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Aspek gizi pada kelainan muskuloskeletal

Minidian FasitasariBagian Ilmu Gizi

Fakultas Kedokteran UNISSULASemarang 2018

Outlines

Aspek gizi pada:

Osteoporosis

Gout

Osteoarthritis

Rheumatoid arthritis

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Osteporosis

Normal Osteopenia Osteoporosis Severe osteoporosis

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Age & bone calcium

Maximizing Bone Mass– Children and adolescents need to consume

enough calcium and vitamin D to create denser bones.

– With a higher initial bone mass, the normal losses of bone density that occur with age will have less detrimental effects.

Minimizing Bone Loss– Ensuring adequate intakes of vitamin D and

calcium are consumed

– Hormonal changes can increase calcium losses.

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Gender & hormones

Men at lower risk than women

Hormonal changes

Rapid bone loss in nonmenstruating women

Medications can be used that inhibit osteoclasts or stimulate osteoblasts.

Soy offers some protection.

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Genetics & ethnicity

Genes may play a role.

Environment also – diet and calcium

Physical activity, body weight, alcohol, and smoking have a role.

Physical activity & body weight

Muscle strength and bone strength go together.

Heavy body weights and weight gains place a stress on bones and promote bone density.

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Smoking & alcohol

Smokers – Less dense bones

– Damage can be reversed when smoking stops.

Alcohol abuse– Enhances fluid excretion, thus increases calcium

losses

– Upsets hormonal balance for healthy bones

– Slows bone formation

– Stimulates bone breakdown

– Increases risks of falling

Nutrients

Dietary Calcium – the key to prevention– 1300 mg/d for 9 -18 years old

– 1500 mg/d for post-menopausal women

Other Nutrients…

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Ca absorption

Factors that enhance absorption

– Stomach acid

– Vitamin D

– Lactose

– Growth hormones

Factors that inhibit absorption

– Lack of stomach acid

– Vitamin D deficiency

– High phosphorus intake

– High-fiber diet

– Phytates in seeds, nuts, and grains

– Oxalates in beet greens, rhubarb, and spinach

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Nutrients…

Other Nutrients– Adequate protein protects bone

– Adequate vitamin D maintain Ca metabolism & optimal bone health

– Vitamin K protects against hip fractures.

– Magnesium and potassium help to maintain bone mineral density.

– Vitamin A bone-remodeling process

– Omega-3 fatty acids preserves bone intergrity

– Fruits and vegetables

– Reduce salt

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Vit D

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Supplements

Calcium-rich foods are best.

Supplements may be needed when requirements are not met through foods.

Types of supplements– Calcium-carbonate, -citrate, -lactate, -

gluconate

– Small doses are better absorbed.

– Different absorption rates from different types of calcium supplements

Prinsip diet osteoporosis

Diet penting utk pencegahan osteoporosis

Osteoporosis timbul sendiri dlm usia 60-70

tahun perlu pertimbangan dini ttg

kecukupan nutrisi dlm diet

Penting: asupan kalsium & vit D ~ RDA

Peak bone mass diperkirakan tjd pd umur 35

th

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Usaha preventif mengurangi risiko ostoporosis

Meningkatkan asupan kalsium

Meningkatkan asupan vitamin D

Jk intoleransi laktosa (+) pertimbangkan pemberian suplemen laktase

Jk diet (-) suplemen

Tingkatkan olahraga, al. renang, jalan, senam aerobik, dll.

Edukasi pasien: manfaat perubahan diet yg positif scr dini

Mengurangi kebiasaan minum kopi yg berlebihan meningkatkan ekskresi kalsium & sdkt menurunkan bone mass

Nutrisi terapeutik

Mengevaluasi kecukupan kalsium & vitamin D dlm diet

Meningkatkan asupan kalsium hingga 800 mg/hr pd laki-laki dan 1200-1500mg/hr pd wanita

Memberikan suplemen kalsium atau vitamin D jk asupan dr makanan tidak memadai

Weight-bearing exercise sgr pd pasien fraktur yg dinyatakan sembuh

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Preskripsi diet

Gunakan susu dlm memasak sereal, sup, dll.

Yoghurt atau sari buah yg diperkaya kalsium

Tambahkan keju pd sayuran atau roti

Batasi konsumsi kopi dan teh yang kental

Minum suplemen kalsium (misal kalk 2x500 mg/hr)

Olahraga teratur, misal jalan 10-30 menit/hr membantu menunda osteoporosis

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Hiperurisemia (Gout)

Ggn metabolisme purin kadar asam urat

darah meningkat timbunan kristal berupa

garam urat di persendian peradangan

sendi pd lutut dan/atau jari.

Diet: rendah purin, rendah lemak, cukup

vitamin & mineral. Dpt menurunkan BB, bila

ada tanda2 BB berlebih.

Tujuan diet

Untuk:

mencapai & mempertahankan status gizi optimal

Menurunkan kadar asam urat darah & urin.

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Syarat diet

1. Energi ~ kebutuhan Bila BB >> kalori diturunkan 500-1000 Kal hingga tercapai BB

normal

2. Cukup protein 1 – 1,2 g/kgBB atau 10-15% dari kebutuhan kalori total.

3. Hindari bahan makanan sumber protein yg mengandung purin > 150 mg/100 g

4. Lemak sedang, 10-20% dari kalori total Tinggi lemak menghambat pengeluaran asam urat atau purin

melalui urin

5. Karbohidrat lbh banyak, 65-75%dari kalori total Px gout dg BB lebih disarankan sumber KH kompleks

6. Vitamin & mineral ~ kebutuhan7. Cairan ~ urin yg diekskresi/hari. Rata2 asupan cairan 2 – 2 ½

liter/hr

Pengelompokan

Kelompok 1

Kandungan purin tinggi (100-1000 mg / 100 g bahan makanan)

Sebaiknya dihindari

Otak, hati, jantung, ginjal, jerohan, ekstrak daging/kaldu, bouillon, bebek, sardin, makarel, remis, kerang.

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Pengelompokan…

Kelompok 2

Kandungan purin sedang (9-100 mg / 100 g bahan makanan)

Dibatasi max. 50-75 g (1-1½ ptg) daging, ikan, unggas; atau 1 mangkuk (100 g) sayuran sehari

Daging sapi & ikan (kec. tmsk kel 1), ayam, udang; kacang kering & hasil olah, spt tahu & tempe; asparagus, bayam, daun singkong, kangkung, daun & biji melinjo

Pengelompokan…

Kelompok 3

Kandungan purin rendah (dpt diabaikan)

Dpt dimakan tiap hari

Nasi, ubi, singkong, jagung, roti, mi, bihun, tepung beras, cake, kue kering, puding, susu, keju, telur; lemak & minyak; gula; sayuran & buah-buahan (kec. sayuran pd kel 2)

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Jenis diet & indikasi pemberian

Indikasi:

– pasien dg gout dan/atau batu asam urat dg kadar asam urat

> 7,5 mg/dl.

Jenis:

– Diet Purin Rendah I (DPR I) 1500 Kal

– Diet Purin Rendah II (DPR II) 1700 Kal

Lama:

– Sampai kadar asam urat darah & BB menjadi normal

Bahan makanan sehari

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Osteoarthritis

OA & RA no specific diet

Risk factors: age, smoking, high BMI at age 40, lack

of hormone tx (in women)

OA & nutrition: overweight

– Weight loss

– Jogging or other weight-bearing exercises

– Kalsium tinggi, asam lemak emak omega 3 memperbaiki

inflamasi sendi. Yg penting: diet rendah kalori gizi seimbang

bagi px obese & olahraga

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Rheumatoid arthritis

“Rheumatoid cachexia”

Possible links to diet through the immune system

– Vegetables & olive oil

– The omega-3 fatty acids (in fish oil) reduce joint

tenderness & improve mobility

– Low in saturated fat (from milk & milk products) & high in

omega-3 fats fatty acids prevents or reduce the

inflammation in the joints

Rheumatoid arthritis

Other possible links: oxidative damage to the

membranes within joints inflammation &

swelling (+)

– Antioxidants: vitamin C, E, & the carotenoids

Tim cakar ayam

kolagen desensitisasi sist imun tdk lg

menyerang kolagen sendi yg sakit.

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The British Dietetic Association Ltd 2003 J Hum Nutr Dietet, 16, pp. 97–109

References

Firmansyah, A. Optimalisasi Nutrisi pada Penyakit Gout dalam CD Abstrak Konas III

PDGMI, Simposium Ilmiah Gizi Medik, Bandung 2004.

Geissler, C., Powers, H. Human Nutrition 11ed. Elsevier, 2005.

Hartono, A. Asuhan Nutrisi Rumah Sakit: Diagnosa, Konseling, & Preskripsi. Penerbit

Buku Kedokteran EGC. Jakarta, 1999.

Instalasi Gizi Perjan RS dr. Cipto Mangunkusumo dan Asosiasi Dietisien Indonesia.

Penuntun Diet edisi baru. Penerbit PT Gramedia Pustaka Utama. Jakarta, 1999.

Lukito, W. Behavior Modification in Nutrition and Physical Activity to Support Weight

Reduction Program dalam Buku Abstrak Konas III PDGMI, Simposium Ilmiah Gizi

Medik, Bandung 2004.

Rahim, A.H. Osteoporosis: Factors that Affecting Progression dalam CD Abstrak

Konas III PDGMI, Simposium Ilmiah Gizi Medik, Bandung 2004.

Whitney, E., Rolfes, S.R. Understanding Nutrition, Int’l student ed. Thomson Learning,

USA, 2008.

Williams, M.H. Nutrition for Health, Fitness, & Sport, 8ed. McGraw Hill, NY, 2007.