Peran Nutrisi pada Penyakit

Kardiovaskular
Dr. dr. Christina Olly Lada, M.Gizi
Fakultas Kedokteran
Univesitas Nusa Cendana
Outline
• Pendahuluan
• Prinsip dasar tunjangan nutrisi
• Peran nutrisi pada pencegahan PKV (penyakit
kardiovaskular)
• Dukungan nutrisi pada penyakit hipertensi
• Dukungan nutrisi untuk penderita stroke
Pendahuluan
Prinsip dasar tunjangan nutrisi
Tujuan
Memberikan dukungan nutrisi untuk:
Memperbaiki keadaan umum penderita
Mencegah malnutrisi
Mengurangi kemungkinan infeksi
Mencegah sindroma disfungsi organ
• multipel (SDOM)
Mempersingkat lama rawat inap
Menurunkan mortalitas
POLA DUKUNGAN NUTRISI
Penentuan Stres
Penentuan Status Metabolik Umum /
Gizi Individu Khusus

Kebutuhan Nutrisi
Penilaian dan Penilaian
Kembali Metoda Pemberian Kembali

Monitoring / Evaluasi
 Alur Dukungan Nutrisi
Pemeriksaan klinis /Antropometri /Laboratorium / Pendukung lain

Diagnosis / status Gizi

Kebutuhan energi & Zat Gizi

Komposisi Zat Gizi

Cara pemberian – Oral / Enteral/ Parenteral

Bentuk/ jenis makanan/ formula & suplemen

Pemantauan & evaluasi
Kebutuhan Energi
KET = HB + AF +
HB = Harris Benedict TEF
AF = Aktivitas Fisik
TEF= Thermic Effect Food
Persamaan Harris Benedict:
♂ = 66,5 + 13,7(BB) + 5(TB) – 6,8 (U)
♀ = 665 + 9,6 (BB) + 1,8(TB) – 4,7(U)

Rule of Thumb = 25-30 kkal/kgBB ideal

Informasi Nilai Gizi
Peran nutrisi pada pencegahan PKV
(penyakit kardiovaskular)
CONGESTIVE HEART
FAILURE
Masalah utama

Cardiac Cachexia
Masalah Nutrisi Pada CHF

Akut Kronik
• Hemodinamik tidak • Anemia
stabil • Kakeksia
• Edema • Perubahan sal cerna
• Ganggguan
keseimbangan elektrolit
• Hipoksia organ spt
Ginjal dan Sal Cerna
• Jalur nutrisi yg tepat
Masalah Nutrisi Pada CHF

Akut Kronik
• Start terapi nutrisi → • Cegah penurunan BB
stabil → nutrisi tepat
• Jika memungkinkan →
oral dan enteral
• Start slowly, increase
gradually
• Restriksi cairan
Tujuan terapi Nutrisi
• Mengurangi beban kerja jantung dengan menghindari
makan berlebihan
• Menghilangkan edema
• Perbaikan Status gizi terutama pasien dengan kakeksia
• Perbaikan fungsi respirasi pada pasien sesak
Patofisiologi Malnutrisi dan kakeksia pada
CHF
Iskemi usus : ↓sirkulasi splanknik
Hiperkatabolism : ↑ hormon stres
↑ sitokin
Malabsorpsi : Edema usus → << abssorpsi
lemak dan protein loss
Anoreksia : Nausea, peristaltik usus
lambat
 Nutrisi pada pasien Gagal Jantung
kongestif
Dukungan nutrisi pada penyakit
hipertensi
Classification and management of blood
pressure for adult

JNC 7 Expresss. The Seventh Report of The Joint Committee on Prevention , Detection,
Evaluation,and Treatment of High Blood Pressure. December 2003.
Lifestyle modification to manage
hypertension

JNC 7 Expresss. The Seventh Report of The Joint Committee on Prevention , Detection,
Evaluation,and Treatmentnof High Blood Pressure. December 2003
Dietary Approch to Stop Hypertension
(DASH) diet

Your Guide to Lowering Your Blood Pressure with DASH. NIH. April 2006
DASH eating plan

Your Guide To Lowering Your Blood Pressure With DASH.NHLBI. NIH. April 2006
 How to caculate Na in table salt
(NaCl)
• Atomic weight→ Na: 23 Cl: 35,4
• Molecular weight NaCl = 23 + 35,4 = 58,4
• To convert specific weight of Na to NaCl :
Multiply by 2,54
Ex: 1000 mg Na x 2,54 = 2.540 mg NaCl
(2,5g)
• To convert specific weight of NaCl to Na
Multiply by 0,393
Ex: 2,5 g NaCl = 2,5 x 0,393 = 1000 mg Na

1 send
1 sendok teh NaCl ~ 2300 mg Na
Aktivitas fisik
• Frekuensi : 3-5 kali seminggu
• Intensitas : Sedang
• Time : durasi 30-60 menit
• Start slowly
• Increase intensity gradually
Pembakaran kalori dalam 30 menit aktivitas
fisik pada orang dengan BB 60 kg

• Stretching, hatha yoga 120 kkal

• Aerobik, low impact 165 kkal
• Sepeda statis 210 kkal
• Dancing; slow, waltz 90 kkal
• Volleyball 90 kkal
• Walking 4 mph (15 min/mil) 135 kkal
• Walk/jog, jog < 10 min 180 kkal
• Soccer 240 kkal
• Sitting 34 kkal
• Gardening 135 kkal
• Housework : mengepel 90 kkal
• Carwash 135 kkal
Sumber: http://www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-and-
routine-activities
Aerobic Interval training reduces blood pressure and
improves myocardial function in hypertensive patients
Molmen-Hansen et al. Eur Jour of Prev Cardio. 2011;19(2): 151-60.

♀, 38 orang, < 65 tahun , terbagi mjd 2 kelompok. I :38

menit exerc, II: 47 menit exerc
DYSLIPIDEMIA
ATP III Cholesterol Classification
Total Cholesterol (mg/dl)
HDL Cholesterol (mg/dl)
< 200 Desirable
< 40 Low HDL cholesterol
200−239 Borderline High
≥ 60 High HDL
≥ 240 High
cholesterol

LDL Cholesterol (mg/dl)

< 100 Optimal
100−129 Near optimal/ above
optimal
130-159 Borderline High
160-189 High
≥ 190 Very High

Third Report of The National Cholesterol Education Program (NCEP) expert Panel On Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults ( Adult Treatment Panel III).NIH,
September 2002
10-Year Risk for Heart Attack
Framingham Point Score

Estimate 10-Year Risk for Men Estimate 10-Year Risk for Women
Your LDL Goal
Risk factor Risk category LDL Goal
Heart disease, diabetes, or a High risk < 100 mg/dl
risk score more than 20%
2 or more risk factors and Next Higher Risk < 130 mg/dl
risk score 10−20%
2 or more risk factors and Moderate Risk < 130 mg/dl
risk score less than 10%
0 or 1 risk factor Low to Moderate Risk < 160 mg/dl
Treatment for High LDL Cholesterol
ATP III Therapeutic Lifestyle Changes
(TLC) diet
SERAT
Soluble Fiber
• Pectins, gums, mucilages, alga
• Kacang-kacangan, oats, buah-
buahan and psyllium lower
serum cholesterol and LDL-C
Insoluble Fiber
• Celluloses and lignin
• Bulky feses
• Brokoli, wortel, gandum utuh,
padi, kentang dengan kulit
Bahan makanan sumber Lemak
Ω-3 PUFA (EPA,DHA)
 Found in fish oils, fish oil capsules, and ocean fish like
salmon, makerel, tuna and sardin (EPA and DHA)
 Anticoagulant effect
 Decrease vasoconstriction
 Improve endothelial dysfunction
 Reduce inflammation
 Consumption of fish and fish oils rich in EPA, DHA
will lower cholesterol, LDL, and TG and reduce
sudden cardiac death
Ω-3 PUFA (ALA)
 Alpha-linolenic acid
 An essential fatty acid
 Found in various plant sources such as flaxseed,
canola, walnuts, and soy
 Benefits less clear; may protect against CVD
by reducing inflammation
MUFA (Monounsaturated Fatty Acid)
 Found in olive oil, canola oil, avocado, olives,
pecans, peanuts, and other nuts
 Oleic Acid
 When SAFA is replaced by MUFA→ lowers
LDL-C without lowering HDL-C
 When substituted for carbohydrate, MUFA
reduces serum triglyceride levels
 Trans fat
 Produced in the hydrogenation process
 Commonly used in the food industry to
harden unsaturated oils and soft margarines
 50% of trans-fatty acids come from animal
foods (beef, butter, milk fats)
 Sources : margarine, shortening, commercial frying
fats, high fat baked goods
Stanols/Sterols
Lowers blood cholesterol
Consuming 2-3 grams/day lowers
cholesterol by 9-20% in persons with
hypercholesterolemia
Inhibits absorption of dietary cholesterol
Nuts
Peanuts also cardioprotective
Almonds, hazelnuts, pecans, pistachio
nuts, and walnuts modestly reduce
serum cholesterol
Rich source of fiber, vitamin E,
magnesium, and MUFA and PUFA
May reduce insulin resistance
 1 to 2 large handfuls in a day
Choose unsalted, roasted, or raw nuts
Tugas

Bagaimana dukungan nutrisi pasien stroke, rawat

jalan?

Kelompok I: Kelompok II: Kelompok III:

Prinsip dasar Terapi diet Jenis bahan
dukungan nutrisi makanan yang
dihindari dan
diijinkan

Kelompok IV:
Monitoring Evaluasi
terapi diet pasien
stroke
Terima Kasih