Nutritional Orthopedics and Space Nutrition as Two Sides of the Same Coin: A Scoping Review

Abstract

Since the Moon landing, nutritional research has been charged with the task of guaranteeing human health in space. In addition, nutrition applied to Orthopedics has developed in recent years, driven by the need to improve the efficiency of the treatment path by enhancing the recovery after surgery. As a result, nutritional sciences have specialized into two distinct fields of research: Nutritional Orthopedics and Space Nutrition. The former primarily deals with the nutritional requirements of old patients in hospitals, whereas the latter focuses on the varied food challenges of space travelers heading to deep space. Although they may seem disconnected, they both investigate similar nutritional issues. This scoping review shows what these two disciplines have in common, highlighting the mutual features between (1) pre-operative vs. pre-launch nutritional programs, (2) hospital-based vs. space station nutritional issues, and (3) post-discharge vs. deep space nutritional resilience. PubMed and Google Scholar were used to collect documents published from 1950 to 2020, from which 44 references were selected on Nutritional Orthopedics and 44 on Space Nutrition. Both the orthopedic patient and the astronaut were found to suffer from food insecurity, malnutrition, musculoskeletal involution, flavor/pleasure issues, fluid shifts, metabolic stresses, and isolation/confinement. Both fields of research aid the planning of demand-driven food systems and advanced nutritional approaches, like tailored diets with nutrients of interest (e.g., vitamin D and calcium). The nutritional features of orthopedic patients on Earth and of astronauts in space are undeniably related. Consequently, it is important to initiate close collaborations between orthopedic nutritionists and space experts, with the musculoskeletal-related dedications playing as common fuel.

Keywords: age-related bone losses; aging prematurely; altered; bones and bone tissue; dietary supplement; gravity; healthy eating; musculoskeletal physiological phenomena; nutritional physiological phenomena; sarcopenia; space travel.

Figure A1

The final online search strategy for PubMed.

Figure A2

Selection process of sources of evidence on Nutritional Orthopedics and Space Nutrition.

Figure A3

Key aspects of human nutrition in orthopedic patients. The perioperative nutritional support program for patients undergoing major orthopedic surgery comprises three phases. (I) First, the optimization of the nutritional status should indicate recommendations on healthy eating, tailored diets, and dietary supplements for nutrient deficits through a structured behavioral program. (II) Second, early oral feeding should be promoted to avoid fasting and to boost recovery. Hospital diets may be integrated according to the patient’s requirements, with services of food and beverages to patients following a model redesign to facilitate engagement and improve satisfaction. Case-specific prevention of food waste should be applied by promoting interaction in the order process and meal sharing. (III) Third, the variety of nutritional issues after discharge include not only high-risk pre-existing illnesses like frailty but also newly occurring conditions from hospital-associated deconditioning, like sarcopenia from immobility. Since the hospital could easily be considered a hostile Environment that affects the Health of patients and limits the Husbandry factor, it is necessary to reach a balance by acting on the central components of the nutritional paradigm, where Food really plays a central role.

Figure A4

Key aspects of human nutrition during space travel. The nutritional program aiming at supporting all the individual’s activities related to space travel should cover three main aspects. (I) First, the individual’s nutritional status should be optimized before launch. Environmental conditions, especially terrestrial gravity, are able to maximize psycho- and physiological interventions. (II) Second, an autonomous food system should be settled on space or planetary stations. Advanced plantations following the principles of eco-sustainability and precision nutrition might cohabit with farms of animals with a high feed conversion efficiency, such as insects. (III) Third, Space Nutrition research should focus on issues of venturing into deep space. During the prolonged absence of the gravitational system, the human body is subjected to various senile-like conditions, which are not necessarily caused by dietary factors, but that can be defied or at least delayed by integrated approaches comprising tailored nutrition. The nutritional paradigm initiated on Earth, where human beings have found a way to make the most of it, will undergo a drastic revolution when the Environment factor is the deep space. Since human Health is assumed to be constant, environmental deviations must be balanced with novel Husbandry systems and Foods.