Clinical Nutrition Physician 4.0.

Future Chalenges, Opportunities and

Upgraded Competencies.

Hertanto W Subagio
Kolegium Ilmu Gizi Klinik Indonesia
Life Expectancy at birth by region
 Population Ageing
Piramida Penduduk Jepang 2021 Piramida Penduduk Brazil 2021
(Piramida Penduduk Tua)
(Piramida Penduduk Muda)
Healthy-life-expectancy ?
Average number of years that a person can expect to live in "full health" by taking into
account years lived in less than full health due to disease and/or injury.
Life-expectancy & healthy-life-expectancy.
Permasalahan Lansia.

Setengah dari lansia di

China dilaporkan
memiliki setidaknya
satu penyakit kronis
dan hampir seperlima
melaporkan setidaknya
dua penyakit kronis.
Wu Fan, Yanfei Guo, Paul Kowal, Yong Jiang, Min Yu, Xinjian Li, et al.
Prevalence of Major Chronic Conditions among Older Chinese Adults:
The Study on Global AGEing and Adult Health (SAGE) Wave 1.PLOS
One. 2013; 8(9):
SINGAPORE LONGITUDINAL
AGEING STUDIES - FINDINGS
A study spanning 14 years and counting has found
that half of the elderly here are frail — especially the
low-income, and those who are single, divorced or
widowed — due to factors including malnutrition,
lack of exercise and having chronic diseases.

“Eating is also very social, you’re more

likely to eat more with others than alone. So
imagine an old person living alone at
home, and they’re probably not eating full
meals every day, especially if they have no
spouse. Also, they may be too poor to afford
nutritious, good meals, and more often than
not they are simple and bland.” - Associate
Professor Ng Tze Pin
Wei K et al. J Am Med Dir Assoc. 2017 Aug 10.
pii: S1525-8610(17)30360-2.
 Penyakit pada Lansia di Indonesia
Prevalensi (%) Diabetes Melitus, Prevalensi (%) Hipertensi,
Riskesdas 2018 Riskesdas 2018

Sumber : Badan Litbangkes, Kementerian Kesehatan RI , 2019

Prevalensi (%) Jantung, Prevalensi (%) Stroke,
Riskesdas 2018 Riskesdas 2018

Sumber : Badan Litbangkes, Kementerian Kesehatan RI , 2019

Prevalensi (%) Penyakit Tidak Menular Prevalensi (%) Penyakit Tidak
pada Pra Lansia (45-59 tahun) Menular pada Lansia (> 60 tahun)
Riskesdas 2018 Riskesdas 2018

Sumber : Badan Litbangkes, Kementerian Kesehatan RI , 2019

Determinants of Healthy Ageing
Genetics and Lifestyle Factors Contribute to
Health and Longevity
 TRY Use Appendix F to calculate your energy requirements.
IT

Public health view : FIGURE 17-3 Modified MyPyramid for Older Adults

Older adults often find it difficult

to get adequate amounts of

• Public health advice about nutrition is

some nutrients from foods alone
and may need supplements.

general in nature in order to address

the need to improve the health of the
wider population. To prevent

• Several nutritional recommendations

dehydration,
older adults
need to drink

are well established and promoted.

plenty of water
and other
beverages.

through the Food Standards Agency.

Regular physical activity helps older adults maintain

independence and enjoy life more fully.

SOURCE: Copyright © 2007 Tufts University. Reprinted with permission from Lichtenstein AH, Rasmussen H, Yu WW, Epstein SR,
Russell RM. Modified MyPyramid for Older Adults. J Nutr. 2008;138:78–82.
Clinical Nutrition
• The role of clinical nutrition services
is emphasized in the care of chronic
diseases;
• The prevalence of chronic diseases
continues to increase due to the
living environment change,
westernized dietary life and the
aging population.
• The effectiveness of clinical nutrition
services in the treatment of diseases
in inpatients has been demonstrated
in several studies.
Personalized Nutrition
J. A. Betts J. T. Gonzalez. Personalised nutrition: What makes you so special ? Nutrition Bulletin.2018. https://doi.org/10.1111/nbu.12238

• Personalized nutrition can be

defined as developing unique
nutrition guidelines for each
individual;
• precision nutrition seeks to
develop effective approaches
based on the combination of
an individual's genetic,
environmental and lifestyle
factors.
Toro Martin Juan, 2017
Information and communication technologies (ICT)
• is defined as a diverse set of technological tools
and resources used to transmit, store, create,
share or exchange information.
• the 4th era of technology is a fusion of advances
in artificial intelligence (AI), robotics, the Internet
of Things (IoT), Web3, blockchain, 3D printing,
genetic engineering, quantum computing, and
other technologies.
• It's the collective force behind many products and
services that are fast becoming indispensable to
modern life.
 Personalized nutrition based on ICT technology

• Innovative changes are pursued in clinical

nutrition services through a convergence with
information and communication technology
(ICT), a core technology of the fourth industrial
revolution such as big data, deep learning, and
artificial intelligence (AI).
• ICT technology can build a personalized nutrition
platform in consideration of individual patient's
diseases, genetic trait, and environment, all of
which can be technical means in personalized
nutrition management services.
• Personalized nutrition based on ICT technology is
able to provide more standardized and high-
quality clinical nutrition services to the patients.

Kim,GY, Seo JS. A New Paradigm for Clinical Nutrition Services in the Era of the Fourth Industrial Revolution .
Clin Nutr Res. 2021 Apr 19;10(2):95-106. doi: 10.7762/cnr.2021.10.2.95.
The role of ICT in Clinical Nitrition
• In hospitals and clinical settings ICT play a major role from storing and
documenting all medical records of patients which not only include
physical and clinical attributes like body composition data but also
accommodates analysis of dietary risk factor and reminders of
preventive care.
• ICTs have become a strong ally in strengthening individuals' healthy
lifestyle, taking into account nutrition intake and physical activity
levels.
• Nutrition applications provide the means for automatic dietary intake
and energy expenditure measurements as well as personalised
counselling and educational services.
• While nutrition education activities usually focus on informing the
individuals about healthy eating habits and lifestyles, communication
recognizes that nutrition-related behaviour of an individual is the
product of his/her continuous interaction with the environment.
Digital health technologies to implement the four steps in the
Medical Nutrition Therapy.

Kim GY, Seo JS. A New Paradigm for Clinical Nutrition Services in the Era of the Fourth Industrial Revolution. Clin Nutr Res. 2021 Apr 19;10(2):95-106.
doi: 10.7762/cnr.2021.10.2.95.
Upgraded Competencies
• Healthy Aging .
• Penyakit Khronik pada Geriatri : (vs adult)
- parameter diagnostic, therapy, monitoring.
• Diagnostic dan monitoring (dari antropometri ke arah body
composition).
• Personalized Nutrition
• Information and Communication Technology
• Penajaman dari Malnutrition ke Hospital Malnutrition
TERIMAKASIH