Alla Aleksandrovna Ryk

Perioperative malnutrition and protein-energy wasting remain key modifiable risk factors for complications, prolonged hospital stay, and increased costs in surgical patients. The updated 2026 FAR guidelines on perioperative nutritional support systematize evidence from 2021–2025 and present a comprehensive multidisciplinary approach to diagnosing and correcting malnutrition at all stages of surgical care. In contrast to the 2021 version, the new edition introduces a two-step model for nutritional assessment: expanded risk screening (NRS-2002, MUST, MST, and others) complemented by formal malnutrition diagnosis according to GLIM criteria, incorporating phenotypic and etiologic features as well as instrumental assessment of sarcopenia and clinical frailty. This enables a shift from simple risk stratification to outcome prediction and individualized selection of nutritional support strategies. The guidelines emphasize the pivotal role of the preoperative phase, including prehabilitation: correction of nutritional deficits, use of oral nutritional supplements and, when indicated, immunonutrition combined with exercise training and educational interventions. The postoperative section maintains a focus on early enteral nutrition and refines criteria for tolerance, options for direct oral feeding after selected procedures, and indications for supplemental and peripheral parenteral nutrition. For the first time, a distinct post-discharge phase is outlined, with recommendations on continued oral nutritional supplements in high-risk patients. Dedicated sections address the use of specialized formulas (lipid emulsions, omega-3 fatty acids, glutamine, fiber-enriched enteral feeds) and the prevention of refeeding syndrome, including identification of high-risk groups and initial treatment algorithms. The guidelines are fully integrated with ERAS principles, positioning nutritional support as an essential component of the patient pathway rather than an isolated module. The final section provides quality indicators and metrics for the delivery of nutritional and metabolic care, forming a foundation for the development of local protocols, clinical audit, and continuous improvement of practice In Russian surgical wards and intensive care units.

The development of protein-energy malnutrition (PEM) syndrome is a pressing issue in surgical settings. The risk of malnutrition developing is determined in the majority of patients admitted to surgical wards. 30–70% of patients demonstrate signs of PEM upon admission, and during treatment, this syndrome can progress, reaching 50–60%. The severity of PEM is closely connected with clinical outcome indicators: length of stay in the intensive care unit and hospital increases, infectious complications occur more frequently, and treatment costs increase significantly. These guidelines, based on the principles of evidence-based medicine, describe methods for diagnosing and correction of PEM at all stages of surgical treatment. Also practical algorithms and criteria for evaluation the quality of nutritional and metabolic support during the perioperative period are included in this paper.

In critically ill patients systemic hypoperfusion can lead to gastrointestinal (GI) mucosal injury, predisposing patients to clinically significant or non-significant bleeding. Bleeding from stress ulcers leads to prolonged intensive care unit (ICU) stays and an increased risk of negative clinical outcomes. A wide range of potential risk factors (prolonged mechanical respiratory support, sepsis, traumatic brain and spinal injury, severe burns, coagulopathy, ulcer history, etc.) leads to the indiscriminate use of pharmacological agents and to the wide routine administration of antisecretory drugs in more than 80–85 % of critically ill patients. The guidelines present the basic principles of upper gastrointestinal stress ulcer prophylaxis in intensive care patients.

Alternative diets have become widely used by patients with cancer, most of whom choose these diets on their own. The shortage of specialists with equal expertise in oncology, nutritional science, and gastroenterology contributes to an increase in self-medication and reliance on unqualified practitioners and unverified online sources. Therefore, evaluating the most popular diets is an urgent task. This work aimed to evaluate the validity of the most popular alternative diets as part of a combined supportive treatment strategy for patients with cancer, based on a review of publications. The following keywords were used to search relevant publications in PubMed and e-Library databases for the past 20 years: диета против рака (anti-cancer diet), альтернативная диета (alternative diet), рак (cancer), комплементарные методы лечения (complementary therapies), and клинические рекомендации (clinical guidelines). Based on the obtained data, the most popular diets in oncology practice are: the ketogenic diet, the Mediterranean diet, the Gerson diet, the Budwig diet, and the Breuss diet. We evaluated their compositions and effects on disease prevention, carcinogenesis, and overall survival. The justification and safety of prescribing these dietary regimens were considered. The data showed that the ketogenic and Mediterranean diets were the most extensively studied. Although the ketogenic diet is based on Warburg hypothesis, it does not have a significant antitumor effect. Moreover, some clinical studies have reported its carcinogenic potential. The Mediterranean diet is shown to be effective in preventing cancer, rather than its treatment. The Gerson, Budwig, and Breuss diets contradict fundamental principles of carcinogenesis and have no evidence base. Therefore, it is crucial to follow the nutritional support recommendations developed by international and Russian professional communities. These recommendations are based on substantial clinical data and sufficient evidence and prohibit risky diets for patients with cancer.

Introduction. Due to the development of medical technologies, improvement of the quality of medical care, progress in the field of disease prevention and lifestyle changes, the average life expectancy is constantly increasing. With age, bones become more fragile and prone to fractures; most often the proximal femur is damaged. Femoral fractures occur, as a rule, due to a fall on a flat surface, and mainly in people over the age of 60 years.It should be borne in mind that proper nutrition is one of the key components of treatment and recovery of the body. Patients in hospital may experience various digestive and appetite problems or have additional nutritional needs. Poor nutrition and insufficient protein intake can be a particularly important risk factor for hip fracture, and is often considered to be the cause of a high incidence of fracture complications in the elderly. Among various general geriatric pathologies, sarcopenia syndrome has attracted special attention in recent years, because its development leads to deterioration in the quality of life, and increases the risk of falls and complications after injury.Perioperative nutritional support plays an important role in the recovery of patients with senile asthenia and fractures of the proximal femur.A comprehensive multidisciplinary approach to the treatment of patients with senile asthenia and fractures of the proximal femur restores ability of self-care and limb support, raises the vitality and improves psychological state of the patient.The Aim of the review is to determine the role of perioperative nutritional support in the management of patients with fractures of the proximal femur and concomitant sarcopenia.Material and Methods. To write this review, we used the following electronic databases of scientific literature: PubMed, Cochrane Library, eLibrary, and Cyberleninka. The papers published in the period from January 1995 to May 2024 on the influence of sarcopenia on the incidence of postoperative complications, mortality rate and overall survival in elderly patients with fractures of the proximal femur were considered.Thanks to the review, it was indicated that so far there is no single view on a comprehensive multidisciplinary approach to the treatment of those patients, who should be carefully examined in order to identify nutritional deficiencies.There is also no complete perioperative algorithm in the available literature; and the issue of medical and social rehabilitation of this complex category of patients has not been resolved.Conclusion. There is a need to create such an algorithm that includes methods for screening and diagnosing nutritional insufficiency in elderly patients with fractures of the proximal femur.

Protein is one of the key macronutrients. Therefore, the development of protein deficiency adversely affects health status and treatment outcomes. At the same time, protein requirements vary considerably among different patient populations. Optimization of protein intake in at-risk groups remains an important issue, as it may influence the effectiveness of specialized treatment, quality of life, and social functioning of patients. The aim of this review was to examine approaches to correcting protein deficiency in the most vulnerable adult populations, including older and elderly individuals, oncology patients, and critically ill patients. Publications indexed in the Scientific Electronic Library (eLibrary.ru) and PubMed databases between 2000 and 2025 were analyzed. The analysis demonstrated the need for an individualized approach to protein prescription. The review discusses current trends in nutritional support for these patient populations. In cases of inadequate protein intake, the use of high-protein enteral formulas as a supplement to the regular diet can positively affect treatment outcomes and quality of life. Whey protein currently attracts particular interest. Its use has demonstrated promising results, especially in combination with omega-3 fatty acids. Thus, an individually tailored protein component in nutritional support may improve treatment outcomes and quality of life in older adults, oncology patients, and critically ill patients.

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.

INTRODUCTION: Nutritional support is an integral part of the treatment process in the intensive care unit (ICU). Patients in critical care receive some methods of enteral or parenteral nutrition based on often conflicting guidelines and controversial strategies. OBJECTIVE: To identify key trends in the use of metabolic control and nutritional support technologies in ICUs of different profiles. MATERIALS AND METHODS: The project of this screening study was developed by members of the FAR RF Committee on Nutritional Support and Metabolic Control. The design trial was simple random sampling. The study included 569 ICU patients. Results. The mean age of the patients was 59.22 ± 17.93 years. APACHE II scale — 1.3 ± 3.9 points, according to SOFA scale — 3.7 ± 1.5 points. 56 % of patients underwent surgical interventions, 45 % were on mechanical ventilation, 28-day mortality — 24 %. In 25 % of oncological patients the total protein was below 50 g\l. Serum albumin level was statistically significantly lower (p = 0,013) in the group of patients with acute cerebral insufficiency (ACI) in comparison with oncosurgical patients. In 25 % of multidisciplinary ICU patients albumin concentration was below 25 g/l. Energy requirement was determined empiricaly in 44 % of oncologic patients, in 50 % of patients with ACI the method of c equations was used, and indirect calorimetry was used in all groups in no more than 1 % of cases. Protein requirements were empirically determined in 20 % of cases in all groups. 35 % of physicians estimated the protein requirement based on the value of 1.2–1.5 g/kg/day. Enteral tube feeding was more frequently used by 70 % of ACI patients and 29 % in the oncology group. In contrast, 29 % of oncologic patients received parenteral nutrition. Only 5 % of patients with ACI required parenteral nutrition. CONCLUSIONS: The majority of ICU patients are characterized by such manifestations of protein-energy deficiency as hypoproteinemia, hypoalbuminemia, hypotransferrinemia. Enteral tube feeding is the prevailing method of nutritional support in ICU. The main problem identified in the course of screening should be considered the very rare use of metabolic monitoring technologies and the lack of a personalized approach to the selection of the nutritional support program.

RELEVANCE. Wernicke encephalopathy (WE) is an acute life-threatening neurological disease caused by thiamine deficiency. Vitamin B1 is a coenzyme that is involved in the process of maintaining the integrity of cell membranes, and, consequently, the normal functioning of the nervous system, muscles and heart. The prevalence of WE in the population is 0.4–2.8%. In the absence of timely treatment, WE leads to the development of severe disability, and in 20% of cases — to death.AIM OF STUDY. Systematization of data on the role of thiamine in the development of Wernicke encephalopathy.MATERIAL AND METHODS. To achieve this goal, the results of scientific research on WE were analyzed. The literature search was carried out in Scopus, eLibrary, PubMed electronic search engines using the following keywords: Wernicke encephalopathy, thiamine, alcohol abuse, thiamine deficiency. Scientific articles published between 1881 and 2024 were selected for analysis.RESULTS. The most common cause of WE is chronic alcoholism, which accounts for 50% of all cases. However, there are many other diseases and conditions that can lead to the development of WE. Vitamin B1 deficiency plays an important role in the development of WE.CONCLUSIONS. Vitamin B1 deficiency can develop as a result of a malfunction at various stages of the metabolic chain, during various pathological processes in the human body. Wernicke encephalopathy occurs not only in people who abuse alcohol, but also in pregnant women, cancer patients, patients with diseases of the gastrointestinal tract, liver and thyroid gland, after bariatric and other abdominal surgeries, as well as in patients on long-term parenteral nutrition. Thiamine deficiency, and, as a consequence, Wernicke encephalopathy, can lead to irreversible brain damage, severe disability and death.

Introduction. In the development of post-traumatic pancreatitis, an important role is played by microcirculatory disorders, developing against the background of inflammation and decreased capillary blood flow not only in the tissues of the pancreas, but also in other organs, including the intestine, which leads to neuroendocrine dysregulation, dysfunction and/or death of intestinal epithelial cells, disruption of the motor and evacuation functions of the intestine, and, as a consequence, the development of intestinal insufficiency syndrome.The objective was to demonstrate the effectiveness of enteral therapy in a patient with a closed abdominal injury, liver injury and posttraumatic pancreatitis.Materials and methods. We analyzed a clinical case of hospitalization of patient K., 38 years old, with the following diagnosis: “Closed abdominal trauma. Liver trauma of the S6 segment. Hemoperitoneum 1000 ml. Complication: right-sided segmental pneumonia. Bilateral hydrothorax. Posttraumatic pancreatitis”. The patient was admitted with complaints of upper abdominal pain and nausea two weeks after blunt abdominal trauma. She was treated as an outpatient. During the last two days she started to notice nausea, increased pain syndrome in the right side and upper parts. She was brought by an ambulance. Hybrid surgical intervention was performed: endovascular celiacography, superselective embolization of the right hepatic artery branch and diagnostic videolaparoscopic sanation and drainage of the abdominal cavity. In the postoperative period, treatment was performed according to the National Clinical Guidelines, supplemented with enteral therapy.Conclusion. This clinical observation demonstrated the effectiveness of including enteral therapy in a complex of therapeutic measures in the patient with closed abdominal trauma, liver trauma, posttraumatic pancreatitis, which was expressed in a decrease in the level of lactate, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, leukocytes on the 3rd day of dynamic observation. At the same time, an increase in the absolute number of lymphocytes, the concentration of total protein and albumin was noted. The proposed scheme contributed to the regression of signs of intestinal insufficiency syndrome, normalization of intra-abdominal pressure by the 7th postoperative day, prevention of the development of purulent-septic complications and multiple organ failure, a successful outcome of hospitalization.