Asupan Gizi Tahap Kehidupan

Dewasa – Lansia
Special Nutritional Needs
Lifecycle Nutrition

Dr Brain Gantoro, M.Gz, SpGK

 CLASSIFICATIONS
SEVEN STAGES
 Infancy - birth to 1 year
 Early childhood - 1 -6 years
 Late childhood - 6-12 years
 Adolescence - 12 -20 years
 Early adulthood - 20 - 40 years
 Middle adulthood - 40 - 65 years
 Late adulthood - 65 and up
Eating Through the Life Cycle
 Adolescence
 energy and nutrient needs
 energy
 -2000-4000 kcal/day
 high activity levels

 males need more than females

Eating Through the Life Cycle
 Adolescence
 energy and nutrient needs
 nutrients
 vitamin D and calcium
 iron

 chronic diseases
 atherosclerosis
 type 2 diabetes

 hypertension
Eating Through the Life Cycle
 Adulthood
 Dilemma
 Need for nutrients but less calories
as we age in adulthood we reduce our metabolic
rate
 Need for exercise but no time

 Solution
 Choosing a variety of healthful, low-calorie food
 Making regular physical activity a priority
Eating Through the Life Cycle
 Adult
 Nutritional Needs
 Follow dietary guidelines for Americans.

(Indonesia)
 Foods to Avoid

 Avoid excessive weight gain and high

calorie foods.
Eating Through the Life Cycle
 Adulthood
 water- avoid dehydration-mobility and
desire to consume water are issues here
 protein- 0.8 g/kg/day

 carbohydrate- increased fibre to offset

constipation- also need more fluid
Eating Through the Life Cycle
 Adulthood
 vitamin B12, vitamin D, calcium & iron
are among the nutrients of primary
concern
 vitamin B12-bacterial overgrowth-in

stomach results in vitamin B12 consumption

by bacteria
 vitamin D and calcium-a concern due to
reduced dairy intake as we age as well as
the risk of osteoporosis
Eating Through the Life Cycle
 Adulthood
 vitamin B12, vitamin D, calcium & iron
are among the nutrients of primary
concern
 iron- deficiency risk if low food energy
intakes-mobility and desire to consume
food are issues here
Table 16-2, p. 574
 Older Adults (50+ years)
 Nutritional Needs  Foods to Avoid
 More vitamin B6,  Eat no more than two

B12, and vitamin D meals per week of fish

and calcium. high in mercury.
 Follow dietary  No unpasteurized

guideline daily. cheese, raw fish, raw

milk, soft cheese,
lightly cooked egg, raw
meat or poultry or raw
sprouts.
11
Eating Through the Life Cycle
 Older Adults
 Good nutrition =
longer life
 Should choose
nutrient-dense foods
 Thirst signals decline
therefore adults
need make sure to
get 8-8oz cups a day
Eating Through the Life Cycle
 Older adults
 Men over 51 need 2300 calories per day
 Women over 51 need 1900 calories per day

 Problems
 Low income
 Disabilities

 Depression
AGING
Inevitable, natural process!
It is the result of cumulative effects of all
biochemical and physiological changes
that occur in a living organism and its
constituents (cells, organs, systems)
over time.
Changes occur also in response to the
interaction between genetic and environmental
events.
 Demographic Trends
and Aging
 Number of elderly Life expectancy in the U.S.
(65+) in the US will
double by 2030 to
more than 70 million
people.

 Improved life
expectancy as a result
of better prenatal and
postnatal care and
improved means of
combating diseases in
older adults.
…More statistics
 In the US, life expectancy is 73
years for men and 75 years for
women.
 Maximum life span (maximum age
at which people die) is 100-120
years.
• Healthy life style (good diet, exercising,
healthy environment) can slow the process of
aging.
Aging at the cellular
level
• Impairment of DNA replication
• Impairment of cellular proliferation
• Loss of viability of the cell
• Reduced rate of DNA repair
• Free radical damage
• Reduced rate of protein synthesis and
catabolism
15-90% reduction
Aging and Nutritional
Needs
Older adults do
need to pay
attention to
quality and
quantity of food.
 Calories
 Energy needs are reduced (reduced
basal metabolism due to loss of lean
tissues and decreased physical
activity)
• Caloric needs decrease about 5% per decade after
age of 50

» Select nutrient-dense food

» Plan regular exercise
 CALORIE RESTRICTION - animal models

30-40% fewer Calories but containing all the

necessary nutrients

Moderate dietary restriction extends lifespan of the

animals studied compared to control animals fed “ad
libitum”

-complete dietary restriction

-selective removal of individual macronutrients (fat,
protein, carbohydrate)
-selective removal of individual micronutrients
(vitamins, etc)
Calorie Imbalance
 Weight Gain
 Risk For Many Health Problems

 Weight Loss
 Risk For Malnutrition
 Don’t go below 1200 calories
 Fat
Fat: Source of energy, biological
membranes, carrier for vitamins,
hormones and intracellular messenger
• Fat digestion and absorption is not
impaired
 Too much fat increases diseases’ risk.
Thus, limit fat to 30% or less of total
calories
 Limit fat intake by choosing reduced
fat (lean meat), and limiting added and
hidden sources of fat
 Water
 Elderly
have increased risk of
dehydration
 Body water decreases with age
 Medications increase water loss
 Thirst mechanism not as effective
 Decreased mobility to reach fluids

- 6-8 cups of water daily

(30ml/kg)
Vitamins and Minerals
 Elderly tend to have low dietary
intakes of some vitamins and
minerals
 Vitamin B6, B12, D
 Folate
 Magnesium
 Zinc
 Iron
 Calcium
Aging and Nutritional
Needs
 Increase of specific nutrients

Reduced stomach acidity (calcium, iron, vitamin B12)

Decline in vision (antioxidant such as -carotene, lutein,

vitamin E)

Reduced exposure to sunlight (vitamin D)

Aging and Nutritional
Needs
 Reduce specific nutrients

Decline in hepatic functions (vitamin A)

Risk of cardiovascular diseases (fat)

Jean Mayer USDA Human Nutrition Research Center on
Aging (USDA HNRCA) at Tufts University (2011)
Nutrition-Related Problems of
Older Adult
Functional decline in almost every
organ (intake, absorption, storage,
utilization and excretion of nutrients)

Chronic diseases (heart diseases, cancer,

diverticulosis, vascular diseases, osteoporosis,
diabetes, oral cavity diseases, neurological diseases,
depression)
Aging and Nutrition Status
 Older people vary in their social, economic,
functional capacities and physical condition.

 Most older people live at home, are fully

independent, and have a good quality of life.

 Some others have problems with the Activity

of Daily Living (ADL) and are at risk of
malnutrition
Factors Influencing the
Nutritional Status of Older
Adults
Socioeconomic

 Cultural Beliefs
 Poverty
 Level of education
 Access to health care
 Institutionalization
Factors Influencing the
Nutritional Status of Older
Adults (cont.)
Physiological
• Polypharmacy
 Dietary intake • Disability
• Oral health problems
 Lack of appetite
 Inactivity/Immobility
 Poor taste or smell
 Alcohol or drug abuse
 Chronic diseases
Factors Influencing the
Nutritional Status of Older
Adults (cont.)
Psychological

 Loneliness
 Cognitive impairment
 Dementia
 Depression
 Loss of spouse
 Social isolation
Factors Influencing the
Nutritional Status of Older
Adults (cont.)
Environmental

 Inadequate housing
 Inadequate cooking facilities
 Lack of transportation
 Lack of access to health
services
Federal Elderly Nutrition
Program
(ENP)
Specific goals:
Low cost nutritional meal
Opportunity for social interaction
Nutrition education and shopping
assistance
Counseling and referral to other social
and rehabilitation services
Transportation services
Warning Signs of Malnutrition in Older Adults
 AGING
WELL
“Life advantages”:
Genetic potential
Continue desire for new knowledge and
experiences
Socialization, intimacy and family integrity
Prudent diet
Avoidance of substance abuse
Acceptable living arrangements
Access to health care
Nutrition and Chronic Conditions
Nutrition and Chronic Conditions
• The following chronic conditions may be affected by managing
ones eating patterns include:
 High Blood Cholesterol
 Hypertension/High blood pressure
 Obesity
 Diabetes
 Osteoporosis
 Eating Disorders
 Anorexia Nervosa
 Bulimia Nervosa

 Binge Eating
Special Diets—
High Blood Pressure

 A risk factor for heart disease

 1# killer of women in US
 Reduce sodium and saturated fats
 Diet rich in calcium, potassium, and
magnesium
Special Diets— High
cholesterol
 Causes
 Eating Fatty (saturated fats) foods
 Eating High cholesterol foods
 Lack of Fiber in the diet
 Increase risk of heart disease and stroke
 Symptoms
 Elevated blood pressure
 Elevated HDL/LDL levels
 Foods to include
 Low-fat or Fat-free
 Whole grains
 Lean meats
 Fish
 Fresh fruits and vegetables
 Foods to avoid
 Partially hydrogenated oils
 Processed snack foods
 Highly marbled meats
Special Diets—Diabetes—Type II
 What is it?
 A condition in which the
body cannot control
blood sugar levels
 If left untreated it can
 Causes
 Eating foods high in sugar
 Excessive body weight
 Low consumption of fiber
 Symptoms
 Excessive thirst
 Fatigue

cause severe damage to  Foods to include

 Low-sugar and sugar-free
the body—especially the  Protein foods
kidneys, eyes, and heart  Whole grains
 Reduced-fat and fat-free
 To control—carbs are  Foods to avoid
rationed through regular  Foods that are high in sugar
meals and careful food  Foods that are high in

choices carbohydrates
Obesity
 65% of all adults are
overweight
 Number of children
under the age of 18
who are overweight
has doubled in the
last 30 years
 Why?
Obesity
 Foods to Include
 Smaller portions
 Reduced-fat or fat free
 Whole grains
 Fish
 Fresh fruits and
vegetables
 Foods that Impact
 Highly processed snack
foods
 Low-fiber content
 High-fat foods
Portions
Obesity
 Health problems
 Excess weight = added strain on bones,
muscles, and internal organs
 Walking and breathing take extra effort

 Heat and humidity increase stress

 High blood pressure, heart disease, stroke,

diabetes, certain types of cancers
 Over 15# can raise chance of early death
Fad Diets
 A diet that is popular for a short period
of time
 Cabbage Diet
 South Beach Diet
 Fad Diets
Ideal Body Myth
 Fashion model  Barbie
(female) Measurements
 5’10’’ 120#
 Average female
 5’4” 152#
 Fashion model (male)
 6’0” 155#
 Average male
 5’9” 180#
Barbie’s Proportions
 “Real Women
 Average woman’s height
is 5′4″
 Their weight is approx.
140 lbs.
 They wear a size 14 dress
 Their bust is between 36″
and 37″ (B cup)
 Their waist is between
30″ and 34″
 Their hips average
between 40″ and 42″
 Their shoe size is
estimated to be between
8.5 and 9.5
 Barbie (as a human)
 Barbie’s height would be
7′2″
 Her weight would be 101
lbs.
 She would wear a size 4
dress
 Her bust would be 39″
(FF cup)
 Her waist would be 19″
(same as her head)
 Her hips would be 33″
 Her shoe size would be a
5
Additional Information
 Barbie’s body would have room
for only half of a liver and
only a few inches of
intestines
 As opposed to the usual 26
feet.
 The result: chronic diarrhea and
death from malabsorption &
malnutrition.
 Barbie’s neck is twice as long
as the average humans
 Making it impossible to hold up
her head.
 Barbie’s waist is the same
circumference as her head.
 There are 3 billion women on
the planet who don’t look
like Barbie; only 8 women
come close.
 To look like a barbie proportionally,
a healthy woman would need to
 add 2 feet to her height,
 subtract 6 inches from her
waist,
 add 5 inches to her chest, and
 3 inches to her neck length.
 If a woman had the same
measurements as Barbie, she would
not have enough body fat to
menstruate (and obviously to have
children).
 Barbie’s legs are 50% longer
than her arms, whereas the
average woman’s legs are only 20%
longer than her arms.
 Barbie would be unable to walk
upright (she would need to
walk on all 4’s):
 Her feet are so proportionately
small that her chest would pull her
perpetually forward onto her toes.”
Why are these unreal for the
“average” American?
 Body’s type is  Models achieve
combination of general “ideals” through
body shape and height strict diets, exercise,
 Determined by parents and photo touch-
through genes ups.
 How do they do it?
 Dove clip
– Evolution--Dove
 Can you tell the
difference?
Underweight
 Who?
 Models, jockeys,
wrestlers, etc.
 Problem
 Not eating enough
nutrients to meet
body’s needs
Underweight
 Health problems
 Suffer from
infections
 Tire easily
 Cold
 Why?
Eating Disorders
 Conditions marked
by extreme
emotions, attitudes,
and behaviors
related to food,
eating, and weight.
 May cause damage
to health or threaten
life
Anorexia Nervosa
 An intense fear of
gaining weight—see
self as fat
 Develop unusual
eating habits
 Strenuous exercising
Anorexia Nervosa
 Starvation diet takes a toll on the body
 Lower heart rate
 Breathing rate
 Blood pressure
 Body temp
 Lead to heart probs, osteoporosis,
constipation
 Stunt growth
 Stop menstrual cycle
Anorexia Nervosa
 Kills approximately
5% of all who suffer
from it
 Death by heart
attack, electrolyte
imbalance, and
suicide
Results of Eating Disorders
 Karen Carpenter (32)
musician:
 Went on a water diet to
lose weight. Died of cardiac
arrest due to anorexia and
weighed only 80 lbs.
 Christy Henrich (22)
gymnast:
 Told to lose weight in order
to make the Olympic team.
She died of multiple organ
failure, as a result of
anorexia. She weighed only
60 lbs.
Those Who Have Struggled With
Eating Disorders
 Paula Abdul
 Dancer, choreographer and
singer
 battled bulimia
 Kelly Clarkson
 The 'American Idol' winner
 struggled with bulimia for
six months until friends
discovered her secret and
begged her to get help.
 Oprah Winfrey
 TV personality
 "It's always a struggle.
I've felt safer and more
protected when I was
heavy. Food has always
been comforting."
Binge Eating Disorder
 Eat abnormally large amounts of food in
a short time
 Approximately 3,000-5,000 in one sitting
 Occurs when alone followed by feelings
of guilt, disgust, and depression
Binge Eating Disorder
 Unbalanced diet and
emotional distress
can lead to…
 Leads to excessive
weight gain
 High blood pressure
 High cholesterol
 Heart disease
 Diabetes
Bulimia Nervosa
 Binge eating is followed by purging to rid the body of
the food and calories and prevent weight gain
 2 or more times a week
 Purging includes
 Self-induced vomiting
 Abuse of laxatives
 Diet pills
 Diuretics (water-removal pills)_
 Fasting
 Excessive exercise
Bulimia Nervosa
 Bulimia hides itself
well
 Fear getting fat but
usually stay 10-15
pounds within
healthy weight
 Signs of bulimia
 Missing food
 Empty containers
 Discovery of laxatives
 Long periods in
bathroom after meals
Bulimia Nervosa
 Health problems
 Vomit eats away at the teeth, gums, and
stomach
 Constant sore throats
 Electrolyte imbalance
 Irregular heart beat and possible heart failure
 Physical signs include…
 Stained, decayed teeth
 Scarred, blistered hands
 Unusual swelling around jaws
Eating Disorders

 Discussion--
 WHY DO EATING DISORDERS EXSIST?
NUTRISI PADA PASIEN PALIATIF
Sebagai sumber energi, menjamin
keadaan pasien tidak makin menurun yang
dapat memperburuk keadaan umum
Faktor utama: cairan, karbohidrat, lemak,
protein, vitamin dan mineral
Normal lanjut usia membutuhkan asupan
cairan 1500 ml tiap hari
Makanan dan air harus tersedia dengan
bebas selama pasien mampu menelan
dengan aman
Angka Kecukupan Gizi (AKG)
Recommended Dietary Allowances (RDA)
 merupakan kecukupan rata2 zat gizi sehari bagi hampir semua orang sehat
(97,5%) menurut golongan umur, jenis kelamin, ukuran tubuh aktifitas fisik,
genetik & keadaan fisiologis utk mencapai derajat kesehatan yg optimal.
 Di Indonesia, Angka Kecukupan Gizi (AKG) disusun dlm Widyakarya Nasional
Pangan & Gizi (WNPG) 1X/5 th sejak th 1978.
 AKG ini mencerminkan asupan rata2 sehari yg dikonsumsi oleh populasi & bukan
merupakan perorangan/individu. Berbeda dg kebutuhan gizi ( requirement),
menggambarkan banyaknya zat gizi minimal yg diperlukan oleh masing 2 individu
shg ada yg rendah & tinggi yg dipengaruhi oleh faktor genetik.
 Kegunaan AKG:
1) utk menilai kecukupan gizi yg telah dicapai melalui konsumsi makanan bagi penduduk.
2) utk perencanaan dlm pemberian makanan tambahan maupun perencanaan makanan
institusi.
3) utk perencanaan penyediaan pangan tingkat regional maupun nasional.
4) Acuan pendidikan gizi.
5) Acuan label pangan yg mencantumkan informasi nilai gizi.
Angka Kecukupan Gizi (AKG)
Recommended Dietary Allowances (RDA)
 Rata2 kecukupan energi & protein bagi penduduk Indonesia
tahun 2013 masing2 sebesar 2150 Kilo kalori & 57 gram
protein /org/hari pd tingkat konsumsi.
 Peraturan Menteri Kesehatan Republik Indonesia Nomor 75
Tahun 2013 ttg Angka Kecukupan Gizi Yang Dianjurkan Bagi
Bangsa Indonesia, ditetapkan di Jakarta pd 28/11/2014. Dg
ditetapkannya Peraturan Menteri ini, maka Keputusan Menteri
Kesehatan Nomor 1593/MENKES/SK/XI/2005 tentang Angka
Kecukupan Gizi yg Dianjurkan Bagi Bangsa Indonesia dicabut &
dinyatakan tdk berlaku.
 (Tabel AKG dapat diakses melalui
link http://gizi.depkes.go.id/download/Kebijakan%20Gizi/Tabel
%20AKG.pdf)