In the Decree of the Ministry of Labor Russian Federation dated March 31, 2003 No. 14 (Appendix No. 2) approved 8 current diets for therapeutic and preventive nutrition, depending on occupational hazards:
Diet No. 1 for those working with x-rays and radioactive substances. Includes products that increase the antitoxic function of the liver, the body's resistance and its adaptive capabilities, stimulate fat metabolism and metabolism, and have a beneficial effect on the neurohumoral regulation of organs and systems. These are foods rich in lipotropic substances: dairy products, especially cottage cheese, liver, fish, buckwheat and oatmeal, eggs. The diet is enriched with 150 mg of vitamin C. Products should promote the synthesis of the stratum corneum of the skin, the function of the sebaceous glands of the skin, normalize the permeability of the skin, mucous membranes of the upper respiratory tract and gastrointestinal tract, improve intestinal motility, reduce the activity of putrefactive intestinal microflora.
Diet No. 2 for those working with inorganic concentrated acids, alkali metals, chlorine and its inorganic compounds, cyanide compounds, fluorine, phosphorus-containing fertilizers, phosgene, etc. This diet reduces accumulation in the body chemical compounds of various natures through the consumption of complete animal proteins (meat, fish, dairy products), vegetable oils rich in essential fatty acids, products containing calcium (fish, dairy products, cheese). The diet is enriched with 2 mg of vitamin A and 100 mg of vitamin C (when working with alkali metals, chlorine and its inorganic compounds, cyanides and nitrogen oxides); 2 mg of vitamin A and 150 mg of vitamin C (when working with fluoride); 100 mg vitamin C (when working with phosgene).
Diet No. 2a for those working with chemical allergens, in particular with chromium and its compounds, ensures weakening and slowing down the processes of sensitization of the body by chemical allergens that cause occupational allergic diseases. The diet improves metabolism and functional state target organ - the liver, increases protective forces body, has a beneficial effect on the nervous and endocrine system. In the diet, the amount of simple carbohydrates is limited, the amount of fats rich in PUFAs is slightly increased, the amount of proteins corresponds to the physiological needs of the body. The diet uses products with an increased amount of sulfur-containing amino acids, lecithin, rich in vitamins C, K, E, A, calcium and magnesium salts, pectin substances and organic acids, products containing alkaline valences. It is advisable to expand the range of fresh vegetables, fruits and berries in the diet through products such as cabbage, zucchini, pumpkin, cucumbers, rutabaga, turnips, lettuce, apples, pears, plums, grapes, chokeberry. In the absence of fresh vegetables, you can use well-soaked (to remove sodium chloride, hot spices and seasonings) salted, pickled and pickled vegetables. The diet is enriched with 100 mg of vitamin C, 2 mg of vitamin A, 15 mg of vitamin PP, 25 mg of vitamin U.Limit products with high sensitizing properties ( egg white, fish, pork, legumes, tomatoes, bananas, citrus fruits, cocoa and chocolate, strawberries, strawberries, raspberries), as well as products containing large amounts of salt and oxalic acid, as it helps remove calcium salts from the body. It is recommended to prepare boiled, steamed, baked and stews, without frying. The thermal regime of cooking dishes is strictly observed in order to qualitatively denature protein substances and reduce their antigenic properties.
Diet No. 3 for those working with lead and its inorganic compounds; Designed to prevent lead accumulation.
The diet contains fermented milk products, vegetables, fruits and berries rich in pectin, which is able to bind and remove lead and its compounds from the body. The diet is enriched with 150 mg of vitamin C. Mandatory daily distribution of dishes from vegetables that have not been subjected to heat treatment(salads, vinaigrettes, etc.).
Diet No. 4 for working with chlorinated hydrocarbons, compounds of arsenic, tellurium, selenium, silicon, etc.; designed to increase the functionality of the liver and hematopoietic organs. The diet includes foods rich in lipotropic factors (meat, fish, cottage cheese, vegetable oils). Fried foods are limited in the diet, as they burden liver function. The diet is enriched with 150 mg of vitamin C and 4 mg of vitamin B1 (at work with compounds of arsenic, mercury, tellurium) to prevent changes in the nervous system.
No. 4a- for those working with phosphorus and its inorganic compounds. The diet is enriched with 2 mg of vitamin B1, 100 mg of vitamin C.
No. 4b- for working with amino and nitro compounds of benzene and its homologues. The diet is enriched with 2 mg vitamin B 1 and B 2, 3 mg vitamin B 6, 20 mg vitamin PP, 100 mg vitamin C, 10 mg vitamin E, 500 mg glutamic acid or monosodium glutamate.
Diet No. 5- for those working with mercury and its inorganic compounds, tetraethyl lead, brominated hydrocarbons, carbon disulfide, thiophos, compounds of manganese, beryllium, barium, etc., intended to protect the nervous system and liver. The diet contains complete animal proteins, vegetable oils rich in PUFAs. The diet is enriched with 4 mg of vitamin B1 and 150 mg of vitamin C.
Limit all diets contain refractory fats (beef, lamb, pork), salt and foods rich in it. Since fats promote absorption toxic substances in the food channel, and salt retains fluid and limits the removal of toxic substances from the body. Drinking plenty of fluids ensures the removal of toxic substances from the body in persons involved in the production of arsenic, chlorinated hydrocarbons, and benzene.
The composition of therapeutic and preventive nutrition diets is given in the table.
Products included in therapeutic and preventive nutrition diets (in grams)
| Product Name |
Diets and their composition |
||||||||
| Wheat/rye bread | |||||||||
| Wheat/potato flour | |||||||||
| Cereals/pasta | |||||||||
| Legumes | |||||||||
| Sugar | |||||||||
| Meat/Poultry | |||||||||
| Fish | |||||||||
| Liver | |||||||||
| Eggs | |||||||||
| Kefir or milk |
Milk 200+kefir 70 | ||||||||
| Cottage cheese 18% fat/Cheese | |||||||||
| Butter / Butter grows. |
10/5 + 5 g live fat | ||||||||
| Sour cream | |||||||||
| Potatoes/Cabbage | |||||||||
| Various vegetables | |||||||||
| Carrots/green peas. | |||||||||
| Tomato puree | |||||||||
| Fruits/Dried fruits (raisins, prunes, dried apricots) | |||||||||
| Cranberries/Lemons | |||||||||
| Min.water "Narzan"/Juice | |||||||||
| Crackers | |||||||||
| Salt | |||||||||
| Tea | |||||||||
| Total: proteins | |||||||||
| Fats | |||||||||
| Carbohydrates | |||||||||
| Calorie content | |||||||||
|
Additionally |
|||||||||
| Vitamin C | |||||||||
| Vitamin B 1 | |||||||||
| Vitamin B 2 | |||||||||
| Vitamin A | |||||||||
| Vitamin PP | |||||||||
| Vitamin U (S-methylmethionine | |||||||||
| glutamic acid | |||||||||
| pyridoxine | |||||||||
| tocopherol | |||||||||
3. As a type of therapeutic and preventive nutrition, a daily free supply of milk or other equivalent products is provided. food products, How the most important sources complete protein, essential amino acids, phosphatides, vitamins and minerals. Milk increases the body's functional abilities and mitigates the negative effects unfavorable factors production environment.
Milk is indicated for work involving exposure to various hydrocarbons, alcohols, aldehydes, esters, organic acids and their anhydrides, alkaloids, halogens and their derivatives, sulfur, selenium, mercury, beryllium, tellurium, antimony, arsenic, manganese, thallium, chromium, cadmium, and other metals, antibiotics, radionuclides and in the formation of all types of soot.
The standards for the free distribution of milk are established in the Appendix to the Resolution of the Ministry of Labor of the Russian Federation dated March 31, 2003 No. 13 “On approval of the standards and conditions for the distribution of milk or other equivalent food products to workers engaged in work with hazardous working conditions.” The norm for milk supply on days of actual employment is 0.5 liters per shift, regardless of its duration.
The distribution and consumption of milk should be carried out in buffets, canteens or in specially equipped premises in accordance with sanitary and hygienic requirements. It is not allowed to replace milk with monetary compensation or other products, except for equivalent ones, the list of which has been agreed upon with the Ministry of Health of the Russian Federation, as well as to issue milk for one or several shifts in advance, for past shifts, and to release it at home.
Instead of milk, employees may be given equivalent food products free of charge:
1. fermented milk products (kefir different varieties, kefir-bio, yogurt, acidophilus, fermented baked milk with low fat content (up to 3.5%), yoghurts of various varieties with a fat content of up to 2.5%, with natural fruit and berry additives - 500 g;
2. cottage cheese - 100 g;
3. curd mass, curd cheeses, curd desserts - 150 g;
4. cheese 24% fat - 60 g;
5. whole milk powder - 55 g;
6. sterilized condensed milk without sugar - 200 g;
8. low-fat fish (raw) - 90 g;
9. chicken egg - 2 pcs.;
10. therapeutic and prophylactic drinks such as “VITA”, vitamin preparations such as “Vetoron”, undevit, glutamevit, aerovit, hexavit, heptavit, kvadevit and bifid-containing fermented milk products.
It is not allowed to replace milk with sour cream or butter.
Replacement of milk with the above equivalent food products is allowed when, for one reason or another, it is impossible to provide milk to employees, with the consent of the employees, taking into account the opinion of the elected trade union body or other body authorized by the employees of the given organization.
Replacing milk with therapeutic and prophylactic drinks, vitamin preparations and bifid-containing fermented milk products is allowed only with a positive conclusion from the Russian Ministry of Health on their use.
Employees who receive free therapeutic and preventive nutrition due to particularly harmful working conditions are not given milk.
Workers in contact with inorganic lead compounds are recommended to use fermented milk products instead of milk during the working day; additionally, before starting work, they are given 2 g of pectin in the form of canned plant foods, drinks, jellies, jams, marmalades, fruit and vegetable juices and canned food enriched with it. It is allowed to replace these products with natural fruit juices with pulp (250 - 300 g).
Workers involved in the production or processing of antibiotics are also recommended fermented milk products enriched with probiotics (bifidobacteria, lactic acid bacteria) or colibacterin prepared from whole milk.
Workers engaged in work involving the use of radioactive substances in open form, used in the first and second classes of work, are provided with milk or other equivalent food products.
When providing safe conditions labor, the employer decides to stop providing free milk, taking into account the opinion of the trade union body or other body authorized by the employees.
All other issues related to the free provision of milk to employees engaged in work with hazardous working conditions are resolved by the employer independently.
4. Vitamins help stimulate the body's defense mechanisms against harmful production factors. They are used in therapeutic and preventive nutrition in the form of foods rich in vitamins and pharmaceuticals. This takes into account the nature of unfavorable factors in the production environment and possible selective action certain vitamins. In particular, tocopherol is shown to be in contact with mercury, which, together with selenium (a biological antagonist of mercury), is involved in its detoxification. The source of tocopherol is vegetable oil, and the source of selenium is cereals and beans. When working with benzene, xylene, toluene, phosphorus, lead, arsenic, the detoxifying properties of ascorbic acid are used, which are rich in rose hips, sweet peppers, black currants, parsley, Brussels sprouts, dill, cauliflower and other plant products. To reduce intoxication with mercury, lead, chlorinated hydrocarbons, it is advisable to use B vitamins, which are abundant in whole grain rye and wheat bread, rye wallpaper and second grade wheat flour, buckwheat and oatmeal, green peas, beans, liver and beef kidneys and pork, beef meat. When working with cadmium, ergocalciferol helps prevent bone damage.
Workers exposed to high temperatures environment and intense heat irradiation during smelting and rolling of hot metal at ferrous metallurgy enterprises; scalders and bakers in bakery production
Workers employed in tobacco, tobacco and nicotine production who are exposed to dust containing nicotine.
According to the List of industries, professions, positions, work in which gives the right to receive free therapeutic and preventive nutrition in connection with particularly harmful working conditions (1977), standards for the free distribution of vitamin preparations are provided (Table 19).
The distribution of only vitamin preparations is provided for workers:
a) exposed to high temperatures and intense heat irradiation during the smelting and rolling of hot metal at ferrous metallurgy enterprises - 2 mg vitamin A, 3 each mg vitamins B 1 and B 2; scalders and bakers in bakery production - 150 mg vitamin C, 20 mg vitamin PP;
b) exposed to dust containing nicotine (tobacco-smoking and nicotine production) - 2 mg vitamin B 1, 150 mg vitamin C.
increasing the body's resistance to many chemical poisons(aromatic hydrocarbons, acetone, some pesticides, lead, carbon disulfide), they enhance metabolic processes, promote healing processes and normalize the functions of target organs. The detoxifying properties of vitamins A and group B, ascorbic acid, and vitamin E as a natural antioxidant are known.
Persons receiving free hot breakfasts will receive vitamins with their breakfast. Persons receiving only vitamins are given them in canteens.
Ascorbic acid, thiamine, nicotinic acid should be consumed in crystalline form, since the use of dragees and tablets increases their cost and makes it difficult to control their intake by workers;
For those receiving hot breakfasts of therapeutic and preventive nutrition, the vitamin solution is added to tea or coffee one teaspoon at a time. In cases where only vitamins are given, their solution (a teaspoon) is added to the first or third course.
Retinol is added by dissolving in fat, which is poured over side dishes of second courses at the rate of 2 mg (or 6600 IU) per person. A typical retinol oil concentrate contains 100,000 IU in 1 ml, t.s. the quantity required for 15 people, and two drops of this concentrate are given per person.
In factories where there are no shop canteens, but only a general factory canteen, retinol is dissolved in a portion of butter or side dishes, weighed separately according to the number of workers in the hot shops.
The correctness of the issuance of vitamins is controlled by the medical and sanitary part of the plant and sanitary and epidemiological stations.
In some cases, it is allowed to issue vitamins in the form of tablets or dragees. Chemical analysis for the content of ascorbic acid should be carried out in solutions that do not contain nicotinic acid, which complicates the titration of ascorbic acid.
The person responsible for fortifying food and distributing vitamins daily enters into the layout menu information about the fortification performed, indicating the dishes, the number of fortified portions and the amount of vitamins used (in mg). Vitamins should be stored in a cool, dry place, protected from light, in a tightly closed container and locked.
| Number of servings | Amount of water, ml | Ascorbic acid, mg | Thiamine, mg | Nicotinic acid, mg |
| 1 | 4 | 150 | 3 | 15 |
| 5 | 20 | 750 | 15 | 75 |
| 10 | 40 | 1500 | 30 | 150 |
| 50 | 200 | 7500 | 150 | 750 |
- vitamins give an unpleasant aftertaste to drinks and dishes;
- preparing vitamin drinks is a very labor-intensive procedure,
- requiring constant monitoring and a lot of time;
- The possibility of contamination of drinks with foreign substances cannot be ruled out.
5. Pectin substances are natural polymers found in vegetables, fruits and berries. They bind and promote the removal of heavy metals from the body, increase the body's resistance to mutagenic environmental influences, stimulate reparative processes in the gastrointestinal tract, and have an antitoxic effect in case of lead poisoning. Eggplants, beets, radishes, carrots, pumpkin, cabbage, apples, apricots, plums, cherries, pears, etc. are rich in pectin. Apple pomace is a good source of pectin, from which cream and mousse are prepared. Natural fruit juices with pulp (300 g), canned vegetable food products enriched with pectin, and fruit drinks are used. A preventive dose of pectin is 2 g per day.
The distribution of pectin-enriched food canned plant products, drinks, jellies, jams, marmalades, fruit and vegetable juices and canned food, as well as natural fruit juices with pulp must be organized before starting work.
6. Therapeutic and preventive nutrition is provided in the form of hot breakfasts before starting work in the form of hot breakfasts, so that the biologically active substances have their beneficial protective effect on the body. In some cases, in agreement with the medical and sanitary service of the organization or with the state sanitary and epidemiological service of the Russian Federation, it is allowed to provide therapeutic and preventive food during the lunch break. Those working in conditions of high pressure (in caissons, medical pressure chambers, diving work) should be given therapeutic and preventive food after release. If any products are unavailable, they can be replaced taking into account the mechanism of action of industrial poisons. It is better to organize meals in a separate room or isolated part of the trading floor. Food distribution should be carried out under the supervision of a nutritionist. It is necessary to ensure mandatory hand washing and mouth rinsing before eating.
Therapeutic and preventive nutrition is given to employees on the days they actually perform work in the industries provided for in the list, when employed for at least half of the working day, as well as on days of illness with temporary loss of ability to work, if the disease is occupational and the sick person is not hospitalized.
Therapeutic and preventive nutrition is also provided:
a) workers engaged in construction, construction and installation, repair, construction and commissioning work, cleaning and preparing equipment for repair, working full time in industries with particularly hazardous working conditions;
b) disabled people due to an occupational disease who used therapeutic and preventive nutrition immediately before the onset of disability until the cessation of disability, but not more than one year;
d) employees who have the right to free therapeutic and preventive nutrition and are temporarily transferred to another job due to the initial symptoms of an occupational disease for a period of not more than one year;
e) women who have the right to receive free therapeutic and preventive nutrition for the entire period of maternity leave. When women with children under the age of one and a half years are transferred to another job, therapeutic and preventive nutrition is given to them until the child reaches the age of one and a half years.
Therapeutic and preventive nutrition is not provided:
a) on non-working days;
b) on vacation days;
c) on business trips;
d) on off-duty study days;
e) on days when work is performed in other areas where therapeutic and preventive nutrition is not established;
f) on days of performing state and public duties;
g) during the period of temporary incapacity for work due to general diseases;
h) during the days of stay in a hospital or sanatorium for treatment.
If it is impossible to receive due to health reasons or due to the distance of residence from the canteen, workers during a period of temporary disability or disabled people or women are allowed to issue therapeutic and preventive food at home in the form of ready-made meals according to the relevant certificates of the health service or the state sanitary and epidemiological service. RF.
The distribution and preparation of therapeutic and preventive nutrition, as well as vitamin preparations, must be carried out by public catering organizations in strict accordance with the approved rations of therapeutic and preventive nutrition.
Menu layouts for each day should be compiled in accordance with the list of products provided for in therapeutic and preventive nutrition diets. Therapeutic and preventive nutrition should be provided to those working in particularly hazardous conditions according to menu standards designed for 6 working days. With a 5-day working week, the employee retains a weekly norm for the distribution of therapeutic and preventive nutrition, calculated for 6 working days.
Workers who use therapeutic and preventive nutrition must be familiarized with the rules for free provision of food, which must be included in the mandatory induction program on labor protection.
All measures are being taken to create conditions that exclude any harmful effects on the health of workers during their work activities.
The main thing in the prevention of occupational hazards is the improvement of working conditions, technical and sanitary-hygienic improvement of enterprises, as well as strict adherence to safety regulations.
In the prevention of occupational hazards along with health improvement external environment great value have measures aimed at increasing the body’s resistance to the adverse effects of physical and chemical factors of production conditions. Among these activities, one of the first places belongs to preventive nutrition.
Preventive nutrition is designed to increase the body's resistance to certain occupational hazards, as well as limit the accumulation in the body harmful substances and increase their excretion from the body.
When organizing preventive nutrition, the main task is to balance it in accordance with the general daily nutrition, which, together with the preventive nutrition diet, should fully ensure the biological usefulness and preventive orientation of the daily diet.
The most important part of biologically active substances in preventive nutrition are vitamins. Currently, most preventive diets provide additional amounts of only two vitamins - ascorbic acid and thiamine. Some preventive diets include increased amount vitamin A.
However, it must be recognized that a significant part of the vitamins, which undoubtedly have high biological activity, are not yet used in full in preventive diets.
At the same time, it is known that by creating targeted diets enriched with protein and a certain complex of vitamins, it is possible to reduce and prevent the negative effects of various occupational hazards.
The second important promising means of preventing occupational hazards and reducing the negative effects of small doses of harmful substances in the body and their cumulative effects are some amino acids - cystine and methionine, tyrosine and phenylalanine, tryptophan, glutamic acid.
Inclusion in food ration Preventive nutrition of sources of these amino acids can be carried out for a variety of the most common occupational hazards.
Currently, there is already sufficiently substantiated data for the inclusion of additional amounts of pectin substances in preventive nutrition diets. The detoxifying properties of pectin are generally recognized. Its colloidal properties, high adsorption capacity, as well as the ability, upon decomposition, to form metal ions with high catalytic ability, put pectin substances in one of the first places among the components of preventive nutrition for various types occupational hazards. There is evidence of the important role of pectin substances in the removal of metal compounds from the body.
The inclusion of food products with a high content of pectin (O.P. Maykova), as well as special products containing pectin, including confectionery products proposed by A.D. Bezzubov, into preventive nutrition diets is quite reasonable and should find practical application.
In preventive nutrition important role belongs to maintaining acid-base balance body. As is known, a violation of the latter towards acidosis leads to increased entry into the blood of harmful substances (for example, lead), and a shift in the acid-base balance of the body towards alkalosis contributes to the retention and immobilization of a number of harmful substances in the body.
It is also necessary to take into account that a shift in acid-base balance towards acidosis is invariably accompanied by a decrease protective properties body.
An important role in the qualitative targeting of preventive nutrition diets is played by calcium and magnesium, the metabolism of which has much in common. The importance of calcium and its role in the deposition of metals and some other substances in bones makes calcium an important component preventive nutrition for many types of occupational hazards.
There is evidence of a large biological activity magnesium, which has the property of increasing the elimination of certain harmful substances from the body.
Modern scientific data make it possible to create new types of preventive nutrition, as well as to make adjustments to previously adopted special preventive diets.
Since 1961, preventive nutrition rations have been established, applied according to the list of positions and productions that have one or another occupational hazard. In preventive nutrition, 5 diets are used.
Calorie content of preventive diets
Depending on the specifics of work, each diet is supplemented with vitamins ( ascorbic acid, retinol, thiamine).
The use of preventive nutrition rations is carried out according to the nature of the occupational hazards of a particular production.
Diet No. 1 intended for those working with radioactive substances and ionizing radiation;
diet No. 2- for those working in the production of strong acids;
diet No. 3 used in combination with other diets by weekly alternation;
diet No. 4- for those working in the production of phosphorus compounds, aniline, hexachlorane;
diet No. 5- for those working in the production of carbon disulfide, thiophos, mercaptophos, mercury.
Rations No. 3 and No. 2, alternating weekly, are used in the production of lead nitrate, varnishes and paints, lead and tin, and lead-acid batteries. In addition to preventive nutrition rations, vitamins are provided.
According to diet No. 1 and No. 3, an additional 150 mg of ascorbic acid is provided, according to diet No. 2 - vitamin A 2 mg and vitamin C 100-150 mg; according to diet No. 4 and No. 5 - vitamin C 150 mg and vitamin B 1 - 4 mg.
In the production of electric coal products, workers in some professions are given ration No. 3 and ration No. 4 by weekly alternation.
All preventive diets include limiting table salt and salty foods, as well as fat and fatty foods.
For those working with benzene, chlorinated hydrocarbons and arsenic compounds, increased drinking is recommended (at least 5-6 glasses per day).
Preventive nutrition rations No. 2 and No. 3 are intended mainly for those working in conditions of possible exposure to lead compounds.
Each of these rations is provided for a week. One week workers receive preventive nutrition according to diet No. 2, the other week - according to diet No. 3.
This alternation of preventive diets for workers working with lead is justified by the following provisions. Diet No. 2 includes a significant amount of calcium (600 mg) and other alkaline mineral elements included in the dairy products, potatoes and vegetables of the diet.
Under the influence large quantities calcium and background alkaline diet lead deposition in bones in the form of tribasic phosphate increases. Lead is immobilized in the body, the entry of lead into the blood is reduced, its excretion in the urine is reduced, and the risk of lead poisoning is reduced.
Diet No. 3 contains little calcium (150 mg) and other alkaline elements. The predominance of acidic elements in this diet causes a shift in the acid-base balance towards acidosis. This type of diet contributes to the gradual elimination of deposited lead from the body.
Preventive nutrition is provided free of charge to persons for whom it is provided.
Organization of preventive nutrition in canteens industrial enterprises should be carried out with the participation of a doctor or nutritionist. Please note:
1) to allocate special tables marked with the ration number for persons using preventive nutrition;
2) for the allocation of service personnel - waitresses and cooks familiar with the preparation of preventive nutrition dishes.
Preventive nutrition is usually provided in canteens.
Preventative nutrition is provided in the form of hot breakfasts, which are provided before work begins. In some cases, it is allowed, in agreement with the medical service of the enterprise, to issue preventive nutrition during the lunch break.
Therapeutic and preventive nutrition(LPP) is the nutrition of persons working in conditions of unfavorable influence of the production environment. It belongs to the types of preventive nutrition, since it is aimed at increasing the protective functions of the physiological barriers of the human body (skin, mucous membrane of the gastrointestinal tract and upper respiratory tract), regulating the processes of biotransformation and elimination of toxic substances from the body, normalizing the functional
tion of organs and systems, strengthening the antitoxic function of the body.
The main task of DILI is nutritional prevention occupational pathology by providing the body with additional amounts of nutrients, the consumption or loss (through sweat or breathing) of which cannot be compensated physiologically balanced diet, and also, which is extremely important, due to the detoxification orientation of DILI and its high elimination efficiency.
Principles and scientific basis DILI correspond to similar concepts within the framework of complex nutritional adaptation to conditions ecological crisis(foreign load). Despite the fact that the intensity of foreign influence in hazardous production conditions significantly exceeds similar characteristics in areas of environmental distress, the main methodological approaches to the implementation of food safety management and nutrition optimization, for example, in settlement areas directly adjacent to industrial facilities, or in areas of intensive urbanization, are common.
In accordance with the Labor Code of the Russian Federation, LPP provides for the free issuance of:
1) hot breakfasts;
2) milk (or fermented milk products);
3) vitamin preparations.
A specific type of LPP is selected based on production conditions in accordance with the approved official “List of occupations and positions in which work gives the right to receive free LPP in connection with particularly harmful working conditions,” which includes more than 3,170 professions and positions.
Hot breakfasts. Currently, eight hot breakfast diets have been developed and are used (in accordance with the main groups of industrial hazards). Hot breakfasts (LPP rations) are given out before the start of the work shift, with the exception of those working in high-pressure conditions (in caissons, pressure chambers, diving work) who receive the LPP ration after release. Hot breakfasts should contain at least 50% of the daily requirement for energy and nutrients.
Diet No. 1 designed for personal injury workers who come into contact with radioactive substances and sources of ionizing radiation, including: 1) those directly involved in the mining and processing (including loading and storage) of uranium and thorium ores; production and processing of uranium, thorium, tritium, radium, thorium-228, radium-228, actinium-228, polonium, transuranic elements, fission products of uranium and thorium;
2) those employed in research, transport, experimental industrial nuclear reactors, on their prototypes, critical assemblies and pulsed reactors, experimental thermonuclear installations and powerful isotope y-irradiation installations. Diet No. 1 contains 59 g of proteins, 51 g of fats, 159 g of carbohydrates, and additionally 150 mg of vitamin C is added to its composition. The diet should provide additional intake of antioxidant nutrients and lipotropic substrates into the body and protect the body from radio load, preventing lipid peroxidation and reducing the consequences of radiation mutagenesis.
Diet No. 2 Intended for use by workers who come into contact with inorganic acids, alkali metals, chlorine and fluorine compounds, organophosphorus and cyanide compounds at work. It contains 63 g of protein, 50 g of fat, 185 g of carbohydrates, and additionally vitamin A and vitamin C are added to its composition in quantities of 2 and 100 mg, respectively.
Diet No. 2a Intended for use by workers who come into contact with chromium and chromium-containing compounds at work. The diet should provide a hypoallergenic diet for this category of workers. It is more strictly balanced in animal proteins and essential amino acids, vegetable oils (PUFAs), and vitamins. Diet No. 2a contains 52 g of protein, 63 g of fat, 156 g of carbohydrates, with the additional inclusion of vitamins C - 150 mg, A - 2 mg, PP - 15 mg, S-methylmethionine - 25 mg, as well as 100 ml mineral water "Narzan".
It is advisable to expand the range of fresh vegetables, fruits and berries in diet No. 2a with products such as cabbage, zucchini, pumpkin, cucumbers, rutabaga, turnips, lettuce, apples, pears, plums, grapes, chokeberries. In cases where fresh vegetables are unavailable, you can use well-soaked (to remove sodium chloride, hot spices and seasonings) salted, pickled and pickled vegetables when preparing dishes. When producing DPP provided for in this diet, it is recommended to prepare mainly boiled and steamed, as well as baked and stewed (without prior frying) dishes.
Diet No. 3 Intended for use by workers who come into contact with inorganic and organic lead compounds at work. It contains 64 g of protein, 52 g of fat, 198 g of carbohydrates and an additional 150 mg of ascorbic acid. When prescribing diet No. 3, it is imperative to provide for the daily provision of dishes from vegetables and fruits that have not been subjected to heat treatment (salads), in order to maximize the preservation of vitamins and indigestible substances in them. dietary fiber. For the same purpose, it is necessary to use bread made from wholemeal flour and...
refined cereals (for example, oats instead of Hercules). Milk in in kind not issued, replaced by kefir and fermented milk products.
Diet No. 4 Intended for use by workers who come into contact with benzene and phenol compounds, chlorinated hydrocarbons, azo dyes, arsenic, mercury, fiberglass in production, as well as when working under conditions of increased external pressure. This diet is one of the most widely used in DILI. It contains 65 g of protein, 45 g of fat, 181 g of carbohydrates with an additional inclusion of vitamins C - 150 mg and b! - 4 mg (the latter when working with compounds of arsenic, mercury and tellurium). The purpose of diet No. 4 is to protect the liver and hematopoietic organs from compounds of both organic and inorganic nature that are tropic to them. It is lipotropic and low in fat.
Diet No. 4a Intended for use by workers who come into contact with phosphoric acid, phosphoric anhydride, phosphorus and its other derivatives at work. It contains significant amounts of vegetables and animal protein sources. This diet should be as low in fat as possible, both through a small amount of oils and through the use of lean meats and dairy products. Whole milk is replaced with kefir. All this helps to reduce the absorption of phosphorus in the gastrointestinal tract. Diet No. 4a contains 54 g of protein, 43 g of fat, 200 g of carbohydrates with the additional inclusion of vitamins C - 100 mg and B - 2 mg.
Diet No. 46 is intended for DIBI of workers who come into contact at work with aniline and toluidine derivatives, dinitrochlorobenzene and dinitrotoluene, which are very hazardous to health. The effect of the diet is aimed at reducing the incorporation of these chemical compounds and increasing cellular protective and adaptive mechanisms. For this purpose, the diet includes a variety of herbal ingredients and is enriched with a wide range of vitamins and glutamic acid, providing a general detoxification effect: vitamins C - 150 mg, B] - 2 mg, B 2 - 2 mg, B 6 - 3 mg, PP - 20 mg, E - 10 mg, glutamic acid - 500 mg. Diet No. 46 contains 56 g of protein, 56 g of fat, 164 g of carbohydrates.
Diet No. 5 Intended for use by workers who come into contact with hydrocarbons, carbon disulfide, ethylene glycol, organophosphorus pesticides, polymeric and synthetic materials, and manganese at work. The action of diet No. 5 is aimed at protecting the nervous system and liver. It contains lecithin, PUFAs, and complete animal proteins. Additionally, vitamin B1 (4 mg) and ascorbic acid (150 mg) are provided. This diet contains 58 g of protein, 53 g of fat, 172 g of carbohydrates.
Vitamins intended for additional intake as part of hot breakfasts, added as aqueous solution, as a rule, in the third course (C, group B, as well as glutamic acid) or in oil solutions as side dishes for main courses or salads (A, E).
Dietary diets are developed taking into account the pathochemical and protective-adaptive processes that occur in the human body during industrial contact with relatively high concentrations of a foreign compound. Because of this, strict adherence to the hot breakfast diet in terms of the food set and additional intake of vitamins and mineral waters is a significant factor ensuring the effectiveness of the diet. In the absence of any product as an exception (one-time or for short time) it is allowed to replace it with another product similar in chemical composition, within the approved standards of product interchangeability.
Other factors that determine the effectiveness of the PPP are the organization of the distribution of hot breakfasts and other types of PPP in strict accordance with the approved rules and the conduct of regular medical examinations and hygienic training for workers employed in hazardous industries.
Milk (fermented milk products). In jobs with hazardous working conditions, workers are given milk or other equivalent food products free of charge according to established standards. In contrast to the broad preventive purpose of hot breakfasts (associated with protection from a complex of particularly harmful working conditions), milk is given, as a rule, for nutritional prevention of exposure to a specific adverse production factor (substance). The list of harmful production factors, under the influence of which it is recommended to consume milk for preventive purposes, contains about 1,000 names of chemical substances. The rate of free milk distribution is 0.5 liters per shift, regardless of its duration.
Free milk is provided to employees on days of actual employment at work related to the presence at the workplace of production factors provided for in the List approved by the Government of the Russian Federation. Instead of milk, employees may be given fermented milk products (various types of kefir, bio-kefir, yogurt, acidophilus, fermented baked milk with a low (up to 3.5%) fat content, various types of yoghurts with a fat content of up to 2.5%, including yoghurts with natural fruit and berry additives) in an amount of 500 g. The basis for replacement may be preventive expediency (need for probiotic, desensitizing effect, etc.) or individual intolerance whole
milk. Thus, instead of fresh milk, workers involved in the production or processing of antibiotics should be given fermented milk products enriched with probiotics (bifidobacteria, lactic acid bacteria), or colibacterin prepared from whole milk.
The distribution and consumption of milk should be carried out in buffets, canteens or specially equipped premises in accordance with sanitary and hygienic requirements. It is not allowed to replace milk with monetary compensation, to replace it with other products other than equivalent ones (provided for by the norms for the free issuance of equivalent food products that can be given to employees instead of milk), as well as to issue milk one or more shifts in advance, as well as for past shifts, and leave him at home. Employees who receive another type of therapeutic and preventive nutrition free of charge due to particularly harmful working conditions - hot breakfasts - are not given milk.
Workers in contact with inorganic lead compounds are given 2 g of pectin in addition to fermented milk products in the form of canned vegetable food products, drinks, jellies, jams, marmalades, fruit and vegetable juices and canned food enriched with it (the actual pectin content is indicated by the manufacturer). It is allowed to replace these products with natural fruit juices with pulp in the amount of 250...300 g. Dispensing milk and pectin-enriched food canned vegetable products, drinks, jellies, jams, marmalades, fruit and vegetable juices and canned food, as well as natural fruit juices with pulp must be organized before starting work.
Vitamin preparations. Workers engaged in industries associated with the adverse effects of high temperatures and nicotine-containing dust on the body are given free vitamin preparations as an independent type of DILI (Table 5.4).
Work in high temperature conditions. Working in such conditions necessitates the need for additional introduction into the diet of not only vitamins lost with sweat, but also requires organization special food and water consumption. At high temperatures, the human body experiences an increased need for complete protein within its physiological norm. It is very important not to increase the total amount of protein in the diet, but only to increase the proportion of high-value (for example, milk) protein. Having a high potential for thermogenesis, excess protein, unlike fat and carbohydrates, will increase internal heat production and reduce intracellular water reserves.
The amount of fat and carbohydrates (especially simple ones) must be maintained at the upper limit of physiological needs. Carbohydrates reduce the excretion of amino acids and nitrogenous compounds from the body, and fats provide endogenous water synthesis, maintaining tissue hydration.
When organizing meals for workers in hot shops, special attention should be paid to water balance. Water balance consists of fluid intake into the body with a diet of -1.5...2 l/day and endogenous water synthesis - 350...400 ml/day and losses: through the kidneys (55% - 1...1. 4 liters with urine), lungs (15% - up to 400 ml), skin (20% - up to 500 ml), intestines (10% - up to 250 ml). Under conditions of prolonged high-temperature stress, the cutaneous pathway of water release comes to the fore due to a 20...25-fold increase in sweating.
For precise definition individual fluid losses during the work shift (mainly through the skin and lungs), it is necessary to calculate the true body weight deficit, equal to the difference between the morning fasting body weight and body weight after work. The maximum permissible true body weight deficit at the end of a work shift can be 1.5 kg. Organizing an optimal drinking regimen requires calculating the need for fluid, justifying its qualitative composition, time and method of administration. At the same time, uncontrolled, disordered drinking in the workplace does not bring the desired effect.
Drinking regime should be organized in the form of regular intake of a calculated amount (100...250 ml) of water or other selected liquid every 25...30 minutes of work. The total amount of fluid consumed can be calculated using a formula or set empirically taking into account true body weight deficiency. In addition to fresh water, it is advisable
use mineral waters, protein-vitamin drinks (based on bread kvass and skim fermented milk), correctors of water-salt losses (containing potassium and sodium chlorides, sodium bicarbonate), green tea and other permitted herbal teas. The use of coffee, cocoa, and low-alcohol drinks (for example, beer) during a work shift produces the opposite results, reducing performance and disrupting thermoregulation.
Rules for issuing PPP. Therapeutic and preventive nutrition is provided free of charge only to those workers for whom the provision of this food is provided for in the “List of industries, professions and positions, work in which gives the right to receive free therapeutic and preventive nutrition in connection with particularly harmful working conditions,” regardless of the what sector of the economy these productions are located in, as well as the organizational, legal forms and forms of ownership of employers. Changes and additions to the above List are made by resolutions of the Government of the Russian Federation on the basis of proposals from federal executive authorities and executive authorities of constituent entities of the Russian Federation in agreement with the Ministry of Health and Social Development of Russia.
Therapeutic and preventive nutrition is given to employees on the days they actually perform work in production, provided that they are employed at the specified job for at least half of the working day, as well as on days of illness with temporary loss of ability to work, if the disease is occupational in nature and the sick person is not hospitalized.
Therapeutic and preventive nutrition is also provided:
1) workers of other industries and workers employed in
construction, construction and installation, repair and construction
and commissioning work, working full time in
existing industries with particularly hazardous working conditions,
in which both for essential workers and for maintenance
personnel are provided with the issuance of personal health insurance certificates;
2) workers cleaning and preparing equipment for
repair or conservation in the workshop (on site) of the organization, for
workers whose workers are provided with the issuance of PPP;
3) disabled people due to an occupational disease,
who used LPP immediately before the onset of
validity due to the nature of their work - up to
termination of disability, but not more than one year from the date of
new disabilities;
4) employees entitled to receive free medical insurance
and temporarily transferred to another job due to initial
mi phenomena of occupational disease due to the cause
due to the nature of their work - for a period not exceeding one year;
5) women employed before the start of maternity leave in industries, professions and positions that give them the right to receive free medical insurance - for the entire duration of maternity leave. If pregnant women, in accordance with a medical opinion, are transferred to another job to eliminate contact with harmful production factors before the onset of maternity leave, the PPP is issued to them for the entire time before and during the period of leave. When transferring to another job for the specified reasons, women with children under the age of one and a half years, the LPP is issued to them until the child reaches the age of one and a half years.
Therapeutic and preventive nutrition is not provided:
On non-working days;
Vacation days;
Business travel days;
Off-the-job study days;
Days of work in other areas where LPP is not established
updated;
Days for fulfilling state and public obligations
ste;
Period of temporary disability for general illnesses
nikah;
Days of stay in a hospital or sanatorium for treatment.
If it is impossible for workers during a period of temporary incapacity for work or disabled people due to an occupational disease who have the right to receive this food to receive it due to health reasons or due to the remoteness of their place of residence, it is allowed to issue it to them at home in the form of ready-made meals according to the relevant certificates of the health service organization, and in its absence - territorial institutions authorized to carry out State Sanitary and Epidemiological Supervision. This procedure for issuing PPP at home in the form of ready-made meals also applies to women with children under the age of one and a half years, in case of their transfer to another job to eliminate contact with harmful production factors. In all other cases, delivery of ready-to-eat meals to the home is not permitted. The issuance of LPP for the past and monetary compensation for LPP not received in a timely manner is also not permitted.
Catering organizations where hot breakfasts are produced and served must be considered full-cycle enterprises and, in their structure and content, fully comply with current sanitary standards and rules.
The preparation and distribution of rations for individuals is carried out in strict accordance with the list of provided products, the approved card file of dishes and sample menus based on milk
Noah working week(5...7 days). In accordance with the card index of dishes, menu layouts are compiled for each day. Hot breakfasts must be prepared by chefs who have high qualifications (special knowledge in the technology of preparing preventive nutrition) and are approved in the prescribed manner for the preparation of dietary (therapeutic, preventive) and fortified dishes.
These types of food are not used in the preparation of dishes for PPPs. culinary processing, like frying, deep-frying and open fire cooking. Dietary diets do not include salted, smoked, pickled products, sausages, cream confectionery, canned food. Refractory fats, hot spices, vinegar, and hot seasonings are not used.
Meals organized in the form of hot breakfasts should serve as an example for the employee of the optimal food choice, which he should also make when independently organizing other meals (at home). Hygienic training activities from outside should be aimed at developing these skills. medical workers and employees of territorial institutions authorized to carry out State Sanitary and Epidemiological Supervision. They plan conversations, lectures, prepare and distribute (hang out) visual medical propaganda (memos, posters, booklets, etc.). The maximum effectiveness of the dietary supplement can be achieved only when the entire daily diet of the employee is compiled in accordance with the requirements of preventive nutrition. Familiarization of workers using PPP with the rules for free provision of food should be included in the mandatory induction training program on labor protection.
Responsibility for providing employees with LPP in accordance with established rules rests with the employer. Supervision over the organization of issuing PPP to employees engaged in work with particularly hazardous working conditions is carried out by the state through the relevant services, territorial institutions authorized to carry out State Sanitary and Epidemiological Supervision, and is also under the control of the relevant trade union bodies within the framework of a collective agreement.
Information sheet
The educational and methodological manual “Therapeutic and preventive nutrition” was prepared by the Department of Hygiene, Public Health and Healthcare of Penza state university(head of the department, candidate of medical sciences Dmitriev A.P.).
Participated in the compilation: Ph.D. Dmitriev A.P., Ph.D. Polyansky V.V. (responsible for preparation), Ph.D. Baev M.V.
The educational and methodological manual was prepared in accordance with the “HYGIENE Program” for students of medical faculties of higher medical educational institutions", developed by the All-Russian Educational, Scientific and Methodological Center for Continuing Medical and Pharmaceutical Education of the Ministry of Health of the Russian Federation and approved by the Head of the Directorate of Educational Institutions of the Ministry of Health of the Russian Federation N.N. Volodin in 1996
This educational manual has been prepared for students of the Faculty of Medicine for self-study for a practical lesson on the specified topic.
Reviewer:
Head of the department of Ryazan State pedagogical university, Doctor of Medical Sciences, Professor V.F. GORBICH.
Topic of the lesson: THERAPEUTIC AND PREVENTIVE NUTRITION
Lesson objectives:
Determine the main objectives of therapeutic and preventive nutrition.
To find out the influence and interaction of basic nutrients on the body under the influence of production factors.
Determine the indications for prescribing therapeutic and preventive nutrition.
Familiarize yourself with therapeutic and preventive nutrition diets.
Student preparation: During practical lesson the student must have an idea and be prepared to answer the following questions for the practical lesson:
Objectives of therapeutic and preventive nutrition.
The importance of basic nutrients in terms of influence on the body harmful factors production process.
Describe the characteristics of therapeutic and preventive nutrition diets.
Answer tests for class.
For preparation you should use: Textbook on Hygiene, ed. acad. RAMS G.I. Rumyantseva. - M., 2001. (Page 285, 540-544). Lecture materials. Educational and methodological manual of the department.
During a person’s work activity, he or she constantly comes into contact with harmful production factors.
These include toxic substances used in industry chemicals, solvents, acids, alkalis, industrial noise, vibration, magnetic fields, ionizing radiation, ultra- and infrasound, increased atmospheric pressure, radiation from optical quantum generators, etc.
In the system of measures to protect against the adverse effects of damaging substances, an obligatory component is therapeutic and preventive nutrition - one of the activities aimed at increasing sustainability healthy body to the influence of unfavorable factors of production conditions.
Therapeutic and preventive nutrition should:
increase the protective functions of the body’s physiological barriers (skin, mucous membranes of the gastrointestinal tract, nasopharynx and respiratory tract);
activate the processes of binding and removing poisons and unfavorable products of their metabolism from the body;
maintain the functional state of target organs and systems that can be affected by harmful factors;
increase the antitoxic function of individual organs and systems of the body (liver, lungs, skin, kidneys);
compensate for the appearance of a deficiency of certain nutrients ( essential amino acids, polyunsaturated fatty acids, vitamins, microelements).
Therapeutic and preventive nutrition diets are compiled taking into account data on the specific influence of individual nutrients on the intensity of absorption of toxic substances that enter the body during the process. production activities, to reduce the deposition of these substances in tissues and enhance their release from tissues and blood.
Thus, calcium inhibits the deposition of fluoride in the bones, while ascorbic acid enhances its excretion. This vitamin restores methemoglobin, which is formed from hemoglobin under the influence of certain industrial poisons.
Most toxic substances in the human body undergo transformations during reactions of oxidation, reduction and hydrolytic breakdown in the liver and other organs and tissues. Some chemical compounds or their metabolites that occur in the body react with endogenous molecules and radicals (glucuronic and sulfuric acids, amino acids, CH 3 group) to form non-toxic soluble substances released in urine, bile or exhaled air.
One of the ways nutrition influences the metabolism and utilization of toxic substances is the influence of food on the activity of the oxidase system, which is contained in the cells of the liver, intestines, kidneys and other organs that ensure the oxidation of xenobiotics (foreign substances).
The most pronounced protective, preventive effect proteins And amino acids with the toxic effects of organic cyanides, methyl chloride, carbon tetrachloride, nitrobenzene, organic compounds, arsenic, selenium, lead. At the same time, with some intoxications (in particular, carbon disulfide), it is necessary to limit proteins in the diet, especially those rich in sulfur-containing amino acids, since in this case the detoxification processes of the poison are disrupted.
In preventing the adverse effects of production factors, it is necessary to carefully approach the use fats, which can have different effects on the absorption of poisons from the digestive tract. Thus, fats promote the absorption of certain pesticides, lead, hydrocarbons and their derivatives in the small intestine, and increase poisoning with nitrobenzene and trinitrotoluene. Excess fats, especially refractory ones, worsen the body’s overall resistance to harmful factors and burden the liver’s functions. Negative influence lipids are counteracted by lipotropic factors, especially lecithin.
Carbohydrates improve the neutralizing barrier function of the liver, increase the body's resistance to the toxic effects of phosphorus, chloroform, and cyanide compounds. When choosing a source of carbohydrates for therapeutic and prophylactic diets, it is important to take into account that a violation of the ratio of starch and easily digestible carbohydrates has an adverse effect on the body and thereby can reduce resistance to harmful factors.
Of particular importance is the deterioration of excretory processes that occur with excessive consumption of easily digestible carbohydrates. This phenomenon is associated with an increase osmotic pressure blood due to an increase in the concentration of glucose in it. High level carbohydrates in the diet enhances allergic phenomena that occur under the influence of certain toxic substances. An excess of easily digestible carbohydrates is especially harmful when working under conditions of exposure to carbon disulfide, which has a diabetic effect.
Pectic substances lead, mercury, manganese bind in the intestines; promote their release from the body and decrease their concentration in the blood. This property is due to the presence of free carboxyl groups of galacturonic acid in pectin substances. Beet pectin is especially active.
Fiber, stimulating the motor activity of the intestinal walls, promotes the release of toxic dust from the body, ingested with saliva. Due to this positive influence enriching the diet with carrots and cabbage has an effect on the body.
Vitamins C, E, A, P, being antioxidants, destroy free oxidative radicals that are formed when the body is exposed to various damaging factors, especially ionizing radiation, which leads to disruption of the structure of cell membranes. Vitamins B 15, U, choline are directly involved in the neutralization processes occurring in the liver as sources of methyl groups. Vitamin C helps reduce intoxication that occurs when exposed to toluene, xylene, arsenic, phosphorus, and lead. B vitamins reduce the damaging effects of chlorine-substituted hydrocarbons, mercury, and lead; Vitamin D 3 prevents damage bone tissue in case of cadmium poisoning.
Vitamins are included in therapeutic and preventive diets not only as part of food products, but also in the form of pure preparations.
Minerals in therapeutic and preventive nutrition should be strictly rationed, and the amount of some of them should be reduced compared to the content in the diets of people who are not in contact with harmful factors.
To prevent the retention of toxins in the body, table salt is limited in therapeutic and preventive nutrition. However, when working under conditions of exposure to lithium, the amount of table salt is not reduced, since sodium reduces its toxicity. If exposure to radioactive strontium is possible, the amount of calcium in the diet should be increased two to three times. Potassium helps remove toxins from the body, so therapeutic and preventive nutrition includes an increased amount of products containing it.
Workers who come into contact with mercury during work should include in their diets plant foods rich in selenium and tocopherol (soybeans, cereals, rice, vegetable oils), which contribute to its detoxification.
The breakfast and lunch menu should include increased quantities of drinks - tea, juices, compotes, milk, kefir, in order to enhance excretory processes, as well as replenish fluid losses through sweat.
Essential oils have an irritating effect on the digestive tract, liver, kidneys, and nervous system, therefore, in therapeutic and preventive nutrition, it is recommended to limit foods rich in these compounds, for example, pepper, mustard, horseradish, garlic, and onions.
It is very important that a person does not start work on an empty stomach, since in this case the body is most sensitive to damaging influences.
Characteristics of the main diets of therapeutic and preventive nutrition:
All diets include products containing biologically valuable proteins: milk, cottage cheese, meat, fish.
Diet No. 1:
Indications: Working with radionuclides and sources of ionizing radiation.
Diet characteristics: The diet is rich in foods containing lipotropic substances (methionine, cysteine, lecithin), which stimulate fat metabolism in the liver and increase its antitotoxic function (milk, dairy products, liver, eggs). An additional 150 mg is given. ascorbic acid. This diet contains the largest amount fresh fruit, potatoes, cabbage.
Diet No. 2:
Indications: Production of inorganic acids, alkali metals, chlorine and fluorine compounds, phosphorus-containing fertilizers, cyanide compounds.
Diet characteristics: The effect of the diet is ensured by the presence of complete proteins (meat, fish, milk), polyunsaturated fatty acids(vegetable oil, milk and cheese), inhibiting the accumulation of chemical compounds in the body. In addition to the diet, 100 - 150 mg of ascorbic acid and 2 mg of retinol are given. At the same time, the diet increases the content of fresh vegetables and fruits: cabbage, zucchini, pumpkin, cucumbers, lettuce, apples, pears, plums, grapes, chokeberries.
Diet No. 2a:
Indications: Working with chromium compounds and chromium-containing compounds.
Diet characteristics: The diet is enriched with amino acids (tryptophan, methionine, cysteine, lysine, tyrosine, phenylalanine, histidine). Additionally, 100 mg of ascorbic acid, 2 mg of retinol, 15 mg of nicotinic acid and 150 ml of Narzan are given.
Diet No. 3:
Indications: Working in contact with lead compounds.
Diet characteristics: The diet is characterized by a high content of protein, alkaline elements, pectin, vitamins (milk and dairy products, potatoes, vegetables and fruits). Additionally, 150 mg of ascorbic acid is given. Pectin is necessary to enhance the removal of lead compounds from the body.
The diet has a reduced content of lipids, including vegetable oil and animal fats, and also provides daily meals from vegetables that have not been subjected to heat treatment (which are sources of carotene, ascorbic acid, and ballast substances). For people who need this diet, 2 g of pectin should be provided in the form of fruit and berry juices with pulp enriched with it, mousses, purees, plum jam, marmalade. Drinks enriched with pectin can be replaced with natural fruit juices with pulp in an amount of 300 g. Employees must receive these drinks and products before starting their shift.
Diet No. 4:
Indications: Production of benzene, arsenic compounds, mercury, phosphorus, and also under conditions of high atmospheric pressure.
Diet characteristics: The purpose of the diet is to increase the functionality of the liver and hematopoietic organs. Includes foods rich in lipotropic substances (milk and dairy products, vegetable oil). Limit the content of foods that burden the liver function (fried meat, fish soups, gravy). Sharply reduce the use of foods rich in table salt (pickles, smoked meats, etc.). Additionally, 150 mg of ascorbic acid and 4 mg of thiamine are given.
Diet No. 5:
Indications: Production of hydrocarbons, carbon disulfide, tetraethyl lead, organophosphorus compounds, etc.
Diet characteristics: The diet is aimed at protecting the nervous system (egg yolk, vegetable oil) and liver (cottage cheese, lean meat, fish and eggs). Limited table salt, salty and fatty foods. Additionally, 150 mg of ascorbic acid and 4 mg of thiamine are given.
Milk:
Indications: Work associated with exposure to organic alcohols, esters and acids, during the production and use of sulfur, mercury, arsenic, chromium, antibiotics, as well as in the production of all types of soot. The norm is 0.5 l. per shift; Substitution with kefir or yogurt is allowed.
Milk increases the overall functional abilities of the body and softens the effects of harmful physical, chemical and biological factors. Milk is dispensed after pasteurization in the manufacturer's packaging or after boiling.
Vitamin preparations:
Indications: Work at high temperature with intense heat radiation and when exposed to dust containing nicotine.
Consumption rates per shift: retinol - 2 mg, riboflavin - 3 mg, ascorbic acid - 150 mg, nicotinic acid - 20 mg.
For “particularly harmful” jobs, the legislation provides for the provision of free therapeutic and preventive nutrition (Article 222 of the Labor Code of the Russian Federation). The provision of such nutrition is intended to minimize the impact of particularly unfavorable factors that exist in such work on the body of people working in particularly hazardous work. In “harmful” jobs, instead of therapeutic and preventive nutrition, employees are given milk or other similar products to restore their health.
If a person works in a job with particularly hazardous working conditions, then such food is given to him regardless of what organizational and legal form the organization has, whether it is public or private, because the only factor influencing whether such food is given or not is given nutrition is the type of work performed, and if it is particularly harmful, its harm must be compensated, among other things, by special food.
The provision of such food is strictly regulated by current legislation and is controlled by the state and trade unions.
The basis for providing such food is the inclusion of production and employee positions in a special List (approved by the Order of the Ministry of Health and Social Development of Russia dated February 16, 2009, hereinafter referred to as the List). For example, employees have the right to therapeutic and preventive nutrition chemical production, non-ferrous metallurgy production, electrical and radio engineering production, work with radioactive materials and others.
The distribution of such food is regulated by the Rules for the free distribution of therapeutic and preventive nutrition (approved by Order of the Ministry of Health and Social Development of Russia dated February 16, 2009 No. 46n, hereinafter referred to as the Rules), which address issues of the order, frequency, and time of distribution of therapeutic and preventive nutrition.
Full responsibility for issuing therapeutic and preventive nutrition to relevant employees and compliance with all necessary rules is assigned exclusively to the employer (clause 17 of the Rules). Monitor the employer’s compliance with the Rules on the part of the state labor inspections, territorial bodies of Rospotrebnadzor, on the part of workers - trade union organizations (clause 18 of the Rules).
How to properly distribute therapeutic and preventive nutrition
If the organization performs the relevant work and all or some of the employees work in positions from the List, the organization must properly ensure that employees are provided with therapeutic and preventive nutrition in order to compensate for the impact of particularly harmful factors on the health of employees. The first step is taken by the employer when hiring employees for particularly hazardous work. First of all, employees who have the right to receive such food must be familiar with this fact. This happens directly during recruitment (clause 15 of the Rules). During the familiarization, employees are explained the rules in force in the organization for providing therapeutic and preventive nutrition to workers.
The main point that must be taken into account when issuing such food is that it is provided to employees only on those days when they actually work in particularly hazardous work for at least half a day, as well as during the period of occupational illness without hospitalization (clause 5 of the Rules).
There are a number of exceptions to this rule, when employees are still provided with such food, for example (clause 6 of the Rules):
- shift workers;
- workers cleaning and preparing equipment for work from the List;
- employees who became disabled as a result of performing work from the List (within one year after the fact of disability was established);
- employees who, during the performance of work from the List, received an occupational disease and, in connection with this, were temporarily transferred to another job;
- women who performed work from the List, are on maternity leave or transferred to light work due to pregnancy.
If employees (women on maternity leave; pregnant women transferred to another job; disabled people) do not have the opportunity to receive food at their place of work, then home delivery of food is allowed. To do this, you need a certificate from the employer’s health service, and if it is not there, from the territorial body of Rospotrebnadzor (clause 10 of the Rules).
When is therapeutic food provided?
By general rule such food must be provided to employees working in particularly hazardous jobs in the form of a hot breakfast before they begin performing the specified work (clause 7 of the Rules). In hard-to-reach regions, where it is impossible to arrange a canteen for employees performing special duties. hazardous work, before the start of the working day, employees are given specialized shift rations.
In exceptional cases, meals may be served during lunch rather than breakfast. To do this, you need prior approval from the employer’s medical and sanitary service, and if there is none, with the territorial body of Rospotrebnadzor.
Some employees specified in the List (subsections 2, 3 of section 8 and subsections 6, 7 of section 9 of the List) are given only vitamins as part of products for dietary (therapeutic and preventive) nutrition under hazardous working conditions.
During what periods of time should employees not be given therapeutic and preventive nutrition?
The rules clarify that in particularly hazardous jobs such food is not provided on days when workers do not actually perform particularly hazardous work, for example (clause 8 of the Rules):
- employees' non-working days;
- employee vacation period;
- the period during which employees are on business trips;
- days for employees to study (with a break from work);
- periods of employees performing work that is related to the implementation of public and government orders;
- employee sick days, unless it is an occupational disease;
- days of employees’ stay in medical institutions (including sanatoriums).
If an employee who has the right to therapeutic and preventive nutrition does not receive it on time (not through the fault of the employer), subsequently neither it nor compensation for it can be received (clause 11 of the Rules).
How to organize the distribution of therapeutic and preventive nutrition
Such food is prepared on the basis of developed therapeutic and preventive nutrition diets (Appendices No. 2 and 3 to the List). For some of them, additional provision of special vitamins is provided.
Based on the developed rations, weekly menu layouts and a card index of dishes are compiled for each day, which are approved by Rospotrebnadzor.
The procedure for issuing milk and therapeutic and preventive nutrition
The rules provide that employees who are provided with therapeutic and preventive nutrition are not given milk (or equivalent products), which means that their joint distribution is not provided for by law (
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