ISUE DIET HIPERTENSI

DAN PENYAKIT GINJAL

Isue Diet Mutakhir

S2 Gizi Kesehatan IKM FK UGM

Susetyowati, DCN.M.Kes
FAKTOR RISIKO HIPERTENSI
 faktor yang tidak dapat dikontrol :
keturunan, jenis kelamin, dan umur.
 Faktor yang dapat dikontrol meliputi
kegemukan, kurang olahraga, merokok
dan pola makan
 Faktor lain yang mempengaruhi
hipertensi adalah geografi dan lingkungan
 stres, obesitas, kurang aktifitas, merokok
dan konsumsi alkohol.
 High Blood Pressure:
Major Component of Chronic Disease Risk

Proportion of incidence due to high blood

pressure (Systolic >115 mmHg)
 Stroke 70-75%

 Congestive Heart Failure 50%

 Ischemic Heart Disease 25%

 Renal Failure 20%

High blood pressure is the leading cause of mortality

worldwide Lancet 2006 367:1747
 Concept of Salt as Harmful
Substance
Salt Intake Hypertension

Disease
(stroke, heart and kidney
disease, osteoporosis, kidney
stones)
 Concept of Salt-Sensitivity

High Salt Intake

Salt-sensitivity Hypertension

Disease
 Ambang Cecap Rasa Asin Dan Asupan Natrium Kaitannya
Dengan Hipertensi Esensial
(intan, susetyowati , mirza, 2011)
 Asupan Na dipengaruhi oleh ambang cecap rasa
asin.
 Semakin tinggi ambang cecap rasa asin, atau
sensitivitasnya terhadap rasa asin berkurang,
maka asupan natriumnya akan meningkat.
Dengan meningkatnya asupan natrium ini, maka
akan meningkatkan risiko hipertensi.
 Penelitian observasional, case control terhadap
82 warga di Puskesmas Mlati I, Sleman
 Hasil Penelitian

 Rata-rata ambang cecap terhadap rasa asin pada

kelompok kasus adalah 0,04 M, pada kelompok
kontrol adalah 0,02 M (p-value < 0,05).
 Rata-rata asupan natrium pada kelompok kasus
adalah 1.956 mg, pada kelompok kontrol adalah
1.485 mg (p-value < 0,05).
 Ambang cecap rasa asin berpengaruh terhadap
hipertensi dengan r=0,668 dan OR= 86,1.
 Asupan natrium berpengaruh terhadap hipertensi
dengan r= 0,596 dan OR= 11,25.
 A Brief History…
The Yellow Emperor’s Classic of Internal Medicine written in
China over 2,000 years ago notes*:

“Hence if too much salt is used for food, the pulse hardens”

 For millions of years daily sodium

intake < 400 mg/day - genetically
programmed level
 Recent change to 3-4,000 mg/day - a
major physiological challenge
*Veith, I. (Translator) U of California Press, 2002.
6000
4903 5200 5260
4678
5000

4000 3527
3000

2000

1000

0
Korea Singapore Hongkong Japan Vietnam*

Mean sodium intake (mg) of selected Asian populations.

* two provinces
 1987

1975 1980 1985 1990 1995

< 10g/day
Trend of salt intake in Japan (ave g/day)
Source: Sasaki, 2006
 Sodium Recommendations from
IOM Report

 Upper Limit (UL):

2.3 g (5,8 g salt)/day for adults

 Adequate Intake (AI):

1.5 g (3,8 g salt)/day for adults
 Recommendations for Adequate
Sodium Intake by Age
Age Sodium Intake per
Day (mg)
0-6 months 120
7-12 months 370
1-3 years 1000
4-8 years 1,200
9-50 years 1,500
50-70 years 1,300
> 70 years 1,200

CMAJ 2008;179(12 Suppl):E1-E93 #2.1

 Sources of Dietary Sodium
(62 adults who completed 7 day dietary records)

Inherent
12%

Food
Processing At the Table
77% 6%

During Cooking
5%

Mattes and Donnelly, JACN, 1991; 10: 383

 PENELITIAN
 Tingkat asupan natrium di Indonesia ?
 Ambang cecap rasa asin pada anak,
remaja, dewasa ?
 Distribusi Sumber natrium pada makanan
sehari-hari ?
 Sodium and Blood Pressure
Evidence:

 Animal studies  Migration studies

 Human Genetic  Interventional
Studies Studies
 Epidemiological  Treatment Studies
Studies
 Treatment Study: DASH Sodium
Randomized 412 adults (mixed B.P. status, racial groups, sexes) to:

 Control diet - low in fruit, veg and dairy, fat content typical of US
 DASH diet - high in fruit, veg and low-fat dairy, reduced fat
content
 Consume diet for consecutive 30 day periods in random order at
each of 3 levels of salt

Intervention Change in mean B.P. vs. control (systolic)

Control diet DASH diet
9g/d salt Control level - 6 mmHg -7 (NT)
-11(HT)
6g/d salt - 2 mmHg - 7 mmHg
3g/d salt - 7 mmHg - 9 mmHg

NEJM 2001; 344:3-10

 Mineral Content in DASH Trials*

Nutrient Control DASH Diet

mg (mmol) mg (mmol)
Natrium 3028 (132) 2859 (124)

Kalium 1752 (45) 4415 (113)

Calcium 443 1265

Magnesium 176 480

* Chemical analysis
of menus Appel LJ et al. N Engl J Med 1997; 336:117-24
 PENELITIAN MAHASISWA
 Hubungan antara asupan natrium, kalium,
kalsium dan magnesium dengan hipertensi
di Puskesmas Mergangsan YOGYAKARTA
(annisa, susetyowati, 2009)
 Ada hubungan antara asupan natrium,
kalium, dan kalsium dengan hipertensi.
 tidak ada hubungan antara asupan
magnesium dengan hipertensi.
ISU DIET PADA
BATU SALURAN
KEMIH Susetyowati,
DCN.M.Kes
 Kidney Stones
 Basic cause is unknown
 Factors relating to urine or urinary tract environment
contribute to formation
 Present in 5% of U.S. women and 12% of U.S. men
 Prevalensi di Indonesia penyakit batu diperkirakan
sebesar 13% pada laki-laki dewasa dan 7% pada
perempuan dewasa
 Major stones are formed from one of three substances:
 Calcium

 Struvite

 Uric acid
 Calcium Stones
 70%-80% of kidney stones are composed
of calcium oxalate
 Almost half result from genetic
predisposition
 Other causes:
 Excess calcium in blood (hypercalcemia) or
urine (hypercalciuria)
 Excess oxalate in urine (hyperoxaluria)
 Low levels of citrate in urine (hypocitraturia)
 Infection
 Faktor-Faktor Risiko Kejadian Batu
Saluran Kemih Pada Laki-laki
(Nur Lina, 2008)
 Penelitian observasional dengan
rancangan kasus kontrol.
 Lokasi penelitian di RS Dr. Kariadi, RS
Roemani dan RSI Sultan Agung. Jumlah
responden sebanyak 44 kasus dan 44
kontrol.
HASIL
 Faktor-faktor risiko kejadian batu saluran
kemih yang terbukti signifikan :
 Kurang minum (OR adjusted=7,009; 95%CI:
1,969-24,944)
 Kebiasaan menahan buang air kemih (OR
adjusted=5,954; 95%CI: 1,919-18,469)
 Diet tinggi protein (OR adjusted=3,962;
95%CI: 1,200-13,082)
 Duduk lama saat bekerja (OR adjusted=
3,154; 95%CI: 1,007-9,871)
 Water for preventing urinary calculi
(Review)
Ke Z, Wei Q (2009)
 Background : Urinary calculi is a common
condition characterized of high incidence and
high recurrence rate. For a long time,
increased water intake has been the main
preventive measure for the disease and its
recurrence.
 Objectives : To access the effectiveness of
increased water intake for the primary and
secondary prevention of urinary calculi.
 Search methods : Relevant RCTs were
identified by electronic and documental searches
of MEDLINE, EMBASE, the Chinese Biomedical
Disk and the Cochrane Central Register of
Controlled Trials. No language restriction was
applied. Date of last search: November 2005.

 Selection criteria : Randomised controlled

trials (RCTs) and quasi-RCTs of increased water
intake for the prevention of urinary calculi and
its recurrence.
 Main results :
 No trials of increased water intake for the primary
prevention of urinary calculi met the inclusion criteria.
 One trial with 199 patients provided results of
increased water intake for the recurrence of urinary
calculi. The recurrence rate was lower in the
increased water intake group than that of the no
intervention group (12% versus 27%, P = 0.008, RR
= 0.45, 95% CI 0.24 to 0.84).
 The average interval for recurrences was 3.23 ± 1.1
years in increased water intake group and 2.09 ± 1.37
years in the no intervention group (P = 0.016, MD =
1.14, 95% CI 0.33 to 1.95).
Effects of Water Consumption on Kidney
Function and Excretion
Ivan Tack, MD, PhD (2010)
 Water homeostasis depends on fluid intake
and maintenance of body water balance by
adjustment of renal excretion under the
control of arginine vasopressin hormone.
 The human kidney manages more efficiently
fluid excess than fluid deficit.
 Small-fluid-volume intake does not alter renal
function but is associated with an increased
risk of renal lithiasis and urinary tract infection.
In that case, increasing fluid intake prevents
recurrence.
 Two recent studies from Danone Research
indicate that increasing water intake in such
people leads to a significant decrease of the
risk of renal stone disease (assessed by
measuring Tiselius’ crystallization risk index)
 Drinking enough fluid’ provide adequate fluid to
restore or maintain total body water, it also
should dilute urinary wastes enough to reduce
the risk of urinary tract infection and renal
lithiasis.

 This point appears particularly critical in SFV

drinker adults and those who eat a large amount
of proteinated food each day since the resulting
increase in urine osmotic load does not produce
fluid intake adjustment in the absence of
dedicated renal feedback, resulting in an
increased risk of stone formation.
 CAIRAN
 Cairan
banyak, minimal 2500 mgl sehari
 Rendah cairan  keluaran volume air
kemih rendah  peningkatan konsentrasi
kalsium dan oksalat
 Jenis cairan  minuman ringan > 1 lt/mg
dalam 3 tahun  kejadian batu kambuh
 HIPOSITRAURIA
 Hipositrauria (sitrat < 320 mg/hr) 
penurunan ekskresi sitrat  inhibitor
pebentukan kristal dalam urine
 Ekskresi sitrat menurun  masukan tinggi
protein  peningkatkan ekskresi asam
dalam urin
 Perbaikan hipositrauria lebih mudah dari
yang lain
 ASAM SITRAT
 Asam Sitrat dianjurkan tinggi 
mencegah hipositrauria sehingga urine
lebih jenuh dan mendorong pertumbuhan
batu kalsium.
sumber : jeruk nipis, apel, anggur, nanas,
jeruk lemon.
 ANALISIS ZAT GIZI JERUK
(Sja’bani, et al, 1995)
Sitrat Kalium Ca Na Mg
g/kg g/kg mg/kg mg/kg mg/kg

Jeruk keprok 5,4 1,58 415 75 135

Jeruk manis 8,75 1,84 435 55 175
J. Nipis Bk 39,6 1,69 390 70 195
Jeruk lemon 48,6 1,44 255 75 265
J.Nipis lokal 55,6 1,53 335 65 210
 DIIT RENDAH KALSIUM 
SUDAH TIDAK DIANJURKAN
 Kalsium 
sesuai kebutuhan normal 400 – 600
mg/hari
Diit rendah calsium  menyebabkan
hiperoxalouria dan pengeroposan tulang.
TERIMA KASIH