Alimentary deficiency diseases: Учебное пособие

80 Pages·2019·2.033 MB·Russian

by  Могилёва И. И., Гальфанович И. Л., Дайнеко М. Ю., Константинова Ю. А., Слободчикова М. П., Тюмина Л. М., Бранис И. Е.

БИБЛИОТЕКА ПЕДИАТРИЧЕСКОГО УНИВЕРСИТЕТА

И.И. МОГИЛЁВА, И.Л. ГАЛЬФАНОВИЧ
М.Ю. ДАЙНЕКО, Ю.А. КОНСТАНТИНОВА
М.П. СЛОБОДЧИКОВА, Л.М. ТЮМИНА
И.Е. БРАНИС

ALIMENTARY
DEFICIENCY
DISEASES

Санкт-Петербург

0
Министерство И.И. МОГИЛЁВА
здравоохранения
Российской Федерации И.Л. ГАЛЬФАНОВИЧ

М.Ю. ДАЙНЕКО

Ю.А. КОНСТАНТИНОВА
М.П. СЛОБОДЧИКОВА
Л.М. ТЮМИНА
И.Е. БРАНИС

Санкт-Петербургский
Государственный
Педиатрический
Медицинский ALIMENTARY
Университет
DEFICIENCY
DISEASES

Учебное САНКТ-ПЕТЕРБУРГ
пособие 2019

1
УДК 616-03
ББК 53.4
А345

А345 Alimentary deficiency diseases. Учебное пособие. / И.И. Могилёва,
И.Л. Гальфанович, М.Ю. Дайнеко, Ю.А. Константинова, М.П. Слободчикова,
Л.М. Тюмина, И.Е. Бранис. – СПб.: СПбГПМУ, 2019. – 80 с.

ISBN 978-5-907184-77-0

Основной целью данного методического пособия является формирование умения
использовать иностранный язык как средство профессионального общения и
самообразования. При составлении авторы руководствовались основными положениями
современной методики и психологии, предусматривающими развитие навыков извлечения и
обработки информации из иноязычного источника, а также умения вести работу с текстами
медицинской направленности.
Задания к текстам направлены на закрепление и активизацию лексического минимума и
развитие навыков устной речи, грамматические упражнения способствуют развитию
навыков чтения и грамотного перевода.
Учебное пособие “Alimentary Deficiency Diseases” («Болезни недостаточности»)
предназначено для студентов 1 курса, обучающихся на педиатрическом и лечебном
факультетах.

Авторы: заведующая кафедрой иностранных языков с курсом русского языка ФГБОУ
ВО «Санкт-Петербургский государственный педиатрический медицинский университет»
Минздрава России, кандидат филологических наук, доцент И.И.Могилёва; старшие
преподаватели кафедры иностранных языков с курсом русского языка ФГБОУ ВО «Санкт-
Петербургский государственный педиатрический медицинский университет» Минздрава
России И.Л.Гальфанович, М.Ю.Дайнеко, Ю.А.Константинова, М.П.Слободчикова,
Л.М.Тюмина, врач высшей категории КГУЗ «Городской центр ВЛДПН» И.Е.Бранис.
Рецензенты: заведующая кафедрой латинского языка ФГБОУ ВО «Санкт-Петербургский
государственный педиатрический медицинский университет» Минздрава России, доцент
А.М.Ивахнова-Гордеева; заведующая кафедрой иностранных языков ФГБОУ ВО «Первый
Санкт-Петербургский государственный медицинский университет имени академика
И.П.Павлова» Минздрава России, кандидат психологических наук, доцент А.П.Василькова.
Ответственный редактор: заведующая кафедрой иностранных языков с курсом
русского языка ФГБОУ ВО «Санкт-Петербургский государственный педиатрический
медицинский университет» Минздрава России, кандидат филологических наук, доцент
И.И.Могилёва.

УДК 616-03
ББК 53.4

Утверждено учебно-методическим советом Государственного бюджетного
образовательного учреждения высшего профессионального образования
«Санкт-Петербургский государственный педиатрический медицинский
университет» Министерства здравоохранения Российской Федерации

Выпускается при поддержке Фонда научно-образовательных инициатив
«Здоровые дети – будущее страны»

ISBN 978-5-907184-77-0 © СПбГПМУ, 2019
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I. NUTRITION AND HEALTH
(General Information, Common Problems)
NUTRITION, MALNUTRITION AND IMPROPER DIET
Nutrition is one of the most important factors affecting people’s health and
working capacity. Normal development of a child very largely depends on proper
nutrition. Nutrition is one of the most therapeutic agents in medical practice.
Nutrients coming from food are essential to us. With these, we can move about, see,
hear, taste, speak, smell, feel, think, learn and remember, sing, walk, run, play and
enjoy life. Without all the 40 to 45 nutrients none of these things so characteristic of
human life is possible.
The quantity and composition of food required by a person depends on his or her
age, stature, character of work, etc. In making up a diet it is necessary to consider the
need of the organism not only in proteins, carbohydrates and fats, but also in vitamins
and mineral salts. According to the contemporary classical medical notion, the diet
must contain the different nutrients in different proportions. It must contain proteins
and fats of animal origin, but vegetable fats and proteins must not be excluded either.
One should keep it in mind that different foodstuffs are differently assimilated. A
combination of various food best satisfies all the requirements of rational nutrition, or
well-balanced diet.
Assimilation of food depends on how it is cooked, and under what conditions and
how many times a day it is ingested. Palatable delicious food taken at definite time is
digested better and more rapidly. A lot of various diets have been invented to solve
health problems. As medical knowledge increases and the range of diseases changes
with time, new ones keep appearing, each of them excluding certain kinds of food as
harmful.
Millions of people, most of them children, suffer from diseases associated with
malnutrition in Africa and other poor countries. In children poor food supply retards
both mental and physical growth and development. In addition, malnutrition severely
impairs the body’s resistance to infections or toxins coming not only from food, but
also from the environment. The poor nutrition of the majority of developing countries
population results in higher mortality and more severe disease cases than in the
industrialized countries.
However, even in countries with a good food supply improper, poorly balanced, diet
has been shown to be associated with quite a few conditions causing either deficiencies
or overnutrition affecting a child’s health. In case of surplus food obesity and both
physical and mental problems may result from it. Moreover, certain diet defects during
pregnancy or childhood proved to harm health severely in the later life.

Diet, nutrition and the prevention of chronic diseases
Report of the joint WHO/FAO expert consultation
Executive summary
The WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of
Chronic Diseases met in Geneva to examine the science base of the relationship
between diet and physical activity patterns, and the major nutrition-related chronic
diseases.
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Recommendations were made to help prevent death and disability from major
nutrition-related chronic diseases. These population nutrient intake and physical
activity goals should contribute in the development of regional strategies and national
guidelines to reduce the burden of disease related to obesity, diabetes, cardiovascular
disease, several forms of cancer, osteoporosis and dental disease. They are based on
the examination and analysis of the best available evidence and the collective
judgement of a group of experts representing the global scope of WHO’s and FAO’s
mandate.
Key findings include:
Obesity: the imbalance between declining energy expenditure due to physical
inactivity and high energy in the diet (excess calories whether from sugar, starches or
fat) is the main determinant of the obesity epidemic. Increasing physical activity, plus
reducing intakes of foods high in fat and foods and drinks high in sugars, can prevent
unhealthy weight gain. Taking these simple goals to concrete action requires major
social and environmental changes in order to effectively promote and support
healthier choices at the individual level.
Diabetes: excess weight gain, overweight and obesity and physical inactivity
account for the escalating rates of type 2 diabetes, worldwide. Diabetes leads to
increased risk of heart disease, kidney disease, stroke and infections. Increased
physical activity and maintaining a healthy weight play critical roles in the prevention
and treatment of diabetes.
Cardiovascular diseases: cardiovascular diseases, the major killers worldwide, are
to a great extent due to unbalanced diets and physical inactivity. Risk of their main
forms, heart disease and stroke, is reduced by eating less saturated and trans fats, and
sufficient amounts of (n-3 and n-6) polyunsaturated fats, fruits and vegetables and less
salt, as well as by physical activity and controlling weight. Reduction of salt intake helps
reduce blood pressure, a major cause of cardiovascular diseases.
Cancer: tobacco is the number one cause of cancer, but dietary factors contribute
significantly to some types of cancer. Maintaining a healthy weight will reduce the
risk for cancers of the oesophagus, colorectum, breast, endometrium and kidney.
Limiting alcohol intake will reduce risk for cancers of the mouth, throat, oesophagus,
liver and breast. Ensuring an adequate intake of fruit and vegetables should further
reduce risk for oral cavity, oesophagus, stomach and colorectal cancer.
Osteoporosis and bone fractures: fragility fractures are a problem of older
people. Adequate intakes of calcium (500 mg per day or more) and of vitamin D in
populations with high osteoporosis rates helps to reduce fracture risk, so does sun
exposure and physical activity to strengthen bones and muscles.
Dental disease: caries is preventable by limiting the frequency and amount of
consumption of sugars and by appropriate exposure to fluoride. Erosion of teeth by
dietary acids in beverages or other acidic foods may contribute to tooth destruction.
The crucial role of physical activity as part of nutrition and health was
acknowledged. Physical activity is a key determinant of energy expenditure, and thus
fundamental to energy balance and weight control. The beneficial effects of physical
activity on the metabolic syndrome are mediated by mechanisms beyond controlling
excess body weight.
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Physical inactivity is already a major global health risk and is prevalent in both
industrialized and developing countries, particularly among the urban poor in
crowded mega cities. Measures and policies required to promote healthier food
consumption patterns and facilitate a physically active life share common grounds
and are mutually interactive in determining healthier behaviours.
Healthy diets and physical activity are key to good nutrition and necessary for a
long and healthy life. Eating nutrient dense foods and balancing energy intake with
the necessary physical activity to maintain a healthy weight is essential at all stages
of life. Unbalanced consumption of foods high in energy (sugar, starch and/or fat)
and low in essential nutrients contributes to energy excess, overweight and obesity.
The amount of the energy consumed in relation to physical activity and the quality of
food are key determinants of nutrition related chronic disease.
Not all fats are the same, it pays to know the difference. The scientific
complexities of these issues should not obscure the simple messages required to
orient and guide consumers. People should eat less high-calorie foods, especially
foods high in saturated or trans fats and sugar, be physically active, prefer unsaturated
fat and use less salt; enjoy fruits, vegetables and legumes; and select foods of plant
and marine origin. This consumption pattern is not only healthier but more favourable
to the environment and sustainable development.
To achieve best results in preventing nutrition-related chronic diseases, strategies
and policies should fully recognize the essential role of both diet and physical activity
in determining good nutrition and optimal health. Policies and programmes must
address the need for change at the individual level as well as the modifications in
society and the environment to make healthier choices accessible and preferable.
In communities, districts and nations in which widespread, integrated
interventions have taken place, dramatic decreases in NCD-related death and
disability have occurred. Successes have come about where people have
acknowledged that the unnecessary premature deaths that occur in their community
are largely preventable and have empowered themselves and their civic
representatives to create health-supporting environments.
This has been achieved most successfully by establishing a working relationship
between communities and governments; through enabling legislation and local
initiatives affecting schools and the workplace; involving food producers and
processing industry. Beyond the rhetoric, this epidemic can be halted – the demand
for action must come from those affected. The solution is in our hands.
This report is only the first step in a process that includes consultations with
governments, as well as other public and private sector stakeholders in all geographic
regions, to culminate in the formulation of a Global Strategy on Diet, Physical
Activity and Health, to be considered by the World Health Assembly.

LACK OF APPETITE
One of the most frequent complaints mothers make to doctors is that their child
has lost his appetite. The mother’s anxiety over her child’s poor appetite is well-
founded, as every mother knows that a healthy appetite is a sign of the child’s health.
Lack of appetite is associated with many illnesses of childhood, but then there are
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also other signs which mother usually notices. If the cause is some illness the doctor
will diagnose it and prescribe treatment, and the child’s appetite will improve as his
health improves. However, feeding problems mostly arise in perfectly healthy
children as the result of mismanagement of nutrition, feeding and care.
To understand the causes leading to loss of appetite one must understand the
nature of appetite itself. Today it has been proved by the experiments of Ivan Pavlov
and his followers that digestion is regulated by the nervous system. There is in the
child’s brain, as in the adult’s brain, a food centre the condition of which determines
whether the individual feels hungry or full. If the food centre is in an excited state the
person feels hungry. If the food centre is in a state of repression, or inhibition, the
desire for food – the appetite – will deteriorate or disappear. Both excitation and
inhibition of the food centre are associated with changes in the constituents of the
blood flowing in this area of the brain. Depletion of the blood of nutritive substances
stimulates the digestive centres; this stimulation or excitation is transmitted to the
salivary glands and the glands secreting gastric juices, and also to the corresponding
muscles.
It is important to feed children at definite times over strictly definite intervals
differing in children of different ages. If a definite feeding schedule is not observed
and the baby has his food irregularly, he will not be hungry and refuse his food at the
feeding hours. A particularly harmful effect on appetite is produced by sugar and
various sweets when given to children before or between meals. An important point
in serving the meals of older children is setting the table. If mothers set the table
attractively and make preparations for the meal, the activity of the digestive glands
will be stimulated, and the child’s appetite will improve. Normal appetite depends to
a great extent on a properly managed schedule. Children must play outdoors, sleep
and eat at fixed hours. If children do not spend much time in the fresh air, they are
commonly poor eaters.
Children must not be overfed, neither must they be given too much high-calorie food
or fats in excess. Fat, if there is too much of it, will inhibit gastric juice secretion, disturb
protein digestion, and thus finally will impair the appetite. Poor appetite may be
connected with a decreased function of the salivary glands. In such cases children keep
their food in the mouth for a long time, not being able to swallow it. These children
should be taught to take their food in very small amounts at a time; they should also be
given a little water to drink during the meal; the moistened food will be easier to
swallow. As the child becomes older his appetite usually becomes normal; however all
measures should be taken to ensure a healthy appetite at all meals.
ACTIVE WORDS AND EXPRESSIONS TO REMEMBER:
Lack; to lose appetite; to associate; to notice; nutrition; loss; to prove; to be
excited; desire; inhibition; juice; harmful; to improve; to a great extent; impair;
properly; to manage; to feed (overfeed); to disturb; to decrease; to moisten; to ensure;
meals; to flow.
EXERCISES
I. Answer the following questions:
1. Why are mothers anxious over the poor appetite of their children? 2. What may
lack of appetite be connected with? 3. What is the nature of appetite? 4. When do we
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feel hungry or full? 5. What are excitation and inhibition of the food center associated
with? 6. What stimulates the digestive center? 7. What factors does normal appetite
depend on? 8. What may poor appetite be connected with? 9. Why is it not good to
give children fats in excess?
II. Put all possible questions to the following sentences:
1. Mothers often complain to doctors that their children have lost their appetite.
2. To understand the cause leading to loss of appetite one must understand the nature
of appetite itself. 3. If the food center of the brain is in a state of inhibition the child
does not feel hungry. 4. Children must play outdoors, sleep and eat at fixed hours.
5. It is most harmful to give children various sweets between or before meals. 6. The
sight of the attractively set table stimulates the activity of the digestive glands and
improves the child’s appetite. 7. Normal appetite depends on a properly managed
daily feeding schedule.
III. Group the following words into pairs with opposite meanings:
1. decrease a. useful
2. improve b. full
3. healthy c. irregular
4. harmful d. disappear
5. inhibition e. impair
6. hungry f. increase
7. regular g. rarely
8. stimulate h. excitation
9. appear i. impair
10. frequently j. sick

OBESITY
Obesity in children is actually more frequent than those cases when overweight
children come for treatment. Parents are inclined to overlook obesity in a young child
and to resent having attention to it.
Pathogenesis. Children grow fat when they persistently eat more than they need.
At the same time there is usually marked physical inactivity. Obesity is only the
symptomatic expression of some underlying disturbance in the weight-regulatory
mechanism. In most children the reflex tends to persist into adult life.
Symptoms. Physical complaints due directly to the burden of weight are relatively
rare in otherwise normal obese children. However, we know obesity to be a
troublesome complication in children with cardiac conditions, diabetes and
orthopedic disorders. Increase in blood pressure is frequently associated with severe
degrees of obesity. Fatigue, perspiration, poor coordination and shortness of breath
may be due to overweight, but these symptoms may also be related to emotional
factors. Their real suffering is experienced in the field of social relations. They often
become objects of ridicule and are excluded from the activities of their age group.
The social and psychological problems which obesity creates for a child become
more serious with increasing age. Obesity in an adolescent may lead to his or her
complete withdrawal.
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Treatment. As a physiological problem the treatment of an obese child is simple.
Doctors suppose diet restriction alone or combined with increased physical activity to
invariably result in a predictable loss of weight. In a rapidly growing child who is
only moderately overweight, it may not be necessary or desirable to plan for weight
reduction. It may be preferable merely to retard or arrest the rate of gain until the
child grows up to his weight. Caution should be exercised in employing complete
starvation as a therapy for obesity. It may be done only under a strict doctor’s
supervision.

Metabolic Syndrome, an Epidemic of the 21st Century
Obesity is closely associated with a so-called metabolic syndrome which has been
recognized to be an epidemic of the 21st century. The metabolic syndrome is a
condition combining a group of risk factors leading to heart diseases, stroke, diabetes.
The syndrome presents as a complex metabolic, hormone and clinical disorders. The
metabolic syndrome depends on the tissue resistance to insulin. One of the basic
signs of the metabolic syndrome is considered the presence of extra fatty layer in the
waist area (visceral obesity). The adipose (fatty) tissue is a large endocrine organ. It
is a source of diabetogenic, atherogenic and pro-inflammatory biologically active
substances. The therapy of the metabolic syndrome focuses on the efforts to lose
weight, especially in case it is accompanied by high blood pressure.
ACTIVE WORDS AND EXPRESSIONS TO REMEMBER:
Obesity, to be inclined, avoidance, to persist, to respond, to achieve, to justify, to
predispose, perspiration, to experience, adjustment, restriction, to retard, to arrest,
caution, starvation, withdrawal.
EXERCISES
I. Fill in the gaps with suitable words from the list in brackets
(in spite of; either … or; not only … but also; both … and; that; after; and; before;
if; for):
1. Eating … … serves to appease bodily hunger … … is charged with emotional
significance. 2. … the mother’s diet is insufficient, the milk will be poor in quality. 3.
Parents should know … obesity may develop at any age. 4. The typical obese patient
tends to be … broader … taller than his age peers. 5. This child is … in a state of
blooming health with excellent nutrition … suffers from obesity.6. The child’s health
was poor … … … the fact that he was carefully nursed. 7. Avoidance of fats is not
necessary … in most individuals they inhibit gastric emptying and delay the onset of
hunger. 8. In some instances there is colic … some food is ingested to which the
patient is allergic. 9. Parents’ questions concerning hygienic … general care of
infants engage an increasing proportion of the time of the pediatrician. 10. A baby
must learn to creep … he begins to walk.
II. Translate sentences into Russian:
1. Excessive eating and avoidance of activity influence the child’s personality
development and life experiences. 2. An evaluation of the emotional problems of an
obese child and an appraisal of the difficulties inherent in his family
interrelationships constitute a necessary part of the diagnostic study. 3. Mere weight
reduction without attention to underlying problems will almost invariably be
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followed by another increase in weight. 4. Vitamin deficiency is to be prevented.
5. Although opinion as to how often to feed the baby varies, most doctors seem to
favour a three or four hour schedule. 6. Obesity is the result of positive energy
balance. 7. Caloric intake is regulated in accordance with energy expenditure. 8. Food
requirements of individuals are affected by several factors: muscular activity, age,
weight, pathologic conditions, climate etc. 9. The most rapid growth period in a
child’s life is the first months.

II. VITAMINS
VITAMINS AND THEIR SIGNIFICANCE
A vitamin is an organic substance that is present in minute amounts in natural
foodstuffs. Vitamins are considered to be essential to normal metabolism. A vitamin
is an essential nutrient that body cannot produce enough of, so we need to take it
from food. If we cannot get a sufficient amount of any kind of vitamin, certain
medical conditions can result.There are currently 13 recognized vitamins.
Vitamins are either fat-soluble or water-soluble. Fat-soluble vitamins are
stored in the fatty tissues of the body and the liver. Vitamins A, D, E, and K are
fat-soluble. They can stay in the body as reserves for days, and sometimes months.
Fat-soluble vitamins are absorbed through the intestinal tract with the help of fats,
or lipids.
Water-soluble vitamins do not stay in the body for long. The body cannot store
them, and they are soon excreted in urine. Because of this, water-soluble vitamins
need to be replaced more often than fat-soluble ones. Vitamin C and all the B
vitamins are water soluble.
Here are the different types of vitamins.
Vitamin A
Its chemical names are: retinol, retinal, and four carotenoids, including beta
carotene. Its deficiency may cause night-blindness and an eye disorder that results in
a dry cornea. Its good sources are believed to include: liver, butter, cheese, milk,
egg, cod liver oil, orange vegetables and fruit (carrots, pumpkin, apricot, melon),
broccoli and some types of cabbage (kale), spinach.
Vitamin B
There is a group of Vitamins B which are known to be important for the
functioning of our nervous system. Their chemical names are: thiamine (B1),
riboflavin (B2), pantothenic acid (B5), folic acid (B9) etc. They are found in yeast,
whole grains (milling removes the vitamin), cereals, sunflower seeds, meat, liver,
heart, kidneys, some fish (tuna, salmon), eggs, asparagus, kale, cauliflower, broccoli,
avocado, tomatoes, bananas, nuts, shellfish and beer (to a moderate extent). Freezing,
drying and canning can reduce the content of vitamins.
Vitamin B1 deficiency can cause beri-beri (a kind of neuritis) and Wernicke-
Korsakoff syndrome. Vitamin B3 deficiency may lead to pellagra with symptoms of
diarrhea, dermatitis and mental disturbances. Vitamin B5 deficiency may result in
paresthesia, or “pins and needles”. Vitamin B6 deficiency may cause anemia,
peripheral neuropathy, or damage to parts of the nervous system other than the brain
and spinal cord. Vitamin B7 deficiency may lead to dermatitis or enteritis, or
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