The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery.

Background: Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.

Residual gastric volume after 3 h of the ingestion of an oral supplement containing carbohydrates alone or associated with whey protein: a randomized crossover pilot study.

Background: New formulas including a nitrogenous source to maltodextrin have been reported as preoperative beverages 2-3 h before anesthesia in the elective procedure. Whey protein is a potential candidate for the composition of this clear oral supplement. This study aimed to investigate the gastric residual volume (GRV) of healthy volunteers 3 h after the ingestion of an oral supplement containing carbohydrates (CHO) alone or combined with whey protein (WP).

Extending the benefit of nutrition intervention beyond the operative setting.

Purpose Of Review: To provide an update of the recent evidence on the potential of perioperative nutritional interventions to benefit adult patients undergoing head and neck and digestive procedures.

Recent Findings: Perioperative nutrition within multimodal prehabilitation programs improve postoperative outcomes. Perioperative fasting time can be reduced with beverages containing carbohydrate alone or blended with a nitrogenous source such as whey protein; this approach seems to be safe and improve outcome.

COST-EFFECTIVENESS OF THE USE OF ACERTO PROTOCOL IN MAJOR DIGESTIVE SURGERY.

Objective: Hospital costs in surgery constitute a burden for the health system in all over the world. Multimodal protocols such as the ACERTO project enhance postoperative recovery. The aim of this study was to analyze the hospital costs in patients undergoing major digestive surgical procedures with or without the perioperative care strategies proposed by the ACERTO project.

ACERTO Project - 15 years changing perioperative care in Brazil.

The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs.

Effectiveness of adductor pollicis muscle thickness as risk marker for sarcopenia in Central-West Brazilian elderly communities.

Objectives: The aim of this study was to determine sensitivity, specificity, and best cutoff point for adductor pollicis muscle thickness (APMT) for diagnosis of sarcopenia in elderly community centers.

Methods: This was a cross-sectional study comprising 321 elderly individuals from four community centers in Cuiabá, Central-West region of Brazil. The main outcome variables were calf circumference (CC; cm) and the APMT (mm).

Hypophosphatemia and risk of refeeding syndrome in critically ill patients before and after nutritional therapy.

Objective: To investigate the prevalence of hypophosphatemia as a marker of refeeding syndrome (RFS) before and after the start of nutritional therapy (NT) in critically ill patients.

Methods: Retrospective cohort study including 917 adult patients admitted at the intensive care unit (ICU) of a tertiary hospital in Cuiabá-MT/Brasil. We assessed the frequency of hypophosphatemia (phosphorus <2.

Major oncological surgery reduces muscular function in patients with or without nutritional risk.

Objectives: to investigate the impact of oncological surgical procedures on the muscle function of patients with and without nutritional risk.

Methods: cross-sectional study conducted with cancer patients undergoing major operations between July 2018 to March 2019 in Cuiabá, Mato Grosso, Brazil. Patients were assessed preoperatively for the nutritional risk by the Nutricional Risk Screening-2002, and handgrip strength (FPP) was assessed both on the pre- and 2nd and 5th postoperative days (PO).

Intravenous overload of fluids and sodium may contribute to the lower infusion of enteral nutrition in critically ill patients.

Objective: To evaluate the effects of intravenous infusion of fluids and sodium on the first day of admission on infusion of enteral nutrition in the first 5 days in intensive care patients.

Methods: A prospective cohort study was conducted with critical nonsurgical patients admitted for at least 5 days who were on mechanical ventilation and receiving enteral nutrition. The amount of intravenous fluids and sodium infused on the first day and the volume of enteral nutrition infused in the first 5 days were investigated.

ACERTO guidelines of perioperative nutritional interventions in elective general surgery.

Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures.

Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies.

[Not Available].

Objective: We investigate the influence of caloric and protein deficit on mortality and length of hospital stay of critically ill patients.

Methods: A cohort prospective study including 100 consecutive patients in a tertiary intensive care unit (ICU) receiving enteral or parenteral nutrition. The daily caloric and protein deficit were collected each day for a maximum of 30 days.

Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study.

Background: Prolonged fasting increases organic response to trauma. This multicenter study investigated the gap between the prescribed and the actual preoperative fasting times in Brazilian hospitals and factors associated with this gap.

Methods: Patients (18-90-years-old) who underwent elective operations between August 2011 and September 2012 were included in the study.

Shrinking preoperative fast time with maltodextrin and protein hydrolysate in gastrointestinal resections due to cancer.

Objective: Prolonged preoperative fasting increases postoperative hospital length of stay and current evidence recommends patients drink a carbohydrate-based liquid drink 2 h before surgery. The aim of this study was to investigate whether the addition of hydrolyzed protein to a carbohydrate-based drink would reduce both the inflammatory response and hospital length of stay.

Methods: We evaluated 22 patients of both sexes, undergoing gastrointestinal resection due to cancer.

Ingestion of glutamine and maltodextrin two hours preoperatively improves insulin sensitivity after surgery: a randomized, double blind, controlled trial.

Objective: To investigate whether the abbreviation of preoperative fasting with a drink containing glutamine and dextrinomaltose improves organic response to surgical trauma.

Methods: Thirty-six female patients adult (18-62 years) candidates for elective laparoscopic cholecystectomy were randomly divided into three groups: conventional fasting (fasting group), and two groups receiving two different diets, eight hours (400ml) and two hours before induction of anesthesia (200ml): carbohydrate (CHO) group (12.5% dextrinomaltose) and the glutamine (GLN) group (12.

Evaluation of the effects of a preoperative 2-hour fast with maltodextrine and glutamine on insulin resistance, acute-phase response, nitrogen balance, and serum glutathione after laparoscopic cholecystectomy: a controlled randomized trial.

Background: Prolonged preoperative fasting increases insulin resistance (IR). The authors investigated whether an abbreviated preoperative fast with glutamine (GLN) plus a carbohydrate (CHO)-based beverage would improve the organic response after surgery.

Methods: Forty-eight female patients (19-62 years) were randomized to either standard fasting (control group) or to fasting with 1 of 3 different beverages before video-cholecystectomy.

Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial.

Background: Prolonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.

Methods: Seventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation.

Early enteral nutrition with whey protein or casein in elderly patients with acute ischemic stroke: a double-blind randomized trial.

Objective: The aim of this study was to investigate the effects of an early enteral formula containing whey protein, in comparison to a standard enteral formula containing casein as the protein source, on the levels of glutathione and inflammatory markers in aged patients with acute ischemic stroke.

Methods: Thirty-one elderly patients (12 males and 19 females; median age = 74 [range,65-90] y old) with ischemic stroke were randomized to receive early nasogastric feeding (35 kcal/kg/d and 1.2 g of protein/kg/d) with either a formula containing polymeric [corrected] casein (casein group, n =16) or another isocaloric and isonitrogenous formula containing hydrolyzed whey protein (WP group, n = 15) for 5 d.

Reducing preoperative fasting time: A trend based on evidence.

Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma.

[Adductor pollicis muscle thickness: a fast and reliable method for nutritional assessment in surgical patients].

Objective: Investigate whether the right adductor pollicis muscle thickness is a reliable method to evaluate the nutritional status of surgical patients and whether it correlates or not correlate to other anthropometric, biochemical, and clinical parameters.

Methods: Cross-sectional study evaluating 87 patients candidates to major operations of the gastrointestinal tract. All were submitted to global subjective evaluation, traditional anthropometry (arm circumpherence ; triceps skin fold; and arm muscle circumpherence, serum albumin, lymphocytes and measurement of in both hands.