Advances in clinical nutrition in GI surgery

Abstract

This review addresses recent relevant advances to clinical nutrition regarding gastrointestinal disease surgery. Medline Ovid, EMBASE and Central were searched systematically in April 2014. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and observational studies evaluating nutritional support in gastrointestinal surgery published within 5 years. The review included 56 relevant studies. Themes were: nutrition screening and risk factors predict outcome; preoperative nutritional support; shortening fasting periods and including carbohydrate solutions; early nutrition after surgery; immune modulating nutrition; synbiotics, growth hormone, omega-3 and oral, enteral and parenteral nutrition in combination. Screening for nutritional risk is profound, with special focus on dietary intake in the past week. Age and severity of disease need to be included in the screening system. Patients at severe nutritional risk benefit from nutritional therapy before surgery. New standards are developing quickly and clinical guidelines on surgery should include updated knowledge within clinical nutrition.

Keywords:

• advances
• clinical outcome
• clinical trails
• enteric feeding
• gastrointestinal
• nutrition risk screening
• patients
• review
• surgery
• undernutrition

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Nutrition screening and assessment of risk factors predict clinical outcome, and should be undertaken in all patients at the earliest point possible, before surgery.

• Preoperative nutritional support for 7–10 days in patients at severe nutritional risk has proven beneficial.

• Shortening of fasting periods and including carbohydrate solution 2 h before surgery reduces perioperative stress response, infectious complications and insulin resistance.

• Early oral and enteral nutrition after surgery reduces gastrointestinal and infectious complications, and has shown to decrease length of stay and mortality.

• Immune modulating nutrition. Despite the very clear beneficial results of earlier studies, the studies found in this search do not show any clinical or outcome improvements with the use of immune modulating nutrition. The expert opinion is, however, that more studies and meta-analysis of studies published only in the past 5 to 10 years are needed, before changing practice.

• Glutamine in PN has shown postoperative immunological and clinical benefits, regarding all major GI surgery.

• Omega-3-fatty acids in PN solutions are associated with immunological and clinical benefits and reduced length of hospital stay.

• A significant improvement in wound healing and overall survival was seen in arginine-supplemented patients.

• Synbiotics in surgery nutrition has shown positive to immune function and bowel irritability in elderly patients; however, only two studies are included.

• Use of growth hormone has shown promising results; however, only scarcely studied.

• Oral, enteral and parenteral nutrition in combination has shown diverging results. Studies are weak regarding control group and cut-off value for timing of supplementation with parenteral nutrition.