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Nutrition Fit for Surgery: Dietitians Week 2014

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TRUST A DIETITIAN

COMPILED BY THE SOUTH AFRICAN ASSOCIATION FOR PARENTERAL AND ENTERAL NUTRITION

Would you prefer to compete in the Grand Prix in a sleek well-tuned Ferrari or an old beaten up Beatle with smoke billowing out of the exhaust? You have no chance winning the Grand Prix in that Beatle! An operation places enormous stress on the body, just like a Grand Prix. Therefore, it is essential to make sure that your body is in the best possible condition before you go to surgery. After surgery it is just as important to make sure the body receives all the nutrients that it need to heal and fight infections.

Despite major strides made in medicine, surgical complications (particularly infections) results in poor outcomes, high health care costs and long period of hospitalization. Severe infections, called sepsis, are one of the most common causes of death in an intensive care unit. Many diseases results in malnutrition, which is associated with more complications, a reduced ability to fight infections, a lower chance for recovery, longer stay in the intensive care unit and hospital, a decreased quality of life after hospitalization and higher costs. The other side of the coin, namely obesity, also results in adverse outcomes. Your new hip or knee will not appreciate the extra loading it has to carry. Quick, unsupervised weight loss, however, can do more damage than good.

For decades patients have been kept without food from the previous evening for surgery to prevent food and fluids running into the lungs during surgery. This practice has been turned on its head in recent years. We now know that this practice dehydrates the patient and makes them miserable! If the water runs out in that fancy Ferrari, the engine will cease and you will still loose the race! Patients can now receive a high carbohydrate drink up to 2h before surgery.

So how can a dietitian help? A dietitian can do an assessment of your nutritional status and give advice for weight gain or weight loss. In certain cases the dietitian can help you to improve you immune system before surgery. These measures have been shown to improve outcomes after surgery. After surgery the dietitian is able to compile a nutrition care plan to optimize your intake after surgery. Since every type of surgery has different requirements, the plan may include feeding via a feeding-tube or specialized feeding directly into the blood stream (parenteral nutrition) or just additional sip feeds to achieve energy and protein targets, immune-enhancing nutrition and various other measures. The dietitian will also keep an eye on food-medication interactions to make sure you get the full benefit of the medication prescribed.

The key is a healthy lifestyle before surgery: stop smoking, do exercise if allowed by your doctor, reduce or stop alcohol intake and follow a healthy diet or a diet appropriate to your disease.

General guidelines for pre-surgery nutrition include:

ANTIOXIDANTS

After surgery the body produces a lot of free radicals (toxic byproducts). They do good work, such as killing invading microbes, but in excess free radicals can harm the body. So we want to make sure you have a lot of defences on board to neutralize the excess free radicals. Foods with a high antioxidant content are identifiable by their bright yellow, red and orange colours. Most fruits and vegetables are high in antioxidants, particularly berries, carrots, broccoli, tomatoes, spinach, red grapes and nuts. Vitamin C and zinc, two of the antioxidants, also play a role in wound healing and can be found in citrus fruits (vitamin C) and oysters, beef, lamb wheat-germ (zinc).

PROTEIN

Protein in necessary for wound healing and optimal function of the immune system. Eat lean proteins such as low fat or fat free dairy products, lean meat and chicken, fish, eggs, legumes and nuts. Dairy products are also rich in calcium. Fish contains omega-3 fatty acids which are beneficial for the immune system and also has a blood thinning effect. Nuts are rich in mono-unsaturated fatty acids.

WOUND HEALING

A whole lot of nutrients are necessary for wound healing, such as vitamin C, zinc, protein, vitamin A and many more. Eat a variety of fruit, vegetables, lean protein, seafood and whole wheat products.

WATER

Water is necessary to keep our cells hydrated and to help the kidneys excrete waste products. Both before and after surgery sufficient water intake is essential.

WHAT NOT TO EAT

Avoid foods that can increase inflammation and suppress the immune system such as refined carbohydrates (e.g. sugar, white flour), saturated fats (animal fats), trans fatty acids (fried food, junk food and commercially prepared biscuits, cakes and pastries) and alcohol.

Arina Prins

(SASPEN President - on behalf SASPEN Council


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