rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2025-6-2607rmt-2654Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESВзаимосвязь между нарушениями состава микробиоты, моторикой кишечника и развитием белково-энергетической недостаточности у пациентов в хроническом критическом состоянии после тяжелого повреждения головного мозгаCasual Relationship between the GUT Microbiota Dysbiosis, Intestinal Motility, and Development of Protein-Energy Malnutrition in Patients in a Chronic Critical State after Severe Brain Damagehttps://orcid.org/0000-0002-9316-8907ЧерневскаяЕ. А.ChernevskayaE. A.

Екатерина Александровна Черневская

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Ekaterina A. Chernevskaya

25 Petrovka Str., Bldg. 2, 107031 Moscow

https://orcid.org/0000-0002-5278-7058ШестопаловА. Е.ShestopalovA. E.

Александр Ефимович Шестопалов

107031, г. Москва, ул. Петровка, д. 25, стр. 2;

125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1

Alexander E. Shestopalov

25 Petrovka Str., Bldg. 2, 107031 Moscow;

2/1 Barricadnaiay Str., Bldg. 1, 125993 Moscow

https://orcid.org/0000-0001-9903-7257ЯковлеваА. В.YakovlevaA. V.

Александра Витальевна Яковлева

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Alexandra V. Yakovleva

25 Petrovka Str., Bldg. 2, 107031 Moscow

https://orcid.org/0000-0003-3792-1682ЯдгаровМ. Я.YadgarovM. Ya.

Михаил Яковлевич Ядгаров

107031, г. Москва, ул. Петровка, д. 25, стр. 2;

109316, г. Москва, ул. Талалихина, д. 26

Mikhail Ya. Yadgarov

25 Petrovka Str., Bldg. 2, 107031 Moscow;

26 Talalikhina Str., 109316 Moscow

myadgarov@fnkcrr.ruhttps://orcid.org/0000-0001-9267-3664БерикашвилиЛ. Б.BerikashviliL. B.

Леван Бондоевич Берикашвили

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Levan B. Berikashvili

25 Petrovka Str., Bldg. 2, 107031 Moscow

https://orcid.org/0009-0009-6185-349XПоляковП. А.PolyakovP. A.

Петр Алексеевич Поляков

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Petr A. Polyakov

25 Petrovka Str., Bldg. 2, 107031 Moscow

СергеевИ. В.SergeevI. V.

Иван Владимирович Сергеев

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Ivan V. Sergeev

25 Petrovka Str., Bldg. 2, 107031 Moscow

https://orcid.org/0009-0000-7776-9537КузнецовИ. В.KuznetsovI. V.

Иван Валерьевич Кузнецов

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Ivan V. Kuznetsov

25 Petrovka Str., Bldg. 2, 107031 Moscow

https://orcid.org/0000-0002-4079-6950ЛисицынА. Б.LisitsynA. B.

Андрей Борисович Лисицын

109316, г. Москва, ул. Талалихина, д. 26

Andrey B. Lisitsyn

26 Talalikhina Str., 109316 Moscow

https://orcid.org/0000-0002-8482-1249ЯковлевА. А.YakovlevA. A.

Алексей Александрович Яковлев

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Alexey A. Yakovlev

25 Petrovka Str., Bldg. 2, 107031 Moscow

https://orcid.org/0000-0002-5442-6950ЛихванцевВ. В.LikhvantsevV. V.

Валерий Владимирович Лихванцев

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Valery V. Likhvantsev

25 Petrovka Str., Bldg. 2, 107031 Moscow

Федеральный научно-клинический центр реаниматологии и реабилитологииРоссияFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Ministry of Education and Science of RussiaRussian FederationФедеральный научно-клинический центр реаниматологии и реабилитологии; Российская медицинская академия непрерывного профессионального образования Минздрава РоссииРоссияFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Ministry of Education and Science of Russia; Russian Medical Academy of Continuous Professional Education, Ministry of Health of RussiaRussian FederationФедеральный научно-клинический центр реаниматологии и реабилитологии; Федеральный научный центр пищевых систем им. В. М. Горбатова РАНРоссияFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Ministry of Education and Science of Russia; V. M. Gorbatov Federal Research Center for Food Systems, RASRussian FederationФедеральный научный центр пищевых систем им. В. М. Горбатова РАНРоссияV. M. Gorbatov Federal Research Center for Food Systems, RASRussian Federation2025261220252163544Copyright © Черневская Е.А., Шестопалов А.Е., Яковлева А.В., Ядгаров М.Я., Берикашвили Л.Б., Поляков П.А., Сергеев И.В., Кузнецов И.В., Лисицын А.Б., Яковлев А.А., Лихванцев В.В., 20252025Черневская Е.А., Шестопалов А.Е., Яковлева А.В., Ядгаров М.Я., Берикашвили Л.Б., Поляков П.А., Сергеев И.В., Кузнецов И.В., Лисицын А.Б., Яковлев А.А., Лихванцев В.В.Chernevskaya E.A., Shestopalov A.E., Yakovleva A.V., Yadgarov M.Y., Berikashvili L.B., Polyakov P.A., Sergeev I.V., Kuznetsov I.V., Lisitsyn A.B., Yakovlev A.A., Likhvantsev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2654

Белково-энергетическая недостаточность (БЭН) остается одной из наиболее актуальных проблем у пациентов отделений реанимации и интенсивной терапии (ОРИТ) с тяжелой черепно-мозговой травмой, поскольку имеет высокую распространенность, трудно поддается коррекции и имеет не до конца изученные причины развития.Цель исследования: определить влияние нарушений микробиоценоза и моторной функции желудочно-кишечного тракта (ЖКТ) на формирование БЭН у пациентов в хроническом критическом состоянии с тяжелым повреждением головного мозга.Материалы и методы. В одноцентровое проспективное обсервационное исследование включили 31 пациента (медиана возраста — 52 года; мужчин — 68%) в возрасте 18–74 лет с черепно-мозговой травмой или инсультом, находившихся в ОРИТ более 5 суток и получавших зондовое энтеральное питание. Исключали пациентов с сахарным диабетом, острой полиорганной недостаточностью, шоком, имплантированными устройствами или трахеопищеводным свищом. Нутритивный статус оценивали в день включения в исследование и на 20-е сутки по российской шкале БЭН и критериям Global Leadership Initiative on Malnutrition (GLIM). В эти же сроки регистрировали клинические исходы, антропометрические показатели, биомаркеры ЖКТ, состав кишечной микробиоты и параметры электрогастроэнтерографии (ЭГЭГ), функциональных шкал.Результаты. БЭН средней и тяжелой степени по критериям GLIM выявили исходно у 29,1% пациентов и у 27,7% — на 20-е сутки (р = 0,9). По российской шкале эти показатели составили 61,3 и 78,6%, соответственно (р = 0,8). За период наблюдения клинически значимых изменений динамики показателей клинических шкал, функциональных показателей и биомаркеров ЖКТ не фиксировали. На обоих этапах наблюдения выявляли выраженные и стойкие отклонения состава микробиоты (снижение содержания E. coli, р = 0,026; увеличение — Enterobacter spp. р = 0,020), и параметров ЭГЭГ от референсных значений. Наличие БЭН ассоциировалось также с нарушениями моторики ЖКТ. Заключение. Полученные данные свидетельствуют о статистически значимой связи между БЭН, изменениями микробиоты кишечника и моторики ЖКТ, что подтверждает важную роль этих факторов в патогенезе БЭН у пациентов в хроническом критическом состоянии с тяжелым повреждением головного мозга.

Protein-energy malnutrition (PEM) remains one of the most pressing issues in patients with severe traumatic brain injury in intensive care units (ICUs), as it is highly prevalent, difficult to manage, and its causes are not fully understood.The aim of the study was to assess the influence of gut microbial imbalance and gastrointestinal motility on the development of malnutrition in patients in a chronic critical state and severe brain damage.Materials and methods. A single-center prospective observational study included 31 patients (median age 52 years; 68% males) aged 18–74 years with traumatic brain injury or stroke requiring ICU stay for more than 5 days and enteral tube feeding. Patients with diabetes mellitus, acute multiple organ failure (MOF), shock, implanted devices, or tracheoesophageal fistula were excluded. Nutritional status was assessed at baseline and on Day 20 using the Russian malnutrition scale and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Additionally, clinical outcomes, anthropometric data, gastrointestinal biomarkers, gut microbiota composition, electrogastroenterography (EGEG) and functional scales parameters were recorded.Results. Moderate and severe malnutrition according to the GLIM criteria was found at baseline in 29.1% of patients, and in 27.7% of patients on Day 20 (p = 0.9), while according to the Russian scale these numbers were 61.3% and 78.6%, respectively (p = 0.8). Dynamics of clinical scales, functional indicators, and gastrointestinal biomarkers during the follow-up revealed no clinically significant changes. Significant and persistent deviations 2 from reference values in gut microbiota composition (decrease in the content of E. coli, p = 0.026; increase in Enterobacter spp., p = 0.020) and EGEG parameters were recorded at both evaluation time-points. Identified PEM was also associated with impaired gastrointestinal motility.Conclusion. The data indicate a statistically significant relationship between PEM, changes in the gut microbiota and gastrointestinal motility, which confirms the important role of these factors in PEM pathogenesis in patients with severe brain damage in a chronic critical state.

белково-энергетическая недостаточностьОРИТмикробиотаэлектрогастрографияинсультчерепно-мозговая травмаprotein-energy malnutritionICUmicrobiotaelectrogastographystroketraumatic brain injuryИсследование выполнили при поддержке Министерства науки и высшего образования Российской Федерации (Соглашение № 075-15-2024-483).This work was supported by the Ministry of Science and Education of the Russian Federation (Grant Agreement 075-15-2024-483).ReferencesPolcz V. E., Barrios E. L., Larson S. D., Efron P. A., Rincon J. C. Charting the course for improved outcomes in chronic critical illness: therapeutic strategies for persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Br J Anaesth. 2024; 133 (2): 260–263. DOI: 10.1016/j.bja.2024.05.005. PMID: 38902117.Polcz V. E., Barrios E. L., Larson S. D., Efron P. A., Rincon J. C. Charting the course for improved outcomes in chronic critical illness: therapeutic strategies for persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Br J Anaesth. 2024; 133 (2): 260–263. DOI: 10.1016/j.bja.2024.05.005. PMID: 38902117.Morris R., Al Tannir A. H., Chipman J., Charles A., Ingraham N. E., Kalinoski M., Bolden L., et al. Deriving a definition of chronic critical illness: ICU stay of 10 days. Am J Surg. 2024; 237: 115767. DOI: 10.1016/j.amjsurg.2024.05.008.Morris R., Al Tannir A. H., Chipman J., Charles A., Ingraham N. E., Kalinoski M., Bolden L., et al. Deriving a definition of chronic critical illness: ICU stay of 10 days. Am J Surg. 2024; 237: 115767. DOI: 10.1016/j.amjsurg.2024.05.008.Berikashvili L. B., Shestopalov A. E., Polyakov P. A., Yakovleva A. V., Yadgarov M. Y., Kuznetsov I. V., Said M. T. S. M., et al. The Neurological metabolic phenotype in prolonged/chronic critical illness: propensity score matched analysis of nutrition and outcomes. Nutr. 2025; 17 (14). DOI: 10.3390/nu17142302.Berikashvili L. B., Shestopalov A. E., Polyakov P. A., Yakovleva A. V., Yadgarov M. Y., Kuznetsov I. V., Said M. T. S. M., et al. The Neurological metabolic phenotype in prolonged/chronic critical illness: propensity score matched analysis of nutrition and outcomes. Nutr. 2025; 17 (14). DOI: 10.3390/nu17142302.Ko S.-H., Shin Y.-I. Nutritional supplementation in stroke rehabilitation: a narrative review. Brain Neurorehabil. 2022; 15 (1): e3. DOI: 10.12786/bn.2022.15.e3. PMID: 36743847.Ko S.-H., Shin Y.-I. Nutritional supplementation in stroke rehabilitation: a narrative review. Brain Neurorehabil. 2022; 15 (1): e3. DOI: 10.12786/bn.2022.15.e3. PMID: 36743847.Shestopalov A. E., Yakovleva A. V., Yadgarov M. Y., Sergeev I. V., KuzovlevA.N. Prevalence and impact of malnutrition risk on outcomes in critically ill patients with traumatic brain injury and stroke: a retrospective cohort study using electronic health records. Nutrients. 2024; 16 (15): 2396. DOI: 10.3390/nu16152396. PMID: 39125277.Shestopalov A. E., Yakovleva A. V., Yadgarov M. Y., Sergeev I. V., KuzovlevA.N. Prevalence and impact of malnutrition risk on outcomes in critically ill patients with traumatic brain injury and stroke: a retrospective cohort study using electronic health records. Nutrients. 2024; 16 (15): 2396. DOI: 10.3390/nu16152396. PMID: 39125277.Powers J., Samaan K. Malnutrition in the ICU patient population. Crit Care Nurs Clin North Am. 2014; 26 (2): 227–242. DOI: 10.1016/j.ccell.2014.01.003. PMID: 24878208.Powers J., Samaan K. Malnutrition in the ICU patient population. Crit Care Nurs Clin North Am. 2014; 26 (2): 227–242. DOI: 10.1016/j.ccell.2014.01.003. PMID: 24878208.Oami T., Shimazui T., Yumoto T., Otani S., Hayashi Y., Coopersmith C. M. Gut integrity in intensive care: alterations in host permeability and the microbiome as potential therapeutic targets. J Intensive Care. 2025; 13 (1): 16. DOI: 10.1186/s40560-025-00786-y. PMID: 40098052.Oami T., Shimazui T., Yumoto T., Otani S., Hayashi Y., Coopersmith C. M. Gut integrity in intensive care: alterations in host permeability and the microbiome as potential therapeutic targets. J Intensive Care. 2025; 13 (1): 16. DOI: 10.1186/s40560-025-00786-y. PMID: 40098052.Jung C. Y., Bae J. M. Pathophysiology and protective approaches of gut injury in critical illness. Yeungnam Univ J Med. 2021; 38 (1): 27–33. DOI: 10.12701/yujm.2020.00703. PMID: 33022904.Jung C. Y., Bae J. M. Pathophysiology and protective approaches of gut injury in critical illness. Yeungnam Univ J Med. 2021; 38 (1): 27–33. DOI: 10.12701/yujm.2020.00703. PMID: 33022904.Сергеев И. В., Петрова М. В., Шестопалов А. Е., Канарский М. М., Лукьянец О. Б., Яроцкая И. А., Некрасова Ю. Ю. Нутритивный статус пациентов в длительном критическом состоянии. Общая реаниматология. 2023; 19 (4): 4–11. DOI: 10.15360/1813-9779-2023-4-2329.Sergeev I. V., Petrova M. V., Shestopalov A. E., Kanarsky M. M., Lukyanets O. B., Yarotskaya I. A., Nekrasova Y. Y. Nutritional status of patients with chronic critical illness. General Reanimatology = Obshchaya Reanimatologiya. 2023; 19 (4): 4–11. (in Russ.&Eng.). DOI: 10.15360/1813-9779-2023-4-2329.Ziaka M., Exadaktylos A. Pathophysiology of acute lung injury in patients with acute brain injury: the triple-hit hypothesis. Crit Care. 2024; 28 (1): 71. DOI: 10.1186/s13054-024-04855-w. PMID: 38454447.Ziaka M., Exadaktylos A. Pathophysiology of acute lung injury in patients with acute brain injury: the triple-hit hypothesis. Crit Care. 2024; 28 (1): 71. DOI: 10.1186/s13054-024-04855-w. PMID: 38454447.Wozniak H., Beckmann T. S., Fröhlich L., Soccorsi T., Le Terrier C., de Watteville A., Schrenzel J., et al. The central and biodynamic role of gut microbiota in critically ill patients. Crit Care. 2022; 26 (1): 250. DOI: 10.1186/s13054-022-04127-5. PMID: 35982499.Wozniak H., Beckmann T. S., Fröhlich L., Soccorsi T., Le Terrier C., de Watteville A., Schrenzel J., et al. The central and biodynamic role of gut microbiota in critically ill patients. Crit Care. 2022; 26 (1): 250. DOI: 10.1186/s13054-022-04127-5. PMID: 35982499.Chernevskaya E., Klimenko N., Pautova A., Buyakova I., Tyakht A., Beloborodova N. Host-microbiome interactions mediated by phenolic metabolites in chronically critically ill patients. Metabolites. 2021; 11 (2): 1–16. DOI: 10.3390/metabo11020122. PMID: 33672777.Chernevskaya E., Klimenko N., Pautova A., Buyakova I., Tyakht A., Beloborodova N. Host-microbiome interactions mediated by phenolic metabolites in chronically critically ill patients. Metabolites. 2021; 11 (2): 1–16. DOI: 10.3390/metabo11020122. PMID: 33672777.Tatucu-Babet O. A., Forsyth A., Udy A., Radcliffe J., Benheim D., Calkin C., Ridley E. J., et al. Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults: a pilot study. JPEN J Parenter Enter Nutr. 2022; 46 (2): 454–461. DOI: 10.1002/jpen.2110. PMID: 33760268.Tatucu-Babet O. A., Forsyth A., Udy A., Radcliffe J., Benheim D., Calkin C., Ridley E. J., et al. Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults: a pilot study. JPEN J Parenter Enter Nutr. 2022; 46 (2): 454–461. DOI: 10.1002/jpen.2110. PMID: 33760268.Pachisia A. V., Pal D., Govil D. Gastrointestinal dysmotility in the ICU. Curr Opin Crit Care. 2025; 31 (2): 179–88. DOI: 10.1097/MCC.0000000000001252. PMID: 39991794.Pachisia A. V., Pal D., Govil D. Gastrointestinal dysmotility in the ICU. Curr Opin Crit Care. 2025; 31 (2): 179–88. DOI: 10.1097/MCC.0000000000001252. PMID: 39991794.Camilleri M. Abnormal gastrointestinal motility is a major factor in explaining symptoms and a potential therapeutic target in patients with disorders of gut–brain interaction. Gut. 2023; 72 (12): 2372–2380. DOI: 10.1136/gutjnl-2023-330542. PMID: 37666657.Camilleri M. Abnormal gastrointestinal motility is a major factor in explaining symptoms and a potential therapeutic target in patients with disorders of gut–brain interaction. Gut. 2023; 72 (12): 2372–2380. DOI: 10.1136/gutjnl-2023-330542. PMID: 37666657.Wang Y., Chen J. D.Z., Nojkov B. Diagnostic methods for evaluation of gastric motility—a mini review. Diagnostics (Basel). 2023; 13 (4): 803. DOI: 10.3390/diagnostics13040803. PMID: 36832289.Wang Y., Chen J. D.Z., Nojkov B. Diagnostic methods for evaluation of gastric motility—a mini review. Diagnostics (Basel). 2023; 13 (4): 803. DOI: 10.3390/diagnostics13040803. PMID: 36832289.Matsuura Y., Yamamoto T., Takada M., Shiozawa T., Takada H. [Application of electrogastrography to public health]. Nihon Eiseigaku Zasshi. 2011; 66 (1): 54–63. DOI: 10.1265/jjh.66.54.Matsuura Y., Yamamoto T., Takada M., Shiozawa T., Takada H. [Application of electrogastrography to public health]. Nihon Eiseigaku Zasshi. 2011; 66 (1): 54–63. DOI: 10.1265/jjh.66.54.Elahmadawy M. A., El-Ayadi M., Ahmed S., Refaat A., Eltaoudy M. H., Maher E., Taha H., et al. F18-FET PET in pediatric brain tumors: integrative analysis of image derived parameters and clinico-pathological data. Q J Nucl Med Mol Imaging. 2023; 67 (1): 46–56. DOI: 10.23736/S1824-4785.20.03267-7. PMID: 33300749.Elahmadawy M. A., El-Ayadi M., Ahmed S., Refaat A., Eltaoudy M. H., Maher E., Taha H., et al. F18-FET PET in pediatric brain tumors: integrative analysis of image derived parameters and clinico-pathological data. Q J Nucl Med Mol Imaging. 2023; 67 (1): 46–56. DOI: 10.23736/S1824-4785.20.03267-7. PMID: 33300749.Yin J., Chen J. D. Z. Electrogastrography: methodology, validation and applications. J Neurogastroenterol Motil. 2013; 19 (1): 5–17. DOI: 10.5056/jnm.2013.19.1.5. PMID: 23350042.Yin J., Chen J. D. Z. Electrogastrography: methodology, validation and applications. J Neurogastroenterol Motil. 2013; 19 (1): 5–17. DOI: 10.5056/jnm.2013.19.1.5. PMID: 23350042.von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., Vandenbroucke J. P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007; 147 (8): 573–577. DOI: 10.7326/0003-4819-147-8-200710160-00010.von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., Vandenbroucke J. P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007; 147 (8): 573–577. DOI: 10.7326/0003-4819-147-8-200710160-00010.Chan A.-W., Tetzlaff J. M., Gøtzsche P. C., Altman D. G., Mann H., Berlin J. A., Dickersin K., et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013; 346: e7586. DOI: 10.1136/bmj.e7586.Chan A.-W., Tetzlaff J. M., Gøtzsche P. C., Altman D. G., Mann H., Berlin J. A., Dickersin K., et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013; 346: e7586. DOI: 10.1136/bmj.e7586.Likhvantsev V. V., Berikashvili L. B., Yadgarov M. Y., Yakovlev A. A., Kuzovlev A. N. The Tri-Steps Model of Critical Conditions in Intensive Care: Introducing a New Paradigm for Chronic Critical Illness. J Clin Med. 2024; 13 (13):. DOI: 10.3390/jcm13133683.Likhvantsev V. V., Berikashvili L. B., Yadgarov M. Y., Yakovlev A. A., Kuzovlev A. N. The Tri-Steps Model of Critical Conditions in Intensive Care: Introducing a New Paradigm for Chronic Critical Illness. J Clin Med. 2024; 13 (13):. DOI: 10.3390/jcm13133683.de van der Schueren M. A.E., Keller H., GLIM Consortium, Cederholm T., Barazzoni R., Compher C., Correia M. I.T .D., et al. Global Leadership Initiative on Malnutrition (GLIM): guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults. Clin Nutr. 2020; 39 (9): 2872–80. DOI: 10.1016/j.clnu.2019.12.022. PMID: 32563597.de van der Schueren M. A.E., Keller H., GLIM Consortium, Cederholm T., Barazzoni R., Compher C., Correia M. I.T .D., et al. Global Leadership Initiative on Malnutrition (GLIM): guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults. Clin Nutr. 2020; 39 (9): 2872–80. DOI: 10.1016/j.clnu.2019.12.022. PMID: 32563597.Shirakabe A., Hata N., Kobayashi N., Okazaki H., Matsushita M., Shibata Y., Nishigoori S., et al. The prognostic impact of malnutrition in patients with severely decompensated acute heart failure, as assessed using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Heart Vessels. 2018; 33 (2): 134–144. DOI: 10.1007/s00380-017-1034-z. PMID: 28803356.Shirakabe A., Hata N., Kobayashi N., Okazaki H., Matsushita M., Shibata Y., Nishigoori S., et al. The prognostic impact of malnutrition in patients with severely decompensated acute heart failure, as assessed using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Heart Vessels. 2018; 33 (2): 134–144. DOI: 10.1007/s00380-017-1034-z. PMID: 28803356.Бутов М. А., Шурпо Е. М., Кузнецов П. С., Джуржевич М. Д. Нормативные показатели периферической электрогастроэнтероколографии. Терапевтический архив. 2015; 2: 45–48. DOI: 10.17116/terarkh201587245-48. PMID: 25864348.Butov M. A., Shurpo E. M., Kuznetsov P. S., Dzhurzhevich M. D. Normative values for peripheral electrical gastroenterocolonography. Ter Arkh. 2015; 87 (2): 45–8. (in Russ.). DOI: 10.17116/terarkh201587245-48. PMID: 25864348.Di Vincenzo O., Luisi M. L.E., Alicante P., Ballarin G., Biffi B., Gheri C. F., Scalfi L. The assessment of the risk of malnutrition (undernutrition) in stroke patients. Nutrients. 2023; 15 (3). DOI: 10.3390/nu15030683. PMID: 36771390.Di Vincenzo O., Luisi M. L.E., Alicante P., Ballarin G., Biffi B., Gheri C. F., Scalfi L. The assessment of the risk of malnutrition (undernutrition) in stroke patients. Nutrients. 2023; 15 (3). DOI: 10.3390/nu15030683. PMID: 36771390.Verheul E. A. H., Koole D., Dijkink S., Krijnen P., Hoogendoorn J. M., Arbous S., Peters R., et al. Association of modified NUTRIC score for nutritional risk and in-hospital developed malnutrition in adults with severe injuries: a prospective observational cohort study. Eur J Trauma Emerg Surg. 2025; 51 (1): 214. DOI: 10.1007/s00068-025-02887-7. PMID: 40394257.Verheul E. A. H., Koole D., Dijkink S., Krijnen P., Hoogendoorn J. M., Arbous S., Peters R., et al. Association of modified NUTRIC score for nutritional risk and in-hospital developed malnutrition in adults with severe injuries: a prospective observational cohort study. Eur J Trauma Emerg Surg. 2025; 51 (1): 214. DOI: 10.1007/s00068-025-02887-7. PMID: 40394257.Liu P., Tian H., Ji T., Zhong T., Gao L., Chen L. Predictive value of malnutrition, identified via different nutritional screening or assessment tools, for functional outcomes in patients with stroke: a systematic review and meta-analysis. Nutrients. 2023; 15 (14): 3280. DOI: 10.3390/nu15143280. PMID: 37513698.Liu P., Tian H., Ji T., Zhong T., Gao L., Chen L. Predictive value of malnutrition, identified via different nutritional screening or assessment tools, for functional outcomes in patients with stroke: a systematic review and meta-analysis. Nutrients. 2023; 15 (14): 3280. DOI: 10.3390/nu15143280. PMID: 37513698.Wei Y-.C., Chen C-.K., Lin C., Shyu Y.-C., Chen P.-Y. Life after traumatic brain injury: effects on the lifestyle and quality of life of community-dwelling patients. Neurotrauma Rep. 2024; 5 (1): 159–171. DOI: 10.1089/neur.2023.0113. PMID: 38463415.Wei Y-.C., Chen C-.K., Lin C., Shyu Y.-C., Chen P.-Y. Life after traumatic brain injury: effects on the lifestyle and quality of life of community-dwelling patients. Neurotrauma Rep. 2024; 5 (1): 159–171. DOI: 10.1089/neur.2023.0113. PMID: 38463415.Ma E. L., Smith A. D., Desai N., Cheung L., Hanscom M., Stoica B. A., Loane D. J., et al. Bidirectional brain-gut interactions and chronic pathological changes after traumatic brain injury in mice. Brain Behav Immun. 2017; 66: 56–69. DOI: 10.1016/j.bbi.2017.06.018. PMID: 28676351.Ma E. L., Smith A. D., Desai N., Cheung L., Hanscom M., Stoica B. A., Loane D. J., et al. Bidirectional brain-gut interactions and chronic pathological changes after traumatic brain injury in mice. Brain Behav Immun. 2017; 66: 56–69. DOI: 10.1016/j.bbi.2017.06.018. PMID: 28676351.Klaus D. A., Motal M. C., Burger-Klepp U., Marschalek C., Schmidt E. M., Lebherz-Eichinger D., Krenn C. G., et al. Increased plasma zonulin in patients with sepsis. Biochem Medica (Zagreb). 2013; 23 (1): 107–11. DOI: 10.11613/bm.2013.013.PMID: 23457771.Klaus D. A., Motal M. C., Burger-Klepp U., Marschalek C., Schmidt E. M., Lebherz-Eichinger D., Krenn C. G., et al. Increased plasma zonulin in patients with sepsis. Biochem Medica (Zagreb). 2013; 23 (1): 107–11. DOI: 10.11613/bm.2013.013.PMID: 23457771.Greis C., Rasuly Z., Janosi R. A., Kordelas L., Beelen D. W., Liebregts T. Intestinal T lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill: a prospective observational study. Crit Care. 2017; 21 (1): 70. DOI: 10.1186/s13054-017-1654-9. PMID: 28327177.Greis C., Rasuly Z., Janosi R. A., Kordelas L., Beelen D. W., Liebregts T. Intestinal T lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill: a prospective observational study. Crit Care. 2017; 21 (1): 70. DOI: 10.1186/s13054-017-1654-9. PMID: 28327177.Martinez E. E., Zurakowski D., Pereira L., Freire R., Emans J. B., Nurko S., Duggan C. P., et al. Interleukin-10 and zonulin are associated with postoperative delayed gastric emptying in critically ill surgical pediatric patients: a prospective pilot study. JPEN J Parenter Enteral Nutr. 2020; 44 (8): 1407–16. DOI: 10.1002/jpen.1874. PMID: 32386238.Martinez E. E., Zurakowski D., Pereira L., Freire R., Emans J. B., Nurko S., Duggan C. P., et al. Interleukin-10 and zonulin are associated with postoperative delayed gastric emptying in critically ill surgical pediatric patients: a prospective pilot study. JPEN J Parenter Enteral Nutr. 2020; 44 (8): 1407–16. DOI: 10.1002/jpen.1874. PMID: 32386238.Potrykus M., Czaja-Stolc S., Stankiewicz M., Kaska Ł., Małgorzewicz S. Intestinal microbiota as a contributor to chronic inflammation and its potential modifications. Nutrients. 2021; 13 (11): 3839. DOI: 10.3390/nu13113839. PMID: 34836095.Potrykus M., Czaja-Stolc S., Stankiewicz M., Kaska Ł., Małgorzewicz S. Intestinal microbiota as a contributor to chronic inflammation and its potential modifications. Nutrients. 2021; 13 (11): 3839. DOI: 10.3390/nu13113839. PMID: 34836095.Shimizu K., Ogura H., Asahara T., Nomoto K., Morotomi M., Nakahori Y., Osuka A., et al. Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome: a preliminary study. Neurogastroenterol Motil. 2011; 23 (4): 330–5, e157. DOI: 10.1111/j.1365-2982.2010.01653.x. PMID: 21199173.Shimizu K., Ogura H., Asahara T., Nomoto K., Morotomi M., Nakahori Y., Osuka A., et al. Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome: a preliminary study. Neurogastroenterol Motil. 2011; 23 (4): 330–5, e157. DOI: 10.1111/j.1365-2982.2010.01653.x. PMID: 21199173.Schmidt S. B., Kulig W., Winter R., Vasold A. S., Knoll A. E., Rollnik J. D. The effect of a natural food based tube feeding in minimizing diarrhea in critically ill neurological patients. Clin Nutr. 2019; 38 (1): 332–340. DOI: 10.1016/j.clnu.2018.01.007. PMID: 29358002.Schmidt S. B., Kulig W., Winter R., Vasold A. S., Knoll A. E., Rollnik J. D. The effect of a natural food based tube feeding in minimizing diarrhea in critically ill neurological patients. Clin Nutr. 2019; 38 (1): 332–340. DOI: 10.1016/j.clnu.2018.01.007. PMID: 29358002.Ghaemi M., Kheradmand D. The gut-brain axis in traumatic brain Injury: literature review. J Clin Neurosci. 2025; 136: 111258. DOI: 10.1016/j.jocn.2025.111258. PMID: 40250160.Ghaemi M., Kheradmand D. The gut-brain axis in traumatic brain Injury: literature review. J Clin Neurosci. 2025; 136: 111258. DOI: 10.1016/j.jocn.2025.111258. PMID: 40250160.Cotoia A., Charitos I. A., Corriero A., Tamburrano S., Cinnella G. The role of macronutrients and gut microbiota in neuroinflammation post-traumatic brain injury: a narrative review. Nutr. 2024; 16 (24): 4359. DOI: 10.3390/nu16244359. PMID: 39770985.Cotoia A., Charitos I. A., Corriero A., Tamburrano S., Cinnella G. The role of macronutrients and gut microbiota in neuroinflammation post-traumatic brain injury: a narrative review. Nutr. 2024; 16 (24): 4359. DOI: 10.3390/nu16244359. PMID: 39770985.Chiu L. S., Anderton R. S. The role of the microbiota–gut–brain axis in long-term neurodegenerative processes following traumatic brain injury. Eur J Neurosci. 2023; 57 (2): 400–18. DOI: 10.1111/ejn.15892. PMID: 36494087.Chiu L. S., Anderton R. S. The role of the microbiota–gut–brain axis in long-term neurodegenerative processes following traumatic brain injury. Eur J Neurosci. 2023; 57 (2): 400–18. DOI: 10.1111/ejn.15892. PMID: 36494087.Tripathi A., Pandey V. K., Panesar P. S., Taufeeq A., Mishra H., Rustagi S., Malik S., et al. Fermentative production of vitamin B12 by Propionibacterium shermanii and Pseudomonas denitrificans and its promising health benefits: a review. Food Sci Nutr. 2024; 12 (11): 8675–91. DOI: 10.1002/fsn3.4428. PMID: 39619983.Tripathi A., Pandey V. K., Panesar P. S., Taufeeq A., Mishra H., Rustagi S., Malik S., et al. Fermentative production of vitamin B12 by Propionibacterium shermanii and Pseudomonas denitrificans and its promising health benefits: a review. Food Sci Nutr. 2024; 12 (11): 8675–91. DOI: 10.1002/fsn3.4428. PMID: 39619983.Procházková N., Falony G., Dragsted L. O., Licht T. R., Raes J., Roager H. M. Advancing human gut microbiota research by considering gut transit time. Gut. 2023; 72 (1): 180–91. DOI: 10.1136/gutjnl-2022-328166. PMID: 36171079.Procházková N., Falony G., Dragsted L. O., Licht T. R., Raes J., Roager H. M. Advancing human gut microbiota research by considering gut transit time. Gut. 2023; 72 (1): 180–91. DOI: 10.1136/gutjnl-2022-328166. PMID: 36171079.Waclawiková B., Codutti A., Alim K., El Aidy S. Gut microbiotamotility interregulation: insights from in vivo, ex vivo and in silico studies. Gut Microbes. 2022; 14 (1): 1997296. DOI: 10.1080/19490976.2021.1997296. PMID: 34978524.Waclawiková B., Codutti A., Alim K., El Aidy S. Gut microbiotamotility interregulation: insights from in vivo, ex vivo and in silico studies. Gut Microbes. 2022; 14 (1): 1997296. DOI: 10.1080/19490976.2021.1997296. PMID: 34978524.

The authors declare that there are no conflicts of interest present.