Denis S. Tsvetkov

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.

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.

Currently, there are no recommendations for managing pain syndrome in patients with acute destructive pancreatitis. A literature search was conducted using PubMed, Cochrane Controlled Clinical Trials Register, and Google Scholar, without restrictions on language, type, or date of the publication. The analysis revealed several possible options for anesthesia in acute destructive pancreatitis. The most commonly used methods for pain relief include narcotic analgesics and nonsteroidal anti-inflammatory drugs. However, in severe forms of acute pancreatitis, nonsteroidal anti-inflammatory drugs should be used with caution due to the risk of acute kidney injury, while opiates may adversely affect the sphincter of Oddi and contribute to the disease progression due to increased ductal pressure. Epidural analgesia also presents limitations, such as risks of hypotension and incompatibility with anticoagulant or antiplatelet therapy. As alternatives, regional anesthesia techniques (paravertebral block and erector spinae plane block) should be considered. Choosing an optimal analgesia method should take into account several factors: pain intensity, disease severity, etiology of acute destructive pancreatitis, comorbidities, and concurrent use of anticoagulants and antiplatelets. Further research into effectiveness of regional analgesia methods is warranted, as they may address both somatic and visceral components of pain and may prove effective and safe in the most severe cases.

INTRODUCTION: Infusion therapy is the main method of correcting pathological changes that occur during the phase of “aseptic” inflammation in acute pancreatitis. OBJECTIVE: Summarize current data on infusion therapy regimens in patients with acute destructive pancreatitis, the advisability of using various infusion solutions and options for monitoring the effectiveness of therapy. MATERIALS AND METHODS: The study was carried out in accordance with international reporting requirements for reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was carried out in the following Internet search engines Pubmed and Cochrane Controlled Clinical Trials Register. To select articles, a literature reference search method was also used. The search strategy did not include restrictions on language, article type, or date. RESULTS: The analysis of literature data revealed two approaches to infusion therapy. The initial interest in “aggressive (4 liters per day or more)” infusion therapy regimens in the first 24 hours of the disease has now been replaced by a trend towards less “aggressive” regimens due to the publication of works on the high incidence of various complications (progression of organ dysfunction, local complications). When considering the qualitative composition of infusion therapy, preference should certainly be given to crystalloids. Basic monitoring of infusion therapy should include non-invasive methods: heart rate, blood pressure, diuresis rate. CONCLUSIONS: The analysis demonstrated different approaches to the tactics of infusion therapy in this category of patients. further research into the effectiveness and safety of infusion therapy, taking into account the varying severity of acute pancreatitis, the possibility of the influence of the qualitative composition of the infusion on the course of this disease and the formation of recommendations for initial and maintenance infusion therapy based on the principles of personalized medicine.

Cancer is currently one of the leading causes of death. Mortality in this group of patients is due to both underlying disease course and therapy complications. The development of cachexia is one of the most important factors that affect both the quality of life of a patient with cancer and the treatment effectiveness. Presently, ideas about the pathogenesis of malnutrition in patients with cancer and its diagnostic methods are fairly clear. However, a particular patient needs to understand which processes are leading to the development of anorexia-cachexia syndrome. Concepts, such as anorexia, cachexia, and sarcopenia, reflect various possible variants of the course or stage of developing metabolic disorders. Their timely detection determines the duration and process intensity and assesses the prognosis of the disease course, as well as develops a patient-oriented nutritional support program. Understanding the pathogenesis of its development allows for the correction of emerging disorders throughout the patient treatment period. Nutritional therapy is a key method that can influence the severity of cachexia. Undoubtingly, the progression of malnutrition is due to the multimodal effect of the tumor on the patients metabolism and can significantly affect the effectiveness of antitumor therapy. Therefore, basic principles of diagnosis and treatment are formulated, including early diagnosis, individual nutritional need calculation (proteins, energy), and the use of pharmaconutrients that can influence the severity of catabolic processes. According to the patient-orientation concept, an oncologist should be involved in the formation of a nutritional therapy program, which allows a simultaneous selection of the most optimal scheme of specialized nutrition based on the patients condition, type and stage of neoplasm, nutrient introduction restrictions, taste preferences, and timely qualitative and quantitative nutrient composition adjustment against the background of the changing patient condition and needs. The maximum effectiveness of nutritional support in patients with cancer can be achieved only with a multimodal approach of correcting all pathological processes that lead to malnutrition occurrence and progression.