Clinical Dietetics Journal. Practical dietetics: making a proper nutrition plan

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SURPRISE!
SPRING INSIDE
on pages 5, 38

Dietetics for therapists
In mid-March, the country's leading nutritionists, experts in the field of nutrition for sick and healthy people, made presentations at the First Congress of Therapists of the Moscow Region with international participation, held in Krasnogorsk at the Government House of the Moscow Region. Read what nutritionists told their colleagues, therapists and doctors of other specialties, in the latest issue of the magazine on page 16.

40 or more events, it-exclusive in Leningrad region, about sanatoriums in the south of the country and much more
How 2016 went for the National Association of Clinical Nutrition, what the most significant events for the life of Russian dietetics took place thanks to the work of the association, read in the news of the spring issue on page 12.

Ministry is in touch!
Feedback - in 2017, the nutritional service launched a large-scale monitoring center to collect reporting information from the constituent entities of the Federation to generate a final report - “ Personal accounts nutritionists." Analytical material intended for consideration by a specialized commission on dietetics Expert Council in the field of healthcare of the Ministry of Health of Russia and the chief freelance nutritionist of the Ministry of Health of Russia for adoption management decisions and submitting recommendations and proposals to the Russian Ministry of Health (p. 32).

What did you buy? What did you get?
6 STAGES OF CORRECT FOOD PURCHASING

3 RULES FOR NOT BEING CHEATED

A nutritionist and a legal consultant tell you how to minimize risks and how to avoid them during the bidding procedure, when accepting food products from the supplier (pp. 22, 26).

The best day of a nutritionist
What is an ideal day for a nutritionist, we asked practicing nutritionists. Imagine that a new department has been opened in our country - the Ministry of Dietetics of the Russian Federation - and you head it. What would you do, what changes would you make to ensure that dietetics has its ideal day? (page 38).

Chronic kidney disease: modern principles therapeutic nutrition
A low-protein diet for renal pathology is becoming a thing of the past. Thanks to the development of efferent treatment methods, the practice of a nutritionist includes new algorithms for prolonging life and preserving high quality life - the use of specialized food products (p. 46).

Weight management
1,900,000,000 ADULTS ON THE PLANET ARE OVERWEIGHT

600,000,000 ARE OBESITY

Epidemic formula

Weight Loss Strategy

Mathematics of nutrition

Patient care plan

–20 KG
Diagnosis of patient G.: exogenous constitutional obesity, stage 1, obesity mixed type, hypercholesterolemia

10 months collaboration with a nutritionist, psychotherapist, fitness trainer.

Rational nutrition, training, specialized foods, bioimpedance analysis, lymphatic drainage massage.

Minus 18.1 kg of fat mass (page 76).

No pain - no diet?
A rather banal plot: the patient is ready to take the most bitter medicine, agrees to any dietary restrictions, even starvation, in order to save himself from pain. However, after the pain symptoms disappear, he quickly forgets how bad he felt and continues to pamper himself with foods that can cause another exacerbation. What is the secret of the psychology of pain and why does a person forget about all the promises to the doctor when the pain goes away? (page 92).

A fun conversation about proper bread
Are there preservatives, colorings, or flavor enhancers in bread?

What are baking improvers, are they safe for health?

How to choose bread, what should you pay attention to when looking at the label of bread and bakery products?

Frozen bread for hot business - are products obtained from frozen semi-finished products healthy?

What is the shelf life of bread and what does it depend on?

What do they do with expired bread left on store shelves?

These and other questions were answered by E. V. Nevskaya, Ph.D., head of the microbiological research department of the Federal State Institution “Research Institute of the Baking Industry” in an interview with the editor-in-chief of the magazine “ Practical Dietetics"A. V. Grozdova (p. 108).

Dietetics lawyers
Everyone reading this article will make many discoveries for themselves (how a person gets sick, why spilling salt is bad luck, how the ancients learned about germs, bacteria and viruses in food, why the ancient Egyptians washed their stomachs every month for three days in a row, etc.) and think hard about what attitude you have modern society to food, in particular to its quality, safety, and in general what is its place in our life: is food used for the prevention of diseases and treatment of the patient or is it just a source of taste for an idle life, what is its vector: is it aimed at development or extinction ... (p. 120).

“Practical Dietetics” No. 1 (17)
The first issue of 2016 was published. With its publication, a new page opened in the history of the journal “Practical Dietetics”.

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A LOT HAS CHANGED WITH US
Design
We carried out extensive work to update the design of the magazine, adding infographics, colorful spreads, interesting and informative elements. The publication has become more convenient for understanding complex information.

Information
Simply about the complex - the principle of our publication, which is more relevant than ever. Experts in the field of nutrition discussed topics of concern to nutritionists from a practical perspective.

Key topics of the issue
Voice of Dietetics
On December 18, 2015, the President of the National Medical Chamber L. M. Roshal signed a document on the entry of the National Association of Clinical Nutrition into the largest public medical organization in Russia, which he heads. Its members are professional organizations, regional medical associations, as well as doctors private practice and departmental medicine. Now, among representatives of various fields uniting the powerful medical mouthpiece of the National Medical Chamber, the voice of domestic dietetics has appeared.

Production control at the catering department
A topic that raises a lot of questions among nutritionists is the organization of production control in the catering department. And this is not surprising. Careful implementation of the program is the basis for the functioning of the catering department of a medical institution, ensuring the safety of medical nutrition, fulfilling the requirements of laws, national standards, SanPiNov. Unclear execution of the tasks of a production control program or a formally drawn up program is incorrect organization nutrition, violation of the human right to receive quality medical care, the basis for bringing the chief physician of a medical institution to administrative liability in the form of a warning, fine or suspension of the activities of the institution itself medical organization.

Therapeutic nutrition for lung diseases
19–25% of COPD patients have protein-energy malnutrition, which negatively affects the survival of these patients. With progressive weight loss in this group of patients, mortality was significantly (2 times) higher compared to those patients who did not have weight loss.

16 DAYS DIET IAP = 36 g SBCS daily = increase in body weight and maximum respiratory pressure.

6% of patients with endogenous asthma have a true food allergy to one or more foods.

Diet for pneumonia
Currently, community-acquired pneumonia remains the most important socially significant infectious disease urban population of all ages and professions. In this regard, an integrated approach to providing care to patients is one of the main tasks of medical organizations. Despite the fact that today the main method of treating community-acquired pneumonia remains timely antimicrobial therapy, diet also plays an important role in the complex of treatment measures.

TOPIC OF THE ISSUE: The obesity epidemic
1980 | 857,000,000 PEOPLE
2013 | 2,100,000,000 PEOPLE
In a world of obese and overweight people.

DON'T OVERFEED!
FROM 1 YEAR TO 4 YEARS
FROM 13 TO 18 YEARS OLD
Periods of possible increase in the number of fat cells.

1-2 GENERATIONS AGO there lived people who were superior modern man on physical activity.

4.5 KG = 4.4 MM RT. ST.
Extra pounds = increased systolic blood pressure.

WARNINGS FROM A NUTRITIONIST: Which methods of combating obesity can be dangerous.

Psychologist's office
Especially for practicing nutritionists in the new issue of the magazine professional psychologist conducted a master class on identifying the psychological factors of obesity.

Close relatives of the disease
Medical science defines a disease as a failure of the body’s vital functions as a result of a genetic defect or the influence of factors on it external environment. Another idea, not without medical meaning, is focused in one of the old wise proverbs: “If the father of the disease is unknown, then its mother is always nutrition.”

FROM 10 AND OLDER - WHAT DO YOU RISK OF GETTING SICK?

MORE TOP QUESTIONS
On the pages of the updated edition we answered difficult questions nutritionists and dietitians, which are not always brought up for general discussion.

Dispute with accounting department
In a dispute with a nutritionist, the chief accountant of a medical institution insists on canceling the calculation by accountants total number food products necessary for the preparation of all dishes (the denominator in the menu layout), and proposes to assign this responsibility to dietary nurses. What solutions may be available in a controversial situation that has arisen between a nutritionist and a chief accountant?

Liability for outsourcing?
When outsourcing food preparation services, there is often responsibility for the safety and quality of medical nutrition, including compliance with the requirements of SanPiNov and other regulatory documents, in an interesting way dissolves somewhere in the middle between a medical institution and a third-party organization.

Who is responsible for compliance with the sanitary and epidemiological regime in the catering unit if the medical organization outsources? What are the limits of responsibility of a nutritionist? nurse dietary and other services when outsourcing?

Our specialists, experts in the field of nutrition, shared their knowledge and tried to help colleagues in the most delicate situations.

In addition to the topics listed, the new issue presents others no less interesting directions. In short, many important changes have appeared in the magazine.

ONLY THE PRICE HAS NOT CHANGED
The only thing that remains untouched is the cost of a subscription to our magazine. Despite the crisis and the unstable situation in the economy of our country, we keep the price unchanged - from 2012 to this day, the cost of the magazine has not increased by a ruble.

AND WE CONTINUE TO CHANGE
The magazine continues to improve. There are huge and amazing changes ahead, both in design and in the information itself! Join us, be with us!

And at the same time, they mentioned how important it is to have a good understanding of the mathematical component of the weight loss process, since parameters such as energy reserve and release lend themselves well to numerical description, thereby providing us with specific numbers on which to rely. Today we will talk about the most important thing: how to calculate and make a plan proper nutrition.

Meal plan: what, how much and when?

The plan that competent nutritionists follow when building a menu is as follows:

• Calorie calculation;
• filling the menu with protein;
• calculating the amount of fat;
• filling with carbohydrates;
• correction for vitamins and microelements.

Now let's take a closer look at each point.

First: calorie calculation

The calorie content of the diet at the rate of active weight loss (200 - 220 g per day) should be a deficit of 25% of the “basic amount” of calories (which, recall, is the calorie content required for basal metabolism, plus the number of calories covering additional energy expenditure). At a moderate pace (100 g per day), the caloric deficit is 15%. When we're talking about about losing 7-8 kg, this is the recommended pace - easy, stress-free weight loss, which allows you to maintain skin tone and makes it possible to use this period for recovery and rejuvenation.

(OO + DE – 200 kcal) – 25%,

where OO is the main metabolism, DE is additional energy consumption, 200 kcal are the so-called hidden kilocalories, that is, those that usually give an error in calculations. We subtract 25% from the total amount and get the calorie content of the diet, which will allow you to lose weight by 200 g per day.

If you eat out at least once a day, then increase the hidden calories to 400 - therefore, the formula is as follows: (OO + DE - 400 kcal) - 25%.

In the case of a moderate rate of weight loss, the calculation is slightly different. If you are eating homemade food, use the formula (OO + DE – 200 kcal) – 15%.

And if at least once a day you have lunch (breakfast, dinner) in a restaurant or use semi-finished products, then, as in the case of intensive weight loss, take into account 400 hidden calories: (00 + DE – 400 kcal) – 15%.

• Women over 40 should consume dairy products with high level fat content, since it is very important to preserve membrane lipids.
• It’s a big mistake to fill the menu at random (had breakfast - counted the calories, had lunch - counted it again) - this leads to the fact that all the “calories” are eaten in the first half of the day, in addition, an imbalance of macronutrients occurs. The menu must be determined in advance!
• You can use not only classic foods (rice, pasta, potatoes or vegetables) as carbohydrates, but also many grains.
• Low-protein diets are justified only in cases where there are problems with protein excretion. In any other case, it would be more correct to maintain the recommended amount of protein - it is precisely such diets that are not only effective, but also stable.
• Remember that your caloric intake during the diet will decrease every time your BMI decreases!
• Be sure to use your favorite foods when creating your menu: dieting is already a stressful event, so don’t force yourself to eat something you don’t like.

Second: filling the menu with protein

There are three protein load standards that are used for healthy people. It is imperative to clarify that when it comes to any pathology of the liver, kidneys, chronic or autoimmune diseases, weight loss should take place under the strict supervision of a doctor, and the protein load should be calculated taking into account the nitrogen excreted in the urine.

What is the norm for protein during weight loss?

• 0.8 protein per 1 kg of weight – at low physical activity;
• 1 g of protein per 1 kg of weight – with moderate physical activity (up to 120 minutes of aerobic activity per week) or a base BMI above 30;
• 1.2 g of protein per 1 kg of weight - with high physical activity.

How are proteins introduced into the diet? The total amount is always divided into three parts - that is, protein should be part of every meal! Preference should be given to low-fat, high-protein foods.

Third: filling your diet with fats

Fats are the second essential macronutrient (substances needed in large quantities for normal growth and development), which cannot be excluded during weight loss. Yes, there are diets with a minimum amount of fat, but it is necessary to remember: if a person receives less than 8 g of fat per day, there is a possibility that the viscosity of bile will change, increase, and even in people who are not initially prone to stone formation, stones may form. This is a very common complication of independent strict diets.

Fat is membranes, brain lipids, skin protection, immune protection of the lungs!

So what do you need to know about filling your diet with fat?

8 g of fat per day is the required minimum, below which you should never fall.

The recommended amount is 15-20 g of fat per day. 30% of the total amount should be animal fats, since only they contain sterols, which are the basic material for building a huge number of important structural elements of the body, from brain neurons to sex hormones. Having filled your diet with proteins, return to the already “given” foods and calculate how much fat they contain. Very often, the products used to calculate protein already contain a fairly high percentage of fat.

Fourth: filling your diet with carbohydrates

It is carbohydrate restrictions that make dieters feel unhappy. And it is carbohydrates that are responsible for the feeling of fullness.

What do you need to know when filling your diet with carbohydrates?

The entire portion of calories remaining after subtracting the portion that went into calculating proteins and fats is filled with carbohydrates.

Preference should be given to “slow” carbohydrates with low glycemic index(from 10 to 40).

The glycemic index is the rate at which glucose is released into the blood after we eat a food. The highest glycemic index is glucose, which is sugar itself. The feeling of satiety is minimal, the feeling of energy is maximum, the amount of energy is large. The risk that it will “end up” in a fat cell, unless we immediately “burn” this energy, is also great.

Low glycemic index foods release glucose very slowly, sometimes over several hours. For example, brown rice or baked potatoes release carbohydrates within 2-3 hours. Consequently, energy is distributed more evenly, and a feeling of fullness arises.

“Fast” carbohydrates can be introduced at very small quantity(50 – 100 kcal per day), preferably in the time period from 15:00 to 17:00. It is during this period that fast carbohydrates are more easily “utilized.” The ideal source of “fast” carbohydrates during a diet is fruit.

Practical lesson

Let's look at an example of a nutritional calculation. Let’s imagine a woman aged 36 years, weight – 72 kg, height – 168 cm (BMI – 25.5), her body type is normosthenic. The goal is to enter lowest point stability (BMI – 22, weight – 60–61 kg). A lady works at the computer 8 hours a day, walks 30 minutes every day, swims in the pool 45 minutes a week. On weekdays he has lunch in a cafe. Planning intensive weight loss. What calorie content should her menu contain?

1. We calculate the basal metabolic rate

According to the above formula, the main exchange will be:

(8.7 x 72 (body weight)) + 829 = 1,455 kcal.

1. We consider the additional expense

Remembering the rule of “aerobic exercise,” we do not include in the calculation the energy spent on working at the computer and walking. From listed types The only aerobic activity is swimming. The “calorie counter” tells us that 45 minutes in the pool takes about 350 kcal. Next, this figure should be divided by 7 days (since the load is only once a week, and we calculate the menu daily). As a result, we get 50 kcal per day.

1. We use the calorie calculation formula for intensive weight loss

1,455 kcal (basic metabolism) + 50 kcal (additional energy expenditure) – 200 kcal (hidden calories on weekdays) or 100 kcal (hidden calories on weekends, when a woman has lunch at home):

(1,455 + 50 – 400) = 1,105 (working days)

(1,455 + 50 – 200) = 1,305 (weekends)

Subtract the required “deficit interest”:

1,105 – 25% = 828 kcal (working days)

1,305 – 25% = 978 kcal (weekends)

Of course, we can talk about exact calorie numbers only if we use pharmacy substitutes for products with a declared energy value.

In case of power regular products The calorie content of the menu will be “floating”, approximate. Please don't forget about this!

1. Calculating the required amount of protein

Since the physical activity of our hypothetical lady is low, the protein requirement will be 0.8 g per 1 kg of weight, that is, 58 g per day. The daily diet might look like this:

breakfast: 100 g cottage cheese 9% (169 kcal, 18 g protein) or cottage cheese 2% (114 kcal, 20 g protein);

• lunch: 100 g tuna (116 kcal, 25 g protein);
• dinner: 2 eggs (155 kcal, 13 g protein).

Total: 58 g protein, 440 kcal.

1. Checking the fat content in already “specified” products

The need for fat, as we remember, is 15–20 g per day. Example of a daily diet:

• breakfast: 100 g cottage cheese 2% (114 kcal, 20 g protein - 2 g fat);
• lunch: 100 g tuna (116 kcal, 25 g protein - 5 g fat);
• dinner: 2 eggs (155 kcal, 13 g protein - 11 g fat).

Total: 58 g protein, 440 kcal, 18 g fat.

1. Filling your diet with carbohydrates

We calculate what part of the calories is left for carbohydrates: 978 kcal (recommended calorie content per day) – 440 kcal (the part that was “eaten” by proteins and fats) = 538 kcal. That is, we need to “fill” 538 kcal with carbohydrates. Add them to every meal:

• breakfast: 100 g cottage cheese 2% + 2 whole grain toast (250 kcal);
• lunch: 100 g tuna + 150 g wild rice (150 kcal);
• afternoon snack: medium-sized apple, or 100 g of fruit yoghurt, or 150 g of raspberries, tangerines, etc. (about 80 kcal);
• dinner: 2 eggs (155 kcal, 13 g protein, 11 g fat) + 200 g green salad (60 kcal).

Total: 980 kcal, 58 g protein, 18 g fat.

Different ages - different needs

How to properly adjust your diet based on your age? There are a few rules to keep in mind.

Youth (up to 25 years old). Minimum quantity protein - 1 g per 1 kg of weight, even with low physical activity, since at this age protein is consumed intensively. Additional vitamin correction is required (multivitamins are administered daily).

Youth (25–35 years old). The minimum amount of protein is 0.8 g per 1 kg of weight. Additional correction is carried out for vitamins and microelements (multivitamins, iron, magnesium, zinc - mandatory).

Middle age (35–45 years). The minimum amount of protein is 0.8 g per 1 kg of weight, additional correction for vitamins and microelements (multivitamins, iron, magnesium, zinc, selenium, iodine).

Maturity (45–60 years old). Protein - at least 0.8 g per 1 kg of weight, fats - at least 20-22 g. Be sure to include PNNA (omega acids), vitamins and microelements (multivitamins, iron, magnesium, potassium, selenium, zinc, omega acids, iodine ).

Aging (60 years and older). Increasing the amount of protein. The minimum calculation is 1 g per 1 kg of weight, we give preference to easily digestible protein (coming from dairy products, offal, fish and poultry). Fat – 20–22 g, 70–75% of which plant origin. Vitamins and microelements: multivitamins (preferably for age), magnesium, potassium, calcium, selenium, omega acids.

In general, by the time you start losing weight, you need to have the following calculations: number of calories, calorie intake, approximate menu (ideally for a week). As an option, write down several options for breakfast, lunch and dinner, from which you can choose and - most importantly - make the necessary purchases for the week in advance. And - start the path to harmony!