Scribd Logo
Upload

Welcome to Scribd!

  • 32 views

    Nutrisi Pada Infeksi Dewasa

    Uploaded by

    Monica Lam
    nutrisi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Nutrisi Pada Infeksi Dewasa

    Uploaded by

    Monica Lam
    32 views51 pages
    nutrisi

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    nutrisi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views51 pages

    Nutrisi Pada Infeksi Dewasa

    Uploaded by

    Monica Lam
    nutrisi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 51

    Nutrisi pada Infeksi Dewasa

    dr. Monica Paotiana, M.Gizi


    Tujuan Pembelajaran
    • Vicious cycle of undernutrition and infection
    • HIV/AIDS and nutrition
    • Nutrition on Critical Ill
    Black, R.E. 2012. The Vicious Cycle of Diarrhea and Malnutrition: Nutritional Risk Factors. Departemen of International Health, John
    Hopkins Bloomberg School of Public Health
    ALUR DUKUNGAN
    Alur DukunganNUTRISI
    Nutrisi

    Pemeriksaan klinis /Antropometri /Laboratorium / Pendukung lain



    Diagnosis / status Gizi

    Kebutuhan energi & Zat Gizi

    Komposisi Zat Gizi

    Cara pemberian – Oral / Enteral/ Parenteral

    Bentuk/ jenis makanan/ formula & suplemen

    Pemantauan & evaluasi
    Nutritional Assesment
    • Anthropometric measurments:
    – Height, Weight, BMI
    – % goal weight
    – Ideal Body Weight and Usual Body Weight
    – Fat, muscle, and body cell mass
    – Waist, hip, neck, thigh circumference
    • Biochemical
    – Protein status (albumin, prealbumin)
    – Blood lipid profile
    – Glucose/insulin status
    – Blood pressure
    – Hb, Ht, MCV
    – Liver fuction test
    – Electrolytes
    Nutritional Assesment
    • Clinical Condition:
    – Oral / intestinal condition
    – Nausea, vomiting
    – Diarrhea
    – Anorexia, appetite
    – Functional capability
    – Neuropathy
    • Dietary intake:
    – Estimated intake and estimated need
    – Food and nutrition security
    – Dietary pattern
    – Food intolerance / allergies
    MUST
    Nutrition Therapy
    • General Nutrition
    – Energy Requirement and Composition (Cho, Protein, Fat)
    – Vitamins
    – Minerals
    • Specific Nutrients  Immunonutrients
    – Antioxidants: A, C, E, Carotenoids, Selenium, Zinc, Copper
    – Glutamine, arginine, nucleotide
    – Probiotics
    • Delivery: small frequent, nutrient-dense meals
    • Appetite stimulants
    General Nutrition
    • Estimated Energy Requirement (EER)
    • Makronutrien (KH, Protein, Lemak)
    • Vitamin
    • Mineral
    Estimated Energy Requirement (EER)
    • EER = BMR x PA x stress factors

    • ♂: BMR = 66 + (13,7 x BB) + (5 x TB) – (6,8 x usia)


    • ♀: BMR = 665 + (9,6 x BB) + (1,8 x TB) – (4,7 x usia)

    • *PA= Physical Activity


    Physical Activity

    Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding Normal and Clinical Nutrition, Eighth Edition. November 3, 2001 . Canada:
    Wadsworth, Cengage Learning. Appendix F
    RECOMMENDED NUTRIENT COMPOSITION

    Protein
    SFA <7% total calorie
    15%
    Fat PUFA <10% total calorie
    Carbohydrate <30%
    >55% MUFA < 15% total calorie

    Cholesterol: <300 mg/d


    Fiber: 20-30 g/d

    Gallagher ML. The nutrients and their metabolism. in Krause’s Food and Nutrition Terapy (Mahan, LK and Escott-Stump
    S eds), 2008: p 42 – 143.
    Karbohidrat
    • 50-60% dari kalori total
    • Minimal intake KH 130 g/hari

    • SERAT: 11g/1000 kkal


    20-30 g/hari
    Serat

    Viscous Non viscous Non viscous


    • Pektin • Inulin • Selulosa
    • β-glukan • Fruktooligosakarida • Hemiselulosa
    • Gum • Dekstrin gandum • Lignin
    • Psyllium • Polidekstrose

    23
    INDEKS GLIKEMIK

    • Definisi : perbandingan respon glikemik (naiknya kadar gula


    darah) antara bahan makanan / campuran dengan bahan
    makanan pembanding
    • Sebagai pembanding : glukosa
    FAKTOR YANG MEMPENGARUHI EFEK GLIKEMIK

    • JUMLAH SERAT, LEMAK, & KH DALAM MAKANAN


    1. SERAT > : MEMPERLAMBAT KECEPATAN MENCERNA & PENYERAPAN
    2. LEMAK > : MEMPERLAMBAT PENGOSONGAN LAMBUNG
    3. GULA > : CEPAT & MUDAH DICERNA, INDEKS 
    4. POLISAKARIDA > : LEBIH LAMA KARENA HARUS DIPECAH MENJADI MONO BARU
    BISA DISERAP, INDEKS 

    • INTERAKSI PROTEIN & KH


    DICERNA LEBIH LAMBAT  PENGOSONGAN LAMBUNG LAMBAT
    GLYCEMIC LOAD (GL)
    • A MATHEMATICAL EXPRESSION TO MEASURE THE INFLUENCE OF FOOD ON BLOOD
    SUGAR
    • LOWER GL OF DIET  THE LESS GLUCOSE BUILD UP IN THE BLOOD
    • GL= (GI x CHO) : 100
    © 2008 Thomson - Wadsworth
    Protein
    • 15-20% dari kalori total
    • DRI : 0,8 g / Kg
    • AKG Indonesia (usia 19-26 th)
    – Pria: 62 gr
    – Wanita: 56 gr
    Protein Function
    • Acid-basa balance : buffer
    • Antibodies
    • Blood clotting : netting
    • Energy
    • Enzymes
    • Fluid and electrolyte balance
    • Gene expression : DNA
    • Hormones
    • Structure : Muscle, Bone, Skin
    • Transportation : lipid, mineral, O2
    Source of Protein
    Fat
    SFA <7% total calorie

    PUFA <10% total calorie

    MUFA < 15% total calorie

    Cholesterol: <300 mg/d


    Source of Fat
    Sepsis
    Goals of Nutrition Support
    • Minimize catabolism
    • Meet energy requirements
    • Meet protein, vitamin, and mineral needs
    • Fluid and electrolyte management
    • Plan nutrition therapy (oral, enteral, and/pr
    parenteral nutrition)
    Targeted nutrition delivery in sepsis
    SEPSIS
    Resistensi Ginjal (kortex)
    Insulin
    ↑Glukoneogenesis
    Hepatic
    ↑Glukoneogenesis
    ↑Glikogenolisis

    HIPERGLIKEMIA

    Resistensi
    Insulin Perifer
    Non Insulin
    Insulin dependent dependent
    Otot Adiposa Ginjal Eritrosit Otak
    Glikogenolisis (medula )
    Glikolisis Glikolisis
    Lipolisis Glikolisis
    anaerob
    anaerob Glikolisis

    Laktat Gliserol Laktat Laktat


    Sintesis & Pemecahan Protein

    Hill, A., G., Wilmore, D., W. 1996. The History of the Metabolic Response to Injury.
    Peningkatan ekskresi N urin pada beberapa penyakit sejalan dgn waktu
    44
    Meet the Requirment
    • Energy: 15  25 to 30 kcal/kg
    • Protein: 1 g/kg/day  1.2-2 g/kg/day
    • Thiamin : 2x200 mg / day IV (7 days)
    • Vitamin D: 100.000 U / day (5 days)
    • Vitamin C (antioxidant) : 1,5 g IV (4 days)
    • Trace element / micronutrient
    NUTRITION TERAPY
    Plan Nutrition Therapy
    • Preferred: oral  enteral
    • Wait until the patient is hemodynamically
    stable intestines are in a state of
    hypoperfusion

    You might also like