Erni Juwita Nelwan, MD, FACP, FINASIM Consultant of...
Transcript of Erni Juwita Nelwan, MD, FACP, FINASIM Consultant of...
Erni Juwita Nelwan, MD, FACP, FINASIM
Consultant of Tropical and Infectious Diseases
Division of Tropical and Infectious Disease
Department of Internal Medicine
Faculty of Medicine University of Indonesia
JAKARTA
Erni Juwita Nelwan
Divisi Tropik dan Penyakit Infeksi
Departemen Ilmu Penyakit Dalam
FKUI / RSCM
Intervensi nutrisi yang dapat memodulasi sistem imun
Immunonutrisi
Pengaruh infeksi HIV/AIDS pada status gizi
Pengaruh malnutrisi pada infeksi HIV
Defisiensi mikronutrien pada infeksi HIV
Komponen tatalaksana nutrisi
Outline
Metabolisme Gizi pada ODHA Asupan gizi tidak adekuat
(gangguan kognitif/depresi, poverty, anorexis, nausea, jamur
mulut )
Memperburuk status gizi (Malnutrition)
Depress antibody production, the function of phagocyte cells,
and levels of complement.
Absorption of amino acids
GIZI & HIV
HIV
Gizi terganggu
sistem imun
menurun
Resiko terhadap penyakit infeksi
meningkat
Kebutuhan zat gizi
meningkat
EFEK HIV PADA GIZI
HIV-GIZI
Kebutuhan nutrisi
meningkat
Kebutuhan energi
meningkat
Infeksi sekunder berulang
Anoreksia
Diare berulang
Multifarmasi
Malabsorbsi
Respon peradangan
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Stages of HIV Disease and Nutrition
Specific nutrition recommendations vary according to the underlying nutritional status and extent (stage) of HIV disease progression
The disease progression may be categorized into three stages:
Early (I): no symptoms, stable weight
Middle (II/III): significant weight loss
Late (IV): symptomatic, full-blown AIDS disease
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Early Stage (I)
No symptoms, stable weight
Increased nutritional requirements during HIV-infection Energy increase: 10 - 15%
Protein increase: ~ 50%
Vitamins and minerals used by the immune system are also increased
Main objective: remain as healthy as possible Build stores of essential nutrients
Identify locally available and acceptable foods
Maintain weight and lean body mass, preserve muscle mass, and increase energy
Adequate diet
Maintain physical activity
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Middle Stage (II/III)
Significant, unintentional or undesirable weight loss as a result of opportunistic infections
Main objective: minimize consequences Increase nutrient intake for recovery/weight gain
Maintain intake during periods of acute illness and depressed appetite
Increase nutrition intake gradually to promote weight and muscle mass gain, and nutritional recovery Make every bite count
Daily vitamin-mineral supplements
Continue physical activity as able
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Late Stage (IV)
Symptomatic, full-blown AIDS disease
Main objective: provide comfort or palliative care
Treat all infections that affect intake
Modify diet according to symptoms
Maintain intake during periods of acute illness and depressed appetite
Encourage eating and physical activity as able
Provide psychological and emotional support
Kejadian HIV dan malnutrisi tinggi di berbagai
negara (~ wasting)
Malnutrisi:
Mempercepat progresivitas infeksi HIV
Infeksi HIV menurunkan status nutrisi
Malnutrisi:
Primer (intake tidak adekuat)
Sekunder (gangguan metabolisme dan penyerapan makanan)
HIV dan Malnutrisi
Banyak ditemukan pada penyakit infeksi termasuk
HIV
Difficult to measure (hidden hunger)
Contoh defisiensi mikronutrien:
Zat besi anemia
Iodine gangguan tiroid
Vitamin A
Vitamin D
Mikronutrien Defisiensi
REKOMENDASI GIZI
Manifestasi Klinis Gangguan Gizi Rekomendasi Gizi
Anoreksia Penurunan nafsu makan, kesulitan menelan karena infeksi jamur mulut (kandidiasis oral).
makanan lunak, porsi kecil dan sering, minum menggunakan sedotan.
Diare Kehilangan zat gizi dalam tubuh
rendah serat, lemak, dan banyak mengkonsumsi cairan, buah-buahan tinggi kalium dan magnesium : pisang
REKOMENDASI GIZI Manifestasi Klinis Gangguan Gizi Rekomendasi
Sesak Nafas Asupan kalori tidak mencukupi, pasien lemah
Makanan diberikan dalam posisi setengah tidur
Malabsobsi Lemak Gangguan penyerapan lemak
sumber lemak nabati
Demam Peningkatan pemakaian kalori dan kehilangan cairan
minum lebih dari 2 liter/ hari (`bb)
BB turun Gangguan makan secara oral
Tinggi kalori protein, padat kalori,rendah serat, porsi kecil dan sering
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The Vicious Cycle of Malnutrition and HIV
• Increased HIV replication • Hastened disease progression • Increased morbidity
Nutritional deficiencies
• Increased oxidative stress • Immune suppression
• Insufficient dietary intake • Malabsorption, diarrhea • Altered metabolism and nutrient storage
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Key Points
HIV can lead to malnutrition by multiple mechanisms
Malnutrition is associated with increased HIV transmission, progression, and mortality
Nutritional supplementation is associated with improved HIV-related outcomes
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Key Points (2)
Maintaining adequate nutrition prolongs well-being of HIV-infected persons but is difficult
HIV affects nutrition in three, sometimes overlapping, ways:
Reduces amount and type of food consumed
Interferes with the digestion and absorption of nutrients
Alters metabolism of nutrients
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Key Points (3)
Counseling and other interventions to prevent or reverse weight loss are likely to have their greatest impact early in the course of HIV infection
Nutritional care and support should be part of a comprehensive program that deals with the needs of the patient and his or her family
Nutritional supplements, particularly antioxidant vitamins and minerals, may improve immune function and other HIV-related outcomes, particularly in nutritionally vulnerable populations
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Key Points (4)
Managing common symptoms related to HIV/AIDS such as diarrhea, nausea, and loss of appetite, can minimize their impact on nutritional status
Prevention of food- and water-borne infections reduces the risk of diarrhea, a common cause of weight loss, malnutrition and HIV disease progression in people living with HIV and AIDS
Continuing physical activity and exercise, as appropriate, increases energy, stimulates appetite and preserves and builds lean body mass