peran konseling g izi final
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Peran Konseling gizi di layanan primer sebagai pencegan terhadap sindroma metabolikTRANSCRIPT
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Peran Konseling Gizi di Puskesmas
sebagai Upaya Preventif menghindari
percepatan sindroma metabolik
Rulli Rosandi, Putu Moda Arsana
Divisi Endokrinologi, Metabolik dan Diabetes
SMF Ilmu Penyakit Dalam RS.Dr. Saiful Anwar –
Fakultas Kedokteran Universitas Brawijaya Malang
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Latar Belakang
• Indonesia mengalami peningkatan angka penyakit tidak
menular (PTM) – 41.7 persen di tahun 1995 menjadi 59.5 persen di tahun 2007.
– Penyakit jantung dan pembuluh darah menempati urutan teratas
sebagai penyebab utama kematian di Indonesia, dengan 26.9 persen
kematian disebabkan stroke.
• Faktor risiko umum PTM : – konsumsi makanan yang tidak sehat
– kurangnya aktivitas fisik
– merokok
• Meningkatnya PTM merupakan ancaman serius karena– peningkatan pembiayaan pemeliharaan kesejahteraan
– menurunnya produktivitas kerja
Kemenkes RI, 2011
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Distribusi Kematian Semua Umur
Menurut Sebab Kematian
Kemenkes RI, 2011
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Persentase Kematian Akibat PTM pada Penduduk
Usia < 60 Tahun Menurut Jenis Penyakit,
Kemenkes RI, 2011
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Sindroma Metabolik :
Kumpulan kelainan metabolik
yang akan meningkatkan resiko
terjadinya penyakit
kardiovaskular dan diabetes
mellitus
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Beberapa kriteria Sindroma Metabolik1
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Beberapa kriteria Sindroma Metabolik2
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Lingkar Pinggang
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Definisi Metabolik syndrome
• Kriteria menurut International Diabetes Federation (IDF) :
Obesitas sentral (kriteria Asia : Laki-laki ≥ 90 cm, wanita ≥
80 cm ) ditambah 2 dari 4 faktor yaitu
• Peningkatan Trigliserida ≥ 150 mg/dl, atau sedang dalam terapi
untuk dyslipidemia
• Penurunan HDL Kolesterol < 40 mg/dl
• Peningkatan Tekanan Darah : SBP ≥ 130 mmHg atau DBP ≥ 85
mmHg atau sedang dalam terapi
• Peningkatan glukosa darah puasa ≥ 100 mg/dl atau sebelumnya
sudah di diagnosa sebagai DM Tipe 2
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Prevalensi Sindroma Metabolik
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Epidemiologi
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Faktor Resiko yang mendasari
sindroma metabolik
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Konsekuensi Sindroma Metabolik
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Konsekuensi Sindroma Metabolik2
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Kematian karena CVD dan CHD
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Relative risk dari sindroma metabolik
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Penatalaksanaan Sindroma Metabolik
• Tujuan utama adalah mengurangi resiko terhadap
clinical atherosclerotic disease – Pengendalian LDL-C, tekanan darah dan gula darah
• Penanganan faktor resiko : obesity, physical inactivity
dan diet )
• Perubahan gaya hidup akan mengurangi semua faktor
resiko metabolik
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Terapi
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Diabetes prevention strategies and outcomes
Intervention
Therapy
Intensive lifestyle
Metformin
Acarbose
Pravastatin
Ramipril
Oestrogen/progesterone
Intensive lifestyle
+ Orlistat
Study
DPP, FDP
DPP
STOP-NIDDM
WOSCOPS
HOPE
HERS
XENDOS
Risk
Reduction
58% a
31% a
25% a
30% a
34% a
35% a
37% b
a versus standard lifestyle advice b versus intensive lifestyle advice
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U.S. Diabetes Prevention Project
• 3234 subjects with BMI > 34 kg/m2
• Placebo, metformin, and lifestyle modification
• Lifestyle modification goal > 7% weight loss
with diet and exercise ( 150 min / week)
• New onset diabetes: 11% placebo,
7% metformin, 4.8% lifestyle group
NEJM 2002
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Finnish Diabetes Prevention Study
• 522 overweight subjects; Intervention group -
met with dietician 4 x /yr and supervised
exercise vs control group (pamphlet)
• Goals: 1) 5 lb wt loss 2) 15gm of fiber/1000 cal
3) < 30% fat 4) < 10% saturated fat 5) 30
minutes of exercise /day
• Intervention group met 4/5 goals 0% new
diabetes, vs control group met 0 goals 32%
new diabetes
DIABETES CARE, VOLUME 26, NUMBER 12, DECEMBER 2003
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Penyebab Kematian
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FENOMENA GUNUNG ES
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Kurang makan sayur dan buah
menurut karakteristik
Riskesdas, 2007
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AHA Statement on Diet
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Practical Tips to Implement AHA Diet and
Lifestyle Recommendations1
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Practical Tips to Implement AHA Diet and
Lifestyle Recommendations2
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Therapeutic Goals and Recommendations for
Clinical Management of Metabolic Syndrome1
Grundy et all, 2005
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Therapeutic Goals and Recommendations for
Clinical Management of Metabolic Syndrome2
Grundy et all, 2005
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Therapeutic Goals and Recommendations for
Clinical Management of Metabolic Syndrome3
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Environmental role in Obesity
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Management Obesity
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Lifestyle Modification to Manage Hypertension and Potential Outcomes
(JNC-7, 2003)
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Barriers to Dietary Adherence
• Restrictive dietary pattern
• Required changes in lifestyle and behavior
• Symptom relief may not be noticable
• Interference of diet with family/personal habits
• Cost, access to proper foods, preparation effort
• Denial or perceiving disease not serious
• Poor understanding of diet/disease link
• Misinformation from unreliable sources
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Strategies for Maintaining Dietary Change
• Tailoring diet to patient’s needs
• Using social support inside and outside healthcare
setting
• Providing patient and caretaker with skills and
training
• Ensuring an effective patient-counselor relationship
• Evaluation, follow-up, and reinforcement
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Brief Nutrition Counseling for Metabolic
Syndrome—5 Minute Version
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Brief Nutrition Counseling for Metabolic
Syndrome—5 Minute Version2
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Brief Nutrition Counseling for Metabolic
Syndrome—15 Minute Version1
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Brief Nutrition Counseling for Metabolic
Syndrome—15 Minute Version2
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Kerangka Konsep Strategi Nasional Penerapan
Pola Konsumsi Makanan dan Aktivitas Fisik
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Kesimpulan
• Prevalensi penyakit tidak menular khususnya penyakit
jantung dan pembuluh darah telah menjadi penyebab
kematian utama di Indonesia, serta menjadi ancaman
serius bagi kesejahteraan masyarakat
• Menghindari berat badan berlebih, healthy diet, aktivitas
fisik reguler efektif dan aman dalam pencegahan
sindroma metabolik pada populasi
• Peran konseling gizi di layanan primer adalah sangat
besar
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