بسم اهللا الرحمن الرحيمبسم اهللا الرحمن الرحيم

DIETARY SUPPLEMENT

Nutrition DeptNutrition DeptFaculty of Medicine,

University of Sumatera Utaray

definisidefinisi

Adalah makanan buatan yang ditujukan untuk mencukupi kekurangan zat-zat gizi.p g g

• Bentuk : - kapsulp- kapsul lunak- tablet

b b k- bubuk- cairan

KandunganKandungan

MakronutrienMikronutrien vitamin mineralMikronutrien vitamin, mineralDapat tunggal atau kombinasi

Zat gizi penting di dalam makanan(dibutuhkan untuk kesehatan)

MakronutrienProteinKarbohidrat

air

Lemak

Vitamin8 vitamin B (tiamin,niacin, riboflavin, asam folat,

MineralCa, Fe, Mg, Mn, Se, Na K V Bo I S Cl , , ,

Vitamin B 12, Vitamin B6, Asam pantotenat, biotin)Vitamin CVitamin A D E K

Na, K, V, Bo, I, S, Cl,P, Cr, Cu, F, Mo, Zn

Vitamin A, D, E, K

Do YOU Need a Dietary S l t?Supplement?

P l t tid k ?•Perlu atau tidak ?

•Kapan dibutuhkan ?•Kapan dibutuhkan ?

•Seberapa banyak dibutuhkan ?p y

•Siapa yang membutuhkan ?

I lid Invalid reasons

The belief that the food supply or soil contains inadequate nutrientsThe belief that supplements can provide energyThe belief that supplements can enhance athletic performance or build lean body tissue without physical performance or build lean body tissue without physical work or faster than work aloneThe belief that supplements will help a person cope with stressThe belief that supplements can prevent, treat, or cure conditions ranging from common cold to cancerconditions ranging from common cold to cancer

Who needs supplements?

People with nutrient deficienciesPeople with low food energy intake (<1200 kcal/day)Vegans and those with atrophic gastritis (need

B 2vitamin B12)Women who bleed excessively during

t ti ( d i )menstruation (needs iron)People with lactose intolerance or milk allergies, or who do not consume enough dairy products to or who do not consume enough dairy products to forestall extensive bone loss, need calcium

People in certain stages of the life cycle who People in certain stages of the life cycle who have increase nutrient needsPeople with limited milk intake and sun pexposure need vitamin DPeople who have disease, infection, or injuries

h h d h i f or who have undergone surgery that interferes with intake, absorption, metabolism & excretion of nutrientsexcretion of nutrientsPeople taking medications that interfere with the body’s use of specific nutrients

Kondisi yang dapat menyebabkan kekurangan zat gizi

Growth in children

Old age alcoholism or Drug addiction

reducing diets

Increased requirement

Low food intake

Restricted Food choicerequirement intake Food choice

Therapeutic diets

VegetarianismIllness Pregnancy & lactation

Tidak dibutuhkan pada :

Orang dengan sumber zat makanan yg mencukupimencukupiOlah ragaCukup istirahat dan tidurCukup istirahat dan tidurKehidupan teraturTdk stressTdk stressBebas dr bhn pencemar (udara, mkn, air).

Recommendations for Nutrient Intake

Dietary Reference Intakes (DRIs)

Reference values of nutrients, primarily used by nutrition & health professionalsy p

Basis for assessing & planning diets of healthy peoplefederal nutrition & food programs

What are the purposes of the DRIs?What are the purposes of the DRIs?

To maintain nutritional adequacyTo promote healthTo reduce risk of chronic diseaseTo provide a measure for evaluating inadequacy and/or excessand/or excessTo assess intakes as distributions

Across population groupsIn individuals

To plan diets

Wh t th diff t What are the different DRI values?

Estimated Average Requirement : EARg qRecommended Dietary Allowance : RDAAdequate Intake : AIAdequate Intake : AITolerable Upper Intake Level : UL

Estimated Average Requirement

Nutrient intake to meet the requirement of half the requirement of half the healthy people of an age & gendergenderThe MEDIAN Basis for establishing an RDABasis for establishing an RDA

Recommended Dietary Allowance

Nutrient intake to meet the requirement for nearly all (97-98%) healthy people of an age & genderage & genderDerived from an EAR EAR 2 t d d EAR + 2 standard deviations

EAR RDAEAR RDA

40

45

50

40

45

50

25

30

35

40

of P

eopl

e

25

30

35

40

of P

eopl

e

10

15

20

25

Num

ber

o

10

15

20

25

Num

ber

o

0

5

10

0 50 100 150 200 250

N

0

5

10

0 50 100 150 200 250

N

Actual Nutrient RequirementActual Nutrient Requirement

Adequate Intake

Nutrient intake of healthy people assumed to be adequateUsed when an RDA cannot be establishedInsufficient data to determine an EARBased on observed intakes, experimental data, etc.When AIs are used this reflects lack of When AIs are used, this reflects lack of knowledge and need for more research

Tolerable Upper Intake Level

Highest daily nutrient intake likely to pose no risk of adverse health effects to almost all the general populationall the general populationMore is not always better!Not a recommended levelNot a recommended level

No established benefits of higher levelIncreased risks at higher intakes

The naive view vs the accurate viewof optimal nutrient intakeof optimal nutrient intake

Danger oftoxicityTolerable Upper

Intake levelsafety

Safety

Intake level(UL)

d

y

Danger of danger Danger of deficiency

K b t h t i iKebutuhan zat gizi

Sangat individualDipengaruhi tingkat kesehatanp g gBerdasarkan AKG untuk rata-rata orang Indonesia yang sehaty gDibedakan berdasarkan kelompok umur dan jenis kelaminj

Vitamin AVitamin A

RETINOL � HATI� GINJAL� MENTEGA� KUNING TELUR� SUSU�

MINYAK IKAN

BETA KAROTEN � SAYURAN DAUN HIJAU TUA� SAYURAN � BUAH BERWARNA KUNING�

MINYAK KELAPA SAWIT�

Kandungan vit A dalam bahan makanan

Apel 1 buah 70 IUPisang 1 buah 90Pisang 1 buah 90Peach 1 buah 470Selada 100 g 446gTomat 1 buah 1390Brokoli ½ cup 1090pBayam ½ cup 7370Wortel ½ cup 19.150

Vi i EVitamin E

Bahan makanan sumber :

Minyak nabati (kedele, jagung) dan d k ( i )produknya (margarin)

Whole grain products, wheat germ.S b d hij tSayuran berdaun hijau tua.hati, telur, kacang.

Kandungan vit E/100 g bahan makanan

Kerang 37,5Kentang goreng 1 5Kentang goreng 1,5Kacang 8,1Min ak 14 7Minyak 14,7Kol 2,4

Vitamin C

Bahan makanan sumber :Bahan makanan sumber :Jeruk, anggur, lemon, jeruk nipis.Strawbery dan berry lain melonStrawbery dan berry lain, melonKol, brokoli, sayuran berdaun hijau,Kentang tomatKentang, tomat

Kandungan vit C (mg/100g) bahan makanan

Brokoli 39,6Kembang kol 62,7Bayam 52,4Bayam 52,4Wortel 30,3Pisang 18 6Pisang 18,6Jeruk 64,3A 23 6Anggur 23,6

KEBUTUHAN VITAMIN PERHARIKEBUTUHAN VITAMIN PERHARI( RDA = RECOMMENDED DAILY ALLOWANCES )

VITAMIN PRIA WANITA

A 1000 IU 800 IU

D 5 ug 5 ug

3 E 3 mg 4 mg

K 80 ug 65 ug

B1 1,5 mg 1,1 mg, g , g

B2 1,7 mg 1,3 mg

B3 19 mg 15 mg

B5 4 – 7 mg 4 – 7 mg

B6 2,0 mg 1,6 mg

B12 2,0 mg 2,0 mgB12 2,0 mg 2,0 mg

C 60 mg 60 mg

Konsumsi megadosis dapat membahayakan Konsumsi megadosis dapat membahayakan

N t i t di l k b ik did t d i Nutrient yang diperlukan sebaiknya didapat dari bahan makanan.

Suplemen hanya digunakan jika memang dibutuhkandibutuhkan

ProteinProtein15%

Lemak20% KHKH

65%

Tujuan Nutritional support

Memastikan intake energi adekwat mencegah kehilangan BB g gMencegah negative nitrogen balance penurunan imune respons & fungsi liver dapat dicegah.Agar level mikronutrient & trace element cukup

tidak terjadi defisiensi

Pilihan tergantung pada :

Kebutuhan zat gizi individugKemampuan pasien utk mengkonsumsi makanan normal

Medical foods

Formula lengkapl d k l k d k d lFormula tidak lengkap, mis produk modular

lemak, protein atau karbohidratF l k khFormula makanan khusus

Getting The Variety of nutrientsGetting The Variety of nutrients

Diet yang seimbang berdasarkan the Food Guide PyramidMakanan yang bervariasi dapat menjamin Makanan yang bervariasi dapat menjamin kecukupan zat gizi.Tidak ada satu bahan makanan yang Tidak ada satu bahan makanan yang mengandung semua zat gizi dalam jumlah yang cukup.Diperlukan bahan yang bervariasi untuk mendapat makanan yang sehat

Figure 18-7P 641

Maintain a healthy weight. be physically active. Don’t smoke.

Fats, Oils & Sweets

• Limit salt to < 6 grams.• Reduce energy-rich foods high in sat. fat & sugar.• Use unsaturated fats instead of sat. or trans fats.• Drink alcohol in moderation, if at all.Page 641

• Eat < 4 eggs per week.• Eat red meat sparingly.• Eat low-fat or fat-

free milk products

Milk, Yogurt &Cheese Group Meat, Poultry,

Fish, Dry Beans,Eggs & Nuts Group

• Eat fish frequently.• Eat nuts and legumes often.

free milk products.

• Eat vegetables

Vegetable Group

F it G

• Eat fruit in abundance.

gin abundance. Fruit Group

• Eat whole-grain breads, cereals, rice, and pastas instead of refined products.

Bread, Cereal, Rice & Pasta Group

p

Food Guide Pyramid for Disease Prevention

Sayuran dan buah-buahan

‘5 porsi / hari’

Hooper L Dietetic Guidelines :diet in secondary preventionof cardiovascular diseaseof cardiovascular disease(J Human Nutr Dietet 2001)

Choose Food Instead of S l tSupplements

Food SupplementsFood

Fun

Supplements

Boring

Offers variety

D ’t h t b i

Lacks variety

C t l t f Doesn’t have to be expensive

Contains other healthful substances

Can cost a lot of money

Doesn’t contain other health benefitssubstances

Safe

benefits

Can be dangerous to your healthhealth

If li l i d If a little is good, i t ilmore is not necessarily

better”better”

الحمد هللاzzt 1208