Perioperative MNT PDF

Clinical Nutrition 41 (2022) 1578e1590 Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http...

Clinical Nutrition 41 (2022) 1578e1590 Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu Narrative Review Unresolved issues in perioperative nutrition: A narrative review Katherine L. Ford a, Carla M. Prado a, Arved Weimann b, Philipp Schuetz c, d, Dileep N. Lobo e, f, * a Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada b Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Leipzig, Germany c Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland d Medical Faculty of the University of Basel, Basel, Switzerland e Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK f MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK a r t i c l e i n f o s u m m a r y Article history: Surgical patients are at an increased risk of negative outcomes if they are malnourished or at risk of Received 25 April 2022 malnutrition preoperatively. Optimisation of nutritional status should be a focus throughout the peri- Accepted 17 May 2022 operative continuum to promote improved surgical outcomes. Enhanced Recovery after Surgery (ERAS) protocols are increasingly applied in the surgical setting but are not yet widespread. This narrative re- Keywords: view focused on areas of perioperative nutrition that are perceived as controversial or are lacking in Immunonutrition agreement. A search for available literature was conducted on 1 March 2022 and relevant high-quality Muscle articles published since 2015 were considered for inclusion. Most malnutrition screening tools are not Muscle health Nutritional interventions specific to the surgical population except for the Perioperative Nutrition Screen (PONS) although more Nutritional screening large-scale initiatives are needed to improve the prevalence of preoperative nutrition screening. Poor Perioperative nutrition muscle health is common in patients with malnutrition and further exacerbates negative health out- comes indicating that prevention, detection and treatment is of high importance in this population. Although a lack of consensus remains for who should receive preoperative nutritional therapy, evidence suggests a positive impact on muscle health. Additionally, postoperative nutritional support benefits surgical outcomes, with some patients requiring enteral and/or parenteral feeding routes and showing benefit from immunonutrition. The importance of nutrition extends beyond the time in hospital and should remain a priority post-discharge. The impact of individual or personalised nutrition based on select patient characteristics remains to be further investigated. Overall, the importance of perioperative nutrition is evident in the literature despite select ongoing areas of contention. © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Abbreviations: BMI, body mass index; CI, confidence intervals; CT, computed tomography; ERAS, Enhanced Recovery After Surgery; ESPEN, European Society for Clinical Nutrition and Metabolism; GLIM, Global Leadership Initiative on Malnu- Nutritional status is an important determinant of outcomes after trition; HERN, home enteral route nutrition; HMB, b-hydroxy b-methylbutyrate; surgical operations ever since Studley, in 1936, showed that pa- HR, hazards ratio; INPAC, Integrated Nutrition Pathway for Acute Care; MNA, Mini tients with a preoperative weight loss of
20% were 10 times more Nutritional Assessment; MNA-SF, Mini Nutritional Assessment-Short Form; MST, Malnutrition Screening Tool; MUST, Malnutrition Universal Screening Tool; NPV, likely to die after surgery for peptic ulcer than those who had lost negative predictive value; NRS, Nutritional Risk Screening; ONS, oral nutritional