Dinh Duong Va an Toan Ve Sinh Thuc Pham

8/14/2019 Dinh Duong Va an Toan Ve Sinh Thuc Pham

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Ten baiPhan I - ai cng

Chng 1 - Sphat trien cua dinh dng hocChng 2 - Dinh dng, sc khoe vabenh tatChng 3 - An ninh thc pham vaan ninh dinh dngChng 4 - ng loi dinh dng

Phan II - Dinh dng c sChng 1 - Cau truc c theChng 2 - Nang lng

Chng 3- ProteinChng 4 - LipidChng 5 - GlucidChng 6 - Vitamin tan trong dauChng 7 - Vitamin tan trong ncChng 8 - Chat khoang a lngChng 9 - Chat khoang vi lngChng 10 - Nc vaien giai

Phan III - Dinh dng cac oi tng vala tuoiChng 1 - Dinh dng cho ngi mekhi mang thai vacho con bu

Chng 2 - Dinh dng cho treemChng 3 - Dinh dng cho ngi lao ongChng 4 - Dinh dng cho ngi cao tuoiChng 5 - Phng phap anh giatnh trang dinh dng

Phan IV - Thc phamChng 1 - Tht, ca, trng, saChng 2 - au ovacac hat codauChng 3 - Ngucoc vakhoai cuChng 4 - Rau - QuaChng 5 - Chat beo, ongot vathc uong

Chng 6 - Thc pham chc nangPhan V - Dinh dng cong ongChng 1 - Suy dinh dng Protein - Nang lngChng 2 - Thieu Vitamin A vabenh khomatChng 3 - Thieu mau dinh dng do satChng 4 - Benh coi xng treemChng 5 - Benh loang xngChng 6 - Cac roi loan do thieu kemChng 7 - Cac roi loan do thieu iodChng 8 - Tha can vabeo ph

Phan VI - Cac benh man tnh khong lay lien quan en dinh dngChng 1 - Dinh dng vabenh ai thao ng


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Chng 2 - Dinh dng vacac benh tim machChng 3 - Dinh dng vaung thChng 4 - Dinh dng vabenh gout

Phan VII - Dinh dng lam sang - Tiet cheChng 1 - Nguyen tac dinh dng tiet cheChng 2 - Suy dinh dng trong benh vienChng 3 - Quy trnh can thiep, cham soc dinh dng benh vienChng 4 - anh giatnh trang dinh dng cua ngi benhChng 5 - Cheoan trong mot sobenh

Phan VIII - Benh do thc pham vangooc thc phamChng 1 - Cac benh do thc phamChng 2 - ieu tra ngooc thc phamChng 3 - Thc an ng phoChng 4 - Phugia thc pham

Phan IX - Kiem soat vesinh thc phamChng 1 - Bao quan thc phamChng 2 - Vesinh an uong cong congChng 3 - Kiem soat vesinh thc phamChng 4 - Gii thieu veanh gianguy c vi sinh trong thc phamChng 5 - Hethong canh bao vean toan thc pham

Phan X - Can thiep dinh dngChng 1 - Can thiep dinh dng vathc phamChng 2 - Cai thien dinh dng da vao thc phamChng 3 - Giao duc truyen thong dinh dngChng 4 - Giam sat dinh dng

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BAN BIEN SOAN

Chubien:

PGS. TS Pham Duy Tng GS. TS. Nguyen Cong Khan

PGS. TS. LeTh Hp

TS. Pham Th Thuy Hoa

Th kybien soan:

ThS. Huynh Nam Phng

THAM GIA BIEN SOAN

GS. TSKH. HaHuy Khoi

PGS. TS Pham Duy Tng

GS. TS. Nguyen Cong Khan

PGS. TS. LeTh Hp

PGS. TS. HaTh Anh ao

PGS. TS. Nguyen Th Lam PGS. TS. LeBach Mai

PGS. TS. Nguyen Xuan Ninh

PGS. TS. oTh Hoa

PGS. TS. LeTh Hng

TS. Pham Th Thuy Hoa

TS. Nguyen oHuy TS. Pham Thu Hng

TS. LeNguyen Bao Khanh

TS. Tran Th Phuc Nguyet

PGS. TS. Pham Van Phu

TS. TNg

TS. LeDanh Tuyen


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DINH DNG VA AN TOAN VE SINH THC PHAM

LI NOI AU

Cuon sach Vesinh dinh dng vaVesinh thc pham c cac thay Hoang Tch Mnh vaHaHuy Khoi bien soan c Trng ai hoc Y HaNoi xuat ban nam 1977 va ac tai ban lan thnhat nam 2004. Cuon sach ac sdung lam giao trnh giang day cho sinh vien chuyen khoavesinh dch tevac dung lam tai lieu tham khao velnh vc nay nhieu trng ai hoc trongnhng nam qua.

Ngay nay, Dinh dng hoc vaAn toan thc pham lalnh vc kien thc cong dung rong rai trongcong tac cham soc vabao vesc khoecho cong ong vangi benh. oi vi cac can bocong tac

lnh vc y tedphong, kien thc vedinh dng vaan toan thc pham cang thiet thc hn trongviec xac nh cac van edinh dng vathc pham, to lap kehoach thc hien cac giai phap

phong chong cac benh dinh dng, cac benh man tnh colien quan en dinh dng, cac van edinh dng vavesinh an toan thc pham trong ieu kien thien tai, cac benh do thc pham gay ra,giam sat dinh dng, thanh tra vesinh thc pham. Cuon sach con ecap en nhng nguyen tac tochc ba an hp lycho ngi benh trong benh vien.

Lan nay, cuon sach c bien soan vacap nhat nhng kien thc mi nham phuc vucho cac oitng sinh vien chuyen khoa, cao hoc Y teCong cong, cao hoc Y hoc Dphong, cao hoc Dinhdng Cong ong vacothelam tai lieu tham khao cho cac oi tng khac coquan tam ti lnh vcsc khoe, dinh dng vaan toan thc pham. Trong khi bien soan, Bomon Dinh dng vaAn toanthc pham acoshp tac vi nhieu chuyen gia cua Vien Dinh dng.

Bomon Dinh dng vaAn toan thc pham xin chan thanh cam n ti Ban Giam hieu Trng aihoc Y HaNoi vaBan giam oc Vien Dinh dng atao ieu kien thuan li ecuon sach c hoanthanh.

Trong quatrnh bien soan mac duaconhieu cogang etong hp vacap nhat cac van e, nhng

cuon sach chac chan khong tranh khoi thieu sot. Cac tac giavaBomon rat mong i vaxin chanthanh cam n cac ykien gop ycua ong nghiep vaban oc.

Trng bomon Dinh dng vaAn toan thc pham

PGS. TS. Pham Duy Tng


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PHAN I - AI CNGChng 1. S PHAT TRIEN CUA DINH DNG HOC

TthekyXIX, dinh dng hoc atrthanh mot bomon khoa hoc oc lap. Tuy nhien, thekyXX mithc slaThekycua Dinh dng hoc vi nhieu thanh tu noi bat trong viec phat hien ra vai trodinh dng cua cac vitamin, cac acid amin, cac acid beo can thiet vamoi lien quan gia cheoanvacac benh man tnh. Trong vong 50 nam trlai ay, cac nghien cu vang dung dinh dng tronghoat ong cai thien sc khoecong ong ac phat trien manh me. Trong thap ky90 cua theky

XX, cai thien dinh dng cong ong atrthanh ng loi chnh sach cua nhieu quoc gia, thehiennhng bc tien bovt bac vemat ng dung xahoi cua dinh dng hoc.

1. OI TNG CUA DINH DNG HOCDinh dng hoc labomon khoa hoc nghien cu moi quan hegia thc an vi c the, olaqua

trnh c thesdung thc an eduy tr ssong, tang trng, thc hien cac chc phan bnh thngcua cac c quan vacac movaesinh nang lng, cung nh phan ng cua c theoi vi an uong,sthay oi cua khau phan vacac yeu tokhac coyngha benh ly(WHO/FAO/IUNS 1974).

Dinh dng ngi lamot bomon khoa hoc nghien cu moi quan hegia thc an vi c theconngi. Dinh dng ngi quan tam ac biet en nhu cau dinh dng, tieu thuthc pham, tap quan

an uong, giatr dinh dng cua thc pham vacheoan, moi lien quan gia cheoan vasc khoecung nh cac nghien cu trong cac lnh vc o.Ngay nay, dinh dng ngi thng bao gom cac phan khoa sau ay:

1. Sinh lydinh dng vahoasinh dinh dng:nghien cu vai trocac chat dinh dng oi vic thevaxac nh nhu cau cac chat o.

2. Benh lydinh dng:tm hieu moi lien quan gia cach dinh dng vasphat sinh cac benhkhac nhau do hau quacua dinh dng khong hp ly.

3. Dch tehoc dinh dng:nghien cu, chan oan, phan tch cac van edinh dng cong

ong, tm hieu vai trocua yeu toan uong oi vi cac van esc khoecong ong vahau quacuadinh dng khong hp ly. Ben canh o, mot lnh vc khac ladch tehoc nhiem trung, nhiem octhc pham cang ngay cang c quan tam.

4. Tiet chedinh dng vadinh dng ieu tr:nghien cu an uong cho ngi benh, chuyeunoi en ieu tr bang thay oi cheoan.

5. Can thiep dinh dng:nghien cu ng dung cac giai phap khac nhau nham thc hien dinhdng hp ly, tang cng sc khoe. Bomon nay bao gom khoa hoc thay oi hanh vi dinh dng,giao duc vaao tao dinh dng. Mot phan nganh khac ladinh dng tap the: ap dung cac thanh

tu khoa hoc vesinh ly, tiet chevakythuat vao an uong cong cong, thiet kec s, trang thiet b,


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tochc lao ong...6. Khoa hoc vethc pham vavesinh an toan thc pham:nghien cu thanh phan hoa hoc

vavai trooi vi dinh dng ngi cua thc pham, nguyen nhan onhiem thc pham vacach phong

chong. Anh hng cua quatrnh san xuat, trong trot vachan nuoi ti giatr dinh dng vaac iemvesinh cua thc pham.

7. Cong nghethc pham vakythuat chebien thc an:xac nh phng phap chebien, baoquan, lu thong thc pham vacac san pham. Nghien cu cac bien oi lyhoaxay ra trong quatrnho. Xac nh cach chebien thc an cho phep sdung toi a cac chat dinh dng trong thc phamvacomui, v, hnh thc hap dan.

8. Kinh tehoc vakehoach hoadinh dng:xay dng kehoach san xuat thc pham trongchnh sach phat trien nong nghiep cung nh chnh sach v movesan xuat vabao am an ninh thc

pham quoc gia vahogia nh.2. YNGHA KINH TEXAHOI VASC KHOECUA KHOA HOC DINH DNG

2.1. Yngha kinh teGan 60% cong nhan tren thegii lao ong trong nong nghiep vasan xuat thc pham. Tren the

gii trung bnh c50% thu nhap chi cho an uong. Lng chi tieu odao ong t30% cac ncgiau, en 80% cac nc ngheo.

2.2. Yngha xahoi

Chi tieu cho an uong cang nhieu th chi cho nha, mac, van hoacang t. ieu ocoyngha xahoi ln. Ngc lai tiet kiem an cho cac nhu cau khac nhieu quaseanh hng ti tnh trang sc khoe,kem sang kien vagiam nang suat lao ong. ieu oanh hng ti kinh teat nc. Dinh dngkhong hp lyanh hng nhieu ti treem, thanh thieu nien, phunco thai vacho con bu. Dinhdng khong hp lycac c san uong cong cong anh hng ti sc khoecua mot tap thengi.

2.3. Yngha sc khoeNgay nay, abiet en nhieu benh conguyen nhan dinh dng nh: coi xng, beri beri, quang

ga, pellagre, scorbut, bu co, beo ph, Kwashiorkor, mot sobenh thieu mau.Ngi ta biet rang dinh dng khong hp lycotheanh hng nhieu ti sphat trien cac benhkhac nh mot sobenh gan, va x ong mach, sau rang, ai thao ng, tang huyet ap, giam btsc ekhang vi viem nhiem Nhng benh thieu dinh dng ien hnh ngay cang t i, thng gaplasthieu hut cac chat dinh dng phoi hp gay ra nhng trieu chng am tham kn ao.

Ngay nay kien thc dinh dng cho phep xay dng cac khau phan hp lycho tat cacac nhomngi. Cac nhaan cong cong cotrach nhiem rat ln trong van enang cao tnh trang dinh dngcua nhng ngi an.

Cung vi quatrnh cong nghiep hoavaoth hoaat nc, hien tng di dan, hang van con


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ngi ri khoi quehng i ti nhng ni lao ong mi, song trong cac ieu kien hoan toan khacvabc au con tam b. ieu ooi hoi cac hoat ong hp lyvemat cung cap thc pham, tochccac c san uong cong cong.

Do quatrnh phat trien kynghethc pham, ngay cang conhieu thc pham atinh che(ng,mat ong nhan tao, bot trang) cung nh thc pham chebien san (ohop), cac loai othng cogiatr dinh dng thap hn cac san pham ban au. Do dedang trong viec sdung nen tieu thucacthc pham nay ngay cang tang, dan ti cac hau quaxau vesc khoe.

Mot sovan emi at ra cho khoa hoc dinh dng do ap dung nhieu chat hoahoc mi trongnong nghiep, chan nuoi, chebien valuan chuyen thc pham, nhng chat nay cothecohai oi vic the. Cac c quan y teconhiem vunghien cu anh hng cac yeu tongoai lai ooi vi c thevabao vecon ngi trc tac hai cua chung.

3. SPHAT TRIEN CUA DINH DNG HOCCon ngi t xa xa a quan tam en moi quan he gia thc an vi sc khoe.Hypocrate (460 - 377 trc cong nguyen) atng viet Mong cho thc an cua anh lathuoc va

loai thuoc duy nhat cua anh lathc an. Ong cho rang c thekhi con non can nhieu nhiet hn khigia, v vay khi con trephai c an nhieu hn. Theo ong, cheoan ch cotac dung khi cung thchien vi loi song hp lyvaong chia thc an ra hai loai: loai khovaloai cha nhieu nc. Loi songhp lyeduy tr can bang nc trong c the. Hypocrate akhuyen dung gan echa benh quangga, ieu omai 2200 nam sau mi c chng minh mot cach khoa hoc.

Aristote (384 - 322 trc cong nguyen) aviet rang thc an c nghien nat mot cach c hoc mieng, pha chedaday roi phan long tham qua thanh ruot vao mau nuoi c thecon phan ran cbai xuat theo phan. Theo ong Cheonuoi dng tot th nhieu tht c hnh thanh vakhi quathasechuyen thanh m- quanhieu mlacohai.

Bac thay ln cua y hoc co la Galen (129 - 199) a tng phan tch t thi va a dung same e cha benh lao. Ong viet: Dinh dng la mot qua trnh chuyen hoa xay ra trong cac tochc, thc an phai c che bien va thay oi bi tac dung cua nc bot va sau o da dayong coi o la mot qua trnh thay oi ve chat. Ong cho rang bat ky mot roi loan nao trong qua trnh lien hp cua hap thu, ong hoa, chuyen hoa, phan phoi va bai tiet eu co the pha v moican bang te nh trong c the va dan ti gay mon hoac beo ph. Ong cung khuyen rang mot baitap mau le nh chay la mot phng phap e giam beo - mot quan niem ma ch gan ay mic phat hien lai.

ai danh Y Viet Nam TueTnh (ThekyXIV) achia thc an ra cac loai han, nhiet vaong cungatng viet Thc an lathuoc, thuoc lathc an.

Tuy nhien, mai en thekyXVIII dinh dng hoc mi coc nhng phat hien edan dan tkhangnh lamot bomon khoa hoc oc lap. Cothehethong cac phat hien theo tng nhom nh sau:


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3.1. Tieu hoavahohap lacac quatrnh hoahocMai en gia thekyXVIII, ngi ta van cho rang quatrnh tieu hoadaday ch lamot quatrnh

c hoc. Reaumur (1752) achng minh nhieu bien oi hoahoc xay ra trong quatrnh tieu hoava

sau ongi ta aphan lap c trong daday coacid clohydric (Prout 1824) vapepsin (Schwann1833), mau cho shieu biet khoa hoc vesinh lytieu hoa.

Cung nh vay, hohap lamot quatrnh hoahoc vatieu hao nang lng cotheo lng c.Nam 1783, Lavoisier cung vi Laplace achng minh tren thc nghiem hohap lamot dang otchay trong c the. Sau oong ao lng c lng oxygen tieu thuvalng CO2 thai ra ngikhi ngh ngi, lao ong vasau khi an. Phat minh oamau cho cac nghien cu vetieu hao nanglng, giatr sinh nang lng cua thc pham vacac nghien cu chuyen hoa.

Dung cuo tieu hao nang lng au tien c Liebig sdung c nam 1824 vasau oc

cac thehehoc tronh Voit, Rubner, Atwater tiep tuc nang cao vasdung trong cac nghien cu vechuyen hoatrung gian.

3.2. Cac chat dinh dng lacac chat hoahoc thiet yeu cho sc khoengi vaong vatQuan niem cua Hypocrate cho rang tat ca moi thc an eu ch cha mot chat dinh dng duy

nhat noi chung c tha nhan cho en au the ky XIX.Nam 1824 thay thuoc ngi Anh laProut (1785 - 1850) langi au tien chia cac chat hu c

thanh 3 nhom, ngay nay goi lanhom protein, lipid, glucid.

ProteinMagendie nam 1816 qua thc nghiem tren choachng minh cac thc pham cha nit can

thiet cho ssong. Luc au ngi ta goi chat nay laalbumin - long trang trng laprotein nhieu ngibiet hn ca. Nam 1838 nhahoahoc HaLan Mulder agoi albumin laprotein (protos: chat quantrong somot).

Nam 1839, Boussingault Phap alam thc nghiem can bang nit bovanga v thay rangcac loai ong vat khong thetrc tiep sdung nit (am) trong khong kh macan thiet phai an cacthc an cocha am thc vat (albumin thc vat) eduy tr ssong.

Vao nhng nam 1850, ngi ta anhan thay cac protein khong giong nhau vechat lng nhngphai vao au thekythXX, khai niem omi c khang nh nhcac thc nghiem cua OsbornevaMendel Trng ai hoc Yale. Theo oThomas (1909) a ra khai niem giatr sinh hoc, BlockvaMitchell (1946) axay dng thang hoahoc da theo thanh phan acid amin eanh giachatlng protein.

Sphat hien cac acid amin alam sang toieu odan dan vacac cong trnh cua Rose vacongs(1938) axac nh c 8 acid amin can thiet cho ngi trng thanh.

Bac s Cicely Williams ngi Anh amotavadung thuat ngKwashiorkor vao nam 1931 nhng

trong mot thi gian dai ngi ta van nham benh Kwashiorkor vi benh pellagre. Sau cac bao cao


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khao sat cua Brock vaAutret nhieu nc chau Phi (1951) vaTrowell, Davies vaDean Uganda(1954) th thuat ngKwashiorkor mi chnh thc xuat hien tren cac sach giao khoa vasuy dinhdng protein mi c cong nhan labenh dinh dng quan trong nhat cua loai ngi. Nam 1959

Jelliffe dung thuat ngsuy dinh dng protein nang lng (PEM) v nhan thay moi lien quan chatchegia Kwashiorkor vaMarasmus.

Cuoc chien nham loai trthieu protein nang lng trc het bamevatreem van ang lavanethi snc ta vanhieu nc ang phat trien.

LipidTac pham Nghien cu khoa hoc vecac chat beo nguon goc ong vatcong bonam 1828 cua

Chevreul Phap axac nh chat beo lahp chat cua glycerol vacac acid beo vaong cung aphan lap c mot soacid beo. Nam 1845, Boussingault achng minh c rang trong c theglucid cothechuyen thanh chat beo. Trong thi gian dai ngi ta ch coi chat beo languon nanglng cho en khi phat hien trong chat beo cocha cac vitamin tan trong chat beo (1913 - 1915).Cac thc nghiem cua Burr (1929) ach ra rang acid linoleic lamot chat dinh dng can thiet. Saunhng nam 50 cua thekyXX vai trocua cac chat beo lai c quan tam nhieu khi conhng nghiencu ch ra khanang comoi lien quan gia solng vachat lng chat beo trong khau phan vibenh tim mach.

Glucid

Cho en nay, glucid van c coi languon nang lng chnh. Nam 1844, Schmidt phan lap cglucose trong mau vanam 1856, Claude Bernard phat hien glycogen gan amau cho cacnghien cu vevai trodinh dng cua chung.

Chat khoangStha nhan cac chat khoang lacac chat dinh dng bat nguon tsphan tch thanh phan c

the. Tuy vay, quatrnh phat hien tnh thiet yeu vavai trodinh dng cua cac chat khoang khongtheo mot con ng vathtnhat nh. Tnam 1713, ngi ta aphat hien sat trong mau vanam1812 aphan lap c iod nhng mai en thekyXIX cac nghien cu phan tch vagiatr sinh hoc

cua thc pham van khong eyen cac thanh phan cotrong tro. Tuy nhien vao na sau thekyXIX,cac nhachan nuoi achng minh c scan thiet cua chat khoang trong khau phan. Vao thekyXX, nhcac phng phap thc nghiem sinh hoc vai trodinh dng cua cac chat khoang cang sangtodan vasphat hien cac nguyen tovi lng nh lacac chat dinh dng thiet yeu nhcac phngphap phan tch hien ai ang lamot lnh vc thi scua Dinh dng hoc.

VitaminNhng phat hien au tien vevai trocua thc an oi vi benh tat phai keen cac quan sat cua

Lind (1753) vetac dung cua nc chanh quaoi vi benh hoai huyet, mot benh acp i sinh


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mang rat nhieu thuythuthi bay gi.Tuy vay nhng phat hien v ai cua Pasteur vevai trocua vi khuan alam lu mi vai trocac

nhan totrong thc an oi vi benh tat. Nam 1886, ngi ta mi thay thuoc HaLan laEijkmann en

Java (Indonesia) echong benh tephu. Langi tin vao lythuyet vi khuan cua Pasteur, Eijkmanncho rang benh tephulado vi khuan gay ra. Tuy vay trong quatrnh thc nghiem tren ga, ong aphat hien thay gamac benh nh tephusau khi cho an gao agiarat kytrong kho cua benh vien.Khi chuyen sang cheoan ban au, gahoi phuc dan dan. Eijkmann anhan ra rang cothegayra hoac cha benh tephubang cach thay oi n gian khau phan thc an. Giathiet vescomattrong thc an cua mot sochat can thiet vi lng nhomakhi thieu cothegay benh ac chngminh bi cac cong trnh cua Funk (1912) tach c thiamin tcam gao. Do ngh rang nhom chatnay colien quan vi cac acid amin nen ong goi lavitamin/amin can cho ssong, mac dusau nay a

thay rang vitamin lamot nhom chat dinh dng oc lap. Cung vi Funk, cac cong trnh thc nghiemcua Hopkins (1906 1912) achng minh mot sochat can thiet cho sphat trien vasc khoecuaong vat thc nghiem.

Vai trothiet yeu cua cac vitamin ac cong nhan vatrong ba mi nam au cua thekyXX achng minh rang cothecha khoi nhieu benh khac nhau bang cach oi khau phan vacheodinhdng hp ly. Nam 1913, nhahoasinh hoc MylaMc Collum aengh goi vitamin theo chcai vanh vay xuat hien vitamin A, B, C, D vasau nay ngi ta them vitamin E vaK.

Sphat hien vesolng cac vitamin can thiet hau nh khong tang them trong may chuc nam

gan ay nhng vai trosinh hoc cua chung khong ngng c tiep tuc phat hien. Lyluan vevai trocac goc tdo vacac chat chong oxy hoa oi vi sc khoematrong onhieu vitamin covai troquantrong ang lamot lnh vc nghien cu vang dung hap dan cua dinh dng hoc hien ai. Ngay nayvi shieu biet cua sinh hoc phan t, dch tehoc vadinh dng lam sang, ngi ta ang tng bchieu vai trocua cheoan, cac chat dinh dng oi vi cac tnh trang benh lyman tnh nh tanghuyet ap, tim mach, ai ng vaung th. Cac thanh phan khong dinh dng trong thc an thc vatcung thu hut squan tam ngay cang ln.

3.3. Quan hetng hogia cac chat dinh dng trong c thevanhu cau dinh dngTrong mot thi gian dai, khoa hoc dinh dng phat trien chuyeu lanhcac thc nghiem tren

ong vat chan nuoi vachuot cong trang. Tnh chat thiet yeu cua cac nhom chat dinh dng dandan c khang nh. Trong c the, cac chat dinh dng khong hoat ong mot cach oc lap macomoi quan hevi nhau chat che. Protein cotac dung tiet kiem lipid vaglucid, vitamin B1 can thietcho chuyen hoaglucid, lng calci bai xuat ra khoi c thetang len khi khau phan tang protein, cacquan hegia phospho/calci, kali/natri lacac th ducuthe. Viec ap dung cac chat ong v phong xavao nghien cu chuyen hoatrung gian au thekyXX acho thay thanh phan cau truc cua c theluon luon thecan bang ong macac chat dinh dng can thiet eduy tr scan bang o. Thieucac chat dinh dng co the gay nen cac benh ac hieu ma moi ngi eu biet nh thieu protein


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- nang lng, bu co do thieu iod, thieu mau do thieu sat, kho mat do thieu vitamin A. Ben canho, tha cac chat dinh dng cung co the gay oc. Ngi ta a mo ta cac tnh trang ngo oc dolieu cao cac vitamin A, D, mot so vitamin tan trong nc cung co the gay oc nhat nh. Tnh gay

oc cua nhieu yeu to vi lng nh selen, fluo, sat, ong va kem cung a c ghi nhan.Nh vay mot van e quan trong cua dinh dng hoc la xay dng mot hanh lang an toan thch

hp nhat oi vi s phat trien va sc khoe cua con ngi, o la lnh vc nghien cu ve nhu caudinh dng.

Cothenoi Voit, nhadinh dng hoc c cuoi thekyXIX langi au tien exuat nhu cau dinhdng cho ngi trng thanh. Luc ieu tra khau phan thc tecua nhng ngi lao ong khoemanh, ong exuat khau phan trung bnh hang ngay oi vi ngi lao ong trung bnh nen at 3000kcal va118 g protein. Chittenden (1904) Sherman va nhieu tac gia khac tm cach da vao cac

nghien cu ve can bang sinh ly e xac nh nhu cau protein va cac chat khoang. Chittenden a cung hoc trothc nghiem tren ban than mnh ei en ket luan langi trng thanh ch can 0,5 gprotein/kg can nang eduy tr can bang nit. oi vi vitamin vao khoang nhng nam 30 cua thekyXX ngi ta ap dung cach thc nghiem, cac test bao hoavaieu tr dphong cac hoi chng thieuvitamin elng hoanhu cau cac chat nay.

Nam 1943, Vien Han lam khoa hoc Hoa Kyacong bolan au bang nhu cau cac thanh phandinh dng vatoc5 nam lai xem xet lai mot lan theo cac tien bokhoa hoc. Nhieu nc khaccung lan lt cong bocac bang nhu cau dinh dng cua nc mnh. Tnam 1950, Tochc Y te

Thegii (WHO), Tochc Nong nghiep vaThc pham thegii (FAO) aphoi hp vi nhau trong hoatong nay tren pham vi toan cau. Viet Nam, nam 1996, BoY teapheduyet Bang nhu cau dinhdng khuyen ngh cho ngi Viet Nam; vaen 2007 Bang nhu cau dinh dng khuyen ngh chongi Viet Nam ac bosung vacap nhat cho phuhp vi tnh hnh phat trien kinh texahoi vanhng thay oi vedinh dng. ay cung latai lieu chnh thc cua nganh trong cong tac cham socdinh dng, bao vevanang cao sc khoenhan dan.

3.4. Can thiep dinh dngNeu dinh dng hoc ch phat hien ra cac b mat cua thc an econ ngi song mot cach thong

thai th nokhong thephat trien c vacolech dng lai v tr mot nganh cua sinh thai hoc.Nhng txa xa, con ngi atm cach dung thc an echa benh vaHai Thng Lan Ong a

tng day Hay dung thc an thay thuoc bocophan li hn.Nhu cau an uong lamot trong cac nhucau c ban cua con ngi. Sau cach mang thang Tam 1945, Chutch HoCh Minh akeu goi cantieu diet giac oi, giac dot, giac ngoai xam.

oi, thieu dinh dng la giac, la tai hoa pha huy hoac ch t la km ham tiem nang phat triencua con ngi. Nhng hieu biet ve dinh dng a tao c s khoa hoc e tm toi cac can thiep vedinh dng.

Tang cng cac chat dinh dng vao thc an lamot trong cac hng u tien. Nam 1924,


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Hoa Kyngi ta atang cng iod vao muoi an, nam 1939 tang cng vitamin A vao margarin vavitamin D c tang cng trong sa vao nhng nam 30.

Cac nghien cu chon cac giong cay trong colng protein cao vachat lng tot, conhieu lysin

nh giong ngoopaque 2, cac loai chepham giau protein nh sa gay, bot au nanh, bot calacacthanh tu quan trong trong nhng nam 60.

Giao duc dinh dng cung c quan tam. Nam 1941, trong thi kyHaLan b c chiem ong,khau phan trung bnh ch di 1300 kcal th cac nhadinh dng hoc nc nay axin phep thanh laptrung tam thong tin giao duc dinh dng hoat ong cohieu quatoen nay.

Skhang nh yngha cong ong quan trong cua nhieu benh varoi loan ac hieu do nguyennhan dinh dng atao ieu kien ra i nhieu tochc nh tochc t van quoc tevevitamin A IVACG (1975), thieu mau dinh dng INACG (1977) vacac roi loan thieu iod ICCIDD (1985).

Van equan trong then chot lamoi quoc gia can cong loi chnh sach dinh dng thch hp.Nam 1992, Hoi ngh cap cao thegii vedinh dng akeu goi cac quoc gia xay dng ng loi vachng trnh hanh ong dinh dng cho nhng nam sap ti.

Khoa hoc dinh dng ang khong ngng phat trien cavelythuyet lan ng dung.

4. SPHAT TRIEN CUA KHOA HOC DINH DNG VIET NAMSong tren manh at Viet Nam, ong cha ta ahnh thanh mot cach an dan toc eduy tr vaphat

trien giong noi. Ngi Viet Nam txa aquan tam en cach an hp lyvadung thc an echa benh.Trong tac pham noi tieng Nam dc than hieu cua mnh, Danh y TueTnh anghien cu 586

v thuoc nam, 3873 phng thuoc uong ieu tr 184 loai chng benh. Trong so586 v thuoc nam doong su tam, tong ket cogan mot na gom 246 loai lathc an vagan 50 loai cothedung lam ouong. TueTnh con at nen mong cho viec tr benh bang an uong.

Hai Thng Lan Ong- LeHu Trac axac nh rat rotam quan trong cua van ean so vi thuoc.Theo ong, Cothuoc makhong coan th cung i en chochet. Trong boHai Thng Y tong tamlnh, ong adanh tron mot cuon Ncong thang lam su tam cach chebien nhieu loai thc an dantoc cotieng ng thi. Sach Vesinh yeu quyetcha ng nhng li khuyen quybau vegignsc khoebao gom cadinh dng hp lyvavesinh thc pham.

Thi kyPhap thuoc, mot sonhakhoa hoc ngi Phap vaViet Nam acocac cong trnh vethcan Viet Nam. ang chuylaong gop cua M. Autret vaNguyen Van Mau trong viec xuat ban bangthanh phan thc an ong Dng gom 200 loai thc an nam 1941.

Tngay Cach mang thang Tam nam 1945 en nay, mac dutrai qua nhng nam chien tranh laudai vagian khonhng khoa hoc dinh dng aconhieu bc phat trien vaong gop cuthe. Cac csnghien cu, giang day vatrien khai vedinh dng alan lt hnh thanh Vien Vesinh dch tehoc, Trng ai hoc Y HaNoi (Bomon Vesinh dch tehoc, Bomon Sinh lyhoc, Bomon Nhi), Hocvien Quan y (Bomon Vesinh quan oi), Vien nghien cu an mac quan oi (BoQuoc phong) vamotsotrng ai hoc khac. Nhieu nghien cu ng dung agop phan vao viec am bao nhu cau dinh


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dng cho ngi Viet Nam, nghien cu bao quan gao, rau vacac cong thc lng khophuc vubooi chien trng. Tnam 1977, trng ai hoc Y HaNoi amchuyen nganh Dinh dng ieutr eao tao bac s dinh dng cho nhu cau cua cac benh vien.

Sra i cua Vien Dinh dng (1980), Bomon Dinh dng vaAn toan thc pham trng aihoc Y HaNoi (1990) cung nh Bomon Dinh dng nhieu trng ai hoc khac, quyet nh cuaBoGiao duc ao tao mcao hoc vedinh dng (1994), ao tao Tien syDinh dng cong ongtngay 1 thang 4 nam 2012 c chuyen thanh Tien sydinh dng (bao gom 3 lnh vc: dinhdng cong ong, dinh dng tiet chevaan toan vesinh thc pham) vaviec Thutng chnh phupheduyet Kehoach hanh ong quoc gia vedinh dng 1995 2000, Chien lc Quoc gia vedinhdng 2001 2010 lacac moc quan trong cua sphat trien nganh Dinh dng nc ta. Chienlc Quoc gia vedinh dng 2001 2010 atrien khai thanh cong vaBoY teach ao xay dng

Chien lc Quoc gia vedinh dng giai oan 2011 2020 trnh Chnh phupheduyet. Chien lcquoc gia vedinh dng atrien khai rong khap tren toan quoc nhieu chng trnh/dan vedinhdng. Tnh trang dinh dng cua nhan dan ac cai thien, ac biet latredi 5 tuoi vabame.Cong tac xay dng nguon nhan lc, phat trien nganh dinh dng ngay cang c quan tam.

Hien nay, tren ban ohoc thuat nc nha, nganh Dinh dng acomot chong rieng vaangtng bc tkhang nh; cac nc trong khu vc vatren thegii abiet en Vien Dinh dng, Hoidinh dng cua Viet nam.


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Chng 2. DINH DNG, SC KHOE VA BENH TAT

An uong la mot trong cac nhu cau quan trong nhat cua con ngi va cac loai ong vat khac. Noian uong can thiet oi vi sc khoe hau nh o la mot chan ly hien nhien. The nhng trong caqua trnh ton tai lau dai cho mai en the ky XVIII, loai ngi van cha hieu c mnh can g thc an. Danh y Hypocrate quan niem cac thc an eu cha mot chat song giong nhau va chkhac nhau ve mau sac, mui v, t hay nhieu nc. Nh cac phat hien cua dinh dng hoc, ngita lan lt biet trong thc an co cha cac thanh phan dinh dng can thiet oi vi c the, o lacac protein, lipid, glucid, cac vitamin, cac chat khoang va nc. S thieu mot trong cac chat nayco the gay ra nhieu benh tat tham ch chet ngi v du nh benh Scorbut do thieu vitamin C a

lay i sinh mang 100 trong so 160 thuy thu theo Vasco de Gama tm ng sang phng ong,benh viem da Pellagra hay gap cac vung an toan ngo do thieu vitamin PP, benh te phu beri beri do thieu vitamin B1...

Ngi ta goi o la cac benh thieu dinh dng ac hieu bi nguyen nhan chu yeu do thieu motthanh phan dinh dng nao o. Nh ap dung kien thc dinh dng vao cham soc sc khoe, nhieuloai benh hien nay a lui ve qua kh, tuy vay cac nc ngheo van con noi troi len cac van esc khoe do thieu dinh dng nh thieu protein nang lng, thieu vitamin A va benh kho mat,thieu mau dinh dng va thieu iod. Hn na khoa hoc dinh dng ngay cang kham pha themvai tro nhieu thanh phan dinh dng trc ay cha biet ro ac biet la cac vi chat dinh dng, vvay danh muc cac benh thieu dinh dng con them cac benh do thieu kem (Zn), thieu selen vado thieu cac chat khac.

oi vacac benh thieu dinh dng, hien nhien laac iem cua cac nc ngheo nhng lieu cacnc ano, d tha vethc pham van evedinh dng cog ang quan tam na khong? Trcthap ky60 cua thekyXX, nhieu ngi cung tng ngh rang van edinh dng khong cog angquan tam nhieu cac nc, cac tang lp ano u.

Sthat khong nh the. Cac thong kedch tehoc so sanh tng nc trong cac thi kykhac nhauvaso sanh cac quan thedi c tvung nay sang vung khac cho thay mohnh benh tat thay oi theoloi song vacach an uong. cac nc giau, tyletvong do benh tim mach, benh ung th, benh aing tang len. Benh beo ph chiem 20 - 40% sodan trng thanh nhieu nc phat trien lamotnguy c quan trong cua nhieu benh khac.

Trong vai thap kygan ay, cac yeu todinh dng ac xem xet, nghien cu rat nhieu vamac dunhieu ieu con cha sang tonhng cac chuyen gia y tecung rut ra c nhieu khuyen ngh quan

trong vecheoan uong eephong cac benh man tnh.


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Nh vay cathieu an lan tha an nen hieu latha vesolng vathieu vechat lng eu cothegaybenh. Mot cheoan can oi, hp lylacan thiet econ ngi song khoemanh valau.

Nc ta ang trong thi kykinh techuyen tiep. Ben canh mohnh benh tat cua mot nc kemphat trien trong osuy dinh dng vanhiem khuan laphobien ang xuat hien sgia tang nhieu loaibenh hay gap cac nc phat trien. Benh beo ph ang coxu hng tang mot sooi tng danc, benh tang huyet ap ang tang roret, hien nay la16,7% ngi trng thanh tren 25 tuoi so vinam 1960 ch vao khoang 1% dan so.

Bai hoc vecham soc sc khoetrong ococham soc dinh dng cua nhieu nc phat trien atthanh tu cao vemat nay rat ang cho chung ta hoc tap ekhong vap phai nhng sai lam acthnghiem.

1. DINH DNG VATANG TRNG

1.1. Quatrnh tang trng vaphat trien chu anh hng sau sac cua ieu kien dinh dngtrong bao thai vasau nay

Thong qua thi kycothai, bao thai phat trien tmot tebao (trng athutinh) cho en 2 x 1012tebao khi evasau ocho en khi trng thanh con tang len 30 lan na. Mot thng ton nang nevedinh dng vachuyen hoamot thi iem nhat nh segay suy yeu cac hethong chc phanang phat trien masau nay t hoac khong cothehoi phuc c. Thieu dinh dng trong bao thai

dan en can nang s sinh thap, vong au vachieu dai c thethap hn. Tres sinh cocan nangthap thng cotyletvong cao vacothetrnen thap nhovesau. Conhieu bang chng cho thaytres sinh nhecan do meb thieu dinh dng layeu tonguy c chnh cua benh tim mach sau nay.

Vong au lamot soo cogiatr vekch thc cua nao. Solng tebao nao gan hoan thanh khisinh, sau ochuyeu lashnh thanh cac noi tiep gia cac nron. Thieu dinh dng bao thai cothedan ti giam bt solng tebao nao vatr thong minh vesau.

S phat trien noi chung phu thuoc vao nhieu yeu to: di truyen, noi tiet, than kinh thc vat vadinh dng. Ba yeu to au bao am tiem nang phat trien nhat nh, dinh dng hp ly cung cap

cac chat lieu can thiet e li dung tiem nang phat trien o. Hieu suat oi vi phat trien c thecua cac thc an co the thay oi khong nhng gia ngi nay vi ngi khac ma ngay ca motngi trong nhng ieu kien an uong khac nhau. Khi thieu an tam thi c the phat trien cham lainhng tnh trang o co the c phuc hoi khi an ay u. Tuy nhien, trong trng hp dinh dngkhong hp ly keo dai co the can tr qua trnh phuc hoi o. V the can quan tam ac biet en dinhdng cua tre em.

Cau truc c thethay oi khong ngng theo quatrnh tang trng, noi chung ham lng proteintrong cac motang gap oi ts sinh en tuoi trng thanh.


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Bang 1.Thay oi ham lng protein trong cac motheo tuoi

1.2. Cac quan thetham khao vetang trngMot van evan ang con tranh cai lacac quoc gia vachung toc cocan xay dng cac tieu chuan vetang

trng rieng hay lamot quan thechuan n lecotheap dung cho moi chung toc. Nhieu nghien cu thay rang skhac nhau vetiem nang tang trng gia cac chung toc cothedo dinh dng vamoi trng hn lado di truyen.

Theo Habicht vaCs (1974) qua so sanh solieu tmot sonc phat trien vakem phat trien nhan thaycac vung oth vi quan dan c c nuoi dng tot th ch 3% skhac nhau vechieu cao va6% vecannang lacothequy cho chung toc. Ngc lai, skhac nhau veieu kien kinh texahoi vatnh trang dinhdng gia nong thon vathanh th cothelen en 12% vechieu cao va30% vecan nang trong cung motnhom chung toc.

Trong thap ky60 va70 cua thekyXX, hai quan thetham khao sau ay hay c dung:- Quan thetham khao Harvard lasolieu ttreem Iowa vaBoston thap ky1930 (Hoa Ky).- Quan theTanner da tren cac soo cua treem Anh quoc thap ky1960.Tthap ky1980, Tochc Y teThegii (WHO) khuyen ngh dung solieu cua Trung tam Quoc gia vethong

kesc khoecua Hoa Ky(NCHS) lam quan thetham khao eanh giavaphan loai tnh trang dinh dng treem. Nhng nam 2000, tochc Y tethegii aconghien cu xay dng quan thechuan vi quan the6 ncai dien cho cac chau luc, thay thecho quan theNCHS, vi quan thematrec nuoi bang sa me, chieucao cua trephat trien tot, nen ch tieu Chieu cao/ tuoi cao hn cua NCHS nhng ch tieu Can nang/ tuoi lai thaphn. Chnh v vay matyletresuy dinh dng thap coi cac bao cao ap dung quan thecua WHO atang lenvaieu oakhuyen khch nhieu nc giai quyet tnh trang trethap coi vanuoi con bang sa me.

2. DINH DNG, AP NG MIEN DCH VANHIEM KHUAN

2.1. Moi quan hegia dinh dng vabenh nhiem khuanMoi quan hegia tnh trang dinh dng cua mot cathevi cac nhiem khuan theo hai chieu:Mot mat, thieu dinh dng lam giam sc ekhang cua c the.

Mat khac, cac nhiem khuan lam suy sup them tnh trang suy dinh dng san co. olamot vong

Tochc c xngTochc mDaXngGanTimTrung bnh cac loai mo

S sinh0,160,110,200,270,180,150,17

Trng thanh0,270,050,481,100,250,170,39

Tysoprotein/nc


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xoan luan quan nh sau:

Tuy nhien, anh hng cua tnh trang dinh dng oi vi tien trien cac benh nhiem khuan khonggiong nhau, benh lao anh hng nay rat ln con benh uon van lai khong ang ke. Cothetomtat moi quan henay bang 1 di ay:

Bang 2.Cac benh nhiem khuan anh hng ti tnh trang dinh dng.

Lng chat dinh dng hap thu thap

Kem ngon miengChat dinh dng hao hutHap thu kemChuyen hoa roi loan

Can nang giamTang trng kemGiam mien dchTon thng niem mac

Tan suat mac benh

Mc omac benhMc okeo dai cua benh

Benh do vi khuan

Benh do virus

Nhiem kysinhtrung

Nhiem nam

Benh khac

NhieuLaoTieu chay nhiem khuanTaHo gaNhiem khuan hohapSiTieu chay do rota virusNhiem khuan hohapKen phoiKysinh trung ng ruotTrypanosomiaseLeishmanioseBilharzioseCandidoseAspergillose

Trung bnhBach hauNhiem tucauNhiem lien cau

Cum

GiardiaGiun ch

oc tonam

Giang maiSot Rickettsia

tThng hanUon vanNhiem oc tovi khuan

au muaSot vangBai lietSot ret


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2.2. Thieu dinh dng protein-nang lng vamien dchPhan nhieu treem trong 3 thang au c busa meeu phat trien tot, sau otnh trang dinh

dng bong xau i mot phan do cheoan bosung khong hp ly, mot phan do cac nhiem khuan lap i

lap lai. Benh Kwashiorkor thng xuat hien sau si vatieu chay keo dai.Thieu protein vanang lng coanh hng trc tiep en hethong mien dch, ac biet lamien

dch qua trung gian tebao, cac chc phan diet khuan cua bach cau a nhan trung tnh, bothevabai xuat cac globulin mien dch nhom IgA. Ngi ta nhan thay treem suy dinh dng, tuyen cgiam cathetch vacobien oi hnh thai. Cac mang Peyer ruot non cung b teo et cung vi giamcac nang lympho bao. Thieu protein nang lng hay gap nhat treem trc tuoi i hoc, bamecothai (anh hng ti thai nhi), cac em gai tuoi v thanh nien.

Chung ta biet rang cac lympho bao T (trng thanh tuyen c) covai trotrong mien dch trung

gian tebao vacac lympho B (trng thanh tuyxng) chu trach nhiem vemien dch dch the,ngha latao ra cac khang theac hieu cua cac khang nguyen tan cong c the. Ngi ta nhan thaycac treem suy dinh dng, ac biet laKwashiorkor, solng lympho T luan chuyen giam sut vaquatrnh trng thanh cua chung b roi loan.

Mac duykien oi vi mien dch dch thevan con cha hoan toan nhat tr, nhng phan ong cactac giaeu cho rang ngay khi cogiam ap ng mien dch dch thevan can tochc tiem chung chocac em nay, ac biet lasi vaho galahai benh anh hng nhieu en tnh trang dinh dng.

2.3. Vai trocua mot sovitamin vamien dchTrong cac vitamin tan trong chat beo, ch covitamin A vavitamin E lacovai trooi vi hethong

mien dch.

Vitamin ACon coten goi laVitamin chong nhiem khuan covai trororet cavi mien dch dch theva

mien dch tebao. Moi ngi eu biet tyletvong do nhiem khuan nhng treem b khomat nangrat cao. C chevevai trocua vitamin A oi vi cac ap ng mien dch van cha sang to, vai trocuavitamin nay oi vi tnh toan ven cac bieu moch mi giai ap c mot phan.

Vitamin CKhi thieu vitamin C, snhay cam oi vi cac benh nhiem khuan tang len, mat khac nhng

ngi ang conhiem khuan, mc vitamin C trong mau thng giam. Mot socong trnh thnghiemcho thay cheoan uvitamin C, cac globulin mien dch IgA vaIgM tang, tnh c ong vahoattnh cac bach cau tang, kch thch chuyen dang cac lympho bao vagiup tao thanh mot trong cacthanh phan cua bothe: yeu toC3.

Cac vitamin nhom B vamien dch

Trong cac vitamin nhom B, vai trocac folat vapyridoxin ang chuyhn ca.Thieu folat lam cham stong hp cac tebao tham gia vao cac c chemien dch. Tng tnh


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thieu sat, mien dch dch thet b anh hng hn mien dch qua trung gian tebao. Thc nghiem trenong vat thieu acid folic cho thay tuyen c b teo et vasolng cac tebao cung giam. Tren thctetreem vanhat laphuncothai, thieu folat thng i kem thieu sat lahai yeu togay thieu

mau dinh dng.Thieu pyridoxin (vitamin B6) lam cham trecac chc phan mien dch, cadch thelan trung gian

tebao.

2.4. Vai trocua mot sochat khoang vamien dchRat nhieu chat khoang vavi khoang tham gia vao chc phan mien dch, trong ovai trocua sat,

kem, ong vaselen c nghien cu nhieu hn ca.

Sat

Can thiet cho tong hp DNA, ngha laoi vi quatrnh phan bao. Hn na sat con tham giavao nhieu enzym can thiep vao cac quatrnh phan giai cac vi khuan ben trong c the. Khi thieusat, tnh nhay cam oi vi nhiem khuan tang. Thieu sat hay i kem vi thieu protein - nang lng,tuy vay khi bosung sat cho treem suy dinh dng can kheo leo v sat can c ket hp vi cacprotein van chuyen ung tieu chuan, neu khong sat tdo selayeu tothuan li cho phat trien cacvi khuan. V the, ngi ta khuyen ch nen bosung sat tngay th5 hoac th7 cua quatrnh phuchoi dinh dng.

Trong tnh trang hieu biet hien nay, ngi ta nhan thay thieu sat anh hng en mien dch qua

trung gian tebao hn lamien dch dch the. Do otiem chung chong cac benh nhiem khuan vancon cotac dung nhng treem b thieu sat va phai. nhng ni cobenh sot ret, viec bosung satcan i kem vi uong thuoc phong sot ret.

KemKhi thieu kem, tuyen c nhoi, cac lympho bao giam solng vakem hoat ong. Thymulin, mot hor-

mon cua tuyen c cocha kem. Kem lacoenzym cua mot somen nh ADN vaARN polymerase, cungnh carbonic anhydrase cua hong cau.

Thieu kem thng t gap n thuan mahay kem theo thieu protein, sat vacac vitamin.

ongong lacoenzym cua cytochrom oxydase vasuperoxyt dismutase. Treem thieu ong bam sinh

(benh Menkes) thng chet do nhiem khuan, nhat labenh viem phoi.

SelenLathanh phan thiet yeu cua glutathion - peroxydase lamen gop phan giai phong shnh thanh

cac goc tdo. Thieu selen, nhat lakhi kem theo thieu vitamin E lam giam san xuat khang the. Moiquan hegia thieu selen vavitamin E ac chng minh trong sinh benh hoc c tim Keshan,

mot vung Trung Quoc malng selen trong at vanc quathap.


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Vequan hegia cac chat khoang, vi chat oi vi mien dch nen chuycac iem sau ay:- Con nhieu chat khoang khac covai trotrong ap ng mien dch: magie, coban, iod, niken va

phan ln cac kim loai nang.

- Cac chat nay va can thiet, va thiet yeu nhng khi tha eu gay oc.- Sthieu tuyet oi cac chat nay t gap ngi trcac benh bam sinh.- ng vephng dien sc khoecong ong, thieu sat vathieu kem ang c quan tam hn ca.Tom lai: cac nhiem khuan cothelam roi loan tnh trang dinh dng hoac lam tram trong hn mot

tnh trang suy dinh dng va bat au. Ngc lai, cac roi loan dinh dng cothegay roi loan cacc chemien dch, lam cho c theconguy c cao oi vi nhiem khuan. Do o, oi vi cac nhom conguy c cao, chien lc ch da vao cham soc phuc hoi cac cathelakem hieu quamaphai lamotchien lc toan dien vesc khoecong ong ket hp phong chong cac benh nhiem khuan vi phong

chong benh do thieu dinh dng.3. THIEU DINH DNG AC HIEU VACHAM TANG TRNG

3.1. Trong lch s phat trien cua dinh dng hoc, cac thc nghiem ve s tang trngthng c s dung e anh gia s can thiet cua mot thanh phan dinh dng nao o. Motchat dinh dng c coi la can thiet khi thieu chat o, ong vat th nghiem ngng hoac chamtang trng.

Hien nay (Golden, 1996), ngi ta thay c thephan ng sthieu mot chat dinh dng nao o

theo hai con ng khac nhau: mot lac thetiep tuc tang trng, sdung cac nguon dtrvagiambt cac chc phan phuthuoc vao chat dinh dng nay cho en mot luc nao oboc lora cac trieuchng ac hieu cua sthieu o, ngi ta goi lathieu dinh dng loai I. Hai la, c thengng hoaccham tang trng mavan duy tr dtrvaam ocac chat dinh dng nay trong cac mocua cthe, olathieu dinh dng loai II.

Thieu dinh dng loai I bao gom cac chat dinh dng can thiet cho cac chc phan chuyenhoa ac hieu trong c the hn la chuyen hoa chung. Khi thieu, c the tiep tuc tang trng bnhthng, cac nguon d tr b s dung dan, am o chat dinh dng nay trong cac mo giam

cho en khi xay ra tnh trang benh ly ac hieu. ay s tang trng b anh hng sau khi bbenh. Co the ke ra nhieu v du quen biet thuoc loai nay: thieu mau do thieu sat, beri beri (thieuthiamin), pellagre (thieu niacin), scorbut (thieu vitamin C), kho mat (thieu vitamin A), bu co(thieu iod).

Chan oan thieu dinh dng loai I tng oi trc tiep thong qua bieu hien lam sang, sau oo lngam ochat dinh dng nay hoac cac protein hay enzym phuthuoc vao chat ohoac cac test vechcphan hoac chuyen hoalien quan.


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Bang 3.Phan loai cac chat dinh dng thuoc nhom loai I hoac nhom loai II

Nhom loai I: bieu hien lam sang ac hieuNhom loai II: cham tang trng

Skhac nhau gia cac ap ng:

V duvi thieu sat, ngi ta nhan thay cac bieu hien lam sang cua thieu mau, em hong cau, nhlng ferritin, sat, transferin hoac protoporphyrin. oi vi thieu iod cung vay, ngi ta cothenhan bietqua chan oan lam sang benh bu co, o lng iod trong nc tieu hoac cac noi tiet tolien quan enhoat ong cua tuyen giap. Do tnh ac hieu cua nonen chien lc bosung hoac tang cng cac chatdinh dng nay trong thc pham hay c sdung egiai quyet van econg ong.

Loai IChat khoang:Sat, ong, CalciMangan, Selen, IodVitamin:Thiamin, Riboflavin, Colabamin,Acid folic, Pyridoxin, acid ascorbicVitamin A, Retinol, TocopherolVitamin E, Vitamin D, Vitamin K

Loai IICac acid amin can thietNitrogenSulfuaNcNatri, kaliMagieKemPhospho

Loai ITang trng tiep tuc thi kyauXuat hien trieu chng lam sang ac hieu.am otrong cac mogiam

Dtrc thecon

Anh hng cac enzym ac hieuThng khong chan anam otrong cac mooc lap vi cac chat dinhdng loai I khacam otrong cac moc duy tr cac tnhtrang chuyen hoakhac nhau

Nguon trong thc pham rat thay oiChan oan da vao cac test hoasinhTnh bat thng vecac ch tieu nhan trac ch xuathien cac giai oan muon

Loai IIAnh hng ngay en tang trngKhong cobieu hien lam sang ac hieuam ocac moc duy tr

Khong codtrtrong c thecung nh cac moac hieu.Anh hng chung en chuyen hoaThng chan anam otrong cac mophuthuoc vao cac chat dinhdng khac nhom IIam otrong cac mocothethay oi vi tnh trangchuyen hoa.

Tyletrong thc pham khong quathay oiKhong gay cac roi loan hoasinhChan oan bang cac ch tieu nhan trac


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Khac vi thieu dinh dng loai I vi cac bieu hien ac hieu, thieu dinh dng loai II eu cohnhanh chung lacham tang trng, coi coc vagay mon. Chung thng c motalathieu an hoac thieudinh dng protein - nang lng nhng khong ch ra c cac nguyen nhan nao khac cothecovai tro.

Khi cothieu dinh dng loai II, trc het c thengng tang trng, giam bai xuat toi a cac chat dinhdng lien quan eduy tr nong ocua chung trong cac mo. en mot luc nao o, cac mobat au bphan huyegiai phong chat dinh dng can thiet nay cho c the, quatrnh nay thng kem theo hientng chan an. Tnh trang othng khong bieu hien tren mot c quan hoac moac hieu nao matacong nhieu nhat ti cng ogian phan vatong hp cao nh hethong mien dch vaniem mac ruot.

Toc otang trng lamot ch tieu chnh exac nh nhu cau cac chat dinh dng thuoc loai II. Trenong vat th nghiem, ngi ta cho cac khau phan conh mc cac chat dinh dng nay tang dan vacoilanhu cau khi toc otang trng khong cai thien na. ong thi cham tang trng hoac ngng tang

trng labieu hien lam sang n oc cho mot cheoan thieu mot trong cac chat dinh dng thuocnhom II nh protein, kem, magie, phospho, kali... Quatrnh luan chuyen tebao giam seanh hng enhethong mien dch, v vay loai thieu dinh dng nay thng kem theo tang tylemac cac benh nhiemkhuan. Ngi ta cung quan sat thay giam tang trng thng lien quan vi cac giam ap ng mien dch.

ng vegoc osc khoecong ong, cac thenhecua thieu dinh dng loai II thng t c chuycho en khi chuyen sang cac giai oan nang (suy dinh dng oII, oIII) kem theo cac benh nh tieuchay vacac nhiem khuan khac.

Do cac chat dinh dng nhom II khong codtrtrong c thenen khi thieu mot chat sekeo theo

can bang am tnh cac chat khac vi tyletng oi cua chung trong cac mo. V vay ay th nghiem canbang khong ch ra c thieu chat dinh dng nao cuthemalathieu dinh dng nhom II noi chung.

Mat khac, cac chat dinh dng nhom II tham gia vao chuyen hoac ban ngi vathegii ongvat nen trong nhieu loai thc pham, chung coam otng tnhau vav vay khi thieu thng thieunhieu chat mot luc. Cothegoi chung lacac chat dinh dng ban ong hanh. ng trc hien tngcham hoac ngng tang trng, rat khohoac khong thetm c thieu chat dinh dng nao lathuphamnhng dedang phat hien ra sthieu cua mot trong socac chat o. Ben canh bieu hien roi loan tangtrng, chan an cung labieu hien thng gap. Do okhi thay mot a trechan an, oladau hieu bao

ong cua thieu dinh dng nhom II.Vemot sophng dien, cothecoi nang lng nh mot chat dinh dng nhom II, nhng thc chat

olamot nhom dinh dng rieng biet. Neu cac chat dinh dng nhom I sdung cho cac chuyen hoaac hieu th nhom II nh lakhoi tao hnh cua c themanang lng lachat ot equatrnh hoat ong.Ban than nang lng khong phai lachat dinh dng, olakch thc cua toan bokhau phan. Thieunang lng n thuan xay ra khi thieu thc pham (nan oi). Tuy nhien nang lng khau phan thapthng lado chan an hn lathieu thc pham. Cung cap them thc pham asan cohogia nh khongieu chnh c mc nang lng an vao thap vagiam can do chan an, macan phai tm nguyen nhan

tiem tang, cha xac nh c cua thieu dinh dng loai II eieu chnh vahanh ong thong qua thay


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oi chat lng cua thc pham san cohn lach solng.

3.2. ng dung

Khi chung ta bosung mot chat dinh dng vao cho c the(thng c ap dung thieu dinh dngloai I) hieu quaoi vi tang trng phuthuoc vao yeu tohan checua khau phan mi c tao thanh,chkhong phai khau phan ban au hoac chat bosung. Nhieu khi hieu quatang trng khong cohoackem hn, ieu ocothexay ra khi bosung them protein lam protein mi tao thanh lai kem hn cu.Chung ta cothethay khau phan cothesekem can oi hn khi bat kychat nao trong nhom II angtrthanh yeu tohan chevi tang trng. olalydo v sao nhieu thnghiem bosung tap trung vaoprotein vanang lng makhong chuyti cac chat dinh dng nhom II khac nhat lakali, magie, kemvaphospho akhong mang lai hieu qua.

Mat khac, nh tren anoi, thieu dinh dng loai I thng bieu hien bang cac bien oi hoasinh mat cobien oi vekch thc nhan trac trong khi thieu dinh dng loai II th sbien oi vetang trnglai lachnh. V vay, cheoan cho trekem tang trng khong ch can unang lng, protein macacac chat dinh dng nhom I (thng c quan tam v tylemac cao) vanhom II (cha c quan tamnhieu) ngha lamot cheoan can oi vahp ly.

Tom lai, cho en nay aconhieu cach phan loai cac chat dinh dng trong c the, v dunh:Nhom chat dinh dng sinh nang lng vakhong sinh nang lng.Nhom chat sinh nang lng, tao hnh vatham gia cac quatrnh chuyen hoa.Cach phan loai va trnh bay tren ay cung lamot cach tiep can da vao vai trocac chat dinh

dng oi vi cac tnh trang benh lyac hieu vaquatrnh tang trng.Chung ta eu biet moi chat dinh dng cotheconhieu vai trokhac nhau vatrong c thehoat

ong cua chung phuthuoc lan nhau. nhng treem b suy dinh dng nang cac bieu hien chamtang trng (nhom II) thng kem theo thieu cac chat dinh dng ac hieu nh thieu vitamin A, thieumau do thieu sat (nhom I).

V vay, moi cach phan loai giup ta them mot cach tiep can rieng nhng khi ap dung khong themay moc.

4. DINH DNG VACAC BENH MAN TNH

Cung vi sgia tang tuoi tho, sgiahoadan so, cac benh man tnh ngay cang trnen cac vanesc khoecong ong coyngha quan trong. Ung th, cac benh tim mach, tang huyet ap, ai thaong, loang xng vabeo ph ang lamohnh benh tat chnh cac nc phat trien vangay cangtang len cac nc ang phat trien. Nguyen nhan cua cac benh man tnh colien quan en dinhdng phc tap bao gom cac yeu todi truyen, loi song vacheoan. Hien nay hay con khokhanethay oi cac yeu todi truyen nhng cac ieu chnh veloi song vacheoan acothelam giamnguy c mot sobenh man tnh colien quan en dinh dng.

4.1. Beo ph

Beo ph lavan edinh dng phobien nhat cac nc phat trien vaang tang len mot cach


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ang bao ong cac nc ang phat trien. Beo ph lam tang nguy c benh mach vanh, ai ng,tang huyet ap vanhieu benh khac. Beo ph khi con belam tang nguy c beo ph tuoi trng thanhvacac benh kem theo ac biet labenh tim mach. Beo ph con gay ra cac hequatam ly. Nhng a

trebeo ph thng hay mac cac benh ng hohap tren vamot sobenh xng khp hn ban becung la tuoi. Coen mot phan ba trng hp ai thao ng ngi trng thanh lado beo ph vacac nguy c cn au that ngc, nhoi mau c tim cung tang len ang ke.

Nhieu nguyen nhan dan en beo ph bao gom di truyen, van ong, cheoan vabenh tat. Tuynhien cac nguyen nhan quan trong nhat chac chan lacheoan vathieu van ong. Cheoan nhieuchat beo, phng tien i lai c gii, lam viec vagiai tr tnh tai, an vat... lacac yeu tohay gap lamgiam van ong vatha nang lng.

4.2. Tang huyet apTang huyet ap layeu tonguy c oc lap cua benh tim, kch thch tao cac mang va, hnh thanh

cac cuc mau, languyen nhan ot qu vacac ton thng than. Cheoan layeu toquan trong ekiem soat huyet ap, v dungi tang huyet ap khi lng chat beo trong khau phan giam 25% thhuyet ap cothegiam 10%.

Ngi tang huyet ap khong nen an nhieu protein, uong ru. Huyet ap thng thap nhngngi an chay cho nen khi chuyen cheoan ttht sang thc an thc vat selam hahuyet ap. Cheoan nhieu muoi vat kali cung gay tang huyet ap.

4.3. Benh tim machLng cholesterol cao trong huyet thanh colien quan en benh tim mach, ac biet lavai trocuacac lipoprotein cotytrong cao (HDL) vathap (LDL). Cheoan conhieu tht beo, oran, ongot,b, sa toan phan, dau mvaoman gay tang LDL-cholesterol layeu tonguy c cua benh timmach. Cheoan nhieu rau, quacung vi hoat ong thelc cotac dung lam tang HDL-cholesterolbao vec theoi vi benh tim mach.

4.4. ai thao ngai thao ng lamot benh man tnh cohai the: theai ng phuthuoc insulin (typ I) vatheai

thao ng khong phuthuoc insulin (typ II). Beo ph languy c chnh cua benh ai thao ng khongphuthuoc insulin, nguy c nay tang len theo thi gian vamc obeo. Chong beo ph, cheoan thcvat nhieu rau, giam acid beo no, giam cholesterol vang cotac dung bao ve. Hoat ong thelckhong nhng cai thien khanang dung nap glucose macon tac dung oc lap coli oi vi chuyen hoainsulin.

4.5. Soi matTrong 30 nam lai ay, sinh benh hoc cua soi mat trnen rorang hn. Cac roi loan cua tui mat

lam hnh thanh soi mat (chuyeu lasoi cholesterol). Soi mat thng phobien hn cac nc phattrien so vi cac nc ang phat trien. cac nc phat trien, benh soi mat thng gap nhng


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ngi an cheot rau hn nhng ngi an nhieu rau. Benh soi mat cholesterol xuat hien ladodch mat quabao hoacholesterol hoac do giam tiet acid mat. Nhng ngi beo bai tiet mot lngcao cholesterol trong dch mat. Do ochong beo ph vacheoan conhieu chat x layeu toquan

trong ephong soi mat.4.6. X gan

Moi lien quan gia sdung ru vax gan ac tha nhan rong rai. Do uong ru, khanangchuyen hoaru cua gan tang len vakhi lng ru uong vao quanhieu dan en ngooc, huyhoai tebao gan vab thay bang tochc seo. Phap trong thi gian chien tranh thegii thhai, tylechet dox gan agiam 80% do han chesdung ru. Ket quamot songhien cu Phap cho thay neu giammc tieu thuru t160g xuong 80g/ngay cothegiam tylemac x gan 58% vaung th thc quan28%. Nh vay, giam tieu thuru rorang lacoli, tuy nhien mc nhay cam oi vi ru khac nhau giacac cathe, ngii cophan nhay cam hn so vi nam.

4.7. Ung thNam 1996, tylemi mac ung th toan cau la10,3 trieu ca vatheo QuyQuoc teNghien cu ve

Ung th c tnh selen ti 14,7 trieu ca vao nam 2020. Nhieu dan lieu cho thay cheoan hp ly, renluyen thelc, duy tr can nang nen co cothephong nga 30 en 40% ung th. Theo hieu biet hiennay, beo ph, cheoan conhieu chat beo layeu tonguy c cua mot soung th. Cac cheoan nhieurau quacothedphong 20% trng hp ung th vahan cheuong ru cothegiam them 20% khac.

4.8. Loang xngLoang xng latnh trang khoi lng xng giam dan ti gay xng ch sau chan thng nhe.

olado lng protein vakhoang trong chat c ban cua xng giam mac dutyletng quan cuachung khong thay oi. Cheoan ucalci vafluo (bao gom catrong nc) tham gia vao quatrnhcot hoahp ly. Ben canh ocan chuyvai trocua vitamin D.

Tom lai: cac hieu biet vemoi quan hegia dinh dng vabenh tat tuy aphong phunhng chathecoi laay u, kecacac benh do thieu dinh dng vatha dinh dng. Tuy vay, vi nhng hieubiet hien nay acho phep xay dng mot cheodinh dng hp lyegign sc khoe, ephong

benh tat. Nhieu nc phat trien axay dng cac khuyen cao vedinh dng theo chu kyvong i,van eocung ang c quan tam nc ta.

5. DINH DNG THEO CHU KYVONG I:Con ngi ta tkhi con labao thai trong bung me, c sinh ra, ln len trng thanh cho en tuoi gia

eu cotheb anh hng hoac mac benh bi cheodinh dng khong hp ly. ieu nay khong nhng anhhng en cuoc i mot con ngi maelai hau quacho cathehemai sau.

Ngi phunkhi mang thai mathieu dinh dng, tang can t seconguy c sinh ra a trecocan

nang s sinh thap, nhng a trenay seconguy c tvong cao hn, khi trng thanh cung seconguy


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c cao mac cac benh man tnh, phat trien tr tuekem... a treera neu c nuoi dng kem sechamtang trng, nguy c mac cac benh nhiem trung cao, khi ln len seconguy c cao thap coi, giam nanglc tr tue... V dunhng phunHaLan b suy dinh dng trong thechien thII asinh ra nhng ngi

con, bay giatrng thanh, rat nhay cam vi benh ai thao ng khong phuthuoc insulin, tang huyetap vabenh mach vanh.

Ngi giathieu hoac tha dinh dng seconguy c cao mac cac benh dinh dng vacac benh mantnh. Van edinh dng cho ngi cotuoi ngay cang c quan tam hn, dinh dng hp lyc coi nhlamot trong cac yeu tothiet yeu khong nhng ekeo dai tuoi thomacon lathem sc song cho nam thang.Cau truc c thethay oi theo tuoi, tuoi cang cao tochc c cang giam dan.. Nhu cau nang lng giamdan nen am ocac chat dinh dng trong cheoan cua ngi cotuoi phai tang cao eephong thieuprotein, kem, vitamin B6, B12vaD.

Tang tvong Phat trien tr tuekem

Tang nguy c benh mantnh tuoi trng thanh

Cho con an bosungkhong ung luc

Nhiem trungthng xuyen

Thieu an vacham socsc khoe kem

Trethap coi

Khanangtr tuegiam

Thieu an - Dch vucham soc kem



Ngi giathieu dinh dng

Giam khanangcham soc tre S sinh

nhecan

Thieudinh dng

bao thai

Chamtang trng

Tyletvongmecao

Tang cankhi cothai kem

Phun

thieu dinh dng

Thieu nienthap coi

Giam nang lctr tue


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Dinh dng theo chu kycuoc i cang c hieu rohn qua s osau:Do vay nhiem vuquan trong cung nh muc ch phat trien cua dinh dng hoc latm ra con

ng cai thien dinh dng ecai thien tam voc, noi giong, mang lai sc khoecho ngi dan, ola

con ng khoa hoc ung an.6. MOI LIEN QUAN GIA VESINH AN TOAN THC PHAM VASC KHOE BENH TAT

Vesinh an toan thc pham ngay cang trthanh van ethc sang quan tam khong ch ncta manhieu nc tren thegii. am bao an uong cung cap cac chat bodng cho c thechkhong phai languon gay benh. Nhieu vungooc thc an hang loat nhieu ngi mac axay ra, dothc an b nhiem trung hoac thc an cha cac chat oc. Thc an khong an toan con languon truyenmam benh vi khuan, k sinh trung vanhat latrong thi k hien nay nhng chat cho them vao thcpham khong an toan, cac chat phugia, cac chat nhiem trong toan boquatrnh nuoi trong, anh bat,thu hoach vachebien bao quan thc pham.

Ngooc thc pham khaphobien trong moi thi k phat trien cua loai ngi, con ngi aphaitragianhieu ton that sinh mang vami i en xac nh c oc chat, hay mam benh cotrong thcan. V du400 nam trc cong nguyen ngi ta biet oc tnh cua hoa oquyen vamat ong lay thoaoquyen vaoc tnh cua cay truc ao vacac loai nc sdung colan hoa truc ao.

Tlau ngi ta abiet oc tnh mot sothc an cooc tomot soloai ca, nhuyen thevaphutang mot soloai ong vat vathc vat nh san, nam oc.

Tai c, thekythIX, ngi ta abiet ngooc do doi tiet vangooc do ergolin hang loat Phap, c, Nga.

Sphat trien cua khoa hoc aconhng bc phat trien ln vetm hieu nguyen nhan cua ngooc thc pham nh ban chat ngooc thc pham, gay nen nhng hau quacho sc khoevi cacbenh canh vamc oton hai khac nhau: ttieu chay, ngooc, cac benh dch truyen nhiem lienquan en thc pham vacac benh man tnh vacaung th.

Nhng nghien cu xac nh nguyen nhan do vi do vi khuan (nhiem trung nhiem oc thc an)ac tha nhan. Nam 1888 Ghecnia lan au tien phat hien ban chat vi khuan cua ngooc thcan bang cach phan lap tc thenan nhan va t tht cua bob benh viem ruot non do vi khuanSalmonella enteritidis.

Sau nay ngi ta aphat hien cac ngooc thc pham do cac loai vi khuan nh Staphylococus,Cl. Botulinum, Salmonella typhimurinum, E coli.

Do virus: Hepatitis A, Hepatitis E, nhum virus Norwalk, Rotavirus, Poliovirus...Cac k sinh trung vaong vat nguyen sinh: Entamoenba Histolytica, Giun, San, n bao.Cac ngooc hoa chat cung lavan erat ln anh hng en tnh mang vasc khoe cua cong

ong. Ngooc do hoa chat conhieu loai khac nhau lien quan ti quatrnh nuoi trong, bao quan chebien. Ngi ta phat hien c cac ngooc thc an do cac kim loai nang, ngooc do hoa chat baovethc vat, cac chat cho them vao thc pham ebao quan, sat trung, pham mau,cac chat phugia


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khong c phep.Ngooc thc pham do ban than thc pham cochat oc nh: Nam oc, khoai tay moc mam, san,

mang, au van trang, hat lanh, hanh nhan ang, langon...

Ngooc thc an ong vat cochat oc nh: Coc, canoc, nhuyen the, bach tuoc, mat co,Trong cac ngooc do thc an cochat oc ngi ta thay mot sochat oc tnhien thng thay

cocac loai thc pham nh: Solanin trong mam khoai tay, Acid Xyanhydric trong san, cac loai auvan, Saponin trong hat s, Muscarin cotrong nam oc, Tretrodoxin trong canoc, Mytilodoxin trongnhuyen the.

Thc pham neu trong quatrnh chebien, bao quan lu gikhong tuan thucac ieu kien vesinh,thi han sebien chat, h hong sinh ra nhng chat oc hai gay oc oi vi ngi an.

Nhng thc pham cotheb bien chat do cac yeu tovenhiet o, oam, anh sang, vaoxy trong

khong kh vangay canhng chat thoi nhiem tcac dung cubao quan, cha ng lam hong thcpham, dan ti bien chat, thay oi camau sac, mui v, tao nen cac chat trung gian gay oc.

Cac vi sinh vat nh cac vi sinh vat, cac nam men, moc cothephat trien cung tao nen sbienchat thc pham, tao nen cac chat phan giai thc pham dan ti cac chat trung gian chuyen hoa cacchat dinh dng cohai ti sc khoe. Cac chat sinh ra do qua trnh bien chat cua protein: Indol,Saptol, Phenol, Histamin, Cadaverin, Betamin, Metylamin, Amoniac, Nitrat, Nitrit...

Cac chat sinh ra do bien chat lipid nh: Glycerin, Peroxyt, Andehyt, Xeton,..Cac chat sinh ra do bien chat glucid: cac acid hu c, ru...

Mot van erat ang quan tam cua vesinh thc pham oi vi sc khoe hien nay lathc pham,thc an lang truyen, lay nhiem cac benh dch nguy hiem, ac biet latieu chay cap vabenh dchta. Nhieu thc an ac xac nh anhiem cac loai vi khuan gay dch tieu chay vabenh ta, chnhlanguy c cho viec bung phat cac vudch nguy hiem. Chnh v vay mavesinh an toan thc pham lamot trong nhiem vutrong tam cua hoat ong cua y hoc dphong, am bao cho ngi dan thoat khoicac anh hng cua thc pham khong an toan, gop phan hathap tylemac benh nhiem trung, khongnhiem trung, cac benh lay truyen qua thc pham vanhat lacac benh man tnh do anh hng cua sonhiem kim loai nang, cac chat cho them vaphugia nguy hai trong quatrnh chebien thc pham.

Vesinh an toan thc pham thc slamot nganh khoa hoc gop phan quan trong trong viecbao vevanang cao sc khoe cua canhan, cong ong vatoan xahoi, cung vi sphat trien cuakhoa hoc vesinh an toan thc pham chung ta cothekhong che, loai trc cac benh nay trongtng lai.


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Chng 3. AN NINH THC PHAM VA AN NINH DINH DNG

I. MAUTuyen ngon nhan quyen cua Lien Hp Quoc nam 1948 neu moi ngi eu coquyen hng tieu

chuan song ay uvethechat vaphuc li cua ban than vagia nh, bao gom lng thc vathcpham mi ch c cai thien mot phan. Tnh trang oi lng thc vathieu cac thc pham can thiethay goi chung lamat an ninh thc pham avaang con lathach thc ln oi vi toan nhan loai.

Van ean ninh lng thc thc pham (goi tat laan ninh thc pham - ANTP) ac ac bietquan tam sau cuoc khung hoang lng thc Thegii 1972-1974 vanan oi Chau Phi 1984-1985.Mac duban au, ANTP c phan tch mc Quoc gia vaQuoc telachuyeu, nhng nocung a

c xem xet mc hogia nh vacathe.Mac duANTP nc ta aat c nhng muc tieu c ban, nhng cha on nh, noi bat nhat

lasan xuat con phuthuoc nhieu vao thi tiet, kh hau. Khi cothien tai xay ra th nhieu vung, nhieungi lam vao canh oi ngheo, ngha lacha am bao tiep can thc pham ben vng cho moi mien,moi hovamoi ngi trong moi luc, vaac biet lacha coc an ninh thc pham hogia nh(ANTPHG) vavesinh an toan thc pham (VSATTP).

Khai niem an ninh thc pham hogia nhnh ngha ANTP: am bao cho tat cathanh vien hogia nh, bat ketuoi tac, gii tnh vatrong bat ky

hoan canh nao cung c tiep can vacoulng thc, thc pham can thiet ean ecocuoc song nangong khoe khoan.

Mat ANTPHG, ngc lai lakhong co, hoac coma thieu (khong u), hoac comot cach thatthng cac loai thc pham cogiatr dinh dng, ea vao ba an cho cac thanh vien hogia nh.

Vanh vay, khanang dtr, phan phoi lu thong cung cap on nh vaac biet lasc mua cotam quan trong ngang vi san xuat. Ngha lakhong ch dng lai khau san xuat, ANTP can cxem xet mot cach cuthevatriet etren c shethong lng thc thc pham, ac biet moi lien quandinh dng vi nong nghiep, kinh tecung nh tnh trang dinh dng.

An uong ch lamot trong nhieu yeu to, ngoai an uvaan a dang, con can phai chuyen cacyeu tosc khoe, benh tat vacham soc bametreem. ANTPHG lacan thiet nhng khong am baochac chan an ninh dinh dng. Cac yeu tomoi trng, van hoa, hanh vi quyet nh hieu quavalich cua thc pham an vao. Nh vay, SDD hay cham phat trien khong han laket quatrc tiep cuamat ANTPHG. Cac nghien cu vao cuoi nhng nam 80s au 90s cho rang ANTP vaDD c coilamot trong nhieu muc tieu phan au. Ngi ta a ra khai niem rong hn vean ninh i song trongoANTP vadinh dng colien quan chat chevi cac yeu tokinh technh tr vangheo kho, vi SDDvacac bien phap phc tap luon luon bien ong etao nen scan bang gia thoa man nhu cau cban vevat chat vatinh than khac. An ninh i song c nh ngha latiep can hp ly, ben vng vi


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thu nhap vacac nguon lc eap ng cac nhu cau c ban (gom an uong, nc, y te, giao duc, nhaca vathi gian hoi nhap xahoi).

II. CH TIEU ANH GIAAN NINH THC PHAM HOGIA NH.Trc kia, ngi ta da chuyeu vao cung cap LTTP cua khu vc/quoc gia. Tuy nhien, khung

hoang thc pham bung nochau Phi vao nhng nam 80 a lam thay oi quan niem venguyennhan cua nan oi. Mat ANTP xay ra trong tnh hnh LTTP van coay unhng khong en c vingi can dung do khong tiep can c. Tiep can thc pham congha lathc tehogia nh cocbao nhieu thc pham tnguon tsan xuat, tcac nguon thu nhap, kiem lm, thotrcua congong, tcac tai san, vatnguon di c lam them.

2.1. Cac loai ch tieu anh giaANTPHG.2.1.1. Ch tieu quatrnh, hay dbao.

* Cac ch tieu phan anh cung cap thc pham:- Khanang coc thc pham vacach la chon cua hogia nh etiep can thc pham ac

xep vao cac ch tieu phan anh rui ro. Loai nay gom cac au t san xuat, khanang tiep can vi nguontai nguyen thien nhien, cac theche, hatang c s, mau thuan khu vc, chien tranh, cung colienquan trung cheo vatng tac ang keen cac ch tieu tiep can.

- Theo doi lng ma hau het cac nc, coi la1 phan cua theo doi san xuat nong nghiep- Nguon tai nguyen thien nhien: Nguon tai nguyen thien nhien anh hng rat ln en viec e

phong thieu an theo mua vucua cac hogia nh nong thon. Phunthng laoi tng conguy ccao, nen mot khi khong tiep can c cac nguon tai nguyen thien nhien seb giam tieu thuTP ratang ke. Mot loai tai nguyen thien nhien quan trong lathc pham hai lm vasan bat, cothecungcap ti 30% tong socalo an vao cua mot soquan dan c.

- Cac solieu venang suat san xuat nong nghiep: c thu thap qua cac vung san xuat th iem.Cac nghien cu gan ay chau Phi acho thay da vao cac bao cao cua nong dan lai chnh xacvaton kem hn.

- Mohnh sinh thai nong nghiep, trong otnh en cakhanang tiep can vi at vanguon nc,v dumohnh can bang at vanccua FAO.

- Can bang lng thc thc pham (CBTP) lacong cuchnh etnh toan ANTP quoc gia, cxay dng ttong hp 6 yeu tochnh: thc pham dtrton, san xuat, nhap khau (cac nguon cungcap); sdung noi a, xuat khau vathc pham dtradung. CBTP khong thehien c skhacnhau tng vung, khong cho thay songui b thieu vathieu au, can loai giup g, khong chobiet nguy c ban au cua tng vung, khong phan anh c khanang tiep can vathng c tnhthap cac thc pham khong coga tr thng mai (v dusan, khoai so, ).

- Cac thong tin vesau benh: Sau benh anh hng en san xuat, lam khanang san xuat cung


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cap TP thap i.* Cac thong tin veth trng: Cac ch tieu bien ong giacacua mot sothc pham c ban (lng

thc) vacua ai gia suc.

* Mau thuan / noi chien: anh hng trc tiep en ANTP cavecung cap, tiep can thc pham,cung nh phahoai nguon tiem nang thien nhien.

2.1.2. Cac ch tieu tiep can thc pham:Do cac gia nh khong thuong vi cac cang thang vethc pham nen nhieu tac giacho rang,

khanang oi phophan anh nguy c mat ANTP hogia nh. Borton vaShoham (1991) khuyen nghnen dung cac ch tieu veKTXH vakhanang oi phovi cac cang thang thc pham lam cac ch tieutiep can.

* Cac bien phap oi phovi thieu an mua vu:Con ngi luon tm moi cach han checac nguy c thieu ANTP vabao vei song cua mnh, vduchan thagia suc, gieo trong, thay oi mua vu, di c vethanh pho/oth etm viec lam, tang sanxuat odung nho, san bat hai lm thc pham, cam co, vay mn, di c, giam bt lng thc phamtng ba, ban tai san (v duotrang sc), ban cui uoc, nhan thc pham tcac chng trnh phanphoi hotr, ban cong cusan xuat, phan chia nhohogia nh, di c. oi pholanham coc thunhap khahn trong tng lai, chkhong n thuan lagiai quyet tnh trang thieu thc pham hien tai.Cac cach oi phothay oi tuy tng vung, tng cong ong, tang lp xahoi, dan toc, gia nh, gii, la

tuoi vamua vu, mc o, thi gian khung hoang vathng mang tnh ac thu.* Dtrtai san: Tai san la1 ch tieu tot phan anh mc onguy c vadtrtai san lacach oiphovi mat ANTP.

* Cac bien phap han cherui ro trong san xuatau tien lamrong san xuat trong nhng nam ma thuan gio, gom han cherui ro vachong that

thoat, tiep en laa dang hoa san xuat vaieu chnh hethong gieo trong.* Cac bien phap ephong that bat: Cotheolacac nguon thu phi nong nghiep, ban tai san, gia

suc, oac, di c mua vu, tng trnhau, khai thac nguon tai nguyen tnhien.

* Gian cach giau ngheo: Cac hongheo, gom canhng nhaphunlam chuho, t tai san shu,conguy c b mat ANTP sm hn cac gia nh khagia. Nhangheo buoc phai ban gia suc, cam coruong at, mac n, ban lao ong, vay lng thc lai xuat cao, trong khi cac hokhagialai mua giasuc vi giare, ban lng thc giacao hn hoac cho vay vi lai xuat cao, thuelao ong vamua atai giarehn..

2.1.3. Cac cach oi phovi mat ANTPHG:Cac cach oi phoc chia lam 3 giai oan: giai oan 1 cac hocogang han chenguy c va

chong that thu, thng huy ong thap nguon lc evt qua neu khung hoang nhe. Khi khung

hoang keo dai, cac hobuoc phai huy ong nguon lc ln hn eton tai (giai oan 2); Do phai ban


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dan cac tai san phuc vusan xuat nen nguy c mat ANTP cang cao. Giai oan 3 cac hoachu auhang vathng lab phasan, phai ban at ai hoac di c.

Cac ch tieu phan anh cac bien phap oi pho:

* Cac ch tieu gi y, hay con goi lacac ch tieu sm: Gom that thu (do thieu/tha ma, thieu giongvaau t san xuat, sau benh); Thieu at san xuat hoac sc keo (do ngi di c en ong hoac dotrau bob chet / ban nhieu); Suy thoai kinh tea phng (giaLT tang, that nghiep, giam dtrTP); au c ai gia suc cua nhng hokhagia(do ban nhieu vi giathap).

* Cac ch tieu cang thang, tnh trang giam khanang tiep can TP:- Tang bat thng songi i tm viec lam;- Ban nhieu otrang sc, cong culao ong, sc keo (trau, bo) tren th trng;- Tang ban at ai vanhaca;

- Tang songi vay tien;- Tang kiem lm thc pham tnhien;- Giam soba an trong ngay,- Tang giup um boc gia cac hogia nh.Cac ch tieu nay cothec xac nh bang phng phap anh gianhanh nong thon (RRA).* Cac ch tieu muon xay ra khi khanang tiep can athap, phan anh hau quacua mat ANTP:- Suy dinh dng, benh tat vatvong- Thoai hoa at ai,

- Ban at, an hat giong vadi c vnh vien, chng tocac hogia nh abat lc trc khung hoangthc pham.

2.1.4. Cac ch tieu ket qua/ au ra:

2.1.4.1. Cac ch tieu trc tiep:

* Chi ph cho tieu thuthc pham hogia nh:Qua ieu tra chi ph cothecho biet sotien chi cho an uong cua mot cathehoac mot hogia nh,

chuyen oi thanh calo tren mot n v giaca. Co2 phng phap: ch gii han trong tieu thulng

thc, hoac chuyen oi tat cacac loai thc pham ra calo.* Nhan thc cua cac hogia nh veANTP:Cac hoatng b thieu an mua vuthng buoc phai tieu chnh. Tham ch conhng thc

pham rat san conhng do tap quan van hoa khong c tieu thu. Can tm hieu ykien cua cac hogia nh veANTP, v dutoan sothang ANTP.

* Tan xuat tieu thuthc pham.* Cac ch tieu tieu thuthc pham.

2.1.4.2 Cac ch tieu gian tiep:


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* c tnh d trLTTP trong mot so thi iem quan trong trong nam co thech ro tnh trangANTP gia nh, ac biet lanhng ni san xuat tcung tcap lachnh.

* Tysotiem nang ttuc: latysogia khanang coc thc pham cua hogia nh so vi nhu

cau. Mot cach theo doi tng tTanzania laphieu ghi chep ANTP gia nh.* Cac ch tieu vetnh trang dinh dng phan anh tnh trang thieu an anh hng en can nang

vachieu cao.

2.2. La chon ch tieu vacac phng phap anh giaANTP vadinh dng

2.2.1. Tieu chuan la chon ch tieu:Viec la chon cac ch tieu ANTPHG tuy thuoc vao muc ch ac thu: nham anh gia1 dan,

hoac thiet lap 1 hethong theo doi, hoac xay dng cach ANTP cua 1 quoc gia. Hn na, viec la

chon ch tieu cung con phuthuoc vao ngi sdung. Cac tieu chuan la chon ch tieu gom:Sdung toi a cac thong tin solieu san co.am bao tnh thch hp vaochnh xac.am bao ung luc/Kp thi.Hai kythuat cothecai thien tnh kp thi cho anh giacac khung khoang TP laban onguy c

vacac kehoach chuong ephong bat trac.

2.2.2. Cac phng phap thu thap thong tin solieu anh giaANTPHGTrong thiet keanh giaANTPHG vala chon cac ch tieu, can trali cac cau hoi chnh sau ay:oi tng nao sdung cac ch tieu ANTPHG.tam v mo, cac chnh phuvacac nhatai tryeu cau cac thong tin solieu giup a ra cac quyet

nh xay dng kehoach vachnh sach, nhat latrong ieu kien han chevetiem lc. Con tam vimo, cac chnh quyen a phng, cac tochc phi chnh phuvacac nhachc trach cua cong ong laican thong tin solieu exac nh nhom nguy c vacac can thiep thch hp ecai thien ANTPHG.

Cac loai thong tin, solieu can thu thap:Cac phng phap nh lng giup thu thap cac solieu lng hoa c qua cac ieu tra thiet ke

trc. Cac solieu nh lng c thu thap khi cac con so, t sohoac tylelien quan en quan dan

c phai c c tnh, xac nh, hoac mot bien sonh san lng phai c o lng.u iem chnh cua cac phng phap nh lng la:Bocau hoi c chuan hoa eloai bocac sai sohethong cua ngi phong van. Mau nghien

cu c chon trong toan boquan dan c vi tylebiet trc, hoac c oan vavi sai socho phep.Nhc iem chnh cua phng phap nh lng la:- Ton thi gian vakinh ph.- Cothemac sai sotrong cach at cau hoi, vado khong gan vi khung canh cuthecua a phng.Nhu cau khac nhau sedan en cac phng phap thu thap vacac thong tin solieu khac nhau. Co2 loai

phng phap chnh lanh lng vanh tnh. Ngi ta thng sdung phng phap anh gianhanh nong


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thon (Rapid Rural Appraisals - RRAs) vaanh gianhanh cotham gia cua cong ong (Participatory RapidAppraisal - PRA) enhan nh kyhn veANTPHG (tham khao tai lieu).

2.2.3. Cac hethong theo doi anh giaan ninh thc pham.* Cac hethong bao ong sm tam quoc gia vatoan cau.* Hethong bao ong sm a phng:Hethong bao ong sm cho vung, tnh c cac chnh quyen a phng ieu hanh.* Ban onguy cBan onguy c ch ronhng vung vanhng bophan dan c conguy c cao nhat vi bat ANTP.

Ban onguy c cung ch ronhng vung can phai theo doi chat chesat xao hn, giup chnh phuvacac tochc phi chnh phutap trung thc pham mot cach cohieu quahn, vaxac nh cac yeu totrong yeu can can thiep.

III. BIEN PHAP AM BAO AN NINH THC PHAM HOGIA NHTrc het can xay dng mo hnh phan tch nguyen nhan thieu / mat ANTP ho gia nh tng

a phng, va mo hnh nguyen nhan cua SDD - t vong tre em cao, tren c s o cung thaoluan e thong nhat cac bien phap cai thien AN NINH THC PHAM HO GIA NH.

Hnh 1.S ophan tch ANTP hogia nh

Tnh trang dinh dng vasc khoe kem

An uong thieu solng vakem chat lng

Thong tin, giao duc, truyen thong yeu kem

Thieu/ Mat An Ninh Thc Pham Hogia nh

Vai trocua nong nghiep vaCNTP

Chnh sach nhanc, kien truc thng tang, nguon tiem nang

San xuatttuc (NN &VAC) thap

DtrTP thap

Kem VSATTP

t TPnguontnhien

Kien thc,t.hanh anuong kem

Chi phan/uong sc

mua thap

ong con,t lao ong


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ecai thien an ninh thc pham hogia nh, cac can thiep can nham vao cac nguyen nhan trctiep sau ay:

Cai thien san xuat ttuc

Tang cng dtrLTTPCai thien thu nhap vasc mua LTTPam bao VSANTPCai thien kien thc. thc hanh dinh dng

Hnh 2.Mohnh phan tch an ninh thc pham & dinh dngRorang, trong thieu ANTPHG, can cvao 2 mohnh tren th thieu an hoac an khong hp ly

cac hogia nh luon ton tai. Cac oi tng b tac ong trc het latreem, phuncothai vacacbameang nuoi con nhodi 5 tuoi. V the, cac can thiep vedinh dng vathc pham can nhamtrc tiep vao cac oi tng nay.

3.1. Giai quyet cac nguyen nhan trc tiep:

3.1.1. Giai quyet nan thieu/oi an hoac an khong hp ly.Chung ta eu hieu rang thieu/mat ANTP sedan en suy dinh dng hay cham phat trien va

ngc lai. Ta cothemotamoi lien quan onh mot vong luan quan sau ay:

Thieu ANTP Thieu / oi an Suy dinh dng Giam khanang lao ong San xuat thc pham kem

TyleSDD vatvong treem cao

An uongkhong hp ly

Mat ANTPhogia nh

Thc hanhcham soccha tot

San xuatLTTPkem

Thunhap/scmua thap

Dch vucham soc

kem

Thieukienthc

Dch vuy tevamoi trng

khongbao am

Cham soc BMTEcha hp ly Benh tat nhieu

Van e

Cacnguyen nhantrc tiep

Cac

nguyen nhantiem nang

Cacnguyen nhan

c ban Cheo, chnh sach, nguon tiem nang v.v.


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hieu qua Thieu thc pham tai hogia nh Thieu ANTP Can phai neu roemoi ngi hieu rang SDD keo dai tresekem phat trien cavethelc vatr

tue, sau nay sethap benhecan vahoc kem vahau qualakhanang lao ong thap dan en san

xuat thc pham kem hieu quavathieu / mat ANTP.Nh vay suy dinh dng va lahau quava languyen nhan cua thieu/mat ANTP. V vay giai

quyet van esuy dinh dng cac nhom nguy c cao trong mot cong ong cung chnh lagiai quyetmot trong nhng nguyen nhan cua thieu ANTP.

Nguyen nhan trc tiep cua SDD, ngoai nhiem khuan laoi an hoac an khong hp lyCac bien phap chuong phong chong SDD sau ay can chuy:u tien cham soc trengay tkhi sinh en 24 thang tuoi.Cham soc phuntrc khi e: Can chuong cham soc vedinh dng sc khoe cho phunco

thai, v thieu an phuncothai sedan en suy dinh dng bao thai.Cham soc bamecho con bu.Trien khai coket quacac chng trnh phan phoi vi chat dinh dng nh vitamin A, thieu mau

do thieu sat, v.v...Xay dng vatrien khai chng trnh dinh dng hoc ng nh tochc an tra cac trng hoc.

3.1.2. Cai thien kien thc vathc hanh cham soc bametreem.

3.1.3. Cai thien dch vuy tevamoi trng ephong chong benh tat.

3.2. Cac bien phap nham am bao ANTP hogia nh.Tren thc teANTP phuthuoc vao 3 yeu to: San coLTTP, cothng xuyen lien tuc vabat ke

au, trong ieu kien nao, cac hogia nh cung cothemua c thc pham neu nh hokhong tsan xuat c. Nh vay ta phai trali cac cau hoi sau:

Thnhat lathc pham cosan sang gia nh ecac thanh vien cothenau nng, chebienean hay khong ?

Thhai lassan coay colien tuc, vng chac hay bat thng ?Vacuoi cung lacac hogia nh neu khong thetmnh coc thc pham tai nhath hoco

utien emua uthc pham can thiet khong, vaneu coutien th lieu coni emua thc phamkhong. Vatham ch co, nhng lieu hocotheen c chhoac ca hang mamua hay khong?

egiai ap c cac cau hoi tren, can can thiep vao 3 yeu tosau:

3.2.1. am bao cho cac hogia nh cosan thc pham a dang trong nha.a.Tang cng vaa dang hoa san xuat LTTP tcung tcap.Cac bien phap cuthetrong lnh vc san xuat tcung tcap, bao gom san xuat nong san ngoai

ong ruong vasan xuat VAC: Vn, Ao, vaChuong chan nuoi, nham am bao cho cac hocouso

lng vachung loai thc pham can thiet, cothela:


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ay manh cac dch vukhuyen nong, ti tieu, giup nong dan phat trien san xuat vachan nuoiCho ngi ngheo vay von tn dung vi lai suat u ai esan xuat, chan nuoi valam kinh te.Hng dan vachuyen giao kythuat lam VAC cho nhan dan, bao gom cac hoat ong sau:

Ho tr von bang nhieu hnh thc khac nhau bao gom ca tai chnh va vat t, ky thuat, quan ly,va x dung hp ly cac san pham lam ra ac biet la t o dinh dng trong VAC gia nh.

Hotrgiong vakythuat nhat lagiong.Hng dan cach bao quan, chebien, lu thong phan phoi vatieu thucac san pham cua VACXay dng cac mohnh VAC phuhp cho cac vung kinh tekhac nhau.Tang cng hethong lu thong phan phoi, vadtrthc pham tai a phng.Cothexay dng cac c schebien thc an bosung qui monhomanguyen lieu lacac thc

pham a phng san xuat c.

b.Nghien cu cho them mot sovi chat: vitamin A, iod, sat vao thc pham a phng neu coieu kien.

c. Tang cng cac chng trnh giao duc vatruyen thong dinh dng.

3.2.2. am bao cung cap thc pham on nh, vng ben cho cac hogia nh.Duy tr san xuat LTTP on nh tng hogia nh vacaa phng, han checac vuthat thu e

am bao c ban tcung tcap cho cac hovatrong a phng.Cai tao vaxay dng mi hethong giao thong cang bovathuy etao ieu kien van chuyen

lu thong trao oi mua ban LTTP trong pham vi a phng vavi cac a phng khac.Cai tao vaxay dng mi hethong kho tang dtr LTTP hogia nh vaa phng.

3.2.3. am bao cho cac hogia nh tiep can c vi LTTP can thiet.a.Trien khai cac chng trnh LTTP hoac tien boi dng cho lao ong vacho hoc tap, hoac thao

luan vecac noi dung giao duc dinh dng vasc khoe.Cac chng trnh nay bao gom: Lao ong sa cha nang cap hoac xay dng mi cac hethong

c shatang nh ng xa, cau cong, trng hoc, tram y te, kho tang, vv.Cac lp tap huan hng nghiep day ngheetao cong an viec lam, tang thu nhap vasc mua

thc pham cho nhan dan a phng. Van enay het sc quan trong nhat lanong thon vao cacvunong nhan oi vi nhng vung thuan nong, maieu kien vatrnh ocanh tac con nhieu han che.b. Tang cng cong tac giao duc kien thc vedinh dng hp lyenhan dan biet cach la chon

thc pham am bao dinh dng tot theo hng an uchat bot, tang chat am, beo vacac vi chat,ong thi biet cach chebien, bao quan hp vesinh, ephong ngooc do an uong.

c.Cai tao th trng von covaxay dng them th trng mi: chvacac ca hang thc pham,tao ieu kien cho tng cum dan c cothethng xuyen mua ban trao oi tien li, nhat lacac vungsau, vung xa b colap do cac ieu kien tnhien.


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Chng 4. NG LOI DINH DNG

1. NH NGHA NG LOI DINH DNGSton tai dai dang cua nan oi cung vi cac hieu biet ngay cang sau hn vemoi quan hegia

dinh dng vi sc khoevabenh tat - cac benh do thieu dinh dng vacanhieu benh man tnh quantrong athu hut moi quan tam chung vescan thiet phai hoach nh tren pham vi quoc gia, khu vchay toan cau cac ng loi chien lc vedinh dng vathc pham v sc khoevasphat trien xahoi.

Nhng hoat ong nh vay acotsau thechien thnhat nhng vao au nhng nam 70 cua thekyXX mi conh ngha nh sau: ng loi dinh dng vathc pham lamot chuoi cac nguyen ly,muc tieu u tien vacac quyet nh c Nhanc phechuan vathc thi nh lamot bophan trong ke

hoach phat trien quoc gia nham muc ch cung cap cho toan thenhan dan trong mot thi gian achieu cac thc pham vacac ieu kien kinh te, xahoi vavan hoaecoc cheodinh dng ay u.

Trong nhng nam gan ay dan dan cosxac nh rohn vepham vi cua ng loi thc phamvang loi dinh dng. Neu ng loi thc pham hng ti an ninh thc pham ngha lamoi ngidan cokhanang tiep can vi thc pham moi ni, moi luc th ng loi dinh dng hng ti moingi thc hien mot cheoan hp lynham bao vevanang cao sc khoe.

Nh vay cothenh ngha ng loi dinh dng nh sau: ng loi dinh dng lamot chuoi cachoat ong phoi hp, thng do Chnh phuvach ra nham muc ch am bao chat lng dinh dng

vavesinh cua thc pham cung cap cho nhan dan etang cng sc khoevacai thien tap quan anuong hay noi gon hn: ng loi dinh dng lamot ng loi vethc pham trong ocac muc tieusc khoevadinh dng c neu len mot cach rorang.

2. NOI DUNGexay dng vatrien khai mot van kien veng loi dinh dng, can chuycac noi dung sau ay:

2.1. Luan chng khoa hocLuan chng khoa hoc cua ng loi dinh dng phai can cvao moi quan hegia cheoan va

sc khoengha laxac nh c cac van esc khoelien quan en an uong cua cong ong trongthi gian o. Luan chng cang xac ang th viec xay dng muc tieu cang dedang, cong viec trienkhai vaanh giasethuan li vanhat latranh thuc song tnh cua gii chuyen mon vacacnhahoach nh chnh sach.

Muon coluan chng tot, trc het can cothong tin. Cac thong tin sau ay can thiet nhat:

2.1.1. Thong tin vetieu thuthc pham vamoi lien quan vi sc khoeTai lieu thong kedo tochc FAO cung cap; cac tai lieu nay da vao cac bang can bang thc

pham ac chuan hoaecho phep so sanh quoc te. Viec sdung cac tai lieu nay ch gii han

cho cac so sanh quoc tevemc ovadien bien tieu thuthc pham.


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Cac bang can bang thc pham quoc gia cung cap cac dan lieu chnh xac hn elap kehoachvanhat laetheo doi cac ket quacua ng loi dinh dng coat c muc tieu hay khong.

Cac ieu tra vech tieu hogia nh thng c tien hanh theo khoang cach nhat nh hau

het cac nc Chau Au. nc ta, Tong cuc Thong kecung cothc hien. Cac thong tin c cungcap theo nhom dan c: thanh th/nong thon, ieu kien kinh te, xahoi

Nhom thong tin tren ay cou iem lathng acosan do c thu thap thng xuyen v nhngmuc ch khac hn laxay dng ng loi dinh dng. Tuy nhien khi sdung van can cossang loc.

Cac ieu tra ve tieu thu thc pham da theo ho gia nh hay ca nhan vi c mau ai dien.ieu tra theo ca nhan co ch li e xac nh nhom co nguy c cao. Do co nhieu phng phapkhac nhau ang c ap dung nen can chuan hoa phng phap thch hp vi ieu kien cu the trc khi tien hanh.

mot so nc (nh Phan Lan chang han), hang nam ngi ta a gi cac cau hoi theo ngbu ien cho 50.000 ngi ve tan suat s dung cac loai thc pham. Viec nay a c thc hientrong nhieu nam va cung cap cac thong tin co gia tr ve khuynh hng dien bien cua tieu thu thc pham.

Cac thong tin vetieu thuthc pham khong nhng can thiet exay dng ng loi dinh dng macon coch cho cac nhalam kehoach vecong nghiep, nong nghiep vacham soc sc khoe.

etien hanh cong viec tren trong pham vi quoc gia can:- Chuan hoacac phng phap ieu tra, thu thap solieu vetieu thuthc pham eap dung mot

cach thong nhat theo ch nh cuthe.- Xay dng vaap dung mot bang thanh phan hoahoc thc an thong nhat etnh toan, xlycac

solieu.- Theo doi dien bien tieu thuthc pham lacong viec u tien exay dng ng loi dinh dng.

2.1.2. Dien bien vehanh vi vatap quan an uongCang ngay ngi ta cang thay rocac dan lieu vetieu thuthc pham n thuan khong cung cap

ucac thong tin can thiet exay dng ng loi dinh dng, macon can them cac thong tin venhan thc hanh vi vaquan niem cua nhan dan oi vi thc pham vasc khoe. mot sonc, cacnghien cu loai nay ang c tien hanh eu ky, v duHoa Kychai nam mot lan ketnam 1982vaPhap cac cuoc ieu tra venhan thc cua ngi tieu dung oi vi thc pham ac tien hanh.

Skhac nhau vehanh vi an uong colien quan ti v tr xahoi (thng c thehien bang sonam c i hoc), cac chng trnh truyen thong giao duc vacon cacac chng trnh van hoavannghe(bat chc cach an uong cua dien vien, nghes). V thecac chng trnh truyen thong giaoduc khong ch nham vao cac oi tng cov tr thap trong xahoi macon cacac oi tng cov trcao v nhieu khi holai lakhuon mau cho ngi khac lam theo.

Xay dng cac cau hoi vehanh vi an uong khong dedang do oeam bao tnh khach quan


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cua cac cau trali ngi ta ne

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Dinh Duong Va an Toan Ve Sinh Thuc Pham