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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medinfo</journal-id><journal-title-group><journal-title xml:lang="ru">Актуальные проблемы теоретической и клинической медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Actual Problems of Theoretical and Clinical Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2790-1289</issn><issn pub-type="epub">2790-1297</issn><publisher><publisher-name>Казахстанско-Российский медицинский университет</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.64854/2790-1289-2026-53-3-09</article-id><article-id custom-type="elpub" pub-id-type="custom">medinfo-1165</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>РИСК-ОРИЕНТИРОВАННАЯ ТРАНСФОРМАЦИЯ  ЛЕЧЕБНО-ПРОФИЛАКТИЧЕСКОГО ПИТАНИЯ РАБОТНИКОВ</article-title><trans-title-group xml:lang="en"><trans-title>RISK-ORIENTED TRANSFORMATION OF THERAPEUTIC AND PREVENTIVE NUTRITION FOR WORKERS</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0006-0950-678X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Актаева</surname><given-names>Л. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Aktayeva</surname><given-names>L. M.</given-names></name></name-alternatives><email xlink:type="simple">rniiot@rniiot.kz</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2033-3625</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бекмагамбетов</surname><given-names>А. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Bekmagambetov</surname><given-names>A. B.</given-names></name></name-alternatives><email xlink:type="simple">Adilet1979@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-4442-057X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Едильбаева</surname><given-names>Л. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Yedilbayeva</surname><given-names>L. I.</given-names></name></name-alternatives><email xlink:type="simple">yedilbayeva.laura@rniiot.kz</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6351-6755</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Абсаттарова</surname><given-names>К. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Absattarova</surname><given-names>K. S.</given-names></name></name-alternatives><email xlink:type="simple">absattarova.k@kaznmu.kz</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0205-2421</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сейдуанова</surname><given-names>Л. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Seiduanova</surname><given-names>L. B.</given-names></name></name-alternatives><email xlink:type="simple">seyduanova.l@kaznmu.kz</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>РГП на ПХВ «Республиканский научно-исследовательский институт охраны труда», Казахстан, Астана</institution><country>Казахстан</country></aff><aff xml:lang="en"><institution>RSE on REM «Republican Research Institute of Occupational Safety and Health of the Ministry of Labor and Social Protection of the Population of the Republic of Kazakhstan», Kazakhstan, Astana</institution><country>Kazakhstan</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>РГП на ПХВ «Республиканский научно-исследовательский институт охраны труда», Казахстан, Астана&#13;
НАО «Казахский национальный медицинский университет имени &#13;
С. Д. Асфендиярова», Казахстан, Алматы</institution><country>Казахстан</country></aff><aff xml:lang="en"><institution>RSE on REM «Republican Research Institute of Occupational Safety and Health of the Ministry of Labor and Social Protection of the Population of the Republic of Kazakhstan», Kazakhstan, Astana&#13;
NJSC «Asfendiyarov Kazakh National Medical University», Kazakhstan, Almaty</institution><country>Kazakhstan</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>05</day><month>10</month><year>2026</year></pub-date><volume>0</volume><issue>3</issue><elocation-id>1165</elocation-id><permissions><copyright-statement>Copyright &amp;#x00A9; Актаева Л., Бекмагамбетов А., Едильбаева Л., Абсаттарова К., Сейдуанова Л., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Актаева Л., Бекмагамбетов А., Едильбаева Л., Абсаттарова К., Сейдуанова Л.</copyright-holder><copyright-holder xml:lang="en">Aktayeva L., Bekmagambetov A., Yedilbayeva L., Absattarova K., Seiduanova L.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://kazrosmedjournal.krmu.edu.kz/jour/article/view/1165">https://kazrosmedjournal.krmu.edu.kz/jour/article/view/1165</self-uri><abstract><sec><title>Актуальность</title><p>Актуальность. Выдача молока работникам, занятым во вредных условиях труда, остаётся масштабной социальной гарантией. Однако универсальный продукт не учитывает свойства токсикантов, интенсивность воздействия, профессиональный риск, нутритивный статус и индивидуальные противопоказания.</p></sec><sec><title>Цель</title><p>Цель. Разработать концептуальную модель риск-ориентированного питания с сохранением законодательно установленных и договорных гарантий работников и определить требования к ее дальнейшей проверке.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Работа представляет собой критический вторичный документальный анализ и концептуальное исследование, а не систематический обзор. Документы рассматривались по их прямой относимости к четырем аналитическим направлениям: охват и расходы, правовые требования, организационные вопросы, биомедицинское обоснование и требования к оценке. Всеобъемлющий библиографический поиск, отбор по схеме PRISMA и формальная оценка риска систематической ошибки не проводились. Новые данные на уровне работников не собирались.</p></sec><sec><title>Результаты</title><p>Результаты. Предложена двухкомпонентная модель, связывающая сохранение обязательных и договорных гарантий с оценкой питания и продуктов применительно к конкретной производственной экспозиции. Определены этапы характеристики воздействия, оценки соответствия продукта индивидуальным потребностям и противопоказаниям, документирования продукта, участия работников и контролируемой проверки. Официальные данные за 2025 г. указывают на 325 429 получателей молока или равноценных продуктов в обследованном круге предприятий. Организационные материалы описывают вопросы внедрения, а экономический анализ определяет данные, необходимые для воспроизводимого будущего сравнения полных затрат. Исторические данные биомониторинга, приписываемые Кольской горно-металлургической компании, исключены из количественного анализа из-за отсутствия исходного отчета и ключевых методических сведений.</p></sec><sec><title>Выводы</title><p>Выводы. Модель формирует основу для разработки и проверки дифференцированного питания с сохранением обязательного обеспечения работников. Научный вклад заключается в объединении правовых гарантий, требований к выбору продукта с учетом экспозиции и последовательности оценки. Профилактическая эффективность, безопасность, приемлемость для работников и экономическая эффективность подлежат проспективной проверке.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Relevance</title><p>Relevance. Milk provision to employees exposed to hazardous working conditions remains a large-scale social guarantee in Kazakhstan. However, a universal food product does not account for differences in toxicant properties, exposure intensity, occupational risk, nutritional status, or individual contraindications.</p></sec><sec><title>Objective</title><p>Objective. To formulate a two-component framework for risk-oriented occupational nutrition that preserves workers’ statutory and contractual guarantees, and to specify its implementation and evaluation requirements.</p></sec><sec><title>Materials and Methods</title><p>Materials and Methods. This was a critical secondary documentary analysis and conceptual policy study, not a systematic review. The documentary corpus comprised statistical, regulatory, organizational, economic and biomedical materials available to the authors, together with accessible public primary sources used to verify legal and statistical claims. No comprehensive bibliographic search, formal study-selection flow or risk-of-bias assessment was undertaken. Narrative synthesis distinguished externally reported observations, authors’ arithmetic calculations and conceptual proposals.</p></sec><sec><title>Results</title><p>Results. The analysis produced a two-component framework linking preservation of existing guarantees with exposure-specific nutritional assessment and product evaluation. It specified a staged decision process covering exposure characterization, individual suitability, product documentation, worker participation and controlled evaluation. Official statistics record 325,429 recipients of milk or equivalent products in the surveyed enterprise population in 2025. Organizational material identifies implementation issues, while the economic analysis specifies the inputs required for a reproducible future full-cost comparison. Incomplete enterprise documentation limits assessment of implementation outcomes. Historical biomonitoring values attributed to the Kola Mining and Metallurgical Company were excluded from quantitative analysis because the original report and essential methodological information were unavailable.</p></sec><sec><title>Conclusions</title><p>Conclusions. The framework provides a structured basis for developing and testing differentiated occupational nutrition while maintaining mandatory provision. It links legal guarantees with requirements for product selection and evaluation. Preventive efficacy, safety, acceptability and cost-effectiveness require prospective assessment.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>профессиональный риск</kwd><kwd>вредные условия труда</kwd><kwd>лечебно-профилактическое питание</kwd><kwd>молоко</kwd><kwd>пектин</kwd><kwd>пектинсодержащие профилактические напитки</kwd><kwd>социальные гарантии</kwd><kwd>биомониторинг</kwd><kwd>Казахстан.</kwd></kwd-group><kwd-group xml:lang="en"><kwd>occupational risk</kwd><kwd>hazardous working conditions</kwd><kwd>therapeutic and preventive nutrition</kwd><kwd>milk</kwd><kwd>pectin</kwd><kwd>pectin-enriched preventive beverages</kwd><kwd>social guarantees</kwd><kwd>biomonitoring</kwd><kwd>Kazakhstan.</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Ministerstvo zdravookhraneniya i sotsialnogo razvitiya Respubliki Kazakhstan. (2015). 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