DIET PADA PENYAKIT

KARDIOVASKULER &
HIPERTENSI
Pre Test

 Sebutkan contoh penyakit kardiovaskuler

! (minimal 2)
 Berapa nilai tekanan darah seseorang
untuk bisa dikatakan hipertensi?
 Diet apa yang dianjurkan untuk kasus
kardiovaskuler dan hipertensi?
Problem
 Since 1900 Cardiovasculer Disease
(CVD)  has been leading cause of
death in the US for every year except
1918 (Thom et al., 2006)
 53% from Coronary Heart Disease
(CHD), 17% from stroke
 2/3 occurs in person >65 years, 1/3 of
death occur before average life
expectacy is reached
 Disease of the heart dan stroke  cause
most death in both sexes in all etnic
groups
 CHD  Myocardial Infarction (MI) or
ischemia
Atherosclerosis

 Is the most common cause of CHD and

related mortality
 First process  accumulation of plaque
(cholesterol from LDLs, Calcium, and
Fibrin) in large and medium arteri.
Etiology
Decreased
Smoking Genes HDL- Obesity
Cholesterol

High
Elevated
Saturated
Aging Hypertension Serum
Fat/Cholester
Triglyserides
ol Diet

Hyperhomoc Elevated LDL

Inactivity Endothelial
ysteinemia Cholesterol

Diabetes
Pathophysiology

Clinical Findings Nutrition Assessment

• Elevated Serum Total • BMI Evaluation

Cholesterol • Waist Circumference;
• Elevated LDL waist to hip ratio
Cholesterol (WHR)
• Elevated Serum • Dietary Assessment for
Triglyserides : SFA, trans-fatty acids,
• Elevated C-Reactive omega-3 fatty, fiber,
Protein sodium, alcohol, and
• Low HDL Cholesterol refined carbohydrates
Manajemen Nutrisi
 Pola diet Therapeutic Life Changes (TLC)  7% kcal dari SFA
 Pola diet American Heart Association (AHA)  7% kcal dari SFA
 Pola makan dengan DASH Diet
 Penurunan Berat Badan jika diperlukan
 Peningkatan Konsumsi Serat hingga 20-35 g/hari
 Tambahkan konsumsi sumber lemak omega-3
 Tambahkan konsumsi protein kedelai
 Tambahkan konsumsi sayur dan buah sebagai antioksidan
 Mengurangi konsumsi kolesterol  < 200 mg/hari
Interaksi Obat dan Makanan
Classification of Blood Pressure for Adults Ages 18
Years and Older
HIPERTENSI
> = 140/90 mm Hg
MENGAPA HIPERTENSI PENTING
 Membuat jantung bekerja >>
 Membuat dinding arteri >>
 Meningkatkan risiko penyakit jantung
dan stroke
 Dapat menyebabkan gagal jantung,
penyakit ginjal
Magnitude of the BP Problem

 62% of strokes and 49% of CHD

events attributed to elevated BP*
 26% of adults worldwide (972 million)
have hypertension**
 Estimated lifetime risk of developing
hypertension is 90%***

*WHO, World Health Report 2002: Reducing Risks, Promoting Healthy Life,
**Kearney Lancet 2005;305:217, ***Vasan, JAMA 2002;287:1003.
 Risk Factors for Developing Hypertension

(Adapted from National High Blood Pressure Education Program Working Group report
on primary prevention of hypertension. Arch Intern Med 153:186, 1993. Copyright 1993,
American Medical Association. Reprinted with permission.)
Medical Management of
Hypertension Based on Risk
 High-normal BP and Stage 1 hypertension
in low- or medium-risk group
—Begin with trial of lifestyle modification
for 6 to 12 months
 High-normal BP and Stage 1 hypertension
in high-risk group
—Begin with drug therapy in addition to
lifestyle modification
 Stages 2 and 3 all risk groups
—Begin with drug therapy in addition to
lifestyle modification
Treatment of Hypertension—Cause

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.
Treatment of Hypertension—
Medical and Nutritional Therapy

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.
Lifestyle Modifications for Prevention of
Hypertension
 Lose weight if overweight
 Limit alcohol
 Increase physical activity
 Decrease sodium intake
 Keep potassium intake at adequate levels
 Take in adequate amounts of calcium and
magnesium
 Decrease intake of saturated fat and
cholesterol
 Stop smoking
Concept of Salt as Harmful Substance

Salt Intake Hypertension

Disease
(stroke, heart and kidney
disease, osteoporosis, kidney
stones)
KEBUTUHAN GARAM

 Natrium  komponen utama cairan

ekstra seluler  membawa zat2 gizi
dalam sel
 Na  pengaturan fungsi tubuh 
tekanan daran dan volume cairan
 FAO/WHO : Kebutuhan Nacl (< 5
gram/hari) ; Na : < 2 gram/hari
KEBUTUHAN NATRIUM

Adequate Upper
Intake Level
(AI) (UL)
Na (g) 1.5 2.3
Na (mmol) 65 100
NaCl (g) 3.8 5.8
2005 Dietary Sodium Guidelines for
Americans

 Populasi dewasa:
 Mengkonsumsi < 2,300 mg Na sehari
(sekitar 1 sdt garam)
 Individu
dengan hipertensi, kulit
hitam, dan usia pertengahan dan
usila:
 Mengkonsumsi tidak lebih dari 1,500 mg
Na sehari
6000
4903 5200 5260
4678
5000

4000 3527
3000

2000

1000

0
Korea Singapore Hongkong Japan Vietnam*

Mean sodium intake (mg) of selected Asian populations.

* two provinces
 Sources of Dietary Sodium
(62 adults who completed 7 day dietary records)

Inherent
12%

Food
Processing At the Table
77% 6%

During Cooking
5%

Mattes and Donnelly, JACN, 1991; 10: 383

KONTROVERSI DIET RENDAH GARAM

 Studi di FK Indiana (2001)  Sensitif garam

 peningkatan tekanan darah (tidak ada
standar sensitif garam)
 Diet tinggi garam  resiko kardiovaskular
meningkat walaupun tidakdisertai hipertensi
 Garam  meningkatkan reaktif dari platelets
 elemen darah menjadi kental
 Diet tinggi garam  resiko stroke, serangan
jantung, walaupun tidak disertai hipertensi
 Concept of Salt-Sensitivity

High Salt Intake

Salt-sensitivity Hypertension

Disease
DASH DIET (1997)
 Dietary Approaches to Stop Hypertension
 Penambahan 1 porsi sayuran dan 1-2 porsi
buah
 Banyak sayuran dan buah (tinggi kalium)
10 porsi sehari
 4 – 5 porsi kacang2an, biji2an  bahan
makanan sumber magnesium, kalium dan
serat
 DASH DIET  tinggi kalsium, kalium dan
magnesium
DASH-Sodium Trial
 multi-center, feeding trial
 randomized to control or DASH diet
 3 levels of sodium intake (150, 100,
50 mmol/d) in cross-over design
 2-week run in; 30 days at each
sodium level randomly assigned
 outcome: change in BP (blinded)

Sacks et al. NEJM 2001; 344:3-10

 Blood Pressure Results

150
3,5 3,3 135 Systolic
128,3
Diastolic

Blood Pressure in mmHg

3 Sodium 125
Intake/ Day in grams

Potassium
2,5 100 86 82,5
2
1,6 1,5 1,6 75
1,5
50
1

0,5 25

0 0
Control Low Salt Control Low Salt
 Mineral Content in DASH Trials*
Nutrient Control DASH Diet
mg (mmol) mg (mmol)
Sodium 3028 (132) 2859 (124)

Potassium 1752 (45) 4415 (113)

Calcium 443 1265

Magnesium 176 480

* Chemical analysis
of menus Appel LJ et al. N Engl J Med 1997; 336:117-24
 DASH-Sodium Trial
8
6.7 Cont Diet-Lo Na
7
DASH-Lo Na
Fall in BP, mmHg

6
5
4 3.5
3.0
3
2 1.6

1
0
Systolic BP Diastolic BP

Sacks et al. N Engl J Med 2001; 344:3-10

TUJUAN DIET

 Menurunkan BB bila obes (Davis,1993; Denkes, 1994)

 laki2  setiap 10% kenaikan BB  kenaikan
tekanan darah 6,6 mm.
 Mengontrol tekanan darah dalam batas normal
 Mengurangi asupan natrium  hanya 1/5 sampai ½
pasien HT sensitif garam  jika diet tidak membantu
dalam 6 bulan  perlu obat.
 Menurunkan intake cafein dan alkohol
 Meningkatkan intake calsium, kalium, magnesium
 Meningkatkan aktifitas fisik
 REKOMENDASI GIZI
1. NATRIUM
 Pengaruh konsumsi garam pd hipertensi
Peningkatan volume plasma, curah
jantung dan tekanan darah.
 Diet Rendah Garam I (RG I)
Natrium : 200 – 400 mg Na/ hari
 Diet Rendah Garam II (RG II)
Na : 600 – 800 mg (1/4 sdt garam)
 Diet Rendah Garam III (RG III)
Na : 1000 – 1200 mg (1/2 sdt garam)
BAHAN MAKANAN
SUMBER NATRIUM
 Garam ( 1 g garam dapur = 400 mg na)
 Makanan yang diawet dengan garam
(ikan asin, telur asin, tauco)
 Bumbu penyedap (vitsin, maggi)
 Makanan kaleng (corned, sarden)
 Fast food (sosis, hamburger dsb)
KANDUNGAN NA DALAM MAKANAN

 Keju 30 gram 200 mg na

 Hamburger regular 800 mg na
 Take away chicken 400 mg na
 1 kotak sedang french fries 150 mg na
 1 sdm tomato/chili sauce 300 mg na
 1 blok kecil bb sop 700 mg na
2. KALIUM

 Suplemen kalium  menurunkan tensi (bila

asupan natrium tinggi).
 Kalium berfungsi sebagai diuretik 
pengeluaran natrium cairan meningkat
 Kalium menghambat pengeluaran renin
sehingga merubah sistem renin angiotensin
 Kebutuhan kalium  1500 – 3000 mg
 Diit tinggi kalium  banyak buah dan sayur
3. KALSIUM

 Hasil studi  konsumsi Ca lebih sedikit

pada kelompok hipertensi
 Bellisan dkk  suplemen kalsium 1
g/hari pada orang dewasa sehat selama
5 bulan  menurunkan tensi
 Kebutuhan kalsium dewasa : 500-800
mg
4. MAGNESIUM
 Hipomagnesemia  banyak pada hipertensi
 membutuhkan dosis anti hipertensi lebih
tinggi untuk mengontrol tensi
 Kebutuhan magnesium : 200-500 mg/hari
 Sumber : sayuran hijau, kacang2an, biji2an,
susu, coklat dan teri
 Suplemen mg  bermanfaat pada penderita
hipertensi dengan hipomagnesemia
PENDIDIKAN GIZI

 Asupan buah dan sayuran ditingkatkan

 Menghindari makanan dalam kaleng
 Menghindari penambahan garam di meja
makan
 Meningkatkan aktifitas fisik
 Mendiskusikan sumber kafeine (kopi,
cola, coklat, the)
 Alkohol dihindari
Post Test

 Sebutkan contoh penyakit kardiovaskuler

! (minimal 2)
 Berapa nilai tekanan darah seseorang
untuk bisa dikatakan hipertensi?
 Diet apa yang dianjurkan untuk kasus
kardiovaskuler dan hipertensi?
 Sebutkan prinsip DASH Diet?