Tang Xian Hui 1, Nurulainin Sofia Binti Hussin 2
1Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur
2Department of Dietetics and Food Service, Hospital Tuanku Ja’afar, Negeri Sembilan
Background: Cancer surgery causes a metabolic stress response as protein catabolism is present for healing, immune response, and functional recovery.
Assessment: Ms. R, a 33-year-old female, undergone an elective open midline laparotomy, salpingo-oophorectomy, omentectomy, and appendectomy for ovarian tumour stage IA. She was obese class III (BMI 56.1kg/m2) with underlying type 2 diabetes mellitus and young hypertension treated with medications. She had low intake from general anesthesia side effects. Despite having normal blood counts and glucose levels, there is an increased muscle breakdown noted from the low creatinine (61mmol/l), which may delay the cascades of wound healing.
Inadequate protein-energy intake related to decreased ability to consume sufficient nutrients due to post-surgical condition as evidenced by estimated intake past 24 hours of approximately 758kcal (45% energy requirement, ER) and 22g protein (20% protein requirement, PR).
To promote positive nitrogen balance to counteract the muscle catabolism and wound healing, the energy (1700kcal) and protein (122g) requirement was calculated using ideal body weight (IBW) 81kg. Therefore, a high protein, low sodium, carbohydrate-modified diet, and a collagen-peptide-based oral nutrition supplement (ONS) were prescribed.
Monitoring & Evaluation
Monitoring and Evaluation: Intake gradually improved to achieving 55% ER, 74% PR, with no signs of gastrointestinal intolerance. To ensure compliance, the importance of adequate protein and energy for optimal healing and functional recovery was educated. To monitor dietary intake, creatinine levels, full blood counts, and glycemic levels.
Discussion: Wound healing requires adequate energy and protein to overcome the catabolic state precipitated from surgery. ONS was initiated immediately after surgery to benefit postoperative recovery, assisting patients in achieving the requirement within five to seven days post-surgery. Collagen-peptide-based protein supplement was used for easier digestion and absorption, providing hydrolysed peptides for wound healing during the postoperative phase.