Gizi pada masa Tumbuh Kembang dan

Geriatri
Gizi pada masa Tumbuh Kembang
 IMR, perkembangan Kurang makan,
mental terhambat, sering terkena
risiko penyakit kronis infeksi, pelayanan
pada usia dewasa kesehatan kurang,
pola asuh tidak
USIA LANJUT memadai
KURANG GIZI Proses Tumbuh
Pertumbuhan kembang
lambat, ASI
BBLR ekslusif kurang,
terhambat
MP-ASI tidak benar
Pelayanan
Kesehatan kurang
memadai BALITA KEP
Gizi janin
Konsumsi tidak
tidak baik
seimbang

Tugas kita! Konsumsi

gizi tidak cukup,
pola asuh kurang
WUS KEK
REMAJA &
USIA SEKOLAH
BUMIL KEK GANGGUAN
(KENAIKAN BB Pelayanan PERTUMBUHAN
RENDAH) kesehatan tidak
memadai
Produktivitas
MMR fisik berkurang/rendah
Konsumsi Kurang
Saat kritis
pembentukan
sel otak
 Saat tepat
ajarkan pola
hidup sehat

Saat anak meniru

tngkah laku termasuk
selera terhadap
makanan tertentu
 Infant Growth
• Occurs in genetically predetermined way
– Can be compromised by nutritional status
– calorie or nutrient undernutrition or imbalance.
• Undernutrition:
– First affects weight gain
• If severe enough, affects linear growth
 Growth
• After birth genetic influences are target
seeking
• Catch Up Growth: Grow faster to get closer to
genetically determined size
– Usually shift growth channels by 3 to 6 months
• Lag Down Growth:
– Usually shift growth channels by 13 months
 Rules of Thumb
• Weight:
– 4 months: Double birth weight
– 12 months: Triple birth weight
– then 2.3 kg/year until 9 or 10
– then adolescent growth spurt
 Growth: Height
• 1 year: 50% increase in height
• 4 years: double birth length
• 13 years: triple birth length
• Adolescence: rapid increase
 Adolescent Growth Spurt
• 2 years later in males than females
• intensity, duration highly variable
• Growth continues until after the epiphysis
closes
• Generally by 4 years post onset of puberty
 Collecting and Assessing Food Intake
• 24-hour recall
• Diet history
• Diet Record 1, 3 and 7 day or more
• FFQ
 Who should be asked about Diet
Intake?
• If the subject is a boy < 13 or 14 years of age,
the caregiver should be asked.
• If a girl under 12 years of age, caregiver.
• Why?
After diet has been taken accurately,
then analysis is required
• How?
• Food Guide Pyramid
• Nutrient analysis using food composition
table/ computer analysis
 Red Flags
• Anthropometric: ht or wt less than 5th %tile
• Infant formula under or over diluted
• whole cow’s milk before 1 year
• reduced fat cow’s milk before 2 years
• semi-solid foods before 4 months
• bottle fed to go to sleep
 Other Assessments Made
• parent’s nutrition knowledge
• adequacy of foods offered
• parent’s knowledge of community services
• delays in feeding skills
• behavior patterns that affect intake
• motivation of parent for change
Feeding problem: organic or inorganic
• Organic: problem with muscle coordination,
development
• Inorganic: stress in family, emotional
• Occupational therapists, speech pathologists
are trained to make these types of
evaluations: if feeding problem exists, you
may need to make a referral to determine
cause.
Organic Feeding Problems
 Stressors

• Moving • Money problems

• Death, divorce, • Drinking
separation • Trouble with the law
• Marriage, pregnancy • Other serious problems
• Serious injury or illness
• Loss of work
• Family fights
 Parents of Maladjusted Children
• Often are:
• younger
• more dependent on relative
• unstable mentally
• have marital or other conflicts
• have a disturbed relationship with their child
 Infant Feeding Choice
• Breast feeding best choice but
• approx. 80 % of infants receive formula at
sometime during first year
• types of formulas available:
– ready to serve
– concentrated
– powdered
 Formulas: types
• Source of Formula and Use
– Cow’s milk based formulas.
– Soy based formulas.
– Specialized formulas.
 Cow’s Milk Formulas
• 2 types:
• 1. Protein diluted to reach amount in human
milk
– add back CHO, Fat, vitamins and minerals
• 2. Casein diluted to reach amount in human
milk
– add back lactalbumin, fat, vitamins and minerals
 Soy Based and Specialized Formulas
• Soy protein used as the protein base
– add back CHO, fat, vitamins, minerals, and
methionine (limiting amino acid)
– e.g.: Prosobee
• Specialized: For special needs
– e.g.: Lofenalac: used with PKU infants
• Low in phenylalanine
 Osmolality
• Measure of solute in solvent
• e.g.: particles in milk
• osmolality: osmoles of solute in 1 kg of solvent
– osmole: solute that dissociates in solution to form
one mole (Avogadro’s number) of particles.
– If too high: water sucked out and causes diarrhea
 Osmolality & Renal Solute Load
• Human milk: low, less than 300 mosmolar, gut
can easily handle
– Creates Renal Solute Load of 13 mosmol/100kcal
• Cow’s milk: Higher osmolality
– Renal Solute Load of 46 mosmol/100kcal
– Skim milk: RSL of 86 mosmol/100kcal
• Formulas: 18-27 mosmol/100kcal
 Potential Problems:
• Mixing formulas too strong (or weak)
• Skim milk to infants or children under 2 yo
• Whole milk under 1 yo
 Nutrient Needs of Children
• Energy Needs based on:
– body size and composition
– physical activity
– rate of growth
– surface area to volume ratio
• Infancy more surface area to volume then later in life
• More loss of energy to surrounding environment
 Energy
• Age Energy
• < 6 months kg x 108
• 6mo-1 year kg x 98

• Consider range of intake of intake

requirements
 Energy requirement/kg BW

age male female

0–1 110 - 120 110 – 120

1–3 100 100

4–6 90 90

7–9 80 - 90 60 – 80

10 – 14 50 -70 40 - 65

14 – 18 40 - 50 40
 HEIGHT
AGE =
13 THN

PANJANG
BADAN =
156 cm
(P10-25)

BB
PERSENTIL 50
USIA 13 THN
= 45 Kg

Digunakan utk menghitung

kebutuhan energi
 Protein
• Infant requirements based on amount found in
breast milk
• Extrapolation from nitrogen balance studies
• RDA’s
• Age Protein
• <6 mo 2.2 g/kg
• 6-12 months 1.6 g/kg
• 1 – 10 yrs 1 – 2 g/kg
• > 10 yrs 0,85 – 0,95 g/kg
 Fat
• No RDA but 40 to 50 % of infant Kcals
• Fat energy spares protein from being used as
an energy source
• 45 to 50 % of infant formulas kcals are from
fat
• 55% of human milk kcals are from fat
• Essential fat recommendation > 1.2% of kcals
(linoleic and linolenic acid)
Jumlah bahan makanan dari tiap kelompok makanan
untuk anak usia 2 – 5 tahun

Energi 1000 1200 1400 1600

Nasi & 300 400 500 500

sejenisnya gram/setara gram/setara gram/setara gram/setara
Sayuran 1 gelas 1,5 gelas 1,5 gelas 2 gelas

Buah 1 gelas 1 gelas 1,5 gelas 1,5 gelas

Susu 2 gelas 2 gelas 2 gelas 2 gelas

Daging & 200 300 gr/setara 400 500

kacang2an gram/setara gram/setara gram/setara
When to reduce fat intake in kids?
• Fat shouldn’t be a concern until after 2 years
of age.
– Then start incorporating lower fat food items into
the diet
• reduced fat milk and milk products are ok
• If these are accepted early, the risk of chronic disease
could be reduced
– Controversy: Am Ac of Pediatrics says don’t worry
until after puberty: too late
 Water
• Age Amount
• 3 days 80-100 ml/kg/day
• 10 days 125-150 ml/kg/day
• 3 mo 140-160 ml/kg/day
• 6 mo 130/155 ml/kg/day
• 9 mo 125-145 ml/kg/day
• With BF and formula: none additionally
needed
 Baseline fluid needs

Weight in Kg Fluid needs

1 – 10 kg 100 ml/kg
11 – 20 kg 1000 mL + 50 ml/kg for each >
10 kg

> 20 kg 1500 ml + 20 ml/kg for each

kg> 20 kg
 Iron(Fe)
• In the fetus, Fe stores are related to body size,
therefore lbw and premature babies are at
increased risk for iron deficiency
• Human milk: 49% of iron is absorbed, only 1%
of cow’s milk
– Human milk not a very good source of Fe so after
4 to 6 months, baby may be deficient in Fe. Iron
fortified cereals with vitamin C.
 Fluoride(Fl)
• Major role in tooth and bone development
• Adequate intake reduces dental decay
– Becomes incorporated in tooth and resists acid
breakdown. Acid produced by cariogenic bacteria
in mouth.
• Supplementation dependent on Fl in water
supply.
 Fluoride Supplementation
• Amount in Water age supplement
• < 0.3 ppm 2 wk-2 y 0.25 mg/day
• 2-3 years 0.5 mg/day
• after 3 y 1.0 mg/day
• 0.3-0.7 ppm 2 to 3 y 0.25 mg/day
• 3-16 years 0.5 mg/day
• over 0.7 no supplementation
 Age of Introduction of Solid Foods
• Developmental readiness, generally 4 to 6
months
– depends on oral skills: tongue thrust, munching
pattern, brings objects to mouth
– palmer grasp develops
– interest: if child reaches for food
• First Foods: iron-fortified cereals for infants
• 6-8 months: strained vegies, fruits, meats,
finger foods
 Adding Foods
• New foods should be added one at a time, no
more than one every three days
– Check for tolerance
• As infant approaches 9 to 12 months, increase
in texture to mashed and finger foods can
progress
• Avoid potential choking foods
– hot dogs
 Feeding Problems
• Colic: gas production, and bloating
– Cause? Not always known: formula fed, may
change formula to casein hydrolysate
• but not always successful
– Breastfeeding?
• Foods in the mother’s diet
• Cow’s milk, or items
 Spitting up
• Normal occurrence
• Unless projectile vomiting:
– Organic problem: pyloric sphincter closure
– What You Should Know About Gastroesophageal
Reflux (GER) in Infants and Children - December 1,
2001 - American Academy of Family Physicians
Screening Infants for special needs
• Nursing Bottle Syndrome: feeding baby to go
to sleep with bottle
– Increases tooth decay
– Treatment: don’t put baby to bed with a bottle
• Infant Obesity:>95%tile wt for age, Wt for ht
– Not predictive of obesity in later life
– Adequate nutrition should be the key: don’t
restrict foods
 Neonatal Care
• Level 1: uncomplicated births and healthy
infants
• Level 2: normal infants and expertise in
screening and referral of high risk infants
– care for moderately ill neonates and convalescing
neonates
• Level 3: equipped to cope with most serious
neonatal problems, illnesses, abnormalities
 Failure to Thrive
• Failure to regain birth weight by 3 weeks
• Wt. loss of >10% of birth weight by 2 wks
• Wt dropping below the 3rf %tile
• Deceleration of growth velocity
• Evidence of malnutrition
 Determination of Short Stature
• Chronological age: actual age
• Height age: compared to 50%tile on growth
chart
• Bone age: x-ray needed and radiologist
measures the width of growth plate to
determine bone age. The thicker the growth
plate, the younger the bone age and the
longer the time for continued growth
Height Prediction: Is the child exhibiting
appropriate growth?
• Female Child
• mother ht(cm) + (father ht-13) + 8.5 cm
• 2

• Male Child
• (mother ht(cm)+13) + father ht + 8.5 cm
• 2
 Height Prediction
• Compare this height to age 18 on growth
chart to determine % tile.
• Compare this %tile to the current %tile of
child and see if it compares favorably.
– If considerably below, cause for further
investigation
• e.g.: If prediction shows 75%tile and actual is 5%tile,
most likely there is some environmental influence.
 Development of Food Patterns in
Young Children
• First 5 or 6 years are important for developing
food likes and dislikes
• Goals for food pattern development:
– 1. Children eat in a matter-of -fact manner
– 2. Independent eating
– 3. Introduction of new foods
 Ellyn Satter Theory
• Caregiver: Gatekeeper: decides what foods are
offered
• Child: Decides whether to eat, and how much
to eat
– Child then develops their own regulation of food
intake
• If caregiver forces food or withholds food, child isn’t
able to develop their own satiety gauge
 Guidance for introducing new foods
• Have then explore food first
– Feel, smell, play with?
• Use small portions.
– Why?
• Decision to consume is left up to the child
• Positive reinforcement when consumption
happens.
– Guard against negative reinforcement, or
coercing.
 New foods
• Gradually intro new textures
• Add individual foods first before mixtures
• Add when child most receptive to food
– Often in morning when well rested
– Often not late in the day when they are tired
• Be patient with self-feeding efforts
– Self-esteem
 Setting up the food environment
• Physical environment
– spills, space, distractions
• Emotional environment
– free from arguing, fighting
• Role model
– Eat the foods you want your kids to eat
BERAPA BANYAK ENERGI YANG
DAPAT DIBERIKAN?

START GO
LOW! SLOW!

MULAILAH DENGAN 80% DARI

KEBUTUHAN BASAL PASIEN
 Jadwal suplementasi vitamin A untuk
pencegahan defisiensi vitamin A

Bayi usia < 6 bulan

•Tidak mendapat ASI 50.000 IU secara oral

•Mendapat ASI dari ibu yang tidak 50.000 IU secara oral

mendapat suplementasi Jangan berikan bayi < 6
Bayi usia 6 – 12 bulan 100.000 IU secara oral setiap
bln dosis 4 – 6lebih
vit A yang
bulan besar.
Anak usia > 12 bulan Kadar
200.000 IU secara oralvitamin
setiap 4A–akan
6
bulan turun dibawah nilai
optimal setelah 3 – 6
Ibu 200.000 IU secara oral, dalam 8 minggu
bulan suplementasi dosis
setelah melahirkan
tinggi
 Jadwal suplementasi dosis tinggi untuk
pencegahan pada anak risiko tinggi

Bayi usia < 6 bulan 50.000 IU secara oral

Bayi usia 6 – 12 bulan 100.000 IU secara oral

Anak usia > 12 bulan 200.000 IU secara oral

•Anak yang menderita campak, diare, penyakit saluran napas, cacar air, dan infeksi
berat lainnya, PEM, tinggal di tempat yang memiliki masalah defisiensi vitamin A
klinis
•Mereka yang telah mendapat dosis rutin tidak perlu dosis tambahan
Suplementasi vitamin A pada wanita
hamil

JANGAN BERIKAN VITAMIN A DOSIS TINGGI

DALAM BENTUK APAPUN PADA IBU HAMIL!
 TERATOGENIK

WANITA HAMIL DENGAN GEJALA DEFF

VITAMIN A PD TRIMESTER KETIGA?

MAKAN CUKUP VIT A

SUPLEMENTASI DOSIS KECIL: MAKS. 10.000 IU/HARI
ATAU 25.000 IU/MINGGU, KECUALI ADA TANDA DEFF
BERAT
 Terapi xerophthalmia pada berbagai
kelompok umur kecuali wanita usia subur

Wanita usia subur yang menderita rabun senja atau ada

Segera setelah di diagnosis
bitot spot mendapatkan dosis ≤ 10.000 IU atau dosis
•Usia < 6 bulan 50.000bila
mingguan ≤ 25.000 IU, namun IU gejala berat maka
diterapi sesuai diatas
•Usia 6 – 12 bulan 100.000 IU
Dosis oral harian 5000 IU – 10.000 selama min 4 minggu
•Usia > 12 bulan 200.000 IU

Hari berikutnya Idem sesuai umur

Paling kurang 2 minggu setelah terapi pertama Idem sesuai umur

Diberikan dalam bentuk preparat oil based

Pemberian hari berikut dilakukan ibu/pengasuh di rumah
Dosis ulangan pada 2 minggu setelahnya dilakukan di fasilitas
kesehatan
Gizi pada Geriatri
 Proses Aging meningkatkan Risiko
masalah gizi

• Berbagai masalah gizi berasal dari heterogenesitas

populasi manula dan perubahan fisiologis dari proses
penuaan

• Hilangnya kemampuan kendali homeostatik

• Contoh: kesulitan untuk mengembalikan berat badan

yang hilang setelah menderita sakit yang lama.
 Xerostomia
Gastric
osteoporosis hypocholrhydria ↓ immune
Poor nutrient function
absorption
Constipation
↓ lean body
mass ↓glucose
↑body fat ↓ renal function
tolerance
Sarcopenia ↓RMR

↓ blood vessel
Sensory losses elasticity
Confusional ↑total ↓ fertility
state peripheral
resistance
+ peningkatan
produksi cytokine
 Faktor fisiologis

• Perubahan komposisi tubuh

– Pertambahan usia: rasio lemak terhadap otot
meningkat
– Manula (usia diatas 65 tahun): keseimbangan energi
positif + penurunan aktifitas fisik  peningkatan berat
badan (obesitas sentral) + penurunan massa otot dan
tulang
– Manula (usia > 75 thn): penurunan BB akibat
hilangnya massa tubuh non lemak akibat aktifitas
rendah dan asupan protein dan energi yang rendah
 sarcopenia (aktifitas growth hormon dan
testosteron) + penyakit kronik + disregulasi hormon +
inflamasi kronik  kerapuhan dan gangguan
fungsional
 Faktor fisiologis

• Perubahan komposisi tubuh

– Program olahraga dapat mencegah atau
mengembalikan hilangnya massa tubuh non lemak
– Penurunan massa otot  menurunkan BMR dan
kebutuhan energi
– Menurunnya otot  menurunkan total body
water  meningkatkan risiko dehidrasi
– Peningkatan massa lemak relatif  distribusi obat
larut lemak terganggu  eliminasi terhambat,
contoh: diazepam, propranolol
 Faktor fisiologis

• Perubahan fungsi endokrin

– Perubahan yang berhubungan dengan status
gizi: peningkatan resistensi insulin +
perubahan metaboisme air
– Resistensi insulin: meningkatkan GDP 
meningkatkan risiko DM tipe 2
– Sistim RAA: respons terhadap vasopresin dan
rasa haus menjadi kurang sensitif  mudah
dehidrasi
 Faktor fisiologis

• Perubahan gastrointestinal
– Anoreksia  menurunkan asupan makan 
penurunan berat badan
– Patofisiologi anoreksi belum jelas, dipengaruhi
gangguan relaksasi fundus gaster dan perlambatan
pegosongan lambung + perubahan pusat kenyang
– 1/3 manula usia > 70 tahun penurunan kemampuan
mensekresi asam lambung + terapi histamin 2
antagonis dan PPI akibat GERD/ulkus peptikum
– Sekresi gaster yang menurun: penurunan absorpsi
B12, Ca, Fe, asam folat dan Zn
– Peningkatan intoleransi laktosa
 Faktor fisiologis

• Perubahan indera sensoris

– Menurunnya kemampuan mencium
– Perubahan kemampuan merasa
– Penurunan fungsi penglihatan dan pendengaran
– Penurunan fungsi olfaktorius + efek obat-obatan dapat
pengaruhi nafsu makan dan asupan makanan
– Ambang batas kemampuan merasakan asin dan manis
meningkat  meningkatkan asupan makanan manis dan
asin
– Gangguan visual: menurunkan kemampuan menyiapkan
makanan
– Gangguan pendengaran mengganggu aspek sosial saat
makan bersama
Faktor patologis
 MULAI
DARI
SINI!

BERAKHIR
DISINI!
 ADIPOSITAS SENTRAL:
ITU AKAR MASALAHNYA!
 RISIKO MENINGKAT
BERKALI LIPAT LEBIH
TINGGI BILA KETIGA
FAKTOR INI
DITEMUKAN
SEKALIGUS
WASPADAI BERAT BADAN BERLEBIH DAN
RESISTENSI INSULIN!
PENINGKATAN KADAR ASAM LEMAK BEBAS:
PENYEBAB UTAMA RESISTENSI INSULIN
Menurunkan BB 10% dan
lemak perut 30% dapat
turunkan risiko PJK
 Faktor patologis

• Kondisi komorbid pada manula meningkatkan risiko

masalah gizi: depresi, penyakit pada rongga mulut,
gangguan fungsi ginjal, & penyakit yang meningkatkan
kebutuhan metabolik
– 17 – 20% manula bergigi lengkap; 60 – 90% memiliki masalah
periodontal berat  masalah pada gusi, kehilangan gigi dan
nyeri pada mulut  menurunkan asupan makanan
– Perubahan fungsi ginjal: penurunan kemampuan memekatkan
urin dan konservasi sodium  penurunan kemampuan
asidifikasi urin dan klirens obat-obatan. Hidroksilasi vit D
menjadi bentuk aktif menurun
– Berbagai penyakit: kanker, CHF, inflamatory bowel disease 
kebutuhan meningkat
 Faktor patologis

• Faktor sosio ekonomi

• Penyakit kronis dan faktor disabilitas
– 85% manula menderita berbagai penyakit kronik
– 60% manula > 75 thn: keterbatasan aktifitas
– 3% manula usia 65 – 74 thn: alzheimer
– Dampak: kemampuan manula untuk
mendapatkan, menyiapkan dan menikmati
makanan “enak” terbatas (diet khusus utk
penyakit yang diderita)
 Faktor patologis

Obat-obatan yang dapat pengaruhi status gizi

gejala Obat-obatan penyebab
anoreksia Selective serotonin reuptake inhibitors,
antibiotik, opioid
Perubahan indera Obat-obatan yang mengandung sulfa
pengecapan (furosemid), abtibiotik (clarithromycin)
mual NSAID, antibiotik, digoksin, teofilin
Mulut kering Antihistamin, antikolinergik
Confusion/distraction Antikolinergik, NSAID, neuroleptik
konstipasi Antikolinergik, antispamodik, Ca channel blocker
diare Antibiotik (amox), obat-obatan yang
mengandung sorbitol
 Kebutuhan zat gizi
• Energi
– Terjadi penurunan kebutuhan energi. Hitung sesuai kebutuhan
umur dan mempertimbangkan berat badan serta faktor aktifitas
• Protein
– Kebutuhan di pertahankan (0,8 g/kgBBI) tidak meningkat sesuai
umur pilih dengan kualitas baik. Bila terdapat stress metabolic
(infeksi/trauma) naikkan hingga 1,2 – 1,5 g/kgBBI/hari.
Sesuaikan dengan fungsi ginjal.
• Lemak
– Tidak ada ketentuan dalam pemberian lemak, namun lemak
sebaiknya tidak melebihi 30% dari asupan energi
• Karbohidrat dan serat
– Sebaiknya tidak lebih dari 130 g/hari, jumlah disesuaikan
dengan kondisi kesehatan yang menyertai.
– Serat 20 – 30 g/hari
• Air
– Minimal 6 gelas/hari, tingkatkan bila faktor stress meningkat
• Vitamin
– Secara umum tak terlalu berbeda dengan
kelompok dewasa
– Vit D: kurang paparan matahari, gangguan
sintesis pre-vitamin D di kulit, penurunan
hidroksilasi vit D di ginjal  kelemahan otot,
gangguan fungsional  meningkatkan risiko
jatuh dan fraktur
– Vit B12: defisiensi pada 10 – 20%, terjadi akibat
food-cobalamin malabsorption 
ketidakmampuan melepaskan kobalamin dari
makanan akibat defisiensi intestinal cobalamin
transport protein akibat gastritis atropi,
pertumbuhan bakteri, terapi dengan obat-obat
gastritis/ulkus petikum
– Suplemen lebih baik dari injeksi. Sumber dari
makanan lebih baik
• Vitamin
– Folat: untuk metabolisme homositein,
meningkat saat manula  berhubungan
dengan penyakit vaskular oklusif,
osteoporosis, presbiop, gangguan kognitif.
Pengaruhi oksidasi LDL, toksisitas sel
endotel, gangguan fungsi platelet
– Vit C: tak ada bukti gangguan pada
metabolisme dan absorpsi, kadarnya sering
rendah pada manula akibat asupan rendah,
penyakit kronik, merokok, penyakit akut.
Mempertahankan kadar vit C dapat menjaga
katarak, penyakit jantung dan stress oksidatif.
– Hati-hati terhadap hipervitaminosis.
• Mineral
– Kecuali Fe, Ca, dan Zn tidak berbeda secara
signifikan dengan kebutuhan populasi dewasa
– Defisiensi Fe terjadi lebih sering karena perdarahan
saluran cerna
– Kalsium: efisiensi absorpsi kalsium pada saluran
cerna pada manula menurun setelah usia 60 tahun
pada pria dan wanita. Kalsium hanya diabsorpsi 1/3
dari jumlah yang diabsorpsi pada kelompok usia lebih
muda
– Suplementasi kalsium dapat mencegah kanker kolon
dan hipertensi.
– Manula berisiko terhadap defisiensi Zn utamanya
yang disertai dengan peningkatan stress metabolik.
– Hati-hati dengan dosis tinggi karena akan mensupresi
sistim imun dan mengganggu metabolisme tembaga.
 Similar features with zinc
deficiency

anergy

Thymus
atrophy

IMUNOLOGICAL CHANGES DUE

↓NK cell
TO AGING PROCESS activity
↓ Cell
mediated
citotoxicity
↓ Th cell
activity
↓ thymulin
level
 Disturbed B-cell function in aging

Poor
response to
vaccination
Increase
autoimmune Lymphocytes
disease malignancies
 NON SPESIFIC
IMMUNITY

ADAPTIVE IMMUNITY

THE ROLE OF ZINC IN IMMUNE

SYSTEM
T LYMPHOCYTE
PROLIFERATION

B LYMPHOCYTE  IG
PRODUCTION
THE ROLE OF ZINC IN IMMUNE SYSTEM

SIGNAL MOLECULE
FOR IMMUNE CELLS
THE EFFECT OF ZINC