Vol 3, No 4 (2022)

Original Study Articles

Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?

Shen N.P., Mukhacheva S.Y.


BACKGROUND: Nutritional support in abdominal surgery is a complex aspect of intensive care with many contradictions in available recommendations and in relation to interdisciplinary interaction. The challenges of assessing nutritional status and timing of the start and methods of clinical nutrition have not yet been resolved. Research has not yet explained whom and how to feed in the intensive care unit, nor has it proved the need for an early start of enteral nutrition or assessed the scale of the problems, such as the lack of uniform views and low adherence to clinical recommendations.

AIM: To analyze the effectiveness of early enteral nutrition in achieving optimal treatment results in patients with abdominal surgical pathology and assess the depth of knowledge and adherence to clinical recommendations of specialists providing care to this cohort.

MATERIALS AND METHODS: The study included 50 patients, 32 of whom started early enteral nutrition and 18 received later enteral nutrition. A survey of 41 specialists (surgeons and intensivists) from three leading hospitals in Tyumen was also conducted. The main set of clinical material was conducted on the basis of the Regional Clinical Hospital No. 1 (Tyumen).

RESULTS: The study demonstrated the advantages of early enteral nutrition over delayed nutrition by an average of 48 h by reducing the length of hospital stay and resuscitation stage of treatment and minimizing pulmonary complications. Moreover, a survey of specialists assisting this cohort showed a lack of consensus in treatment approaches and insufficient adherence of patients with abdominal surgical pathology to existing clinical recommendations on clinical nutrition.

CONCLUSIONS: Further research on nutritional support in patients with abdominal surgical pathology should aim at reducing the decision-making time in favor of an earlier and combined method of nutritional support, which can be facilitated by enhancing literacy and promoting adherence to clinical recommendations of specialists at the interdisciplinary level.

Clinical nutrition and metabolism. 2022;3(4):181-192
pages 181-192 views


Review of ESPEN-2021 Practice Guidelines for Patients with Cancer. Part 2: Interventions Relevant to Specific Patient Categories

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


This study further discussed the 2021 ESPEN practical recommendations 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 significant to both oncologists and allied specialists working in oncology. The second part of the review discusses particular issues of nutritional support for patients with cancer and analyzes the domestic experience of their use. The review provides the main protocols for artificial nutrition in surgery, during irradiation, and in drug therapy in patients in remission and at the palliative stage and proves the need to maintain physical activity in patients with cancer. The presented practical guidance allows organizing an adequate supply of nutrient substrates to patients with cancer receiving various types of anticancer treatment, in remission, and at the stage of palliative care.

Clinical nutrition and metabolism. 2022;3(4):193-206
pages 193-206 views

Nutritional support as part of the basic therapy of a patient in the acute period of ischemic stroke in the intensive care unit

Krylov K.Y., Sviridov S.V., Vedenina I.V., Yagubyan R.S.


Ischemic stroke remains the predominant cause of disability in the population (3.2 per 1000 population). Only 8% of ischemic stroke survivors can return to their previous work. Nutritional support is an integral part of the multidisciplinary approach to the treatment of ischemic stroke in the intensive care unit during the acute and rehabilitation phases. Brain damage always has metabolic consequences on the patient’s body, and premorbid malnutrition and stroke-stroke malnutrition significantly affect disease outcomes. The incidence of malnutrition in patients with ischemic stroke varies widely, ranging from 6.1% to 62%, depending on the method for determining protein-energy malnutrition. Despite the relevance of the problem of nutritional support in patients with ischemic stroke, only a few specific recommendations are available in the literature for this category of patients. This review focuses on nutritional support for patients who require mechanical ventilation or admission in the intensive care unit for >48 h.

Clinical nutrition and metabolism. 2022;3(4):207-216
pages 207-216 views

Nutritional therapy for protein-energy malnutrition in children with sepsis

Satvaldieva E.A., Ashurova G.Z.


This review presents meta-analyses on nutrition in patients with critical illness using ASPEN/SCCM (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. The ESPNIC (2020) guideline, based on new evidence, complements most of the existing ASPEN (2017) guidelines for critical pediatrics. Children’s SSC (2020) did not find direct evidence and sufficient data to develop strong nutritional recommendations for children with sepsis/SS. Many issues remain unresolved, requiring systematic analysis. In the literature search, only a few randomized clinical trials have focused on the assessment and correction of protein-energy malnutrition in pediatric intensive care. Over the past decade, small and large pediatric studies have recommended nutritional therapy. However, given the heterogeneity of children admitted to intensive care units in terms of age, pathology, disease severity, presence of comorbidities, and nutritional status, it is unrealistic to expect that one nutrition strategy applies to all patients requiring intensive care. Therefore, most clinicians emphasize the need for an individualized approach to nutrition support in children, taking into account the pathology, severity, initial nutritional status, and risk–benefit ratio of different nutritional therapies. An extensive search of the literature on the problem did not reveal strong nutritional recommendations for children with sepsis/SS, which dictates the need for future research on the topic and correction of protein-energy malnutrition in children with sepsis/SS.

Clinical nutrition and metabolism. 2022;3(4):217-229
pages 217-229 views

Issues of diagnostics and treatment of vitamin D deficiency in older patients

Nikitin I.G., Brutskaya L.A., Gultiaeva N.A., Podkhvatilina A.S.


Vitamin D is a fat-soluble compound that a person obtains from food or synthesizes independently when the skin is exposed to sunlight.

Vitamin D metabolism is modulated by various intrinsic and extrinsic factors, including genetic polymorphism, skin type (pigmentation), age, health, season, latitude, clothing, and diet. Some of them are modifiable, i.e., they can be controlled by humans.

To assess the vitamin D level in the body, the recommendation was to determine the concentration of total 25(OH)D in the blood serum, the main circulating form, which reflects both the intake of vitamin D from food and native preparations and the synthesized vitamin D in the skin under the influence of ultraviolet irradiation. This study focused on the diagnosis and treatment of vitamin D deficiency in older patients.

The age-related problem is associated with a more frequent history of surgery and chronic diseases requiring drug therapy, which in turn can affect the metabolism of this vitamin. Vitamin D deficiency in older people requires constant and long-term use of cholecalciferol; however, the risks of drug interactions and polypharmacy should not be overlooked.

The diagnosis and treatment of vitamin D deficiency in older people should consider all the characteristics of this group. Moreover, this study presents the features of vitamin D metabolism in older people, nosologies predisposing to the development of vitamin D deficiency, methods for diagnosing and correcting vitamin D deficiency, and relationship between severe COVID-19 and vitamin D levels.

Further study of possible drug interactions, additional effects of vitamin D, and its contribution to comorbidities is warranted.

Clinical nutrition and metabolism. 2022;3(4):230-245
pages 230-245 views

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