MALNUTRITION effect to health and life.pptx

gizi

1. Nutritional status ( Status Gizi ) Normal Malnutrition Overnutrition Undernutrition Specific deficiency

2. OVERNUTRITION Keadaan tubuh sebagai akibat kelebihan masukan makanan dalam waktu lama

3. Merupakan lambang kemakmuran & kesuburan OBESITAS

4. Kanker Batu empedu Penyakit ginjal Stroke Penyakit jantung Aterosklerosis Type 2 diabetes Hipertensi Penyakit pernafasan Obesitas Akibat Obesitas

5. Prevalensi Meningkat drastis diseluruh dunia

6. Epidemiology : Indonesia Family health survey / SKRT (1995) Overweight males 5,6%, females 7,8% Ministry of Health (1996-1997) 26 cities, adult age 19 – 65 overweight 17.5%; obese 4.7% ISSO (2003-2004) 7 cities included Semarang, 6,318 subjects, overweight & obese 46.45%

7. Undernutrition

8. Deficiency Primary deficiency : a nutrient deficiency caused by inadequate dietary intake of a nutrient Secondary deficiency : a nutrient deficiency caused by something other than an inadequate intake such as a disease condition that reduces absorption, accelerates use, hasten excretion, or destroys the nutrien

9. Generalized scheme for the development of a nutritional deficiency Stage Depletion stage Method(s) used 1 Dietary inadequacy Dietary 2 Decreased level in reserve tissue store Biochemical 3 Decreased level in body fluids Biochemical 4 Decreased functional level in tissues Anthropometric/Biochemical 5 Decreased activity in nutrient-dependent enzyme Biochemical 6 Functional change Behavioral/Physiological 7 Clinical symptoms Clinical 8 Anatomical sign Clinical

10. 2013 5,7 13,9 18,4 17,9 19,6 PERKEMBANGAN MASALAH GIZI Untuk mencapai sasaran MDG tahun 2015 ( 15,5 persen ) prevalensi gizi buruk-kurang secara nasional harus diturunkan sebesar 4.1 persen dalam periode 2013 sampai 2015. (Bappenas, 2012)

11. 18,0 2013 19,2 PERKEMBANGAN MASALAH GIZI Masalah kesehatan masyarakat dianggap berat bila prevalensi pendek sebesar 30 – 39 persen dan serius bila prevalensi pendek ≥40 persen ( WHO 2010 ). Sebanyak 14 provinsi termasuk kategori berat, dan sebanyak 15 provinsi termasuk kategori serius.

12. Prevalensi Balita Pendek Menurut Provinsi 2010 < 20% (0) 20%-29,9% (9) 30%-39,9% (17) 40%+ (7) Jahari A.B

13. 5,3 2013 6,8 PERKEMBANGAN MASALAH GIZI Masalah kesehatan masyarakat sudah dianggap serius bila prevalensi kurus antara 10,0 - 14,0 persen , dan dianggap kritis bila ≥15,0 persen (WHO 2010). Pada tahun 2013, anak balita masih 12,1 persen, masalah kurus di Indonesia masih merupakan masalah kesehatan masyarakat yang serius.

14. Pohon Masalah Gizi Kurang

15. Consequences of PEM throughout the Life-cycle fetus infant child adolescent Pregna n cy Older age Birth defects Low birth weight stunting Increased risk of poor health Poor physical performance Decreased mental capacity High prevalence of infections Risk of obstructed labor Risk of maternal mortality . Food insecurity . Intra-households biases Heavy physical labor Diarrheal disease Increased physiological needs

16. Hospital Malnutrition: Numerous studies on hospital malnutrition have been published . Prevalence of malnutrition in U.S. hospitals today ranges from 30% to 50%.

17. Illness Malnutrition Example : Cancer Altered Food Intake Altered Digestion and Absorption Altered Metabolism Altered Nutrient Excretion Examples: Loss of appetite, altered food likes/dislikes, difficulty chewing and swallowing, reduced saliva secretion Examples: radiation enteritis, surgical resection of GI tract, diarrhea Example: increased energy needs due to altered energy use in cancer Examples: fecal loss of fat-soluble vitamins and calcium in clients with cancers that affect enzyme secretion or bile salt production

18. Types of Malnutrition Marasmus (Chronic) Kwashiorkor (Acute) Mixed Because this is a disease with multiple etiologies, the best terminology would probably be polydeficient malnutrition. Green CJ. Clin Nutr 1999;18(s):3-28

19. Malnutrition and Increased Complications Many studies have shown that complications are 2 to 20 times more frequent in malnourished patients than in well-nourished patients.

20. Malnutrition and Increased Complications 42% of severely malnourished patients suffer major complications 9% of moderately malnourished patients suffer major complications Severely malnourished patients are four times more likely to suffer postoperative complications than well-nourished patients

21. Malnutrition and its Consequences Loss of weight Slow wound healing Impaired immunity Increase in length of hospital stays Increased treatment costs Increase in mortality

22. Nutritional support Nutrition Care Nutrition Therapy

23. The Nutrition Care Process Nutritional Assessment Estimating Nutritional Requirements Nutrition Modalities Monitoring Nutritional Therapy

24. Nutritional Assessment Risk Factors Diet History Medical History Physical Examination Subjective Global Assessment Laboratory Tests

25. Estimating Nutritional Requirements Determine Ideal or “Adjusted” Body Weight Energy Requirements Protein Requirements Fluid Requirements Electrolyte Requirements Fat Requirements Micronutrient Requirements

26. Nutrition Modalities Oral Diet Enteral Nutrition Parenteral Nutrition

27. Oral route the preferred route for providing nutritional intake. Many different types of oral diets are available In addition, commercially prepared liquid oral supplements can be used in conjunction with an oral diet to promote adequate nutrient intake . Dietitians can perform a nutrient intake analysis (calorie/protein count) to evaluate the adequacy of daily oral nutrient intake if needed .

28. Specific Deficiency Iron deficiency Iodine deficiency Vitamin A deficiency Folat , Zn, Se etc.

29. Anemia

30. Consequences of anemia throughout the Life-cycle fetus infant child adolescent Pregna n cy Older age Low birth weight Impaired cognition Diminished ability to fight infections Increased maternal deaths . Low dietay iron intake . Low iron bioavailability Parasitic infections Malaria HIV & associated chronic disorders micronutrients deficiency Neonatal mortality Reduced physical capacity Reduced transfer of iron to the fetus

31. GAKY

32. Consequences of IDD throughout the Life-cycle fetus infant child adolescent Pregna n cy Older age Increased infant deaths Stunted growth Problems with movement, speech & hearing Maternal mortality . Low intake of iodine . High intake of goitrogens Mental impairment Goiter Risk of miscarriage & stillbirth Impaired brain development

33. Vit A Deficiency

34. Consequences of VAD throughout the Life-cycle fetus infant child adolescent Pregnacy Older age Low birth weight Ocular problems Morbidity & mortality Anemia Nightblindness Maternal mortality . Inadequate intake . Reccurent infections Reproductive cycles Neonatal mortality Impaired immune system Lost productivity Miscarriage or still birth Reduced transfer

35. Rickets

36. The role of B vitamins-in energy metabolism

37. Thiamin B1 Chief function : Part of co E TPP (Thiamin Pyrophosphate) in the metabolism of CHO Deficiency : manifest chiefly as neuromuscular disorders Symptoms : Beri-beri, enlarged heart, cardiac failure, weakness, apathy, poor short term memory, anorexia, weight loss Wernicke-Korsakoff syndrome (alcoholism)

38. Riboflavin: B 2 Chief function: part of FMN (flavin mononucleotide), FAD (Flavin adenine dinucleotide) used in energy metabolism Riboflavin co E have redox reaction function Deficiency : manifested chiefly as dermal and neural disorders Symptoms : sore throat, cracks and redness at corners of mouth, painful, smooth, purplish red tongue

39. Riboflavin deficiency lesions of the margin of the lips (cheilosis) and corners of the mouth (angular stomatitis) painful desquamation of the tongue, so that it is red, dry and atrophic (magenta tongue) sebhorroeic dermatitis, with filiform excrescences. Deficiency is widespread; rarely fatal because there is efficient reutilization of riboflavin released in catabolism of enzymes Riboflavin functions as a redox coenzyme in all energy-yielding pathways 

40. Pellagra – the niacin deficiency disease Sunburn-like dermatitis in areas exposed to sunlight 

41. Folic Acid Deficiency Anemia (megaloblastic type) Neural tube defect Non NTD birth defects Homocysteinemia – cardiovascular diseases Cancer

42. Folate in nucleic acid metabolism

43. Efek defisiensi folat di tingkat molekuler

44. Folic Acid

45. Cyanocobalmine Last of 15 vitamins to be identified chemically complex, cobalt nucleus function: coenzyme in metabolic reactions, maturation of erythrocytes, uracil->thymine deficiency: pernicious anemia, nerve disorders

46. Ascorbic Acid: C function: antioxidant, stress reducer, bone calcification, iron metab , tyrosine metab , blood clotting Important for growth/repair of connective tissue, teeth, bones, and cartilage Promotes wound healing, enhances absorption of iron, helps synthesize several hormones deficiency: stomatitis, scorbut , slow woun healing

47. Questions?