Therapeutic and therapeutic-prophylactic nutrition
KNOWLEDGE:
Diseases associated with the nature of nutrition.
The role of vitamins in human life, their classification.
Hypo- and avitaminosis, their causes: nutritional deficiency, inhibition of normal intestinal microflora that produces vitamins, impaired absorption of vitamins, increased need for vitamins.
Minerals (calcium, phosphorus, magnesium, potassium, sodium), their role in the human body.
Microelements (iron, copper, cobalt, manganese, iodine), their significance in human life.
Medical nutrition. Brief characteristics of the main therapeutic diets.
SKILLS:
Determine using reference books a set of food products for the preparation of therapeutic diets.
LESSON CONTENT*:
Diseases associated with the nature of nutrition: diseases of nutritional deficiency, diseases of excess nutrition.
The role of vitamins in human life, their classification. Hypo- and vitamin deficiencies, their causes.
Minerals, macroelements and microelements and their role in the human body.
Nutritional and biological value of food products. The importance of physiological norms of consumption of the most important food products for human health.
Medical nutrition, therapeutic diets, principles of their preparation, brief description basic therapeutic diets.
Hygienic principles of therapeutic and preventive nutrition.
1. Diseases associated with the nature of nutrition: diseases of nutritional deficiency, diseases of overnutrition
Nutritional adequacy is judged by nutritional status of a person – his state of health, which has developed against the background of the body’s heredity under the influence of actual nutrition. At optimal nutrition - the body works without changes. At excessive When eating, the body receives an excess of any nutrients. Insufficient nutrition occurs when there is a quantitative or qualitative lack of nutrition. In both cases, the body is overexerted, tissues and functions of the body are disrupted, which is reflected in impaired performance, poor health and, ultimately, leads to illness. Eating disorders can be divided into 3 stages:
inferior status– manifests itself in a decrease in the body’s adaptive capabilities to normal microclimatic conditions and performance (“no desire”... to wake up, get up, work, etc. - instead of: “wake up and shine!”). Correction of this condition involves changing the diet: increasing the intake of missing nutrients and following recommendations for compliance healthy image life;
premorbid status- deeper violations are noted. The body's adaptive capabilities are reduced in the form of frequent colds and herpes. The biochemical parameters of blood and urine, determined in the laboratory, as well as the functional capabilities of organs (digestion, muscles, heart) are reduced. Disturbances mainly occur in an organ predisposed to the disease (locus morbi - see topic No. 3). For correction, it is no longer enough to follow the recommendations to eliminate the inferior status. The diet should be supplemented by taking appropriate dietary supplements:
morbid (pathological) status– manifested by pronounced clinical symptoms of the disease, characteristic of a certain nutritional deficiency. Correction of this stage requires, in addition to changing the diet and including dietary supplements, also therapeutic assistance.
Drinking water. A person is 70% water, so the loss of 5-10% of water leads to painful disorders, and 20% leads to death. It is recommended to drink at least 1.5-2 liters of water daily.
At low consumption water, the excretion of metabolic products in the urine decreases and they settle in the internal organs, constipation, headaches, skin rashes, etc. are observed, and performance decreases. Chronic acidosis is created in the blood, which accelerates the aging of the body and the occurrence of “diseases of old age.”
Increased drinking(water, beer) dilutes the blood, oxygen transfer deteriorates, the person suffocates, the heart contracts intensely. Long-term increased water load transforms blood vessels, kidneys and heart (a “bull’s heart” is formed). IN summer period Increased drinking alkalinizes the stomach, promotes easy penetration intestinal infections(summer diarrhea). Random drinking has no effect: sweat production becomes more and more intense. It must be remembered that the usual drinking water not the best thirst quencher. During the hot period, the body loses more table salt (16 g per 3 liters of sweat) than it receives (10-15 g per day), which upsets the salt balance. Therefore, hygienic recommendations for workers in hot shops include the use of carbonated water with a 0.5% solution of table salt. Table salt promotes water retention in the body (salty foods), while potassium and calcium salts remove water from the body (apricots, raisins). Beer does not quench your thirst, and the alcohol it contains adds extra calories to your heated body.
National characteristics are manifested in a set of enzymes capable of digesting and assimilating certain foods. The ability to digest and assimilate food is partly determined by blood type: group 1 requires more B, but milk is undesirable; Group 2 – vegetarian food is preferred; 3rd group - mixed food is required, but with a predominance of vegetarian food, milk is useful; Group 4 – universal in nutrition.
Let's consider the nutritional and biological health value of basic foods.
Meat and meat products– have high digestibility (95%) and low palatability. Meat contains 16% proteins and they include all the essential amino acids necessary for growth and tissue replacement, as well as fat, minerals and vitamins (group B, calciferol, retinol). The extractive substances (broth) contained in meat are energetic stimulants of gastric secretion. Boiled meat is devoid of extractives.
Fish and fish products contain 8-14% B, which differs little from B meat, as well as all the necessary amino acids. Moreover, they are well balanced, including a lot of methionine, tryptophan (growth factors) and vitamins. The F content of different fish ranges from 0.3 to 30%; their meat contains retinol and calciferol, and polyunsaturated fatty acids predominate. Meat sea fish healthier than river ones, because they contain important microelements - iodine, zinc, etc. Fish meat is distinguished from animal meat by ease of digestion and good digestibility. Fresh fish spoils quickly - poisoning is dangerous. Frozen fish, when stored at proper storage times and temperatures, is not inferior to fresh fish, although the B content in it decreases. Salted fish worse than fresh in nutritional and taste properties.
Milk and dairy products belong to essential food products, because they contain all the nutrients necessary for the body in a balanced state (including B - in amino acid composition). Children and elderly people especially need them. Milk contains B - 3.2%, F - 3.6%, U - 4.8%. Milk fat is in a state of emulsion and high dispersion, contains deficient arachidonic acid and a biologically active protein-lecithin complex. Natural milk contains the most digestible Ca along with vit. C, A, B, choline, macro- and microelements.
Great role lactic acid products : kefir, sour cream, cottage cheese - sources of B and Ca + promoting the release of cholesterol from the body + causing a diuretic effect. They are very useful for patients with cardiovascular failure, hypertension, and renal impairment. They are absorbed better and faster than milk. Their important component is lactic acid, which is absent in milk, promotes more complete absorption of the components of lactic acid products (the presence of lactose in milk and the absence of the lactase enzyme in the stomach in older people causes intestinal dysfunction), strengthens the normal microflora of the large intestine and inhibits development putrefactive bacteria in it. Acidophilus milk, bifidoc, etc. improve stomach acidity and intestinal motility, reduce gas formation and strengthen microflora.
Eggs– a highly valuable product containing in protein (12%) the entire complex of essential amino acids, incl. vitalin found only in eggs. Egg fats (11.5%) contain valuable polyunsaturated fatty acids, lecithin, cholesterol, and all fat-soluble vitamins. Includes many minerals (P, S, Fe, Zn, Cu, K). All components of the egg are well digestible. The yolk is more valuable in its raw form. It is recommended to consume one egg every 2-3 days.
Cereal products are the main source of vegetable food and drink. The nutritional and biological properties of cereals depend on the grain crop and the nature of their technological processing. The main types of cereals: buckwheat, oatmeal, pearl barley, rice, millet. Buckwheat and oatmeal are a source of B. Buckwheat is rich in vitamins, millet – in iron and magnesium. It is better to eat cereals in their natural form, pouring a minimum amount of water for cooking, do not boil for a long time - 3-6 minutes, and then wrap them in thermal insulating material and let stand until cool. Rice cereal cooks for 1-2 minutes, It is less valuable nutritional composition, but contains a substance important for the brain - serotonin, which increases the tone of the central nervous system. Therefore, inclusion in a student’s breakfast rice porridge advisable before stress - an exam.
Bread has in the diet of the Russian people great value, covering 40-45% of daily calories. The main part of the bread is U (40-45%). It is an important source of B (5-7%), vitamin B1 and minerals. Daily norm bread - 390g with a caloric intake of 2500-2800 kcal. The main source of vit. B 1 - black bread enhances intestinal motility, prevents constipation (especially in patients with bed rest). White bread contains a lot of fiber and easily digestible U, therefore it is less valuable, but is indicated for patients with gastritis and intestines.
Vegetables, fruits and greens occupy a special place in human nutrition, because cannot be replaced by other products. These are important sources of vitamins, pectin fibers, active fiber, alkaline minerals, organic acids and carbohydrates. They stimulate the secretory function of the gastrointestinal tract, increase the digestibility of the main parts of food (B, F, U). Normalize intestinal microflora, reduce putrefactive processes. Increases intestinal motor function. An important place among vegetables is occupied by beets (cleanses the body), cabbage (stimulates stomach secretions) and tomatoes (as antioxidants - rejuvenate).
Edible fats– suppliers of polyunsaturated fatty acids, retinol, calceferol, tocopherol, stearins. According to their structure, they are divided into fats animal origin – dairy ( butter), beef, lamb, pork fat and vegetable origin – sunflower, corn, olive and combined fats – margarine and cooking fat. Particularly valuable for the content of lipids, polyunsaturated fatty acids and tocopherols vegetable oil: with daily intake of 20 g of herbal or olive oil a sufficient amount of them enters the body. 10% margarine (pure butter is not currently produced) containing retinol and calciferol is widely used; its disadvantage is that in the light it goes rancid and “greasy”.
5. Medical nutrition, therapeutic diets, principles of their preparation, brief description of the main therapeutic diets
As is known from previous lectures, we draw energy mainly from U (bread, sugar, cereals, vegetables) and, partly, from G. Plastic (construction) functions are carried out by B (meat, legumes, dairy products) and to a lesser extent F, U and minerals. Knowing this, selecting the correct nutritional composition for a particular person (sick or healthy) will help normalize metabolism, timely tissue restoration, accelerate recovery and prevent relapse of the disease. Medical nutrition (diet therapy) enhances the effect of therapeutic agents, prevents complications and progression of the disease.
The purpose of the diet is to select one or more food states: include especially recommended foods or exclude undesirable ones, or carry out suitable culinary processing, or create the necessary consistency of food and turn on the diet. In our time of mass physical inactivity dietary food– this is not only the prerogative of a sick person, but also an element of culture healthy person, an element of a healthy lifestyle is the key to his daily health and longevity. Based on these goals, the basic principles for drawing up therapeutic diets are:
choose a diet taking into account the underlying disease + concomitant diseases + age + other characteristics;
when determining the calorie content of the diet, take into account the regimen prescribed to the patient: with bed rest (less energy consumption) - less calorie content. But, in any case, sufficient calorie content must be provided (in accordance with paragraph 1);
Physiological needs for B and vitamins must be covered, because their deficiency negatively affects reparative (restorative) processes: the lower norm B is 1 g/kg of the patient’s weight. Moreover, 50% of B should come in the form of B of animal origin. For some diseases (burns) it is necessary sharp increase consumption B (chicken broth);
should be included in the patient's diet. foods rich in fiber - raw fruits, vegetables, berries, herbs - they are also sources of vitamins and minerals. It is rational to prescribe dietary supplements - vitamins and mineral salts - to the level of physiological norms, and some substances (Vit. C, A. E and Ca) and in excess;
culinary processing, food consistency and diet must correspond to the state of the patient’s organs that affect the absorption of food;
in dietary and therapeutic nutrition, use the sparing method, when contrasting days (replacing strict diets with less gentle ones) and fasting days (partial or complete fasting) are used.
6. Hygienic principles of therapeutic and preventive nutrition
In accordance with Article 222 Labor Code RF (2001), in jobs with hazardous working conditions, the employer is obliged to provide employees with free therapeutic and preventive nutrition (TNF) according to established standards. The use of LPP is aimed at:
blocking the absorption of incoming toxic substances into the gastrointestinal tract;
delay in their entry into the blood;
limiting accumulation in the body;
accelerated neutralization and excretion from the body.
Diet diet depends on availability harmful substances in a specific production.
Scroll industries, professions and positions, work in which gives the right to free receipt LPP, approved by Resolution of the Ministry of Labor of Russia dated March 31, 2003 No. 14.
List of harmful production factors , when exposed to which, for preventive purposes, the consumption of milk or other equivalent products is required, approved by the relevant order of the Ministry of Health of the Russian Federation dated March 28, 2003 No. 126.
Issue norms milk and equivalent food products approved by Decree of the Government of the Russian Federation of November 29, 2002 No. 849 “On the procedure for approving the norms and conditions for the free provision of milk or other equivalent food products, as well as therapeutic and preventive nutrition, to employees engaged in work with hazardous working conditions.”
5 types of diets for PPP have been developed - from No. 1 to No. 5 and a daily set of products in them. It may include milk or equivalent food products (cottage cheese, cheese, eggs, fish). For example: milk is given to those working with disinfectants; fermented milk products and jams - those working with lead; vitamins for workers in hot shops, etc. The issuance of PPP can be carried out at enterprises in the form of hot breakfasts before starting work or lunches. In this case, it is issued on the basis of a menu layout for 5-6 days. LPP is not issued or compensated on weekends, vacations, business trips, or sick days.
Security questions
Diseases associated with a lack or excess of drinking water.
Diseases associated with a deficiency or excess of B.
Diseases associated with a lack of methionine, tryptophan, lysine.
Diseases associated with deficiency or excess of fat.
Diseases associated with deficiency or excess of U.
Diseases associated with a lack of pectin and fiber.
Signs of vitamin C deficiency.
Signs of vitamin A deficiency.
Diseases associated with a lack of calcium and phosphorus.
Diseases associated with iron deficiency.
Diseases associated with poor diet.
Prescribing therapeutic nutrition and therapeutic diets.
Principles of compilation. therapeutic diets.
Hygienic principles of therapeutic and preventive nutrition.
The role of intestinal microflora for the health of the body.
Diseases associated with nutrition are called nutritional diseases. They are divided into:
I. Diseases of malnutrition.
II. Diseases associated with eating poor quality food (food poisoning, infections, helminthiasis).
III. Diseases associated with the individual characteristics of the body (hereditary and acquired enzymopathies, food allergies).
Malnutrition diseases are divided into 4 groups:
· Associated with complete starvation and general malnutrition - nutritional dystrophy.
· Associated with partial malnutrition - a relative or absolute lack of one or more nutrients.
· Associated with excess nutrition.
· Associated with nutritional imbalances and improper diet.
With starvation or general malnutrition, nutritional dystrophy develops, which is characterized by a sharp loss of body weight up to exhaustion, dysfunction of all organs and systems (hunger edema), decreased body resistance, and possible death.
Partial deficiency diseases include:
· protein-energy malnutrition(kwashiorkor, nutritional marasmus, nutritional dwarfism, anemia, cachexia).
· vitamin deficiency– hypo- and vitamin deficiencies (scurvy, rickets, night blindness, beriberi, pellagra, etc.).
· mineral deficiency– endemic goiter, caries, rickets, etc.
· fat deficiency– “fat deficiency” disease.
· PUFA deficiency
Nutritional deficiency diseases are widespread among poor populations, especially in developing countries. Their cause is most often malnutrition, lack of animal proteins and fats in the diet, predominantly monotonous carbohydrate foods, as well as disturbances in the absorption of nutrients. At the same time, clinical manifestations of nutritional deficiency do not occur immediately, but after some certain time, because At first, the mechanisms of biochemical adaptation are still functioning.
If the energy value of the diet does not cover energy costs, and all nutrients, including proteins from food and the body’s own tissues, are used as energy material, then this leads to the development of protein-energy deficiency diseases (PEM). With a long-term lack of protein, there is a slowdown in the growth and development of the body, a decrease in body weight, dysfunction of the endocrine glands, liver, nervous system, inhibition of hematopoiesis, disruption of immune processes, sexual development, reproductive processes, functioning of enzyme systems, adverse effects on the health of offspring are manifested, concomitant deficiency of vitamin A, group B, and hypochromic anemia develops.
Clinical manifestations of PEM are cachexia, kwashiorkor, and marasmus. Children are most vulnerable to protein deficiency, especially during breastfeeding and the first years of life - from 6 months to 4 years.
In the absence or insufficiency of fats in food, the so-called “fat deficiency” disease develops, which is expressed in a decrease in body weight, slower growth and development, dysfunction of the liver, kidneys, endocrine, nervous systems, increased capillary permeability, suppression of reproductive function, eczematous skin lesions up to necrotic, reducing resistance to adverse factors.
Vitamin deficiency leads to the development of hypo- and avitaminosis, in which many aspects of metabolism and the functioning of certain organs and systems are disrupted. Specific diseases develop - scurvy, beriberi, pellagra, etc.
Mineral deficiency can be observed in the absence or insufficient content in the diet of foods that are the main suppliers of minerals. In addition, it may be due to the low content of these substances in products due to their insufficient level in water and soil of certain areas, i.e. has the character of a biogeochemical endemic, for example, endemic goiter, which develops with a lack of iodine in the soil, caries - with a lack of fluoride, etc.
In economically developed countries, as well as among prosperous sections of the population, diseases of overnutrition. These include diseases associated with:
Excessive protein nutrition;
Excessive lipid nutrition;
Excessive carbohydrate diet;
· excessive mineral nutrition (fluorosis, calcinosis, kidney and gallstone disease, etc.);
Excessive intake of vitamins - hypervitaminosis.
Excessive carbohydrate nutrition leads to increased conversion of carbohydrates into fats and the development of obesity, as well as the development of pathological disorders of the liver, pancreas, gastrointestinal tract, etc. Thus, consuming large amounts of easily digestible carbohydrates (sugar, confectionery etc.) causes hyperglycemia, as a result of which the pancreas produces increased amounts of insulin, and with prolonged stress on the gland, diabetes mellitus develops. In addition to fat formation, excess carbohydrates in the blood have a hypercholesterolemic effect, which can be considered a risk factor for the development of atherosclerosis.
A change in the amount of carbohydrates in the diet leads to a decrease in appetite, a deterioration in the secretion of the digestive glands, and the development and rapid progression of caries. Excessively large amounts of carbohydrate foods, especially rich in fiber, makes it difficult to soak it with digestive juices, as a result of which the digestion process slows down, the digestion of proteins and fats worsens, the absorption of nutrients is disrupted, which can lead to the development of a relative deficiency of protein, vit. B 1, B 2, B 3, iron and manganese. In addition, fermentation processes in the intestines intensify, and flatulence develops due to the formation of gases by microbes that decompose fiber. In children, excess carbohydrate nutrition also leads to inhibition of growth and development, and decreased immunity.
Excessive protein content in food also has negative impact on the body. The formation of a significant amount of nitrogenous waste increases the load on the liver and kidneys. Excess proteins lead to excessive excitability of the cerebral cortex, causing adverse reactions from the nervous and cardiovascular systems. Overloading the intestines with protein foods contributes to the development of putrefactive microflora, under the influence of which toxic breakdown products of proteins are formed - phenol, indole, skatole, paracresol, etc. Excessive consumption of fats leads to obesity, the development of acidosis due to the accumulation of under-oxidized products, decreased absorption of proteins and carbohydrates, disruption of processes growth and puberty, early development atherosclerosis, hypertension, diabetes mellitus, cholelithiasis, inhibition of hematopoietic processes, reduced life expectancy. Adipose tissue has the ability to accumulate highly fat-soluble toxic substances supplied with food, including pesticides, as a result of which, even in the absence of direct contact with the latter, their toxic effect may occur.
In people with excess weight, due to metabolic disorders, wound healing processes slow down, and vascular complications are frequent.
Excess mineral nutrition is most often associated with the consumption of foods or water containing increased amounts of minerals, or the addition of additional large amounts of salt to food due to established habits. Thus, with a high concentration of fluoride in water, the development of fluorosis is possible; drinking mineralized and hard water can lead to the development of kidney and gallstone diseases, hypertension, etc.
Hypervitaminosis, mainly A, D, C, occurs when consuming large quantities of certain natural foods rich in these vitamins, as well as when overdosing on vitamin preparations.
When nutrition is inadequate to the needs of the body, cell metabolism disorders occur. Nutritional deficiency significantly reduces the body's ability to synthesize specific antibodies, the phagocytic activity of micro- and macrophages, nonspecific resistance to bacterial toxins, causes a weakening of the inflammatory response, slows down wound healing and collagen formation, and changes the intestinal microflora.
Diseases of nutritional deficiency are accompanied by persistent changes in the biochemical constants of the internal environment of the body. Sensitivity to deficiency nutrients the higher, the younger the organism and the more intensively it grows. Malnutrition diseases are associated with a lack of proteins, vitamins, minerals and trace elements in the diet.
Protein-energy malnutrition
Protein-energy deficiency in clinical practice occurs in the form of kwashiorkor and nutritional marasmus.
Kwashiorkor happens in children 2-3 years old. The main cause of the disease is an unbalanced diet, especially animal proteins. As a rule, the energy component of the diet is provided by easily digestible carbohydrates. At the same time, kwashiorkor almost never has an exclusively food etiology: infectious, psychological, and cultural factors very often take part in its occurrence.
The transition from breastfeeding to the common table represents a critical period for the child. In the 2-3rd year of life, the need for proteins (essential amino acids) is especially great due to the rapid growth and development of muscle tissue. The protein requirement for a 1-3 year old child is 0.88-1.76 g/kg. Insufficient supply of complete protein leads to the appearance of edema. Violation of the synthesis of pancreatic enzymes is accompanied by disturbances in the processes of digestion and absorption (malabsorption), resulting in diarrhea syndrome.
There are symptoms of kwashiorkor, which occur constantly: edema (the absence of edema allows us to exclude kwashiorkor, this is the main sign) lag in height and body weight from age norms (body weight is up to 68% of regional norms, height - 91%); muscle hypotonia with preservation of subcutaneous tissue and psychomotor disorders (apathy, despondency, inertia, indifferent attitude towards environment and loss of appetite).
Desquamation dermatosis with areas of hyperpigmentation is considered inconsistent symptoms; spleno- and hepatomegaly; keratomalacia as a consequence of vitamin A deficiency; glossitis, cheilitis and angular stomatitis as a consequence of vitamin B2 deficiency.
The second important syndrome of protein-energy malnutrition is nutritional insanity (cachexia) . The occurrence of nutritional insanity is associated with a lack of both proteins and energy-valuable food. This condition can develop in all age groups, including adults, but is more common in children of the first year of life. The reasons are socio-economic factors (hunger), early cessation of breastfeeding without adequate artificial nutrition. Marasmus is often combined with diarrhea of infectious etiology and tuberculosis.
Nutritional marasmus is accompanied by a lag in physical development (the lag in body weight from the age norm reaches 60%, growth retardation occurs) and muscular dystrophy in the absence of subcutaneous fat. Loss of subcutaneous tissue causes wrinkles ("little old man" or "monkey" face),
Hypo- and vitamin deficiencies. Vitamin deficiency is understood as a state of complete depletion of vitamin reserves in the body; with hypovitaminosis, the content of one or another vitamin is sharply reduced. IN recent years They distinguish another form of vitamin deficiency - Subnormal supply, which manifests itself as a marginal (biochemical) deficiency. It manifests itself in clinical symptoms of deficiency and causes only biochemical disorders.
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Ministry of Health of the Republic of Sakha (Yakutia)
GBPOU "Yakut Medical College"
Branch of the city of Nyurba, Nyurba district
ABSTRACT
"Diseases,relatedWithcharacternutrition"
Completed by: 1st year student
2 brigades 1 group
Arkhipova Motrena
Teacher: Nikolaeva G.M.
Nyurba, 2017
Introduction
1. Cachexia
2. Kwashiorkor
Conclusion
Introduction
According to the World Health Organization, only 15% of a person’s health depends on the organization of medical services, the same amount is due to genetic characteristics, and 70% is determined by lifestyle and nutrition. Nutrition is the most important physiological need of humans. Food is an environmental factor through which the human body comes into close contact with all chemicals of plant and animal origin. All vital functions of the body are closely related to nutrition. Nutrition ensures the development and continuous renewal of cells and tissues, the supply of energy necessary to restore the body’s energy expenditure at rest and during physical activity. Food is a source of substances from which enzymes, hormones and other regulators of metabolic processes are formed in the body. Metabolism, which underlies the vital functions of the body, is directly dependent on the nature of nutrition.
Poor nutrition - both insufficient and excessive - is equally harmful to the health of adults and children. This can be expressed in a deterioration in physical and mental development, in a decrease in the body's resistance to various environmental factors, decreased performance, premature aging and shortened life expectancy. Employees of the Institute of Nutrition of the Russian Academy of Medical Sciences conducted large-scale research and identified significant imbalances in the nutrition of the Russian population. This is, first of all, excessive consumption of animal fats, which contributes to an increase in the number of people with various forms obesity. And at the same time - a deficiency of polyunsaturated fatty acids, and in some groups - complete (animal) proteins, a deficiency of vitamins (especially antioxidants - A, C, E, beta-carotene), a deficiency of macro- and microelements - calcium, iron, iodine, fluoride, selenium and zinc, deficiency of dietary fiber. Malnutrition leads to an increase in the number of children with reduced indicators of physical development, disruption of the immune status of the population, and an increase in the incidence of diseases associated with a deficiency of vital substances that ensure the normal state of the body.
According to the proposal of the World Health Organization (WHO), it is recommended to distinguish between the following forms of pathological conditions associated with poor nutrition.
Malnutrition is a condition caused by consuming an amount of food that is insufficient in calorie content for a more or less long time.
Overeating is a condition associated with consuming excess amounts of food. A specific form of deficiency is a condition caused by a relative or absolute deficiency in the diet of one or more nutrients. Imbalance is a condition that occurs when the ratio of essential nutrients in the diet is incorrect. Inadequate nutrition, when the energy value of the daily diet does not cover the energy expenditures produced during the day, leads to the development of a negative energy balance. At the same time, there is a mobilization of all the body’s resources for maximum energy production in order to eliminate the resulting energy deficit. In case of energy deficiency, all nutrients, including protein, are used as a source of energy, not only protein from food, but also tissue protein, which leads to the development of protein deficiency. Eating disorders make a significant contribution to the development of diseases. This contribution ranges from 10% to 40%. The health of children is largely determined by the nutrition of women, especially during pregnancy. Epidemiological studies over the past 15 to 20 years show that the role of insufficient or unbalanced nutrition may be comparable to the role of genetic factors and active chemical or infectious influences. Malnutrition diseases include primarily diseases associated with protein-energy malnutrition: cachexia, kwashiorkor and marasmus.
The most vulnerable group of the population to protein deficiency are children, especially during breastfeeding and the first years of life - from 6 months to 4 years. A disease in children that develops as a result of protein deficiency is called kwashiorkor. Kwashiorkor, meaning “red boy” or in other interpretations “weaned child”, occurs as a result of a deficiency of animal proteins in the diet. A concomitant factor is a lack of B complex vitamins. A monotonous carbohydrate diet can also be a cause. Childhood dystrophy (kwashiorkor) and cachexia are widespread in parts of West Africa. Kwashiorkor develops when a baby is fed a protein-poor starch diet after weaning. Kwashiorkor is characterized by a slowdown in the growth and development of the child, changes in skin and hair color, depigmentation, changes in the condition of the mucous membranes, deterioration in the functions of many systems, especially the digestive system (dyspeptic symptoms and persistent diarrhea). In severe cases, the main manifestations of kwashiorkor are swelling and mental disorders.
1. Cachexia
Cachexia is extreme exhaustion of the body, which is characterized by general weakness, a sharp decrease in weight, activity of physiological processes, as well as changes in the patient’s mental state.
Symptoms of cachexia include severe weakness, loss of ability to work, and sudden weight loss, often accompanied by signs of dehydration. Weight loss can reach 50% or more.
Subcutaneous tissue decreases sharply or disappears completely, and there are signs of hypovitaminosis (vitamin deficiency). As a result, the skin of patients becomes flabby, wrinkled, turns pale or acquires an earthy-gray tint.
Trophic changes in hair and nails are also present; stomatitis may develop, characterized by the appearance of severe constipation.
In patients it decreases sexual function, amenorrhea may occur in women (as the patient’s circulating blood volume decreases).
Glomerular filtration in the kidneys often decreases. Hypoproteinemia, hypoalbuminemia, as well as iron anemia or B 12 deficiency anemia are manifested.
Mental disorders are often observed with cachexia. At the beginning of its development, asthenia appears, which causes irritable weakness, tearfulness, and subdepressive mood. With the development of cachexia and asthenia, the adynamic component begins to manifest itself to a greater extent. During exacerbations of the underlying disease, which caused cachexia, clouding of consciousness in the form of amentia, twilight stupefaction, severe or rudimentary forms of delirium, which are replaced by anxious and melancholy states, apathetic stupor, and pseudoparalytic syndrome, may often occur.
K.'s pathogenesis is determined by the disease that caused it, but in all cases it includes profound metabolic disorders with depletion of fat and carbohydrate reserves, increased protein catabolism and a decrease in its synthesis.
Clinically, K. is manifested by pronounced weakness, loss of ability to work, and sudden weight loss. which is often combined with signs of dehydration, although in some cases hypooncotic (protein-free) swelling of the subcutaneous tissue and accumulation of transudate in various body cavities are observed.
Treatment of patients with K. in most cases is carried out in a hospital. It is aimed primarily at the underlying disease, but necessarily includes measures to restore the nutrition of patients, as well as thorough general care behind them. The diet must be enriched with protein, fats, vitamins, and easily digestible foods are used whenever possible. For symptoms of impaired digestion and absorption of food, multienzyme drugs (festal, pancreatin, etc.) are prescribed. To remove patients with K. from a serious condition, glucose, electrolytes, vitamins, protein hydrolysates, and amino acid mixtures are administered parenterally. Anabolic hormones are used according to indications. For psychogenic anorexia, treatment is prescribed and carried out by a psychiatrist; Appetite stimulants may be used.
2. Kwashiorkor
Kwashiorkor is a type of severe dystrophy caused by a lack of protein in the diet. The disease usually occurs in children 1-4 years old. When a baby is breastfed, he receives certain amino acids necessary for growth from mother's milk. When a baby is weaned, if the products that replace mother's milk are high in starches and sugars and low in protein (as is usually the case in countries where the main diet of people consists of starchy vegetables, or where mass famine has occurred, the child may develop kwashiorkor.
The name comes from a coastal Ghanaian language and literally means "first-second", and means "rejected", reflecting that the condition begins in the eldest child after weaning, often due to the birth of another child in the family. .
One of the symptoms is bloating in children (ascites, which often occurs in children in poor areas of Africa, is explained by the fact that cassava contains only a small amount of protein (1.2%) and very few essential amino acids. In a diet based on cassava, these factors lead to children pellagra (kwashiorkor) Due to the lack of important amino acids, the internal organs accumulate water. In this regard, it is also recommended to consume cassava leaves, which contain a large amount of protein, as a vegetable.
Treatment is carried out in a hospital. It is necessary to adjust nutrition in accordance with the age needs of the child. The missing amount of protein is compensated by introducing milk, cottage cheese, protein enzymes, and amino acid preparations into the diet. The protein content and energy value of the diet are increased gradually. Vegetable fats are preferable, because they are better absorbed than animal fats.
From the first days of treatment, vitamin preparations (especially A and group B), potassium, magnesium, iron (for anemia), as well as enzyme preparations are prescribed. For complications caused by secondary infection, antibacterial agents are indicated. Treatment is carried out for diseases that promote or cause the development of K. After the start of treatment, body weight can decrease within several weeks due to a decrease in edema.
The prognosis with early diagnosis and timely treatment is favorable.
Prevention consists mainly of rational nutrition of young children (natural feeding in the first year of life, timely and correct introduction of complementary foods, a sufficient amount of dairy products in the diet). Important has timely and adequate treatment of diseases leading to protein deficiency.
cachexia kwashiorkor marasmus nutrition
Marasmus (from the Greek marasmus - exhaustion, extinction).
Nutritional marasmus is a disease, a form of protein-energy malnutrition, usually in children under one year of age.
There are currently no effective methods for treating atrophic processes. However, proper care and the prescription of symptomatic remedies (for individual symptoms of the disease) are of great importance for the fate of such patients. At the onset of the disease, it is advisable to keep them at home without sudden changes in their lifestyle. Hospitalization may cause the condition to worsen. The patient needs to create conditions for a fairly active lifestyle so that he moves more, lies less during the day, and is more occupied with his usual household chores. In case of severe dementia and in the absence of the possibility of constant care and monitoring of the patient at home, inpatient treatment or stay in a special boarding school is indicated. Psychotropic drugs are prescribed only for sleep disorders, fussiness, delusional and hallucinatory disorders. Preference is given to drugs that do not cause weakness, lethargy, or other side effects and complications. Tranquilizers are recommended only at night (radedorm, eupoctin). Antidepressants used include pyrazidol and azafen; neuroleptics - sonapax, teralen, etaparazine, haloperidol drops. All drugs are prescribed in minimal doses in order to avoid unwanted complications. Treatment with nootropics and other metabolic agents is advisable only in the early stages of the disease, when it helps to some extent stabilize the process. There is no prevention for senile dementia. Good care timely treatment internal diseases and maintaining mental state can significantly prolong the patient’s life. Patients require bed rest and the prescription of symptomatic medications (for individual symptoms of the disease). At the onset of the disease, it is advisable to keep them at home, without sudden changes in living habits. Hospitalization may cause the condition to worsen. The patient needs to create conditions for a fairly active lifestyle so that he moves more, lies less during the day, and is more occupied with his usual household chores.
Problems arising from protein deficiency. A lack of protein in the body is caused by a lack of the required amount or the amount of amino acids necessary for protein synthesis. As a rule, protein deficiency is a regular occurrence in strict vegetarians, in people with large physical activity due to nutritional imbalance. Protein deficiency in the body has negative consequences for almost the entire body. Insufficient intake of protein into the body from food leads to a slowdown in the growth and development of children, in adults - to disturbances in the activity of the endocrine glands, to changes in the liver, changes hormonal levels, disturbances in the production of enzymes, resulting in deterioration in the absorption of nutrients, many microelements, healthy fats, vitamins. In addition, protein deficiency contributes to memory impairment, decreased performance, weakened immunity due to a decrease in the level of antibody formation, and is also accompanied by vitamin deficiency. Insufficient protein intake leads to weakening of the cardiac and respiratory systems and loss of muscle mass.
Daily requirement female body in protein should be based on the calculation of 1.3 g multiplied by a kilogram of weight. For men, this coefficient increases to 1.5 g. When engaging in training or any physical activity, protein consumption must be increased to 2.5 g times a kilogram. It is better if the protein consumed is easily digestible, that is, in the form of milk, soy proteins or specially prepared amino acid mixtures.
Conclusion
In the human body, there are practically no reserves of protein, and the synthesis of new proteins is possible only from amino acids that come from food. Protein consumed by a person with food, entering the body, is broken down into amino acids during the digestion process, which are then easily absorbed into the blood and absorbed by the body. From amino acids, cells synthesize protein, which differs from consumed protein and is characteristic only of the human body. Amino acids synthesized in our body are considered replaceable, and from which the proteins of our body are built are considered essential. They are not synthesized in our body and must be supplied with food. We can say that nonessential amino acids are more important for the cell than essential ones. Nutritional requirements for certain compounds indicate that dependence on an external source of amino acids may be more favorable for the survival of the body than the body’s own synthesis of these compounds.
Proteins are usually divided into plant and animal groups. Protein of animal origin includes protein chicken egg and whey protein. Chicken protein is easily digestible and is a standard, since it consists of 100% albumin and yolk. Other proteins are also evaluated in relation to chicken protein. To the squirrels plant origin can be attributed to soy. Since the synthesis of new protein in the human body is constant, it is necessary to ensure a constant supply of protein to the body in the required quantity.
To avoid disruption of protein metabolism, the following recommendations must be followed:
The consumption of semi-finished products and shelf-stable meat products (sausage, frankfurters, ham, sausages) is prohibited. Since semi-finished and finished “meat” products contain little complete protein, people who frequently consume these products most often experience protein starvation.
Fatty meats and fish should be consumed in rare cases, since they contain a large percentage of fat, which interferes with the absorption of protein.
Eat more poultry, eggs, lean beef. Plant proteins contained in peas, beans, nuts, and buckwheat should be regularly included in the daily diet.
It is best to cook meat on the grill or as a shish kebab, since this method of cooking removes excess fat, which does not overload the gastrointestinal tract.
Do not combine meat and fish with cereals, potatoes and bread; the best addition would be a vegetable salad.
Protein foods should be consumed in the evening before 18.00.
Protein products high quality are milk, eggs and meat.
Preferred protein foods: egg whites, low-fat cottage cheese, low-fat cheeses, lean fresh fish and seafood, young lamb, lean veal, chicken, turkey, (meat without skin), soy milk, soy meat.
The basic rule to follow when choosing protein foods is: choose foods that are low in fat and high in protein.
List of used literature
1. Marilov, V.V. Private psychopathology /V.V. Marilov. M.: Academy, 2004. - 400 p.
2. Donchenko L.V., Nadykta V.D. Food safety. M.: Pishchepromizdat, 2001.
3. Liflyandsky V.G., Zakrevsky V.V., Andronova M.N. Medicinal properties food products. M.: Terra, 1996.
4. Malakhov G. P. Healing powers. St. Petersburg, 1994.
5. Popular about nutrition. / Ed. A.I. Stolmakova. Kyiv, "Health", 1990.
6. Rational nutrition/ Smolyar V.I. Kyiv: Nauk. Dumka, 1991.
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Nutritional diseases– these are diseases that develop with insufficient or excessive consumption of foods containing proteins, fats, carbohydrates, minerals, and vitamins.
Such diseases associated with excessive consumption of food (fats, easily digestible carbohydrates) include nutritional obesity. The cause of other nutritional diseases, such as protein-energy deficiency, hypovitaminosis, microelementosis, is insufficient consumption of food products containing them.
These diseases can go unnoticed for years, with only one symptom: asthenovegetative - a person gets tired quickly and has low performance. This is the borderline stage of a nutritional disease, when protein, fat, and carbohydrate metabolism change at the biochemical level, and after a few years or decades this situation gives impetus to the development chronic diseases associated with nutritional risks of disease development.
But nutritional diseases do not always occur hidden. A significant lack of nutrients, increased physical, mental stress or stress cause pronounced clinical manifestations characteristic of this nutritional disease (manifestation).
For example, with insufficient protein intake protein deficiency develops clinical manifestations: impaired immunity, memory, thinking abilities, iron deficiency anemia develops, decreased production of hormones, including sex hormones, production of enzymes that promote normal digestion. In children, physical, biological, intellectual development, the child begins to get sick often and for a long time.
With a lack of vitamin C - ascorbic acid ( main sources : fruits, vegetables, berries, greens) hypovitaminosis C develops, which in a person can last for years, manifested by a decrease in mental and physical performance, lethargy, feeling general weakness, increased incidence of acute respiratory viral infections. Often observed increased sensitivity to cold, chilliness, drowsiness, or, conversely, poor sleep, depression and loss of appetite.
The earliest clinical microsymptom of vitamin C deficiency is pinpoint hemorrhages on the skin (petechiae) and bleeding gums.
With a lack of vitamin B1(thiamine), The main sources of which are grain products: bread, cereals- hypovitaminosis develops. Its manifestations: rapid mental and physical fatigue, general loss of strength, muscle weakness, chilliness when room temperature. Pain in the legs and fatigue when walking, soreness of the calf muscles on palpation.
With a lack of vitamin B2 (riboflavin), the main sources of which are dairy products, is developing ariboflavinosis. External manifestations: “jams” - cracks in the corners of the mouth, peeling skin on the face and ears. Photophobia, conjunctivitis, lacrimation, itching and burning in the eyes, and blurred vision in the dark often develop.
In addition, iron deficiency anemia, dysfunction of the liver, capillaries, digestive organs, and gastric secretion may occur. A frequent manifestation may be cerebral vascular insufficiency of varying severity, manifested by a feeling of general weakness, dizziness, decreased tactile and pain sensitivity, and increased tendon reflexes. In some cases, nervous disorders are possible, manifested in muscle weakness and burning pain in the legs.
If there is a shortage folic acid (source - greens, green leafy vegetables) the hematopoietic tissue and intestinal mucosa, which are responsible for intensive DNA synthesis and a high rate of cell division, are affected. As a result, it develops macrocytic hyperchromic anemia. Deficiency of folacin during pregnancy can cause prematurity, postpartum hemorrhage, congenital deformities (defects of newborns are often observed - spina bifida and anencephaly), and mental development disorders in newborns.
For iodine deficiency (
