Vol 3, No 3 (2022)

Original Study Articles

Distribution of water sectors in patients in chronic critical illness: Early rehabilitation stage

Yakovleva A.V., Orekhova Z.M., Shestopalov A.E., Petrova M.V.


BACKGROUND: Fluid therapy in the intensive care unit is not only one of the most common components of therapy but also one of the most controversial and widely discussed. The choice of volume and type of infusion is a multifactorial issue. Currently, the search continues for a convenient non-invasive method that can be used to assess the water composition of the patient’s body.

AIM: To analyze the distribution of fluid sectors in patients with chronic critical illness using bioimpedance with standard fluid therapy.

MATERIALS AND METHODS: The study included 63 patients with chronic critical illness (CCI) after brain damage (men, n=28; women, n=35; average age, 54±19 years). According to nosology, 22 patients had ischemic stroke; 17, traumatic brain injury; 14, hemorrhagic stroke; 7, condition after brain surgery; and 2, post-hypoxic conditions. The study was conducted in the morning before breakfast using the analyzer of bioimpedance metabolic processes and body composition ABC-02 “Medass.” A total of 140 measurements were conducted.

RESULTS: In most cases, the volume of the total body water (TBW) in patients was within the age and sex norm (78.6%); however, the volume of extracellular water (ECW) reached normal values only in 45.7%. Moreover, both indicators were simultaneously within the normal range only in 44.3%. In addition, TBW and ECW did not coincide at 35.7%. The most common option was an increase in ECW while maintaining a normal TBW (24.3%). When conducting a correlation analysis of TBW and ECW indicators with biochemical blood test data (a decrease in the total protein level and albumin level), the strength of the relationship between the correlation coefficients of the samples on the Chaddock scale turned out to be very weak for all options considered.

CONCLUSIONS: In patients in CCI after brain damage, there may be an accumulation of water in the extracellular space without visible edema in >50% of the patients, whereas the TBW indicator is within the age and sex norm in 24.3%. This indicator does not depend on either the level of hypoproteinemia and hypoalbuminemia.

Clinical nutrition and metabolism. 2022;3(3):123-131
pages 123-131 views

Role of intestinal lavage in the normalization of the functions of the gastrointestinal tract in patients with chronic critical illness

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


BACKGROUND: The resolution of intestinal insufficiency syndrome remains one of the urgent problems of nutritional support for patients with traumatic brain injury (TBI) and chronic critical illness.

AIM: To determine the effectiveness of intestinal lavage in restoring the basic functions of the gastrointestinal tract and microbiocenosis in patients with chronic critical illness.

MATERIALS AND METHODS: This prospective, randomized, single-center study analyzed 56 men with TBI of various etiologies and chronic critical illness. At the beginning of treatment and on day 10, the effectiveness of gastrointestinal lavage was evaluated as a complex intensive treatment of intestinal insufficiency syndrome.

RESULTS: Patients were randomized into two groups depending on the conduct of intestinal lavage. In group 1 (n=27), enteral tube feeding was performed according to the standard method. In group 2 (n=29), intestinal lavage was also performed and an enterosorbent was added to the saline enterosorbent solution, three procedures with an interval of 3 days. A significant positive dynamics of carbohydrate and protein metabolism, restoration by day 10 of the barrier function of the intestine, motility of the gastrointestinal tract, and microbiocenosis were observed in group 2 (main group) compared with those in group 1 (control).

CONCLUSION: The inclusion of gastrointestinal lavage in the complex intensive therapy for SCI in patients with a chronic critical illness for a short period helps resolve the main pathogenetic links of SCI — restoration of the barrier function of the intestine, digestive transport, motor evacuation processes in the gastrointestinal tract, normalization of microbiocenosis, and metabolic parameters and nutritional status.

Clinical nutrition and metabolism. 2022;3(3):132-139
pages 132-139 views


Review of ESPEN-2021 Practice Guidelines for Cancer Patients: Part 1

Ivanova A.S., Obukhova O.A., Kurmukov I.A., Volf L.Y.


This study discusses the 2021 ESPEN Practical Guidelines for Nutritional Support in Oncology. The updated version of the 2021 ESPEN practice guidelines differs slightly from the 2017 version and contains flowcharts to facilitate the use of the guidelines in clinical practice, which is also relevant for domestic healthcare. ESPEN-2021 Clinical Guidelines, which offer practical solutions in all areas of oncology, are of particular interest to both oncologists and allied specialists working in oncology. The first part of the review discusses general recommendations for nutritional support for patients with cancer and the possibility of their use in our country: screening of nutritional status at the initial visit, indications for prescribing additional nutrition, benefits of one or another type of nutritional support in various situations, norms for providing macronutrients, vitamins, and minerals, and need for physical activity. This practical guide forms an algorithm of actions to ensure optimal nutrition for patients with cancer. The general principles of nutritional therapy for all patients with cancer are based on timely screening for nutritional deficiencies and adherence to appropriate nutritional support of patients, which can be achieved by modifying the diet or prescribing additional nutrition, mainly enteral nutrition.

Clinical nutrition and metabolism. 2022;3(3):140-152
pages 140-152 views

Nutritional interventions in the framework of a person-centered model of health care and geroprotection

Martyushev-Poklad A.V., Yankevich D.S., Savitskaya N.G., Petrova M.V.


The existing system of prevention of age-related diseases that focused on cohort-based risk factors shows insufficient effectiveness; thus, practicable methodology of health promotion compliant with the principles of P4 medicine, with a special focus on nutritional interventions, is needed. The study outlines an algorithm of nutritional interventions designed in accordance with the principles of person-centered organizational model of healthcare. The algorithm is based on the modern concept of exposome and its influence on the key mechanisms of accelerated aging and pathogenesis of age-related diseases. The proposed approach to personalized nutritional interventions is implemented in three steps: (1) the need for nutritional intervention is identified through the evaluation of the signs and symptoms of health impairment and accelerated aging that have very probable association with suboptimal nutrition, (2) individual exposome factors are evaluated as potential sources of health problems, and (3) first-line nutritional interventions are selected and implemented. The algorithm focused on eliminating the shortcomings of the diagnosis-centered organizational model of healthcare prevailing worldwide: to enable early detection of distress, use of the most effective and affordable interventions (diet and nutrition), and maximum involvement of the patient in health management. The algorithm bears a good potential of automation through decision support for patients regarding health. The use of original questionnaires and patient-centered data reduces the cost and expands the possibilities of scaling the algorithms of intervention. The algorithm can become the basis for the wide introduction of the principles of predictive, personalized, and participatory prevention of age-related diseases.

Clinical nutrition and metabolism. 2022;3(3):153-166
pages 153-166 views

Calcium and vitamin D supplements for the treatment and prevention of osteoporosis. Should it be widely used?

Kaminarskaya Y.A.


Osteoporosis is the most common age-related skeletal diseases, which is characterized by the rapid loss of bone mineral density and increased risk of fragility fractures. The social significance of osteoporosis is attributed to its complications, which increase disability and mortality rates mostly among older people. Inadequate dietary calcium intake and vitamin D deficiency are well-known risk factors for osteoporosis. Thus, for many years, calcium and vitamin D have been considered crucial in the prevention and treatment of osteoporosis. However, in recent years, the efficacy and safety of calcium and vitamin D have been questioned because some randomized clinical trials have reported only a weak positive effect of calcium with or without vitamin on reducing fragility fracture risks. On the contrary, besides the gastrointestinal side effects of calcium supplements and the risk of kidney stones related to the co-administration of calcium and vitamin D supplements, other recent data suggested that calcium supplementation has potential adverse cardiovascular effects. This study focused on the evidence regarding the possible usefulness for bone health and the potential harmful effects of calcium and/or calcium with vitamin D supplementation.

Clinical nutrition and metabolism. 2022;3(3):167-176
pages 167-176 views

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