Kuliah PakarProblem Jangka Panjang KEP dan Ganguan

Imunitas Pada KEPHaryson Tondy Winoto, Msi.Med,Sp.A

Bag. IKA UWKS

• South East Asia Nutritions Surveys (SEANUTS): sekitar 24,1 persen anak laki-laki dan 24,3 persen anak perempuan Indonesia mengalami ukuran tubuh pendek (stunting).

• Survei yang dilakukan terhadap lebih dari 7.000 anak-anak Indonesia berusia 6 bulan hingga 12 tahun ini juga menunjukkan sekitar 1 dari 3 balita Indonesia mengalami masalah pertumbuhan tinggi badan. lebih banyak dibandingkan negara-negara ASEAN lainnya, seperti Malaysia, Thailand dan Vietnam.

• Dr. Sandjaja, MPH, (SEANUTS Indonesia), kondisi ini dipicu karena kurangnya asupan gizi yang diterima anak di masa awal kelahirannya.

• Selain itu, faktor kurangnya kebutuhan nutrisi saat masa kehamilan juga turut mempengaruhi.

• Kurang gizi pada anak dapat mempengaruhi pertumbuhan fisik dan otak anak serta menjadikan perkembangan kognitif anak tidak bertumbuh optimal anak menjadi kurus dan pendek (stunting)

Berdasarkan Riset Kesehatan Dasar 2010 (RISKESDAS) :• 13,0% berstatus gizi kurang,

diantaranya 4,9% berstatus gizi buruk. • Data yang sama menunjukkan 13,3%

anak kurus, diantaranya 6,0% anak sangat kurus dan 17,1% anak memiliki kategori sangat pendek.

Menurut WHO lebih dari 50% kematian bayi dan anak terkaitdengan gizi kurang dan gizi buruk

Short-Term ImplicationsImmune Implicationsmore susceptible to infectious diseaseszinc, iron and vitamin A are commonly associated with weakened immune function.Growth Implications gastrointestinal infection places the child at even greater risk for nutrient deficiencies because nutrients are unable to be absorbed properly. Consequently, nutrient deficiency combined with infection can cause growth retardation.

• deficiency in one nutrient may lead to a deficiency in another nutrient. deficiencies in iron, magnesium and zinc can cause anorexia result in reduced intake of other important nutrients such as protein.

• Low lipid intake can also affect the absorption of important fat-soluble vitamins such as vitamins A and D.

• Zinc and protein deficiencies can retard bone growth and development, putting a child at risk for long-term complications.

Long-Term ImplicationsThe short-term implications of malnutrition eventually give way to long-term complications, such as growth and cognitive delays.

Growth ImplicationsMalnutrition not only impacts growth in the short term, but can also limit total bone growth. Additionally, children classified as low height-for-age (stunted) may never be able to regain lost growth potential if they continue to live in a nutritionally deprived situation.

Cognitive ImplicationsMalnutrition negatively effects brain development causing delays in motor and cognitive development, such as:• Attention deficit disorder• Impaired school performance• Decreased IQ scores• Memory deficiency• Learning disabilities• Reduced social skills• Reduced language development• Reduced problem-solving abilities

Iron DeficiencyIn most cases, iron deficiency is asymptomatic. However, children with severe anemia may display the following symptoms:• Fatigue and weakness• Pale skin and hair loss• Shortness of breath• Headache and lightheadedness• Cold hands and feet

• Inflammation or soreness of tongue• Brittle or spoon-shaped nails• Unusual cravings for non-nutritive

substances such as ice, dirt, or pure starch (a condition known as “pica”)

• Poor appetite (especially in infants and children)

• Irritability• Difficulty thinking• Rapid heartbeat

Risk Factors

The following can put children at risk for iron deficiency or anemia:• Poor maternal health – especially a

mother with iron deficiency anemia herself

• Blood loss in the stools due to intestinal parasites

• Inability to absorb iron• Lack of iron in the diet

• Low birth weight• Bottle-feeding with formula not iron-

fortified and drinking milk rather than formula in the first year

• Tea drinking• Iodine Deficiency

Iodine DeficiencyIf a child has goiter caused by iodine deficiency, they may display the following symptoms:• Sensation of choking, especially when

lying down• Difficulty swallowing and breathing• Swollen neck• If a child has hypothyroidism caused by

iodine deficiency, they may display the following symptoms:

• Feeling cold• Tiring easily• Dry skin• Depression• Forgetfulness• Constipation

Risk Factors• Iodine deficiency can be caused by:• Not enough iodine in the diet• Levels of iodine in soil (certain countries

or regions

Vitamin D Deficiency

Children with Vitamin D Deficiency, or rickets, may present the following symptoms:

• Bone pain or tenderness• Skeletal deformity, including bowed legs,

windswept knees, boxy forehead, abnormal curvature of the spine, and/or breastbone projection in the chest

• Dental problems, including defects in tooth structure, increased chance of cavities, poor enamel, and delayed formation of teeth

• Increased tendency for fractures, especially greenstick fractures

• Poor growth in height or limbs• Muscle spasms

Risk FactorsProlonged lack of direct exposure to sunlightLack of Vitamin D and calcium in the diet

Selenium DeficiencyChildren with selenium deficiency may present the following symptoms:• Extreme fatigue• Muscle weakness or pain• Skin or hair discoloration• Mental decline

If a selenium deficiency is prolonged and severe, children may develop:

• Weakened immune function• Poor heart function (Keshan Disease)• Hypothyroidism• Mental retardation (Myxedematous

Endemic Cretinism)• Risk Factors• Low dietary intake of selenium• Low selenium content in the soil (certain

countries or regions)

Vitamin A DeficiencyVitamin A deficiency can result in a condition called night blindness, where a child is unable to adapt their vision to darkness. Prolonged and severe vitamin A deficiency can lead to complete and irreversible blindness. Other symptoms of vitamin A deficiency include:• Dry eyes• Eye inflammation• Dry skin• Dry hair• Broken fingernails• Decreased resistance to infections

Risk Factors• Low dietary intake of vitamin A, retinol

and beta carotene• Diet low in animal sources of pre-formed

vitamin A• Iron deficiency• Vitamin B12 Deficiency

Vitamin B12 DeficiencyVitamin B12 deficiency can be asymptomatic, but when symptoms present they can include:• Fatigue and weakness• Diarrhea• Loss of appetite• Pallor• Sore mouth and tongue• Shortness of breath• Irritability and depression• Sleep disturbances• Psychosis• Megaloblastic anemia

Serious cases of vitamin B12 deficiency can cause damage to the nervous system, called subacute combined degeneration of the spinal cord, with the following symptoms:• Numbness and tingling of extremities• Disturbed coordination• Ataxic gait• Risk Factors• Low dietary intake of vitamin B12• Impaired absorption of vitamin B12• Intestinal parasites such as tape worm or

giardiasis• Pernicious anemia• Folate Deficiency

Folate DeficiencySymptoms of folate deficiency include:• Diarrhea• Loss of appetite• Weight loss• Weakness• Sore mouth and tongue• Headaches• Heart palpitations• Pallor• Irritability• Behavioral disorders

Risk Factors• Need for folate increased (e.g. liver

disease and anemia)• Inadequate dietary intake of folate• Excreting more folate than usual• Certain medications• Zinc Deficiency

Zinc DeficiencyBecause zinc plays so many roles in the body, a deficiency of zinc can impact multiple bodily functions and result in a wide variety of symptoms:• Dandruff, eczema, and skin rashes• Behavioral and sleep disturbances• Delayed wound healing• Joint pain• Growth retardation• Hair loss• Hyperactivity

• Increased allergic sensitivity• Inflammatory bowel disease and diarrhea• Loss of appetite• Mild anemia• Poor nail growth, white spots on

fingernails and transverse lines on fingernails

• Hang nails

Risk Factors• Low intake of dietary zinc• Intestinal parasites• Intake of foods that prevent zinc

absorption (e.g. foods high in iron, calcium, vitamin D and fiber)

correct

• hypothermia, • hypoglycaemia and • silent infection

There are ten essential steps:

1.Treat/prevent hypoglycaemia2.Treat/prevent hypothermia3.Treat/prevent dehydration4.Correct electrolyte imbalance5.Treat/prevent infection6.Correct micronutrient deficiencies7.Start cautious feeding8.Achieve catch-up growth9.Provide sensory stimulation and emotional

support10. Prepare for follow-up after recovery

TERIMA KASIH