Center for Translational Research in Aging & Longevity, Donald W. Reynolds Institute on Aging, Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Nutrients. 2021 May 15;13(5):1675. doi: 10.3390/nu13051675.
Nutritional status is a strong predictor of postoperative outcomes and is recognized as an important component of surgical recovery programs. Adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality. Especially in older patients, inadequate protein can lead to significant muscle atrophy, leading to a loss of independence and increased mortality risk. Current nutritional recommendations for surgery primarily focus on screening and prevention of malnutrition, pre-surgical fasting protocols, and combating post-surgical insulin resistance, while recommendations regarding macronutrient composition and timing around surgery are less established. The goal of this review is to highlight oral nutrition strategies that can be implemented leading up to and following major surgery to minimize atrophy and the resultant loss of functionality. The role of carbohydrate and especially protein/essential amino acids in combating the surgical stress cascade and supporting recovery are discussed. Practical considerations for nutrient timing to maximize oral nutritional intake, especially during the immediate pre- and post- surgical periods, are also be discussed.
营养状况是术后结局的强有力预测因素，被认为是外科康复计划的重要组成部分。充足的营养摄入对于应对手术应激反应、减轻肌肉质量、力量和功能丧失至关重要。特别是在老年患者中，蛋白质摄入不足会导致显著的肌肉萎缩，从而导致独立性丧失和死亡率增加。目前针对手术的营养建议主要集中在筛查和预防营养不良、术前禁食方案以及对抗术后胰岛素抵抗，而关于手术前后宏量营养素组成和时间的建议则不太确定。本综述的目的是强调在重大手术前后可实施的口服营养策略，以最大程度地减少萎缩和由此导致的功能丧失。讨论了碳水化合物、特别是蛋白质/必需氨基酸在对抗手术应激级联反应和支持康复方面的作用。还讨论了为了最大程度地增加口服营养摄入而对营养素时间进行优化的实际考虑因素，特别是在手术前后的即刻期间。
