Руководство ВОЗ по питанию женщин
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ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɄɈȾɈȽɊȺɆɆɕ
ɏȺɊȺɄɌȿɊɂɋɌɂɄȺ ɋɌȺɌɍɋȺ ɉɂɌȺɇɂə ɂ ɉɈɌɊȿȻɅȿɇɂə ɉɂɓɂ ɍ ɇȿȻȿɊȿɆȿɇɇɕɏ, ȻȿɊȿɆȿɇɇɕɏ ɂ ɄɈɊɆəɓɂɏ ɀȿɇɓɂɇ
ɐȿɅɂ
ɉɨ ɨɤɨɧɱɚɧɢɢ ɷɬɨɝɨ ɡɚɧɹɬɢɹ ȼɵ ɫɦɨɠɟɬɟ:
•Ɉɛɴɹɫɧɢɬɶ ɩɨɧɹɬɢɹ "ɫɬɚɬɭɫ ɩɢɬɚɧɢɹ" ɢ "ɩɨɬɪɟɛɥɟɧɢɟ ɩɢɳɢ", ɚ ɬɚɤɠɟ ɯɚɪɚɤɬɟɪ ɜɡɚɢɦɨɨɬɧɨɲɟɧɢɣ ɦɟɠɞɭ ɧɢɦɢ ɜ ɬɟɱɟɧɢɟ ɠɢɡɧɟɧɧɨɝɨ ɰɢɤɥɚ
•Ɉɛɴɹɫɧɢɬɶ, ɱɬɨ ɬɚɤɨɟ ɢɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ, ɤɚɤ ɟɝɨ ɪɚɫɫɱɢɬɵɜɚɬɶ ɢ ɩɪɢɦɟɧɹɬɶ ɩɪɢ ɪɚɡɪɚɛɨɬɤɟ ɪɟɤɨɦɟɧɞɚɰɢɣ ɩɨ ɩɪɢɛɚɜɤɟ ɜɟɫɚ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ
•ɉɟɪɟɱɢɫɥɢɬɶ ɫɭɳɟɫɬɜɭɸɳɢɟ ɩɪɚɜɢɥɚ ɡɞɨɪɨɜɨɝɨ ɩɢɬɚɧɢɹ ɞɥɹ ɜɡɪɨɫɥɨɝɨ ɧɚɫɟɥɟɧɢɹ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 1
ɀɢɡɧɟɧɧɵɣ ɰɢɤɥ: ɩɪɟɞɩɨɥɚɝɚɟɦɵɟ ɩɪɢɱɢɧɧɨ-ɫɥɟɞɫɬɜɟɧɧɵɟ ɫɜɹɡɢ
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ȼɵɫɨɤɢɣ |
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ɭɪɨɜɟɧɶ |
ɇɚɪɭɲɟɧɢɟ |
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ɫɦɟɪɬɧɨɫɬɢ ɭɦɫɬɜɟɧɧɨɝɨ |
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ɋɧɢɠɟɧɧɚɹ ɫɩɨɫɨɛɧɨɫɬɶ |
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ɪɚɡɜɢɬɢɹ |
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ɤ ɭɯɨɞɭ ɡɚ ɪɟɛɟɧɤɨɦ |
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ɉɨɜɵɲɟɧɧɵɣ ɪɢɫɤ |
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ɯɪɨɧɢɱɟɫɤɢɯ ɡɚɛɨɥɟɜɚɧɢɣ |
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ɋɬɚɪɨɫɬɶ |
Ɇɥɚɞɟɧɟɰ |
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ɜɨ ɜɡɪɨɫɥɨɦ ɜɨɡɪɚɫɬɟ |
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ɇɟɞɨɫɬɚɬɨɱɧɨɫɬɶ |
ɇɢɡɤɢɣ ɜɟɫ |
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ɇɟɫɜɨɟɜɪɟɦɟɧɧɨɟ/ |
ɩɢɬɚɧɢɹ |
ɩɪɢ ɪɨɠɞɟɧɢɢ |
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ɧɟɚɞɟɤɜɚɬɧɨɟ |
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ɨɬɧɹɬɢɟ ɨɬ ɝɪɭɞɢ |
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ɑɚɫɬɵɟ ɢɧɮɟɤɰɢɢ |
ɇɟɚɞɟɤɜɚɬɧɨɟ |
ɇɟɚɞɟɤɜɚɬɧɵɣ |
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ɇɟɚɞɟɤɜɚɬɧɵɟ |
ɩɢɬɚɧɢɟ |
ɧɚɜɟɪɫɬɵɜɚɸɳɢɣ |
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ɩɢɳɚ, ɡɞɨɪɨɜɶɟ |
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ɩɥɨɞɚ |
ɪɨɫɬ |
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ɢ ɭɯɨɞ |
ɇɟɚɞɟɤɜɚɬɧɚɹ |
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ɩɢɳɚ, ɡɞɨɪɨɜɶɟ |
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ɢ ɭɯɨɞ |
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Ɋɟɛɟɧɨɤ |
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Ɂɚɞɟɪɠɤɚ |
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ɀɟɧɳɢɧɚ |
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ɪɚɡɜɢɬɢɹ |
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ɇɟɞɨɫɬɚɬɨɱɧɨɫɬɶ |
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ɋɧɢɠɟɧɢɟ |
ɩɢɬɚɧɢɹ |
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ɭɦɫɬɜɟɧɧɵɯ |
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ɫɩɨɫɨɛɧɨɫɬɟɣ |
Ȼɟɪɟɦɟɧɧɨɫɬɶ |
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ɇɢɡɤɢɣ ɩɪɢɪɨɫɬ |
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ɉɨɞɪɨɫɬɨɤ |
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ɜɟɫɚ |
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ɇɟɚɞɟɤɜɚɬɧɵɟ |
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Ɂɚɞɟɪɠɤɚ |
ɩɢɳɚ, ɡɞɨɪɨɜɶɟ |
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ɪɚɡɜɢɬɢɹ |
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ɢ ɭɯɨɞ |
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ȼɵɫɨɤɚɹ |
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ɋɧɢɠɟɧɢɟ |
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ɇɟɚɞɟɤɜɚɬɧɚɹ |
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ɦɚɬɟɪɢɧɫɤɚɹ |
ɩɢɳɚ, ɡɞɨɪɨɜɶɟ |
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ɫɦɟɪɬɧɨɫɬɶ |
ɭɦɫɬɜɟɧɧɵɯ |
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ɫɩɨɫɨɛɧɨɫɬɟɣ |
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ɢ ɭɯɨɞ |
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Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 2 |
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ɉɊɂɆȿɊ
ɉɨɫɥɟ ȼɬɨɪɨɣ ɦɢɪɨɜɨɣ ɜɨɣɧɵ ɞɥɹ ɜɡɪɨɫɥɵɯ ɛɵɥɨ ɪɟɤɨɦɟɧɞɨɜɚɧɨ ɩɨɬɪɟɛɥɟɧɢɟ ɨɤɨɥɨ 100 ɝ ɛɟɥɤɚ ɜ ɫɭɬɤɢ
ȼɛɵɜɲɟɦ ɋɋɋɊ ɠɟɧɳɢɧɚɦ ɞɟɬɨɪɨɞɧɨɝɨ ɜɨɡɪɚɫɬɚ ɛɵɥɨ ɪɟɤɨɦɟɧɞɨɜɚɧɨ ɩɨɬɪɟɛɥɟɧɢɟ ɨɤɨɥɨ 80 ɝ ɛɟɥɤɚ ɜ ɫɭɬɤɢ
Ɉɞɧɚɤɨ:
•Ɇɵ ɧɟ ɦɨɠɟɦ ɡɚɩɚɫɚɬɶ ɛɟɥɨɤ (ɜ ɨɬɥɢɱɢɟ ɨɬ ɷɧɟɪɝɢɢ), ɢ ɩɨɷɬɨɦɭ ɥɸɛɨɟ ɢɡɛɵɬɨɱɧɨɟ ɤɨɥɢɱɟɫɬɜɨ ɛɟɥɤɚ ɩɪɟɜɪɚɳɚɟɬɫɹ ɜ ɠɢɪ ɢ ɨɬɤɥɚɞɵɜɚɟɬɫɹ ɜ ɜɢɞɟ ɠɢɪɨɜɨɣ ɬɤɚɧɢ
•Ƚɨɪɚɡɞɨ ɦɟɧɶɲɟɟ ɤɨɥɢɱɟɫɬɜɨ ɛɟɥɤɚ (45–47 ɝ ɜ ɞɟɧɶ ɞɥɹ ɧɟɛɟɪɟɦɟɧɧɵɯ, 48–60 ɝ ɜ ɞɟɧɶ ɞɥɹ ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ) ɞɨɫɬɚɬɨɱɧɨ ɞɥɹ ɩɨɞɞɟɪɠɚɧɢɹ ɚɡɨɬɧɨɝɨ ɛɚɥɚɧɫɚ ɡɞɨɪɨɜɨɝɨ ɱɟɥɨɜɟɤɚ
•ɉɨɜɵɲɟɧɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɛɟɥɤɚ ɱɚɫɬɨ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɩɨɜɵɲɟɧɧɵɦ ɩɨɬɪɟɛɥɟɧɢɟɦ ɠɢɪɨɜ (ɨɫɨɛɟɧɧɨ ɧɚɫɵɳɟɧɧɵɯ ɠɢɪɨɜ)
•ɍɜɟɥɢɱɟɧɢɟ ɩɨɬɪɟɛɥɟɧɢɹ ɦɹɫɚ ɫɜɹɡɚɧɨ ɫ ɭɜɟɥɢɱɟɧɢɟɦ ɱɚɫɬɨɬɵ ɧɟɤɨɬɨɪɵɯ ɯɪɨɧɢɱɟɫɤɢɯ ɡɚɛɨɥɟɜɚɧɢɣ (ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ, ɪɚɤɚ, ɩɚɬɨɥɨɝɢɢ ɫɨɫɭɞɨɜ ɦɨɡɝɚ ɢ ɞɪ.)
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 4
ɉɈɌɊȿȻɇɈɋɌɂ ȼ ɉɂɌȺɌȿɅɖɇɕɏ ȼȿɓȿɋɌȼȺɏ
ɉɨɬɪɟɛɧɨɫɬɢ ɜ ɷɧɟɪɝɢɢ ɢ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜɚɯ ɦɨɝɭɬ ɡɧɚɱɢɬɟɥɶɧɨ ɜɚɪɶɢɪɨɜɚɬɶ ɤɚɤ ɫɪɟɞɢ ɢɧɞɢɜɢɞɭɭɦɨɜ, ɬɚɤ ɢ ɭ ɨɞɧɨɝɨ ɢ ɬɨɝɨ ɠɟ ɢɧɞɢɜɢɞɭɭɦɚ ɜ ɪɚɡɧɨɟ ɜɪɟɦɹ
ɇɟɤɨɬɨɪɵɟ ɮɚɤɬɨɪɵ, ɜɥɢɹɸɳɢɟ ɧɚ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜɚɯ:
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ɜɨɡɪɚɫɬ |
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ɢɧɮɟɤɰɢɢ, ɡɚɛɨɥɟɜɚɧɢɹ |
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ɩɨɥ |
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ɪɨɫɬ, ɪɚɡɜɢɬɢɟ |
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ɪɚɡɦɟɪɵ ɬɟɥɚ (ɪɨɫɬ, ɜɟɫ) |
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ɛɟɪɟɦɟɧɧɨɫɬɶ, ɥɚɤɬɚɰɢɹ |
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ɫɨɫɬɚɜ ɬɟɥɚ |
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ɩɪɟɛɵɜɚɧɢɟ ɧɚ ɫɨɥɧɰɟ |
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ɮɢɡɢɱɟɫɤɚɹ ɚɤɬɢɜɧɨɫɬɶ |
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(ɜɢɬɚɦɢɧ D) |
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ɩɫɢɯɨɥɨɝɢɱɟɫɤɢɣ ɫɬɪɟɫɫ |
ɩɨɬɪɟɛɥɟɧɢɟ ɷɧɟɪɝɢɢ |
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ɢɧɞɢɜɢɞɭɚɥɶɧɵɟ |
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(ɜɢɬɚɦɢɧ B1) |
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ɨɫɨɛɟɧɧɨɫɬɢ ɦɟɬɚɛɨɥɢɡɦɚ |
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Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 5 |
ɋɈɋɌɈəɇɂȿ ɉɂɌȺɇɂə
ɋɨɫɬɨɹɧɢɟ (ɫɬɚɬɭɫ) ɩɢɬɚɧɢɹ – ɨɛɵɱɧɨ ɨɩɪɟɞɟɥɹɟɬɫɹ ɫ ɩɨɦɨɳɶɸ ɚɧɬɪɨɩɨɦɟɬɪɢɢ ɢ ɚɧɚɥɢɡɨɜ ɤɪɨɜɢ
ɉɨɬɪɟɛɥɟɧɢɟ ɩɢɳɟɜɵɯ ɩɪɨɞɭɤɬɨɜ – ɤɨɥɢɱɟɫɬɜɨ ɷɧɟɪɝɢɢ ɢ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ, ɫɨɞɟɪɠɚɳɟɟɫɹ ɜ ɩɨɬɪɟɛɥɹɟɦɨɣ ɩɢɳɟ
ɋɨɫɬɨɹɧɢɟ ɩɢɬɚɧɢɹ ɨɬɪɚɠɚɟɬ ɬɨ, ɧɚɫɤɨɥɶɤɨ ɫɨɛɥɸɞɚɟɬɫɹ ɛɚɥɚɧɫ ɦɟɠɞɭ ɩɨɬɪɟɛɥɟɧɢɟɦ ɩɢɳɢ ɢ ɩɨɬɪɟɛɧɨɫɬɹɦɢ ɨɪɝɚɧɢɡɦɚ ɜ
ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜɚɯ
Ʉɚɤ ɧɟɞɨɫɬɚɬɨɱɧɨɟ, ɬɚɤ ɢ ɱɪɟɡɦɟɪɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ ɹɜɥɹɟɬɫɹ ɧɟɠɟɥɚɬɟɥɶɧɵɦ ɢ ɦɨɠɟɬ ɛɵɬɶ ɜɪɟɞɧɵɦ ɞɥɹ ɡɞɨɪɨɜɶɹ
ɂɫɫɥɟɞɨɜɚɧɢɹ ɩɨɫɥɟɞɧɢɯ ɞɟɫɹɬɢɥɟɬɢɣ ɩɨɤɚɡɚɥɢ, ɱɬɨ ɫɬɚɪɵɣ ɫɨɜɟɬ "ɱɟɦ ɛɨɥɶɲɟ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ – ɬɟɦ ɥɭɱɲɟ" ɧɟ ɜɫɟɝɞɚ ɹɜɥɹɟɬɫɹ ɩɪɚɜɢɥɶɧɵɦ, ɨɫɨɛɟɧɧɨ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 3
ɉɈɌɊȿȻɅȿɇɂȿ ɉɂɓɂ ɂ ɋɈɋɌɈəɇɂȿ ɉɂɌȺɇɂə
ɋɨɫɬɨɹɧɢɟ ɩɢɬɚɧɢɹ ɡɚɜɢɫɢɬ ɨɬ ɧɵɧɟɲɧɟɝɨ ɢ ɩɪɟɞɵɞɭɳɟɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɩɢɳɢ
ɉɪɟɞɵɞɭɳɟɟ ɩɨɬɪɟɛɥɟɧɢɟ ɩɢɳɢ ɨɩɪɟɞɟɥɹɟɬ ɜɟɥɢɱɢɧɭ ɡɚɩɚɫɨɜ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ ɜ ɨɪɝɚɧɢɡɦɟ
ȿɫɥɢ ɩɪɟɞɵɞɭɳɟɟ ɩɨɬɪɟɛɥɟɧɢɟ ɩɢɳɢ ɛɵɥɨ ɧɟɞɨɫɬɚɬɨɱɧɵɦ, ɬɨ ɧɵɧɟɲɧɢɟ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ɧɟɣ ɦɨɝɭɬ ɩɪɟɜɵɲɚɬɶ ɧɨɪɦɚɥɶɧɵɣ ɭɪɨɜɟɧɶ ɢɡ-ɡɚ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɜɨɫɩɨɥɧɢɬɶ ɢɫɬɨɳɟɧɧɵɟ ɡɚɩɚɫɵ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ
ȿɫɥɢ ɜ ɨɪɝɚɧɢɡɦɟ ɢɦɟɸɬɫɹ ɞɨɫɬɚɬɨɱɧɵɟ ɡɚɩɚɫɵ ɩɢɬɚɬɟɥɶɧɨɝɨ ɜɟɳɟɫɬɜɚ, ɬɨ ɤɪɚɬɤɨɜɪɟɦɟɧɧɨɟ ɫɧɢɠɟɧɢɟ ɩɨɬɪɟɛɥɟɧɢɹ ɦɨɠɟɬ ɧɟ ɭɯɭɞɲɢɬɶ ɫɬɚɬɭɫ ɩɢɬɚɧɢɹ ɞɨ ɬɟɯ ɩɨɪ, ɩɨɤɚ ɡɚɩɚɫɵ ɧɟ ɢɫɬɨɳɚɬɫɹ
ɇɟɤɨɬɨɪɵɟ ɩɢɬɚɬɟɥɶɧɵɟ ɜɟɳɟɫɬɜɚ, ɤɨɬɨɪɵɟ ɦɨɝɭɬ ɡɚɩɚɫɚɬɶɫɹ ɜ ɨɪɝɚɧɢɡɦɟ:
•ɷɧɟɪɝɢɹ (ɜ ɜɢɞɟ ɝɥɢɤɨɝɟɧɚ ɢ ɠɢɪɚ)
•ɀɢɪɨɪɚɫɬɜɨɪɢɦɵɟ ɜɢɬɚɦɢɧɵ (ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɜɢɬɚɦɢɧɚ K)
•ɧɟɤɨɬɨɪɵɟ ɦɢɧɟɪɚɥɵ (ɧɚɩɪɢɦɟɪ, ɠɟɥɟɡɨ ɜ ɩɟɱɟɧɢ, ɤɚɥɶɰɢɣ ɜ ɤɨɫɬɧɨɣ ɬɤɚɧɢ)
ɇɟɤɨɬɨɪɵɟ ɩɢɬɚɬɟɥɶɧɵɟ ɜɟɳɟɫɬɜɚ, ɤɨɬɨɪɵɟ ɧɟ ɦɨɝɭɬ ɡɚɩɚɫɚɬɶɫɹ ɜ ɨɪɝɚɧɢɡɦɟ:
•ɛɟɥɨɤ
•ɜɨɞɨɪɚɫɬɜɨɪɢɦɵɟ ɜɢɬɚɦɢɧɵ (ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ B12)
•ɧɟɤɨɬɨɪɵɟ ɦɢɧɟɪɚɥɵ (ɧɚɩɪɢɦɟɪ, ɧɚɬɪɢɣ, ɤɚɥɢɣ, ɯɥɨɪ)
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 6
- 17 -
ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɈɐȿɇɄȺ ɉɈɌɊȿȻɅȿɇɂə ɉɂɓȿȼɕɏ ɉɊɈȾɍɄɌɈȼ
Ɇɟɬɨɞɵ ɨɰɟɧɤɢ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɵɟ: ɉɪɨɫɩɟɤɬɢɜɧɵɟ:
- 24-ɱɚɫɨɜɨɟ ɜɨɫɩɪɨɢɡɜɟɞɟɧɢɟ ɮɚɤɬɢɱɟɫɤɨɝɨ ɩɢɬɚɧɢɹ
ɉɪɟɢɦɭɳɟɫɬɜɚ: ɛɵɫɬɪɨɬɚ, ɞɟɲɟɜɢɡɧɚ, ɭɞɨɛɫɬɜɨ ɞɥɹ ɨɰɟɧɤɢ ɛɨɥɶɲɢɯ ɝɪɭɩɩ ɧɚɫɟɥɟɧɢɹ
ɇɟɞɨɫɬɚɬɤɢ: ɧɟ ɪɟɩɪɟɡɟɧɬɚɬɢɜɟɧ, ɡɚɜɢɫɢɬ ɨɬ ɩɚɦɹɬɢ ɢ ɫɩɨɫɨɛɧɨɫɬɢ ɨɰɟɧɢɬɶ ɤɨɥɢɱɟɫɬɜɨ ɩɨɬɪɟɛɥɟɧɧɨɣ ɩɢɳɢ
- ɜɨɫɩɪɨɢɡɜɟɞɟɧɢɟ ɬɢɩɢɱɧɨɝɨ ɫɭɬɨɱɧɨɝɨ ɪɚɰɢɨɧɚ
ɉɪɟɢɦɭɳɟɫɬɜɚ: ɛɵɫɬɪɨɬɚ, ɞɟɲɟɜɢɡɧɚ, ɛɨɥɶɲɚɹ ɪɟɩɪɟɡɟɧɬɚɬɢɜɧɨɫɬɶ
ɇɟɞɨɫɬɚɬɤɢ: ɦɟɧɶɲɚɹ ɬɨɱɧɨɫɬɶ, ɫɭɛɴɟɤɬɢɜɧɨɫɬɶ
- ɱɚɫɬɨɬɚ ɩɨɬɪɟɛɥɟɧɢɹ ɩɢɳɢ
ɉɪɟɢɦɭɳɟɫɬɜɚ: ɛɵɫɬɪɨɬɚ, ɥɭɱɲɟ ɨɬɪɚɠɚɟɬ ɬɢɩɢɱɧɵɣ ɪɚɰɢɨɧ
ɇɟɞɨɫɬɚɬɤɢ: ɧɟɜɨɡɦɨɠɧɨ ɨɰɟɧɢɬɶ ɤɨɥɢɱɟɫɬɜɨ ɩɨɬɪɟɛɥɟɧɧɨɣ ɩɢɳɢ, ɡɚɜɢɫɢɬ ɨɬ ɩɚɦɹɬɢ ɪɟɫɩɨɧɞɟɧɬɚ
- ɞɧɟɜɧɢɤ ɩɪɢɟɦɚ ɩɢɳɢ (ɨɛɵɱɧɨ ɡɚ 3–7 ɞɧɟɣ)
ɉɪɟɢɦɭɳɟɫɬɜɚ: ɧɟ ɩɨɥɚɝɚɟɬɫɹ ɧɚ ɩɚɦɹɬɶ, ɦɨɠɟɬ ɨɬɪɚɠɚɬɶ ɬɢɩɢɱɧɵɣ ɪɚɰɢɨɧ
ɇɟɞɨɫɬɚɬɤɢ: ɬɪɟɛɭɟɬ ɨɬ ɩɚɰɢɟɧɬɚ ɚɤɤɭɪɚɬɧɨɫɬɢ ɢ ɬɨɱɧɨɫɬɢ
- ɧɚɛɥɸɞɟɧɢɟ
ɉɪɟɢɦɭɳɟɫɬɜɚ: ɧɚɢɛɨɥɟɟ ɬɨɱɟɧ ɢ ɨɛɴɟɤɬɢɜɟɧ
ɇɟɞɨɫɬɚɬɤɢ: ɬɪɟɛɭɟɬ ɨɱɟɧɶ ɛɨɥɶɲɢɯ ɡɚɬɪɚɬ ɜɪɟɦɟɧɢ ɢ ɞɟɧɟɝ
- ɦɟɬɨɞ ɞɜɨɣɧɵɯ ɩɨɪɰɢɣ ɫ ɩɪɨɜɟɞɟɧɢɟɦ
ɯɢɦɢɱɟɫɤɨɝɨ ɚɧɚɥɢɡɚ ɜɬɨɪɨɣ ɩɨɪɰɢɢ
ɉɪɟɢɦɭɳɟɫɬɜɚ: ɧɚɢɛɨɥɟɟ ɬɨɱɟɧ ɢ ɨɛɴɟɤɬɢɜɟɧ
ɇɟɞɨɫɬɚɬɤɢ: ɬɪɟɛɭɟɬ ɨɱɟɧɶ ɛɨɥɶɲɢɯ ɡɚɬɪɚɬ ɜɪɟɦɟɧɢ ɢ ɞɟɧɟɝ
- ɩɢɳɟɜɨɣ ɚɧɚɦɧɟɡ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 7
ɈɐȿɇɄȺ ɋɈɋɌɈəɇɂə ɉɂɌȺɇɂə
Ɇɟɬɨɞɵ ɨɰɟɧɤɢ ɫɬɚɬɭɫɚ ɩɢɬɚɧɢɹ
Ɇɟɞɢɰɢɧɫɤɢɣ ɚɧɚɦɧɟɡ
Ɏɢɡɢɤɚɥɶɧɨɟ ɨɛɫɥɟɞɨɜɚɧɢɟ
-ɨɛɳɢɣ ɜɢɞ
-ɧɚɥɢɱɢɟ ɩɪɢɡɧɚɤɨɜ ɧɟɞɨɫɬɚɬɨɱɧɨɝɨ ɢɥɢ ɢɡɛɵɬɨɱɧɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɛɟɥɤɚ ɢɥɢ ɷɧɟɪɝɢɢ
-ɤɥɢɧɢɱɟɫɤɢɟ ɩɪɢɡɧɚɤɢ ɧɟɞɨɫɬɚɬɤɚ ɢɥɢ ɢɡɛɵɬɤɚ ɤɚɤɢɯ-ɥɢɛɨ ɨɬɞɟɥɶɧɵɯ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ
-ɧɚɥɢɱɢɟ ɮɚɤɬɨɪɨɜ, ɤɨɬɨɪɵɟ ɦɨɝɭɬ ɜɥɢɹɬɶ ɧɚ ɧɨɪɦɚɥɶɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɢɥɢ ɭɫɜɨɟɧɢɟ ɩɢɳɢ
Ⱥɧɬɪɨɩɨɦɟɬɪɢɹ
-ɜɟɫ, ɪɨɫɬ, ɢɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ
-ɢɡɦɟɪɟɧɢɟ ɤɨɠɧɵɯ ɫɤɥɚɞɨɤ (ɧɚ ɛɢɰɟɩɫɟ, ɩɨɞ ɥɨɩɚɬɤɨɣ ɢ ɬ.ɞ.)
-ɢɡɦɟɪɟɧɢɟ ɨɤɪɭɠɧɨɫɬɟɣ (ɬɚɥɢɢ, ɛɟɞɟɪ)
-ɨɛɳɚɹ ɩɨɬɟɪɹ ɢɥɢ ɩɪɢɛɚɜɤɚ ɜ ɜɟɫɟ
Ɉɩɪɟɞɟɥɟɧɢɟ ɚɡɨɬɧɨɝɨ ɛɚɥɚɧɫɚ
Ʌɚɛɨɪɚɬɨɪɧɵɟ ɚɧɚɥɢɡɵ
-ɨɛɳɢɣ ɚɧɚɥɢɡ ɤɪɨɜɢ, ɦɨɱɢ, ɛɢɨɯɢɦɢɱɟɫɤɢɟ ɚɧɚɥɢɡɵ ɢ ɬ.ɞ.
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 10
Ɇɟɬɨɞ 24-ɱɚɫɨɜɨɝɨ ɜɨɫɩɪɨɢɡɜɟɞɟɧɢɹ ɮɚɤɬɢɱɟɫɤɨɝɨ ɩɢɬɚɧɢɹ
•ɇɟ ɩɪɢɦɟɧɢɦ ɫɪɟɞɢ ɞɟɬɟɣ ɜ ɜɨɡɪɚɫɬɟ ɞɨ 7 ɥɟɬ
•ɇɟɨɛɯɨɞɢɦɨɫɬɶ ɢɫɩɨɥɶɡɨɜɚɬɶ ɹɡɵɤ, ɧɚ ɤɨɬɨɪɨɦ ɪɚɡɝɨɜɚɪɢɜɚɟɬ ɢɧɬɟɪɜɶɸɢɪɭɟɦɵɣ
•Ⱦɨɥɠɟɧ ɩɪɨɜɨɞɢɬɶɫɹ ɜ ɬɢɯɨɦ ɦɟɫɬɟ
•Ɋɚɡɞɚɬɨɱɧɵɟ ɦɚɬɟɪɢɚɥɵ – ɮɨɬɨɚɥɶɛɨɦ ɫ ɩɨɞɚɜɚɟɦɵɦɢ ɩɨɪɰɢɹɦɢ ɩɢɳɢ
ȼɨɩɪɨɫɵ
1.ɑɬɨ?
2.Ƚɞɟ?
3.Ʉɚɤ ɦɧɨɝɨ?
4.ɇɟ ɡɚɛɵɥɢ ɥɢ ȼɵ? (ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ ɧɚɜɨɞɹɳɢɟ ɜɨɩɪɨɫɵ)
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 8
ɂɇȾȿɄɋ ɆȺɋɋɕ ɌȿɅȺ
•Ɉɞɢɧ ɢɡ ɩɪɨɫɬɟɣɲɢɯ ɢ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɩɪɢɦɟɧɹɟɦɵɯ ɢɧɞɢɤɚɬɨɪɨɜ ɫɨɫɬɨɹɧɢɹ ɩɢɬɚɧɢɹ
•ɉɨɤɚɡɚɬɟɥɶ ɢɡɛɵɬɨɱɧɨɣ ɦɚɫɫɵ ɬɟɥɚ, ɜɵɱɢɫɥɹɟɦɵɣ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɪɨɫɬɚ ɢ ɜɟɫɚ
ɂɆɌ = ɜɟɫ (ɤɝ) / ɪɨɫɬ (ɦ)2
•ɂɆɌ ɹɜɥɹɟɬɫɹ ɥɭɱɲɢɦ ɢɧɞɢɤɚɬɨɪɨɦ ɫɨɫɬɨɹɧɢɹ ɩɢɬɚɧɢɹ ɠɟɧɳɢɧɵ, ɱɟɦ ɩɪɨɫɬɨ ɜɟɫ, ɩɨɫɤɨɥɶɤɭ ɜ ɧɟɦ ɬɚɤɠɟ ɩɪɢɧɢɦɚɟɬɫɹ ɜ ɪɚɫɱɟɬ ɟɟ ɪɨɫɬ
•Ɋɟɤɨɦɟɧɞɨɜɚɧɧɚɹ ɩɪɢɛɚɜɤɚ ɜ ɜɟɫɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɡɚɜɢɫɢɬ ɨɬ ɂɆɌ (ɢ, ɫɥɟɞɨɜɚɬɟɥɶɧɨ, ɫɨɞɟɪɠɚɧɢɹ ɠɢɪɚ ɜ ɨɪɝɚɧɢɡɦɟ) ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ
•Ɋɚɫɱɟɬ ɢɞɟɚɥɶɧɨɣ ɦɚɫɫɵ ɬɟɥɚ – ɫɦ. ɩɪɢɦɟɪ ɧɚ ɫɥɟɞɭɸɳɟɣ ɤɨɞɨɝɪɚɦɦɟ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 11
ɉɂɓȿȼɈɃ ȺɇȺɆɇȿɁ
• |
ɋɨɰɢɨɷɤɨɧɨɦɢɱɟɫɤɢɟ ɮɚɤɬɨɪɵ |
• |
ɏɪɨɧɢɱɟɫɤɚɹ ɭɫɬɚɥɨɫɬɶ |
• |
Ɏɢɡɢɱɟɫɤɚɹ ɚɤɬɢɜɧɨɫɬɶ |
• |
Ⱦɢɚɪɟɹ, ɡɚɩɨɪɵ |
•ɗɬɧɢɱɟɫɤɢɟ, ɤɭɥɶɬɭɪɧɵɟ ɮɚɤɬɨɪɵ
•ɍɫɥɨɜɢɹ ɢ ɨɛɵɱɧɚɹ ɩɪɚɤɬɢɤɚ ɩɪɢɝɨɬɨɜɥɟɧɢɹ ɩɢɳɢ ɧɚ ɞɨɦɭ, ɧɚɥɢɱɢɟ ɩɢɳɟɜɵɯ ɩɪɨɞɭɤɬɨɜ
•Ⱥɩɩɟɬɢɬ
•Ⱥɥɥɟɪɝɢɢ, ɧɟɩɟɪɟɧɨɫɢɦɨɫɬɶ ɩɢɳɢ, ɫɩɟɰɢɚɥɶɧɵɟ ɞɢɟɬɵ
•ɋɨɫɬɨɹɧɢɟ ɡɭɞɨɜ ɢ ɩɨɥɨɫɬɢ ɪɬɚ
•Ɏɭɧɤɰɢɹ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɨɝɨ ɬɪɚɤɬɚ
•ɏɪɨɧɢɱɟɫɤɢɟ ɡɚɛɨɥɟɜɚɧɢɹ
•ɉɪɢɟɦ ɦɟɞɢɤɚɦɟɧɬɨɜ, ɩɢɳɟɜɵɯ ɞɨɛɚɜɨɤ
•Ɂɥɨɭɩɨɬɪɟɛɥɟɧɢɟ ɩɫɢɯɨɚɤɬɢɜɧɵɦɢ ɜɟɳɟɫɬɜɚɦɢ
•ɇɟɞɚɜɧɢɟ ɢɡɦɟɧɟɧɢɹ ɜɟɫɚ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 9
Ɋɚɫɱɟɬ ɢɞɟɚɥɶɧɨɣ ɦɚɫɫɵ ɬɟɥɚ
ɂɆɌ = ɜɟɫ (ɤɝ) / ɪɨɫɬ (ɦ)2
ɍɫɬɚɧɨɜɢɬɟ ɠɟɥɚɟɦɵɣ ɢɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ (ɧɚɩɪɢɦɟɪ, 24)
24 = ɢɞɟɚɥɶɧɵɣ ɜɟɫ / (ɪɨɫɬ 1,6 ɦ)2
ɂɞɟɚɥɶɧɚɹ ɦɚɫɫɚ ɬɟɥɚ = 24 x (ɪɨɫɬ 1,6 ɦ)2
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɢɞɟɚɥɶɧɚɹ ɦɚɫɫɚ ɬɟɥɚ = 24 x (1,6 x 1,6) = 60,5 ɤɝ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 12
- 18 -
ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
BODY MASS INDEX
|
|
|
Underweight (BMI > 18.5) |
|
Overweight (BMI = 25-29.9) |
|
2.03 |
|
More food may be needed |
|
Some loss of weight would be |
|
|
and this should be part of a |
beneficial to health. |
||
|
2.00 |
|
|||
|
|
well balanced and nutritious |
|
|
|
|
1.98 |
|
diet. In cases of very low |
|
Obese (BMI = 30-39.9) |
|
1.95 |
|
weight, a doctor should be |
In view of the risk from further |
|
|
1.93 |
|
consulted. |
weight gain, it is really |
|
|
1.90 |
|
|
|
important for people in this |
|
1.88 |
|
OK (BMI = 20-24.9) |
category to lose weight. |
|
|
1.86 |
|
The right quantity of food is |
|
Very obese (BMI > 40) |
|
1.83 |
|
being eaten to maintain |
|
|
|
|
weight in the desirable |
Being this overweight could |
||
(m) |
1.80 |
|
range for health, but make |
seriously affect health and |
|
1.78 |
|
||||
|
sure there is a healthy |
wellbeing. There is an urgent |
|||
1.75 |
|
balance in the diet. People |
need to lose weight. It is |
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Height |
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1.73 |
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at the lower end of the |
advisable for a doctor or |
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1.70 |
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weight range should |
dietician to be consulted. |
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1.68 |
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maintain their weight and |
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1.66 |
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not be tempted to aim for |
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1.63 |
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the underweight category. |
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1.60 |
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1.58 |
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1.55 |
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1.53 |
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1.50 |
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1.47 |
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38 45 51 57 64 70 76 83 89 95 102 108 114 121 127 134 140 146 153 159 165 |
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Weight (kg) |
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Health Education Authority 1994, reproduced by permission |
1, Ʉɨɞɨɝɪɚɦɦɚ 13 |
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Ɋɚɡɞɟɥ |
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ɋɈȼȿɌɕ ɉɈ ɁȾɈɊɈȼɈɆɍ ɉɂɌȺɇɂɘ
ɋɟɫɫɢɹ 1, Ʉɨɞɨɝɪɚɦɦɚ 16
5 ɉɂɓȿȼɕɏ ȽɊɍɉɉ
ɏɥɟɛ, |
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Ɇɨɥɨɤɨ ɢ |
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Ɇɹɫɨ, ɪɵɛɚ |
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ɞɪɭɝɢɟ |
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ɦɨɥɨɱɧɵɟ |
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ɮɪɭɤɬɵ |
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ɫɥɚɞɨɫɬɢ |
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ɤɚɪɬɨɮɟɥɶ |
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Ɋɚɫɬɢɬɟɥɶɧɨɟ |
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ɦɚɫɥɨ, |
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ɋɜɟɠɢɟ |
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ɦɚɪɝɚɪɢɧ, |
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ɏɥɟɛ, |
ɫɭɯɢɟ |
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ɦɨɪɨɠɟɧɵɟ, |
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Ɇɨɥɨɤɨ, |
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ɫɥɢɜɨɱɧɨɟ |
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ɡɚɜɬɪɚɤɢ, |
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ɤɨɧɫɟɪɜɢɪɨ- |
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Ɇɹɫɨ, ɪɵɛɚ, |
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ɦɚɫɥɨ, |
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ɦɚɤɚɪɨɧɵ, |
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ɜɚɧɧɵɟ, |
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ɤɟɮɢɪ, |
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ɩɬɢɰɚ, ɹɣɰɚ, |
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ɞɪɭɝɢɟ ɠɢɪɵ, |
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ɤɚɪɬɨɮɟɥɶ, |
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ɫɭɲɟɧɵɟ |
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ɫɵɪɵ, |
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ɛɨɛɨɜɵɟ |
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ɦɚɣɨɧɟɡ, |
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ɪɢɫ ɢ ɞɪ. |
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ɨɜɨɳɢ ɢ |
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ɣɨɝɭɪɬ ɢ ɞɪ. |
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ɛɢɫɤɜɢɬɵ, |
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ɮɪɭɤɬɵ |
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ɬɨɪɬɵ, |
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ɩɟɱɟɧɶɟ, |
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ɫɥɚɞɤɢɟ |
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ɧɚɩɢɬɤɢ |
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6-11 ɩɨɪɰɢɣ |
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5 ɢ ɛɨɥɶɲɟ |
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ɜ ɞɟɧɶ |
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2-3 ɩɨɪɰɢɢ |
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2 ɩɨɪɰɢɢ |
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ɩɨɪɰɢɣ |
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ȿɲɶɬɟ |
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ɜ ɞɟɧɶ |
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ɧɟɦɧɨɝɨ |
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ɜ ɞɟɧɶ |
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ɜ ɞɟɧɶ |
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ɍɝɥɟɜɨɞɵ |
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Ⱥɧɬɢɨɤɫɢ- |
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ɀɢɪɵ, |
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ɤɪɚɯɦɚɥ |
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Ʉɚɥɶɰɢɣ |
, |
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ɀɟɥɟɡɨ |
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( |
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ɞɚɧɬɵ, |
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ɛɟɥɨɤ, |
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ɜ ɬ.ɱ. ɧɟɡɚ- |
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ɩɢɳɟɜɚɹ |
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ɜɢɬɚɦɢɧ ɋ, |
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ɛɟɥɨɤ, |
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ɤɥɟɬɱɚɬɤɚ, |
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ɦɟɧɢɦɵɟ |
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ɤɚɪɨɬɢɧɵ, |
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ɜɢɬɚɦɢɧɵ |
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ɜɢɬɚɦɢɧɵ |
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ɠɢɪɧɵɟ |
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ɧɟɦɧɨɝɨ |
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ɮɨɥɚɬɵ ɋ, |
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Ⱥɢ D, |
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ɝɪɭɩɩɵ ȼ, |
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ɤɢɫɥɨɬɵ, |
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ɜɢɬɚɦɢɧ ȼ12, |
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ɨɫɨɛɟɧɧɨ ȼ12, |
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ɤɚɥɶɰɢɹ ɢ |
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ɩɢɳɟɜɚɹ |
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ɠɟɥɟɡɚ, |
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ɤɥɟɬɱɚɬɤɚ, |
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ɰɢɧɤ, ɦɚɝɧɢɣ |
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ɜɢɬɚɦɢɧɵ |
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ɪɢɛɨɮɥɚɜɢɧ |
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ɬɢɚɦɢɧ ɢ |
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ɤɚɥɢɣ |
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Ɋɚɡɞɟɥ 1, ɄɨɞɨɝɪɚɦɦɚȺ, D ɢ ȿ, 16 |
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ɧɢɚɰɢɧ |
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ɫɚɯɚɪ |
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ɉɊɂȻȺȼɄȺ ȼȿɋȺ ȼɈ ȼɊȿɆə ȻȿɊȿɆȿɇɇɈɋɌɂ
ɋɪɟɞɧɹɹ ɩɪɢɛɚɜɤɚ ɜɟɫɚ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ 10-12 ɤɝ, ɢ ɨɧɚ ɫɨɫɬɨɢɬ ɢɡ ɫɥɟɞɭɸɳɢɯ ɫɨɫɬɚɜɥɹɸɳɢɯ:
ɉɥɨɞ, ɩɥɚɰɟɧɬɚ, ɨɤɨɥɨɜɨɞɧɵɟ ɜɨɞɵ |
5 ɤɝ |
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ɍɜɟɥɢɱɟɧɢɟ ɈɐɄ ɦɚɬɟɪɢ (ɤɪɨɜɶ) |
1–1,5 ɤɝ |
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ȼɧɟɤɥɟɬɨɱɧɚɹ ɠɢɞɤɨɫɬɶ |
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1–1,5 ɤɝ |
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Ɇɚɬɤɚ, ɦɨɥɨɱɧɵɟ ɠɟɥɟɡɵ |
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1–1,5 ɤɝ |
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ɀɢɪɨɜɚɹ ɬɤɚɧɶ |
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4 ɤɝ |
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ɢɥɢ: |
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7 ɤɝ |
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ɜɨɞɚ |
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ɛɟɥɨɤ |
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1 ɤɝ |
(ɀɢɪ ɨɬɤɥɚɞɵɜɚɟɬɫɹ ɜ ɨɫɧɨɜɧɨɦ ɜ |
ɦɚɬɟɪɢɧɫɤɢɣ ɠɢɪ |
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4 ɤɝ |
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1–2-ɦ ɬɪɢɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ) |
Ɋɟɤɨɦɟɧɞɨɜɚɧɧɚɹ ɜ ɋɒȺ ɩɪɢɛɚɜɤɚ ɜɟɫɚ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ* |
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ȼɟɫ ɬɟɥɚ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ |
Ɋɟɤɨɦɟɧɞɭɟɦɵɣ |
ɉɪɢɛɚɜɤɚ ɜɟɫɚ |
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ɇɂɁɄɂɃ |
ɂɆɌ <19,8 |
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12,5–8,0 |
ɇɈɊɆȺɅɖɇɕɃ |
ɂɆɌ 19,9–26,0 |
11,5–16,0 |
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ɂɁȻɕɌɈɑɇɕɃ |
ɂɆɌ 26,1–29,0 |
7,0–11,5 |
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ɈɀɂɊȿɇɂȿ |
ɂɆɌ >29,1 |
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>7 |
*ȼ ȼɟɥɢɤɨɛɪɢɬɚɧɢɢ ɨɛɫɭɠɞɚɟɬɫɹ ɜɨɡɦɨɠɧɨɫɬɶ ɪɟɤɨɦɟɧɞɨɜɚɬɶ ɠɟɧɳɢɧɚɦ ɫ ɧɨɪɦɚɥɶɧɵɦ ɂɆɌ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɢɛɚɜɤɭ ɜ ɜɟɫɟ ɫɜɵɲɟ 6,8 ɤɝ, ɧɨ ɧɟ ɛɨɥɟɟ 11,4 ɤɝ (Feig & Naylor, Lancet 1998; 351: 1054-55)
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 14
ɊȺɋɉɊɈɋɌɊȺɇȿɇɇɈɋɌɖ
ɈɀɂɊȿɇɂə
ɋɊȿȾɂ
ɀȿɇɓɂɇ
ȼ ɇȿɄɈɌɈɊɕɏ ɋɌɊȺɇȺɏ
ɋɟɫɫɢɹ 1, Ʉɨɞɨɝɪɚɦɦɚ 15
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ɋɌɊȺɇȺ |
ɊȺɃɈɇ/ȽɈɊɈȾ |
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ɂɆɌ |
- ɀȿɇɓɂɇɕ |
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L ith u a n ia |
K a u n a s |
< 2 5 |
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2 5 -30 |
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> 30 |
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R u s si a |
N o v o s ib ir s k : in t e rv e n t. |
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R u s si a |
N o v o s ib irs k c o n t ro l |
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M a lta |
M a lta |
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R u s si a |
M o s c o w : In te r v e n tio n |
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R u s si a |
M o s c o w : co n tro l |
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P o la n d |
T a r n o b rz e g V o iv o d s h ip |
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C z e c h o s lo v a k ia |
C z e c h o s lo v a k ia |
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It a ly |
A r e a L a tin a |
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S e rb ia |
N o v i-S a d |
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E . G e r m a n y |
R e s t o f D D R -M o n ic a |
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B e lg iu m |
C h a rle ro i |
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H u n g a r y |
P e c s |
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P o la n d |
W a r s a w |
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E . G e r m a n y |
H a lle C o u n t y |
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S p a in |
C a ta lo n ia |
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F ra n c e |
B a s -R h in |
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F in la n d |
N o rth K a re lia |
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E . G e r m a n y |
C o ttb u s C o u n ty |
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W . G e rm a n y |
A u g s b u rg : r u ra l |
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F in la n d |
K u o p io P ro v in c e |
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E . G e r m a n y |
K a rl-M ar x -S ta d t c o u n ty |
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It a ly |
F riu li |
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W . G e rm a n y |
B re m e n |
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H u n g a r y |
B u d a p e s t |
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F ra n c e |
L ille |
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L u x e m b o u rg |
L u x e m b o u rg P ro v in c e |
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W . G e rm a n y |
B e rlin -L ic h te n b e r g |
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F in la n d |
T u rk u /L o im a a |
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C a n ad a |
H a lifa x C o u n t y |
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U K |
G la s g o w |
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W . G e rm a n y |
A u g s b u rg : u rb a n |
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It a ly |
A re a B ria n z a |
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U S A |
S ta n fo r d |
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B e lg iu m |
G h en t |
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S w it ze rla n d |
T ic in o |
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A u s tr a lia |
N e w c a s tle |
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U K |
B e lfa s t |
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S w e d en |
N o rth e r n S w e d e n |
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W . G e rm a n y |
R h e in - N e c k a r R e g io n |
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S w it ze rla n d |
V a u d /F rib o u rg |
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Ic e la n d |
Ic e la n d |
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F ra n c e |
H a u te -G a r o n n e |
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D e n m a rk |
G lo s tru p |
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A u s tr a lia |
P e rt h |
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S w e d en |
G o t e b o r g |
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N e w Z e a la n d |
A u c k la n d |
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C h in a |
B e jin g |
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Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ |
15 |
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0 |
25 |
50 |
75 |
10 0 |
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% |
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Ɋɚɡɦɟɪɵ ɩɨɪɰɢɣ
Ƚɪɭɩɩɚ 1: ɏɥɟɛ, ɡɥɚɤɨɜɵɟ ɢ ɤɚɪɬɨɮɟɥɶ
1 ɛɨɥɶɲɨɣ ɤɭɫɨɤ ɯɥɟɛɚ (ɨɤɨɥɨ 30–40 ɝ)
0,5 ɱɚɲɤɢ ɨɬɜɚɪɧɵɯ ɦɚɤɚɪɨɧɧɵɯ ɢɡɞɟɥɢɣ
Ƚɪɭɩɩɚ 2: Ɉɜɨɳɢ ɢ ɮɪɭɤɬɵ
160 ɦɥ ɮɪɭɤɬɨɜɨɝɨ ɢɥɢ ɨɜɨɳɧɨɝɨ ɫɨɤɚ (100-ɩɪɨɰɟɧɬɧɵɣ ɧɚɬɭɪɚɥɶɧɵɣ ɫɨɤ)
0,5 ɱɚɲɤɢ (ɨɤɨɥɨ 100 ɝ) ɜɚɪɟɧɵɯ ɢɥɢ ɧɚɪɟɡɚɧɧɵɯ ɫɜɟɠɢɯ ɨɜɨɳɟɣ
Ƚɪɭɩɩɚ 3: Ɇɨɥɨɤɨ ɢ ɦɨɥɨɱɧɵɟ ɩɪɨɞɭɤɬɵ
1 ɫɬɚɤɚɧ (300 ɦɥ) ɦɨɥɨɤɚ (ɫɧɹɬɨɟ, ɫ ɧɢɡɤɢɦ ɫɨɞɟɪɠɚɧɢɟɦ ɠɢɪɚ ɢɥɢ ɰɟɥɶɧɨɟ) 55 ɝ ɬɜɟɪɞɨɝɨ ɫɵɪɚ (ɫɨ ɫɩɢɱɟɱɧɵɣ ɤɨɪɨɛɨɤ)
Ƚɪɭɩɩɚ 4: Ɇɹɫɨ, ɪɵɛɚ ɢ ɡɚɦɟɧɢɬɟɥɢ
70–80 ɝ ɜɚɪɟɧɨɝɨ ɦɹɫɚ ɢɥɢ ɪɵɛɵ 1 ɱɚɲɤɚ (ɨɤɨɥɨ 150–200 ɝ) ɜɚɪɟɧɵɯ ɛɨɛɨɜ
Ƚɪɭɩɩɚ 5: ɀɢɪɵ ɢ ɫɥɚɞɨɫɬɢ
2 ɱɚɣɧɵɟ ɥɨɠɤɢ ɫɥɢɜɨɱɧɨɝɨ ɦɚɫɥɚ, ɦɚɪɝɚɪɢɧɚ ɢɥɢ ɬɨɩɥɟɧɨɝɨ ɫɜɢɧɨɝɨ ɠɢɪɚ (10 ɝ) 4 ɱɚɣɧɵɟ ɥɨɠɤɢ ɪɚɫɬɢɬɟɥɶɧɨɝɨ ɦɚɫɥɚ (10 ɝ)
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 17
ɉɂɊȺɆɂȾȺ
ɉɂɌȺɇɂə
CINDI
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 18
- 19 -
ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɁȾɈɊɈȼɕȿ
ɉɈɊɐɂɂ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 19
ȼɕȼɈȾɕ, ɈɋɇɈȼȺɇɇɕȿ ɇȺ ɄɈɇɐȿɉɐɂɂ ɀɂɁɇȿɇɇɈȽɈ ɐɂɄɅȺ
•Ɋɟɤɨɦɟɧɞɚɰɢɢ ɩɨ ɩɢɬɚɧɢɸ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ ɨɫɧɨɜɚɧɵ ɧɚ ɨɛɳɢɯ ɪɟɤɨɦɟɧɞɚɰɢɹɯ ɩɨ ɩɢɬɚɧɢɸ ɞɥɹ ɜɡɪɨɫɥɨɝɨ ɧɚɫɟɥɟɧɢɹ ɫ ɩɨɩɪɚɜɤɨɣ ɧɚ ɭɜɟɥɢɱɟɧɧɵɟ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ɩɢɬɚɧɢɢ ɜ ɩɟɪɢɨɞ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɝɪɭɞɧɨɝɨ ɜɫɤɚɪɦɥɢɜɚɧɢɹ
•ȼɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ ɠɟɧɳɢɧɵ ɧɚɢɛɨɥɟɟ ɜɨɫɩɪɢɢɦɱɢɜɵ
ɤ ɫɨɜɟɬɚɦ ɨɬɧɨɫɢɬɟɥɶɧɨ ɡɞɨɪɨɜɶɹ ɢ ɛɨɥɟɟ ɫɤɥɨɧɧɵ ɩɟɪɟɣɬɢ ɤ ɡɞɨɪɨɜɨɦɭ ɨɛɪɚɡɭ ɠɢɡɧɢ, ɧɚɢɛɨɥɟɟ ɛɥɚɝɨɩɪɢɹɬɧɨɦɭ ɞɥɹ ɪɟɛɟɧɤɚ
•ɀɟɧɳɢɧɵ, ɩɪɢɨɛɪɟɬɲɢɟ ɡɞɨɪɨɜɵɟ ɩɪɢɜɵɱɤɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ ɦɨɝɭɬ ɩɪɨɞɨɥɠɢɬɶ ɩɪɢɞɟɪɠɢɜɚɬɶɫɹ ɢɯ ɜ ɞɚɥɶɧɟɣɲɟɦ, ɚ ɬɚɤɠɟ ɫɨɞɟɣɫɬɜɨɜɚɬɶ ɨɡɞɨɪɨɜɥɟɧɢɸ ɨɛɪɚɡɚ ɠɢɡɧɢ ɜɫɟɣ ɫɟɦɶɢ
•Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɫ ɩɨɦɨɳɶɸ ɞɚɧɧɨɝɨ ɩɨɞɯɨɞɚ ɦɨɠɧɨ ɫɨɤɪɚɬɢɬɶ ɧɟ
ɬɨɥɶɤɨ ɩɨɤɚɡɚɬɟɥɢ ɦɚɬɟɪɢɧɫɤɨɣ ɢ ɦɥɚɞɟɧɱɟɫɤɨɣ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ ɢ ɫɦɟɪɬɧɨɫɬɢ, ɧɨ ɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɫɬɶ ɨɫɧɨɜɧɵɯ ɯɪɨɧɢɱɟɫɤɢɯ ɡɚɛɨɥɟɜɚɧɢɣ
Ɋɚɡɞɟɥ 1, Ʉɨɞɨɝɪɚɦɦɚ 20
- 20 -
ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɊȺȻɈɌȺ ȼ ȽɊɍɉɉȺɏ
Ɋɚɛɨɬɚ ɜ ɝɪɭɩɩɚɯ 1 ɄȺɄɍɘ ɁɇȺɑɂɆɈɋɌɖ ɂɆȿɘɌ ɌȺɄɂȿ ȼɈɉɊɈɋɕ ɄȺɄ ɇɍɌɊɂɐɂɈɇɇɕɃ
ɋɌȺɌɍɋ ɂ ɇɕɇȿɒɇɂɃ ɊȺɐɂɈɇ ɉɂɌȺɇɂə?
Ƚɪɭɩɩɵ ɩɨ 3–6 ɱɟɥɨɜɟɤ ɍɱɚɫɬɧɢɤɚɦ ɩɪɟɞɥɚɝɚɟɬɫɹ ɨɛɫɭɞɢɬɶ ɪɟɡɭɥɶɬɚɬɵ ɩɪɨɜɟɞɟɧɧɨɝɨ ɢɦɢ ɨɩɪɨɫɚ ɪɚɛɨɬɧɢɤɨɜ
ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɨɬɧɨɫɢɬɟɥɶɧɨ ɪɟɤɨɦɟɧɞɚɰɢɣ ɩɨ ɩɢɬɚɧɢɸ, ɞɚɜɚɟɦɵɯ ɛɟɪɟɦɟɧɧɵɦ ɢ ɤɨɪɦɹɳɢɦ ɠɟɧɳɢɧɚɦ (ɩɪɟɞɤɭɪɫɨɜɨɣ ɛɭɤɥɟɬ ɫ ɥɢɬɟɪɚɬɭɪɨɣ ɞɥɹ ɱɬɟɧɢɹ ɢ ɡɚɞɚɧɢɹɦɢ ɞɥɹ ɭɱɚɫɬɧɢɤɨɜ, ɉɪɢɥɨɠɟɧɢɟ Ⱥ: Ⱦɨɦɚɲɧɹɹ ɪɚɛɨɬɚ I).
ȼɯɨɞɟ ɨɛɫɭɠɞɟɧɢɹ ɫɥɟɞɭɟɬ ɡɚɬɪɨɧɭɬɶ ɫɥɟɞɭɸɳɢɟ ɚɫɩɟɤɬɵ:
ɦɧɟɧɢɹ ɪɚɛɨɬɧɢɤɨɜ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɨɬɧɨɫɢɬɟɥɶɧɨ ɜɚɠɧɨɫɬɢ ɧɭɬɪɢɰɢɨɧɧɨɝɨ ɫɬɚɬɭɫɚ ɢ ɨɩɬɢɦɚɥɶɧɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɩɢɳɟɜɵɯ ɩɪɨɞɭɤɬɨɜ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ
ɤɚɤɨɝɨ ɪɨɞɚ ɪɟɤɨɦɟɧɞɚɰɢɢ ɩɨ ɩɢɬɚɧɢɸ ɩɨɥɭɱɚɸɬ ɠɟɧɳɢɧɵ ɢ ɤɚɤ ɱɚɫɬɨ
ɡɚɢɧɬɟɪɟɫɨɜɚɧɵ ɥɢ ɠɟɧɳɢɧɵ ɜ ɩɨɥɭɱɟɧɢɢ ɫɨɜɟɬɨɜ ɩɨ ɩɢɬɚɧɢɸ
ɩɨɥɨɠɢɬɟɥɶɧɵɣ ɢ ɨɬɪɢɰɚɬɟɥɶɧɵɣ ɨɩɵɬ ɤɨɧɫɭɥɶɬɢɪɨɜɚɧɢɹ ɩɨ ɜɨɩɪɨɫɚɦ ɩɢɬɚɧɢɹ
Ɉɫɧɨɜɵɜɚɹɫɶ ɧɚ ɷɬɢɯ ɞɚɧɧɵɯ ɭɱɚɫɬɧɢɤɢ ɩɪɟɞɫɬɚɜɥɹɸɬ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɟ ɞɨɤɥɚɞ ɫɨ ɫɜɨɢɦɢ ɜɵɜɨɞɚɦɢ, ɤɨɬɨɪɵɟ ɞɨɥɠɧɵɟ ɜɤɥɸɱɚɬɶ ɥɢɱɧɭɸ ɢ/ɢɥɢ ɝɪɭɩɩɨɜɭɸ ɨɰɟɧɤɭ ɫɥɟɞɭɸɳɢɯ ɦɨɦɟɧɬɨɜ:
ɚɞɟɤɜɚɬɧɨɫɬɶ ɧɵɧɟɲɧɟɣ ɫɢɫɬɟɦɵ ɩɪɨɫɜɟɳɟɧɢɹ ɛɟɪɟɦɟɧɧɵɯ ɢ ɤɨɪɦɹɳɢɯ ɠɟɧɳɢɧ ɩɨ ɜɨɩɪɨɫɚɦ ɩɢɬɚɧɢɹ
ɧɚɫɤɨɥɶɤɨ ɯɨɪɨɲɨ ɫɚɦɢ ɪɚɛɨɬɧɢɤɢ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɩɨɧɢɦɚɸɬ ɜɚɠɧɨɫɬɶ ɡɞɨɪɨɜɨɝɨ ɩɢɬɚɧɢɹ
ɢɦɟɸɬ ɥɢ ɪɚɛɨɬɧɢɤɢ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɞɨɫɬɚɬɨɱɧɭɸ ɩɨɞɝɨɬɨɜɤɭɞɥɹ ɬɨɝɨ ɱɬɨɛɵ ɞɚɜɚɬɶ ɪɟɤɨɦɟɧɞɚɰɢɢ ɩɨ ɩɢɬɚɧɢɸ
ɤɚɤɢɟ ɢɡ ɢɦɟɸɳɢɯɫɹ ɡɧɚɧɢɣ/ɭɛɟɠɞɟɧɢɣ ɪɚɛɨɬɧɢɤɨɜ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɧɟ ɫɨɨɬɜɟɬɫɬɜɭɸɬ ɫɨɜɪɟɦɟɧɧɵɦ ɪɟɤɨɦɟɧɞɚɰɢɹɦ ɩɨ ɩɢɬɚɧɢɸ
ɱɬɨ ɦɨɠɟɬ ɛɵɬɶ ɩɪɟɞɩɪɢɧɹɬɨ ɞɥɹ ɭɥɭɱɲɟɧɢɹ ɫɢɬɭɚɰɢɢ ɢ ɞɥɹ ɬɨɝɨ ɱɬɨɛɵ ɡɚɢɧɬɟɪɟɫɨɜɚɬɶ ɪɚɛɨɬɧɢɤɨɜ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɜ ɩɪɢɨɛɪɟɬɟɧɢɢ ɫɨɜɪɟɦɟɧɧɵɯ ɡɧɚɧɢɣ ɨɬɧɨɫɢɬɟɥɶɧɨ ɩɢɬɚɧɢɹ ɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ ɢɯ ɫɪɟɞɢ ɫɜɨɢɯ ɩɚɰɢɟɧɬɨɜ.
Ʉɚɠɞɚɹ ɝɪɭɩɩɚ ɜɵɛɢɪɚɟɬ ɞɨɤɥɚɞɱɢɤɚ, ɤɨɬɨɪɵɣ ɛɭɞɟɬ ɩɪɟɞɫɬɚɜɥɹɬɶ ɪɟɡɭɥɶɬɚɬɵ ɫɨɫɬɨɹɜɲɢɯɫɹ ɨɛɫɭɠɞɟɧɢɣ. ɍɱɚɫɬɧɢɤɢ ɨɛɫɭɠɞɚɸɬ ɪɚɫɫɦɚɬɪɢɜɚɟɦɭɸ ɬɟɦɭɜ ɫɨɫɬɚɜɟ ɝɪɭɩɩ, ɞɨɤɥɚɞɵɜɚɸɬ ɨ ɪɟɡɭɥɶɬɚɬɚɯ ɫɜɨɟɣ ɪɚɛɨɬɵ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɟ, ɩɨɥɭɱɚɸɬ ɤɨɦɦɟɧɬɚɪɢɢ ɨɬ ɫɜɨɢɯ ɤɨɥɥɟɝ, ɚ ɬɚɤɠɟ ɡɚɫɥɭɠɢɜɚɸɬ ɞɨɤɥɚɞɵ ɩɨ ɪɟɡɭɥɶɬɚɬɚɦ ɪɚɛɨɬɵ ɞɪɭɝɢɯ ɝɪɭɩɩ.
- 21 -
ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
Ɂɚɧɹɬɢɟ 2
ɊȿɄɈɆȿɇȾȺɐɂɂ ɉɈ ɉɈɌɊȿȻɅȿɇɂɘ ɉɂɌȺɌȿɅɖɇɕɏ ȼȿɓȿɋɌȼ ȾɅə ɇȿȻȿɊȿɆȿɇɇɕɏ, ȻȿɊȿɆȿɇɇɕɏ ɂ ɄɈɊɆəɓɂɏ ɀȿɇɓɂɇ
- 22 -
ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɆȺɌȿɊɂȺɅɕ ȾɅə ɉɊȿɉɈȾȺȼȺɌȿɅȿɃ
ɐȿɅɂ
ɐɟɥɢ ɩɪɟɩɨɞɚɜɚɬɟɥɟɣ:
ɩɨɦɨɱɶ ɭɱɚɫɬɧɢɤɚɦ ɩɨɧɹɬɶ ɪɚɡɥɢɱɢɹ ɦɟɠɞɭ ɢɧɞɢɜɢɞɭɚɥɶɧɵɦɢ ɩɨɬɪɟɛɧɨɫɬɹɦɢ ɜ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜɚɯ, ɪɟɤɨɦɟɧɞɭɟɦɵɦɢ ɧɨɪɦɚɦɢ ɩɨɬɪɟɛɥɟɧɢɹ ɢ ɩɪɚɜɢɥɚɦɢ ɪɚɰɢɨɧɚɥɶɧɨɝɨ ɩɢɬɚɧɢɹ;
ɩɨɦɨɱɶ ɭɱɚɫɬɧɢɤɚɦ ɩɨɧɹɬɶ ɦɟɠɞɭɧɚɪɨɞɧɵɟ ɪɟɤɨɦɟɧɞɚɰɢɢ ɩɨ ɩɨɬɪɟɛɥɟɧɢɸ ɷɧɟɪɝɢɢ ɢ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ, ɚ ɬɚɤɠɟ ɩɪɢɧɰɢɩɵ, ɥɟɠɚɳɢɟ ɜ ɨɫɧɨɜɟ ɷɬɢɯ ɪɟɤɨɦɟɧɞɚɰɢɣ.
Ʉɨɞɨɝɪɚɦɦɚ 1: ɰɟɥɢ
ɉɨ ɨɤɨɧɱɚɧɢɢ ɷɬɨɝɨ ɡɚɧɹɬɢɹ ɭɱɚɫɬɧɢɤɢ ɫɦɨɝɭɬ:
ɨɛɴɹɫɧɢɬɶ ɪɚɡɥɢɱɢɹ ɦɟɠɞɭ ɩɢɳɟɜɵɦɢ ɩɨɬɪɟɛɧɨɫɬɹɦɢ, ɪɟɤɨɦɟɧɞɭɟɦɵɦɢ ɧɨɪɦɚɦɢ ɩɨɬɪɟɛɥɟɧɢɹ ɢ ɩɪɚɜɢɥɚɦɢ ɪɚɰɢɨɧɚɥɶɧɨɝɨ ɩɢɬɚɧɢɹ;
ɩɟɪɟɱɢɫɥɢɬɶ ɢ ɪɚɡɴɹɫɧɢɬɶ ɦɟɠɞɭɧɚɪɨɞɧɵɟ ɪɟɤɨɦɟɧɞɚɰɢɢ ɨɬɧɨɫɢɬɟɥɶɧɨ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ, ɛɟɥɤɚ, ɠɟɥɟɡɚ, ɣɨɞɚ, ɤɚɥɶɰɢɹ, ɜɢɬɚɦɢɧɚ D, ɰɢɧɤɚ, ɜɢɬɚɦɢɧɚ ɋ ɢ ɮɨɥɢɟɜɨɣ ɤɢɫɥɨɬɵ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɚ ɬɚɤɠɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ.
Ʉɨɞɨɝɪɚɦɦɚ 2
ɉɪɢ ɨɛɴɹɫɧɟɧɢɢ ɪɟɤɨɦɟɧɞɭɟɦɵɯ ɧɨɪɦ ɩɨɬɪɟɛɥɟɧɢɹ ɞɥɹ ɧɚɫɟɥɟɧɢɹ ɩɪɟɩɨɞɚɜɚɬɟɥɶ ɞɨɥɠɟɧ ɩɨɞɱɟɪɤɧɭɬɶ, ɱɬɨ ɢɧɞɢɜɢɞɭɚɥɶɧɵɟ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜɚɯ ɡɧɚɱɢɬɟɥɶɧɨ ɜɚɪɶɢɪɭɸɬ, ɢ ɩɨɷɬɨɦɭɧɟɜɨɡɦɨɠɧɨ ɭɫɬɚɧɨɜɢɬɶ ɨɞɢɧ ɫɬɚɧɞɚɪɬ ɩɪɢɟɦɚ ɩɢɳɢ ɞɥɹ ɪɚɡɥɢɱɧɵɯ ɢɧɞɢɜɢɞɭɭɦɨɜ. Ɉɞɧɚɤɨ ɫɭɳɟɫɬɜɭɟɬ ɩɨɬɪɟɛɧɨɫɬɶ ɜ ɧɟɤɨɬɨɪɵɯ ɫɬɚɧɞɚɪɬɧɵɯ ɧɨɪɦɚɬɢɜɚɯ, ɫ ɤɨɬɨɪɵɦɢ ɦɨɠɧɨ ɛɵ ɛɵɥɨ ɫɪɚɜɧɢɜɚɬɶ ɩɨɬɪɟɛɥɟɧɢɟ ɩɢɳɢ ɛɨɥɶɲɢɦɢ ɝɪɭɩɩɚɦɢ ɧɚɫɟɥɟɧɢɹ.
Ʉɨɞɨɝɪɚɦɦɚ 3
ɉɪɟɩɨɞɚɜɚɬɟɥɶ ɨɛɴɹɫɧɹɟɬ ɤɨɧɰɟɩɰɢɸ “ɧɨɪɦɚɥɶɧɨɝɨ ɪɚɫɩɪɟɞɟɥɟɧɢɹ” ɢɧɞɢɜɢɞɭɚɥɶɧɵɯ ɩɢɳɟɜɵɯ ɩɨɬɪɟɛɧɨɫɬɟɣ. Ɋɚɫɩɪɟɞɟɥɟɧɢɟ ɢɧɞɢɜɢɞɭɚɥɶɧɵɯ ɩɨɬɪɟɛɧɨɫɬɟɣ ɜ ɷɧɟɪɝɢɢ ɢ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜɚɯ, ɤɚɤ ɩɪɚɜɢɥɨ, ɢɦɟɟɬ ɜɢɞ “ɧɨɪɦɚɥɶɧɨɝɨ ɪɚɫɩɪɟɞɟɥɟɧɢɹ”. ɗɬɨ ɨɡɧɚɱɚɟɬ, ɱɬɨ ɩɨɞɚɜɥɹɸɳɟɟ ɛɨɥɶɲɢɧɫɬɜɨ ɥɸɞɟɣ ɜ ɞɚɧɧɨɣ ɩɨɩɭɥɹɰɢɢ ɢɦɟɸɬ ɩɨɬɪɟɛɧɨɫɬɢ, ɤɨɬɨɪɵɟ ɨɱɟɧɶ ɛɥɢɡɤɢ ɤ ɫɪɟɞɧɢɦ ɩɨɬɪɟɛɧɨɫɬɹɦ ɜ ɞɚɧɧɨɣ ɩɨɩɭɥɹɰɢɢ, ɚ ɩɨ ɦɟɪɟ ɨɬɞɚɥɟɧɢɹ ɨɬ ɫɪɟɞɧɟɝɨ ɡɧɚɱɟɧɢɹ ɜɫɟ ɦɟɧɶɲɟ ɥɸɞɟɣ ɢɦɟɸɬ ɩɨɬɪɟɛɧɨɫɬɢ ɜɵɲɟ ɢɥɢ ɧɢɠɟ ɫɪɟɞɧɢɯ.
Ɋɟɤɨɦɟɧɞɭɟɦɵɟ ɧɨɪɦɵ ɩɨɥɭɱɚɸɬ ɩɭɬɟɦ ɢɡɭɱɟɧɢɹ ɩɢɳɟɜɵɯ ɩɨɬɪɟɛɧɨɫɬɟɣ ɛɨɥɶɲɢɯ ɝɪɭɩɩ ɧɚɫɟɥɟɧɢɹ. ɗɬɢ ɧɨɪɦɵ ɦɨɝɭɬ ɛɵɬɶ ɭɫɬɚɧɨɜɥɟɧɵ ɧɚ ɪɚɡɥɢɱɧɵɯ ɭɪɨɜɧɹɯ, ɧɚɩɪɢɦɟɪ, ɧɚ ɭɪɨɜɧɹɯ ɧɢɡɤɢɯ, ɫɪɟɞɧɢɯ ɢɥɢ ɜɵɫɨɤɢɯ ɩɨɬɪɟɛɧɨɫɬɟɣ. Ɋɟɤɨɦɟɧɞɭɟɦɵɟ ɜɟɥɢɱɢɧɵ ɢɥɢ
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ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɧɨɪɦɵ ɧɟɨɛɯɨɞɢɦɨ ɩɪɢɦɟɧɹɬɶ ɫ ɛɨɥɶɲɨɣ ɨɫɬɨɪɨɠɧɨɫɬɶɸ ɧɚ ɢɧɞɢɜɢɞɭɚɥɶɧɨɦ ɭɪɨɜɧɟ, ɩɨɫɤɨɥɶɤɭ ɨɧɢ ɩɪɟɞɧɚɡɧɚɱɟɧɵ ɞɥɹ ɩɨɩɭɥɹɰɢɣ, ɚ ɧɟ ɞɥɹ ɨɬɞɟɥɶɧɵɯ ɢɧɞɢɜɢɞɭɭɦɨɜ.
Ʉɨɞɨɝɪɚɦɦɚ 4
ɇɟɨɛɯɨɞɢɦɨ ɨɛɴɹɫɧɢɬɶ, ɱɬɨ ɪɟɤɨɦɟɧɞɭɟɦɵɟ ɧɨɪɦɵ, ɤɨɬɨɪɵɟ ɛɭɞɭɬ ɩɪɟɞɫɬɚɜɥɟɧɵ ɞɚɥɟɟ ɜɨ ɜɪɟɦɹ ɡɚɧɹɬɢɹ (ɧɨɪɦɵ ȼɈɁ, ȿɜɪɨɩɵ ɢ ɋɒȺ), ɭɫɬɚɧɨɜɥɟɧɵ ɧɚ ɭɪɨɜɧɹɯ, ɞɨɫɬɚɬɨɱɧɵɯ ɩɨɱɬɢ ɞɥɹ ɤɚɠɞɨɝɨ ɡɞɨɪɨɜɨɝɨ ɜɡɪɨɫɥɨɝɨ ɱɟɥɨɜɟɤɚ. Ɉɞɧɚɤɨ ɷɬɢ ɧɨɪɦɵ ɦɨɝɭɬ ɛɵɬɶ ɡɚɜɵɲɟɧɧɵɦɢ ɞɥɹ ɦɧɨɝɢɯ ɥɸɞɟɣ (ɨɫɨɛɟɧɧɨ ɧɟɠɟɥɚɬɟɥɶɧɨ ɢɡɛɵɬɨɱɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɛɟɥɤɚ ɢ ɷɧɟɪɝɢɢ).
ɋɦ.: Garrow JS, James WP (eds), Human Nutrition and Dietetics, 9th ed., Churchill and Livingstone, 1993, pp. 787-796.
ɉɪɚɜɢɥɚ ɩɢɬɚɧɢɹ ɪɚɡɪɚɛɚɬɵɜɚɸɬɫɹ ɧɚ ɨɫɧɨɜɟ ɪɟɤɨɦɟɧɞɭɟɦɵɯ ɧɨɪɦ ɢ ɫɨɜɪɟɦɟɧɧɵɯ ɧɚɭɱɧɵɯ ɡɧɚɧɢɣ ɫ ɰɟɥɶɸ ɞɚɬɶ ɧɚɫɟɥɟɧɢɸ ɩɪɨɫɬɵɟ ɢ ɩɪɚɤɬɢɱɧɵɟ ɫɨɜɟɬɵ ɩɨ ɡɞɨɪɨɜɨɦɭ ɩɢɬɚɧɢɸ (ɧɚɩɪɢɦɟɪ, “ɩɢɪɚɦɢɞɚ ɡɞɨɪɨɜɨɣ ɩɢɳɢ”, “ɫɨɜɟɬɵ ɩɨ ɡɞɨɪɨɜɨɦɭɩɢɬɚɧɢɸ”, “ɬɚɪɟɥɤɚ ɡɞɨɪɨɜɨɣ ɩɢɳɢ” ɢ ɬ.ɞ.).
Ʉɨɞɨɝɪɚɦɦɚ 5
ȼɫɟ ɟɳɟ ɫɭɳɟɫɬɜɭɸɬ ɩɪɨɬɢɜɨɪɟɱɢɹ ɨɬɧɨɫɢɬɟɥɶɧɨ ɫɪɟɞɧɟɝɨ ɪɟɤɨɦɟɧɞɭɟɦɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ. ɉɪɟɩɨɞɚɜɚɬɟɥɶ ɞɨɥɠɟɧ ɩɨɞɱɟɪɤɧɭɬɶ ɪɚɡɥɢɱɢɹ ɦɟɠɞɭɫɪɟɞɧɢɦɢ ɪɟɤɨɦɟɧɞɭɟɦɵɦɢ ɧɨɪɦɚɦɢ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ ɢ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ ɨɬɧɨɫɢɬɟɥɶɧɨ ɩɨɬɪɟɛɥɟɧɢɹ ɞɪɭɝɢɯ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ. ȼ ɬɨ ɜɪɟɦɹ ɤɚɤ ɪɟɤɨɦɟɧɞɚɰɢɢ ɩɨ ɩɨɬɪɟɛɥɟɧɢɸ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ ɦɨɝɭɬ ɛɵɬɶ ɭɫɬɚɧɨɜɥɟɧɵ ɧɚ ɫɥɟɝɤɚ ɡɚɜɵɲɟɧɧɨɦ ɭɪɨɜɧɟ, ɜ ɫɥɭɱɚɟ ɷɧɟɪɝɢɢ ɷɬɨ ɧɟɠɟɥɚɬɟɥɶɧɨ. ɇɟɨɛɯɨɞɢɦɨ ɩɨɞɱɟɪɤɧɭɬɶ, ɱɬɨ ɩɨɫɤɨɥɶɤɭɨɠɢɪɟɧɢɟ ɹɜɥɹɟɬɫɹ ɨɞɧɨɣ ɢɡ ɜɚɠɧɟɣɲɢɯ ɩɪɨɛɥɟɦ ɫɨɜɪɟɦɟɧɧɨɝɨ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ, ɩɪɨɩɚɝɚɧɞɚ ɢɡɛɵɬɨɱɧɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ ɹɜɥɹɟɬɫɹ ɧɟɠɟɥɚɬɟɥɶɧɨɣ. ɇɚ ɫɟɝɨɞɧɹɲɢɣ ɞɟɧɶ ɫɭɳɟɫɬɜɭɸɬ ɥɢɲɶ ɩɪɢɛɥɢɠɟɧɧɵɟ ɨɰɟɧɤɢ ɫɨɜɪɟɦɟɧɧɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ, ɤɨɬɨɪɵɟ ɦɨɝɭɬ ɞɚɬɶ ɨɛɳɟɟ ɩɪɟɞɫɬɚɜɥɟɧɢɟ ɨɬɧɨɫɢɬɟɥɶɧɨ ɬɨɝɨ, ɤɚɤɢɦɢ ɦɨɝɭɬ ɛɵɬɶ ɢɧɞɢɜɢɞɭɚɥɶɧɵɟ ɩɨɬɪɟɛɧɨɫɬɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ. ɉɨɷɬɨɦɭɞɥɹ ɪɟɤɨɦɟɧɞɚɰɢɣ ɨɬɧɨɫɢɬɟɥɶɧɨ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ ɢɫɩɨɥɶɡɭɟɬɫɹ ɋɇɉ (ɩɪɟɞɩɨɥɚɝɚɟɦɚɹ ɫɪɟɞɧɹɹ ɧɨɪɦɚ ɩɨɬɪɟɛɥɟɧɢɹ, ɞɨɫɬɚɬɨɱɧɚɹ ɩɪɢɛɥɢɡɢɬɟɥɶɧɨ ɞɥɹ 50% ɧɚɫɟɥɟɧɢɹ), ɬɨɝɞɚ ɤɚɤ ɞɥɹ ɨɫɬɚɥɶɧɵɯ ɩɢɬɚɬɟɥɶɧɵɯ ɜɟɳɟɫɬɜ ɢɫɩɨɥɶɡɭɟɬɫɹ Ɋɇɉ (ɪɟɤɨɦɟɧɞɭɟɦɚɹ ɧɨɪɦɚ ɩɨɬɪɟɛɥɟɧɢɹ, ɞɨɫɬɚɬɨɱɧɚɹ ɞɥɹ 95% ɧɚɫɟɥɟɧɢɹ).
Ɉɛɵɱɧɨ ɠɟɧɳɢɧɵ ɫ ɧɨɪɦɚɥɶɧɵɦ ɭɪɨɜɧɟɦ ɩɢɬɚɧɢɹ ɧɭɠɞɚɸɬɫɹ ɜ ɨɬɧɨɫɢɬɟɥɶɧɨ ɧɟɛɨɥɶɲɨɦ ɭɜɟɥɢɱɟɧɢɢ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ (ɨɤɨɥɨ 200 ɤɤɚɥ/ɞɟɧɶ) ɜ ɩɨɫɥɟɞɧɟɦ ɬɪɢɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ (ɫɦ. Durnin et al., ɚ ɬɚɤɠɟ Feig and Naylor, Lancet, 1998, ɜ ɫɩɢɫɤɟ ɪɟɤɨɦɟɧɞɨɜɚɧɧɨɣ ɥɢɬɟɪɚɬɭɪɵ). ɗɬɨ ɦɨɠɟɬ ɛɵɬɶ ɞɨɫɬɢɝɧɭɬɨ, ɧɚɩɪɢɦɟɪ, ɭɩɨɬɪɟɛɥɟɧɢɟɦ ɞɨɩɨɥɧɢɬɟɥɶɧɨ 3 ɧɟɛɨɥɶɲɢɯ ɤɭɫɤɨɜ ɯɥɟɛɚ, 2 ɫɪɟɞɧɢɯ ɤɚɪɬɨɮɟɥɢɧ ɢɥɢ 1,5 ɫɬɚɤɚɧɚ ɦɨɥɨɤɚ ɜ ɞɟɧɶ (ɫɦ. ɬɚɛɥɢɰɭɩɪɨɞɭɤɬɨɜ, ɫɨɞɟɪɠɚɳɢɯ 100 ɤɤɚɥ). ɍɪɨɜɟɧɶ ɢɧɞɢɜɢɞɭɚɥɶɧɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɷɧɟɪɝɢɢ ɞɨɥɠɟɧ ɦɨɞɢɮɢɰɢɪɨɜɚɬɶɫɹ ɫ ɭɱɟɬɨɦ ɫɬɚɬɭɫɚ ɩɢɬɚɧɢɹ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɫɬɟɩɟɧɢ ɮɢɡɢɱɟɫɤɨɣ ɚɤɬɢɜɧɨɫɬɢ ɢ ɞɪɭɝɢɯ ɮɚɤɬɨɪɨɜ (ɫɦ. ɤɨɞɨɝɪɚɦɦɭ). ɇɟɨɛɯɨɞɢɦɨ ɩɨɞɱɟɪɤɧɭɬɶ, ɱɬɨ ɞɚɠɟ ɢɫɬɨɳɟɧɧɵɟ ɠɟɧɳɢɧɵ ɫ ɧɢɡɤɢɦ ɩɨɬɪɟɛɥɟɧɢɟɦ ɩɢɳɢ ɫɩɨɫɨɛɧɵ ɜɵɪɚɛɚɬɵɜɚɬɶ ɞɨɫɬɚɬɨɱɧɨɟ ɤɨɥɢɱɟɫɬɜɨ ɝɪɭɞɧɨɝɨ ɦɨɥɨɤɚ. Ⱦɨɩɨɥɧɢɬɟɥɶɧɵɟ ɷɧɟɪɝɟɬɢɱɟɫɤɢɟ ɩɨɬɪɟɛɧɨɫɬɢ ɥɚɤɬɚɰɢɢ (ɨɤɨɥɨ 400–500 ɤɤɚɥ/ɞɟɧɶ) ɦɨɝɭɬ ɛɵɬɶ ɱɚɫɬɢɱɧɨ ɭɞɨɜɥɟɬɜɨɪɟɧɵ ɡɚ ɫɱɟɬ ɡɚɩɚɫɨɜ ɠɢɪɨɜɨɣ ɬɤɚɧɢ, ɧɚɤɨɩɥɟɧɧɵɯ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ. ɏɨɬɹ
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ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
ɨɩɹɬɶ ɠɟ, ɢɞɟɚɥɶɧɵɦ ɢɫɬɨɱɧɢɤɨɦ ɷɧɟɪɝɢɢ ɹɜɥɹɟɬɫɹ ɯɥɟɛ (ɞɨɩɨɥɧɢɬɟɥɶɧɨ 6–8 ɤɭɫɤɨɜ ɜ ɞɟɧɶ) ɢɥɢ ɤɚɪɬɨɮɟɥɶ (ɞɨɩɨɥɧɢɬɟɥɶɧɨ 4–5 ɤɚɪɬɨɮɟɥɢɧ ɜ ɞɟɧɶ).
Ʉɨɞɨɝɪɚɦɦɚ 6
Ɋɟɤɨɦɟɧɞɚɰɢɢɩɨɩɨɬɪɟɛɥɟɧɢɸɷɧɟɪɝɢɢɜɨɜɪɟɦɹɥɚɤɬɚɰɢɢɛɚɡɢɪɭɸɬɫɹɧɚɫɥɟɞɭɸɳɢɯ ɫɨɨɛɪɚɠɟɧɢɹɯ. ɋɪɟɞɧɟɟɫɨɞɟɪɠɚɧɢɟɷɧɟɪɝɢɢɜɝɪɭɞɧɨɦɦɨɥɨɤɟ– 70 ɤɤɚɥ/100 ɦɥ. ɗɧɟɪɝɢɹ ɦɚɬɟɪɢ ɩɪɟɜɪɚɳɚɟɬɫɹ ɜ ɷɧɟɪɝɢɸ ɝɪɭɞɧɨɝɨ ɦɨɥɨɤɚ ɫ ɷɮɮɟɤɬɢɜɧɨɫɬɶɸ ɨɤɨɥɨ 80% (ɜ ɩɪɟɞɟɥɚɯ 76–94%). ɋɥɟɞɨɜɚɬɟɥɶɧɨ, ɞɥɹɫɢɧɬɟɡɚ100 ɝɦɨɥɨɤɚɬɪɟɛɭɟɬɫɹɨɤɨɥɨ85 ɤɤɚɥɷɧɟɪɝɢɢ ɦɚɬɟɪɢ. ɋɪɟɞɧɹɹɜɵɪɚɛɨɬɤɚɝɪɭɞɧɨɝɨɦɨɥɨɤɚ– 750 ɦɥ/ɞɟɧɶɜɩɟɪɜɵɟ6 ɦɟɫɹɰɟɜɩɨɫɥɟɪɨɞɨɜɢ 600 ɦɥ/ɞɟɧɶɧɚɩɪɨɬɹɠɟɧɢɢɩɨɫɥɟɞɭɸɳɢɯ 6 ɦɟɫɹɰɟɜ, ɱɬɨɫɨɨɬɜɟɬɫɬɜɭɟɬ 640 ɤɤɚɥ/ɞɟɧɶɢ 510 ɤɤɚɥ/ɞɟɧɶ ɦɚɬɟɪɢɧɫɤɨɣ ɷɧɟɪɝɢɢ. Ɉɞɧɚɤɨ ɡɚɩɚɫɵ ɷɧɟɪɝɢɢ ɜ ɜɢɞɟ ɠɢɪɨɜɨɣ ɬɤɚɧɢ ɦɚɬɟɪɢ (2–3 ɤɝ) ɦɨɝɭɬ ɩɨɫɬɚɜɥɹɬɶ 100–150 ɤɤɚɥ/ɞɟɧɶ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɩɟɪɜɵɯ 6 ɦɟɫɹɰɟɜ ɥɚɤɬɚɰɢɢ. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɞɨɩɨɥɧɢɬɟɥɶɧɚɹ ɧɟɨɛɯɨɞɢɦɚɹ ɷɧɟɪɝɢɹ, ɤɨɬɨɪɚɹ ɞɨɥɠɧɚ ɩɨɫɬɭɩɚɬɶ ɫ ɩɢɳɟɣ, ɫɨɫɬɚɜɥɹɟɬ ɨɤɨɥɨ 500 ɤɤɚɥ/ɞɟɧɶ.
Ʉɨɞɨɝɪɚɦɦɚ 7
ɍɜɟɥɢɱɟɧɢɟ ɩɨɬɪɟɛɧɨɫɬɟɣ ɜ ɛɟɥɤɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ ɨɬɧɨɫɢɬɟɥɶɧɨ ɧɟɜɟɥɢɤɨ ɢ ɦɨɠɟɬ ɛɵɬɶ ɭɞɨɜɥɟɬɜɨɪɟɧɨ ɩɭɬɟɦ ɞɨɩɨɥɧɢɬɟɥɶɧɨɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɯɥɟɛɚ, ɱɬɨ ɭɞɨɜɥɟɬɜɨɪɹɟɬ ɨɞɧɨɜɪɟɦɟɧɧɨ ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ɷɧɟɪɝɢɢ. Ɋɟɤɨɦɟɧɞɚɰɢɢ ɩɨ ɩɨɬɪɟɛɥɟɧɢɸ ɛɟɥɤɚ, ɩɪɢɧɹɬɵɟ ɜ ɛɵɜɲɟɦ ɋɋɋɊ, ɹɜɥɹɸɬɫɹ ɡɚɜɵɲɟɧɧɵɦɢ (ɫɦ. ɨɛɫɭɠɞɟɧɢɟ ɜ ɡɚɧɹɬɢɢ 1). Ȼɨɥɶɲɢɧɫɬɜɨ ɠɟɧɳɢɧ ɢ ɛɟɡ ɬɨɝɨ ɩɨɬɪɟɛɥɹɟɬ ɛɨɥɶɲɟ ɛɟɥɤɚ, ɱɟɦ ɪɟɤɨɦɟɧɞɨɜɚɧɨ, ɬɚɤ ɱɬɨ ɞɚɥɶɧɟɣɲɟɟ ɭɜɟɥɢɱɟɧɢɟ ɟɝɨ ɩɨɬɪɟɛɥɟɧɢɹ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɥɚɤɬɚɰɢɢ ɧɟ ɩɨɤɚɡɚɧɨ. ɑɬɨɛɵ ɨɛɟɫɩɟɱɢɬɶ ɫɨɯɪɚɧɟɧɢɟ ɫɢɧɬɟɡɢɪɨɜɚɧɧɨɝɨ ɛɟɥɤɚ, ɧɟɨɛɯɨɞɢɦɨ ɩɨɬɪɟɛɥɹɬɶ ɞɨɫɬɚɬɨɱɧɨɟ ɤɨɥɢɱɟɫɬɜɨ ɷɧɟɪɝɢɢ ɫ ɬɚɤɢɦɢ ɩɪɨɞɭɤɬɚɦɢ, ɤɚɤ ɯɥɟɛ, ɤɪɭɩɵ ɢ ɦɚɤɚɪɨɧɧɵɟ ɢɡɞɟɥɢɹ, ɤɨɬɨɪɵɟ ɜ ɬɨ ɠɟ ɜɪɟɦɹ ɹɜɥɹɸɬɫɹ ɯɨɪɨɲɢɦɢ ɢɫɬɨɱɧɢɤɚɦɢ ɛɟɥɤɚ ɜ ɪɚɰɢɨɧɟ. ȿɫɥɢ ɠɟ ɞɟɣɫɬɜɢɬɟɥɶɧɨ ɫɭɳɟɫɬɜɭɸɬ ɨɩɚɫɟɧɢɹ ɨɬɧɨɫɢɬɟɥɶɧɨ ɧɟɞɨɫɬɚɬɤɚ ɛɟɥɤɚ ɜ ɪɚɰɢɨɧɟ, ɬɨ ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ 6 ɝ ɛɟɥɤɚ ɦɨɝɭɬ ɛɵɬɶ ɨɛɟɫɩɟɱɟɧɵ ɩɭɬɟɦ ɩɨɬɪɟɛɥɟɧɢɹ 1 ɹɣɰɚ ɢɥɢ 25 ɝ ɫɵɪɚ, ɢɥɢ 175 ɝ ɦɨɥɨɤɚ/ɤɟɮɢɪɚ.
Ʉɨɞɨɝɪɚɦɦɚ 8
ɇɟɞɚɜɧɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɤɚɡɵɜɚɸɬ, ɱɬɨ ɢɡɛɵɬɨɱɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɛɟɥɤɚ, ɨɫɨɛɟɧɧɨ ɠɢɜɨɬɧɨɝɨ, ɫɜɹɡɚɧɨ ɫ ɪɢɫɤɨɦ ɞɥɹ ɡɞɨɪɨɜɶɹ, ɜɤɥɸɱɚɹ ɪɢɫɤ ɨɫɬɟɨɩɨɪɨɡɚ, ɭɯɭɞɲɟɧɢɹ ɮɭɧɤɰɢɢ ɩɨɱɟɤ, ɡɚɛɨɥɟɜɚɧɢɣ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ, ɤɚɬɚɪɚɤɬɵ, ɧɟɤɨɬɨɪɵɯ ɜɢɞɨɜ ɪɚɤɚ ɢ ɞɪɭɝɢɯ ɩɨɜɪɟɠɞɟɧɢɣ ɬɤɚɧɟɣ. Ʌɸɞɢ, ɩɨɬɪɟɛɥɹɸɳɢɟ ɫɥɢɲɤɨɦ ɦɧɨɝɨ ɠɢɜɨɬɧɨɝɨ ɛɟɥɤɚ, ɢɦɟɸɬ ɛɨɥɶɲɢɣ ɪɢɫɤ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɢ ɪɚɤɚ. Ȼɨɥɟɟ ɬɨɝɨ, ɢɯ ɪɚɰɢɨɧ, ɤɚɤ ɩɪɚɜɢɥɨ, ɬɚɤɠɟ ɛɨɝɚɬ ɠɢɪɚɦɢ ɢ ɛɟɞɟɧ ɚɧɬɢɨɤɫɢɞɚɧɬɚɦɢ ɢ ɩɢɳɟɜɨɣ ɤɥɟɬɱɚɬɤɨɣ. ȼɞɨɛɚɜɨɤ, ɬɟ, ɤɬɨ ɩɨɬɪɟɛɥɹɟɬ ɛɨɥɶɲɟ ɠɢɜɨɬɧɨɝɨ ɛɟɥɤɚ, ɤɚɤ ɩɪɚɜɢɥɨ, ɦɟɧɟɟ ɡɚɛɨɬɹɬɫɹ ɨ ɫɜɨɟɦ ɡɞɨɪɨɜɶɟ ɜ ɰɟɥɨɦ ɢ ɦɟɧɟɟ ɮɢɡɢɱɟɫɤɢ ɚɤɬɢɜɧɵ. ȼɨɡɦɨɠɧɨ, ɱɬɨ ɜɫɟ ɷɬɢ ɮɚɤɬɨɪɵ ɜ ɤɨɦɩɥɟɤɫɟ, ɚ ɧɟ ɬɨɥɶɤɨ ɩɨɜɵɲɟɧɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɛɟɥɤɚ, ɨɬɜɟɬɫɬɜɟɧɧɵ ɡɚ ɩɨɜɵɲɟɧɢɟ ɪɢɫɤɚ ɞɥɹ ɡɞɨɪɨɜɶɹ.
ɉɨɜɵɲɟɧɧɨɟ ɩɨɬɪɟɛɥɟɧɢɟ ɦɹɫɚ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɫɜɹɡɚɧɨ ɫ ɩɨɜɵɲɟɧɢɟɦ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɞɟɬɫɤɨɝɨ ɰɟɪɟɛɪɚɥɶɧɨɝɨ ɩɚɪɚɥɢɱɚ (Ⱦɐɉ) ɭɧɨɜɨɪɨɠɞɟɧɧɨɝɨ; ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɩɨɬɪɟɛɥɟɧɢɟ ɡɥɚɤɨɜɵɯ (ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɯɥɟɛɚ) ɢ ɪɵɛɧɵɯ ɩɪɨɞɭɤɬɨɜ ɫɧɢɠɚɟɬ ɪɢɫɤ Ⱦɐɉ
(Petridou E. et al. 1998, Diet during pregnancy and the risk of cerebral palsy. British J Nutrition 79:407-412).
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ɍɱɟɛɧɵɣ ɤɭɪɫ “Ɂɞɨɪɨɜɚɹ ɩɢɳɚ ɢ ɩɢɬɚɧɢɟ ɠɟɧɳɢɧ ɢ ɢɯ ɫɟɦɟɣ”
Ʉɨɞɨɝɪɚɦɦɵ 9-10
ɋɱɢɬɚɟɬɫɹ, ɱɬɨ ɩɨɜɵɲɟɧɧɚɹ ɩɨɬɪɟɛɧɨɫɬɶ ɜ ɠɟɥɟɡɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɜ ɡɧɚɱɢɬɟɥɶɧɨɣ ɦɟɪɟ ɤɨɦɩɟɧɫɢɪɭɟɬɫɹ ɡɚ ɫɱɟɬ ɩɪɟɤɪɚɳɟɧɢɹ ɦɟɧɫɬɪɭɚɰɢɣ, ɭɥɭɱɲɟɧɢɹ ɭɫɜɨɹɟɦɨɫɬɢ ɢ ɦɨɛɢɥɢɡɚɰɢɢ ɡɚɩɚɫɨɜ ɨɪɝɚɧɢɡɦɚ. ɇɟ ɪɟɤɨɦɟɧɞɨɜɚɧɨ ɩɨɜɫɟɦɟɫɬɧɨɟ ɧɚɡɧɚɱɟɧɢɟ ɩɪɟɩɚɪɚɬɨɜ ɠɟɥɟɡɚ ɠɟɧɳɢɧɚɦ, ɢɦɟɸɳɢɦ ɞɨɫɬɚɬɨɱɧɵɟ ɢɫɬɨɱɧɢɤɢ ɠɟɥɟɡɚ ɜ ɩɢɳɟɜɨɦ ɪɚɰɢɨɧɟ, ɨɬɱɚɫɬɢ ɩɨɬɨɦɭ, ɱɬɨ ɩɪɟɩɚɪɚɬɵ ɠɟɥɟɡɚ ɭɯɭɞɲɚɸɬ ɭɫɜɨɹɟɦɨɫɬɶ ɰɢɧɤɚ ɢ ɧɚɪɭɲɚɸɬ ɨɛɦɟɧ ɦɟɞɢ. ɇɟɨɛɯɨɞɢɦɨ ɬɚɤɠɟ ɨɛɪɚɬɢɬɶ ɜɧɢɦɚɧɢɟ ɭɱɚɫɬɧɢɤɨɜ ɧɚ ɨɫɨɛɟɧɧɨɫɬɢ ɭɫɜɨɟɧɢɹ ɠɟɥɟɡɚ (ɝɟɦɨɜɨɟ ɢ ɧɟ-ɝɟɦɨɜɨɟ ɠɟɥɟɡɨ, ɩɪɨɞɭɤɬɵ, ɭɥɭɱɲɚɸɳɢɟ ɢ ɭɯɭɞɲɚɸɳɢɟ ɭɫɜɨɟɧɢɟ). ɉɨɬɪɟɛɧɨɫɬɢ ɜ ɠɟɥɟɡɟ ɜɨ ɜɪɟɦɹ ɥɚɤɬɚɰɢɢ ɬɟ ɠɟ ɢɥɢ ɞɚɠɟ ɧɢɠɟ, ɱɟɦ ɭ ɧɟɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ (ɜɨ ɜɪɟɦɹ ɥɚɤɬɚɰɢɢ ɨɬɫɭɬɫɬɜɭɸɬ ɦɟɧɫɬɪɭɚɥɶɧɵɟ ɩɨɬɟɪɢ ɢ ɩɨɜɵɲɚɟɬɫɹ ɭɫɜɨɟɧɢɟ ɠɟɥɟɡɚ ɢɡ ɩɢɳɟɜɵɯ ɩɪɨɞɭɤɬɨɜ).
Ʉɨɞɨɝɪɚɦɦɵ 11-12
Ƀɨɞ ɧɟɨɛɯɨɞɢɦ ɞɥɹ ɧɨɪɦɚɥɶɧɨɝɨ ɪɚɡɜɢɬɢɹ ɩɥɨɞɚ ɢ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ. Ɇɚɬɶ ɞɨɥɠɧɚ ɩɨɬɪɟɛɥɹɬɶ ɞɨɫɬɚɬɨɱɧɨ ɣɨɞɚ, ɱɬɨɛɵ ɩɪɟɞɨɬɜɪɚɬɢɬɶ ɝɢɩɨɬɢɪɟɨɡ ɧɨɜɨɪɨɠɞɟɧɧɵɯ, ɤɨɬɨɪɵɣ ɦɨɠɟɬ ɫɬɚɬɶ ɩɪɢɱɢɧɨɣ ɪɚɡɜɢɬɢɹ ɭɪɟɛɟɧɤɚ ɤɪɟɬɢɧɢɡɦɚ, ɡɨɛɚ, ɡɚɞɟɪɠɤɢ ɪɨɫɬɚ ɢ ɧɟɜɪɨɥɨɝɢɱɟɫɤɢɯ ɩɨɜɪɟɠɞɟɧɢɣ ɪɚɡɥɢɱɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ. Ƀɨɞɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ ɜɫɟ ɟɳɟ ɞɨɜɨɥɶɧɨ ɱɚɫɬɨ ɜɫɬɪɟɱɚɟɬɫɹ ɜ ɫɬɪɚɧɚɯ ɋɇȽ. ɗɬɨ ɱɚɫɬɢɱɧɨ ɨɛɭɫɥɨɜɥɟɧɨ ɨɫɥɚɛɥɟɧɢɟɦ ɝɨɫɭɞɚɪɫɬɜɟɧɧɵɯ ɦɟɪ ɩɨ ɦɨɧɢɬɨɪɢɧɝɭɢ ɤɨɧɬɪɨɥɸ, ɱɬɨ ɫɜɹɡɚɧɨ ɫ ɨɛɳɢɦ ɩɪɨɝɪɟɫɫɢɪɨɜɚɧɢɟɦ ɷɤɨɧɨɦɢɱɟɫɤɢɯ ɩɪɨɛɥɟɦ ɡɚ ɩɨɫɥɟɞɧɢɟ ɝɨɞɵ. Ʉɚɤ ɪɟɡɭɥɶɬɚɬ, ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɫɬɶ ɣɨɞɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɭɜɟɥɢɱɢɥɚɫɶ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɫɬɪɚɧ ɋɇȽ ɩɨɫɥɟ ɪɚɫɩɚɞɚ ɋɋɋɊ. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɤɪɚɣɧɟ ɜɚɠɧɨ ɪɚɡɪɚɛɨɬɚɬɶ ɢ ɜɨɩɥɨɬɢɬɶ ɧɚɰɢɨɧɚɥɶɧɵɟ ɩɪɨɝɪɚɦɦɵ ɩɨ ɩɪɨɮɢɥɚɤɬɢɤɟ ɢ ɦɨɧɢɬɨɪɢɧɝɭɣɨɞɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ, ɚ ɬɚɤɠɟ ɩɨ ɣɨɞɢɡɚɰɢɢ ɫɨɥɢ. ɉɨɷɬɨɦɭɛɟɪɟɦɟɧɧɵɟ ɢ ɤɨɪɦɹɳɢɟ ɠɟɧɳɢɧɵ ɞɨɥɠɧɵ ɭɩɨɬɪɟɛɥɹɬɶ ɢɫɤɥɸɱɢɬɟɥɶɧɨ ɣɨɞɢɪɨɜɚɧɧɭɸ ɫɨɥɶ ɜɨ ɜɪɟɦɹ ɟɞɵ ɢ ɞɥɹ ɩɪɢɝɨɬɨɜɥɟɧɢɹ ɩɢɳɢ. ɗɬɨɬ ɫɨɜɟɬ ɨɫɨɛɟɧɧɨ ɜɚɠɟɧ ɞɥɹ ɠɟɧɳɢɧ, ɩɪɨɠɢɜɚɸɳɢɯ ɜ ɷɧɞɟɦɢɱɟɫɤɢɯ ɩɨ ɡɨɛɭɪɟɝɢɨɧɚɯ ɫ ɧɢɡɤɢɦ ɫɨɞɟɪɠɚɧɢɟɦ ɣɨɞɚ ɜ ɩɨɱɜɟ ɢ ɜɨɞɟ.
ɋɨɞɟɪɠɚɧɢɟɣɨɞɚɜɪɚɫɬɟɧɢɹɯ ɢɠɢɜɨɬɧɵɯ ɡɚɜɢɫɢɬɨɬɨɤɪɭɠɚɸɳɟɣɫɪɟɞɵ, ɜɤɨɬɨɪɨɣ ɨɧɢɪɚɫɬɭɬ. ɉɨɫɤɨɥɶɤɭɛɨɥɶɲɢɧɫɬɜɨɩɨɱɜɫɨɞɟɪɠɚɬɦɚɥɨɣɨɞɚ, ɩɪɨɞɭɤɬɵɩɢɬɚɧɢɹɹɜɥɹɸɬɫɹ ɩɥɨɯɢɦɢɫɬɨɱɧɢɤɨɦɣɨɞɚ. Ɏɪɭɤɬɵ, ɨɜɨɳɢ, ɡɥɚɤɢ, ɦɹɫɨɢɦɹɫɨɩɪɨɞɭɤɬɵɨɛɵɱɧɨɫɨɞɟɪɠɚɬ ɨɤɨɥɨ 20–50 ɦɤɝɣɨɞɚ/ɤɝ. ȿɞɢɧɫɬɜɟɧɧɵɦɯɨɪɨɲɢɦɢɫɬɨɱɧɢɤɨɦɣɨɞɚɹɜɥɹɸɬɫɹɩɪɨɞɭɤɬɵ ɦɨɪɹ, ɩɨɷɬɨɦɭɢɯɭɩɨɬɪɟɛɥɟɧɢɟ 1–2 ɪɚɡɚɜɧɟɞɟɥɸɦɨɠɟɬɨɛɟɫɩɟɱɢɬɶɪɟɤɨɦɟɧɞɭɟɦɨɟ ɦɢɧɢɦɚɥɶɧɨɟɩɨɬɪɟɛɥɟɧɢɟɣɨɞɚ – 150 ɦɤɝ/ɞɟɧɶ. ȼȼɟɥɢɤɨɛɪɢɬɚɧɢɢɢɛɨɥɶɲɢɧɫɬɜɟ ɋɟɜɟɪɧɵɯ ɫɬɪɚɧɦɨɥɨɤɨɢɦɨɥɨɤɨɩɪɨɞɭɤɬɵɹɜɥɹɸɬɫɹɨɫɧɨɜɧɵɦɢɫɬɨɱɧɢɤɨɦɣɨɞɚ, ɩɨɫɤɨɥɶɤɭ ɣɨɞɢɡɚɰɢɹɤɨɪɦɚɞɥɹɫɤɨɬɚɭɫɬɚɧɨɜɥɟɧɚɜɡɚɤɨɧɧɨɦɩɨɪɹɞɤɟ. ɂɡ-ɡɚɫɟɡɨɧɧɨɣɢɡɦɟɧɱɢɜɨɫɬɢ ɧɚɞɨɥɸɦɨɥɨɤɚɜɨɛɳɟɦɩɨɬɪɟɛɥɟɧɢɢɣɨɞɚɥɟɬɨɦɢɡɢɦɨɣɩɪɢɯɨɞɢɬɫɹɫɨɨɬɜɟɬɫɬɜɟɧɧɨɨɤɨɥɨ 45% ɢ 70% . Ʉɪɨɦɟɬɨɝɨ, ɜɫɟɋɟɜɟɪɧɵɟɫɬɪɚɧɵ (ɜɤɥɸɱɚɹȾɚɧɢɸ, ɤɨɬɨɪɚɹɩɥɚɧɢɪɭɟɬɧɚɱɚɬɶ ɷɬɨɜ 1998 ɝ.) ɣɨɞɢɪɭɸɬɜɬɨɣɢɥɢɢɧɨɣɫɬɟɩɟɧɢɫɜɨɸɫɨɥɶ.
ɋɨɝɥɚɫɧɨ ɫɨɜɪɟɦɟɧɧɵɦ ɪɟɤɨɦɟɧɞɚɰɢɹɦ ȼɈɁ, ɧɚ ɦɟɫɬɟ ɩɪɨɢɡɜɨɞɫɬɜɚ ɫɨɥɶ ɞɨɥɠɧɚ ɫɨɞɟɪɠɚɬɶ 20–40 ɦɝ ɣɨɞɚ (ɢɥɢ 34–66 ɦɝ ɣɨɞɚɬɚ ɤɚɥɢɹ) ɧɚ 1 ɤɝ ɫɨɥɢ, ɱɬɨɛɵ ɨɛɟɫɩɟɱɢɬɶ ɩɨɬɪɟɛɥɟɧɢɟ 150 ɦɤɝ ɣɨɞɚ ɜ ɞɟɧɶ. Ɉɞɧɚɤɨ ɩɪɢ ɷɬɨɦ ɞɟɥɚɸɬɫɹ ɧɟɤɨɬɨɪɵɟ ɞɨɩɭɳɟɧɢɹ, ɜ ɱɚɫɬɧɨɫɬɢ, ɩɪɟɞɩɨɥɚɝɚɟɬɫɹ, ɱɬɨ ɫɪɟɞɧɟɟ ɩɨɬɪɟɛɥɟɧɢɟ ɫɨɥɢ ɫɪɟɞɢ ɧɚɫɟɥɟɧɢɹ ɪɚɜɧɨ 10 ɝ/ɞɟɧɶ. ȼ ɨɬɞɟɥɶɧɵɯ ɫɬɪɚɧɚɯ ɫɪɟɞɧɟɟ ɩɨɬɪɟɛɥɟɧɢɟ ɫɨɥɢ ɜ ɞɟɧɶ ɦɨɠɟɬ ɛɵɬɶ ɡɧɚɱɢɬɟɥɶɧɨ
ɜɵɲɟ ɢɥɢ ɧɢɠɟ 10 ɝ. ɋɨɛɫɬɜɟɧɧɨ ɝɨɜɨɪɹ, ȼɈɁ ɪɟɤɨɦɟɧɞɭɟɬ ɩɨɬɪɟɛɥɟɧɢɟ ɧɟ ɛɨɥɟɟ 6 ɝ ɫɨɥɢ
ɜɞɟɧɶ. ɇɟɤɨɬɨɪɵɟ ɫɬɪɚɧɵ ɜ ɰɟɥɹɯ ɩɪɨɮɢɥɚɤɬɢɤɢ ɝɢɩɟɪɬɨɧɢɢ ɪɟɤɨɦɟɧɞɭɸɬ ɩɨɬɪɟɛɥɟɧɢɟ
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