Diets and therapeutic nutrition. Nomenclature of medical (dietary) tables


Currently, by Order of the Ministry of Health Russian Federation dated August 5, 2003 “On measures to improve clinical nutrition in medical institutions of the Russian Federation” a new nomenclature was approved therapeutic diets– a system of standard diets, including five options.

The formation of variants of standard diets is carried out not according to the main nosological forms (diseases), which underlay the formation of diets (tables) as such, as described above, but in relation to mechanical and chemical sparing, the amount of protein and calorie content.

1. The main version of the standard diet, combining number diets No. 1, 2, 3, 5, 6, 7, 9, 10, 13, 14 and 15. Indications for use: chronic gastritis in remission, gastric ulcer and duodenum in remission, chronic diseases intestines with a predominance of irritable bowel syndrome with predominant constipation, acute cholecystitis And acute hepatitis in the recovery stage, chronic hepatitis with blurred pronounced signs functional failure liver, chronic cholecystitis and cholelithiasis, gout, uric acid diathesis, nephrolithiasis, hyperuricemia, phosphaturia, diabetes type 2 without concomitant overweight or obesity, cardiovascular disease with mild circulatory disorders ( hypertonic disease, ischemic heart disease, atherosclerosis, cerebral and peripheral vessels), acute infectious diseases, feverish conditions.

2. Diet option with mechanical and chemical sparing (diets No. 16, 46, 4v, 5p). Indications for use: peptic ulcer of the stomach and duodenum in the acute stage, acute gastritis, chronic gastritis with high acidity in the stage of mild exacerbation, gastroesophageal reflux disease, dysfunction of the masticatory apparatus, acute pancreatitis in the stage of subsiding exacerbation, severe exacerbation of chronic pancreatitis, recovery period after acute infections, after operations (not on internal organs).

3. Diet option with increased amount protein (high-protein diet - diets No. 4, 5, 7c, 7d, 9, 10, I). Indications for use: condition after gastric resection after 2–4 months. for peptic ulcer disease in the presence of dumping syndrome, cholecystitis, hepatitis; chronic enteritis in the presence of a pronounced disorder functional state digestive organs, chronic pancreatitis in remission, chronic glomerulonephritis in the nephrotic version in the stage of subsiding exacerbation without impairment of the nitrogen-excreting function of the kidneys, diabetes mellitus type 1 or 2 without concomitant obesity and impairment of the nitrogen-excreting function of the kidneys, rheumatism with a low degree of process activity with a prolonged course without circulatory impairment, pulmonary tuberculosis, suppurative processes, anemia, burn disease.

4. Diet option with reduced amount protein (low-protein diet - numbered diets No. 7a, 76). Indications for use: chronic glomerulonephritis with severe and moderate pronounced violation nitrogen excretion function of the kidneys.

5. Option of a diet with a reduced calorie content (low-calorie diet - numbered diets No. 8, 9, 10c). Indications for use: various degrees nutritional obesity in the absence of pronounced complications from the digestive organs, blood circulation, as well as diseases requiring special diets; diabetes mellitus type 2 with obesity, cardiovascular diseases if present overweight bodies.

Along with the basic standard diet and its variations, in accordance with the profile of the medical institution, there are also surgical diets(diet No. 0, diet for ulcer bleeding, gastric stenosis, etc.), fasting diets and special diets (potassium, magnesium diets, diets for myocardial infarction, feeding through a tube, diets for fasting-dietary therapy, vegetarian diet etc.). The Order of the Ministry of Health of the Russian Federation provides for average daily food sets depending on the diet option.

Based on the importance of the health of the nation for the development and security of the country, as well as based on the importance healthy eating the younger generation for the future of Russia, the Decree of the Government of the Russian Federation (1998) approved the “Concept public policy in the field of healthy nutrition of the population of the Russian Federation for the period until 2005.” One of the priorities of this concept is the development of production related to the production of new high-tech drugs, including biologically active additives (BAA) to food. Biologically active additives are concentrates of natural or biologically identical to natural active substances, intended for consumption simultaneously with food or for inclusion in food products. Supplements serve as a means of improving the health of the body, reducing morbidity, increasing the effectiveness of drug therapy, prolonging active longevity etc.

Diet

General leadership dietary nutrition in a medical institution carries out chief physician, and in his absence - deputy chief physician for medical work. A nutritionist is responsible for the organization of therapeutic nutrition and its adequate use in all departments of a medical institution. He supervises dietary nurses (diet nurses) and supervises the work of the catering department. If there is no position of a dietician in a medical institution, a dietary nurse is responsible for this work.

Monitoring of therapeutic nutrition is carried out by a dietician and a nutritionist at a medical institution. The responsibilities of a nutritionist include the correct preparation of therapeutic diets, monitoring their correct use, advisory assistance to doctors in the optimal prescription of the dietary table, control over the menu, compliance with cooking technology dietary dishes, their quality and chemical composition. The dietary nurse is responsible for monitoring the operation of the catering unit and compliance with sanitary and hygienic standards.



Principles of organizing children's nutrition in the hospital

The general management of diet in the hospital is carried out by the chief physician, and in his absence - by the deputy for medical care. Heads of departments manage clinical nutrition in departments.

A nutritionist is responsible for organizing therapeutic nutrition. In cases where the position of a dietitian is not available, a dietary nurse is responsible for this work.

In a multidisciplinary medical institution with a number of beds of 100 or more, a Medical Nutrition Council is created.

The Council for Medical Nutrition includes: the chief physician (or his deputy for medical work), a nutritionist, heads of departments, doctors (gastroenterologist, resuscitator, transfusiologist, etc.), nurses dietary, deputy chief physician for food and chemical preparation, production manager (chef). If necessary, other specialists may be involved in the work of the Council.

Objectives of the Council for Clinical Nutrition:

    improving the organization of therapeutic nutrition;

    introduction of new technologies for preventive, dietary and enteral nutrition;

    approval of the nomenclature of diets, seven-day menu, card index of dishes, mixtures for enteral nutrition;

    control over the organization of therapeutic nutrition and analysis of the effectiveness of diet therapy for various diseases.

In children's hospitals, two systems for organizing therapeutic nutrition are used - group and individual. Individual used mainly in the organization of nutrition for children of the first year of life and for seriously ill older patients:

    the diet is prescribed by the doctor;

    food is prepared for a specific child.

For children over 1 year of age, as a rule, it is used group a nutritional system in which a child, depending on the pathology, is prescribed one or another type of nutrition. Each type of therapeutic nutrition has a letter designation that corresponds to the designations in adult dietetics. This ensures that dietary treatment is staged and consistent.

The concept of physiological and therapeutic tables for children of different ages.

New diet nomenclature

Currently, by order of the Ministry of Health of Russia dated August 5, 2003 No. 330 “On measures to improve clinical nutrition in medical institutions of the Russian Federation,” a new nomenclature of diets (system of standard diets) has been approved, including five options, differing:

    cooking technology (the main one is the principle of sparing);

    average daily set of products.

Previously used diets of the number system (1 - 15) are combined or included in the system of standard diets, which are prescribed for various diseases depending on:

    on the stage, severity of the disease;

    complications from various organs and systems.

New nomenclature of diets (system of standard diets)

Options

standard diets

Designations

standard diets in the food department documentation

Previously used number system diets

The main version of the standard diet.

1-3, 5-7, 9, 10, 12,

Diet option with mechanical and chemical sparing (gentle diet)

5p (1 option)

High protein option.

(high protein diet)

4a, 4d, 5p (2nd option), 7c, 7d, 9b, 10b, 11, R-I,R-II

Reduced protein option (low protein diet)

Diet option with reduced calorie content (low-

calorie diet)

Therapeutic nutrition for chronic diseases Kaganov Boris Samuilovich

Chapter 3 System of standard diets for therapeutic nutrition

System of standard diets for therapeutic nutrition

Dietary therapeutic nutrition based on physiological needs healthy person V nutrients ah and energies, which are corrected based on the characteristics of pathogenesis, clinical course, stages of the disease, severity metabolic disorders, risk factors for the development of nutrition-dependent diseases in each individual patient.

Numerous studies on the mechanisms of food assimilation under normal conditions and in various diseases formed the basis for the development of balanced nutrition concepts, and then optimal nutrition concepts, according to which chemical structure diet and its nutritional, biological and energy value must correspond to the functional state of the body's enzyme systems responsible for the assimilation of nutrients, provided that the body's needs for basic nutrients, essential nutritional factors and energy are fully met.

It is more correct to consider the complex and essentially unified process of food assimilation in a certain sequence and at different levels of food assimilation: at the level of perception of food and its digestion in the gastrointestinal tract, at the level of the entry of food digestion products into cellular structures and their transformation in intracellular structures and, finally, at the level of excretion of metabolic products from the body.

Until 2003, therapeutic nutrition in medical institutions (HCIs) of the USSR and the Russian Federation was based on a nosological principle in the form of dietary rations developed in the Medical Nutrition Clinic of the Federal State Budgetary Institution "Research Institute of Nutrition" of the Russian Academy of Medical Sciences and approved by the Ministry of Health of the USSR, in relation to each specific disease, which were designated by numbers from 1 to 15. The number system of diets included 15 basic diets and their numerous modifications depending on the characteristics of the course of a particular disease. In total, more than 60 dietary table options were developed. In practical diet therapy, with all the variety of nosologies, five diet options were mainly used - No. 1, 5, 7, 9 and 15. The number system was convenient for organizing group, rather than personalized (individualized) nutrition.

The basis for determining the quantitative proportions of individual components of the diet are the values physiological need body of a healthy person in nutrients and energy corresponding to gender, age, body weight, level of energy expenditure, climatic and geographical conditions, etc., taking into account individual habits and national characteristics nutrition. Adjustments are made to the physiological proportions of nutrients taking into account the disease-modified need for macro- and micronutrients of each individual patient.

Before the approval of the order of the Ministry of Health of the Russian Federation dated 08/05/2003 No. 330 “On measures to improve therapeutic nutrition in medical institutions of the Russian Federation,” the main documents regulating the organization of therapeutic nutrition in health care facilities were orders of the USSR Ministry of Health dated 04/23/1985 No. 540 “On improving the organization of medical nutrition in medical institutions” and dated June 14, 1989 No. 369 “On amending and supplementing the order of the USSR Ministry of Health.”

Order of the Ministry of Health of Russia dated August 5, 2003 No. 330 “On measures to improve clinical nutrition in medical institutions of the Russian Federation” introduced a new nomenclature of diets (system of standard diets), which combines the previously used diets of the number system (diets No. 1-15 ).

In accordance with this order, the system of standard diets included five options for standard diets: the main diet option (OVD), a diet option with mechanical and chemical sparing (sparing diet, SB), a diet option with an increased amount of protein (high-protein diet, VBD), a diet option with a reduced amount of protein (low-protein diet, LBD), a diet option with a reduced calorie content (low-calorie diet, LCD). The standard diet system is presented in Table 7.

Standard diets in their chemical composition and energy value are adapted to the characteristics of pathogenesis, clinical course, stage of the disease, the nature of metabolic disorders of the main and concomitant diseases.

Table 7

Standard diet system

* Until 2013 - high-protein diet for patients with tuberculosis VBD (t) (order of the Ministry of Health and Social Development of Russia dated April 26, 2006 No. 316).

In subsequent years, the Ministry of Health and social development The Russian Federation issued a number of orders that introduced changes and additions to the order of the Ministry of Health of Russia dated 08/05/2003 No. 330. Thus, in accordance with the order of the Ministry of Health and Social Development of Russia dated 04/26/2006 No. 316 “On amendments to the order of the Ministry of Health of the Russian Federation” Federation “On measures to improve clinical nutrition in medical institutions of the Russian Federation”, the second version of the high-protein diet for tuberculosis patients - VBD (t) - was introduced into the system of standard diets.

June 21, 2013 for implementation purposes Federal Law Russian Federation dated November 21, 2011 No. 323 “On the fundamentals of protecting the health of citizens in the Russian Federation” The Ministry of Health of the Russian Federation issued Order No. 395n “On the approval of clinical nutrition standards.” In accordance with this order, the option of a high-protein diet for patients with tuberculosis (HPD (t)) was replaced by a diet option with increased calorie content (high-calorie diet, HPD), taking into account the fact that this option of a standard diet, along with a high protein and fat content, is characterized by high calorie content .

Table 8

Characteristic, chemical composition and energy value of standard diets used in medical organizations

From the book Nutrition for Tuberculosis author Melnikov Ilya

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From the book The Big Book of Nutrition for Health author Gurvich Mikhail Meerovich

From the book Dietary Secrets of the Madrid Court author Gerasimova Natalya

Oleg Lamykin This tasty and healthy life. A complete system of nutrition and cleansing of the body Dedicated to my beloved wife, who selflessly protects me and inspires all these

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Exercise and Our Diet I am a big fan of exercise and its impact on health. But I don't see what's the point in wasting time without your family and friends when you spend hours on it thinking you need crazy weight loss exercises that create

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Prescribing a type of therapeutic nutrition The first option: is prescribed to patients with normal body weight in the absence of pronounced disturbances in nutritional and metabolic status. A diet with a physiological content of proteins, fats and carbohydrates, enriched with dietary fiber,

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From the author's book

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Nomenclature of dietary tables (developed at the Medical Nutrition Clinic of the Institute of Nutrition of the Russian Academy of Medical Sciences) Diet No. 1 Peptic ulcer of the stomach and duodenum in the stage of fading exacerbation and compensation; chronic gastritis with

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Characteristics of diets and sample menus for diseases of the cardiovascular system (developed by the Medical Nutrition Clinic of the Institute of Nutrition of the Russian Academy of Medical Sciences) Diet No. 10 Indications for prescribing the diet. Various diseases heart and blood vessels with mild circulatory disorders.

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“Dieta” means “food system.” In Spain they say: “ Mediterranean diet is coming back into fashion." The most common advice given in Lately doctors and nutritionists to the population - to return to the basics of healthy eating. “How can this be?” – the reader will ask: “Is it really

Basic diet(1st) combines diets No. 1, 2, 3, 5, 6, 7, 9, 10, 13, 14, 15. Characteristic: physiological content of proteins, fats and carbohydrates; enriched with vitamins, minerals And vegetable fiber food. For diabetics, refined carbohydrates are excluded. Nitrogenous extractives are limited, salt(6-8 g per day), spicy seasonings, spinach, sorrel and smoked meats are excluded. Dishes are boiled or steamed, baked. The temperature of the dishes is not higher than 60-65°C and not lower than 15°C. Free liquid – 1.5-2 l. Diet: 4-6 times a day. Nutrient content: proteins 85-90 g, incl. animals 40-45 g; fats 70-80 g, incl. vegetable 25-30 g; carbohydrates 300-330 g, incl. mono- and disaccharides 30-40 g; calorie content 2170-2400 kcal.

Diet option with mechanical and chemical sparing (2nd) combines diets Nos. 1b, 4b, 4c, 5p (1st option). Characteristic: physiological diet enriched with vitamins and minerals with moderate restriction of irritants gastrointestinal tract. Spicy snacks, seasonings and spices are excluded. Table salt is limited (6-8 g per day). Boiled or steamed dishes, pureed. The temperature of the dishes is from 15 to 60-65°C. Diet fractional: 5-6 times a day. Nutrient content: proteins 85-90 g, incl. animals 40-45 g; fats 70-80 g, incl. vegetable 25-30 g; carbohydrates 300-330 g, incl. mono- and disaccharides 50-60 g; calorie content 2170-2480 kcal.

Diet option with increased protein (3rd) combines diets Nos. 4a, 4d, 5p (2nd option), 7c, 7d, 9b, 10b, 11. Characteristic: increased content protein, limiting easily digestible carbohydrates. For patients with diabetes mellitus and after gastric resection with dumping syndrome, sugar is excluded. Table salt (6-8 g/day), chemical and mechanical irritants of the stomach and biliary tract. Dishes in boiled, stewed, baked, mashed and unmashed form, steamed. Temperature from 15 to 65°C. Free liquid – 1.5-2 l. Diet fractional: 4-6 times a day. Nutrient content: proteins 110-120 g, incl. animals 45-50 g; fats 80-90 g, incl. vegetable - 30 g; carbohydrates 250-350 g, incl. mono- and disaccharides 30-40 g. K caloric content: 2080-2690 kcal.

Diet option with reduced protein (4th) includes diets: 7a, 7b. Characteristic: protein restriction, restriction of table salt (1.5-3 g/day) and liquid (0.8-1.0 l). Nitrogenous extractives, alcohol, cocoa, chocolate, coffee are excluded. Dishes made from sago, starch, protein-free bread, purees and mousses are introduced. Dishes are prepared without salt, boiled and steamed, the food is not crushed and is enriched with vitamins and minerals. Diet: 4-6 times a day . Nutrient content: proteins 20-60 g, incl. animals 15-30 g; fats 80-90 g, of which vegetable fats 20-30 g; carbohydrates 350-400 g, incl. mono- and disaccharides 50-100 g; calorie content 2120-2650 kcal.

Reduced calorie diet option (5th) includes diets: 8, 9a, 10c. Characteristic: caloric restriction to 1300-1600 kcal/day, mainly from fats and carbohydrates. Excluded simple sugars, animal fats, table salt (3-5 g/day), liquid (0.8-1.5 l) are limited. Includes vegetable fats and dietary fiber. Diet: 4-6 times a day. Nutrient content: proteins 70-80 g, incl. animals 40 g; fats 60-70 g, incl. vegetable 25 g; carbohydrates 130-150 g, without mono- and disaccharides; calorie content 1340-1550 kcal.

Currently, the Order of the Ministry of Health of the Russian Federation of August 5, 2003 “On measures to improve clinical nutrition in medical institutions of the Russian Federation” has approved a new nomenclature for treatment. diet - standard system diets, including 5 options.

The formation of variants of standard diets is carried out not according to the main nosological forms (diseases), which underlay the formation of diets (tables) as such, as described above, but in relation to mechanical and chemical sparing, the amount of protein and calorie content.

1. The main version of the standard diet, combining numbered diets Nos. 1, 2, 3, 5, 6, 7, 9, 10, 13, 14 and 15. Indications for use: chronic gastritis in remission, gastric and duodenal ulcers in remission, chronic intestinal diseases with a predominance of irritable bowel syndrome with predominant constipation, acute cholecystitis and acute hepatitis in the recovery stage, chronic hepatitis with mild signs of functional liver failure, chronic cholecystitis and cholelithiasis, gout, uric acid diathesis, nephrolithiasis, hyperuricemia, phosphaturia, type 2 diabetes mellitus without concomitant overweight or obesity, cardiovascular diseases with mild circulatory disorders (hypertension, coronary artery disease, atherosclerosis, cerebral and peripheral vessels), acute infectious diseases , fever. condition.

2. Diet option with mechanical and chemical sparing(diets No. 16, 46, 4c, 5p). Indications for use: peptic ulcer of the stomach and duodenum in the acute stage, acute gastritis, chronic gastritis with high acidity in the stage of mild exacerbation, gastroesophageal reflux disease, dysfunction of the masticatory apparatus, acute pancreatitis in the stage of subsiding exacerbation, severe exacerbation of chronic pancreatitis, recovery period after acute infections, after operations (not on internal organs).

3. Diet option with increased protein(high-protein diet - diets No. 4, 5, 7c, 7d, 9, 10, 11). Indications for use: condition after gastric resection after 2-4 months. about peptic ulcer in the presence of dumping syndrome, cholecystitis, hepatitis; chronic enteritis in the presence of a pronounced impairment of the functional state digestive organs, chronic pancreatitis in remission, chronic glomerulonephritis in the nephrotic version in the stage of subsiding exacerbation without impairment of nitrogen excretion function of the kidneys, diabetes mellitus type 1 or 2 without concomitant obesity and impairment of nitrogen excretion function of the kidneys, rheumatism with a low degree of process activity with a prolonged course without impairment blood circulation, pulmonary tuberculosis, suppurative processes, anemia, burn disease.



4. Diet option with a reduced amount of protein(low-protein diet - numbered diets No. 7a, 76). Indications for use: chronic glomerulonephritis with severe and moderate impairment of nitrogen excretory function of the kidneys.

5. Reduced calorie diet option(low-calorie diet - numbered diets No. 8, 9, 10c). Indications for use: various degrees of nutritional obesity in the absence of pronounced complications from the digestive system, blood circulation, as well as diseases requiring special diets; diabetes mellitus type 2 with obesity, cardiovascular diseases in the presence of excess body weight.

Along with the basic standard diet and its variants, in accordance with the profile of the medical institution, surgical diets are also provided (diet No. 0, diet for ulcer bleeding, gastric stenosis, etc.), fasting diets and special diets (potassium, magnesium diets, diets for myocardial infarction, feeding through a tube, diets for fasting-dietary therapy, vegetarian diet, etc.). The Order of the Ministry of Health of the Russian Federation provides for average daily. sets of products depending on the diet option.

Based on the importance of the nation’s health for the development and security of the country, as well as on the importance of healthy nutrition of the younger generation for the future of Russia, the Decree of the Government of the Russian Federation (1998) approved the “Concept of state policy in the field of healthy nutrition of the population of the Russian Federation for the period until 2005.” . One of the priorities of this concept is the development of production related to the production of new high-tech drugs, including biologically active additives (BAA) to food. Dietary supplements are concentrates of natural or natural-identical biologically active substances intended for consumption along with food or for inclusion in food products. Supplements serve as a means of improving the body’s health, reducing morbidity, and increasing the effectiveness of medications. therapy, prolongation of active longevity, etc.