Tesis

Pengaruh terapi medik gizi terhadap manajemen berat badan dan komposisi tubuh pasien gangguan psikiatri dengan obesitas = Effect of medical nutrition therapy on weight management and body composition of patients with psychiatric disorder and obesity.

Gangguan psikiatri meningkatkan risiko penderitanya mengalami obesitas dan sindroma metabolik akibat interaksi faktor genetik, lingkungan, gejala penyakit psikiatri dan pengobatannya. Pengaturan asupan makan dan perubahan pola hidup tetap menjadi tatalaksana awal pada pasien dengan gangguan psikiatri. Penggunaan metformin telah disarankan dalam studi sebagai adjuvan dalam tatalaksana berat badan pada pasien gangguan psikiatri terutama yang menggunakan obat psikiatri dalam jangka panjang. Empat pasien rawat inap dengan gangguan psikiatri dipantau selama perawatan dan sebulan setelah rawat jalan dengan kontak per minggu. Dilakukan pencatatan masalah subjektif, objektif, riwayat peningkatan berat badan, riwayat pengobatan pola asupan serta pengukuran antropometri dan komposisi tubuh. Pola asupan harian dan 24 jam terakhir dikumpulkan dengan metode FFQ semi kuantitatif dan 24h dietary recall. Perencanaan terapi medik gizi dilakukan dengan restriksi kalori, peningkatan asupan protein, penyesuaian asupan karbohidrat, motivasi melakukan aktivitas fisik yang cukup dan pemberian metformin dengan dosis bertahap. Tiga pasien memiliki status gizi obes 2, 1 pasien memiliki status gizi obes morbid yang disertai massa lemak yang tinggi dan massa otot yang rendah. Seluruh pasien memiliki lingkar pinggang diatas normal, kadar kolesterol total, LDL yang tinggi dan HDL yang rendah. Tiga pasien tidak mematuhi preskripsi selama perawatan. Setelah rawat jalan, dua pasien memiliki caregiver yang memberikan pemantauan dan motivasi yang baik terhadap pasien selama sebulan dan terdapat penurunan berat badan, penurunan lingkar pinggang, dan perbaikan komposisi tubuh. Terapi medik gizi pada pasien dengan gangguan psikiatri membutuhkan kerjasama dengan caregiver agar dapat bermanfaat bagi pasien.
Kata kunci: gangguan psikiatri, obesitas, restriksi kalori, metformin, sindroma metabolik


Patients with psychiatric disorders experienced an increased risk of obesity and metabolic syndrome due to genetic, environmental, disease symptoms and medication factor. Diet and lifestyle modification remained the firstline modalities for management of obesity in patients with psychiatric disorders. Metformin as an adjuvant therapy is recommended for preventing weight gain in patients especially with long-time psychiatric medication usage. Four inpatients with various psychiatric disorders were monitored during hospital stay and one month after discharge with weekly contact for monitoring. Subjective symptoms and objective signs, including history of weight gain, psychiatric medication history, intake pattern, anthropometric and body composition measurements were recorded. Daily intake pattern and 24 hour food intake were recorded and analyzed with semi-quantitative FFQ method and 24h food recall, respectively. Energy restriction, adjustment of protein and carbohydrate intake, physical activity encouragement and oral metformin administration with increasing dose were implemented in all patients. Three patients were grade 2 obese, one patients was morbidly obese with high fat mass and low muscle mass. All patients showed an increased waist circumference, high total cholesterol and LDL level, and low HDL level. Three patients failed to comply with nutrition prescription. After discharge, two patients had a supportive caregivers that gave an adequate monitoring and encouragement. Weight loss, reduced waist circumference, and better body compositition were found in 2 patients with supportive caregivers. Medical nutrition therapy on patient with psychiatric disorder will benefit greatly from supportive caregiver to bring benefit for patients.
Keyword: psychiatric disorder, obesity, energy restriction, metformin, metabolic syndrome