Organization of Therapeutic-Prophylactic Nutrition at Enterprise

Therapeutic-prophylactic nutrition is administered to those, working in conditions of constant contact with harmful physical or chemical factors not less than half of working hours. It is given out free-of-charge at the expense of enterprise in a factory dining room as 0.5 litre of milk or hot breakfast. Vitamins are given out as vitamin preparations or enriched first dishes. Therapeutic-prophylactic nutrition is given out before the beginning of work (the optimal variant) or during a lunch break. The doctor of a health center of enterprise supervises the quality of therapeutic-prophylactic nutrition and if necessary gives recommendations as for replacing the missing products with foods having the same detoxic effect.

Medical Nutrition (Dietotherapy)

A science about nutrition of patients is called dietology. The basis of dietology is change of nutrition and metabolism of a sick person.

The main tasks of dietetic therapy are:

· to give to the patient’s organism all necessary nutrients;

· to change metabolism of a sick person in the necessary direction promoting treatment of illness.

A practical part of dietology is dietetic therapy, which applies the statements of dietology to clinical and out-patient conditions with respect to the given patient, taking into account the features of his disease course and individual properties of organism. The task of dietetic therapy also includes the coordination and conformity of applied diet with other medical means (medicinal therapy, physiotherapy, etc).

A practical part of dietology also includes medical cooking, i.e. practical applying of statements and requirements of dietology to culinary processing of food.

Dietetic therapy is a powerful medical means of strengthening effect of medicaments and other kinds of therapy. Dietetic therapy can also be the main kind of therapy. Sometimes only dietetic therapy may be sufficient to cure a disease.

Nutrition of the patient is making up an optimal proportion of nutrients on the basis of physiological needs of organism for food substances and energy of a person, proceeding from features of pathogenesis, clinical course, stage of disease, level and character of metabolic disturbances.

Classification of Foodstuffs in View of their Medical Effect

1 groupincludes foods having a sparing effect on intestinal mucous: groats for a children's and dietary nutrition, homogenized vegetable and fruit canned food, dietary fruit-and-vegetable, meat and fish canned food, rolls with a lowered acidity, enpits for IV injections.

Indications for administration: gastric and intestinal illnesses, postoperative conditions, craniofacial traumas. Mechanical care is necessary because of high degree of dispersion.

2 group — foods with low content of sodium chloride (saltless): bread and saltless crackers, salt substitutes (calcium chloride or ammonium chloride, sanasol). Indications: hypertonic illness of 1-2 degree, acute and chronic forms of urolithiasis, blood circulation insufficiency of 1-2 stages, nephropathy of pregnant, long treatment with corticosteroids.

3 group — foods with low food value: albumin bread (caloric content is reduced by 15-30%, carbohydrates — by 3 times), products with methylcellulose (for replacement of butter or sour cream by 40%), aerin (a sour-milk product from skim milk with fruit additives). These foods are administered for patients with diabetes, adiposity and chronic constipations.

4 group — foods with reduced amount of fats: The skim dairy products (sandwich butter, sour cream with 10% fat content, skim milk and kefir) products with the increased content of polyunsaturated fat acids ("Dietary" oil containing 25-30% of vegetable oil, dairy dietary margarine "Health"). Foods of this group are recommended at vascular atherosclerosis, adiposity.

5 group — foods with modified carbohydrate component: group of dietary products-substitutes of sugar (sorbite, xylite, fructose, saccharin, etc), as well as stewed fruit, confectionery and juices on their basis. These foods are applied at diabetes and adiposity.

6 group — foods without protein simulating bakery, groats. As a substitute of protein corn and amylopectin starch are used. These are applied at chronic kidney insufficiency.

7 group — foods enriched with microelements and vitamins: products enriched with iodine (sea kale, iodine salt, etc.), fluorine, vitamins (milk with vitamin C, etc).

Principles of Medical Nutrition

The bases of dietetic therapy are principles of a balanced diet: conformity of caloric content of food with energy losses of organism, balance between nutrients, optimal diet regimen, good digestion, maintaining the feeling of pleasure and saturation, safety of nutrition. However, in case of necessity, the essential corrections caused by character of disease, condition of the patient, his specific features can be brought to these principles.

Thus, in dietetic therapy the principle of qualitative and quantitative restriction of nutrition down to partial or full starvation is widely used. Full starvation during rather short time intervals is applied at acute inflammatory processes in the body, at intoxication, uremia, etc. For a longer period of time partial starvation or so-called fasting days are used allowing apples, cottage cheese, salad, potato, water-melon, pumpkin, cucumber and fatty days used at treatment of obesity and cardiovascular diseases. To diet regimen with quantitative restriction the nutrition with limited amount of liquid also refers which, as a rule, is combined with limitation of salt — it is recommended at obesity, atherosclerosis, hypertonic disease, urological diseases, etc.

Diets with increased amount of liquid are widely used: at intoxication, infectious diseases, diathesis, etc.

Diets with increased amount of vegetative raw food are applied. Besides enrichment of organism with vitamins, this diet is a source of cellulose, pectin substances, tartaric acid preventing adiposity, a complex of optimum balanced mineral substances, etc. The increasing of raw vegetative food is recommended at gout, obesity, diabetes, diseases of cardiovascular system, liver, kidneys, chronic constipations, etc.

In some cases (anemia, decrease of reactivity of organism, etc.) raw animal food is administered, i.e. blood, raw liver, minced meat seasoned up to a level of pleasant look and taste. At food processing the content of pathogenic microorganisms in raw food should be excluded.

Main Principles of Medical Nutrition

· Principle of mechanical safety.

It is used at restriction or exclusion of indigestible foods, rich in cellulose (brown bread, cabbage, haricot, etc.), using at cooking food methods of mincing, cutting, chopping, etc., as well as special methods of food processing aimed at reduction of cellulose content, dissolving pectin and softening foods.

· Principle of chemical safety.

It is based on exclusion of foods rich in extractive substances, and on restriction of dishes having a stimulating effect on secretory and motor functions of the stomach, such as thick broth, rich soups, fried dishes, smoked products, etc). A stimulating effect of dishes on intestines can be lowered at steam cooking.

Principles of safety are usually used at the initial stage of treatment with the purpose of strict diet, further it is necessary to pass to a principle of "training". Thus step systems with gradual transition, or systems of "zigzags" with rather sharp, but short-term changes of diets as loading (plus "zigzags") or unloading (minus "zigzags") are used.

The diet regimen of dietetic therapy provides uniform within a day intake of a small amount of food with more often intakes (5-6 times a day). A fractional nutrition (a small amount every 1.5-2 hours) in some cases is applied.

Hygienic Bases of Alimentary Regulation of Metabolic Disorders and Prevention of Adiposity