PENGELOLAAN DIIT PADA PENYAKIT CARDIOVASCULAR

AGUS PRASTOWO

PENDAHULUAN :

Faktor pencetus al :Tingginya konsumsi garamTingginya konsumsi lemakAlkoholKurang exercisePaparan pestisidaSoft drinkRendah seratFaktor risk biochemical : high kolesterol, low HDL, rendahnya level Cu, kelebihan Zn, DM, megalovirus

ATEROSKLEROSIS Jejas utama adalah kolesterol.Faktor risk yang terberat adalahKolesterolRatio LDL/HDL Tekanan darah : hipertensi pencetus/mempercepat pembentukan ateromMerokok : Hipoxia. Meningkatnya radical bebasStress emosional : HDL dan radical bebas, fibrinogenDM : oxidasi LDLTekanan oksigen rendahKeracunan metalObesityRendah konsentrasi Vit A,C,ETingginya lipoproteinTingginya fibrinogenTingginya homosisteinInfeksi : TNF

FREE RADICAL :Externa:

Radiasi, polusi, toxin ROSInterna :

Inflamasi, citocromsuperoxide

hidroperoxide

aldehide Foam cell

PENENTU KUALITAS PEMBULUH DARAH•Genetik pola makan dan perilaku•DM kurangi elastisitas pembuluh darah•Lemak •Obesitas •Rokok inflamasi•Hipertensi •Inactivity •Stress •Sex •Umur •Radical bebas •Alkohol •Ras

Recomendasi DIIT :

•Kurangi lemak kolesterol, perbaiki LDL/HDL•Kurangi garam hipertensi•Hindari the, kopi, soft drink obesitas•Kurangi rokok hipoxia•Banyak minum balance cairan•Serat regulasi absorpsi zat gizi•Konsumsi PUFA kolesterol•Antioksidan seperti ACE•Kurangi alkohol•Konsumsi ikan•Konsumsi Vit B terutama B6 dan B12, asam folat•Konsumsi protein terutama arginin (kedelai)

Bahaya PUFA :

PUFA + LDL terpapar polutant = OX LDL (radikal bebas)

Konsumsi PUFA harus dengan antioksidan

Konsumsi MUFA lebih aman pada penderita menurunkan kolesterol lebih cepat, menurunkan lipoprotein oksidan dan mengaktifkan antioksidanSumber MUFA : asam oleat (olive oil, rice, palm)

Bahaya suplementasi Vit dosis tinggi

Vit C + Fe + O2 = hidroxil radical (highly toxic)

Konsumsi Vit C alami lebih aman

Efek dari PUFA terutama Omega 3•Menurunkan platelet agregasi pada vasokontriksi dengan menurunkan faktor tromboxane (TxA2)•Mencegah platelet agregasi pada vasodilatasi dengan meningkatkan faktor prostacyclin (PGI2)•Menurunkan aktivitas platelet dengan menurunkan faktor Platelet Activating faktor (PAF)•Menurunkan superoxide yang berguna mencegah perusakan sel•Menurunkan TNF•Merupakan pelindung permukaan endotelial

Terapi diit Tujuan :

1. Memberikan makanan adekuat tanpa memberatkan kerja jantung/pembuluh darah

1. Menurunkan berat badan jika perlu2. Menurunkan kadar kolesterol3. Mencegah retensi garamPrinsip :1. Rendah kalori jika perlu2. Protein dan lemak cukup, lemak tu MUFA, PUFA dengan rasio 10% LJ, 10% LTJT, 10% LTJG3. Cukup vitamin terutama sumber antioksidan4. Cukup mineral terutama sumber antioksidan5. Rendah garam6. Mudah cerna7. Porsi kecil sering8. Suplementasi antioksidan9. Rendah kolesterol

Indikasi pemberian bentuk makanan :Pada MCI akut, CHF berat, makanan ini dalam bentuk cairanPada transisi bentuk lunakPada masa transisi bentuk lunak atau biasaPada penderita ringan atau sudah membaik dalam bentuk makanan biasaRendah garam diberikan sesuai berat ringannya hipertensi dan oedema

Makanan yang dihindari :o kue-kue maniso daging berlemako Sayuran mentaho buah durian,nangka, o bumbu merangsang seperti lombok

Interaksi obat dan makanan

•Obat digitalis menurunkan absorpsi semua zat gizi porsi keci tapi sering tidak semua makanan dikonsumsi bersamaan obat

•Diuretik ekskresi meningkat nutrition loss perlu suplementasi zat gizi larut air dan zat gizi yg ekskresi melaui urin

•Obat-obat penurun tensi merunkan absorpsi zat gizi

DIIT HIPERTENSI

Screening Parameters Body weight assessmentBMI 22-27Waist circumference (men = 40 in., women = 35 in.)Dietary intake of calcium, magnesium, potassium, sodiumAssess alcohol intakeUse of vitamins/minerals and complementary/alternative therapiesDepression and dementia

Nutrition EducationReduce intake of sodium, saturated fat and cholesterolCaloric intake to achieve optimal weightIf BMI > 23, weight reduction is indicatedMaintain adequate intake of dietary potassium, calcium and magnesiumConsider (DASH) Diet:*Level I - 2400mg sodium daily (1 tsp. total salt that includes naturally occurring salt in food and 1/4 tsp. added salt or salt in processed food)Level II - 1500 mg sodium dailySupplementsConsider mineral supplements calcium, magnesium, potassium) if dietary intake insufficientConsider high calorie, nutrient-rich foods or liquid supplements if weight loss is a problem

CAD

Screening Parameters Body weight assessmentBMI 22-27Waist circumference = 40 inches for men, = 35 inches for women).Dietary history of cholesterol, saturated and total fat, and caloriesDetermine serum cholesterol, (LDL, HDL) triglycerides and C-reactive protein (CRP)Diabetes mellitusDepressionUse of vitamins/minerals and complementary/alternative therapies

Nutrition Education

Moderate total fat intake Reduce intake of saturated fat (fat solid at room temperature, i.e. animal fats, hydrogenated fats and tropical oils and trans-fatty acids)Monounsaturated fats may lower triglycerides (e.g. olive oil, peanut oil, flax seed oil and canola oil)Polyunsaturated fats may lower LDL levels (e.g. safflower oil, sunflower oil and corn oil)Three or more broiled/baked fish meals/week (e.g. salmon, mackerel, tuna and herring)Increase daily intake of foods rich in or fortified with folate (e.g. leafy green vegetables, whole grains)Calorie intake to achieve optimal weight

Medications

Commonly used drugs may have nutritional Implications, e.g.:Cardiac glycosides (digitalis) may result in anorexia and/or nauseaStatins may result in elevated liver enzymesHigh doses of niacin (nicotinic acid) may be associated with flushing, hyperglycemia, hypotension, hypoalbuminemia, upper GI distress and liver enzyme elevation (hepatotoxicity)

CHFScreening Parameters Body weight assessmentInvoluntary loss or gain (check for fluid retention)BMI 22-27Blood pressure (watch for hypotension)Nutritional intake of electrolytes, including: excessive sodium, inadequate potassium, magnesium and calciumPedal/presacral (dependent) edema and/or ascitesSerum electrolytesUse of vitamins/minerals and complementary/alternative therapiesDepression

Nutrition Education

Adjust nutrient and fluid intakesKeep sodium intake low, i.e. = 2400 mg sodium daily (1 tsp. total salt that includes naturally occurring salt in food and 1/4 tsp. added salt or salt in processed food).Reduce fluid intake if neededChange number, timing and content of meals as neededEnsure adequate calories and proteinLimit/eliminate alcoholSupplementsConsider vitamin/mineral supplements if food intake is poorConsider high calorie, nutrient-rich foods or liquid supplements

Medications

Some medications commonly used to treat CHF may have nutritional implications, e.g.:Diuretics - some may lead to electrolyte abnormalities, especially sodium and potassium and/or thiamine deficiency (furosemide).Cardiac glycosides (digitalis) - may result in anorexia and/or nausea

TERIMA KASIH