World J Gastrointest Surg. 2016 Jul 27;8(7):521-32. doi: 10.4240/wjgs.v8.i7.521.
Benefits of post-operative oral protein supplementation in gastrointestinal surgery patients: A systematic review of clinical trials.
World journal of gastrointestinal surgery
Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne
Affiliations
Affiliations
- Mike Crickmer, Colum P Dunne, Andrew O'Regan, J Calvin Coffey, Suzanne S Dunne, Graduate Entry Medical School, University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
PMID: 27462395
PMCID: PMC4942753 DOI: 10.4240/wjgs.v8.i7.521
Abstract
AIM: To evaluate published trials examining oral post-operative protein supplementation in patients having undergone gastrointestinal surgery and assessment of reported results.
METHODS: Database searches (MEDLINE, BIOSIS, EMBASE, Cochrane Trials, Cinahl, and CAB), searches of reference lists of relevant papers, and expert referral were used to identify prospective randomized controlled clinical trials. The following terms were used to locate articles: "oral'' or "enteral'' and "postoperative care'' or "post-surgical'' and "proteins'' or "milk proteins'' or "dietary proteins'' or "dietary supplements'' or "nutritional supplements''. In databases that allowed added limitations, results were limited to clinical trials that studied humans, and publications between 1990 and 2014. Quality of collated studies was evaluated using a qualitative assessment tool and the collective results interpreted.
RESULTS: Searches identified 629 papers of which, following review, 7 were deemed eligible for qualitative evaluation. Protein supplementation does not appear to affect mortality but does reduce weight loss, and improve nutritional status. Reduction in grip strength deterioration was observed in a majority of studies, and approximately half of the studies described reduced complication rates. No changes in duration of hospital stay or plasma protein levels were reported. There is evidence to suggest that protein supplementation should be routinely provided post-operatively to this population. However, despite comprehensive searches, clinical trials that varied only the amount of protein provided via oral nutritional supplements (discrete from other nutritional components) were not found. At present, there is some evidence to support routinely prescribed oral nutritional supplements that contain protein for gastrointestinal surgery patients in the immediate post-operative stage.
CONCLUSION: The optimal level of protein supplementation required to maximise recovery in gastrointestinal surgery patients is effectively unknown, and may warrant further study.
Keywords: Clinical trial; Gastrointestinal surgery; Oral supplementation; Protein supplementation; Systematic review
References
- Lancet. 1983 Jan 22;1(8317):143-6 - PubMed
- N Engl J Med. 1991 Aug 22;325(8):525-32 - PubMed
- Am J Clin Nutr. 1988 Feb;47(2 Suppl):352-6 - PubMed
- Clin Nutr. 1992 Dec;11(6):337-44 - PubMed
- Clin Nutr. 2012 Dec;31(6):817-30 - PubMed
- J Pediatr Health Care. 2011 Jan-Feb;25(1):1-2 - PubMed
- J Am Diet Assoc. 2004 Aug;104(8):1258-64 - PubMed
- Stroke. 1996 Oct;27(10):1812-6 - PubMed
- Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001880 - PubMed
- Clin Nutr. 2010 Oct;29(5):574-9 - PubMed
- Gut. 2000 Jun;46(6):813-8 - PubMed
- Cochrane Database Syst Rev. 2012 Nov 14;11:CD008879 - PubMed
- Arch Surg. 2009 Oct;144(10):961-9 - PubMed
- Proc Nutr Soc. 2007 Aug;66(3):378-83 - PubMed
- Nutrition. 1996 Jan;12(1):23-9 - PubMed
- Gut. 1997 Mar;40(3):393-9 - PubMed
- Eur J Surg Oncol. 1990 Aug;16(4):326-31 - PubMed
- Age Ageing. 2013 Jan;42(1):39-45 - PubMed
- Br J Surg. 2004 Aug;91(8):983-90 - PubMed
- Nutrition. 1997 May;13(5):422-30 - PubMed
- Cochrane Database Syst Rev. 2010 Jun 16;(6):CD001706 - PubMed
- Surg Today. 2002;32(8):672-8 - PubMed
- Nutrition. 2000 Sep;16(9):723-8 - PubMed
- J Invest Surg. 2010 Dec;23(6):309-13 - PubMed
Publication Types