DIETARY SUPPLEMENT Nutrition Dept Faculty of Medicine, University of Sumatera Utara بسم الله الرحمن الرحيم

definisi Adalah makanan buatan yang ditujukan untuk mencukupi kekurangan zat-zat gizi. Bentuk : - kapsul - kapsul lunak - tablet - bubuk - cairan

Kandungan Makronutrien Mikronutrien  vitamin, mineral Dapat tunggal atau kombinasi

Zat gizi penting di dalam makanan (dibutuhkan untuk kesehatan) Makronutrien Protein Karbohidrat Lemak Vitamin 8 vitamin B (tiamin, niacin, riboflavin, asam folat, Vitamin B 12, Vitamin B6, Asam pantotenat, biotin) Vitamin C Vitamin A, D, E, K air Mineral Ca, Fe, Mg, Mn, Se, Na, K, V, Bo, I, S, Cl, P, Cr, Cu, F, Mo, Zn

Do YOU Need a Dietary Supplement?

Perlu atau tidak ? Kapan dibutuhkan ? Seberapa banyak dibutuhkan ? Siapa yang membutuhkan ?

Invalid reasons The belief that the food supply or soil contains inadequate nutrients The belief that supplements can provide energy The belief that supplements can enhance athletic performance or build lean body tissue without physical work or faster than work alone The belief that supplements will help a person cope with stress The belief that supplements can prevent, treat, or cure conditions ranging from common cold to cancer

Who needs supplements? People with nutrient deficiencies People with low food energy intake (<1200 kcal/day) Vegans and those with atrophic gastritis (need vitamin B12) Women who bleed excessively during menstruation (needs iron) People with lactose intolerance or milk allergies, or who do not consume enough dairy products to forestall extensive bone loss, need calcium

People in certain stages of the life cycle who have increase nutrient needs People with limited milk intake and sun exposure need vitamin D People who have disease, infection, or injuries or who have undergone surgery that interferes with intake, absorption, metabolism & excretion of nutrients People taking medications that interfere with the body’s use of specific nutrients

Kondisi yang dapat menyebabkan kekurangan zat gizi Growth in children Old agealcoholism or Drug addiction reducing diets Increased requirement Low food intake Restricted Food choice Therapeutic diets VegetarianismIllnessPregnancy & lactation

Tidak dibutuhkan pada : Orang dengan sumber zat makanan yg mencukupi Olah raga Cukup istirahat dan tidur Kehidupan teratur Tdk stress Bebas dr bhn pencemar (udara, mkn, air).

Recommendations for Nutrient Intake Dietary Reference Intakes (DRIs) Reference values of nutrients, primarily used by nutrition & health professionals Basis for assessing & planning diets of healthy people federal nutrition & food programs

What are the purposes of the DRIs? To maintain nutritional adequacy To promote health To reduce risk of chronic disease To provide a measure for evaluating inadequacy and/or excess To assess intakes as distributions Across population groups In individuals To plan diets

What are the different DRI values? Estimated Average Requirement : EAR Recommended Dietary Allowance : RDA Adequate Intake : AI Tolerable Upper Intake Level : UL

Estimated Average Requirement Nutrient intake to meet the requirement of half the healthy people of an age & gender The MEDIAN Basis for establishing an RDA

Recommended Dietary Allowance Nutrient intake to meet the requirement for nearly all (97-98%) healthy people of an age & gender Derived from an EAR EAR + 2 standard deviations

Number of People EARRDA Actual Nutrient Requirement

Adequate Intake Nutrient intake of healthy people assumed to be adequate Used when an RDA cannot be established Insufficient data to determine an EAR Based on observed intakes, experimental data, etc. 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 population More is not always better! Not a recommended level No established benefits of higher level Increased risks at higher intakes

safety danger Danger of toxicity Safety Danger of deficiency Tolerable Upper Intake level (UL) The naive view vs the accurate view of optimal nutrient intake

Kebutuhan zat gizi Sangat individual Dipengaruhi tingkat kesehatan Berdasarkan AKG untuk rata-rata orang Indonesia yang sehat Dibedakan berdasarkan kelompok umur dan jenis kelamin

Vitamin 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 Apel1 buah70 IU Pisang1 buah90 Peach1 buah470 Selada100 g 446 Tomat1 buah1390 Brokoli½ cup1090 Bayam½ cup7370 Wortel½ cup19.150

Vitamin E Bahan makanan sumber : Minyak nabati (kedele, jagung) dan produknya (margarin) Whole grain products, wheat germ. Sayuran berdaun hijau tua. hati, telur, kacang.

Kandungan vit E/100 g bahan makanan Kerang37,5 Kentang goreng 1,5 Kacang 8,1 Minyak14,7 Kol2,4

Vitamin C Bahan makanan sumber : Jeruk, anggur, lemon, jeruk nipis. Strawbery dan berry lain, melon Kol, brokoli, sayuran berdaun hijau, Kentang, tomat

Kandungan vit C (mg/100g) bahan makanan Brokoli39,6 Kembang kol62,7 Bayam52,4 Wortel30,3 Pisang18,6 Jeruk64,3 Anggur23,6

KEBUTUHAN VITAMIN PERHARI ( RDA = RECOMMENDED DAILY ALLOWANCES ) VITAMINPRIAWANITA A1000 IU800 IU D5 ug E3 mg4 mg K80 ug65 ug B11,5 mg1,1 mg B21,7 mg1,3 mg B319 mg15 mg B54 – 7 mg B62,0 mg1,6 mg B122,0 mg C60 mg

Konsumsi megadosis dapat membahayakan Nutrient yang diperlukan sebaiknya didapat dari bahan makanan. Suplemen hanya digunakan jika memang dibutuhkan

Tujuan Nutritional support Memastikan intake energi adekwat  mencegah kehilangan BB Mencegah 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 individu Kemampuan pasien utk mengkonsumsi makanan normal

Medical foods Formula lengkap Formula tidak lengkap, mis produk modular lemak, protein atau karbohidrat Formula makanan khusus

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

Figure 18-7 Page 641 Food Guide Pyramid for Disease Prevention 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. Eat < 4 eggs per week. Eat red meat sparingly. Eat fish frequently. Eat nuts and legumes often. Eat fruit in abundance. Eat whole-grain breads, cereals, rice, and pastas instead of refined products. Eat low-fat or fat- free milk products. Eat vegetables in abundance. Milk, Yogurt & Cheese Group Vegetable Group Meat, Poultry, Fish, Dry Beans, Eggs & Nuts Group Fruit Group Bread, Cereal, Rice & Pasta Group

Sayuran dan buah-buahan ‘5 porsi / hari’ Hooper L Dietetic Guidelines : diet in secondary prevention of cardiovascular disease (J Human Nutr Dietet 2001)

Choose Food Instead of Supplements Food Fun Offers variety Doesn’t have to be expensive Contains other healthful substances Safe Supplements Boring Lacks variety Can cost a lot of money Doesn’t contain other health benefits Can be dangerous to your health

If a little is good, more is not necessarily better”

الحمد لله zzt 1208