Vol 3, No 2 (2022)

BACKGROUND: Medical rehabilitation of spinal cord injured patients is an important medical and social problem associated with the high level of disability in this patient category.

AIM: This study aims to improve the efficiency of medical rehabilitation of spinal cord injured patients based on a set of measures of nutritional support and raising the exercise tolerance.

MATERIALS AND METHODS: A total of 78 patients in the intermediate recovery period of spinal cord injury were monitored, and their nutritional status was evaluated in the dynamics. In the first (main) group, a complex correction of the nutritional status with additional use of high protein hypercaloric mixtures for enteral nutrition was performed before and after hand cycling. In the second (control) group, the rehabilitation techniques were performed on the generally accepted basis.

RESULTS: As a result of the complex correction, the proportion of patients with mild and moderate malnutrition was significantly lower in the first (main) group than that in the second (control) group (p=0.05). Peak oxygen consumption increased in the first group of patients with mild malnutrition on 34.1% (p=0.019) and with moderate malnutrition on 23.6% (p=0.02) compared to that in the control group. All spinal cord injured patients of the first (main) group were found to have improved their motor and social activity according to the FIM scale compared to that in the control group (p <0.001).

CONCLUSIONS: Combining adequate nutritional support and proper handcycling significantly contributes to reducing malnutrition in patients with spinal cord injury (p=0.05). Tolerance to physical exercises during the complex correction of malnutrition significantly increased (p <0.01) as well as the motor and social activities and, therefore, the quality of life (p <0.0001).

BACKGROUND: The current dietary advice for the elderly is not in line with contemporary understanding of the effects that nutrition produces on the universal mechanisms of age-related diseases.

AIM: This review is designed to consider modern concepts on the impact of nutrition on the development of age-related diseases and compare them with the current dietary advice for the elderly, with special focus on prevention of frailty and sarcopenia, the key factors of longevity and health quality.

METHODS: Search in Google Scholar and PubMed for reviews and clinical trials using the keywords nutrition, frailty, and sarcopenia.

RESULTS: Frailty is affected by several biopsychosocial factors, with nutrition having the paramount role. It dominates the onset and progression of the key mechanisms of accelerated aging: most importantly, chronic systemic inflammation, insulin resistance, and gut dysbiosis. There is strong evidence that frailty is promoted by malnutrition (insufficiency of energy and nutrients), obesity (insulin resistance), protein deficit, high dietary inflammatory index, easily digested carbohydrates (including fructose and starch), highly processed food, and trans fats and indirectly by gluten. Frailty and sarcopenia can be prevented through the consumption of high-quality (animal) protein, vegetables and fruit (the source of dietary fiber, vitamins, minerals, and phytonutrients), fats, nutrients with antioxidant properties (including vitamins A and E, zinc, selenium, and omega-3 fatty acids), correction of vitamin D status, support of gut microbial diversity, correction of hyperinsulinemia, and increased intestinal permeability.

CONCLUSION: The dietary advice for elderly patients requires revision in line with the contemporary understanding of mechanisms behind age-related diseases and the recent evidence base. This review covers the basics of nutrition essential to prevent frailty and sarcopenia.

Effective nutritional-metabolic support strategies are of interest to athletes, coaches, and physicians prescribing various supplements. Dietary deficiencies in macronutrients, vitamins, and minerals of the right type can interfere with training adaptation, while for athletes who eat a balanced diet; physiological training adaptation can be enhanced. Therefore, in the event of a lack of specific nutrients, athletes are forced to use various supplements, but will individual combinations of these supplements be safe for the body as a whole and will be effective for improving athletic performance? This study analyzes and summarizes studies on the compatibility of some supplements and the safety and efficacy of such combinations in sports, in particular: the compatibility of vitamins E and C, vitamin D and calcium, creatine and caffeine, and branched chain amino acids (isoleucine, leucine, and valine).

In the intensive care unit, along with other methods of intensive care, such as maintaining blood pressure, antibiotic therapy, mechanical ventilation, and vasopressors, clinical nutrition should always be present. Clinical nutrition is an integral part of the treatment process in the intensive care unit. A large number of publications concerning the prevention and treatment of intensive care outcome syndrome exist. One of the most important and low-cost strategies to prevent this condition is nutritional support for critically ill patients at all stages of curation, from the moment of admission to the intensive care unit to the end of the rehabilitation course. With the correct appointment of nutritional support, taking into account the indications and contraindications for various nosological forms, the advantages are obvious in the form of improved treatment outcomes. Proper organization of nutritional support in the hospital is the main key to success in early rehabilitation. From the understanding of nutritional support, its effectiveness will depend on its organization and mutual understanding between all links. Based on the experience of creating a laboratory for clinical nutrition and metabolism, it can be concluded that the creation of such a laboratory and the organization of clinical nutrition in a hospital can improve the results of treatment of even the most severe category of patients.