MALNUTRISI

Bunga Syifa Fauzia Yusuf

2009730003

Dr. H. Toton Suryotono, Sp.PD
Malnutrisi
Malnutrition can arise from primary or secondary causes, with the
former resulting from inadequate or poor-quality food intake and
the latter from diseases that alter food intake or nutrient
requirements, metabolism, or absorption, particularly diseases
that cause acute or chronic inflammation.

Traditionally, the two major types of PEM have been marasmus
and kwashiorkor. Marasmus has been considered the end result of
a long-term deficit of dietary energy, whereas kwashiorkor has
been understood to result from a protein-poor diet.

Harrisons principles of internal medicine. 18
th
edition.
BMI Classification
BMI = kg/m2 = 32/(1.5) = 14.22
Classification BMI (kg/m)
Underweight <18.50
Severe thinnes <16.00
Moderate thinnes 16.00-16.99
Mild thinnes 17.00-18.49
Normal Range 18.50-24.99
Overweight 25.00
Pre-obese 25.00-29.99
Obese 30.00
Obese class I 30.00-344.99
Obese class II 35.00-39.99
Obese class III 40.00
Source : adapted from WHO 2006
The High-Risk Patient
Underweight (body mass index <18.5) and/or recent loss of 10% of usual body mass
Poor intake: anorexia, food avoidance (e.g., psychiatric condition), or NPO status for
more than about 5 days
Protracted nutrient losses: malabsorption, enteric fistulas, draining abscesses or
wounds, renal dialysis
Hypermetabolic states: sepsis, protracted fever, extensive trauma or burns
Alcohol abuse or use of drugs with antinutrient or catabolic properties: steroids,
antimetabolites (e.g., methotrexate), immunosuppressants, antitumor agents
Impoverishment, isolation, advanced age
Harrisons principles of internal medicine. 18
th
edition.
Physiologic Characteristics of Hypometabolic and Hypermetabolic States
Physiologic Characteristics Hypometabolic,
Nonstressed Patient
(Marasmic)
Hypermetabolic, Stressed
Patient (Kwashiorkor Risk
*
)
Cytokines, catecholamines,
glucagon, cortisol, insulin

Metabolic rate, O
2

consumption




Proteolysis, gluconeogenesis



Ureagenesis, urea excretion



Fat catabolism, fatty acid
utilization
Relative Absolute
Adaptation to starvation Normal Abnormal
Estimating Energy and Protein Requirements
A patient's basal energy expenditures (BEE, measured in
kilocalories per day) can be estimated from height, weight,
age, and gender by using the Harris-Benedict equations :
Women: BEE = 655.10 + 9.56W + 1.85H
4.68A
(W is weight in kilograms; H is height in centimeters, and A is age in years)

655.10 + 9.56(32) + 1.85(150) + 4.68(15) = 1,309 kkal/day
Ketidakseimbangan energi merupakan faktor utama kegagalan
pertumbuhan dan malnutrisi pada anak dengan kelainan jantung
bawaan yang memiliki tingkat metabolisme yang lebih tinggi.
Sejumlah faktor dapat menjadi penyebab terjadinya malnutrisi
pada anak dengan PJB, antara lain hipoksemia, asupan kalori
yang tidak adekuat, hipermetabolisme, malabsorpsi, dan faktor
hormon pertumbuhan.





Sari pediatri, vol.13, No.2, Agustus 2011