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Adverse nutritional conditions

during fetal development lead toadaptive changes in metabolism thatlead to a thrifty phenotype

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Poor nutrition in early lifeproduces permanent changes in

glucose-insulin metabolism,including a reduced capacity forinsulin secretion and insulin

resistance

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Despite signifcant progress againsthunger and poverty in the last

decade, undernutrition is anunderlying killer o more than 2.6million children and more than100,000 mothers every year.

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The devastating impact oundernutrition spansgenerations, as poorlynourished women are morelikely to suer di!cultpregnancies and give "irth to

undernourished childrenthemselves.

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#ood nutrition during thecritical 1,000$day window

rom pregnancy to a child%ssecond "irthday is crucial todeveloping a child%scognitive capacity and

physical growth.

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&nsuring a child receivesade'uate nutrition during thiswindow can yield dividends or

a lietime, as a well$nourishedchild will perorm "etter inschool, more eectively fghto disease and even earn more

as an adult.

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It has been suggested thatdifferences in sodium contentbetween breastmilk and formula

would be one of the mechanisms forthe programming of later bloodpressure: Blood pressure at age 3-!

years was lower among the breastfedsub"ects##

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$ong-chain polyunsaturated fattyacids are present in breastmilk, butnot in most brands of formula% thesesubstances are important structuralcomponents of tissue membranesystems, including the vascular

endothelium#

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&he effect of early infantfeeding on blood pressure

might also be mediated byoverweight or obesity inadulthood, as this is a risk

factor for 'ypertension#

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'igh cholesterol intake ininfancy may have a longtermprogramming effect on synthesisof cholesterol by down-regulation of hepatichydro(ymethylglutaryl coen)yme

A *'+-oA.#

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Breastfeeding may beassociated both with a lowerprevalence ofoverweight/obesity and withunderweight in later life#

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0ormula feeding leading to a

greater insulin responseresulting in fat depositionand increased number ofadipocytes

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Tinggi badan menciut dengan kecepatan 0,03 cm per tahunsampai usia 45 tahun, dan 0,28 cm per tahun setelah itu.Pemendekan ini diduga akibat penipisan lempeng tulang

belakang, di samping pengurangan massa tulang.

Susutan ini ditaksir sebanyak 12 !lelaki" dan 25 !#anita",yang kemudian tere$a#antah sebagai %ste%p%r%sis dan ki&%sis.'etidakakti&an &isik dianggap sebagai &akt%r risik% n%m%rsatu.

(kuran lipat kulit triseps !TS)" menipis sebanyak 14!#anita" hingga 8 !lelaki" pada usia *5+5 tahun.

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Topik

(ahasan )emeriksaan status gi*i Dasar penghitungan ke"utuhan akan *at$

*at gi*i

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il i

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Penilaian

Antropometrik+normasi minimal yang harus diperolehdalam menilai status gi*i lansia

1. eterangan tentang diet

2. (erat dan tinggi "adan

-. ingkar perut dan lengan

/. Te"al lemak "awah kulit

. eadaan ungsi tu"uh

6. iwayat ineksi

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Tabel. Persentasebagian tubuh yang teramputasi

Bagian yg teramputasi % BB totalTangan 0,3%

Lengan bawah & tangan 2,6%Seluruh lengan 6,2%a!i ",#%$mputasi i bawah lutut #,0%$mputasi i atas lutut "",0%

Seluruh tung!ai ",6%um"er3 4rances 5. eman dan Denise 7. 8ey. Applications of clinical nutrition, 19::.

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Per!iraan BB berasar!an TL an '$( lansia i atas 60 tahun

BB ) * +TL - 0,2/ '$( - 2,10/ - 0,"44/5 42, 143 , !g BB$

BB 7 * +TL - 0,26/ '$( - 2,""6/ - 0,"33/5 3",46 "0," !g BB$-- / berat badan aktual dari 5 p%pulasi.Sumber ung et al. stimating geriatric patient6s b%dy #eight using the knee height caliper and mid+arm circum&erence in 7%ng '%ng hinese. AsiaPac J Clin Nutr 2004;13 (3):261-264.

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Tabel. Petentuan status gi8i berbasis

persentase perubahan berat baanBla9!burn et al. "##/

Persentase BB: * BBS;BB: - "00

80+0 / anutrisi ringan

0+ / alnutrisi sedang

0+* / alnutrisi berat

Persentase BBB * BBS;BBB - "00

85+5 / alnutrisi ringan

5+84 / alnutrisi sedang

0+4 / alnutrisi berat

Persentase perubahan Berat Baan

/ !---+--S"9--- : 100

Sumber arie - et al. ;utriti%nal and etab%lic Supp%rt %& 7%spitali

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Persentase !ehilangan berat baan

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TB ) * 64," > 0,40 - usia/ 2,02 - TL/

TB 7 *4, > 0,24 - usia/ ",3 - TL/Sumber )rances . >eman dan ?enise . ;ey. Applications of clinical nutrition,188.

Per!iraan TB berasar!an se!s, usia an T?

TB ) * "13," > 0,26 - usia/ " - "/ ",01 - T?/

TB 7 * "13," > 0,26 - usia/ " - 2/ ",01 - T?/heung+kei @ee, et al. %urnal %& the 7%ng '%ng Aeriatrics S%ciety. B%l. 10 ;%.1 an. 2000

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TB ) * 13,4 0,6# - P@T/

TB 7 * ",0 0,4 - P@T/

TB * +0,#3 - 2 - A P@T/5 0,43

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lasii!asi obesitas ewasa berasar!an nilai B':

lasii!asi B': @isi!o !omorbi

BB !urang C",1@enah, namun risi!o terhaapmasalah !linis lain tetap tinggi

BB normal ",10>24, >

BB berlebih D21,00 @ata>rata

Pre obes 21,00>2, 'ening!at Ebes eraFat : 30,00>34, Seang

Ebes eraFat :: 31,00>3, Berat

Ebes eraFat ::: D40,00 $mat berat

BMI < 16.0 !"nan#a$an $urus tin%$at &"ratBMI 16.0 16.99 !"nan#a$an $urus tin%$at s"#an%BMI 17.0 18.49 !"nan#a$an $urus tin%$at rin%an

'a&"l ini s"$"#ar !"n"#"rana$an ru&un%an antaraBMI#an risi$o komorbid* an% #apat #ip"n%arui ol"&"r&a%ai fa$tor s"!isal:asal #i"t* "tnis* #an #"ra+at $"%iatan.Sumber: Workoshop on obesity preention !nd "ontro# str!te$ies in the %!"i&i"' W() *00*.

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Dasar

penghitungankebutuhan

akan zat-zat gizi

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?ormula LEGH

$I * B'@ - ? - ?TA,

/,'

an%$a $"cu$upan "n"r%i

&asal !"ta&olic rat" fa$tor $"%iatan fa$tor trau!a (atau fa$tor str"s)

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?ormula Jarris>Bennei9t

B'@ C/ * 66,42"3,#1 BB/ 1 TB/ >6,# /B'@ D/ * 611," ,61BB/ ",1 TB/>4,6 /

BBK:* +BBS BB:/ - 0,215 BB:i

"rat &a#an an% #iin%in$an"rat an s"$aran%"rat &a#an i#"al5i#a!an

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?a!tor !egiatanonisi Tetapan

'uadriparesisParalisis

7emiparesisPasien tirah baringPasien ra#at $alan

Erang n%rmal akti&Erang n%rmal sangat akti&

0,80,

1,2+1,31,201,301,5 F 1,52,00

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?a!tor stress;traumaenis stres;trauma Tetapan

'elaparan ringan-edah min%r

-edah terencanaTransplantasi mata

Trauma multipel G in&eksiTrauma tulang multipelTrauma $aringan lunak

Trauma kepala dg ster%id

0,85 F 1,001,20

1,441,201,30 F 1,551,20 F 1,351,14 F 1,3

1,40 F 2,00

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(ontoh "

?iketahui @elaki usia 40 tahun, tinggi badan 10 cm,berat badan *0 kg

?itanya -H

a#aban -H / **,42 G !13,5 : *0"G !5 : 10" F !*,8 : 40" / 1470 +k!#

,al$ulasi iti#a$ #ila$u$an $ar"na ti#a$ !"l"&ii

120

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1. ;onsume a variety o nutrient$denseoods

and "everages rom the "asic oodgroups,

and while limiting intake o saturatedand

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2. ;onsume su!cient 'uantities oruits and vegeta"les while staying

within energy needs.This may "e especially di!cult or the

older adult "ecause the 'uantity oood re'uired to meet energy needsmay "e signifcantly less than that to

supply vitamin and other micronutrientneeds=

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-. ;hoose a variety o ruits and vegeta"leseach day=

/. ;onsume - or more ounce$e'uivalents

owhole grain products per day=. ;onsume - cups per day o at$ree or low

at milkor e'uivalent milk products=

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6. ;onsume

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