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the science of the nutrition of sick individuals which studies and substantiates the principles of nutrition in various diseases. (Nutritional hygiene is concerned with the nutrition of healthy individuals.) Dietetics theoretically substantiates dietotherapy, or therapeutic nutrition. The practical aspect of dietetics is dietetic cooking—the preparation of food to meet the special requirements of patients afflicted with various conditions.
Much attention has been accorded to the nutrition of the sick in all periods of human society’s development. Hippocrates believed that treatment should consist in the proper selection of foods, with respect to both quantity and quality, at various stages of a disease. The Roman physician Aesculapius (128-56 B.C.), who is considered the founder of dietetics, contrary to the views of his time rejected pharmacotherapy and studied efficacious treatment based principally on diet. In collaboration with his students, he worked out detailed instructions for the use of foodstuffs in treating various diseases. The Roman physician Galen devoted considerable attention to problems of the nutrition of the ill. In the Middle Ages, the science of the nutrition of the ill fell into a decline, along with the general decline of culture; only the Salerno Medical School’s Code (13th century) contained instructions for therapeutic nutrition.
Some development of dietetics can be noted in the 17th century. The British physician T. Sydenham worked out a diet for gout and obesity, cautioned against the excessive use of medications, and placed great value on the nutrition of patients, demanding substitution of the kitchen for the pharmacy. Dietetics attained its further development at the end of the 18th century and particularly from the second half of the 19th century. The discovery of vitamins (N. I. Lunin, C. Funk), the development of the problems of mineral substances in the nutrition of patients (G. Bunge, among others), the works of C. Noorden, E. von Leyden, G. Klemprer, and others, and the publication at that time of the fundamental works on therapeutic nutrition significantly advanced the development of dietetics into a science. Russian scientists, who defined many of the basic propositions of modern dietetics, made a great contribution to the science of nutrition in general and to dietetics in particular. I. M. Sechenov believed that tracing the course of a nutrient in the body would make possible a full knowledge of the processes of life. V. V. Pashutin worked out and published a number of new propositions regarding the physiological bases of nutrition. Such Russian clinicians as S. P. Botkin, G. A. Zakhar’in, A. A. Ostroumov, and A. I. larotskii, who consistently used diet as an indispensable component in the comprehensive treatment of patients, greatly influenced the development of dietetics. The studies of I. P. Pavlov were epoch-making in the development of the science of nutrition of the healthy and the sick. His discovery of the most important laws of digestion, including the conditioned reflex changes in the activity of the digestive glands, served as the basis of modern dietetics and as the starting point for developing the principles of dietetics. I. P. Razenkov’s studies devoted to the influence of various dietary regimens on the degree of stimulation of the digestive glands, on the function of the cerebral cortex, and on the strength of the manifestations of conditioned and unconditioned reflexes played a large role in the development of dietetics.
Dietetics developed considerably in the USSR after the Great October Socialist Revolution. The first dietotherapy clinics were organized as early as the 1920’s; a dietetic division in the health resort clinics and a dietetic station of the A. A. Ostroumov Hospital in Moscow were functioning. The extensive development of health resorts and the creation of nutrition institutes (Moscow, Leningrad, Kharkov, Kiev, Odessa, Novosibirsk, and other cities) fostered the subsequent development of dietetics. The Soviet doctor of internal medicine M. I. Pevzner worked out in 1922 for the first time diets for the principal groups of diseases. These diets, having undergone development and improvement, subsequently be-came widespread in the medical practice of many countries. The Soviet scientists S. M. Ryss, M. M. Gubergrits, L. A. Cherkes, D. B. Marshalkovich, N. I. Leporskii, N. K. Miuller, O. P. Molchanova, and B. A. Lavrov, among others, made important contributions to the development of dietetics. Their studies made it possible to outline the following basic propositions of dietetics: a dietary ration may not only increase an organism’s resistance to various diseases but may also have the opposite effect, that is, decrease it; a change from one dietary ration to another produces a reorganization of the organism, including its reactive capacity: and special diets affect not only the function and condition of afflicted systems or organs but the entire organism as well.
Modern dietetics uses the latest methods and achievements of medicine, biochemistry, physiology, morphology, and other sciences, in which the developed propositions receive practical application in the whole complex of treatment. The principal methodological trend in dietetics is a dynamic one, combining elements of experimental research on animals and clinical observations of patients.
The most important problems of dietetics are ensuring balanced and optimal nutrition in planning various-purpose diets; the rational combination of the principles of balanced nutrition and the requirements determined by the nature of the disease; determination of the duration and the limited use of unbalanced and inadequate diets in various diseases; working out the principles of the nutrition of patients in conjunction with specific treatments and chemotheropy, radiation therapy, and the like; working out the principles of combining the elements of dietotherapy with the use of antibiotics, endocrine preparations, and other medications; the development of dietary rations according to the patient’s mobility regimen, taking into account the influence of nutrition on preventing the harmful sequelae of hypokinesia (limitation of mobility).
The following occupy a prominent place in solving the specific problems of dietetics: study of the effectiveness of nutrition in atherosclerosis and associated cardiovascular disturbances in order to introduce the necessary corrective measures in the principles of patient nutrition; determination and scientific validation of the use of fasting as a therapeutic measure in treating the chronically ill; study of the influence of diet in the use of new methods of treating the digestive organs at gastroenterological institutes, clinics, and other medical institutions; and broadening the study of food allergens to more effectively prevent and treat allergies and to develop special diets for these diseases.
The methods and principles of dietetics are widely used in the most varied medical instutitions. In the USSR there is not a single specialized medical establishment that does not make use of nutrition based on the achievements of dietetics in the treatment of its patients. For the most complete and correct use of the achievements of modern dietetics in medical practice, the positions of physician-dietician and nurse-dietician have been introduced at sanatoriums and medical establishments. The theoretical and practical center of dietetics is the Institute of Nutrition of the Academy of Medical Sciences of the USSR; problems of dietetics are also studied by institutes of gastroenterology (Moscow, Alma-Ata). Problems of dietetics are discussed in the journal Voprosy pitaniia (Problems of Nutrition; since 1932) and in several clinical journals. Dietetics abroad amounts principally to the technology of dietetic cooking; in practice, doctors of internal medicine do not concern themselves with problems of dietetics.
REFERENCESPevzner, M. I. Osnovy lechebnogo pitaniia, 3rd ed. Moscow, 1958.
Lechebnoe pitanie. Edited by I. S. Savoshchenko. Moscow, 1971.
K. S. PETROVSKII