卷 6, 编号 1 (2025)

Nutritional deficiency in chronic pancreatitis is a complex, multifactorial problem associated with malabsorption, pain, severe metabolic disturbances, and comorbid conditions. The most common cause of chronic pancreatitis is alcohol consumption. Timely diagnosis based on medical history, physical examination, and laboratory and instrumental findings helps prevent the development of severe protein–energy malnutrition. Before initiating nutritional support, it is essential to identify the individual causes of weight loss. The goal of nutritional support is to correct malnutrition and address the underlying causes of impaired digestion and absorption. It prevents further progression of protein–energy deficiency. Nutritional status should be assessed using clinical evaluation, functional tests, anthropometric measurements, and biochemical parameters. Body mass index alone does not adequately reflect the presence of sarcopenia in patients with obesity and chronic pancreatitis. Prevention and correction of nutritional deficiency require pancreatic enzyme replacement therapy, adequate caloric intake, and sufficient protein and micronutrient supply. If nutritional needs cannot be met through a regular diet, nutritional support should be initiated. Enteral nutrition is the preferred method. Parenteral nutrition is indicated in patients with gastric outlet obstruction, fistula formation, or intolerance to enteral feeding. This approach helps prevent malnutrition and sarcopenia and improves quality of life.

BACKGROUND: Surgical intervention activates catabolic processes, which adversely affect treatment outcomes, increase the risk of complications, and prolong recovery. Implementation of a second-stage rehabilitation program promotes restoration of functional status; however, patients with concomitant nutritional disorders often tolerate such programs poorly.

AIM: The work aimed to evaluate the effect of a second-stage rehabilitation program—including moderate-intensity physical exercise combined with additional oral enteral nutrition enriched with protein and omega-3 fatty acids—on the functional and nutritional status of patients after radical surgery for gastric cancer (gastrectomy with D2 lymph node dissection).

METHODS: A prospective, observational, single-center study included 40 patients with gastric cancer (23 men and 17 women) aged 56–73 years. All patients had undergone radical surgery within 30 days before enrollment. The 14-day rehabilitation program consisted of supervised therapeutic exercise, independent training, correction of water–electrolyte imbalance, and supplemental enteral nutrition (Supportan Drink, 400 mL/day). Nutritional status, anthropometric parameters (weight loss over the previous 6 months and in the early postoperative period, body mass index, and mid-arm muscle circumference), physical endurance (6-minute walk test and handgrip strength), as well as anxiety and depression levels according to the Hospital Anxiety and Depression Scale (HADS), were assessed before and after completion of the rehabilitation program. Results are expressed as mean ± standard deviation. Differences were considered statistically significant at p ≤ 0.05.

RESULTS: Preoperative weight loss was 14.9% ± 9.03%, and postoperative weight loss before enrollment was 7.12% ± 2.28%. After completion of the rehabilitation program, mean mid-arm muscle circumference, handgrip strength, and 6-minute walk distance significantly increased: 24.38 ± 0.85 cm vs 26.77 ± 0.82 cm, 27.95 ± 2.1 kg vs 34.52 ± 2.2 kg, and 380.74 ± 15.26 m vs 437.18 ± 19.75 m, respectively (for all parameters, p < 0.05). Daily protein intake increased from 0.86 ± 0.19 g/kg to 1.39 ± 0.18 g/kg. Anxiety and depression scores significantly decreased from 11.35 ± 1.15 to 8.08 ± 1.12 points and from 12.5 ± 1.2 to 9.08 ± 1.1 points, respectively (p < 0.05).

CONCLUSION: Supplementation of the second-stage rehabilitation program (moderate-intensity physical exercise under the supervision of a therapeutic exercise instructor) with enteral nutrition enriched with protein and omega-3 fatty acids had a positive effect on the functional, psychological, and nutritional status of patients with gastric cancer after radical surgical treatment.

BACKGROUND: Although homocystinuria is a rare disorder, its management remains an important issue in modern pediatrics. Diet therapy is the main pathogenetic treatment for patients with homocystinuria. The use of betaine as part of combination therapy helps reduce plasma homocysteine concentrations, particularly in patients who do not respond to other treatment approaches.

A CASE REPORT: A 12-year-old child with genetically confirmed pyridoxine-responsive homocystinuria underwent substitution of an imported preparation containing anhydrous betaine with a specialized medical nutrition product, Amino Acid Module Betaine (ORPHANIC® trademark). The previously effective combination therapy regimen remained unchanged.

CONCLUSION: Replacement of anhydrous betaine within the previously established treatment regimen, followed by 30 days of administration of the medical nutrition product Amino Acid Module Betaine (ORPHANIC® trademark) containing betaine anhydrous, demonstrated a good safety profile. This substitution did not significantly affect the patient’s general condition, disease course, or key parameters of sulfur-containing amino acid metabolism.

Prescription of the medical nutrition product Amino Acid Module Betaine (ORPHANIC® trademark) containing anhydrous betaine, or transition of a patient to this product, requires monitoring of the patient’s general condition and regular determination of sulfur-containing amino acid metabolism parameters. This study represents the first clinical evaluation of anhydrous betaine produced in Russia. The obtained results indicate its efficacy and safety in the treatment of a patient with homocystinuria.