title: The role of the enteral route and the composition of feeds in the nutritional support of malnourished surgical patients.
abstract: In surgical patients, malnutrition is an important risk factor for post-operative complications. In undernourished patients undergoing major gastrointestinal procedures, preoperative enteral nutrition (EN) should be preferred whenever feasible. It may be given either orally or by feeding tubes, depending on patient compliance. Early oral intake after surgery should be encouraged, but if an insufficient postoperative oral intake is anticipated, tube feeding should be initiated as soon as possible. The use of immunomodulating formulas offers significant advantages when compared to standard feeds and the positive results on postoperative complications seem independent from the baseline nutritional status. In malnourished patients, the optimal timing and dose of immunonutrition is unclear, but consistent data suggest that they should be treated peri-operatively for at least two weeks.
authors.affiliation: Department of Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy. luca.nespoli@unimib.it
authors.forename: Luca
authors.initials: L
authors.lastname: Nespoli
authors.forename: Sara
authors.initials: S
authors.lastname: Coppola
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
mesh_terms: D013505:Digestive System Surgical Procedures; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D056747:Immunomodulation; D007441:Intubation, Gastrointestinal; D044342:Malnutrition / Q000628:therapy*; D009752:Nutritional Status; D011183:Postoperative Complications / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
keywords: enteral nutrition; immunonutrition; malnutrition; surgery