Peran Zat Gizi Makro Mikro Serta Kebutuhannya Pada Masa

Pubertas Dan Proses Reproduksi

faktor fisiologis yang mempengaruhi keadaan gizi perempuan

hamil dan menyusui

Peran Zat Gizi Bagi Bumil Dan Produksi Asi, Tumkem Janin
GIZI DAUR HIDUP
dr. Ni Nyoman Sri Yuliani, Sp.GK
Departemen Gizi FK UPR
2019
Each stage of the lifecycle has
nutritional concerns specific to the
physiological issues of that stage
All people—pregnant and lactating
women, infants, children,
adolescents, and adults—need the
same nutrients, but the amounts
they need vary depending on their
stage of life

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BARKER HYPOTHESIS

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PUBERTY AND NUTRITION
PRENATAL PRECURSOR
Learning
• Nutritional requirements and dietary recommendations for preteens
• Nutrition-related concern at the onset of puberty
 Puberty
• The beginning of adolescence (transition between childhood and adulhood) 
window of opportunity for the improvement of nutritional status and
correcting poor nutritional practices.
• Development of primary and secondary sex characteristics, growth spurts
• Increase in body fat
• Increase in bone and muscle development

Supported with adequate nutrition

The onset of Puberty

• Two phases:
Phase-1 : height increasement
Phase-2 : weight gain

Most girls enter puberty : age 8-13 y

Boys : 10-15 years
Nutrition requirements
• Energy : differ according to gender, growth and activity level
• Girls : 1400 – 2200 kkal/hari
• Boys : 1600 – 2600 kkal/day
 Macronutrients

Carbs • 45-65 % of daily calories

• Carbohydrates high fiber

Protein
• 10-30% of daily calories
• Maintain & development of lean body mass, growth & sexual
maturation

• 25-35% of daily calories

Fats • Depending caloric intake and activity level

• Precursor agents of metabolic function & a potent gene regulator
 Micronutrients
• Key vitamins : vitamins D, K and B12
Mineral :
• Calcium : essential for building bone and prevent
osteoporosis later in life
• Iron : young females need more iron at the onset
of menstruation
• Young males need additional iron for
development of lean body mass
• Not supplements!! Except iron
• Zinc : growth and sexual maturation
• The RDA for zinc for males and females ages 9-13 is 8 mg/day.
For females ages 14-18, the RDA 9 mg/day.

• Folate : integral role in DNA, RNA and protein synthesis.

Why Nutrition is essential for adolescent girls?
• Nutritional deficiency during this critical period of life affect on the
future health of the individual & their offspring
• Adolescence is a time to prepare for the nutritional demands of
pregnancy and lactation.
• children born to short, thin women are more likely themselves to be
stunted and underweight (low weight for age).
• the negative effects of adolescent malnutrition persist throughout a
woman’s reproductive life.
Pregnancy and Lactation

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 The Time To Begin Thinking About
Prenatal Nutrition Is Before
Becoming Pregnant
• Adequate and balanced diet
• Achieve and maintain a healthy body weight
• Be physically active
• Regular medical check up
• Manage chronic conditions
• This include making sure folic acid intake is
adequate (400 mcg) and that any supplemental use
of preformed vit. A doesn’t exceed 100% (600 RE)
of daily value
 Nutrition Prior to Pregnancy

From conception through the end of the first year of life,

adequate nutrition is essential for tissue formation, neurologic
development, and bone growth, modeling, and remodeling.
 PLACENTAL DEVELOPMENT

Maternal influences on placental function

• maternal metabolic and endocrine status

• maternal hypoxemia and anemia
• maternal diet and nutritional status,
particularly in the periconceptional period

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 PLACENTAL DEVELOPMENT

The Role of the Placenta in Fetal Programming—A Review

Keith M. Godfrey

 Alterations in placental growth and vascular resistance, altered

nutrient and hormone metabolism in the placenta, and changes in
nutrient transfer and partitioning between mother, placenta and
fetus all have important effects on the fetal adaptations.
 Placental weight/birthweight ratio (placental ratio) 
 both a low and a high placental ratio were associated with cardiovascular and
metabolic outcomes in adult life.
 Future interventions to improve placental function are likely to have
lifelong health benefits for the offspring
 Placenta (2002), 23, Supplement A, Trophoblast Research, 16, S20–S27
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 FETAL GROWTH AND DEVELOPMENT
• Human embrionic development during the first 10 weeks.
Organ systems are most vulnerable to teratogens during this time,
when cells are dividing and diferentiating

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Critical Periods

First trimester is the most critical periode of

differentiation. Embryo is most susceptible to alcohol,
drugs, x-ray and nutrient deficiencies
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Woman’s body changes during pregnancy.

to carry the
additional nutrients
and other materials

in preparation
in preparation
for lactation.
for lactation.

(increase
in size and
strength)
Joints become more
Feet swelling (high concentrations of estrogen), flexible 
which promotes water retention & to ready the preparation for
uterus for delivery childbirth 25
1 kg

2 kg

0,75 kg

2 kg

1 kg

3,75 kg

1 kg

3,5 kg
15 kg
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29
 Nutrition during Pregnancy

From conception to birth, all parts of the infant—bones, muscles,

organs, blood cells, skin, and other tissues—
are made from nutrients in the foods the mother eats.

 optimal interval between pregnancies is 18 to 23 months

 1st trimester
 Quality > Quantity
 Same amount of energy but the foods chosen should be more nutrient dense.

 2nd & 3rd trimester

 More complex

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Energy and Nutrient Needs during Pregnancy

• Non-pregnant (13-49 th) : 1800-2350 kkal/hari

Energy • TM1 (+) 100 kkal/hari; TM2 (+) 300 kkal/hari; TM3
(+) 300kkal/hari (AKG 2005)

• Non-pregnant (13-49) : 50 – 57 g/hari

Protein • TM1, 2, 3 (+) 17 gram/hari (AKG 2005)

Essential • essential long-chain PUFA : omega-3 and omega-6

Fatty Acids • for brain growth, function, and structure
2013 32
Energy and Nutrient Needs during Pregnancy
Nutrients for Blood Production & Cell Growth
All nutrients are important.
folate, vitamin B-12, iron, & zinc  requirement >>>; key roles in the synthesis of
DNA and new cells.
Folate Vitamin B-12 Iron Zinc
 supplements, fortified  the B vitamin that  a daily iron supplement,  DNA and RNA synthesis
foods, and a diet that activates the folate during 2nd and 3rd and thus for protein
includes fruits, juices, enzyme trimesters synthesis
green vegetables, and  meat, fish, eggs, or milk  between meals/ bed  Non-pregnant (13-49) :
whole grains. products time 9,8 – 15,4 mg/hari
 Non-pregnant (13-49):  Non-pregnant (13-49) :  liquids other than milk,  TM 1 (+) 1,7 mg/hari
400 mcg/hari 2,4 mcg/hari coffee, or tea, which  TM2 (+) 4,2 mg/hari
 TM1, 2, 3 (+) 200  TM1, 2, 3 (+) 0,2 inhibit iron absorption.  TM3 (+) 9,0 mg/hari
mcg/hari (AKG 2005) mcg/hari (AKG 2005)  Non-pregnant (13-49) :  Routine
26 mg/hari supplementation is not
 TM 2 (+) 9 mg/hari advised.
 TM 3 (+) 13 mg/hari
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 Energy and Nutrient Needs during Pregnancy
Nutrients for Bone Development
• Non-pregnant : 5 mcg/day; does not increase during pregnancy
Vitamin • vital role in calcium absorption and utilization
D • Regular exposure to sunlight and consumption of vitamin D–fortified milk

• last trimester, fetal bones begin to calcify

• Non pregnant : 800-1000 mg/hari
Calcium • TM 1, 2, 3 (+) 150 mg/hari
• milk, cheese, yogurt, and other calcium-rich foods (broccoli, tofu, orange, sardines,
tortilla flour)

• Fosfor
• Non-pregnant : 600-1000 mg/hari
Phosphorus • does not increase during pregnancy
Magnesium • Magnesium
• Non-pregnant : 230 – 270 mg/ hari
• TM 1, 2, 3 (+) 30 mg/ hari 34
POST PARTUM
PERIODE

dr. Ni Nyoman Sri Yuliani, Sp.GK

Changes in the post partum periode
• Called : the “puerpurium”
• Period end : 6-8 weeks after delivery

dr. Ni Nyoman Sri Yuliani, Sp.GK

 POSTPARTUM NUTRITION

• Recommendations for nutrient intake during the postpartum period

are based on the following goals :
Replenish nutrient stores, specifically calcium,vit B and folate
Support requirement of lactation, when the women is breastfeeding
Non-breastfeeding women : No nutrient guidelines

dr. Ni Nyoman Sri Yuliani, Sp.GK 37

• adequate diet is needed to support stamina, patience, and self-
confidence that nursing an infant demands

2013 38
 Nutritional Requirements During Lactation

• Breastfeeding is an anabolic state, resulting in increased energy and nutrient

needs:
• 500 kcal/day (birth to 6 mo)
• 400 kcal/day (7 - 9 mo)
• Protein, zinc, niacin, vitamins A, E, C requirements increase above those in
pregnancy.
• Protein = 71 g/day
• OR 1,3g protein/kgbw/day
Fat
• Omega-3 and omega-6 are important for component of cell
membranes and essential to the formation of new tissue.

CARBOHYDRATE
• Recommendation : increase intake during lactation, because of
increased needs for production of breastmilk

dr. Ni Nyoman Sri Yuliani, Sp.GK

 Water
 need plenty of fluids to prevent dehydration
 drink a glass of fluid at each meal and each nursing session

 Nutrient Supplements
 iron to replace stores
 often continue prenatal vitamins

dr. Ni Nyoman Sri Yuliani, Sp.GK

 Insufficient Lactation
Infant Failure-to-Thrive
• Maternal causes
• Poor milk production: diet, illness, fatigue
• Poor let down: psychological, drugs, smoking
• Inverted nipples
• Significant breast reduction

• Infant problems
• Poor intake: poor suck, infrequent
feedings, Cleft palate
• Low intake: vomiting, diarrhea,
malabsorption
• High energy needs: CNS impairment,
premie, SGA, Congenital Heart disease
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 POST PARTUM DEPRESSION
(PPD)

 Postpartum depression affect between 10-15% right after birth through

the first year postpartum
 Risk factor : social, physical and biological factors

BMC Pregnancy Childbirth. 2013 Jan 16;13:2. doi: 10.1186/1471-2393-13-2.

Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort.
Leung BM1, Kaplan BJ, Field CJ, Tough S, Eliasziw M, Gomez MF, McCargar LJ, Gagnon L; APrON Study Team.
dr. Ni Nyoman Sri Yuliani, Sp.GK
 Biological Risk Factors for
Postpartum Depression
• Hormonal Influences
 Sex hormones (estrogen and progesterone) drop dramatically after
delivery.

• Nutrient Deficiencies: folate and vitamin B12, calcium, iron, selenium, zinc,
and omega-3 polyunsaturated fatty acids

BMC Pregnancy Childbirth. 2013 Jan 16;13:2. doi: 10.1186/1471-2393-13-2.

Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort.
Leung BM1, Kaplan BJ, Field CJ, Tough S, Eliasziw M, Gomez MF, McCargar LJ, Gagnon L; APrON Study Team.
dr. Ni Nyoman Sri Yuliani, Sp.GK
 Most Important Micronutrients
to Lower Risk of PPD
• Optimal Levels of
• Active B-vitamins to prevent elevated levels of homocysteine
(folate, B6, and B12)
• Omega-3 fats
• Selenium
• Vitamin D
• Iodine
• Iron
• Magnesium
• Zinc
 Evidence-Based Natural Support for PPD
• Reduce gut inflammation by eliminating food sensitivities, lowering chronic
gut inflammation with bone broth, coconut oil, glutamine, probiotic foods,
and supplements.
 Support brain health with sleep, social support, and anti-inflammatory foods.

 Optimize micronutrient levels with a nutrient dense diet high in omega-3 fats,
selenium, vitamin D, iodine, iron, zinc, magnesium, active B-vitamins, and
turmeric.
 Offer additional support with referrals for interpersonal psychotherapy, coaching,
and group support networks of other mothers who normalize the experience of
(imperfect) motherhood.
 FINISH
"If we could give every individual the right amount
of nourishment and exercise, not too little and not
too much, we would have found the safest way to
health."

-Hippocrates c. 460 - 377 B.C.

dr. Ni Nyoman Sri Yuliani, Sp.GK