title: Impact of nutritional support that does and does not meet guideline standards on clinical outcome in surgical patients at nutritional risk: a prospective cohort study.
abstract: To investigate the impact of nutritional support on clinical outcomes in patients at nutritional risk who receive nutritional support that meets guideline standards and those who do not.
  
  
  
  This prospective cohort study enrolled hospitalized patients from the Second Affiliated Hospital of Kunming Medical University from February 2010 to June 2012. The research protocols were approved by the university's ethics committee, and the patients signed informed consent forms. The clinical data were collected based on nutritional risk screening, administration of enteral and parenteral nutrition, surgical information, complications, and length of hospital stay.
  
  
  
  During the study period, 525 patients at nutritional risk were enrolled in the cohorts. Among patients who received nutritional support that met the guideline standards (Cohort 1), the incidence of infectious complications was lower than that in patients who did not meet guideline standards (Cohort 2) (17.1 % vs. 26.9 %, P = 0.01). Subgroup analysis showed that individuals who received a combination of parenteral nutrition (PN) and enteral nutrition (EN) for 7 or more days had a significantly lower incidence of infectious complications (P = 0.001) than those who received only PN for 7 or more days or those who received nutritional support for less than 7 days or at less than 10 kcal/kg/d. Binary logistic regression analysis showed that, after adjusting for confounding factors, nutritional support that met guideline standards for patients with nutritional risk was a protective factor for complications (OR: 0.870, P < 0.002).
  
  
  
  In patients at nutritional risk after abdominal surgery, nutritional support that meets recommended nutrient guidelines (especially regimens involving PN + EN ≥ 7 days) might decrease the incidence of infectious complications and is worth recommending; however, well-designed trials are needed to confirm our findings. Nutritional support that does not meet the guideline standards is considered clinically undesirable.
authors.affiliation: Department of General Surgery, Wuhan Clinical School of Southern Medical University/Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070, China.|Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Da-Li
authors.initials: DL
authors.lastname: Sun
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Shu-Min
authors.initials: SM
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Yun-Yun
authors.initials: YY
authors.lastname: Cen
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Yue-Ying
authors.initials: YY
authors.lastname: Lin
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Qing-Wen
authors.initials: QW
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Yan-Bo
authors.initials: YB
authors.lastname: Sun
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Yu-Xing
authors.initials: YX
authors.lastname: Qi
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Yang
authors.affiliation: Department of General Surgery, Wuhan Clinical School of Southern Medical University/Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070, China. ptwklqp111@163.com.
authors.forename: Qi-Ping
authors.initials: QP
authors.lastname: Lu
authors.affiliation: Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China. destiny1978@163.com.|Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China. destiny1978@163.com.
authors.forename: Peng-Yuan
authors.initials: PY
authors.lastname: Xu
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D018529:Nutritional Support / Q000592:standards; D010288:Parenteral Nutrition / Q000379:methods; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Abdominal surgery patients; Guidelines; Logistic regression analysis; Nutritional risk; Outcome