Therapeutic nutrition in sanatorium-and-spa institutions

Since ancient times people understood the importance of nutrition, considering food a source of health, strength and vivacity. Proper nutrition, taking into account the conditions of life, work and mode of life, provides constant internal environment of the human organism, the activity of different organs and systems, and thus, it is the compulsory condition of good health, harmonious development and high working ability.

Depending on its properties and composition, food affects the organism in different ways. However, by any variety of nutrition food, which is eaten, has to function in the organism at physiologically optimal level. Only the solution of the mentioned problem will ensure the achievement of the sanatorium rehabilitation efficiency.
Dining rooms of sanatorium-and-spa institutions specialize in serving holidaymakers, who need clinical nutrition.
Dietary nutrition is a compulsory and an integral part of multimodality therapy, regardless of the disease in sanatorium-and-spa institutions.
The basic principle of dietary nutrition is the balanced chemical composition of rations with taking into account the biological effects of food substances and certain products at various pathologies.
In the sanatorium-and-spa institutions five combined universal dietary rations of nutrition are offered to patients.
The purpose of such nutrition consists in facilitating the processes of sanatorium-and-spa treatment of certain diseases and not causing exacerbation of concomitant diseases.
Dietary rations are considered as training and stimulating the compensatory mechanisms, which allow a patient to receive the diverse and adequate nutrition.
 
Dietary ration No.1 (ungrated version) combines existing dietary cookeries according to Pevzner No.1 and No.5 “п” – it is prescribed for chronic diseases of stomach with hyperacidity and chronic pancreatitises.
Purpose of administration: normalization of secretory and movement functions of stomach and pancreas, preventing of fatty infiltration of pancreas.
The nutrition of this group of patients is based on the following principles: adequacy, balance, temperance, mechanical and chemical sparing.
Dietary ration consists of vegetarian and dietary soups and vegetable brothes, cooked in bain-marie, low-fat sorts of boiled meat and fish, dairy and cultured milk foods.
Energy value of the ration is: proteins – 100-120g; fat – 80-100g; carbohydrate – 400-450g; energy value is 3500 kcal, 1.5 liters of free liquid.
 
Dietary ration No.2 combines the diets No.2 and No.5 and is prescribed by chronic diseases of stomach with low acidity by chronic cholecystitises.
Purpose of administration: to provide with adequat nutrition. Meanwhile to facilitate the increase of functions of gastric glands, biliary excretion, chemical sparing of liver, normalization of its functions, moderately affect the function of bowels.
Methods of dietotherapy meanwhile aim at the active influence on biliary excretion system, obstruction of cholestasia, and also on the stimulation of secretory and movement functions of stomach. The diet should be enriched with vegetables and fruits.
Energy value of the ration is: proteins – 100-120g; fat – 100-110g; carbohydrate – 350-400g; energy value is 3500-3600 kcal.
 
Dietary ration No.3 combines the existing diets No.8 and No.9, it is prescribed, when there are diseases in the result of metabolic disorders, including diabetes and obesity of the 1st and 2nd degree.
The basis of these diseases is the disorder of carbohydrate and fat metabolism. As a result, endocrine and central nervous systems suffer.
Purpose of administration: favourable impact on metabolism, normalization of carbohydrate metabolism, prevention of derangement of fat metabolism. In the ration there should be low-fat sorts of meat and fish, not strong and unsalted cheese, egg whites.
Carbohydrates are excluded or limited from the dietary ration,using sugar, confectionery, sweet drinks, jam, honey and others instead.
Sugar in food and drinks is replaced by xylite, sorbitol (30g a day) and other sugar substitutes.
Energy value of the ration is: proteins – 100-110g; fat – 80-90g; carbohydrate – 250-300g; energy value is 2770-3000 kcal.
 
Table 4.2.1. Basic average daily set of products for sanatorium-and-spa institutions
 
Name of products
Ration allowance, g/day
Rye bread
200
White bread
150
Wheat flour bran
90
Potato starch
10
Pasta, cereals, legumes
100
Potatoes
400
Vegetables, including:
500
Fresh fruit, berries
200
Dried Fruit
30
Fruit juice
200
Sugar
80
Preserves, jam, butter, marmalade, honey
25
Milk, kefir
500
Tinned food: meat, fish, seafood and other
10
Sour cream
40
Hard cheese
30
Low-fat cheese
90
Eggs (pcs)
1
Fish and fish products
Meat, liver, tongue
125
250
Sausage products and groceries
70
Poultry
50
Dairy Butter
70
Oil
40
Tomato paste
3
Yeast
1
Tea
2
Cocoa (coffee)
1
  
Dietary ration No.4 combines diets Nos 10, 7 and 6, it is prescribed, when there are diseases of cardiovascular and urinary systems and musculoskeletal apparatus.
Purpose of administration: promoting better blood circulation, functions of cardiovascular system, moderate sparing of kidneys function, reducing hypertension and edema, improving the egestion of nitrous purines and other metabolic products from the organism.
In the dietary rationcontent of sodium chloride and extractive substances are limited, use of liquid is reduced, but the content of potassium, magnesium, lipotropic substances and products, which exert alkaline influence (dairy products, vegetables, fruit), increases.
Energy value of the ration is: proteins – 100-110g; fat – 80-90g; carbohydrate – 400-450g; energy value is 3500-3000 kcal.
 
Dietary ration No.5 is prescribed for the patients and holidaymakers in the sanatorium-and-spa institutions, who need no special nutrition.
Purpose of administration is the providing with physiologically adequate nutrition in the conditions of the resort.
Chemical composition and energy value: proteins – 110-120g; fat – 100-110g (30% of oil); carbohydrate – 400-450g; energy value is 3600-3800 kcal, 1.5-2 liters of free liquid, 8-10g of table salt.
The peculiarity of nutrition organisation in the sanatorium-and-spa institutions is that it should be organized simultaneously for various contingent with taking into account the special approach to the structure of the products set and providing with food substances according to the physiological needs.
Nutrition in the sanatoriums is provided according to the 7-day menu, which is made, taking into account the dietary rations and average daily norms of products. The menu can be corrected depending on the type of the sanatorium, the cost of nutrition and seasonal prevalence. Seven-day menus are approved at the medical council of the sanatorium and agreed in the municipal sanitary-and-epidemiologic service (see the device of menu in Appendix 1).
The basis of the menu is the balanced daily ration with the basic chemical nutrients (proteins, fat, carbohydrates) and amino acid composition, mineral substances, vitamins etc. Meanwhile the energy value of the therapeutic diet, various nutrition and appropriate combination of products and culinary dishes is necessarily taken into account.
If necessary, individual nutrition is prescribed in special cases (for example, the combination of several diseases, exacerbation of the disease, by individual peculiarities of patient’s condition).
In the sanatorium-and-spa practice the expanded range of dishes and commercial system of nutrition organization to order are allowed.
Staff of dining rooms is well-prepared theoretically and practically for dietary cooking.
Dietary dishes are cooked according to the special recipes and technology. Cooks have the high skill category and proper knowledge in clinical nutrition.
The primary and basic document at enterprises is the card-file of dishes, i.e. a set of technological cards, which are used in nutrition. Every card has its numeration in the card-file. It is made up and signed by an engineer-technologist, the head of an enterprise, dietitian, and is approved by the head of the sanatorium.
If necessary, changes and components are put to the recipes of dishes and culinary food according to the “Norms of interchange of products when cooking dietary dishes”. Every card describes the cooking of culinary dishes and food.
In order to improve the control and safety of food at enterprises, system of quality assurance is organized. Quality system at enterprises has the following criteria:
  • responsibility;
  • control;
  • safety of raw materials and food;
  • purchase of provisions;
  • managing the process of cooking food.

The most important prerequisite for effective and rhythmical production is the rational organization of food delivery by the canteens.

According to the current requirements at enterprises the quality-control commission has been established and is functioning, and the following documentation is being kept:

  • quality control journals of raw products and prepared food;
  • registry (theoretical calculations) of chemical composition and caloric content of the diet;
  • journal of food vitaminization;
  • folder for laboratory analyses;
  • registry of medical examination of staff of the nutrition unit;
  • sanitary journal, where the results of research of sanitary state of the nutrition unit are recorded.

The nutrition unit of a health-improving institution includes: dining halls, shopfloors, storehouses, personal service and technical rooms, which have to be kept in perfect cleanness.

The serving of the table, i.e. the correct position of all necessary items of serving (dishes, table linen, covers etc.) in the determined order should be made before food intake.The serving of the table has to meet the following requirements:

  • to meet the kind of service – breakfast, dinner, supper;
  • to meet the menu of snacks, meals and drinks, which are served;
  • to be aesthetic – to be combined with the form of the table, the colour of the tablecloths and napkins (with the form of their folding) and the general interior of the hall;
  • to reflect the national spirit and thematic orientation of an enterprise of nutrition, hall etc.
  • all the items of the serving should be placed according to the rules.
 
Highly qualified service of personnel requires knowledge of items of serving, their names and purpose, and also carefulness, artistic taste and great desire to please the guests.
Nutrition in the dining rooms is organized according to the modern scientific principles and recommendations. In addition to the system to order, the realization of commercial nutrition and fixed meals is provided at enterprises.
The unification of production is carried out and food products in small packing are used.
The experts and masters-cooks develop and introduce specialities into the menu, new forms of service are practised.
In the dining rooms school of “Culinary Skills” and “Hospitality” have been working, and once five years the certification of cooks and waiters for the level of qualification is carried out.
The staff of the kitchens carries out active work as to the introduction of new forms of organization of clinical nutrition, which aims at the maximum satisfaction of holidaymakers’ demands.
 
V.I. Ponomarenko