Prevention and treatment of acute secondary sarcopenia in patients with infected necrotizing pancreatitis. Literature review

Abstract

This review of the current scientific literature focuses on the etiological factors, pathophysiological mechanisms, diagnostic approaches, and methods of prevention and treatment of acute secondary sarcopenia in patients with acute necrotizing pancreatitis. Acute secondary sarcopenia represents a severe complication of acute pancreatitis, resulting from a combination of systemic inflammation, physical inactivity, and nutritional deficiency. Scientific evidence indicates that sarcopenia and sarcopenic obesity are associated with higher mortality, an increased incidence of complications in acute pancreatitis, and longer hospital stays. According to the literature, the prevalence of secondary sarcopenia among patients with acute pancreatitis ranges from 18 % to 70 – 80 %, with variability in these indicators attributed to differences in diagnostic approaches, assessment criteria, and clinical characteristics of the patient cohorts studied. Contemporary studies have explored various approaches to diagnosing this condition, emphasizing the importance of early detection of secondary sarcopenia through functional tests, imaging, and instrumental diagnostic methods. It has been demonstrated that the prevention and treatment model for secondary sarcopenia requires a multidisciplinary team approach and includes effective anti-inflammatory therapy, optimization of nutritional support (early enteral nutrition with adequate protein and energy provision and correction of micronutrient deficiencies), the use of nutrients with anti-catabolic and anti-inflammatory properties (omega-3 polyunsaturated fatty acids, b-hydroxy-b-methylbutyrate, creatine), as well as early mobilization according to an individualized physiotherapy program. Clinical observations have confirmed that such interventions are associated with improved preservation and restoration of muscle mass and functional status, which directly influence survival rates, hospital stay duration, risk of complications, and disability. In summary, the review of international publications enabled the synthesis of current evidence on the diagnosis, prevention, and treatment of secondary sarcopenia in patients with acute necrotizing pancreatitis. The limited number of studies addressing this issue in the context of complicated acute pancreatitis underscores the relevance and necessity of further research aimed at refining and identifying optimal preventive and therapeutic strategies in this patient population.