Nutrition Problems in Indonesia

Fakultas Kedokteran
Universitas Muhammadiyah
Semarang
2011
 Malnutrition
The definition of malnutrition is broad and
controversial
Jelliffe defined malnutrition as a morbid
state, secondary to deficiency or surplus of
one or more essential nutrients
According to Allison, malnutrition refers to
a deteriorated nutrition state
(undernourishment) most commonly seen
in hospitals
Malnutrition includes any nutritional
alteration, deficiency illnesses, or even
obesity, a reality that is an increasing
problem worldwide and represents a state
Allison suggests defining malnutrition in the
form of undernourishment as a deficiency
in energy, protein, or any other specific
nutrient used in measurable body functions
linked to poor patient progress that can be
reversed with nutrition therapy
Malnutrition can be the result of chronic
(hypometabolic) starvation or acute stress-
related (hypermetabolic) starvation
Chronic starvation
In chronic starvation, as nutrient intake is reduced
overtime, the adaptive responses leads to reduced
metabolic activity (hypometabolism) in order to protect
energy reserves. Chronic and acute starvation differ in
the rate at which stored energy is depleted and in the
patterns of hormonal changes associated with each
condition
When caloric intake is insufficient, the body becomes
dependent on energy reserves. Although fat (adipose
tissue) is more abundant, the brain prefers carbohydrates
in the form of glucose as an energy source
With normal metabolic expenditure, carbohydrate
reserves only about 24 hours. Once hepatic glycogen has
been depleted, the brain depends on gluconeogenesis
(primarily from muscle protein) as its main source of
glucose
 PEM (Protein Energy
Malnutrition)
Causes :
Insufficiency energy
Insufficiency protein
Insufficiency nutrient to meet metabolic
demand
Increases metabolic demand due to disease
(fever, inflamation, trauma)
Infections may not be companie by
hyperthermic
Nutrient loses due to diarrhea, vomiting
Inadequate of quality of nutrient
Concequences :
PEM clearly and consistently impact the rate of
heeling, degree of complications morbidity, mortality
and length of hospitalization
PEM can lead to multiple organ and functional
alterations, such as :
Decreased wound healing ability
Diminished functional ability
Compromised immune function
Changes in multiple organ system
Morbidity and mortality. Risk factor 20 times more
complications compared to those who are well
nourished.
Length of stay. Malnourished patients longer
hospitalizations. Up to twice as long as well nourished
patients.
Among adult and children under five
PEM and infections
Infection worsen the PEM
Host response : complexes interactions
among microbial signal molecules, leucocyte
humoral factors and vascular endothelium
Infections : the host reactions to invading
microbes involves a rapid amplifying
polyphony of signal and response that may
spread beyond the invaded tissue
Infection can be response to infection caused
by any class of micro organism (bacteria for
most cases)
Masalah Gizi Buruk
Tidak terdeteksi, 50-60% gizi buruk TIDAK
DILAPORKAN
Ditemukan TERLAMBAT (sudah marasmus,
kwashiorkor dengan komplikasi)
Ditemukan TIDAK MAU DIRAWAT (+10-20%
dirawat)
Dirawat tetapi PULANG PAKSA
Ditemukan dirawat SEMBUH, pada bulan
berikutnya menjadi GIZI BURUK lagi
 KURANG GIZI

Penyebab
langsung Asupan gizi infeksi

YanKes &
Penyebab tak Pola asuh
Pangan sanitasi
langsung tak
tak cukup tak
memadai
memadai

Pendidikan, pengetahuan & ketrampilan rendah

Masalah di Pemberdayaan
masyarakat kurang

Pengangguran, inflasi, kurang pangan & kemiskinan

Akar masalah Situasi pol ek

sos
Pelayanan Gizi Klinik
Pelayanan gizi klinik dapat dilakukan di
Puskesmas maupun RS
Anak dengan gizi buruk yang dirujuk ke
Puskesmas/Rumah Sakit umumnya sudah
dengan komplikasi
Anak gizi buruk (biasanya) disertai dengan
penyakit

Gizi Buruk (WHO, 2000) :

Marasmus : BB/PB < -3 SD
< 70% kurus sekali
Kwashiorkor : oedema kedua tungkai
Pelayanan Gizi di RS
Tujuan :
Mengobati penyakit penyerta
Rehabilitasi
Pakar gizi :
Jangan sakit jangan mati
Jika tidak mati jangan berpotensi bodoh (jangan
bikin malu kita semua)
Kematian Akibat Gizi Buruk
Kematian di RS mencapai 20-40% kasus yang dirawat
(global)
Kematian gizi buruk di RS tidak menurun dalam kurun
waktu 40 tahun (Golden MHN, 2002)
Kematian tinggi disebabkan akibat berbagai faktor
High extracellular fluid
High intracellular sodium content
Toxic shock syndrome
Multi organ failure
Respiratory distress syndrome
Hypovolemia (frequent small mucoid stools)
Uncontrolled vasodilatation
Decompensation cordis
Pelayanan klinik terhadap gizi
buruk
Dikenal sebagai 10 langkah atasi gizi buruk :
Atasi/cegah hipoglikemi (glucose & fat loss)
Atasi/cegah hipotermi
Atasi/cegah dehidrasi (diarrhea, vomiting)
Koreksi gangguan keseimbangan elektrolit
Obati/cegah infeksi
Pemberian makanan secara bertahap
Kejar tumbuh kembang (catch up growth)
Atasi defisiensi gizi mikro
Stimulasi sensorik, mental
Evaluasi dan tindak lanjut
Kegagalan penanganan klinik
24 jam pertama : hipoglikemi, hipotermi,
sepsis, rehidrasi terlambat
72 jam : pemberian formula terlalu banyak,
pemilihan formula tidak tepat
Malam hari : terjadi hipotermi, anak tidak
mau makan, perubahan formula terlalu
cepat
Pengelolaan penderita gizi
buruk
Fase Stabilisasi
Ancaman komplikasi masih tinggi
Perlu pengawasan ketat
Fase Transisi
Komplikasi berkurang
Infeksi teratasi
Dapat tersenyum, mau minum tiap 3 jam
Mulai F100
Fase Rehabilitasi
Mulai aktif, makanan keluarga
Sirup besi
Fase Follow-up
Mempertahankan rehabilitasi
Komplikasi gizi buruk
Hipoglikemi
Hipotermi (suhu aksiler kurang dari 350)
Infeksi/sepsis
Diare dan dehidrasi
Anemia berat
Kemampuan regulasi tubuh
Keluarga sadar gizi (Kadarzi)
Ialah keluarga yang :
Berdaya dalam memiliki, mengelola dan
mengambil keputusan tentang gizi dan
kesehatan dengan benar
Berperilaku gizi seimbang (4 sehat 5
sempurna) : semua anggota keluarga
mengkonsumsi makanan yang mengandung
semua zat gizi yang diperlukan dalam jumlah
yang cukup, aman dan halal
Mampu mengenal dan mengatasi masalah
gizi keluarga
Berperilaku menjaga kesehatan diri dan
lingkungan serta memanfaatkan pelayanan
Terima
kasih