Vol 3, No 1 (2022)

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.

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.

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.