Outlines

Kewaspadaan gizi buruk

Minidian Fasitasari Bagian Ilmu Gizi FK UNISSULA

Konsep dasar penyakitHub. agent-host-environmentHub. dg status giziMalnutritionIndicators of malnutritionMasalah gizi di Indonesia (& dunia)13 pesan dasar gizi seimbang

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Types of malnutrition

Protein-energy malnutritionLow birth weight (LBW)Vitamin A deficiencyIron deficiencyIodine deficiencyGrowing insight that other micronutrientdeficiencies like zinc, folic acid,calcium,selenium are also seriousOverweight & 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 18.5normal 17 – 18.4mild 16 – 16.9moderate < 16severe

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PEM = KEP atau PCM = KKP

MarasmusKwashiorkorGabungan

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Extent of malnutrition

+ 848 million people suffer from hunger, of whom +800 million live in developing countries, more than in1996In Sub-Saharan Africa currently 212 million hungrypeople, 40 million more than 1990-1992Per year, 30 million babies are born with an IUGR(82.000 per day)182 million children under 5 years (1 of 3) arestunted50 million children under 5 are wasted150 million are underweight

Gizi Buruk Sebabkan 3,5 Juta Kematian Anak per Tahun

1990 – 1992 : 842 million undernourished2003 – 2005 : 848 million undernourished2007: 923 million undernourished

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Banyak Balita gizi buruk di Bogor

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Present challenges

HIV/AIDS33 million people living with HIV/AIDS (PLWHA)Global % of adults PLWHA leveled off since 2000↑ treatment access over past 10y↓ annualnumber of AIDS deathsWorrisome ↑ in new infectionIndonesia, Russian Federation, & various high-income countries

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 orAIDS infected household membersDiminish capacity to ensure food securityDirect effect on nutritional status…

Indirect effect on nutrition…

Present challenges…

Poor urban & rural populationsLandless & ‘female-headed’ householdsAre 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 globalmarket?Could they shift to production of foods that yieldmore?

Malnutrition matters: why?

Malnutrition is ethical unacceptableHuman 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 isexplicitly recognized as a human right

Security?Malnutrition has unacceptable functionalconsequences

Unacceptable functionalconsequences

HEALTH (morbidity & mortality)

EDUCATION (enrolment & performance)

ECONOMIC DEVELOPMENT (productivity)

Micronutrients malnutrition:Main health consequences

DeficiencyIodine

Iron

ConsequencesImpaired mental development (not onlycretinism)Impaired mental development; anemia (↓work performance, etc.); ↓ immunity;stunting; fetal growth retardation (LBW);mortalityBlindness, ↑ risk of mortality & morbidityfrom infectious diseases; anemia; stunting↑ risk of mortality & morbidity frominfectious diseases; stunting; ↓ appetite

Vitamin A

Zinc

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Child mortality & morbidity

Infants born (1500-1999 g) & (2000-2499 g)were 8.1 & 2.8 times resp. more likely to dieNon-supplemented population with vit A hada relative risk of 1.47 for diarrhea mortality &1.35 for measles mortalityZinc deficiency: relative risk on morbidity: forpneumonia (1.25), for diarrhea (1.09), formalaria (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’malnutrition20% of maternal deaths is related with anemiacaused by iron deficiencyIodine deficiency & intelligence

Intelligence ↓ with 13.5 IQ points in iodine deficientpopulations

Education

PEM

Attend school at later ageLower school performanceMore frequent duplication

Productivity

1% reduction in length = 1.4% reduction inproductivity1% reduction in iron status = 1% reduction inproductivityIncome & wealth associated with

Birthweight, IUGRHeight-for-age; weight-for-age

Anemic children

Test scores 0.5 – 1.5 sd lower

Schooling (in years) associated with

Maternal height (weak association)Birthweight, & IUGRHeight-for-age; weight-for-age

Consequences of malnutrition

deficiency

Vitamin A

PEM

Iron

IodineIntelligence

reduces

Survival

Productivity

Sasaran program gizi

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Menurunkan prevalensi gizi kurang pd anak balita menjadi 20%

Menurunkan prevalensi GAKY pd anak menjadi < 5%

Menurunkan anemia gizi besi pada ibu hamil menjadi 40%

Tidak ditemukannya kekurangan vit A (KVA) klinis pd anakbalita & ibu hamil

Meningkatkan jumlah rumah tangga yg mengonsumsi garamberyodium menjadi 90%

Tercapainya konsumsi gizi seimbang dengan rata2 konsumsienergi sebesar 2200 Kal per kapita per hari dan protein 50gram per kapita per hari

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Menurunkan prevalensi gizi kurang pd anakbalita menjadi 20%

Susenas 2003: prevalesi gizi kurang & buruk27,5%SKRT 2001: prevalensi gizi kurang 22,5% & giziburuk 8,5%Susenas: prevalensi gizi kurang 19,8% & giziburuk 6,3%

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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 mengonsumsigaram beryodium menjadi 90%

2003 rmh tangga yg mengonsumsi garam beryodiumsecara cukup 73,2%pencapaian sasaran 81,3%

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Menurunkan anemia gizi besi (AGB) pada ibuhamil menjadi 40%

Prevalensi AGB bumil turun dr 50,9% (1995)menjadi 40,1% (2001)pencapaian target99,75%

4.Tidak ditemukannya kekurangan vit A (KVA) klinis pdanak balita & ibu hamil

1992 Indonesia bebas KVA , tp 50% anak balita mempunyaiserum retinol < 20mcg/100 ml+ pola makan tdk seimbang berisikokapsul vit A

WHO 1995 + 250 jt balita di dunia menderita KVA, 3 jtdiantaranya 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

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Tercapainya konsumsi gizi seimbang denganrata2 konsumsi energi sebesar 2200 Kal perkapita per hari dan protein 50 gram per kapitaper hari

Susenas 2002, konsumsi rata2 penduduk 1.985 Kaldan 54,4 gram proteindistribusi tdk merata, adayg < 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

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… 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. WageningenInternational – 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 2/5/2008Hartono, A. Asuhan Nutrisi Rumah Sakit. PenerbitEGC, Jakarta, 2000.Supariasa,IDN; Bakri, B; Fajar, I. Penilaian StatusGizi. Penerbit EGC, Jakarta, 2002.

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