Konsep Dasar

Timbulnya Masalah Gizi

Akmal Novrian Syahruddin M.Kes
SUB TOPIK MK. PSG

• Faktor Penyebab Masalah Gizi

• Gambaran Masalah Gizi di Dunia
• Gambaran Masalah Gizi di Indonesia
 Teori Unicef.
Kehilangan Asupan gizi dan penyakit mempunyai
Orang sakit gairah untuk hubungan yang saling ketergantungan.
makan

Status
gizi

Kurang Rendahnya
daya tahan
asupan
tubuh dan
makanan mudah sakit

Timbulnya Masalah
 AKAR PENYEBAB MASALAH GIZI :
Diadopsi dari World Bank 2011 dan Lancet 2013
-Status -
1.
Intervensi Spesifik
Gizi & Kesehatan Pada remaja dan
Gizi prakonsepsi
-Intervensi 2. Suplemen ibu hamil
3. Suplementasi atau fortiifikasi
mikronutrien
 Penanganan balita gizi buruk -ASI, 4. Menyusui dan Makanan
 Suplementasi micronutrient & makanan kaya -Pelatihan -rendah resiko Pendamping ASI
zat gizi dan pengasuhan
terjangkit 5. Suplementasi makanan
fortifikasi makan yg dan stimulasi
 Kebersihan diri rutin penyakit 6. Diversifikasi makanan
infeksi 7. Stimulasi dan kebiasaan makan
8. Penanganan Gizi Kurang
9. Pencegahan dan manajemen
 Ketahanan pangan penyakit
 Sistim kesehatan 10. Intervensi gizi darurat
 Jaminan sosial -Keamanan - Intervesi Sensitif
-Sumber -Akses & 1. Pertanian dan keamanan pangan
 Air bersih bersih pangan, makanan dan penggunaan 2. Jaringan keamanan sosial
 Gender dan pembangunan termasuk pengasuhan
ketersediaan,- yankes, 3. Perkembangan anak usia dini
 Pendidikan remaja putri (tingkat lingkungan 4. Kesehatan mental ibu hamil
daya beli dan
 Perubahan iklim maternal, rumah 5. Pemberdayaan perempuan
penggunaan yang aman
tangga & 6. Perlindungan anak
pangan dan higienis 7. Kelas edukasi
masyarakat
 Program pengentasan 8. Air dan sanitasi
kemiskinan & pertumbuhan 9. Layanan kesehatan dan keluarga berencana

ekonomi -Kelembagaan
 Kepemerintahan dan
keteladanan -Politik dan ideologi - Menciptakan Lingkungan yang Kondusif
 Perdagangan dan peran 1. Evaluasi yang ketat
dunia usaha -Kebijakan ekonomi 2. Strategi advokasi
 Penanganan konflik 3. Koordinasi horizontal dan vertikal
 Pelestarian lingkungan 4. Akuntabilitas, peraturan insentiff, undang-
-Sumber daya, lingkungan, teknologi, undang
penduduk 5. Program kepemimpinan
6. Kapasitas investasi
7. Mobilisasi sumber daya alam
 Trias Epidemiologi
Penyebab Masalah Gizi
Lingkungan
(Environment)

Lingkungan (environment) mempengaruhi keadaan

gizi seseorang seperti lingkungan fisik (cuaca, iklim,
Penyakit tanah, air), lingkungan biologi dan lingkungan sosial
ekonomi.
Pejamu (Host)
(Masala
h
Gizi) Agen
Agen adalah agregat yg keberadaannya
a/ ketidakberadaannya mempengaruhi
timbulnya masalah gizi.
Misalnya akibat kekurangan zat gizi
Pejamu (host) adalah factor yg terdapat pada diri tertentu dapat menimbulkan masalah gizi
manusia yg dapat mempengaruhi keadaan gizi seperti, (kekurangan vitamin C mengakibatkan
umur, jenis kelamin, imunologik, etnik, genetic dll. sariawan).
Jika keseimbangan ini terganggu dalam
waktu yang lama dan terus menerus
maka masalah gizi dapat timbul pada
individu

Jika sejumlah individu yang mengalami

ketidakseimbangan status gizi berada dalam satu
kelompok populasi dengan prevalensi tinggi, maka
masalah gizi tersebut menjadi masalah kesehatan
masyarakat.
1
 Kekurangan
gizi

“
M asalah gizi pada dasarnya merupakan
Mrefleksi dari konsumsi zat gizi yang belum
Jika Asupan Kurang

mencukupi kebutuhan tubuh Jika Asupan Berlebih

Kelebihan
gizi

Jadi status gizi adalah gambaran individu

sebagai akibat asupan gizi sehari-hari 1
 Asupan tidak adekuat, gangguan
absorbsi zat gizi dan peningkatan
kehilangan zat gizi
Gangguan fisiologis tubuh pada
kondisi tertentu. Kondisi awal yang
berlanjut terus dan menimbulkan
pangurangan cadangan gizi dalam
tubuh

Gangguan fisiologi,
gangguan di tingkat sampai munculnya
selular gejala klinis dan
terjadinya kesakitan

Patogenesis Penyakit Gizi

Mortalitas (kematian)
-Parameter ini bertujuan u/mengidentifikasi
individu a/klp populasi yg berisiko mengalami masalah
Mengapa
gizi penilaian
Individu a/klp yg mengalami masalah gizi dapat mendapatkan
tindakan penanggulangan agar masalah dapat teratasi dan
Status gizi
tidak berlanjut menjadi lebih parah penting ?
Program yankes termasuk pelayanan gizi lebih mudah
direncanakan, & lebih terarah sesuai sasaran

Dapat mengukur keberhasilan program gizi & intervensi

yg telah dilaksanakan
Besaran Masalah Gizi Di Dunia
The global burden of malnutrition is
unacceptably high

Children under 5 34% of children in conflict states are

affected by stunting, compared with 20%
1 in 5 stunted in non-conflict states
15.9m stunted and wasted
8.23m stunted and overweight

Adults Adolescents
Undernutrition explains around 1 in 3 either Record
45% of deaths among children overweight overweight
under five, mainly in low and or obese and obesity
middle-income countries

2018 Global Nutrition Report

Stunting is declining (2000–2017)
Most significant declines are in Asia and Latin America and the Caribbean

250
198.4
200
Children affected, millions

150.8
150

100

38.3 Stunting
30.1
50
Overweight

0
2000 2004 2008 2012 2017

Source: NCD Risk Factor Collaboration

2018 Global Nutrition Report

48% of countries are on track for at least
one nutrition target
Global non-communicable disease
Global nutrition targets for 2025
targets for 2025 (diet-related)

TARGET 1: TARGET 4:
TARGET 4:
40% reduction in the 30% relative reduction in
No increase in
number of children under mean population intake
childhood overweight
5 who are stunted of salt

TARGET 5: TARGET 6:
TARGET 2:
Increase the rate of exclusive A 25% relative reduction
50% reduction of
breastfeeding in the first 6 in the prevalence of
anaemia in women
months to at least 50% raised blood pressure
of reproductive age

TARGET 6: TARGET 7:
TARGET 3:
Reduce and maintain Halt the rise
30% reduction
childhood wasting to in obesity and
in low birth weight
less than 5% diabetes

2018 Global Nutrition Report

Yet progress towards targets is too slow
Maternal, infant and young child nutrition targets Nutrition-related NCD targets

Anaemia Obesity, men

49 138 7 180 14

Exclusive breastfeeding Obesity, women

31 13 20 130 178 16

Childhood stunting Diabetes, men

24 27 16 127 8 182 4

Childhood overweight Diabetes, women

38 23 133 26 164 4

Childhood wasting On course Some progress

37 12 24 121
No progress or worsening No data

2018 Global Nutrition Report

Rates of anaemia and women underweight
have barely changed, while obesity is rising
Global prevalence of anaemia, overweight (including obesity) and underweight in women, 2000–
2016

50%
Prevalence of overweight
45% 39.2% and obesity among adult
women (18+)
40%
31.7% Prevalence of anaemia
35%
among women of
30% reproductive age (15–49)
Prevalence, %

25% 31.6% 32.8% Prevalence of underweight

among women aged 20–49
20%

15%

10%

5%
11.6%
9.7%
0%
2000 2004 2008 2012 2016

2018 Global Nutrition Report

88% of countries face overlapping burdens
Number of countries with overlapping forms of childhood stunting, anaemia and overweight in adult women, 2017
and 2018

Anaemia only: Stunting only:

5 countries Anaemia and stunting: 26 countries
1 country
15.95m children
stunted and
Overweight
Overweight, anaemia and stunting: 41 countries and stunting: wasted
3 countries

8.23m children
stunted and
Overweight and anaemia: 54 countries
141 countries overweight
in total
Overweight only: 11 countries

2018 Global Nutrition Report

Spotlight on the UK
• 10.1% (8.4 million people) live in
households where adults report
insecure access to food
• More than 1 million emergency food
parcels given out by the Trussell Trust
in 2016/17
• 22% of girls aged 11-18 % below the
Lower Reference Nutrient Intake value
Obesity in the UK
for calcium; 27% for zinc; 54% for iron
• 1.3 million people over age 65
Me n

68%
experience, or are at risk of,
Childre n Wome n

56% undernutrition

31

2018 Global Nutrition Report

Every country in the world is affected
by malnutrition

Every country has

a malnutrition problem,
irrespective of wealth

88% of countries
experience more than one
type of malnutrition
burden

2018 Global Nutrition Report

The poor quality of diets among
infants, young children,
adolescents and adults is
universal - and unacceptable
Diets low in nutritious foods are a leading
cause of healthy life years lost Risk factors

DALYs related to each dietary risk factor A diet that is low in

A diet that is high in

70
62.6 61.0
60
Ischemic heart disease
49.5 47.6
50
Other cancers
DALYs, millions

40 35.5
Diabetes mellitus 33.3
30
Ischemic stroke 20.1
20
14.2
Intracerebral hemorrhage
10 8.4
5.1 3.4 3.2 2.6 1.2 0.8
Colon and rectum cancer
0
Other Salt Trans
fatty acids
Processed
meat
Real
meat
Sugar-
sweetened
Whole Fruits Nuts and Vegetables Seafood Fibre Legumes Poly- Calcium Milk beverages
grains seeds omega-3 unsaturated
fatty acids fatty acids

2018 Global Nutrition Report

Diets of infants and young children are
suboptimal everywhere in all wealth groups

74.6% of children 6–
23 months of age do
not have sufficient
diet diversity for a
healthy diet –
75.6% in lowest
wealth quintile
56.7% in highest
wealth quintile

2018 Global Nutrition Report

Many countries have areas where majority of
people cannot afford a nutritious diet

Results from the

World Food
Program Fill the
Nutrient Gap
Tool

2018 Global Nutrition Report

The cost of nutritious diets in the UK
According to The Food Foundation study Affordability of the UK’s Eatwell Guide
(September 2018), the cost of the UK Government’s recommended diet is 74% of
the household income of the poorest families (£41.93 per adult per week, or
£103.17 per week for a family of two adults and two children)

10 0 %
re quire d to buy the Ea twe ll Guide
Pe rce nta ge of a fte r-ho using income

80 % 74%

60 %

40 %
28%
21% 22% 19%
20 % 16% 13% 11% 10 %
6%
0%
£11,70 0 £11,70 1- £15,861- £20 ,0 73- £24,961- £30 ,577- £37,441- £46,125- £58,293- £79,197
£15,860 £20 ,0 72 £24,960 £30 ,576 £46,124 £58,292 £79,196
Source: Food Foundation, 2018

2018 Global Nutrition Report

Exclusive breastfeeding has increased
4 percentage points since 2012 to 41%

Burkina Faso
Exclusive breastfeeding rates
TARGET 5: improved from 9% to over
Increase the rate of 50% between 1992 and 2014
exclusive breastfeeding
in the first 6 months to Nepal
at least 50% Exclusive breastfeeding in targeted
districts increased from 46% to
70% between 2012 and 2016
Infant formula (0–36 months) sales increased
from 16.0kg–28.5kg per infant 2005–2017
Trends and patterns in per infant/child commercial breast milk substitutes sales by
region, 2005–2017
60
55.2 56.2
51.5
50.3
49.0
50 47.3
Sales (kg) per infant/child

43.7
40.6
40

Standard 29.2 28.5

30
(0–6 months) 25.7
24.6
Follow-up 20.7 21.6 20.3
(7–12 months) 20 17.2
15.7 16.0

Growing-up 11.7 12.3

(13–36 months) 10 7.1

5.9 6.5
5.0
Special
(0–6 months)
0
2009

2009

2009

2017
2005

2013

2017

2005

2009

2013

2017

2005

2013

2017

2005

2013

2005

2009

2013

2017

2005

2009

2013

2017
North America Europe Asia Latin America Africa Global

2018 Global Nutrition Report

In some regions up to 33% of school-aged
children eat no fruit daily – and up to 59%
consume soda
100%
Prevalence of daily
90% 88%
fruit, vegetable and 80%
86%

78% 79%
soda intake among 80%
72%
70%71%70%
school-age children 70% 67% 66%

and adolescents 60%

59%
Prevalence, %

52%
50%
44%
40%
Asia 40% 38%

Oceania 30%

20%
Africa 13%
11%
10%
4% 4%
Latin America
and the Caribbean 0%
Daily fruit Daily vegetables Daily soda Never or Always or
rarely hungry mostly hungry

2018 Global Nutrition Report

69% packaged foods aren’t aligned with
healthy diets
Trends and patterns in per capita packaged food category sales by region, 2005–2017
Breakfast cereals
180 175
168 166
Ready meals 164

160
Sweet biscuits, snack 144
147 146 145 145
142
bars and fruit snacks 140 133
138

125
Confectionary 121 120
120 116
KG per capita

Savoury snacks 100

Ice cream and
80 74 77
frozen desserts 71
68 71
65
61
Edible oils 60 54 51
46
Sauces, dressings and 40 35
40

condiments
Processed meat and seafood 20

0
Dried processed foods
2017

2013

2017

2017

2017

2017
2005

2009

2013

2005

2009

2005

2009

2013

2005

2009

2013

2017

2005

2009

2013

2017

2005

2009

2013

2005

2009

2013
Baked goods
North America Europe Oceania Asia Latin America Africa Global

2018 Global Nutrition Report

Percentage of unhealthy packaged foods
higher in “emerging” markets
Deve lop e d m a rke ts Em e rging m a rke ts

10 0 %
% produc ts with
He a lth Sta r Ra ting <3.5

87%
76% 78% 79%
80 %
74%
66% 66% 69% 69%
63%
60 %

40 %

20 %

0%
Ne w US Austra lia UK Hong South Me xico India China Ave ra g e
Ze a la nd Kong Afri
Note: Amended from Global Nutrition Report 2018

2018 Global Nutrition Report

What we are eating (or not) in the UK
• 69% of packaged foods in the UK do
not align with healthy diets
• 8% of UK teenagers meet the 5 A
Day recommendation for fruit and
vegetables
• Children aged 1.5-3 years consume
11.3% of their calories from added
sugars, more than double
recommendations.
England, 2018
Source: Public Health England, 2018
2018 Global Nutrition Report
• Adults 19-64 years eat on average
19g dietary fibre per day, far less
than the recommended 30g
• Meat intake in women meets the
recommendation of no more than 70
g/day but men exceed
recommendations
• All age groups have a mean
consumption of oily fish well below
the recommended one portion
(140g) per week.
Besaran Masalah Gizi Di Indonesia
 PERMASALAHAN GIZI
Setiap Negara Di Dunia Mengalami
Permasalahan Gizi Indonesia merupakan salah satu negara
dengan triple ganda permasalahan
gizi.
Status Gizi Balita, 2013-2018

37,2
30,8

12,1 10,2 11,9

8,0

Stunting Wasting Overweight

single burden double burden triple burden
2013 2018

22,2% balita di dunia

Obesitas Penduduk Usia 18+ tahun
(150,8 juta)
7,5% 5,6%
(50,5 juta) (38,3 juta) 2013 2018

Stunting Wasting Overweight 14,8% 21,8%

Sumber: Global Nutrition Report, 2018 Sumber: Riskesdas, 2013 dan

2018
PERMASALAHAN GIZI
Kurang Gizi pada Anak
• Masalah Kurang Gizi pada BALITA stunting, wasting, dan underweight.

Sumber: RISKESDAS 2007, 2010, 2013, 2018; SIRKESNAS 2016

Kemajuan terhadap Target RPJMN 2015-2019 untuk Bayi dengan
Berat Badan Lahir Rendah, Anemia dan ASI Eksklusif

RISKESDAS 2007, 2010, 2013, 2018; SIRKESNAS 2016.

Kemajuan terhadap Target RPJMN 2015-2019 untuk Kegemukan
dan Obesitas

Sumber: RISKESDAS 2007, 2010, 2013, 2018; SIRKESNAS 2016

 POLA KONSUMSI PANGAN MASYARAKAT INDONESIA
Konsumsi pangan penduduk Indonesia masih didominasi oleh
Pola makan merupakan faktor risiko nomor 1 yang
padi-padian. Konsumsi bahan pangan hewani dan sayur dan
buah masih rendah. berkontribusi pada kematian dan kecacatan di Indonesia

Skor Pola Pangan Harapan (PPH) Faktor Risiko Kematian dan Kecacatan di Indonesia,
Tahun 2017 mencapai 83,04%. 2007-2017

25%
Padi-padian

21,74% 2017
Sayur
dan Buah
15,49%
Pangan
9,81%
Kacang- Hewani
kacangan

Sumber: Kementerian Pertanian

Penduduk usia ≥ 5 tahun kurang

konsumsi sayur dan buah Sumber: IHME Data Visualization
Sumber: Riskesdas, 2018
Asupan Energi dan Protein per Kapita per Hari Menurut Kelompok Tingkat
Kekayaan pada Tahun 2017

Sumber: SUSENAS 2017

Asupan Energi per Kapita per Hari dari Kelompok Makanan yang Berbeda pada
Tahun 2007 dan 2017

Sumber: BPS, 2007; BPS, 2017

Sumber Pangan Lokal Sebagai Kunci Penanganan Masalah Gizi
THANK YOU
Tugas Individu
• Buat Paper  3-5 lembar (tidak termasuk sampul)
• Gambarkan Kejadian Masalah Gizi yang ada didaerah Anda
berdasarkan Data RISKESDAS 2018
• Jelaskan Penyebab Timbulnya masalah gizi tersebut sesuai
karakterstik daerah Anda
• Tuliskan Alternatif Sumber Pangan Lokal didaerah Anda untuk
mengatasi masalah gizi tersebut