Perioperative nutritional status

Perioperative nutritional status is closely linked to the development of postsurgical complications, infectious and non-infectious, and mortality. In the Spanish multicenter study Prevalence of Malnutrition and Associated Costs (PREDyCES), the prevalence of malnutrition in surgical patients was established at 10%. 
However, these rates are increased in oncological surgeries in thoracic locations (lung, stomach, esophagus), head and neck, etc.

In this group of patients, the perioperative malnutrition is caused in most cases by decreased intake and metabolic changes (increased basal metabolism, insulin resistance, lipolysis or proteolysis) caused mainly by the systemic inflammatory response syndrome and catabolic factors derived from the oncological disease, all of which effects will be increased in the post-surgical period due to the aggression and metabolic stress that the intervention entails.
Immunomodulatory formulas are complete diets that contain nutrients that have demonstrated a benefit on the patient's immune status, improving the patient's clinical evolution. These immunomodulatory nutrients are: arginine, omega-3 fatty acids (EPA and DHA) and nucleotides.
The benefits demonstrated by immunomodulatory formulas are:
- Reduction in the risk of developing surgical fistulas
- Reduction of surgical complications
- Reduction of infectious complications
- Reduction of hospital stay

The ESPEN and ASPEN guidelines recommend its use in the days before surgery (5-7 days) and in the postoperative period (7-10 days) in patients with head and neck and upper digestive cancer. There is evidence about its benefits in the perioperative period of colorectal cancer.
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