Homeostasis and nutritional status. Modern problems of science and education. Impaired absorption of nutrients

Malnutrition is one of the prominent and frequent manifestations of chronic obstructive pulmonary disease (COPD), which affects the frequency of exacerbations, respiratory parameters and quality of life of patients. The aim of the study is to assess the nutritional status of COPD patients using anthropometry and bioimpedancemetry methods in a comparative aspect. 60 patients with COPD stages I, II and III were examined. According to the results of the study, a decrease in body mass index (BMI) was found in COPD stages II and III compared with the control group. Loss of the muscle component or lean body mass (TMB) occurs already in COPD stage I, the most significant decrease in TMB was found in stage III of the disease. When comparing the two diagnostic methods, there were no significant differences in BMI and TMT in the general group of COPD patients and at various stages of the disease. When dividing the examined into groups with normal, low and high body mass index, significant differences were found in TMT in the group of patients with BMI >25 kg/m2. In this group, the bioimpedancemetry method has lower TMT values compared to the anthropometry method. Accordingly, the bioelectrical impedance method can be recommended for a more accurate assessment and early diagnosis of protein-energy malnutrition in COPD patients with BMI>25kg/m2.

chronic obstructive pulmonary disease

nutritional deficiencies

anthropometry method

bioimpedancemetry method

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Introduction

The nutritional status reflects the state of the plastic and energy resources of the body, is closely related to the processes of systemic inflammation, oxidative stress, and hormonal imbalance. Malnutrition is one of the most prominent and frequent manifestations of chronic obstructive pulmonary disease (COPD), which affects the frequency of exacerbations, respiratory parameters and quality of life. It has been established that the appearance of protein-energy deficiency aggravates the course of the underlying disease and worsens its prognosis.

Anthropometric measurements are a simple and affordable method that allows using calculation formulas to assess the composition of the patient's body and the dynamics of its change. The ratio of plastic and energy resources can be described through two main components: lean body mass (TMB), which includes muscle, bone and other components and is an indicator of protein metabolism, as well as adipose tissue, indirectly reflecting energy metabolism. With nutritional deficiencies in COPD patients, a disproportionate loss of various components of the body occurs, in which the absence of significant changes in the patient's body weight can mask a protein deficiency while maintaining a normal or somewhat excessive fat component.

The method of anthropometric measurements is not recommended for elderly patients, as well as for edematous syndrome, due to the disproportionate distribution of adipose tissue and its predominant localization in the abdominal cavity. An alternative or more accurate measurement of the composite structure of the body is the bioelectrical impedance method, based on the assessment of the distribution of water volumes, during which the electrical conductivity of tissues is estimated. When conducting impedancemetry, the determination of body composition is based on the greater conductivity of TMT in comparison with body fat, which is associated with different fluid content in these tissues.

Comparison of the information content of widely used methods for assessing nutritional deficiencies in COPD determines the relevance of the study.

Purpose of the study:

To assess the state of the nutritional status of COPD patients using anthropometry and bioimpedancemetry methods in a comparative aspect.

Materials and methods:

We examined 60 patients with phenotypic manifestations of the European race, living in Primorsky Krai for more than 15 years at the age of 63 ± 12.1 years, who were treated in the pulmonology department of City Clinical Hospital No. 1 and the allergorespiratory center in Vladivostok during 2009-2010. with a diagnosis of COPD (general group of patients). All patients were informed about the study in full and filled out informed consent. The control group consisted of 10 healthy non-smoking volunteers, 8 men and 2 women aged 59 ± 10.7 years, who were not relatives of the main group. To diagnose the stage of COPD, the recommendations of the international classification GOLD 2008 were used. All examined patients were divided into 3 groups based on the indicators of the post-bronchodilation test FEV1: group I - 20 patients with stage I COPD (FEV1 = 85 ± 1.3), group II - 20 people with COPD stage II (FEV1=65±1.8), group III - 20 people with COPD stage III (FEV1=40±1.5). The exclusion criteria from the study were the presence of bronchial asthma, myocardial infarction, stroke and other serious diseases, alcohol and drug abuse, elderly people who are unable to understand the goals and objectives of the study, patients' refusal to participate in the study. To assess nutritional deficiencies, methods of anthropometric measurements and calculations of BMI, TMT, as well as bioimpedancemetry and determination of BMI, BFMT (fat-free mass, expressed in %) were used. When calculating the anthropometric parameters of TMT, the Durnin-Womersley method (1972) was used, which is based on the assessment of the average skin-fat fold (SCF) with a caliper, followed by the calculation of TMT according to the formula depending on the gender, age of the patient and BMI. The definition of BMI, which makes it possible to initially diagnose the degree of malnutrition, was determined by the formula of A. Ketele: BMI = MT (kg) / height (m 2).

Bioimpedansometry was carried out with the help of a reoanalyzer "Diamant" St. Petersburg. The results obtained were processed on an IBM PC running Windows-XP using the Statistica 6.0 program with the calculation of the arithmetic mean (M), its error (± m), and relative error (± m%). Statistical processing when comparing two independent groups was carried out using the nonparametric Mann-Whitney test and the determination of significant differences between groups according to this criterion. Differences between comparative values were recognized as statistically significant at a significance level p<0,05. Анализ взаимосвязей проводился непараметрическим методом корреляционного анализа Спирмена для ненормального распределения с вычислением ошибки коэффициента корреляции.

Research results

The main group of patients had the following anthropometric data: average height 172 ± 5.3 cm, average weight 76.5 ± 5.5 kg. The smoking person index (HCI) averaged 33 ± 2.3, the smoking experience was 30 ± 3.3 years, which indicates a high degree of nicotine-associated risk. We analyzed the ratio of BMI (body mass index) and TMB%, as well as BJMT using anthropometry and bioimpedancemetry methods in COPD patients, depending on the stage of the disease (Table 1).

Table 1. Ratio of BMI, TMT and FBMT in COPD patients

Groups surveyed	Anthropometry method		Bioimpedancemetry method
	Indicators		Indicators

Control group
General group	25.2±0.4 *	72.2±1.3 *	25.0±0.6 *	71.7±0.7 *
COPD stage I		75.5±1.1 *		75.5±0.4 *
COPD IIstages	24.3±0.9 * #	72.0±1.6 * #	23.8±0.8* #	71.65±0.6 #
COPD stage III	19.9±0.7 * #&	64.6±1.7 *#&	19.4±0.5 *#&	64.2±0.5 *#&

Note. Significance of differences (p<0,05): * - между группой контроля, общей группой и стадиями ХОБЛ, # - Significance of differences between COPD stages I and II, COPD stages I and III , & - between II and III stages of COPD.

According to the presented results, BMI indices in COPD patients in the general group are lower than in the control group both in the study by anthropometry and bioimpedancemetry. Analysis of BMI values depending on the stage of COPD showed that at stage I of the disease, BMI does not change compared to the control. Its significant decrease occurs only in COPD stages II and III (p<0,05). Несмотря на снижение показателей ИМТ по сравнению с контрольной группой, при всех стадиях ХОБЛ ИМТ находится в пределах референсных значений для нормальных показателей или превышает 20 кг/м 2 . Различий в значениях ИМТ, определенных как методом антропометрии, так и импедансометрии не установлено. Выяснено, что показатели ИМТ при II и III стадиях ХОБЛ достоверно ниже, чем при I стадии ХОБЛ (p<0,05), более того установлено наибольшее снижение показателей ИМТ при III стадии заболевания (p< 0,05).

The data characterizing TMT in the general group of COPD patients, obtained by anthropometry and bioimpedancemetry, are significantly reduced compared to the control group (p<0,05).

The results of the analysis of TMT values depending on the stage of COPD showed that, in contrast to BMI, the loss of TMT occurs already at stage I of COPD. Thus, in COPD stage I, TMT indicators are lower compared to the control (p<0,05). При II и III стадиях ХОБЛ значения ТМТ становятся еще меньше (p<0,05), достигая минимальных результатов при III стадии ХОБЛ (p=0,004). В последнем случае показатели ТМТ достоверно ниже результатов, полученных при исследовании пациентов с I и II стадий ХОБЛ (p<0,05). Во всех группах различий в данных, относящихся к ТМТ, в результате использования методов антропометрии и биоимпедансометрии не установлено.

In contrast to the BMI, which is within the reference interval, for healthy people (BMI 18.5-25 kg / m 2) at all stages of COPD, TMT indicators at stage III of the disease decrease below the recommended values and become below 70%.

Based on the main goal of our study and based on the results of the authors, indicating a greater sensitivity of the bioimpedancemetry method in assessing the nutritional status of patients with signs of obesity and an uneven distribution of adipose and muscle tissue, we compared BMI and TMT in patient groups depending on the mass index body.

To do this, COPD patients were divided into three groups: group I - BMI from 20-25 kg/m 2 , group II - BMI< 20 кг/м 2 и III группа ИМТ >25 kg/m2. The results of the study are presented in table 2.

Table 2. Indicators of MI, TMT, FJMT in COPD patients depending on BMI values

Index	IgrueppAn=20	IIgroupn=20	IIIgroupn=20
	BMI20- 25	BMI< 2 0	BMI>25
TMT (%), anthropometry method
BJMT(%), bioimpedancemetry method

Note: Significance of differences(p<0,05): *- между ТМТ метода антропометрии и БЖМТ биоимпедансометрии у пациентов ХОБЛ.

As follows from the presented results, significant differences were obtained between the values of TMT as a result of the anthropometry method and BJMT using bioimpedancemetry in COPD patients with BMI>25 kg/m 2 . In this group of patients, TMT indicators were significantly higher than those of FBMT and amounted to 78.5 ± 1.25 and 64.5 ± 1.08 p<0,05 соответственно. Очевидно, что использование метода биоимпедансометрии в группе пациентов ХОБЛ с ИМТ>25kg/m 2 has clear advantages for diagnosing BJMT loss compared to standard anthropometric measurements.

Discussion of the results

COPD is characterized by weight loss associated with protein-energy imbalance. In clinical practice, when determining the nutritional status of patients, it is often limited to calculating only BMI. As a result, it was found that BMI in COPD patients in the general group is lower than in the control group, both in the study by anthropometry and bioimpedancemetry. Analysis of BMI values depending on the stage of COPD showed that at stage I of the disease, BMI does not change compared to the control. Its significant decrease occurs only in COPD stages II and III. At the same time, regardless of the stage of COPD, BMI values are within the reference values for healthy people or exceed 20 kg/m 2 . Accordingly, the definition of BMI is not enough to assess the nutritional status in COPD. To assess body composition, it is necessary to differentiate body fat from lean body mass, since COPD, with a normal or elevated BMI, is characterized by a decrease in muscle mass.

According to our study, TMT values in the general group of COPD patients, assessed by anthropometry and bioimpedancemetry, were significantly reduced compared to the control group (p<0,05). Анализ результатов измерения ТМТ в зависимости от стадии ХОБЛ показал, что в отличие от показателей ИМТ при I стадии заболевания ТМТ достоверно ниже по сравнению с контролем (p<0,05).

In stages II and III of COPD, there is an even more pronounced loss of the protein component of the body weight of patients. This is evidenced by a significant decrease in data characterizing TMT in COPD stages II and III compared with stage I of the disease. The lowest TMT values were found in COPD stage III. Attention is drawn to the fact of the decrease in TMT expressed below the recommended values in stage III COPD. In other words, our study established an advanced loss of TMT in COPD patients compared to BMI. A distinctive feature of our sample is that for all patients with COPD, regardless of stage, BMI is within the recommended values for a healthy population. Despite this, we recorded the fact of a true decrease in TMT in stage III COPD by both methods of research. Taking into account the most pronounced changes in the values of BMI and TMT in COPD stage III, it seemed interesting to us to conduct a correlation analysis between BMI, TMT and FEV1.

The correlation analysis performed showed the absence of significant relationships between FEV1, a diagnostic indicator of the stage of COPD and BMI, in the methods of anthropometry and bioimpedancemetry. At the same time, a direct correlation of the average strength between the values of TMT was established as a result of the study of the anthropometric method and FEV1 (R=0.40+/-0.9; p<0,001) и прямая связь средней силы между данными БЖМТ в результате измерений методом биоимпедансометрии и ОФВ1 (R=0,55+/-0,9; p<0,0005).

Obviously, in COPD, such an indicator of the composite body structure as TMT or BJMT suffers most significantly. Regardless of the presence or absence of signs of hypoxemia, the loss of TMT is directly related to the progression of COPD and a decrease in the rate of respiratory function.

Based on the purpose of the study, the indicators of TMT and BJMT diagnosed using anthropometry and bioimpedancemetry methods do not differ significantly, however, these methods were used with BMI in patients who were not divided into groups with normal, low and high body mass index, which must be taken into account. We analyzed the comparative characteristics of TMT and BJMT as a result of the applied methods for various BMI indicators. Significant differences were revealed between TMT obtained by anthropometry and BJMT, as a result of measurement using the bioimpedansometry method, with BMI> 25 kg/m 2 in COPD patients (p<0,05). Однако при ИМТ (20-25 кг/м 2), находящегося в пределах референсного значения для здоровых людей и при ИМТ<20кг/м 2 , достоверных различий не выявлено.

Obviously, the method of anthropometric measurements is not recommended for patients with BMI>25kg/m 2 due to their predominant concentration of adipose tissue in the abdominal cavity, which leads to an underestimation of the total fat mass.

The method of bioelectrical impedance makes it possible to more accurately determine protein-energy deficiency with a predominant decrease in muscle mass in COPD patients with BMI>25kg/m 2 .

conclusions

COPD is characterized by the development of nutritional deficiencies, the phenotypic manifestations of which are the loss of lean body mass, which is recorded even with a normal body mass index. There is a loss of lean body mass, the muscle component of the body, already at stage I COPD, the most significant decrease in TMT was found at stage III of the disease (p<0,05).
In contrast to the body mass index, loss of lean body mass has a direct relationship with the stage of COPD, as evidenced by the correlation analysis performed.
In the general group of patients, without taking into account body mass indicators, when comparing the methods of anthropometry and bioimpedancemetry, the indicators of BMI and TMT do not differ significantly. The method of bioelectrical impedance makes it possible to more accurately determine protein-energy deficiency with a predominant decrease in muscle mass in COPD patients with BMI>25kg/m 2 .

Reviewers:

Duizen I. V., Doctor of Medical Sciences, Professor of the Department of General and Clinical Pharmacology of the VSMU, Vladivostok.
Brodskaya T. A., Doctor of Medical Sciences, Dean of the Faculty of Advanced Studies, VSMU, Vladivostok.

Bibliographic link

Burtseva E.V. STUDY OF THE NUTRITIONAL STATUS OF COPD PATIENTS USING ANTHROPOMETRY AND BIOIMPEDANSOMETRY METHODS // Modern problems of science and education. - 2012. - No. 2.;
URL: http://science-education.ru/ru/article/view?id=5912 (date of access: 01.02.2020). We bring to your attention the journals published by the publishing house "Academy of Natural History"

Quantification of the patient's nutritional status is an important clinical parameter and should be performed for each patient.

The cost of inpatient treatment of a patient with a normal nutritional status is 1.5-5 times less than that of a patient with malnutrition. In this regard, the most important task of the clinician is to recognize the states of malnutrition and adequate control over their correction. Numerous studies have shown that the state of protein-energy deficiency significantly affects the morbidity and mortality rates among patients.

Obesity and severe malnutrition can be recognized by history and clinical examination, but minor signs of malnutrition are often seen, especially in the presence of edema.

Quantifying nutritional status allows timely detection of life-threatening disorders and assessing positive changes when recovery begins. Objective measures of nutritional status correlate with morbidity and mortality. However, none of the indicators of the quantitative assessment of nutritional status has a clear prognostic significance for a particular patient without taking into account the dynamics of changes in this indicator.

Nutritional (nutritional, trophological) status of the patient and indications for its assessment
In the domestic literature there is no generally accepted term for assessing the nutrition of the patient. Different authors use the concepts of nutritional status, nutritional status, trophological status, protein-energy status, nutritional status. When assessing the state of nutrition, it is most correct to use the term "nutritional status of the patient", since it reflects both the nutritional and metabolic components of the patient's condition. The ability to timely diagnose malnutrition is necessary in the practice of doctors of all specialties, especially when working with geriatric, gastroenterological, nephrological, endocrine and surgical continents of patients.

Nutritional status should be determined in the following situations:
- In the diagnosis of protein-energy malnutrition.
- When monitoring the treatment of protein-energy malnutrition.
- When predicting the course of the disease and assessing the risk of surgical and unsafe methods of treatment (chemotherapy, radiation therapy, etc.).

Methods for assessing nutritional status

Physical examination

Physical examination allows the doctor to diagnose both obesity and protein-energy malnutrition, as well as determine the deficiency of individual nutrients. If a patient is suspected of having a nutrient deficiency, after the examination, it is necessary to confirm the assumption with laboratory tests.

WHO experts describe the following clinical signs of protein-energy malnutrition: protrusion of the bones of the skeleton; loss of skin elasticity; thin, sparse, easily pulled out hair; depigmentation of skin and hair; swelling; muscle weakness; decrease in mental and physical performance.

Nutrients	Deficiency disorders and symptoms	Results of laboratory studies
Water	Thirst, decreased skin turgor, dry mucous membranes, vascular collapse, mental disorder	Increasing the concentration of electrolytes in the blood serum, the osmolarity of the blood serum; a decrease in the total amount of water in the body
Calories (energy)	Weakness and lack of physical activity, loss of subcutaneous fat, muscle wasting, bradycardia	Decreased body weight
Protein	Psychomotor changes, graying, hair thinning and loss, "scaly" dermatitis, edema, muscle wasting, hepatomegaly, growth retardation	Decreased OMP, serum concentrations of albumin, transferrin, protein-bound retinol; anemia; decrease in creatinine / growth, the ratio of urea and creatinine in the urine; increase in the ratio of essential and non-essential amino acids in the blood serum
Linoleic acid	Xerosis, desquamation, thickening of the stratum corneum, alopecia, fatty liver, delayed wound healing	An increase in the ratio of triene and tetraenoic fatty acids in the blood serum
Vitamin A	Xerosis of eyes and skin, xerophthalmia, Byto's plaque formation, follicular hyperkeratosis, hypogeusia, hyposmia	Decrease in the concentration of vitamin A in the blood plasma; increasing the duration of dark adaptation
Vitamin D	Rickets and growth disorders in children, osteomalacia in adults	Increased serum concentration of alkaline phosphatase; a decrease in the concentration of 25-hydroxycholecalciferol in the blood serum
Vitamin E	Anemia	Decrease in the concentration of tocopherol in the blood plasma, hemolysis of erythrocytes
Vitamin K	Hemorrhagic diathesis	Increase in prothrombin time
Vitamin C (ascorbic acid)	Scurvy, petechiae, ecchymosis, perifollicular hemorrhage, loosening and bleeding gums (or tooth loss)	Reducing the concentration of ascorbic acid in the blood plasma, the number of platelets, the mass of whole blood and the number of leukocytes; decrease in the concentration of ascorbic acid in the urine
Thiamin (Vitamin B1)	Beriberi, muscle soreness and weakness, hyporeflexia, hyperesthesia, tachycardia, cardiomegaly, congestive heart failure, encephalopathy	Decreased activity of thiamine pyrophosphate and transketolase contained in erythrocytes and increased in vitro action of thiamine pyrophosphate on it; decrease in the content of thiamine in the urine; increased blood levels of pyruvate and ketoglutarate
Riboflavin (vitamin B2)	Zaeda (or angular scars), cheilosis, Gunther's glossitis, atrophy of the papillae of the tongue, corneal vascularization, angular blepharitis, seborrhea, scrotal (vulvar) dermatitis	Decreased EGR activity and increased effect of flavin adenine dinucleotide on EGR activity in vitro; a decrease in the activity of pyridoxal-phosphate oxidase and an increase in the action of riboflavin on it in vitro; decrease in the concentration of riboflavin in the urine
Niacin	Pellagra, bright red and "peeled" tongue; atrophy of the papillae of the tongue, fissures of the tongue, pellagrozny dermatitis, diarrhea, dementia	Decrease in the content of 1-methyl-nicotinamide and the ratio of 1-methyl-nicotinamide and 2-pyridone in urine

Note: RBMS - basal metabolic rate; BUN, blood urea nitrogen; creatinine/growth - the ratio of the concentration of creatinine in daily urine to growth; ECG - electrocardiogram; EGSUT - erythrocyte glutamine oxaloacetic transaminase; EGR, erythrocyte glutathione reductase; OMP - the circumference of the muscles of the shoulder; KZhST - skin-fat fold over the triceps; RAI - radioactive iodine; Τ, triiodothyronine; Τ, thyroxine; TSH is the pituitary thyroid stimulating hormone.

Anthropometric measurements and body composition analysis

Anthropometric measurements are of particular importance in the physical examination. Anthropometric measurements are a simple and affordable method that allows using calculation formulas to assess the composition of the patient's body and the dynamics of its change. However, when analyzing the data obtained, it must be remembered that tabular data is not always suitable for a particular person. The existing standards were originally calculated for healthy people and may not always be accepted for the patient. It is correct to compare the identified indicators with the data of the same patient in his favorable period.

Body mass

Determination of body weight (BW) is the baseline for assessing nutritional status.

Body weight is usually compared with the ideal (recommended) body weight. The body weight calculated according to one of the numerous formulas and normograms, or the body weight that was most "comfortable" in the past for this patient, can be taken as the recommended weight.

The edematous syndrome may affect the reliability of the body weight estimate. In the absence of edema, body weight calculated as a percentage of ideal body weight serves as a useful indicator of body fat plus lean body mass. Ideal body weight can be calculated from a standard height/weight table.

With a disproportionate loss of various components of the body, the absence of significant changes in the patient's body weight may mask a protein deficiency while maintaining a normal or slightly excess fat component (for example, the body weight of an emaciated patient who was initially obese may be equal to or exceed the recommended one).

A decrease in the ratio of measured body weight / ideal body weight to 80% or less usually signals an insufficient protein-energy diet.

Body weight limits (kg)
Height, cm	Low	Medium	high
MEN
157,5	58,11-60,84	59,47-64,01	62,65-68,10
160,0	59,02-61,74	60,38-64,92	63,56-69,46
162,6	59,93-62,65	61,29-65,83	64,47-70,82
165,1	60,84-63,56	62,20-67,19	65,38-72,64
167,6	61,74-64,47	63,11-68,55	66,28-74,46
170,2	62,65-65,83	64,47-69,92	67,65-71,73
172,7	63,56-67,19	65,83-71,28	69,01-78,09
175,3	64,47-68,55	67,19-72,64	70,37-79,90
177,8	65,38-69,92	68,55-74,00	71,73-81,72
180,3	66,28-71,28	69,92-75,36	73,09-83,54
182,9	67,65-72,64	71,28-77,18	74,46-85,35
185,4	69,01-74,46	72,64-79,00	76,27-87,17
188,0	70,37-76,27	74,46-80,81	78,09-89,44
190,5	71,73-78,09	75,82-82,63	79,90-91,71
193,04	73,55-79,90	77,63-84,90	82,17-93,98
WOMEN
147,3	46,31-50,39	49,49-54,93	53,57-59,47
149,9	46,76-51,30	50,39-55,84	54,48-60,84
152,4	47,22-52,21	51,30-57,20	55,39-62,20
154,9	48,12-53,57	52,21-58,57	56,75-63,56
157,5	49,03-54,93	53,57-59,93	58,11-64,92
160,0	50,39-56,30	54,93-61,29	59,47-66,74
162,6	51,76-57,66	56,30-62,65	60,84-68,55
165,1	53,12-59,02	57,66-64,01	62,20-70,37
167,6	54,48-60,38	59,02-65,38	63,56-72,19
170,18	55,84-61,74	60,38-66,74	64,92-74,00
172,72	57,20-63,11	61,74-68,10	66,28-75,82
175,26	58,57-64,47	63,11-69,46	67,65-77,18
177,8	59,93-65,83	64,47-70,82	69,01-78,54
180,34	61,29-67,19	65,83-72,19	70,37-79,90
182,88	62,65-68,55	67,19-73,55	71,73-81,27

body composition

Body composition assessment is based on the concept of extracellular and intracellular body mass.

The cell mass is mainly visceral organs and skeletal muscles. The assessment of cell mass is based on the determination of the content of potassium in the body by various, mainly radioisotope methods. The extracellular mass, which performs mainly a transport function, anatomically includes blood plasma, interstitial fluid, adipose tissue and is assessed by determining exchangeable sodium. Thus, the intracellular mass reflects mainly the protein component, and the extracellular mass reflects the fat component of the body.

The ratio of plastic and energy resources can be described through two main components: the so-called fat-free or lean body mass (TMB), which includes muscle, bone and other components and is primarily an indicator of protein metabolism, and adipose tissue, which indirectly reflects energy metabolism. .

MT = TMT + fat component.

Thus, to assess body composition, it is sufficient to calculate one of these values. The normal body fat content for men is 15-25%, for women 18-30% of the total body weight, although these figures may vary. Skeletal muscle averages 30% of TMT, the mass of visceral organs is 20%, and bone tissue is 7%.

A decrease in body fat reserves is a sign of a significant deficiency of the energy component of nutrition.

Methods for determining body composition

To assess the fat content in the body, the method of assessing the average skin-fat fold (anthropometric data) is usually used. There are also various ways to calculate the content of adipose tissue, which are based on determining the density of the human body. Based on the difference in the density of different tissues, the fat component is estimated.

To assess lean body mass, creatinine excretion is studied or bioimpedancemetry is performed.

The main method for determining body fat content is based on the assessment of the average skin-fat fold (SKF) with a caliper for several SKFs (most often over the triceps, over the biceps, subscapular and supraileal).

The caliper is a device that allows you to measure the QOL and has a standard fold compression ratio of 10 mg/cm 3 . The manufacture of the caliper is available on an individual basis.

Rules for measuring the skin-fat fold with a caliper.

Anthropometric measurements are carried out on the non-working (non-dominant) arm and the corresponding half of the body.
The direction of the folds created during the measurement must coincide with their natural direction.
Measurements are taken three times, the values are recorded 2 seconds after the device lever is released.
The skin-fat fold is captured by the researcher with 2 fingers and pulled back by about 1 cm.
Measurements on the shoulder are carried out with the arm hanging freely along the body.
Middle of the shoulder: the middle of the distance between the points of articulation of the shoulder with the acromial process of the scapula and the olecranon of the ulna (the circumference of the shoulder is also determined at this level).
CVJ above the triceps is determined at the level of the middle of the shoulder, above the triceps (in the middle of the back surface of the arm), is located parallel to the longitudinal axis of the limb.
CVJ above the biceps is determined at the level of the middle of the shoulder, above the triceps (on the front surface of the arm), is located parallel to the longitudinal axis of the limb.
The subscapular (subscapular) SCJ is defined 2 cm below the angle of the scapula, usually located at an angle of 45° to the horizontal.
SIJ above the iliac crest (supraileal): determined directly above the iliac crest along the mid-axillary line, usually located horizontally or at a slight angle.
Anthropometric indicators are determined in the middle third of the shoulder of the non-working arm. Their proportions make it possible to judge the ratio of tissues throughout the body.
Measurements of the triceps skinfold (TSF) and arm circumference are usually taken, from which the arm muscle circumference (OMC) is calculated.

The calculated values that characterize the masses of the muscles of the shoulder and subcutaneous adipose tissue correlate with a fairly high accuracy, respectively, with lean (OMP) and fat (FAB) body masses, and, accordingly, with the total peripheral reserves of proteins and fat reserves of the body.

On average, anthropometric indicators corresponding to 90-100% of the generally accepted ones are characterized as normal, 80-90% - as corresponding to a mild degree of malnutrition, 70-80% - to a moderate degree, and below 70% - to a severe degree.

Basic anthropometric indicators of nutritional status (according to Heymsfield S.B. et al., 1982)

Index	Norms
Index	men	women
Skin fold over the triceps (KZhST), mm	12,5	16,5
Shoulder circumference (OP), cm	26	25
Shoulder muscle circumference (OMC), cm \u003d OP - π × KZhST	25,3	23,2
Area of subcutaneous adipose tissue, cm 2 = KZhST×ΟΜΠ/2 – π×KZhST2/4	17	21
Shoulder muscle area, cm 2 = (ΟΠ – π × KZhST)2/4p	51	43

Note: average values are given. Somatometric indicators vary depending on the age group.

Immunological indicators of nutritional status assessment.

Comprehensive methods for assessing nutritional status
A large number of complex indices and methods have been developed that allow assessing the nutritional status of a patient with varying degrees of reliability. All of them include a combination of anthropometric, biochemical and immunological parameters.
1. Decrease in body weight by more than 10%.
2. Decreased total blood protein below 65 g/l.
3. Decreased blood albumin below 35 g/l.
4. Reducing the absolute number of lymphocytes less than 1800 per µl.
Subjective global assessment according to A. S. Detsky et al. (1987) includes a clinical assessment of 5 parameters:
1. Weight loss in the last 6 months
2. Dietary changes (diet assessment).
3. Gastrointestinal symptoms (anorexia, nausea, vomiting, diarrhea) lasting more than 2 weeks.
4. Functionality (bed rest or normal physical activity).
5. Disease activity (degree of metabolic stress).
In parallel with the above studies, a subjective and physical examination is carried out: loss of subcutaneous fat, muscle wasting, and the presence of edema.
According to the above indicators, patients are divided into three categories:
- With normal nutritional status.
- With moderate exhaustion.
- With severe exhaustion.
The most common is the scoring of 8 diverse markers of nutritional status. Among these indicators, different authors introduce a clinical assessment, anthropometric and biochemical parameters, the results of a skin test with an antigen, etc.

Each of the indicators is evaluated: 3 points - if it is within the normal range, 2 points - if it corresponds to a mild degree of protein-energy deficiency, 1 point - moderate, 0 points - severe. A sum equal to 1–8 points makes it possible to diagnose mild protein-energy malnutrition, 9–16 points – moderate, 17–24 points – severe. A total score of 0 points indicates the absence of malnutrition.

According to the order of the Ministry of Health of the Russian Federation No. 330 of August 5, 2003, the assessment of the state of nutrition is carried out according to indicators, the totality of which characterizes the nutritional status of the patient and his need for nutrients:
- Anthropometric data: height; body mass; body mass index (BMI); shoulder circumference; measurement of the triceps skin-fat fold (TSF).
- Biochemical parameters: total protein; albumen; transferrin.
- Immunological indicators: the total number of lymphocytes.

Nutritional Status in children with disabilities, the topic of today's article. In children with neurological problems nutritional status disorder can be associated both directly with nutritional disorders (malnutrition), and with other, non-nutritive factors - the type and severity of neurological disorders, endocrine dysfunction, cognitive disorders, etc.

Greetings dear readers! Let us consider in more detail the causes of malnutrition in such children, since their understanding will allow us to influence them.

Of course, the main cause of malnutrition in children with neurological disorders is a mismatch between the food they eat and their nutritional and energy needs.

Researchers such as S. Reilly and V. Stallings have shown that they generally consume less nutrients and energy than healthy peers.

This situation is due to factors that are presented below.

Oral motor dysfunction

In children with cerebral palsy, insufficient is most often a consequence of the disease. Usually, the severity of oral-motor dysfunction correlates with the severity of the delay in the child's motor development.

Often parental complaints are as follows:

sucking problems
breastfeeding
swallowing
introduction of solid food
drinking
biting off
chewing
itching and coughing while feeding

According to a study by S. Reilly et al., these manifestations could be observed in 60% of children with. In a study by P. Sullivan et al. it was found that 28% of parents of children with cerebral palsy spend more than three hours daily on the process of feeding a special child, and 3% are forced to spend more than 6 hours daily on such a “routine” element of care.

One can only imagine how stressful (and not pleasant, as it should be) the process and duration of such feeding is for parents and how they feel.

However, for the effective consumption of food by the child, it is precisely the good mood of the guardians during feeding that is important, since the child is completely dependent on them to satisfy his basic needs.

In addition, such a process of feeding and its duration tires not only the guardians, but also the child himself, which cannot but affect his appetite and ability to eat the proper amount.

Unfortunately, even such a significant increase in the time of feeding a child does not necessarily compensate for the existing difficulties and does not always mean that the calories consumed are sufficient.

Examination of oral-motor function

When examining the oral-motor function of children, problems such as:

difficulty closing the mouth
salivation
persistent protrusion of the tongue, which causes leakage of food
the formation of a lump of food is difficult due to poor coordination of voluntary muscle movements
delayed development of age-related oral skills
delay in the implementation of the swallowing reflex, which can cause aspiration

Severe oral-motor dysfunction is often associated with poor nutritional status.

Children who are severely affected (unable to eat on their own, unable to hold their head up) are at greater risk of aspiration.

Children who present with early, persistent, and severe feeding difficulties, considered predictors of poor nutritional status, should be included in the group in which the use of a gastrostomy tube may be beneficial.

Significant loss of food. Children with neurological impairments who are able to eat on their own may have poor hand/mouth coordination, leading to food wastage. A. Ravelli et al. found that children with neurological lesions are much more likely to experience gastroesophageal reflux (GERD) and delayed gastric emptying, leading to increased nutrient loss due to frequent vomiting.
Violation of the natural regulation of nutrition. Due to communication difficulties, children with disabilities cannot clearly communicate their hunger, satiety, and taste preferences. Thus, the natural regulation of nutrition is replaced by the choice and responsibility of adults. Caregivers, on the other hand, tend to exaggerate the amount of food consumed by the child and underestimate the time needed for feeding, since this process, as noted above, can be too difficult and lengthy, which results in an insufficient energy intake relative to the energy needs of the child.

To fully understand the cause of malnutrition in a special child, it is common to:

study of medical
nutritional
social history
adequate anthropometric measurements
physical examination
observation of the eating process
carrying out special diagnostic procedures

The medical history is important in understanding the cause, duration, and severity of the nervous system injury and, accordingly, the expected consequences.

It is important to note the use of anticonvulsants by a child, as some anticonvulsants can change the child's eating pattern, affect his level of consciousness and, as a result, oral motor dexterity and airway protection.

The presence of signs of respiratory or gastrointestinal problems should be especially carefully examined, because they will affect all aspects of nutritional support.

Symptoms such as frequent vomiting, refusal to eat, restless behavior, anemia suggest GER.

According to research by J. Sondheimer and B. Morris, children with severe retardation and severe scoliosis often suffer from acid reflux.

The possibility of aspiration is indicated by chronic cough, frequent pneumonia, and poorly controlled asthma.

A nutritional history helps to find out:

how did the child acquire new appropriate feeding skills, what difficulties were observed and what is the child's feeding now (the answer to these questions often helps to identify the obvious cause of poor absorption);
what was the dynamics of the growth and body weight of the child at the same time (children with low birth weight are at risk for developing malnutrition; it is good to have records of the food actually consumed by the child for three days to study habitual nutrition, its energy and nutritional value).

Social history

The social history helps to understand how much the institution that cares for a child with a disability has the resources (information, human, financial, professional, etc.) for adequate nutritional care.

It is well known that the nutritional status of most children can be assessed by their body weight and height. However, monitoring these indicators in children with is difficult due to the following factors.

1. It is difficult to obtain reliable measurements of height or body length due to deformities, fixed joint contractures, involuntary muscle spasms, and inappropriate behavior due to cognitive deficits. Therefore, for children with cerebral palsy, formulas have been developed based on indicators of shoulder length, tibia length and knee height, which are advised to be used as substitutes for height or body length when accurate measurements cannot be made.

2. Generally accepted standards for healthy children may not be adequate for children with significant neurological impairment. So, for certain genetic diagnoses (syndromes: Down, Turner, Marfan, Prader-Willi, fragile X-chromosome, etc.), their own, specific to the diagnosis, growth and body weight curves have been developed.

Cerebral palsy does not apply to genetic diseases, however, many experts have tried to develop growth and body weight curves specific for this diagnosis.

Specific curves of growth and body weight

Although specific growth and weight curves for children may be useful to clinicians, any representative sample of individuals with severe or moderate cerebral palsy is heterogeneous.

At present, there may be many children with various degrees of malnutrition in it, which results in the danger of introducing malnutrition into the rank of "norm" for children with neurological lesions.

Therefore, researchers are discussing the appropriateness of conducting a multicentre survey of a cohort of children with cerebral palsy who grew up with good medical care, in a healthy atmosphere, in "good health", to analyze and create anthropometric standards.

Taking into account the listed difficulties in clinical practice, when assessing the nutritional status of a special child by the “classical” method (measurement of height and body weight), it is possible to use “alternative” methods: the circumference of the shoulder and the thickness of the skin-fat fold.

Shoulder circumference

The circumference of the shoulder is measured with an ordinary centimeter tape at the middle of the distance between the acromial and olecranon processes.

It does not require a lot of time and equipment, low rates clearly correlate with mortality and morbidity.

However, some studies have established the same reliability of this criterion for the diagnosis of malnutrition, as well as weight indicators for age.

In children from 6 to 59 months, the circumference of the shoulder changes little, so it can be used as an age-independent indicator in this age range.

So, in accordance with the recommendations of the working groups of the World Health Organization (WHO), which are working on standardizing the assessment of nutritional status, at the age of 6-59 months, severe malnutrition is diagnosed with a shoulder circumference of 110 mm, and moderate - with 110-125 mm.

The thickness of the skin-fat fold

Skinfold thickness (Of the four typical locations—above the biceps, triceps, iliac crest, and under the scapula—the most common measurement used by clinicians is above the triceps)

characterizes the fat reserve in the body; the results obtained are compared with centile tables (a database has been created for all ages and gender).

Regarding children with cerebral palsy, some studies have found that low skin-fat fold thickness is better at identifying malnourished children in this cohort than weight/height/age (96 vs. 45-55%, respectively).

It is interesting to note that the Committee of the Pediatric Society of Canada back in 1994 recommended a method for determining the thickness of the skin-fat fold as the best screening test for malnutrition in children with cerebral palsy.

Physical examination

Physical examination reveals signs of malnutrition and micronutrient deficiencies.

If a child with cerebral palsy has symptoms such as increased muscle tone and hyperkinesis, this will mean increased energy requirements compared to children who do not have such manifestations. Contractures and scoliosis can significantly worsen the position of the child during meals.

Monitoring the process of eating a child who has problems with nutrition is a common procedure in Canada, USA, Holland, etc.

Often, for the adequacy of the assessment, video filming of the feeding process in the usual

Carrying out such an assessment is of interest not only for the doctor, who will have invaluable factual material for the diagnostic process, but also for the speech therapist, who will be able to observe oral-motor skills and problems, for the physical therapist, who will find out the adequacy and safety of the child’s position during feeding times, will evaluate the appropriateness of the feeding aids used, for a behavioral psychologist who will be able to evaluate parent-child interaction during meals.

Diagnostic procedures

Special diagnostic procedures are necessary to identify certain symptoms.

To determine aspiration and its conditions, it is appropriate to conduct a video fluoroscopic examination of the swallowing process using food of various textures and.

Occasionally, this examination may reveal asymptomatic (silent) aspiration in the absence of cough.

It is also important to consider the position of the child during the procedure, as in some children the aspiration depends on their position.

It is appropriate to have this swallowing test done at the end of a feed, as a child's fatigue can trigger aspiration. Videofluoroscopic examination of the swallowing process will help to choose a safe food texture and an adequate feeding technique.

Diagnosis of GER

Diagnosis of GER (vomiting, chest and abdominal pain, irritability, food refusal) may sometimes require testing such as gastric emptying test, upper GI endoscopic examination, 24-hour pH sounding.

After identifying children with malnutrition or at risk of malnutrition, an individual nutritional support plan is drawn up, the purpose of which is to achieve target anthropometric indicators (target weight, skinfold thickness, etc.), which as a result optimizes the child’s health, his functional ability and the quality of life.

First of all, a team of specialists tries to maximize the oral intake of food by a child in a safe way.

To do this, you can select the optimal position of the child’s body for feeding and the necessary adaptive equipment, adjust the composition of food and its calorie content, change the texture of food and feeding means, increase the frequency of feeding, select appropriate feeding techniques, conduct behavioral modification, and eliminate medical problems.

Particularly relevant are attempts to improve the motor-oral skills of children with disabilities under 5 years of age.

Probe feeding

If, despite the optimization of the feeding intake, the child is not able to meet his nutritional and energy needs, it is necessary to start tube feeding.

In addition, tube feeding is indicated if the duration of the feeding process is too long (more than 3 hours per day) and there is a risk of aspiration.

Tube feeding has become the accepted standard of care for children with severe disabilities. When choosing this method, consider the following points:

what will be delivered through the probe (ground food, ready-made commercial mixes)
what access to the gastrointestinal tract will be optimal (nasogastric, nasojejunal tube, gastrostomy)
what mode of nutrient intake to choose (portioned, infusion during the day and / or night, combined)

It is believed that the use of nasogastric tubes is indicated for short-term use (within 3-8 weeks, depending on the material from which the tube is made).

gastrostomy

If it is necessary to conduct a longer tube feeding (more than 6-8 months), it is appropriate to consider the expediency of a gastrostomy.

The gastrostomy can be used either for complementary feeding (predominantly at night; during the day, the child should be encouraged to oral feed if it is safe) or to completely change the way of feeding.

Studies conducted by specialists have shown the expediency of using a gastrostomy in children with severe forms of cerebral palsy for general health and.

P&S

Today you may have received a lot of new information, and of course not everyone understands what they read. But, my dears, this gives you an impetus to go to the attending physician and find out what your child is suffering from from the above.

And, if you did not pay attention to this before, now, at your request, the doctors will carefully conduct an examination.

Why did I write to you about this, everything is simple, I myself fed the child and my relatives helped me. Everyone takes pity on her, wants to add a tastier piece to the plate, treat her with a tasty treat.

Now we are reaping the fruits of our love, being treated by a nutritionist-gastroenterologist, plus from this, now we give a lot of time, life has become mobile.

So now we lead a healthy lifestyle!

That's all, on this we say goodbye, do not forget to subscribe to new publications and share the article with your friends. Bye!

And indeed it is. Preventive medicine is one of the main areas of work of the modern healthcare system. What is its disadvantage? Preventive measures are massive and do not take into account the characteristics of each person. Nowadays, "Preventive Medicine" can be heard more and more often. In Russia, this area is just beginning to develop, and European specialists have been actively developing it for several years. Preventive medicine deals with each person individually, taking into account his characteristics. Thus, the specialist works with each patient according to the system of an individual approach, which significantly increases the effectiveness of preventive measures.

The program for assessing the functional state of the body was developed to study hemostasis (a complex biological process in the body that ensures its viability) in patients older than 18 years.

At the first stage, you take a blood test to study your nutritional status. It is necessary to observe According to the result of the examination, the dietitian will draw up an individual plan for monitoring, correcting the identified violations.

The composition of research within the framework of a comprehensive program:

Nutritional status basic - 3900 rubles.

includes: AST, ALT, GGT, alkaline phosphatase, ferritin, creatinine, urea, uric acid, total protein, albumin, total bilirubin, total cholesterol, triglycerides, HDL-C, LDL-C, CRP, CPK, glycated hemoglobin, ionized calcium, calcium general, sodium, potassium, chlorine, complete blood count, TSH, LDH

Nutrition is essential for the healthy functioning of the human body. And especially for cancer patients.

At any stage of the complex treatment of oncological diseases - from the diagnosis of the disease to the stage of rehabilitation - it is necessary to pay due attention to what and how the patient eats. Nutrition is an important indicator of a patient's quality of life.

The patient's quality of life is an integral characteristic. It includes his physical, psychological and social functioning.

The doctor's goal is not just to cure a person, but also to maintain social adaptation and psychological well-being, so that the patient can feel as comfortable as possible during the treatment period and after it.

Nutritional deficiencies and their risk

It is important that the patient and doctor understand what they are talking about to each other. So let's look at some terms.

Nutritional status is a complex of clinical, anthropometric and laboratory indicators characterizing the quantitative ratio of human muscle and fat mass.

Another important concept is nutritional or nutritional deficiencies. This is a condition that is caused by a discrepancy between the intake of nutrients in the body and their consumption, which leads to a decrease in body weight and a change in the composition of the body.

The risk of developing nutritional deficiencies in cancer patients is high. It depends on the location of the tumor and the stage of the process.

Causes of nutritional deficiencies

1. Decreased food intake.

It can be associated both with manifestations of the disease itself (difficulties in swallowing food, nausea, vomiting), and with a conscious restriction of food intake by the patient.

2. Violation of the absorption of nutrients.

Often this is due to organic and structural changes in the digestive tract.

3. Loss of nutrients.

This can occur against the background of vomiting or diarrhea in connection with the underlying disease or as a result of treatment.

4. Disorders of metabolism (metabolism).

Metabolic disorders associated with cancer may be due to a lack of certain nutrients, such as vitamins. They are involved in many biological reactions of the body. If there is a violation of absorption or intake of vitamins in the body, the metabolism as a whole is disturbed.

5. Psychological stress.

Firstly, against the background of stress, appetite may decrease, and, as a result, the amount of food consumed may decrease. A vicious circle is closing. Secondly, mechanisms can be triggered in the body that accelerate the breakdown of nutrients.

The following methods help specialists in monitoring the dynamics and state of the patient's nutritional status:

1. Control of body weight.

Body weight control is not only the doctor's task, but also the patient's. You need to monitor your weight, nutrition and pay attention to the changes that are taking place.

2. Clinical and biochemical blood tests.

Based on blood test data (for example, protein levels, blood albumin, lymphocyte count), doctors can monitor and record the presence and dynamics of nutritional deficiencies in a patient.

3. Bioimpedancemetry.

This is one of the instrumental methods in the arsenal of doctors. It is based on the study of the quantitative ratio of muscle and fat body mass, the assessment of their ratio in dynamics. It is based on the physical laws of different electrical conductivity of body tissues.

4. Computed tomography.

It is also used to estimate the amount of lean and fat body mass. It is performed for each patient at the stage of diagnosis and further treatment.

Screening for nutritional deficiencies: self-test

The patient can self-screen for nutritional deficiencies.

To do this, you need to answer three simple questions:

Have you noticed a spontaneous weight loss lately? (no - 0 points, yes - 2 points)
If yes, how much? (1-5 kg - 1 point; 6-10 kg - 2 points; 11-15 kg - 3 points; over 15 kg - 4 points; unknown - 2 points)
Do you have a decrease in appetite and, as a result, the amount of food? (no - 0 points; yes - 1 point)

If more than 2 points were scored for 3 questions, then the patient needs nutritional support.

It is necessary to promptly identify patients at risk of impaired nutritional status. This helps to protect them from progressive weight loss and the development of related complications.

Screening and monitoring of malnutrition should be carried out throughout treatment, which is important for assessing the dynamics of the nutritional status of cancer patients.

Prevention of sarcopenia

Sarcopenia is a concept that is closely related to nutritional deficiencies.

Sarcopenia is a change in skeletal muscle resulting in a gradual loss of lean body mass and decreased muscle function. Usually this condition is due to recurrent changes in metabolic processes, malnutrition and increased muscle catabolism (nutrient breakdown).

The following methods can help in the prevention of sarcopenia:

Mandatory observance of the mode of physical activity (if the muscles do not perform their functions, they begin to weaken and muscle mass gradually decreases)
Balanced and enriched nutrition, which should provide the required energy value of products (sufficient protein content, the presence of vitamins, microelements and the so-called pharmaconutrients - essential amino acids, fatty acids and some other nutrients)

If we talk about specific indicators, then you can pay attention to the following elements and adhere to the indicated values:

Energy supply: 25-35 kcal/kg/day
Protein supply: 1.2-1.5 g / kg / day
Pharmaconutrients
Vitamins B6, B12, folic acid, zinc
Fumarate, succinate, citrulline, citric acid

Anorexia-cachexia syndrome

The next important concept is anorexia-cachexia syndrome. This is a multifactorial syndrome characterized by weight loss, anorexia (including loss or lack of appetite), and various metabolic disorders (increased nutrient breakdown, muscle protein breakdown, chronic inflammation syndrome).

There are 3 degrees of this syndrome: precachexia, cachexia and refractory cachexia.

Precachexia: anorexia, metabolic disorders, weight loss
Cachexia: anorexia, chronic inflammation syndrome, weight loss >5%
Refractory cachexia: progressive disease on treatment, weight loss > 8-10%

The syndrome of anorexia-cachexia is closely related to the general well-being of the patient. With an increase in the phenomena of anorexia-cachexia syndrome, the general well-being of the patient worsens, which entails the impossibility of continuing specialized antitumor treatment.

Broadly speaking, cachexia does not equate to weight loss. Weight loss is only a part, one of the links that leads to its development.

Cancer cachexia is:

Decrease in total body weight and loss of lean body mass;
Malabsorption (loss of nutrients due to insufficient absorption in the small intestine);
Anorexia;
Dysphagia (difficulty swallowing food);
Postoperative catabolism;
"Trap for micronutrients" (tumor tissues actively absorb nutrients, which can lead to deficiencies in healthy cells)

Nutritional support as a type of accompanying therapy

Nutritional support is a nutritional therapy that aims to provide the body with all the nutrients it needs through nutritional formulas. This optimizes the metabolic processes, and also increases the reserves of the body.

Goals and objectives of nutritional support:

Improving the quality of life of the patient (this is what doctors strive for in the first place)
Compensation for increased energy costs
Improved tolerability of anticancer treatment
Improved response to ongoing therapy (improved efficacy)
Nutrition optimization for the purpose of earlier rehabilitation (in the postoperative period, after treatment, in remission)
Improving the prognosis of the disease
Improving Survival Rates

sip nutrition– oral intake of modern liquid formulas (partial or complete)
Probe feeding- carried out through a nasogastric or nasointestinal tube or through a gastro- and enterostomy (more than 3-4 weeks)
parenteral nutrition- central, peripheral
mixed option introduction of nutrient substrates

sip nutrition

Enteral nutrition (siping) is nutrition that is physiological for the body. It is usually used in addition to the patient's usual diet. This is the oral intake of a nutrient mixture through a tube in small sips.

You should follow simple rules regarding sipping: you must drink strictly through a straw (so that the sip is small) and drink slowly (for about 30 minutes). In this case, it is preferable to use specialized mixtures containing the maximum amount of nutrients in a minimum volume.

Particular attention should be paid to the amount of protein in the mixture - a building material for restoring the body, increasing its resistance. With the development of nutritional deficiency, the breakdown of proteins in the first place increases, their synthesis in the body is disturbed.

Sip mixes come in a variety of flavors, and patients can often individually choose the flavor they like.

Probe feeding

Another method of nutritional support is tube feeding. It is enteral nutrition. Such nutrition is carried out by placing a probe in the stomach or small intestine.

If it is impossible to insert a probe, it is necessary to form a gastro- or enterostomy, in which nutrition is supplied directly to the corresponding organ.

This approach is applicable in three cases: when patients cannot, do not want or should not receive food orally (by mouth).

parenteral nutrition

Parenteral nutrition involves the use of mixtures that are specially designed for administration into peripheral or central veins.

Indications for the use of this method:

Inability to insert a probe or form a gastrostomy
Patient's categorical refusal to insert a probe
Presence of recurrent vomiting
Pathologies of the gastrointestinal tract (for example, intestinal obstruction or the development of any pathological inflammation in the intestines)
If enteral nutrition is not possible for three or more days
During chemoradiation therapy
With a decrease or lack of appetite with a complete refusal of the patient from food
With a decrease in protein levels, even if active nutritional support with enteral mixtures is carried out

Who needs nutritional support?

The principles of nutritional support include the following:

Timeliness (specialists should clearly identify the need for nutritional support)
Adequacy to the needs of the patient (they must be calculated individually for each patient)
Optimal timing (it is necessary to find the optimal timing of support for the individual patient)

It is important that the stages of assessing the patient's nutritional status, developing a nutritional support plan for the patient coincide with the diagnosis and treatment of the underlying disease. Thus, the efficiency of both methods can be increased.

Absolute indications for the appointment of active nutritional support are:

Presence of unintentional, rapidly progressive and significant weight loss

The patient has initial signs of malnutrition: BMI (body mass index) = 19 and below, a decrease in the level of protein and albumin in the blood, a decrease in the level of lymphocytes in a clinical blood test
The threat of developing rapidly progressive nutritional deficiencies: the inability to eat naturally, manifestations of increased breakdown of nutrients in the body

Start and duration of nutritional support

The period when nutritional support is prescribed:

With initial malnutrition: at least 7 days before the start of planned treatment
With satisfactory indicators of nutritional status: from the first days of treatment

Duration of nutritional support:

Patients with malnutrition who are to undergo radical treatment: start a course of active nutritional support 7-14 days before the intervention
Patients who have received radical treatment: early use of sips or tube feeding in the recovery period

Criteria for the duration of nutritional support or indicators that it can be completed:

Stabilization or increase in body weight (due to lean body mass)
Normal protein levels
No anemia
Satisfactory physical activity

Overweight and nutritional support

A very important issue is to assess whether overweight patients require nutritional support.
Normal or increased body weight does not mean that the patient does not have signs of sarcopenia (decrease in muscle mass).

With increasing weight loss, it is not adipose tissue that first decreases, but muscle tissue is lost. This leads to protein loss and the development of various complications. This process does not depend on the initial body weight of a person.

In addition, many studies have shown that the presence of sarcopenic obesity (a combination of a decrease in lean body mass with an increased fat mass) also adversely affects the prognosis of the disease, because. worsens the tolerability of anticancer treatment.

Tumor development and nutritional support

Another frequently asked question from patients is: does nutritional support affect tumor growth and spread?

Currently, there are no data supported by any scientific studies that would speak about the impact of nutritional ("artificial") nutrition on tumor growth in patients.

Normal, unaltered body cells (just like malignant ones) need nutrients to function better, to be able to resist active anticancer treatment.

A severe restriction in nutrients and any products will not only not help in treatment, but can also be harmful.

Thus, the guidelines of the Russian Society of Clinical Oncology RUSSCO give clear instructions on nutritional support:

The use of a high protein sip diet is preferred;
It is recommended to use enteral nutrition enriched with various nutrients - omega-3 fatty acids, glutamine, prebiotics;
The use of oral enteral nutrition enriched with omega-3 fatty acids and dietary fiber has advantages in the prevention of gastrointestinal toxicity;
Most patients require continued nutritional support at the outpatient stage as part of their rehabilitation.

What do you need to know about nutritional support?

Nutrition is a fundamental part of a healthy lifestyle.
Cancer patients are at risk for developing nutritional deficiencies.
Nutritional malnutrition prophylaxis should be used from the start of anticancer treatment.
Treatment of nutritional deficiencies must be individualized and tailored to the unique needs of the patient.
Adequate nutritional support improves tolerability and treatment efficacy, improving disease outcomes.

Is sports nutrition suitable for patients?

Some patients are interested in the possibility of using sports nutrition because it contains many nutrients.

Sports nutrition is designed for athletes who receive increased physical activity. In such a diet, doses of all nutrients are very high, not just vitamins. This food is created based on the fact that a person will experience a lot of physical activity.

Patients, as a rule, do not go to the gym during the treatment period, so it is still better to turn to medical nutrition. It is more balanced and designed specifically for the needs of patients who are currently receiving treatment.

Recommendations for therapeutic nutrition should be given by an oncologist. There are also other specialists - nutritionists and nutritionists who can help with the selection of nutrition. In addition, you can also consult with a gastroenterologist, who will take into account the existing gastroenterological problems associated with malnutrition.

Therapeutic starvation and tumor treatment

There is an opinion that therapeutic fasting is useful in oncological diseases so as not to “feed” the tumor.

Experts strongly disagree with this. The tumor, which is present in the body, receives only a part of the nutrients that enter the body. When fasting, the body lacks strength, building material for a quick and successful recovery after chemotherapy, radiation therapy or surgical treatment. Therefore, there should be no restrictions in the diet.

Of course, this issue should be resolved individually: many patients have comorbidities. In this case, the doctor must choose a specific diet. But purposefully limiting yourself in the use of protein, fish, dairy and other products is not worth it. The whole body, except for a malignant tumor, is tuned to fight the disease and needs nutrients.

Every second, tumor cells are formed in the body - cells over which the body loses control - in some they are effectively destroyed, in others they actively divide. It is naive to think that limiting protein intake will lead to the death of the tumor. During starvation, the body triggers alternative synthesis and begins to “take” protein from healthy tissues. In this case, irreversible processes occur in the human body, which leads to the limitation of the use of modern methods of antitumor treatment.

Can malnutrition be assessed by body mass index alone?

Malnutrition is also measured by BMI. Body mass index is the ratio of weight to height squared. But in cancer patients, BMI is not an unambiguous indicator for assessing nutritional status.

To assess the state of nutritional homeostasis in a patient, it is necessary to evaluate everything in a complex: both clinical data, and the patient's complaints about weight loss, and indicators of clinical and biochemical blood tests, as well as calculate the ratio of muscle and fat body mass using computed tomography and bioimpedancemetry.

Great attention should be paid to the stability of body weight. Any weight loss should be reported to the attending physician. It is very important to consider for what period and how many kilograms were lost.

When is nutritional support not needed?

Not all patients need nutritional support.

Nutrition should be complete and in the process of treatment, and during the rehabilitation period, and throughout life. The diet should be harmonious.

Vitamin complexes and nutritional support (therapeutic, special nutrition) should be prescribed only by the attending physician. There is a whole line of such nutrition, and the specialist chooses exactly what is needed to support and treat a particular patient.

The role of conventional foods in the treatment of cancer

Based on studies, including foreign ones, doctors come to the conclusion that "unnecessary" products do not exist as such. For example, there are no justified prohibitions regarding the consumption of sugar.

As for protein, it must be present in the diet - both vegetable and animal. Some deviation into vegetarianism against the background of a rather difficult and complex treatment by doctors is not very welcome, since this sharply limits the diversity of the patients' diet.

In the treatment of cancer, stability is important. Including in nutrition. You should not abruptly switch to a different type of food (for example, vegetarianism, if you always eat meat), or go on any other diet. This is stress for the body.