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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
7ha does hissaemen mean1
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
7ha does hissaemen mean1
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
7ha does his saemenmean1
7hendoes hissaemen app!#1
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!#
7ha does his saemenmean1
7hendoes hissaemen app!#1
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
7ha does his saemenmean1
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
7ha does his saemenmean1
7hendoes hissaemen app!#1
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.
7ha does hissaemen mean1
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.
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