Nutrisi pada kelainan Outlines

muskuloskeletal

Osteoporosis

Minidian Fasitasari

Gout
Bagian Ilmu Gizi
Fakultas Kedokteran UNISSULA
Osteoarthritis
Semarang 2008

Rheumatoid arthritis

Osteporosis

Normal Osteopenia Osteoporosis Severe osteoporosis

Cortical bone
Trabecular bone

1
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.

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.

2
Genetics & ethnicity Physical activity & body weight

Genes may play a role.
Muscle strength and bone strength go

Environment also – diet and calcium together.

Physical activity, body weight, alcohol, and
Heavy body weights and weight gains place
smoking have a role. a stress on bones and promote bone density.

Smoking & alcohol Nutrients

Smokers
Dietary Calcium – the key to prevention

– Less dense bones – 1300 mg/d for 9 -18 years old
– Damage can be reversed when smoking stops. – 1500 mg/d for post-menopausal women

Alcohol abuse
Other Nutrients…
– Enhances fluid excretion, thus increases calcium
losses
– Upsets hormonal balance for healthy bones
– Slows bone formation
– Stimulates bone breakdown
– Increases risks of falling

3
Ca absorption

Factors that enhance
Factors that inhibit

absorption absorption
– Stomach acid – Lack of stomach acid
– Vitamin D – Vitamin D deficiency
– Lactose – High phosphorus
– Growth hormones intake
– High-fiber diet
– Phytates in seeds,
nuts, and grains
– Oxalates in beet
greens, rhubarb, and
spinach

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

4
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
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
Prinsip diet osteoporosis

Diet penting utk pencegahan osteoporosis

Osteoporosis timbul sendiri dlm usia 60-70
tahun  perlu pertimbangan dini ttg
kcukupan nutrisi dl diet

Penting: asupan kalsium & vit D ~ RDA

Peak bone mass diperkirakan tjd pd umur 35
th
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
5
Preskripsi diet Hiperurisemia (Gout)

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

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 Syarat diet

1. Energi ~ kebutuhan
Untuk:
Bila BB >> kalori diturunkan 500-1000 Kal hingga tercapai BB
normal

mencapai & mempertahankan status gizi
2. Cukup protein  1 – 1,2 g/kgBB atau 10-15% dari kebutuhan
optimal kalori total.
3. Hindari bahan makanan sumber protein yg mengandung purin >

Menurunkan kadar asam urat darah & urin. 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 ~ kebutuhan
7. Cairan ~ urin yg diekskresi/hari. Rata2 asupan cairan 2 – 2 ½
liter/hr

Pengelompokan Pengelompokan…

Kelompok 1 Kelompok 2

Kandungan purin tinggi (100-1000 mg / 100 g bahan
Kandungan purin sedang (9-100 mg / 100 g bahan
makanan) makanan)

Sebaiknya dihindari
Dibatasi max. 50-75 g (1-1½ ptg) daging, ikan, unggas;

Otak, hati, jantung, ginjal, jerohan, ekstrak atau 1 mangkuk (100 g) sayuran sehari
daging/kaldu, bouillon, bebek, sardin, makarel, remis,
Daging sapi & ikan (kec. tmsk kel 1), ayam, udang;
kerang. kacang kering & hasil olah, spt tahu & tempe;
asparagus, bayam, daun singkong, kangkung, daun &
biji melinjo

6
Pengelompokan… Jenis diet & indikasi pemberian

Kelompok 3
Indikasi:

Kandungan purin rendah (dpt diabaikan) – pasien dg gout dan/atau batu asam urat dg kadar asam urat

Dpt dimakan tiap hari > 7,5 mg/dl.

Nasi, ubi, singkong, jagung, roti, mi, bihun, tepung
Jenis:

beras, cake, kue kering, puding, susu, keju, telur; lemak – Diet Purin Rendah I (DPR I) 1500 Kal
& minyak; gula; sayuran & buah-buahan (kec. Sayuran – Diet Purin Rendah II (DPR II) 1700 Kal
pd kel 2)

Lama:
– Sampai kadar asam urat darah & BB menjadi normal

Bahan makanan sehari

7
 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

Rheumatoid arthritis Rheumatoid arthritis

Possible links to diet through the immune
Other possible links: oxidative damage to the
system membranes within joints  inflammation &
– Vegetables & olive oil swelling (+)
– Antioxidants: vitamin C, E, & the carotenoids
– The omega-3 fatty acids (in fish oil)  reduce
joint tenderness & improve mobility
Tim cakar ayam. kolagen  desensitisasi 
– Low in saturated fat (from milk & milk products) & sist imun tdk lg menyerang kolagen sendi yg
high in omega-3 fats fatty acids  prevents or sakit.
reduce the inflammation in the joints

References
Firmansyah, A. Optimalisasi Nutrisi pada Penyakit Gout dalam CD Abstrak Konas III
PDGMI, Simposium Ilmiah Gizi Medik, Bandung 2004.
Geissler, C., Powers, H. Human Nutrition 11ed. Elsevier, 2005.
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
Konas III PDGMI, Simposium Ilmiah Gizi Medik, Bandung 2004.
Whitney, E., Rolfes, S.R. Understanding Nutrition, Int’l student ed. Thomson Learning,
USA, 2008.
Williams, M.H. Nutrition for Health, Fitness, & Sport, 8ed. McGraw Hill, NY, 2007.