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The importance of proper nutrition when playing sports is difficult to overestimate. Athletes of any age need to consume a sufficient amount of macro- and micronutrients for bone health. High-quality and balanced nutrition in terms of quantity and composition is important for optimal recovery after training, adaptation to intense physical activity and prevention of sports injuries. The aim of the study was to summarize the current data of domestic and foreign literature on the factors affecting bone mineral density (BMD) in athletes, as well as to consider the key points of nutritional support necessary for the prevention and treatment of osteoporosis. Material and methods. The search was conducted using the Google Academy search engine and electronic databases PubMed, MEDLINE, EMBASE, Scopus, Web of Science, eLIBRARY for the period from 2008 to 2022. For the search, we used keywords and their combinations: "athletes", "osteoporosis", "stress fractures", "calcium" and "vitamin D". Results and discussion. Bone health is influenced by many factors, the most significant of which are lifestyle and the nature of a person's physical activity. Despite strong evidence for the benefits of exercise for bone health, there are sports that predispose to low BMD and increase the risk of osteoporosis. First of all, athletes involved in aerobic and aesthetic disciplines (long-distance running, cycling, swimming, rhythmic gymnastics, dancing, etc.) are at risk. In addition, factors that predispose to a decrease in BMD include female gender, low intake of energy substrates, protein, vitamin D and calcium, and certain medications. Of great importance for the regulation of bone metabolism and maintaining optimal BMD are the genetic characteristics of the athlete. The main adverse consequences for athletes with reduced BMD are fractures of various localization. At the same time, the problem of a high risk of developing stress injuries of bones is especially relevant. Calcium and vitamin D are key nutritional factors needed to maintain bone health. Optimal intake of carbohydrates, proteins, and polyunsaturated fatty acids is also important. There is evidence of a positive effect on the skeletal system of such nutritional factors as potassium, magnesium, sodium, vitamins K, C, B12 and folic acid. The specific mechanisms of the influence of these micronutrients on bone metabolism and the relationship of their consumption level with BMD need further research. Conclusion. Thus, athletes of all ages and specializations need to pay great attention to the state of the skeletal system. Given the association between the risk of osteoporosis and malnutrition, it is essential for athletes to maintain an optimal nutritional status and consume adequate amounts of vitamins and minerals.

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In recent years, close attention has been paid to energy deficiency in professional athletes. More and more studies confirm the widespread prevalence of relative energy deficiency syndrome in sports and its relationship with various pathological conditions that lead to a decrease in the level of athletic performance. Nowadays the possibilities of early diagnosis and treatment of this syndrome are being carefully studied, and clinical protocols are being actively developed to facilitate the early detection of energy deficiency. The aim of the study was to summarize the modern data on the influence of the syndrome of relative energy deficiency in sports on the health and performance of athletes, as well as to consider effective methods for the diagnosis, treatment and prevention of this syndrome. Material and methods. The search was carried out using the Google Academy engine and electronic databases PubMed, MEDLINE, EMBASE, Scopus, Web of Science, eLIBRARY for the period from 2017 to 2021. For the search, we used keywords and their combinations: "relative energy deficit in sports", "female athlete triad", "menstrual dysfunction", "osteoporosis". Results. Based on our analysis, we can conclude that the syndrome of relative energy deficit in sports has a multicomponent negative effect on the athlete's organism and negatively affects his performance, well-being and sports results. Diagnosis of this condition is challenging due to the nonspecificity and variety of symptoms. Key diagnostic methods include physical examination, anamnesis gaining, dual energy X-ray absorptiometry, bioimpedance body composition analysis, and hormonal profile studies. Additional methods include: electrocardiography, study of the basal metabolic rate, hematological examination (hemoglobin, ferritin, etc.), determining the level of energy consumption using diaries of food and physical activity, determining blood vitamin level, etc. To facilitate the screening, diagnosis and follow-up of athletes, it is possible to use specially developed clinical protocols. Non-drug nutritional correction and optimal training plan are the main methods of treatment and prevention of energy deficiency. If this type of treatment is ineffective, hormone therapy should be considered. It is recommended to use transdermal estrogen therapy in combination with shortterm progestin therapy. In some cases, when very low bone mineral density or delayed fracture consolidation is detected, it is possible to use recombinant parathyroid hormone. Conclusion. Due to the relatively high prevalence of relative energy deficiency syndrome in athletes of both sexes and its long-term negative impact on athlete health and performance, further research is needed to improve the effectiveness of early diagnosis, prevention and treatment of pathological conditions associated with malnutrition.

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Progressive weight loss is a frequent companion to somatic pathology. The risk of death is known to increase dramatically among those with a body mass index of less than 19 kg/m2. Even mild weight loss in the presence of severe diseases can have a substantial impact on the course of the disease. The paper presents current views on malnutrition, its prevalence in the presence of various somatic diseases, and clinical significance. It describes the basic pathogenetic components of weight loss and the possible ways of correcting nutritional status. Particular emphasis is placed on the methods of nutritional support that is currently regarded as one of the most important components of a comprehensive approach to treating patients with chronic diseases. The authors give recommendations for the assessment of the nutritional status of patients in clinical practice and algorithms for their malnutrition management.

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The purpose of this investigation was to evaluate the effect of highly mineralized drinking water on children's health. To reveal a relationship of children's health to the chemical composition of portable water, two Kazan districts differing in the conditions of water supply and the mineral composition of the water were selected. A total of 833 schoolchildren aged 7-9 years underwent a questionnaire survey and their objective status was examined. Special methods were used to determine the urinary content of trace elements, such as copper, zinc, cadmium, and gross elements, such as calcium and magnesium, by performing atomic absorption spectrophotometry on an AAS-SA 10 MP apparatus.

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The study was undertaken to evaluate the effect of highly mineralized drinking water on the health status of children. Two Kazan districts that greatly differed in the conditions of water supply and in the mineral composition of water were chosen to define a relationship of the health indices in children to the chemical composition of water. Eight hundred and thirty three schoolchildren aged 7-9 years were interviewed by a questionnaire and examined for their objective status. The urinary levels of trace elements, such as copper, zinc, cadmium, and gross elements, such as calcium, magnesium, were measured by atomic absorption spectrophotometry on an AAS-SA 10 MP device.

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AIM: To study morphological alterations in small intestinal wall in patients with chronic cardiac failure (CCF) of various severity and their relations with functional condition of the small intestine. MATERIAL AND METHODS: 63 patients (mean age 58.7 years) entered an open cohort study. By CCF and body mass index (BMI) the patients were divided into 4 groups. Estimation of ejection fraction (EF), BMI and lean body mass (LBM) was made in all the patients as well as functional intestinal activity was assessed by fat excretion and fecal protein. Small intestinal biopsies were made endoscopically for collagen quantitation. RESULTS: A rise in collagen content in the small intestine correlated with severity of CCF. In patients free of CCF relative area of collagen averaged 12.8%, in CCF FC I-II--16.5%, in CCF FC III-IV with cachexia--32.4%. Greater fibrosis of the small intestine corresponded to greater malabsorption. A 3-fold increase in collagen area led to a 2-3-fold growth in protein and fat loss with feces. In CCF, LBM was subnormal while body mass reduction correlated with relative collagen area. CONCLUSION: Morphofunctional changes of the small intestine developing in parallel with CCF severity lead to a significant loss in basic nutrients, regression of LBM and development of protein-energy insufficiency in patients with CCF.

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AIM: To elucidate efficacy of enteral feeding and the role of small intestine in pathogenesis of cardiac cachexia in patients with heart failure and reduced body mass. MATERIAL: Patients with NYHA class III-IV chronic heart failure and deficient body mass (n=34). Control group comprised 32 patients. METHODS: In intervention group standard therapy was supplemented for 24 weeks with balanced nutritional mixture constituting 25% of daily energy requirements. Efficacy of treatment was assessed by 6 minute walk test, evaluation of lean body mass. Studies of intestinal functional activity and biopsies of small intestinal mucosa with morphometrical analysis of bioptates were also performed. RESULTS: Results of 6-minute walk test improved in intervention and control groups by 46.8 and 10.3%, respectively. Average lean body mass increased in intervention group (by 6.7%) and decreased in controls (by 4.9%, p=0.03). Morphometrical study of bioptates revealed augmentation of relative collagen area up to 35-37% (normal value - 10-15%) and pronounced villus atrophy.

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