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• W2000758622 abstract "If routine oral dietary supplements do not increase a patient’s total nutritional intake— or supply nutrients when no other food is given there is no reason to believe that the patient will benefit from such supplements. This might be the simple explanation behind why MacFie et al. did not demonstrate any effects at all of oral nutritional supplements given perioperatively.1 In fact the patients who got the supplements did not totally consume more energy of protein than the controls, at least not in the postoperative days. The explanation could either be that they already had sufficient nutritional intake or that the supplements were not consumed in sufficient amounts. All of MacFie et al.’s patients followed a modern, postoperative regimen in which nasogastric tubes were avoided, and drinking and eating were allowed and advocated immediately after operation. This regimen of feeding the bowel immediately after emergency surgery3,4 or elective gastrointestinal operation 5 is not only known to improve nutritional intake considerably,2 but has proven to reduce postoperative morbidity. In such studies demonstrating this effect 3‐5 the patients were given an average of 1500 kcal and 50 g protein daily. An intake of this magnitude is perhaps what is needed the first days after surgery to reduce nutritiondependent morbidity. This matched the intake for the control patients in the MacFie study—and for the patients in the intervention group, who did not increase their total nutritional intake (they drank too little of the oral supplements offered). The intake averaged 250 kcal and 8 g protein daily. This is far less than the amount seen in earlier studies, 6 and explains why weight loss and lean body mass were the same in controls as in those offered supplements. It must still be reasonable to expect well-informed and motivated patients to drink liquid supplements adding about 600 ‐ 800 kcal and 20 ‐30 g protein to the nutritional intake after colonic surgery, as seen in both old6 and recent 7 studies. A supplement of this magnitude has been shown to improve nitrogen balance and reduce weight loss.6,7 Two good reasons for increasing patients’ nutritional intake during the last weeks before surgery might be that they are malnourished or have suboptimal spontaneous nutrition during the time before operation, therefore depleting their nutritional stores. No former studies have focused on patients’ nutritional intake at home before surgery and neither was this intake measured in the present study.1 We therefore do not know if the majority of the intervention patients would theoretically benefit from a nutritional intervention, as only one fifth of them were malnourished. Neither do we know if the supplements given during the last 15 d before surgery (mean, 500 kcal and 17 g protein daily) actually improved the patients’ total preoperative nutritional intake. We doubt however, as the average intervention patient lost 1‐2 kg during this period—the same or a little more than the controls. Thus, after having read MacFie et al.’s article, I am still in doubt. The authors may be right when they write, “these results suggest that the routine use of perioperative oral dietary supplements undergoing gastrointestinal surgery confers no clinical or functional benefit,” since their patients were well nourished— or they may be wrong, since they did not succeed in improving the nutritional intake of their patients." @default.
• W2000758622 created "2016-06-24" @default.
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• W2000758622 date "2000-09-01" @default.
• W2000758622 modified "2023-10-18" @default.
• W2000758622 title "Oral dietary supplements before and after surgery" @default.
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• W2000758622 doi "https://doi.org/10.1016/s0899-9007(00)00383-x" @default.
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