nutrisi psikiatri

7/29/2019 nutrisi psikiatri

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NUTRITION ROLE IN BRAIN AND

MENTAL HEALTH

dr. Nazly Hanim, D.A.Nut., MA.

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Learning Objectives

To understand and able to describe the

nutritional role on brain and mental

development

To describe the nutrient role on the brain andmental function

To understand the way to prevent and overcome

neuropsychiaric problems from nutritional point

of view

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Basic Principles

I. Undernutrition is the primary cause of thehigh rates of infant morbidity and mortality indeveloping countries

II.

The combination of inadequate food intakeand deprived family environment has adevastating effect on the growth anddevelopment of a child, especially on hisintellectual development

III. Recent evidence indicates a causal relationshipbetween undernutrition and deficient mentalfunction

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The Effects of Undernutrition to Brain

Growth

In most regions of the brain, the total number ofcells present in adults is largely determined bythe end of the first year of life

When undernutrition is imposed during theproliferative phase of growth, the rate of celldivision is slowed, the ultimate number of cellsreduced. This change is permanent.

The brain cell number can be reduced by 15% to20% when it occurs during the entire period oflactation.

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The Effects of Undernutrition to Brain

Growth

Deficiencies in nutrients such as vit A, B6, folicacid, zinc, and magnesium may also affectdevelopment of the nervous system

If it persists beyond 8 months of age, the size ofcells will also be reduced. Total cholesterol orphospholipid content is reduced, hence, thenumber or length of myelin sheaths is reduced.This leads to a retarded dendritic branching

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Undernutrition and Mental

Development

In studies, the specific effects of undernutrition

on brain development in humans are

inseparable from effects of the environment.

Adequate nutrition generally is part of a goodenvironment and undernutrition occurs

primarily in poor and limited environments

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Development

Early undernutrition in a deprived environment

interferes with subsequent learning ability

Among the poor, a better nourished, taller ones

generally score higher in IQ tests. The lowestIQs are usually associated with the poorest

prior nutritional status

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Development

Performance on psychological tests was found

to be related to dietary practice and not to

differences in personal hygiene, housing, cash

income, crop income, proportion of incomespent on food, parental education, or other

social or economic indicators.

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Development

Performance of both preschool and schoolchildren on the Terman and Goodenough draw-a-man tests was positively correlated with bodyweights and heights

The most important variable reflected by theshort stature was poor nutrition during early lifeand that this also led to the lag in developmentof sensory integrative competence

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Development

The exact time span when undernutrition has

the most serious effect on the brain is not yet

known

In a study done in Jamaica, all of the chilrenfrom a low-income group undernourished at any

time during the first 2 years of life had

significant behavioral abnormalities at school

age

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Rehabilitation from Undernutrition

There are indications that the deleterious

effects on development of early undernutrition

can be reversed

When malnourished children before their 2ndbirthday have better prognosis when they are

placed in a good nutrition and stimulating

environment

The well-nourished and stimulated children

have the highest learning capacity

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Rehabilitation from Undernutrition

Preliminary results show that the test levels of

the stimulated undernourished children are

higher than those of the children from the

higher socio-economic group who were notstimulated

Results show that the well-nourished and

stimulated children have the highest learning

capacity

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The Relationship between Brain

Chemicals and Nutrients13


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Introduction

Nearly 50 compounds have been discovered to act as

neurotransmitter (NT)

The ability NT synthesis depends upon the availability of

precursor compounds in diet

Synthesis and release of NT can be altered to some

extent by certain foods

Amino acids are the precursors of NT

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Amino Acids and Neurotransmitter

Tryptophan Serotonin

Lecithin & Choline Acetylcholine

Tyrosine the Catecholamines

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Vitamins and Trace Minerals

Serious deficiencies of thiamin, vitamin B6, B12,vitamin C, and folic acid can also provokepsychiatric symptoms

Mild vitamin deficiencies might cause some

impairment of brain functionThe known minerals which deficiency may result

on brain and nerve function damage are: Iodine,Iron, Zinc, Copper, Calcium, Manganese,

MagnesiumWhile high lead and mercury levels result in

central nervous system abnormalities

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Hyperactivity in Children

The use of diet therapy to treat hyperactivechildren has always been questionable

The Feingold Diet proposed that salicylates,artificial food colors, and artificial flavors causedhyperactivity

In autistic children, gluten and casein cannot bedigested completely leaving peptides that canfunction as opoid or endomorphin, hence glutenfree and casein free diet is recommended forautistic children.

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Hyperactivity in Children

Caffeine has been claimed to cause hyperactivity

The truth is caffeine causes increased motor

activity and fidgetiness in pre-adolescent boys

Sugar consuming directly enhances serotoninproduction, predicting that sugar may have

calming effect on children, rather than being

more hyperactive

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Malnutrition and Behavior

While most links between diet and behavior are

weak, there is no question that severe

malnutrition can have a significant impact on

behavior, particularly in childrenMalnourished children tend to have difficulties

in learning to speak, in adaptive and

motivational behavior, interpersonal

relationships, and development of motor skills

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Breakfast and School Performance

Far more subtle are the learning difficulties that

may or may not relate to fasting in school-

children

In general, it was found that children who atebreakfast performed better throught the

morning on different measures of cognitive

performance than those who skipped it

The optimal breakfast was one that was

balanced in protein, carbohydrates, and fats

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Medical Nutrition Therapy

for Psychiatric Conditions21


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Nutritional Aspects of Brain and Nervous

System Structure and Function

One of the most important contributions of nutrition to

mental health is the maintenance of the structure and

function of the neurons and brain centers coordinating

communication within the body and between the body

and the environment

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Nutritional Aspects of Brain and Nervous

System Structure and Function

Sixty percent of the brains dry weight is fat, and

under optimal conditions 25% of this fat isdocosahexaenoic acid (DHA), an omega-3 (n-3)fatty acid

n-3 fatty acids appear to be the type of fatpreferred by the brain and nervous system

Each of the three n-3 has been found to haveunique, important, and noninterchangeablecontributions to overall brain and nervoussystem functioning

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Eicosapentaenoic Acid (EPA) &

Docosahexaenoic Acid (DHA)

EPA (20:5 n-3) is primarily found in fish

Under conditions of tissue DHA saturation, DHA

can retroconvert into EPA

DHA (22:6 n-3) is also primarily found in fish,which obtain it by eating marine algae

DHA is stored in the fishs muscle tissue and can

also be obtained from marine algae as

supplements

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Omega-3 Fatty Acids

and Brain Function

DHA is the brains building block, providing

structure to neurons and is an anchor point forneurotransmitter receptor

DHA also has an antioxidant effect

Adequate DHA is important for maintaininghealthy neurotransmitter function, including fordopamine and serotonin

DHA has the ability to raise the seizurethreshold of the nervous system

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Obtaining Adequate DHA and EPA

Obtaining and retaining DHA and EPA depend on

adequate intake, as well as important lifestyle

and macro nutritional choices

It is often what is eaten in addition to DHA andEPA that determines whether overall essential

fatty acid levels are adequate

The daily needs of omega-3 fatty acids

recommended by ISSFAL is 220 mg each of both

DHA and EPA.

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Source of DHA and EPA

Currently DHA and EPA are appearing in foods in

four different forms: Menhaden,

Microencapsulated Fish Oil Powder, DHA and

EPA Produced by Other Livestock and MarineAlgae

It is important to note that eggs and marine

algae-based products contain DHA only

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During Infancy

One of the most important sources of DHA and

EPA is mothers milk

Reduced time spend between mother and

babies has reduced the availability of omega-3fatty acids to babies.

Important Note : Some baby formulas contain

only DHA as their source is marine algae

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During Adulthood

Long-chain fatty acid (LCFA) supplements willoften improve depression and its relatedpathology

They should be used with vitamin Esupplementation to make sure that they are notoxidized and are thus effective

Patients with bipolar disorder, postpartumdepression, schizophrenia, dementia,alcoholism, tardive dyskinesia and otherpsychiatric conditions may also improve withLCFA supplementation

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Nutrition Recommendations

Goal 1 : Consumption of Dietary DHA and EPA

Goal 2 : Maintenance of a Diet With a Low Total

Daily Omega-6 to Omega-3 Ratio

Goal 3 : Avoidance of Restrictive Diets thatEncourage Rapid Weight Loss

Goal 4 : Increased Antioxidant Intake

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Eating Disorders

Includes :

Anorexia Nervosa (AN)

Bulimia Nervosa (BN)

Eating Disorders Not Otherwise Specified (EDNOS)

Binge Eating Disorder (BED)

Treatment requires a multidisciplinary approachincluding psychiatric/ psychological, medical, andnutritional intervention

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Nutrition Rehabilitation and

Counseling

Nutrition rehabilitation includes nutrition

assessment, medical nutrition therapy (MNT),

nutrition counseling, and nutrition education

Nutrition assessment routinely includes a diethistory and the assessment of biochemical,

metabolic, and anthropometric indices of

nutrition status

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Diet History

Guidelines include assessment of energy intake,

macro & micronutrient consumption, eating attitudes

& behaviors

BN : Energy intake may be unpredictable Energyelimination by vomiting is below energy consumption

Many AN patients follow vegetarian diets

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Diet History

Inadequate calorie + limited variety + poor foodgroup representation = inadequate vitamin andmineral consumption

Micronutrient intake parallels macronutrientintake (fat fatty acid & fat soluble vitamins)

Extreme fluid restriction or consumption mayrequire monitoring of urine specific gravity andserum electrolytes

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Eating Behavior

Patients tend to regard foods as absolutely

good or absolutely bad

Determine unusual or ritualistic behaviors

Determine meal spacing and length of timeallocated for a meal

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Anorexia Nervosa

Goals of Nutritional Rehabilitation

Correction of biologic and psychological

sequelae of malnutrition

Restoration of body weights

Normalization of eating patterns, eatingbehaviors, and hunger/satiety cues

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Bulimia Nervosa

Goals of Nutritional Rehabilitation

Interruption of the binge-and-purge cycle

Restoration of normal eating behavior

Stabilization of body weight

Cognitive Behavioural Therapy

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The nutritionists role is to help develop a

reasonable plan of controlled eating whileassessing the patients tolerance for

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Bulimia Nervosa

Estimating Initial Caloric Prescriptions

1. For a typical week, ask patient to estimate thenumber of binge/purge days (B/P),binge/nonpurge days (B/nP), moderate-intakedays (MI), and restrained-intake days (RI)

2. Have the patient describe a typical food on aB/P, B/nP, MI, and RI days

3. Estimate 50% of the caloric intake on the B/P,and 100% on the B/nP, MI, and RI

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Bulimia Nervosa

Estimating Initial Caloric Prescriptions

4. Calculate the total caloric intake over the 7-

day period

5. Calculate an average daily intake. The RD can

than formulate an initial eating and meal planbased on this estimated average daily intake

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Guidelines for Medical Nutrition Therapy for AN

and BN

Fat : 25%-30% ; provide source of essential fattyacids

Protein : 15%-20%, minimum : RDA in g/kg idealbody weight ; high biologic vale sources

Carbohydrate : 50%-55% ; encourage insolublefiber for treatment of constipation

Multivitamin-mineral preparation to ensure

adequacy, particularly in the initial phase,especially calcium, iron and vitamin D

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Nutrition Education

Though patients tend to have knowledge aboutfood and nutrition, nutrition education is still anessential component of the treatment plan

The patients may receive from unreliablesources or have distorted interpretation

Choose the information carefully, some sourceindicate a low-fat low-calorie intake (for

preventing chronic disease)

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Prognosis

Relapse rates after weight restoration in AN is high,

Adolescents have better outcomes than adult, and

younger adolescents is better than older adolescents

Mortality rates in AN : among the highest in psychiatric

illness half is caused by emaciation, half to suicide

(Palmer, 1990)

AN women are 12 times more likely to die than women

of similar ages in the general population

BN patients have a short-term success rate of 50%-70%,

and a relapse rates of 30%-85%

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