Strategies for minimizing bedrest in colorectal cancer patients: Exercising to ERAS

Schram, Alexandra; Carli, Francesco; Ferreira, Vanessa; Scheede‐Bergdahl, Celena

doi:10.1016/j.clnesp.2017.04.077

Cited by 1 publication

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“…However, in metabolic stress situations, cells develop insulin resistance based on stress, which continues for up to three weeks even after uncomplicated, moderate surgery. Likewise, common perioperative experiences like nothing per mouth (NPO) status, pain, and bed rest can also contribute to a reduced sensitivity to insulin as well [3][4][5]. In situations such as starvation, the drop of glucose level will cause a reduction in insulin levels and result in a condition known as glucose repression [6].…”

Section: Introductionmentioning

confidence: 99%

"Oral Nutrition Supplements in Enhanced Recovery After Surgery (ERAS): The Pandora’s Box for Prehabilitation Practice"

Fathi

2021

BJSTR

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Background: Malnutrition is present in 25 to 54% of hospitalized patients upon admission and it has a direct association with increased morbidity, mortality, length of stay (LOS), increased readmissions, and cost of care. The high level of insulin will block the lipolysis and the usage of FAs as the primary fuel (insulin inhibits ketogenesis). Therefore, the body will shift towards gluconeogenesis and use amino acids as the main fuel. This process will lead to protein and skeletal muscle wasting and increase the risk of malnutrition and other postoperative complications. Prehabilitation includes the process of improving the patient's overall condition before surgery to keep a higher level of the patient's functional body capacity during surgery and also inhibit postoperative consequences including complications caused by metabolic stress. One of the best practical methods of prehabilitation is the Enhanced Recovery After Surgery (ERAS) protocol. ERAS is a multi-professional model to educate patients and improve their physical and nutritional status prior to surgery. The ERAS protocol mainly targets the inflammatory responses and hormonal changes during metabolic stress. This can alter the metabolism leading to suppression of protein-sparing resulting in a decrease in protein wasting. The ERAS program was initially started at CRMC as a pilot quality improvement project in 2017. Furthermore, there is no standardized protocol for ERAS, especially on Oral Nutrition Supplementation (ONS). To date, there is sufficient data to support the benefits of oral nutrition supplementation for patients undergoing metabolic stress. Nonetheless, there is not enough evidence regarding the effectiveness of any specific product over others for improving the patients' nutritional status prior to surgery and the patients' overall survival and complications post surgery. Materials and Methods:In this review paper we sought to compare some of the most common nutritional supplements and their ingredients used for ERAS programs in the United States by focusing on the cell signaling effect they may have on metabolism, protein sparing, some elective amino acids, insulin resistance, and glycemic index. Results:The main results revealed that an optimal oral nutrition supplementation should provide an opportunity to trigger the cell signaling pathways that would increase the transcriptional level of endogenous protein synthase while other ingredients would provide further benefits. Conclusion:Despite several review articles and clinical trials and clinical outcome measurements, there is very limited metabolic research on prehabilitation biochemical mechanisms and cell signaling responses pathways. There is an absolute need for mechanistic studies that will help to select the most appropriate formulas.

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Section: Introductionmentioning

confidence: 99%

"Oral Nutrition Supplements in Enhanced Recovery After Surgery (ERAS): The Pandora’s Box for Prehabilitation Practice"

Fathi

2021

BJSTR

View full text Add to dashboard Cite

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Strategies for minimizing bedrest in colorectal cancer patients: Exercising to ERAS

Cited by 1 publication

References 0 publications

"Oral Nutrition Supplements in Enhanced Recovery After Surgery (ERAS): The Pandora’s Box for Prehabilitation Practice"

"Oral Nutrition Supplements in Enhanced Recovery After Surgery (ERAS): The Pandora’s Box for Prehabilitation Practice"

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