Clinical nutrition in Crohn's disease

Content

  • The purpose of clinical nutrition
  • Diet 4
  • Diet 4 b
  • Diet 4


  • Clinical nutrition in Crohn's disease
    Character diet in Crohn's disease depends on the location and extent of bowel injury, phase of the disease, and patients tolerance of certain foods.

    During an exacerbation appointed split meals 5-6 times a day. The protein content of the diet, especially when persistent diarrhea, should be raised to 1.3-2 g / kg per day.

    The acute phase of the diet should be mechanically andchemically gentle with an increased content of protein, vitamins, milk-intolerant and at a limited number of coarse fiber, particularly when narrowing the gut sections. These conditions correspond to diet number 4, then number 4 b.

    When extensive lesions of the small intestine in the periodacute enteric recommended elementary balanced mono-diet containing hydrolyzed protein, fat, carbohydrates with the exception of lactose and fat. With significant depletion of patients, persistent diarrhea is shown parenteral nutrition, it is necessary and in the treatment of intestinal lesions as fistulas, obstructive processes, short bowel syndrome, as well as in the preparation of patients for surgery underweight and metabolic disorders.



    The purpose of clinical nutrition

    The main goal of nutritional therapy ismechanical, chemical and thermal bowel sparing. Clinical nutrition has a positive effect on the main pathogenetic factors of chronic enteritis and diarrhea.

    With a sharp aggravation of the disease, severe diarrhea, recommended 1-2 so-called "hungry" days. The "hungry" days should be about 1.5-2 liters of fluid per day in the form of:

    • strong, hot, not too sweet tea with lemon 5-6 times with 1-2 1/2 cups croutons;
    • diluted with boiled water, black currant juice, blueberry juice, broth hips.

    Instead of "hungry" days can be used under the supervision of individual tolerance:

    • acidophilic day - 1.5 liter per night acidophilus milk;
    • Kefir day - 1.5 liters of yogurt three days ago in a day;
    • an apple a day - 1.5 kg of peeled apples Mince or finely rub and make a homogeneous mass equal portions during the day (pureed apples have antidiarrhoeal action due to the large amount of pectin);
    • carrot day - in equal portions during the day taking 1.5 kg of carrots prepared in the same manner as apples (carrot has antidiarrhoeal and adsorbing action).

    After 1-2 "hungry" days go to the table number 4 andvariants thereof (46, 4c). These diets provide sufficient introduction to the body all necessary for normal functioning of nutrients, especially protein, vitamins, electrolytes; good digestion thanks to an adequate set of products and the corresponding cooking (meals are prepared boiled or steamed, is given in a shabby).



    Diet 4

    Indications for: acute and chronic bowel disease in the period of profuse diarrhea and sharply expressed dyspeptic phenomena. This version of the diet prescribed for chronic enteritis during the exacerbation of the presence of profuse diarrhea and sharply expressed dyspeptic phenomena. Diet 4 can be administered after 1-2 "hungry" days or once during an exacerbation.

    general characteristics

    Restricted diet of fats and carbohydrates, andnormal protein, a sharp limitation of the mechanical and chemical irritants of the mucosa and receptors of the gastrointestinal tract, with the exception of products and foods, enhancing the processes of fermentation and putrefaction in the intestine, as well as strong promoters secretion, secretion of gastric and pancreatic substances irritating liver .

    Culinary processingAll dishes are boiled or steamed, rubbed.

    Energy value

    Ingredients: Protein - 100 g, fat - 70 g, carbohydrates - 250 g, salt - 8-10 g, the energy value - 2100 kcal. The amount of free liquid - 1.5-2 liter.

    Diet:
    fractional (5-6 times a day).

    food temperature hot dishes - 57-62 ° C, cold - not below 15 ° C.

    A list of recommended dishes:

    Bread and bakery products: crackers of white bread, thinly sliced ​​and nepodzharistye;

    Soup: with the addition of the mucous broths, steam or boiled in water, meat or fish quenelle, Burgers, cooked minced meat;

    meat and fish: steam meat and fish burgers, Burgers, meat souffle, lean meat (beef, rabbit), minced meat is prepared by passing the meat 3-4 times through a meat grinder with a fine grid;

    dishes and side dishes from cereals: pureed porridge on the water or skim meat broth - rice, oats, buckwheat, semolina; All legumes and pasta are excluded;

    egg dishes: eggs are not more than 1 day only in dishes, with good endurance allowed soft-boiled eggs or omelettes in the form of steam (not more than 2 eggs a day);

    desserts, fruit, berriesSugar in limited quantities (up to 40 grams per day), jelly, jelly, blueberry, cherry, ripe pears, berries and other fruits, rich in tannins:

    dairy: freshly grated cheese and a soufflé, all other dairy products are not allowed;

    beverages: tea, black coffee, cocoa, water, broth hips, blueberries;

    fats: butter (add ready-made meals to 5 grams per serving). Sauces, spices, snacks, alcohol is prohibited. After 4-5 days, the patient is assigned to a diet number 4 b.

    Diet number 4b

    Special purpose: ensure adequate nutrition in termsmoderately pronounced inflammation of the gastrointestinal tract, help to reduce inflammation in the gut, normalizing its functional state.

    General characteristics: physiologically complete diet with normalproteins, fats, carbohydrates, salt restriction to the lower limit of normal (8-10 g), with a moderate restriction of mechanical and chemical irritants of the mucosa and receptors of the gastrointestinal tract, excluding products that enhance the processes of fermentation and putrefaction in the intestine, and also strong secretion stimulants, gastric secretion, pancreas.

    Culinary processing: All dishes are boiled or steamed, rubbed.

    Energetic value and composition:

    proteins - 100-120 grams (according to AL Grebeneva - up to 135 g), fat - 100-120 g, salt - 8-10 g, the energy value - 3000-3500 kcal. The amount of free liquid - 1.5 l. The diet includes increased amounts of vitamins, minerals, calcium, phosphorus, iron, and lipotropic agents. Diet: fractional (5-6 times a day).

    A list of recommended dishes:

    Bread and bakery products: yesterday's white bread, dry biscuits, biscuits, 1-2 times a week nesdobnye muffins, pies with apples, jam, cheesecake with cottage cheese;

    Soup: on skim meat broth with well-boiled cereals, pasta, meatballs, finely chopped vegetables (potatoes, carrots, cauliflower, pumpkin);

    meat and fish: lean meat (beef, veal, chicken,turkey, rabbit), tender varieties in the form of a piece of beef minced (burgers, Burgers, dumplings, soufflés, rolls, boiled or steam), lean fish (perch, bream, cod, perch, hake) in the form of pieces or chopped (boiled or steam);

    dishes and side dishes of vegetables: potatoes, squash, pumpkin, carrots, cauliflowercabbage, peas (if tolerated) and cooked in a shabby, steam vegetable soufflé; ripe tomatoes no more than 100 grams per day (if tolerated); excluded cabbage, beets, radishes, turnips, spinach, onion, garlic, mushrooms;

    dishes and side dishes from cereals, legumes, pasta: various cereals (except wheat and barley) on the water with the addition of the Ouse milk or cream 10% fat, steamed puddings from mashed cereals, boiled vermicelli;

    egg dishes: whole eggs (no more than 1 per day) in the food; dishes from egg whites: steam omelettes; scrambled eggs;

    desserts, fruits, berries: jelly and mashed fruit drinks, jelly, mousse, soufflésweet berries and fruit (except melons, apricots, plums), baked apples, pears, fruit jellies, marshmallows, candy, preserves and jams sweet fruits and berries; good tolerability of 100 g per day of sweet berries in the raw form (strawberry, strawberries, raspberries, peeled ripe apples, but grated); Juices apple, cherry, raspberry, strawberry, tangerine, orange mixed with water;

    dairy:
    milk fresh water only in small dishesamount, yogurt, acidophilus milk, fermented baked milk; cheese Russia, Yaroslavl; non-acidic sour cream in limited quantities as a seasoning; Fresh cheese is in the pudding, puddings, cottage cheese weight;

    sauces, spices: bay leaf, dill, parsley, cinnamon, milk sauce, fruit sauces;

    snacks: Jellied fish and veal, caviar;

    beverages: broth hips, tea with milk, 10% cream, coffee with milk and black coffee (rather weak);

    fats: butter added to the ready-made meals and provide in-kind of bread no more than 5-15 grams per reception.


    Diet number 4b appointed for 4-6 weeks before full normalization of stool elimination of exacerbation of chronic enteritis. Then, the patient is recommended diet number 4.


    Diet № 4

    General characteristics:
    physiologically complete diet with normalproteins, fats, carbohydrates, with a certain restriction of mechanical and chemical irritants of the mucosa and receptors of the gastrointestinal tract, with the exception of food products and enhancing the processes of fermentation and putrefaction in the intestine, and also strong secretion stimulants, gastric secretions and pancreatic.

    Culinary processing: All dishes are boiled or steamed and baked in the oven, the food given mainly in the form of unmilled.

    Diet: it is desirable to fractional (5-6 times a day, but at least 4 times).

    food temperature hot dishes - 57-62 ° C, cold - not below 15 ° C.

    A list of recommended dishes:

    Bread and bakery products:
    bread, yesterday, a dry biscuit, biscuits, 1-2 times a week, muffins, pies and jam, meat, apples, jam, jam, cheesecake with cottage cheese;

    Soup: on low fat or fish broth witha variety of cereals (excluding wheat) noodles, vegetables (potatoes, carrots, squash, pumpkin, cauliflower), with good endurance allowed cabbage, green peas, young beans, beets;

    meat and fish:
    lean meat (beef, veal, chicken, turkey) as a whole piece, cutlets, Burgers steam or boiled; lean boiled fish;


    Clinical nutrition in Crohn's diseasedishes and side dishes of vegetables: potatoes, squash, carrots, pumpkin, cauliflowerboiled cabbage or steam neprotertye in the form of puree, vegetable casseroles, with good endurance - green peas, cabbage, beans, ripe tomatoes (100-120 g per day); excluded turnip, radish, radish, spinach, onion, garlic, mushrooms;

    dishes from cereals, legumes pasta:
    Various friable porridges (except millet and barley) on the water with the addition of 1/3 of the milk, steam puddings and baked, boiled vermicelli;

    egg dishes: whole eggs (1 per day) in the dish, steam omelettes, good tolerability of boiled eggs (no more than 2 per day);

    sweet dishes, fruits, berries: jellies, compotes, jelly, mousse, souffle sweetfruits and berries (other than apricots, plums, melons), baked apples, pears, fruit jellies, marshmallows, candy, toffee, marmalade and jams, sweet berries and fruits, raw sweet variety of berries (strawberries, strawberry, raspberry), ripe soft apples and pears are peeled (100-200 g per day), with good tolerability and mandarin oranges, watermelons, grapes, juice of sweet fruits and berries (apple, strawberry, cherry, tangerine, etc.);

    dairy:
    unfermented milk in dishes, with good endurance - in its pure form; yogurt, acidophilus milk, fermented baked milk, yogurt; mild cheese (Russia, Yaroslavl), fresh cheese;

    sauces and spices: bay leaf, dill, parsley, cinnamon, cloves, milk sauce, fruit sauces;

    snacks: jellied fish, veal, doctoral sausage, caviar, herring soaked, lean ham;

    beverages: Broth hips, weak coffee and tea;

    fats: butter in the food and in-kind of bread no more than 5-15 grams per one time, depending on tolerability.


    In clinical nutrition patients with chronic enteritiswidely used nutritional mixture, recommended for baby food (for example, "The Kid" and others.), as well as protein enpit Institute of Clinical Nutrition.

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