New standard diets for medical institutions. List of standard diets

In the first issue of the magazine " Practical Dietetics» in the section “To suit the patient’s taste” information was provided on the compilation of a specialized card index dietary dishes, which is a document on the basis of which a seven-day summary menu, layout menu, and requirement menu are compiled. The next important document, after the card index of dishes, when organizing dietary (therapeutic and preventive) nutrition in health care institutions and social service institutions is the planned seven-day (10-, 14-day) menu.

In general, the seven-day summary menu is

A seven-day consolidated menu is a menu compiled for seven days of the week, which combines all the diets used in a given institution (“Organization therapeutic nutrition in healthcare institutions”, ed. M. M. G. Gapparova, B. S. Kaganova, Kh. Kh. Sharafetdinova, 2011).

A correctly compiled seven-day consolidated menu should provide patients with a balanced diet and at the same time satisfy the requirements of variety and compliance with the average daily food intake per patient:

• for healthcare institutions in accordance with the Order of the Ministry of Health of the Russian Federation dated August 5, 2003 No. 330 “On measures to improve clinical nutrition in therapeutic and preventive institutions of the Russian Federation" (as amended on October 7, 2005, January 10, April 26, 2006) (hereinafter Order of the Ministry of Health of the Russian Federation No. 330);
• elderly citizens and disabled people in social service institutions in accordance with the Resolution of the Ministry of Labor of the Russian Federation dated February 15, 2002 No. 12 “On approval methodological recommendations on the organization of catering in institutions (departments) of social services for elderly citizens and the disabled" (as amended on June 4, 2007, order No. 397);
• pregnant women, nursing mothers and patients of children's medical institutions (departments) in accordance with Order of the USSR Ministry of Health dated March 10, 1986 No. 333 “On improving the organization of medical nutrition in maternity hospitals (departments) and children's hospitals (departments)”, taking into account age characteristics children.

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Methodology for creating a seven-day menu

At the Medical Nutrition Council, it is necessary to determine what types of standard, specialized and individual diets will be used in a particular health care institution or social service institution for elderly and disabled citizens. This choice of diet will depend on the profile of the institution and its departments, on the contingent of patients and residents. The selected range of diets must be approved by the Council for Medical Nutrition.

In accordance with Appendix No. 1 “Regulations on the organization of activities of a nutritionist” (approved by order of the Ministry of Health of the Russian Federation dated August 5, 2003 No. 330 “On measures to improve therapeutic nutrition in medical preventive institutions Russian Federation", as amended on October 7, 2005, January 10, April 26, 2006), the preparation of a seven-day consolidated menu is the responsibility of a nutritionist or specialist responsible for organizing dietary (therapeutic and preventive) nutrition. He should be helped in this work nurse dietary, production manager (chef, senior cook). Drawing up a seven-day consolidated menu is a very responsible, complex and time-consuming job.

Documents for creating a seven-day menu

1. Characteristics of diets is an important document that reflects the following features: the purpose of each diet, its general characteristics, features of culinary processing of products (cold and thermal), chemical composition and energy value rations; list of permitted and prohibited foods, temperature of food intake, diet, indications for its purpose. The characteristics of the diets were developed by the Federal State Budgetary Institution Research Institute of Nutrition of the Russian Academy of Medical Sciences and approved by the Ministry of Health and Social Development of the Russian Federation (Table No. 1 to the Instructions for organizing therapeutic nutrition in health care facilities to Order of the Ministry of Health of the Russian Federation No. 330).
2. A card file of dishes compiled taking into account necessary requirements and approved by the head of a specific healthcare or social service institution (in the first issue of the journal “Practical Dietetics” it is given detailed description rules for compiling layout cards and a list of collections of recipes recommended for compiling a card index of dishes).
3. Recommended values ​​of the body's physiological needs for proteins, fats, carbohydrates, and the energy value of the diet, which were developed by the Federal State Budgetary Institution "Research Institute of Nutrition of the Russian Academy of Medical Sciences" and are available in each diet characteristic (Table No. 1 to the Instructions for organizing therapeutic nutrition in health care facilities to Order of the Ministry of Health of the Russian Federation No. 330).
4. Average daily food sets approved by current departmental orders and regulations, which are the basis for drawing up seven-day menus. In accordance with them, the need for inpatient institutions of any type to supply food products is established, and monetary allocations allocated for the purchase of food products are determined. In order to rationally and effectively spend financial resources allocated for the purchase of food products, the analysis of the required financial resources must be carried out according to actual needs in accordance with the characteristics of the hospital and the number of incoming patients. To do this, it is necessary to introduce a system of timely (more than once) removal of patients from food. The most rational way to do this is by automating document flow in the system of organizing medical nutrition (“Organization of medical nutrition in healthcare institutions”, edited by M. M. G. Gapparov, 2011).
5. “Tables of the chemical composition and calorie content of Russian food products,” ed. I. M. Skurikhina, V. A. Tutelyana, Moscow 2008
6. “Norms for the replacement of products for proteins and carbohydrates” (Table No. 7 to the Instructions for organizing therapeutic nutrition in health care facilities to Order of the Ministry of Health of the Russian Federation No. 330).
7. “Interchangeability of products in the preparation of dietary dishes” (Table No. 6 to the Instructions for organizing therapeutic nutrition in health care facilities to Order of the Ministry of Health of the Russian Federation No. 330).
8. "Ratio natural products and specialized food products in the patient’s daily diet” (Table No. 1a to the Instructions for organizing therapeutic nutrition in health care facilities to Order of the Ministry of Health of the Russian Federation No. 330).

The sequence of drawing up a seven-day menu

Next, let's move directly to drawing up a seven-day menu. Its formation begins with the preparation of lunch: using a card file of dishes, first they write down the first courses of lunch. They should not be repeated throughout the week. An example of compiling a seven-day menu for a diet with mechanical and chemical sparing (gentle diet - SP) is presented in Table. No. 1, 2.

Then the second dishes are distributed with increased content protein, taking into account the average daily food sets for beef, fish and poultry. For example, if a patient is supposed to receive 100 g of meat per day, then in 7 days he needs to be given 700 g of beef. Birds must be given 140 g per week at the rate of 20 g per day, etc. To do this, layout cards for the corresponding net weight of the product are selected from the food card index approved by the head of the institution.

To create a seven-day menu, choose different meat dishes, which ensure the consumption of the required amount of product per week. It is also necessary to pay attention to the fact that if soup is prepared on the same day with the inclusion of cereals or pasta, then the side dish of the second course should be vegetable, and vice versa, if the first dish is vegetable, the side dish should be of cereals or pasta. This is important, on the one hand, from the point of view of taste diversity, and on the other hand, from the position of the correct inclusion of products and dishes with a predominance of either acidic or alkaline valences, designed to support acid-base balance in organism. Vegetable, fruit, and dairy dishes are mainly a source of alkaline valences. Cereals, meat, fish, and legumes are a source of acidic valences.

Next, the seven-day menu includes third lunch courses for all days of the week. These are compotes, jelly, juices, decoctions. It should be noted that dried fruit compotes for the ShchD diet should be served mainly in pureed form.

Then they move on to preparing breakfasts, dinners and afternoon snacks, taking into account food standards according to the above rule. First of all, it is necessary to monitor compliance with food standards for protein content in ready-made dishes. It is important to take into account, especially in breakfast, the presence of ready-made dishes with high biological value for protein, the so-called protein dishes. In addition, it should be borne in mind that breakfast should be represented by less labor-intensive dishes in terms of their preparation, including both cold and heat treatment products. As for protein products, you should include dishes made from eggs and cottage cheese for breakfast, and fish dishes for dinner, but sometimes it is also possible to include a dish made from meat if the remainder of the beef meat allowance allows. Meat dishes are included in breakfast less often, given the labor-intensive process of preparing meat dishes for the first meal. During dinner, meat dishes should be served even less frequently, due to the specific dynamic effect of proteins on the human body. Between the main meals (breakfast, lunch and dinner), it is necessary to plan a second breakfast, an afternoon snack and a second dinner to provide, if necessary, five or six meals a day for certain categories of eaters.

When meeting food standards, it is necessary to calculate the amount of products that are included in certain dishes as constituent ingredients. For example, the dish “Boiled Chicken Soufflé” includes, in addition to chicken, an egg, milk, and flour.

After fulfilling food standards for protein dishes, it is necessary to calculate, using the same principle, standards for vegetables, cereals, fruits, milk and other products that are part of the average daily set of products, combining them with protein dishes for all meals per day.

Then the amount of bread, sugar, butter, cheese and some other products that were introduced into the dishes during cooking is counted in accordance with the list of products on the layout card. Then, based on the obtained values, the standards for buffet products are derived. Standards for pantry products must be approved by the Medical Nutrition Council.

In a similar way, seven-day menus are compiled for all categories of diets approved by a health care institution or social service institution.

Optimizing Dietary Nutrition

Standard diets in their nutritional and energy value are adapted to clinical and metabolic disorders in various diseases. Despite this, there is a need to optimize dietary (therapeutic and preventive) nutrition both for patients in medical institutions and for elderly and disabled citizens living in social service institutions, in order to ensure that the body receives an adequate amount of macro- and micronutrients and biologically active substances , absolutely necessary to ensure the protective and adaptive capabilities of the body.

One of the most accessible ways to optimize dietary (therapeutic and preventive) nutrition is the correction of the protein component of the diet, which is achieved through the inclusion in a particular diet of specialized dietary food products - mixtures of protein composite dry - as a component in the preparation various dishes(“Organization of clinical nutrition in healthcare institutions”, edited by M. M. G. Gapparov, B. S. Kaganov, Kh. Kh. Sharafetdinov, 2011).

As an example of the inclusion of a dry protein composite mixture in a therapeutic diet with mechanical and chemical sparing, layout cards are given with their further introduction into the seven-day menu at various meals. The inclusion of protein composite dry mixtures does not affect organoleptic properties And taste qualities ready-made dietary dishes, allows you to increase the nutritional and energy value of both a specific dish and the entire diet as a whole.

The seven-day (or 10-, 14-day) menus for each diet compiled in this way are the basis for the formation of a consolidated menu, taking into account all dietary options used in a medical institution or social service institution for elderly citizens and people with disabilities, which is submitted for consideration by the Council for Clinical Nutrition and approved by the head of the institution.

In health care institutions or social service institutions, winter and summer versions of the seven-day menu must be approved, the difference between which lies in the list of vegetables and fruits included in the dishes. different periods year, taking into account seasonality.

Once again, it should be emphasized that compiling a seven-day consolidated menu is a very complex, labor-intensive job that takes more than one month of patient, painstaking work. To reduce labor costs, it is necessary to use medical institutions automated programs that replace a dietitian in preparing a number of documents or are the main assistants in their preparation.

Conclusion

Using the information provided in this material, practitioners in the field of nutrition have the opportunity to qualitatively, taking into account all regulatory requirements, formulate a consolidated seven-day menu, which is of primary importance in the future. proper organization dietary (therapeutic and preventive) nutrition in inpatient institutions of any type.

The article presents layout cards from the regulatory document “Seven-day menus for the main options standard diets optimized composition used in medical and preventive health care institutions and institutions (departments) of social services for elderly citizens and the disabled" (compiled by B. S. Kaganov, Kh. Kh. Sharafetdinov, E. N. Preobrazhenskaya et al., M., 2010 ), which is an appendix to practical guide“Card index of dietary (therapeutic and preventive) nutrition dishes of optimized composition” (edited by Academician of the Russian Academy of Medical Sciences, Professor V. A. Tutelyan, M., 2008).

BASIC DIET – DIET B

A diet with a physiological content of proteins, fats and carbohydrates, enriched with vitamins, minerals, plant fiber (vegetables, fruits). Limit nitrogenous extractives, table salt (6–8 g/day), foods rich in essential oils, spicy seasonings, spinach, sorrel, and smoked meats are excluded. Dishes are prepared boiled or steamed or baked. The temperature of hot dishes is no more than 60–65 °C. Free liquid – 1.5–2 l. The feeding rhythm is fractional, 4–6 times a day.

Indications for use.

Diseases and conditions that do not require special therapeutic diets. Diabetes mellitus type 2.

Proteins – 90–95 g (including animals – 40–45 g).

Carbohydrates – 300–330 g, including mono- and disaccharides (30–40 g), refined carbohydrates are excluded from the diet of patients with type 2 diabetes.

Energy value – 2170–2400 kcal.

Vitamin C – 70 mg (for veterans – 80 mg, for women maternity wards– 100 mg).

For women in maternity wards: additional milk – 200 ml, juices – 100 ml, fruits – 100 g.

Diet 15.

DIET WITH MECHANICAL AND CHEMICAL SPARING – DIET P

General characteristics, culinary processing.

A diet with a physiological content of proteins, fats and carbohydrates, enriched with vitamins, minerals, with moderate limitation of chemical and mechanical irritants of the mucous membrane of the receptor apparatus of the gastrointestinal tract. Spicy snacks, seasonings, spices are excluded, table salt is limited (10 g/day). Dishes are prepared boiled or steamed, pureed or unmashed. Food temperature – from 15 to 60–65 °C. Free liquid – 1.5–2 l. The feeding rhythm is fractional, 5–6 times a day.

Indications for use.

Diseases of the digestive system requiring a diet with mechanical and chemical sparing. Disorders of the masticatory apparatus. The period after operations on internal organs.

Proteins – 85–90 g (including animals – 40–45 g).

Fats – 79–80 g (including vegetable fats – 25–30 g).

Carbohydrates – 300–350 g, including mono- and disaccharides (50–60 g).

Energy value – 2170–2480 kcal.

Vitamin C is prescribed according to the standard basic diet (B).

A close analogue of the number system.

Diet 5 (for patients in the postoperative period, meals can be prepared according to the cards defined for diet 0 - DIET PP).

DIET WITH HIGH PROTEIN CONTENT –

DIET M (HIGH PROTEIN)

General characteristics, culinary processing.

A diet high in protein, normal amounts of fat, complex carbohydrates and limited in digestible carbohydrates. Table salt (6–8 g/day), chemical and mechanical irritants of the stomach and biliary tract are limited. Dishes are prepared boiled, stewed, baked, pureed or unmashed, or steamed. Food temperature – from 15 to 60–65 °C. Free liquid – 1.5–2 l. The feeding rhythm is fractional, 4–6 times a day.

Indications for use.

Diseases and conditions requiring the introduction of increased amounts of protein (malabsorption, kidney disease with nephrotic syndrome without impaired nitrogen excretory function, type 1 diabetes mellitus, sepsis and other severe bacterial diseases, severe anemia).

Proteins – 110–120 g (including animals – 45–60 g).

Fats – 80–90 g (including vegetable fats – 30 g).

Carbohydrates – 250–350 g, including mono- and disaccharides (30–40 g); Refined carbohydrates are excluded for patients with diabetes.

Energy value – 2080–2650 kcal.

Vitamin C – 70 mg.

A close analogue of the number system.

Diets 5, 7, 7a, b, 10.

According to the indications of the attending physician, special pharmacological composites and mixtures are prescribed.

LOW PROTEIN DIET –

DIET N (LOW PROTEIN)

General characteristics, culinary processing.

A diet limiting protein to 0.8, or 0.6, or 0.3 g/kg of ideal body weight (up to 60, 40 or 20 g/day), with a sharp restriction of table salt (2–3 g/day) and fluids (0.8–1 l/day). Nitrogenous extractives, cocoa, chocolate, coffee, and salty snacks are excluded. The diet includes protein-free white bread, purees, and mousses made from swelling starch. Dishes are prepared without salt, boiled, unprocessed. The diet is enriched with vitamins and minerals. The feeding rhythm is fractional, 4–6 times a day.

Indications for use.

Chronic glomerulonephritis with severe and moderate impairment of nitrogen excretory function of the kidneys and severe and moderate azotemia. Liver cirrhosis with hepatic encephalopathy.

Proteins – 20–60 g (including animals – 15–30 g).

Fats – 80–90 g (including vegetable fats – 20–30 g).

Carbohydrates – 350–400 g, including mono- and disaccharides (50–100 g).

Energy value – 2120–2650 kcal.

Vitamin C – 70 mg.

A close analogue of the number system.

Diets 5, 7g.

According to the indications of the attending physician, special pharmacological composites and mixtures are prescribed.

A DIET WITH INCREASED PROTEIN CONTENT AND INCREASED CALORIES – DIET T (HIGH PROTEIN AND HIGH CALORIE)

General characteristics, culinary processing.

A diet high in proteins, fats and carbohydrates. Dishes are prepared boiled, stewed, baked, or steamed. Second meat and fish dishes, boiled in pieces or chopped. Frying fish and meat after boiling is allowed.

Food temperature – from 15 to 60–65°C. Free liquid – 1.5 l. Sodium chloride – 15 g. The feeding rhythm is fractional, 4–6 times a day.

Indications for use.

Pulmonary tuberculosis. Burn disease.

Proteins – 110–130 g (including animals – 70–80 g).

Fats – 100–120 g (including vegetable fats – 20–30 g).

Carbohydrates – 400–450 g.

Energy value – 3000–3400 kcal.

Vitamin C – 70 mg.

A close analogue of the number system. Diet T and patients with burn disease if there are medical indications.

According to the indications of the attending physician, special pharmacological composites and mixtures are prescribed.

(developer name)

Layout card (technological map) No. ________________ for culinary products

________________________________________________

(name of culinary products)

1. Recipe

2. Description of the technology for preparing culinary products.

3. Characteristics of culinary products according to organoleptic indicators ( appearance, color, taste, smell and consistency).

4. Shelf life and storage conditions.

5. Nutrition information.

Replaceability table food products when preparing dietary dishes

	Name of the food product being replaced	Weight of food product (gross, kg)	Name of replacement food product	Equivalent mass of food product (gross, kg)	Food use
	Eggs without shell		Frozen egg melange		In egg dishes, casseroles, flour products, for breading products, in sweet dishes
	Unsalted cow butter		Peasant oil and other types of animal oil		In culinary products, semi-finished products, dishes
	Sunflower oil		Corn oil, soybean oil, olive oil and others		In cold dishes, marinades, fish dishes, flour products and others
	Refined sunflower oil		Unrefined sunflower oil		In marinades, cold vegetable and fish dishes, some sauces, and flour products
	Pasteurized whole cow's milk		Pasteurized low-fat cow's milk (with an increase in the amount of unsalted cow's butter in the recipe by 0.04 kg)
			Whole cow's milk powder		In soups, sauces, egg dishes, vegetable, sweet dishes, drinks, flour products and others
			Skimmed cow's milk powder (with an increase in the amount of unsalted cow's butter in the recipe by 0.04 kg)		In soups, sauces, egg dishes, sweet dishes, cereals, flour products
			Dry cream (with a decrease in the amount of unsalted cow butter in the recipe by 0.042 kg)		In milk porridges and flour culinary products
			Whole condensed milk with sugar (with a reduction in sugar in the recipe by 0.17 kg)		In sweet dishes, drinks
			Sterilized condensed milk in cans		In soups, sauces, sweet dishes, baked goods and drinks
			Condensed cream with sugar (with a reduction in unsalted cow butter in the recipe by 0.07 kg and sugar by 0.18 kg)		In milk porridges, flour products
	Granulated sugar		Xylitol, sorbitol*		In all dishes where sugar is replaced with xylitol
			Natural honey		In drinks, jelly, mousses, jelly
			Refined powder		In sweet dishes, casseroles, puddings
	Jam, jam		Fruit and berry marmalade (carved)		In sweet dishes
			Seedless jam
	Dry potato starch		Corn starch		In milk jelly, jelly
	Wheat breadcrumbs made from 1st grade flour		Wheat bread made from flour not lower than 1st grade		For breading culinary products
	Natural coffee, roasted		Natural instant coffee		In drinks
			Vanilla sugar		In sweet dishes
			Vanilla essence
					In sweet jelly dishes
	Green peas (canned)		Vegetable peas (shoulder) fresh		In cold dishes, soups, vegetable dishes, side dishes
			Fresh vegetable beans (shoulder)
			Fresh frozen green peas
	Fresh dill, parsley, celery		Salted dill, parsley, celery sprigs (with a reduction in salt in the recipe by 0.29 kg)**		For flavoring broths, soups, sauces
			Chopped salted dill, parsley, celery (with a reduction in salt in the recipe by 0.22 kg)**
			Dill, parsley, celery sprigs, quick-frozen
	Parsnips, parsley, fresh root celery		Dried white roots of parsley, celery and parsnips
	Fresh sorrel		Sorrel puree (canned)		In soups using sorrel
	Fresh spinach		Spinach puree (canned)		In soups using spinach and in vegetable dishes
	Fresh tomatoes				In soups, sauces and when stewing vegetables
	Fresh onions		Fresh green onion		In salads
	Fresh beets		Side beets (canned)		In dishes that use fresh beets
	Pickled cucumbers (net weight)		Salted tomatoes (net weight)		In salads, vinaigrettes
	Tomato puree with dry matter content 12%		Natural tomato juice with dry matter content 4.5%		In soups, sauces, when stewing meat, fish, vegetables
			Tomato puree with dry matter content 15%
			Tomato puree with dry matter content 20%
			Tomato puree with a dry matter content of 25–30%
			Tomato puree with a dry matter content of 35–40%
			Salted tomato paste with a dry matter content of 27–32% (with a reduction in salt in the recipe by 0.04 kg)**
			Salted tomato paste with a dry matter content of 37% (with a reduction in salt in the recipe by 0.03 kg)**
	Fresh apples		Apples whole, halves, quarters (blanched in sugar syrup) quick frozen		In sweet dishes
					In puddings, sweet sauces and dishes
	Dried grapes (raisins, sabza)		Candied fruits, dried apricots
	Kernel of nut, sweet almond		Core walnuts, hazelnuts, peanuts		In sweet dishes, puddings

*The norm for the interchangeability of sugar with xylitol and sorbitol is 1:1.

***Numerator is the mass of apples when the semi-finished product is defrosted in air, the denominator is the mass of apples when the semi-finished product is defrosted in sugar syrup.

MAGAZINE on control over the quality of prepared food (graining)

______________________________________

INFORMATION about the presence of patients on nutrition

at ___ o'clock "__" __________________ 20__

_________________________________________

(full name of organization)

Order for individual additional meals

____________________________________________________________________________

(full name of organization)

I APPROVED

_____________________________

(job title)

_____________________________

(signature, I.O. Surname)

_____________________________

Chamber number (department name)

Last name, first name, patronymic of the patient (number of patients)

Name of food products (code)

Quantity of food (g)

SUMMARY INFORMATION on the presence of patients on nutrition

at _____hours "__" ___________ 20__

___________________________________

(full name of organization)

REQUIREMENT No. __________ for the issuance of food products from a warehouse (pantry)

on _____ date _____ 20_

_____________________________

(name of company)

I APPROVED

_____________________________

(job title)

_____________________________

(signature, I.O. Surname)

_____________________________

SHEET for accounting for the supply of food rations to patients

_________________________________

(full name of organization)

Name (number) of the department

Number of patients

Numbers of dietary rations

The number of rations released from the kitchen to the departments and the receipt for their receipt

Number of dietary rations

breakfasts

receipt

receipt

receipt

HANDOUT SHEET for dispensing food rations to patients

to "__" _________________ 20__

(bill of lading dated ________ No. ______)

___________________________________

(full name of the supplier organization)

____________________________________

(full name of the recipient organization)

Diet number

Layout card number (technological card)

Name of dishes

Yield of one portion, g

Including by department

portions, pcs.

portions, pcs.

portions, pcs.

portions, pcs.

portions, pcs.

I.O.Name of the person financially responsible for receiving and issuing ready meals

I.O.Last name

I.O.Last name

I.O.Last name

I.O.Last name

Signature of the financially responsible person

(signature)

(signature)

(signature)

(signature)

Table on food replacement for protein and carbohydrates when preparing dietary dishes

Name of food products	Quantity of food products (net, g)	Chemical composition				Addition to the daily diet (+) or exclusion from daily ration (–)
		proteins (g)		carbohydrates (g)
Replacement of bread (protein and carbohydrates)
Wheat bread from grade I flour
Plain rye bread
Wheat flour, grade I
Pasta, vermicelli I grade
Semolina
Potato replacement (carbohydrates)
Potato
Cabbage
Pasta, vermicelli I grade
Semolina
Wheat bread, grade I
Plain rye bread
Replacement of fresh apples (in terms of carbohydrates)
Fresh apples
Dried apples
Dried apricots (seedless)
Prunes
Milk replacement (by protein)
Cottage cheese semi-fat
Fat cottage cheese
Fish (cod fillet)
Meat replacement (protein)
					oil +6 g
Cottage cheese semi-fat					oil +4 g
Fat cottage cheese					oil –9 g
Fish (cod fillet)					oil +13 g
Replacement of fish (by protein)
Fish (cod fillet)
					oil –11 g
					oil –6 g
Cottage cheese semi-fat					oil –8 g
Fat cottage cheese					butter –20 g
					oil –13 g
Replacement of cottage cheese (for protein)
Cottage cheese semi-fat
					oil –3 g
Fish (cod fillet)					oil +9 g
					oil –5 g
Egg replacement (by white)
Egg, 1 piece
Cottage cheese semi-fat
Fat cottage cheese
Fish (cod fillet)

Note. Use to analyze compliance with average daily food sets.”

Treatment of any disease begins with nutrition, and our health in general depends on good nutrition - this is what WHO believes. The concepts of healthy eating, therapeutic nutrition and diet are different. Healthy eating necessary for everyone who wants to stay healthy. Medical nutrition refers to the treatment of a disease, and diet is a broader term that includes both therapeutic and healthy nutrition.

Table No. 1 is prescribed for pathologies of the digestive system, that is, it refers to therapeutic nutrition.

The classification of tables according to Pevzner in dietetics is already outdated; since 2003, a new classification has been used in medical practice - a system of standard diets. It includes 6 varieties, since 2006 another one was added there, that is, now there are only 7 standard diets. Table No. 1 refers to the main option, as well as a gentle diet.

If we talk about the old classification, then there are several types of diet: table 1, 1a, 1b and their surgical options.

Table number 1 is prescribed for the following diseases:

• acute gastritis or exacerbation of chronic gastritis (in its various forms);
• peptic ulcer;
• diseases of the esophagus;
• GERD (when stomach contents leak into the esophagus);
• dumping syndrome (develops after removal of part of the stomach);
• diaphragmatic hernia (accompanied by the release of part of the stomach into the chest);
• irritable bowel syndrome with constipation;
• acute and chronic enteritis;
• after surgical interventions.

The main purpose of the diet is to meet the body's needs the right set nutrients during illness, as well as “help” organs restore their normal functioning - motor skills, the formation of digestive juices, and activate the healing of the organ mucosa.

General principles:

• diet involves limiting the intake of food that can increase damage to the mucous membrane upper sections digestive system (esophagus, stomach, duodenum);
• therapeutic nutrition is aimed at restoring functioning digestive tract;
• is complete in terms of protein, fat and carbohydrate content;
• meals are often taken in small portions;
• Steamed or boiled foods are served;
• food should be warm;
• Anything containing difficult-to-digest components, such as plant fiber, is excluded from the set of products;
• products are served in an easily digestible form - pureed, liquid or semi-liquid.

Table of ratios of BZHU for different types of diet

	1	1a	1b
Proteins, g	100	80-90	90
Fats, g	100	80-90	90
Carbohydrates, g	400-500	200	300-350
Calorie content, kcal	Up to 3000	Up to 2500	Until 2000
Salt, g	12	8	10

The diet is easily adapted to individual characteristics body by replacing several products. It can be in pureed or unprocessed form. Nutrition involves a “careful attitude” towards the mucous membrane of the diseased organ - mechanical sparing is achieved by grinding foods into purees, thermal - eating warm food, chemical - excluding irritating foods, which we will talk about in more detail later.

Table No. 1 for illnesses

Let's look at the features of diet for some diseases.

For stomach ulcers

Table number 1 is indicated for exacerbation of the disease. The need to use varieties of medical diet - 1a and 1b arises only with severe exacerbation in the first days of the disease. Then the food is served boiled and not pureed. stomach and duodenum up to 6 times a day, remove everything spicy, salty, smoked, and canned from the diet.

As the ulcers scar, symptoms subside and health improves, they move on to the general table. It is also recommended frequent meals and the optimal amount of protein in the diet. Since the latter reduces the activity of glandular cells, which leads to a decrease in production gastric juice, and also has a neutralizing effect on it. And consuming soy flour before meals for a period of 4–6 weeks reduces the production of pepsin and normalizes the peristaltic function of the stomach. Recently, the influence of diet therapy on the healing time of ulcers has been questioned.

For gastroduodenitis

Gastroduodenitis is accompanied by damage to both the stomach and duodenum. If the pathology comes from the intestine itself, that is, there is primary duodenitis, not provoked by pathology of the pancreas (pancreatitis), gall bladder (cholecystitis, cholelithiasis) or biliary tract, then in this case table No. 1 is introduced.

The emphasis in nutrition is on limiting fats and carbohydrates (sugar, honey), irritating foods are excluded, the diet is low in salt - 5-6 g per day. Avoid foods that can cause fermentation in the intestines - legumes, baked goods, some vegetables (cabbage, radishes, turnips), carbonated and alcoholic drinks. Also required frequent appointments food, excluding hot and cold dishes. Food is steamed, boiled, pureed.

For gastritis

Inflammatory diseases of the stomach are corrected by nutrition, taking into account the secretory function of the stomach. At lower education gastric juice ( autoimmune form chronic gastritis) in the acute phase of the disease, all products that irritate the gastric mucosa are excluded:

• strong broths, rich soups;
• strong tea, coffee;
• salty dishes;
• smoked meats;
• coarse vegetable fiber;
• spicy foods;
• products with added spices.

Meals are taken in small portions, every 2-3 hours. The amount of protein provided is slightly less than for peptic ulcer disease - approximately 15-20 g. The ratio of BZHU is 1: 1: 4.

After exiting the acute phase, the purpose of dietary nutrition is to stimulate the work of the gastric glands, aimed at enhancing the formation of hydrochloric acid. Mechanical irritants are added to the diet - stale white bread, crackers, dry cookies, kefir, yogurt, diluted milk (if it is well tolerated). A fragmented diet and restrictions on fats and fried foods also remain.

For infectious gastritis, preference is given to table 1b with a diet of 4–5 times a day. Remove juicey, irritating dishes. Food comes in semi-liquid form, with carbohydrates limited, since the latter increase the activity of the stomach glands. Cooking is carried out without frying.

The diet includes mucous and milk soups with buckwheat, semolina, oatmeal, pearl barley, soft-boiled eggs, soufflé, quenelles, meat and fish cutlets. From the second week of illness, the diet is expanded to table No. 1 with a gradual transition to the general table as recovery progresses.

With erosions in the stomach (erosive gastritis), nutrition is structured in the same way as with a peptic ulcer.

For GERD (gastroesophageal reflux disease)

For reflux, nutrition according to Pevzner has a number of features.

1. The diet includes a high protein content, which helps to increase the tone of the lower esophageal sphincter. It is because of its deficiency that aggressive digestive juice from the stomach enters the esophagus, which disrupts the functioning of the organ.
2. Avoid foods that increase pressure in the stomach and carbonated drinks.
3. Limit fats as they slow down gastric emptying.
4. Foods to be avoided: pork, beef, cold cuts, sea ​​fish, rice, pasta, fresh bread, cream, butter, cheeses with a fat content of more than 20%, spices, pickles, citrus fruits, nuts.

Grocery list

Let's look at what people on diet #1 can and can't eat.

Authorized Products

Flour products	Dried bread made from premium flour, biscuits, dryers.
Cereals	Semolina, rice, buckwheat, oatmeal, boiled in water or half milk, pureed, semi-viscous.
Soups	Vegetables with well-cooked cereals or pureed, seasoned with low-fat sour cream, egg-milk mixture.
From meat and fish	Steamed or boiled beef, young lamb, chicken, turkey, rabbit. Lean fish (pike, hake, cod, pollock) in pieces, steamed without skin, and also in the form of cutlets, quenelles, casseroles.
Vegetable dishes	Boiled vegetables (potatoes, carrots, cauliflower, beets) or in the form of souffles, purees, puddings. Pumpkin, zucchini, and broccoli are also allowed.
Dairy	Milk, cream, cottage cheese in the form of quenelles, lazy dumplings, puddings, fermented milk products with slight acidity
Snacks	Jellied fish in vegetable broth, boiled sausage, boiled tongue, salads from boiled vegetables.
Egg dishes	Steamed egg white omelette, soft-boiled eggs.
Sweet dishes, fruits	Fruit puree, baked apples, jelly, mashed compotes.
Beverages	Freshly squeezed diluted juices from sweet berries and fruits, jelly, weak tea, coffee drink, coffee, rose hip decoction, mineral water without gas.
Oils	Butter, peeled sunflower, corn, olive - are added to dishes.

Prohibited Products

Flour products	Rye bread, fresh bread, muffins, puff pastries.
Soups	Rich meat and fish broths, steep vegetable soups, mushroom broths, cabbage soup, borscht, okroshka.
Cereals	Millet, corn, barley, pearl barley.
From meat and fish	Goose, duck, pork, semi-finished products, stringy meat, smoked meat and fish, meat, canned fish, fatty fish.
Vegetables	White cabbage, turnips, radishes, rutabaga, salted, pickled and pickled vegetables, legumes (peas, beans, lentils), spinach, sorrel. Dill can be added to salads and ready-made dishes.
Dairy	Fermented milk products with high acidity.
Beverages	Carbonated, strong tea, coffee, alcohol, sour juices, freshly squeezed undiluted juices, kvass.
Sweets	Ice cream, sweets, cakes, pastries.
Other	Spicy snacks, seasonings, ketchup, mayonnaise, tomato paste, mustard, hot sauces, chili, horseradish dressing, etc.

Food Frequently Asked Questions

Below we will look at a number of frequently asked questions.

Is it possible to eat fruits and what kind?

You can eat sweet fruits and berries in the form of puree, jelly, baked, drink berry compotes, jelly, diluted juices. Varieties include bananas, apples, peaches, pears, nectarines, apricots, and berries: strawberries, raspberries, cherries.

What types of lean meat and fish are allowed?
Chicken, beef, rabbit, turkey, and lean lamb are allowed from animal and poultry meat. Fish allowed are hake, pollock, cod, saury, blue whiting, pike, and perch.

Menu

For your convenience, a menu has been developed below for every day and for the whole week.

Menu for every day for 5 meals a day:

Menu for a week for 5 meals a day

Monday
Breakfast	2 boiled soft-boiled eggs, milk jelly.
Dinner	Vegetable soup seasoned with butter, steamed chicken cutlets, dried fruit compote without sugar.
Afternoon snack	Fruit puree, diluted apricot juice.
Dinner	Lazy dumplings with sour cream, tea with milk.
Before bedtime	A glass of milk.
Tuesday
Breakfast	Steamed protein omelette, pureed oatmeal, weak tea.
Dinner	Buckwheat soup, turkey quenelles, rosehip infusion.
Afternoon snack	Baked apple, dried fruit compote.
Dinner	Steamed fish cutlets, baked vegetables, coffee drink.
Before bedtime	A glass of milk.
Wednesday
Breakfast	Oatmeal porridge with half milk is viscous, cottage cheese with berries, weak tea.
Dinner	Pumpkin puree soup, meat casserole, oatmeal jelly.
Afternoon snack	A glass of milk, drying.
Dinner	Jellied fish in vegetable broth, vegetable puree from potatoes, cauliflower and zucchini, tea.
Before bedtime	A glass of curdled milk.
Thursday
Breakfast	Buckwheat milk porridge, mashed, soft-boiled egg, tea.
Dinner	Noodle soup, chicken breast meatballs, apple compote.
Afternoon snack	Fruit puree, biscuits.
Dinner	Cottage cheese pudding, rosehip infusion.
Before bedtime	Boiled milk.
Friday
Breakfast	Semolina porridge, soft-boiled egg, weak tea with milk.
Dinner	Buckwheat soup with vegetables, boiled chicken breast.
Afternoon snack	Fruit jelly, biscuits.
Dinner	Fish dumplings, assorted steamed vegetables.
Before bedtime	Boiled milk.
Saturday
Breakfast	Milk soup with homemade noodles, steamed omelette, oatmeal jelly.
Dinner	Potato soup, boiled turkey, dried bread, coffee drink.
Afternoon snack	Fruit puree, curdled milk, straws (unsalted).
Dinner	Pumpkin and carrot puree, fish cutlets, tea.
Before bedtime	Not sour kefir.
Sunday
Breakfast	Steamed protein omelette, pureed oatmeal, coffee drink with milk.
Dinner	Vegetable soup seasoned with butter, steamed chicken cutlets, rosehip infusion.
Afternoon snack	Steamed cottage cheese souffle, boiled milk.
Dinner	Fish and vegetable casserole, mashed potatoes.
Before bedtime	Curdled milk.

Features of the diet for children

For children, as well as for adults, the treatment table is prescribed according to indications. If the child was on a general diet before the disease, then the recommendations will not differ from those for adults. All products allowed on the menu are in accordance with age standards on nutrition. If any products are not yet allowed for the child due to age (for example, if these are children under one year old) or due to individual intolerance or allergies, then they are also excluded from the menu.

Recipes

All the recipes below are suitable for people who follow the Pevzner diet table 1.

First meal

Vegetable soup with beets

Take: 2 medium beets, 2 carrots, 2-3 potatoes, 1 onion, sour cream, dill, salt. Preparation: Boil the beets whole in their skins. While the beets are cooking, peel and chop the onions, potatoes, and carrots. Grate the carrots. Pour water into a saucepan, place the chopped vegetables in it, and put on fire. Cool the beets, remove the peel, grate them, and place them in the pan. Before turning off the soup, add salt and dill. Serve with sour cream.

Pumpkin soup with croutons

Take half a medium pumpkin (about 500 g), 1 onion, 1 carrot, 50 g low-fat cream, salt, crackers. Preparation: Peel the onions and carrots. Finely chop the onion, grate the carrots, heat the vegetables in oil in a frying pan for 1 minute. Peel the pumpkin and cut it into small pieces to make it cook faster. Place it in a saucepan and add some water and the rest of the vegetables. Once the vegetables are cooked, cool a little and blend with a blender, add salt, add cream, and bring to a boil. Serve the puree soup with croutons.

Second courses

Take: 500 g turkey fillet, 2 onions, 1 large carrot, 1 medium zucchini, sour cream, dill, salt, vegetable oil. Preparation: Wash and cut the turkey. Peel the vegetables, cut them, lightly simmer the onions and carrots in a frying pan with a little water. Mix sour cream with salt and pour it over the vegetables, stir. Place the vegetables in the baking sleeve, then the turkey, secure the bag tightly on both sides and place in a preheated oven for 1 hour. Serve the dish with finely chopped dill. Take: fish fillet 500 g (or fish with few bones), 2 heads onions, 100 g of bread, dill, salt, half a glass of cream, egg. Preparation: wash the fish, remove bones. Cut into small pieces. Peel the onion and cut into quarters. Soak the bread in cream. Then the fish, onions and bread need to be twisted in a meat grinder. If you decide to take a bony fish, for example, pike, then you will need to twist it 2 times in order to grind the small bones well.

Add salt, finely chopped dill, egg to the minced meat, stir well. Place a pan of water on the gas. While the water is heating, make balls from the minced meat. As soon as the water boils well, carefully lower the balls into the water, stirring lightly for 15 minutes. Then place the quenelles in a dish and serve with sour cream and herbs.

Salads

Beet salad and chicken breast

Take: 1 medium beet, 3 potatoes, 150 g chicken breast, sour cream, dill, onion. Preparation: Boil vegetables and meat. Grate the beets, cut the potatoes into cubes, finely chop the breast. Chop the onion and pour boiling water for 5 minutes to remove the bitterness. Mix vegetables with breast, season with sour cream, sprinkle with dill on top.

Carrot, apple, raisin salad

Take: 2 carrots, 1 apple, half a glass of raisins, sour cream. Preparation: Peel the carrots and grate them. Remove the core from the apple, cut off the peel, and cut into cubes. Rinse the raisins well and soak in boiling water for 10 minutes. Mix carrots, apples, raisins with sour cream. Salad ready.

Dessert

Take: 2 cups of flour, half a cup of water, half a cup of vegetable oil, egg, 1 tbsp. sugar, 300 g of cottage cheese, soda on the tip of a knife. Preparation: mix water, butter, sugar, egg, add cottage cheese, then flour. Stir well. The dough should turn out like thick sour cream. Grease a baking sheet with oil and spoon the dough onto the sheet. You can use a special cookie cutter. Bake for 30 minutes.

Table No. 1 after operations

When prescribing therapeutic nutrition according to Pevzner after operations, surgical modification of diet 1a and 1b is used.

Features of surgical table 1a:

• prescribed 2–3 days after surgery;
• provides maximum unloading of the gastrointestinal tract (gastrointestinal tract);
• easily digestible forms of nutrients are used;
• food comes with maximum sparing of the digestive tract - in crushed form;
• food temperature is less than 45 degrees;
• BJU ratio is 1:1:5, 50 g of protein and fat, 250 g of carbohydrates per day;
• energy value up to 1600 calories;
• additional enrichment of nutrition with vitamins and microelements;
• sharp restriction of salt to 5 g per day;
• additional liquid 1.5-1.8 l;
• frequent meals - up to 6 times a day, in portions of no more than 350 g at a time.

Patients are then transferred to table 1b as digestion is restored. Dishes are pureed and pureed, the temperature of hot dishes is up to 50 degrees, cold ones - more than 20 degrees. The BJU ratio changes slightly to 1:1:4(4.5), the calorie content of the diet increases to an average of 2500 calories, additional liquid to 2 liters, salt to 6 g.

The transition from diet 1a to 1b occurs gradually, first expanding on individual products. If well tolerated, new products are continued to be introduced. Be sure to monitor symptoms of digestive disorders (diarrhea, flatulence, increased peristalsis), and the appearance of pain. Products that cause such symptoms are excluded from the diet for a long time (up to several months).

The prescription of therapeutic diets is combined with the intake of special enteral mixtures - balanced products with high nutritional value, enriched with vitamins and microelements. As the diet expands, the amount of nutritional mixtures is reduced. Let's take a closer look at the nutritional features after operations on the intestines and gall bladder.

After intestinal surgery

The diet should be aimed not only at ensuring the restoration of substances important for the functioning of the body lost during the intervention (electrolytes, water, proteins, fats, carbohydrates, vitamins, microelements, etc.), but also at the earliest possible activation of digestion.

Since it was “turned off” during the operation, absorption from the digestive tract is therefore impaired immediately after the operation. And now the task is to “start” digestion, absorption, and restore normal composition microflora and generally normalize the functioning of the digestive tract.

On days 3–6 after surgery, therapeutic nutrition begins to be introduced; the start time is based on the patient’s condition. Transfer too early natural nutrition after intestinal surgery significantly worsens the course of the recovery period.

Therapeutic nutrition is carried out through the appointment of table No. 0a, 1, 1b surgical. Surgical diets have a generally low nutritional value and are combined with the use of special nutritional mixtures for oral administration. A few days after surgery, patients' diet is expanded to surgical table 1a, which is prescribed for up to 4 days.

After another 10 days, a smooth transition is made to surgical diet 1b, and then to surgical diet number 1, while the pureed version will have to be followed for a long time. And in the first 3–4 weeks after discharge from the hospital, patients are prescribed surgical table No. 1 in a wiped form. After this, there is a transition to the unprocessed version of diet 1.

Good tolerability of a new dish indicates that the restoration of the digestive system is proceeding correctly, namely: the ability to produce digestive juices, digest incoming food and remove unnecessary contents from the intestines.

If any product is poorly tolerated, patients after intestinal surgery should not exercise their intestines, that is, when they specifically load the intestines with products that are poorly accepted by them so that they “get used” to them. These workouts can aggravate the deficiency of intestinal enzymes and provoke the development of irreversible phenomena.

With the development of intolerance to milk and dairy products - manifested by the inability to digest milk sugar lactose should be avoided for a long period whole milk. TO fermented milk products(kefir, cottage cheese, yogurt, sour cream) this applies to a lesser extent. Dairy products can be replaced with soy products; they have a set of amino acids similar in chemical composition to milk proteins, but are superior to animal milk proteins due to unique biologically active substances.

After gallbladder surgery

The principles of therapeutic nutrition in the rehabilitation of patients who have undergone gallbladder removal have not changed significantly over the past decade. Usually the following scheme is followed:

1. On the first day you cannot eat or drink.
2. On the second day, they begin to introduce liquid a little at a time, gradually increasing it to 1 liter; you can drink in small sips. Mineral is allowed still water, rosehip decoction with gradual expansion to decoctions of dried fruits, weak tea, low-fat kefir. All drinks come without added sugar. By the 3rd day, the total volume of liquid is brought to 1.5 liters.
3. Then add unsweetened vegetables and fruit juices(from pumpkin, carrots, beets, rose hips, apples), fruit jelly, mashed potatoes, tea with sugar, pureed soups meat broth second or third cooking. Food intake is in small portions, such nutrition continues until the 5th day after surgery.
4. After a week, the menu continues to expand: white bread crackers, savory cookies, dried porridges, pureed porridges (buckwheat, oatmeal, wheat) with water or half and half with milk, cottage cheese, twisted meat (beef, veal, chicken, rabbit), boiled fish, vegetable puree, fermented milk products.
5. Starting from 1.5 weeks and up to 1.5 months, a gentle diet (all dishes are steamed or boiled).

And a person’s ability to work.

By changing the nature of nutrition, you can regulate the metabolism in the body and thereby actively influence the course of the disease. When prescribing dietary nutrition, the starting point is a rationally constructed diet for a healthy person, which changes qualitatively and quantitatively according to the disease of an organ or an entire organ system.

Dietary measures either completely eliminate certain nutrients from the diet, or prepare them technologically in such a way that the impaired functions are compensated. For example, when diabetes mellitus when the disturbance in the absorption of carbohydrates changes, simple sugars are temporarily or completely eliminated from food, and the inclusion of foods rich in starch is limited. In some cases, simple sugars are replaced with sweeteners. For gastritis with hypersecretion of gastric juice, food substances that are strong irritants of gastrointestinal secretion are excluded from the diet.

Sparing

These techniques constitute the principles of dietary (therapeutic) nutrition, the so-called “sparing”. There are three types of sparing: mechanical, chemical, thermal.

Mechanical sparing is achieved mainly by grinding food, as well as by an appropriate method of heat treatment - grinding cooked food (steamed or in water).

Chemical sparing is achieved by eliminating or limiting those nutrients that can further disrupt the functions of the diseased organ, as well as by changing the method of culinary processing.

Thermal sparing- exclusion of strong thermal irritants from food, i.e. very cold or very hot food. The temperature of the first and second hot courses should not be higher than 60°, snacks and drinks should not be lower than 15°. This must be taken into account, since hot dishes have a juice-like effect and weaken gastric motility, while cold foods reduce gastric secretion and increase motility. Thermal sparing is used mainly for gastrointestinal diseases.

When prescribing a particular diet, it is necessary to take into account overall impact products and dishes on the gastrointestinal tract. For example:

• foods that quickly leave the stomach (dairy products, soft-boiled eggs, fruits and berries);
• slowly digestible foods (fresh bread, refractory fats, fried meats, legumes);
• having a pronounced juice effect - nitrogenous extractive substances (mushrooms (broths made from them), cheese, spices, cabbage, cucumbers, smoked meats);
• having a weak juice effect (milk and dairy products, boiled vegetables and fruits, boiled meat, green peas, butter, fresh cottage cheese, soft-boiled egg);
• having a laxative effect (prunes, vegetable oil, xylitol, sorbitol, cold vegetable dishes, cold vegetable juices, sweet drinks, vegetables and fruits, one-day kefir, cold mineral water, wholemeal bread);
• reverse action (hot dishes, jelly, rice and semolina, flour dishes, cocoa, coffee, chocolate);
• have a choleretic effect (vegetable oil, especially olive oil, vegetables rich vegetable fiber, tomatoes, grated radish with vegetable oil, beets, sorbitol, xylitol);
• cause flatulence (legumes, fresh bread, especially rye, white cabbage, whole milk);
• stimulate the central nervous system (meat and fish broths, cocoa, strong tea, herbs, spices).

For some diseases (obesity, atherosclerosis, hypertonic disease etc.) are used fasting diets, the purpose of which is to ensure the most complete sparing of the affected organs and systems, to promote the normalization of metabolism and the removal of excessive amounts of adversely active substances from the body. This is achieved by sharply reducing the energy value of the diet and the content of nutrients that burden the functioning of diseased organs.

The diet is very important in dietary nutrition. The number of meals a day is increased to five. Accordingly, the intervals between meals are reduced (up to 3-4 hours). Due to a decrease in appetite in patients, it is necessary to strictly observe the timing of meals, with the exception of diet No. 1 (for gastritis with increased secretion of gastric juice) and diet No. 8 (obesity). Some diets recommend more uniform distribution calorie content by meal. Important has an assortment of dishes, culinary processing of food, which improves the taste of dietary dishes and provides all types of pacing, preserves biological value diet and optimal digestibility of nutrients.

Characteristics of basic diets

Dietary nutrition is used both in hospitals (hospitals) and in sanatoriums. In our country, a group number system for prescribing therapeutic nutrition is used. The main diets are designated by corresponding numbers from No. 1 to No. 15. The most common diets are No. 1, 2, 5, 7, 8, 9, 10, 15.

Diet No. 1

Indications: inflammatory diseases of the stomach (gastritis) with impaired secretory and motor functions, gastric and duodenal ulcers. The causes of these diseases are systematic violation of the diet, consumption for long period very hot and spicy food, very hot or cold food, poor chewing, dry food, nervous system disorder, smoking, alcohol abuse.

Purpose of destination. Normalize the secretory and motor functions of the stomach, stimulate the process of restoration of the mucous membrane and promote the healing of ulcers.

general characteristics. A complete diet. All types of sparing are used.

Mechanical sparing. All dishes are prepared boiled (in water or steamed), chopping, pureed dishes, meat is consumed without tendons, cartilage, fish and poultry - without skin.

Chemical sparing. The diet excludes extractive substances (strong meat, fish, mushroom broths, all sour dishes and salty, fermented products, all types of spices, except dill and parsley). It is not recommended to use strong tea, coffee, or fried foods.

The diet is 5 meals a day, with short breaks and small portions.

Diet No. 2

Indications: inflammatory processes gastric mucosa, gastritis with decreased secretion gastric juice, chronic inflammatory diseases of the small (enteritis) and large (colitis) intestines.

Purpose of destination. Stimulate the secretory function of the stomach, normalize the motor function of the stomach and intestines, reduce putrefactive and fermentative processes in gastrointestinal tract.

The causes of stomach diseases are similar to those described in diet No. 1. A common cause of intestinal diseases are intestinal infections (food poisoning, dysentery, etc.), consumption of rough food (unripe vegetables and fruits), disordered eating, nervous system disorders, etc.

General characteristics. A complete diet. Moderate mechanical, chemical and thermal sparing is used.

Chemical sparing involves eliminating excess fat, which inhibits gastric secretion.

Dishes that are difficult to digest, irritating the mucous membrane of the gastrointestinal tract, increasing fermentation (whole milk, white cabbage, rye bread, sweet fruit juices, sweets, etc.), rotting (fried meat dishes in large quantities) are excluded.

To stimulate gastric secretion, extractive substances from meat, fish and mushroom broths are used, but they must be secondary, since it is necessary to reduce the fat content in the broths. The same goal is pursued by maintaining a diet, especially strictly observing the time of eating to develop a conditioned food reflex. The conditions of eating, table setting, and organoleptic characteristics of the food are also important. The correct composition of the menu is also important, especially for lunch - including a snack and a hot dish.

Meal regimen: 5 meals a day, 4 meals a day allowed. Diet No. 5

Indications: acute and chronic diseases of the liver (hepatitis), gall bladder (cholecystitis), cholelithiasis.

Purpose of destination. Help normalize the activity of the liver and gallbladder and prevent the formation of stones.

Most common reasons These diseases are biliary tract infections and violation of the principles rational nutrition: overeating, especially foods rich in animal fats, cholesterol (dishes and gastronomic products made from fried meat, offal, goose, duck, eggs); restriction in the diet of protein, vegetable oils, vegetables with a choleretic effect, grain products rich in dietary fiber; abuse of salt, pickled vegetables, vegetables containing oxalic acid (sorrel, spinach, rhubarb, etc.), fried foods; non-compliance with the diet (food intake is a stimulus for bile secretion: the less often a person eats, the longer and more bile stagnates in the gallbladder).

General characteristics. A complete diet, but with a limitation of refractory fats, and the inclusion of an increased amount of lipotropic substances in the diet. Also excluded are products rich in extractives, purines, cholesterol, oxalic acid, essential oils, and fat oxidation products. To normalize liver function, in addition to lipotropic substances, it is necessary to include fiber, pectin substances and a lot of liquid.

Diet - 5 times a day, in small portions at the same time.

Diet No. 7

Indications: spicy and chronic inflammation kidney (nephritis).

Purpose of destination. Sparing the affected organ and removing excess fluid and nitrogenous waste from the body.

general characteristics. The diet is complete, with some protein restrictions. The fluid content in the diet is reduced, all dishes are prepared without salt, 3-4 g of salt are given to the patient, dishes rich in extractive substances, foods rich in oxalic acid and essential oils are excluded. Your diet should include foods rich in potassium.

Diet - 5 times, 4 times allowed.

Diet No. 8

Indications: obesity as a primary disease or concomitant with other diseases.

The main causes of obesity are physical inactivity, excess nutrition, rare but generous receptions write, abuse of fatty gastronomic products and flour confectionery products, sweets, spices.

Purpose of destination. Normalize body weight, promote metabolism restoration.

General characteristics. The diet is incomplete. Calorie restriction due to carbohydrates (digestible) and partly fats (animal). Exclusion from the diet of appetite-stimulating foods and dishes, confectionery and sweets, limiting salty foods and liquids.

Including increased amounts of seafood and fiber-rich foods in the diet.

Diet: 5-6 meals a day.

Diet No. 9

Indications: promote normalization carbohydrate metabolism, prevention of fat metabolism disorders.

General characteristics. A diet with a moderately reduced energy value due to the exclusion of easily digestible carbohydrates and fats of animal origin. Limited complex carbohydrates(starch) and products that burden the liver, containing cholesterol, extractive substances.

In the diet, the content of lipotropic substances, vitamins (especially vitamin C and the B group of vitamins), and dietary fiber is increased. Food is prepared boiled and baked.

For sweet dishes, sweeteners are used - xylitol and sorbitol.

Diet: 5-4 meals a day.

Diet No. 10

Indications: for diseases of cardio-vascular system(hypertonic disease, ischemic disease heart, myocardial infarction, atherosclerosis).

Purpose of destination. Help restore impaired blood circulation, normalize liver and kidney function, and slow the progression of atherosclerosis.

General characteristics. The diet excludes substances that stimulate the central nervous system and the cardiovascular system, strong tea, coffee, cocoa, chocolate, meat, fish, mushroom broths, spicy dishes, smoked meats, foods rich in cholesterol. Limit vegetables causing flatulence(radish, cabbage, garlic, onions, legumes), carbonated drinks. Products of predominantly alkaline orientation (containing K, Mg, Ca salts) are recommended.

The share is increasing vegetable fats(up to 40%). The diet is enriched with dietary fiber, vitamins C, P, E, carotenes, and iodine.

Limiting salt and water.

Diet: 4-5 meals a day.

Diet No. 15

Indications: various diseases that do not require the use of special diets, as well as a transitional diet during the recovery period from special medical nutrition to a balanced diet.

Purpose of destination. Provide physiological needs for nutrients and energy.

General characteristics. The diet is physiologically complete, biologically rich valuable substances: essential amino acids, unsaturated fatty acids, vitamins. Salt— 10-15 g, free liquid 1.5-2 l. Avoid hard-to-digest foods and dishes, spicy foods and spices, and smoked foods.

Diet- 4 times.

Order No. 330 of the Ministry of Health of the Russian Federation

Information letter from the Ministry of Health of Russia dated 04/07/2004, which provides clarifications, additions and clarifications to the specified document. It says that a new nomenclature of diets (a system of standard diets) is being introduced into health care facilities, which differ from each other in the content of basic nutrients and energy value, food preparation technology and the average daily set of food products.

Previously used diets of the number system (1-15) are combined or included in the system of standard diets, which are prescribed for various diseases depending on the stage and severity or complications of the organs or body systems.

Table 1. System of standard diets

The introduction of a new nomenclature of diets (a system of standard diets) into the work of medical institutions provides for the possibility of using in these institutions an individual approach to dietary therapy for a specific patient with a specific disease (Tables 1, 2).

Table 2. Chemical composition and energy value of standard diets

Medical nutrition for chronic diseases Kaganov Boris Samuilovich

Chapter 3 System of standard diets for therapeutic nutrition

System of standard diets for therapeutic nutrition

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

Numerous studies on the mechanisms of food assimilation under normal conditions and in various diseases formed the basis for the development of balanced nutrition concepts, and then optimal nutrition concepts, according to which the chemical structure of the diet and its nutritional, biological and energy value must correspond functional status enzyme systems of the body 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 on different levels assimilation of food: 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 and preventive institutions (HCI) of the USSR and the Russian Federation was based on a nosological principle in the form of dietary rations developed in the Clinical Nutrition Clinic of the Federal State Budgetary Institution "Research Institute of Nutrition" of the Russian Academy of Medical Sciences and approved by the Ministry health care 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 options were developed dietary tables. In practical diet therapy, with all the variety of nosologies, five diet options were mainly used - No. 1, 5, 7, 9 and 15. The number system was convenient for organizing group, rather than personalized (individualized) nutrition.

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

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

Order of the Ministry of Health of Russia dated August 05, 2003 No. 330 “On measures to improve clinical nutrition in medical institutions of the Russian Federation” introduced a new nomenclature of diets (a system of standard diets), which combines the previously used diets of the number system (diets No. 1-15 ).

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

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

Table 7

Standard diet system

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

In subsequent years, the Ministry of Health and Social Development 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).

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

Table 8

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

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