Ho Chiou Yi 1,2, Zuriati Ibrahim 1,*, Zalina Abu Zaid 1, Zulfitri 'Azuan Mat Daud 1, and Nor Baizura Md Yusop 1, Mohd Norazam Mohd Abas 3, Jamil Omar 3
1 Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Seri Kembangan, Selangor, Malaysia
2 Department of Dietetics and Food Service, National Cancer Institute, 4, Jalan P7, Presint 7, 62250 Putrajaya, Ministry of Health, Malaysia
3 Department Surgical Oncology, National Cancer Institute, 4, Jalan P7, Presint 7, 62250 Putrajaya, Ministry of Health, Malaysia
Surgery-related stress and inadequate post-operative dietary intake might cause prolong convalescence. The optimal post-operative dietary intake promotes wound healing and ensures a better surgical outcome. This analysis aims to determine the post-operative dietary intake achievement and factors of early dietary intake achievement (EDIA) in gynecologic cancer patients.
This secondary analysis included 118 participants from the RCT. Post-operative dietary data were pooled and re-categorized into EDIA (daily energy intake (DEI) ≥75% from the estimated energy requirement (EER)) and delayed dietary intake achievement (DDIA) (DEI <75% EER).
Results & Discussion
The secondary analysis shows EDIA better in preserved weight (p=0.002), muscle mass (p=0.018), handgrip strength (p=0.010), and greater post-operative daily energy and protein intake from operation day to discharged (p=0.000 and p=0.036) as compared to DDIA after surgery. There were four significant independent EDIA factors including preoperative whey protein-infused carbohydrate loading (p=0.000), post-operative nausea vomiting (PONV) (p=0.001), age (p=0.010), and time to tolerate clear fluid (p=0.016). The multilinear regression model significantly predicted EDIA, F (4,116) = 68.013, p=0.000, adj. R2 =0.698.
EDIA preserve body composition and functional status by minimizing glycogen breakdown, glucose synthesis from protein or fat and fat oxidation. The perioperative nutrition approaches in the ERAS protocol (preoperative CHO loading and post-operative early oral feeding), PONV management, and age showed a greater impact on the post-operative dietary intake than preoperative malnutrition. Perioperative intensive individualized nutritional management is crucial to optimize energy protein intake and preserved nutritional status. Post-discharged intensive individualized nutritional management with integration of oral nutrition supplement is crucial to be provided and explained to the patients and caregiver in order to achieve energy protein requirement and promote post-operative recovery. With the four EDIA factors recognition, the creation of better multidisciplinary patient-centered ERAS approaches should include more precise and detailed individualized intensive nutrition management to aid post-operative functional recovery.