Penatalaksanaan Diet Pada

Inflammatory Bowel Disease

Dr. Susetyowati, DCN, M.Kes
September 2019
 01 Meliputi Crohn’s Disease &
Ulcerative Colitis

Inflammatory
02 Penyakit Autoimmune,
Bowel Disease dipengaruhi faktor genetik
(IBD) & lingkungan

03 Biasanya terjadi pada usia

15-30 tahun
 INFLAMMATORY BOWEL DISEASE (INFLAMASI USUS)
Ulcerative Colitis
Penyakit kronik
dengan inflamasi
dan ulserasi pada
mukosa usus besar
 perdarahan
rektum dan diare
kronik

Gejala: feses dg pus

dan darah, diare,
sakit perut/kram,
anemia, demam,
stomatitis,
malnutrisi
Crohn’s Disease Ulcerative Colitis
• Small & large intestine. (mulut
sampai rectum). • Starts in rectum
• Segmental (“skip” areas) • Progresses in a retrograde fashion to colon
Inflammatory Bowel Disease

Crohn’s Disease

1
Melibatkan berbagai bagian
dalam saluran gastrointestinal
2
Melibatkan seluruh lapisan
mukosa dalam saluran cerna
3
Mengalami Steatorhea secara
frekuensi
4 Segmental (terpisah-pisah)
5 Mengalami striktur dan fistula

6
Progresifitas penyakit lambat
dan jarang terjadi malignansi
Ulcerative Colitis
Melibatkan kolon,
meluas hingga rektum

Continous (bagian yang

terinflamasi menyambung)

Melibatkan mukosa dan

sub-mukosa saluran cerna
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Tidak ditemukan steatorea;
Striktur dan fistula jarang
ditemukan

Remissions and Relapses

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Sering terjadi malignansi

Normal colon

Chron’s Disease

Ulcerative colitis
 Gejala IBD

Clinical
Features Kram Fatigue Nausea Anoreksia
• Food
intolerances
• Diarrhea, fever
• Weight loss
• Malnutrition
• Growth failure
• Extraintestinal
manifestation:
Artritis,
Dermatologi
hepatik
 NUTRITIONAL ASSESSMENT

Miele E, et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the
Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology,
Hepatology and Nutrition. JPGN. Vol 66, No 4, 2018
 NUTRITION ASSESSMENT

Miele E, et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the
Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology,
Hepatology and Nutrition. JPGN. Vol 66, No 4, 2018
 Kebutuhan Energi
Recent studies
have shown
resting energy
requirements are
not increased in
patients with
Crohn’s disease
 KARBOHIDRAT DAN SERAT
• Recommendation 1:
• A diet rich in fruit and vegetables, n-3 fatty acids, and low in n-6
fatty acids is associated with a decreased risk of developing
Crohn's disease (CD) or ulcerative colitis (UC)  recommended
• High dietary fibre and decreased risk of CD, with the protective
effect statistically significant in those consuming >22.1 g/d.
• High intake of fruit is associated with 73-80% decreased risk of CD.
This association was confounded by dietary fibre intake and the
fact that a diet high in fruits may conversely be low in fats and
meats
• Recommendation 4:
• In general, the energy requirements of patients with IBD are
similar to those of the healthy population

Forbes A, et al. ESPEN Guidelines : Clinical Nutrition in Inflammatory Bowel

Disease. Clinical Nutrition. 36(2017) pp. 321-347
 PROTEIN
• Recommendation 5 A:
• Protein requirement are increased in active IBD, and intake
should be increased (to 1.2-1.5 g/kg/d in adults) relative to that
recommended in the general population

• Recommendation 5 B:
• The protein requirements in remission are generally not elevated
and provision should be similar (about 1 g/kg/d in adults) to that
recommended for the general population

Forbes A, et al. ESPEN Guidelines : Clinical Nutrition in Inflammatory Bowel

Disease. Clinical Nutrition. 36(2017) pp. 321-347
IBD
NUTRITIONAL RENDAH SISA :
MANAGEMENT Mengurangi diare
(ACUTE)
RENDAH SERAT :
Mencegah obstruksi

NUTRISI PARENTERAL :
Untuk mengistirahatkan usus

PORSI MAKAN :
Makan porsi kecil tetapi frekuensi sering

SUPLEMENTASI :
Suplementasi MCT jika terdapat
malabsorbsi
IBD NUTRITION MANAGEMENT
(CHRONIC)

PROTEIN TINGGI

KALORI TINGGI

VITAMIN – MINERAL STATUS

Iron, calcium, selenium, folate, thiamin,
riboflavin, pyridoxine, vitamin B12, zinc,
magnesium, vitamins A, D, E

TINGGI SERAT DIPERBOLEHKAN

Risiko Defisiensi Gizi Pada IBD
 Anemia in IBD

Prevalence 6.2 – 74%

Etiology:
a. Iron deficiency: 36 – 90%
b. Anemia of chronic disease: ~11%
c. Severe GI bleeding, vitamin
B12/Folate def, etc <5%
d. Inadequate dietary intake <1%
 Iron
 Blood losses sering terjadi pada ulcerative colitis  ADB 
Kejadian ini sulit dikoreksi dengan terapi diet saja.

 Perlu suplemen zat besi, disertai dengan makanan sumber

vitamin C (suplemen)  meningkatkan bioavailabilitas

Iron deficiency
a. Oral iron supplements: Niferex; Ferrous sulfate
b. Parenteral: Iron Sucrose; Iron Dextran

Severe anemia Blood transfusion

Miele E, et al. Nutrition in Pediatric
Inflammatory Bowel Disease: A
Position Paper on Behalf of the Porto
Inflammatory Bowel Disease Group of
the European Society of Pediatric
Gastroenterology, Hepatology and
Nutrition. JPGN. Vol 66, No 4, 2018
 MALNUTRISI PADA IBD
• Recommendation 24 C:
• If malnutrition is diagnosed  IBD surgery should be delayed
for 7-14 days whenever possible, and that time should be used
for intensive artificial feeding
• Recommendation 27 A:
• Normal food intake or EN can be commenced early after
surgery in most IBD patients in the postoperative phase
• Recommendation 28:
• All IBD patients in remission should undergo counselling by a
dietician as part of the multidisciplinary approach to improve
nutritional therapy and to avoid malnutrition and nutrition
related disorders

Forbes A, et al. ESPEN Guidelines : Clinical Nutrition in Inflammatory Bowel

Disease. Clinical Nutrition. 36(2017) pp. 321-347
 DUKUNGAN GIZI PADA IBD
• Recommendation 15 B:
• If oral feeding is not sufficient then tube feeding should be considered
as supportive therapy.
• Recommendation 18 A:
• Standard EN (polymeric, moderate fat content, no particular
supplements) can be employed for primary and supportive nutritional
therapy in active IBD
• Recommendation 24 A:
• Patients who do not meet their energy and/or protein needs from
normal food  take oral nutritional supplements (ONS) during the
perioperative period

Forbes A, et al. ESPEN Guidelines : Clinical Nutrition in Inflammatory Bowel

Disease. Clinical Nutrition. 36(2017) pp. 321-347
 SUPLEMENTASI PADA IBD
• Recommendation 7 A:
• Iron supplementation is recommended in all IBD patients when iron
deficiency anaemia is present
• Recommendation 8:
• There is no “IBD diet” that can be generally recommended to promote
remission in IBD patients with active disease
• Recommendation 12 B:
• IBD patients with hyper-oxaluria often also have fat malabsorption and
these patients should be counselled regarding fat malabsorption
• Recommendation 14 B:
• Probiotics should not be used for treatment of active CD

Forbes A, et al. ESPEN Guidelines : Clinical Nutrition in Inflammatory Bowel

Disease. Clinical Nutrition. 36(2017) pp. 321-347
Recommendations on Foods to Eat and Avoid
for IBD
Tips for Managing IBD with a Healthy Diet

• Eat smaller meals

• Have more frequent meals
• Eat in a relaxed atmosphere
• Avoid trigger foods
• Limit food with insoluble fiber (i.e., seeds,
nuts, beans, green leafy vegetables, fruit
and wheat bran)
• Reduce the amount of greasy or fried foods
Con’t
 Con’t

• Carefully Select and Prepare

Sources of Fiber
• Eat a Variety of Vegetables and
Fruits
• Select the Right Grains
• Choose the Best Sources of Protein
• Get Enough Calcium
• Maintain Adequate Caloric Intake
TERAPI DIET PADA CELIAC DISEASE
 PENYAKIT SELIAK (Sariawan Nontropikal/Enteropati
Gluten Sensitif)

 Atrofi vili usus disebabkan intoleransi gluten.

 Daerah permukaan usus berkurang  kehilangan

aktivitas enzim disakaridase dan peptidase

 Gejala : diare, steatorea, gangguan penyerapan KH,

protein , lemak, kehilangan BB
 TERAPI DIIT
 Diet Bebas Gluten

Bahan makanan sumber gluten:

Gandum, jawawut, gabah, havermout,
tepug terigu, tepung maezena, sereal, roti,
pasta (spageti, mi, makaroni, dll)., biskuit
dan bahan makanan lain hasil produk
gandum dan sereal
TERAPI DIET PADA DIVERTIKULAR
 PENYAKIT DIVERTIKULAR
 Kondisi adanya kantong2 kecil di dinding kolon
 Satu kantong (diverticulum)
 Banyak kantong (divertikula)
 Kantong meradang/ infeksi  divertikulitis
 Banyak terdapat di negara barat  pola makan
siap saji  rendah serat.

 Pada Usia lanjut

 Penyebab utama konstipasi  kurang serat
dalam diit  Peningkatan tekanan pada colon
 Pencegahan  diit cukup serat
 Diverticulitis: MNT for acute disease

 Cairan jernih
 Mulai diet lunak dengan menghindari bumbu
tajam atau serat.
 Hindari kacang-kacangan, biji-bijian, popcorn,
sayuran berserat
 Pastikan cukup asupan protein dan zat besi
 Setelah peradangan berkurang  serat normal
Diverticulosis: MNT for chronic disease

Diet tinggi serat (meningkat secara

bertahap)
Asupan cairan cukup-tinggi, 2-3 L
Diet rendah lemak mungkin menolong
 HAEMORRHOID
 Varises atau pecahnya
pembuluh darah
disekitar anal
sphincter  internal
atau external

 Penyebab  sering
konstipasi, kehamilan,
penggunaan obat
pencahar yang terlalu
lama
 TERAPI DIIT

 Mencegah konstipasi  tekanan feses yang keras

 perdarahan dan rasa sakit.
 Akut  diberikan diit rendah sisa dan rendah serat
 Secara bertahap serat ditingkatkan  mencegah
konstipasi
 Cukup cairan : 8-10 gelas sehari
 DIIT TINGGI SERAT

Buah2an : 3-5 porsi sehari : apel, orange, peer,

nanas, dll
Sayuran 4 porsi sehari
Sereal / roti : 4 porsi sehari (beras merah,
oatmeal, roti coklat)
Protein  3 porsi sehari
Minuman : 6-8 gelas sehari
Thank you
SELAMAT BELAJAR !