Vol 3, No 1 (2022)

Original Study Articles

Results of clinical trials of a specialized product for enteral nutrition: Nutrigen Low Fat

Shen N.P., Tretiakova E.P.


BACKGROUND: Hereditary disorders of fatty acid oxidation are a group of fermentopathies caused by biallelic mutations in genes encoding enzymes of the mitochondrial β-oxidation cascade of fatty acids. Mitochondrial fatty acid oxidation deficiency is a genetically heterogeneous group of diseases in humans caused by defects in mitochondrial fatty acid β-oxidation. A common characteristic of all mitochondrial fatty acid β-oxidation disorders is hypoketotic hypoglycemia, resulting from an increased dependence on glucose oxidation and an inability to synthesize ketone bodies from fatty acids. The clinical manifestations of diseases in this group are highly variable. Patients with a defect in the oxidation of long-chain fatty acids are at risk of developing cardiac and skeletal muscle abnormalities, including cardiomyopathy and arrhythmias, which can progress to early death, as well as rhabdomyolysis and exercise intolerance. The optimal composition of Nutrigen Low Fat enteral mixture allows its use in children with intestinal dysfunction and metabolic disorders as a component of nutritional support or the sole source of nutrition.

AIMS: To study the clinical evidence on intestinal insufficiency syndrome in critically ill children, to assess the role of enteral nutrition in intestinal dysfunction prevention and treatment in critically ill patients in the pediatric intensive care unit, and to perform clinical monitoring of young children with inborn errors of fatty acid oxidation.

MATERIALS AND METHODS: Twelve children aged 3 months to 7 years with digestive dysfunction took part in the study. The study duration was 3 weeks. During the intervention, children received the product Nutrigen Low Fat in accordance with their age and individual nutritional needs. Throughout the study, the children’s nutritional status and the dynamics of digestive dysfunction were taken into account. A clinical trial of the dry complete enteral product Nutrigen Low Fat took place from May to August of 2021. A clinical trial of the product was conducted against a background of generally accepted medical treatment in accordance with the character of the disease. The study design was an observational, longitudinal cohort study.

RESULTS: The dynamics of objective clinical and laboratory data, as well as subjective patient characteristics, indicated an improvement in well-being, physical development, and positive dynamics of blood parameters. The product Nutrigen Low Fat meets the hygienic requirements for the composition and quality of pediatric medical nutrition products and has good organoleptic characteristics. It should be noted that Nutrigen Low Fat is convenient to use because it allows individual selection of the dilution and dosage in accordance with the child’s age and clinical status, has a high biological value (contains easily absorbed fat, with 84% medium-chain triglycerides, and easily digestible milk protein comprised of 60% whey). The product’s gluten-free formula is another advantage.

CONCLUSIONS: All of the above allows us to recommend the use of a complete product, Nutrigen Low Fat, as a supplement to the diet or as the sole source of nutrition. It can be used for oral nutrition (sipping) or tube feeding from birth in children with acute surgical and therapeutic diseases, as well as orphan inborn errors, including fatty acid oxidation errors, with maldigestion and malabsorption syndrome, intoxication, and malnutrition.

Clinical nutrition and metabolism. 2022;3(1):5-18
pages 5-18 views

The effect of beet juice-based foods on the performance of athletes in cyclic sports

Shestopalov A.E., Grishina Z.V., Lomazova E.V., Kalinin A.V., Feshchenko V.S., Zholinsky A.V.


BACKGROUND: Modern data from the scientific literature indicate that nitrate, when added to food, can serve as a precursor of nitric oxide (NO). According to research results, the concentrations of nitrates and nitrites in plasma increase when subjects are taking dietary supplements containing nitrates. Such an increase not only contributes to training performance by activating the nitrate pathway of energy supply to muscle activity but also generally improves physical performance.

AIMS: To evaluate the effect of consumption of beet juice, as a source of nitrates, on the performance of biathletes-sprinters.

MATERIALS AND METHODS: Forty male biathletes aged from 18 to 22 years took part in the study. The study took place in a training camp in the summer of 2017. The athletes were divided into an experimental group and a control group. The experimental group was given a preparation containing beet juice of a special variety twice daily after each training session, and the athletes of the control group did not consume anything after training sessions. Before the experiment and after 20 days of intervention, load testing before work refusal was carried out, as well as biochemical and general blood analysis.

RESULTS: In the athletes of the experimental group, who were consuming beet juice, there was a decrease in oxygen uptake per kilogram of body weight and an increase in heart rate at the moment of anaerobic threshold, as well as an increase in load time, which indicates an increase in endurance during anaerobic exercise. This parameter is one of the limiting factors of performance in cyclic sports. In addition, increases in blood iron content, transferrin saturation, hemoglobin concentration, and average erythrocyte volume were observed in participants who consumed the beet juice preparation.

CONCLUSIONS: The observed changes in indicators of the oxygen-transport system of the blood may be one of the mechanisms through which exogenous nitrates realize their positive effect on performance in the anaerobic phase.

Clinical nutrition and metabolism. 2022;3(1):19-27
pages 19-27 views


The role of nutritional support in non-small-cell lung cancer treatment

Kononets P.V., Obukhova O.A., Sergienko A.D.


Scientific discoveries from recent years, along with rapid progress in clinical nutrition, are gradually changing the views of physicians around the world regarding the role of nutritional support in the treatment of patients with cancer. Nutritional support in the modern context is considered not only as part of basic care but also as a serious therapeutic tool in the treatment and rehabilitation of patients with cancer. The effectiveness of additional substrate provision in reducing the number of complications during specific treatment, as well as the ability of nutritional therapy to improve patients’ quality of life, has been proven.

The present review is devoted to the problem of nutritional supplementation in patients with non-small-cell lung cancer.

According to the current international clinical guidelines, the primary treatment for non-small-cell lung cancer is surgery, included as part of combination treatment, which aggravates nutritional status disorders. Against the background of metabolic disorders characteristic of the malignant process, anorexia-cachexia syndrome develops, accompanied by weight loss, which is extremely difficult to reverse. The metabolic response caused by surgical injury significantly accelerates catabolic processes and blocks anabolic ones, sharply increasing the patient's need for macronutrients and especially for protein, which, in the absence of exogenous intake, is “extracted” from muscle tissue. For the assimilation of this protein, an energy supply (carbohydrates and fats) is necessary, most of which is also derived from the patient's own tissues. With progressive weight loss in the preoperative period, protein and fat reserves in the postoperative period are not sufficient.

The relationship between malnutrition and adverse treatment outcomes dictates the need for routine determination of nutritional status and correction of existing disorders in all patients with lung cancer. Nevertheless, most clinicians pay insufficient attention to the problem of nutritional status disorders in patients with non-small-cell lung cancer.

To describe the necessity and safety of nutritional therapy in patients with non-small-cell lung cancer, an analysis of publications on the topic was carried out with a preliminary search in the medical databases PubMed and Medline. The data obtained show convincingly that patients with non-small-cell lung cancer often have anorexia-cachexia syndrome. In the perioperative period, nutritional support for non-small-cell lung cancer improves the immediate and long-term results of surgical treatment.

Currently, nutritional therapy should be considered as an integral component of any anticancer treatment, as it contributes to the improvement of therapeutic results.

Clinical nutrition and metabolism. 2022;3(1):28-37
pages 28-37 views

Metabolic predictors of life-threatening conditions in patients in chronic critical illness

Shestopalov A.E., Yakovleva A.V., Lukyanets O.B., Petrova M.V.


Due to modern advances in medicine, more and more patients survive after severe acute diseases. However, some such patients remain dependent on life-support systems. Therefore, a chronic critical condition is an urgent problem for patients in the intensive care unit. The main syndrome of this complex is maladaptive responses to long-term existing stress factors. This review examines the main pathophysiological mechanisms of chronic critical illness, as well as the resulting metabolic disorders. A literature search was conducted in the English-language databases of medical and biological publications PubMed and Scopus, as well as the Russian bibliographic system RSCI. The coverage interval was the last 20 years. Emphasis was placed on the systemic inflammatory reaction; the reaction of hypermetabolism-hypercatabolism; disorders of carbohydrate, protein, and fat metabolism; and the development of secondary sarcopenia. In conclusion, the volume of metabolic control and intensive nutritional and metabolic support, which are critical components of a comprehensive approach to the treatment of chronic critical illness, are key considerations considered.

Clinical nutrition and metabolism. 2022;3(1):38-49
pages 38-49 views

The effect of nutritional support on nutritional status, quality of life, and survival in cancer patients receiving systemic anticancer therapy

Obukhova O.A., Kurmukov I.A., Ryk A.A.


Malnutrition, a common problem among cancer patients, due to the direct influence of the tumor and the consequences of specific therapy, negatively affects the patient’s quality of life and is detrimental to the results of anticancer treatment. Nutritional support plays a vital role in systemic drug anticancer therapy; however, malnutrition that develops against a background of malignant neoplasms remains underestimated and receives little attention in clinical practice.

To assess the need for and safety of nutritional support in this context, an analysis of publications in the medical databases e-Library, PubMed, and Medline was performed with an emphasis on assessing the safety and efficacy of NP in the presence of systemic drug antitumor treatment for the period 2003–2022 using the keywords oncology, chemotherapy, nutritional support, omega-3 fatty acids, and glutamine.

The obtained data show that patients with cancer have anorexia-cachexia syndrome, leading to the development of sarcopenia, which negatively affects the results of specific therapy. Timely appointment of nutritional support significantly improves the results of treatment, as well as quality of life, and increases the survival rate in patients receiving non-surgical anticancer therapy; moreover, nutritional support administered in parallel with anticancer drug therapy improves treatment results.

Clinical nutrition and metabolism. 2022;3(1):50-61
pages 50-61 views

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