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PEMICU 1 SHEANY LESTATILA 405110062 FK UNTAR Kelompok 4 – Blok Sistem

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PEMICU 1

SHEANY LESTATILA

405110062

FK UNTAR

Kelompok 4 – Blok Sistem

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"ernin# $!%eti'es(

1) Men%elskn *siolo#i rs ken+n# dn lpr)

,) Men%elskn o!esits)• Etiolo#i

• Pto*siolo#i

• Kriteri

• Kompliksi

•  Ttlksn

-) Men%elskn sindrom met!olik)

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"$1)Fisiolo#i rs ken+n# dn lpr)

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FISI$"$.I RASA KEN/AN. 0AN

"APAR• , meknisme rs ken+n# (• tin#kt otk

• tin#kt gastrointestinal)

• Nukleus ventromedial  p2st ken+n#

• Hypothalamus lateral  p2st lpr)

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Meknisme ne2ro32morl +n# men#t2rkeseim!n#n ener#i (

• Sistem perier5eren mener2skn sin+l dri!er!#i tempt) Komponen 2tmn+(

• "eptin dn diponetin  sel lemk

•.3relin

 lm!2n#• Peptide ile2m dn kolon

• Ins2lin –6 pnkres

• Proses inti di 3ipotlm2s dn sin+l perier

ne2ro32morl dn diter2skn sin+l eeren• Sistem eeren mem!7 sin+l dri 3ipotlm2s kene2ron 2tk men#endlikn s2pn mknn dnpen##2nn ener#i

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Fktor /n# Mempen#r23i Rs "pr PdMn2si

• 8ipotesis "iposttik• "eptin  men#2k2r persentse lemk dlm sel lemk

•  92ml3 lemk rend3  3ipotlm2s menstim2lsi kit2nt2k mers lpr dn mkn)

• 8ipotesis 8ormon Peptid pd $r#n Penernn• Mknn +n# d di .IT mern#sn# m2n2ln+ st2

t2 le!i3 peptid onto3n+ kolesistokinin :CCK;)

• Ap!il %2ml3 kolesitokinin rend3  3ipotlm2smenstim2lsi 2nt2k mem2li pems2kn mknn kedlm t2!23)

• .3relin < 3ormon +n# = perilk2 mkn) = di st p2s= sest se!el2m mkn dn > setel3 mkn)

• 8ipotesis .l2kosttik

• Rs lpr

 kren k2rn#n+ #l2kos dlm dr3)

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• 8ipotesis Termosttik• s232 din#in t2 di !73 set point  3ipotlm2s

menin#ktkn ns2 mkn)

• Ne2rotrnsmitter

• !erpen#r23 ter3dp ns2 mkn)• norepinep3rine dn ne2ropeptid /  kons2msi K8

• dopmine dn serotonine  tidk men#kons2msi K8

• Psikososil• B2 rs 7rn dn tekst2r mknn %2# memi2 rs lpr)

• Stres %2# dpt !erpen#r23 ter3dp ns2 mkn tetpi ini!er#nt2n# pd msin#?msin# indi'id2)

• Ke!isn %2# mempen#r23i rs lpr) Seperti orn# norml+n# !is mkn - kli se3ri !il ke3iln#n 1 7kt2 mknkn mers lpr pd 7kt2n+ mkn 7l2p2n s2d3 2k2pdn#n @t #i@i dlm %rin#n?%rin#nn+)

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• Kontrksi di 02oden2m dn "m!2n#•  Ter%di %ik lm!2n# s2d3 koson# selm !e!erp %m

t2 le!i3)

• Kontrksi %2# dpt sn#t ditin#ktkn ki!t kdr #2l

dr3 +n# rend3)• Menim!2lkn senssi n+eri di !#in !73 lm!2n# +n#

dise!2t 32n#er pns :rs n+eri menddk 7kt2 lpr;+n# ter%di setel3 1, ? ,4 %m ses2d3 mkn) Pdkelprn 32n#er pns menpi intensits ter!esr

dlm 7kt2 - ? 4 3ri dn melem3 ser !ert3ppd 3ri?3ri !erik2tn+)

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Mkn Cept < .em2k

• Pen#2k2rn mknn ole3 reseptor?reseptor kepl:men#2n+3 sli' meneln dn men#ep

men#2k2r mknn 7kt2 mell2i m2l2t dn setel3 %2ml3 tertent2 le7t p2st mkn 3ipotlm2s men%di

ter3m!t; < , menit < sin+l ken+n# ke otk)• Mkn ept < mkn !erle!i3 se!el2m t2!23 sempt

men#irimkn sin+l ken+n#)

• Mkn ept < men#3entikn prod2ksi 3ormon peptid /dn #l2k#on?peptid di 2s2s +n# !ertindk se!#i

pen#erem ns2 mkn pd otk < tidk kn mersken+n# dn men%di keter2sn mkn)

• Mkn ept mem!2t t2!23 dipks 2nt2k menernle!i3 ept dn ke3iln#n n2trisi se!el2m mknndiern ser semp2rn)

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 KESEIMBANGAN ENERGI

MASUKANENERGI (I) KELUARANENERGI (O)

I = O keseimbangan energi netral 

BB =

I > O keseimbangan energi psiti! BB"

I < O keseimbangan energi negati! BB #

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RE.U"ASI ENER./ BA"ANCE

Adipose tiss2es #enerte Derent si#nls t3t in2ene t3e ti'it+ o t3e

3+pot3lm2s 73i3 is t3e entrl re#2ltor o ppetite nd stiet+) T3ese si#nlsderese ood intke !+ in3i!itin# n!oli ir2its nd en3ne ener#+

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 9A"UR NEUR$8UM$RA" 0I 8IP$TA"AMUS

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"$,) $BESITAS

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$!esits ? 0e*nisi

• $!esits mer2pkn s2t2 pen+kit m2ltiktoril+# ter%di ki!t k2m2lsi %rin#n lemk!erle!i3n se3in## dpt men##n##2kese3tn)

• $!esits ter%di !il !esr dn %2ml3 sel lemk!ertm!3 pd seseorn# !il seseorn#!ertm!3 !ert !dnn+ mk 2k2rn sellemk kn !ertm!3 !esr & kem2din

 %2ml3n+ kn !ertm!3 !n+k):B2k2 A%r Ilm2 Pen+kit 0lm;

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Etiolo#i

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Klsi*ksi o!esits !erdsrkn pen+e!!(

$!esits Primer :ekso#en;

• S2t2 kedn ke#em2kn pd seseorn#+n# ter%di tanpa sebab penyakit ser

 %els tetpi semt – mt dise!!kn ole3interksi ktor #enetik dn lin#k2n#n)

• Plin# serin# didptkn pd nk)$!esits Sek2nder :endo#en;

• S2t2 !ent2k o!esits +n# %els kitnn+ t2tim!2ln+ !ersmn se!#i bagian daripenyakit 3ormonl t2 sindrom +n# dptdideteksi ser klinis)

• "e!i3 %rn# ter%di pd nk dn 3n+ G1Ho!esits pd nk)

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$!esits Endo#en pd nk

Penyebab Horona! "#kti$b#kti %iagnostik 8ipotiroidism Kdr TS8 ⇑ kdr t3+roine :T4 ; ⇓

8iperkortisolism U%i s2presi deksmetson !norml kdr

kortisol !e!s 2rin ,4?%m⇑

8iperins2linism primer Kdr ins2lin plsm ⇑ kdr C?peptide ⇑

Pse2do3ipoprtiroidism 8ipoklsemi 3iperostemi kdr PT8 ⇑

"esi 3ipotlm2s didpt Adn+ t2mor ineksi sindrom tr2m lesi'sk2lr 3ipotlm2s

%e&ek geneti'  "eptin

Bet-?drener#i reeptor

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Sindro (enetik )arakteristik k!inisPrder?illi $!esits 3iper#i retrdsi mentl 3ipo#ondism

str!ism2s"2rene?Moon 5Brdet?Biedl

$!esits retrdsi mentl retinopti pi#mentos3ipo#ondism prple#i spstik

AlstrLm $!esits retinitis pi#mentos t2li di!etes mellit2sBLr%eson?Forssmn?"e3mnn

$!esits retrdsi mentl 3ipo#ondism 3ipomet!olismepilepsi

Co3en $!esits tr2nkl retrdsi mentl 3ipotoni 3ipo#ondism T2rners Per7kn pendek m!i#2o2s #enitli kelinn %nt2n#!7n 7e!!ed nek o!esits #enotipe 4O$

Fmilillipod+strop3+

8ipertro* otot krome#li 3eptome#li nt3osisni#rins ins2lin resisten 3ipertri#liseridemi retrdsimentl

Bek7it3?

iedemnn

.i#ntism eomlos mkro#losi or#nome#li

Sotos .i#ntism sere!rl pert2m!23n *sik !erle!i3n 3ipotoniretrdsi psikomotorik

e'er Sindrom t2m!23?lmp2 !+i :Innt o'er#ro7t3 s+ndrome;pereptn pemtn#n t2ln# rn#k :elerted skeletlmt2rtion; 2n2s2l ies

R2'l! Retrdsi mentl miroseli !normlits t2ln#

3ipo#ondism !r3+metpod+

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K"ASIFIKASI BENTUK TUBU8(ynoid *"ent#k Peer+ 

"emk disimpn di sekitr pin##2l dn !okon# Tipeini ender2n# dimiliki 7nit) Resiko ter3dp

pen+kit pd tipe #+noid 2m2mn+ keil

App!e S,ape *Android+Bisn+ terdpt pd pri) "emk tert2mp2k di

sekitr per2t) Resiko kese3tn pd tipe ini le!i3 tin##idi!ndin#kn den#n tipe .+noid kren sel?sel lemk

di sekitr per2t le!i3 sip melepskn lemkn+ kedlm pem!2l23 dr3 di!ndin#kn den#n sel?sel

lemk di tempt lin

-.id *"ent#k )otak "#a,+Ciri dri tipe ini dl3 !esr di sel2r23 !#in !dn) Tipe $'id 2m2mn+ terdpt pd orn#?orn# +n#

#em2k ser #enetik

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 TIPE $BESITASBER0ASARKANKEA0AAN SE"

"EMAK 

•   -besitas Tipe Hyperp!astik $!esits ter%di kren %2ml3 sel lemk +n#

le!i3 !n+k di!ndin#kn kedn normltetpi 2k2rn sel?seln+ tidk !ertm!3 !esr) Ter%di pd ms nk?nk)

•   -besitas Tipe Hypertropik $!esits ter%di kren 2k2rn sel lemk

men%di le!i3 !esr di!ndin#kn kednnorml tetpi %2ml3 sel tidk !ertm!3!n+k dri norml) Ter%di pd 2si de7s)Up+ 2nt2k men2r2nkn !ert !dn le!i3m2d3 di!ndin#kn tipe 3+perplstik)

•   -besitas Tipe Hyperp!astik %anHypertropik $!esits ter%di kren %2ml3 dn 2k2rn sellemk mele!i3i norml) $!esits ini dim2lipd nk?nk dn !erln#s2n# ter2s smpide7s) Up+ 2nt2k men2r2nkn !ert !dn

plin# s2lit dn resiko tin##i 2nt2k ter%di

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"$,) $BESITASKriteri

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ANAMNESIS

• St m2lin+ tim!2l o!esits ( prentl erl+diposit+ re!o2nd rem%

• Ri7+t t2m!23 kem!n# :mend2k2n# o!esitsendo#eno2s;

• Adn+ kel23n ( menden#k2r :snorin#; restlesssleep n+eri pin##2l

• Ri7+t #+ 3id2p (• Pol mkn5ke!isn mkn

• Pol kti*ts *sik ( serin# menonton tele'isi• Ri7+t kel2r# den#n o!esits :ktor #enetik;+n# diserti den#n resiko seperti pen+kitkrdio'sk2ler di 2si m2d 3iperkolesterolemi3ipertensi dn di!etes melit2s tipe II

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MEN.UKUR "EMAK TUBU8• /nderater eig,t pen#2k2rn !ert !dn dilk2kn di dlm ir dnkem2din lemk t2!23 di3it2n# !erdsrkn %2ml3 ir +n# tersis)

• "-% P-% mer2pkn r2n# !er!ent2k tel2r +n# tel3 dikomp2terissi)Setel3 seseorn# mems2ki B$0 P$0 %2ml3 2dr +n# tersis

di#2nkn 2nt2k men#2k2r lemk t2!23)

• %EA :d2l ener#+ O?r+ !sorptiometr+; men+er2pi skenin# t2ln#)Sinr O di#2nkn 2nt2k menent2kn %2ml3 dn loksi dri lemk t2!23)

• angka k#!it kete!ln liptn k2lit di !e!erp !#in t2!23 di2k2rden#n %n#k :s2t2 lt ter!2t dri lo#m +n# men+er2pi orseps;)

• "ioe!e'tri' ipedan'e ana!ysis :nlis t3nn !ioelektrik; penderit!erdiri dits skl k32s2s dn se%2ml3 r2s listrik +n# tidk !er!3+dilirkn ke sel2r23 t2!23 ll2 dinlis)

• 3T s'an

• I

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PEMERIKSAAN ANTR$P$METRI

• Bod+ Mss Inde :BMI;

• Per!ndin#n BB den#n TB men##2nkn t!el!ert !dn

• ist Cir2merene•   8n+ Men#2k2r lin#kr pin##n# :per2t;

• ist?8ip Cir2merene•   Men#2k2r lin#kr pin##n# :per2t; dn pin##2l dlm m

"I

"erat "adan *kg+

Tinggi badan *+ Tinggi badan*+

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Klsi*ksi $!esits

• "ody ass Inde7 *"I+ ata# Indeks assaT#b#, *IT+  indiktor pentin# 2tk men#2k2rtin#kt pop2lsi !ert !dn le!i3 dn o!es pdorn# de7s)

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Klsi*ksi Bert Bdn "e!i3 dn $!esits pd$rn# 0e7s Berdsrkn IMT Men2r2t 8$

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Klsi*ksi Bert Bdn "e!i3 dn $!esitsBerdsrkn IMT dn "in#kr Per2t Men2r2t

Kriteri Asi Psi*k

)!asi8kasi IT *kg92+

isiko )o$orbiditas

Lingkar Per#t

: ;0 ' *Laki$!aki+

: <0 '*Perep#an+

= ;0 ' *Laki$!aki+

= <0 '*Perep#an+

Bert !dnk2rn#

G 1Q)

Rend3:risiko menin#kt

pd msl3 klinislin;

Sedn#

Kisrn norml 1Q) – ,,) Sedn# Menin#kt

Bert !dnle!i3

,-)

• Berisiko ,-) – ,4) Menin#kt Modert

• $!es I ,) – ,) Modert Bert

• $!es II -) Bert Sn#t !ert

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BMI Clssi*tion o C3ildren ndAdolesents

)ategori IT Stat#s

G P Under7ei#3t

P – PQ4 8elt3+ 7ei#3t

PQ – P4 $'er7ei#3t6 P $!esits

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"$,) $BESITASKompliksi

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$!esit+?Assoited Comor!id Conditions

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82!2n#n $!esits Sentrl 0en#n 0M &0islipidemi

• Resistensi ins2lin pd o!esits sentrl did2# mer2pknpen+e!! sindrom met!olik

• Ins2lin !erpern pentin# dlm pen+impnn lemkm2p2n sintesis lemk dlm %rin#n dipos

• Ins2lin mern#sn# lipo#enesis pd %rin#n rteril & %rin#n dipos mell2i penin#ktn prod2ksi et+l?CoApenin#ktn T. dn #l2kos

• 0islipidemi +n# ditndi den#n penin#ktnkonsentrsi tri#liserid & pen2r2nn kolesterol 80"mer2pkn ki!t dri pen#r23 ins2lin ter3dpkolesterol trnser protein :CETP; +n# memperlnrtrnser kolesterol ester :CE; dri 80" ke "0" :T.;  kt!olisme dri Apo A komponen 80"

• Resistensi ins2lin dpt dise!!kn ole3 !n+k ktorsl3 st2n+ dl3 $!esits

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8ipertensi

• Ter%di kren penin#ktnplsm dr3

• Pd orn# +n# o!esitsmenin#kt se!n+k 1?

,H• Pen+2m!tn ole3 lemkse3in## %nt2n# memompdr3 den#n ept dptter%di 3ipertensi)

• Teknn dr3 tin##i t2 dits 145 mm 8#2m2mn+ terdpt pdle!i3 dri seperti# orn#o!esits

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Pen+kit 9nt2n# Koroner

• $!esits dpt men+e!!kn pen+kit %nt2n#koroner mell2i !er!#i r +it2 den#n rper2!3n lipid dr3 +it2• penin##in kdr kolesterol dr3

• kdr "0" menin#kt :kolesterol %3t +it2 @t +n#memperept penim!2nn kolesterol pd dindin#pem!2l23 dr3;

• pen2r2nn kdr 80"?kolesterol :kolesterol !ik +it2 @t+n# mene#3 ter%din+ penim!2nn kolesterol pd

dindin# pem!2l23 dr3;• 3ipertensi

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Stroke

• Seirin# den#n menin#ktn+ teknn dr3 #2ldn lemk dr3 mk orn# o!esits sn#tm2d3 tersern# stroke  kren dn+s2m!tn pd pem!2l23 dr3 +n# dise!!kn

ole3 lemk +n# men#endp di pem!2l23 dr3  men+e!!kn 3ipertensi  kl2 lm di!irknkn men#ki!tkn ker2skn pem!2l23 dr3dn men%di pendr3n

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• -steoartritisBisn+ ter%di pd o!esits 2m2mn+ pd sendi?sendi!esr pen+n##3 !ert !dn misln+ l2t2t dn kki+n# kn mem!2t sendi !eker% le!i3 !ert) Kren senditerse!2t !eker% den#n kers mk ter%di pen2r2nn2n#si sendi)

• "at# Eped#Pd o!esits den#n BMI dits - didptknkeender2n#n tim!2l !t2 emped2 d2 kli liptdi!ndin#kn orn# norml pd o!esits den#n BMI le!i3dri 4 ditem2kn n#k kli lipt)

• )anker Pay#daranit +n# tel3 menop2se le!i3 !erisiko men#lmiknker p+2dr) Ini ter%di kren pd 7nit menop2se+n# o!esits ter%di penin#ktn estro#en +n# di3silkndri %rin#n lemk) Kren %rin#n lemk terll2 !n+kmk men#3silkn estro#en dlm %2ml3 +n# !esrse3in## !erpen#r23 ter3dp resiko knker p+2dr)

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"$,) $BESITAS

 Ttlksn

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Mn%emen Bert Bdn pd Psien$'er7ei#3t dn $!esits

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Mnt Pen2r2nn Bert Bdn pdIndi'id2 $!esits dn $'er7ei#3t

• Men2r2nkn perkem!n#n di!etes mellit2s tipe, sert krdio'sk2lr

• Men2r2nkn teknn dr3

• Men#2rn#i kolesterol totl ser2m tri#liserid dnmenin#ktkn kolesterol 80"

• Men#2rn#i kdr #l2kos dr3 sert 8!A1

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 TU9UAN PENURUNAN BB

• SAT(

Spei* – es2r!le – A3ie'!le – elisti –Time limited

• T2%2n 7l terpi pen2r2nn BB( men2r2nkn BB1H dri BB 7l selm V !2ln

• Psien +n# tidk mmp2 men2r2nkn BB sersi#ni*kn  e#3 kenikn BB

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Strte#i Pen2r2nn dn Pemeli3rn BB

• TEAPI %IET• Uk2r BEE :r2m2s 8rris – Benedit;

• $ ( VV W :1- k#; W :- m; – :V #e;

• % ( V1 W :V- k#; W :1Q m; – :4VV #e;

• Ke!2t23n klori( BEE %2ml3 ktor stress dn kti'its:1, s5d ,;

• Priorits( k2rn#i lemk %en23  2nt2k men2r2nknkolesterol?"0"

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• Penderit den#n resiko kese3tn rend3  dietsedn# :1,?1 klori53ri 2nt2k 7nit 14?, klori53ri 2nt2k pri; diserti den#n ol3r#

• Penderit den#n resiko kese3tn menen#3  diet rend3 klori :Q?1, klori53ri 2nt2k7nit 1?14 klori53ri 2nt2k pri; disertiol3 r#

• Penderit den#n resiko kese3tn tin##i t2sn#t tin##i  mendptkn o!t nti?o!esitsdiserti diet rend3 klori dn ol3 r#)

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0IET ENER.I REN0A8

• T2%2n diet (• Menpi stt2s #i@i +n# ses2i

• Menpi IMT 1Q?, k#5m,

• Pen2r2nn BB )?1 k#5min##2

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0IET ENER.I REN0A8

• As2pn ener#i dik2rn#i ?1 kkl53ri drike!2t23n norml

• Protein 1?1 #5k#BB53ri t2 1?,H ener#i totl

• "emk ,?,H dri ener#i totl

• K8 ?VH ener#i totl

• itmin dn minerl ses2i ke!2t23n

• Cirn Q?1 #els53ri

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Strte#i Pen2r2nn dn Pemeli3rn BB

• A)TI>ITAS ?ISI) • Mem!nt2 mene#3 kenikn BB

• Men#2rn#i risiko K & di!etes

• 0pt dim2li den#n kti'its *sik rin#n kem2din

intensits ditin#ktkn !ert3p)• Perl2 moti'si

• K2rn#i sedentr+ d#n r !erkti'its *sik

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$"A8RA.A

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K$MP$NEN $"A8RA.A

• Terdiri dri - pilr 2tm(

1) rmin# 2p 5pemnsn

,) Min eerise 5 ol3r#inti

-) Coolin# do7n 5pendin#inn

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1) rmin# Up 5 Pemnsn

• 0ilk2kn selm X menit

• T2%2nn+ (1) $tot %nt2n# dn pr2?pr2 sip melk2kn ker% +n#

le!i3 !ert

,) Mempersipkn met!olisme dlm t2!23 #r dpt!eker% le!i3 !ik

-) Men#2rn#i kem2n#kinn ter%din+ eder

• Persipn (1) Pili3 ol3r# +n# di#emri mn m2d3 dn m2r3)

,) Se!ikn+ #2nkn pkin dn sept2 ol3r# +n#ses2i dn n+mn)

-)  9n#n lk2kn ol3r# setel3 mkn ken+n#se!ikn+ t2n##2 smpi , %m)

4) Min2m min2mn +n# se%2k dn sedikit mnis)

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,) Min Eerise

• Ter!#i men%di - 3l (1)  9enis ol3r#

1) Aero!ik

,) Anero!ik

,) Intensits ol3r#(•& VH ? QH kpsits ero!ik mksiml

•& ,H ? QH rek2ensi %nt2n# mksiml :Training Zone;

-) "m ol3r#(•& 1?, menit53ri :dlm trinin# @one;

•& - 5 min##2

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Met!olisme $l3r#

Anaerobik Aerobik  

Proses prod2ksi ATP ept Prod2ksi ATP le!i3 lm!t

1 molek2l #l2kos Y , ATP 1 molek2l #l2kos Y -V ATP

Prod2k smpin# s) "ktt Prod2k smpin# C$, W 8,$

Eekti :G - menit; Eekti :6 - menit;

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$"A8RA.A AER$BIK 

• Adl3 olr# +n# dilk2kn ser ter2s mener2sdimn ke!2t23n oksi#en msi3 dpt dipen23iole3 t2!23

• Tipe 1 (

• $l3r# den#n nik t2r2nn+ den+2t ndi +n# relti st!il• Conto3 ( %ln %o##in# !erseped

• Tipe , (• $l3r# den#n nik t2r2nn+ den+2t ndi ser !ert3p

• Conto3 ( senm dns renn#

• Tipe - (• $l3r# den#n nik t2r2nn+ den+2t ndi ser

menddk) Um2mn+ dlm !ent2k perminn)

• Conto3 ( sepk !ol !sket 'oli tenis lpn#n

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$"A8RA.A ANAER$BIK 

• $l3r# dimn ke!2t23n oksi#en tidk dptdipen23i sel2r23n+ ole3 t2!23

• Conto3 ( n#kt !esi lri ept 1 m

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-) Coolin# 0o7n 5 Pendin#inn

• 0ilk2kn selm X menit

• T2%2n (• Men#em!likn sem2 2n#si t2!23 ke kedn norml

• Persipn (

• Melk2kn #erkn 5 lti3n +n# intensitsn+ dit2r2nknser #rd2il 5 !ert3p

• 8l?3l +n# perl2 diper3tikn (•  9n#n ln#s2n# mkn ken+n# setel3 !erol3r# :!il

perl2 mknl3 mknn l2nk5irn seperti !2!2r kn#3i%2;)

• Min2ml3 se2k2pn+ !il !n+k !erkerin#t dn %n#nln#s2n# mndi :X 1 menit;)

• .ntil3 pkin ol3r# +n# di#2nkn !il terll2 !s3)

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• Psien dpt mem2li kti'its *sik den#n!er%ln selm - menit den#n %n#k 7kt2 -semin##2 dn dpt ditin#ktkn intensitsn+selm 4 menit den#n %n#k 7kt2

semin##2 < pen#el2rn ener#i tm!3nse!n+k 1 – , klori per 3ri dpt dipi)

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Strte#i Pen2r2nn dn Pemeli3rn BB

• TEAPI PEILA)/• Strte#i spesi*k 2nt2k men#tsi 3m!tn +n# m2n2l

st terpi diet & terpi *sik(• Pen#7sn mndiri ter3dp ke!isn mkn & kti'its

*sik

• Mn%emen stress

• Stim2l2s ontrol

• Peme3n msl3

• Conti#en+ mn#ement

• Co#niti'e restr2t2rin#

• 02k2n#n sosil

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Strte#i Pen2r2nn dn Pemeli3rn BB

?AA)-TEAPI• Ad d2 o!t resep +n# s2d3 dii@inkn ole3 Food and Drug Administration  :F0A; di Amerik Serikt 2nt2k pen#o!tn %n#k pn%n# o!esits (

• Sib#traine• $!t ini mer2!3 persrn di otk nd +n# mem!2t nd le!i3

ept mers ken+n#

• Eek smpin# ( menin#ktkn teknn dr3 skit kepl m2l2t kerin#konstipsi dn insomni

• KI( 3ipertensi P9K ##l %nt2n# kon#esti ritmi t2 ri7+t s+ok

• -r!istat *eni'a!+• Cr ker% ( mene#3 pen+erpn lemk dlm 2s2s nd) "emk

+n# tidk terserp kn di!2n# !ersm tin%

• Eek smpin# ( penin#ktn #erkn 2s2s

• Kren o!t ini %2# kn men+erp n2trisi selin lemk dokter ndkn men+rnkn 2nt2k men#kons2msi m2lti'itmin)

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-"AT

PEN()-NT-L

NA?S/ A)AN @

-"ESITAS

%ES)IPSI IN%I)ASI)-NTAIN%I)AS

I

Si!2trmin

$!t ?3idroksitriptmin

:serotonin; +# mer2pkn %enis

indiret?tin# s+mpt3omimeti

• BMI , k#5m, ATAU 6 +# p2n+

ktor risiko krdio'sk2lr ATAU -k#5m ATAU 6 tnp dn+ risiko

•  9ik BB> G H dr BB 7l :slm -

!2ln; BB st!il pd G H

setel3n+ BB= 6 -k# setel3 BB>

 8ENTIKAN

8ipertensi !ert retri okl2siperier pen+kit %nt2n#

koroner ritmi krdi

3ipertro* prostt ker2skn

3epr t2 renl !ert

P3entermin $!t s+mp3tomimeti #onisBB > :!il diserti d#n pen+kit 'l'2l

 %nt2n# & 3ipertensi p2lmoner;

0iet3+lpropion $!t s+mp3tomimeti #onisBB > :!il diserti d#n pen+kit 'l'2l

 %nt2n# & 3ipertensi p2lmoner;

$rlisttPentnoi id ester :.I lipse

in3i!itor;

• Usi 1Q? t32n

• IMT ,Qk#5m ATAU 6 +# p2n+ risiko

krdio'sk2lr ATAU - k#5m ATAU

6 tnp o?mor!idits

• BB> , k# d#n diet dn kti'its

*sik = pd !2ln se!el2mn+

Ml!sorpsi intestinl !ert

ATAU kolestsis

B2propionAntidepresn +# mer2pkn %enis

tetrsiklik & 2nisiklik 9# BB +# relti & BB >

Fl2oetin

Antidepresn +# mer2pk %enis

seleti'e serotonin re2ptke

in3i!itor

BB >

Sertrlin

Antidepresn +# mer2pk %enis

seleti'e serotonin re2ptke

in3i!itor

BB >

 TopirmtS2lmt?s2!stit2ed

monos3ride :ntisei@2re;BB > :toksiksits;

Zonismid 0eri'ti s2lonmid :ntisei@2re; BB >

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Strte#i Pen2r2nn dn Pemeli3rn BB

• TEAPI "E%AH• Horizontal banden gastroplasty 

• Vertical banded gastroplasty 

• Rou en ! gastric by pass

• "astric binding• #iliopancreatic by pass

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• Terpi !ed3 • Se!#i lternti terk3ir 2tk psien +# ##l den#n

rmkoterpi dn menderit kompliksi o!esits +n# ekstrim)

• Pd psien o!esits !ert ser klinis d#n IMT 64 t2 6-den#n kondisi komor!id)

• Eek smpin# (• Pne2moni

• Pem!ek2n dr3

• Ineksi

• Pen2r2nn !ert !dn +n# terll2 ept kn men#3silkn!t2 emped2 3erni :pd tempt pemoton#n;

• Sindrom dumping s2t2 kondisi dimn isi per2t terll2 eptms2k ke 2s2s 3l2s men+e!!kn m2l m2nt3 direp2sin# dn !erkerin#t

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Pene#3n

Primer – mene#3 ter%din+ o!esits

Sek2nder – men2r2nkn pre'lensi o!esits

 Tersier – men#2rn#i dmpk o!esits

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PENCE.A8AN

• Men#2!3 %2ml3 mknn +n# dimkn 2k2rn mknn7kt2 mkn :rek2ensi; dn komposisi n2trisi k32s2s drimknn it2)

• Menin#ktkn kti'its *sik ter2tm +n# meli!tkn #erksel2r23 t2!23)

• "ti3n *sik !2kn 3n+ sekedr pen#el2rn ener#i tetpidpt p2l• menekn ns2 mkn

• men#2rn#i stres

• menekn tin#kt ser2m ins2lin

• menm!3 mss !2kn lemk dlm t2!23

• menin#ktkn kpsits penn#nn kr!o3idrt• pen2r2nn kem2n#kinn 3ipertensi

• men2r2nkn ser2m tri#liserid

• resistensi ker2skn t2ln#

• menin#ktkn rsio kolesterol lipoprotein +n# dpt melind2n#i t2!23 kitdri pen+kit %nt2n#)

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"$-)

Sindrom Met!olik

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Sindrom Met!olik

• Fit2r 2tm Sindrom met!olik• resistensi ins2lin

• 3ipertensi :teknn dr3 tin##i;

• dislipidemi

• o!esits

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H/" -"ES % %AN

HIPETENSI

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Pat,op,ysio!ogy o& t,e etabo!i' syndroe

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Pat,op,ysio!ogy o& t,e etabo!i'syndroe

• Free tt+ ids :FFAs; re relesed in !2ndne rom n epndeddipose tiss2e mss)

• In t3e li'er FFAs res2lt in n inresed prod2tion o #l2osetri#l+erides nd seretion o 'er+ lo7 densit+ lipoproteins :"0"s;)

• Assoited lipid5lipoprotein !normlities inl2de red2tions in 3i#3?densit+ lipoprotein :80"; 3olesterol nd n inresed densit+ olo7?densit+ lipoproteins :"0"s;)

• FFAs lso red#'e ins#!in sensiti.ity in m2sle !+ in3i!itin# ins2lin?medited #l2ose 2ptke) Assoited deets inl2de red2tion in#l2ose prtitionin# to #l+o#en nd inresed lipid 2m2ltion intri#l+eride :T.;)

• Inreses in ir2ltin# #l2ose nd to some etent FFA inresepnreti ins2lin seretion res2ltin# in ,yperins#!ineia)

• 8+perins2linemi m+ res2lt in en3ned sodi2m re!sorption ndinresed s+mpt3eti ner'o2s s+stem :SNS; ti'it+ nd ontri!2teto t3e ,ypertension s mi#3t inresed le'els o ir2ltin# FFAs)

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• T3e proinmmtor+ stte is s2perimposed nd ontri!2tor+ to t3eins2lin resistne prod2ed !+ eessi'e FFAs)

• T3e en3ned seretion o interle2kin V :I"?V; nd t2mor nerosistor [ :TNF?[; prod2ed !+ dipo+tes nd mono+te?deri'edmrop3#es res2lts in more ins#!in resistan'e nd lipol+sis odipose tiss2e tri#l+eride stores to ir2ltin# FFAs)

• I"?V nd ot3er +tokines lso en3ne 3epti #l2ose prod2tion"0" prod2tion !+ t3e li'er nd ins2lin resistne in m2sle)

• C+tokines nd FFAs lso inrese t3e 3epti prod2tion o *!rino#ennd dipo+te prod2tion o plsmino#en ti'tor in3i!itor 1 :PAI?1;res2ltin# in prot,roboti' state)

• 8i#3er le'els o ir2ltin# +tokines lso stim2lte t3e 3eptiprod2tion o C?reti'e protein :CRP;)

• Red2ed prod2tion o t3e nti?inmmtor+ nd ins2lin sensiti@in#+tokine diponetin re lso ssoited 7it3 t3e met!olis+ndrome) $Reprinted %rom &ckel et al'( )ith permission %rom&lsevier'*

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$BESE

• Pen2r2nn BB ?1H s2d3 dpt mem!erikn per!iknpro*l met!olik) Penn#nn +n# terinte#rsi dlmpen#eloln BB dl3 diet kti'its *sik per2!3nperilk2 :+n# terpentin#; o!t :si!2trmin dn orlistt;)

• Si!2trmin r ker%n+ di sentrl mem!eri eek

men#2rn#i s2pn ener#i mell2i eek memperept rsken+n# dn mempert3nkn pen#el2rn ener#i setel3BB t2r2n dpt mem!eri eek tidk 3n+ 2nt2kpen2r2nn BB tpi %2# mempert3nkn BB +n# s2d3t2r2n)

• Unt2k eek met!olik pem!erinn+ setel3 ,4 min##2+n# diserti diet dn kti'its *sik memper!iki kdrtri#liserid dn kolesterol 80")

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8IPERTENSI

• 8T mer2pkn ktor risiko pen+kit krdio'sk2lr) 8T  mikro!l!2min2ri +n# dipki se!#i indiktorindependen mor!idits krdio'sk2lr pd ps tnpdi!etes58T)

• En@im pen#kon'ersi n#iotensin dn pen#3m!t reseptor

n#iotensin p2n+ mnt +n# !ermkn dlmmere#resi 3iperto* 'entrikel kiri di!ndin# den#npen#3m!t !et dre#enik di2retik dn nt#onisklsi2m)

• lsrtn s2t2 pen#3m!t reseptor n#iotensin dpt

men#2rn#i mikrol!2min2ri +n# diket32i se!#iktor risiko independen krdio'sk2lr)

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INT$"ERANSI ."UK$SA

• Intolernsi #l2kos mer2pkn sl3 1 mniestsisindrom met!olik +n# dpt %di 7l s2t2 0M) Ad32!2n#n k2t ntr T.T dn risiko krdio'sk2lr pdsindrom met!olik dn di!etes)

• Per2!3n #+ 3id2p dn kti'its *sik +n# tert2r

eekti men2r2nkn BB dn T.T) Modi*ksi diet ser!ermkn memper!iki #l2kos , %m ps prndil dnkdr ins2lin)

•  Ti@olidindion p2n+ pen#r23 +n# rin#n tpi persistendlm men2r2nkn T0 sistolik dn distolik) $!t ini dn

metormin %2# dpt men2r2nkn kdr sm lemk!e!s)

• Pd 0i!etes Pre'ention Pro#rm pen##2nnmetormin dpt men#2rn#i pro#res di!etes se!esr-1H dn eekti pd ps m2d den#n o!esits)

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0IS"IPI0EMIA

• 0islipidemi terpi n+ den#n per2!3n #+3id2p +n# diik2ti mediksi) Per2!3n diet dnlti3n %smni s% tidk 2k2p !er3silmenpi tr#et) 9di o!t W per2!3n #+

3id2p)• .em*!ro@il tidk 3n+ memper!iki pro*l lipidtpi %2# men2r2nkn risiko K)

• Feno*!rt ser k32s2s dipki 2nt2k t2r2nkn

tri#liserid dn menin#ktkn kolesterol 80"per!ikn pro*l lipid +n# sn#t eekti dnmen#2rn#i risiko K men2r2nkn kdr*!rino#en)

• Feno*!rt W sttin memper!iki kdr

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 Tt lksn

• Per2!3n #+ 3id2p• Pen#7sn tert2r tentn# teknn dr3kolesterol dn #2l dr3

• $l3 r#

• K2rn#i kons2msi lemk %en23 kolesterol dns2pn #rm)

• Tin#ktkn mknn +n# men#nd2n# serttin##i seperti s+2r !i%i?!i%in dn !23?!23n)

• $!t?o!tn

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0tr P2stk

• S3er7ood") ,1) Fisiolo#i Mn2si) 9krt( E.C• S2do+o A dkk editor) B2k2 %r ilm2 pen+kitdlm) Edisi ke?4) 9ilid III) 9krt( FKUI ,V)

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