ESPEN guideline on clinical nutrition in surgery - Update 2025

Area of Science:

• Surgical Nutrition
• Perioperative Medicine
• Gastroenterology

Background:

• Malnutrition and underfeeding increase postoperative complication risks.
• Early oral feeding is preferred for surgical patients.
• Nutritional therapy is essential, particularly for upper gastrointestinal surgery patients.

Purpose of the Study:

• To provide guidelines on nutritional aspects of Enhanced Recovery After Surgery (ERAS).
• To address the nutritional needs of patients undergoing major surgery or developing severe complications.
• To integrate nutrition into perioperative management.

Main Methods:

• Development of 44 clinical practice recommendations.
• Inclusion of new recommendations for frailty, sarcopenia, and prehabilitation.
• Presentation of recommendations in decision-making flowcharts.

Main Results:

• Key perioperative aspects include early oral feeding, timely nutritional therapy, metabolic control, and early mobilization.
• Recommendations cover integration of nutrition, avoidance of prolonged fasting, and minimizing factors impairing gastrointestinal function.
• Guideline addresses both elective and non-elective surgical patients.

Conclusions:

• Optimized perioperative nutrition is vital for surgical patient outcomes.
• Early nutritional intervention and ERAS principles improve recovery.
• The guideline provides a framework for evidence-based nutritional care in surgery.