Therapeutic Nutrition For Respiratory Diseases And Tuberculosis

Dietary nutrition plays an important role in the complex therapy of respiratory diseases. It is built individually, taking into account the nature of the underlying process and its pathogenetic mechanisms, complications and concomitant diseases.

Dietary nutrition plays an important role in the complex therapy of respiratory diseases. It is built individually, taking into account the nature of the underlying process and its pathogenetic mechanisms, complications and concomitant diseases. It is necessary to remember about the possible involvement in the pathological process of the cardiovascular system with the development of cor pulmonale and circulatory failure of the right ventricular type. In particular, with pulmonary emphysema, therapeutic nutrition is mainly prescribed based on the functional state of the cardiovascular system.

Nutrition for the treatment of pneumonia

In acute pneumonia in the febrile period, the basal metabolism increases. There is an intoxication of the human body with the products of vital activity of microorganisms and tissue decay. The load on the cardiovascular system increases, as a result of which, in severe cases, circulatory failure may develop. The functional activity of the digestive organs decreases (B.D. Borevskaya and others).

Therapeutic nutrition should contribute to the fastest resolution of the inflammatory process, detoxification of the body, increasing its immune properties and general reactivity, sparing the organs of the cardiovascular and digestive systems, and preventing possible negative effects of pharmacotherapy. The anti-inflammatory effect is provided by limiting the amount of carbohydrates (up to 200-250 g), salt (up to 6-7 g) and increasing the content of calcium salts in the diet.

In order to detoxify the body, the introduction of a sufficient amount of vitamins (especially ascorbic acid) and liquid and (up to 1400-1700 ml) is shown; it is natural that the use of such an amount of liquid is allowed only in the absence of cardiac decompensation.

It is recommended to significantly reduce the total caloric content of the diet at the onset of the disease (in the acute febrile period) (up to 1500-1800 kcal) by limiting, in addition to carbohydrates, the amount of proteins (50-60 g), fats (30-40 g) consumed, which in combination with fractional nutrition (meal up to 6-7 times a day) and the use of predominantly liquid and well-chopped food helps to spare the activity of the digestive organs.

During the recovery period, it is necessary to significantly increase the calorie content of the daily diet (up to 2500-3000 kcal), mainly by increasing the content of proteins (up to 130-150 g), fats (80-190 g) and, to a lesser extent, carbohydrates (up to 300-350 g) . Enrichment of the protein diet helps to replenish its losses during tissue breakdown, stimulates reparative processes, antibody production, and prevents leukopenia due to the use of sulfanilamide drugs. It is allowed to increase the amount of salt (up to 10-12 g), it is necessary for the production of hydrochloric acid by the stomach, which increases appetite. In this regard, the use of products that stimulate gastric secretion and exocrine pancreatic activity (meat and fish broths, bread kvass, sauces, spices and seasonings, ksfe, cocoa, fruit and vegetable juices, etc.) is shown.

Diet therapy for exacerbations of chronic pneumonia is the same as for acute pneumonia.

Chronic suppurative lung diseases and diet for them

Abscesses of the lungs and bronchiectasis are characterized by a combination of a purulent inflammatory process with destruction of the lung tissue. Stagnation of purulent contents leads to intoxication of the body. With purulent sputum, a large amount of protein is lost. With extensive lesions, pulmonary heart failure may develop. A prolonged purulent process can be accompanied by exhaustion of the body and lead to amyloidosis.

Therapeutic nutrition is necessary to increase the immunobiological defenses of the body, replenish protein losses with sputum; it should promote detoxification of the body, reduce the effects of inflammatory exudation, stimulate reparative processes, sparing the activity of the cardiovascular system.

To improve the general nutrition of the patient, it is necessary to provide sufficient caloric content of the daily diet (2600-3000 kcal) by introducing an increased amount of proteins (130-160 g), a moderate amount of carbohydrates (350-400 g) and a slightly reduced amount of fat (70-80 g ).

The use of an increased amount of proteins helps to increase the body's defenses and immune processes, replenish the protein lost with purulent sputum, stimulates re-. parative processes. Excess protein nutrition prevents and delays the development of amyloidosis. Care should be taken to include in the diet a sufficient amount of complete proteins of animal origin (meat, fish, cottage cheese, eggs, etc.). With an exacerbation of the process, it is advisable to reduce the amount of carbohydrates (up to 200-250 g), which, in combination with salt restriction (6-8 g) and the introduction of an excess amount of calcium salts, is aimed at reducing inflammatory exudation.

The need for a slight restriction of fats in the diet is explained by their property to inhibit the already reduced appetite in long-term febrile patients.

The hypochlorite diet has an anti-inflammatory effect due to the fixation of calcium salts in tissues and reduces fluid retention in the body, which is one of the measures to prevent circulatory failure.

To reduce the amount of sputum and facilitate the activity of the cardiovascular system, a restriction of the amount of free fluid (up to 700-800 ml) is shown.

In order to stimulate the protective forces, reparative processes and compensate for the deficiency of vitamins in the body, their increased intake with food (especially retinol, ascorbic acid, B vitamins) is shown. In particular, ascorbic acid promotes detoxification of the body, together with thiamine and riboflavin, it has a positive effect on oxidative processes in the body and protein metabolism. Retinol improves the regeneration of the mucous membrane of the respiratory tract. To enrich the body with vitamins, the use of foods rich in them (yeast, rosehip broth, vegetables, fruits) is shown. The improvement of appetite is facilitated by the inclusion in the diet of products that stimulate gastric secretion (meat and fish concoctions, kvass, vegetable and fruit juices, strong tea, coffee, etc.)

In cases where there are no signs of heart failure, it is advisable to take diet No. 5 as a basis for building a dietary regimen. In the presence of circulatory failure, the construction of therapeutic nutrition should be based on diets No. 10 or 10a.

PREMIUM CHAPTERS ▼

Diet therapy for exudative pleurisy and bronchial asthma (PREMIUM)

The disease often has a tuberculous and less often other etiology (pneumococcus, staphylococcus, streptococcus, etc.) - It is characterized by an inflammatory lesion of the pleura. The pleural cavities are filled with an inflammatory exudate rich in protein.

Therapeutic nutrition is aimed at reducing inflammatory exudation, reducing hyperreactivity. This is ensured by the restriction of carbohydrates (200-250 g), salt (up to 3-5 g) and an increase in the content of calcium salts in the diet (up to 5 g); some restriction of the use of free liquid (500 — 700 ml) is shown.

Care should be taken to introduce a sufficient amount of vitamins (especially retinol, ascorbic acid, vitamin P, vitamin B).

Excluded: foods that cause thirst (pickles, smoked meats, canned food, extracts, etc.).

When prescribing therapeutic nutrition at the beginning of the disease, diets No. 7a, 76, 7 should be the main ones. In the future, taking into account the tuberculous etiology of the disease, it is advisable to transfer patients to a therapeutic diet No. 11.

Bronchial asthma has an allergic nature and is characterized by periodic bronchospasms. With a long and persistent course, bronchial asthma leads to the development of emphysema of the lungs and cor pulmonale, which can be complicated by right ventricular circulatory failure.

Therapeutic nutrition is aimed primarily at reducing hyperergy and autonomic dystonia. For this purpose, restriction of carbohydrates, salt and the introduction of an increased amount of calcium are shown.

It is recommended to include foods rich in calcium in the diet (cottage cheese, milk, cheese, etc.).

You should not use pickles, marinades, herring, easily digestible carbohydrates (honey, jam, sugar, semolina, potatoes, etc.). Products that excite the nervous system (strong coffee, cocoa, meat and fish broths, spicy snacks, spices, etc.) are subject to restriction. Foods rich in oxalic acid (sorrel, spinach, lettuce) are excluded, as it helps to remove calcium salts from the body.

When a food allergy is detected, foods to which there is hypersensitivity should be excluded from the diet, or specific desensitization can be carried out by consuming small amounts of allergen foods 1 hour before taking their bulk.

In the event of a complication of the disease with pulmonary heart failure, appropriate dietary adjustments are necessary (exclusion of salt, enrichment with potassium salts, fluid restriction, etc.).

Medical nutrition for tuberculosis (PREMIUM)

The disease is caused by Mycobacterium tuberculosis. Various organs and systems can be affected (lungs, intestines, bones and joints, kidneys, serous membranes, larynx and nasopharynx, skin, liver, cardiovascular system, etc.).

Pathogenetic mechanisms determine the important role of therapeutic nutrition in the complex therapy of tuberculosis.

Diet therapy is aimed at increasing the body's defenses, stimulating reparative processes, normalizing metabolic disorders, restoring impaired functions and reducing body hyperergy.

Medical nutrition should be built taking into account the localization, the nature of the process, the degree of activity, the reactivity of the body, the state of the digestive organs, the patient's fatness and lifestyle, concomitant diseases and complications, the functional state of the affected organs.

When calculating the total calorie content, along with taking into account the height, body weight, sex and lifestyle (mode) of the patient, it is necessary to keep in mind the frequent presence of increased energy consumption in tuberculosis associated with infection and fever. M. V. Pevzner recommends prescribing for each kilogram body weight;

a) in the mode of complete rest - 35 kcal;

b) in a regime of relative rest (lying down - 5-6 hours during the day) with small walks - 40 kcal;

c) in the training mode (lying down for 3.5 hours during the day, outdoor games and labor processes) - 45 kcal;

d) in the labor regime with a 2-hour rest during the day and work for 3-6 hours - 50 kcal.

With a patient's body weight below normal and progressive weight loss, the appointment of enhanced nutrition is indicated, which provides for an increase in calorie content by 1/3 compared to the proper one. You should not resort to enhanced nutrition with severe disorders of the stomach, intestines, liver and cardiovascular system. The previously practiced more significant increase in calorie content, the so-called "excess" nutrition, did not justify itself; it leads to an overload of the digestive organs, interstitial metabolism, an overstrain of regulatory mechanisms, a weakening of the defenses and an increase in the body's allergization. The beneficial effect of increased nutrition is evidenced not so much by an increase in body weight, but by an improvement in appetite, mood, and the appearance of cheerfulness. However, if the patient's body weight does not increase with increased nutrition,

In connection with the increased protein breakdown, the inclusion of an increased amount of protein in the diet (during an outbreak up to 2.5 g and outside the outbreak of the tuberculosis process up to 1.5-2 g per 1 kg of body weight) is shown, which helps to increase the body's resistance to tuberculosis infection; at least half of the prescribed amount of proteins should be of animal origin (meat, fish, eggs, milk, cottage cheese, etc.).

There is evidence of the possible formation of substances with antibiotic action in the process of metabolism in the body of such amino acids as arginine, tryptophan, phenylalanine. Therefore, it is advisable to recommend the inclusion in the diet of foods containing these amino acids (milk, cottage cheese, pike perch, cod, beef, chicken, lamb, pork, oatmeal and buckwheat, millet, rice, soybeans, beans, barley, peas, carrots, potatoes, cabbage, etc.).

Outside of an outbreak of the tuberculosis process, the body should be provided with a normal amount of carbohydrates (7 g per 1 kg of body weight). When the process is activated, it is recommended to reduce their content in the diet (up to 4-5 g per 1 kg of body weight), which has an anti-inflammatory effect. The restriction of carbohydrates, especially easily digestible ones (sugar, honey, jam, etc.), is indicated for disorders of nervous regulation, which are manifested by the lability of the autonomic nervous system (erased symptoms of hypo- and hyperglycemia), hypersensitization of the body.

Previously practiced consumption of large amounts of fat is not recommended, as it has a negative effect on the body. An excess of fat in the diet contributes to an acidotic shift, impedes the activity of the digestive organs, causes diarrhea, fatty infiltration of the liver, and inhibits the already often reduced gastric secretion and appetite. Rapid satiety leads to insufficient introduction of proteins, vitamins and minerals into the body. At present, the expediency of some restriction of the amount of fat in the diet during the period of activation of the tuberculosis process (up to 1 g per 1 kg of body weight) and the normal amount of fat (1.5 g per 1 kg of body weight) in the remission phase has been substantiated. Preference should be given to butter and vegetable fats. The latter are the main source of essential fatty acids.

In tuberculosis, there is an increased need for vitamins (retinol, ascorbic acid, vitamin O, thiamine, riboflavin, pyridoxine, nicotinic acid), especially in the presence of lesions of the digestive system (enterocolitis, gastritis, hepatitis, etc.), which hinder the absorption of vitamins . The lack of some vitamins (pyridoxine, ascorbic acid, etc.) can be caused by the use of a number of antibacterial agents (PASK-sodium, ftivazid, isoniazid, larusai, etc.). Animal experiments have shown an increased susceptibility to tuberculosis in the absence of vitamins in the diet (I. Ya-Goldberg). Providing the body with a sufficient amount of vitamins has a beneficial effect on the course of tuberculosis.

The impoverishment of the body with calcium, its anti-inflammatory and desensitizing effect determines the need to enrich the diet with calcium salts at the expense of foods rich in them (milk, cottage cheese, cheese, cabbage, leafy lettuce, legumes, raisins, etc.). Better absorption of calcium is facilitated by its introduction in optimal ratios with phosphorus (1: 1 or 2: 1) and providing the body with a sufficient amount of vitamin B. Calcium fixation in tissues is facilitated by limiting the amount of salt. It is recommended to use it during the outbreak of the tuberculosis process up to 8 g and in the inactive phase up to 12 g per day. The presence of fluid in the cavities (exudative pleurisy, empyema, transudate) is an indication for a more severe restriction of salt intake (2-4 g per day), which contributes to the resorption of fluid. However, after large blood loss, profuse diarrhea,

It is necessary to ensure the body's need for other minerals (iron, magnesium, etc.).

Since tubintoxication contributes to an increase in the hydrophilicity of tissues, it is necessary to avoid drinking excess amounts of fluid.

To increase the often reduced appetite, it is recommended to diversify the menu, include gastric secretion stimulants (meat broth, fish soup, herring, etc.), taking into account possible contraindications, take care of high taste qualities and beautiful presentation of dishes, develop an individual diet with regular meals and the use of its main amount during a decrease in temperature. It is important to create a favorable external environment while eating (clean and well-ventilated room, no excessive noise, pleasant neighborhood, etc.), in case of overwork - a short rest before and after dinner, eliminate the possible negative effects of certain medicines, provide the body with enough vitamins, to carry out active treatment of the tuberculosis process.

With tuberculous lesions of the intestine, it is necessary to keep in mind possible violations of the absorption of the most important nutrients (proteins, vitamins, calcium, phosphorus, iron, etc.), which leads to a pronounced deficiency in the body and requires inclusion in the diet in a significantly increased amount. An important role in the epithelialization of intestinal ulceration belongs to retinol. Profuse diarrhea determines the need to introduce an increased amount of salt (up to 20 g). Due to poor tolerance, it is advisable to reduce the amount of fat in the diet. With the predominance of fermentation processes, the content of carbohydrates in the diet (bread, cereals, vegetables, etc.) should be limited. To prevent intestinal overload, more frequent fractional meals (5-6 times a day) are shown.

Excluded: whole milk, spicy dishes, smoked meats, black bread, carbonated drinks, cold dishes, kvass, raw vegetables, fatty meat, canned food, marinades, lard, raw eggs.

It is allowed to use slimy and pureed soups, weak broths, boiled fish, soufflés, steam cutlets, meatballs, meatballs from low-fat meats, various cereals, white crackers, non-acidic cottage cheese, mild cheese, jelly, jelly, soaked low-fat herring, protein omelet, pudding , butter, jam and mashed vegetables (carrots, pumpkin, potatoes, zucchini, etc.), raw vegetable and fruit juices, rosehip broth.

In case of tuberculous kidney damage, foods that irritate them (pepper, mustard, horseradish, radish, alcohol, smoked meats, canned food) should be excluded from consumption.

With exudative pleurisy, it is necessary to make adjustments as described in the appropriate section (see "Exudative pleurisy"). With tuberculous lesions of the larynx and nasopharynx, it is especially important to provide the body with an increased amount of retinol, since it helps to restore the damaged mucosal epithelium. A slow meal is recommended in a liquid, jelly-like, well-mashed and mushy form. Forbidden: irritating food (spicy, salty, pickled, pickled foods, mustard, pepper, vinegar, horseradish, cold and hot dishes), alcoholic beverages. It is recommended to use slimy soups, weak frozen broths, strained jelly, liquid milk porridges, milk, weak coffee, soft mashed potatoes, tea with milk. In case of tuberculosis of the bones and joints, special care should be taken to provide the body with an increased amount of calcium and phosphorus. For better absorption of calcium salts, a sufficient content of vitamin B in the diet is shown, which can, in particular, be provided through the use of fish oil.

With tuberculous skin lesions (lupus), a moderate restriction of carbohydrates, salt (up to 3-5 g) and the introduction of an increased amount of vitamins (retinol, ascorbic acid) are recommended.

Liver damage determines the expediency of excluding egg yolks, fatty meat, fish and vegetables, pastry, smoked meats, spicy dishes, strong coffee, and alcoholic beverages.

With hemoptysis, it is important to provide the body with an increased amount of vitamins (ascorbic acid, vikasol), calcium salts, and in case of large blood loss, an increased amount of salt (up to 20-30 g per day). Chilled jelly, fruit and berry jelly, mashed cottage cheese with milk, cream, soft-boiled egg, liquid semolina milk porridge, cool drink (tomato juice, acidified lemon water, etc.) are recommended.

When pulmonary tuberculosis is complicated by pulmonary heart failure, restriction of fluid, salt, enrichment of the diet with potassium salts, fasting days are shown (for more details, see the section "Chronic circulatory failure").

If tuberculosis is complicated by amyloidosis in the albuminuric stage without edema, the daily diet should contain up to 2 g of protein per 1 kg of the patient's weight, the amount of fats and carbohydrates in accordance with the nature of the main process. The presence of edema requires a sharp restriction of salt (2-4 g). With azotemia, a decrease in the amount of protein in the diet is indicated (for more details, see the section "Chronic renal failure").

Among the common methods of diet therapy in this case is koumiss therapy. One liter of koumiss provides the body with 530 yakal and contains 22 g of protein, 17 g of fat, 32.6 g of carbohydrates, 200-250 ml of ascorbic acid, and about 20 g of alcohol. It is recommended to prescribe koumiss one glass 5-6 times a day. Koumiss therapy is contraindicated in acute and decompensated tuberculosis lesions, concomitant chronic suppuration in the lungs and pleura (abscess, bronchiectasis, pyopneumothorax, etc.), peptic ulcer and gastritis with increased gastric secretion, liver diseases, the predominance of fermentation processes in the intestines, metabolic diseases (sugar diabetes, gout, obesity), neurosis with severe lability of the autonomic nervous system, hyperfunction of the thyroid gland, circulatory failure stage II-III, tuberculosis of the intestines and kidneys.

Conclusion (nutrition for respiratory diseases) (PREMIUM)

Therapeutic nutrition in diseases of the respiratory system and tuberculosis is very important. Diet for diseases of the respiratory system, especially for bronchial asthma, provides for the appointment of a hypoallergenic fortified, varied diet. In a family where there is a patient with bronchial asthma, “Solidarity” nutrition should be organized. Especially important is the "gastronomic" solidarity of all family members around the patient, if this is a baby who wants to try everything and no prohibitions and persuasions convince him. Foods that contain preservatives, emulsifiers, artificial colors (the most dangerous yellow, tartrazine) should be excluded from the diet. Dishes cooked in dark vegetable oil, ghee, butter, refractory fats can be considered harmful. According to recent studies, the Mediterranean diet,

A feature of dietary nutrition for tuberculosis, regardless of its localization, is the increased need of the patient's body for vitamins (primarily vitamin C, B vitamins, vitamin A) and minerals. The introduction into the diet of products such as fish oil, egg yolk, carrots, tomatoes, red peppers, etc.) is shown. Since, in conditions of tuberculous intoxication, it is difficult to compensate for the lack of vitamins and minerals with the help of rational nutrition, it is necessary to take vitamins and minerals in the form of medicines.

For patients with reduced body reactivity, general hypotension, a slight increase in temperature, with a sluggish course of the disease, the calorie content of the diet is in the range of 2700-3000 kcal. The diet is characterized by a high content of ascorbic acid, vitamins of group B. Culinary processing is normal, nutrition is fractional.

With a lack of body weight (Quetelet index below 19.5), an increase in temperature to 38 degrees Celsius, without signs of increased tissue destruction in the foci of tuberculous inflammation, the daily calorie content of the diet is raised to 3500 kcal. Calcium-rich foods are introduced into food (milk, dairy products - calcined cottage cheese, eggs).

 

During the period of exacerbation of the disease (high temperature, pronounced symptoms of intoxication, significant depletion), it is necessary to introduce additional amounts of ascorbic acid, calcium. The diet is built mainly on the use of a large amount of fresh juices, vegetables, fruits. During this period, all food is cooked in pureed form. The food is fractional, every 2-3 hours. If the disease occurs with allergic reactions in the diet, limit carbohydrates, mainly due to sugar, honey, sweets, sweet fruits. With a tendency to form effusions (exudates, transudates), table salt is limited in the diet.