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- Title
Nutritional prehabilitation: physiological basis and clinical evidence.
- Authors
Pillinger, N. L.; Robson†, J. L.; Kam, P. C. A.; Robson, J L; Kam, Pca
- Abstract
In this narrative review, we describe the physiological basis for nutritional prehabilitation and evaluate the clinical evidence for its current roles in the perioperative period. Surgical stress and fasting induce insulin resistance as a result of altered mitochondrial function. Insulin resistance in the perioperative period leads to increased morbidity in a dose-dependent fashion, while preoperative carbohydrate loading attenuates insulin resistance, minimises protein loss and improves postoperative muscle function. Carbohydrate loading is an established practice in many countries and a key component of enhanced recovery after surgery (ERAS) programs, yet its independent effects on clinical outcomes remain unclear. Amino acid supplements may confer additional positive effects on a number of markers of clinical outcomes in the perioperative period, but their current role is also poorly defined. Clinical studies evaluating nutritional interventions have been marred by conflicting data, which may be due to small sample sizes, as well as heterogeneity of patients and surgical procedures. At present, it is known that carbohydrate loading is safe and improves patients' wellbeing, but does not appear to influence length of hospital stay or rate of postoperative complications. This should be appreciated before its routine inclusion in ERAS programs.
- Subjects
DIETARY carbohydrates; PHYSIOLOGICAL effects of carbohydrates; CONVALESCENCE; SURGICAL nutrition; POSTOPERATIVE period; POSTOPERATIVE care; PREVENTION of surgical complications; FASTING; CARBOHYDRATE content of food; LENGTH of stay in hospitals; INSULIN resistance; PHYSIOLOGICAL stress; SYSTEMATIC reviews; PERIOPERATIVE care
- Publication
Anaesthesia & Intensive Care, 2018, Vol 46, Issue 5, p453
- ISSN
0310-057X
- Publication type
journal article
- DOI
10.1177/0310057x1804600505