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What is the therapeutic and preventive nutrition

Treatment is called nutrition, which is issued to workers and employees with harmful working conditions. The main purpose of treatment-and-prophylactic nutrition is to increase the body's defenses and reactivity, to prevent occupational diseases and poisonings.

At present, in connection with the automation and mechanization of production processes, the continuous improvement of working conditions of workers and the increase in the production culture, the expressed forms of occupational diseases and intoxications are very rare. However, the occupational health of workers exposed to occupational hazards arising from the violation of production technology is paid much attention to. This is due to the fact that even the minimal impact of certain production hazards can have an adverse effect on the human body, cause pathological changes to it, as well as adversely affect productivity.

In the complex of recreational activities aimed at preserving and strengthening the health of workers, the organization of rational and therapeutic and prophylactic nutrition under production conditions becomes important. A major role in preserving and enhancing the health of the population of a balanced, nutritious diet, the consistent implementation of measures to improve the quality and rational use of food products is emphasized in the “Main Directions for the Development of Public Health Protection and the Restructuring of Public Health of the USSR in the 12th Five-Year Plan and for the period up to 2000 year”.

The principles of treatment-and-prophylactic nutrition, substantiated by A. A. Pokrovsky, academician of the Academy of Medical Sciences of the USSR, are reduced to the following provisions:

 Slowdown with the help of food substances processes of absorption of toxic substances in the digestive system. So, scientists believe that the speed and strength of the poison that got into the stomach, largely depend on its content. Substances taken on an empty stomach are absorbed more quickly, since they are in free contact with the mucous membrane of the stomach, without being diluted by its contents. Absorption of toxic substances entering the stomach and intestines in the presence of a sufficient amount of food, that is, in the case of mechanical difficulty in access of poisons to the mucous membrane, slows down. Therefore, it is important that those who work in hazardous conditions do not start work on an empty stomach.

 The use of antidote properties of individual components of food in order to neutralize certain toxic substances, for example, the ability of pectin substances and pectin-containing products to bind salts of heavy metals and their compounds in the digestive system.

 Acceleration or deceleration via neutralization poisons nutrients depending on the starting materials or products of their conversion in the body.

 The influence of food factor on the acceleration of the removal of toxic substances from the body (for example, protein with sulfur-containing amino acids).

 Compensation with the help of food increased costs the body of individual nutrients (amino acids, vitamins, macro-and micronutrients, etc.) associated with exposure to poison.

 The impact of food substances on the state of the most affected organs and systems (liver, kidney). The most widespread use of products found - sources of animal protein (milk, cottage cheese, eggs), sources of vitamins, etc.

 The increase in the overall resistance of the body to the effects of occupational hazards with the help of food factors (unbalanced nutrition, especially for the protein component and the content of water-soluble vitamins, exacerbates the effects of toxic substances on the body).

In the prevention of adverse effects of production factors on the body, the leading role is played by proteins of animal origin, which are a source of essential amino acids, especially sulfur-containing (methionine and cystine), as well as choline.

Basic rations of therapeutic and preventive nutrition

Treatment-and-prophylactic nutrition is given free of charge to workers, whose nature and working conditions can lead to chronic intoxication and occupational disease. There are the following forms of therapeutic and preventive nutrition: diets of therapeutic and preventive nutrition or separately issued milk, pectin and vitamin preparations.

Rations of preventive nutrition in the form of breakfast should be issued to workers and employees before the start of the work shift. Depending on the profession of working breakfast is prepared on one of six rations with the simultaneous issuance of vitamin preparations. The diet number 1 is characterized by the content of foods rich in nutrients (methionine, cystine, lecithin), stimulating fat metabolism in the liver and increasing its antitoxic function. In addition, the inclusion in this diet of products of high biological value (milk and dairy products, liver, eggs) increases the overall resistance of the body to the action of ionizing radiation. Additionally, 150 mg of ascorbic acid is given.

Preventive diet ration 2 is achieved by including a sufficient amount of vegetables and grains - sources of vitamins and minerals, as well as dairy products, fish, vegetable oils, etc., to ensure the intake of animal protein, calcium and polyunsaturated fatty acids.

The ration number 2a is characterized by a high content of animal proteins, vegetables, ascorbic acid, retinol, nicotinic acid, B-methylmethionine. In addition, the workers are additionally issued mineral water Narzan. The main purpose of the diet number 2a is to reduce the toxic and allergenic effect of chromium and its compounds on the body.

The ration number 3 is compiled in accordance with modern requirements for therapeutic and preventive nutrition for workers in contact with lead. This diet includes milk and dairy products - sources of high-value animal protein and calcium. In addition, for this contingent of workers, daily delivery of dishes from vegetables that are not subjected to heat treatment (salads, vinaigrettes), which are good sources of pectin, ascorbic acid, group B vitamins, mineral salts, carotene, is provided for.

Workers and employees engaged in the production of nitro and amino compounds of benzene and its homologues, chlorinated hydrocarbons, arsenic compounds, tellurium, mercury, phosphorus, when working under conditions of high atmospheric pressure, as well as at works on unloading and loading apatite in marine and river ports, issued treatment-and-prophylactic ration number 4. The main purpose of this diet is to increase the functional capabilities of the liver and the hematopoietic system. In the treatment-and-prophylactic ration number 4 include milk and dairy products, vegetable oils as sources of lipotropic factors that have a beneficial effect on liver function. At the same time it is necessary to limit the use of various fatty dishes, fish, meat and mushroom soups, as well as sauces and gravies. It is necessary to minimize the use of herring, smoked meat and pickles. In the diets of people working with phosphorus, it is necessary to limit the fats, especially refractory ones, since they contribute to the absorption of this substance in the intestines. In order to prevent changes in the function of the nervous system working with compounds of arsenic, mercury, tellurium and phosphorus, an additional 4 mg of thiamine and 150 mg of ascorbic acid are given out.

In the diet number 5 include cottage cheese, lean meats, fish, eggs, vegetable oil, fresh vegetables and fruits. The main focus of therapeutic and prophylactic rations number 5 - protection of the nervous system and liver.

The use of fats in therapeutic and prophylactic nutrition should be approached with great care, as they contribute to the absorption of toxic substances soluble in them. In this regard, in all diets of therapeutic and preventive nutrition it is necessary to limit the consumption of fatty

products and refractory fats (mutton, beef, pork). It should also limit the salt and salted foods.

In the production of benzene, chlorinated hydrocarbons and arsenic it is recommended to drink plenty of liquids.

Use of milk and vitamins in preventive nutrition

Milk and dairy products increase the body's resistance to harmful physical, chemical and biological production factors. These products improve the overall functional abilities of the body, soften the effect of radioactive and toxic substances on the liver, normalize protein and mineral metabolism.

The issuance of milk or other equivalent food products to workers and employees who work in hazardous working conditions is regulated by decrees of the USSR Council of Ministers and other documents. Thus, Article 64 of the Fundamentals of Labor Law of the USSR and the Union Republics states: “Workers in unhealthy working conditions give workers and employees free of charge, according to established standards, milk and other equivalent food products.” The lists of jobs and professions that give workers and employees the right to receive milk are determined by the heads of enterprises and institutions in agreement with trade union organizations and in accordance with medical indications approved by the USSR Ministry of Health. Natural milk in exceptional cases, in coordination with the medical-sanitary part of the enterprise or with the local sanitary-epidemiological station, can be replaced by an equal amount of kefir, yogurt, acidophilic milk or matsoni.

For a long time, it was not recommended to issue milk to persons who are in contact with lead under production conditions. This was associated with the presence of readily absorbable calcium in milk, the increased intake of which in the body causes a negative effect on the course of lead intoxication. However, as shown by experimental studies in recent years, milk added to food rations, poor animal proteins, contributes to a significant reduction in the severity of lead poisoning and stimulates the removal of lead from the body. The favorable effect of milk is associated, above all, with the presence in it of high-grade animal proteins, sulfur-containing amino acids, lactic calcium, thiamine and ascorbic acid. In order to improve and improve the nutrition of workers engaged in work related to the effects of inorganic lead compounds, the USSR Ministry of Health recommends that they be given dairy products in the amount of 0,5 l. The issuance of fermented milk products to workers and employees should be carried out during the working day.

In therapeutic and prophylactic nutrition, fat and water-soluble vitamins are widely used both in the form of pharmaceutical preparations and in the composition of food products included in the diet.

The delivery of vitamins in the form of pharmaceutical preparations (retinol, thiamine, riboflavin, nicotinic and ascorbic acids) was officially approved by the State Committee on Labor and Social Affairs of the Council of Ministers of the USSR and the Presidium of the All-Union Central Council of Trade Unions.

In tab. 9 presents the norms for the free distribution of vitamin preparations in accordance with the “List of industries, professions, positions, work in which gives the right to receive free treatment-and-prophylactic nutrition due to particularly harmful working conditions” (1977).

Workers in hot workshops have increased sweating, which leads to a significant loss of water-soluble vitamins. In this regard, when exposed to a high temperature of the production environment and intensive heat radiation, vitamins are provided free of charge to workers in hot shops of the blast furnace, steel-smelting, rolling and pipe production, in the baking industry. Vitamin preparations are also given to workers engaged in tobacco and tobacco production and the production of nicotine, who are exposed to nicotine-containing dust.

Along with vitamin preparations, one should include foods rich in fat and water-soluble vitamins in therapeutic and preventive nutrition.

9 table. The norms of free delivery of vitamin preparations in connection with particularly harmful working conditions

Categories of workers

Name

vitamins

DAY

naya

dose,

mg

Workers exposed to high ambient temperatures and intense heat radiation:

a) directly involved in the work you

retinol

2

metal smelting and hot metal on rental

thiamine

3

ferrous metallurgy

riboflavin

3

b) scalds and bakers in the bakery pro

Ascorbic

duction

acid

150

A nicotinic acid

20

Employees engaged in tobacco and tobacco

thiamine

2

cottage industries exposed to

Ascorbic

150

Dust action containing nicotine

acid

Pectin in preventive nutrition

To prevent poisoning by heavy metals (mercury, lead, cadmium, etc.) Are recommended pectin, which are part of vegetables, fruits and berries. Pectic substances bind to the gut of lead, mercury, manganese, and other metals, thereby facilitating their removal from the body and reduction of their concentration in the blood.

Name of food products and preventive orientation

Mashed carrots and beets (1 waRihanna)

Beets, stewed in sour cream sauce

Mashed carrots and beets (2 wa

Stewed cabbage

Rihanna)

Puree prunes

carrot Cutlets

Puree carrots or beets

Cutlets beet

Pumpkin puree

Cutlets cabbage

Apples baked

Cabbage Casserole

Vegetables prypuschennыe

Carrot casserole with cheese

Kissel from dried apples with cranberries

or without cheese

howl or without cranberries

Pumpkin, zucchini, eggplant Ms.renye

Kissel from apples fresh with cranberrieshowl or without cranberries

Vegetable Stew (1 version)

Vegetable Stew (2 version)

Canned fruits

Carrots, stewed in sour cream

Puree apricots

sauce

Puree apples

Carrots, stewed with prunes

Puree apples with rice

and apples

Puree apples and apricots

Beetroot stew

Note. Cooking technology, see “Collection of recipes of dishes and culinary products for catering” (M., “Economy”, 1982).

The positive role of pectic substances in the prevention of lead poisoning, radioactive strontium, and cobalt has been proven. The enrichment of the diet with products containing pectic substances in the experiment helps to remove lead from the body (by 38 — 44%) and reduce toxicity. The use of 2 g of food pectin per day for 2 months prevents mercury poisoning in the corresponding production.

At enterprises associated with exposure to inorganic lead compounds, it is recommended that workers produce pectin-enriched canned vegetable foods, fruit juices, and beverages that can be replaced with natural fruit juices with pulp in the amount of 300.

Pectin-containing products emit workers before the start of the work shift (fermented milk - during the working day). Pectin is found in large quantities in beetroot, radish, eggplant, pumpkin, carrot, cabbage, baked apples, apricots, plums. Very useful apple jelly with pectin, used in special nutrition.

The Department of Nutrition Hygiene of the Lviv Medical Institute has developed recommendations for the nutrition of workers in contact with heavy metals and their compounds in production. For them were made dishes and foods rich in pectin substances, that is, having a preventive focus.

Preventive nutrition at home and at work

The organization of preventive nutrition at home should pay special attention to the preparation of food in compliance with the maximum preservation of vitamins and other biologically valuable nutrients.

The vitamin value of prepared food essentially depends on the conditions of storage and preparation of food products. Of great importance for the preservation of ascorbic acid in plant products is their storage temperature. The smallest losses are observed at 4 ° С. Peeled roots and other vegetables should not be stored for more than 2 — 3 hours at 12 ° C. However, they should not be cut and filled with water. To protect against contamination and drying, it is necessary to cover with a damp cloth.

All products of plant origin, with the exception of seeds of legumes, it is better to lay in boiling water, because in the process of heating a significant portion of vitamins are destroyed, especially ascorbic acid. This happens because the enzymes in vegetables at 40 ° C temperature actively destroy ascorbic acid. At the temperature of 60 ° C, these enzymes themselves are destroyed, and therefore the loss of vitamin in hot water is significantly reduced. Smaller losses of vitamins are noted when boiling vegetables and fruits in containers closed with lids (due to which oxygen access to them is significantly reduced). Steel, titanium, chromonic acid and aluminum containers are most suitable for this, copper and iron are not suitable.

The use of certain properties of products is of great importance in therapeutic and prophylactic nutrition. Therefore, the irrational replacement of some products with others can adversely affect the value of the diet. Replacement of some food products with others in therapeutic and prophylactic diets is allowed in exceptional cases and taking into account the approved norms of their interchangeability (Table 10). *

Responsibility for providing workers, engineers and technical workers and employees of hazardous industries with medical and preventive meals and for observing the rules for issuing them is assigned to managers of enterprises and institutions.

Issuance of preventive nutrition is made on the basis of the dining room, serving industrial enterprise or institution. Most blagopryatnym option is

10 Table. The norms of interchangeability of products in the manufacture of breakfast preventive nutrition, kg

Replacement products

Weight

substitute products

Equiva

covalent

weight

Meat (beef)

1

Pork Edged

1

»

1

Lamb lean

1

»

1

fresh fish

1,5

1

»

1

Fish fillets

The egg (without shell)

1

Melange

1

»

1

Egg powder

0,278

whole milk

1

Pasteurized condensed milk without sugar

0,45

1

Milk powder

0,13

»

1

Kefir

1

1

Atsidofilin

1

»

1

clabber

1

fresh Curd

1

Curd dry

0,35

»

1

Cheese 30% fat

0,5

Butter

1

heating oil

0,85

Vegetable oil

1

Margarine plant

1

Cheese

1

Curd

2

Cream

1

Butter

0,25

pulse

1

Buckwheat

1

Krupa is different (except for buckwheat)

1

Krupa different (legumes)

1

fresh Potatoes

1

dried potatoes

0,2

fresh vegetables

1

dried vegetables

0,1

Fruits and berries

1

fruit juices

1

»

1

Dried fruits

0,25

preparation of preventive meals in dietary canteens. Industrial enterprises must promptly send the administration of canteens applications for preparing a certain number of breakfasts for different treatment-preventive rations. In the canteens of enterprises, special tables are provided for therapeutic and preventive nutrition. Responsibility for the correctness of cooking, as well as for drawing up a menu of therapeutic and preventive diets is borne by the head of the catering enterprise.

Depending on the profession, therapeutic and preventive nutrition is issued in the form of therapeutic and preventive diets or products in accordance with the approved standards and recommendations. With a five-day working week, the norm of therapeutic and preventive nutrition calculated for 6 days is maintained, while the cost of the daily ration increases by 20%. In such cases, the quality of food of workers and employees should be improved not by increasing the energy value of food by increasing the level of carbohydrates, but by increasing the amount of biologically important substances.

In industrial enterprises with hazardous working conditions, sanitary and educational work is aimed at preventing occupational diseases in specific conditions and instilling in workers the skills of rational and therapeutic and preventive nutrition. At the same time, special attention is paid to the need to observe the principles of preventive nutrition at home. These recommendations are set out for each treatment-and-prophylactic ration in special leaflets for workers. Issues of treatment-and-prophylactic nutrition are covered in individual conversations of doctors and nursing staff during medical examinations. The same questions are included in the program of compulsory briefing on safety regulations and industrial hygiene for persons working in enterprises with harmful production factors.

Important in the prevention of diseases is the observance of each employee diet and personal hygiene. The best way to prevent many diseases is the hard habit of not starting work on an empty stomach. This weakens the body, reduces its resistance to the effects of occupational hazards, which contributes to the growth of not only professional, but also general morbidity.

Nutrition in the prevention of atherosclerosis

The leading place in the development of atherosclerosis belongs to the increase in the body's cholesterol level. This also contributes to the overstrain of the nervous system, insufficient disintegration of cholesterol due to limited exercise, increased synthesis and its excessive content in food, insufficient elimination from the body.

In the prevention of atherosclerosis, it is important to limit the amount of animal fats in the diet, as well as moderate consumption of simple carbohydrates. Observations have shown that in the diet of people with severe forms of atherosclerosis, excessive consumption of animal fats and simple carbohydrates was most often noted with limited consumption of fats of plant origin, excessive energy value and irregular meals.

Excess energy value of food also leads to the development of obesity, often associated with atherosclerosis. The risk of atherosclerosis in obese patients is significantly reduced if it is possible to reduce their body weight with the help of diets. Increased blood pressure also favors the progression of atherosclerosis. A close association of smoking with an increase in blood levels of cholesterol and low-density lipoproteins has been established.

The diet aimed at preventing atherosclerosis is based on the principle of a moderate restriction of foods containing large amounts of cholesterol, salt and liquid. It is recommended the exclusion of nitrogenous extractive substances, enrichment of food with vitamins, especially ascorbic acid. Food should contain 90 — 100 g of proteins, 80 — 90 g of fats (of which 30 g - vegetable) and 300 — 350 g of carbohydrates.

Reduction of fat in the diet should be carried out mainly due to the restriction of fats of animal origin, as well as foods rich in cholesterol (eggs, egg yolks, brains, kidneys, liver). Completely these foods from the diet should not be excluded, because cholesterol is necessary for the synthesis of hormones, bile acids and calciferols.

It is necessary to give preference to fats of plant origin (sunflower, corn, cotton), rich in liioli acid and phosphatides. Vegetable oils have a choleretic effect, which contributes to the secretion of bile cholesterol.

Restriction of carbohydrates in the diet should be carried out by reducing the amount of digestible - sugar, honey, jam, semolina and rice cereal, cookies, muffins. At the same time, the use of complex carbohydrates and plant fibers contained in cereals, vegetables, unsweetened fruits with a large number of pectins, sitosterols, substances that interfere with the absorption of cholesterol in the intestines, is very useful. p-sitosterol also inhibits the conversion of excess carbohydrates into fats.

The development of atherosclerosis is delayed by ingestion of potassium, magnesium, phosphorus and iodine with food. Magnesium ions help to reduce cholesterol in the blood. There is a lot of magnesium in buckwheat groats, bran, carrots, dried apricots, apricots. The positive role of iodine in the prevention of atherosclerosis is associated with the stimulation, under its influence, of the formation of the thyroid gland hormone, thyroxine, which contributes to the breakdown of cholesterol, has anti-sclerotic effect. Iodine is found in seafood, so they are recommended to be included in the diet and consumed daily. Potassium salts contribute to the excretion of sodium, inhibiting the activity of enzymes that break down fats and proteins. The source of potassium are vegetables and fruits, baked potatoes.

Thus, for the prevention of atherosclerosis, it is recommended to include in the diet complete foods that do not aggravate the organs of the digestive system, heart, liver and kidneys and contain moderate amounts of cholesterol: rye bran bread, borscht, beetroot soup, cabbage soup, dairy, fruit, vegetable soups, lean meat soup (once a week), lean beef, lamb, chicken, turkey, mostly boiled; low-fat fish (cod, pike-perch, pike, perch), soaked low-fat herring (once a week), dairy products, cottage cheese

From egg whites can cook an omelet. The use of egg yolks should be limited to 4 pieces. in Week.

Recommended dishes and side dishes of vegetables - vinaigrettes, salads - with vegetable oil. Useful fruits, berries, fresh fruit juices. If you are overweight and tend to obesity pasta dishes should be avoided. Fatty meat soups, fatty meats, caviar, kidneys, liver, beef and mutton fat, baking, spicy and salty snacks, coffee, cocoa, chocolate are limited in the diet.

Eating during the day with the anti-sclerotic diet is better 4 — 5 times. The last meal (no later than 2 hours before bedtime) should not be abundant. Meals should be prepared mainly boiled and baked. Consumption of salt is limited to 8 — 10 g per day.

Nutrition and obesity

In connection with the changed working and living conditions of the population of economically developed countries, metabolic diseases, leading among which is obesity, are widespread. General obesity is a disease that proceeds with a deep violation of metabolic processes and is manifested by excessive accumulation of adipose tissue in the body. The diagnosis of common obesity is usually not difficult. To do this, it is necessary to compare the indicators of growth and body weight and determine the ideal body weight. The ideal body weight in normal conditions, each person can be determined (in kilograms) using Broca's formula: equal to height (in centimeters) minus 100. This formula can be used to determine the ideal mass of men in the normostenic constitution, the intercostal epigastric angle approaching 90 °, with an increase in 155 — 170, see. In the hypersthenic constitution (wide chest, epigastric angle more than 90 °, musculature is well developed) the value of ideal body weight obtained using Brock's formula requires adding 5% of it, and for asthenic physique (narrow chest, epigastric angle less than 90 °, musculature is poorly developed) to subtract 5%. The ideal body weight of women is 5% less than the ideal body weight of men of corresponding height and constitution. For men, height 171 cm and above - the value 105 is subtracted from the height value (in centimeters). The result obtained determines the ideal body weight (in kilograms). There are other methods for determining ideal body weight (Appendix 2)

Normal is considered to be the body weight that corresponds to the ideal or deviates from it no more than ± 5%. Excess of ideal body weight on b — 14% indicates excess nutrition. Excess of the actual body weight over the ideal on 15 — 29% makes it possible to speak about obesity of the first degree, on 30 — 49% - of the second degree, on

50 — 99% —third degree, on 100% or more — fourth degree.

The cause of obesity is, as a rule, overeating, especially foods that contain large amounts of carbohydrates. Obese patients often consume a lot of sweets. Taken in abundant amounts of sweets stimulate the secretion of the hormone insulin by the pancreas. He, in turn, contributes to the rapid transformation of carbohydrates into fat, which is deposited in the subcutaneous base. At the same time, the amount of sugar in the blood quickly decreases and develops a strong appetite.

The negative effect of irregular nutrition (with rare meals) is due to the fact that the body consumes less energy in digestion and assimilation of food. In addition, long intervals between meals excessively stimulate the appetite, and satiety can be achieved after ingesting a much larger amount of food than with frequent meals in small portions. It also contributes to the development of obesity. The same role is played by plentiful meal at night.

Frequent consumption of alcoholic beverages even in small quantities contributes to the development of fatty dystrophy of organs. General obesity develops in people drinking beer.

Hereditary predisposition to obesity is noted in those families in which the cult of food prevails, when children are overfed with sweets and flour products.

Synthesized from carbohydrates or fat intake in an overdose of food in an obese patient's body is deposited not only on a subcutaneous basis, but also in cells and intercellular spaces of vital organs such as the liver and heart, significantly impairing their functions. Obesity is the cause of early development of atherosclerosis, coronary heart disease, diabetes. It contributes to the emergence of diseases such as hypertension, pancreatitis, cholelithiasis, cholecystitis, etc. Obesity leads to premature disability, creates a hereditary predisposition to diseases of impaired metabolism in children, reduces the average life expectancy of a person by an average of 10 — 12 years

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