ﺑﺴﻢ اﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ
DIETARY SUPPLEMENT Nutrition Dept Faculty of Medicine, Universityy of Sumatera Utara
definisi z
Adalah makanan buatan yang ditujukan untuk mencukupi p kekurangan g zat-zat g gizi.
• Bentuk : - kapsul p - kapsul lunak - tablet - bubuk b b k - cairan
Kandungan z z z
Makronutrien Mikronutrien Æ vitamin, vitamin mineral Dapat tunggal atau kombinasi
Zat gizi penting di dalam makanan (dibutuhkan untuk kesehatan) Makronutrien Protein Karbohidrat Lemak
Mineral Ca, Fe, Mg, Mn, Se, Na K, Na, K V, V Bo Bo, II, SS, Cl Cl, P, Cr, Cu, F, Mo, Zn
air
Vitamin 8 vitamin B (tiamin, niacin,, riboflavin,, asam folat,, Vitamin B 12, Vitamin B6, Asam pantotenat, biotin) Vitamin C Vitamin A, A D D, E E, K
Do YOU Need a Dietary S Supplement? l t?
•Perlu P l atau t tidak tid k ? •Kapan dibutuhkan ? •Seberapa p banyak y dibutuhkan ? •Siapa yang membutuhkan ?
I Invalid lid reasons z
z z
z
z
The belief that the food supply or soil contains inadequate nutrients The belief that supplements can provide energy The belief that supplements can enhance athletic performance or build lean body tissue without physical work or faster than work alone The belief that supplements will help a person cope with stress The belief that supplements can prevent, treat, or cure conditions ranging from common cold to cancer
Who needs supplements? z z
z
z
z
People with nutrient deficiencies People with low food energy intake (<1200 kcal/day) Vegans and those with atrophic gastritis (need vitamin B12) B 2 Women who bleed excessively during menstruation t ti (needs ( d iiron)) People with lactose intolerance or milk allergies, or who do not consume enough dairy products to forestall extensive bone loss, need calcium
z z z
z
People in certain stages of the life cycle who have increase nutrient needs People p with limited milk intake and sun exposure need vitamin D People who have disease, infection, or injuries or who h h have undergone d surgery that h iinterferes f with intake, absorption, metabolism & excretion of nutrients People taking medications that interfere with the body’s use of specific nutrients
Kondisi yang dapat menyebabkan kekurangan zat gizi Growth in children
reducing diets
Increased requirement
Pregnancy & lactation
Old age
Low food intake
Illness
Vegetarianism
alcoholism or Drug addiction
Restricted Food choice
Therapeutic diets
Tidak dibutuhkan pada : z
z z z z z
Orang dengan sumber zat makanan yg mencukupi Olah raga Cukup istirahat dan tidur Kehidupan teratur Tdk stress Bebas dr bhn pencemar (udara, mkn, air).
Recommendations for Nutrient Intake z
Dietary Reference Intakes (DRIs)
z
Reference values of nutrients, primarily used byy nutrition & health p professionals
z
Basis for z assessing & planning diets of healthy people z federal nutrition & food programs
What are the purposes of the DRIs? z z z z z
To maintain nutritional adequacy To promote health To reduce risk of chronic disease To provide a measure for evaluating inadequacy and/or excess To assess intakes as distributions z z
z
Across population groups In individuals
To plan diets
Whatt are th Wh the diff differentt DRI values? z z z z
Estimated Average g Requirement q : EAR Recommended Dietary Allowance : RDA Adequate Intake : AI Tolerable Upper Intake Level : UL
Estimated Average Requirement z
z z
Nutrient intake to meet the requirement of half the healthy people of an age & gender The MEDIAN Basis for establishing an RDA
Recommended Dietary Allowance z
z z
Nutrient intake to meet the requirement for nearly all (97-98%) healthy people of an age & gender Derived from an EAR EAR + 2 standard t d d deviations
RDA
50
50
45
45
40
40
Number o N of People
Number o N of People
EAR
35 30 25 20 15 10 5 0
35 30 25 20 15 10 5
0
50
100
150
200
250
Actual Nutrient Requirement
0
0
50
100
150
200
250
Actual Nutrient Requirement
Adequate Intake z z z z z
Nutrient intake of healthy people assumed to be adequate Used when an RDA cannot be established Insufficient data to determine an EAR Based on observed intakes, experimental data, etc. When AIs are used used, this reflects lack of knowledge and need for more research
Tolerable Upper Intake Level z
z z
Highest daily nutrient intake likely to pose no risk of adverse health effects to almost all the general population More is not always better! Not a recommended level z z
No established benefits of higher level Increased risks at higher intakes
The naive view vs the accurate view of optimal nutrient intake
safety
Tolerable Upper Intake level (UL)
Danger of toxicity
Safetyy
d danger
Danger of deficiency
K b t h zatt gizi Kebutuhan i i z z z
z
Sangat individual Dipengaruhi p g tingkat g kesehatan Berdasarkan AKG untuk rata-rata orang Indonesia yyang g sehat Dibedakan berdasarkan kelompok umur dan jjenis kelamin
Vitamin A
RETINOL HATI GINJAL MENTEGA KUNING TELUR SU MINYAK IKAN BETA KAROTEN SAYURAN DAUN HIJAU TUA SAYURAN MINYAK KELAP SAWIT
BUAH BERWARNA KUNING
Kandungan vit A dalam bahan makanan Apel Pisang Peach Selada Tomat Brokoli Bayam Wortel
1 buah 1 buah 1 buah 100 g 1 buah p ½ cup ½ cup ½ cup
70 IU 90 470 446 1390 1090 7370 19.150
Vi Vitamin i E z
Bahan makanan sumber : z
z z z
Minyak nabati (kedele, jagung) dan produknya d k ((margarin) i ) Whole grain products, wheat germ. S Sayuran berdaun b d hij hijau ttua. hati, telur, kacang.
Kandungan vit E/100 g bahan makanan Kerang Kentang goreng Kacang Min ak Minyak Kol
37,5 15 1,5 8,1 14 7 14,7 2,4
Vitamin C z
Bahan makanan sumber : z z z z
Jeruk, anggur, lemon, jeruk nipis. Strawbery dan berry lain lain, melon Kol, brokoli, sayuran berdaun hijau, Kentang tomat Kentang,
Kandungan vit C (mg/100g) bahan makanan Brokoli Kembang kol Bayam Wortel Pisang Jeruk A Anggur
39,6 62,7 52,4 30,3 18 6 18,6 64,3 23 6 23,6
KEBUTUHAN VITAMIN PERHARI ( RDA = RECOMMENDED DAILY ALLOWANCES ) VITAMIN
PRIA
WANITA
A
1000 IU
800 IU
D
5 ug
5 ug
E
3 mg
4 mg
K
80 ug
65 ug
B1
, mg g 1,5
1,1 , mg g
B2
1,7 mg
1,3 mg
B3
19 mg
15 mg
B5
4 – 7 mg
4 – 7 mg
B6
2,0 mg
1,6 mg
B12
2,0 mg
2,0 mg
C
60 mg
60 mg
z
Konsumsi megadosis dapat membahayakan
z
Nutrient N t i t yang di diperlukan l k sebaiknya b ik did didapatt d darii bahan makanan.
z
Suplemen hanya digunakan jika memang dibutuhkan
Protein 15%
Lemak 20%
KH 65%
Tujuan Nutritional support z
z
z
Memastikan intake energi adekwat Æ mencegah g kehilangan g BB Mencegah negative nitrogen balance Æ penurunan imune respons & fungsi liver dapat dicegah. Agar level mikronutrient & trace element cukup Æ tidak terjadi defisiensi
Pilihan tergantung pada : z z
Kebutuhan zat g gizi individu Kemampuan pasien utk mengkonsumsi makanan normal
Medical foods z z
z
Formula lengkap Formula l tidak d k llengkap, k mis produk d k modular d l lemak, protein atau karbohidrat F Formula l makanan k kh khusus
Getting The Variety of nutrients z z z
z
Diet yang seimbang berdasarkan the Food Guide Pyramid Makanan yang bervariasi dapat menjamin kecukupan zat gizi. Tidak ada satu bahan makanan yang mengandung semua zat gizi dalam jumlah yang cukup. Diperlukan bahan yang bervariasi untuk mendapat makanan yang sehat
Maintain a healthy weight. be physically active. Don’t smoke.
Figure 18-7 P Page 641 Milk, Yogurt & Cheese Group
• Eat low-fat or fatfree milk products products.
Fats, Oils • Limit salt to < 6 grams. & Sweets • Reduce energy-rich foods high in sat. fat & sugar. • Use unsaturated fats instead of sat. or trans fats. • Drink alcohol in moderation, if at all.
Meat, Poultry, Fish, Dry Beans, • Eat < 4 eggs per week. Eggs & Nuts Group • Eat red meat sparingly. • Eat fish frequently. • Eat nuts and legumes often.
Vegetable Group • Eat vegetables g in abundance.
F it Group Fruit G • Eat fruit in abundance.
Bread, Cereal, Rice & Pasta Group • Eat whole-grain breads, cereals, rice, and pastas instead of refined p products.
Food Guide Pyramid for Disease Prevention
Sayuran dan buah-buahan z
‘5 porsi / hari’
Hooper L Dietetic Guidelines : diet in secondary prevention of cardiovascular disease (J Human Nutr Dietet 2001)
Choose Food Instead of S Supplements l t Food
Supplements
Fun
Boring
Offers variety
Lacks variety
D Doesn’t ’t have h tto b be expensive i
C costt a llott off money Can
Contains other healthful substances
Doesn’t contain other health benefits
Safe
Can be dangerous to your health
If a li little l iis good, d more is i nott necessarily il better”
اﻟﺤﻤﺪ ﷲ zzt 1208
