Low Sodium Potassium Diet_2015

LOW SODIUM POTASSIUM DIET

Inggita Kusumastuty

Jurusan Gizi-FKUB

• Sodium is the principal cation of extracellular fluid and amajor determinant of intravascular fluid volume (Journal ofthe American College of Nutrition, Vol. 25, No. 3, 165–169(2006))

• It helps keep normal fluids balanced in the body (SunitaAlmatsir, 2004)

• Sodium also aids in nerves impuls and muscle contractioncontrol

Sodium

(Krause’s, 11th ed)

Estimated Minimun Requirements in Health Person

Sodium

Age Weight (kg) Sodium (mg)*

Months

0-5 4.5 120

6-11 8.9 200

Year

1 11 225

2-5 16 300

6-9 25 400

10-18 50 500

>18 70 500 (Krause’s, 11th ed)

• Makanan sehari-hari biasanya cukup mengandung natriumyang dibutuhkan sehingga tidak ada penetapan kebutuhannatrium sehari

• WHO (1990) menganjurkan pembatasan konsumsi garamdapur hingga 6 g (2400 mg)

Sodium

(Sunita Altmatsir,2004)

• Tujuan :membantu menghilangkan retensi garam atau air,dalam jaringan tubuh dan menurunkan tekanan darahpada hipertensi

• Syarat Diet :1. cukup energi, protein, mineral dan vitamin2. bentuk makanan sesuai dengan keadaan pasien3. jumlah Na disesuaikan dengan berat tidaknyaretensi garam/air/hipertensi

Low Sodium Diet


Low Sodium Diet

• A low sodium diet includes no more 2000 to 3000 mg of sodium perday (Heart Failure Society , St. Paul, MN, 2006)

• The four most common forms of sodium-restricted diet :• 3 g of sodium/day; an intake of no more than ½ tsp of table salt• 2 g of sodium/day; an intake of no more than ¼ tsp of table salt• 1 g of sodium/day; table salt is not allowed• 500 mg of sodium/day; table salt is not allowed


Macam Diet RendahGaram

Rendah garam I (200-400 mg Na)

Rendah garam II (600-800 mg Na)

¼ sdt garam dapur

Rendah garam III (1000-1200 mg Na)½ sdt garam dapur


persistenly high arterial blood pressure, define as systolic blood pressure above 140 mmHg, or diastolic blood pressure above 90 mmHg

Hypertension

Category Blood Pressure (mmHg)

Systolic Diastolic

Optimal <120 And <80

Normal <130 And <85

High-normal 130-139 Or 85-89

Hypertention

Satge 1 140-159 Or 90-99

Stage 2 160-179 Or 100-109

Stage 3 ≥180 Or ≥110

(Kraus, 11 ed)

Classification of Blood Pressure in Adult Age 18 Years and Older

Target Organs that are Damaged:

• The heart – heart disease

• The brain - cerebrovascular disease

• The kidneys - renal disease

• Arteries - large vessel disease

Untreated Hypertension

• Rendah garam I (200-400 mg Na)untuk pasien dengan edema, asites, hipertensi berat

• Rendah garam II (600-800 mg Na)untuk pasien dengan edema, asites, hipertensi tidakterlalu berat

• Rendah garam III (1000-1200 mg Na)untuk pasien dengan edema, hipertensi ringan

Treatment of Hypertension

Treatment of Hypertension

Medical Management

Nutrition Management :-Weight management- sodium restriction- alcohol restriction-Increased fruit and

vegetable- education

(Krause, 11 ed)

• High in whole grains, fruits, vegetables, and low-fatdairy

• Adequate Calcium, Potassium, Magnesium

• Low in red meat, sweets and sugar beverages

• Low in saturated and trans fat, cholesterol

DASH DIET

Dietary Approaches to Stop Hypertension

Potassium

• Clinical trials and meta-analyses indicate potassium (K) supplementation lowers BP

• Adequate K intake, preferably from food sources, should be maintained

• Evidence is strong enough to support a health claim on high potassium foods

• Best sources are fruits and vegetables

Mineral Intake and Hypertension

Magnesium

• Evidence suggests an association between lower dietary magnesium intake and high blood pressure

• Food sources are nuts, beans, vegetables


Calcium

• American Heart Association Statement• Increasing calcium intake may preferentially lower blood pressure in salt-

sensitive people

• Benefits more evident with low initial calcium intakes

(300-600 mg/day)

• Best food sources are dairy products.


Food Group Servings

Grains 6-8

Vegetables 4-5

Fruits 4-5

Low-fat or fat free dairy 2-3

Meats, poultry, fish less than 6

Nuts, seeds, dry beans and peas 4-5/week

Fats and oils 2-3

Sweets 5/ week

Sodium 2300 mg

DASH Diet Patternbased on a 2,000 calorie diet

•DASH is more effective if also reduce sodium

•Less than 2400 milligrams per day

•Reduce slowly in 2-3 weeks so that taste buds will get use to less salt

Eat less sodium

• Remove salt shaker

• Add little if any salt to cooking

• Buy more fresh or plain frozen “no added salt” veggies

• Use more herbs and spices

• Make soups and stews ahead without salt and let flavors blend

• Use fresh poultry, lean meat, and fish

Ways to cut sodium

We get most of our salt from convenience foods.

• Use unsalted canned or frozen vegetables. If use regular, rinse canned foods to reduce sodium.

• Choose convenience foods low in salt when available.

• Use fewer convenience foods

• Compare labels

Ways to cut sodium

2 grams of sodium is equal to 1 teaspoon of salt

• Most restaurant foods are very high in sodium

• Eat out less often

• Make more foods from scratch.

Ways to cut sodium

• Sodium is a chemical that makes up ½ of table salt

• Limit to 2400 milligrams per day

• Look for “low sodium” or “salt free” – watch “reduced sodium”

• Choose more foods with Daily Value less than 10%

• Balance higher sodium foods with lower sodium foods

Using the Food Label to Cut Sodium

• Look for the amount of sodium in foods by finding it on the Nutrition Facts Label.

• Choose foods that have lower amount of sodium based on the label.

22

Examples of Sodium Contents of Selected Foods

Sumber Karbohidrat

Jenis Bahan Makanan Kadar Natrium (mg/100g)

Biskuit 500

Kraker 710

Roti cokelat 500

Roti kismis 300

Roti putih 530

Roti susu 500

Roti bakar 700

(Andry Hartono, 2000)

Sumber Protein Hewani dan Nabati

Jenis Bahan Makanan Kadar Na (mg/100g)

Daging corned 1250

Ham 1250

Keju 1250

Liverworst 900

Sosis 1000

Kecap 4000

Keju kacang tanah 607


Susu dan Lain-lain

Jenis Bahan Makanan Kadar Na (mg/100g)

Susu bubuk asam 600

Susu fullcream 380

Susu skim 470

Bouillon blok 5000

Cokelat bubuk 500

Garam dapur 38758

Margarin 987

Mentega 987

Saus tomat 2100

Soda kue ?

Vitsin ?


Example of sodium content in fast food

Food Sodium content per serving (mg)

Fried chicken 500-800

Mashed potato with gravy 297

Small hamburger 506

Small cheeseburger 743

Large cheeseburger 1220

Chef salad 850

Bean burrito 922

Taco 273

Enchilada 1260

Taco salad 1368

(Heart Failure Society , St. Paul, MN, 2006)

1.2. Potassium

• Potassium is a mineral necessary for normal muscle and heart function (Andry Hartono, 2000)

• Potassium requirements for adult : 1600-2000 mg/ day (40-50 mEq) (Krause’s, 11th ed)

Potassium

Estimated Minimun Requirements in Health Person

Potassium

Age Weight (kg) Sodium (mg)* Potassium(mg)

Months

0-5 4.5 120 500

6-11 8.9 200 700

Year

1 11 225 1000

2-5 16 300 1400

6-9 25 400 1600

10-18 50 500 2000

>18 70 500 2000


The Kidneys• Kidneys act as filters to rid the body of wastes.

• High blood pressure can damage the small blood vessels in the kidneys.

• Waste builds up in the blood leading to dialysis.

Image: www.umich.edu29

Gagal ginjal

Menjagakeseimbangan cairan

dan elektrolit

DIET

Treatment of Renal Failure

Cronic Renal Failure

Acute Renal Failure

- energi cukup- protein rendah- lemak cukup- karbohidrat cukup- Na dibatasi (1-3 g) jika terdapat HT,edema, asitea, oliguri, anuria- K dibatasi (40-70 mEq) jikahiperkalimia, oliguria, anuria

- energi cukup- Protein disesuaikan dengan

katabolisme protein- lemak sedang- KH, sisa dari kebutuhan energi- Na : 20-40 mEq/hari,jika oliguria- K : 30-50 mEq/ hari, jika oliguria

(Sunita Altmatsir,2004)(Krause’s, 11th ed)

ESRD

Therapy Energy Protein Na K

hemodialysis 35 kcal/IBW 1.2g/kg IBW 2-3 g/ day 2-3 g/day

CAPD 30-35 kcal/IBW 1.2-1.3g/kg IBW 3-4 g/day 3-4 g/ day


Sumber Karbohidrat

Examples of Potassium Contents of Selected Foods

Jenis Bahan Makanan Kadar K (mg/100g)

Singkong 394

Ubi kuning 304

Havermout 400

Terigu 400

Kentang 396

tapioka 400


Sumber Lauk Hewani dan Nabati


Daging ayam 350

Daging bebek 300

Daging sapi 489

Daging domba 350

Ikan mas 335

Ikan sardin 501

Ikan tongkol 470

Udang 333

Kacang hijau 1132

Kedelai 1504

Kecap 500


Sayur dan Buah-Buahan


Alpokat 278

Pisang 435

Bayam 416

Bit 330

Daun pepaya muda 652

Kapri 370

Kembang kol 349


Susu


Susu cokelat 500

Susu bubuk asam 1800

Susu fullcream 1200

Susu skim 1500


TUGAS

A.3.1 A.3.2

Kel 5: low sodium potassium 1700 Kalori, RG I,

makanan biasa, makanan jawa barat

Kel 6: low sodium potassium 1900 Kalori, RG II,

makanan biasa, makanan sulawesi

Kel 7: low sodium potassium 1500 Kalori, RG III, makanan biasa, makanan continental

Kel 5: low sodium potassium 1700 Kalori, RG I, makanan biasa, makanan jawa baratKel 6: low sodium potassium 1900 Kalori, RG II, makanan biasa, makanan sulawesiKel 7: low sodium potassium 1500 Kalori, RG III, makanan biasa, makanan continentalKel 8: low sodium potassium 1500 Kalori, RG III, makanan lunak, makanan jawatimur

Low Sodium Potassium Diet_2015

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