LOW PURIN
PROTEIN DIET
Inggita kusumastuty
PURIN LOW
DIET
PURIN
• hasil akhir penguraian
nukleoprotein,
jenis basa nitrogen
DIET RENDAH PURIN
• menghindari atau
membatasi bahan
makanan 7nggi
purin
MENGAPA DIET RENDAH PURIN PERLU?
hidrolisis
Nukleoprotein
Mononukleo.da
Nukleosida Basa pirimidin
Basa purin Asam urat
Di dalam GIT Enzim rebonuklease, deoksiribonuklease, polinukleotidase
Enzim nukleotidase dan fosfatase
Enzim fosforilase intestinal
Enzim fosforilase intestinal
Teroksidasi
Asam Urat Asam
Urat
Asam Urat
INDIKASI PEMBERIAN DIET RENDAH
PURIN
INDIKASI PEMBERIAN DIET RENDAH PURIN
Diet rendah purin direkomendasikan untuk pasien dengan penyakit :
Gout
Penyakit atritis akibat metabolisme abnormal purin yang ditandai
dengan meningkatnya kadar asam urat dalam darah (hiperurisemia)
INDIKASI PEMBERIAN DIET RENDAH PURIN
Batu ginjal
batu ginjal type batu asam urat
Lesch-Nyhan Syndrome
hiperurisemia/ overproduksi asam
urat akibat disfungsi enzim
EFEK TINGGINYA KADAR ASAM URAT
à Hipertensi à Diabetes mellitus
TUJUAN DIET RENDAH PURIN
menurunkan kadar asam urat dalam
darah
mengurangi komplikasi akibat tingginya kadar asam
urat dalam darah
SYARAT DIET RENDAH PURIN
Energi diberikan sesuai dengan kebutuhan dan kondisi penyakit pasien
Protein : 1,0 -1,2 g/kgBB (10-15% TEE) Lemak : 20-25% TEE
Karbohidrat : 50-65% TEE
PROTEIN
completely avoid all forms of animal protein and seafood that contain high levels of purines.
do not eat organ meats, such as kidneys, brains and liver, and avoid game meats, such as goose and duck. do not eat oily fish, such as mackerel, sardines
consume limited amounts of proteins that are lower in purines, if you can tolerate them without symptoms, such as chicken,
turkey, beef, lamb, pork, crab and lobster.
SYARAT DIET RENDAH PURIN
- Cairan : 2 – 2,5 L - Karbohidrat
- Vit. C - Lemak : 10 – 20% TEE
- Alkohol
- Pemanis yang mengandung fruktosa - Kopi, teh,cokelat
- Berat badan
- Bahan makanan .nggi purin
VITAMIN C
Data from the large Health
Professionals Follow-up Study (HPFS) have shown that :
vitamin C supplementation (500 mg/day) for 2 months resulted in a significant reduction in uric
acid level of 0.5 mg/dl (20% of
the starting values)
MAKANAN TINGGI VITAMIN C
Jeruk Kiwi Berri Pepaya Nanas Melon
• Jambu biji
• Bunga kol
• cerri
• tomat
• (cabe)
• (Paprika)
One cup of raw radish slices has about 20 calories, 2 grams of fiber and around 17 milligrams of vitamin C.
RADISH MERAH ATAU LOBAK MERAH
FRUCTOSA
high-fructose corn syrup and table sugar are extremely prevalent additives used to give many foods a sweet flavor.
beverages sweetened with either of these additives raise uric acid and increase the risk of gout flare-ups in people with a certain gene variant, according to a study published in the december 2014 issue of the journal annals of rhuematic diseases. drinking fewer beverages sweetened with sugar or hfcs helps manage gout, according to the authors
MEAT, POULTRY AND SEAFOOD
High purine (>400 mg purin per 100 grams) à Should be avoided
calf’s liver, 460 mg; sardines in oil, 480 mg; and calf’s neck sweetbreads, 1,260 mg.
moderate-purine food (100-400 mg purine per 100 grams) à restrict
beef fillet, 110 mg; beef chuck, 120 mg; chicken breast with skin, 175 mg; chicken liver, 243 mg; lobster, 118 mg; pork chop with bone, 145 mg; salmon, 170 mg; sole, 131 mg; trout, 297 mg;
tuna, 257 mg; tuna in oil, 290 mg; cooked ham, 131 mg; turkey with skin, 150 mg; anchovies, 239 mg; cod, 109 mg; halibut, 178 mg; ocean perch, 241 mg; atlantic herring, 210 mg; pork sausages, fried, 101 mg; scallops, 136 mg; liverwurst, 165 mg.
DAIRY
dairy products, such as yogurt, cheese and milk, are usually safe to eat if consumed in low-fat or fat-free varieties.
FRUITS AND VEGETABLES
Generally, fruits and vegetables are low in purine content and can be eaten freely. only one food in this category falls into the high-purine category. with 488 mg of uric acid, the dried boletus mushroom, spinach, asparagus, cauliflower, is a food to be avoided.
moderate-purine fruits and vegetable include sultana raisins, which come in at 107 mg, and dried beans and lentils, including white beans, 128 mg; soybeans, 190 mg; lentils, 127 mg; and chickpeas, 109 mg.
FOOD ADDITIVES TO AVOID WITH GOUT
avoid any additives
not everyone is sensitive to the same additives or to the same degree.
BE ALERT FOR GUANYLATES
when reading food labels, check for disodium guanylate or any of its derivatives.
guanylates are converted to uric acid and may trigger a gout flare-up.
disodium guanylate is used commercially as a flavor enhancer in foods like processed meats, salad dressings, gravies, instant soups and chicken salads. it's particularly used to enhance meaty flavors in packaged foods.
also find it listed on the label under the names guanosine monophosphate, calcium guanylate, guanylic acid, dipotassium guanylate and potassium guanylate.
CHECK FOR INOSINATES
like guayanates, inosinate is used to enhance the meaty flavor in packaged foods and is converted to uric acid in your body.
it's commonly used along with guayanates for a combined flavor-enhancing effect.
find it in powdered soup mixes, sauces, soybean-based seasonings and condiments, mushroom dishes, ready-to-eat savory meals, and dried or dehydrated vegetable products.
inosinate may also be listed as disodium inosinate, calcium
KEEP AN EYE OUT FOR MSG
monosodium glutamate is used to enhance the savory flavor of a variety of foods.
available data suggests that people with gout may have an impaired ability to breakdown glutamate, according to a review published in the january 2014 issue of the epma journal. the authors found evidence that people with gout have elevated levels of glutamate and that it may play a role in high uric acid levels. msg is also commonly used with additives that are converted to uric acid, like inosinates and guanylates.
this additive may be listed as hydrolyzed vegetable protein, textured vegetable protein or yeast extract.
JENIS DIET RENDAH PURIN
RSSA
Diet rendah purin I (1500 kal) Diet rendah purin II (1700 kal) Diet rendah purin III (1900 kal)
RSCM
BAHAN MAKANAN SUMBER PURIN
kelompok 1 : dihindari!!!
kandungan purin tinggi (100-1000mg purin/100g)
otak, hati, jantung, ginjal, jerohan, kaldu, ikan sarden, makarel, remis, kerang,bebek
BAHAN MAKANAN SUMBER PURIN
kelompok 2 : dibatasi!!!!
kandungan purin sedang (50-150 mg purin/100g). maksimal 50 – 75g (1 – 1 ½ ptg)
v daging, ayam/unggas, ikan, bayam, kedelai, asparagus, belut, buncis,
v udang, kacang kering dan olahannya, tahu, tempe, daun
BAHAN MAKANAN SUMBER PURIN
kelompok 3 : diperbolehkan!!
kandungan purin rendah (0 - 50 mg purin/100g)
Ø nasi, ubi, singkong, jagung, roti,bihun, mie,
tepung beras, puding, susu, buah-buahan, sayuran
(kecuali sayuran pada kelompok 2)
PEMBAGIAN MAKANAN SEHARI
Waktu Bahan Makanan 1500 kkal 1700 kkal
(gram) Jml URT Jml
(gram) URT
Pagi Beras
Telur ayam Sayuran Minyak
Susu skim bubuk Gula pasir
50 50 50 5 20 10
½ gls nasi 1 btr
½ gls
½ sdm 4 sdm 1 sdm
75 50 100 5 20 10
1 gls nasi 1 btr 1 gls
½ sdm 4 sdm 1 sdm
Jam 10.00 Buah 100 1 ptg sdg pepaya 100 1 ptg sdg pepaya Siang Beras
Ikan 75
50 1 gls nasi
1 ptg sdg 100
50 1 ½ gls nasi 1 ptg sdg
Waktu Bahan
Makanan 1500 kkal 1700 kkal
(gram) Jml URT Jml (gram) URT Jam 16.00 Buah 100 1 ptg sdg
pepaya 100 1 ptg sdg pepaya Malam Beras
Ayam Tempe Sayuran Buah Minyak
75 50 25 100 100 5
1 gls nasi 1 ptg sdg 1 ptg sdg 1 gls
1 ptg sdg pepaya
½ sdm
75 50 25 100 100 5
1 gls nasi 1 ptg sdg 1 ptg sdg 1 gls
1 ptg sdg pepaya
½ sdm
PEMBAGIAN MAKANAN SEHARI
LOW PROTEIN
PROTEIN
Protein is a nutrient needed by the body for normal growth, wound healing, and the ability to fight infection
DIET RENDAH PROTEIN
A low-protein diet limits the amount of
protein that every body can eat each day
METABOLISME PROTEIN
Diabetes melitus dengan nefropati
Penyakit Ginjal GGK Pre Dialisis
Indikasi Pemberian Diet Rendah Protein
Penyakit Hepar
§ Encepalopathy Hepatic Diet rendah protein
diberikan pada pasien yang mengalami koma hepatic
Indikasi Pemberian Diet Rendah Protein
Menumpuknya sisa metabolisme protein dalam darah
Fungsi ginjal menurun
fungsi liver menurun
Kadar BUN menurun
Keadaan Patologis
TUJUAN DIET RENDAH PROTEIN
the purpose of a low protein diet is to provide only amount of protein necessary to maintain nutrition status but not enough to allow the buildup of matabolic waste products from protein that, when they accumulate can be toxic to tissue
LIMITED PROTEIN
although your diet may be limited in high protein foods, you’ll still eat a variety of foods, such as eggs, milk, meat, poultry, fish, fruits, vegetables and grains. eating adequate calories is important to prevent muscle breakdown and weight loss. you may be advised to eat more healthy fats, such as olive oil, or take supplements to help you get enough calories.
HIGH BIOLOGICAL VALUE
BAHAN MAKANAN SUMBER PROTEIN
highest amount of protein
o meat, fish, poultry, eggs
o milk, yogurt, cheese, peanut butte small amount of protein
o vegetables
o starches such as breads, cereals, and pasta (the protein in these foods is of poorer but still good quality)
trace amount of protein
SYARAT DIET RENDAH PROTEIN
Ø energi diberikan sesuai dengan kebutuhan dan kondisi pasien
Ø lemak cukup : 20 – 30% tee Ø karbohidrat cukup
SYARAT DIET RENDAH PROTEIN
protein dibatasi sesuai dengan derajat penyakit pasien
pembatasan protein mulai dari 0 – 60 gram protein/ hari kebutuhan mikronutrient (vitamin dan mineral
disesuaikan dengan penyakit pasien)
MINERAL
Pilih bahan makanan tinggi kalsium Pilih bahan makanan rendah kalium Pilih bahan makanan rendah natrium Pilih bahan makanan rendah fosfor
JENIS DIET RENDAH PROTEIN
Diet Rendah Protein RSCM
Diet rendah protein I : 30g, untuk pasien dg BB 50kg Diet rendah protein II : 35g, untuk pasien dg BB 60kg Diet rendah protein III : 40g, untuk pasien dg BB 65kg
JENIS DIET RENDAH PROTEIN
Diet Rendah Protein RSSA Diet rendah protein 30g
Diet rendah protein 40g
BAHAN MAKANAN YANG DIANJURKAN
untuk penyakit ggk
sumber karbohidrat
:nasi, bihun, jagung, kentang, mie, tepung
sumber protein
:telur, daging, ikan, ayam, susu
sumber lemak : minyak jagung, minyak kacang tanah,
minyak kelapa sawit, minyak kedelai, margarin, mentega
rendah garam
BAHAN MAKANAN YANG TIDAK DIANJURKAN/
DIBATASI
sumber protein :
kacang-kacangan dan hasil olahannya
sumber lemak :
kelapa, santan, minyak kelapa, margarin, mentega biasa, dan lemak hewan
sumber vitamin & mineral :
sayur dan buah yang tinggi kalium
Untuk penyakit GGK
Diet rendah protein 30g
Pembagian Makanan Sehari
Waktu Bahan Makanan Jumlah (gram) URT
Pagi Nasi
Telur Sayuran Minyak
150 25 50 5
10 sdm
½ btr
½ gls
½ sdm
Jam 10.00 Sirup 40 4 sdm
Siang Nasi
Daging 150
30 10 sdm
1 ptg sdg
Waktu Bahan Makanan Jumlah (gram) URT Jam 16.00 Gula
Pepaya Permen
10 200 25
1 sdm 1 ptg sdg 4 bks
Malam Bubur
Ikan Sayuran Minyak Buah
150 25 75 7,5 125
10 sdm 1 Ptg sdg
¾ gls
¾ sdm 1 bh apel
Diet rendah protein 30g
Pembagian Makanan Sehari
Diet rendah protein 40g
Pembagian Makanan Sehari
Waktu Bahan
Makanan Jumlah (gram) URT
Pagi Nasi
Telur Sayuran Minyak
150 25 50 5
10 sdm
½ btr
½ gls
½ sdm
Jam 10.00 Sirup 20 2 sdm
Siang Nasi 200 14 sdm
Waktu Bahan Makanan
Jumlah (gram)
URT
Jam 16.00 Gula Pepaya Permen
10 200 25
1 sdm 1 ptg sdg 4 bks
Malam Nasi Ikan Sayuran Minyak Buah
150 50 75 7,5 125
10 sdm 1 Ptg
¾ gls
¾ sdm 1 bh apel
Diet rendah protein 40g
Pembagian Makanan Sehari
SELAMAT BELAJAR J
Kelompok 3
Diet Rendah protein 30 gram dan rendah purin, makanan lunak (nasi tim). Energi 1500 Kalori
Kelompok 4
Diet Rendah protein 40 gram dan rendah purin, makanan biasa. Energi 1700 Kalori