Nutritional care in musculoskeletal Diseases

Prof. DR. Dr. Suryani Asad, MSc,SpGK DEPARTMENT OF NUTRITION FACULTY OF MEDICINE HASANUDDIN UNIVERSITY

OBJECTIVES

KNOW THE COMMON MUSCULOSKELETAL DISEASES RELATED TO NUTRITION SUPPORT

EXPLAIN NUTRITION AND:

RHEUMATOID ATRTHRITIS OSTEOARTHRITIS GOUT ARTHRITIS

APPLY NUTRITIONAL SUPPORT IN

RHEUMATOID ATRTHRITIS OSTEOARTHRITIS GOUT ARTHRITIS

Common Musculoskeletal diseases related to nutritional support

RHEOMATOID ARTHRITIS

OSTEOARTHRITIS
GOUT

RHEUMATOID ARTHRITIS

Nutritional care in RHEUMATOID ARTHRITIS

Articular involvement of the small and

large joints may limit ability to perform activities of daily living (ADLs) including shopping, preparing and eating foods. Involvement of the temporomandibular joint (TMJ) can impact the ability of chew and swallow and necessitate change in diet consistency

Nutritional care in RHEUMATOID ARTHRITIS

The increase in metabolic rate secondary to the

inflammatory process leads to increased nutrients needs Taste alteration due to xerostomia, anorexia due to medication , fatique and pain reduce dietary intake. Changes in the GI tract mucosa affect ingestion, digestion and absorption Increased cytokine production in RA may be associated with reduced body mass, altered energy intake, and metabolism

Energy
Determined using Harris Benedict formula for

REE Stress factor in the range of 1.4-.1.35 An activity factor of 1.2 times REE for patient with limited mobility receiving physical activity and 1.3 for those receiving intensive physical therapy Patients weight should be monitored and energy intake modified accordingly.

protein
Well-nourished individuals require at the

level of RDA for age and sex. For poorly nourished patients or in inflammatory state : 1.5-2.0 g/kg/day The more precise method using a nitrogen balance study, between nitrogen intake and N loss through urin and other routes

lipids
Omega 3 and 6 fatty acids, either in

tablet form or as they occur in oils, have increased popularity in the management of RA because their role in inflammatory pathways. Need more evidences

Vitamins and minerals

No need for routine supplementation
Osteoporosis and osteomalacia are

frequently seen in patients with RA Ca and Vit D malabsorption are characteristic of advanced stage of the disease.

Nutritional care in OSTEOARTHRITIS

More prevalent in obese ---need to lose

weight Excess weight puts an added burden on the weight bearing joints. Weight reduction even seems to improve all of the joints Intake of Ca and Vit D should satisfy the RDA

Nutritional care in Gout

Uric acid is derived from the metabolism

of purine, which constitute a part of nucleoprotein In fact 85% of serum uric acid derived from simple metabolite and purine breakdown Recommended to avoid or restrict purine consumption

Nutritional care in Gout

Encouraged fluid intake of 3 lt/day to

assist with excretion of uric acid and minimize the possibility of calculi formation Carbohydrate enhance excretion of urate Lipid reduces urate excretion. alcohol increases uric acid production

Nutritional care in Gout

Low-purine Diet
A typical diet contains from 600-1000 mg

of purine daily Restricted purine to approximately 100150 mg in severe or advanced case Carbohydrate 50-55%, fat 30%, cholesterol <300mg/day

Gout

Penyakit radang sendi akut, yang biasanya melibatkan satu sendi saja terutama ibu jari kaki Kadar asam urat

Klasifikasi
akibat gangguan metabolisme - Gout sekunder akibat dari penyakit lain
- Gout primer
- Sering terjadi pada laki-laki, perempuan

menopouse, obesitas, konsumsi makanan yang berprotein tinggi

Terapi

Medikamentosa Pengaturan makanan ( diet )

Diet Rendah Purin

* Tujuan : 1. Mengurangi pembentukan asam urat 2. Menurunkan berat badan bila penderita terlalu gemuk dan mempertahankannya dalam batas normal.

Syarat syarat :
1. 2. 3. 4. 5.

Rendah purin,mengandung 100-150 mg purin. Cukup kalori, protein, mineral dan vitamin Hidrat arang tinggi Lemak sedang Banyak cairan

Makanan yang boleh dan tdk boleh diberikan

Gol.Bhn.Mkn. Sumber H.A Sumber P. Hewani Mkn.yg.boleh Semua Daging,ayam,ikan tongkol,tenggiri,telursus u,keju 50gr/hr Mkn.yg.tdk.boleh Sardin, kerang, jantung, hati, limpa, paru, otak, ekstrak daging/kaldu,bebek, angsa, burung -

Sumber P. Nabati

Kacang-kacangan atau tahu/tempe 50gr/hr

Gol.Bhn.Mkn. Sumber Lemak Sayuran

Mkn.yang.boleh Minyak dalam jumlah terbatas Semua sayuran sekehendak kecuali asparagus,kacang polong,buncis,kembang kol,bayam jamur maksimum.50 gr/hr Semua macam buah The,kopi,soda Semua bumbu

Mkn.yg.tdk.boleh -

Buah Minuman Bumbu dll.

alkohol ragi