As the saying goes, “Before the army moves, the food goes first”. The “army” is the body’s immune cells, and the “food” is the nutrients. The study showed that for patients with preoperative malnutrition, 1-2 weeks of nutritional support can reduce the occurrence of many postoperative complications, promote wound healing, and shorten the length of hospital stay.
The Nutrition Guidelines for Oncology Patients, developed by the Chinese Anti-Cancer Society and the European Society for Enteral and Parenteral Nutrition, recommend that oncology patients should receive assessment and personalized dietary guidance from a clinical nutrition professional once diagnosed. If nutritional risk or malnutrition is identified, intervention or treatment should be initiated as early as possible to maintain or improve nutritional status and improve patient tolerance and efficacy of treatment.
Next, let’s take a look at a case study to “replay” what requires preoperative nutritional intervention. How do you do it?
Brief history
Mr. Wang noticed mild swallowing difficulties 2 months ago. At first, he did not take it seriously, but his symptoms gradually worsened and he had difficulty swallowing any slightly hard food.
At the urging of his family, he came to Peking University Cancer Hospital for a gastroscopy and pathological biopsy, and the diagnosis was early esophageal cancer. The doctor advised him to have surgery as soon as possible.
Nutritional screening and assessment
Along with the treatment plan, the doctor screened Wang for nutritional risk. It was found that he had significantly decreased eating for more than a week, had lost >5% of his body weight in the last 3 months, and had a nutritional risk screening score of 3, suggesting a nutritional risk. As a result, Mr. Wang was referred to the nutrition clinic for preoperative nutritional intervention first.
The dietitian performed a comprehensive nutritional assessment through history taking, dietary survey, nutritional screening, and hematology, combined with a standard nutritional assessment scale.
1. The nutritional assessment form showed that Mr. Wang had moderate malnutrition;
2. The medical history revealed that the main cause of his malnutrition was reduced food intake due to swallowing difficulties;
3. A 24-hour dietary survey showed that his daily food intake for the past 2 weeks was more than 1/3 less than the target nutrient intake;
4. Hematologic examination revealed that plasma albumin and prealbumin were below normal values, and a preliminary determination of protein nutritional deficiency was made;
5.
5. Nutritional examination, including height, weight, body composition analysis, upper arm muscle circumference, and positive signs of malnutrition, of which the main indicator, body mass index (BMI), was 20.5, within the normal range (18.5 to 23.9).
Despite not looking too thin and having a normal BMI, the doctor concluded that Wang had lost more weight and his food intake was less than his target, so he could still be diagnosed as malnourished.
Taken together, these assessment findings lead to a nutritional diagnosis of moderate to severe or higher nutritional risk due to swallowing dysfunction and decreased appetite, as well as energy-protein malnutrition, which requires nutritional therapy as soon as possible.
Accordingly, the dietitian developed an individualized dietary nutrition program for Mr. Wang.
Developing a dietary nutrition plan and standardizing treatment
Because of the difficulty in swallowing, the dietitian advised Mr. Wang to make a “homogenized meal” of food to facilitate swallowing. The lack of intake can be supplemented by oral intake of special medical food (“special medical food”).
Mr. Wang had a few questions at this point: How do you make a “homogenized meal”?
What is “special medical food”?
Nutritionist says:
Homemade homemade meals can be made from rice porridge, eggs, lean meat, tofu, young leafy vegetables and other food ingredients, cooked and then beaten into a homemade paste with a wall-breaker, with the appropriate addition of oil and salt. After the production is completed, it should be consumed as soon as possible, preferably eaten now. If you can’t finish it, put it in the refrigerator in time. If you are not able to finish it, you should put it in the refrigerator. If you leave it at room temperature for more than 4 hours, the nutrients will be easily oxidized and may be contaminated by bacteria.
“Special medical foods” are specially formulated to meet the nutrient or dietary needs of certain groups of people. This includes people with limited access to food, digestive and absorption disorders, metabolic disorders, or specific disease states. These products must be consumed alone or in combination with a daily diet under the guidance of a physician or clinical nutritionist.
During the time he was waiting for a bed, Mr. Wang followed the nutrition protocol developed by the dietitian at home and saw the nutrition clinic again 1 week later, having gained 1 kg.
The dietitian again performed a dietary nutritional assessment, which showed that energy intake was generally on target and protein-based food intake was still inadequate. The dietitian readjusted his nutritional regimen to include an additional 20 g of whey protein powder daily.
After 2 weeks, Mr. Wang continued to gain weight. A repeat nutritional assessment showed significant improvement in his nutritional status, and his weight and labs were in compliance. The dietitian gave a recommendation in the outpatient chart that “the next step in the fight against cancer can be taken. The surgeon followed the dietitian’s recommendation and admitted Mr. Wang to the hospital for surgery.
Nutritional status improves, surgery goes smoothly
Mr. Wang underwent the surgery without any problems. After surgery, the dietitian continued to monitor his follow-up through consultations and, together with his supervising physician, developed a postoperative enteral parenteral nutrition support program during the dietary transition. The dietitian also gave him regular dietary instructions, such as eating smaller and more frequent meals, not going to bed immediately after eating, and moderate activity after meals.
During this time, he did not lose any significant weight, which ensured the smooth implementation of the treatment. 2 weeks later, Mr. Wang was discharged from the hospital with a successful recovery.
For more postoperative dietary guidance, read: