Enteral nutrition in surgical patients

Malnutrition is common in patients admitted for surgery and is a major cause of increased morbidity and mortality. Nutritional support has been shown to be of help in reducing complications. Parenteral nutrition and commercially available enteral diets are expensive, so the efficacy of a 'home-brew' enteral diet was studied in such patients.

Forty malnourished patients, 20 with benign disease and 20 with malignancy, were administered a 'home-brew' enteral diet (1140 calories and 60 g protein per litre) perioperatively for 14 days. They received 2500 to 4000 calories per day according to their requirement. Weight, triceps skinfold thickness, midarm circumference, serum albumin and transferrin, absolute lymphocyte count and creatinine-height index were monitored on days 0, 7 and 14. Nitrogen balance was estimated on alternate days and the results of the two groups were compared.

Weight, skinfold thickness and midarm circumference did not change. Serum albumin levels showed a rise in the benign group by day 7, but the rise attained significance in the malignancy group by day 14. A similar pattern was observed in transferrin levels and there was a significant correlation (r = 0.652, p < 0.001) between albumin and transferrin levels. A positive nitrogen balance was attained earlier in the benign group (4.3 v. 5.8 days, p < 0.001). The creatinine-height index showed a rise in both groups by day 7 and a further rise by day 14. Diarrhoea was the commonest complication but was easily controlled with loperamide. The efficacy of the diet was evidenced by the improvement recorded in various objective nutritional parameters and complications were minimal.

This cost-effective diet may be used for nutritional support with good results in patients in India and other developing countries.