Perioperative nutrition: what do we know?

Surgery patients are at risk for iatrogenic malnutrition and subsequent deleterious effects. The benefits of nutrition support on patient outcomes have been demonstrated and the possible benefit of perioperative nutrition support thus implied. Enhanced recovery after surgery (ERAS) protocols, including perioperative nutrition support as a component thereof, is indicated in the management of patients. In contrast to this, it seems the current trend is to follow the traditional perioperative management even when existing data demonstrate no merit in continuing with these practices. Data suggests that all surgical patients should receive early postoperative nutrition support. Immunonutrition, as part of ERAS has also been reported to derive beneficial effects in surgery patient outcomes but current clinical practice guidelines are inconsistent with regards to the administration of specific immunonutrients. Arginine is an immunonutrient that is of specific interest in surgical patients due to an assumed deficiency thereof. Insufficient arginine levels can lead to immunosuppression with an increased risk for complications. Available evidence indicates that all patients undergoing elective surgery with substantial risk of infectious complications should be prescribed arginine-supplemented diets along with omega-3 fatty acids, preferably pre- and postoperatively. No recommendations can be made on the practice of combined glutamine and arginine supplementation.