The purpose of the review is to analyze the data available in the literature on the actual nutrition of preschoolers. The main provisions of the review are the reasons leading to malnutrition of children in preschool institutions both in the past and in the present, the physical and economic accessibility of food, as well as violations of sanitary legislation in catering.
Keywords: preschoolers, violations in the organization of food, balanced diet; prevention and health improvement of preschoolers.
Socio-economic trends in our society and unfavorable environmental situation entail a deterioration in the health of the child population. According to medical examinations, the proportion of healthy preschoolers has decreased 2.7 times over the past 10 years. A 3–4 times increase in the pathological incidence of children during the period of receiving preschool education indicates a persistent sanitary and epidemiological problem in most preschool educational institutions [1–3]. The negative dynamics of the health status of the younger generation require both preventive medicine specialists and society as a whole to search and implement scientifically based prevention and recovery strategies. Among the complex preventive measures, rational nutrition occupies a special place as one of the main reserves for reducing morbidity and ensuring the normal growth and development of a child [4–6]. Prevention of nutritional disorders is not only a medical and biological, but also a social and hygienic problem and should be aimed primarily at eliminating the causes leading to these disorders. Along with socio-economic and organizational factors, the causes of nutritional disorders in preschoolers are various prenosological conditions in children, which lead to disorders in the absorption and utilization of several nutrients by the body, increased metabolism of energy and nutrients, aggravating the already reduced nonspecific resistance of the body. The emergence of such conditions is often due to the unsatisfactory provision of the body with micronutrients and minor biologically active components of food when organizing food both in the home and in the educational environment [7–9]. Revision of the sanitary rules for preschool institutions: SANITARY RULES AND NORMS 2.4.1.2660–10 «Sanitary and epidemiological requirements for the device, content, and organization of work in preschool organizations» did not lead to significant changes in the organization of children's nutrition. Changes in the direction of weakening the supervisory function of Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (the developed exemplary menus do not pass the approval procedures with the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing authorities, the procedure for conducting and preliminary examination of the draft diet for preschoolers is not regulated) today lead to the fact that incorrectly developed menus are daily implemented in kindergartens. So, we see that despite a large number of regulatory and methodological documents on the organization of children's nutrition in organized groups, its actual state over the past decades remains imperfect.
Of course, the socio-economic situation in the country and the physical and economic availability of food are of great importance in organizing food. In the 1990s, the economic crisis in the country, low wages, and a meager assortment of food products in stores were the reasons leading to the disruption of the organization of meals for children both at home and in kindergarten. Over the years of reforms, the consumption of the number of the most important food products by the population has decreased, and the structure of food rations has sharply deteriorated. The lack of adequate nutrition led to the fact that in 1999, 10 % of conscripts were underweight; more than 40 % of pregnant women suffered from anemia, and the majority of children and young people did not have the necessary set of nutrients and vitamins in their diet.
The structure of children's nutrition at the end of the 20th century was characterized by low consumption of the most biologically valuable food products (meat, meat products, milk, dairy products, fish and seafood, eggs, vegetable oil, fruits, and vegetables) against the background of high consumption of bread and bakery products, and potatoes. Today, despite the huge range of products in stores, the economic instability in the country associated with rising prices leads to disruptions in the supply of food to educational institutions and requires the administration of the preschool educational institution to urgently review the menu without taking into account the correct replacement of products. In this case, the question is no longer raised about a balanced diet. In almost all regions of the country, both in the past and in the present, both general and specific problems in the field of nutrition were identified, depending on socio-economic, climatic, and geographical factors. The issue of physical and economic accessibility of food products at regional levels has not been resolved.
The physical availability of food implies the availability of food throughout the country at any time and in the required range. At present, the saturation of the food market makes it possible to ensure the physical availability of food at least at the minimum level of consumption. Economic accessibility of food — the level of income that allows a citizen to purchase food at least at the minimum level of consumption, regardless of social status and place of residence, is today also a fundamental condition for achieving food security. In the context of the economic crisis in the country, the economic availability of food for organizing children's meals in preschool educational institutions is often the primary reason leading to serious violations in the preparation of food rations.
Studies on the study of the nutrition of children in preschool educational institutions with different material resources in Arkhangelsk (North-Western Federal District) have shown that, regardless of the state of the material resources of preschool institutions, the average protein content in the diets for the seasons was always below the norm (by 10–30 %), proteins of animal origin accounted for only 44 % of their total. In addition, the diet was deficient in carbohydrates (23.3 %) and fats (14.4 %).
A hygienic assessment of the actual nutrition of children showed its imbalance. The diet of children had an excess of calories, carbohydrate-fat orientation with a reduced quota of protein, including animal origin, vitamin, and mineral deficiency was noted. Of the daily compulsory foods, children received sufficient quantities of only bread, potatoes, and sugar, rations were deficient in vegetables and fruits, and children received milk and dairy products not only irregularly, but also in quantities less than the daily requirement.
When studying the actual nutrition of children, it was found that the average daily rations of preschoolers are deficient in the content of the main nutrients: total protein was 76.9 % of the normal physiological requirements (NPR), fats — 74.2 %, carbohydrates — 83.8 %. The actual set of products for the week was characterized by a shortage of fresh fruits, juices, fermented milk products, and cheese. Children received less meat by 30–39 % of the recommended consumption rates (RCR), milk — 62–66 %, fish — 7–24 %, butter — 27 %.
This fact testifies to persistent violations in the organization of children's nutrition in organized groups for a quite long period, indicates the urgency of the problem in modern conditions, emphasizes the need for constant monitoring of the nutrition of the child population at the regional level within the framework of social and hygienic monitoring with an annual in-depth analysis of information. Why nutrition for preschool children attending preschool educational institutions continues to be a problem, and its organization does not meet the requirements, it is necessary to puzzle out. Undoubtedly, the reasons are the physical and economic accessibility of food (insufficient budgetary allocation for food allocated in the regions, which does not take into account the processes of inflation and appreciation, and often the shortage of food). The outdated material and technical base of preschool educational establishments, the lack of conditions for their work on raw materials (lack of production space), the insufficient level of training of kitchen staff and medical workers do not make it possible today to diversify the diet of preschoolers. In this way, it is the monitoring of the organization of nutrition that will make it possible to substantiate the most acceptable ways to rationalize the nutrition of children of organized groups, based on replacing foods with low nutritional value in the diet of preschoolers with alternative functional products saturated with deficient micronutrients following the needs of the child's body of specific age groups and regional affiliation.
References:
- Goncharova I. I. The state of nutrition and health of children in kindergartens in Rostov-on-Don: Diss. candidate of medical sciences. Rostov-on-Don; 2002.
- Onishchenko G. G. The concept of state policy in the field of healthy nutrition: social and hygienic monitoring. In the book: Healthy food: upbringing, education, advertising: materials of the All-Russian scientific and practical conference. M.; 2001: 147.
- Kuchma V. R. Scientific and methodological foundations of the state policy of providing healthy nutrition for children and adolescents in educational institutions Bulletin of the Saint Petersburg State Medical Academy named after I. I. Mechnikov. 2007; (2): 18–22.
