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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
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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
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USA, 2008.
Williams, M.H. Nutrition for Health, Fitness, & Sport, 8ed. McGraw Hill, NY, 2007.