e done o ensure he

sudies were com+ina+!e, oassess heir homogenei# eg

χ-s4uared es0. "f

heerogenei# e5iss a randomeecs mode! shou!d +e usedand


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/riica!! Appraisa!

Saemen ).) 8he !ike!ihood of pu+!icaion +ias is assessed



esponse3

" is a!wa#s possi+!e for

pu+!icaion +ias o e5is,+u i canno +e pro&ed ordispro&ed a+so!ue!#. Agood re&iew shou!dne&erhe!ess ake accounof he possi+i!i# ha ima# +e presen. Anassessmen of pu+!icaion

+ias shou!d inc!ude acom+inaion of graphica!aids eg funne! p!o, ohera&ai!a+!e ess0 and


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/riica!! Appraisa!

Saemen).))

/on2ics of ineres are dec!ared.


7hendoes hissaemen

app!#1

esponse3

An# 9nancia! or oherre!e&an ineress ofhe re&iew auhorsshou!d +e repored,a!ong wih an#9nancia! suppor

pro&ided for heconduc of he re&iew."dea!!#, ha auhorsshou!d a!so repor onhe funding ofindi&idua! sudiesinc!uded in he re&iew.

A!wa#sapp!ies.

o. 7here here is no discussionof sources of suppor.

Jurnal OCS dan weight gain

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