Text of the book “Therapeutic nutrition for chronic diseases”

General rules

There is no doubt that good nutrition is the main component of a healthy lifestyle and human health in general.
Dietary nutritional therapy meets the physiological needs of the body and is adjusted depending on the course of the disease and the stage of the disease. Until 2003, the numbered diet system was based on a nosological principle (by disease), including 15 diets and numerous (up to 60) modifications. However, Table No. 1 , 5 , 7 , 9 and 15 . In 2003, a new nomenclature of diets was introduced, which for convenience combined the standard diets used in healthcare facilities and developed by M.I. Pevzner back in the 30s of the 20th century.

The new standard diet system includes:

• The main version of the standard diet (this is the decoding of the OVD) replaced the main therapeutic Tables according to Pevzner No. 1 , 2 , 3 , 5 , 6 , 7 , 9 , 10 , 13 , 14 , 15 , which do not require special restrictions on products. It is recommended for all healthy people to maintain health and for people suffering from gastrointestinal diseases in remission, acute febrile diseases and diseases of the cardiovascular system without circulatory disorders or with a minimal degree of disorders. In this regard, it is divided into: OVD1 (for diseases of the stomach with high acidity), OVD2 (diseases of the stomach with low acidity), OVD5 (diseases of the liver and biliary tract), OVD10 (cardiovascular system), etc. This diet is distinguished by its physiological content of proteins, fats, and carbohydrates. It is enriched with vitamins , minerals and plant fiber. The diet is 4-6 times a day, including snacks and fermented milk drinks at night. If you have diabetes, an adjustment is made: quickly absorbed carbohydrates are limited or eliminated, preference is given to foods with a low glycemic index. Patients should eat up to 5 times a day. This diet provides for the consumption of 85-90 g of protein (of which 40-45 g are animal), 70-80 g of fat (25-30 g of vegetable), 300-330 g of carbohydrates (simple - 30-40 g, which are excluded in case of sugar diabetes). The energy value of the therapeutic version of the diet is 2016-2400 kcal. When losing weight, reduce to 1500 kcal. The diet is limited to extractive substances (broths), salt (up to 8 g/day), spicy seasonings, smoked foods, as well as spinach and sorrel containing oxalic acid are excluded. Dishes are steamed, boiled or baked. The amount of liquid you drink is 1.5–2 liters per day.
• Option with mechanical and chemical sparing (includes Tables 1B , 4B , 4B , 5p ). Prescribed for gastrointestinal diseases. It is distinguished by the limitation of chemical (spicy, fried, extractive dishes) and mechanical irritants, so dishes are prepared exclusively by steaming or boiling; sometimes mashing or pureeing food is recommended.
• An option with a reduced protein content - a low protein diet (LPD) includes Tables 7A , 7B .
• With a high protein content - a high-protein diet (HPD), which includes Tables 4e , 4ag , 5p (second option), 7c , 37g , 9b , 10b .
• With reduced calorie content - a low-calorie diet (LCD) includes Tables 8 , 8A , 8o , 9A , 10C . Indicated for varying degrees of obesity without gastrointestinal complications. The diet provides for a moderate calorie restriction (1340-1550 kcal) due to fats (maximum 60 g in total) and the complete exclusion of easily digestible carbohydrates. It is enhanced by the content of plant fiber. Diet 5 times a day.
• With increased calorie content ( Table 11 ) for patients with tuberculosis - 3110-3640 kcal.

General characteristics of the OVD diet:

• It is balanced, so the feeling of hunger when doing it is eliminated.
• Designed for continuous adherence by healthy people and patients in remission.
• Contains healthy foods and a lot of fiber.
• Provides for fractional meals - 4 times or more when organizing snacks, which contributes to the rhythmic activity of the gastrointestinal tract.
• Involves preparing food by boiling, baking or steaming. These heat treatment methods do not involve the use of fats during cooking, so the food has a lower calorie content than fried food. In addition, it is easily absorbed and digested without disturbing the function of the digestive system.
• Excludes fatty and fried foods, extractive substances.
• Limits the consumption of simple carbohydrates and foods high in cholesterol.

The OVD diet, to summarize, is a healthy diet containing the physiological norm of all nutrients, aimed at maintaining a normal weight. If you want to lose weight, you will have to significantly increase physical activity and reduce caloric intake to 1500 kcal in your diet, or immediately choose an option with a reduced energy value, intended for obese patients .

Diet according to Pevzner

In Russia, the countries of the post-Soviet space and the countries of the Eastern bloc (Czech Republic, Slovakia, Poland, Hungary, Bulgaria, etc.), adherence to the system of therapeutic nutrition, developed back in the 20s of the last century by a therapist, professor, founder of Russian dietetics and clinical gastroenterology, has remained. Manuil Pevzner. He devoted more than 30 years of his life to studying the influence of nutrition on the functioning of various organs and systems of human life, which ultimately made it possible to create a system of 15 diets for groups of diseases. The Pevsner system, the numbered diet system, dietary tables, the gentle diet system - all these are different names for the diet system, divided into 15 groups/tables according to the characteristics of the effect on the body. Let's look at each of the diets in detail.

Diet No. 1

Prescribed for gastritis with high acidity, stomach and duodenal ulcers. The purpose of the diet is to normalize the secretory and motor functions of the stomach, stimulate the healing processes and restoration of the mucous membrane. There are diets 1a and 1b: the first is indicated during periods of exacerbation of ulcers or gastritis, the second - during periods of subsidence of exacerbation. Diet No. 1 involves all types of sparing; it is recommended to eat 5 meals a day in small portions and short intervals between meals. The daily norm is 2800-3000 kcal.

The diet includes dishes boiled in water or steamed, chopped and pureed, meat strictly without tendons and cartilage, fish and poultry without skin. Avoid the consumption of strong broths, sour, salty and fermented foods, spices, strong tea and coffee, and fried foods. The basis of nutrition is pureed milk, vegetable and cereal soups; processed vegetables; mashed porridge with butter or milk; steam cutlets; boiled meat, lean fish and chicken; butter and vegetable oils; boiled eggs; cottage cheese; white stale bread; sweet berries and fruits, berry juices, jelly and compotes; lightly brewed tea, cocoa with milk; no more than 8 g of salt per day. Chew food thoroughly and do not serve it very hot or cold.

Diet No. 2

Indicated for diagnosing gastritis with low acidity, chronic enteritis and colitis. The diet is designed to normalize the secretory function of the intestines, eliminate the processes of rotting and fermentation in the gastrointestinal tract. As part of this diet, there is a ban on breading, hard-to-digest foods, foods that cause irritation to the mucous membranes, fermentation (whole milk, cabbage, rye bread, sweets, etc.) and rotting (fried meat dishes). Moderate sparing of all types is used; it is recommended to eat 5 times a day, in some cases 4 times a day, with a daily allowance of 2800-3000 kcal.

Meat, fish and mushroom broths with low fat content, and cereal and vegetable soups cooked on their basis help to activate the secretory function. Chopped, fried lean meat is welcome; boiled chicken; steamed, stewed, lightly fried cutlets without a hard crust. Low-fat herring and black caviar are added to the diet. Dairy products allowed are milk (with normal tolerance), butter, kefir, yogurt, cream, sour cream, fresh cottage cheese, and grated mild cheeses. On the dietary table appear soft-boiled eggs, fried omelettes, boiled or mashed porridges, flour products (except butter), stale white and gray bread, crackers, fruits and vegetables, natural juices, tea, coffee, cocoa with water and milk, marmalade, sugar. The daily salt intake is 12-15 g.

Diet No. 3

Indicated for atonic constipation. A complete diet includes dishes and ingredients that stimulate bowel movements. The diet must include foods high in plant fiber: vegetables and fruits, compotes, prunes, figs, natural juices, dried fruit puree, black bread, dairy products, buckwheat and pearl barley porridge, lean meat and fish, butter and vegetable oil. It is recommended to drink plenty of fluids, including lightly carbonated mineral waters. On the contrary, slimy soups, jelly, strong tea, cocoa, baked goods, smoked meats, canned food, rice, semolina, legumes, mushrooms, and hot sauces are excluded from the menu. Energy value increases to 3000-3200 kcal.

For spastic constipation, accompanied by increased intestinal motility, all foods containing fiber are limited (small portions of pureed, raw and boiled vegetables are allowed).

Diet No. 4

Prescribed to patients with acute intestinal diseases and chronic diseases during exacerbation, accompanied by severe diarrhea. The diet is characterized by an energy value reduced to 2000 kcal due to fats and carbohydrates. Meals are split, 5-6 times a day, table salt is limited as much as possible, vitamins C, B1, B2 and PP are added to the diet.

The menu for diet No. 4 is filled with semi-liquid and liquid dishes, always in crushed form. Recommended diet: wheat crackers; soups with weak meat and fish broth; lean meat and fish in steamed cutlets and meatballs; fresh cottage cheese; ground porridge; vegetable decoctions; berry and fruit jelly; green tea, black coffee, berry infusions.

All bakery and flour products (except crackers) are excluded from the menu of this diet table; fatty broths, varieties of meat, fish and poultry; smoked meats; canned food; dairy products; legumes; fresh vegetables, berries and fruits; sweet; coffee and cocoa with milk; carbonated and cold drinks.

• Diet No. 4a: prescribed for colitis accompanied by fermentation processes. The diet is distinguished by a sharp limitation of high-carbohydrate foods, and protein consumption increases.
• Diet No. 4b: indicated for chronic colitis in the stage after an exacerbation, up to 10 g of salt is allowed.
• Diet No. 4c: indicated during the recovery period, protein consumption is increased, salt is limited, food is not crushed.
• Diet No. 4ag (gluten-free): indicated for patients with celiac enteropathy, whose body loses the ability to digest gluten.

Diet No. 5

Indicated for patients with chronic cholecystitis, cholelithiasis and hepatitis outside the acute stage, acute cholecystitis and hepatitis, liver cirrhosis without liver failure. Compliance with diet No. 5 helps normalize the functioning of the liver and gall bladder, and prevents the formation of stones. The consumption of refractory fats, foods rich in purines, extractives, cholesterol, and oxalic acid is limited or completely eliminated. On the other hand, the consumption of lipotropic substances, fiber, pectin and liquid increases. Meals on this diet are 5 times a day, in small portions at strictly fixed times.

Allowed: fruit and milk soups, cereal soups with vegetable broths; boiled meat, lean poultry and boiled fish; milk, curdled milk, kefir, a portion of cottage cheese, porridge; stale black bread, white bread; fruits and non-acidic berries, vegetables and herbs; jam, honey up to 70 g of sugar per day, natural juices. Up to 10 g of salt per day, vitamins A, C, B1, B2, B12, 2800-3000 kcal. Excluded: liver, legumes, mushrooms, baked goods, smoked meats, extractive substances of meat and fish, cocoa, carbonated drinks, chocolate, creams.

For chronic pancreatitis, table No. 5a is prescribed, which increases the volume of consumed proteins and lipotropic substances while limiting carbohydrates and fats. There are also diets No. 5v, 5p, 5sch, 5zh, 5p, which are determined by the doctor.

Diet No. 6

Prescribed for gout, urolithiasis (uraturia). The diet is based on the exclusion of purine-containing foods, oxalic acid, increasing the volume of alkalizing foods and drinking plenty of fluids (2-3 liters). Recommended: bakery products made from 1st and 2nd grade flour; vegetarian soups; lean meat, poultry, fish; cereals; dairy products; vegetables, fruits and berries in any form; marmalade, pastille, honey, jam. Vitamins C and B1 are added.

The daily intake of table salt is limited to 6-8 g. Spices, meat decoctions and broths, liver, kidneys, fried and smoked meat, lard, sardines, anchovies, sardines, herring, legumes, coffee, cocoa, chocolate are excluded from the diet.

Diet No. 7

The indication for prescribing the diet is acute nephritis during the recovery period and chronic nephritis outside the acute stage without signs of renal failure. The result of the diet should be to spare the kidneys and remove excess fluid and nitrogenous waste from the body. All dishes are prepared without salt, up to 4 g are given to the patient. Fluid consumption is reduced to 800-1000 ml per day. Dishes with a high content of extractive substances, oxalic acid, and essential oils are excluded. Meal mode: 5 times a day or 4 times a day.

Ingredients: vegetarian soups; lean meat, poultry, fish; dairy products; cereals; potatoes and vegetables; fruits and vegetables; salt-free bread; flour dishes; 1 egg per day; greenery. The intake of cream, sour cream, onions, garlic, mushrooms, chocolate, strong coffee, and cocoa is limited.

Table No. 7a is indicated for acute nephritis or exacerbation of the chronic form. The diet is limited to pureed boiled vegetables, fruits (especially dried apricots, apricots and raisins, which contain potassium salts), small portions of cereal and flour dishes, tea, salt-free bread, 70 g of sugar and 30 g of butter per day. Vitamins C, K, B group are added, liquid is limited to 600-800 ml, salt is completely excluded. Table No. 7b is transitional between No. 7 and No. 7a, and is prescribed when acute inflammatory processes subside. Diets No. 7v, 7d and 7r are prescribed less frequently.

Diet No. 8

The diet is prescribed to people with obesity as the main disease. Or if obesity is a concomitant disease, but the underlying disease does not require dietary prescription. The main property of diet No. 8 is that the energy value of the diet is reduced to 1700-1800 kcal due to carbohydrates and partially proteins. Free liquid, table salt and intake of foods that improve appetite are limited. The goal of the diet is obvious - to reduce the patient’s weight and restore normal metabolism. For a short period of time, diet No. 8a is sometimes prescribed, which is characterized by severe caloric restriction of food.

If you follow this diet, the menu will include: rye, bran and wheat bread; vegetable soups, borscht, okroshka; 2-3 times a week soups in light meat or fish broth with meatballs; boiled, baked or stewed meat (poultry, fish); seafood; milk, cottage cheese, low-fat cheeses; raw vegetables and fruits. A diet for weight loss excludes the consumption of baked goods and products made from premium and first-grade flour; cereal, legume, potato soups; sausages, smoked meats, canned food; cream, rice, semolina and oatmeal; sugar, honey, confectionery, cocoa and sweet fruits and berries; fatty and hot sauces, mayonnaise, spices.

Diet No. 9

Prescribed to patients with mild to moderate diabetes mellitus. Easily digestible carbohydrates and animal fats are excluded from the diet, the consumption of starch and foods with cholesterol and extractives is reduced, sugar is replaced with xylitol or sorbitol. The consumption of lipotropic substances, dietary fiber, vitamins B and C increases, the daily norm is 2300-2500 kcal.

Dietary table No. 9 can offer rye, wheat and bran bread; vegetable soups; weak meat and fish broths; lean varieties of meat, fish and poultry; milk and fermented milk products; cereals; legumes, potatoes and vegetables; fresh fruits and berries of sweet and sour varieties. Excluded from the diet: baked goods, salted fish, sausages, cream, rice, semolina, grapes, jam, raisins, lemonades, sweets, sweet juices.

Diet No. 10

Indicated for diseases of the cardiovascular system (hypertension, cardiac ischemia, atherosclerosis, condition after myocardial infarction, heart failure grades I-IIA). The dietary table is characterized by some limitation of fats and carbohydrates, refusal of chlorides and foods that stimulate the cardiovascular and central nervous systems. Following a diet helps normalize blood circulation, liver and kidney function, and slow or stop the development of atherosclerosis. The consumption of salt and water is limited, 4-5 meals a day with an energy value of 2500-2600 kcal are recommended. If there are indications, the doctor may prescribe one of the subtypes of diet No. 10a, 10b, 10c, 10p, 10g or 10i.

During the diet, you should avoid strong tea, coffee, cocoa, chocolate, rich broths, spicy foods, smoked foods and foods high in cholesterol. Also prohibited are foods that provoke attacks of flatulence: radish, cabbage, garlic, onions, beans, peas and other legumes. It is recommended to fill the diet with dishes and foods rich in potassium, magnesium and calcium salts, vitamins C, E, P, carotenes and iodine. The diet menu includes yesterday's bread, savory baked goods, vegetarian soups, lean meats, fish and poultry, milk, fermented milk products, cereals, pasta, boiled and baked vegetables, soft fruits and berries, honey, jam.

Diet No. 11

Prescribed to patients with tuberculosis of bones, lymph nodes and joints with gradual exacerbation or attenuation; with exhaustion after infectious diseases, operations, injuries. Diet No. 11 is characterized by an increased energy value of the diet due to proteins. The daily norm increases to 3200-3500 kcal. Fatty meats and poultry, cooking fats, cakes and pastries rich in cream are limited. The emphasis is on dishes and foods high in dairy proteins, vitamins and minerals. The diet has no other features.

Diet No. 12

Prescribed to people with functional diseases of the nervous system. The diet is complete, only those foods and dishes that increase the excitability of the central nervous system are excluded: alcohol, strong tea, coffee, spicy seasonings, rich soups, smoked foods, fatty, fried foods, especially meat. Particular attention should be paid to the liver, tongue, dairy products and legumes, rich in phosphorus salts.

Diet No. 13

Table No. 13 is prescribed to patients with acute infectious diseases. The diet is characterized by a high content of vitamins and an energy value reduced to 2200-2300 kcal due to fats and carbohydrates.

When following diet No. 13, fresh bread and baked goods are excluded from the diet; fatty broths, fatty meats, poultry and fish; whole milk and cream, cheeses, full-fat sour cream; pasta, millet; white cabbage, radishes, onions, garlic, cucumbers, legumes; fruits high in fiber; chocolate, cakes, cocoa. And, conversely, it is recommended to eat fermented milk products, cottage cheese, ground rice, buckwheat and semolina porridge; low-fat broths; slimy and vegetable soups; dried wheat bread; cauliflower, carrots, potatoes, tomatoes, ripe soft fruits and berries; decoctions; sugar, honey, jam, jam, marmalade.

Diet No. 14

Prescribed for urolithiasis (phosphaturia). The diet is a complete diet with limited content of alkalizing and calcium-rich foods in dishes. The energy value of the diet is 2800-3000 kcal.

The consumption of dairy, vegetable and fruit soups is limited; smoked meats; salted fish; dairy products; potatoes, vegetables and fruits (except those listed below); berry and vegetable juices. It is recommended to eat all types of bread and flour products; meat, fish and cereal broths and soups; lean meat and fish; green peas, pumpkin, mushrooms, sour varieties of apples and berries; sugar, honey, confectionery.

Diet No. 15

Table No. 15 is prescribed for diseases that do not require special dietary nutrition. Practically no different from a regular balanced balanced diet. The daily diet consists of 90-95 g of proteins, 100-105 g of fats and 400 g of carbohydrates, energy value - 2800-2900 kcal. Difficult to digest and spicy foods, refractory animal fats, fatty meats and poultry, pepper and mustard are limited.

Authorized Products

• Fish, steamed, boiled or baked.
• Lean meats and poultry prepared in the same way.
• Rye and wheat bread, flour products. These foods are limited when losing weight.
• Soups made from weak (secondary) broths or vegetable broths. To keep the diet varied, alternately include borscht, cabbage soup with fresh cabbage, rassolnik, various vegetable soups, beetroot soup (indicated for those prone to constipation ), and mushroom cereals. It is better to limit the consumption of the latter due to their higher calorie content.
• Any low-fat fermented milk drinks - yogurt, acidophilus, kefir, ayran, yogurt.
• Milk and sour cream for adding to dishes, cottage cheese 100-150 g per day, cheese 30 g.
• Boiled eggs or in the form of steamed, baked omelettes.
• Various cereals and pasta. They should be limited if you want to lose weight.
• Butter no more than 20 g, vegetable oils for seasoning dishes in the amount of 1-2 tbsp. l.
• Any vegetables according to tolerance. It's best to limit radishes, radishes, sorrel and spinach.
• Fresh fruits and berries in dishes (purees, mousses, jellies), compotes, juices, jelly and fruit drinks.
• Cocoa with water and milk, tea, coffee, rosehip infusion. According to the basic diet, sugar is allowed in the amount of 35 g per day. When losing weight, it is limited or eliminated.

Table of permitted products

Allowed and prohibited foods of the ATS diet

Foods that can be eaten:

• Bread with bran.
• Chicken egg.
• Low-fat meat and fish.
• Nuts.
• Vegetables and fruits.
• Fermented milk drinks.
• Dried fruits.

Foods that should not be eaten:

• Pickled foods, saltiness.
• Canned food.
• Bread and other baked goods.
• Milk.
• Smoked products.
• Sausages.
• Meat and fish of fatty varieties.
• Alcohol.

Fully or partially limited products

• Refractory fats, margarine, mayonnaise.
• Fatty meat broths.
• Fatty meat, poultry.
• Any fried food.
• Sausage, smoked meats, any canned food.
• Baking, sweets, jams, jams, sugar, ice cream, cakes and pastries are excluded when losing weight.

Table of prohibited products

Menu (power mode)

There are several options for OVD with strictly taken into account calorie content and prescribed BZHU content. After studying all the examples, you can choose the seven-day menu that is most suitable for you and suits your taste. You can create your own diet for the week without using foods from the prohibited list.

The seven-day menu below for the main options for standard diets has a calorie content of 1500 to 1700 kcal on different days of the week, excluding the consumption of bread, butter and sugar. If you add 150 g of rye bread, 150 g of wheat, 20 g of butter and 35 g of sugar (7 teaspoons in all dishes), the energy value will increase by 830 kcal, which is significant for a person who is trying to lose weight. This menu takes into account all the necessary nutrients, the food is very varied and is organized 6 times a day.

If eating this menu is not accompanied by weight loss, you can reduce the consumption of carbohydrates (porridge, potatoes) and replace them with vegetable dishes. This way you will reduce the energy value of your diet.

Text of the book “Therapeutic nutrition for chronic diseases”

Chapter 3 System of standard diets for therapeutic nutrition

Dietary therapeutic nutrition is based on the physiological needs of a healthy person for nutrients and energy, which are adjusted based on the characteristics of pathogenesis, clinical course, stage of the disease, severity of metabolic disorders, risk factors for the development of nutrition-related diseases in each individual patient.
Numerous studies on the mechanisms of food assimilation in normal conditions and in various diseases formed the basis for the development of the concept of a balanced diet,

and then
the concept of optimal nutrition,
according to which the chemical structure of the 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 ​​of the physiological needs of a healthy person’s body for 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 nutritional characteristics. 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.

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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).

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In subsequent years, the Ministry of Health and Social Development of 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 “On measures to improve clinical nutrition in medical institutions of the Russian Federation”, a second version of the high-protein diet for tuberculosis patients was introduced into the system of standard diets - VBD (t).

On June 21, 2013, in order to implement the Federal Law of the Russian Federation of 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 .

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Table 8

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

Indications for prescribing diets

The main indications for the use of standard diets are cardiovascular diseases

(IHD, atherosclerosis, hypertension, etc.),
diseases of the digestive system
(chronic gastritis, peptic ulcer of the stomach and duodenum, etc.),
hepatobiliary system
(chronic hepatitis with mild signs of functional liver failure, acute and chronic cholecystitis, cholelithiasis etc.),
metabolic diseases
(diabetes mellitus type I and II, obesity, gout, etc.),
diseases of the lungs and lung tissue
(acute and chronic bronchitis, respiratory tuberculosis, extrapulmonary tuberculosis, etc.), etc.

Standard diets differ in the quantitative and qualitative composition of basic nutrients, micronutrients, energy value, technology for preparing dietary dishes, and the average daily set of products. They are formed taking into account the “Norms for the physiological needs of the body in nutrients and energy for various groups of the population of the Russian Federation”, approved by the then-current Chief State Doctor of the Russian Federation, Academician of the Russian Academy of Medical Sciences G. G. Onishchenko (MR 2.3.1.24.32-08) .

The basis of one or another version of the diet used in each health care facility is the characteristics of the standard diet, which includes the following requirements: regulated chemical composition (content of proteins, fats, carbohydrates, vitamins, minerals), the amount of fluid consumed and the energy value of the diet, a list of permitted and not recommended food products, physical properties of food (volume, weight, consistency, temperature), features of culinary processing of food, diet (number of meals, time of meals, distribution of daily ration between individual meals).

The characteristics, chemical composition and energy value of standard diets are given in the “Instructions for organizing therapeutic nutrition in medical institutions” to the order of the Ministry of Health of Russia dated 05.08.2003 No. 330 “On measures to improve therapeutic nutrition in medical institutions of the Russian Federation” (as amended in accordance with the order of the Ministry of Health of Russia dated June 21, 2013 No. 395n “On approval of clinical nutrition standards”) (Table 8). On page 260 there is also a table of Norms for therapeutic nutrition.

Chapter 4 Medical nutrition for diseases of the gastrointestinal tract

4.1. Therapeutic nutrition for gastric and duodenal ulcers

Recommendations are applicable for acute pancreatitis or exacerbation of chronic recurrent pancreatitis
Nutritional therapy for peptic ulcer disease

is aimed, on the one hand, at fully meeting the physiological needs of the patient’s body for basic nutrients and energy, and on the other hand, at restoring impaired secretory and motor functions of the stomach, at activating reparative processes in its mucous membrane. At the same time, special attention is paid to achieving full satisfaction of the body's needs for essential nutritional factors (essential amino acids, PUFAs, vitamins, microelements, etc.) - the most important regulators of metabolic processes, primarily in the gastric mucosa and duodenum.

Important conditions for achieving an optimal therapeutic effect are compliance with the technological requirements for preparing dishes and a regimen of frequent, split meals with the consistent use of the main version of the standard diet and the diet version with mechanical and chemical sparing during the period of exacerbation of the disease.

General characteristics of the diet
The diet in its chemical composition, set of products and dishes, food preparation technology, nutritional, biological and energy value is physiologically complete, contains both basic nutrients (proteins, fats, carbohydrates) and essential nutritional factors (vitamins, microelements, essential amino acids, PUFAs, etc.), and therefore adaptation of the diet to the individual clinical and pathogenetic features of the course of the disease is easily carried out by equivalent replacement or additional inclusion of only 1-2 components for a targeted impact on a specific mechanism of homeostasis disturbance.
Peculiarities of cooking technology
The diet is used in two versions: pureed and unmashed. They differ from each other only in the technology of cooking.

Hyposodium diet: foods and dishes that are strong secretion stimulants and chemically irritating to the gastric mucosa are excluded.

In the pureed version of the diet, food is given in a liquid, mushy form, and then boiled or steamed - in a denser form.

Below is an approximate seven-day menu for the pureed version of the diet.
List of recommended products and dishes
Bread and bakery products.

Wheat bread made from premium flour, yesterday baked or dried. Rye bread, any fresh bread, as well as products made from butter and puff pastry are excluded.

Soups.

Using a vegetable decoction of mashed, well-cooked cereals, dairy, vegetable puree soups, slimy soups, seasoned with butter, egg-milk mixture, and sour cream. Meat, fish, chicken broths, strong mushroom and vegetable broths, cabbage soup, borscht, okroshka are excluded.

Meat and poultry dishes.

Steamed or boiled from beef, young lean lamb, trimmed pork, chicken, turkey. Fatty and stringy meats, goose, duck, offal, canned and smoked meat products are excluded.

Fish dishes.

From low-fat varieties of river and sea fish without skin, in pieces or in the form of cutlets, boiled or steamed.

Cereal dishes

Porridges made from semolina, buckwheat, oatmeal, boiled in water or milk, semi-viscous, mashed. Millet, pearl barley, barley, legumes.

Vegetable dishes.

Potatoes, carrots, beets, cauliflower, boiled in water or steamed in the form of souffles, purees, puddings. White cabbage, turnips, rutabaga, radishes, onions, salted, pickled and pickled vegetables are excluded.

Dairy products.

Milk, cream, non-acidic kefir, yogurt, cottage cheese in the form of soufflé, lazy dumplings, puddings. Fermented milk products with high acidity are excluded.

Snacks.

Salads from boiled vegetables, boiled tongue, doctor's sausage, dairy sausage, dietary sausage, jellied fish in vegetable broth.

Egg dishes.

Soft-boiled eggs (1-2 eggs per day), egg white omelettes, steam omelets if well tolerated.

Sweet dishes, fruits.

Fruit purees, baked apples, jelly, jelly, pureed compotes, sugar, honey.

Juices.

From fresh ripe sweet fruits and berries.

Fats.

Butter, refined sunflower, corn, olive oil for adding to dishes.

An approximate diet menu with mechanical and chemical sparing is given in Table 9.

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Table 9

Sample diet menu with mechanical and chemical sparing

Table 10 shows the chemical composition and energy value of the diet with mechanical and chemical sparing (on average per week).

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Table 10

Chemical composition and energy value of a diet with mechanical and chemical sparing (on average per week)

The content of vitamins and minerals in the daily diet is presented

in table 11.

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Table 11

Content of vitamins and minerals in the daily diet

In the acute phase of the disease, with severe dyspeptic disorders, persistent pain, and poor general condition, hypocaloric, hyposodium, and gentle diet options are prescribed during the first 4-5 days.

All dishes are prepared boiled or steamed, in liquid and semi-liquid form. Food is taken in small portions every 2-3 hours.

An approximate menu for a patient with gastric ulcer in the first week of exacerbation of the disease is given in Table 12.

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Table 12

One-day menu for a patient with gastric ulcer in the first week of exacerbation of the disease

As the exacerbation of the disease subsides, the patient is prescribed a diet with mechanical and chemical sparing.

With a successful course of the disease, relief of acute symptoms, restoration of impaired secretory processes in the stomach and intestines, activation of reparative processes in the mucous membrane of the stomach and duodenum, achievement of synchronicity in the functioning of the gastrointestinal tract, after two weeks of treatment the patient is gradually transferred to the main version of the standard diet, which is followed for 2-3 months, since restoration of morphofunctional disorders in the stomach and intestines occurs later than the clinical therapeutic effect is achieved.

In case of acute gastritis or severe exacerbation of chronic gastritis, the tactics of therapeutic nutrition are the same as for gastric ulcer in the acute period.

For chronic gastritis with secretory insufficiency, the main version of the standard diet is used without chemical sparing using food stimulants of secretory processes.

Purpose of the diet

– promoting the restoration of the secretory and motor functions of the stomach and intestines, increasing gastric secretion and reducing the processes of fermentation and putrefaction in the intestines.

An approximate menu for the main version of the standard diet is given in Table 13.

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Table 13

Sample menu for the main version of a standard diet

4.2. Therapeutic nutrition for peptic ulcer after gastric resection and the presence of dumping syndrome

With extensive and even economical resection of the stomach, dumping syndrome very often occurs, caused not only by anatomical changes in the gastrointestinal tract, but also by profound disorders of the neurohumoral regulation of digestive processes, especially in the sympathoadrenal system (its mediator link), which lead to disruption of various homeostasis systems.

For two weeks after surgery, nutritional therapy is carried out according to an individual plan in the surgical department. On the 15-20th day, a diet option with mechanical and chemical sparing is prescribed, taking into account the following requirements:

• adherence to frequent, fractional meals with separate intake of the first and second courses, especially in the initial stage;

• exclusion from the diet of oligosaccharides that have dumping properties, both in pure form and as part of foods and dishes;

• exclusion of milk in its pure form and as part of dishes from the diet;

• limiting liquid, fatty, hot foods.

In all other respects, this diet is quite adequate to the characteristics of the clinical and metabolic status of patients suffering from dumping syndrome.
General characteristics of the diet
The diet is physiologically complete, with a high content of easily digestible protein, a normal quota of total carbohydrates with an almost complete exclusion of refined carbohydrates (sugar, honey), since they have a high dumping-stimulating effect. The diet limits the amount of mechanical and chemical irritants to the gastric mucosa and the receptor apparatus of the gastrointestinal tract.

Strong stimulants of bile secretion and pancreatic secretion, as well as foods and dishes that have a dumping effect (sweet liquid milk porridges, sweet milk, sweet tea, hot fatty soup) are excluded from the diet. In case of severe dumping syndrome, separate intake of liquid and solid food is recommended. Liquid food is taken half an hour after consuming solid food. Sugar in the amount of 30 g is given out in the form of buffet products.

For the first 10 days after the operation, the patient’s nutrition is carried out according to an individual plan, and from the 10th day, if the disease progresses well, a pureed version of the diet is prescribed, which is used for a long time.

The principle of mechanical and chemical sparing during dumping syndrome is observed for a long time, especially if there are disorders of the hepatobiliary system, pancreas, and small intestine. When dyspepsia disappears and digestion processes stabilize, a high-protein version of the standard diet without mechanical sparing is prescribed.

An approximate one-day menu for a diet with mechanical and chemical sparing after gastrectomy is given in Table 14.

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Table 14

One-day menu of diet options with mechanical and chemical sparing after gastrectomy
Methodology for using diet options for dumping syndrome
In the first days after gastrectomy, a strict individual diet is prescribed. After 1-2 weeks, in the absence of complications, a pureed version of the diet is prescribed. For one meal, 1-2 dishes are allowed without a side dish, then the patient is gradually transferred to a full version of the pureed diet with limited consumption of carbohydrates (vegetables, cereals), especially refined ones (sugar, honey, jam), which are completely excluded at the first stage of treatment.

The patient is transferred to an unprocessed version of the diet gradually. In the first days, ungrated vegetables are given in limited quantities as part of the first course. If the patient experiences an exacerbation in the postoperative period, regardless of the period, the pureed version of the diet is again prescribed.

If dumping syndrome persists for a long time, provided that the clinical picture is not dominated by symptoms of pancreatitis, the patient is prescribed a diet without mechanical sparing, the main version of the standard diet.

When dumping syndrome is complicated by enterocolitis or colon dyskinesia in the acute phase, a pureed version of the diet is used, excluding white cabbage, beets, turnips, radishes, sorrel, spinach, onions, garlic, mushrooms, millet and pearl barley from the diet. For colitis with a tendency to constipation and flatulence, an unprocessed version of the diet is prescribed with the exception of black bread and spicy vegetables. Peeled fruits can be consumed in their natural form, with the exception of grapes.

4.3. Nutritional therapy for irritable bowel syndrome with constipation

For intestinal diseases, one of the main requirements for dietary therapy, as well as for other diseases, is to satisfy the body’s physiological needs for nutrients and energy in conditions of disrupted digestive processes.

The range of products and the nature of their culinary processing are determined primarily taking into account the degree of disturbance of intestinal secretion. Secretion in the intestine is influenced mainly by external factors.

In the small intestine, the liquid part of the juice is separated in response to mechanical irritation, while the release of enzymes is enhanced by local action on the intestinal mucosa of the products of digestion of protein, fat, and pancreatic juice. The secretion of digestive juice in the colon is caused primarily by mechanical irritation of the mucous membrane. Inflammatory processes contribute to increased intestinal secretion.

In case of diarrhea, depending on the severity of the inflammatory process, the principle of mechanical sparing is observed. For irritable bowel syndrome with constipation, foods and dishes that enhance the motor function of the colon are used.

Physiological stimulants of peristalsis include

bile acids, sugary substances, especially in high concentrations, organic acids, hypertonic solutions of table salt, substances containing or forming carbon dioxide, fats, fiber, cell membranes.
The most pronounced laxative effect is found in
raw vegetables and fruits, dried fruits, especially prunes, dried apricots, various boiled and stewed vegetables, and lactic acid products.

Substances that reduce peristalsis include

foods rich in tannin (blueberries, bird cherry, strong tea, cocoa in water), Cahors wine, dishes with a viscous consistency. Milk in its natural form and in large quantities in dishes for intestinal diseases is not recommended. During the period of remission, milk is added to dishes.

For irritable bowel syndrome with constipation during a period of mild exacerbation and when it is combined with diseases of the stomach, liver, and biliary tract, the main version of the standard diet is used.

Purpose of the diet

consists of:

• compensation of the body's need for nutrients and energy in conditions of impaired intestinal motor function with a predominance of constipation;

• restoration of impaired motor function of the intestine and other organs involved in the pathological process;

• strengthening of reparative processes in the intestinal mucosa;

• restoration of impaired metabolism in general.

Reviews and results

The main point of this diet is that it is balanced and contains the optimal calorie content for maintaining weight, and if it is reduced, for weight loss. Moreover, weight loss will occur slowly and without harm to health. This nutritional option is also suitable for overweight people with medical conditions. Strict adherence to all requirements will allow you to get rid of 500 g to 1 kg per week with increased physical activity. This rhythm of weight loss is the most optimal for losing weight.

• “... While staying in the sanatorium, I was on a similar diet. Only I didn’t eat pastries, sweets, I only took one piece of bread. At the same time, I ate porridge three times a day as a side dish for meat or fish. We were crushed by porridge - I don’t eat it three times a day at home, but there was no way out. There were also vegetable salads three times a day. I think that I ate normally and without any special restrictions. Imagine my surprise when, after 15 days, it turned out that the weight had decreased by 2 kg. I attribute this to the fact that the food was not fatty, and meat dishes were served boiled. All dishes were under-salted. I also went a lot (to the springs three times a day).”
• “... On such a diet I managed to lose 4 kg in a month. Yes, this is not much, but the important thing is that I did not feel hungry, I was cheerful and active. But to achieve such results, I ate porridge only once a day, sometimes twice, including milk. Potatoes were baked only 3 times in a month. For side dishes I used fresh or stewed vegetables, as well as various vegetable dishes. The diet was in the summer, so there was plenty of zucchini, eggplant, cucumbers, any greens, fruits (raspberries, currants, apricots). I made the juices myself. Of course, I excluded all unhealthy foods, and did not keep temptations in the form of sweets, cookies, and cakes in the house at this time. My conclusions: it’s easy to lose weight in the summer, eliminating fried foods helps, losing the first kilograms is easier - later I had to reconsider the diet and tighten it.”