Abdullah AW, Muhammad Nazirul Asri BH, Nur Adilah MB, & Zulfitri Azuan MD. 


Department of Dietetics, Hospital Pengajar Universiti Putra Malaysia



Background: Nutrition is a cornerstone in perioperative care to attenuate stress and mitigate the impact of postoperative catabolism following a major surgery. Therefore, we epitomize the role of perioperative nutrition optimization for a malnourished patient.


Nutrition Assessment: Mrs. S, 71 years old Malay female was electively admitted for recto-sigmoid cancer operation, with underlying diseases of diabetes mellitus and hypertension. Patient was underweight for elderly (BMI 21 kg/m2), and had experienced severe weight loss (24% in less than 6 months). Hypoglycemia, hypoalbuminemia and electrolyte imbalance were not present. Patient was moderately malnourished (SGA score B) with loss of appetite since one month ago. In ward, she consumed 30% of energy and 0.6 g/kg BW of protein intake from hospital diet.



Inadequate protein energy intake related to reduce ability to consume sufficient nutrients as evidence by severe weight loss, underweight for elderly, and 30% of energy and 0.6 g/kg BW of protein intake.



Energy and protein requirement (ESPEN) were 30 kcal/kg (1560 kcal) and 1.2 g/kg BW, respectively. The goals were to achieve >50% of energy and protein adequacy within 7 days of postoperative period by prescribing diabetes specific formula with oral intake optimization. Prolonged preoperative fasting was not recommended and early postoperative oral intake initiation was suggested.


Monitoring & Evaluation

Energy (64%) and protein (63%) intake goals were achieved at POD4. Patient was discharged on the 8th day of admission (POD5) with low level of inflammation and well controlled blood glucose level.


Learning points:

i) Correction of undernutrition before surgery and maintenance of nutritional status after surgery are beneficial to attenuate morbidity, length of hospital stays and mortality.

ii) The incorporation of early postoperative oral intake and reduced duration of preoperative fasting is crucial in to obtain the beneficial outcomes.