Nutrition in Prehabilitation

Question 1

Why is nutritional state prior to a operation important?

Answer 1

• Micronutrients help in immune function reducing risk of sepsis (Vitamin C, Vitamin A, and Zinc)
• Anabolic state is favourable for muscle, tissue repair and immune function following surgery
• Surgery triggers release of stress hormones that create catabolic state
• Post-operative immobilization which can accelerate muscle atrophy
• Adequate hydration to manage blood pressure and blood glucose
• Body fat or lipid oxidation
• Omega-3 fatty acids have anti-inflammatory effects

Question 2

What the impact of anesthesia on surgical outcomes?

Answer 2

• Anesthetic agents impair insulin sensitivity and promote insulin resistance leading to dysregulation of glucose metabolism and increased protein breakdown

Question 3

When would you refer patients to specialist support

Answer 3

• Red Flag with anyone scoring 9 or over
• Amber Flag with score of 5 or over - nutritional supplements
• Less than 18.5 ml/kg/min BMI
• 10-15% unintentional weight loss in the previous 6 months or indicative of that direction
• Anyone who states they have stopped eating

Question 4

What are the stage of the PG-SGA and how they scored?

Answer 4

Weight in past 2 weeks: 1 for decreased.
Food intake: Less than usual 1, Normal food but less than normal amount 1
Symptoms: 3 for all that add together (appetite, fatigue, pain, mouth sores)
Activities: 3 for top 2, 2 for not feeling up to most things, 1 not normal self, 1 for top.

Question 5

What are the recommendations for Protein Intake in Cancer patient in Pre-Operative setting from the European Society for Clinical Nutrition and Metabolism?

Answer 5

• 1.2 to 1.5 kg/day for cancer patients pre surgery
• 1.5 to 2.0 kg/day for patient with significant muscle wasting or severe malnutrition
• 25-30 kcal/kg/day

Question 6

What does the ESPEN class as indicator of malnutrition?

Answer 6

• 5% or more weight loss over 3 to 6 months or 10% over 6 months or more unintentionally
• BMI <18.5 kg/min2
• Energy intake below 25-30 kcal/kg/day
• Protein below 0.8-1.0 kg/day
• Handgrip strength <30kg for men, <20kg for women
• Gait speed below 0.8 m/s or other functional measures

Question 7

How might someones meals be structured in the pre-operative setting?

Answer 7

• 30-g protein intake 3 times a day completed by an additional 20g or whey protein in a beverage choice 0-60 minutes after exercise

Question 8

What is sarcopenia?

Answer 8

• Progressive loss of muscle mass and strength with aging