ó㳺í³÷íà îö³íêà âïëèâó ì³íåðàëüíîãî ñêëàäó ïèòíèõ âîä íà çäîðîâ’ÿ íàñåëåííÿ

Êëþ÷îâ³ ñëîâà: ïèòíà âîäà, ì³íåðàëüí³ ðå÷îâèíè, çäîðîâ'ÿ íàñåëåííÿ.

ÀÍÍÎÒÀÖÈß

Âîðîõòà Þ.Ì. Ãèãèåíè÷åñêàÿ îöåíêà âëèÿíèÿ ìèíåðàëüíîãî ñîñòàâà ïèòüåâûõ âîä íà çäîðîâüå íàñåëåíèÿ.

Äèññåðòàöèÿ íà ñîèñêàíèå íàó÷íîé ñòåïåíè êàíäèäàòà ìåäèöèíñêèõ íàóê ïî ñïåöèàëüíîñòè 14.02.01 - "Ãèãèåíà" - Ãîñóäàðñòâåííîå ó÷ðåæäåíèå "Èíñòèòóò ãèãèåíû è ìåäèöèíñêîé ýêîëîãèè èì. À.Í. Ìàðçååâà" ÀÌÍ Óêðàèíû, Êèåâ

Äèññåðòàöèÿ ïîñâÿùåíà ðåøåíèþ ïðîáëåìû ãèãèåíè÷íîé îöåíêè âëèÿíèÿ ïèòüåâûõ âîä ðàçíîãî ìèíåðàëüíîãî ñîñòàâà íà ñîñòîÿíèå çäîðîâüÿ íàñåëåíèå. Óñòàíîâëåíî, ÷òî äëÿ îòäåëüíûõ ñîëåâûõ êîìïîíåíòîâ âîçìîæíà àäàïòàöèÿ íàñåëåíèÿ äàæå ïðè óñëîâèè ñóùåñòâåííîãî ïðåâûøåíèÿ äåéñòâóþùèõ ñòàíäàðòîâ. Îïðåäåëåí âêëàä âîäíîãî ôàêòîðó â ñíàáæåíèè îðãàíèçìà ïîòðåáèòåëåé ïèòüåâîé âîäû ýññåíöèàëüíûìè ìèíåðàëüíûìè âåùåñòâàìè, â ÷àñòíîñòè ñ âîäîé ïîñòóïàåò îò 3,7 % äî 26 % ìàãíèÿ, îò 1,1 % äî 21 % êàëüöèÿ, îò 0,04 % äî 10 % íàòðèÿ; îò 0,18 % äî 0,56 % êàëèÿ, è îò 92,7 % äî 99,9 % ôòîðà.

Óñòàíîâëåíà ðîëü âëèÿíèÿ ðàçíûõ êîìïîíåíòîâ ñîëåâîãî ñîñòàâà ïèòüåâûõ âîä íà çäîðîâüå äåòñêîãî è âçðîñëîãî íàñåëåíèÿ; â ÷àñòíîñòè íà çäîðîâüå äåòåé â áîëüøåé ìåðå âëèÿåò ñîäåðæàíèå êàòèîíîâ êàëüöèÿ è ìàãíèÿ (ñèëà ôàêòîðó ñîîòâåòñòâåííî +0,7 è -0,82), à òàêæå ñîäåðæàíèå íèòðàòîâ (+0,73) è ôòîðà (-0,71); òîãäà êàê äëÿ âçðîñëûõ áîëåå âàæíûì ÿâëÿåòñÿ ñîäåðæàíèå íàòðèÿ (+0,69), çíà÷åíèÿ æåñòêîñòè (-0,69) è ñîäåðæàíèÿ ñòðîíöèÿ (+0,7), ñóùåñòâåííî âëèÿþùèõ íà ðèñê âîçíèêíîâåíèÿ êàðäèîâàñêóëÿðíî¿ ïàòîëîãèè, óâåëè÷èâàÿ åãî âäâîå.

Ïîêàçàíî, ÷òî ïîòðåáëåíèå ïèòüåâîé âîäû ôèçèîëîãè÷åñêè íåàäåêâàòíîãî ñîëåâîãî ñîñòàâà îòðèöàòåëüíî âëèÿåò íà çäîðîâüå äåòñêîãî íàñåëåíèÿ. Ïðè ñîïîñòàâëåíèè ïîêàçàòåëÿ ÷àñòîòû äèñãàðìîíè÷åñêîãî ôèçè÷åñêîãî ðàçâèòèÿ ó äåòåé, ïðèíÿâøèõ ó÷àñòèå â èññëåäîâàíèè ïîëó÷åíû ñâåäåíèÿ î ðîëè îòäåëüíûõ ìèíåðàëüíûõ âåùåñòâ â ôîðìèðîâàíèè àíòðîïîìåòðè÷åñêîãî ïðîôèëÿ ðåáåíêà. Ïðè óâåëè÷åíèè ñîäåðæàíèÿ â ïèòüåâîé âîäå ñîëåé æåñòêîñòè ÷àñòîòà äèñãàðìîíè÷åñêîãî ðàçâèòèÿ óìåíüøàëàñü (R=-0,32 p<0,05). Ïîäîáíûé ïðîòåêòèâíûé ýôôåêò íàáëþäàëñÿ è â îòíîøåíèè ôòîðà (r=-0,44; p<0,05). Íàéäåíà ñèëüíàÿ êîððåëÿöèîííàÿ ñâÿçü ìåæäó ÷àñòîòîé äèñãàðìîíè÷åñêîãî ôèçè÷åñêîãî ðàçâèòèÿ è ñîäåðæàíèåì â ïèòüåâîé âîäå íèòðàòîâ (r=0,87, p<0,01) - èõ ïðèñóòñòâèå óâåëè÷èâàëî ÷èñëî äåòåé ñ îòêëîíåíèÿìè â ñîñòîÿíèè çäîðîâüÿ ïî÷òè â äâà ðàçà (OR=1,7 (1,1; 2,0). Ïðè ýòîì, ðîëü ñòðîíöèÿ áûëà íåçíà÷èòåëüíîé, ÷òî îòëè÷àåò ýòîò êîíòèíãåíò îò âçðîñëîãî íàñåëåíèÿ.

Ïî äàííûì íàøèõ èññëåäîâàíèé, ìåæäó ïîêàçàòåëÿìè áèîëîãè÷åñêîãî ñòàðåíèÿ âçðîñëîãî íàñåëåíèÿ è ôèçè÷åñêèì ðàçâèòèåì äåòåé è ïîäðîñòêîâ ñóùåñòâóåò êîððåëÿöèîííàÿ çàâèñèìîñòü ñðåäíåé ñèëû (R=0,37 p<0,05).

Ïîêàçàíî, ÷òî óïîòðåáëåíèå ïèòüåâûõ âîä áîëåå âûñîêîé ìèíåðàëèçàöèè ìîæåò ïðèâîäèòü ê ðàçâèòèþ ñîìàòè÷åñêîé ïàòîëîãèè. Âûÿâëåíà ïîëîæèòåëüíàÿ êîððåëÿöèîííàÿ ñâÿçü (R=0,30 p<0,05) ìåæäó ÷àñòîòîé îñòðûõ íàðóøåíèé ìîçãîâîãî êðîâîîáðàùåíèÿ (ÎÍÌÊ) è ñîäåðæàíèåì íàòðèÿ â ïèòüåâîé âîäå. Ïîäîáíàÿ êîððåëÿöèÿ ñ ñîäåðæàíèåì íàòðèÿ óñòàíîâëåíà â îòíîøåíèè ÷àñòîòû ñëó÷àåâ èøåìè÷åñêîé áîëåçíè ñåðäöà (R=0,32, p<0,05), îáùåé ðàñïðîñòðàíåííîñòüþ çàáîëåâàíèé ñåðäå÷íî-ñîñóäèñòîé ñèñòåìû (R=0,30, p<0,05) è îíêîëîãè÷åñêîé ïàòîëîãèè (R=0,33, p<0,05). Îïðåäåëåíà îòðèöàòåëüíàÿ êîððåëÿöèîííàÿ çàâèñèìîñòü ìåæäó äèíàìèêîé ðàñïðîñòðàíåííîñòè çàáîëåâàíèé ñåðäå÷íî-ñîñóäèñòîé ñèñòåìû è îáùåé æåñòêîñòè ïèòüåâîé âîäû (R=-0,35 p<0,05). Ïîêàçàíî, ÷òî ìåæäó ÷àñòîòîé îñòðîãî èíôàðêòà ìèîêàðäà è îáùåé ìèíåðàëèçàöèåé ïèòüåâîé âîäû ñóùåñòâóåò îòðèöàòåëüíàÿ êîððåëÿöèîííàÿ çàâèñèìîñòü (R=-0,45 p<0,05), à ìåæäó äèíàìèêîé ýòîãî ïîêàçàòåëÿ çà 1995-2004 ãã. è ñîäåðæàíèåì ôòîðà - ïîëîæèòåëüíàÿ êîððåëÿöèîííàÿ çàâèñèìîñòü ñðåäíåé ñèëû (R=0,31 p<0,05). Âûÿâëåíà ïîëîæèòåëüíàÿ êîððåëÿöèîííàÿ ñâÿçü ìåæäó ðàñïðîñòðàíåííîñòüþ îñòðîãî èíôàðêòà ìèîêàðäà è êîíöåíòðàöèåé â ïèòüåâîé âîäå íèòðàòîâ (R=0,49 p<0,05).

Íåñêîëüêî äðóãèå äàííûå ïîëó÷åíû ïðè èçó÷åíèè çàâèñèìîñòè ïîêàçàòåëåé ñìåðòíîñòè îò ñîëåâîãî ñîñòàâà ïèòüåâûõ âîä. Óñòàíîâëåíî íàëè÷èå îòðèöàòåëüíîé êîððåëÿöèîííîé ñâÿçè ìåæäó ñìåðòíîñòüþ îò èíñóëüòîâ è ñîäåðæàíèåì íèòðàòîâ (R=-0,33 p<0,05). Ïîäîáíàÿ ñâÿçü ñóùåñòâóåò è ìåæäó ïîêàçàòåëÿìè ñîäåðæàíèÿ â ïèòüåâîé âîäå íèòðàòîâ è ñìåðòíîñòè îò îñòðîãî èíôàðêòà ìèîêàðäà (R=-0,31 p<0,05).

Óñòàíîâëåíî íàëè÷èå ïîëîæèòåëüíîé êîððåëÿöèîííîé çàâèñèìîñòè ìåæäó ñìåðòíîñòüþ îò îñëîæíåíèé ïåïòè÷åñêîé ÿçâû æåëóäêà è ñîäåðæàíèåì â ïèòüåâîé âîäå ôòîðà (R=0,32 p<0,05), ñìåðòíîñòüþ îò îñëîæíåíèé ïåïòè÷åñêîé ÿçâû äâåíàäöàòèïåðñòíîé êèøêè è ïîêàçàòåëÿìè îáùåé ìèíåðàëèçàöèè è ñîäåðæàíèÿ íàòðèÿ (R=0,35 p<0,05) Ïîêàçàíî ñóùåñòâîâàíèå íåãàòèâíîé ñâÿçè ñðåäíåé ñèëû ìåæäó ïîêàçàòåëåì îáùåé ìèíåðàëèçàöèè è óðîâíåì ñìåðòíîñòè îò õðîíè÷åñêîãî ÿçâåííîãî êîëèòà è áîëåçíüþ Êðîíà (R=-0,40 p<0,05).

Óñòàíîâëåíî íàëè÷èå îòðèöàòåëüíîé êîððåëÿöèîííîé çàâèñèìîñòè ìåæäó ïîêàçàòåëÿìè ñîîòíîøåíèÿ â ïèòüåâîé âîäå ìåæäó êàëüöèåì è ñòðîíöèåì è ñìåðòíîñòüþ îò ðàêà ïðÿìîé êèøêè - R=-0,48 (p<0,05) è ðàêà ìî÷åâîãî ïóçûðÿ (R=-0,42 p<0,05). Îáùàÿ æåñòêîñòü ïèòüåâûõ âîä íå êîððåëèðîâàëà íè ñ îäíèì èç ïîêàçàòåëåé ñìåðòíîñòè îò çëîêà÷åñòâåííûõ íîâîîáðàçîâàíèé.

Íàèáîëåå íåáëàãîïðèÿòíûìè äëÿ ñåðäå÷íî-ñîñóäèñòîé ñèñòåìû ÿâëÿþòñÿ ñî÷åòàíèÿ âûñîêîé îáùåé ìèíåðàëèçàöèè, íèçêîé æåñòêîñòè ïèòüåâîé âîäû ïðè êàëüöèé-ìàãíèåâîì ñîîòíîøåíèè ìåíåå 1,5 è ñîäåðæàíèè õëîðèäîâ âûøå 250 ìã/äì ³ íà ôîíå äåôèöèòà ôòîðà), ïàòîëîãèè ìî÷åâûâîäÿùåé ñèñòåìû (ñî÷åòàíèå âûñîêîé îáùåé ìèíåðàëèçàöèè, îáùåé æåñòêîñòè áîëåå 10,0 ìã-ýêâ/äì ³ ïðè êàëüöèé-ìàãíèåâîì ñîîòíîøåíèè ìåíüøå 1,5), ïàòîëîãèè æåëóäî÷íî-êèøå÷íîãî òðàêòà (ñîåäèíåíèÿ âûñîêîé îáùåé ìèíåðàëèçàöèè, îáùåé æåñòêîñòè âûøå 10,0 ìã-ýêâ/äì ³ ïðè êàëüöèé-ìàãíèåâîì ñîîòíîøåíèè ìåíüøå 1,5 è ñîäåðæàíèè õëîðèäîâ è ñóëüôàòîâ âûøå 250 ìã/äì ³ ïðè äåôèöèòå ôòîðà).

 òî æå âðåìÿ, óñòàíîâëåíî, ÷òî âçðîñëîå íàñåëåíèå, êîòîðîå ïîòðåáëÿåò ïèòüåâóþ âîäó ñ âûñîêèì ñîäåðæèìûì îòäåëüíûõ íåòîêñè÷íûõ ìèíåðàëüíûõ ñîåäèíåíèé, õîðîøî àäàïòèðóåòñÿ ê ñîëåâîìó ñîñòàâó ïèòüåâîé âîäû. Äëÿ ðàéîíîâ ñ íåáëàãîïðèÿòíûìè ïî ñîëåâîìó ñîñòàâó ïèòüåâûìè âîäàìè ÿâëÿåòñÿ öåëåñîîáðàçíîé ðàçðàáîòêà ðåãèîíàëüíûõ ñòàíäàðòîâ êà÷åñòâà ïèòüåâîé âîäû. Ðàçðàáîòàííûå âðåìåííûå ðåãèîíàëüíûå ñòàíäàðòû êà÷åñòâà ïèòüåâîé âîäû äîëæíû èñïîëüçîâàòüñÿ ëèøü â îòíîøåíèè âçðîñëîãî íàñåëåíèÿ, äåòñêîå è ïîäðîñòêîâîå íàñåëåíèå äîëæíî ïîëó÷àòü ïèòüåâóþ âîäó íàèâûñøåãî êà÷åñòâà.

 óñëîâèÿõ Îäåññêîé îáëàñòè áåçîïàñíûìè óðîâíÿìè ñîäåðæàíèÿ îñíîâíûõ ñîëåâûõ êîìïîíåíòîâ ÿâëÿåòñÿ: äëÿ îáùåé ìèíåðàëèçàöèè - äî 1500 ìã/äì ³, äëÿ îáùåé æåñòêîñòè - äî 12 ìã-ýêâ/äì ³, äëÿ ñîäåðæàíèÿ íàòðèÿ - 250 ìã/äì ³, äëÿ êàëüöèé-ìàãíèåâîãî ñîîòíîøåíèÿ - äî 1,0; äëÿ ñòðîíöèé-êàëüöèåâîãî ñîîòíîøåíèÿ - äî 0,01.

Êëþ÷åâûå ñëîâà: ïèòüåâàÿ âîäà, ìèíåðàëüíûå âåùåñòâà, çäîðîâüå íàñåëåíèÿ.

ABSTRACT

Vorokhta Y.M. Hygienic assessment of the influence of mineral composition of drinking water on population health.

Dissertation for the competition for a degree of Candidate of Medical Sciences for the specialty 14.02.01 - "hygiene" - State Institution "Î. M. Marzeev Institute of Hygiene and Medical Ecology" of the Academy of Medical Sciences of Ukraine, Kyiv.

The dissertation is devoted to the issues of the hygienic assessment of the influence of drinking waters with the various mineral composition on population health. There was determined that adults are adopting to some mineral components of drinking water even if its content exceeds current standards significantly. The quotes of water factor in the supply of customer's organism with essential mineral salts were identified. The influence of the various mineral components of drinking water on children's and adults' health have been assessed. There was determined that the consumption of physiologically inadequate waters influences on health of children and adolescents, e.g. significant negative correlation was found between general hardness, fluorine and nitrates content and the dynamics of anthropometric indices. There was found, that adults consumption drinking water with high content of some non-toxic mineral components could adapt themselves to salt composition of drinking water. For the districts with unfavorable mineral composition of drinking water there is expediently to develop regional standards of drinking water quality. There are recommended following values: for general mineralization - up to 1500 mg/dm³, for general hardness - 12 mg-eq/dm³, for sodium content - 250 mg/dm³, for Ca/Mg ratio - up to 1,0; for Sr/Ca ratio - up to 0,01. There is emphasized that similar temporary regional standards of drinking water could be used only for adults water supply.

Key words: drinking water, minerals, population health.

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