Kebutuhan Zat Gizi untuk

Pasien pada Berbagai

Gangguan
Oleh :
dr. Ikbal Gentar Alam, MKes, SpGK, AIFO
ENERGY BALANCE

Key Term:

Energy intake
Energy expenditure
Energy requirement
Energy balance
Energy intake  obtain from the food.

1 gram CH  4 Kkal
1 gram Protein  4 Kkal
1 gram fatty acid  9 Kkal

Vitamin, mineral and water do not

provide adequate energy.
Total Energy Expenditure = TEE : sum of
Basal Energy Expenditure (BEE), Physical
Activity (PA) / Stress Factor (SF) and
Spesific Dynamic Action of food (SDA) or
Thermic Effect of Food (TEF).
The calculation:

TEE = BEE + PA/SF + SDA (TEF)

BEE is energy expenditure in basal
condition, the ongoing activity
while the body rest: heart beat,
peristaltic, hormone secretion,
enzyme secretion, muscle
contraction, etc.
Basal condition:
 12 – 16 hours after the last meal
 Lying position
 No physical activity an hour before the
test
 Relax
 Normal body temperature
 Room temperature should be 21-25oC
 Normal humidity
Harris & Benedict calculation for BEE:

Men : 66 + (13,7 x BW kg) + (5 x BH cm) – (6,8 x age)

Women: 665 + (9,6 x BW kg) + (1,7 x BH cm) – (4,7 x age)

Simple calculation for BEE:

Men : 1 Kkal / BW Kg / h = 24 Kkal / BW Kg / d

Women: 0,9 Kkal / BW Kg / h = 21,6 Kkal / BW Kg/ d
Factors that influence BEE

Body weight, height, age, gender,

growth, temperature, muscle mass,
sleep, endocrine activity, nutrition
status.
Age : above 20  BEE will decrease 2%
every 10 y.
Gender : BEE in men > women (at age >10 y)
Growth: highest for baby and adolescence.
Height: the taller the higher BEE
Muscle mass : the greater the higher BEE
Temperature : every 1oC elevation of body
temperature (body temp above 37oC) 
BEE will increase 13%
Sleep : BEE decrease 10%
Endocrine:- hiperthyroid: BEE increase
75-100%
- hipothyroid : BEE decrease
30-40%
- right before menstruation BEE
slightly increase and during
menstruation BEE decrease
Nutrition status : BEE decrease in PEM
Pregnancy : BEE increase 15-25%
Physical Activity (PA)

 PA very light = 10-30% BEE

 PA light = 30-50% BEE
 PA moderate = 50-80% BEE
 PA heavy = 80-100% BEE
 AF very heavy = > 100% BEE
 Level of Activity
 Very light: - Activity in sitting position
- Bedrest
 Light: Teacher, lecturer, general
practitioner, housewife.
 Moderate: Farmer, student(+ sport),
office worker
 Heavy : Athlete during TC, unskilled
worker, manual laborer,
army during training
 Very heavy : Sawyer of wood,blacksmith,
ricksaw carrier, becak
driver.
SDA or TEF
SDA /TEF is the amount of energy used
for digestion, absorption and utilization of
food consumed.
- SDA of protein 30% BEE
- SDA of carbohydrate < protein
- SDA of fat  the lowest
SDA of Indonesian food on the average is
10% of BEE + AF
TEE for hypermetabolism

 TEE = BEE x SF x PA

 Simple calculation:
“The rule thumb”  25-30 of
kkal/kg BW
Stress Factor (SF)
 Postoperative (without comp.)1.00-1.10

 Fracture of long bone 1.15-1.30

 Cancer 1.10-1.30
 Peritonitis/sepsis 1.10-1.30
 Serious infection/mult. Trauma1.20-1.40

 Multiple organ failure syndr. 1.20-1.40

 Burn 1.20-2.00
Physical activity (PA)
 Bedridden  1.1

 Ambulatory  1.2
 Start low, increase gradually
 Use ideal body weight for underweight
patient
 Use adjusted body weight for overweight
patient
 Ideal body weight = ((Body height cm)-
100) – (10%x (Body height-100))
 Adjusted body weight = Actual body
weight (ABW) – (25% x (Actual Body
Weight- Ideal Body Weight))
Contoh

 Pasien laki laki, 30 tahun, dosen

UBK, BB 85 kg, TB 168 cm,
mengalami KLL # os fibula dex,
dilakukan ORIF, saat ini sudah
pulang ke rumah, ADL mandiri.
 Berapa kebutuhan energi pasien
tersebut saat sehat?
 Berapa kebutuhan energi pasien
tersebut sekarang?
 Sehat
 BEE 24 x 61 = 1464 ≈ 1500 kkal
 PA = 0,3 x 1500 = 450 kkal

 SDA/TEF = 0,1 x 1500 = 150

 TEE = 1500 + 450 + 150

= 2100 kkal
 Sakit
 BEE 30 x 61 = 1830 ≈ 1800 kkal
 PA = 0,2 x 1800 = 360 kkal

 SF = 0,2 x 1800 = 360

 TEE = 1800 + 360 + 360 = 2520

≈ 2500 kkal
Vitamin
 1. Konsep Dasar Ilmu Gizi (CV)
 2&3. Peran Zat Gizi pada Berbagai
Tingkat Usia (CV)
 4&5. Kebutuhan Zat Gizi Untuk
Pasien pada Berbagai Gangguan
 6&7. Jenis Jenis Diet dan
Hubungannya dengan Berbagai
Penyakit
 8. UTS
 9. Nutritional Assessment (Penilaian
Status Gizi)
 10&11. Kebutuhan Nutrisi Bagi
Proses Penyembuhan Luka (Post
Op) (CV)
 12&13. Diet Gastrointestinal, Diet
Jantung, Diet Ginjal, Diet
Metabolisme, Diet DM
 14&15. Peran Perawat Anestesi
dalam Pelaksanaan Diet Pasien (CV)
 16. UAS
Referensi

 Almatsier, Prinsip Dasar Ilmu

Gizi
 Barasi, M.E, Nutrition at a
Glance
 N, Malikarjuna Rao, Medical
Biochemistry
Metode Pembelajaran

 Daring
 2x tatap muka
 Tugas, Kuis, Belajar Mandiri
Pertanyaan??