Vol 1, No 1 (2020)

Nutritional support: a modern concept of clinical nutrition
Popova T.C.

Interview with Vice President of the Russian Association of Parenteral and Enteral Nutrition Professor T. S. Popova is devoted to the topic of nutritional deficiency associated with diseases, trauma and surgical interventions, as well as the inclusion of nutritional support in all treatment standards in inpatient and outpatient stages. The questions of raising the level of doctors’ training and promising areas in the science of nutrition are considered.

Clinical nutrition and metabolism. 2020;1(1):5-7
Medical rehabilitation: problems and solutions
Ivanova G.E.

To questions regarding the rehabilitation process in patients with impaired functions and structures, limited activity due to diseases or conditions, which in most cases lead to disability, Galina E. Ivanova MD the head of department of medical rehabilitation, Faculty of Additional Professional Education, State Autonomous Educational Institution named after N. I. Pirogova, and also the head of the medical rehabilitation department of the Federal Center for Cerebrovascular Pathology and Stroke of the Russian Ministry of Health. During the conversation, important aspects of clinical nutrition were touched upon like “in order to compensate for the loss of energy and structural elements of tissues in this category of patients.”

Clinical nutrition and metabolism. 2020;1(1):8-9
The role of indirect calorimetry in the treatment and rehabilitation of patients in long-term unconsciousness after brain damage
Krylov K.Y., Sergeev I.V., Yakovleva A.V., Yagubyan R.S., Yakovlev A.A., Petrova M.V.

Background. Nutritional support is an important part of the treatment of critically ill patients. However, there are no specific recommendations for patients in a long unconscious state after brain damage to determine their energy needs.

Aim. To determine the role of indirect calorimetry in assessing the energy expenditure of patients in prolonged unconsciousness after brain damage.

Methods. Prospective cohort study included 81 patients with brain damage who were treated in the intensive care unit. All patients with prolonged unconsciousness had stayed in the intensive care unit for more than 30 days. Mean age of patients was 48.4 ± 16.3 years. Men were predominant (58%). Almost all patients had normal body mass index (BMI) (mean 22.8 ± 6.2 kg/m2). The main cause of brain damage was severe traumatic injury (42%). There were also patients with consequences of subarachnoid hemorrhage (35%), stroke (19%) and hypoxic damage (4%).

Results. According to indirect calorimetry, mean energy requirements in patients in prolonged unconsciousness was 25.12 ± 8.8 kcal/kg/day (1595.3 ± 560 kcal/day). Variability of this value was high in this sample (10.6–61.6 kcal/kg/day, 673–3514 kcal/day). According to urine nitrogen loss, mean protein requirement was 0.83 ± 0.46 g/kg/day that was lower than the recommended values for critically ill patients. Variability of data obtained by indirect calorimetry was higher than that of the calculated values despite statistically similar energy requirements of patients. Variability of data obtained by Harris-Benedict equation ranged from 15.4 kcal/kg/day (1023 kcal/day) to 37.3 kcal/kg/day (2065 kcal/day). There was no relationship between energy expenditure and causes of brain damage. Moreover, significant correlation between metabolic rate, urine nitrogen loss and outcomes of disease was also absent.

Conclusion. Indirect calorimetry alone is not enough to prescribe optimal nutritional support in patients with prolonged unconsciousness if function of the gastrointestinal tract and other factors affecting energy expenditure are not considered.

Clinical nutrition and metabolism. 2020;1(1):10-16
Changes in the nutritional structure of the population of Russia for 100 years
Burlyaeva E.A., Kambarov A.O., Nikityuk D.B.

Background. In recent years, great importance has been given to preserving and strengthening the health of the population, the role of disease prevention and formation of a healthy lifestyle, including the formation of a culture of healthy nutrition of the population. With the aim to study changes in nutrition of the Russian population over the past 100 years, we have conducted a nutrition assessment based on statistical data. The results obtained indicate significant changes in the quantitative composition of the main groups of products consumed by the population of Russia. The structure of the diet indicates significant deviations from the recommendations on rational food consumption standards that meet modern requirements for a healthy diet. There is a lack of consumption of potatoes, vegetables, fruits, milk and dairy products, eggs, which are a source of essential nutrients for the body — proteins, dietary fiber, vitamins, minerals. At the same time, over the past hundred years, there has been a significant, even excessive, increase in the consumption of meat products and sugar.

Conclusion. Good nutrition largely determines the quality of life and health indicators of the nation.

Clinical nutrition and metabolism. 2020;1(1):17-26
Glutamine and its derivatives in the correction of metabolic disorders in HIV-infected patients (review)
Luft V.V., Dmitriev A.V.

It has been established that HIV-infection is associated with progressive deficiency of L-glutamine followed by immune dysfunction, reduced body mass and muscle strength, morphological disorders and functional disintegration of the intestine, as well as neurological disorders. According to current ideas, correction of L-glutamine deficiency is one of the important components of adjuvant therapy for HIV-infected patients within general nutritional support strategy. This measure helps to slow development of AIDS, reduce side effects of antiretroviral therapy and enhance effectiveness.

Clinical nutrition and metabolism. 2020;1(1):27-35
Cachexia and sarcopenia at oncological patients: diagnostics and treatment tactics
Khoroshilov I.E.

Background. The features of malnutrition are revealed at 30–85% of oncological patients.

Aims. To represent present knowledges on causes and mechanisms of development, clinical features and treatment of cachexia and sarcopenia at oncological patients, including nutritional support and target pharmacotherapy.

Discussion. Cancer cachexia it is necessary to install in case of weight loss on 10% and more from initial and body mass index in adults less than 17 kg/m2. To diagnose of sarcopenia and cachexia are used the bioelectrical impedance analysis, computer and the magnetic resonances tomography. To be treated and warning of sarcopenia and cachexia is used the nutritional support. The enteral nutrition is appointed, when the energy intakes with nutrition less than 60% from required during 1–2 weeks, or in the presence of sarcopenia or cachexia. Beyond that, the oncological patients are to get the target pharmacotherapy. For maintaining of muscle mass by the oncological of a patients it is recommended physical activity, exercise, this refers and to palliative patients.

Conclusion. Cachexia and sarcopenia are characteristic of most of the oncological patients. The development of these conditions can cause substantial increase of different complicating diseases and lethality. To prevent their may be in due time designated personalized nutritional support, including additional enteral nutrition and target pharmacometabolic therapy.

Clinical nutrition and metabolism. 2020;1(1):36-46
The experience of using a modern mixture for oral nutrition in a child with epidermolysis bullosa
Erpuleva Y.V., Shurova L.V., Dmitrienko L.I.

Bullous epidermolysis is a congenital disease characterized by skin vulnerability due to the formation of blisters and erosion on the skin and mucous membranes, which makes it difficult for a child to eat naturally. The problem of providing the necessary nutrients to children with this serious illness remains relevant. The article shows its own clinical experience in the use of modern enteral nutritional mixtures in a child with epidermolysis bullosa. Given the skin manifestations, the possibility of infection of the catheter for prolonged parenteral nutrition, children with bullous epidermolysis are not recommended for prolonged use of parenteral nutrition, so the use of modern mixtures for enteral nutrition remains the method of choice.

Clinical nutrition and metabolism. 2020;1(1):47-51

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