Peran Konseling Gizi di Puskesmassebagai Upaya Preventif menghindari  percepatan sindroma metabolik       Rulli Rosandi, P...
Latar Belakang• Indonesia mengalami peningkatan angka penyakit tidak  menular (PTM) – 41.7 persen di tahun 1995 menjadi 59...
Distribusi Kematian Semua UmurMenurut Sebab Kematian                                 Kemenkes RI, 2011
Persentase Kematian Akibat PTM pada PendudukUsia < 60 Tahun Menurut Jenis Penyakit,                                    Kem...
Sindroma Metabolik :Kumpulan kelainan metabolikyang akan meningkatkan resikoterjadinya penyakitkardiovaskular dan diabetes...
Beberapa kriteria Sindroma Metabolik1
Beberapa kriteria Sindroma Metabolik2
Lingkar Pinggang
Definisi Metabolik syndrome• Kriteria menurut International Diabetes Federation (IDF) :  Obesitas sentral (kriteria Asia :...
Prevalensi Sindroma Metabolik
Epidemiologi
Faktor Resiko yang mendasarisindroma metabolik
Konsekuensi Sindroma Metabolik
Konsekuensi Sindroma Metabolik2
Kematian karena CVD dan CHD
Relative risk dari sindroma metabolik
Penatalaksanaan Sindroma Metabolik• Tujuan utama adalah mengurangi resiko terhadap  clinical atherosclerotic disease – Pen...
Terapi
Diabetes prevention strategies and outcomesIntervention                                                      RiskTherapy  ...
U.S. Diabetes Prevention Project• 3234 subjects with BMI > 34 kg/m2• Placebo, metformin, and lifestyle modification• Lifes...
Finnish Diabetes Prevention Study• 522 overweight subjects; Intervention group -  met with dietician 4 x /yr and supervise...
Penyebab Kematian
FENOMENA GUNUNG ES
Kurang makan sayur dan buahmenurut karakteristik                              Riskesdas, 2007
AHA Statement on Diet
Practical Tips to Implement AHA Diet andLifestyle Recommendations1
Practical Tips to Implement AHA Diet andLifestyle Recommendations2
Therapeutic Goals and Recommendations forClinical Management of Metabolic Syndrome1                                 Grundy...
Therapeutic Goals and Recommendations forClinical Management of Metabolic Syndrome2                                 Grundy...
Therapeutic Goals and Recommendations forClinical Management of Metabolic Syndrome3
Environmental role in Obesity
Management Obesity
Lifestyle Modification to Manage Hypertension andPotential Outcomes                                            (JNC-7, 2003)
Barriers to Dietary Adherence• Restrictive dietary pattern• Required changes in lifestyle and behavior• Symptom relief may...
Strategies for Maintaining Dietary Change• Tailoring diet to patient’s needs• Using social support inside and outside heal...
Brief Nutrition Counseling for MetabolicSyndrome—5 Minute Version
Brief Nutrition Counseling for MetabolicSyndrome—5 Minute Version2
Brief Nutrition Counseling for MetabolicSyndrome—15 Minute Version1
Brief Nutrition Counseling for MetabolicSyndrome—15 Minute Version2
Kerangka Konsep Strategi Nasional PenerapanPola Konsumsi Makanan dan Aktivitas Fisik
Kesimpulan• Prevalensi penyakit tidak menular khususnya penyakit  jantung dan pembuluh darah telah menjadi penyebab  kemat...
Peran konseling g izi final
Peran konseling g izi final
Peran konseling g izi final
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Peran Konseling gizi di layanan primer sebagai pencegan terhadap sindroma metabolik

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  • In 1988, Reaven [2] proposed that several risk factors for atherosclerotic CVD(ASCVD) (eg, dyslipidemia, hypertension, and hyperglycemia) tend to clustertogether in a syndrome that he called syndrome X. Subsequently, syndrome Xwas also called the insulin resistance syndrome because of the belief that insulinresistance is the underlying cause of risk factor clustering. Another term that iswidely employed for this clustering is the metabolic syndrome, the term used byATP III [1]. Although most of the field agrees that ASCVD is the primary outcome,the metabolic syndrome confers increased risk for type 2 diabetes, as well.Moreover, diabetes itself is a major risk factor for ASCVD. Finally, there are otherconditions, such as polycystic ovary syndrome, fatty liver, cholesterol gallstones,asthma, sleep disturbances, and some forms of cancer, that are found to bemore common in subjects with the metabolic syndrome.In addition, there are several underlying risk factors for the metabolic syndrome:obesity (especially abdominal obesity), physical inactivity, atherogenic diet, primaryinsulin resistance, advancing age, and hormonal factors.
  • DASH diet (higher in fruits, vegetables, and low-fat dairy products and lower in total fat, saturated fat, and cholesterol).
  • Peran konseling g izi final

    1. 1. Peran Konseling Gizi di Puskesmassebagai 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
    2. 2. 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
    3. 3. Distribusi Kematian Semua UmurMenurut Sebab Kematian Kemenkes RI, 2011
    4. 4. Persentase Kematian Akibat PTM pada PendudukUsia < 60 Tahun Menurut Jenis Penyakit, Kemenkes RI, 2011
    5. 5. Sindroma Metabolik :Kumpulan kelainan metabolikyang akan meningkatkan resikoterjadinya penyakitkardiovaskular dan diabetesmellitus
    6. 6. Beberapa kriteria Sindroma Metabolik1
    7. 7. Beberapa kriteria Sindroma Metabolik2
    8. 8. Lingkar Pinggang
    9. 9. 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
    10. 10. Prevalensi Sindroma Metabolik
    11. 11. Epidemiologi
    12. 12. Faktor Resiko yang mendasarisindroma metabolik
    13. 13. Konsekuensi Sindroma Metabolik
    14. 14. Konsekuensi Sindroma Metabolik2
    15. 15. Kematian karena CVD dan CHD
    16. 16. Relative risk dari sindroma metabolik
    17. 17. 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
    18. 18. Terapi
    19. 19. Diabetes prevention strategies and outcomesIntervention RiskTherapy Study ReductionIntensive lifestyle DPP, FDP 58% aMetformin DPP 31% aAcarbose STOP-NIDDM 25% aPravastatin WOSCOPS 30% aRamipril HOPE 34% aOestrogen/progesterone HERS 35% aIntensive lifestyle XENDOS 37% b+ Orlistat a versus standard lifestyle advice b versus intensive lifestyle advice
    20. 20. 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 groupNEJM 2002
    21. 21. 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
    22. 22. Penyebab Kematian
    23. 23. FENOMENA GUNUNG ES
    24. 24. Kurang makan sayur dan buahmenurut karakteristik Riskesdas, 2007
    25. 25. AHA Statement on Diet
    26. 26. Practical Tips to Implement AHA Diet andLifestyle Recommendations1
    27. 27. Practical Tips to Implement AHA Diet andLifestyle Recommendations2
    28. 28. Therapeutic Goals and Recommendations forClinical Management of Metabolic Syndrome1 Grundy et all, 2005
    29. 29. Therapeutic Goals and Recommendations forClinical Management of Metabolic Syndrome2 Grundy et all, 2005
    30. 30. Therapeutic Goals and Recommendations forClinical Management of Metabolic Syndrome3
    31. 31. Environmental role in Obesity
    32. 32. Management Obesity
    33. 33. Lifestyle Modification to Manage Hypertension andPotential Outcomes (JNC-7, 2003)
    34. 34. 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
    35. 35. 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
    36. 36. Brief Nutrition Counseling for MetabolicSyndrome—5 Minute Version
    37. 37. Brief Nutrition Counseling for MetabolicSyndrome—5 Minute Version2
    38. 38. Brief Nutrition Counseling for MetabolicSyndrome—15 Minute Version1
    39. 39. Brief Nutrition Counseling for MetabolicSyndrome—15 Minute Version2
    40. 40. Kerangka Konsep Strategi Nasional PenerapanPola Konsumsi Makanan dan Aktivitas Fisik
    41. 41. 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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