Dietary Considerations and Nutritional Strategies to Enhance Recovery After Cardiac Surgery: A Comprehensive Review

The metabolic and inflammatory burden of cardiac surgery results in increased protein catabolism, elevated energy expenditure and thereby a consequent increased risk of postoperative complications. Therefore, it is imperative to optimise nutritional status preoperatively and postoperatively to ameliorate these effects on wound healing, immune function, and recovery of the myocardium, in addition to other clinical outcomes. Despite its benefits, structured perioperative nutritional care is rarely undertaken. In this narrative review, we will summarise contemporary literature (2017-2026) and international guideline recommendations to outline phase-specific nutritional strategies for patients undergoing cardiac surgery. In the early postoperative period, early initiation of enteral nutrition, adequate protein provision (1.2-2.0 g/kg/day), and careful fluid and glycaemic management are critical to attenuate catabolic stress and reduce complications. During hospital recovery and discharge to home, emphasis should shift towards caloric adequacy, micronutrient optimisation-particularly vitamins C and D, zinc, and iron-and management of medication-related gastrointestinal effects. In the long-term phase, adoption of cardioprotective dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets supports secondary prevention and cardiovascular risk reduction. Elderly patients who are sarcopenic, individuals with diabetes mellitus or chronic kidney disease (CKD), overweight individuals and people on anticoagulation warrant special consideration. Integrating nutritional assessment and intervention into Enhanced Recovery After Cardiac Surgery (ERACS) pathways may help improve recovery trajectories and reduce morbidity. Further high-quality research should be conducted to define procedure-specific and individualised nutritional protocols in the cardiac surgical population.