Defisensi Zat Gizimikro

Hertanto W Subagio
Bagian Ilmu Gizi FK Undip
 Gizi mikro
• Vitamin
- larut air (water soluble)
- larut lemak (fat soluble)
• Mineral / element
- makromineral
- mikromineral (trace element)
• Marginal compounds
(carnitin, taurine, isoflavon dsb)
 Marginal compounds
(probably) not dietary essentials

Bioflavonoids (“vitamin P”)

Carnitine

Choline

Inositol

Pyrroloquinolone quinone (PQQ)

Taurine

Ubiquinone (coenzyme Q, “vitamin Q”)


Micronutrients 1 - Hertanto
VITAMIN
 vitamins
• Vital to life ( vita amine )
• Organic
• Essential
• CO ENZYME in numerous enzymatic reactions
• Required in tiny amount to perform specific functions that :
- promote growth
- reproduction
- maintenance of health and life
 Water soluble vitamins
Absorption Directly into the blood

Transport Travel freely into the blood

Storage Circulate freely in water-filled parts of the body

Excretion Kidney detect and remove excess in urine

Toxicity Possible to reach toxic levels when consumed from

supplements
Requirements Needed in frequent doses
 Fat soluble vitamins
Absorption First into the lymph, the blood

Transport Many require protein carriers

Storage Stored in the cells associated with fat

Excretion Less readily excreted, tend to remain in fat-storage sites

Toxicity Likely to reach toxic level when consumed from supplements

Requirements Needed in periodic doses (perhaps weeks or even months)

MINERAL
 Functions
• Important constituents of essential molecules
• Cofactors in numerous enzymatic reactions
• Serve in the maintenance of pH, osmotic
pressure, nerve conductance, muscle
contraction,blood clotting, energy production,
and in almost of every aspect of life.
 Sifat
• Bioavailibility
• Amplification of action
• Specivity
• Homeostatis
• Interaction
 Availability vs Bioavalibility
• Availability :
- quantity provided by a food
- tables of food composition

• Bioavailability :
- the percent of the consumed mineral that
enters via the intestinal absorptive cells and is
used for its intended purpose.
 Amplification of action
• Dibutuhkan dalam jumlah sedikit, tapi efeknya
sangat besar bagi tubuh.
• Contoh :
- Yodium
- Seng
Thyroxin and gene expression
Spektrum gejala GAKY
 Defisiensi seng
• Gangguan
imunnokompetensi
• Cacat lahir
• Stunting
Specivity
 Contoh Specivity

• Zn dapat mengganti Fe
dalam struktur, namun
tak bisa menggantikan
fungsi Fe
Homeostatis
Ca Homeostatis
Spektrum gejala defisiensi besi
 Requirement and Allowance

Requirement (Kebutuhan)
The lowest continuing intake of a nutrient that
will maintain a specified criterion of adequacy

Allowance (Anjuran)
The average daily amount of a nutrient
considered adequate to meet the known
nutrient needs of practically all healthy people.
EAR & RDA
 Nutrients and Risk of Death
Increasing concentration or intake of nutrient

100%

0%
Death Deficiency Marginal Optimal Marginal Toxicity Death
Naive vs Accurate view of nutrient needs
ANGKA KECUKUPAN GIZI (AKG) 2013
(10 Kolom) BB TB Energi Protein Lemak Omega-6 Omega-3 Karbohidrat Serat Air
(kg) (cm) (kkal) (g) (g) (g) (g) (g) (g) (mL)
Bayi 0 – 6 bulan 6 61 550 12 34 4,4 0,5 58 0 -
Bayi 7 – 11 bulan 9 71 725 18 36 4,4 0,5 82 10 800
Anak 1-3 tahun 13 91 1125 26 44 7,0 0,7 155 16 1200
Anak 4-6 tahun 19 112 1600 35 62 10,0 0,9 220 22 1500
Anak 7-9 tahun 27 130 1850 49 72 10,0 0,9 254 26 1900
Laki-laki 10-12 tahun 34 142 2100 56 70 12,0 1,2 289 30 1800
Laki-laki 13-15 tahun 46 158 2475 72 83 16,0 1,6 340 35 2000
Laki-laki 16-18 tahun 56 165 2675 66 89 16,0 1,6 368 37 2200
Laki-laki 19-29 tahun 60 168 2725 62 91 17,0 1,6 375 38 2500
Laki-laki 30-49 tahun 62 168 2625 65 73 17,0 1,6 394 38 2600
Laki-laki 50-64 tahun 62 168 2325 65 65 14,0 1,6 349 33 2600
Laki-laki 65-80 tahun 60 168 1900 62 53 14,0 1,6 309 27 1900
Laki-laki >80 tahun 58 168 1525 60 42 14,0 1,6 248 22 1600

Perempuan 10-12 tahun 36 145 2000 60 67 10,0 1,0 275 28 1800

Perempuan 13-15 tahun 46 155 2125 69 71 11,0 1,1 292 30 2000
Perempuan 16-18 tahun 50 158 2125 59 71 11,0 1,1 292 30 2100
Perempuan 19-29 tahun 54 159 2250 56 75 12,0 1,1 309 32 2300
Perempuan 30-49 tahun 55 159 2150 57 60 12,0 1,1 323 30 2300
Perempuan 50-64 tahun 55 159 1900 57 53 11,0 1,1 285 28 2300
Perempuan 65-80 tahun 54 159 1550 56 43 11,0 1,1 252 22 1600
Perempuan >80 tahun 53 159 1425 55 40 11,0 1,1 232 20 1500
Tambahan Bumil Timester 1 +180 +20 +6 +2,0 +0,3 +25 +3 +300
Tambahan Bumil Trimester 2 +300 +20 +10 +2,0 +0,3 +40 +4 +300
Tambahan Bumil Trimester 3 +300 +20 +10 +2,0 +0,3 +40 +4 +300
Tambahan Busui 6 bln pertama +330 +20 +11 +2,0 +0,2 +45 +5 +800
Tambahan Busui 6 bln kedua +400 +20 +13 +2,0 +0,2 +55 +6 +650
 (14 kolom) Vit A Vit D Vit E Vit K Vit B1 Vit B2 Vit B3 Vit B5 Vit B6 Vit B9 Vit B12 Biotin Kolin Vit C
(mcg) (mcg) (mg) (mcg) (mg) (mg) (mg) (mg) (mg) (mcg) (mcg) (mcg) (mg) (mg)
Bayi 0 – 6 bulan 375 5 4 5 0,3 0,3 2 1,7 0,1 65 0,4 5 125 40
Bayi 7 – 11 bulan 400 5 5 10 0,4 0,4 4 1,8 0,3 80 0,5 6 150 50
Anak 1-3 tahun 400 15 6 15 0,6 0,7 6 2,0 0,5 160 0,9 8 200 40
Anak 4-6 tahun 450 15 7 20 0,8 1,0 9 2,0 0,6 200 1,2 12 250 45
Anak 7-9 tahun 500 15 7 25 0,9 1,1 10 3,0 1,0 300 1,2 12 375 45
Laki-laki 10-12 tahun 600 15 11 35 1,1 1,3 12 4,0 1,3 400 1,8 20 375 50
Laki-laki 13-15 tahun 600 15 12 55 1,2 1,5 14 5,0 1,3 400 2,4 25 550 75
Laki-laki 16-18 tahun 600 15 15 55 1,3 1,6 15 5,0 1,3 400 2,4 30 550 90
Laki-laki 19-29 tahun 600 15 15 65 1,4 1,6 15 5,0 1,3 400 2,4 30 550 90
Laki-laki 30-49 tahun 600 15 15 65 1,3 1,6 14 5,0 1,3 400 2,4 30 550 90
Laki-laki 50-64 tahun 600 15 15 65 1,2 1,4 13 5,0 1,7 400 2,4 30 550 90
Laki-laki 65-80 tahun 600 20 15 65 1,0 1,1 10 5,0 1,7 400 2,4 30 550 90
Laki-laki >80 tahun 600 20 15 65 0.8 0,9 8 5,0 1,7 400 2,4 30 550 90

Perempuan 10-12 tahun 600 15 11 35 1,0 1,2 11 4,0 1,2 400 1,8 20 375 50
Perempuan 13-15 tahun 600 15 15 55 1,1 1,3 12 5,0 1,2 400 2,4 25 400 65
Perempuan 16-18 tahun 600 15 15 55 1,1 1,3 12 5,0 1,2 400 2,4 30 425 75
Perempuan 19-29 tahun 500 15 15 55 1,1 1,4 12 5,0 1,3 400 2,4 30 425 75
Perempuan 30-49 tahun 500 15 15 55 1,1 1,3 12 5,0 1,3 400 2,4 30 425 75
Perempuan 50-64 tahun 500 15 15 55 1.0 1,1 10 5,0 1,5 400 2,4 30 425 75
Perempuan 65-80 tahun 500 20 15 55 0,8 0,9 9 5,0 1,5 400 2,4 30 425 75
Perempuan >80 tahun 500 20 15 55 0,7 0,9 8 5,0 1,5 400 2,4 30 425 75
Tambahan Bumil Timester 1 +300 +0 +0 +0 +0,3 +0,3 +4 +1,0 +0,4 +200 +0,2 +0 +25 +10
Tambahan Bumil Trimester 2 +300 +0 +0 +0 +0,3 +0,3 +4 +1,0 +0,4 +200 +0,2 +0 +25 +10
Tambahan Bumil Trimester 3 +350 +0 +0 +0 +0,3 +0,3 +4 +1,0 +0,4 +200 +0,2 +0 +25 +10
Tambahan Busui 6 bln +350 +0 +4 +0 +0,3 +0,4 +3 +2,0 +0,5 +100 +0,4 +5 +75 +25
Tambahan Busui 6pertama
bln kedua +350 +0 +4 +0 +0,3 +0,4 +3 +2,0 +0,5 +100 +0,4 +5 +75 +25
 Interaction
Interactions among the trace minerals are common and often lead to nutrient
imbalances.
An excess of one may cause a deficiency of another.
A deficiency of one may open the way for another to cause a toxic reaction.
A deficiency of one may exacerbate the problems associated with the deficiency of
another.
Interlocking gear system
Vitamin & Mineral interactions
 4 tahap terjadinya malnutrisi
• decreases in nutrient intake (e.g. poor diet, eating
difficulty) or excessive losses (e.g. chronic
diarrhea, abnormal bleeding, large draining
wounds) limit nutrient availability.
• Next, nutrient stores are depleted as nutrients are
required to meet metabolic demands.
• metabolic or biochemical changes occur, leading
to marginal malnutrition
• deficiency symptoms
 Defisiensi Gizimikro
• Terjadi bila asupan (intake) kurang dari
angka kecukupan dalam waktu tertentu.
• Ada tenggang waktu saat memanfaatkan
cadangan yang ada dalam tubuh
• Tanda dan gejala defisiensi :

- Lihat tabel !
 Vitamin A: retinol

• Can only be found intact in

animal sources
• in its natural form, it is alcohol
known as retinol
• Provitamin : caroten
• stored in the liver
• retinol + opsin (protein) =
rhodopsin (vision)
• deficiency = improper growth,
xerophthalmia, follicular keratosis
 Vitamin D : cholecalciferol
• Vitamin D found as ergocalciferol
(D2) and cholecalciferol (D3)
• Both activated in plants/animal
skin by UV radiation (‘conditional
vitamine’)
• D3 primarily used as precursor for
calcium regulation
• Deficiency : bone deformation
(rickets)
• An excess of vitamin D can lead to
hypervitaminosis resulting in
renal failure, weight loss, and
calcification of soft tissues in the
body
Rickets
 Vitamin E: tocopherol
• active form is alpha tocopherol
• good antioxidant (protects unsaturated fatty acid
component of cell membranes from free-radical attack)
• smokers are especially likely to develop vit E deficiency,
also result of genetic abnormality of lipoprotein synthesis
• the primary def. symptoms is nervous system damage.
Immune function also reduced
• deficiency leads to fragile red blood cells
• effects of overdosing: diarrhea, nausea, headaches,
fatigue
 Vitamin K: menadione

• Originally identified as a fat-soluble factor required for

normal blood clotting
• menadione is the most active form
• actually works by activating blood-clotting proteins
• Defic. occurs when a person takes antibiotic (certain type), or
has impaired fat absorption
• Also occur in newborn, typically low birth weight
 Thiamin B1

• Chief function : Part of co E TPP

(Thiamin Pyrophosphate) in the
metabolism of CHO
• Deficiency : manifest chiefly as
neuromuscular disorders
• Symptoms : Beri-beri, enlarged
heart, cardiac failure, weakness,
apathy, poor short term memory,
anorexia, weight loss
• Wernicke-Korsakoff syndrome
(alcoholism)
 Riboflavin: B2
• Chief function: part of FMN
(flavin mononucleotide), FAD
(Flavin adenine dinucleotide)
used in energy metabolism
• Riboflavin co E have redox
reaction function
• Deficiency : manifested chiefly as
dermal and neural disorders
• Symptoms : sore throat, cracks
and redness at corners of mouth,
painful, smooth, purplish red
tongue
 Riboflavin deficiency

 lesions of the margin of the lips

(cheilosis) and corners of the mouth
(angular stomatitis)
 painful desquamation of the tongue, so
that it is red, dry and atrophic (magenta
tongue)
 sebhorroeic dermatitis, with filiform
excrescences.

Riboflavin functions as a redox coenzyme

in all energy-yielding pathways

Deficiency is widespread; rarely fatal because there is efficient reutilization

of riboflavin released in catabolism of enzymes


 Niacin
• forms: niacin, nicotinic acid,
nicotinamide
• the co E form : niacin, NAD and
NADP are active participants in
redox reactions.
• sources: rice polishings, yeast,
rice bran
• tryptophan can be converted to
niacin in the body.
• deficiencies: pelagra, dermatitis,
anemia (fish), skin lesions (fish),
sunburning (fish)
Pellagra – the niacin deficiency disease

Sunburn-like dermatitis in areas exposed to sunlight


 Folic Acid
• Recently shown as very
important for pregnant
females to avoid birth
defects
• function: synthesis of
purines, pyrimidines,
nucleic acids
• deficiencies: anemia,
large erythrocytes,
Neural Tube Defect
(NTD).
 B vitamins-in CHO metabolism concert

Defisiensi Vit B complex : Gangguan dalam metabolisme Energi

 Ascorbic Acid: C
• function: antioxidant, stress
reducer, bone calcification, iron
metab, tyrosine metab, blood
clotting
• Important for growth/repair of
connective tissue, teeth, bones,
and cartilage
• Promotes wound healing,
enhances absorption of iron,
helps synthesize several
hormones
• deficiency: stomatitis, scorbut,
slow woun healing
• toxicity: nausea, diarrhea kidney
stone
 Masalah Gizi Utama

• KEP
• Anemia defisiensi besi
• GAKY
• Defisiensi vitamin A
 Anemia dan Defisiensi Zat Besi
Beberapa fakta dan penyebab
• Sekitar 60% ibu hamil yang anemia menderita
defisiensi zat besi.
• Prevalensi defisiensi protein dan zat gizimikro lain
tinggi : bisa menjadi penyebab anemia.
• Infeksi merupakan penyebab anemia yang sering
kurang dipertimbangkan.
• Pola makan orang Indonesia kurang menguntungkan
untuk penurunan prevalensi anemia.
• Interaksi antar obat/suplemen (mis dg Ca) kurang
dipertimbangkan.
 Akibat anemia sepanjang Daur Hidup
fetus
Reduced transfer
of iron to the fetus
Low birth weight Neonatal mortality
Impaired cognition
infant
Diminished ability to fight
infections
. Low dietay iron intake
. Low iron bioavailability
child
- Micronutrients deficiency
-- Infection

Pregnancy

Older age Reduced physical capacity

adolescent
Increased maternal deaths
 Yodium dan GAKY
• Daerah endemik yang terus bertambah.
• Solusi utama : Garam Beryodium belum
memenuhi harapan.
• Interaksi berbagai senyawa (a.l. Tiosianat) dan
zat gizi (a.l selenium)
• Lingkungan (logam berat, Pb, Pestisida)
• Kehamilan merupakan ‘kondisi goitrogenik’
 Akibat GAKY sepanjang Daur Hidup
Risk of miscarriage &
stillbirth Minimal brain damage

Impaired brain Increased infant deaths

development
infant Stunted growth
fetus Problems with movement,
speech & hearing
Cognitif & Mental impairment

. Low intake of iodine

child
. Toxic Environtment

Pregnancy

Older age
adolescent
Hipotiroidi Goiter
Maternal mortality Hipotiroidi
 Kurang Vit A
beberapa penyebab

• Asupan rendah
• Infeksi berulang
• Siklus reproduksi
 Akibat KVA sepanjang Daur Hidup
Low birth weight Neonatal mortality
fetus
Ocular problems
infant
Morbidity & mortality
Miscarriage or still birth Anemia
Reduced transfer
. Inadequate intake
. Reccurent infections child
- Reproductive cycles
Pregnancy

Older age
adolescent
Impaired immune system
Nightblindness
Lost productivity
Maternal mortality
Prevalensi
 Program Prioritas
Iron
- supplement
- Pendidikan Gizi : Pola makan yg benar
- periodic deworming
- malaria prevention & treatment
Vit A
- suplementasi
- diversify diet
Iodine
- garam beryodium
LAMPIRAN
 Signs and Symptoms of
Micronutrients Deficiency and Toxicity
 Signs and Symptoms of
Micronutrients Deficiency and Toxicity
 Signs and Symptoms of
Micronutrients Deficiency and Toxicity
 Signs and Symptoms of
Micronutrients Deficiency and Toxicity
 Signs and Symptoms of
Micronutrients Deficiency and Toxicity