Comprehensive Nutritional Care for Surgical Patients

IG patients were consulted (at least once pre- and postoperatively) for detailed nutritional counseling, which lasted approximately 45 min. However, a few additional counseling sessions were also provided at the request of physicians. Nutritional history, including anthropometric data, such as weight, disease-related weight loss, and height, was obtained by the dietitian. Quantitative and qualitative food intake, appetite, and gastrointestinal symptoms were also asked. In case of persistent nutritional problems, such as low food intake or malnutrition, high-caloric fluid supplements (2–3 potions (200 mL) per day with 2.0 kcal/mL) and enteral or parenteral nutrition were prescribed. In addition to the changes in nutritional physiology and/or possible complications from the surgery, some practical recommendations to avoid gastrointestinal symptoms, the risk of malnutrition, possible symptoms of dumping syndrome, the necessity of pancreatic enzyme supplementation, and possible lactose intolerance were also discussed. We also calculated the energy requirements and derived a recommendation for protein intake, weight maintenance, and weight gain, respectively. The total energy expenditure was calculated as 25–30 kcal/kg body weight per day, depending on patient activity, and recommended protein intake was calculated as 1.2–1.5 g/kg body weight per day, according to DGEM and ESPEN guidelines [1 (link),2 (link)]. Additionally, each patient received written nutritional recommendations related to surgery or individual symptoms, and the contents of the nutritional therapy were documented in the electronic medical record. A standard stepwise introduction to a full diet was further provided to the patients in accordance with the Enhanced Recovery after Surgery (ERAS) Standard Operating Procedure (SOP). All patients received supportive parenteral nutrition (SMOF lipid at 2200 kcal/d) for at least the first 4 postoperative days. All parts of nutritional therapy followed the recommendations of standardized clinical practice guidelines from DGEM and ESPEN. It is worth mentioning that the postoperative nutritional treatment was comparable in both study groups.