Anemia Classification

I = increased; N = normal; D = decreased; TIBC = total iron-binding capacity

Source: Grant A, DeHoog S.  Nutrition Assessment Support and Management.  5th ed. Seattle, Wash: Grant/DeHoog; 1999:183. Reprinted by permission.

 

Hypoglycemia

Discussion

There are two primary categories of hypoglycemia: fasting and postprandial (reactive) hypoglycemia. True hypoglycemia (less than 40 mg/dL) releases certain hormones, such as catecholamines, which cause trembling, hunger, dizziness, weakness, headaches, and palpitations. Because many different causes of hypoglycemia exist, treatments are personalized according to the cause.

The most frequent cause of fasting hypoglycemia results from the use of insulin or oral glucose-lowering medications in the treatment of diabetes mellitus. See Medical Nutrition Therapy for Diabetes Mellitus in Section IC. Fasting hypoglycemia may occur in response to not having food for 8 hours or longer. Other less common causes are pancreatic tumors (insulinoma), pancreatic islet cell disease, severe heart failure, and critical organ failure. Certain medications, such as exogenous insulin, sulfonylureas, ethanol, salicylates, pentamidine, quinine, are also noted for causing hypoglycemia in some patients. Diet therapy is the primary treatment, and, in some cases, adjustments in medications also are needed. Surgery may be required to improve the situation for some conditions, such as insulinoma.

Postprandial hypoglycemia is seen most frequently as alimentary hypoglycemia (dumping syndrome) in adults who have undergone gastric surgery, such as Billroth gastrectomy. It usually occurs 1½ to 5 hours after meals, especially carbohydrate-rich meals

Currently, there are no widespread accepted criteria for the diagnosis of reactive hypoglycemia. The techniques range from confirming that the blood glucose level is low when the patient is experiencing a hypoglycemic reaction after an ordinary meal to performing an oral glucose tolerance test (OGTT). However, 10% of asymptomatic healthy persons respond to the OGTT with a lower-than-normal glucose level.

Approaches

Treatment of reactive hypoglycemia depends on the specific cause. Alimentary hypoglycemia following gastric surgery involves treatment. Other modifications that may be helpful are:

• Allow five to six small meals or feedings per day.
• Determine frequency and symptoms of hypoglycemia, activity levels, and exercise for the patient and schedule appropriate times for meals and snacks.
• Use a balanced diet with a mixture of complex carbohydrates, protein, fat, and fiber. The reaction occurs in response to a high carbohydrate load. If necessary, limit carbohydrate to 100 g and increase protein intake accordingly. Use more soluble fibers, such as fruits and vegetables, but avoid concentrated sugar in dried fruit. Carbohydrate counting may be helpful in regulating total carbohydrate intake.
• Limit caffeine, which may reduce cerebral blood flow, and, glucose supply to the brain.
• Limit alcohol because it inhibits gluconeogenesis.

Educate the patient on fast-acting carbohydrate foods that should be used or avoided.

Reference

Reactive hypoglycemia. Manual of Clinical Dietetics. Chicago, Ill: American Dietetic Association; 2000

HIV INFECTION AND AIDS

Discussion

No Super Hero can't save for AIDS

Human immunodeficiency virus (HIV) is a retrovirus, transmitted through contact with blood or body fluids from an infected person.  This virus attacks helper T lymphocytes in the blood, often referred to as CD4 cells or T cells.  The systematic destruction of the CD4 cells leads to a weakening of the body’s immune function, increasing the host’s vulnerability to opportunistic infections.  Acquired immunodeficiency syndrome (AIDS) defines a specific stage of HIV infection when the progression of the virus has advanced and the immune system is severely compromised.  There are a number of specific opportunistic infections as well as counts of the CD4 cells that define when a person has AIDS.  The impact of nutrition on HIV and AIDS is significant.

A major component of the clinical syndrome in HIV infection and AIDS is HIV wasting.  The Centers for Disease Control and Prevention (CDC) define the HIV wasting syndrome as profound involuntary weight loss of greater than 10% of baseline body weight, plus at least one of the following :

chronic diarrhea (at least two stools a day for 30 days or longer)

chronic weakness and documented fever for 30 days or longer in the absence of a concurrent illness or condition other than HIV infection that could explain the findings

Previous estimates of the prevalence of HIV wasting as the first AIDS-defining diagnosis ranged up to 37% (2).  However, with the advent of the highly active antiretroviral therapy (HAART), researchers have shown that the prevalence of all AIDS-defining diagnoses has decreased. In a more recent study, while 63% of the patients showed evidence of malnutrition, the prevalence of wasting had decreased to 21%.

The causes of wasting and malnutrition in HIV disease are complex and multifactorial. Suspected mechanisms of weight loss and malnutrition include reduced intestinal absorption, abnormal utilization of nutrients, anorexia, altered metabolism, hypogonadism, and increased cytokine production.

It has been shown that there is an increase in resting energy expenditure (REE) with HIV infection that may contribute to weight loss.  However, there is now increasing evidence to show that whereas REE does increase slightly, total energy expenditure (TEE) decreases.  This decrease in TEE illustrates that HIV may increase the metabolic rate, but it more significantly decreases the infected individual’s activity level and energy intake. This decline in general functional ability affects a person’s exercise and eating patterns in ways that may greatly contribute to HIV wasting.

Wasting and weight loss also influences the timing of the progression from HIV to AIDS and death in AIDS.  Studies have shown that a 5% to 10% weight loss over 4 months increases the relative risk for death and opportunistic infections twofold.  Other research has demonstrated that an overall weight loss of 34% of ideal body weight (IBW) or 46% of usual body cell mass is linked to the occurrence of death. Evidence also exists that a combination of therapies to combat weight loss, malnutrition, and loss of lean body mass will be more effective in helping to reduce associated morbidity.  There are many new and developing treatment options to choose from, including nutritional supplements, appetite-stimulating drugs, testosterone and testosterone analogues, growth hormone, resistance exercise, and cytokine modulation.

Nutritional Priorities

All patients with a new diagnosis of HIV infection should have a thorough nutrition assessment. Early referral to medical nutrition therapy in HIV-infected patients can improve nutritional status and may lead to an increased ability to fight opportunistic infections and a decreased number of hospitalizations.  Early intervention efforts should be focused on optimizing nutrient stores before the onset of nutrition-related complications in an attempt to prevent or delay the onset of malnutrition and wasting.

Initial assessment: The assessment should include the patient’s medical-surgical history, profile of medications and nutritional supplements, anthropometrics (calculation of body cell mass) if possible, laboratory data, diet history, financial evaluation, psychosocial assessment, and physical symptoms.

Establish energy requirements: Energy needs can be estimated by using the Harris-Benedict equation and multiplying by a stress factor of 1.2 to 1.8, with allowance for extra needs associated with fever and exercise.  An alternative method to estimate energy needs is 25 to 45 kcal/kg of usual body weight.  Both methods are acceptable and commonly used in practice. 

Establish protein requirements: Protein needs for males and females can be estimated using a range of 1 to 2 g/kg.  Consider renal and hepatic function, nitrogen balance studies, prealbumin, serum albumin, transferrin levels, and exercise regimen.

Establish fluid requirements: Water requirements for patients with normal fluid status can be estimated using 30 to 35 mL/kg of body weight or 9 to 12 (8-oz) cups per day.  Coffee and other caffeine-containing beverages do not count as fluids and should be avoided because of their dehydrating effects.  Consider increasing fluid requirements when the patient has fever, nausea, vomiting, or diarrhea or with initiation of medication, exercise, and inclement weather. Fluid restrictions may be indicated with renal or hepatic failure .

Vitamin and mineral recommendations: Researchers have identified vitamin and mineral deficiencies in individuals infected with HIV.  Clinicians routinely recommend the use of a multivitamin and mineral supplement that provides 100% of the Dietary Reference Intakes (DRI) for vitamins and minerals. It is often recommended to take these multivitamin and mineral supplements twice daily.  Other vitamins and mineral recommendations have been published that are not verified by research but may be considered within the realm of prudent practice. For example, some practitioners recommend additional supplementation of antioxidants such as vitamin E, vitamin C, beta-carotene, magnesium and selenium.

Exercise recommendations: Resistance exercise has been shown to help increase lean body mass, and HIV wasting has been shown to deplete lean body mass.  Maintenance of lean body mass is very important in helping the body to resist opportunistic infections and to rebound after infection.  Therefore, dietitians should recommend that all patients who are physically able begin a routine of resistance exercise. A physician or physical therapist should monitor program intensity and scope.

Determine appropriate mode of nutrition support based on diagnostic findings:

Oral feedings are preferred over any other feeding method.  Efforts to maintain the oral feeding route should be maximized.  Nutrient-dense foods and supplements should be used to support maintenance and restoration of nutritional status and body weight. Appetite stimulants may be indicated for patients experiencing anorexia. Two appetite stimulants have been approved for this purpose, megestrol acetate and dronabinol.  It should be noted, however, that typically the weight gain associated with the use of these appetite stimulants is in the form of fat mass and not the desired lean body mass.  Additionally, megestrol acetate may exacerbate diabetes mellitus .

1. The enteral feeding route is preferred over parenteral administration in order to preserve gut structure and function. Assess patients carefully and reassess them on a regular basis . 
2. Parenteral nutrition may become necessary when a patient meets the criteria for initiation of total parenteral nutrition (TPN). Continual assessment and routine monitoring of laboratory values is essential.

---

References

1.      Centers for Disease Control.  Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults.  MMWR. 1992;41:1-19.

2.      Cohen PT, Sande MA, Valberding PA.  The AIDS Knowledge Base [University of California-San Francisco Web site (InSite Version)]. Available at: http://hivinsite.ucsf.edu/akb/1997. Accessed November 4, 1999.

3.      Brodt HR, Kamps BS, Gute P,Knupp B, Staszewski S, Helm EB. Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy.  AIDS. 1997;15(11):1731-1738.

4.      Suttmann U, Ockenga J, Selberg O, Hoogestraat, Diecher H, Muller MJ.  Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J Acquired Immune Defic Syndrome Hum Retrovirol. 1995;8(3): 239-246.

5.      Strawford A, Hellerstein M. The etiology of wasting in the human immunodeficiency virus and acquired immunodeficiency syndrome.  Semin Oncol. 1998;25(2 suppl  6):76-81.

6.      McCallan DC. Wasting and HIV infection. J Nutr. 1999;129(1S suppl):S238-S242.

7.      Chang HR, Dulloo AG, Bistrian BR.  Role of cytokines in HIV wasting. Nutrition.  1998;14(11-12):853-863.

8.      Macallan DC, Noble C, Baldwin C, Jebb SA, Prentice AM. Energy expenditure and wasting in human immunodeficiency virus infection.  N Engl J Med. 1995;333:83-88.

9.      Wheeler DA, Gilbert CL, Launer CA,  et al..  Weight loss as a predictor of survival and disease progression in HIV infection.  J Acquired Immune Defic Syndrome Hum Retrovirol. 1998;18(1):80-85.

10.  Kotler DP, Tierney AR, Wang J, Pierson RN Jr.  Magnitude of body cell mass depletion and the timing of death from wasting in AIDS.  Am J Clin Nutr.  1989;5(suppl 3):444-447.

11.  Wanke C. Single-agent/combination therapy of human immunodeficiency virus-related wasting. Semin Oncol. 1998;25(2 suppl  6):98-103.

12.  Wood, AJ, Corcoran C, Grinspoon, S.  Treatments for wasting in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1999;340(22): 1740-1750.

13.  Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chilsom DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet. 1999;353:2093-2099.

14.  Ward DE. The AmFAR Handbook: The Complete Guide to Understanding HIV and AIDS. New York, NY: WW Norton; 1999.

15.  Romeyn M.  Nutrition and HIV: A New Model Treatment. San Francisco, Calif: Jossey-Bass; 1998.

16.  Kruse LM.  Nutritional assessment and management for patients with HIV disease. The AIDS Reader. 1998; 8(3):121-130.

17.  Wilkes GM.  Cancer and HIV Clinical Nutrition. 2nd ed.  Sudbury, Mass: Jones and Bartlett; 1999.

18.  Young JS. HIV and medical nutrition therapy.  J Am Diet Assoc. 1997;97(suppl 2):S161-166.

19.  Kotler D, Engelson ES.  Are you addressing your patients’ nutritional health yet? Proceedings of the 12th World AIDS Conference. Geneva, Switzerland; 1998.

Menopause Dini, Pencegahan dan Gizi

Menopause Dini adalah suatu keadaan dimana fungsi ovarium (indung telur) dan menstruasi berhenti sebelum usia 40 tahun.

Penyebab
Pada menopause dini, kadar estrogen rendah tetapi kadar hormon hipofisa yang merangsang ovarium (terutama FSH) tinggi sebagai usaha untuk merangsang ovarium.
Menopause dini bisa disebabkan oleh:

• Kelainan bawaan (biasanya kelainan kromosom)
• Penyakit autoimun (tubuh membentuk antibodi yang menyerang ovarium)
• Pengangkatan ovarium. Merokok bisa menyebabkan menopause dini yang terjadi beberapa bulan lebih awal.

Gejala yang dialami
Selain tidak lagi mengalami menstruasi, penderita juga mengalami gejala menopause lainnya seperti hot flashes dan emosi yang tidak stabil.

Diagnosa
Diagnosis ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik.
Jika diduga penyebabnya adalah penyakit autoimun, dilakukan pemeriksaan darah untuk mencari adanya antibodi.

Pada penderita yang berusia dibawah 30 tahun biasanya dilakukan analisa kromosom.
Jika ditemukan kromosom Y, maka dilakukan pembedahan untuk mengangkat setiap jaringan testis dari perut karena jaringan ini memiliki resiko kanker sebesar 25%.
Analisa kromosom tidak perlu dilakukan pada wanita yang berusia diatas 35 tahun.

Bagaimana mencegah Menopause Dini ?

Awal wanita memasuki Menopause, sering jadi perdebatan.
Meski sekarang ada perkiraan dari para ahli, wanita memasuki menopause pada umur 45 tahun, bukan tidak mungkin manopause terjadi kurang dari perkiraan umur itu. 

Untuk mencegah manopause dini, wanita perlu memiliki kepekaan tanda tandanya.

Tanda tanda menopause, diantaranya perdarahan. 

Perdarahan disini,tidak seperti menstruasi yang datangnya teratur,perdarahan yang terjadi sebagai tanda menopause tidak teratur.
Gejala ini terutama muncul pada saat permulaan menopause. Perdarahan akan muncul beberapa kali dalam rentang beberapa bulan untuk kemudian berhenti sama sekali.Karena munculnya pada masa awal menopause, gejala ini sering disebut gejala peralihan.

Rasa panas dan berkeringat pada malam hari, juga bisa jadi tanda awal menopause. Bahkan gejala Rasa panas ini, sering dialami wanita yang memasuki masa menopause. Perasaan ini sering dirasakan mulai dari wajah menyebar ke seluruh tubuh.Rasa panas ini sering disertai dengan warna kemerahan pada kulit dan berkeringat.
Perasaan ini sering terjadi selama 30 detik sampai dengan beberapa menit.Meski penjelasan fenomena ini belum diketahui dengan pasti, tapi diduga terjadi akibat dari fluktuasi hormon estrogen. Seperti diketahui, pada saat menopause,kadar hormon estrogen dalam darah akan anjlok secara tajam sehingga berpengaruh terhadap beberapa fungsi tubuh yang dikendalikan oleh hormon ini.Sampai saat ini belum ditemukan metode untuk memperkirakan pada usia berapa penomena ini akan muncul dan kapan akan berakhir.Rasa panas ini bahkan sudah terjadi sebelum seorang wanita memasuki masa menopause.Fenomena seperti ini, jelas akan menggagu beragam aktivitas wanita.

Makanan apa yang baik untuk menghambat terjadinya Menopause Dini?

Berdasarkan berbagai penelitian ilmiah , terbukti bahwa kedelai dengan berbagai produknya (tempe dan susu kedelai) mampu mengatasi penyakit kanker (usus, payudara, dan prostate), menurunkan kadar Cholesterol, menghambat menopause, mencegah osteoporosis, dan mampu meningkatkan imunitas tubuh.

Kendati merupakan proses alami, tak sedikit kaum wanita merasa takut dan khawatir menghadapi masa menopause. Hal ini wajar karena proses yang ditandai dengan berhentinya siklus menstruasi itu kerap menimbulkan gangguan psikis dan fisik yang sangat mengganggu; baik sebelum maupun setelah memasukinya.

Berhentinya siklus haid pada wanita menopause sangat dipengaruhi oleh Hormon Estrogen yang diproduksi oleh Kelenjar Ovarium. Karena itu terapi medis yang biasa diberikan adalah Hormone Replacement Therapy (HRT).

Meskipun (HRT) ini cukup ampuh mengatasi beberapa sindroma menopause; tetapi dalam jangka panjang bisa menyebabkan gangguan kesehatan; antara lain Kanker Payudara (33%),Stroke (49.1 %), Thromboemboli (125.3 %), dan Penyakit Jantug (34.4%)- (Woman Health Initiaive USA).

Solusi yang bisa dilakukan adalah terus mencari dan meneliti FITO-ESTROGEN atau ESTROGEN yang berasal dari tumbuh-tumbuhan .

Salah satunya yang terbukti efektif mengatasi sindroma menopause adalah ISOFLAVON yang terkandung dalam Susu Kedelai. Selain harganya murah; produknya juga telah dikenal masyarakat.

Selain Isoflavon, zat gizi susu kedelai yang dapat menghambat menopause adalah Vitamin E; yang bermanfaat menjaga keseimbangan hormone yang memperlambat terjadinya menopause. Vitamin E alami lebih mudah diserap tubuh dibandingkan Vitamin E sintetik.

Selain mampu menghambat Menopause, Isoflavon ternyata dapat mencegah Osteoporosis; dengan menstimulir proses Osteoblastik melalui aktifitas reseptor estrogen; dan meningkatkan produksi Hormon Pertumbuhan –(Insuline Like Growth Factor 1 (IGF-1). Mengkonsumsi Susu Kedelai secara teratur dapat mempertahankan tulang tengkorak dan tulang belakang. 

Mudah2an Informasi ini dapat membantu Anda.

Pneumonia

Discussion

Pneumonia is defined as inflammation and consolidation of lung tissue in response to an infectious agent . Several organisms and disease conditions have been identified to infect or inflame the lungs.  The epidemiology of the disease has changed due to changes in the microorganisms and modalities used to treat the condition. The incidence of pneumonia requiring hospitalization is highest among the elderly .  Subgroups at risk for pneumonia include individuals with chronic obstructive pulmonary disease (COPD), diabetes mellitus, asthma, alcoholism, and congestive heart failure and diseases that affect the immune system (eg, HIV disease/AIDS and cancer).  Mechanically ventilated patients are at most risk for developing hospital-acquired pneumonia.

     Approximately 50% of pneumonia cases are caused by viruses and tend to be less severe than those of bacterial origin.  Pneumococcus (Streptococcus pneumoniae) is the most common cause of bacterial pneumonia.  Aspiration pneumonia results when solid or liquid food passes into the lungs, causing infection.  Aspiration pneumonia results in approximately 50,000 deaths per year, mostly in the elderly.   Nosocomial pneumonia is the leading cause of death from hospital-acquired infection in the world.  

    Prevention of pneumonia primarily includes maintenance of immune status and pneumococcal vaccination.  Treatment of pneumonia involves a combination of pharmacologic therapy (eg, antibiotics), pulmonary rehabilitation, and maintenance of nutritional status.   Protein energy malnutrition (PEM) is associated with involuntary weight loss, functional impairment and impaired immunity.  It has been demonstrated that nutritional status plays a critical role in the modulation of immune function.  In a study of 277 patients admitted to the hospital for treatment of community-acquired pneumonia, the most important factor independently associated with fatal disease was a low serum albumin level (4).  In the same study, a serum albumin level under 3.0 g/dL during treatment of the pneumonia was also associated with death due to pneumonia after discharge.  Craven and colleagues identified malnutrition as a risk factor for nosocomial pneumonia in hospitalized patients.  

Approaches

The primary goal of medical nutrition therapy in the management of pneumonia is to preserve lean body mass and immune function, prevent unintentional weight loss, and maintain nutritional status. For detailed intervention strategies, refer to the Pneumonia Medical Nutrition Therapy Protocol in Medical Nutrition Therapy Across the Continuum of Care .

Energy, Provide enough energy to maintain reasonable body weight.  Increased energy may be needed for patients with infection, fever, or weight loss.

Protein, Provide enough protein to maintain visceral protein status and meet the demands of infection.  

Fluids, Fluids are encouraged, unless contraindicated.  From 3 to 3.5 L of fluid per day has been recommended to liquefy secretions and help lower temperature in febrile patients.

    Nutrients and the immune system: Several nutrients have been linked to the preservation and maintenance of immune function.  Nutrients that have been identified include vitamins A, E, and B₆, zinc, copper, selenium, the amino acids glutamine and arginine, and omega-3 fatty acids.  These nutrients all seem to modulate specific aspects of human immune function.   Current studies do not demonstrate a direct cause and effect relationship with the incidence of pneumonia.  The current thought is that these nutrients may play a key role in the immune function, leading to less of a risk of developing pneumonia.   Currently, supplementation with these identified nutrients is not warranted.  However, it is recommended to increase the consumption of foods that provide these nutrients as good sources, such as fruit, vegetables, grains, meats, and fish. 

     Aspiration risk reduction: Instituting feeding techniques that prevent risk for aspiration may be indicated in patients who demonstrate symptoms of aspiration, such as coughing before, during, or after consumption of solids, liquids or medications; drooling; pocketing food in the mouth; and repetitive movement of the tongue from front to back of the mouth.  To reduce the risk of aspiration, consider the following strategies:

• Position patient at a 90^o angle during meals.
• Serve food at appropriate temperatures.
• Limit mealtime distractions.

Encourage small bites.

• Avoid using straws since liquids will be rushed to the back of the mouth before swallowing is safe.
• Avoid serving thin liquids, as they can be easily aspirated.  Thickened liquids will slow transit time.

 

     References

1. Marrie TJ.  Bacterial pneumonia.  In: Conn RB, Borer WZ, Snyder JW, eds. Current Diagnosis 9. Philadelphia, Pa: WB Saunders; 1997: 307-311.
2. Pneumonia. American Lung Association; 1996.   Fact sheet.
3.  White J, ed.  The Role of Nutrition in Chronic Disease Care.  Washington, DC:  Nutrition Screening Initiative; 1997:22-35..
4. Hedlund JU, Hansson LO, Ortqvist AB.  Hypoalbuminemia in hospitalized patients with community-acquired pneumonia.  Arch Intern Med.  1995;155:1438-1442.
5.  Craven DE, Steger KA, Barat LM, Duncan RA.  Nosocomial pneumonia: epidemiology and infection control.  Intensive Care Med. 1992; 18(suppl 1):S3-9.
6. Inman-Felton A, Smith K, Johnson E, eds. Medical Nutrition Therapy Across the Continuum of Care. 2^nd ed. Chicago, Ill: American Dietetic Association; 1998.
7. Escott-Stump S.  Nutrition and Diagnosis-Related Care. 5th ed.  Baltimore, Md: Lippincott Williams & Wilkins; 2002:199.
8. Romore MM.  Vitamin A as an immunomodulating agent.  Clin Pharm.  1993;12:506-514.
9. Chandra RK.  Effect of vitamin and trace element supplementation on immune responses in elderly subjects.  Lancet. 1992;340:1124-1127.
10. Neidert KC, ed. Nutrition Care of the Older Adult.  Chicago, Ill: American Dietetic Association; 1998:213.

Pengaruh Kopi dan Teh pada Kesehatan Tulang

Banyak penelitian menunjukkan hubungan antara konsumsi kafein dan keropos tulang tidak jelas. Para peneliti telah menemukan tingkat keropos tulang yang lebih tinggi  pada tulang belakang antara peminum kopi (3 atau lebih cangkir per hari), tetapi keropos tulang di bagian pinggul dan kaki tidak tampak dipengaruhi oleh konsumsi kafein.

Sejumlah penelitian lain membuktikan,  bahwa tidak ada hasil sangat signifikan antara kafein dengan kekeroposan tulang. Meskipun kafein / kopi memiliki pengaruh yang kecil, teh tampaknya dapat meningkatkan kekuatan tulang pada wanita. Flavonoid dan fluoride kemungkinan berada di balik manfaat teh. 1200 wanita Inggris yang diteliti, dan mereka yang dianggap 'peminum teh' sendiri memiliki tulang yang lebih kuat daripada mereka yang tidak minum teh. Berapa banyak teh dibutuhkan untuk mendapatkan manfaat tulang tidak dicatat dan diketahui dengan pasti. Menambahkan sedikit susu pada teh Anda akan meningkatkan kalsium tambahan.

Dr. Thomas Lee mengutip sejumlah penelitian panjang yang menunjukkan bahwa "minum kopi mengurangi risiko kematian awal dari serangan jantung atau stroke. Kopi juga untuk menawarkan beberapa perlindungan kecil terhadap diabetes tipe 2, batu empedu dan penyakit Parkinson's. " 

TEMPE UNTUK PEREMAJAAN TULANG DAN KULIT

Salah satu jenis makanan tradisional yang tidak henti-hentinya dibahas khasiatnya bagi kesehatan adalah tempe. Salah satu produk fermentasi dari kedelai oleh kapan Rhyzopus Oligosporus. Khasiat tempe sudah terkenal dimanca negara, khususnya di Jepang, USA, Belanda dan Jerman. Selain karena nilai gizinya yang prima, beberapa khasiat tempe bagi kesehatan antara lain memberikan pengaruh hipokolesterolemik, antidiare, khususnya karena bakteri E. Coli enteropatogenik dan antioksidan.

Tempe Goreng

Menurut Prof. Dr. Ir. Made Astawan. Indonesia adalah negara produsen tempe terbesar didunia dan pasar kedelai terbesar di Asia. Lima puluh persen dari konsumsi kedelai Indonesia berbentuk tempe sisanya dalam bentuk produk seperti tahu, tauco, kecap dan lain-lain. Produk olahan kedelai populer ini ternyata memiliki banyak manfaat. Menurut Prof. Dr. Achmad Biben, tempe mengandung superoksida desmutase yang dapat menghambat kerusakan sel dan proses penuaan. Dalam sepotong tempe terkandung berbagai unsur yang bermanfaat, seperti hidrat arang, lemak, protein, serta, vitamin, enzim, daidzein, genistein serta komponen anti bakteri. Selain itu tempe juga bisa bersifat sebagai antianemia, menurunkan kadar kolsterol serta menurunkan risiko penyakit jantung koroner. Manfaat lain dari tempe adalah dapat mengurangi keluhan pada wanita yang memasuki usia menopause (berhenti haid). Kesehatan perempuan dimasa menopause dapat dipelihara melalui pemanfaatan bahan makanan alami yang memiliki kandungan sediaan serupa hormon esrogen.

Kedelai sebagai bahan baku tempe ternyata mengandung zat yang mampu meningkatkan vitalitas dan meremajakan sel tubuh, terkenal dengan nama Lesitin HPF (highly Purified Fraction), yakni sejenis lesitin kedelai dengan kadar fosfatidikolin optimal (70-75%), serta mengandung asam lemak esensial. Pernyataan tersebut semakin populer setelah DR. Edward mengemukakan hasil penelitiannya didalam “Bio Control News and Information, Discover & Science News”.

Lesitin dipercaya dapat mencegah arterosklerosis (penumpukan dan penempelan kolesterol pada dinding pembuluh darah), karenanya dapat mengurangi kecenderungan agregasi platelet atau penggumpalan pada sel darah. Selain itu, lesitin dapat mengurangi kandungan kolesterol berlebih dalam darah dengan membantu terjadinya pembentukan HDL (yang terkenal dengan sebutan kolesterol baik). HDL berguna sebagai alat pembersih kolesterol berlebih. Lesitin juga dapat membantu mengurangi tumpukan lemak dalam hati, sehingga kerja hati pada orang-orang yang organ hatinya penuh dengan lemak dapat normal kembali, dan mereka akan tampak lebih segar.

Lesitin dapat dihasilkan dari pangan hewani maupun nabati. Namun Dr. Erward percaya lesitin dari bahan nabati yang khasiatnya paling oke. Karena lesitin nabatilah yang bersifat superior, maksudnya adalah lesitin yang dapat berfungsi sebagai peremaja sel tubuh, sehingga vitalitasnya meningkat. Lesitin dari bahan nabati dapat ditemukan pada kacang kedelai, kacang tanah, jagung dan bunga matahari. Saat ini lesitin dari kacang kedelai yang terpopuler.

Dalam penelitian Dr. Erward berikutnya, ia sampai pula pada kesimpulan bahwa lesitin yang terkandung dalam kedelai memiliki sifat lebih unggul sebagai peremaja sel tubuh dibandingkan dengan bahan-bahan lain. Pada kacang kedelai, kandungan lesitin bersama zat-zat lain merupakan senyawa yang sangat tinggi khasiatnya sebagai obat awet muda, penguat tulang dan mempertinggi daya tahan tubuh.

Meski begitu, khasiat tempe bagi perempuan menopause sangat tergantung pada proses pengolahannya. Sebaiknya tempe jangan digoreng, karena akan membuat banyak khasiat tempe hilang tetapi bisa secara optimal di dapatkan jika proses pengolahannya tepat. Akan tetapi lebih baik jika tempe disemur, disup, dibacem, atau dipepes dari pada digoreng. Cara memasak serupa itu membuat khasiat tempe hanya sedikit mengalami penurunan dibandingkan dengan jika digoreng.

Perempuan menopause sebaiknya mengonsumsi, tahu, tauco, susu kedelai, kacang tunggak, bengkoang, tokbi, hingga biji-bijian seperti gandum wijen, dan biji bunga matahari. Disarankan juga agar makanan sehari-hari bagi perempuan yang memasuki masa menopause banyak mengandung unsur mineral dan vitamin. Keduanya bermanfaat bagi perawatan kesehatan organ tubuh serta alat reproduksi. Vitamin A misalnya, bermanfaat bagi pertumbuhan dan kesehatan kulit, mata dan mukosa. Vitamin B kompleks untuk mencegah rasa lelah dan menjaga stabilitas. Vitamin C dibutuhkan dalam menjaga fungsi kolagen, sehingga mengurangi keriput dan menjaga kekebalan tubuh, infeksi dan alergi. Vitamin D untuk mencegah osteoporosis, sedangkan vitamin E membantu mengurangi gejala pans serta keluhan psikologis. Mineral bermanfaat untuk menambah energi. Mineral yang paling penting bagi perempuan menopouse adalah kalsium. Dibutuhkan setidaknya 1000-1500 mg kalsium setiap hari.

Pengoperasian DM Software ver 1.2

Langkah-Langkah Konsultasi Menggunakan DM Software ver 1.2

Tampilan “Registrasi”

Hal yang pertama kali harus dilakukan adalah mengisi registrasi pasien sesuai dengan hasil anamnesa dan pengukuran antropometri yang telah dilakukan.

Tampilan “Kebutuhan Zat Gizi Per Individu”

Setelah mengisi registrasi secara lengkap maka hasil perhitungan kebutuhan pasien akan secara otomatis muncul baik dengan perhitungan cara askandar maupun Perkeni, sehingga dapat dijelaskan kepada pasien tentang status gizi dan kebutuhan zat gizinya seperti terlihat pada Tampilan kebutuhan zat gizi.

Tampilan “Tujuan Diit”

Selanjutnya yaitu proses penjelasan materi sesuai dengan diit yang diderita pasien. Seperti terlihat pada tampilan tujuan diit diatas merupakan tujuan diit untuk penderita DM diit B/B1 tanpa komplikasi.

Tampilan “Pelaksanaan Diit”

Proses penjelasan materi untuk pelaksanaan diit diatas merupakan prinsip diit diabetes mellitus yang harus diingat yaitu tepat jenis, jumlah, dan jadwal.

Tampilan “Bahan Makanan yang Tidak Boleh Dimakan”

Tampilan bahan makanan yang tidak boleh dimakan ini merupakan penjelasan contoh bahan makanan beserta gambar tentang BM yang tidak boleh dimakan untuk penderita diabetes mellitus dengan komplikasi hipertensi. Dengan adanya tampilan gambar maka diharapkan pasien akan lebih mengerti dan mengingat materi yang dijelaskan.

Tampilan “Bahan Makanan yang harus Diperhitungkan”

Tampilan bahan makanan yang harus diperhitungkan ini merupakan penjelasan contoh bahan makanan beserta gambar tentang BM yang diperhitungkan untuk penderita diabetes mellitus. Dengan adanya tampilan gambar maka diharapkan pasien akan lebih mengerti dan mengingat materi yang dijelaskan.

Tampilan “Yang Harus Diketahui”

Tampilan diatas merupakan keterangan penting yang harus diketahui dan tidak terdapat pada tampilan tujuan dan prinsip diit diabetes mellitus.

Tampilan “Pembagian Makan Sehari”

Tampilan ini, menampilkan bahan makanan yang dibutuhkan pasien dalam sehari sesuai dengan perhitungan nilai gizinya. Di dalamnya terdapat juga pembagian 3x makan pokok beserta snack.

Tampilan “Leaflet Diabetes Mellitus”

Leaflet tersebut berisi ringkasan dari semua materi yang telah ditampilkan sebelumnya. Pada lesflet ini, secara otomatis akan terisi identitas pasien sesuai pengisian registrasi dan pembagian makan dalam sehari sesuai dengan kebutuhannya.

Keterangan, logo Institusi atau Rumah Sakit dapat di ganti sesuai user

Tampilan “Contoh – Contoh Makanan Pengganti”

Tampilan ini berisi beberapa bahan makanan untuk makanan pengganti yang sudah disesuaikan dengan ukuran rumah tangga (URT) untuk dikonsumsi pasien diabetes mellitus. Hal ini mempermudah proses konsultasi karena dengan tampilan ini sehingga pengguna  tidak perlu lagi menggunakan food model.

Diabetes Mellitus Software ver 1.2

Salah satu penyakit serius yang tidak bisa kita anggap remeh adalah penyakit diabetes mellitus. Penyakit diabetes mellitus juga dikenal sebagai penyakit kencing manis atau penyakit gula darah adalah golongan penyakit kronis yang ditandai dengan peningkatan kadar gula dalam darah sebagai akibat adanya gangguan sistem metabolisme dalam tubuh, dimana organ pankreas tidak mampu memproduksi hormon insulin sesuai kebutuhan tubuh (Nursing student,2009).

Menurut beberapa laporan tentang DM dari berbagai tempat di Indonesia menunjukkan angka prevalensi dan komplikasi DM yang tidak banyak berbeda, sehingga masalah DM kiranya tidak dapat dianggap sebagai masalah regional, melainkan suatu masalah nasional yang harus kita kelola bersama (Askandar, 1992).

Proses konsultasi gizi dirumah sakit umumnya dilakukan secara manual, untuk perhitungan status gizi dan kebutuhan zat gizi pasien juga secara manual yaitu dihitung dengan menggunakan bantuan kalkulator sehingga memerlukan waktu yang relatif lama ,yaitu berlangsung ± 50 menit. 

Ahli gizi merupakan orang ahli yang dibutuhkan dalam membangun basis pengetahuan khususnya dalam penentuan menu harian dengan gizi seimbang. Ada beberapa masukan yang dibutuhkan berasal dari ahli gizi, antara lain: beberapa kasus yang pernah dialami dalam menentukan menu harian dengan gizi seimbang yang dibutuhkan bagi penyandang DM. Ahli gizi dapat menerima informasi terkait dengan basis pengetahuan tentang manajemen diet penyandang DM beserta data penyandang DM yang menjadi asuhannya yang sudah tersimpan pada sistem (Sri K, 2009).

Aplikasi informatika medis terbukti handal dan memberikan kontribusi sebesar-besarnya bagi masyarakat. Salah satu contohnya adalah sistem penatalaksanaan DM terpadu yang dibangun dalam beberapa basis pemrograman. Alasan utama penggunaan beberapa basis pemrograman adalah untuk kemudahan akses data dan informasi serta pemanfaatan teknologi informasi dan komunikasi yang sudah sangat berkembang. Teknologi informasi dan komunikasi memberikan manfaat yang luar biasa di bidang informatika medis. Aplikasi informatika medis untuk penatalaksanaan DM secara terpadu memaksimalkan unsur-unsur ICT Sistem yang dibangun dengan basisdata yang terpusat ini memungkinkan para pengguna untuk berbagi data meskipun beberapa aplikasi dibangun dengan platform yang berbeda. Melalui sistem ini, pelayanan kesehatan dapat dilakukan meskipun terhalang oleh jarak dan waktu (Sri K, 2009)

DM Software ver 1.2 ini merupakan solusi menjawab masalah tersebut di atas!

Children, Obesity, And Sleep

Some 13 percent of children aged 6 to 11 and 14 percent of adolescents aged 12 to 19 are overweight. The ever-increasing waistlines put children at risk for heart disease, type 2 diabetes, and high blood pressure. But there is another problem, often overlooked, accompanying the grim statistics from the U.S. Surgeon General's office. Those extra pounds also put children at risk for sleep apnea, a serious, debilitating and potentially life-threatening sleep disorder, according to the National Sleep Foundation (NSF).

Sleep apnea is characterized by brief but numerous involuntary breathing pauses during sleep. These breathing pauses cause awakenings throughout the night, making it impossible for sleep apnea sufferers to enjoy a night of deep, restorative sleep. People with sleep apnea often feel sleepy during the day and their concentration and daytime performance suffer. While being overweight or obese are risk factors for sleep apnea, being thin does not preclude a diagnosis.

Sleep apnea, generally considered a problem among middle-aged men, can be a problem for youngsters, too. "With the increasing rates of obesity in children, it's likely there will also be an increase in sleep apnea," said Jodi A. Mindell, PhD a pediatric sleep expert and member of NSF's Board of Directors. Dr. Mindell is a professor of psychology at St. Joseph's University in Philadelphia and associate director of the Sleep Disorders Center at Children's Hospital.

The repercussions of sleep apnea and poor sleep for children are vast. When children do not get the sleep they need, they are at risk for health, performance and safety problems; difficulties in school are often the result. However, sleep deprivation in children is often overlooked or attributed to attention-deficit or behavior disorders.

Medium Chain Triglycerides

Description

Commercial medium-chain triglycerides (MCT) are composed of 8 to 10 carbon fatty acids synthesized from palm kernel and coconut oils .  MCT provide 8.3 kcal per g and 116 kcal per tablespoon .

Indications

MCT are indicated in conditions where long-chain triglycerides (LCT) are not well tolerated.  MCT are commonly used in fat-controlled diets to provide increased calories and improve the palatability of a reduced-fat diet See Fat-Controlled Diet in Section IC.  The following properties of MCT may make it useful in disorders where LCT are problematic:

·         Absorption can occur despite pancreatic lipase deficiency.

·         Bile salts or micelles are not required for dispersion in water and subsequent absorption .

·         Transport across the intestinal mucosa occurs more readily than with LCT.

·         MCT are not dependent upon chylomicrons for transit and consequently do not require lipoprotein lipase for oxidation.

·         Transport does not occur through the lymphatic system.  MCT travel directly to the liver via the portal vein, as free fatty acids bound to albumin .

·         MCT hydrolyzes to fatty acids more quickly  and oxidizes more rapidly and efficiently than LCT .

MCT may be adjunctive to a fat-controlled diet in the following conditions:

·         pancreatic insufficiency

·         cystic fibrosis

·         intestinal resection

·         hepatobiliary disease

·         lymphangiectasia

·         chyluria

·         chylous ascites

·         chylothorax

·         secondary carnitine deficiency syndromes

·         whipple’s disease  

·         hyperchylomicronemia

    MCT may be therapeutically incorporated into the ketogenic diet, which is used to control epileptic seizures (see Ketogenic Diet) and may also be used in adjunct with antineoplastic treatment for pediatrics .

Contraindications

Under normal physiologic conditions, MCT are ketogenic.  Therefore, MCT are contraindicated in persons who are prone to diabetic ketoacidosis.

    In cirrhosis, MCT accumulate in the blood, resulting in a condition that presents with symptoms similar to hepatic encephalopathy, including hyperlactacidemia, hyperammonemia, hyperventilation, and altered EKG findings.

Nutritional Adequacy

MCT are used in conjunction with specific diets, such as fat-controlled or ketogenic diets.  Nutritional adequacy will depend on the prescribed diet.

How to Order the Diet

MCT are generally ordered in conjunction with a fat-controlled diet.  The order should specify the number of mL or g MCT to be added to the diet.  For example: “____ g Fat-Controlled Diet plus ____ mL (g) MCT”.

Planning the Diet

·          MCT are available as MCT oil or in formulas containing MCT.

·          MCT should be introduced slowly to avoid the abdominal distention and pain, nausea, vomiting, and diarrhea associated with rapid infusion or high dose.

·          MCT in divided doses of no more than 15 to 20 mL (3 to 4 tsp) at a time are generally well tolerated (2).  Patients should initially receive no more than 20 to 30 mL per day, increasing by 5 to 10 mL per day as tolerated until the MCT goal is met.

·          To incorporate MCT into the diet, the following are suggested:

-        Add 1 tsp MCT oil to 4 oz fat free milk, carbonated beverages, juices, or flavored drinks.  If patient is prescribed a ketogenic diet, use sugar-free beverages and follow fluid restrictions.

-        Substitute an equal amount of MCT oil for other fats when cooking and baking.

-        Prepare salad dressings with MCT oil.

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References

1.       Babineau TJ, Pomposelli J, Forse RA, Blackburn GL.  Specific nutrients: carbohydrates, lipids, nucleic acids.  In: Zaloga GP, ed. Nutrition in Critical Care.  St. Louis, Mo: Mosby; 1994:196-197.

2.       Nelson JK, Moxness KE, Jensen MD, Gastineau CF, eds. Gastrointestinal diseases and disorders. In: Mayo Clinic Diet Manual: A Handbook of Nutrition Practices. 7th ed. St. Louis, Mo: Mosby; 1994:230-232.

3.       Pons R, De Vivo DC. Primary and secondary carnitine deficiency syndromes. J Child Neuro. 1995;10:S8-S24.

4.       Long-chain trigylceride restricted medium-chain triglyceride diet. In: Manual of Clinical Dietetics. 6^th ed. Chicago, Ill: American Dietetic Association; 2000: 725.

5.       Nebeling LC, Lerner E. Implementing a ketogenic diet based on medium-chain triglyceride oil in pediatric patients with cancer. J Am Diet