Clinical nutrition and metabolism

BACKGROUND: Common consequences of spinal cord injury in athletes include reduced basal metabolic rate, loss of muscle mass, impaired thermoregulation, and the development of chronic subclinical inflammation. Evidence-based recommendations for nutritional support in this group of athletes are currently lacking.

AIM: This work aimed to characterize the plasma proteomic and metabolomic profiles of athletes from the Russian national wheelchair basketball team with spinal cord injury in order to develop personalized nutritional support recommendations.

METHODS: Mass spectrometry analysis of blood plasma was performed in nine athletes from the Russian national wheelchair basketball team (mean age 37.9 ± 5.8 years, spinal cord injury at Th3–L1). A total of 61 proteins were identified and 40 endogenous metabolites were quantitatively measured.

RESULTS: Activation of the acute-phase response was revealed (an increase in the levels of ITIH4, SERPINA3, AHSG, and ORM2 proteins by 2.3–9.6-fold), as well as a fivefold increase in apolipoprotein C-III concentration (57.78 ± 30.39 μM). Marked reductions were detected in glucogenic amino acids (alanine, serine, threonine decreased by 84%–96%), urea cycle components (arginine, ornithine decreased by 78%–88%), and Krebs cycle substrates (citrate and lactate decreased by 89%–99%). A sixfold increase in d-hydroxylysine concentration (54.022 ± 13.599 μM) indicates intensive collagen catabolism.

CONCLUSION: Wheelchair basketball players exhibit a specific metabolic phenotype characterized by deficiency of amino acids involved in energy metabolism, dyslipidemia, and activation of inflammatory processes. To correct these alterations, personalized nutritional support is recommended, including increased protein intake to 2.0–2.2 g/kg, additional supplementation with L-citrulline (6–8 g/day), taurine (2–3 g/day), collagen synthesis substrates, and omega-3 polyunsaturated fatty acids (3–4 g/day).

BACKGROUND: Enteral nutrition during the acute phase of poisoning with psychoactive substances is an integral component of intensive care. However, its effectiveness remains understudied.

AIM: This study aimed to evaluate the effectiveness of early enteral nutrition in patients with severe acute poisoning by psychoactive substances.

METHODS: The study included 36 patients treated in the intensive care unit (ICU) for acute poisoning with psychoactive substances. Patients were randomized into two groups. In the first (main) group, enteral nutrition was initiated within 24 hours of ICU admission. In the control group, enteral nutrition was started after 36 hours. In all patients, neurological status trends were assessed using the FOUR (Full Outline of UnResponsiveness) score; the number of days to liberation from mechanical ventilation and ICU length of stay were recorded. Plasma albumin and total protein concentrations were also analyzed.

RESULTS: On day 3, neurological deficit in the control group was 12 (10; 14) points on the FOUR scale. This indicator was significantly lower than in the main group—15 (14; 16) points (p = 0.006). No significant differences between groups were observed on day 1.

Plasma total protein and albumin concentrations did not differ between groups on day 1. By day 3, total protein concentration was significantly higher in the main group (62.48 ± 5.77 g/L) compared with the control group (55.34 ± 5.28 g/L, p = 0.001). Albumin concentration was also higher in the main group: 39.55 ± 3.75 g/L vs 34.48 ± 4.51 g/L (p = 0.002). No significant association was found between the timing of enteral nutrition initiation and the duration of mechanical ventilation or ICU stay.

CONCLUSION: Early enteral nutrition in patients with severe poisoning by psychoactive substances significantly increases plasma albumin and total protein levels and contributes to faster neurological recovery. No significant effect of enteral nutrition timing on ICU length of stay or duration of mechanical ventilation was observed.

Severe burn injury is a major global medical and social challenge associated with high mortality rates, primarily due to sepsis and multiple organ failure. Burn disease induces a persistent hypermetabolic response characterized by pronounced protein and energy deficiency, loss of muscle mass, and marked glutamine depletion. Glutamine is a conditionally essential amino acid in critical illness. It is crucial in maintaining immune cell function, intestinal barrier integrity, antioxidant defense, and modulation of systemic inflammation.

This review analyzes the pathophysiology of glutamine deficiency, mechanisms of its action, and the results of clinical studies, including pilot trials and meta-analyses. Conflicting data regarding the potential harm of high-dose glutamine administration in related populations of critically ill patients (REDOXS, METAPLUS trials) are discussed. The safety and efficacy of enteral glutamine at a dose of 0.5 g/kg×day in patients with severe burns are detailed.

The use of glutamine as part of comprehensive therapy in patients with burn injury is pathogenetically justified. It contributes to a reduction in infectious complications, shortens hospital length of stay, and may have a beneficial effect on survival.

Nutrition of newborns is critical, because it is an adaptation period to the harsh environment. Breast milk is considered the optimal food for newborns, providing the foundation for immune system. Breastfeeding is essential for the development of a healthy gut microbiota. This is supported by a significant correlation between breastfeeding duration and the risk of infectious diseases in newborns. However, in situations like severe pathological conditions, breastfeeding becomes impossible. In such cases, breast milk substitutes are required, followed by specialized enteral nutrition formulas. A particular challenge in the early postoperative period is providing all essential nutrients when natural feeding is not feasible. Enteral nutrition is more physiological than parenteral. Therefore, breast milk is the best option for newborns, and semi-elemental formulas are used in its absence. This lecture compares breast milk and various specialized formulas. It also discusses the characteristics of artificial feeding in newborns and provides a clinical case illustrating nutritional support in the development of chylothorax.