Healthy Eating for Elective Major Orthopedic Surgery: Quality, Quantity, and Timing

Figures & data

Table 1 Categorizations of Foods Based on the Primary Nutritional Function and Tips on How to Consume Standard Portions

Primary Nutritional Use	Major Food Groups	Food Products	Examples	Portion* g (Edible, Drained)	Primary Cooking Techniques	Comments
Carbohydrates: energy	Cereals and derivatives	Wheat products	Pasta, cous-cous, semolina	80	Boiling	To be preferred in this food group; from wholegrains
		Grains	Rice, barley, spelled	80	Boiling	To be preferred in this food group; from wholegrains
		Salty baked goods (soft)	Durum wheat bread, rye bread	50	Ready-to-eat	Prefer wholegrains; might contain too much salt
		Salty baked goods (hard)	Rusks, bread sticks, crackers, taralli	30	Ready-to-eat	Prefer wholegrains; might contain too much salt
		Sweet baked goods (soft)	Brioche, croissant	50	Ready-to-eat	Might contain seasoning fat and too many sugars
		Sweet baked goods (hard)	Biscuits, breakfast cereals	30	Ready-to-eat	Prefer wholegrains; might contain seasoning fat/sugars
	Tubers	Tubers (raw)	Potato, yam, sweet potato	200	Boiling, baking	Avoid frying or excessive salting
Proteins: structure, micronutrients	Milk	Milk	Cow milk, goat milk	150	Ready-to-eat	To be preferred in this food group; prefer the skimmed
	Dairy products	Yogurt	Cow’s milk yogurt	150	Ready-to-eat	To be preferred in this food group; avoid added sugars
		Cheese (fresh)	Mozzarella, stracchino	100	Ready-to-eat	Prefer the low-fat or fat free
		Cheese (aged, soft)	Blue cheese, camembert	100	Ready-to-eat	Might contain a lot of salt
		Cheese (aged, hard)	Cheddar, parmesan, grana padano, pecorino	50	Ready-to-eat	Might contain a lot of salt
	Meat	White meat (fresh)	Chicken, turkey, other birds, rabbit	100	Pan broiling, roasting	To be preferred in this food group; avoid chargrill/panfrying
		Red meat (fresh)	Beef, sheep, hog, horse, deer	100	Pan broiling, roasting	Avoid chargrill/panfrying
		Cold cuts, cured	Ham, salami, bresaola, mortadella	50	Raw	Might contain a lot of salt
	Seafood	Fish, mollusks, crustaceans (fresh)	Turbot, swordfish, mackerel, prawns, shrimps, mussels	150	Sautéing, baking, poaching	To be preferred in this food group
		Fish (preserved)	Tuna, salmon, cod	50	Ready-to-eat	Avoid preservations in oil or brine
	Egg	Egg	Chicken egg, duck egg	50	Soft boiling, poaching	The white is the protein part; the yolk is the fat part
	Legumes	Legumes (fresh or canned)	Beans, lentils, soy, chickpeas, peas	150	Ready-to-eat, boiling	To be preferred in this food group
		Legumes (dried)	Beans, lentils, soy, chickpeas, peas	50	Soaking-boiling	Cook in salty water to lower nutrient loss
Lipids: energy	Seasoning fats	Oily fruits	Olive oil	10	Ready-to-eat	To be preferred in this food group; source of unsaturated fats
		Oily fruits	Coconut oil, palm oil	10	Ready-to-eat	Source of saturated fats
		Animal fats	Butter, lard	10	ready-to-eat	Source of saturated fats
	Fruit	Fruits (dried in shell)	Walnuts, hazelnuts, almonds, cashews, pine/Brazil nuts	30	Raw	To be preferred in this food group; very caloric
		Oily seeds	Sunflower seeds, sesame seeds, pumpkin seeds	30	Raw	To be preferred in this food group; very caloric
Carbohydrates: fiber, micronutrients	Greens and vegetables	Leafy greens	Lettuce, spinach, chard, kale	80	Raw, boiling	Avoid lengthy cooking; cook in salty water to lower nutrient loss
		Vegetables	Tomato, carrot, aubergine, broccoli, zucchinis	200	Raw, steaming, boiling, baking	Avoid lengthy cooking; cook in salty water to lower nutrient loss
	Legumes	Beans (in edible pods)	Green beans	200	Steaming, boiling, stewing	Do not remove the pots if edible
	Fungi	Mushrooms	White button, shiitake, porcini	200	Steaming, poaching	Avoid panfrying or excessive roasting
Carbohydrates: fiber, micronutrients	Fruits	Fruits (fresh)	Apple, pear, orange, apricots, banana, peach, berries	150	Raw	Avoid juice machines that remove the fiber
		Fruits (dehydrated)	Dates, raisins, prunes, apricots	30	Raw	Contain high concentration of sugar
Flavoring	Plants and products	Aromatic herbs (fresh)	Basil, parsley, oregano, chives, sage, rosemary, coriander	Quantum satis	Blanching	Used as seasonings in place of salt and fatty seasonings
		Spice seeds (dried)	Anise, cumin, fennel, poppy, sesame	Quantum satis	Raw, blanching	Used as seasonings in place of salt fatty seasonings
		Spices (dried)	Pepper, chili peppers, ginger, cardamom, cinnamon, cloves	Quantum satis	Raw, stewing	Used as seasonings in place of salt and fatty seasonings
		Vegetables (fresh)	Onion, garlic	Quantum satis	Poaching, stewing	Prefer the cooking in little water in place of oil; avoid frying

Notes: *The standard portion is defined as the quantity of food that is assumed to be an accepted reference unit by health professionals, an amount easily identifiable, and a serving that meets the consumer’s expectations. The standard portion must be adapted in the case of a personalized diet.

Figure 1 Exemplary healthy eating calculations for a lady candidate for major orthopedic surgery.

Notes: (a) Parameters to be considered for setting a dietary plan in a lady between 60 and 74 years of age, body weight of 65 kg, height of 170 cm, sedentary lifestyle, daily energy requirement in preparation for surgery 1800 kcal, and protein 1.2 g/kg of body weight. (b) Qualitative values of the dietary plan. (c) Composition of a daily plan that comprises three main meals (breakfast, lunch, dinner) and two snacks (morning and afternoon). Energy per gram of food component = 4 kcal for proteins, 9 kcal for lipids, 4 kcal for carbohydrates, and 2 kcal for fiber. (d) Histograms showing the daily trends for energy (kcal), protein (g), lipid (g), and carbohydrate (g) intakes at breakfast (B), morning snack (MS), lunch (L), afternoon snack (AS), and dinner (D). The tables report the energy intakes at each meal and the energetic contribution of the three macromolecules.