Aringazina
A. M., Kolpakova A.S.
(KAZAKHSTAN'S MEDICAL UNIVERSITY
"KSPH", Almaty)
Organization
of clinical nutrition at the hospital
Review: Clinical nutrition can be as the meal, fully meets the needs of patient
body in nutrients and especially taking into account how it occurring in the
metabolic processes and the status of individual functional systems.
Key words: nutrition, hospital, patient diet .
Everyone knows that food is necessary for normal functioning of the
body. Nutrition is a set of processes including entry into the body, digestion,
absorption and assimilation of the nutrients, that is an integral part of the
metabolism.
The nutrition satisfies as one of the
most important physiological needs of the human body, providing its formation,
operation, resistance to adverse environmental effects, but also it plays an
important role in the prevention and treatment of many diseases. Special
organized clinical nutrition is a prerequisite of many diseases treatment.
Clinical nutrition can be as the meal, fully meets the needs of the body of the
patient in nutrients and especially taking into a count how it occurring in the
metabolic processes and the status of individual functional systems.
In accordance with the physiological principles of health food
constructions diets are made in the form of daily food rations. Each daily food
patient's diet, in other words, has its energy value, caloric content, chemical
composition (certain amount of protein, fats, carbohydrates, minerals, water,
vitamins, extractives, and other materials), or physical properties like:
weight (amount), consistency, temperature of the food and finally, the routine
of diet. All of this are the main elements of the diets, which are practically
realized in the form of a menu of specific products corresponding cooking
processing [1,2].
In the Republic of Kazakhstan all the principles of construction and
system of clinical nutrition appointment are written in the resolution of the
Government from January 26, 2002 ¹128 “On approval of natural food rules and
the minimum standards for equipment soft inventory of public health
organizations of the RK”[3]. The another main document concerning the clinical
nutrition is the Decree of the Minister of Health of the Republic of Kazakhstan
from April 8, 2002 ¹343 “On the organization of clinical nutrition in health
prevention organizations” [4].
Nutrition of the patient is of great importance not only to restore the
disease occurring during losses in the body and to maintain the force, but also
as an effective therapeutic agent. Modern science found that during any disease
the diet has some impact, and in some cases has a decisive influence on the
course and outcome of disease.
There are two systems that are used in the appointment of clinical
nutrition: elemental and dietary [5,6]. The elemental appointment of clinical
nutrition is made for each patient by writing a specific recipe transfer
performance of each element of the daily diet; the daily menu is made on the
basis of this recipe. This system is referred to as an individual, but this
definition is not entirely true, because properly organized clinical nutrition
necessarily requires an individual diet destination. If the elemental system is
developed by physician for each patient's individual diet, dietary system is
prescribed by the number of pre-designed, clinically proven and have certain
medicinal properties of diets.
The basic system of medical and health care institutions is a system of
dietary nutritional therapy appointment. The elemental system can practically
be used only in rare cases, when developed and applied in the hospital diets
are in need of amendments, taking into account the complexity and the specific
conditions of the patient’s disease [7].
The specific issue of dietary system is adjusting the prescribed diet.
Such additional purpose or dietary restrictions should be carried out by
designating products having specific therapeutic properties (cottage cheese,
liver, milk, watermelon, apples, garlic, etc.), or by adding or limiting
nutrients (proteins, fats, carbohydrates, salt, vitamins). Further designation
of special products must correspondingly be reduced in the content of other
dietary products to maintain essentially the chemical composition and calorific
intake.
It is common knowledge that each diet has its characteristics, the
number of the diets is determined by the profile of the hospital. In each
hospital, the main, permanent diet and contrasting days are established. The
average number of the diets in hospital is 7–8 [8].
The routine of the diet is essential to the effective operation of
clinical nutrition, which consists of the number of meals, time of patient’s
nutrition, nutritional value and volume of food received for 1 time.
Since the Soviet times hospitals have established at least four meals
mode, but for the some groups of patients (heart diseases, stomach ulcer,
infectious diseases and others) have had 5–6 times mode [9,10]. It is necessary
to strive for a more or less uniform distribution of the daily diet, but in any
case not to allow a significant amount of high-calorie dinner; usually in the
evening should not account for more than 25–30% of daily calorie routine.
Between the individual meals should not be allowed a break of more than 4 hours
during the day and between the last evening meal and morning breakfast break
should be no more than 10–11 hours (Table 1).
Table 1 – Uniform distribution of daily diet
|
Hours |
Caloric
value in % to daily ration |
|
8–9
(breakfast) |
30 |
|
13–14
(lunch) |
40 |
|
17–18
(dinner) |
20–25 |
|
21
(overnight) |
5–10 |
|
Source: Michael
J. Gibney et al, 2010 |
|
According
to the 5 times nutrition mode the tiffin is set, to the 6 times nutrition mode
– afternoon snack with more or less uniform distribution of the daily diet. It
is necessary to include hot food in each meal of the patient. The temperature
of the liquid hot dishes should be about
Typically, clinical nutrition is administered in combination with other
therapies (drugs pharmacological, physiotherapeutic procedures and etc). In
some cases, the nutritional therapy serves as one of the main therapeutic
factors for the patients with the digestive system diseases or metabolic
diseases, in other cases it creates a favorable background for the more effective
implementation of other therapeutic measures.
Clinical nutrition should be tailored to the physiological needs of the
patient. Therefore, any diet should meet the following requirements [15,16]:
1) to vary, but their energy value in accordance with the power
consumption of the organism;
2) to provide the body's need for nutrients based on their balance;
3) to cause an optimal filling of the stomach necessary to achieve easy
satiety;
4) to satisfy the tastes of the patient to the extent permitted by the
diet, taking into account the tolerance of food and menu variety. Monotonous
food quickly bored, helps oppression and loss of appetite, lack of digestive
organs arousal activity impairs digestion [17];
5) to ensure proper cooking of food while maintaining the high
palatability of food and valuable properties of raw foods;
6) to observe the principle of regular meals.
So, clinical nutrition should be sufficiently dynamic. The need for
dynamism dictated by the fact that any medical diet in one way or another is
restrictive and, therefore, one-sided and incomplete. That’s why long
compliance particularly strict diets can lead, on the one hand, to the partial
body fasted for certain nutrients, to the other, to not training of functional
mechanisms during recovery.
In the conclusion, we would to say, that is very imporant to pay
attention on the clinical nutrition (diet), which is prescribed in the form of
food ration and is consisted of certain products subjected to appropriate
cooking. The word “diet”, which meant in Ancient Greece “lifestyle” after
repeated transformation of the original dio, dies (day) today is treated as a “diet
and nutrition, prescribed to patients”[18]. Now the science of dietary include
nutritionists, who studies nutrition of healthy and sick person, develops the
basics of good nutrition and methods of organization and diet therapy (healthy
food). Thus, nowadays diet is not only an effective means of complex treatment
of many ailments, but also means of contributing to their prevention.
References:
1.
Tutelyan V.A., Diet guide.
M.:Medicina, 2002, –544 p.
2.
Werbach M.R., Nutritional Influences
on Illness: A Source Book of Clinical Research, Thorsons, 2006, – 450 p.
3.
Decree of the Minister of Health of
the Republic of Kazakhstan “On approval of natural food rules and the minimum
standards for equipment soft inventory of public health organizations of the Republic
of Kazakhstan”. January 26, 2002. ¹128.
4.
Decree of the Minister of Health of
the Republic of Kazakhstan “On the organization of clinical nutrition in health
prevention organizations”. April 8, 2002. ¹343.
5.
Rosalinda T. L., Virginia S. C., Nutrition
and Diet Therapy Reference Dictionary. Jones & Bartlett Learning, 1996. –
491p.
6.
Lashkina A.M., Food Hygiene. A
teaching book for students. SKL. 2002. P.20-38.
7.
Shelton G., Correct combination of
food. STP.: EKAM, 1991. – 267 p.
8.
Bregg P.E., Health and longevity. M.:
Unity. 2004. – 124 p.
9.
Pokorn D., Complete encyclopedia of
clinical nutrition. Olma-Press. 2012. – 515 p.
10.
Baranovski A.Y., Guide to the
nutrition. StP.:Piter. 2001. – 544 p.
11.
Smolyanski B.L., Clinical nutrition.
StP.: SOVA. 2006. – 896 p.
12.
Michael J. Gibney, Marinos Elia, Olle
Ljunggvist, Julie Dowsett. Clinical Nutrition. Blackwell: 1st Edition. 2010. –
421 p.
13.
Leah Coles. Clinical Nutrition: The
Interface Between Metabolism, Diet, and Disease. Apple Academic Press. 2014. –
444 p.
14.
Luboš Sobotka, Simon P. Allison,
Alastair Forbes, Olle Ljungqvist. Basics in clinical nutrition. Galen: 4th
edition. 2015. – 47p.
15.
Vishwanath Sardesai, Introduction to
Clinical Nutrition. CRC Press. October 11, 2011– 704 p.
16.
Katherine L. Tucker; Benjamin
Caballero; Robert J. Cousins; A. Catharine Ross; Thomas R. Ziegler, Modern
Nutrition in Health and Disease.11th ed by Shils. 2012. – 328 p.
17.
Christos S. Mantzoros, Nutrition and
Metabolism. KM.: Time. 2013. – 107 p.
18.
Greece's diet crisis: Greeks abandon
traditional foods, and an obesity epidemic is the result from https://www.marketplace.org/2012/10/29/sustainability/food-9-billion/greeces-diet-crisis-greeks-abandon-traditional-foods-and-obesity-epidemic-result