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Perioperative nutrition: Recommendations from the ESPEN expert group
Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza, Italy.
Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
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2020 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, no 11, p. 3211-3227Article, review/survey (Refereed) Published
Abstract [en]

Background & aims: Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14–15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients.

Methods: This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art.

Results: Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro- and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer.

Conclusions: Nutritional assessment of the surgical patient together with the appropriate interventions to restore the energy deficit, avoid weight loss, preserve the gut microbiome and improve functional performance are all necessary components of the nutritional, metabolic and functional conditioning of the surgical patient. 

Place, publisher, year, edition, pages
Churchill Livingstone , 2020. Vol. 39, no 11, p. 3211-3227
Keywords [en]
Malnutrition, Nutritional assessment, Nutritional intervention, Perioperative care, Perioperative nutrition, Sarcopenia
National Category
Surgery Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:oru:diva-81740DOI: 10.1016/j.clnu.2020.03.038ISI: 000583382200001PubMedID: 32362485Scopus ID: 2-s2.0-85083877660OAI: oai:DiVA.org:oru-81740DiVA, id: diva2:1429642
Note

Funding Agency:

European Society for Clinical Nutrition and Metabolism (ESPEN), Luxemborg 

Available from: 2020-05-12 Created: 2020-05-12 Last updated: 2020-12-04Bibliographically approved

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Ljungqvist, Olle

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