title: Nutrition adequacy in enhanced recovery after surgery: a single academic center experience.
abstract: BACKGROUND
  A prospective observational study was initiated to determine the prevalence of nutrition risk before surgery and assess nutrition adequacy of food choices after elective colorectal surgery.
  
  
  METHODS
  Patient-Generated Subjective Global Assessment was used to screen all preoperative clinic patients (n = 70) scheduled for elective colorectal surgery. Adequacy of dietary intake (n = 40) was determined for the first 3 postoperative days by estimating total energy and protein intake from leftover food at each meal based on standard hospital portions with food composition tables. Food access questionnaire provided a rationale for observed food intake. All patients received Enhanced Recovery After Surgery (ERAS) and room service system care.
  
  
  RESULTS
  Before surgery, 63% of patients were considered well-nourished, 29% suspected or moderately undernourished, and 8% severely undernourished. Fifty-one percent of patients scored > 4 on the Patient-Generated Subjective Global Assessment, indicating requirement for dietary intervention or symptom management. On average, 77% ± 27%, 63% ± 28%, and 92% ± 39% of energy requirements were met on postoperative days 1, 2, and 3, respectively; conversely, 55% ± 24%, 43% ± 16%, and 45% ± 12% of protein requirements were met. Most common reasons for missed meals included loss of appetite and feelings of fatigue or worry. Preoperative nutrition risk tended to result in a greater 30-day hospital readmission rate compared to well-nourished patients (P = .07).
  
  
  CONCLUSIONS
  A third of patients scheduled for elective colorectal surgery were at nutrition risk. An acceptable intake of dietary protein was not achieved during the first 3 days of hospitalization. Preoperative nutrition education, as part of Enhanced Recovery Programs, may be useful to optimize nutrition status before surgery to mitigate clinical consequences associated with undernutrition and empower patients to make adequate food choices for recovery. NCT 01727570.
authors.affiliation: Department of Anesthesia, McGill University Health Centre, Montreal, Quebec chelsia.gillis@mail.mcgill.ca.
authors.forename: Chelsia
authors.initials: C
authors.lastname: Gillis
authors.affiliation: School of Dietetics & Human Nutrition, McGill University, Montreal, Quebec.
authors.forename: Thi Haiyen
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: A Sender
authors.initials: AS
authors.lastname: Liberman
authors.affiliation: Department of Anesthesia, McGill University Health Centre, Montreal, Quebec.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carli
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects*; D004044:Dietary Proteins / Q000008:administration & dosage / Q000032:analysis; D002149:Energy Intake; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D010359:Patient Readmission; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D004044:Dietary Proteins
keywords: Enhanced Recovery After Surgery; colorectal surgery; nutrient intake; nutrition assessment; nutrition therapy; nutritional requirements; nutritional status; nutritive value