Tuberculosis - I.T. Pyatnochka 2005

Treatment of tuberculosis
Patient nutrition in tuberculosis and therapeutic diets according to Pevzner

Medical Nutrition therapy for tuberculosis patients is a crucial component of comprehensive Treatment in inpatient, sanatorium, and outpatient settings. The cornerstone of this approach is a diverse and balanced diet comprising both animal and plant-based foods, supplemented with mineral salts and Vitamins. A well-fortified diet creates optimal conditions for the assimilation of Proteins, fats, and CARBOHYDRATES. The total caloric intake required for a tuberculosis patient averages 3,000–4000 kcal. The daily ration consists of 120–130 g of protein (at least half of which must be of animal origin), 70–100 g of fats, and 400–500 g of carbohydrates.

Vegetables and fruits supply the body with adequate amounts of vitamins and mineral salts, particularly calcium, potassium, and phosphorus. Patients require sufficient quantities of vitamins, including vitamin complexes (C, A, B-complex, D, etc.). The administration of multivitamins is of great importance, as an excess of any single vitamin can disrupt the overall vitamin balance.

Food preparation must preserve the natural properties and high quality of the ingredients. To ensure variety, various culinary techniques should be employed, delivering high palatability and an appetizing appearance.

A diet represents the nutritional regimen of a patient. Because Pulmonary Tuberculosis patients frequently suffer from concurrent comorbidities, phthisiologists—just like physicians of other specialties—must be thoroughly familiar with all standard dietary regimens. According to Pevzner, there are 15 such diets.

Diet No. 1a. This is the strictest regimen, prescribed for acute gastritis and exacerbations of gastric and duodenal ulcers. It is characterized by the maximum restriction of chemical and mechanical irritants. Food is administered in small portions every 1–2 hours: mucilaginous soups, milk, butter, and rice soup. Raw or soft-boiled eggs, kissels, jellies, and fruit juices in small quantities are permitted.

Diet No. 1b. This diet is less restrictive than the previous one. Meals are given every 3 hours. The diet is supplemented with 50 g of white rusks, strained porridges with butter, mashed potatoes, and steamed meat or fish cutlets and meatballs.

Diet No. 1. Prescribed for Chronic gastritis with high acidity and for unremitting gastric ulcers. The diet includes stale white bread, steamed cutlets, boiled lean meat and fish, boiled strained vegetables and fruits, and weak tea.

Diet No. 2. Indicated for gastritis with achylia or hyposecretion. This diet excludes mechanical irritants while retaining chemical stimulants to a certain degree to promote gastric secretion. Dishes are served in a puréed form. Meals are given 4–5 times a day. The menu includes tea, cocoa, coffee with milk or cream, vegetable soups with cabbage, lean meat broths, white rusks, stale white bread, strained vegetables, kissels, and compotes. Ham, black caviar, and, in somewhat smaller quantities, soft-boiled eggs and lean herring are permitted. Salt is not restricted.

Diet No. 3 is prescribed for constipation. It incorporates coarse foods rich in fiber and other roughage that stimulate the intestinal mucosa and enhance peristalsis. The diet includes black bread, buckwheat porridge, buttermilk, cream, raw vegetables, raw cabbage, pickled cucumbers, and honey. Cold vegetable soups and compotes are recommended. Sweets, cold Water on an empty Stomach, and mineral waters are also beneficial.

Diet No. 4. Indicated for diarrhea and acute intestinal catarrh. The diet is mechanically and chemically sparing, excluding milk, eggs, and fats. Food is consumed in small portions and must be served warm. In the first few days, liquid and semi-liquid foods are provided, such as strained soups, porridges, blueberry or red wine kissels, and jelly. White rusks and fresh, non-acidic cottage cheese are permitted. Later, boiled lean meat in the form of steamed cutlets, boiled lean fish, and fruit juices are introduced.

In acute colitis, apple days are prescribed (800–1000 g of grated apples divided into 5 meals, with no other food). Afterward, the patient transitions to a mechanically sparing diet: strained vegetables, fruits, minced boiled meat, and sour cream. Food is consumed in small, warm portions up to 5 times a day.

Diet No. 5a. Prescribed for acute Liver diseases (hepatic colic, cholecystitis, cholangitis). This is primarily a lacto-vegetarian diet rich in carbohydrates and plant proteins. Food is served puréed and warm, 4–5 times a day, with a strict restriction on fats. The menu includes milk porridges, kissels, non-acidic compotes, cottage cheese, sour cream, and stale white bread.

Diet No. 5. A more liberal hepatic diet consisting of lacto-vegetarian dishes, though not in a puréed form. Small amounts of bread, egg whites, various salads, berries, certain flour-based dishes, boiled meat, and lean fish are permitted. All smoked and fried foods are strictly prohibited.

Diet No. 6. Prescribed for pyelitis and Gout. Patients are given dairy, flour-based, sweet, and fruit dishes. Foods high in fats, meat—especially glandular Organs—beans, tomatoes, sorrel, smoked meats, and marinated products are excluded.

Diet No. 7a (salt-free). This is a strict renal diet prescribed for acute nephroso-nephritis and severe chronic nephritis. Water, salt, and proteins are restricted to 25–30 g per day. Plant, flour, vegetable, berry, and fruit dishes are permitted, with the exception of legumes and mushrooms. Spicy foods, radishes, garlic, onions, parsley, etc., are prohibited. Fasting days (sugar, fruit, or dairy) are periodically prescribed. After diet No. 7a, patients transition to the more liberal diet No. 7b.

Diet No. 7. A strict renal diet (hypochloride). It is used in cases of chronic nephritis. The patient is allotted 1–4 g of salt per day, and dishes containing egg yolks, dairy products, and a small amount of meat are permitted.

Diet No. 8. Prescribed for obesity without concomitant gastrointestinal disorders. The diet is characterized by a restriction in calories and fluids. To alleviate thirst, salt intake is also reduced. Patients consume large quantities of plant-based foods, while flour-based and sweet dishes are limited. Dairy products, black bread, vegetables (except legumes), sour fruits and berries, lean meat, and fish are permitted. Apple and dairy fasting days are prescribed.

Diet No. 9. A personalized diet for diabetic patients, the composition of which is determined by the form and severity of the disease. To this end, the body's carbohydrate tolerance and the degree of acidosis are first assessed. Patients are prescribed unsweetened dishes. The diet includes eggs, cottage cheese, and lean meat. Bran bread, fresh herbs, cabbage, cucumbers, and tomatoes are provided. Vegetables such as potatoes, carrots, and beets are soaked for 12–24 hours before cooking.

Diet No. 10a. Prescribed for severe Circulatory Disorders in patients with cardiovascular pathology. Fluid intake is restricted to relieve strain on the Circulatory system; salt and spicy foods are reduced. Food is served frequently in small, easily digestible, calorie-restricted, and puréed portions. Fasting days include milk, cottage cheese, and fruit.

Diet No. 10. A more liberal diet prescribed for patients with cardiovascular diseases. Fluid intake is restricted. Food is not puréed; salt is limited, and the menu includes dairy dishes, boiled meat, and fish. Egg dishes are permitted in the absence of Hypertension and atherosclerosis. Meat broths and spicy foods are excluded.

Diet No. 11 is prescribed for tuberculosis patients, individuals with anemia, and convalescents. The diet is mixed, complete, and rich in proteins, fats, carbohydrates, and minerals, particularly calcium. The diet includes increased amounts of vitamins, fruits, and berries. All of this aims to improve Digestion and strengthen the patient's constitution, while avoiding overfeeding or excessive fat loading.

Diet No. 12 is prescribed for neuropsychiatric patients. It consists of a diverse, mixed liquid diet for tube feeding. Meat and stimulants such as tea and coffee are restricted in the dietary regimen.

Diet No. 13. Intended for patients with acute infectious diseases accompanied by high fever. The food is high-calorie, served frequently in small portions, in a liquid or semi-liquid puréed state. Fluid intake is increased, particularly fruit, vegetable, and berry juices. Dairy products, eggs, boiled meat, sweet dishes, berries, and acid jellies are prescribed.

Diets No. 14 and 14a are prescribed for various Metabolic Disorders to influence the acid-base balance.

Diet No. 14a. Indicated for phosphaturia to increase Blood acidity. This is a meat-based diet, as The breakdown of meat yields a high amount of Amino Acids.

Diet No. 14 is prescribed for oxaluria, a condition characterized by excessive excretion of oxalic acid salts. It aims to increase the alkalinity of the blood. The diet is primarily lacto-vegetarian, excluding vegetables rich in oxalic acid: sorrel, spinach, beans, cocoa, and rhubarb.

Diet No. 15. The general or rational diet. It is prescribed for patients who do not require a special therapeutic dietary regimen.

In addition to the aforementioned therapeutic diets, there are nutritional regimens designed to exert a systemic effect on the body. These include: high-calorie (enhanced) nutrition, fasting and semi-fasting regimens, fluid-restricted or fluid-varied regimens, and the zigzag diet.