Vol 2, No 3 (2021)


Celiac disease, wheat allergy, and nonceliac sensitivity to gluten: topical issues of the pathogenesis and diagnosis of gluten-associated diseases

Kaminarskaya Y.A.


Historically, wheat and other gluten-containing grains have been an essential part of the diet of many people worldwide. However, the widespread use of gluten-containing products has led to an increased incidence of adverse reactions associated with their consumption, such as celiac disease and wheat allergy, as well as nonceliac gluten sensitivity, which has become common in recent years.

Gluten-associated diseases have similar clinical manifestations (abdominal pain, bloating, diarrhea, nausea, and vomiting). The pathogenetic mechanisms underlying celiac disease and wheat allergy are quite well understood; in both cases, an immune response occurs when wheat proteins are consumed, both with effective treatment. Nonceliac gluten sensitivity is the subject of discussion; however, the processes underlying this disease are not fully understood; thus, its diagnosis and treatment have no unified approach. To date, nonceliac gluten sensitivity is a diagnosis of exclusion, which is established in the absence of markers of celiac disease or wheat allergy and improved following a gluten-free diet.

A gluten-free diet is the most effective treatment for gluten-related diseases. However, like any other strict dietary restriction, gluten avoidance can result in reduced intakes of important nutrients, such as dietary fiber, protein, and micronutrients. In recent years, an increasing trend is found in the general population without confirmed gluten-related disorders that gluten-free product consumption or gluten-free diet adherence since gluten avoidance can improve well-being or gluten can be toxic for all human beings

According to current guidelines, only patients diagnosed with celiac disease or wheat allergy are advised to follow a strict gluten-free diet.

Herein, the modern conception of the immunopathology of gluten-related diseases and an overview of new potential therapies are presented.

Clinical nutrition and metabolism. 2021;2(3):113-124
pages 113-124 views

Malnutrition in oncology: etiology, pathogenesis, and principles of correction

Tsvetkov D.S.


Cancer is currently one of the leading causes of death. Mortality in this group of patients is due to both underlying disease course and therapy complications. The development of cachexia is one of the most important factors that affect both the quality of life of a patient with cancer and the treatment effectiveness. Presently, ideas about the pathogenesis of malnutrition in patients with cancer and its diagnostic methods are fairly clear. However, a particular patient needs to understand which processes are leading to the development of anorexia-cachexia syndrome. Concepts, such as anorexia, cachexia, and sarcopenia, reflect various possible variants of the course or stage of developing metabolic disorders. Their timely detection determines the duration and process intensity and assesses the prognosis of the disease course, as well as develops a patient-oriented nutritional support program. Understanding the pathogenesis of its development allows for the correction of emerging disorders throughout the patient treatment period.

Nutritional therapy is a key method that can influence the severity of cachexia. Undoubtingly, the progression of malnutrition is due to the multimodal effect of the tumor on the patient’s metabolism and can significantly affect the effectiveness of antitumor therapy. Therefore, basic principles of diagnosis and treatment are formulated, including early diagnosis, individual nutritional need calculation (proteins, energy), and the use of pharmaconutrients that can influence the severity of catabolic processes.

According to the patient-orientation concept, an oncologist should be involved in the formation of a nutritional therapy program, which allows a simultaneous selection of the most optimal scheme of specialized nutrition based on the patient’s condition, type and stage of neoplasm, nutrient introduction restrictions, taste preferences, and timely qualitative and quantitative nutrient composition adjustment against the background of the changing patient condition and needs.

The maximum effectiveness of nutritional support in patients with cancer can be achieved only with a multimodal approach of correcting all pathological processes that lead to malnutrition occurrence and progression.

Clinical nutrition and metabolism. 2021;2(3):125-140
pages 125-140 views

Trace elements and metalloenzymes in patients with acute pancreatitis

Kotchergin V.G., Sviridov S.V., Subbotin V.V., Vetsheva M.S.


For many decades, acute pancreatitis has occupied third place in the structure of emergency surgical abdominal conditions, second to acute calculous cholecystitis and acute appendicitis. Simultaneously, acute pancreatitis ranks first in mortality among other acute surgical conditions. Often acute pancreatitis occurs under the “mask” of gastroenterological problems.

Complex electrolyte and trace element disorders are often formed in the early stages of developing pancreatitis. The concepts of diagnosis and therapeutic and surgical treatment of acute pancreatitis are formulated and reflected in numerous domestic and international monographs and recommendations, which emphasize the important role of water-electrolyte disorders, microbiota, systemic inflammatory response, and cytokine storm as etiological factors in inflammatory development and maintenance and destructive pancreatic and parapancreatic cellular processes. Sepsis, septic shock, and multiple organ failure are the leading causes of mortality in patients with infected pancreatic necrosis.

Problems of the interrelation and role of individual trace elements and metalloenzymes as etiological factors in acute pancreatitis formation, prognostic biochemical markers of the severity of patients’ condition, and prognostic criteria of mortality and recovery are actively studied.

Clinical nutrition and metabolism. 2021;2(3):141-156
pages 141-156 views

The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

Bear D.E., Wandrag L., Merriweather J.L., Connolly B., Hart N., Grocott M.P.


Randomized controlled trials addressing the role of nutrition during long-term recovery from critical illness, including other outcomes, have not shown clear benefits, leading to significant controversy on the topic. Although methodological caveats with failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact.

This narrative review focuses on recent clinical trials, evaluating the impact of nutrition on long-term physical and functional recovery from critical illness, with specific emphasis on the details of trial design and methodological limitations. Such limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes, and disregard for baseline nutritional status and intake in the post-ICU period. With survival at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design, which strongly influence long-term physical and functional outcomes among others. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potential benefits of nutrition interventions during critical illness.

This article is the legal Russian-language translation from the original publication of Bear D.E. et al. “The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review” in Critical Care [2017;21(1):226. doi: 10.1186/s13054-017-1810-2] with the permission of the copyright holders.

Clinical nutrition and metabolism. 2021;2(3):157-172
pages 157-172 views


Nutritional support for patients in the neurosurgical and neurological intensive care unit: are special guidelines necessary?

Krylov K.I., Sviridov S.V., Savin I.A.


The nutritional support for patients in the intensive care unit is an integral component of intensive care. Patients of a neurological and neurosurgical profile who are in the intensive care unit are a special group of patients, whose treatment differs both in the used intensive therapy methods and nutritional support provision.

Indirect calorimetry should be used to determine the energy requirements in neurosurgical and neurological patients. The use of calculation equations, such as the Harris-Benedict equation, is impossible due to its large discrepancy with indirect calorimetry data. The need for protein in patients of this category should be made at the rate of 1.2–2.0 g/kg of body weight per day. The urinary nitrogen loss data should not be used as a routine method for determining protein requirements in these patients. Insufficient energy and protein intake in neurosurgical and neurological patients can lead to increased infectious complications, mechanical ventilation duration, and length of intensive care unit stay, and rehabilitation potential deterioration. Excessive energy intake can lead to increased carbon dioxide production and intra-abdominal pressure, thereby increasing the intracranial pressure and aggravating secondary brain damage.

The central nervous system damage leads to increased intestinal permeability, worsens motility, and even changes the microbiota, which requires constant monitoring of the gastrointestinal tract functions to provide adequate nutritional support in neurological and neurosurgical patients who are in the intensive care unit.

In modern guidelines, both on intensive care and nutritional support, recommendations for its implementation in these patients are unclear.

Clinical nutrition and metabolism. 2021;2(3):173-179
pages 173-179 views

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