PENENTUAN STATUS GIZI SECARA BIOKIMIA

(1)

Edited by:

Suyatno

, Ir.

MKes

Fakultas

Kesehatan

Masyarakat

Universitas

Diponegoro

Semarang

E

E--mailmail : : suyatno@undip.ac.idsuyatno@undip.ac.id Hp

Hp : 08122815730: 08122815730 Blog

(2)

Specific Lab Tests

Measurement of individual

nutrient in body fluids (e.g.

serum retinol, serum iron,

urinary iodine, vitamin D)

Detection of abnormal amount of

metabolites in the urine (e.g.

urinary

creatinine/hydroxyproline ratio)

Analysis of hair, nails & skin for

micro

(3)

Advantages of Biochemical Method

It is useful in detecting early changes in

body metabolism & nutrition before the

appearance of overt clinical signs.

It is precise, accurate and reproducible.

Useful to validate data obtained from

dietary methods e.g. comparing salt

intake with 24

(4)

Limitations of Biochemical Method

Time consuming

Expensive

They cannot be applied on large

scale

Needs trained personnel &

facilities

(5)

PENGGUNAAN

PSG BIOKMIA

Dpt

Dpt menentukanmenentukan status status gizigizi spesifikspesifik Dpt

Dpt membuktikanmembuktikan pemeriksaanpemeriksaan tktk sub sub klinis

klinis

Sebagai

(6)

PEMERIKSAAN DARAH

Sampel

Sampel DarahDarah: : KapilerKapiler atauatau VenaVena

1.

1. DARAH KAPILERDARAH KAPILER

!

! Pd Pd ujungujung jarijari , , DaunDaun TelingaTelinga, , TumitTumit (

(BayiBayi)) !

! SejumlahSejumlah ±± 0,2 ml 0,2 ml –– 1 ml1 ml !

! DptDpt langsunglangsung dipipetdipipet

2.

2. DARAH VENADARAH VENA

!

! Pd Vena Pd Vena CubitiCubiti ((lenganlengan)) !

! Plasma (+ Plasma (+ AntikoagulanAntikoagulan)) !

(7)

PEMERIKSAAN URINE

!

Langsung

atau

dg

Kateter

!

Pd

penyimpanan

dpt

+

pengawet

(

Toluol

,

Timol

)

!

Dpt

Midstream/

tidak

!

(8)

PEMERIKSAAN FAESES

!

Dpt

mengetahui

gangguan

metabolisme

zat

gizi

(KH,

Lemak

)

!

(9)

Biochemical Tests

!

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(10)

Biochemical Tests

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(11)

++ ++

Biochemical Tests

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(12)

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(13)

+ +

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)

(14)

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Causes of iron deficiency

(15)

+ +

Tingkatan

Anemi

besi

(16)

# #

Stage of iron deficiency

Erythron

Normal Iron store Depletes: •Marrow iron

absent

•Serum ferritin Consentration < 12 u g/L

Iron deficient Erithropoiesis - Hb drop

Iron deficiency Anemia

(17)

+ +

Changes in body iron compartments and laboratory parameters of iron status during development of iron deficiency due to a continuous negative iron balance

(18)

INDIKATOR

ANEMIA GIZI BESI

Hemoglobi

Hemoglobi ((HbHb), ), Hematokrit

Hematokrit,, Serum

Serum BesiBesi/Serum /Serum FerritinFerritin ((SfSf),), Transferin

Transferin Saturation (Ts), Saturation (Ts), Free

Free ErytrocytesErytrocytes ProtophophyrinProtophophyrin (FEP)(FEP) Unsaturated Iron

Unsaturated Iron!!binding Capacity binding Capacity Serum

(19)

+ +

1. HAEMOGLOBIN (

Hb

) :

Dpt

Dpt tentukantentukan prevalensiprevalensi AnemiaAnemia

Macamnya

Macamnya::

A.

A. METODE SAHLIMETODE SAHLI

!

! KesalahanKesalahan 2 2 –– 3 kali3 kali !

! HbHb + + HclHcl ➔➔➔➔➔➔➔➔ GlobinGlobin Fe Fe ++++ _Heme_Heme ➔➔➔➔➔➔➔➔ _O2_O2

➔ ➔ ➔ ➔ ➔ ➔➔

➔ Fe Fe ++++++ _Heme_Heme _{+ Ion}_{+ Ion}_cl_cl ➔➔➔➔➔➔➔➔ _Ferri_Ferri Hemeclorid

Hemeclorid ((coklatcoklat)) !

(20)

B.

B. METODE CYANMETHEMEGLOBINMETODE CYANMETHEMEGLOBIN

!

! HbHb OksidasiOksidasi K. K. PeroksidaPeroksida ➔➔➔➔➔➔➔➔ Methemoglobin

Methemoglobin ➔➔➔➔➔➔➔➔ Ion Ion SianidaSianida ➔➔➔➔➔➔➔➔ Sian

Sian –– MethemoglobinMethemoglobin ((merahmerah)) !

! HasilHasil lbhlbh obyektifobyektif

HARGA NORMAL

!

! LakiLaki –– LakiLaki : 14 : 14 –– 18 g %18 g % !

! WanitaWanita : 12 : 12 –– 16 g %16 g % !

(21)

+ +

2. HEMATOKRIT (HCT)

!

! Volume SDM Volume SDM ygyg terpisahterpisah drdr plasmaplasma !

! EstimasiEstimasi scrscr tdktdk langsunglangsung HbHb (HCT (HCT 3 X

3 X HbHb))

HARGA NORMAL

!

! LakiLaki –– lakilaki : 40 : 40 –– 54 % 54 % KeplerKepler !

! WanitaWanita : 37 : 37 –– 47 % 47 %

!

! lakilaki –– lakilaki : 42 : 42 –– 50 % Wells50 % Wells !

(22)

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

+

(23)

3. SERUM FERRITIN (SF)

Menilai

status

besi

di

hepar

SF < 12

g /L (

Defisiensi

Fe)

Metode

(24)

4. TRANSFERIN SATURATION (TS)

!

Menilai

kadar

Fe

dlm

serum

!

TS < 16 % (

Defisiensi

Fe)

!

(25)

5. FREE ERYTHROCYTE

PROTOPHORPHYRIN (FEP)

Menilai

Menilai kecukupankecukupan Fe Fe utkutk pembtkpembtk SelSel Darah

Darah MerahMerah didi sumsumsumsum TulangTulang Normal

Normal : 35 : 35 –– 50 50 IIg/dl RBCg/dl RBC FEP > 100

FEP > 100 IIg/dl ( g/dl ( DefisiensiDefisiensi Fe)Fe) Metode

(26)

DEFISIENSI Fe

!

Tahap

1

1 :

:

Cadangan

Fe

hepar

<<

!

Tahap

2

2 : Fe <<

: Fe <<

utk

sintesis

SDM

di

SSM

Tulang

!

(27)

PSG BIOKIMIA KEP

ANALISIS BIOKIMIA YG DIGUNAKAN

Nilai

Nilai Protein & Protein & HasilHasil MetabolitMetabolit Protein (

Protein ( DarahDarah, Urine), Urine) INDIKATOR

INDIKATOR

!

! HidroksiHidroksi ProlinProlin IndeksIndeks (Urine)(Urine) !

! RasioRasio As Amino As Amino BebasBebas (Plasma)(Plasma) !

! Plasma Protein, Albumin, Pre Plasma Protein, Albumin, Pre –– Albumin

Albumin

!

(28)

HARGA NORMAL

!

! AlbuminAlbumin : 3,5 : 3,5 –– 5 5 grgr/dl/dl !

! GlobulinGlobulin : 1,5 : 1,5 –– 3 3 grgr/dl/dl !

! FibrinogenFibrinogen : 0,2 : 0,2 –– 0,8 0,8 grgr/dl/dl PRE

PRE –– ALBUMINALBUMIN !

! GiziGizi BaikBaik : 23,8 : 23,8 ±± 0,9 mg/dl0,9 mg/dl !

! GiziGizi SedangSedang : 16,5 : 16,5 ±± 0,8 mg/dl0,8 mg/dl !

! GiziGizi KurangKurang : 12,4 : 12,4 ±± 1,0 mg/dl1,0 mg/dl !

! MarasmusMarasmus : 7,6 : 7,6 ±± 0,6 mg/dl0,6 mg/dl !

! Mars Mars –– KwasKwas : 3,3 : 3,3 ±± 0,2 mg/dl0,2 mg/dl !

(29)

SERUM ALBUMIN

!

! < 1 < 1 ThTh : : CukupCukup > 2,5 > 2,5 grgr/dl/dl !

! 1 1 sdsd 5 5 ThTh : : CukupCukup > 3 > 3 grgr/dl/dl !

! 6 6 sdsd 16 16 ThTh : : CukupCukup > 3,5 > 3,5 grgr/dl/dl !

! 16 16 ThTh Cukup

Cukup : > 3,5 : > 3,5 grgr/dl/dl Kurang

Kurang : < 2,8 : < 2,8 grgr/dl/dl Margin

Margin : 2,8 : 2,8 –– 3,4 3,4 grgr/dl/dl !

! WanitaWanita HamilHamil Cukup

Cukup : > 3,5 : > 3,5 grgr/dl/dl Kurang

Kurang : < 3,5 : < 3,5 grgr/dl/dl Margin

(30)

SERUM PROTEIN

!

! < 1 < 1 ThTh : : CukupCukup > 5 > 5 grgr/dl/dl Margin < 5

Margin < 5 grgr/dl/dl !

! 1 1 sdsd 5 5 ThTh : : CukupCukup 5,5 5,5 grgr/dl/dl Margin < 5,5

Margin < 5,5 grgr/dl/dl !

! 6 6 sdsd 16 16 ThTh : : CukupCukup 6 6 grgr/dl/dl Margin < 6

Margin < 6 grgr/dl/dl !

! > 16 > 16 ThTh : : CukupCukup 6 6 grgr/dl/dl Kurang

Kurang 5,5 5,5 grgr/dl/dl Margin 6,5

Margin 6,5 –– 5,9 5,9 grgr/dl/dl INDIKATOR KEP

INDIKATOR KEP

Abumin

(31)

+ +

Levels of serum albumin concentrations in malnourished children

Pathological

(32)

PSG BIOKIMIA KVA

PROSES

(33)

Prevalence criteria for determining public health

significance of vitamin A deficiency

5

Plasma vitamin A <10

Plasma vitamin A <10 µµg/dlg/dl

Corneal xerosisxerosis/corneal /corneal

ulceration/

ulceration/keratomalaciakeratomalacia

0.5

Bitot's

Bitot's spotsspots

1

Night blindness

Prevalence above

(%)

Sign

(34)

Pemeriksaan

GAKI

_GAKI

Test

Test LaboratoriumLaboratorium ::

–

– TSH : TSH : kadarkadar normal 0,4 normal 0,4 –_– 4,8 4,8 IIg/mlg/ml

–

– Urinary Urinary ExretionExretion Iodine (UEI) :Iodine (UEI) :

(35)

(36)

Pemeriksaan

Urinary

Exretion

Iodine (UEI)

$ ! ( % ,,

$ ! ( % ,, (( ** $ *$ *

) 2!

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6 == ** %!%! #!<#!< ? *? * BB 1 #!

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9 *

(37)

Severity and public health significance of IDD

Critical

Clinical featuresfeaturesaa Severity

Severity

Source: Adapted from WHO, 1994.

a _{0 = absent; + = mild/least severe; ++ = moderate/more severe;}

(38)

Batasan

Batasan GOAL GOAL indikatorindikator dalamdalam surveilanssurveilans GAKIGAKI

< 3 %

Neonatal TSH

Proporsi

Proporsi bayibayi dengandengan kadarkadar TSH TSH

darah

Hasil PalpasiPalpasi/ultrasound)/ultrasound)

< 50%

< 20%

Iodium

Iodium dalamdalam urineurine

Proporsi

Garam beriodiumberiodium

Proporsi

Proporsi rumahrumah tanggatangga yang yang mengkonsumsimengkonsumsi

garam

garam beriodiumberiodium ((efektifefektif))

GOAL

INDIKATOR