PENENTUAN STATUS GIZI SECARA BIOKIMIA

  

Semarang

Semarang

  Blog Blog

  

: 08122815730

: 08122815730

  Hp Hp

  : : suyatno@undip.ac.id suyatno@undip.ac.id

  mail mail

  E E

  Diponegoro Diponegoro

  

Edited by:

Edited by:

  Universitas Universitas

  Masyarakat Masyarakat

  Kesehatan Kesehatan

  Fakultas Fakultas

  MKes MKes

  , Ir.

  Suyatno Suyatno , Ir.

  : : suyatno.blog.undip.ac.id suyatno.blog.undip.ac.id

Specific Lab Tests Specific Lab Tests Measurement of individual Measurement of individual nutrient in body fluids (e.g. nutrient in body fluids (e.g. serum retinol, serum iron, serum retinol, serum iron, urinary iodine, vitamin D) urinary iodine, vitamin D)

  

Detection of abnormal amount of

metabolites in the urine (e.g. metabolites in the urine (e.g. urinary urinary creatinine/hydroxyproline ratio) creatinine/hydroxyproline ratio) Analysis of hair, nails & skin for Analysis of hair, nails & skin for micro micro ! ! nutrients. nutrients.

Detection of abnormal amount of

  Advantages of Biochemical Method Advantages of Biochemical Method

  It is useful in detecting early changes in It is useful in detecting early changes in body metabolism & nutrition before the body metabolism & nutrition before the appearance of overt clinical signs. appearance of overt clinical signs. It is precise, accurate and reproducible. It is precise, accurate and reproducible. Useful to validate data obtained from Useful to validate data obtained from dietary methods e.g. comparing salt dietary methods e.g. comparing salt intake with 24 intake with 24 ! ! hour urinary excretion. hour urinary excretion.

  

Limitations of Biochemical Method

Limitations of Biochemical Method

  Time consuming Time consuming Expensive Expensive

They cannot be applied on large

  

They cannot be applied on large

scale scale Needs trained personnel & Needs trained personnel & facilities facilities

  Dpt Dpt menentukan menentukan status status gizi gizi spesifik spesifik Dpt Dpt membuktikan membuktikan pemeriksaan pemeriksaan tk tk sub sub klinis klinis Sebagai Sebagai pemeriksaan pemeriksaan pelengkap pelengkap

PEMERIKSAAN DARAH PEMERIKSAAN DARAH Sampel Sampel Darah Darah : : Kapiler Kapiler atau atau Vena Vena 1

  1. DARAH KAPILER DARAH KAPILER ! ! Pd Pd ujung ujung jari jari , , Daun Daun Telinga Telinga , , Tumit Tumit ( ( Bayi Bayi ) ) ! ! Sejumlah Sejumlah ± ± 0,2 ml 0,2 ml – – 1 ml 1 ml ! ! Dpt Dpt langsung langsung dipipet dipipet 2.

  2. DARAH VENA DARAH VENA ! ! Pd Vena Pd Vena Cubiti Cubiti ( ( lengan lengan ) ) ! ! Plasma (+ Plasma (+ Antikoagulan Antikoagulan ) ) ! ! Serum ( Serum ( tanpa tanpa Antikoagulan Antikoagulan ) )

PEMERIKSAAN URINE PEMERIKSAAN URINE ! ! Langsung Langsung atau atau dg dg Kateter Kateter ! ! Pd Pd penyimpanan penyimpanan dpt dpt + + pengawet pengawet ( ( Toluol Toluol , , Timol Timol ) ) ! ! Dpt Dpt Midstream/ Midstream/ tidak tidak ! ! Media Media yg yg baik baik

  

utk

utk

tumbuh tumbuh kuman kuman

PEMERIKSAAN FAESES PEMERIKSAAN FAESES ! ! Dpt Dpt mengetahui mengetahui gangguan gangguan metabolisme metabolisme

  

zat

zat gizi gizi (KH, (KH, Lemak Lemak ) ) ! ! Dpt Dpt mengetahui mengetahui adanya adanya infeksi infeksi Biochemical Tests Biochemical Tests

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  Biochemical Tests Biochemical Tests

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Biochemical Tests

Biochemical Tests

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ANEMIA GIZI BESI

ANEMIA GIZI BESI

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  Fe dar makanan (1 mg) Darah Merah (35 mg Fe Turn Over)

  Sumsum tulang haemoglobin

  Sel-sel jaringan Sel dm mati Keringat, urin, feces

  (1 mg Fe) 34 mg Fe

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  Causes of iron deficiency Causes of iron deficiency

  Tingkatan Anemi besi Tingkatan Anemi besi

  (Gibson, 1990) (Gibson, 1990)

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1 %! % # % . . B

  

Stage of iron deficiency

Stage of iron deficiency

  # # _{# #} Erythron

  Normal Iron store Iron deficient Iron deficiency Depletes: Erithropoiesis Anemia

• Marrow iron
• Hb drop Hb < standart absent
• Serum ferritin Consentration < 12 u g/L

  Changes in body iron compartments and laboratory parameters of iron status

during development of iron deficiency due to a continuous negative iron balance

Source: _{International Nutritional Anemia Consultative Group, 1977}

  INDIKATOR

  INDIKATOR ANEMIA GIZI BESI ANEMIA GIZI BESI Hemoglobi Hemoglobi ( ( Hb Hb ), ), Hematokrit Hematokrit , , Serum Serum Besi Besi /Serum /Serum Ferritin Ferritin ( ( Sf Sf ), ), Transferin Transferin Saturation (Ts), Saturation (Ts), Free Free Erytrocytes Erytrocytes Protophophyrin Protophophyrin (FEP) (FEP) Unsaturated Iron Unsaturated Iron ! ! binding Capacity binding Capacity Serum Serum

  1. HAEMOGLOBIN (

  1. HAEMOGLOBIN ( Hb Hb ) : ) : Dpt Dpt tentukan tentukan prevalensi prevalensi Anemia Anemia Macamnya Macamnya : : A.

  2

  2 – – 3 kali 3 kali ! ! Hb Hb + + Hcl Hcl ➔ ➔ ➔ ➔

  ➔ ➔ ➔ ➔ Globin Globin Fe Fe

• ^{++ ++}

  Heme Heme ➔ ➔ ➔ ➔

  ➔ ➔ ➔ ➔

• + Ion

• + Ion cl cl

  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

  Fe Fe

• ^{+++ +++}

  Heme Heme

  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

  Ferri Ferri Hemeclorid Hemeclorid ( ( coklat coklat ) ) ! ! Sangat Sangat subyektif subyektif

  B.

  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

  Methemoglobin Methemoglobin ➔ ➔ ➔ ➔

  ➔ ➔ ➔ ➔ Ion Ion Sianida Sianida

  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

  Sian Sian – – Methemoglobin Methemoglobin ( ( merah merah ) ) ! ! Hasil Hasil lbh lbh obyektif obyektif HARGA NORMAL HARGA NORMAL ! ! Laki Laki – – Laki Laki

: 14

  

: 14

• – – 18 g % 18 g % ! ! Wanita Wanita

  

: 12

: 12

• – – 16 g % 16 g % ! ! Wanita Wanita Hamil Hamil

  

: 11

: 11

gr gr % %

  2. HEMATOKRIT (HCT)

  2. HEMATOKRIT (HCT)

  ! ! Volume SDM Volume SDM yg yg terpisah terpisah dr dr plasma plasma ! ! Estimasi Estimasi scr scr tdk tdk langsung langsung Hb Hb (HCT (HCT

  3 X

  3 X Hb Hb ) ) HARGA NORMAL HARGA NORMAL ! ! Laki Laki – – laki laki : 40 : 40 – – 54 % 54 % Kepler Kepler ! ! Wanita Wanita : 37 : 37 – – 47 % 47 % ! ! laki laki – – laki laki : 42 : 42 – – 50 % Wells 50 % Wells ! ! Wanita Wanita : 40 : 40 – – 48 % 48 %

  Suggested criteria for diagnosis of anaemia using haemoglobin (Hb) and haematocrit (PCV) determinations Hb PCV Hb PCV Subject below below Subject below below

• A%
• A%

  2 + A% & &

  2 + A% $ (

  3 $ (

  3 (

• &

  ,

• ( &

  , /.! % .# # ++

• /.! % .# #
• /.! % + #
• /.! % + # Source: WHO, 1975a.

  3. SERUM FERRITIN (SF)

  3. SERUM FERRITIN (SF) Menilai Menilai status status besi besi di di hepar hepar SF < 12 SF < 12 g /L ( g /L ( Defisiensi Defisiensi Fe) Fe) Metode Metode : IRMA, RIA, ELLISA : IRMA, RIA, ELLISA

  

4. TRANSFERIN SATURATION (TS)

  

4. TRANSFERIN SATURATION (TS)

! ! Menilai Menilai kadar kadar

  

Fe

Fe

dlm dlm serum serum ! ! TS < 16 % ( TS < 16 % ( Defisiensi Defisiensi Fe) Fe) ! ! TIBC TIBC tinggi tinggi (Anemia (Anemia Gizi Gizi Besi Besi ) )

  5. FREE ERYTHROCYTE

  5. FREE ERYTHROCYTE PROTOPHORPHYRIN (FEP) PROTOPHORPHYRIN (FEP)

  Menilai Menilai kecukupan kecukupan Fe Fe utk utk pembtk pembtk Sel Sel Darah Darah Merah Merah di di sumsum sumsum Tulang Tulang Normal Normal : 35 : 35 – –

  50

  50 I

  I g/dl RBC g/dl RBC FEP > 100 FEP > 100

  I I g/dl ( g/dl ( Defisiensi Defisiensi Fe) Fe) Metode Metode : : Flurometic Flurometic

DEFISIENSI Fe DEFISIENSI Fe ! ! Tahap Tahap

  1

  1 : : Cadangan Cadangan Fe Fe hepar hepar << << ! ! Tahap Tahap

  2

  2 : Fe << : Fe << utk utk sintesis sintesis SDM SDM di di SSM SSM Tulang Tulang ! ! Tahap Tahap

  3

  3 : : Kadar Kadar Hb Hb << <<

PSG BIOKIMIA KEP PSG BIOKIMIA KEP

  ANALISIS BIOKIMIA YG DIGUNAKAN ANALISIS BIOKIMIA YG DIGUNAKAN Nilai Nilai Protein & Protein & Hasil Hasil Metabolit Metabolit Protein ( Protein ( Darah Darah , Urine) , Urine)

  INDIKATOR

  INDIKATOR ! ! Hidroksi Hidroksi Prolin Prolin Indeks Indeks (Urine) (Urine) ! ! Rasio Rasio As Amino As Amino Bebas Bebas (Plasma) (Plasma) ! ! Plasma Protein, Albumin, Pre Plasma Protein, Albumin, Pre – – Albumin Albumin ! ! Plasma Plasma Transferin Transferin

  HARGA NORMAL HARGA NORMAL ! ! Albumin Albumin : 3,5 : 3,5 – –

  5

  5 gr gr /dl /dl ! ! Globulin Globulin : 1,5 : 1,5 – –

  3

  3 gr gr /dl /dl ! ! Fibrinogen Fibrinogen : 0,2 : 0,2 – – 0,8 0,8 gr gr /dl /dl PRE PRE – – ALBUMIN ALBUMIN ! ! Gizi Gizi Baik Baik : 23,8 : 23,8 ± ± 0,9 mg/dl 0,9 mg/dl ! ! Gizi Gizi Sedang Sedang : 16,5 : 16,5 ± ± 0,8 mg/dl 0,8 mg/dl ! ! Gizi Gizi Kurang Kurang : 12,4 : 12,4 ± ± 1,0 mg/dl 1,0 mg/dl ! ! Marasmus Marasmus : 7,6 : 7,6 ± ± 0,6 mg/dl 0,6 mg/dl ! ! Mars Mars – – Kwas Kwas : 3,3 : 3,3 ± ± 0,2 mg/dl 0,2 mg/dl ! ! Kwashiorkor Kwashiorkor : 3,2 : 3,2 ± ± 0,4 mg/dl 0,4 mg/dl

  SERUM ALBUMIN SERUM ALBUMIN ! ! < 1 < 1 Th Th : : Cukup Cukup > 2,5 > 2,5 gr gr /dl /dl ! !

  1

  1 sd sd

  5

  5 Th Th : : Cukup Cukup > 3 > 3 gr gr /dl /dl ! !

  6

  6 sd sd

  16

  16 Th Th : : Cukup Cukup > 3,5 > 3,5 gr gr /dl /dl ! !

  16

  16 Th Th Cukup Cukup : > 3,5 : > 3,5 gr gr /dl /dl Kurang Kurang : < 2,8 : < 2,8 gr gr /dl /dl Margin Margin : 2,8 : 2,8 – – 3,4 3,4 gr gr /dl /dl ! ! Wanita Wanita Hamil Hamil Cukup Cukup : > 3,5 : > 3,5 gr gr /dl /dl Kurang Kurang : < 3,5 : < 3,5 gr gr /dl /dl Margin Margin : 3 : 3 – – 3,4 3,4 gr gr /dl /dl

  SERUM PROTEIN SERUM PROTEIN ! ! < 1 < 1 Th Th : : Cukup Cukup > 5 > 5 gr gr /dl /dl Margin < 5 Margin < 5 gr gr /dl /dl ! !

  1

  1 sd sd

  5

  5 Th Th : : Cukup Cukup 5,5 5,5 gr gr /dl /dl Margin < 5,5 Margin < 5,5 gr gr /dl /dl ! !

  6

  6 sd sd

  16

  16 Th Th : : Cukup Cukup

  6

  6 gr gr /dl /dl Margin < 6 Margin < 6 gr gr /dl /dl ! ! > 16 > 16 Th Th : : Cukup Cukup

  6

  6 gr gr /dl /dl Kurang Kurang 5,5 5,5 gr gr /dl /dl Margin 6,5 Margin 6,5 – – 5,9 5,9 gr gr /dl /dl

  INDIKATOR KEP

  INDIKATOR KEP Abumin Abumin /Globulin, /Globulin, Kolest Kolest & & Hb Hb turun turun

  

Levels of serum albumin concentrations in malnourished children

Concentration Interpretation

  

Concentration Interpretation

(g/dl)

  (g/dl) > 3.5 Normal

  > 3.5 Normal

  3

  3.4 Subnormal - 3 -

  3.4 Subnormal

  2.5 2.9 - Low

• 2.5

  B < B Pathological

  < Pathological Source: Alleyne et al., 1977.

PSG BIOKIMIA KVA PSG BIOKIMIA KVA PROSES PROSES Cadangan Vit A Hepar << Cadangan Vit A Hepar <<

  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

  Deplesi Vit A dlm tbh Kadar Vit A Deplesi Vit A dlm tbh Kadar Vit A ➔ ➔ ➔ ➔

  ➔ ➔ ➔ ➔

plasma turun Disfungsi Retina

plasma turun Disfungsi Retina

  ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

  ➔ ➔ ➔ ➔ perubahan epitel perubahan epitel

  INDIKATOR

  INDIKATOR 1.

  1. Vit A Plasma Normal :

  30 I g/dl Vit A Plasma Normal :

  30 I g/dl ≥≥≥≥

  ≥≥≥≥ KVA : &lt; 5 I g/dl KVA : &lt; 5 I g/dl 2.

  2. Vit A Hepar Normal :

  15 I g/dl Vit A Hepar Normal :

  15 I g/dl ≥≥≥≥

  ≥≥≥≥ KVA : &lt;15 I g/dl KVA : &lt;15 I g/dl 3.

  20

  20 I I g/dl g/dl ≥≥≥≥

  ≥≥≥≥ KVA : &lt; 20 I g/dl KVA : &lt; 20 I g/dl

  3. RBP RBP Normal Normal : :

  Prevalence criteria for determining public health Prevalence criteria for determining public health significance of vitamin A deficiency significance of vitamin A deficiency

  ulceration/

  Sign

  (%)

  (%)

  Prevalence above

  Prevalence above

  Night blindness 1 Night blindness

  1

  spots

  spots

  0.5 Bitot's Bitot's

  0.5

  keratomalacia

  keratomalacia

  ulceration/

  5

  /corneal

  /corneal

  xerosis

  xerosis

  0.01 Corneal Corneal

  0.01

  0.05 Corneal scar Corneal scar

  0.05

  g/dl

  g/dl

  µ

  µ

  Plasma vitamin A &lt;10 5 Plasma vitamin A &lt;10

  Sign Source: WHO, 1982.

• – –
• – –

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  ( 6 &amp;7

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  8

  3

  /11 /11

  8

  &amp;&amp;' &amp;&amp;' .

  Pemeriksaan Pemeriksaan

  GAKI GAKI Test Test Laboratorium Laboratorium : :

  TSH : TSH : kadar kadar normal 0,4 normal 0,4 – – 4,8 4,8

  I I g/ml g/ml

  Urinary Urinary Exretion Exretion Iodine (UEI) : Iodine (UEI) : &amp;&amp;'

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TSH neonatal

TSH neonatal

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  Pemeriksaan Pemeriksaan

  Urinary Urinary

  Exretion Exretion

  Iodine (UEI) Iodine (UEI)

  $ ! ( % ,, $ ! ( % ,,

  ( (

  . ! . !

  = =

.

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%! B

%! B

  Severity and public health significance of IDD Severity and public health significance of IDD

  

Critical Critical &lt;20 &lt;20 &gt;30 &gt;30 ++ ++ +++ +++ +++ +++ (Stage III) (Stage III)

^{Severe Severe Urgent Urgent 20 49 20 49 20 20 - - 29.9 29.9 + + ++ ++ (Stage II) (Stage II) Moderate Moderate Important Important &gt;50 &gt;50 - - 99 99 5.019.9 5.019.9 + + (Stage l) (Stage l) Mild Mild Cretinism Cretinism Hypothyr Hypothyr oidism oidism Goit Goit re re Need for Need for correction correction Median Median urinary urinary iodine iodine ( ( µ µ g/litre g/litre ) ) Typical Typical goitre goitre prevalence prevalence (%) (%) Clinical Clinical features features a a Severity Severity} Source: Adapted from WHO, 1994. _a 0 = absent; + = mild/least severe; ++ = moderate/more severe;

  Batasan Batasan GOAL GOAL indikator indikator dalam dalam surveilans surveilans GAKI GAKI

  &lt; 3 % &lt; 3 % Neonatal TSH Neonatal TSH Proporsi Proporsi bayi bayi dengan dengan kadar kadar TSH TSH darah darah lebih lebih dari dari

  5

  5 mU mU /L /L &lt; 5% &lt; 5% Gondok Gondok Anak Anak usia usia sekolah sekolah (6 (6

  12

  12 th th ) ) Hasil Hasil Palpasi Palpasi /ultrasound) /ultrasound) &lt; 50% &lt; 50% &lt; 20% &lt; 20% Iodium Iodium dalam dalam urine urine Proporsi Proporsi dibawah dibawah 100 100 u u g g / L / L Proporsi Proporsi dibawah dibawah

  50

  50

u

u

g g /L /L &gt; 90 % &gt; 90 % Garam Garam beriodium beriodium Proporsi Proporsi rumah rumah tangga tangga yang yang mengkonsumsi mengkonsumsi garam garam beriodium beriodium ( ( efektif efektif

  

)

)

  INDIKATOR

  INDIKATOR