1.

Food for Recovery Nutrition

a. Principle
1) Food for Nutritional Rehabilitation is energy-dense foods are fortified with
vitamins and minerals.
2) Food for Nutritional Rehabilitation given to malnourished children during the
recovery period.
3) Food for Nutritional Rehabilitation can be: F100, therapeutic food / nutrition fast
food and local food. Local food with shapes ranging from food liquid, creamed,
lembik, solid.
4) The main basic ingredients Food For Nutritional Rehabilitation in the formula F100
and nutrition of fast food (therapeutic feeding) is an oil, milk, flour, sugar, pulses and
animal sources. The content of fat as an energy source of 30-60% of total calories.
5) Local food with calories 200 kcal / kg per day, derived from fat 30-60% of total
energy, protein 4-6 g / kg per day.
6) When will use local food is not done in a single (local food of course) but it must
be combined with food formula.
b. The amount and frequency
Food for Nutritional Rehabilitation instead of the usual food but it is a special food for
the nutritional recovery of children who are given in stages:
1) Children malnutrition with clinical signs given in stages:
Phase early rehabilitation of 150 kcal / kg per day, given 5-7 times Award / day.
Given for one week in the form of liquid food (Formula 100).
Advanced Rehabilitation Phase 200-220 kcal / kg per day, given 5-7 times Award /
day (Formula 100).
2) Children without clinical signs of malnutrition directly given subsequent
rehabilitation phase 200-220 kcal / kg per day, given 5-7 times Award / day (Formula
100).
Subsequent rehabilitation was given for 5 weeks by feeding gradually to reduce the
frequency of liquid food, and increase the frequency of solid food.
Feeding Frequency Sample per day Table 1: Children without clinical signs of
malnutrition:

Minggu Ke

Formula 100

Makanan Utama + Buah

Makanan Selingan

5 kali

1 kali

1 kali

II

4 kali

2 kali

1 kali

III

4 kali

2 kali

1 kali

IV

3 kali

3 kali

2 kali

3 kali

3 kali

2 kali

Table 2: Children with clinical signs of malnutrition

Minggu Ke

Formula 100

Makanan Utama + Buah

Makanan Selingan

6 kali

II

5 kali

1 kali

1 kali

III

4 kali

2 kali

1 kali

IV

4 kali

2 kali

1 kali

3 kali

3 kali

2 kali

VI

3 kali

3 kali

2 kali

2. Malnutrition Vitamin
II.1 Vitamin After Fat

Vitamins are essential nutrients that the body needs in small amounts for various roles
in the human body. Vitamins are divided into two groups: water soluble (B complex
and C) and fat soluble (A, D, E and K). Unlike water-soluble vitamins that need to be
replaced regularly in the body, fat-soluble vitamins are stored in the liver and fat
tissue, and disposed of much slower than water-soluble vitamins.
Because fat-soluble vitamins are stored for a long time, they generally pose a greater
risk for toxicity of water-soluble vitamins when consumed in excess. Eating a
balanced diet that normally would not cause toxicity in healthy individuals. However,
taking vitamin supplements that contain mega doses of vitamins A, D, E and K can
cause poisoning.
In children, some conditions can cause an imbalance of vitamins. This often occurs in
pregnant women and infants with a shortage of adequate dietary intake of vitamins.
Vitamin D deficiency is often the case, also known as rickets, due to the unavailability
of vitamin D fortification of milk results.
1. Vitamin A (Retinol)
The function of vitamin A is to meet the needs component in the formation of pigment
rhodopsin (vision purple), establishing and maintaining epithelial tissue, helps the
growth and development of bones and teeth, help the growth of spermatogenesis,
helping the formation of thyroxine, and as an antioxidant. Sources of vitamin A can be
formed naturally, such as the liver, kidneys, liver oil, milk, and egg yolks. Another
source is formed of provitamin A (carotene), such as carrots, potatoes, spinach,
cabbage, broccoli, pumpkin, apricot, and others.
Vitamin A deficiency can lead to the occurrence,
Night blindness
keratinization epithelium
Xeroftalmia
phrynoderma (rough skin)
Drying in the respiratory, gastrointestinal and genitourinary tract
Tooth enamel is damaged
Stunted growth
Impaired bone formation
Decrease the formation of thyroxine
Decreased resistance to infection.

The earliest signs in children with excess vitamin A views with irritability, anorexia,
pruritus, fissures in the corner of the nose and lips, and dry skin. While the sign next
to the condition characterized by excess hepatomegaly, jaundice, delayed growth,
achieve low weight, cortical thickening along with bone pain and weakness, swelling
of the extremities and soft hard bone of the skull occiput.
Excess vitamin A can also cause birth defects if excessive intake of vitamin A during
pregnancy. Conditions resulting excess vitamin A can not be digested vitamin so well
that a number of carotene in the blood (karotinemia). This causes a yellowish tint to
the skin (not on the sclera, urine, or feces as in jaundice), but no symptoms of the
above.
Treatment of children with vitamin A deficiency, among others:
Encourage the consumption of foods rich in vitamin A, such as cow's milk (after 12
months)
As the reduction in the consumption of milk, suggest foods rich in vitamin A
Ensure adequate intake in premature infants
Encourage families to use supplements that are safe for children with measles
Prevent bronkopulmonar severity of dysplasia in premature infants (the growing
influence of epithelial cells in the respiratory tract)
Handling in children with excess vitamin A, among others:
Emphasize the use of vitamin supplements and correction of potential dangers of
excess
Evaluate the child's eating habits to calculate roughly intake; if the excess, avoid
supplemental sources
Encourage families to the natural carotenes are not berbahayah; avoiding excess
pigmented fruits and vegetables, especially carrots; skin color returned to normal
within 2 to 6 weeks.

2. Vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol)

Vitamin D has a function to absorb calcium and phosphorus, and decrease the
phosphorus excretion in the kidney. Sources of vitamin D is sunlight, cod liver oil,
mackerel, salmon, tuna, and sardines. Other sources of vitamin D-fortified foods, such
as milk, dairy products, cereals fortified vitamin D, and some drinks for breakfast.

Signs of vitamin D deficiency in children is rickets and rachitic tetany (spasms), and
some marks on the body, among other things:
- Head: Craniotables (softening on the part of the cranial bone, frontal bone parts to be
high), change in shape (flat skull and are hollow in the middle), delayed fontanelle
closure.
- Chest: Rachitic rosary (extension on the connecting costochondral rib), Harrison
groove (horizontal basin at the bottom of the ribs), pigeon chest (form bulges out at
the sternum).
- Spine (spine): kyphosis, scoliosis, lordosis
- Abdomen: constipation, protruding belly / fat
- Extremities: arms and legs bent, feet kneed out, saber shins, hip joint is unstable,
change the shape of the pelvis, widening the epiphysis at the end of long bones.
- Teeth: a slowdown in calcification, particularly the permanent teeth
Excess vitamin D can lead to osteoporosis in the long bones, increase in serum
calcium and phosphorus, and calcification of soft tissues, such as kidneys, lungs,
adrenal glands, blood vessels (hypertension), heart, stomach lining, the tympanic
membrane (deaf).
Based on the circumstances, excess vitamin D can be characterized by:
- Acute: vomiting, dehydration, fever, abdominal cramps, bone pain, convulsions, and
coma
- Chronic: weak, mental retardation, anorexia, failure to thrive, thirst, urinary urgency,
polyuria, vomiting, diarrhea, abdominal cramps, bone pain, pathological fractures.
Excess vitamin D can be done with the handling of low-calcium diet during early
therapy. In children with vitamin D deficiency with are:
- Encourage the consumption of foods rich in vitamin D, especially cow's milk that
has been fortified (age> 12 months)
- Encourage use of vitamin D supplements by the age of 2 months in all types of
infant
- Observation possibility of an overdose of supplements
- If specified, oversees the proper use of orthoses (splints and braces)
3. Vitamin E
Vitamin E in the body has a function to help produce red blood cells and protects from
hemolysis, maintaining the integrity of the muscle and liver, as a coenzyme factor in

respiratory tissues, minimizing poliunsaturasi oxidation of fatty acids and vitamins A

and C in the channel and intestinal tissue. The source of vitamin E are vegetable oils,
wheat germ oil, milk, egg yolks, fish, rice, beans, peas, spinach, and broccoli.
Vitamin E deficiency in children will cause hemolytic anemia of hemolysis caused by
the lifetime of the red blood cells are short, especially in premature infants; focal
necrosis on the network. While excess vitamin E only a few are known, such as less
toxic than other fat-soluble vitamins.
Treatment for vitamin E deficiency in children, among other things:
- Early Initiation of Breastfeeding (IMD) in premature infants; may also need
supplements
- Potentially as an antioxidant in immune function, preventing or minimizing the
severity of retinopathy and the prevention of hemolytic anemia, bronkopulmonar
dysplasia, and intracranial hemorrhage.

4. Vitamin K
The function of vitamin K in the body as a catalyst for the production of prothrombin
and blood coagulation factors II, VII, IX, and X in the liver. Sources of vitamin K is
pork, greens, cabbage, tomato, egg yolk and cheese. This vitamin deficiency in
children is characterized by bleeding. While the advantages of this vitamin can result
in hemolytic anemia in individuals deficient in glucose 6-phosphate dehydrogenase.
Treatment of children with vitamin K deficiency is by:
- The provision of prophylaxis for all newborns
- Other indications include diseases of the intestine, the absence of bile, which
extended antibiotic therapy; this allows the use of the management of blood clotting
when

anticoagulants

such

as

warfarin

(Coumadin)

and

dicumarol

(bishydroxycoumarin), a vitamin K antagonist used.

II.2 Water Soluble Vitamins
The substance contained in the human body consists of vitamins, minerals, fats and
some other substances. The human body needs at least 13 kinds of vitamins, which
consists of fat soluble vitamins and water soluble vitamins. Water-soluble vitamin is
vitamin B complex and vitamin C.
1. Vitamin B complex

Vitamin B complex consists of vitamins Thiamin (B1), riboflavin (B2), niacin (B3)
Pantothenic Acid (B5), Pyridoxine (B6), biotin (B7) and Folic Acid (B9) and
Cyanocobalamin (B12, Jathar, R. , 2010). Each type of these vitamins have varied
benefits and functions of the human body. The imbalance of vitamin intake can lead to
impaired function of human organs. The following will explain some of the benefits
of each vitamin B complex, including:
Changes in the form of carbohydrates into glucose and energy in the body
Synthesis of DNA and RNA
Set the function of the adrenal glands
Maintaining balance hormone secretion and regulation of the nervous system enzyme
Solving fat and fat metabolism
Participate in maintaining healthy hair, nails, eyes and skin
Participate in maintaining the health of the central nervous system (CNS) and
prevent some of the conditions of mental disorders such as depression, fatigue,
lethargy, impaired concentration, irritability, stress, and anxiety.
a. Vitamin B1 (Thiamine)
Beef, liver, legumes, cereals, grains, green vegetables, fruits, milk, brown rice
b. Vitamin B1 (Ribovlafin)
Milk and milk products, eggs, meat, liver, kidneys, and heart, yangdiperkaya
cereals, green vegetables, legumes
c. Niacin (nicotinic acid, Nicotinamide)
Meat, poultry, fish, peanuts, green kacangg, legumes, whole grains pure or
enriched except corn and rice
d. Vitamin B6 (pyridoxine)
Meat, liver and kidney teruatama, grain cereals (wheat and corn), yeast, soya
beans, peanuts, tuna, chicken, salmon
e. Folic Acid (Folasin)
Green leafy vegetables, asparagus, liver, kidney, beans, eggs, cereals, grains
pure, peas, bananas
f. Vitamin B12 (cobalamin)
Meat, liver, kidney, fish, shellfish, poultry, milk, eggs, cheese, nutritional
yeast, sea vegetables
g. biotin
Liver, kidney, egg yolks, tomatoes, peas, beans
h. pantothenic acid
Liver, kidney, heart, salmon, eggs, vegetables, legumes, whole grains pure.
Table B-complex vitamin composition in accordance with human needs

Vitamin B Complex Dosage Chart

Vitamin B Type
Vitamin

B1

(Thiamine)
Vitamin

B2

(Riboflavin)
Vitamin

B3

(Niacin)
Vitamin

B5

(Pantothenic Acid)
Vitamin B6
Vitamin

B7

(Biotin)
Vitamin B9 (Folic
Acid)
Vitamin

B12

(Cobalamin)
Rutuja

0-6

6-12

1-18

18

Months

Months

Years

Years +

0.3 mg

0.5 mg

1-1.5 mg 1.5 mg

+ 0.5 mg

0.4 mg

0.6 mg

1-1.5 mg 1.7 mg

+ 0.5 mg

6 mg

8 mg

2.5 mg

10-15

15-20

mg

mg

3 mg

4-7 mg

10 mg

0.3 mg

0.6 mg

1-2 mg

35 mcg

50 mcg

30 mcg

50 mcg

0.5 mcg

1.5 mcg

Jathar

100-200
mcg
100-400
mcg

2-2.5
mg

Pregnant/Lactating

+ 4 mg
+ 3 mg
+ 0.6 mg

300 mcg + 50 mcg

400 mcg 1 mg

2-4 mcg 4-6 mcg + 1 mcg

http://www.buzzle.com/articles/vitamin-b-complex-

dosage.html
The imbalance of vitamin B complex may result in a wide variety of side effects.
Consumption of vitamin B complex in excessive amounts can lead to several health
problems, including diarrhea, abdominal cramps, bloating, and some of the health
problems related to gastrointestinal health, insomnia, problems in the eye, mouth
tereasa bitter, calcium deficiency, hyperactivity, increased the severity of the disorder
certain mental such as depression and irritability, reduced metabolism and absorption
of nutrients. Some side effects vitamin B complex imbalance between, anemia, low
blood pressure, headache, palpitations, edema, joint pain, itching, redness of the skin,
loss of appetite, and a few other side effects (Jathar, R., 2010) ,
2. Vitamin C

Vitamin C (ascorbic acid), which is not a fat-soluble vitamin has several benefits
(Wong, 2002), including:
a. Essential for collagen formation
b. Increase the absorption of iron for the formation of hemoglobin
c. Encourage the conversion of folic acid into acid folinik
d. Affect cholesterol synthesis and conversion of proline into hydroxyproline
e. Antioxidant ingredients (keep other vitamins from being oxidised).
Vitamin C sourced from some foods, such as citrus fruits, strawberries, tomatoes,
potatoes, cabbage, broccoli, cauliflower, green peppers, spinach, papaya, mango,
cantaloupe, watermelon, fruit juices fortified.
Deficiency or excess of vitamin C can result in disruption multiple functions,
including disorders of the musculoskeletal system, disorders of the gums, and some
health problems. Disorders of the musculoskeletal system results in muscle and joint
bleeding, pseudoparalisis due to pain, joint swelling, lumps kostokondrial (skorbutik
rosary). While the disruption of the gums resulting in gum soft, brittle, swollen, easily
bleeding, black or bluish red, rocking gear and date. Some other health problems such
as irritation, anorexia, anxiety, pain, refusing to move, like a frog when supine
position (pose Skorbutik), the emergence of anemia, slow wound healing process, and
lead to increased susceptibility to infection.
Management of vitamin C to balance disturbance consists in some way. Here will be
explained in several ways penetalaksanaan children with balance disorders vitamin C:
a. Assess sources of vitamins on babies diet, especially if the source of the main diet is
derived from cow's milk
b. Emphasize the importance of applying the techniques of cooking and food storage
techniques right
c. Wash the vegetables properly, never soak vegetables in water
d. Cook the vegetables in a pot with a lid with minimal water and a short time, do not
use cookware of copper or iron
e. Do not add baking soda in lukewarm water
f. Consumption of fresh vegetables or fruit as soon as possible, refrigerate
g. Save the juice in containers opaque and airtight
h. Wrap the fruit that has been cut or eaten immediately after being exposed to the air
i. Caring for a child suffering from scurvy is to position the child in a comfortable
position and and the resting state. Handle with a very soft and minimal. Give

analgesics as needed, prevent infection, give good oral care, provide a liquid and soft
diet emphasize proper recovery when given vitamin
j. Emphasize the use of vitamin true supermen and potential side effects when given
in excessive doses.
k. Bearisiko group identification to be given supplements of vitamin C, thalassemia,
the group receiving anticoagulant therapy and aminoglycoside antibiotics.
3. Mineral Malnutrition
Minerals are essential nutrients and 4% of the human body is composed of minerals.
Minerals are classified into two types, namely makromineral and mikromineral.
Makromineral took more than 100 mg per day, including calcium (Ca), phosphorus
(P), sodium (Na) and potassium (K), magnesium (Mg), sulfur (S), and chloride (Cl).
Mikromineral or microscopic element is a mineral needed less than 100 mg per day, ie
iron (Fe), zinc (Zn), iodine (I), and selenium (Se). The biggest problem is a mineral
deficiency, teutama iron, calcium, phosphorus, magnesium, and zinc. Low zinc levels
can lead to failure to thrive aibat nutrients.
Regulation of mineral balance in the body is a complex process. Extreme Diet mineral
intake can cause a number of interactions minerals which can lead to a deficiency or
excess of minerals that are not expected. Deficiency also can occur when substances
in the diet interacts with minerals. For example, iron, zinc, and calcium can form
insoluble complexes with fitrat and / or oxalate (a substance that many terdaat in plant
protein), which interfere with mineral bioavailability.
In the composition of sweat water, three major minerals are sodium, potassium and
chloride is a mineral with the largest concentration contained therein. So with the
greater rate of transpiration, the rate of loss of sodium, potassium and chloride in the
body also will be great. Among the three, sodium and chloride, a mineral with the
highest concentration were carried out of the body through the sweat glands (sweat
glands).
The following is a table of deficiency and excess makromineral and mikromineral:
a) chloride
Function: acid-base balance, Activation of the enzyme in saliva, Components
of hydrochloric acid in the stomach
Salt, meat, eggs
Dairy products
Fast food

 Food preserved
b) Copper
Function: Production of Hb, essential component of several enzyme systems
Meat
Nuts
oysters
Corn Oil
c) Florin
Function: The formation of dental caries resistant, The development of strong
bones
floride waters
food or beverages prepared with fluoridated water,
fish
tea
d) Iron
Function: The formation of hemoglobin and Myoglobin, An essential part of
many enzymes and proteins
liver
Beef
Chicken meat
Nuts
Shellfish
Grains of pure
e) Magnesium
Function: Formation of bones and teeth, Production of protein, Conduction
of nerve to muscle, Activation of the enzyme needed for the metabolism of
carbohydrates and protein
All grains
Nuts
Soybeans
Meat
Salad
The and chocolate
f) Phosphor
Function: The growth of bones and teeth, Involved in many chemical
reactions in the body, The balance of acids and bases
Dairy products
Eggs
Meat
Chicken
Soft drink
g) Potassium / Potassium
Function: acid-base balance, Nerve conduction, particularly cardiac muscle
contraction, The release of energy

 Bananas, oranges, dried fruit

beef, fish
Potatoes
The, chocolate, coffee
h) selenium
Function: Antioxidants are especially protective vitamin E, Protect from
heavy metal toxicity, Liaise with fat metabolism
Seafood
Egg yolk
Grains
Chicken and meat
Tomatoes, garlic, cabbage
Mushrooms
milk

Ref:

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