ó㳺í³÷íà òà òîêñèêîëîã³÷íà îö³íêà õàð÷óâàííÿ ä³òåé äîøê³ëüíîãî â³êó â îðãàí³çîâàíèõ êîëåêòèâàõ

Êëþ÷îâ³ ñëîâà: ä³òè äîøê³ëüíîãî â³êó, ðàö³îíè õàð÷óâàííÿ, òðàíñàë³ìåíòàðíå íàäõîäæåííÿ êñåíîá³îòèê³â, ô³çè÷íèé ðîçâèòîê, êîìá³íîâàíà ä³ÿ.

ÀÍÍÎÒÀÖÈß

Êèöóëà Ë.Ì. Ãèãèåíè÷åñêàÿ è òîêñèêîëîãè÷åñêàÿ îöåíêà ïèòàíèÿ äåòåé äîøêîëüíîãî âîçðàñòà â îðãàíèçîâàííûõ êîëëåêòèâàõ. - Ðóêîïèñü.

Äèññåðòàöèÿ íà ñîèñêàíèå ó÷åíîé ñòåïåíè êàíäèäàòà ìåäèöèíñêèõ íàóê ïî ñïåöèàëüíîñòè 14.02.01 - ãèãèåíà. - Ëüâîâñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè Äàíèëà Ãàëèöêîãî, Ëüâîâ, 2002.

Äèññåðòàöèÿ îñâåùàåò ñîñòîÿíèå ïèòàíèÿ äåòåé äîøêîëüíîãî âîçðàñòà â îðãàíèçîâàííûõ êîëëåêòèâàõ, òðàíñàëèìåíòàðíîå ïîñòóïëåíèå êñåíîáèîòèêîâ, âëèÿíèå èõ íà îòäåëüíûå ïîêàçàòåëè çäîðîâúÿ è ôèçè÷åñêîå ðàçâèòèå äåòåé.

Ðåçóëüòàòû èçó÷åíèÿ ïèòàíèÿ (ïàðàëëåëüíî ïî ìåíþ-ðàñêëàäêàì è ëàáîðàòîðíûì ìåòîäàì) äåòåé â äåòñêèõ ó÷ðåæäåíèÿõ (ÄÓ) ã. Ëüâîâà è Ëüâîâñêîé îáëàñòè, ñâèäåòåëüñòâóþò î íåäîñòàòî÷íîì ïîòðåáëåíèè äåòüìè îñíîâíûõ ïðîäóêòîâ ïèòàíèÿ. Ïî äàííûì ìåíþ-ðàñêëàäîê, îáåñïå÷åííîñòü äåòåé îñíîâíûìè íóòðèåíòàìè íå ñîîòâåòñòâóåò ôèçèîëîãè÷åñêèì íîðìàì è âî ìíîãîì çàâèñèò îò îðãàíèçàöèè ïèòàíèÿ äåòåé â îòäåëüíûõ äåòñêèõ ó÷ðåæäåíèÿõ.  ÷àñòíîñòè, äåôèöèò îáùåãî áåëêà â ðàöèîíàõ äåòåé ã. Ëüâîâà ñ 4-êðàòíûì ïèòàíèåì ñîñòàâëÿë â 1994 ãîäó 6,6-9,3 %, â 1995 ãîäó - 12,4 %, â 1996 ãîäó - 11,3-14,4 %. Êîëè÷åñòâî æèðà â ðàöèîíàõ äåòåé òàêæå èìåëî òåíäåíöèþ ê ñíèæåíèþ íà÷èíàÿ ñ 1994 ãîäà ê 1996 ãîäó ïðè îáùåì äåôèöèòå ñîîòâåòñòâåííî 5-12 % è 19,6- 22,8 %. Àíàëîãè÷íûå äàííûå ïîëó÷åíû ïðè èçó÷åíèè 3-êðàòíîãî ïèòàíèÿ äåòåé â ÄÓ ã. Ëüâîâà è Ëüâîâñêîé îáëàñòè. Äåôèöèò âèòàìèíà Ñ â ñðåäíåñóòî÷íûõ ðàöèîíàõ ïðè 4-êðàòíîì ïèòàíèè äåòåé ñîñòàâëÿë 9,6-63,5 %, ïðè 3-êðàòíîì ïèòàíèè â ÄÓ ã. Ëüâîâà - 25-50 %, îáëàñòè - 26,1-50,4 %.  ðàöèîíàõ äåòåé îòìå÷àëñÿ áîëüøîé äåôèöèò âèòàìèíà À, êîòîðûé ïðè 4-êðàòíîì ïèòàíèè ñîñòàâëÿë 42-70 %, ïðè 3-êðàòíîì ïèòàíèè - 75-80 % â ÄÓ ã. Ëüâîâà è 23,7-81,6 % â ÄÓ îáëàñòè. Îáåñïå÷åííîñòü äåòåé ìèíåðàëüíûìè âåùåñòâàìè òàêæå áûëà íåäîñòàòî÷íîé, â ÷àñòíîñòè, äåôèöèò ôîñôîðà â ðàöèîíàõ äåòåé ñ 4-êðàòíûì ïèòàíèåì ñîñòàâëÿë 16,8-30,1 %, êàëüöèÿ - 17,1-33 %, ìåäè - 23-32 %, öèíêà - 26-41 %.

Ñîäåðæàíèå òÿæåëûõ ìåòàëëîâ â ðåêîìåíäîâàííîì ïðîäóêòîâîì íàáîðå äëÿ äåòåé 4-6 ëåò ñ 4-êðàòíûì ïèòàíèåì, èñõîäÿ èç óñëîâèÿ ñîäåðæàíèÿ èõ â ïðîäóêòàõ ïèòàíèÿ íà óðîâíå äåéñòâóþùèõ ïðåäåëüíî äîïóñòèìûõ êîíöåíòðàöèé (ÏÄÊ), ïðåâûøàåò äîïóñòèìóþ ñóòî÷íóþ äîçó (ÄÑÄ)äëÿ ñâèíöà, êàäìèÿ, ðòóòè, öèíêà è ìûøüÿêà è ñâèäåòåëüñòâóåò î íåîáõîäèìîñòè ñíèæåíèÿ èõ ÏÄÊ â ïðîäóòàõ ïèòàíèÿ.

Ñðåäíåãîäîâîå ñîäåðæàíèå ñâèíöà â äóáëèêàòàõ ñóòî÷íûõ ðàöèîíîâ äåòåé ñ 4-êðàòíûì ïèòàíèåì ñîñòàâëÿëî â 1994 ãîäó - 0,47 ìã, â 1995 ãîäó - 0,54 ìã, â 1996 ãîäó - 0,33 ìã è çíà÷èòåëüíî ïðåâûøàëî ÄÑÄ. Ñîäåðæàíèå êàäìèÿ â ðàöèîíàõ äåòåé ã. Ëüâîâà ñ 4-êðàòíûì ïèòàíèåì íàõîäèëîñü â ïðåäåëàõ 0,0039-0,012 ìã/ðàöèîí, ñ 3-êðàòíûì ïèòàíèåì â 1998 ãîäó - 0,019 ìã/ðàöèîí â ÄÓ ã. Ëüâîâà è 0,017 ìã/ðàöèîí â ÄÓ îáëàñòè, â 1999 ãîäó - 0,032 ìã/ðàöèîí è 0,029 ìã/ðàöèîí ñîîòâåòñòâåííî, ÷òî òàêæå âûøå ÄÑÄ. Ñîäåðæàíèå ðòóòè, ìûøüÿêà è íèòðàòîâ â ðàöèîíàõ äåòåé íå ïðåâûøàëî ÄÑÄ.

 òîêñèêîëîãè÷åñêèõ ýêñïåðèìåíòàëüíûõ èññëåäîâàíèÿõ íà áåëûõ êðûñàõ óñòàíîâëåíî, ÷òî êîìáèíèðîâàííîå äåéñòâèå äâîéíîé (íèòðàò è íèòðèò íàòðèÿ) è òðîéíîé (íèòðàò íàòðèÿ, íèòðèò íàòðèÿ, àçîòíîêèñëûé ñâèíåö) ñìåñåé çàâèñèò îò ñîñòàâà ñìåñè, èññëåäîâàííûõ äîç, âðåìåíè äåéñòâèÿ, èññëåäóåìîãî ýôôåêòà è ïðîÿâëÿåòñÿ àíòàãîíèçìîì, ãåòåðîàääèòèâíîñòüþ, äåñåíñèòèçàöèåé è íåçàâèñèìûì äåéñòâèåì. Äîâåäåíî íåîáõîäèìîñòü èñïîëüçîâàíèÿ ïðè êîíòðîëå ôîðìóëû àääèòèâíîñòè ïðè ñîâìåñòíîì ïîñòóïëåíèè íèòðàòà è íèòðèòà íàòðèÿ, à ïðè óñëîâèè îäíîâðåìåííîãî ïîñòóïëåíèÿ íèòðèòîâ, íèòðàòîâ è ñâèíöà êîíòðîëü íåîáõîäèìî îñóùåñòâëÿòü ïî èíäèâèäóàëüíîìó íîðìàòèâó ñâèíöà. Ïî ðåçóëüòàòàì èññëåäîâàíèÿ ïðåäëîæåíî ñíèçèòü ÄÑÄ íèòðàòà íàòðèÿ äî óðîâíÿ 3,5 ìã/êã, à îðèåíòèðîâî÷íóþ ÄÑÄ äëÿ íèòðèòà íàòðèÿ ïðèíÿòü íà óðîâíå 0,1 ìã/êã.

Íàòóðíûìè èññëåäîâàíèÿìè ïîäòâåðæäåíî ãèïîâèòàìèíîçíîå ñîñòîÿíèå äåòåé, â ÷àñòíîñòè ýêñêðåöèÿ âèòàìèíà Ñ ñ ìî÷îé â 2-3 ðàçà íèæå ôèçèîëîãè÷åñêîãî óðîâíÿ. Ñîäåðæàíèå ÀËÊ â ìî÷å äåòåé êîððåëèðóåò ñ ñîäåðæàíèåì ñâèíöà â ðàöèîíàõ è ñîñòàâëÿåò â ñðåäíåì 3,75 ìã/ë ñ êîëåáàíèÿìè îò 2,5 ìã/ë äî 6 ìã/ë, ÷òî â 2-3 ðàçà âûøå äîïóñòèìîé âåëè÷èíû.  áîëüøèíñòâà äåòåé ñ ñîäåðæàíèåì ÀËÊ â ìî÷å ñâûøå 3 ìã/ë, â êðîâè îòìå÷àëàñü ëåéêîïåíèÿ, ñíèæåíèå óðîâíÿ ãåìîãëîáèíà, ïðè ýòîì ñîäåðæàíèå æåëåçà â ñûâîðîòêå êðîâè áûëî ïîâûøåííûì, ÷òî ñâèäåòåëüñòâóåò î âîçìîæíîé ñâèíöîâîîáóñëîâëåííîé àíåìèè ó äåòåé.  êðîâè îáñëåäîâàííûõ äåòåé îòìå÷àëîñü ïîâûøåííîå ñîäåðæàíèå ìåòãåìîãëîáèíà, â ÷àñòíîñòè, ó 18,7 % îáñëåäîâàííûõ äåòåé ñîäåðæàíèå ìåòãåìîãëîáèíà ïðåâûøàëî 2 % è íå âñåãäà áûëî îáóñëîâëåíî ïîñòóïëåíèåì íèòðàòîâ â îãàíèçì ñ ðàöèîíàìè ïèòàíèÿ.

Ïî ðåçóëüòàòàì îáñëåäîâàíèÿ äåòåé äîøêîëüíîãî âîçðàñòà ã. Ëüâîâà (1995-1996 ãã.) è ñåëüñêîé ìåñòíîñòè îáëàñòè (1998-1999 ãã.) ðàçðàáîòàíû ñòàíäàðòû ôèçè÷åñêîãî ðàçâèòèÿ. Óñòàíîâëåíî, ÷òî íîðìàëüíîå ôèçè÷åñêîå ðàçâèòèå èìåþò 72,4 % ìàëü÷èêîâ è 71,2 % äåâî÷åê ã. Ëüâîâà, 68,8 % ìàëü÷èêîâ è 71,5 % äåâî÷åê ñåëüñêîé ìåñòíîñòè. Íàèáîëüøåå îòêëîíåíèå îò íîðìàëüíîãî ôèçè÷åñêîãî ðàçâèòèÿ ïðèíàäëåæèò äåôèöèòó è èçáûòêó âåñà òåëà I ñòåïåíè. Äåòè ñåëüñêîé ìåñòíîñòè îòñòàþò â ðîñòå îò ñâîèõ ãîðîäñêèõ ñâåðñòíèêîâ íà 0,5-1,7 ñì (ìàëü÷èêè) è 0,7-2,0 ñì (äåâî÷êè) è èìåþò ìåíüøèé âåñ ñîîòâåòñòâåííî íà 0,4-0,7 êã è 0,3-0,8 êã.

Ñäåëàí âûâîä î òîì, ÷òî äåòè èññëåäóåìîé ïîïóëÿöèè íàõîäÿòñÿ â ñîñòîÿíèè ïîëèãèïîâèòàìèíîçà, ïîëèãèïîìèêðîýëåìåíòîçà è õðîíè÷åñêîé ñâèíöîâîé èíòîêñèêàöèè.

Íà îñíîâàíèè ïðîâåäåííûõ èññëåäîâàíèé íàìå÷åíû ïóòè îïòèìèçàöèè ïèòàíèÿ äåòåé è ïðåäóïðåæäåíèÿ íåãàòèâíîãî äåéñòâèÿ êñåíîáèîòèêîâ íà îðãàíèçì äåòåé. Ïðåäëîæåíî äëÿ âûÿâëåíèÿ ýêîëîãè÷åñêîãî âëèÿíèÿ íà îðãàíèçì äåòåé îïðåäåëÿòü ñîäåðæàíèå ìåòãåìîãëîáèíà â êðîâè, íèòðàòîâ è ÀËÊ â ìî÷å. Ðàçðàáîòàí àëãîðèòì èçó÷åíèÿ è îöåíêè ôàêòè÷åñêîãî ïèòàíèÿ ñ îöåíêîé ïèùåâîãî è “ýíäîýêîëîãè÷åñêîãî” ñîñòîÿíèé äåòåé èëè äðóãèõ ãðóïï íàñåëåíèÿ.

Êëþ÷åâûå ñëîâà: äåòè äîøêîëüíîãî âîçðàñòà, ðàöèîíû ïèòàíèÿ, òðàíñàëèìåíòàðíîå ïîñòóïëåíèå êñåíîáèîòèêîâ, ôèçè÷åñêîå ðàçâèòèå, êîìáèíèðîâàííîå äåéñòâèå.

SUMMARY

Kitsula L. M. Hygienic and toxicological assessment of preschool children nutritioin organized groups. - Manuscript.

The dissertation for receiving scientific degree of candidate of medical sciences on speciality 14.02.01 - hygiene. - Lviv state medical university named after Danylo Galitskyy, Lviv, 2002.

Dissertation is devoted to study and hygienic assessment of nutrition, trans-alimentary intake of xenobiotics ( lead, cadmium, mercury, arsenic, nitrates ) with daily rations in organized groups and physical development and certain indices of health condition of preschool children for the aim of grounding the ways of optimization of nutrition and prevention of negative effect of xenobiotics on children's organism, elaborating standards of physical development. It was set that children's nutrition is insufficient as to content of main products, is not valuable as to content of main nutrient. It were revealed possible causes of irrational nutrition of children. The excess of permissible daily intake of lead with ration of children's nutrition was revealed, it correlates with content of - ALA in urine. Necessity of reducing existing MPC of heavy metals in food products. It was set that children have poor degree of protein - energy deficiency, polyhypovitaminoses, polyhypomicrielementoses, chronic lead intoxication. Standards of physical development of preschool children of Lviv-city and region were elaborated. More significant deflection of physical development from normal physical development was revealed among village children. Character of double effect (nitrate and nitrite of lead) and triple effect ( with the following addition of lead nitrate) in toxicological experiment depends on mixture composition, tested doses, time of effect, tested effect. The addition of lead nitrate improves effect of double mixture, but at small doses independent action of lead was revealed. It was proposed to reduce permissible daily dose of lead nitrate and oriented PDD for nitrite of sodium. The algorithm of jointed effect of fact nutrition and trans-alimentary chemical loading and consequences of their effect on the children's organism and other groups of the population was composed.

Key words: preschool children, ration of nutrition, trans-alimentary xenobiotics intake, physical development, combined effect.

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