Best of Gastronomie

Best of Gastronomie Hospital and hospice cuisine 23.1 Health in the Kitchen. 23.1/1 Malnutrition is a widespread term, which can be defined as a state of nutrition in which the deficiency of energy, protein or other macro and micronutrients causes undesirable effects to the body, with clinical and functional consequences. 23.1/2 The occurrence of malnutrition in hospitalized patients is a public health problem that has been described for a long time, and its impact on the course of disease is considered a clinical problema significant. 23.1/3 The prevalence of malnutrition in a hospital environment varies from 20% to 50% in diferente studies, according to the criteria used. 23.1/4 Patients may be malnourished at the time of admission to the hospital and many develop the malnutrition during hospitalization. 23.1/5 This can be prevented if a special attention is given to the state patients' nutrition. 23.1/6 Hospital malnutrition is associated with a significant increase in morbidity and mortality,time and cost of hospitalization. Different factors contribute to the malnutrition in hospitalized patients. While some cases are consequences of disease, others from inadequate intake, due to loss of appetite, inability to eat or malabsorption, in cases of disease that affect the digestive organs. 23.1/7 A long period, or even a short period without adequate food intake, can cause damage to organic functions. 23.1/8 Hospital diet is importante for ensuring the supply of nutrients to the hospitalized patient and, thus, preserve or recover your nutritional status. 23.1/9 It is also important for alleviating suffering. generated in this period in which the individual is separated from his activities and roles performed in the family, community and working relationships, in addition to being anxious given the illness and procedures hospitals, often little understood. 23.1/10 It is necessary to work on the feeding of patients, elaborating it not only in the sense of meet your basic needs maintenance or recovery of health, but providing well-being physical and mental.

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Best of Gastronomie 23.1/11 Currently, the diet view hospital is being expanded and adapted to the gastronomy trends, and the search to combine the diet and dietary restrictions attractive and tasty meals is a challenge that requires improvement technical and nutritional assistance individualized. The combination of diet therapy with gastronomy is called hospital gastronomy, which should serve as an instrument for that diet therapy be carried out nice way, mostly to the eyes and to the palate. 23.1/12 Given the high prevalence of hospital malnutrition and its negative consequences on recovery and quality of life of patients, it is important that the nutritionist is always looking for new ways to provide adequate intake of nutrients, thus contributing to minimize this problema of public health. 23.1/13 The objective of this work was discuss hospital gastronomy as an ally in the recovery the nutritional status of patients malnourished hospitalized. 23.2 Hospital gastronomie 23.2/1Good sensory quality is the key point for a food be consumed, because the human being don't feed just thinking in your nutrition. 23.2/2 He looks for foods that are to his liking, regardless of its value nourishing, and rejects others, even refusing to experience the who deviate from their dietary pattern, their family heritage or by psychological problems. 23.2/3 The power design applied to health or diet has based on a series of knowledge that make it one of the fundamental branches of medicine and constituted one of the first therapeutic resources that medicine relied on in its beginnings. 23.2/4 If we think of the sick, bedridden or in need of special needs, confined in an environment outside the home, we realized that It is very important to work carefully with your diet. 23.2/5 Gastronomy is defined as the grounded knowledge of all that pertains to man, as he feeds, with the main objective of ensuring for its conservation, maintaining healthy the species, through the best possible nutrition, qualitatively and quantitatively. 23.2/6 With the competitive atmosphere between hospitals and the emergence of hospitals with new concepts service, which influence positively every segment of the organization to seek improvements and to challenge professionals in provide nutritional assistance that goes beyond providing a diet balanced, gastronomy combined with nutrition becomes a differentiator in meeting expectations growing number of customers. 23.2/7 The challenges of gastronomy in hospital diets are identified in different aspects, which

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Best of Gastronomie 23.2/8 Ranging from the precise identification of needs and expectations from clients to the most accurate translation reliable in healthy products, nutritious, attractive and tasty and, above all, to collaborate for maintenance and recovery of nutritional status. 23.2/9 It is still necessary to redeem the association of the pleasure in eating food, even if they are part of dietsrestricted and controlled. Hospital gastronomy is defined as the art of reconciling dietary prescription and restrictions customers to the preparation of healthy and nutritious, attractive and tasty meals, in order to promote the association of goals dietary, clinical and sensory and promote nutrition with pleasure. 23.2/10 In public hospitals, there are work for the identification of hospital gastronomy priorities and strategies for staff involvement. 23.2/11 In addition emphasis on improving restricted diets has been the focus of action and practical action of gastronomy. 23.2/12 Us private hospitals, there are several differentiated services. 23.2/13 The menu of options, instrument that the patient with a diet general participates in the process of choosing your meal, currently it is also offered for diets restricted. 23.2/14 The food service of a hospital for the patient companions and employees gained prestige with the introduction of gastronomy hospital, and some hospitals even have restaurants and cafeterias unrelated to the Nutrition and Dietetics Unit (UND), where you can taste delicious culinary preparations and even sophisticated, served in na nice. 23.2/15 Installing a kitchen experimental experience within the hospital UND has been very valid, as current and innovative trend in this environment and, mainly, as quality promotion tool. the experimental kitchen hospital applies and associates concepts and practices of dietary technique and cooking, diet therapy and analysis sensorial, with the objective of developing preparations for a diversified clientele specialized in the scope of their nutritional needs, helping to value the oral nutritional therapy. 23.2/16 Other attributes of the hospital experimental kitchen is the help in the technical advice when purchasing food and in the quality control of food products training and updating of kitchen staff and also of patients and companions, so that, close to their discharged, the patient, or member of his/her family, be instructed on the preparation of the diet that should be followed at home. 23.2/17 the cooking workshop It is one of the practical tools of dietary guidance and nutritional education used. 23.2/18 In places where there is a presence of the chef, nutritionist and chef must

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Best of Gastronomie work in partnership, exchanging their technical knowledge among themselves, so that no of the two doubts the importance of their presence to the satisfaction of the goals of nutrition and gastronomy in patient care and their companions. 23.2/19 Hospitals that try to improve the food service, using gastronomy, cannot forget the relationship between the meals that are part of the diet offered to the patient and their sociocultural characteristics and personal. 23.2/20 Thus, it is of paramount importance that the nutritionist reserves a time to get to know each new patient 23.3 The application of gastronomy hospital in patients malnourished 23.3/1 The therapeutic function of food has evolved thanks to the considerable advance in knowledge related to dietetics and to nutrition, and research in these areas provided and opened new views on therapy nutrition, getting more and more Of course, food can fact, play an important role in the health and disease process. 23.3/2 However, food is not just a food substance, and foods do not induce man eel free to eat just because of its chemical composition, but they must also be attractive. 23.3/3 Eating is a nutritional act, and eating is a social act linked to uses, customs, conducts, protocols and situations. 23.3/4 The food and the food bring with them different meanings and implications in the people's lives, in addition to being sources of pleasure from start to finish of life and form an integral part maintenance or reconstruction of the individual's identity hospitalized. 23.3/5 The acceptance of food by part of the hospitalized patient is constituted by a sum of factors inherent to the disease state and of service-related factos offered. 23.3/6 In a study carried out in the city of Curitiba, who interviewed 216 patients with the aim of to determine the characteristics of required quality with regard to food during hospitalization, it was observed that the taste, the temperature, the variation of the menu, the hygiene of the food offered, the courtesy in the service provided by the maid and the appearance of these when serving the meal, as well as the visual appearance of the meal tray and the availability of suitable utensils for food, are characteristics that assume a high degree of importance in the concept of quality of the meal served. 23.3/7 Another study, carried out in Santa Catarina, evaluated the remains lunch and dinner food of patients before and after the implementation of the hotel system hospital for the private sector.

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Best of Gastronomie 23.3/8 The main result found with these modifications was the reduction of food scraps left by patients in the sector particularly at lunch, meal in that the main changes were observed, such as the inclusion of dessert, meat replacement from second to first quality, from packaging the salad in individual pots with sachets of oil, vinegar and sauce Italian, use of glass plate for remove food from utênsil stainless steel and cutlery individually wrapped. 23.3/9 It was observed that the quality of raw material, variety of menu, presentation and utensils used to serve meals and also the attention of the team to the patient's food preferences positively influencedmind in the reduction of the remains of food. 23.3/10 Knowledge of the art of cooking to provide greater pleasure to those who eat is a powerful tool for the which professional should launch hand to devise tasty diets and improve patient compliance. 23.3/11 Preparing food for patients on a special diet requires skill and knowledge basics of cooking techniques and ingredients that can make a more easily accepted diet by the patient. 23.3/12 Thus, liquid, semi-pasty or pasty diets, without salt, excluding fat etc., need to be worked on to make it more desirable. 23.3/13 In liquid, liquid-pasty or pasty diets, monotony must be taken into account, as they are similar looking diets regardless of the ingredients used. 23.3/14 In such cases, industrial thickeners are indicated, mucilages, gelatins and farinaceous that imitate or create forms/structures for food, stimulating its ingestion. 23.3/15 By restricting ingredientes such as fat, gluten, milk, eggs, with specific functions in terms of texture, shape and consistency, other substances with similar gastronomic properties should be used. 23.3/16 On diets withfat reduction or exclusion, sugar or salt, the taste may suffer changes. 23.3/17 Use spices and condiments can make up for the absence of other ingredients, generating such delicious insights as for the originals. 23.3/18 When the possibilities of variation of ingredients are excluded, it remains to be tried to give the patient tray assembly an aesthetic presentation, for the crockery, cutlery, napkin, the arrangement of food on the plate, etc. 23.3/19 The acceptance of food on the part of the hospitalized patient is decisive for effective action by the nutritional therapy. 23.3/20 The evolution of gastronomy can therefore allow hospital diets, known

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Best of Gastronomie for their insipidity, to participate of therapy, adding pleasure to the nutritional value of food 23.4 Conclusion 23.4/1 It is concluded that gastronomy hospital can be used as an ally in the recovery of the nutritional status of malnourished hospitalized patients, improving the sensory characteristics of the preparations, the presentation of the diets and patient care. 23.4/2 However, further field studies are needed to prove this benefit. 23.5 What is an adverse food reaction? Food plays a fundamental role in our lives. 23.5/1 Far beyond being a basic need to be met for survival, it also has an important social character in all age groups. 23.5/2 That's why the so-called adverse reaction to food can generate so many concerns. 23.5/3 But do you know exactly what this problem is about? Next, clear your doubts about this condition. 23.6 Adverse food reaction: what is it? 23.6/1 Every time the body comes into contact with a food or food additive that contains a specific substance that it cannot transform in its process, the reaction happens to warn that that additive does not work for the body. 23.6/2 That is, the adverse reaction to food happens when the body reacts in an abnormal and undesirable way during ingestion. 23.6/3 The American Academy of Allergy and Immunology defines an adverse food reaction as any undesirable reaction that occurs after eating a food that is generally tolerated by most people. 23.6/4 These reactions can be secondary to food allergy or food intolerance, and cover a wide range of signs and symptoms. 23.7 How does the adverse reaction to food appear in the body? 23.7/1 The reactions are usually quite visible and involve skin problems such as itching. 23.7/2 In the gastrointestinal tract, they can cause pain, vomiting and diarrhea. 23.7/3 But depending on the level of allergic reaction that the food causes, there can be complications, too, in different organs of the body.

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Best of Gastronomie 23.8 What are the types of adverse food reactions? 23.8/1 Basically, there is a difference between intolerance and hypersensitivity. 23.8/2 A patient intolerant to some food suffers from a metabolic disorder, whereby the body does not have enzymes that help in the digestion of certain substances. 23.8/3 Hypersensitivity is a reaction of the body that acts by producing antibodies against the specific substance. 23.8/4 The most common example of food intolerance is lactose intolerance, where patients who have it start to show absence or decrease in the function of the lactase enzyme, which acts in the digestion of lactose. 23.8/5 Thus, patients who ingest milk and dairy products may experience symptoms of nausea, colic, gas and even vomiting and diarrhea. 23.9 What is the cross-form allergic reaction to food? 23.9/1 This is what happens when a food ends up generating an allergic reaction to other substances that belong to the same family. For example, a patient who is allergic to wheat may experience the same allergic symptoms when eating rye and barley. 23.9/2 Or, those who have an adverse reaction to nuts may experience the same problems by ingesting Brazil nuts, hazelnuts and cashews. 23.10 Can an adverse food reaction cause an anaphylactic reaction? 23.10/1 Yes, this is one of the most serious reactions that the body can face when ingesting a food that causes allergy. 23.10/2 This happens when too many chemicals are released at the same time to respond to the allergy generated by that product. 23.10/3 The problem is that this causes a drop in blood pressure, generalized itching and even vascular collapse, known as anaphylactic shock, a sudden condition that requires immediate attention and help.

23.11 Food additives are substances that are added to food for preserve or improve their properties such as appearance, taste or texture. 23.11/1 They are used in the food industry and in cooking and classified into various categories. Current European legislation requires that all food additives are designated by a code consisting of the letter 23.11/2 E followed by a number of 3 or 4 digits. So, for example, the dyes are designated E100 to E181, the preservatives from E200 to E297 and

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Best of Gastronomie antioxidants from E300 to E321. In table 1 it is indicated the main categories of additives and their functions food by the industry, in food processing, forces one not to exceed the maximum concentrated levels for each additive. 23.11/3 However, there is a small The importance of the assessment can be made at levels below the levels allowed. 23.11/4 Patients with asthma are those who most often have reactions to food additives. 23.11/5 In some cases contact, handling or inhalation of substances containing compatible additives without being necessary the ingestion. 23.11/6 Oral provocation testing may be necessary for establishment definitive diagnosis of food allergies and food intolerances.an execution This test is not risky and should always be requested by a specialist doctor. experienced in performing this procedure in a hospital environment. 23.11/7 Table 2 shows some food additives, possible adverse reactions in all the same, European equivalents, and more

1 Main categories of additives and their functions Additive categories Functions Additive preservatives They control the growth of microorganisms, allowing food to stay longer in conditions suitable for consumption. Dyes They can be natural or synthetic and are used to enhance or restore the color lost by food during processing or to maintain a uniform color during storage. Flavorings They give foods particular flavors or aromas (sweet, salty, acidic or bitter). They can be of artificial or natural origin, extracted from fruits, spices, seeds and animals. Examples of natural flavorings: citric acid (found in citrus fruits like oranges), lactic acid (in dairy products), tartaric acid (in grapes and wines) and malic acid (in apples). Sweeteners or Low-calorie sugar substitutes Sweeteners Flavor enhancers They intensify the original flavor and/or smell of food. Examples: glutamic acid (E620), monosodium glutamate (E621), monopotassium glutamate (E622). Acidity or pH regulators Alter or control the acidity or alkalinity of foods. Examples: acid bicarbonate or carbonate, citric, lactic and acetic acids Stabilizers They make it possible to maintain the physical-chemical state of food. Thickeners and Gelling They increase the viscosity of food products without modifying other Agents properties such as taste. They may originate from polysaccharides (starches or gums from plants, usually legumes) and proteins of animal origin (egg yolk and collagen). Examples: agar, alginine, carrageenan, collagen, corn starch, gelatin, guar gum, locust bean gum, xanthan gum and pectin. Emulsifiers or They make it possible to form or maintain a homogeneous mixture from Emulsifiers substances that are immiscible or difficult to mix, as in the case of mayonnaise

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Best of Gastronomie Humidifiers

Prevent food from drying out, allowing it to retain its texture after industrial processing, without rotting Adverse reactions to additives are mostly non-allergic, much less common than food allergies. However, they may not be recognized because are more difficult to diagnose or even be confused with other diseases, such as food poisoning. The legislation that regulates the use of additives

2 Main food additives and associated adverse reactions European code Function/Origin More food sources Additive common / other sources E 102 yellow dye Caramelos, snacks Tartarazine Synthetic jellies, soft drinks

E 200 acid

Sorbic preservative sugar acid Natural

E 210 Benzoic Preservative acid natural or Synthetic E211 benzoate Preservative from sodium E 220 Dioxide of Sulfur Sulphites: E 221 sodium sulfite E 222 bisulfite of sodium E 223 metabisulfite of sodium E 224 metabisulfite of potassium

preservative and antioxidant Synthetic Preservatives and antioxidants synthetics

Present in many fruits. It is an additive with wide use eg. in fruits candied, jellies, dairy products, vinegar, wine and other drinks, canned fish and meat, gummies, bread and others bakery products Plums and red berries. food additive (beer, liqueurs, jellies, marmalade) cosmetics, hygiene products and medicines Can be found at margarines, sauces soft drinks, juices, preserves, cosmetics, hygiene products and medicines Used in the process of wine production They are widely used in several products: Fresh, frozen Seafood or canned Meat mainly charcuterie Fish: Dry cod, frozen fish Drinks: Teas, juices fruit, beer, wine, cider, drinks that contain sugar or corn syrup Cereals and derivatives: Corn bread, breads that contain conditioner pasta, pasta, noodles, rice mixes, cornstarch Fruits and derivatives: Dried fruits and raisins fruit, preserves and sweets fruit, guava, marmalade

Clinical manifestations possible Urticaria, Rhinitis, Eczema, Asthma Particularly in asthmatics with hypersensitivity to aspirin May have irritating effects on the skin

Urticaria, Rhinitis, Eczema, Asthma Urticaria, Angioedema Eczema, Dermatitis Contact Nausea and Vomiting Headaches, Urticaria, Rhinitis, Eczema or Asthma Chest oppression, hypotension, Headaches, Urticaria, Angioedema Itching, Red skin Rhinitis, Nausea, Vomiting, abdominal cramps or Diarrhea in asthmatics, particularly those who have nasal polyps and with hypersensitivity to aspirin can precipitate

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Best of Gastronomie Spice: mustard, wine vinegar, various sauces Sugars: White sugar, chewy Several: Ice cream, jellies, vegetables canned and preserved preservatives and Processed meats like healing agents sausages, meatballs and synthetics salamis

severe asthma attacks

Emulsifier Stabilizer antioxidant thickener

Natural. can be extracted in: soybean seeds, peanut, corn and yolk egg. In extremely sick allergic to soy, peanut, corn or egg yolk it may be necessary to avoid products that contain Lecithin

E 410 gum carob E 412 guar gum E 413 Gum tragacanth E 414 arabic gum

Emulsifiers Thickeners Natural: extracted from legumes

Can enter the yogurt composition, ice cream and pastilles elastic. In the pharmaceutical industry and cosmetics can enter inhaler composition, emulsions, lotions, creams and toothpaste

E 420 Sorbitol

Stabilizer Humidifier sugar-alcohol natural or synthesized to from glucose intensifier of flavor presente salt in all animal proteins and vegetables

Occurs in some fruits Used in formulations drugs like drops and suspensions

You should try to find out origin of lecithin, because although most of patients allergic to sources of lecithin do not react to foods that contain it, by the low content in proteins, if any suspected risk of reaction, these foods should not be ingested without guidance of the Immunoallergologist. E 412 – Down syndrome oral allergy (may cause systemic reactions when associated with cofactors, such as taking non steroidal anti inflammatory drugs) E 410 and E 412 rhinitis and/or occupational asthma. E 413 and E 414 – the reactions are less frequent In excessive amounts can cause: Flatulence Diarrhea Cramps

Can be added to meat, fish, poultry, vegetables, seafood, sauces, synthetic soups, pre-cooked food, canned goods and preserve. In many countries, particularly from the East, is used as a

A small percentagem of individuals is sensitive to monosodium glutamate showing symptoms immediately after your ingestion, such

nitrites and Nitrates: E 249, E 252 nitrite from potassium E 250, E 251 Sodium nitrite E 322 Lecithin

E 621 glutamate monosodium

Urticaria, Asthma, Pain Head, Dizziness, Diarrhea Or Abdominal pain

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Best of Gastronomie seasoning table. may also be presente in a wide variety of Ingredients, including proteins source hydrolysates vegetable, hydrolyzed yeast, yeast extract and extracts of soy.

as: head, red skin, Nausea, Dizziness, vertigo, tingling heartburn, abdominal pain Thirst, feeling of “squeezing” chest or palpitations The combination of several of these symptoms is many sometimes referred to as “Restaurant Syndrome Chinese" The current lifestyle does not allow, on a day-to-day basis, to most consumers, the ingestion just fresh food. Some food additives are essential to keep under adequate conditions of conservation the foods that are not consumed immediately after its preparation. However, you can also add preservatives, flavorings or flavor enhancers for foods intended to immediate consumption. Meals eaten away from home are, therefore, those that constitute greater risk. Once the diagnosis is established, the patient will learn from your Immunoallergist to avoid the food(s) responsible for your allergy or intolerance, being aware of possible ingestion of allergens/hidden products and preparing to face emergency situations. If you suspect that you suffer from an adverse food reaction should seek advice in a differentiated medical consultation of Immunoallergology

23.12 What foods are most often involved in Food Allergy? 23.12/1 Any food can trigger an allergic reaction. 23.12/2 However, cow's milk, egg, soy, wheat, fish and crustaceans are the most involved. 23.12/3 Sensitization to these foods (IgE antibody formation) depends on the population's eating habits. 23.12/4 Peanuts, crustaceans, cow's milk and tree nuts are the foods that most often cause severe (anaphylactic) reactions. 23.12/5 Foods can cause cross-reactions, that is, different foods can induce similar allergic responses in the same individual. 23.12/6 The shrimp allergic patient may not tolerate other crustaceans. 23.12/7 Likewise, peanut allergic patients may also have a reaction when ingesting soy, peas or other beans. 23.13 What about food colorings and additives? 23.13/1 Adverse reactions to food preservatives, colorings and additives are rare, but should not be overlooked.

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Best of Gastronomie 23.13/2 The artificial dye tartrazine (FD&C yellow#5), sulfites and monosodium glutamate are reported to cause reactions. 23.13/3 Tartrazine can be found in artificial juices, jellies and colored candies while monosodium glutamate can be present in salty foods such as seasonings (beef or chicken broths). 23.13/4 Sulfites are used as preservatives in foods (dried fruits, wines, industrialized juices) and medications have been linked to asthma attacks in sensitive individuals. 23.14 What are the main clinical manifestations of Food Allergy? 23.14/1 Reactions involving the skin (hives, swelling, itching, eczema), the gastrointestinal tract (diarrhea, abdominal pain, vomiting) and the respiratory system, such as coughing, hoarseness and wheezing, are more common. 23.14/2 More intense manifestations, affecting several organs simultaneously (Anaphylactic Reaction), can also occur. 23.14/3 In young children, blood loss may occur in the stool, which will lead to anemia and growth retardation. Isolated nasal symptoms are not common. 23.15 What is Anaphylactic Reaction? 23.15/1 It is a sudden, severe reaction that requires immediate help as it is potentially fatal. 23.15/2 The Anaphylactic Reaction can be provoked by drugs, insect poisons and food. 23.15/3 In Food Allergy, the food induces the massive release of chemical substances that will determine a serious picture of systemic response associated with generalized itching, swelling, cough, hoarseness, diarrhea, belly pain, vomiting, chest tightness with drop in blood pressure, cardiac arrhythmias and vascular collapse (“anaphylactic shock”). 23.16 What is Oral Allergy Syndrome? 23.16/1 It is a manifestation of Food Allergy that occurs after contact of certain foods with the oral mucosa. The manifestations occur immediately after contact of the food with the mucosa of the mouth, causing itching and swelling of the lips, palate and pharynx. Glottic edema is infrequent. It occurs mainly in patients with allergies to pollens and the most frequently involved foods are: melon, watermelon, banana, apple, peach, cherry, potato, carrot, plum, almond, hazelnut and celery. 23.17 According to this list, the following substances or products that cause allergies or intolerances are considered:

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Best of Gastronomie a. b. c. d. e. f. g. h. i. j. k. l. m. n.

Cereals containing gluten, namely: wheat, spelt, Khorasan wheat, rye, barley, oats Crustaceans Eggs Fish peanuts Soy Milk (including lactose) Nuts, namely: almonds, hazelnuts, walnuts, cashews, pecans, Brazil nuts, pistachios, macadamia or Queensland nuts Celery Mustard Sesame seeds Sulfur Dioxide and Sulphites Lupine Molluscs

Types of production Relationship Features typology Hot and cold The meal is produced in the cooking center and immediately placed in thermal containers that keep it warm. It is then transported to the places of consumption, where it is consumed directly, without further handling. Consumption must take place within 2 hours of preparation, and the temperature must never drop below 65ºC. Cooled Preparations are made in the kitchen, then stored at a temperature not lower than 65ºC for rapid cooling (temperature chiller), the temperature inside the product must be brought from 65ºC to 10ºC within 2 hours, the preparations are stored in refrigerators at a temperature between 0ºC to 4ºC for 5 days. One hour before consumption, the product must undergo regeneration where

Advantages and disadvantages It allows a wide articulation of the menu, but the transport must be very fast and, if not respected, exposes to the risk of proliferation of pathogenic microorganisms.

This tool favors greater organizational flexibility because production can take on moments other than consumption.

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Best of Gastronomie

Frozen

Cozinhar a Frio

the interior must remain at 65ºC, this can be done before or at the place of service. Food is packaged within 30 minutes of preparation. Taken to the chiller to reach the temperature from 0 to -3ºC within 90 minutes, then it is taken to the core temperature to -18ºC within 4 hours, in this way, it can be kept for a few months. Transport to the consumption area must be carried out in vehicles with freezing chambers. When starting the product regeneration, it must reach 70ºC in the center within 60 minutes from the display forecast. Consumption must occur within one hour after regeneration The preparations are refrigerated and packed in special closed containers under sterile conditions (passing under UV lamps), the air is then replaced by the introduction of a mixture of nitrogen and carbon dioxide, which limits the growth of microorganisms, lowers the pH and prevents degradation reactions.

Freezing increases the nutritional and organoleptic characteristics of the preparations and prolongs their shelf life. In addition, it does not impose time restrictions between preparation and consumption. However, the costs to be dropped with equipment and energy must be considered as well as a possibility to propose a wide range of preparations.

This technique, and others to extend the shelf life (the time in which a product can be marketed) of the preparations, avoids gaseous changes with the outside and avoids the nutritional and organoleptic characteristics of the preparations.

23.18 Hospice Hospital care aims to provide patients with maximum comfort as well as a better quality of life by controlling the pain and discomfort that comes with a terminal illness. The hospice does not shorten or prolong a patient's life, but simply focuses on meeting physical, emotional, and spiritual needs. 23.18/1 Among the many myths circulating about hospital care is that the hospice prevents a patient from getting food and water, which is not true. In this article, we will discuss the issues surrounding who makes such decisions. 23.18/2 Food is more than a source of nutrition, health and well-being; it's also one of the ways we show our love and care. 23.18/3 It can be very difficult for the family when a loved one loses the desire or ability to eat normally. As someone becomes sicker, their body needs less energy, and physiques can also be difficult to chew or swallow. 23.18/4 However, they can make small changes and you can make some suggestions. 23.19 Ideas to encourage eating and drinking a. b. c. d.

Offer small plates of food more often Present the food in an attractive way Keep food simple without strong flavors or smells Offer a variety of flavors and textures such as purees and broths

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Best of Gastronomie e. Talk to your hospice care team about adding thickening fluids (available at your local pharmacy) if they are having trouble swallowing f. Use straws for liquids, or encourage small sips g. Ice chips and ice packs will help maintain fluid intake h. Use cotton swabs soaked in water or other refreshing drinks. 23.191 How to manage common issues. 23.19/1 There are many common problems and symptoms that can affect your loved one's ability, or desire, to eat or drink. Below are some practical tips you can try to help make eating and drinking more enjoyable and easier to manage. 23.19/1a Sore mouth 23.19/1b If your loved one is complaining of a sore mouth, offer foods that are soft and easily chewed. 23.19/1c It is also important to help them maintain good oral health. Use the steps below to help keep your teeth and gums clean and your lips moist and comfortable. 23.19/1d Mouth care process • • • • • • • •

Assemble the items you need, including a bowl and water in glasses to rinse your mouth; a towel, sponges in the mouth or a soft toothbrush and toothpaste; Lip balm and mouth moisturizer Remove dentures, if applicable, and clean separately Clean your teeth as you would your own, remembering to be very gentle and give clear instructions as needed. If using sponges; Dip the sponge into the water and use it to gently swab between the lips/cheek and teeth. If your loved one sucks on the sponge, continue soaking in the water. Don't force mouth care if your loved one bites or puts their lips together. Try again later Move the sponge along the teeth on both sides and across the tongue Rinse the sponge as many times as necessary Apply mouthwash or lip balm to keep lips moist and comfortable.

23.19/1e Nausea • • •

Offer simple foods with light flavors and smells Give anti-disease medication, if prescribed, 20-30mins before meals to give them time to work Give regular pain relief medication as prescribed and as needed, giving them time to work

23.19/1f Constipation

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Best of Gastronomie • • •

Encourage your loved one to take prescribed laxatives regularly, drink plenty of fluids, and move if they can. Extra fiber can help those who are eating relatively normally. Try vegetable and fruit soups (these can be puree), whole grain bread and porridge Some herbal teas and drinks (eg Smooth Motion, Alpine Tea, Kiwi Crush) can help.

23.19/1g Diarrhea •

Offer clear fluids or foods that are easily digested (e.g. broths)

23.19/1h. Fatigue • •

Offer frequent, small meals when the person is awake If they are no longer alert enough to eat, stop and remove any food that may be accumulating in their mouths.

23.19/1i Disease progression •

Discuss with your GP or Hospice team who will help you adjust your expectations accordingly

23.19/1j Safety during feeding • • • •

Encourage your person to sit up as much as possible so they can safely swallow If they cannot sit up, offer foods they can eat while lying on their side or back (e.g. finger sandwiches, ice packs) If you are feeding them and they say 'stop' then stop immediately Don't leave them alone while they eat.

23.19/1l Level of consciousness •

Only offer food and drink if the person is awake and alert.

23.19/2 Your GP and Hospice team are here to help, so don't hesitate to discuss any concerns with them. Always follow advice and suggestions from your medical team to keep your loved one safe. 23.20 To strengthen the body. Good nutrition, based on a natural menu, is essential for a healthy life. 23.20/1 It is from a complete and varied meal with proteins, carbohydrates, fibers and other nutrients, that the body fights diseases and ensures disposition for daily practices. Want to know how to put this into practice on this date and at all other times of the year? 23.201 Balance and diversity.

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Best of Gastronomie 23.20/2 As usual, promoting a good functioning of the body depends on some factors, such as the habit of eating well and practicing physical activities. But as there is no "universal diet", nutritionist Nathália Oliveira indicates how to vary the menu. “We all have different biochemical individualities, so we must follow different diets. But, in general, a healthy diet is guided by the daily consumption of fruits, vegetables, tubers (yam, cassava, sweet potato), pasta, whole carbohydrates, proteins (chicken, eggs, lean meats), good fats (salmon, avocado). 23.20/3 A suggestion is to read the Food Guide for the Brazilian Population, published by the Ministry of Health to help with healthy eating with items that are easily accessible and easy to assimilate”, he points out. It is interesting to avoid products with high levels of dyes, preservatives, sodium and sugar, as they are harmful to the body, such as industrialized products and sausages. 23.202 Immune system 23.20/4 The professional also reports that, in addition to obtaining aesthetic results and achieving whatever the objective, the internal results are evident. "There is an improvement in physical and mental disposition, improvement in mood and anxiety, increased concentration, increased libido, helps in the health of hair and nails", he says. cardiovascular diseases, various types of cancers and arterial hypertension, 23.20/5 "Preventive nutrition is the best key to obtaining a good quality of life, free from diseases and complications. Therefore, the importance of monitoring. The nutritionist is the only professional who can prescribe diets, so it is through him that you can obtain a specific food plan for your need and desire'', 23.203 Organic food 23.20/6 And, gaining space in the market and people's preference, organic foods (free from synthetic pesticides, transgenics or chemical fertilizers) are also bets, according to the expert. “They have more nutrients, because the type of cultivation free of pesticides allows them to produce their own defenses, making them more nutritious,'' she points out. Nathália also talks about future complications when ingesting inorganic products. 23.20/7 "Many of the pesticides still do not have conclusive studies of their real effect on our health, but the exacerbated consumption can cause dizziness and abdominal cramps to hormonal dysregulation and cancer. Therefore, a clean body of these substances will make whoever consumes them have a source healthier way of eating, since these foods have more nutrients and are less harmful to the environment'', Regarding recipes, it is very subjective, depending on the pathology of each person.

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Best of Gastronomie Terms for Review: Health in the Kitchen Hospital gastronomie The application of gastronomy hospital in patients malnourished What is an adverse food reaction What foods are most often involved in Food Allergy What about food colorings and additives What are the main clinical manifestations of Food Allergy What is Anaphylactic Reaction What is Oral Allergy Syndrome Hospice

Questions for Discussion: The occurrence of malnutrition in hospitalized patients is a public health problem that has been described for a long time, and its impact on the course of disease is considered a clinical problema significant? -------------------------------------------- (Yes__ or No__ Patients may be malnourished at the time of admission to the hospital and many develop the malnutrition during hospitalization? -------------- (Yes__ or No__ It is also important for alleviating suffering. generated in this period in which the individual is separated from his activities and roles performed in the family, community and working relationships, in addition to being anxious given the illness and procedures hospitals, often little understood? ---------------------------------------- (Yes__ or No__ Given the high prevalence of hospital malnutrition and its negative consequences on recovery and quality of life of patients, it is important that the nutritionist is always looking for new ways to provide adequate intake of nutrients, thus contributing to minimize this problema of public health? ------------------------------ (Yes__ or No__ The power design applied to health or diet has based on a series of knowledge that make it one of the fundamental branches of medicine and constituted one of the first therapeutic resources that medicine relied on in its beginnings? ------------------ (Yes__ or No__ Gastronomy is defined as the grounded knowledge of all that pertains to man, as he feeds, with the main objective of ensuring for its conservation, maintaining healthy the species, through the best possible nutrition, qualitatively and quantitatively? (Yes__ or No__ In public hospitals, there are work for the identification of hospital gastronomy priorities and strategies for staff involvement? ------------------------------------ (Yes__ or No__ The food service of a hospital for the patient companions and employees gained prestige with the introduction of gastronomy hospital, and some hospitals even have restaurants and cafeterias unrelated to the Nutrition and Dietetics Unit (UND), where you can taste delicious culinary preparations and even sophisticated, served in na nice? (Yes__ or No__ Hospitals that try to improve the food service, using gastronomy, cannot forget the relationship between the meals that are part of the diet offered to the patient and their sociocultural characteristics and personal? ----------------------------- (Yes__ or No__

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Best of Gastronomie Knowledge of the art of cooking to provide greater pleasure to those who eat is a powerful tool for the which professional should launch hand to devise tasty diets and improve patient compliance? --------------------------------------------------------- (Yes__ or No__ By restricting ingredientes such as fat, gluten, milk, eggs, with specific functions in terms of texture, shape and consistency, other substances with similar gastronomic properties should be used? ------------------------------------------------------------- (Yes__ or No__ That is, the adverse reaction to food happens when the body reacts in an abnormal and undesirable way during ingestion? --------------------------------------- (Yes__ or No__ The most common example of food intolerance is lactose intolerance, where patients who have it start to show absence or decrease in the function of the lactase enzyme, which acts in the digestion of lactose? ------------------------------------------------ (Yes__ or No__ They are used in the food industry and in cooking and classified into various categories. Current European legislation requires that all food additives are designated by a code consisting of the letter? ---------------------------------------------------- (Yes__ or No__ E followed by a number of 3 or 4 digits. So, for example, the dyes are designated E100 to E181, the preservatives from E200 to E297 and antioxidants from E300 to E321. In table 1 it is indicated the main categories of additives and their functions food by the industry, in food processing, forces one not to exceed the maximum concentrated levels for each additive? ----------------------------------------------------------- (Yes__ or No__ Foods can cause cross-reactions, that is, different foods can induce similar allergic responses in the same individual? ---------------------------------------- (Yes__ or No__ Tartrazine can be found in artificial juices, jellies and colored candies while monosodium glutamate can be present in salty foods such as seasonings (beef or chicken broths)? -------------------------------------------------- (Yes__ or No__ “They have more nutrients, because the type of cultivation free of pesticides allows them to produce their own defenses, making them more nutritious,'' she points out. Nathália also talks about future complications when ingesting inorganic products? (Yes__ or No__ Therefore, a clean body of these substances will make whoever consumes them have a source healthier way of eating, since these foods have more nutrients and are less harmful to the environment''? ------------------------------------------------------- (Yes__ or No__ Bibliography Raslan M, Gonzalez MC, Dias MCG, Paes-Barbosa FC, Cecconello I, Waitzberg DL. Aplicabilidade dos métodos de triagem nutricional no paciente hospitalizado. Rev Nutr. 2008 Set/Out;21(5):553-61. 2. Vanis N, Mesihovi R. Application of nutritional screening tests for determining prevalence of hospital malnutrition. Med Arch. 2008;62(4):211-4. 3. Venzin RM, Kamber N, Keller WCF, Suter PM, Reinhart WH. How important is malnutrition? A prospective study in internal medicine. Eur J Clin Nutr. 2009 Mar;63(3):430-6. 4. Beghetto MG, Manna B, Candal A, Mello ED, Polanczyk CA. Triagem nutricional em adultos hospitalizados. Rev Nutr. 2008 Set/ Out;21(5):589-601. 5. Garcia RWD. A dieta hospitalar na perspectiva dos sujeitos envolvidos em sua produção e em seu planejamento. Rev Nutr. 2006 Mar/Abr;19(2):129-44. 6. Jorge AL. Oficinas de culinária em cozinha experimental hospitalar como estratégia de educação nutricional e gastronomia. Rev Nutr Profissional. 2008 Out;IV(21):38-46. 7. Borges CMF. A percepção do profissional nutricionista sobre a gastronomia hospitalar: um estudo de caso sobre um hospital particular do Distrito Federal [Monografia]. Brasília: Universidade de Brasília; 2009. 55f. (Especialização em Hotelaria Hospitalar) 8. Guerra PMS. Avaliação da aceitação de dietas infantis modificadas em hospital público – Estudo de caso [Monografia]. Brasília: Universidade de Brasília; 2009. 41f. (Especialização em Gastronomia e Segurança Alimentar)

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Best of Gastronomie 9. Azevedo LC, Medina F, Silva AA, Campanella ELS. Prevalência de desnutrição em um hospital geral de grande porte de Santa Catarina/Brasil. Arq Catarin Med. 2006 Out/Dez;35(4):89-96. 10. Malafaia G. A desnutrição protéicocalórica como agravante da saúde de pacientes hospitalizados. Arq Bras Ciên Saúde. 2009 Mai/Ago;34(2):101-7. 11. Sarni ROS, Carvalho MFCC, Monte CMG, Albuquerque ZP, Souza FIS. Avaliação antropométrica, fatores de risco para desnutrição e medidas de apoio nutricional em crianças internadas em hospitais de ensino no Brasil. J Pediatr. 2009 Mai/Jun;85(3):223-8. 12. Leandro-Merhi RW, Garcia RWD, Mônaco DV, Oliveira MRM. Comparación del estado nutricional, consumo alimentício y tiempo de hospitalización de pacientes de dos hospitales, uno público y outro privado. Nutr Hosp. 2006 Fev;21(1):32-7. 13. Monti GR. Desnutrición hospitalaria: una patología subdiagnosticada. Rev Asoc Méd Argent. 2008 Dez;121(4):25-8. 14. Giraldo NAG, García NEM, Piñeres LM. Prevalencia de malnutrición y evaluación de la prescripción dietética em pacientes adultos hospitalizados en una instituición pública de alta complejidad. Perspect Nutr Hum. 2007 Jan/Jun;9(1):37-47. 15. Fuchs V, Mostkoff D, Salmeán GG, Amancio O. Estado nutricio en pacientes internados en un hospital público de la ciudad de México. Nutr Hosp. 2008 Mai/Jun;23(3):294-303. 16. Suárez MMS, Astoviza MB, Rodríguez TF, Manríquez JRM, Caldas LM, Companioni J. Desnutrición hospitalaria em el hospital universitário “Calixto García”. Rev Cubana Invest Biomed. 2004 Set/Dez;23(4):227-34. 17. Lima AM, Gamallo SMM, Oliveira FLC. Desnutrição energético-proteica grave durante a hospitalização: aspectos fisiopatológicos e terapêuticos. Rev Paul Pediatr. 2010 Set;28(3):353-61. 18. Waitzberg DL, Caiaffa WT, Correia MITD. Hospital malnutrition: The Brazilian National Survey (IBRANUTRI): a study of 4000 19. Correia MITD, Campos ACL. Prevalence of malnutrition in Latin America: the multicenter ELAN study. Nutrition. 2003 Out;19(10):823-5. 20. Villar MH. Dietética e gastronomia. In: Silva SMCS, Mura JDP. Tratado de alimentação, nutrição e dietoterapia. São Paulo: Roca; 2007. p. 461-86. 21. Souza AA. A interação entre a terapia nutricional e a produção de refeições: repensando a função da alimentação hospitalar. Nutr Pauta. 2002 Mar/Abr;X(53):17-21. 22. Jorge AL, Maculevicius J. Gastronomia hospitalar – como utilizá-la na melhoria do atendimento da unidade de nutrição e dietética. In: Guimarães NDV. Hotelaria hospitalar: uma visão interdisciplinar. São Paulo: Atheneu; 2007. p. 77-86. 23. Assis MAA. A importância da gastronomia na elaboração de dietas saudáveis. Nutr Pauta. 2002 Jul/Ago;X(55):5862. 24. Ginani V, Araújo W. Gastronomia e dietas hospitalares. Nutr Pauta. 2002 Set/Out;X(56):49-52. 25. Jorge AL. História e evolução da gastronomia hospitalar. Nutr Pauta. 2005 Jan/Fev;XIII(70):6-14. 26. Demário RL, Sousa AA, Salles RK. Comida de hospital: percepções de pacientes em um hospital público com uma proposta de atendimento humanizado. Cien Saúde Colet. 2010 Jan/Jun;15(1):1275-82. 27. Morimoto IMI, Paladini EP. Determinantes da qualidade da alimentação na visão de pacientes hospitalizados. Mundo Saúde. 2009 Jul/Set;33(3):329-34. 28. Parisenti J, Firmino CC, Gomes CE. Avaliação de sobras de alimentos em uma unidade produtora de refeições hospitalares e efeitos da implantação do sistema de hotelaria. Alim Nutr. 2008 Abr/Jun;19(2):191-4. 29. Dias MAA. Humanização do espaço hospitalar: uma responsabilidade compartilhada. Mundo Saúde. 2006 Abr/ Jun;30(2):340-3 1 Hospital gastronomy helping to reduce malnutrition rates among hospitalized patients La gastronomía hospitalaria ayudando la reducción de los índices de desnutrición entre pacientes hospitalizados reaoes-alimentares-adversas-a-aditivos (2).pdf Alergia Alimentar – ASBAI Alimentação & Nutrição - Hospício Portuário (harbourhospice.org.nz) What Can a Hospice Patient Eat and Drink - Samaritan Hospice Blog (samaritannj.org) Nutricionista Nathália Oliveira Consultório: Ed. Olympia, rua do Hospício, 194, Boa Vista Instagram: @nathaliaoliveiranutri

Chefe Olim

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Best of Gastronomie

1.Food security HACCP + Corona 2. Organisation of a kitchen brigade 3.How to buy your ingredients? 4.Managment skills 5. All about knives! 6.Different cooking technique 7. How to hire staff? 8.How to increase your sales? 9.Fish and Sea food 10. Meat preparation 11.Sauces hot and cold 12.Soups hot and cold 13.Cocktails 14.Pastry skills 15.Chocolate 16.Sugar art 17.Coffee and tea 18 Digestives spirits

19.Vegetarian cuisine 20. Vegan cuisine 21.Viking cuisine 22.Middle age cuisine 23.Hospital and hospice cuisine 24.Hallal cuisine 25.Casher cuisine 26.Low calories cuisine 27.Molecular cuisine 28.Italian cuisine 29.French cuisine 30.Sushi and Japanese cuisine 31.Chinese cuisine 32.African cuisine 33.Middle-East cuisine 34.North American cuisine 35.South American cuisine

President Georges Grunenwald Founder of Best of Gastronomy

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Best of Gastronomie Code of Ethics Best of Gastronomie is a chef’s and Gourmet brotherhood: * Best of Gastronomie is a professionals group of kitchen, food and beverage trades. * Best of Gastronomie’s vocation is exchange, sharing, culinary transmission and promotion of chefs. * Best of Gastronomie is also a link between producers and chefs implanted in the world with the objective of discovering quality products. * With the logo of a handshake distinctly displayed on the medals, the Pin's and the trophy, "Best of Gastronomie" clearly displays the spirit of brotherhood which animates its members and its teams in which are banished all religious, political and racial considerations. * Best of Gastronomie is an exceptional quality label for gastronomy professionals. We have 110 000 members representative of the masters of taste and close to consumers at the search for good gastronomic addresses and product. * Best of Gastronomie has ambassadors in France, abroad in 155 countries and by profession: Master Bakers, Community catering, Gastronomic press, Diplomatic tables ... *"Best of Gastronomie" has also 12 training centers, in Middle East, in Africa and South America, Asia and Europe. * To request membership of "Best of Gastronomie" and obtain its culinary recognition medal, the request must be sent by mail to the President of the institution accompanied by a motivation letter and to answer the following questions: 1. Number of years of experience? 2. Current position and name of restaurant? 3. Diplomas already obtained in the culinary world? * After rigorous study of each file and subject to acceptance, a gold or silver medal is awarded to proven gastronomy professionals, in bronze for gourmets who make a commitment to support "Best of Gastronomie" with certain culinary references. * All new members are choosen and approved by the office of the country concerned * Best of Gastronomie ambassador are dedicated to organize Events, exchange and transmission, show, culinary demonstrations, gala dinners, promotions of establishments and products, cooking courses, national and international culinary competitions, presses ... * As a member you have to participate actively to our local events. * Long live gastronomie , long live "Best of Gastronomie", its commitments and its values, as Samuel Chamberlain expressed it so well with these words: "The fine art of gastronomy is a warm art. It crosses the language barrier, makes friends among civilized people and warms the heart”! More facts ... * Best of Gastronomie" now has more than 110,000 members cumulated on social networks and its Facebook page and capitalizes up to 5 million views per month on Instagram. With more than 155 countries represented. * Best of Gastronomie is an exceptional quality label for gastronomy professionals with the ambition of exceeding 300 ambassadors to be even more representative of the masters of taste and closer to consumers at the search for good gastronomic addresses.

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