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7/24/2019 Malnutrition 2011
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Malnutrition in Children
mtsdarmawan
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Background
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02/18/16 dr. Darmawan, S! "
#i$i %&utrition'
( )roses enggunaanmakanan secaranormal
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02/18/16 dr. Darmawan, S! *
+eadaan #i$i
( +eseimanganantarakonsumsi, en-eraan emakaian.
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Learning Obyektif
( Mamu menelaskan engertian malnutrisisecara umum dan kondisi malnutrisi dindonesia
( Mamu menelaskan engertian, ciri enanganan kekurangan gi$i
( Mamu menelaskan engertian, ciri danenanganan keleihan gi$i
( Mamu menelaskan engertian malnutrisimikronutriendan entingn-aenanggulangan malnutrisi mikronutrien
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Background
terentingmoriditas mortalitas304kematian sedunia5
3*4 kematian di negara erkemang d2001
( )M 7 1stdigamarkan d 120s 79:eran-ak di de;eloing countries
S!.
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Background
(:wo
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Background
( Marasmus7 intake rotein calories,
9 !datasi star;ation %kelaaran'
( +washiorkor79 ntake kalori
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Background
(:wo
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+washiorkor
( BB :B aku( dema anasarkamen-amarkan BB
( Massa otot mengecil.
(+ulit tiis, lemek erercak merah( amut erwarna irang, kasardan kaku,serta mudah dicaut
( !nak aatis, cengengdan rewel
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Marasmus
( !nak kurus kering.( Sering rewel, cengeng, enakut.
( +ulit keriut waah st orang tua.
( )erut uncit, ramut merah arang( !nak cengeng dan rewel
( Marasmik ~ Kwashiorkor7 gaungankeduan-a
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)rinsi enanganan kurang
gi$i( !suan makanan dg an-ak rotein,tinggi kalori, cuku cairan, ;itamin danmineral.
( Makanan dalam entuk mudah dicernadisera.
( Bertaha.
( )en-akit lain-g men-ertai ditangani.
( )emantauan en-uluhankeluarga
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Mengaa enting diatasi
( +arena tidak akan caai tum angsemurna.
erkemangan otak uga uruk
generasi yg EOonF 7 tidak rodukti< dan tidakmamu hadai tantangan
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re=uenc-
>S!( 147 malnutrisi kronik.
( ncidence 104,ahkan d kelomokristi
( 104di oedalaman 7 secondar- toinade=uate nutrition
( Hositali$ed children 7
9 1/* acute )M %istilah lama'
9 2I 4 chronic )M.
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re=uenc-
nternationalJHK 7
( 2013 7 re;alence to 1I.64
( Low weight
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re=uenc-
( Sekarang, 304anak di!siaselatan 7)M, 6.3 ?re;alence dio Barat.
( SuASaharan !
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DeNnition
JHK 7( OCellular imalanceetween 7
9 sul- energi nutrisi keutuhan tuuh
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DeNnition
(:uuh tidakmendaatkan kecukuan9 ;itamins, minerals other nutrients
maintain aringan sehat ndernourished or o;ernourished
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Malnutrisi Akut
Malnutrisi !kutBerat
Malnutrisi !kutModerat
Rawat inap Rawat jalan
+lasiNkasi :raditional
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)eredaan Malnutrisi !kut +ronis
( tiologiereda( ndikatordiagnostik ereda
9 Malnutrisi kronis 7
(stunting %:B/>'(>nderweight stunting %BB/>'
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)eredaan Malnutrisi !kut +ronis
( tiologiereda( ndikatordiagnostik
ereda
9 Malnutrisi !kut 7(wasting %kurus' LL! atau
BB/:B'
HIV
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)eredaan Malnutrisi !kut +ronis
( )eredaan endekatan terai9:ie rogram
(Malnutrisi kronis 9 re;enti< 7 sulemennutrisi
(Malnutrisi !kut 9 terai 7 diet terai komlet
9 Durasi rogram
(Malnutrisi kronis A ertahun
(Malnutrisi !kut 9 1A2 ulan
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Malnutrisi akut
( okus ada underweight %BB/>'
9 Lancet 7 tidak menggunakan
( JHK masih gunakan
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Malnutrisi akut
( MC% ntegrated Management Child ll M:BS
tidak memakai indikator antroometrik
9 Han-a erdasar tanda klinis
9 Malnutrisi akut tidak sensiti< dan nonAseciNc
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Tenis malnutrisi
a. Malnutrisi mikronutrien, terenting 7kekurangan ;it !, -odium e
. +ekurangan gi$i
c. +eleihan gi$i %o;erweight oesitas'
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>ndernutrition
( +ekuranganintake nutrien esensial orenggunaan or ekskresi erleihan.
( Bisa erua 7
9 Malnutrisi Sekunder9 Malnutri Mikronutrien
9 Malnutrisi )rotein nergi %)M'
(Most imortant
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Malnutrisi Sekunder
( Diet normal
( Makanan :D!+
dicerna atai diasorsi9 Diarea
9 )arasit
Tapeworm
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>ndernutrition
( Ba-i, anak kecil, elasan tahun, wanitahamil or uteki 7 erlu additionalnutrients.
( &utrient loss7 accelerated- diarrhea,keringat erleih, erdarahan masi
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Malnutrisi Sekunder
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>ndernutrition
( Chronic malnutrition 79 14in the >S!;sto 304Southeast !sia.
( @ 2/"malnourished 7 !sia
( @ 1/*7 in !
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>ndernutrition
( )M 7 en-ea kematian di negerkemang
( !kiat intakekalori inade=uate 7 roteins,;itamins minerals.
( >ndernourished child mjd )M ila 79 +eceatan ertumuhan , in
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K;ernutrition
( n >S!, akiat dietar- imalances.( esults
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K;ernutrition
( isk 7 - eing 204o;erweight,consuming a diet high in
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K;ernutrition
( +urang gi$i pengaruhis-stem the senses o< sight,taste, and smell.
an?iet-, eruahan mood s-chiatrics-mtoms
( Dimulai dg eru le;elnutrient darah
aringan perub levelen$-me, anormalitasaringan, mal
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K;er weight Kesitas
( BB/:B or BM 834ile7 o;erweight 34ile 7oese.
( Masukanenergi keutuhan
( Berhu dg oesitas ortu inactivity(eramAam memaca, :U'
re;alensi d anak dewasa.
( )re;ensi LBH M>D!H terai.( dukasi health- eating
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K;er weight Kesitas
( BB :B anak seusia.( Hidung mulut relati< kecil, dagu
erentuk ganda, erut uncit
( Sering malas ergaul karenamalu
risiko en-akit erat saatdewasa
9 kardio;askuler 7 stroke,hiertensi,
9 metaolik 7 DM
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)rinsi :atalaksana
( !tasi
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Malnutrisi Mikornutrien
( !suan nutrien st ;it !, e -odium tidak cuku.
( Secara Nsik sering tak terdeteksitai memengaruhi kesehatan leihdari 2 mil-ar orang di seluruh dunia.
Seelum terai 2 tahun setelah :? kalsium
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Seelum terai 2 tahun setelah :? kalsium
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DeNsiensi Uitamin !
( )en-ea utama 7 konsumsi
( Sumer 7
V daun singkong, a-am, tomat, kangkung
V daun ea-a, daun katukV ea-a, wortel, telur, ikan, hati
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!kiat DeNsiensi Uitamin !
imunitasmudah in
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Bercak Bitot
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Werosis
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Werosis
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)re;ensi
( +onsumsi harian79 Sa-uran hiau uah erwarna,
sa-ur ditumis or dimasak dg
santan, agar ;it ! larut( +asul ;it ! dosis tinggidierikan
tia 6 ulan %eruari !gustus',
uga dierikan ada iu melahirkan
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DeNsiensi e
!kiat 7(:ersering 7 anemia de< esi
%!dee'.
risiko rematur, BBL
risiko kematian iu hamil
kemamuan kera Nsik %leto-' kemamuan elaar
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!nemia DeNsiensi Besi !DeBe
( Men-erang 2 uta org,
( 04 di negara erkemang9 "4 anak ra sekolah, 324 umil
( Berkurang dengan 7
9 !kti;itas Nsik mental
( Meningkat karena 79 Mortalitas a-i lahir
9 Cacing, Malaria, HU
( Beras tinggi esi daatmenolong
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)ellagra deNsiensi B"
%&iacin'
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DeNsiensi Xodium
( )en-ea 7
Makanan air kurang mengandung-odium.
(:idak gunakan garam -odium dlmmakanan, khususn-a kelg -g tinggal didaerah gondok endemik.
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!kiat #!+X
( Y rendah( #gn erkemangan Nsik 7 :B terhamat,
ggn sara< motorik gerakan laman,
ggn endengaran tuli.( DeNsiensi tingkat kretinisme.
( Dewasa 7 emesaran kelear gondok
( Janita usia suur sering 7 inD
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Hiotiroidisme kongenital
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2. DeNciensi Xodium
( DeNsiensi Xodium9 Men-erang I*0 uta org di
seluruh dunia
9 )en-ea tunggal kerusakanotakada a-i -g dapatdicegah
9 #oiter
9 Lahir mati
9 Miscarriages
9 etardasi Mental( Sumer teraik -odium alami
9 Sea weed / rumput aut
9 Sea food
Goiter
(pembesaran tiroid)
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)re;ensi
( Selalu gunakan garam -odium di :.( >ntuk endemik anak 1A3 tahun
dieri kasul -odium selama 1 tahun
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DeNsiensi Mikronutrien Lain
( Zinc9 etardasi ertumuhan
9 Maturasi seksual terlamat
9 Lesi kulit mata
9 *84 enduduk dunia erisikoerisiko deNsiensi $inc
( +alsium
9 Ksteoorosis7 kerauhantulang
( UitaminD
9 ickets7 mal
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Kther DeNciencies
( Uitamin C9 Seakan Scur;-7 rolem in
kam engungsian
( &iacin9 Seakan )ellagra7 dermatitis,
diarea, dementia
9 !kiat diet tinggi mai$ena%rendah tr-tohan'
(:hiamin9 seakan erieri
9 !kiat diet tinggi eras EkilatF
( olate9 De
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Cheilosis de< ;it B2
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!kiat Malnutrisi
Defisiensi engurangi !
survivalVitamin A
PEM
LBW productivity
Ironintelligence
Iodine
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Mortalitas Balita !kiat >nderweight
( Deaths
Over 375,000
child deaths
Year
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Causes and S-mtoms
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Causes
>S! 7( )rimar- reasons 7 kemiskinan kurang
makan.
( 104 saa7
( )M occurs in
9 304 asien edah
9 in *84 asien rawat ina
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Causes
risk chronic diseases, eseciall- dintestinal tract, kidne-s, and li;er 7
( Cancer, !DS, intestinal arasites, andother gastric disorders ma- lose weight
raidl- rentanundernourishment karenatak daat asorsi;itamins, calories iron.
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Causes
( +etergantungan drug or alcohol
kemamuan asorsi nutrients rusak
( ating disorders 7
anore?iaor ulimia7 restrict
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S-mtoms
( +etidaksengaaan losing 10 ounds7sign o< malnutrition.
( Skinn-or loated %kemung/engkak'79 ale, thick, dr-, and ruises easil-.
( ashesand changes in igmentation(Tointsache ones 7 so
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Kther s-mtoms include
( !nemia, diarrhea, disorientation( night lindness, irritailit-, an?iet-,
attention deNcits, goiter, loss o< re[e?esand lack o< muscular coordination
( muscle twitches, amenorrhea
( scaling and cracking o< the lis andmouth.
( Malnourished children ma- e short
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Causes
( ood allergies.di\cult to otain
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Clinical
Hi t
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Histor-
( Clinical signs and s-mtoms o< )Minclude7
9 )oor weightgain
9Slowing o< linear growth9 Beha;ioralchanges 9
(irritailit-, aath-, socialresonsi;eness, an?iet-, and
attention deNcits
Hi t
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Histor-
(Clinical signs and s-mtoms o
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Histor-( :he most commonand clinicall- signiNcant
deNciencies 79 ron A atigue, anemia, cogniti;e
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)h-sical o< )M
sucutaneoustissue 7 most a]ected 7legs, arms, uttocks
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)h-sical o< )M
(!dominalNndings9 !dominal distension secondar- to oor
adominal musculature
9 Heatomegal- secondar- to
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Causes
( Most common cause 7 inade=uate
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Causes
(nstead, diseases and, in articular, chronicillnesses la- an imortant role in theetiolog- o< malnutrition.
( Children with chronic illness 7 risk
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Causes
( Chronic illnesses that commonl-are associated with nutritionaldeNciencies include the
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Causes
( SigniNcant risk 79 )rematurit-
9 De;elomental dela-
9 n utero to?in e?osure %ie,
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#i$i uruk
( Bentuk terarah kurang gi$i menahun( ndonesia kehilangan 220 uta Y oin
( Damak lain 7^ rodukti;itas 20A"04
( !nak endek
( #gn tumuh kemang otak Yrendah
#i$i uruk
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#i$i uruk
(:umuh kemang otak 80 4saat dlmkandungan s/d 2A3 tahun.
( JHK 7 3*4 kematiana-i alitadidasari gi$i anak -ang elek.
( +) erat 7 risiko kematian 334.( 6,I uta alita / 2I."4ndonesia kurang
gi$i akiat !S M)!S
( 1,3 uta gi$i uruk.( +) ringan ada anak ulan A 2 tahun,
#i$i uruk
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#i$i uruk
1. Daat dicegah2. Bukan han-a karena kemiskinan,
tai ola asuh_ tidak
tercaain-a gi$i memadai%masalah keluarga'.
". isiko meninggal gi$i uruk 1" ?
+LB #i$i
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+LB #i$i
(Ditemukann-a alita 7 BB/> di awahstandar atau
(:andaAtanda marasmusatau kwasiorkor
Diagnosis
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Diagnosis
K;erall 79 aearance, eha;ior, od-A
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Diagnosis
( Blood urine 7 measure ;itamins minerals le;els waste roducts.
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:reatment
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:reatment
( &ormali$ingnutritional status starts with anutritional assessment. :his rocess enales7
9 a nutritionist or dietician conNrm themalnutrition
9 assess the e]ects o< the disorder
9
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:reatment
(:ue
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:reatment
:ue ndergoing chemothera- or radiation :?( Seriousl- urned( )ersistent diarrhea or ;omiting( Jhose # tract is aral-$ed.
i;
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)rognosis
( 104od- weight lost 7 withoutsidee]ects,
( *04 7 almost alwa-s
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)rognosis
( Some )M childrens reco;ercomletel-
( Kthers 7 rolems throughout li
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)re;ention
( !S e?clusi;e
( !ll !mericans 2 - 7
9 Consume lent- o<
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)re;ention
( Screening
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ood ntolerance !llerg-
( !lergi7 reaksi imunologisterhada makanan
( ntoleransi7 nonAimmunologis
( +linis 79 sistem resirasi, #, dermatologis
or geala sistemik
(:es challenge
ood !llerg- S-mtoms
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ood !llerg- S-mtoms
( # 7 n-eri adomen,kemung, diare, malasorsi,nausea, muntah, konstiasi
( esirator-7 asma,
atuk kronik erulang %B+B',
hidung untu atau meler,whee$ing
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ood !llerg- S-mtoms
( Dermatologis 7
eksema, atoi, urtikaria,
angioedema, gatal, rash
( Sistemic 7 anaNlaksis, n-erikeala, eruahan keiasaan/
eha;ioral
ood !llerg- S-mtoms
Hidu is )ilihan
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Hidu is )ilihan
terima
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terima
kasih