Preventive nutrition. Rations of therapeutic and preventive nutrition

POWER (BOB)

3.1. Features and biomedical aspects of therapeutic and preventive nutrition

3.2. Therapeutic and preventive nutrition harmful conditions labor

3.3. Therapeutic and preventive nutrition under especially harmful working conditions

3.4. Characteristics of LPP diets

3.5. Fundamentals of cooking technology LPP

3.1. Features and biomedical aspects

therapeutic and preventive nutrition

The intensive development of all industries, the expansion of the production of new materials, the creation of new technologies (not always safe) led to an increase in the number of people employed in hazardous industries. In the process of labor activity, workers may come into contact with harmful factors of production. These include potentially hazardous chemical compounds used in industry (solvents, acids, alkalis, varnishes, dyes, hydrocarbons, heavy metals, drugs (for example, antibiotics), etc.); as well as physical factors of influence (noise, vibration, magnetic and sound fields, increased Atmosphere pressure etc.). These factors have an adverse impact both on individual life support systems and on the whole body of a person employed in hazardous and especially hazardous industries.

In this regard, the prevention of occupational diseases is relevant. In the system of measures to protect against adverse effects, a special place is given to medical and biological measures, among which an important place belongs to therapeutic and preventive nutrition. It is aimed at preserving the health and preventing occupational diseases of production workers associated with the influence of harmful production factors on the human body.

The basis of therapeutic and preventive nutrition is a balanced diet, built taking into account the metabolism of xenobiotics (foreign compounds) in the body and the role of individual food components that have a protective effect when exposed to chemical and physical factors. Therefore, therapeutic and preventive nutrition should be differentiated taking into account pathogenetic mechanisms actions of harmful and especially harmful factors of production.

Occupational hazards and hazards include aggressive chemical substances, physical factors (noise, vibration, radiation, magnetic fields, ultra- and infrasound, laser radiation), as well as biological factors of influence. They call the workers specific diseases (occupational diseases): occupational diseases caused by exposure to industrial dust (dust bronchitis, rhinitis, etc.); occupational diseases caused by the action of physical factors of the production environment (radiation, noise and vibration diseases); occupational diseases caused by the influence of biological factors; occupational diseases caused by exposure to chemical factors (intoxication).

The main route of penetration of toxins into the body is the respiratory organs, through which toxic substances in the gaseous state, aerosols and dust penetrate. Through the respiratory tract, they enter the bloodstream, bypassing the liver. Fat-soluble substances (esters, organophosphorus compounds, etc.) penetrate through the skin. this case Substances can be in liquid, gaseous and solid states. Some toxic substances are not completely neutralized, but form a depot (lead, mercury, phosphorus, etc.).

The most widespread occupational diseases arising from exposure to chemical reagents. The degree of air pollution with toxic impurities is determined by numerous factors (the nature of production activities, meteorological conditions, etc.). The majority of organic and inorganic industrial compounds have a negative effect on the body.

Depending on which substance has a negative effect, they form an adequate diet that can enhance the antitoxic properties of the body, and also introduce products that can neutralize toxins.

^ Professional allergic diseases common in regions with a high level of industrial development (their steady growth is noted - bronchial asthma, allergic bronchitis, dermatitis, rhinopathy, etc.). There is an opinion that this is due to the allergenic effect of industrial chemical compounds.

It is assumed that the “threshold of action” is inherent in all substances (substances will show their allergic properties under certain conditions). Once in the body, industrial chemical compounds form complexes with proteins (“complete antigens”) that can cause allergies in humans.

On the other hand, the development of allergies is associated with a violation of the activity of specific enzyme systems that neutralize substances harmful to the body.

The most common allergies are among persons employed in work with chromium (tri- and hexavalent, that is, with chromites, chromates and bichromates). Chromium compounds are used in ferrous and non-ferrous metallurgy, in the chemical, electrochemical and radio engineering, textile and leather industries, as well as in photography, in the preparation of paints, etc. Hexavalent chromium has a greater ability to penetrate through cell membranes and stronger sensitizing activity compared to trivalent chromium.

Other industrial chemical allergens are nickel, formaldehyde, polymer materials based on it (formaldehyde resins), resins, antibiotics, compounds of beryllium, manganese, platinum.

Diseases dust etiology associated with the extraction of coal and other solid minerals (ores, sand, slag), as well as their processing. The reaction of the body of miners to the impact adverse factors mine (quarry) production environment depends on the characteristics of their biological action, the intensity of exposure, as well as individual features organism.

Of the occupational diseases of dust etiology, pneumoconiosis, conitis tuberculosis, and chronic dust bronchitis are common. The mass of inhaled dust and the time of its exposure are of decisive importance in the development of these diseases (the most dangerous is dust with a particle size of up to 0.5 microns, which can penetrate into the alveoli; larger dust particles damage mainly the upper respiratory tract).

The nature of changes in the lungs also depends on the content of mineral and other impurities in the dust (crystalline silicon dioxide in coal mining; calcium carbonate in the development of chalk, marble and limestone deposits). If their level exceeds 10-20% when working in conditions of high dust content, the damaging effect of dust increases.

In this case, diets are formed in such a way as to maximally stimulate the activity of detoxifying enzymes (use a complete protein, vitamins) and accelerate the passage of chyme through the gastrointestinal tract (due to dietary fiber).

It has been found that when exposed to electromagnetic fields can develop chronic diseases, characterized by changes in the nervous system (astheno-vegetative syndrome), functional disorders of the cardiovascular system (neurovascular hypo- or hypertension), as well as changes in the composition of the blood (a tendency to leukemia), endocrine system disorders are possible.

In the prevention of diseases caused by electromagnetic fields, an important place is played by lipotropic substances and water-soluble vitamins, as they stimulate the activity of the affected organs and systems.

^ Air temperature is in driving factor that determines the conditions of the working environment. High temperatures are typical for blast-furnace, converter, rolling, foundry, forging, thermal shops, as well as for a number of textile, rubber, clothing, Food Industry, in the production of bricks and glass, mine workings.

A low temperature is observed in unheated work areas during the cold season (warehouses, refrigerators), as well as when working outdoors. The influence of temperature on a person enhances the movement of air, as well as its humidity.

Prolonged stay in unfavorable microclimatic conditions (with a constant voltage of thermoregulation systems) may cause permanent changes in the physiological functions of the body - the activity of the cardiovascular system, depression of the central nervous system, violation of all types of metabolism.

In order to prevent these consequences, the energy value of the diet is reduced by 5%, the intake of protein is monitored (the body is sensitive to both excess and lack of protein). The amount of fat should not exceed 30% of the total energy value of the diet (on the one hand, when fat is broken down, a large number of(108% of the mass of expended fat) of exogenous water, on the other hand, a large amount of energy is released). Due to the fact that carbohydrates are easily transformed and stimulate the digestive glands, their amount is 57-59% of the total energy value of the diet.

Carefully monitored water-salt balance in the body (there is a drinking schedule - dosed drinking, starting with rinsing the mouth, then every 25-30 minutes take 100 ml of water (in case of large losses of water, the dose is increased to 250 ml)). Unlimited drinking indiscriminately produces worse results. In addition to fresh and carbonated water, 0.3-0.5% solutions of carbonated common salt are used. The use of specialized drinks is shown.

Based on bread kvass, a protein-vitamin drink enriched with baker's yeast, salts, vitamins and lactic acid has been developed. In hot shops, it is recommended to use the Korvasol drink (water-salt loss corrector), which contains, in addition to table salt, potassium and magnesium chlorides, as well as sodium bicarbonate. The use of tea, especially green tea, is shown. It stimulates the secretion gastrointestinal tract and normalizes water-salt metabolism. Tea catechins contribute better assimilation ascorbic acid. It is advisable to use compotes, decoctions, whey, sweetened milk (chala, ayran). Beer and coffee are not used, since beer inhibits processes in the cerebral cortex (contributes to injuries), and coffee worsens the body's temperature response.

Work at low temperatures contributes to the weakening of skin sensitivity, diseases of the peripheral nervous system, muscles and joints. In addition to sanitary and technical measures for adaptive processes, it is necessary to properly organize hot meals (the diet provides for an increase in fats, an increased amount of vitamins C, A, D; enrichment with calcium, magnesium, zinc salts).

^ ionizing radiation affects when working with various natural and artificial radioactive substances (uranium, radium, thorium, radioactive isotopes). Spontaneous transformation of the nuclei of chemical elements, accompanied by the emission of radioactive rays (-, -, -rays, neutrons, x-ray radiation), causes pathological processes in the body (acute or chronic radiation sickness). The ingress of radioactive substances is possible through the lungs, skin, gastrointestinal tract; the resulting radionuclides become a source of radioactive radiation.

In prevention radiation sickness along with organizational, technical and sanitary and hygienic measures, rational nutrition occupies an important place (the introduction of cystine, which can exert a protective effect due to the -SH group; the consumption of pectins, phosphatides and some amino acids (methionine, glutamic acid), which form chelate complexes with radionuclides and remove them from the body; increased intake of calcium and iodine).

^ Ambient pressure can be increased and decreased (depending on the type of work). Increased pressure occurs during underwater and underground work. Occupational diseases are possible with insufficiently slow transition from normal to high atmospheric pressure and vice versa. Pathological phenomena lead to decompression (caisson) disease (the transition of blood gases and body tissues from a dissolved state to a free (gaseous) state as a result of rapid decline excess pressure).

At the heart of the prevention of caisson diseases are the diets of LPP, which provide for the protection of blood circulation, the central nervous system, the cardiovascular system, the gastrointestinal tract (especially the liver) and the organs of hematopoiesis, hearing, and respiration. This is possible with the use of foods rich in lipotropic substances, potassium, vegetable unrefined fats, ascorbic acid.

Reduced ambient pressure is possible during the work of the flight crew, as well as various mining operations. The amount of pressure drop depends on the height at which the work is carried out. The higher the altitude, the more hypoxia in the body. A prolonged state of hypoxia leads to disturbances in the work of the central nervous and cardiovascular systems, the gastrointestinal tract and other organs; in the blood, the concentration of underoxidized toxic products increases.

In addition to general technical events, it is important to organize rational nutrition(protein intake is reduced, the proportion of PUFAs and vitamins is increased (up to 200%) in the diet; freeze-dried products are shown (to reduce the weight of the diet while maintaining a high nutritional and biological value), as well as dishes with a sharp taste and smell (to stimulate appetite) ; the amount of fluid - at least 3-4 liters per day).

Vibration occurs as a physical factor of influence in the metalworking, mining, engineering and other industries. When exposed to vibration, a vibration disease occurs - a change in the cardiovascular and nervous systems, the musculoskeletal system, a violation of the activity of the digestive glands, a violation of all types of metabolism; the danger of neuro-reflex disorders is great.

The most pronounced preventive effect has a diet high in methionine and vitamins C, B 1 , B 2 , B 6 , PP. Proven beneficial effect on the body with vibration disease tonic drinks (coffee, extracts of ginseng and eleutherococcus).

Noise also has an adverse effect on the human body. Noise sources are engines, pumps, compressors, turbines, hammers, crushers, machine tools, bunkers and other installations with moving parts. The mechanism of noise exposure is complex and not fully understood. Under the influence of noise, functional changes in the state of the central nervous system and the cardiovascular system, auditory analyzer, enzyme system, protein, carbohydrate, fat and vitamin metabolism occur.

AT scientific research it has been shown that exposure to noise with a noise level of more than 100 dB causes a deficiency of vitamins C, P, B 1 , B 2 , B 6 , PP, E; has an effect on the intensity of the course of redox processes, reduces the resistance of capillaries and cell membranes.

The protective effect of the diet was noted with an increased amount of these vitamins, animal protein and a low intake of carbohydrates.

Considered some occupational hazards and hazards have a negative effect almost immediately after the impact of a harmful factor on the human body. Such effects are easy to assess.

Of particular danger are the “long-term effects” of the action of xenobiotics and other harmful factors. These include mutagenic, embryonic, carcinogenic and other effects. Such effects are quite difficult to objectively assess due to the variety chemical structures exposure, duration of contact and routes of entry, as well as the sensitivity of the body to the poison (depending on gender, age, individual characteristics). The problem is exacerbated by the combined effect of these factors, which can exhibit synergistic properties with respect to each other.

In general, the achievements of the science of nutrition should contribute to the creation of DIET diets that have an effective prevention of occupational diseases, increase efficiency, and also increase the life expectancy of workers and employees.

Due to the fact that any diet contains various substances that have a protective effect on the body, it is necessary to dwell on them in more detail.

^ 3.2. Therapeutic and preventive nutrition

under harmful working conditions

Workers employed in production with harmful working conditions are provided with the issuance of milk, lactic acid products; pectin, pectin-containing products and vitamins.

The issuance of milk and dairy products is due to the fact that they are products of a preventive action that increases the body's resistance to adverse factors in the working environment. Milk is issued to persons working in conditions of constant contact with harmful physical production factors and toxic substances during their production, processing and use. They cause dysfunction of the liver, protein and mineral metabolism, a sharp irritation of the mucous membranes of the upper respiratory tract.

For a work shift (regardless of its duration) they give out 0.5 liters of milk. Workers and employees transferred to a 5-day working week with two days off receive a weekly milk ration calculated for 6 working days.

Milk is issued to workers and employees on the days of the actual performance of work in production, workshops, sites and other units with harmful working conditions, if they are employed in these jobs for at least half of the working day (shift) according to the orders or work schedules.

Milk is not issued to workers and employees on the days of their actual absence at the enterprise, institution and organization, regardless of the reasons, as well as on days of work in other areas where milk is not provided. Milk is not given out for one or several shifts in advance, as well as for previous shifts, as well as for workers receiving rations for POB due to especially harmful working conditions. Issuance of money instead of milk, delivery of milk to the house, replacement of milk with other food products is prohibited. When working in the production and processing of antibiotics, only fermented milk products are given out instead of fresh milk. In work related to the impact of not organic compounds lead, recommend issuing fermented milk products in a volume of 0.5 l and pectin in the amount of 2 g (instead of the previously recommended 8-10 g) in the form of canned vegetable foods, fruit juices, drinks enriched with it. Pectin-enriched juices can be replaced with natural fruit juices (300 g) with pulp. The required mass of foodstuffs, fruit juices and drinks enriched with pectin is calculated based on the actual content of pectin.

Reception of pectin-enriched food products, fruit juices, drinks, as well as natural fruit juices with pulp by workers is organized before starting work, and fermented milk products - during the working day. These recommendations for the prevention of intoxication with lead compounds can also be used when working with other heavy metals.

Free distribution of only vitamins is made for workers exposed to high temperatures, intense infrared radiation, and tobacco dust.

At work on steel smelting and hot metal rolling, as well as in bakery production (scalderers, bakers), 2 mg of vitamin A, 3 mg of vitamin B 1 and B 2, 20 mg of vitamin PP, 150 mg of vitamin C are given daily. dust containing nicotine, daily give out 2 mg of vitamin B 1 and 150 mg of vitamin C.

Water-soluble vitamins are given in an aqueous solution, which is added to ready-made first courses and drinks. Fat-soluble vitamins are pre-dissolved in fats and added as oil solution in garnishes. In some cases, vitamins are given in the form of tablets or dragees.

^ 3.4. Therapeutic and preventive nutrition

under especially harmful working conditions

At enterprises with especially hazardous industries, free distribution of rations to PBOs is carried out. There are exemplary 6-day layout menus for POB hot breakfasts by diet, product interchangeability standards in the manufacture of therapeutic and preventive nutrition breakfasts, and instructions for workers receiving POB hot breakfasts.

When new enterprises are commissioned, it is mandatory to consider the need to issue medical and preventive nutrition to workers, engineering and technical workers and employees of these enterprises, production and workshops, regardless of the fact that existing enterprises producing similar products do not issue LPP .

Therapeutic and preventive nutrition is a balanced diet that includes elements of a special, targeted nutrition designed to increase the body's resistance to certain occupational hazards, as well as limit the accumulation of harmful substances in the body and enhance their excretion from the body.

Therapeutic and preventive nutrition increases the efficiency, protective functions of the body systems (skin, gastrointestinal tract, lungs, etc.), preventing the penetration or exposure to harmful production factors, has a beneficial effect on the self-regulatory reactions of the body, on the nervous, immune and endocrine systems, improves metabolism, health. This is achieved by including in the diet food products that enhance the synthesis of the stratum corneum, the function of the sebaceous glands of the skin, the normalization of the permeability of the skin, the mucous membrane of the upper respiratory tract and the gastrointestinal tract, the improvement of intestinal motility, the suppression of the activity of putrefactive intestinal microflora, etc.

Therapeutic nutrition promotes the biotransformation of toxic substances by oxidation, methylation, deamination and other biochemical processes in order to form low-toxic metabolic products or, conversely, inhibiting these reactions if metabolic products are more toxic than the original ones. Therapeutic and preventive nutrition enhances the processes of binding and excretion of poisons or their unfavorable metabolic products on the body.

Detoxification mechanisms are different: binding of poisons by natural compounds (methionine, cystine, glycine, bile acids, nucleic acids, vitamins); neutralization by enzyme systems; as well as binding by substances that are part of food products (for example, pectins have the ability to bind salts of heavy metals and radionuclides and remove them from the body).

Therapeutic and preventive nutrition improves the condition of organs and systems that are affected by harmful factors. For example, under the influence of factors that affect the nervous system, vitamins B 1 and PP are introduced into the diet, which have a beneficial effect on it. Under the action of harmful factors that affect the urinary system, the amount of protein in the diet is limited, mineral salts, extractive substances in order not to overload the activity of this system.

Therapeutic and preventive nutrition increases the antitoxic function of the liver, especially when exposed to substances that affect mainly the liver (lipotropic substances are included in the diet).

Thus, DLP compensates for the deficit arising under the influence of harmful factors. nutrients, especially those that are not synthesized in the body (essential fatty and amino acids, vitamins, mineral elements).

Therapeutic and preventive nutrition is issued to workers, engineering and technical workers and employees on the days of their actual performance of work in the prescribed industries, professions and positions; workers, engineering and technical workers and employees of industries, professions and positions on sick days with temporary disability, if the disease is occupational in nature and the sick person is not hospitalized; disabled people due to an occupational disease who used therapeutic and preventive nutrition immediately before the onset of disability caused by the nature of their work, until the disability ceases, but not more than 6 months from the date of its establishment; workers, engineering and technical workers and employees entitled to free receipt therapeutic and preventive nutrition and temporarily transferred to another job due to the initial symptoms of an occupational disease due to the nature of their work - for a period not exceeding 6 months; women employed before the onset of maternity leave in professions and positions that give the right to receive free medical and preventive nutrition, for the entire duration of maternity leave; pregnant women transferred in connection with a medical opinion to another job in order to eliminate contact with products that are harmful to health, before the start of the said vacation; therapeutic and preventive nutrition is issued for the entire time before and during maternity leave; when transferring to another job for the indicated reasons, breastfeeding mothers and women with children under the age of 1 year, therapeutic and preventive nutrition is issued for the entire period of feeding or the child reaching the age of 1 year.

Therapeutic and preventive nutrition is not issued: on non-working days, vacation days, business trips, off-duty studies, performing work in other areas, performing state and public duties, during a period of temporary disability with general diseases, being in a hospital or sanatorium for treatment, as well as during a stay in a dispensary.

Therapeutic and preventive nutrition is given in the form of hot breakfasts or lunches before starting work. In some cases, in agreement with the medical institution, they allow the issuance of these breakfasts or lunches at lunchtime or in the form of two meals a day. Working in conditions high blood pressure(caisson, hyperbaric chambers) therapeutic and prophylactic nutrition is issued after being sent out.

If it is impossible to receive rations of the PPO in the canteen of the enterprise (due to health reasons or due to the remoteness of the place of residence), employees who are entitled to this, during the period of temporary incapacity for work or disabled due to an occupational disease, are given rations to the PPO at home in the form of ready-made meals only according to the relevant certificates. This procedure for dispensing rations to PBOs at home in the form of ready-made meals also applies to breastfeeding mothers and women with children under the age of 1 year, in cases of their transfer to another job in order to eliminate contact with products that are harmful to health. .

In other cases, ready-made meals of therapeutic and preventive nutrition are not given out at home. They do not compensate and issue diets to PPOs for the past time and for non-received therapeutic and preventive nutrition in a timely manner.

^ 3.5. Characteristics of LPP diets

The composition of DILI diets is based on the ability of various food components to have a detoxifying effect when exposed to chemical compounds or to reduce the harmful effects of physical factors.

The preventive orientation of diets is ensured taking into account the principles of rational nutrition (any diet, in terms of its energy value and chemical composition in general, with the total daily food should satisfy the needs of a specific professional group of the population in energy and in individual components of food).

The preparation and distribution of rations to DIs is carried out in strict accordance with the approved norms of the food set and chemical composition for each ration (Table 9). In the absence of any product, it is allowed to replace it in accordance with the norms of interchangeability, since the diets are designed purposefully, taking into account the action of harmful factors. In addition to each diet, they give out certain types vitamin preparations.

Persons receiving free hot breakfasts are given vitamins along with breakfast. When issuing vitamins to persons receiving only vitamin preparations, it is taken into account that the use of dragees and tablets increases their cost and makes it difficult to control their intake by workers, that is, vitamin crystals are dissolved in an aqueous solution that is added to ready meals (tea, coffee or first course). A solution of vitamins is prepared daily in such a way that a teaspoon of it (4 ml) contains the required dose of one of them or all together. Vitamin A is dissolved in fat, which is poured over the side dishes of 2 dishes at the rate of 2 mg (or 6600 IU) per person.

The preparation of vitamin solutions is carried out under the supervision of a doctor or nurse. As needed, a certain amount of vitamins is dissolved in hot water as demand (since vitamin C is destroyed during storage).

Table 9

Diet structure LPP

Therapeutic and preventive nutrition is necessary in conditions of an increased risk of the pathogenetic influence of negative environmental factors. Principles of organization in various adverse conditions described in this article. Here you can also get acquainted with special diets that contribute to the elimination of groups of poisons and toxins. The provision of therapeutic and preventive nutrition is necessary for the full recovery of the human body after the negative impact of production conditions on it. There are a number of professions for which the Federal Law establishes the right to receive special meals. Therefore, providing workers with therapeutic and preventive nutrition is part of the job responsibilities of responsible workers. The article describes the basic principles and characteristics of diets. But specific standards, diets and products can only be found in specialized decrees and by-laws. They change every year and it makes no sense to duplicate information from them here.

Who is therapeutic nutrition for?

Therapeutic and preventive nutrition is understood as the use of food products that increase the body's resistance to adverse factors of the production environment due to the normalization of a number of metabolic processes and functions, as well as contributing to the neutralization and accelerated removal of harmful substances from the body.

Therapeutic and preventive nutrition is currently developed for a limited group of people. Basically, therapeutic and preventive nutrition is intended to protect working people from harmful physical and chemical effects at work in order to prevent diseases.

The purpose and foundations, principles and significance of therapeutic and therapeutic nutrition

The principles of therapeutic and preventive nutrition, developed by A. A. Pokrovsky, are reduced to the following provisions:

1. The purpose of therapeutic and preventive nutrition- this is a slowdown with the help of nutrients of the absorption of toxic substances in the digestive system. The absorption of toxic substances entering the stomach and intestines in the presence of a sufficient amount of food there, i.e., in the case of mechanical difficulty in the access of poisons to the mucous membrane, is hampered. Therefore, it is important that those working in harmful conditions do not start work on an empty stomach.
2. The use of food ingredients for neutralization of certain toxic substances, for example, the ability of pectin substances and pectin-containing products to bind salts of heavy metals and their compounds in the digestive system.
3. The main importance of therapeutic and preventive nutrition It consists in accelerating or slowing down the neutralization of poisons with the help of food substances, depending on the chemical nature of the initial substances or the products of their transformation in the body.
4. The influence of the nutritional factor on the acceleration of the elimination of toxic substances from the body(for example, a protein with sulfur-containing amino acids).
5. The basics of therapeutic and preventive nutrition lie in the fact that food compensates for the increased costs of individual nutrients (amino acids, vitamins, macro- and microelements, etc.) associated with the effects of poison by the body.
6. The impact of food substances on the state of the most affected organs and systems(liver, kidney). The use of products - sources of animal protein (milk, cottage cheese, eggs), vitamins, etc. has become widespread.
7. Increasing the overall resistance of the organism to the action of harmful conditions production with the help of food factors ( unbalanced diet, especially in terms of protein component and content water soluble vitamins exacerbates the effect of toxic substances on the body).

Features of prescribing therapeutic and preventive nutrition: recommendations and definition

The definition of therapeutic and preventive nutrition is that these are specially designed diets that help protect the human body from adverse environmental factors.

Features of therapeutic and preventive nutrition are that it helps to increase the overall resistance of the body, improve well-being, performance, and reduces the general and occupational morbidity of people.

The fundamental possibility of using nutrition for the prevention and treatment of certain intoxications has long been known. A significant content of pectin in some fruits and vegetables can contribute to the binding of a number of heavy metals. When prescribing therapeutic and preventive nutrition, it should be borne in mind that proteins rich in methionine and other sulfur-containing amino acids can protect the body from the toxic effects of pesticides. The main recommendations for therapeutic and preventive nutrition can be found in the developed diets offered for review on the page below.

Rations for the issuance of therapeutic and preventive nutrition: characteristics and products

The rations for therapeutic and preventive nutrition were developed by the Institute of Nutrition of the Russian Academy of Medical Sciences.

First ration issuance of therapeutic and preventive nutrition is intended for those working with radioactive substances and ionizing radiation. In order to increase the overall resistance of the body to the effects of ionizing radiation, it includes foods enriched with certain essential amino acids and lecithin to increase the antitoxic function of the liver. In addition, ascorbic acid, pectin, vlginates, and dietary fiber are introduced into the diet.

Second ration therapeutic and preventive nutrition - when working with compounds of fluorine, alkali metals, chlorine, cyanide compounds, formalin and its polymerization products, nitrogen oxides, in the production of sulfuric, hydrochloric, nitric and other acids. It consists of vegetables, grains, dairy products, fish, vegetable oils and other products containing proteins, vitamins, minerals, polyunsaturated fatty acid.

Ration number 2- for persons in contact with chromium and chromium-containing compounds. Contains a lot of proteins and a number of vitamins, pectin.

The characteristic of the third ration of therapeutic and preventive nutrition is such that it is intended for persons associated with the production of lead and exposed to inorganic lead compounds.

Contains an increased amount of animal proteins, pectin, carotene, vitamins, calcium and others minerals as part of milk and dairy products, vegetables, etc.

According to the diet number 4 therapeutic and preventive nutrition products help to cope with the harm caused to the body when working with nitro- and amino compounds of benzene, chlorinated hydrocarbons, arsenic, phosphorus, and tellurium compounds. The diet includes milk and dairy products, vegetable oils, etc. Be sure to include thiamine and vitamin C in the diet.

Ration number 5- for those working with brominated hydrocarbons, thiophos, inorganic compounds of mercury, manganese, barium, etc. The diet includes cottage cheese, lean meat, eggs, fish, vegetable oils, vegetables, fruits.

The characteristic of therapeutic and preventive nutrition is such that in all diets it is recommended to limit salt, salty and fatty foods, and refractory fats. In the production of benzene, chlorinated hydrocarbons, arsenic and other toxic substances shown plentiful drink. Therapeutic and preventive nutrition is carried out in the form of hot breakfasts before starting work, so that the nutrients absorbed in the gastrointestinal tract have a protective effect when exposed to harmful physical and chemical factors of production.

The table shows the data nutritional value and calorie content of therapeutic and prophylactic diets issued at the enterprises of the chemical industry.

Nutritional value and calorie content of rations of therapeutic and preventive nutrition

Types and norms for the issuance of therapeutic and preventive nutrition

In all types of therapeutic and preventive nutrition, biologically active food supplements in the form of fat- and water-soluble vitamins, minerals, pectin and other components are widely used. The detoxifying properties of B vitamins, ascorbic acid and some other biologically active substances have long been known. In the prevention of intoxication, macro- and microelements, especially calcium, iron, magnesium, phosphorus, etc., play an important role. Vitamins, minerals and other biologically active substances are introduced into all diets, since they play an important role in correcting damage to the enzymatic systems of the body that occur under action of the poison.

There are norms for the issuance of therapeutic and preventive nutrition, which are annually approved by the Ministry of Health, so it does not make much sense to indicate exact numbers here. Tentative rations are compiled based on the potential harmfulness of production. Food safety plays a special role in the preservation and maintenance of human health.

According to the World Health Organization, 80-95% of substances alien to humans come with food, 4-7% - with drinking water, 1-2% - from atmospheric air through the skin of the body into adjacent tissues. More than 9 million xenobiotics are known in the world today different nature. Their number is constantly increasing while expanding the scale of distribution in vital facilities and the environment. AT modern conditions each of us needs therapeutic and preventive nutrition due to the increasing number of substances and factors that adversely affect the human body.

Against the background of adverse environmental conditions, the presence of harmful chemicals in food, mass diseases of people, negative changes in the potential gene pool can occur. In this regard, it becomes relevant to correct diets with the additional use of biologically active substances in food in the form of enriched foods or dietary supplements with a general strengthening, adaptogenic, detoxifying effect.

Organization of therapeutic and preventive nutrition of workers at enterprises under harmful working conditions

The organization of therapeutic and preventive nutrition for people working in hazardous industries was carried out at a time when the concept of biologically active food supplements had not yet been created. At the same time, even then the basic principles for the use of dietary supplements for this category of people were laid down. At present, the expediency of organizing therapeutic and preventive nutrition at enterprises has been proven to reduce the risk of developing occupational diseases among people working at oil refineries and enterprises of other industries with harmful working conditions, as well as for those living in environmentally unfavorable regions.

Therapeutic and preventive nutrition under harmful working conditions has also been developed for representatives of certain professions - astronauts, submariners, climbers, etc. The development of therapeutic and prophylactic products was carried out in relation to specific factors space flight and long scuba diving.

At the same time, the emphasis was placed on the development and use of products with anti-stress, adaptogenic, tonic, stimulating and radioprotective properties. For this purpose, in addition to the diet, macro- and microelements (calcium, iron, etc.), vitamins, complete proteins, herbal ingredients. Enriched foods are widely used in therapeutic and preventive nutrition, and together with a properly selected diet and biologically active additives to food are the basis of this trend.

The use of dietary supplements greatly facilitated the scientific development and especially the practical use of therapeutic and preventive nutrition for workers both in conditions of hazardous production and in environmentally unfavorable living conditions for a healthy and sick person.

Technology of dietary therapeutic and preventive nutrition

Modern technology of therapeutic and preventive nutrition implies the use of various additives in the process of cooking. They are designed to reduce the risk of pathogenetic influence and accelerate the processes of tissue regeneration.

Dietary therapeutic and preventive nutrition, with its proper organization, should:

• increase the protective functions of the physiological barriers of the body (skin, mucous membranes of the gastrointestinal tract, upper respiratory tract, etc.) from the adverse effects of the production and environment on it;
• regulate the processes of biotransformation of various xenobiotics, including endotoxins, by oxidation, methylation, deamination and other biochemical reactions aimed at their neutralization;
• activate the processes of binding and excretion of poisons or their unfavorable metabolic products from the body;
• improve the functional state of the affected organs and systems of the body, which can mainly be affected by harmful factors of production and the environment;
• increase the antitoxic function of individual organs and systems of the body (liver, lungs, skin, kidneys, etc.), and if they are damaged, the principles of dietary correction can be used;
• compensate for the deficiency of mainly essential nutrients, which occurs both under the influence of adverse production factors and the environment, and as a result of pathological processes development of an acute or chronic disease;
• have a beneficial effect on the autoregulatory reactions of the body, especially on the nervous and endocrine regulation immune system, metabolism, etc., as well as help to increase the overall resistance of the body and its adaptive reserves.

When justifying therapeutic and preventive nutrition, it is necessary to take into account regional environmental and hygienic nutritional factors of natural or anthropogenic origin.

Information sheet

The educational and methodological manual "Therapeutic and preventive nutrition" was prepared by the Department of Hygiene, Public Health and Healthcare of the Penza State University (Head of the Department, Candidate of Medical Sciences A.P. Dmitriev).

The following people took part in the compilation: c.m.s. Dmitriev A.P., Ph.D. Polyansky V.V. (responsible for preparation), Ph.D. Baev M.V.

The educational and methodological manual has been prepared in accordance with the “HYGIENE Program for students of medical faculties of higher medical educational institutions”, developed by the All-Russian Educational, Scientific and Methodological Center for Continuous Medical and Pharmaceutical Education of the Ministry of Health of Russia and approved by the Head of the Department of Educational Institutions of the Ministry of Health of the Russian Federation N. N. Volodin in 1996

This Study Guide has been prepared for students of the Faculty of Medicine for self-preparation for a practical lesson on this topic.

Reviewer:

Head of the Department of the Ryazan State Pedagogical University, Doctor of Medical Sciences, Professor V.F. GORBICH.

Lesson topic: THERAPEUTIC AND PREVENTIVE NUTRITION

Lesson objectives:

Determine the main tasks of therapeutic and preventive nutrition.

Find out the influence and interaction of the main nutrients on the body under the influence of production factors.

Determine the indications for the appointment of therapeutic and preventive nutrition.

Familiarize yourself with diets of therapeutic and preventive nutrition.

Student preparation: During the practical session, the student should have an idea and be ready to answer the following questions: questions for practice:

Tasks of therapeutic and preventive nutrition.

The value of the main nutrients in the conditions of influence on the body of harmful factors of the production process.

To characterize the rations of therapeutic and preventive nutrition.

Answer tests for class.

For preparation, use: Textbook on Hygiene, ed. acad. RAMS G.I. Rumyantsev. - M., 2001. (P. 285, 540-544). Lecture materials. Educational-methodical manual of the department.

In the process of human labor activity, contact with harmful production factors is constantly carried out.

These include poisonous chemicals used in industry, solvents, acids, alkalis, industrial noise, vibration, magnetic fields, ionizing radiation, ultra- and infrasound, high atmospheric pressure, radiation from optical quantum generators, etc.

In the system of measures to protect against the adverse effects of damaging substances, an obligatory component is therapeutic and preventive nutrition - one of the measures aimed at increasing the resistance of a healthy organism to the effects of adverse factors of working conditions.

Therapeutic nutrition should:

increase the protective functions of the physiological barriers of the body (skin, mucous membranes of the gastrointestinal tract, nasopharynx and respiratory tract);

activate the processes of binding and excretion of poisons and unfavorable products of their metabolism from the body;

maintain the functional state of organs and systems - targets that can be affected by harmful factors;

increase the antitoxic function of individual organs and systems of the body (liver, lungs, skin, kidneys);

compensate for the appearance of a deficiency of certain nutrients (essential amino acids, polyunsaturated fatty acids, vitamins, trace elements).

The rations of therapeutic and preventive nutrition are compiled taking into account data on the specific effect of individual nutrients on the intensity of absorption of toxic substances that enter the body during production activities, on reducing the deposition of these substances in tissues and increasing their release from tissues and blood.

So, calcium inhibits the deposition of fluorine in the bones, ascorbic acid enhances its excretion. This vitamin restores methemoglobin, which is formed from hemoglobin under the influence of some industrial poisons.

Most toxic substances in the human body undergo transformations during oxidation, reduction and hydrolytic cleavage reactions in the liver and other organs and tissues. Some chemical compounds or their metabolites that occur in the body react with endogenous molecules and radicals (glucuronic and sulfuric acids, amino acids, CH 3 group) to form non-toxic soluble substances that are excreted in urine, bile or exhaled air.

One of the ways in which nutrition influences the metabolism and utilization of toxic substances is the influence of food on the activity of the oxidase system, which is contained in the cells of the liver, intestines, kidneys and other organs that ensure the oxidation of xenobiotics (foreign substances).

The most pronounced protective, preventive effect proteins and amino acids with the toxic effect of organic cyanides, methyl chloride, carbon tetrachloride, nitrbenzene, organic compounds, arsenic, selenium, lead. However, with some intoxications (in particular, carbon disulfide), it is necessary to limit the diet of proteins, especially those rich in sulfur-containing amino acids, since in this case the detoxification processes of the poison are disturbed.

In the prevention of the adverse effects of production factors, it is necessary to carefully approach the use fat, which can affect the absorption of poisons from the digestive tract in different ways. So, fats promote absorption in small intestine some pesticides, lead, hydrocarbons and their derivatives, increase the poisoning of nitrobenzene and trinitrotoluene. An excess of fats, especially refractory ones, worsens the overall resistance of the body to the action of harmful factors and aggravates liver function. The negative influence of lipids is counteracted by lipotropic factors, especially lecithin.

Carbohydrates improve the neutralizing, barrier function of the liver, increase the body's resistance to the toxic effects of phosphorus, chloroform, cyanide compounds. When choosing a source of carbohydrates for therapeutic and prophylactic diets, it is important to take into account that the violation of the ratio of starch and easily digestible carbohydrates has an adverse effect on the body and thus can reduce resistance to harmful factors.

Of particular importance is the deterioration of excretory processes occurring during overconsumption easily digestible carbohydrates. This phenomenon is associated with an increase in the osmotic pressure of the blood due to an increase in the concentration of glucose in it. High level carbohydrates in the diet enhances allergic phenomena that occur under the influence of certain toxic substances. An excess of easily digestible carbohydrates is especially harmful when working in conditions of exposure to carbon disulfide, which has a diabetic effect.

pectin substances lead, mercury, manganese bind in the intestine; contribute to their excretion from the body and lowering the concentration in the blood. This property is due to the presence of free carboxyl groups of galacturonic acid in pectin substances. Beet pectin is especially active.

Cellulose, stimulating the motor activity of the intestinal walls, promotes the release of toxic dust from the body, swallowed with saliva. Concerning positive influence Enrichment of the diet with carrots and cabbage has an effect on the body.

vitamins C, E, A, P, being antioxidants, destroy free oxidative radicals, which are formed when the body is exposed to various damaging factors, especially ionizing radiation, which leads to disruption of the structure of cell membranes. Vitamins B 15 , U, choline are directly involved in the processes of detoxification occurring in the liver, as sources of methyl groups. Vitamin C helps to reduce intoxication that occurs when exposed to toluene, xylene, arsenic, phosphorus, and lead. B vitamins reduce the damaging effect of chlorine-substituted hydrocarbons, mercury, lead; vitamin D 3 prevents damage bone tissue with cadmium poisoning.

Vitamins are included in therapeutic and prophylactic diets not only as part of food products, but also in the form of pure preparations.

Minerals in therapeutic and preventive nutrition should be strictly normalized, and the number of some of them should be reduced compared to the content in the diets of people who are not in contact with harmful factors.

To prevent the retention of toxins in the body, table salt is limited in therapeutic and preventive nutrition. However, when working under conditions of lithium exposure, the amount of table salt is not reduced, since sodium reduces its toxicity. With possible exposure to radioactive strontium, the amount of calcium in the diet should be increased two to three times. Potassium helps to remove toxins from the body, therefore, an increased amount of products containing it is included in therapeutic and preventive nutrition.

Workers who come into contact with mercury in the course of work should include in their diets plant foods rich in selenium and tocopherol (soybeans, cereals, rice, vegetable oils), which contribute to its detoxification.

The menu of breakfasts and lunches should include an increased number of drinks - tea, juices, compotes, milk, kefir, in order to enhance excretory processes, as well as replenish fluid losses through sweat.

Essential oils have an irritating effect on the digestive tract, liver, kidneys, nervous system, therefore, in therapeutic and preventive nutrition, it is recommended to limit foods rich in these compounds, for example, pepper, mustard, horseradish, garlic, onion.

It is very important that a person does not start work on an empty stomach, since in this case the body is most sensitive to damaging effects.

Characteristics of the main diets of therapeutic and preventive nutrition:

All diets include products containing biologically valuable proteins: milk, cottage cheese, meat, fish.

Ration number 1:

Indications: Work with radionuclides and sources of ionizing radiation.

Characteristics of the diet: The diet is saturated with products containing lipotropic substances (methionine, cysteine, lecithin), which stimulate fat metabolism in the liver and increase its antitotoxic function (milk, dairy product, liver, eggs). Additionally, 150 mg is given. ascorbic acid. This diet includes the largest number fresh fruits, potatoes, cabbage.

Ration number 2:

Indications: Production of inorganic acids, alkali metals, chlorine and fluorine compounds, phosphorus-containing fertilizers, cyanide compounds.

Characteristics of the diet: The action of the diet is ensured by the presence of complete proteins (meat, fish, milk), polyunsaturated fatty acids ( vegetable oil, milk and cheese), inhibiting the accumulation of chemical compounds in the body. In addition to the diet, 100-150 mg of ascorbic acid and 2 mg of retinol are given. At the same time, the content of fresh vegetables and fruits in the diet is increased: cabbage, zucchini, pumpkin, cucumbers, lettuce, apples, pears, plums, grapes, chokeberry.

Ration number 2a:

Indications: Working with chromium compounds and chromium-containing compounds.

Characteristics of the diet: The diet is enriched with amino acids (tryptophan, methionine, cysteine, lysine, tyrosine, phenylalanine, histidine). Additionally, 100 mg of ascorbic acid, 2 mg of retinol, 15 mg of nicotinic acid and 150 ml of Narzan are given.

Ration number 3:

Indications: Work in contact with lead compounds.

Characteristics of the diet: The diet is characterized by a high content of protein, alkaline elements, pectin, vitamins (milk and dairy products, potatoes, vegetables and fruits). Additionally, 150 mg of ascorbic acid is given. Pectin is necessary to enhance the excretion of lead compounds from the body.

The content of lipids, including vegetable oil and animal fats, is reduced in the diet, and daily delivery of dishes from vegetables that have not been heat-treated (which are sources of β-carotene, ascorbic acid, and ballast substances) is provided. For persons in need of this diet, 2 g of pectin should be provided in the form of fruit and berry juices with pulp enriched with it, mousses, mashed potatoes, plum jam, marmalade. Drinks enriched with pectin can be replaced with natural fruit juices with pulp in the amount of 300 g. Workers must receive these drinks and products before the start of the shift.

Ration number 4:

Indications: Production of benzene, arsenic, mercury, phosphorus compounds, as well as under conditions of high atmospheric pressure.

Characteristics of the diet: The purpose of the diet is to increase functionality liver and hematopoietic organs. Includes products rich in lipotropic substances (milk and dairy products, vegetable oil). Limit the content of foods that burden the function of the liver (fried meat, fish soups, gravy). Dramatically reduce the use of foods rich in table salt (pickles, smoked meats, etc.). Additionally, 150 mg of ascorbic acid and 4 mg of thiamine are given.

Ration number 5:

Indications: Production of hydrocarbons, carbon disulfide, tetraethyl lead, organophosphorus compounds, etc.

Characteristics of the diet: The diet is aimed at protecting the nervous system (egg yolk, vegetable oil) and the liver (cottage cheese, lean meat, fish and eggs). Salt, salty and fatty foods are limited. Additionally, 150 mg of ascorbic acid and 4 mg of thiamine are given.

Milk:

Indications: Work associated with exposure to organic alcohols, esters and acids in the production and use of sulfur, mercury, arsenic, chromium, antibiotics, as well as in the production of all types of soot. Norm - 0.5 l. in shift; replacement with kefir or yogurt is allowed.

Milk increases the overall functional abilities of the body and softens the effect of harmful physical, chemical and biological factors on it. Milk is issued after pasteurization in the manufacturer's packaging or after boiling.

Vitamin preparations:

Indications: Work at high temperature with intense heat radiation and exposure to dust containing nicotine.

Consumption rates per shift: retinol - 2 mg, riboflavin - 3 mg, ascorbic acid - 150 mg, a nicotinic acid- 20 mg.

Therapeutic and prophylactic nutrition (TLP). Rations of therapeutic and preventive nutrition

LPP limits the accumulation of harmful substances in the body, increases its resistance to certain occupational hazards. Certain food products are able to accelerate or slow down the action of poisons, accelerate their elimination from the body, increase its overall resistance, affect the state of the most affected organs, compensate for the additional energy costs associated with the influence of harmful production factors, therefore, to prevent disorders in the human body, which is affected by harmful professional factors, diets are developed by the LPP.

Proteins play an important role in LPP. So, proteins rich in sulfur-containing amino acids contribute to the formation of compounds that are readily soluble and quickly excreted from the body, and can bind toxic substances. On the other hand, with some intoxications (carbon disulfide, hydrogen sulfide), it is necessary to limit the protein in the diet, because. the detoxification processes of the poison are disrupted.

The role of fats in DILI is diverse and ambiguous. Fats containing polyunsaturated fatty acids and antioxidant vitamins have a preventive effect on the body, while oxidized fats do the opposite.

The biochemical role of carbohydrates is the formation of glucuronic acid, which is involved in the processes of binding and excretion of toxic substances or their metabolites.

The body's resistance to many chemical poisons is well increased by vitamins. The detoxifying properties of ascorbic acid, vitamin A, B vitamins are known. The role of vitamin E as a natural antioxidant is unique.

Rations of therapeutic and preventive nutrition are made depending on professional factors that affect the body. At the same time, it is necessary to observe the general principles balanced nutrition.

Depending on the nature of the work, LPP is prescribed one of seven diets. Their characteristics, as well as the list of products contained in them, are given in tables 4.2, 4.3.

For workers in a number of industries, only vitamin preparations are provided (those who are exposed to high temperatures and intense heat radiation): 2 mg of vitamin A, 3 mg of vitamins B 1 and B 2, 150 mg of vitamin C and 20 mg of vitamin PP are prescribed; and for those employed in the tobacco-mahoric and nicotine industries when exposed to dust containing nicotine - 2 mg of vitamin B 1 and 150 mg of vitamin C.

Employees of medical and sanitary units and health centers control the issuance of LPP and vitamins. The heads of enterprises are responsible for providing workers with this food, and the heads of public catering enterprises are responsible for the correct preparation of food and menu preparation.

In addition to therapeutic and preventive nutrition, daily delivery of milk to workers in contact with toxic substances is provided.

The preparation of diets for therapeutic and preventive nutrition is based on the ability of various food components to have a detoxifying effect when exposed to chemical compounds or to weaken the harmful effects of physical factors. Harmful substances are classified according to their mechanism of action. The preventive orientation of diets cannot be ensured without observing the basic principles of the concept of a balanced diet, therefore, any diet in terms of its energy value and chemical composition as a whole with a total daily diet must meet the needs of a specific professional group of the population for energy and individual food components.

Table 4.2

Characteristics of LPP diets

The energy value of therapeutic and preventive nutrition rations should be approximately 45% of daily requirement. On average, in the diets of therapeutic and preventive nutrition, the mass of proteins is 60 g, fats - 50 g, carbohydrates - 160 g, and the energy value- 5.86 MJ (1400 kcal).

For persons receiving free hot breakfasts, vitamins are given out together with breakfast, and for those receiving only vitamins, their distribution should be organized in canteens. At the same time, the following rules:

1. Vitamins C, B 1 and PP should be consumed in crystalline form, since the use of dragees and tablets increases their cost and makes it difficult to control their intake by workers.

2. Vitamins should be given in an aqueous solution, which is added to prepared meals. A solution of vitamins is prepared daily so that a teaspoon (4 ml) contains the required dose of one of the vitamins or all together.

Table 4.3

for daily use, for BIB diets

3. The preparation of portions of vitamins should be carried out in the dining room under the supervision of a doctor or nurse. Powders with vitamins containing a certain number of doses are dissolved in hot water only as needed, since vitamin C is destroyed when the solution is stored even for several hours. Preparation of a solution for more than 50 people is not recommended.

4. If therapeutic and preventive nutrition is given in the form of hot breakfasts, then the vitamin solution is added to tea or coffee. In cases where only vitamins are given, their solution (1 teaspoon) is added to soups or sweet dishes. Vitamin A is dissolved in fat, which is poured over the side dishes of hot dishes, at the rate of 2 mg (or 6600 IU) per person. In factories where there are no shop canteens, but there is a general canteen, vitamin A is dissolved in a portion of butter or garnish, weighed separately by the number of workers in hot shops. In some cases, the issuance of vitamins in the form of tablets and dragees is allowed.

All measures are taken to create conditions that exclude any harmful effects on the health of workers in the course of their work.

The main thing in the prevention of occupational hazards is the improvement of working conditions, technical and sanitary-hygienic improvement of enterprises, as well as strict observance safety regulations.

In the prevention of occupational hazards along with the improvement of the external environment great importance have measures aimed at increasing the body's resistance to the adverse effects of physical and chemical factors of production conditions. Among these activities, one of the first places belongs to preventive nutrition.

Preventive nutrition is designed to increase the body's resistance to certain occupational hazards, as well as limit the accumulation of harmful substances in the body and increase their excretion from the body.

When organizing preventive nutrition main task is to balance it in accordance with the general daily diet, which, together with the diet of preventive nutrition, should fully ensure the biological usefulness and preventive orientation of the daily diet.

Vitamins are the most important part of biologically active substances in preventive nutrition. Currently, most preventive diets provide additional amounts of only two vitamins - ascorbic acid and thiamine. Some preventive diets provide an increased amount of vitamin A.

However, it must be admitted that a significant part of the vitamins, which undoubtedly have a high biological activity, is not yet fully used in preventive nutrition rations.

At the same time, it is known that by creating targeted diets enriched with protein and a certain complex of vitamins, it is possible to reduce and prevent the negative effects of various occupational hazards.

The second important promising means of preventing occupational hazards and reducing the negative effects in the body of small doses of harmful substances and their cumulative effect are some amino acids - cystine and methionine, tyrosine and phenylalanine, tryptophan, glutamic acid.

Inclusion in diet preventive nutrition of sources of these amino acids can be carried out at a variety of the most common occupational hazards.

At present, there are already sufficiently substantiated data for the inclusion of additional amounts of pectin substances in the composition of preventive nutrition rations. The detoxifying properties of pectin are generally recognized. Its colloidal properties, high adsorption capacity, as well as the ability to form metal ions with high catalytic ability during splitting, push pectin substances to one of the first places among the components of preventive nutrition for various types of occupational hazards. There is evidence of the important role of pectins in the excretion of metal compounds from the body.

The inclusion of food products with a high content of pectin (O.P. Maikova), as well as special products containing pectin, including confectionery products proposed by A.D. Bezzubov, into preventive nutrition rations is quite reasonable and should find practical application.

In preventive nutrition important role belongs to the maintenance acid-base balance organism. As is known, the violation of the latter in the direction of acidosis leads to an increase in the intake of harmful substances (for example, lead) into the blood, and a shift in the acid-base balance of the body towards alkalosis contributes to the retention and immobilization of a number of harmful substances in the body.

It should also be taken into account that the shift of the acid-base balance towards acidosis is invariably accompanied by a decrease in the protective properties of the body.

Calcium and magnesium play an important role in the qualitative purposefulness of preventive nutrition rations, the exchange of which has much in common. The importance of calcium and its role in the deposition of metals and some other substances in bones make calcium an important component of preventive nutrition in many types of occupational hazards.

There is evidence of a high biological activity of magnesium, which has the property of increasing the excretion of certain harmful substances from the body.

Modern scientific data make it possible to create new types of preventive nutrition, as well as to make corrections to previously adopted special preventive diets.

Since 1961, preventive nutrition rations have been established, applied according to the list of positions and production that have one or another occupational hazard. In preventive nutrition, 5 diets are used.

Caloric content of preventive nutrition rations

Depending on the characteristics of labor, vitamins (ascorbic acid, retinol, thiamine) are additionally provided for each diet.

The use of preventive nutrition rations is carried out in accordance with the nature of the occupational hazard of a particular production.

Ration number 1 intended for those working with radioactive substances and ionizing radiation;

diet number 2- for those working in the production of strong acids;

diet number 3 used in combination with other diets by weekly alternation;

diet number 4- for those working in the production of phosphorus compounds, aniline, hexachlorane;

diet number 5- for those working in the production of carbon disulfide, thiophos, mercaptophos, mercury.

Rations No. 3 and No. 2 alternate weekly and are used in the production of lead nitrate, varnishes and paints, lead and tin, lead acid batteries. In addition to preventive nutrition rations, vitamins are provided.

According to diet No. 1 and No. 3, 150 mg of ascorbic acid is additionally given, according to diet No. 2 - vitamin A 2 mg and vitamin C 100-150 mg; according to diet No. 4 and No. 5 - vitamin C 150 mg and vitamin B 1 - 4 mg.

In the production of electric coal products for workers of some professions, ration No. 3 and ration No. 4 are issued by weekly alternation.

All preventive diets include limiting salt and salty foods, as well as fat and fatty foods.

For those working with benzene, chlorinated hydrocarbons and arsenic compounds, increased drinking is recommended (at least 5-6 glasses per day).

Preventive nutrition rations No. 2 and No. 3 are intended mainly for those working in conditions possible impact lead compounds.

Each of these rations is issued within a week. For one week, workers receive preventive nutrition according to ration No. 2, the other week - according to ration No. 3.

Such an alternation of preventive nutrition rations for workers with lead is justified by the following provisions. Diet No. 2 includes a significant amount of calcium (600 mg) and other alkaline mineral elements that are part of the dairy products, potatoes and vegetables of the diet.

Under the influence of large amounts of calcium and against the background alkaline diet the deposition of lead in the bones in the form of tribasic phosphate increases. Immobilization of lead in the body occurs, the intake of lead into the blood decreases, its excretion in the urine decreases, and the risk of lead poisoning decreases.

Diet #3 is low in calcium (150 mg) and other alkaline elements. The predominance of acidic elements in this diet causes a shift in the acid-base balance towards acidosis. This nature of the diet contributes to the gradual removal of deposited lead from the body.

Preventive nutrition is provided free of charge to persons for whom it is provided.

The organization of preventive nutrition in canteens of industrial enterprises should be carried out with the participation of a doctor or dietitian. At the same time pay attention to:

1) to allocate special tables with the designation of the diet number for persons using preventive nutrition;

2) for selection service personnel- waitresses and cooks familiar with the preparation of preventive meals.

The issuance of preventive nutrition is carried out, as a rule, in canteens.

Preventive nutrition is provided in the form of hot breakfasts, which are provided before work starts. In some cases, it is allowed in agreement with medical service enterprises issuing preventive meals during the lunch break.