Clinical nutrition and metabolism

An unbalanced diet is known to be a leading factor in the prevalence of cardiovascular disease. However, awareness regarding the consumption of various popular soft drinks and red wine is significantly lower. A lack of understanding of the harms and benefits of various beverages negatively impacts health, making it crucial to summarize their impact on the risk of developing and preventing cardiovascular disease.

In the first part of our work, we detailed the cardioprotective effects of traditionally used foods, as well as the mechanisms by which these effects are mediated. The aim of the second part of the study is to provide information on the most common beverages whose beneficial properties can be used for the prevention and treatment of cardiovascular disease.

To achieve this aim, we summarized data from studies over the last five years examining the preventive effects of the most popular beverages: various types of tea, hibiscus, coffee, chicory, cocoa, and red wine. A literature search was conducted in the PubMed database. Analysis of the obtained data showed that prolonged consumption of various types of tea, hibiscus, chicory, and cocoa has a positive effect on metabolism. The resulting metabolic changes reduce the risk of developing and improve the course of existing cardiovascular diseases. Moderate consumption of filtered coffee in patients with controlled hypertension has been shown not to increase overall cardiovascular risk. However, experts believe that red wine should not be considered a preventive measure against the development of cardiovascular disease.

This article is a continuation of the article by Galenko AS, Bulaeva SP. Nutrients in cardiology: a review. Part 1. Clinical nutrition and metabolism. 2026;7(1):48–61. doi: 10.17816/clinutr701894

Stress hyperglycemia develops in a significant proportion of patients in intensive care units, the majority of whom have no history of diabetes mellitus. The relevance of this issue stems from the consistently demonstrated association between stress hyperglycemia and adverse outcomes, and an increased risk of complications. The aim of this review is to analyze current understanding of the pathophysiology of stress hyperglycemia. A search was conducted for articles in the MEDLINE, PubMed, and Scopus databases over the past 25 years using the keywords: stress-induced hyperglycemia; hypercatabolism; glucotoxicity; intensive care units. Full-text articles, reviews, and meta-analyses were included; case reports were excluded. As a result of the search, 47 articles were selected. The present work provides an analysis of the molecular mechanisms underlying stress-induced hyperglycemia. The review examines the pathways of post-receptor insulin resistance mediated by activation of stress kinases and suppressors of cytokine signaling, the mechanisms of persistent gluconeogenesis, and the four principal pathways of glucotoxicity (the polyol pathway, the hexosamine pathway, protein kinase C activation, and the AGE–RAGE axis), which trigger endothelial dysfunction, oxidative stress, and a procoagulant state. It has been clinically proven that the findings of early studies favoring strict glycemic control were not replicated in subsequent multicenter trials. This can be explained not so much by the failure of the concept of maintaining normoglycemia in critically ill patients as by the dual role of stress hyperglycemia: an evolutionarily conserved protective mechanism ensuring energy supply to vital organs, on the one hand, and a driver of organ damage when prolonged, on the other.

The frequency of total pancreatectomy has recently increased, but most Russian clinics have limited experience managing patients in the apancreatic state. Sudden loss of pancreatic endocrine function leads to pancreatogenic insulin-dependent diabetes mellitus type 3c, while exocrine insufficiency impairs the digestion and absorption of nutrients, primarily fats. Clinics with extensive experience treating patients after total pancreatectomy effectively address glycemic control by developing and implementing insulin therapy protocols, while nutritional deficiencies are addressed with adequate enzyme replacement therapy. We present a clinical case of a patient without preexisting diabetes who underwent total pancreatectomy for pancreatic cancer. Postoperatively, continuous intravenous insulin was administered in the intensive care unit. Adequate doses were titrated throughout the day to maintain moderate hyperglycemia. Mixed nutritional support and pancreatic enzyme supplementation were initiated. On the fourth postoperative day, the patient was transferred to the surgical ward. However, 12 hours later, he was readmitted to the intensive care unit with severe diarrhea and hyperglycemia, which was controlled, and the pancreatic enzyme dose was increased. After stabilization, on the sixth postoperative day, he was transferred to a surgical ward, where insulin and pancreatic enzyme replacement therapy was selected. He was discharged from the surgical ward on the 15th day in satisfactory condition. This clinical case demonstrates the need to implement protocols for the management of patients after total pancreatectomy in Russian clinical practice. This will allow for the timely diagnosis and prevention of sharp fluctuations in glucose levels in these patients, significantly reducing the incidence of complications and mortality in the early postoperative period.

Short bowel syndrome is a severe condition in which partial intestinal resection significantly impairs absorptive capacity. The resulting intestinal failure significantly impacts the growth and development of children. The purpose of this lecture is to discuss the etiology, pathogenesis, and prevalence of short bowel syndrome worldwide, as well as to provide a comprehensive description of the main causes, demographics, and clinical characteristics of short bowel syndrome in Russia.

To achieve this aim, PubMed and eLibrary databases were analyzed for the period from 2002 to 2025. The epidemiology of short bowel syndrome worldwide is highly variable: the incidence ranges from 0.09 to 1.67 per 100,000 children in different regions. The incidence of short bowel syndrome due to surgical causes is 0.7%. The most common congenital malformations leading to the development of the disease are abdominal wall defects, small intestinal atresia, neurocristopathies, and childhood intestinal pseudo-obstruction. Acquired diseases include necrotizing enterocolitis, intestinal volvulus, and intestinal wall infarction. Subsequent intestinal adaptation is manifested by smooth muscle hypertrophy, enterocyte proliferation, increased villus height, and crypt depth. Parenteral nutrition is used to maintain nutritional status, the predicted complications of which include sepsis, thrombosis, catheter leakage, catheter-related infection, and hepatosis. The Russian registry of children with short bowel syndrome, created in 2016, includes 663 children from 72 Russian regions. The prevalence of the disease was 20.7 cases per 1,000,000 children under 18 years of age. The majority of patients (63.5%) were children in the first three years of life. More than half (53%) of the patients were girls. The leading cause (73.0%) of various surgical interventions with subsequent development of the disease was congenital anomalies and malformations. More than half of the patients (51.8%) underwent 2–3 surgeries. The majority of patients (63.0%) had a critically short small bowel length—less than 50 cm. In 20 patients (16.0%), the colon was completely absent. Reconstructive plastic surgery was performed in 229 patients. The most common surgical technique was sequential transverse enteroplasty.

Thus, the main reason for surgical interventions leading to the development of short bowel syndrome was congenital anomalies and malformations. The prevalence of the disease, its causes, and treatment principles in our country are consistent with global standards.