B GIO DC V O TOTRNG I HC CNG NGH SI GNKHOA CNG NGH THC PHM

DINH DNG ti : Dinh dng cho bnh nhn gtThnh vin nhm:1. Khc Th M 2. Nguyn Th Thanh H 3. Nguyn Th Thanh Vn 4. Dng Tiu Bnh5. V Th Dim TrinhGVHD: Th.s Bi Th Minh ThyI. Gii thiu bnh gt1.1 Bnh gt Gt l mt trong nhng dng vim khp gy au n nht. L dng ri lon chuyn ha cht m dn n vic tng sn xut hoc gim o thi axit uric. T c cc hin tng: Cc tinh th axit uric sc nhn lng ng li cc khp, thng ngn chn ci Cc lp axit uric lng ng (c gi l sn urat) trng ging nh nhng cc u di da Si thn t cc tinh th axit uric trong thn.1.2 Nguyn nhn: Hm lng acid uric do qu trnh ph v cc protein v thng c thn bi tit qua nc tiu, nhng khi c th khng t o thi ht lng acid uric d tha chng s kt li thnh cc tinh th ng ti cc khp v gy au n.1.3 Tnh hnh hin nay Trn th gii: Thng gp cc nc pht trin v ang pht trin, chim khong 0,02 - 0,2% dn s, nam gii chim ch yu trn 95% v tui thng t 30 tui tr ln.

Hnh 1: Kh nng mc bnh gt cc tui khc nhau nm 2007 (http://www.map-france.com/Gout-Rossignol-24320/population-Gout-Rossignol.html ) Vit Nam: Theo kho st ca Vin Gt t thng 07/2007 n 7/2012 trn c nc c hn 22 ngn ngi mc bnh gt trong s bnh nhn gt ti Tp. HCM l ln nht ln ti 8246 ngi chim hn 1/3 bnh nhn gt trn c nc.1.4 Tc hi

Xng khp b hy hoi: Cc xng, khp ca ngi bnh s b ph hy khi cc ht tophi b lot v, c bit l u cc ngn tay, chn, khp bn tay bn chn. y l c hi thun li cc vi khun xm ln gy nn nhim khun xng, ng huyt. y l bin chng m tt c nhng ngi mc bnh gout u phi i mt khi khng sm iu tr kp thi. Tn thng thn: Lng axit uric ca ngi bnh gout l rt cao, khi i qua thn to iu kin cho mui urat lng ng ti y d gy si thn, gy tc ng tit niu. Lu ngy khin bnh nhn gout b suy thn cp.II. Thc phm v bnh gt:Nguyn nhn chnh gy nn bnh gt l do acid uric m acid uric l sn phm sau cng ca chuyn ho purine. Da vo hm lng purine trong cc sn phm m ngi ta chia thnh 3 nhm thc phm: Nhm A (hm lng purine thp), nhmB (hm lng purine trung bnh), Nhm C (hm lng purine cao).2.1 Nhm A: 0-50mg purine mi l00g thc phm- Tri cy, rau: Tt c cc tri cy, rau, ngoi tr nhng loi trong nhm B.- Cc sn phm t sa nh: sa, kem, sa chua, kem, ph mai, trng l cc sn phm t sa.- Cc sn phm nh b, hu ht cc loi du nu n, m ln,- ung: bao gm tr, c ph, nc gii kht c cha caffeine.2.2 Nhm B: 100-150mg purine mi l00g thc phm - Gia cm: g, vt, g ty, ngng, - Cc loi tht : tht b, tht b, tht cu, tht ln, tht xng khi v xc xch. - C (ngoi tr nhng loi c trong nhm c), hu, vm v loi c v khc nh tm, cua, - Ng cc nguyn cm: bao gm c bt yn mch, go nu, - Cc loi u nh: u tng, bt u nnh, u ph, u xanh, u phng, b uphng, ht iu, u H Lan, - Cc loi rau nh: sp l (bng ci), ci xon, rau bina (rau chn vt), mng ty, tri b v nm,2.3 Nhm C: 150-1000mg purine mi l00g thc phm.- Cc ng vt nui hoc ngoi t nhin: g li, chim ct, th, tht th rng, ni tng ng vt (thn, tim, lch, gan,) v cc th phm t ni tng ng vt (pa t gan, xc xch,- Cc sn phm t tht ln men: nem chua,- Trng c: trng c tuyt, trng c mui,- S ip, c trch, c thu, c hi tm cng, tm hm, c cm, c mi, nc mm,2.4 Thc phm c li cho bnh nhn gt- Sp l:l mt trong nhng loi rau cha t nhn purin (mi 100g ch c di 75mg). Theo dinh dng hc c truyn, sp l tnh mt, v ngt, cng dng thanh nhit, li tiu, thng tin nn l thc phm thch hp cho ngi c acid uric mu cao.- Da chut (Da leo):l loi rau kim tnh. Theo dinh dng hc c truyn, da chut tnh mt, v ngt, cng dng thanh nhit, gii c nn c kh nng bi tit tch acid uric qua ng tit niu.- Ci xanh:cng l loi rau kim tnh, v hu nh khng cha nhn purin. Ci xanh c tc dng gii nhit tr phin, thng li trng v. Sch Trn nam bn tho cho rng ci xanh cn c tc dng li tiu, rt thch hp vi ngi b bnh gt.- C:c pho, c bt, c tm... u c tc dng hot huyt tiu thng, kh phong thng lc, thanh nhit ch thng. y cng l loi thc phm kim tnh v hu nh khng cha nhnpurin. Nghin cu hin i cho thy c cn c tc dng li niu mt mc nht nh. Ci bp:l loi rau hu nh khng c nhn purin, Sch Bn tho cng mc thp di cho rng ci bp c cng dng "b tinh ty, li ng tng lc ph, li quan tit (c ch cho khp), thng kinh hot lc" nn l thc phm rt tt cho ngi c acid uric trong mu cao. C ci:tnh mt, v ngt, c cng dng li quan tit, hnh phong kh, tr t nhit (Thc tnh bn tho), tr phong thp (Ty tc c m thc ph), rt thch hp vi ngi b phong thp ni chung v thng phong ni ring. y cng l loi rau kim tnh, giu sinh t, nhiu nc v hu nh khng c nhn purin. Khoai ty:l mt thc phm kim tnh, giu mui kali. Trong thnh phn ha hc hu nh khng c nhn purin. B :tnh m, v ngt, cng dng b trung ch kh, gim m mu v h ng huyt, l loi thc phm kim tnh v hu nh khng cha nhn purin, l tng cho ngi b cao huyt p, ri lon lipid mu, bo ph v tng acid uric trong mu. B xanh:tnh mt, v ngt m, c tc dng thanh nhit tiu m, li tiu tin, gii c, gim bo. L loi thc phm kim tnh, nhiu nc v cha rt t nhn purin, c kh nng thanh thi acid uric qua ng tit niu kh tt. Da hu:tnh lnh, v ngt, c cng dng thanh nhit gii th, tr phin ch kht v li tiu tin. Trong thnh phn c cha nhiu mui kali, nc v hu nh khng c nhn purin. y l loi qu c bit tt cho nhng ngi b gt giai on cp tnh. u :cn gi l xch tiu u, tnh bnh, v ngt chua, c cng dng kin t ch t, li niu tiu thng. Trong thnh phn ha hc ca u hu nh khng c nhn purin, l thc phm rt tt cho bnh nhn b bnh gt. L v to:hai loi qu tnh mt, v ngt, cng dng thanh nhit sinh tn, ch kht tr phin. Trong thnh phn c cha nhiu nc, sinh t, mui kali v hu nh khng c nhn purin. L loi qu kim tnh, dng rt tt cho bnh nhn b bnh gt cp tnh v mn tnh. Nho:tnh bnh, v ngt, cng dng b kh huyt, cng gn ct v li tiu tin. y cng l loi qu kim tnh, nhiu nc, giu sinh t v hu nh khng c nhn purin. Sa b:l loi thc phm b dng giu cht m, nhiu nc v cha rt t nhn purin. L th nc ung l tng cho bnh nhn bbnh gtc cp tnh v mn tnh.

2.5 King tuyt i nhng thc phm giu m c gc Purin (v hm lng purin trong c th tng, qu trnh chuyn ha chng thnh acid uric tng) nh : Hi sn, cc loi tht c mu nh : Tht tru, b, nga, tht d; Ph tng ng vt nh : Li, lng, tim, gan, thn, c; Trng gia cm ni chung, nht l cc loi trng ang pht trin thnh phi nh trng vt ln King tt c cc loi thc phm c tc tng trng nhanh nh : Mng tre, mng trc, mng ty, nm, gi, bc h (dc mng) (v s lm gia tng tc tng hp acid uric trong c th) Gim bt nhng thc phm giu m trong khu phn n nh: m ng vt ni chung nh : tht ln, tht g, tht vt . . . ; c v cc loi thy sn nh: ln, cua , c, ch . . . m thc vt: u ht ni chung nht l cc loi u n c ht nh : u H Lan, u trng, u , u xanh,Cc ch phm t u nnh nh : u ph, sa u nnh, to ph nhn chung t lm tng acid uric hn cc loi u cha ch bin. Gim cc thc phm giu cht bo no nh: m, da ng vt, thc n chin, quay, thc phm ch bin vi cc cht bo no nh: m tm, thc n nhanh. ung: Tuyt i khng ung bt k mt dng cht cn no nh : ru bia, cm ru, np than Hn ch ung c gaz, nc ung ngt nhiu ng v s lm tng nguy c bo ph, mt trong nhng yu t tng nng bnh gout.III. Nguyn tc xy 3.1 Khng n tht c mu nh : Tht tru, b, nga, tht d; Ph tng ng vt nh : Li, lng dng ch dinh dng cho bnh nhn gt3.2 Khng n thc n giu nhn purin: Thc phm giu m l cch nhn bit chung nht cho nhm thc phm c purin cao. Hi sn, cc loi tht, tim, gan, thn, c; Trng gia cm ni chung, nht l cc loi trng ang pht trin thnh phi nh trng vt ln Nhng c th cn m, v vy, s dng thc phm cung cp m nhng purin phi di 50mg/100g. l: tht ln nc, trng, sa, pho mt.3.3 Khng s dng thc ung c cn v cht kch thch Bia c nhiu purin, khng nn ung bia khi ang b gt. Ru lm chm qu trnh o thi acid uric nn cn gim ru. C ph, ch l cc thc ung c cha xanthin tin cht trung gian to ra acid uric. ung c gaz, nc ung ngt nhiu ng v s lm tng nguy c bo ph, mt trong nhng yu t tng nng bnh gt. Ung nc y : Nn ung nhiu nc (ti thiu 2,5 n 3 lt nc mi ngy), ung nc khong khng ga c kim cao, cc loi tr tho dc, nc hoa qu.IV. Xy dng khu phni tng nam, tui 3060, cn nng trung bnh 65kg, lao ng nh v ang b bnh gt. NL CHCS = 11,6 x W + 879 = 11,6 x 65 + 879 = 1633 KcalNL c ngy = NL CHCS x 1,55 = 1633 kcal x 1,55 = 2531 Kcal T l NL theo cc bui trong ngy:BuiSngTraTi

T l (%)354025

Nng lng (Kcal)8861012633

T l cn i dinh dng P : L : G l 1 : 0,5 : 5Bit 1gam Protid oxy ha trong c th cho 4 Kcal x 1 = 4 phnBit 1gam Lipid oxy ha trong c th cho 9 Kcal x 0,5 = 4,5 phnBit 1gam Glucid oxy ha trong c th cho 4 Kcal x 5 = 20 phn Tng cng = 28,5 phn Phn trm nng lng tng cht28,5 phn 100% NL4 phn 14% NL4,5 phn 16% NL20 phn 70% NL Suy ra trong khu phn n Protid chim 14%, Lipid chim 16%, Glucid chim 70% ph hp vi t l dinh dng cc cht ca Vin gt Thnh ph H Ch Minh.Bng: T l nng lng gia cc cht sinh nng lng i vi bnh nhn gtCht dinh dngPhn trm nng lng (%)

Potid12-12

Lipid18-20

Glucid65-70

Nng lng v s gam cn c ca tng cht trong mi bui nSng: 100% NL 886 Kcal Protid 14% NL 124 Kcal : 4 = 31 (g) Lipid 10% NL 141,8 Kcal : 9 = 15,8 (g) Glucid 70% NL 620 Kcal : 4 = 155 (g)Tng t ta c:Bng: Nng lng v khi lng tng cht trong mi bui nBuiCht dinh dngNng lng (Kcal)Khi lng (gam)

SngProtid12431

Lipid141,815,8

Glucid620155

TraProtid141,735,42

Lipid16218

Glucid708,3177

ChiuProtid88,622,2

Lipid101,311

Glucid443,1111

Thc nBa nTh 2 + 4Th 3 + 5 + 7Th 6 + Ch nht

Ba sngBnh m trng Chui tiu SaXi bpMt ong chanhPh xo chayNhoSa

Ba traCm Canh b tht bm Rau mung xo tht ToCm Canh khoai ty, c rt hm xngTrng chinC r kho tChui tiuCmCanh b xanh nu tpTrng xo xu hoDa hu

Ba chiuCmCanh b xanh nu tht Sp l xo Da huCm Ci xanh lucC st cCh u

CmCanh da leoC r om l ltCi tha xoTo

Kt hp thc n v khi lng cn c mi cht tnh khi lng ca nguyn liu

STTThc phmLng (g)Protid (g)Lipid (g)Glucid (g)

1Bnh m13010,31,01,0

2Trng608,97,00,3

3X du201,4--

4Tiu50,40,41,7

5ng12--11,9

6Du n2-2,0-

7Chui tiu3004,50,666,6

8Sa1003,94,44,8

Tng29,415,4153,7

9Cm15011,91,5114,3

10B 3000,9-16,8

11Tht100197-

12Rau mung2002,4-2,1

13ng10--9,93

14Du n10-10-

15Hnh l200,2-0,8

16To ty3001,5-33,9

Tng35,918,5178

17Cm1007,9176,2

18B xanh3001,8-7,2

19Tht203,81,4-

20Sp l1502,5-3,9

21ng10--9,93

22Du n3-4-

23Da hu2002,40,44,6

24Sa1003,94,44,8

Tng22,311,2107

NL= (29,4 + 35,9 + 22,3) x 4 + (15,4 + 18,5 + 11,2) x 9 + (153,7 + 178 + 107) x 4 = 2511 Kcal 2531 Kcal Vy thc n ph hp

STTTn thc phmLng (g)Protid (g)Lipid (g)Glucid (g)

1Bp15012,97,05104,1

2Vng153,0156,962,64

3ng5--5

4Da50,241,80,31

5Mt ong500,2-40,65

6Chanh500,45-2,4

Tng1715,8155

7Cm15011,91,5114,3

8Khoai ty1503-31,5

9C rt1001,5-8

10Xng10017,912,8-

11Hnh100,13-0,43

12Trng vt101,31,420,1

13C r ng305,81,6-

14Tiu50,350,371,7

15Chui tiu1001,50,222,2

Tng43,3818178

16Cm1007,91,576,2

17C diu hng509,552,75-

18C chua1000,6-4,2

19Ci xanh3005,1-6,3

20u 256,050,42513,325

21ng10--9,93

Tng29,211110

NL= (17 + 43,38 + 29,2) x 4 + (15,8 + 18 + 11) x 9 + (155 + 178 + 110) x 4 = 2534 Kcal 2531 KcalVy thc n ph hp

STTThc phmKhi lngProtid (g)Lipid (g)Glucid (g)

1Ph25017,752131,5

2C rt751,125-6

3Ci xanh751,275-1,575

4Hnh l250,325-2,125

5Du5-5-

6Tiu50,350,371,705

7X du503,5--

8Nho1000,4-3,1

9Sa2007,88,89,6

Tng34,516155,6

10Cm15011,851,5114,3

11B trng2000,6-11,2

12Tp101,170,12-

13Hnh l100,13-0,43

14G5010,156,55-

15Trng g101,481,160,05

16Xu ho 1504,2-9,45

17Du9-9-

18Nc mm60,425--

19Da hu2002,40,44,6

20Chui1502,250,333,3

Tng3519174

21Cm1007,9174,9

22Da leo1001,2-4,5

23C r ng253,71,04-

24Ci tha1001,4-2,6

25Tht heo54,91,75-

26Nm mo101,060,026,5

27u h300,6540,0420,08

28C ci200,3-0,52

29Du7-7-

30Nc mm30,213--

31To2001-22,6

Tng22,311111

NL= (34,5 +35 + 22,3) x 4 + (16 +19 +11) x 9 + (155,6 + 174 + 111) x 4 = 2543 2531 KcalVy thc n ph hp.