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Nutrition is an essential physiological requirement of the body. It is necessary for construction and continuous renewal of cells and tissues; energy intake required to replenish energy costs; the admission of substances, of which in the body form enzymes, hormones and other regulators of metabolic processes and vital functions. Metabolism, function and structure of all cells, tissues and organs is dependent on the nature of power. Nutrition is a complex process proceeds, digestion, absorption and assimilation in the body of nutrients.The main nutrients are proteins, fats, carbohydrates, minerals, vitamins and water.
Is indispensable substances, which are not formed in the body or are formed in small quantities, include proteins, certain fatty acids, vitamins, minerals and water.
The dietary intake of essential nutritional substances is required. Needed in the diet and non-essential nutrients, since the lack of the last on their formation in the body is consumed, other nutrients, and metabolic processes are violated.
Power is supplied through food. Only in some diseases in the body provide for certain nutrients: amino acids, vitamins, glucose, etc.
Food — is a complex mixture prepared for food food.
Diet — is the composition and amount of food used during the day (days).
Digestion begins with the digestion in the digestive tract, continues with the absorption of nutrients into blood and lymph and ends with the absorption of nutrients by cells and tissues of the body. During digestion under the action of enzymes of the digestive system, mainly the stomach, pancreas, small intestine, proteins are broken down to amino acids, fats into fatty acids and glycerin, digestible carbohydrates — glucose, fructose, galactose. These simplest component parts of nutrients absorbed from the small intestine into the blood and lymph, which travels to all organs and tissues.
The comprehensibility — is the degree of use of the contained food (nutrients) into the body. The digestibility of food substances depends on their ability to be absorbed from the gastrointestinal tract. The digestibility of food substances depends on the features included in the diet products, their culinary processing, condition of the digestive system. Mixed (consisting of animal and vegetable products) food meal.
Dietary intake is presented following requirements: 1) the energy value of the diet should cover the energy expenditure of the body; 2) the appropriate chemical composition is the optimal number of balanced between a food (nutritional) substances; 3) good digestibility of food, depending on its composition and method of preparation; 4) high organoleptic properties of food (appearance, texture, taste, smell, color, temperature); 5) variety of food due to the wide range of products and various techniques, their culinary processing;6) the ability of the food (composition, volume, cooking) to create a feeling of fullness; 7) sanitary-epidemiological perfection and harmlessness of food.
Diet includes time and the number of meals, the intervals between them, the distribution of food ration on energy content, chemical composition, product set, weight for meals.
Important terms of eating: the appropriate atmosphere, table setting, no distractions from the food of factors. It promotes good appetite, better digestion and absorption of food.
Clinical nutrition (dietotherapy) — is the application of therapeutic or prophylactic specially composed diets and diets for patients (with acute illnesses or exacerbation of chronic diseases) people.
Dietetics — is a branch of medicine dealing with the study and justification of the nature and principles of nutrition in various diseases, as well as the organization of the medical (dietary) nutrition.
Dietary (medical) food — is nutrition people with chronic diseases without exacerbation, such as organized for able-bodied working people in sanatoria-dispensaries and diet kitchens. Basic principles of clinical nutrition in certain diseases persist in the diets.The list of requirements for the medical (dietary) nutrition is different from that of balanced diet, however, given the nature of the disease, for short or long term may change the requirements of energy value and chemical composition of the diet, balance in it of nutrients, the set of products and method of cooking, some organoleptic characteristics of food, diet.
A balanced diet involves the supply of all nutrients in certain proportions among themselves.
Of particular importance is the balance indispensable parts of food, of which there are more than 50.
When evaluating rations include their balance in many respects. Thus, the ratio between proteins, fats and carbohydrates in the norm is taken as 1:1,1:4,1 for men and women of young age, an amusing mental labor, and for 1:1,3:5 in heavy physical labor.
The noted ratio may not be appropriate for therapeutic diets, in which you have to change the contents of protein, fat or carbohydrates (in the diet in obesity — 1:0,7:1,5; in chronic renal failure — 1:2:10, etc.).
These proportions can vary significantly in clinical nutrition. When taking into account the balance of protein take into account that animal proteins should account for 55% of the total proteins. Of the total amount of fats in the diet with vegetable oils as a source of essential fatty acids up to 30%. The estimated balance of carbohydrates: starch — 75-80%, digestible carbohydrates, 15-20%, cellulose and pectin — 5% of the total number of carbohydrates.
The balance of essential vitamins given per 4.184 MJ (1000 kcal) diet: vitamin C — 25 mg, B1 — 0.6 mg, B2 — 0.7 mg, B6 — 0.7 mg, PP — 6,6 mg. In clinical nutrition these values are higher.
For best absorption ratio of calcium, phosphorus and magnesium is 1:1,5:0,5. All considered indicators of the balance of power must be taken into account when assessing the diets used in medical and sanatorium establishments (sanatoriums and canteens dietary).
Eating the body is a painful (pathological) conditions arising from lack or excess from food energy or nutrients. Depending on the degree and duration of the violations complete, balanced nutrition eating disorders body can be expressed: 1) in the deterioration of metabolism and reduce adaptive capacity of the organism, its resistance to adverse environmental factors;2) the deterioration of the function of individual organs and systems on the background of metabolic disorders and reduced adaptive capacity of the organism, clinical symptoms with little expressed; 3) in symptomatic manifestation of eating disorders — nutritional diseases, such as beriberi, obesity and other eating Disorders of the body arises not only from primary alimentary (nutritional) disorders. They can be caused by diseases of the body, violating the digestion of food and absorption of nutrients, increases the consumption of the latter, impairing their absorption by cells and tissues.Thus, one of the most important tasks of the medical (dietary) nutrition is the prevention or elimination of eating disorders of the body caused by diseases.
Daily energy requirement depends on the daily energy cost (energy expenditure), which result from energy consumption for: a) basal metabolic rate; b) digestion; C) physical (neuromuscular) activity.
Different diets for medical institutions greatly differ in their energy content.
In those diseases, when special dietotherapy is not required, appoint a diet № 15 (common table) with a daily average energy value of 11.7 MJ (2800 kcal).
The energy value of the diets increase to an average of 13-13,8 MJ (3100—3300 kcal) due to the balanced increase of all nutrients in the recovery period after severe, debilitating diseases and operations, in tuberculosis, chronic enterocolitis and other diseases.Reduce the energy value of diets for obesity, diabetes mellitus (without insulin therapy), hypothyroidism, acute diseases and exacerbations of chronic diseases due to the reduction of energy expenditure during bed rest or reduce the burden on the digestive system, cardiovascular system and kidneys in marked loss of function. Limit the calorie content primarily through fats and carbohydrates. In severe circulatory failure, kidney or liver problems and also reduce the amount of protein.
In the sanatorium-resort institutions of the energy value of the diets increases by 15-20% in comparison with used in hospital diets. For most diets (except diet for obesity, diabetes), calorie content should be, on average 13,4—14,2 MJ (3200—3400 kcal). The energy value of diets in sanatoriums should be focused on the daily energy requirements of the main groups feeding on given the intensity of their work.
The source of the necessary energy for life is food.
The oxidation of 1 g of protein obtained are 16.7 kJ (4 kcal), 1 g of fat is 37.7 kJ (9 kcal), 1 g of carbohydrates is 16.7 kJ (4 kcal). The main sources of energy are fats and carbohydrates, and insufficient flow — proteins. Oxidation in the body, 1 g of ethyl alcohol gives to 29.3 kJ (7 kcal), malic, citric, lactic acids — 10-15,1 kJ (2,4—3,6 kcal).
The most important part of the diet is water, which provides for metabolic processes (reactions), digestion, the urinary excretion of products of metabolism, thermoregulation, etc. Water makes up almost 2/3 of the total body weight. Loss of body of more than 10% of the water threatening his life. Water demand depends on the nature of power and labor, climate, health status and other factors. The average need is 2.5 liters/day.Man gets 1-1,5 liters of water in the form of free liquid (soup, tea, compote, juice, etc.), 1-1,5 liters — from food and 0.3—0.4 liters is produced in the body during metabolism. Of this amount excreted in the urine, about 1.4 liters, through the skin (sweating and evaporation) — 0.6 liters, with the exhaled air through the lungs — 0.4 liters, with the cal — 0,1 liters water Losses increase with the increased sweating, diarrhea, vomiting, fever, patients after surgery, extensive burns, etc.
The excessive use of water creates increased load on the heart and kidneys, and are excreted from the body minerals and vitamins.
When water restriction increases the concentration of urine, it can fall precipitation of salts decreases the secretion from the blood of metabolic waste products.
Sodium chloride promotes water retention in the body, potassium, and calcium salts have the opposite effect. Increase liquids in the diet is recommended during intoxication, infectious diseases, high body temperature, kidney stones, gout, diseases of the liver and biliary tract in the postoperative period. The amount of liquid is reduced in diseases of the cardiovascular system, especially with edema, obesity, diseases of the kidney with excretory function.
Loss of body much water is accompanied by a thickening of the blood, which leads to feelings of thirst.
Quench your thirst decoction of the dried fruit and rosehip fruit drinks, green tea, low fat milk drinks. To quench thirst in the water should not be more than 1-2% sugar. At temperatures above 12-15°C water gives a refreshing effect. Cold water on an empty stomach increases the motor function of the intestine that is used for constipation. Cold water, drunk after a fatty meal, contributes to its delay in the stomach, and after fresh fruit and berries can lead to increased gas and flatulence. Drinking water while eating slows down digestion.
The concept of diet includes:
1. The number of meals during the day (frequency of meals);
2. The distribution of the daily diet for its energy value, chemical composition, product set and weight individual meals;
3. Meals during the day;
4. The intervals between meals;
5. The time spent on the meal.
Proper diet ensures the efficient functioning of the digestive system, a normal digestion and for metabolism and good health.
For healthy people recommended 3-4 meals a day with 4-5-hour intervals. 4 meals a day more conducive to mental and physical work.
The food in between main meals "interrupts" the appetite and breaks the rhythmic activity of the digestive system. Fast food food is poorly chewed and crushed, is not enough saliva is being processed. This leads to extra stress on stomach, poor digestion and assimilation of food.
If hasty eating slower the feeling of satiety, which contributes to overeating.
The dinner should not be products, a burden on the secretory and motor functions of the digestive organs, causing flatulence, flatulence (flatulence) and nocturnal gastric secretion (fried foods, rich in fat, etc.). The last meal should be not later than 1.5—2 hours before bedtime. It should be 5-10% of the daily energy content of the diet and include such foods as milk, milk drinks, fruits, juices, bakery products.
Systematic violations of diet (food cold food, rare and abundant meals, messy eating, etc.) impair metabolism and contribute to the emergence of diseases of the digestive system, in particular gastritis. Large meal at night would increase the possibility (risk factor) occurrence of myocardial infarction, acute pancreatitis, exacerbation of peptic ulcer disease and other diseases.
When the air temperature is high, the appetite is reduced, inhibited secretion of digestive glands, motor function of the gastro-intestinal tract is disturbed.
It is established that the need for food intake is related to individual characteristics of circadian rhythm of body functions.
Patients people diet may vary depending on the nature of the disease and the treatment procedures.
For treatment-and-prophylactic and sanatorium-resort establishments at least 4 meals a day.
Eating 5-6 times a day during exacerbation of peptic ulcer disease, cholecystitis, myocardial infarction, circulatory failure, in the postoperative period, etc.
The following is the approximate distribution of the energy content of the daily diets in hospitals.
The distribution of energy value of daily rations (%)
the techniques in hospitals
| Meal | 4 meals a day | 5 meals a day (optional) | 6 meals a day | |
| Breakfast | 25—30 | 20—25 | 25 | 20—25 |
| 2nd Breakfast | — | 10—15 | — | 10—15 |
| lunch | 35—40 | 30 | 35 | 25—30 |
| afternoon tea | — | — | 10 | 10—15 |
| dinner | 20—25 | 20—25 | 20—25 | 20 |
| 2nd dinner | 5—10 | 5—10 | 5—10 | 5—10 |
Features of diet in sanatoria associated with the drinking of mineral water and balneological (mineral and sea baths) procedures.
Balneology and mud treatments are better tolerated 2-3 hours after eating, worse on an empty stomach and worse after eating, especially massive (worse after lunch than after Breakfast).
Diet in sanatoria can be 4-time and 5-6 one-off. It depends on the profile of the sanatorium and local conditions. For example, in sanatorium for diseases of the digestive system should be organized 5-6 meals.
In sanatoriums and canteens diet need to bind the modes of work and power.
V.I. Dubrovsky,
Academician of the Russian Academy of Natural Sciences,
IANPO and the New York Academy of Sciences,
Doctor of Medical Sciences, Professor,
A.V. Dubrovskaya, pediatrician
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