Unresolved issues in perioperative nutrition: A narrative review

Ford, Katherine L.; Prado, Carla M.; Weimann, Arved; Schüetz, Philipp; Lobo, Dileep N.

doi:10.1016/j.clnu.2022.05.015

Cited by 14 publications

(10 citation statements)

References 119 publications

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“…Preoperative nutrition status is especially important, as it represents the patient's baseline health status before the trauma introduced by surgical stress 1 . The homeostatic state responsible for maintaining body composition is disrupted by the metabolic response to surgery, which causes breakdown of fat and glycogen stores 13,18 .…”

Section: Surgical Stress Provokes Catabolism Which Influences Postope...mentioning

confidence: 99%

“…body composition, frailty, GLIM, imaging, malnutrition, muscle mass, nutritional assessment, nutritional risk, nutritional screening, perioperative nutrition, sarcopenia, surgery Preoperative nutrition status can be optimized and is a modifiable risk factor for surgical outcomes. 1 The impact of malnutrition on adverse surgical outcomes has been repeatedly demonstrated, yet screening for the presence or risk of malnutrition in this context is not integrated into all surgical pathways. 2 Furthermore, few at-risk patients receive nutrition therapy preoperatively.…”

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confidence: 99%

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Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado

Ford

Gonzalez

et al. 2022

J Parenter Enteral Nutr

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Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long‐term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care.

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Section: Surgical Stress Provokes Catabolism Which Influences Postope...mentioning

confidence: 99%

mentioning

confidence: 99%

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado

Ford

Gonzalez

et al. 2022

J Parenter Enteral Nutr

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“…Malnutrition as a modifiable risk factor should be treated carefully not only in the early stage of disease but also in the early and late postoperative periods. Cumulative effects may be expected from small gains [4].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Nutrition Management: Who Needs What?

Wobith¹,

Weimann²

2022

Visc Med

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Background: Early oral feeding after major abdominal surgery has been clearly shown to be safe and not a risk factor for anastomotic dehiscence. Within the Enhanced Recovery after Surgery protocol, it is the nutritional plan A. Nonetheless, one must consider that postoperative protein and energy requirements will often be not covered by oral food intake alone. Because nutritional status has been shown to be a prognostic factor in patients undergoing major abdominal surgery, the preoperative identification of patients at risk may be mandatory. Malnutrition may be underestimated in an overweight society. With special regard to patients with cancer and those with preexisting malnutrition, an accumulating caloric gap may be harmful in the early and late postoperative periods. Furthermore, complications requiring reoperation and intensive care treatment may occur. Summary: Therefore, a plan B for postoperative nutrition therapy is needed, using preferentially the enteral route. The European Society for Clinical Nutrition and Metabolism recently addressed perioperative nutritional management and the indications for enteral and even parenteral supplementation to achieve caloric requirements in the postoperative course. In the first months after surgery, persisting weight loss is common in patients with upper gastrointestinal resections, even in those with an uncomplicated course. This may delay the initiation of adjuvant chemotherapy, increase toxicity, and worsen long-term outcomes.

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Section: Introductionunclassified

“…Assim, uma série de intervenções nutricionais tem sido propostas para evitar catabolismo muscular e promover o anabolismo e melhora da sensibilidade à insulina (Ford et al, 2022). Dentre as diversas intervenções perioperatórias, os protocolos do projeto Enhanced Recovery AfterSurgery (ERAS) tem se destacado como terapia padrão (Ford et al, 2022). Este protocolo inclui uma série de abordagens, entre elas a nutrição pré-operatória na forma de soluções de carboidratos, que quando combinadas apresentam uma redução nos dias de internação e em complicações em geral (Hammond et al, 2020;Varadhan et al, 2010).…”

Section: Introductionunclassified

Efeito de soluções de carboidratos (pré carga) sobre resistência insulínica e morbidade perioperatória

Oliveira

Oliveira²

2022

RSD

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Introdução: A administração de solução de carboidratos tem ganhado destaque nos últimos anos como parte de protocolos de abreviação de jejum e de aprimoramento no cuidado e recuperação do paciente. Nesse contexto, o protocolo ERAS (Enhanced Recovery after Surgert) tem ganhado destaque como um dos processos em que a pré carga de carboidratos é utilizada como parte da abordagem para melhor desfecho perioperatório. Objetivos: Revisar e discutir dados sobre os efeitos de soluções de carboidratos em parâmetros ligados ao metabolismo de macronutrientes. Ainda, foram analisados desfechos metabólicos específicos como resistência insulínica, níveis de adipocitocinas e parâmetros de qualidade, como: tempo de internação e complicações pós-operatórias. Métodos: Foi desenvolvida uma revisão da literatura a partir dos seguintes descritores: Oral carbohydrate, Carbohydrate loading, Preoperative. As variáveis analisadas foram sensibilidade à insulina, níveis de adipocitocinas, glicemia, insulina, níveis de corpos cetônicos e ácidos graxos livres, além de desfechos pós operatórios, como tempo de internação, consumo de opióides, náuseas e vômitos e infecção de ferida operatória. Resultados: A busca resultou em nove trabalhos para a composição dos resultados, uma meta-análise e oito ensaios clínicos randomizados. Evidências cada vez mais robustas fortalecem o efeito da solução pré-operatória de carboidratos como importante intervenção para diminuir resistência insulínica e efeitos catabólicos desencadeados pelo jejum pré-operatório e pelo estresse do trauma cirúrgico, bem como melhora em parâmetros clínicos. Conclusão: A pré-carga de carboidratos é intervenção robusta para melhora de parâmetros metabólicos perioperatórios, sendo necessários mais estudos para a delimitação de populações mais beneficiadas e melhor forma de administração.

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Unresolved issues in perioperative nutrition: A narrative review

Cited by 14 publications

References 119 publications

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Postoperative Nutrition Management: Who Needs What?

Efeito de soluções de carboidratos (pré carga) sobre resistência insulínica e morbidade perioperatória

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