Nutritional status is without a doubt one of the necessary parameters that decide the course of post surgical recovery. The concept of nutritional status in surgery involves numerous aspects of perioperative nutrition that includes both preoperative and postoperative nutritional status. Studies have demonstrated that many early and late postoperative problems could be prevented with a suitable nutritional status.
Klein et al. published a study in 1996 that compared two groups of patients: a previously malnourished group and another in agreeable nutritional condition. Both groups were voluntarily subjected to a lumbar spinal surgery. It was reported that out of 26 postoperative complications, twenty four were in the malnourished group. Primarily based on the study findings, the study authors recommend that close attention ought to be paid to the preoperative nutritional status of patients undergoing surgical procedure. It also implies that individuals with less then optimum nutrition should be supplemented and replenished before elective surgery. Similar studies done indicate that the conclusions will be generalized for any kind of operations. So individuals that are malnourished and undernourished should be given special consideration.
Successful recovery from a surgical intervention depends on several elements, and post surgical nutritional support is one among these. Post surgical nutrition ought to be started as quickly as possible. The improved nutritional status helps in:
- The healing of wounds
- Enhancing the response of the immune system to threats
- Fighting off infections or sepsis and
- Preventing immediate and late complications.
Proteins are a source of amino acids, the essential building structure of the body. Owing to this property, adequate protein intake is crucial for proper wound healing. Protein depletion appears to holdup wound healing by: prolonging the inflammatory part; by inhibiting fibroplasia, collagen and proteoglycan synthesis; and by inhibiting neoangiogenesis (proliferation phase) and wound remodeling.
Surgery poses great metabolic stress on the patient, with the severity of the strain depending on the severity of the wounded site. An injured patient requires more protein than a non-injured patient as a result of of the increased metabolic activity of wound healing, acute-phase protein production in response to stress, and amino acid mobilization from muscle used for hepatic gluconeogenesis.
In animals that were experimentally tested on a protein depletion showed a decrease in tensile strength of wounds. In 108 human patients, a study involving experimental wounds was done and the ones with low serum protein or serum slbumin had significantly weaker wounds than those with normal protein quantities.
Protein calorie malnutrition increases morbidity and mortality in the surgical patient. In studies conducted on hospitalized patients the findings indicated that many patients were already in a state of malnutrition at admission. In these people, to optimize healing and immune function and in addition to prevent post-surgical problems an increased protein consumption is beneficial.
Protein requirement
In a non-injured state, adults need about 0.8 grams of dietary protein per kilogram of body weight daily. Since aged patients possess a decreased capability to synthesize proteins it's recommended they possess a higher protein consumption of about 1-1.2 grams of dietary protein per kilogram of body weight per day. More protein can also be necessary for someone that experiences surgery or trauma of any kind. Minor surgery could not considerably increase the protein demand; but, if the patient is already protein malnourished, wound healing will be adversely affected unless dietary protein intake is increased. Major surgery and trauma will enlarge the protein requirement notably, with surgery requiring an extra 10% and trauma an extra 75% more protein than normal. The protein requirement is raised the most (as much as 75-100%) for special cases like burn victims, whose wounds produce great metabolic stress.
Therapeutic modes of nutrition
For patients in whom the protein requirement of the body outweighs the intake, supplements are required to satisfy the increased demand. Therapeutic modes may be useful in this case.
- Oral nutrition is safest, least expensive and best.
- Enteral tube nutrition may be utilized in patients with a functioning gastro intestinal tract to supplement oral feeding or to replace it entirely. The latter is indicated for patients who need intensive protein support.
- Another aid to oral intake is partial parenteral nutrition, which provides a portion of the patients daily nutritional requirements.
- By utilizing TPN (total parenteral nutrition) all of the patient's each day nutritional requirements are supplied. Thrombosis is often the effect of long periods of concentrated solutions use, however in temporary conditions a peripheral vein maybe utilized.
Monitoring of weight, plasma proteins, glucose, etc ought to be done repeatedly.
Role of milk proteins in recovery process
Regardless of age, whey proteins have been found to be an excellect source of protein for everyone. Nutritionally speaking, whey is one of the greatest proteins obtainable. It comes from the cheese and casein making process. It contains approximately twenty percent of the original milk proteins. Exciting new research is being conducted that indicates certain whey protein elements help provide the growth of new body tissue. Immune modulation, anit-inflammatory and healing effects are amone the biological activities related to whey protein.
The major protein fraction of milk is casein, basically a mild protein. Caseins are synthesized inside the mammary gland and are considered phosphoproteins. They possess immune modulator activity and will influence gut motility. Caseins are extremely high in the amino acid glutamine, which is the most abundant amino acid found in skeletal muscles and may play a role in supporting the immune system.
References:
1. Loimaranta V., Laine M., Soderling E., et al. Effects of bovine immune and non-immune whey preparations on the composition and pH response of human dental plaque. Eur J Oral Sci 1999; 107:244-50.
2. Bolke E., Orth K., Jehle P.M., et al. Enteral application of an immunoglobulin-enriched colostrum milk preparation for reducing endotoxin translocation and acute phase response in patients undergoing coronary bypass surgery--a randomized placebo-controlled pilot trial. Wien Klin Wochenschr 2002; 114:923-8.
3. Zello G.A., L.J. Wykes P.B., Pencharz and R.O. Ball. (1995) Recent advances in methods of assessing the dietary amino acid requirements for adult humans. J. Nutr. 125: 2907-2915.
4. Ayles H.L., R.M. Friendship and R.O. Ball. (1996) Effect of dietary particle size on gastric ulcers, assessed by endoscopic examination, and relationship between ulcer severity and growth performance of individually fed pigs. Swine Health & Prod. 4(5): 211-216.
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About Protica Research
Founded in 2001, Protica Research (Protica, Inc.) is a nutritional research firm specializing in the development of capsulized foods (dense nutrition in compact liquid and food forms). Protica manufactures Profect (www.profect.com), IsoMetric, Pediagro, Fruitasia and more than 100 other brands in its GMP-certified, 250,000 square foot facility. One area of specialty is the manufacturing of Medicare-approved, whey protein drinks for immunodeficiency patients.
You can learn more about Protica at www.protica.com - Copyright - Protica Research
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