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PENGELOLAAN DIIT PADA PENYAKIT CARDIOVASCULAR

AGUS PRASTOWO

PENDAHULUAN :

Faktor pencetus al : Tingginya konsumsi garam Tingginya konsumsi lemak Alkohol Kurang exercise Paparan pestisida Soft drink Rendah serat Faktor risk biochemical : high kolesterol, low HDL, rendahnya level Cu, kelebihan Zn, DM, megalovirus

 fibrinogen DM : oxidasi LDL Tekanan oksigen rendah Keracunan metal Obesity Rendah konsentrasi Vit A. Meningkatnya radical bebas Stress emosional :  HDL dan  radical bebas.E Tingginya lipoprotein Tingginya fibrinogen Tingginya homosistein Infeksi : TNF .ATEROSKLEROSIS Jejas utama adalah kolesterol. Faktor risk yang terberat adalah Kolesterol Ratio LDL/HDL Tekanan darah : hipertensi  pencetus/mempercepat pembentukan aterom Merokok : Hipoxia.C.

toxin ROS Interna : Inflamasi. polusi. citocrom superoxide hidroperoxide aldehide Foam cell .FREE RADICAL : Externa: Radiasi.

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  .

asam folat •Konsumsi protein terutama arginin (kedelai) . perbaiki LDL/HDL •Kurangi garam  hipertensi •Hindari the.Recomendasi DIIT : •Kurangi lemak   kolesterol. 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. kopi.

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 antioksidan Sumber MUFA : asam oleat (olive oil. palm) Bahaya suplementasi Vit dosis tinggi Vit C + Fe + O2 = hidroxil radical (highly toxic) Konsumsi Vit C alami lebih aman . rice.

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 .

Rendah kalori jika perlu 2.Terapi diit Tujuan : 1. Mudah cerna 7. Suplementasi antioksidan 9. Memberikan makanan adekuat tanpa memberatkan kerja jantung/pembuluh darah 1. PUFA dengan rasio 10% LJ. Porsi kecil sering 8. lemak tu MUFA. 10% LTJT. Menurunkan kadar kolesterol 3. Cukup vitamin terutama sumber antioksidan 4. 10% LTJG 3. Menurunkan berat badan jika perlu 2. Cukup mineral terutama sumber antioksidan 5. Protein dan lemak cukup. Rendah kolesterol . Rendah garam 6. Mencegah retensi garam Prinsip : 1.

nangka.Indikasi pemberian bentuk makanan : Pada MCI akut. makanan ini dalam bentuk cairan Pada transisi bentuk lunak Pada masa transisi bentuk lunak atau biasa Pada penderita ringan atau sudah membaik dalam bentuk makanan biasa Rendah garam diberikan sesuai berat ringannya hipertensi dan oedema Makanan yang dihindari : o kue-kue manis o daging berlemak o Sayuran mentah o buah durian. o bumbu merangsang seperti lombok . CHF berat.

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 assessment BMI 22-27 Waist circumference (men = 40 in. women = 35 in. sodium Assess alcohol intake Use of vitamins/minerals and complementary/alternative therapies Depression and dementia ..) Dietary intake of calcium. magnesium. potassium.

nutrient-rich foods or liquid supplements if weight loss is a problem . saturated fat and cholesterol Caloric intake to achieve optimal weight If BMI > 23.2400mg sodium daily (1 tsp. calcium and magnesium Consider (DASH) Diet:* Level I . magnesium.1500 mg sodium daily Supplements Consider mineral supplements calcium.Nutrition Education Reduce intake of sodium. potassium) if dietary intake insufficient Consider high calorie. total salt that includes naturally occurring salt in food and 1/4 tsp. weight reduction is indicated Maintain adequate intake of dietary potassium. added salt or salt in processed food) Level II .

= 35 inches for women).CAD Screening Parameters Body weight assessment BMI 22-27 Waist circumference = 40 inches for men. Dietary history of cholesterol. and calories Determine serum cholesterol. saturated and total fat. HDL) triglycerides and C-reactive protein (CRP) Diabetes mellitus Depression Use of vitamins/minerals and complementary/alternative therapies . (LDL.

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

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

inadequate potassium. including: excessive sodium. magnesium and calcium Pedal/presacral (dependent) edema and/or ascites Serum electrolytes Use of vitamins/minerals and complementary/alternative therapies .CHF Screening Parameters Body weight assessment Involuntary loss or gain (check for fluid retention) BMI 22-27 Blood pressure (watch for hypotension) Nutritional intake of electrolytes.

Reduce fluid intake if needed Change number. i.Nutrition Education Adjust nutrient and fluid intakes Keep sodium intake low. timing and content of meals as needed Ensure adequate calories and protein Limit/eliminate alcohol Supplements Consider vitamin/mineral supplements if food intake is poor Consider high calorie. total salt that includes naturally occurring salt in food and 1/4 tsp. added salt or salt in processed food).e. = 2400 mg sodium daily (1 tsp. nutrient-rich foods or liquid supplements .

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

TERIMA KASIH .