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Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

Published in Nutrients, July 2021

 OPEN ACCESS  View online here

While nutrition support is integrated into ERAS (Enhanced Recovery after Surgery) pathways, it is still common for patients undergoing gastrointestinal (GI) surgery to have an inadequate nutritional intake. Malnutrition and sarcopenia are often masked, particularly in overweight and obese patients, but can have significant influence on prognostic outcomes. Wobith and Weimann review this area and provide a summary of recent evidence on the current concepts of perioperative enteral nutrition in patients undergoing GI surgery.

The review includes recent guidelines (e.g. ESPEN) and evidence specifically looking at the pathway for nutritional care in 3 areas and includes recommendations for use of oral nutritional supplements (ONS) and enteral feeding as follows:

Preoperative

  • screening for malnutrition, assessment of nutritional status
  • ONS, preferably immunonutrition for 5-7 days

In hospital

  • early oral feeding
  • supplementation when calorie/protein intake is inadequate, by ONS, enteral via feeding tube or parenteral

Post discharge

  • dietary counselling before discharge
  • monitoring of nutritional status and nutrition intake regularly
  • ONS or tube feeding in case of inadequate calorie intake or weight loss

They conclude that ‘ONS and/or enteral nutrition provide clinical benefits for the attenuation of weight loss’ and in summary the authors make a list of 8 recommendations for the management of perioperative nutrition support for this group of GI surgical patients.