Perioperative nutrition: Recommendations from the ESPEN expert group

Dileep N Lobo; Luca Gianotti; Alfred Adiamah; Rocco Barazzoni; Nicolaas E P Deutz; Ketan Dhatariya; Paul L Greenhaff; Michael Hiesmayr; Dorthe Hjort Jakobsen; Stanislaw Klek; Zeljko Krznaric; Olle Ljungqvist; Donald C McMillan; Katie E Rollins; Marina Panisic Sekeljic; Richard J E Skipworth; Zeno Stanga; Audrey Stockley; Ralph Stockley; Arved Weimann

doi:10.1016/j.clnu.2020.03.038

Perioperative nutrition: Recommendations from the ESPEN expert group

Dileep N Lobo, Luca Gianotti, Alfred Adiamah, Rocco Barazzoni, Nicolaas E P Deutz, Ketan Dhatariya, Paul L Greenhaff, Michael Hiesmayr, Dorthe Hjort Jakobsen, Stanislaw Klek, Zeljko Krznaric, Olle Ljungqvist, Donald C McMillan, Katie E Rollins, Marina Panisic Sekeljic, Richard J E Skipworth, Zeno Stanga, Audrey Stockley, Ralph Stockley, Arved Weimann

Deanery of Clinical Sciences

Research output: Contribution to journal › Review article › peer-review

Abstract / Description of output

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.

Original language	English
Pages (from-to)	P3211-3227
Number of pages	17
Journal	Clinical Nutrition
Volume	39
Issue number	1
Early online date	18 Apr 2020
DOIs	https://doi.org/10.1016/j.clnu.2020.03.038
Publication status	Published - 1 Nov 2020

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Perioperative Nutrition_Manuscript_August_2019_Gianotti3_v2Accepted author manuscript, 2.72 MB

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Lobo, D. N., Gianotti, L., Adiamah, A., Barazzoni, R., Deutz, N. E. P., Dhatariya, K., Greenhaff, P. L., Hiesmayr, M., Hjort Jakobsen, D., Klek, S., Krznaric, Z., Ljungqvist, O., McMillan, D. C., Rollins, K. E., Panisic Sekeljic, M., Skipworth, R. J. E., Stanga, Z., Stockley, A., Stockley, R., & Weimann, A. (2020). Perioperative nutrition: Recommendations from the ESPEN expert group. Clinical Nutrition, 39(1), P3211-3227. https://doi.org/10.1016/j.clnu.2020.03.038

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title = "Perioperative nutrition: Recommendations from the ESPEN expert group",

abstract = "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.",

author = "Lobo, {Dileep N} and Luca Gianotti and Alfred Adiamah and Rocco Barazzoni and Deutz, {Nicolaas E P} and Ketan Dhatariya and Greenhaff, {Paul L} and Michael Hiesmayr and {Hjort Jakobsen}, Dorthe and Stanislaw Klek and Zeljko Krznaric and Olle Ljungqvist and McMillan, {Donald C} and Rollins, {Katie E} and {Panisic Sekeljic}, Marina and Skipworth, {Richard J E} and Zeno Stanga and Audrey Stockley and Ralph Stockley and Arved Weimann",

year = "2020",

month = nov,

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doi = "10.1016/j.clnu.2020.03.038",

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pages = "P3211--3227",

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Lobo, DN, Gianotti, L, Adiamah, A, Barazzoni, R, Deutz, NEP, Dhatariya, K, Greenhaff, PL, Hiesmayr, M, Hjort Jakobsen, D, Klek, S, Krznaric, Z, Ljungqvist, O, McMillan, DC, Rollins, KE, Panisic Sekeljic, M, Skipworth, RJE, Stanga, Z, Stockley, A, Stockley, R & Weimann, A 2020, 'Perioperative nutrition: Recommendations from the ESPEN expert group', Clinical Nutrition, vol. 39, no. 1, pp. P3211-3227. https://doi.org/10.1016/j.clnu.2020.03.038

TY - JOUR

T1 - Perioperative nutrition

T2 - Recommendations from the ESPEN expert group

AU - Lobo, Dileep N

AU - Gianotti, Luca

AU - Adiamah, Alfred

AU - Barazzoni, Rocco

AU - Deutz, Nicolaas E P

AU - Dhatariya, Ketan

AU - Greenhaff, Paul L

AU - Hiesmayr, Michael

AU - Hjort Jakobsen, Dorthe

AU - Klek, Stanislaw

AU - Krznaric, Zeljko

AU - Ljungqvist, Olle

AU - McMillan, Donald C

AU - Rollins, Katie E

AU - Panisic Sekeljic, Marina

AU - Skipworth, Richard J E

AU - Stanga, Zeno

AU - Stockley, Audrey

AU - Stockley, Ralph

AU - Weimann, Arved

PY - 2020/11/1

Y1 - 2020/11/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.clnu.2020.03.038

DO - 10.1016/j.clnu.2020.03.038

M3 - Review article

C2 - 32362485

SN - 0261-5614

VL - 39

SP - P3211-3227

JO - Clinical Nutrition

JF - Clinical Nutrition

IS - 1

ER -

Perioperative nutrition: Recommendations from the ESPEN expert group

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