Prinsiple, use and method to preparing LOW ENERGY DIETInggita Kusumastuty

Low Energy dietDiet untuk menurunkan berat badan

Low Energy dietAdalah diet yang kandungan energinya di bawah kebutuhan normal, cukup vitamin dan mineral, serta banyak mengandung serat yang bermanfaat dalam proses penurunan berat badanDiet ini membatasi makanan padat energi, seperti kue-kue yang banyak mengandung karbohidrat sederhana dan lemak serta goreng-gorengan

IndikasiPasien overweight/ obesity / yang mau menurunkan Berat badannya

Mengapa pasien obesitas?

Tujuan Diet Rendah EnergiReduce body weightMaintain a lower body weight over the long timePrevent futher weight gainThe National Institutes of Health suggests a reduction of 10% in body weight as an initial goal. A weight loss of 5%10% has been shown to reduce the risk of heart disease and stroke.CMAJ January 3, 2006 174(1)Nutrition and Diagnosis Related Care, 2008*

Note !Pastikan bahwa yang berkurang adalah sel lemak dengan mengukur tebal lemak lipatan kulit dan lingkar pinggang

Syarat Diet

BATASI !!!

Tinggi serat dan gunakan karbohidrat kompleks

ProteinMemelihara keseimbangan N dalam tubuh Sebagai sumber energi bila tubuh kekurangan Energi1-1,5 gr/KgBB/hari atau 15-20% dari keb. Energi total

LemakMembatasi makanan dengan kandungan lemak tinggi20-25% kebutuhan

Vitamin dan mineral sesuai kebutuhanCairan 8-10 gelas/hari3x makan utama dan 2-3x makan selingan

MACAM DIET RENDAH ENERGI

Low Calorie Diet (LCD)Energy intake reduced by 20004000 kJ (5001000 kcal) Total daily energy intake10%15% proteinsCMAJ January 3, 2006 174(1)Diets in this category include the National Cholesterol Education Program (NCEP) Step I Diet with energy intake restriction; the DASH diet*

Low Calorie Diet (LCD)50%55% carbohydratesFiber : 20 30 glow-glycemic-index dietsNa : 2.4 g or 6 g NaClCa : 1000 1500 mg

CMAJ January 3, 2006 174(1)*

Evidence of LCDThe National Institutes of Health reviewed that :Low-calorie diets can lower total body weight by an average of about 8% during a period of 312 monthsWeight-loss and weight-loss maintenance interventions lasting 34.5 years resulted in an average weight loss of 4%,Reduction in WC 1,5 9,5 cm

CMAJ January 3, 2006 174(1)*

Low Carbohydrate DietsNo restriction of energy intake Carbohydrates restricted to 3% 10% of total daily energy intakeNo restrictions on protein or fat intake No restrictions on saturated fat intakeVitamin and mineral supplementation is recommendedCMAJ January 3, 2006 174(1)*

Low Carbohydrate DietsLow-carbohydrate diets are relatively high in fat and protein content and are not recommended by the American Heart Association.Included in this category are the Protein Power diet and the Atkins diet

CMAJ January 3, 2006 174(1)*

Positive Effect Of Low Carbohydrate DietBoth the low-calorie and low-carbohydrate diets result in weight loss. Two studies, each 6 months in duration, reported greater weight loss with the low-carbohydrate diet than with the low-calorie dietGreater decreases in triglyceride levelsfasting plasma glucose, insulin, cholesterol and triglyceride levels were decreased in the low carbohydrate dietCMAJ January 3, 2006 174(1)*

Negative Effect Of Low Carbohydrate Diet depletion glycogen store gluconeogenesisFFA keton body formation appetide TEF greather weight lossCMAJ January 3, 2006 174(1)*

Brehm and associates and Yancy and associates reported that weight loss resulted mainly from decreases in fat mass and lean body massNutrient analyses of low-carbohydrate diets by Freedman and associates1 and Anderson and associates show low amounts of vitamins A, B6 and E and of folate, calcium, magnesium, iron, potassium and dietary fibre, which makes these diets nutritionally inadequateNegative Effect Of Low Carbohydrate DietCMAJ January 3, 2006 174(1)*

Very Low Calorie Diets (VLCD) Energy : 800 kkal/ dayWith vitamin and supplementationWeekly monitoring by physicianIndication : person with BMI 27 30 kg/mCMAJ January 3, 2006 174(1)*

Very Low Calorie Diets (VLCD) The average weight loss at 1216 weeks on very-lowcalorie diets is about 20 kg, compared with 8 kg on low calorie dietsSide effects and with numerous complications, such as cholelithiasis, loss of lean body mass, ketosis and increased serum uric acid concentrations due to severe negative energy balanceSudden death can occur if calorie intake ; < 600 kcal/dCMAJ January 3, 2006 174(1)*

Very Low Calorie Diets (VLCD) Overall, very-low-calorie diets present a number of medical risks but offer rapid weight loss. Intensive monitoring is required on the part of the physician, and patients must learn to maintain their weight loss when returning to normal eating patternsCMAJ January 3, 2006 174(1)*

Nutrition Intervention for ObesityCarbohydrate : 35 50% TEEFat : 25 35% TEEProtein : 25 35% TEELow glicemic loadFiber : 25 35 g/ dayAdaquate fluidLow saltNutrition and Diagnosis Related Care, 2008*

ESTIMATING ENERGY NEEDS FOR OBESEUsing ideal body weight (IBW) when calculating energy requirements in the obese population does not allow for increased lean body mass (LBM) needed for structural support of the extra adipose tissue*Cunningham developed a formula to estimate energy requirements of the obese, often referred to as Adjusted Body-Weight for Obesityequations like the Harris Benedict equation

Adjustment Body Weight for Obesity:[(ABW-IBW )x 0.25 + IBW]= weight to be used for calculating REEABW= actual body weightIBW=ideal body weight0.25 represents the percentage of excess body weight that is metabolically active*ESTIMATING ENERGY NEEDS FOR OBESE

Nutrition Intervention in Childhood Obesity*The two most popular diets followed by adults, the low-carbohydrate diet and the low-fat/low-calorie diet, have not yet been evaluated extensively for safety and efficacy in childrenSource : Philippas, G. Niki & Lo, W. Clifford. Nutrition in Clinical Care, Volume 8, Number 2, 2005 77 88

Energy according age, activity, likelihood growthProtein : 10 35% TEEFat : 25 40% TEECarbohydrate : 45 60%TEEDecrease the use of sweets as snack food or dessertControl between meal-snack*Nutrition Intervention in Childhood ObesityKrauses Food & Nutrition Therapy 12 editionNutrition and Diagnosis Related Care, 2008

Metode untuk mencapai penurunan berat badan meliputi :

Diet

Modifikasi perilaku

Kunyah makanan secara perlahan-lahan, dan taruh sendok dan garpu diantara waktu mengunyah

Makanlah hanya pada satu atau dua tempat saja (mislanya hanya di meja makan)

Jangan makan sewaktu ada aktivitas lain

3. Olahraga

Pembakaran energi dalam keadaan diam : +/- 1 kal/menitBergerak: 2x lipat

4. Operasi

5. Obat-obatan

Penurun nafsu makanMempercepat rasa kenyangMengurangi Cairan (Diare, banyak BAK)

No one food plan is magicalNo specific food must be included or avoided in a weight management programBe realistic about energy intake. The main characteristic of weight loss diet

provides less energy than the person needs +- 500 Kcal/day

Emphasize Nutritional AdequacyEat small portionsLower energy densityRemember WaterFocus on Complex CarbohydratesChoose fat sensiblyPENGATURAN MAKAN

Tidak DianjurkanTidak makan malam menimbulkan rasa tidak nyaman. Merangsang selera makan sehingga waktu makan berikutnya >>Tidak makan pagi tidak dapat bekerja secara efisien dan mendorong rasa lapar yang hebat siang hari.

METODE PEMASAKANHindari pemasakan dengan digorengLebih baik dikukus, ditim, direbus ataupun ditumis

TUGAS PRAKTIKUM