KewaspadaanKewaspadaan gizigizi burukburuk

Minidian Fasitasari
Bagian Ilmu Gizi
FK UNISSULA
Outlines
#Konsep dasar penyakit
#Hub. agent-host-environment
#Hub. dg status gizi
#Malnutrition
#Indicators of malnutrition
#Masalah gizi di Indonesia (& dunia)
#13 pesan dasar gizi seimbang
KewaspadaanKewaspadaan gizigizi burukburuk
Minidian Fasitasari
Bagian Ilmu Gizi
FK UNISSULA
Outlines
#Konsep dasar penyakit
#Hub. agent-host-environment
#Hub. dg status gizi
#Malnutrition
#Indicators of malnutrition
#Masalah gizi di Indonesia (& dunia)
#13 pesan dasar gizi seimbang
Types of malnutrition
#Protein-energy malnutrition
#Low birth weight (LBW)
#Vitamin A deficiency
#Iron deficiency
#Iodine deficiency
#Growing insight that other micronutrient
deficiencies like zinc, folic acid,calcium,
selenium are also serious
#Overweight & obesity
Indicators PEM in infants &
children
#Height-for-age (stunting: z score < -2)
#Weight-for-age (wasting: z score < -2)
#Weight-for-age (underweight: z score <-2)
Classification of severity of PEM:
#< -1 mild
#< -2 moderate
#< -3 severe
Types of malnutrition
#Protein-energy malnutrition
#Low birth weight (LBW)
#Vitamin A deficiency
#Iron deficiency
#Iodine deficiency
#Growing insight that other micronutrient
deficiencies like zinc, folic acid,calcium,
selenium are also serious
#Overweight & obesity
Indicators PEM in infants &
children
#Height-for-age (stunting: z score < -2)
#Weight-for-age (wasting: z score < -2)
#Weight-for-age (underweight: z score <-2)
Classification of severity of PEM:
#< -1 mild
#< -2 moderate
#< -3 severe
Indicator PEM in adult
#Body Mass Index (BMI)
Classification of severity of PEM
##18.5 normal
#17 � 18.4 mild
#16 � 16.9 moderate
#< 16 severe
PEM = KEP atau PCM = KKP
#Marasmus
#Kwashiorkor
#Gabungan
Extent of malnutrition
#+ 848 million people suffer from hunger, of whom +
800 million live in developing countries, more than in
1996
#In Sub-Saharan Africa currently 212 million hungry
people, 40 million more than 1990-1992
#Per year, 30 million babies are born with an IUGR
(82.000 per day)
#182 million children under 5 years (1 of 3) are
stunted
#50 million children under 5 are wasted
#150 million are underweight
Extent of malnutrition
#+ 848 million people suffer from hunger, of whom +
800 million live in developing countries, more than in
1996
#In Sub-Saharan Africa currently 212 million hungry
people, 40 million more than 1990-1992
#Per year, 30 million babies are born with an IUGR
(82.000 per day)
#182 million children under 5 years (1 of 3) are
stunted
#50 million children under 5 are wasted
#150 million are underweight
#1990 � 1992 : 842 million undernourished
#2003 � 2005 : 848 million undernourished
#2007 : 923 million undernourished
Gizi Buruk Sebabkan 3,5 Juta Kematian Anak per Tahun
www.kompas.co.id
www.kompas.co.id
Banyak Balita gizi buruk di Bogor
Present challenges
#HIV/AIDS
#33 million people living with HIV/AIDS (PLWHA)
#Global % of adults PLWHA leveled off since 2000
#�treatment access over past 10y #�annual
number of AIDS deaths
#Worrisome �in new infection
#Indonesia, Russian Federation, & various high-
income countries
#Direct effect on nutritional status�
#Indirect effect on nutrition�
Present challenges�
#Direct effect on nutritional status:
#Diarrhea (loss of nutrients), chronic fever (�
energy requirements), oral pharyngeal ulceration
(�food consumption), opportunistic infections
(high demand on immune system)
#Indirect effect on nutrition:
#Diminish capacity to care for young children or
AIDS infected household members
#Diminish capacity to ensure food security
Present challenges
#HIV/AIDS
#33 million people living with HIV/AIDS (PLWHA)
#Global % of adults PLWHA leveled off since 2000
#�treatment access over past 10y #�annual
number of AIDS deaths
#Worrisome �in new infection
#Indonesia, Russian Federation, & various high-
income countries
#Direct effect on nutritional status�
#Indirect effect on nutrition�
Present challenges�
#Direct effect on nutritional status:
#Diarrhea (loss of nutrients), chronic fever (�
energy requirements), oral pharyngeal ulceration
(�food consumption), opportunistic infections
(high demand on immune system)
#Indirect effect on nutrition:
#Diminish capacity to care for young children or
AIDS infected household members
#Diminish capacity to ensure food security
Present challenges�
#Poor urban & rural populations
#Landless & �female-headed� households
#Are they net food buyers?
#Do they buy mainly internationally traded corps
(such as maize, rice, wheat)
#Do they have possibility to change to cheaper
(traditional) foods not incorporated in global
market?
#Could they shift to production of foods that yield
more?
Malnutrition matters: why?
#Malnutrition is ethical unacceptable
#Human right to food
#In most conventions/declarations referred to as
�freedom from hunger� or �right to food�
#Convention on the rights of the child: nutrition is
explicitly recognized as a human right
#Security?
#Malnutrition has unacceptable functional
consequences
Unacceptable functional
consequences
#HEALTH (morbidity & mortality)
#EDUCATION (enrolment & performance)
#ECONOMIC DEVELOPMENT (productivity)
Micronutrients malnutrition:
Main health consequences
�risk of mortality & morbidity from
infectious diseases; stunting; �appetite
Zinc
Blindness, �risk of mortality & morbidity
from infectious diseases; anemia; stunting
Vitamin A
Impaired mental development; anemia (�
work performance, etc.); �immunity;
stunting; fetal growth retardation (LBW);
mortality
Iron
Impaired mental development (not only
cretinism)
Iodine
Consequences Deficiency
Child mortality & morbidity
#Infants born (1500-1999 g) & (2000-2499 g)
were 8.1 & 2.8 times resp. more likely to die
#Non-supplemented population with vit A had
a relative risk of 1.47 for diarrhea mortality &
1.35 for measles mortality
#Zinc deficiency: relative risk on morbidity: for
pneumonia (1.25), for diarrhea (1.09), for
malaria (1.11)
Malnutrition matters:
functional consequences
#Health: morbidity & mortality
#35% of all child deaths are related to malnutrition,
only 1 out of 10 deaths due to �severe�
malnutrition
#20% of maternal deaths is related with anemia
caused by iron deficiency
#Iodine deficiency & intelligence
#Intelligence �with 13.5 IQ points in iodine deficient
populations
Child mortality & morbidity
#Infants born (1500-1999 g) & (2000-2499 g)
were 8.1 & 2.8 times resp. more likely to die
#Non-supplemented population with vit A had
a relative risk of 1.47 for diarrhea mortality &
1.35 for measles mortality
#Zinc deficiency: relative risk on morbidity: for
pneumonia (1.25), for diarrhea (1.09), for
malaria (1.11)
Malnutrition matters:
functional consequences
#Health: morbidity & mortality
#35% of all child deaths are related to malnutrition,
only 1 out of 10 deaths due to �severe�
malnutrition
#20% of maternal deaths is related with anemia
caused by iron deficiency
#Iodine deficiency & intelligence
#Intelligence �with 13.5 IQ points in iodine deficient
populations
Education
#PEM
#Attend school at later age
#Lower school performance
#More frequent duplication
#Anemic children
#Test scores 0.5 � 1.5 sd lower
#Schooling (in years) associated with
#Maternal height (weak association)
#Birthweight, & IUGR
#Height-for-age; weight-for-age
Productivity
#1% reduction in length = 1.4% reduction in
productivity
#1% reduction in iron status = 1% reduction in
productivity
#Income & wealth associated with
#Birthweight, IUGR
#Height-for-age; weight-for-age
Consequences of malnutrition
deficiency reduces
Survival
Iron
Iodine
PEM
Vitamin A
Productivity
Intelligence
Sasaran program gizi
1. Menurunkan prevalensi gizi kurang pd anak balita menjadi 20%
2. Menurunkan prevalensi GAKY pd anak menjadi < 5%
3. Menurunkan anemia gizi besi pada ibu hamil menjadi 40%
4. Tidak ditemukannya kekurangan vit A (KVA) klinis pd anak
balita & ibu hamil
5. Meningkatkan jumlah rumah tangga yg mengonsumsi garam
beryodium menjadi 90%
6. Tercapainya konsumsi gizi seimbang dengan rata2 konsumsi
energi sebesar 2200 Kal per kapita per hari dan protein 50
gram per kapita per hari
Menurunkan prevalensi gizi kurang pd anak
balita menjadi 20%
#Susenas 2003: prevalesi gizi kurang & buruk
27,5%
#SKRT 2001: prevalensi gizi kurang 22,5% & gizi
buruk 8,5%
#Susenas: prevalensi gizi kurang 19,8% & gizi
buruk 6,3%
1. 2. & 5.
Menurunkan prevalensi GAKY pd anak menjadi < 5%
#1980 prevalensi GAKY pd anak usia sekolah 30%
#1990 turun menjadi 27,9%
#1996/1998 menjadi 9,8%
#2003 sedikit meningkat 11,1%
Meningkatkan jumlah rumah tangga yg mengonsumsi
garam beryodium menjadi 90%
#2003 rmh tangga yg mengonsumsi garam beryodium
secara cukup 73,2% #pencapaian sasaran 81,3%
Menurunkan prevalensi gizi kurang pd anak
balita menjadi 20%
#Susenas 2003: prevalesi gizi kurang & buruk
27,5%
#SKRT 2001: prevalensi gizi kurang 22,5% & gizi
buruk 8,5%
#Susenas: prevalensi gizi kurang 19,8% & gizi
buruk 6,3%
1. 2. & 5.
Menurunkan prevalensi GAKY pd anak menjadi < 5%
#1980 prevalensi GAKY pd anak usia sekolah 30%
#1990 turun menjadi 27,9%
#1996/1998 menjadi 9,8%
#2003 sedikit meningkat 11,1%
Meningkatkan jumlah rumah tangga yg mengonsumsi
garam beryodium menjadi 90%
#2003 rmh tangga yg mengonsumsi garam beryodium
secara cukup 73,2% #pencapaian sasaran 81,3%
3.
Menurunkan anemia gizi besi (AGB) pada ibu
hamil menjadi 40%
#Prevalensi AGB bumil turun dr 50,9% (1995)
menjadi 40,1% (2001) #pencapaian target
99,75%
4.
Tidak ditemukannya kekurangan vit A (KVA) klinis pd
anak balita & ibu hamil
#1992 Indonesia bebas KVA , tp 50% anak balita mempunyai
serum retinol < 20mcg/100 ml #+ pola makan tdk seimbang
#berisiko #kapsul vit A
#WHO 1995 + 250 jt balita di dunia menderita KVA, 3 jt
diantaranya gx kerusakan mata menuju kebutaan.
#10% kasus kebutaan di negara berkembang disebabkan KVA
#Buta krn KVA, 70% meninggal dlm 1 tahun
#Study di Sumatra 1980an: KVA berkaitan dg morbiditas &
mortalitas
6.
Tercapainya konsumsi gizi seimbang dengan
rata2 konsumsi energi sebesar 2200 Kal per
kapita per hari dan protein 50 gram per kapita
per hari
#Susenas 2002, konsumsi rata2 penduduk 1.985 Kal
dan 54,4 gram protein #distribusi tdk merata, ada
yg < 70% dr kecukupan gizi yg dianjurkan
13 pesan dasar gizi seimbang
1. Makanlah makanan yang beraneka ragam
2. Makanlah makanan untuk memenuhi kebutuhan
energi
3. Makanlah makanan sumber karbohidrat setengah
dari kebutuhan energi
4. Batasi konsumsi lemak dan minyak sampai
seperempat dari kecukupan energi
5. Gunakan garam beryodium
6. Makanlah makanan sumber zat besi
� 13 pesan dasar gizi seimbang
7. Berikan ASI saja kepada bayi sampai berumur 6
bulan
8. Biasakan makan pagi
9. Minumlah air bersih, aman, dan cukup jumlahnya
10. Lakukan kegiatan fisik dan olah raga yang teratur
11. Hindari minuman beralkohol
12. Makanlah makanan yang aman bagi kesehatan
13. Bacalah makanan pada label yang dikemas
Referensi
#Course of Food & Nutrition Security. Wageningen
International � WUR. Wageningen, the Netherlands.
March � June 2009.
#Khomsan, A. SDM Bangsa dan Gizi Buruk.
http://kompas.com/kompas-
cetak/0602/18/opini/2445871.htm dikutip 2/5/2008
#Hartono, A. Asuhan Nutrisi Rumah Sakit. Penerbit
EGC, Jakarta, 2000.
#Supariasa,IDN; Bakri, B; Fajar, I. Penilaian Status
Gizi. Penerbit EGC, Jakarta, 2002.
� 13 pesan dasar gizi seimbang
7. Berikan ASI saja kepada bayi sampai berumur 6
bulan
8. Biasakan makan pagi
9. Minumlah air bersih, aman, dan cukup jumlahnya
10. Lakukan kegiatan fisik dan olah raga yang teratur
11. Hindari minuman beralkohol
12. Makanlah makanan yang aman bagi kesehatan
13. Bacalah makanan pada label yang dikemas
Referensi
#Course of Food & Nutrition Security. Wageningen
International � WUR. Wageningen, the Netherlands.
March � June 2009.
#Khomsan, A. SDM Bangsa dan Gizi Buruk.
http://kompas.com/kompas-
cetak/0602/18/opini/2445871.htm dikutip 2/5/2008
#Hartono, A. Asuhan Nutrisi Rumah Sakit. Penerbit
EGC, Jakarta, 2000.
#Supariasa,IDN; Bakri, B; Fajar, I. Penilaian Status
Gizi. Penerbit EGC, Jakarta, 2002.