Nutritional prehabilitation: physiological basis and clinical evidence

Area of Science:

• Nutrition science
• Surgical outcomes
• Metabolic physiology

Background:

• Surgical stress and fasting induce insulin resistance, impacting patient recovery.
• Perioperative insulin resistance correlates with increased morbidity.
• Nutritional prehabilitation aims to mitigate these negative effects.

Purpose of the Study:

• To review the physiological basis of nutritional prehabilitation.
• To evaluate the clinical evidence for preoperative carbohydrate loading and amino acid supplements.
• To assess their role in enhanced recovery after surgery (ERAS) programs.

Main Methods:

• Narrative review of existing literature.
• Analysis of physiological mechanisms linking nutrition and surgical stress.
• Evaluation of clinical trial data on nutritional interventions.

Main Results:

• Preoperative carbohydrate loading attenuates insulin resistance and improves postoperative muscle function.
• Carbohydrate loading is safe and enhances patient well-being.
• Current evidence does not demonstrate significant effects on hospital stay or complication rates.

Conclusions:

• While safe and beneficial for well-being, carbohydrate loading's impact on key clinical outcomes needs further investigation before routine ERAS integration.
• The role of amino acid supplements in perioperative nutrition remains poorly defined.
• Heterogeneity in studies hinders definitive conclusions on nutritional interventions.