PROSES ASUHAN GIZI TERSTANDAR (NCP) PADA PENYAKIT OSTEOPOROSIS
ETIKA RATNA NOER, S.Gz, M.Si
OUTLINE 1.
OVERVIEW OF OSTEOPORO OSTEOPOROSIS SIS
2.
NUTRITION ASSESSMENT
3.
NUTRITION DIAGNOSIS
4.
NUTRITION INTERVENTION
5.
MONITORING & EVALUATION
ILUSTRASI : KEPARAHAN OSTEOPOROSIS
The Importance of Connections in Maintaining Strength
Loss of Connections Results in a Loss of Strength
Background
Penyebab kesehatan serius dini (patah tulang)
kecacatan
Dipengaruhi : hormonal, nutritional and lifestyle factors Osteopenia = BMD (1-2,5 SD) of bone loss
early stages
Osteoporosis = BMD > 2,5 SD bone loss
progressive
Penyakit yg ditandai dg massa tulang rendah & kerusakan jar tulang, kerapuhan tulang dan peningkatan resiko fraktur
Uncontrollable Risk Factors for Osteoporosis
Genetic factors
family history
ethnicity
Uncontrollable factors thinness and/or small frame advanced age hormone levels post-menopause anorexia certain medications
National Osteoporosis Foundation, 2004
Controllable Risk Factors for Osteoporosis
Controllable factors
low calcium intake
physical inactivity
smoking
excessive alcohol intake
excessive caffeine use
Antropometri : IMT, riwayat BB, BMD (bone mineral density, bone scan) Riwayat gizi : pola makan, asupan kalsium (porsi), phospor, caffein, garam/Na, makanan pengawet, junkfood, aktivitas fisik a.
Riwayat personal : riwayat obes, fraktur tulang, tk pendidikan, sosek, terapi obat jangka pjg (HRT)
PEMERIKSAAN BIOKIMIA
blood calcium levels blood
vitamin D levels
thyroid function
parathyroid hormone levels
estradiol levels to measure estrogen (in women)
follicle stimulating hormone (FSH) test to establish menopause status testosterone levels (in men) osteocalcin levels to measure bone formation
Domain Klinis : 1. 2.
Overweight (NC 3.3) Altered nutrition related laboratory values (NC 2.2)
Domain Intake : 1. Excessive energy intake (NI 1.5) 2. Excessive fat intake (NI 5.6.2) 3. Inadekuat mineral (NI 5.10.1)
Domain Perilaku 1. Rendahnya pengetahuan gizi (NB 1.1) 2. Kepatuhan diit rendah (NB 1.6)
:
CONTOH DIAGNOSIS GIZI PADA OSTEOPOROSIS PES :
Inadekuat calcium intake berkaitan dengan pantangan makan hewani dan tidak konsumsi susu jangka panjang yang ditandai asupan kalsium < AKG, dan kadar kalsium rendah (Ni 5.10.1)
Data asesmen-nya : recall makanan dan hasil pemeriksaan laboratorium darah Intervensi gizi : pemberian diet tinggi kalsium Mon-ev : Pemeriksaan lab dan asupan makanan.
INTERVENSI 1.
Tujuan Diit
Membantu mencegah terjadinya osteoporosis
Membantu mengurangi kerapuhan masa tulang lebih lanjut agar dapat melakukan pekerjaan sehari-hari seperti biasanya
Syarat Diit 1.
Bahan makanan yang digunakan berkalsium tinggi dan makanan sumber vitamin D
2.
Sebagian besar protein yang digunakan golongan nabati
3.
Penggunaan bahan makanan yang mengandung natrium dibatasi
4.
Mengkonsumsi sayur dan buah dalam jumlah cukup.
5.
Menghindari konsumsi alkohol
6.
Bila terlalu gemuk, jumlah kalori dibatasi
ANGKA KECUKUPAN CALCIUM
BAHAN MAKANAN YANG DIBATASI / BAHAN MAKANAN YANG DAPAT MENGHAMBAT PENYERAPAN KALS 1.
Kopi, teh kental, minuman yang mengandung soda dan alcohol.
2.
Semua daging yang banyak mengandung lemak.
3.
Bahan makanan yang berserat tinggi
INTERAKSI CALCIUM DENGAN ZAT GIZI LAIN
Sodium and protein intakes: high sodium intake increases urinary calcium excretion. High protein intake also increases calcium excretion and was therefore thought to negatively affect calcium status. Caffeine intake: this stimulant in coffee and tea can modestly increase calcium excretion and reduce absorption Alcohol intake: alcohol intake can affect calcium status by reducing its absorption and by inhibiting enzymes in the liver that help convert vitamin D to its active form. Phosphorus intake: the effect of this mineral on calcium excretion is minimal. Several observational studies suggest that consumption of carbonated soft drinks with high levels of phosphate is associated with reduced bone mass and increased fracture risk. Fruit and vegetable intakes: Fruits and vegetables, when metabolized, shift the acid/base balance of the body towards the alkaline by producing bicarbonate, which reduces calcium excretion.
Food
Portion
Milligrams
Milk
Fat free Lactose reduced, fat
free 1% low fat
1 cup
306
1 cup
300
1 cup
290 Yogurt
Plain, fat free
8 ounces
452
Fruit, low fat
8 ounces
343
Frozen yogurt, vanilla, 1/2 cup soft serve
103 Cheese
Pasteurized process
2 ounces
438
Ricotta, part skim
1/2 cup
335
Pasteurized process American
2 ounces
323
Swiss
Mozzarella, part skim 1.5 ounces
311
Fortified foods
Soy drink with added calcium
1 cup
368
1 cup
300
Tofu with added calcium
1/2 cup
253
Cereal with added calcium
1 ounce
236-1043
Orange juice with added calcium
Cereal bar with added calcium 1 bar
200
Bread with added calcium
1 slice
100
1 tortilla
40
Whole-grain tortilla with added calcium
Vegetables
Collards, cooked from frozen
1/2 cup
178
Kale, cooked from frozen
1/2 cup
90
Bok choy, cooked from fresh
1/2 cup
79
Broccoli, cooked or fresh
1 cup
61 Other foods
Soybeans, green, cooked
1/2 cup
130
White beans, canned
1/2 cup
96
Al
1
75
d d
t d
BAGAIMANA SEBAIKNYA CARA MEMASAK ? 1.
Cara-cara memasak yang baik ialah merebus, mengukus, mengungkep, menumis, memanggang atau membakar.
2.
Hindarkankanlah makanan yang diolah dengan cara menggoreng.
MENU UNTUK OSTEOPOROSIS Pagi : Nasi goreng keju + tomat Snack (10.00) : Selada bangkok Siang : Nasi Pecel daun papaya Tempe mendoan Ikan Mas bakar Melon Snack (16.00) : Puding yoghurt Malam : Nasi Tauge cah tahu teri Brokoli saus bawang Ayam goreng Jeruk
Pemilihan Bahan Makanan
Bahan makanan sumber Kalsium : 1. Tinggi ( > 200 mg/100 gr BM ) Saridele bubuk, rebon, teri, udang kering, sarden, bayam, keju ) 2. Sedang ( 100 – 200 mg/100 gr BM ) Brokoli, pecay, kacang ijo, tahu, tempe, susu 3. Rendah ( 10 – 100 mg / 100 gr BM )
Daging, ayam, hati, telur, ayam
BAHAN MAKANAN SUMBER NATRIUM : Roti, krekers, dendeng, abon, ikan asin, ikan pindang
BAHAN MAKANAN SUMBER VITAMIN D Susu, produk olahan susu ( keju, yoghurt ), kedelai, produk olahan kedelai ( tahu, tempe ), ikan, hati.
Perbedaan diit OSTEOPOROSIS dengan makanan biasa 1.
Bahan makanan yang digunakan berkalsium tinggi dan makanan sumber vitamin
2.
Sebagian besar protein yang digunakan golongan nabati
3.
Penggunaan bahan makanan yang mengandung natrium dibatasi
4.
Mengkonsumsi sayur dan buah dalam jumlah cukup
5.
Menghindari konsumsi alkohol
6.
Bila terlalu gemuk, jumlah kalori dibatasi
1.
Cek perub IMT
2.
Cek perub data biokimia
3.
Cek aktivitas fisik
4.
Kesiapan klien menuju pola makan seimbang
5.
Klien dpt menjelaskan pola makan seimbang
OLAHRAGA YG DIANJURKAN UNTUK PENDERITA OSTEOPOROSIS
Berjalan kaki
Jogging
Menaiki tangga
Senam aerobik “low impact”
Menari
Senam Pelenturan
Tai chi
Yoga
OLAHRAGA YG TIDAK DIANJURKAN
Aerobik “high impact” Latihan yang memerlukan gerakan tiba-tiba dan bertenaga Sit-up perut Latihan yang memerlukan gerakan memelintir badan, seperti mengayun stik golf Latihan yang memerlukan hentakan, berhenti dan memulai dengan tiba-tiba, seperti tenis dan squash
TIPS SEHAT CEGAH OSTEOPOROSIS
Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products. Includes lean meats, poultry, fish, beans, eggs, and nuts. Tofu made with calcium salts is a good source of calcium (check the label), as are canned sardines and canned salmon with edible bones. Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. Low-fat and nonfat dairy products provide amounts of calcium that are roughly similar to the amounts in their fullfat versions. Stays within your daily calorie needs
REFERENSI
Almatsier, S (2004) Penuntun Diet , Instalasi Gizi RSCM dan Asosiasi Dietisien Indonesia , Jakarta : PT Gramedia Pustaka Utama Nelms M, Sucher K, Long S. Nutrition Therapy and Pathophysiology 4 th ed. 2009. Thomson Escott-Stump,S (1998), Nutrition and Diagnosis Related Care (Fourth ed.) Baltimore: Williams & Wilkin Mahan, K & Stump, SE (2005) “ Krause’s Food, Nutrition & Diet Therapy ”, 11th ed, Pennsylvania : Saunders, Elsevier. Nelms, anderson. Medical Nutrition Therapy: a case study approach. 2 nd ed. 2004. Wardswoth Billon . Clinical Nutrition: Case studies. 2006. Wardswoth
