EKOFISIOLOGI MANUSIA DAN

KESEHATAN
Kuliah -3

Dr. Yaktiworo Indriani

PS Manajemen Lingkungan
Pasca Sarjana Unila
Obesity
 Obesity BMI >=30, overwt 25.0-29.9
 Obesity increases risk of death due to
CHD, cancer and others
 Health risks & obesity studied mostly
in adults
 Childhood obesity is predictive of
adult obesity and adult mortality, and
it has psychosocial consequences
Obesity & Chronic Disease
 Adults & children : obesity is associated with
CHD and type 2 diabetes
 Others : elevated blood pressure, high total
cholesterol, triglycerides, LDL, low HDL
 Obese are likely to experience 2 or more of
these risk factors.
 25-50 % obese children and adolescents
remain obese as adults
ATHEROSCLEROSIS
Obesity & Morbidity
 Obese adults suffer greater morbidity
 Obesity associated with menstrual
irregularity, amenorrhea, and infertility
 Obesity during pregnancy increases
hypertension, complications during labor and
delivery, neural tube defects
 Obesity increases risk of poor respiratory
function, sleep apnea, osteoarthritis, and
cancer
Obesity & Mortality
 People with low and high BMIs have
elevated rates of death; BMI >=30
may have mortality rates 50-100%
greater than 20-25
 Overweight in childhood was

associated with a 50% increase in all

cause mortality
Economic Costs of Obesity
 In industrialized countries 2-7% health
care costs are attributed to obesity
 In US health care costs of obesity was

$70 billion (diagnosing and treating

illnesses caused by obesity)
 Other costs: loss of productivity

causes by morbidity and premature

death
Epidemilogy (Sex)
 Prevalence of obesity is
higher among adult women
than adult men.

 Differential is fairly consistent across racial,

ethnic groups, developed or developing
countries
 Women tend to have a higher proportion of fat
relative to total body weight.
 Women have more fat in hips, men have more
abdominal fat
APEL DAN PEAR
MENJADI LANGSING = SEHAT

JAN 03 = 315 POUNDS AGST 03 = 180 POUNDS

BUAH PEAR
Epidemiology (Race/Ethnicity)
 Levels of overwt vary among racial groups
 It reflects interaction among genes, social
class, cultural attitudes
 In US obesity higher among non-Hispanic
black (37%) and Mexican American women
(33%) than among non-Hispanic white women
(33%). The differential is not observed for men
 Obesity is higher among those born in the US
than those not
Epidemiology (Age)
 The prevalence of obesity increases for each
decade until 50-59 years of age
 Adults age usually lose lean body mass, have
greater body fat
 Lower prevalence of obesity in older age may
reflect a selective survival
 The incidence of major weight gain occurred for
young adults aged 24-34 yrs
Epidemiology (Sosec)

 Obesity is a condition of affluent society, abundant food

supply and sedentary work environment may contribute

 Higher SES higher obesity ; reflect greater access to

adequate food, and positive culture perception of

obesity as a sign of wealth and health

PLACE & TIME
 The problem of obesity is increasingly
becoming global
 Especially in most developed countries with

the exception of Japan

 Relatively rare in Asian countries (China and

India)
 In the US prevalence 1988-1994 increased

55% (over 1976-1980), in western European

countries 10-40%
Behaviors
 Excessive energy intake and inadequate
physical activity
 Epidemiological data are inconsistent (precise

measurement is lacking)
 Additional 50 kcal per day, gain weight 20 kg

over 10 years
 Fat : energy-dense, more palatable, less likely

to provide short-term satiety, fat stores are

less tightly regulated
WASPADAI LEMAK JENUH

PANGAN HEWANI
SOTO, KONRO, COTO MAKASSAR, SOP
BUNTUT, TENGKLENG SOLO, SATE,
TONGSENG, GULAI
Genetics
 The proportion of body fat that can be
explained by genetic transmission is 24-70%
 An obesity-encouraging environment may be

necessary for their expression

 Genes may directly cause obesity (genetic

disorders: Badet-Biedl syndrome and Prader-

Willi syndrome)
Other Factors
 Increased birth weight and intrauterine
exposure to maternal diabetes
 Disease : hypothyroidism, growth hormone

deficiency, injuries to hypothalamus

 The use of a variety of drugs : insulin, lithium

etc.
 MANAJEMEN OBESITAS

Obesitas Kelebihan berat badan 20% di atas

standar

Refleksi ketidakseimbangan konsumsi dan

pengeluaran energi
Penyebab:
1. Exogenous (konsumsi E yang
berlebihan)
2. Endogenous (gangguan metabolik dalam tubuh  adanya
tumor pada hipotalamus menyebabkan hiperphagia/nafsu
makan berlebihan)
KATEGORI KEADAAN GIZI
BERDASARKAN IMT
IMT Kategori
< 17,0 Kurus berat
17,0 – 18,5 Kurus ringan
18,5 – 25,0 Normal
23 – 24,9 Beresiko Gemuk
> 25,0 – 27,0 Gemuk ringan
> 27,0 Gemuk berat
 Studi di Framingham (AS) Kenaikan 10% BB pria

Tekanan darah naik 6.6 mg/dl

Gula darah 2 mg/dl
Kolesterol 11 mg/dl
 Panjang umur berkorelasi terbalik dengan panjang ikat
pinggang
 Angka statistik dari perusahaan asuransi AS:
60% penderita obes yang bisa mencapai umur 60 tahun
(90% bagi yang normal)
30% penderita obes yang bisa mencapai umur 70 tahun
(50% yang normal)
Hereditas merupakan faktor penyebab obesitas
 peluang anak obes adalah 10%  orang tua normal
 peluang anak obes adalah 40%  salah satu orang
tua obes
 peluang anak obes adalah 80%  kedua orang tua
obes

Lingkungan ?
??

Anak kembar yang diasuh dalam lingkungan yang berbeda

mempunyai perbedaan BB yang lebih besar dibandingkan
yang diasuh dalam lingkungan yang sama
 Penderita obes kurang sensitif terhadap
rasa lapar (internal), tetapi lebih peka
terhadap bau dan rasa makanan (eksternal)
 cenderung makan terus.

 Mereka yang berbobot normal biasanya

makan lebih sedikit bila telah mengonsumsi
snack, tapi orang obes sebaliknya.
 Pengaruh Diit
:
1. Puasa 24 jam bobot badan turun 2-4 kg hari itu
juga (terutama air dan natrium keluar).
Tidak dianjurkan
2. Protein-Sparing Modified Fast (PSMF)
Diit rendah kalori (300 kal/hari)
Protein ditingkatkan: normal 1 g/kg BB 1.3-1.5 g ~
100g/hari
Protein tinggi untuk mengganti cadangan protein otot.
Satu minggu pertama BB turun drastis, hari-hari
berikutnya turun 0,1 – 0,2 kg/hari.
3. Diit Protein tinggi : protein 120 g
karbohidrat < 50 g
energi 1000 kal
Semua diit kalori rendah memaksa tubuh melakukan
penyesuasian metabolik: glikogen otot dipecah 
kadar gula normal, lemak tubuh dimobilisasi untuk
energi
4. Pengurangan Energi seimbang
• Mencukupi kebutuhan gizi
• Hanya energi saja yang dikurangi
• Karbohidrat < 100 g
• Protein 0.8-1.2 g/kg BB
• Batasi konsumsi lemak
 5. Dengan makanan formula
• iklan penuh janji
• bentuk makanan: cairan, bubuk, wafer, snack
• Diit formula: 900 Kal, 20% prot, 30% L, 50% KH
(relatif aman)
• diit formula 300 Kal (waspadai)
• Untung: tidak perlu menghitung jumlah dan jenis
makanan
Rugi : membosankan

Program Weight Watchers di AS: mengatasi obesitas

dengan modifikasi perilaku dengan bantuan peer group.
Anggotanya seolah menjadi masyarakat eksklusif yang
saling mengingatkan pentingnya pola makan yang baik.
 Modifikasi
Perilaku :
 Upaya mendisiplinkan diri untuk menghindari
kebiasaan makan yang jelek
 Sangat tergantung keinginan individu untuk
menurunkan BB
 Perlu ditanamkan rasa percaya diri akan suatu tujuan
bahwa menurunkan berat badan obes adalah penting
bagi kesehatan
 Memperhatikan faktor risiko kesehatan yang mungkin
muncul
 Pada keluarga ekonomi mapan
ketersediaan pangan biasanya berlebihan
 Modifikasi perilaku menghendaki
makanan tersedia di tempat yang
terbatas dengan jumlah secukupnya
 Menonton TV sambil ngemil harus
dikurangi
 Perlu dukungan dari lingkungan (teman
kuliah/bekerja) agar tidak menyimpan
makanan sembarangan
Hindari area yang banyak makanan (dapur, meja
snack pada pesta)
Kurangi kunjugan ke restoran
Jangan berbelanja ke supermarket ketika perut
lapar
Siapkan daftar belanja dan jangan menyimpang
Bila makan di luar rumah, pilih yang berkadar lemak
rendah
Lakukan exercise secara teratur
 DIET GOL DARAH

PETER J D’ADAMO :
SETIAP GOLONGAN DARAH
MERESPONS SECARA BERBEDA
TERHADAP MAKANAN YANG
DIKONSUMSI
 GOLONGAN DARAH

DARAH O : 50.000 – 25.000 SM

(PEMAKAN DAGING)

DARAH A : 25.000 – 15.000 SM

(AGRARIS)
 GOLONGAN DARAH

DARAH B : PERCAMPURAN ANTAR RAS

(MIGRASI DARI AFRIKA)

DARAH AB : 500 – 1000 TH LALU

 KELOMPOK MAKANAN
(dalam diet golongan darah)

BERMANFAAT : OBAT

NETRAL : KESEIMBANGAN GIZI

MERUGIKAN : SEPERTI RACUN

 BILA MAKANAN TIDAK SESUAI

GIZI TIDAK TERSERAP BAIK

OBESITAS
PENYAKIT DEGENERATIF

KELEBIHAN LEMAK ?
 GOLONGAN DARAH O

MERUGIKAN
IKAN LELE/CUMI
SUSU SAPI/ES KRIM
JAGUNG/GANDUM/KACANG TANAH
AVOKAD/PISANG RAJA
 GOLONGAN DARAH A
MERUGIKAN

DAGING SAPI/DOMBA
UDANG/KEPITING
SUSU/ES KRIM
JERUK/MANGGA/PEPAYA
 GOLONGAN DARAH B
MERUGIKAN
AYAM
UDANG/KEPITING
SUSU KEDELAI
KACANG KEDELAI
BELIMBING/TOMAT
 GOLONGAN DARAH AB
MERUGIKAN
DAGING SAPI
BELUT
SUSU SAPI/ES KRIM
JAGUNG
JAMBU BIJI/MANGGA
 MENYIKAPI DIET :
Diet seimbang : memangkas 500 Kalori
Asupan gizi lain tetap
Berat badan turun 2 kg per bln
Tanpa diet : makan jangan berlebihan, ngemil
secukupnya, olah raga 3x seminggu, jangan stres.
Beragam bergizi Seimbang dan aman, serta
halal
HYPERTENSION
 Hypertension : strong determinant of
CHD and stroke
 Blood pressure levels are very

sensitive to body fat, somewhat

sensitive to variation in sodium intake
 Responsive to diet rich in low-fat dairy

products, and fiber-rich fruits &

vegetables, even if energy and sodium
are not restricted
 HIPERTENSI
Definisi dan klasifikasi
 dahulu:

Hipertensi adalah jika tekanan darah

sistolik ≥ 140 mm Hg atau jika
tekanan darah diastolik ≥ 90 mm Hg
 Sekarang ≥130/80 mm Hg
Tensi
 Normal: berada di bawah 120/80 mmHg.
 Meningkat: berkisar antara 120-129 untuk

tekanan sistolik dan < 80 mmHg untuk

tekanan diastolik.
 Hipertensi tingkat 1: 130/80 mmHg hingga

139/89 mmHg.
 Hipertensi tingkat 2: 140/90 atau lebih

tinggi.
 HIPERTENSI
Klasifikasi Tekanan Darah :
Kategori Tek.darah (mm Hg)
Sistolik Diastolik
Optimal < 120 dan < 80
Normal < 130 dan < 85
Normal tinggi 130-139 atau 85-89
Hipertensi
Stage 1 140-159 atau 90-99
Stage 2 160-179 atau 100-109
Stage 3 ≥ 180 atau N ≥ 110
 PREVALENCE AND INCIDENCE

Di AS :
 Overall, 28% of American adults have
High Blood Pressure (HBP)
 With aging, the prevalence of HBP
increases. Before the age of 55, more
men than women have HBP. After age
65, the rates of HBP in women in each
racial group surpass those of the men
in their group.
 PREVALENCE AND INCIDENCE
Di AS (lanjutan):
 In the third National Health and
Nutrition Examination Survey (NHANES
III, 1992-1994), 32% of persons with
hypertension were not aware that they
had it, 15% were aware and untreated,
and 26% received treatment but did not
reach recommended blood pressure
goals. Thus only 27% of Americans
were adequately controlling their blood
pressure.
PREVALENCE AND INCIDENCE

Di AS :
 The Healthy People 2010 goal is for at
least 50% of people with hypertension to
normalize their blood pressure through
lifestyle or pharmacologic treatment.
PREVALENCE AND INCIDENCE
Di Indonesia :
 Penelitian Monica 1994 (di masyarakat) pada
kelompok umur 45-54 tahun menunjukkan
tekanan darah tinggi sebesar 16,5% pada laki-
laki dan wanita 17 %.
 Dari Survei Kesehatan Rumah Tangga (SKRT)
1995, prevalensi hipertensi di Indonesia adalah
8.3%.
 Survei faktor risiko penyakit kardiovaskular (PKV)
oleh proyek WHO di Jakarta  angka prevalensi
hipertensi dengan tekanan darah 160/90 pada
pria 12,1% (thn 2000), pada wanita 12,2% (thn
2000).
Prevalensi Hipertensi nasional
Riskesdas 2013: 25,8%,
tertinggi di Kepulauan Bangka Belitung
(30,9%), terendah di Papua sebesar (16,8%).
25,8% orang yang mengalami hipertensi
hanya 1/3 yang terdiagnosis,
hanya 0,7% orang yang terdiagnosis
minum obat Hipertensi.
sebagian besar penderita Hipertensi
tidak menyadari menderita Hipertensi
ataupun mendapatkan pengobatan.
Hipertensi banyak terjadi pada umur 35-44
tahun (6,3%), umur 45-54 tahun (11,9%), dan
umur 55-64 tahun (17,2%).

Menurut status ekonominya, proporsi

Hipertensi terbanyak pada tingkat menengah
bawah (27,2%) dan menengah (25,9%).

Menurut data Sample Registration System

(SRS) Indonesia tahun 2014, Hipertensi
dengan komplikasi (5,3%) merupakan
penyebab kematian nomor 5 (lima) pada
semua umur.
Data World Health Organization (WHO) tahun 2011
menunjukkan satu milyar orang di dunia menderita
Hipertensi, 2/3 diantaranya berada di negara
berkembang yang berpenghasilan rendah sampai
sedang.

Prevalensi Hipertensi akan terus meningkat tajam

dan diprediksi pada tahun 2025 sebanyak 29%
orang dewasa di seluruh dunia terkena Hipertensi.

Hipertensi telah mengakibatkan kematian sekitar 8

juta orang setiap tahun, dimana 1,5 juta kematian
terjadi di Asia Tenggara yang 1/3 populasinya
menderita Hipertensi sehingga dapat menyebabkan
peningkatan beban biaya kesehatan.
 PATOFISIOLOGI
 Blood Pressure is a function of cardiac
output multiplied by peripheral resistance
(the resistance in the blood vessels to the
flow of blood)
 Diameter pembuluh darah sangat
mempengaruhi aliran darah.
◦ Jika diamater menurun (mis pd
aterosklerosis), resistance dan tek darah
meningkat
◦ Jika diameter meningkat (dg terapi obat
vasodilator), resistance menurun dan tek
darah turun
PATOFISIOLOGI (lanjutan)
 Many systems maintain
homeostatic control of blood
pressure
1. Short-term control
The sympathetic nervous system
2. Long-term control
The kidney
PATOFISIOLOGI (lanjutan)
1. Short-term control
Sebagai respons thd penurunan tek
darah, The sympathetic nervous
system mensekresikan
norepinephrine, suatu
vasoconstrictor, yang akan bekerja
pd small arteries dan arterioles
untuk meningkatkan peripheral
resistance dan meningkatkan
tekanan darah
PATOFISIOLOGI (lanjutan)
2. Long-term control
Ginjal mengatur tekanan darah
dengan cara mengontrol volume
cairan ekstraselular dan
mensekresikan renin, yg akan
mengaktivasi sistem renin-
angiotensin
 Decreased arterial pressure

Renin (kidney)

Renin substrate Angiotensin I

Converting
Angiotensin II Enzyme (lung)
Angiotensinase
(Inactivated)

Renal retention Vasoconstriction

Of salt and water

Increased arterial pressure

Renin-Angiotensin Cascade
 PATOFISIOLOGI (lanjutan)
 Pd sebagian besar kasus hipertensi,
peripheral resistance meningkat.
 Resistance ini memaksa ventrikel kiri jantung

untuk meningkatkan usahanya dlm

memompa darah.
 Seiring berjalannya waktu, ventrikular kiri

mengalami hipertrofi dan akhirnya menjadi

congestive heart failure
 Primary Prevention
 Lifestyle
Modifications for
Hypertension Prevention and
Management
◦ Lose weight if overweight
◦ Limit alcohol intake
◦ Increase aerobic physical activity to 30-
45 min most days of the week
◦ Maintain adequate intake of dietary
potassium
 Primary Prevention
 Lifestyle
Modifications for
Hypertension Prevention and
Management (lanjutan)
◦ Maintain adequate intake of dietary
calcium and magnesium for general
health
◦ Stop smoking
◦ Reduced intake of dietary saturated fat
and cholesterol for overall
cardiovascular health
 Primary Prevention
Dietary Factors
1. Changing 4 modifiable factors has
documented efficacy in the primary
prevention and control of
hypertension. These 4 factors are:
1. Overweight
2. High salt intake
3. Alcohol consumption
4. Physical Inactivity
 Primary Prevention
Dietary Factors (lanjutan)
2. Intervension Trial :
 A 5-year intervention trial in
normotensive men and women
demonstrated that lifestyle changes
could lessen the incidence of
hypertension.
 Primary Prevention
Dietary Factors (lanjutan)
 Intervention goals were to :
1. Lose 4.5 kg or 5% of body weight
2. Follow an AHA fat-modified diet
3. Reduce sodium intake to 1800 mg
daily or less
4. Limit alcohol to no more than 2
drinks per day
5. Increase physical activity to 30
minutes three times per week
 Primary Prevention
Dietary Factors (lanjutan)
 The incidence of hypertension was 8% in
the intervension group and 19% in the
control group.
3. The DASH (Dietary Approaches to Stop
Hypertension) study showed that a diet
high in fruits, vegetables, and nonfat dairy
foods and low in saturated fat and total fat
decrease SBP an average of 6-11 mmHg.
The total diet was more effective than just
adding fruits and vegetables.
 Primary Prevention
Other Dietary Factors
1. Potassium
 In population studies, dietary
potassium and blood pressure are
inversely related  higher
potassium intakes are associated
with lower blood pressures
 A meta-analysis found that high
dietary potassium may help prevent
and control hypertension
 Primary Prevention
Other Dietary Factors
1. Potassium (lanjutan)
 Effects of potassium intake on blood
pressure include :
1. Reduced peripheral vascular resistance
by direct arteriolar dilatation
2. Increased loss of water and sodium
from the body
3. Suppression of renin and angiotensin
secretion
4. Stimulation of the sodium-potassium
pump activity
 Primary Prevention
Other Dietary Factors
2. Calsium
 The JNC (The Joint National Comittee on
Detection, Evaluation, and treatment of
HBP) VI includes recommendations for
prevention and management of
hypertension, including increasing
potassium, calsium, and magnesium
intake along with aggressive control of
blood pressure.
 An intake of dietary calsium to meet the
goal of 1000 to 2000 mg daily is
recomended
 Primary Prevention
Other Dietary Factors
3. Magnesium
 Magnesium is a potent inhibitor of
vascular smooth-muscle contraction
and play a role in blood pressure
regulation as a vasodilator
 An inverse relationship has been
reported between dietary
magnesium and blood pressure
(JNC, 1997)
 Primary Prevention
Other Dietary Factors
3. Magnesium (lanjutan)
 In most clinical studies, however,
magnesium supplementation has been
ineffective in altering blood pressure,
possibly because of the confounding
effects of antihypertensive medications
and the short duration of the studies.
 Overall, adequate data are lacking to
recommend routine supplementation
with magnesium to prevent
hypertension.
 Primary Prevention
Other Dietary Factors
4. Lipids
 Fewer vegans have hypertension
than omnivores, even though their
salt intake is not significantly
different.
 The Vegan diet tends to be higher in
PUFAs among other nutrients, and
lower in total fat, saturated fatty
acids, and cholesterol.
 Primary Prevention
Other Dietary Factors
4. Lipids (lanjutan)
 PUFAs are precursors of
prostaglandins, whose action affect
renal sodium excretion and relax
vascular musculature. Thus an effect
on blood pressure is plausible
(masuk akal).
 Primary Prevention
Other Dietary Factors
4. Lipids (lanjutan)
 Both the amount and type of fat have
been studied with respect to blood
pressure. In a large cohort study of
male health professionals (Ascherio et
al 1992), neither total fat nor specific
fatty acids were related to baseline
blood pressure or incidence of
hypertension over a 4-year period.
 Primary Prevention
Other Dietary Factors
4. Lipids (lanjutan)
 Most other studies have found no
hypotensive effect of PUFAs, which led
the National High Blood Pressure
Education Program Working Group
(1994) to conclude that “macronutrient
alteration has limited or unproven
efficacy in the primary prevention of
hypertension”
 Primary Prevention
Other Dietary Factors
4. Lipids (lanjutan)
 More recently, studies have shown
that supplementation with large
doses of fish oil (median dose 0f 3,7
g/day) can give a modest reduction
in SBP and DBP, especially in older
hypertensive persons.
 Primary Prevention
Other Factors
 Factors other than dietary fat, such as
increased potassium levels, appear to
lower blood pressure in vegans.
 Although dietary lipids do not seem to
affect blood pressure, they strongly
affect CVD risk; thus, the step I diet is
recommended for preventing
complications from hypertension and
CVD.
 Primary Prevention
Other Factors (lanjutan)
 Although fatty acids may not directly
affect blood pressure, an olive oil-
enriched diet has been shown to
decrease antihypertensive drug usage
by 48% (Ferrara 2000).
 Soy protein is another factor that may
contribute to the lowering of blood
pressure (Hecker 2001)