Discussion on perioperative nutrition support from the update of ESPEN surgical nutritional guidelines / 中华消化外科杂志

ABSTRACT

Surgical diseases and traumatic stress can cause body catabolism, which result in inflammation, protein decomposition and nitrogen loss. In surgical patients, sarcopenia, cachexia and muscle fat infiltration, which are related to nutrition deficiencies, lead to adverse clinical outcomes. The first step of nutrition support is nutrition risk screening and assessment. The nutrition risk screening tools recommended by relevant guidelines of European Society for Parenteral and Enteral Nutrition (ESPEN) include Nutrition Risk Screening 2002, short-form Mini Nutritional Assessment, Malnutrition Universal Screening Tool, etc. Evaluation tools include Subjective Global Assessment and Global Leadership Initiative on Malnutrition. Due to the close relationship with clinical outcomes, the change of lean body mass has received increasing attention in nutritional assessment. If the patient has malnutrition before surgery, it is recommended to perform 10-14 days of preoperative nutrition support. Enteral nutrition is the first choice, especially oral enteral nutrition. Enteral nutrition is also preferred for postoperative nutrition support, however, supplementary parenteral nutrition or total parenteral nutrition should be performed if enteral nutrition is non-compliant or infeasible. There are still controversies on the application of pharmacological nutrients in the perioperative period, which are recommended for parenteral nutrition in critically ill patients after major surgery by relevant guidelines and consensus. Combined with the update of ESPEN surgical nutritional guidelines and perioperative nutrition support recommendations, the authors elaborate on perioperative nutritional management strategies.