title: Compliance with preoperative oral nutritional supplements in patients at nutritional risk--only a question of will?
abstract: OBJECTIVE
  Preoperative nutrition has been shown to reduce morbidity after major gastrointestinal (GI) surgery in selected patients at risk. In a randomized trial performed recently (NCT00512213), almost half of the patients, however, did not consume the recommended dose of nutritional intervention. The present study aimed to identify the risk factors for noncompliance.
  
  
  METHODS
  Demographic (n = 5) and nutritional (n = 21) parameters for this retrospective analysis were obtained from a prospectively maintained database. The outcome of interest was compliance with the allocated intervention (ingestion of ⩾ 11/15 preoperative oral nutritional supplement units). Uni- and multivariate analyses of potential risk factors for noncompliance were performed.
  
  
  RESULTS
  The final analysis included 141 patients with complete data sets for the purpose of the study. Fifty-nine patients (42%) were considered noncompliant. Univariate analysis identified low C-reactive protein levels (P = 0.015), decreased recent food intake (P = 0.032) and, as a trend, low hemoglobin (P = 0.065) and low pre-albumin (P = 0.056) levels as risk factors for decreased compliance. However, none of them was retained as an independent risk factor after multivariate analysis. Interestingly, 17 potential explanatory parameters, such as upper GI cancer, weight loss, reduced appetite or co-morbidities, did not show any significant correlation with reduced intake of nutritional supplements.
  
  
  CONCLUSIONS
  Reduced compliance with preoperative nutritional interventions remains a major issue because the expected benefit depends on the actual intake. Seemingly, obvious reasons could not be retained as valid explanations. Compliance seems thus to be primarily a question of will and information; the importance of nutritional supplementation needs to be emphasized by specific patients' education.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Grass
authors.affiliation: Clinical Nutrition Unit, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: P C
authors.initials: PC
authors.lastname: Bertrand
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
authors.affiliation: Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Ballabeni
authors.affiliation: Department of Urology, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Y
authors.initials: Y
authors.lastname: Cerantola
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001066:Appetite; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D013505:Digestive System Surgical Procedures / Q000379:methods; D005247:Feeding Behavior; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010349:Patient Compliance; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein