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Clinical nutrition, enteral and parenteral nutrition

Compliance with preoperative oral nutritional supplements in patients at nutritional risk─only a question of will?

European Journal of Clinical Nutrition volume 69, pages 525–529 (2015)Cite this article

Subjects

Abstract

Background/Objectives:

Preoperative nutrition has been shown to reduce morbidity after major gastrointestinal (GI) surgery in selected patients at risk. In a randomized trial performed recently (NCT00512213), almost half of the patients, however, did not consume the recommended dose of nutritional intervention. The present study aimed to identify the risk factors for noncompliance.

Subjects/Methods:

Demographic (n=5) and nutritional (n=21) parameters for this retrospective analysis were obtained from a prospectively maintained database. The outcome of interest was compliance with the allocated intervention (ingestion of ⩾11/15 preoperative oral nutritional supplement units). Uni- and multivariate analyses of potential risk factors for noncompliance were performed.

Results:

The final analysis included 141 patients with complete data sets for the purpose of the study. Fifty-nine patients (42%) were considered noncompliant. Univariate analysis identified low C-reactive protein levels (P=0.015), decreased recent food intake (P=0.032) and, as a trend, low hemoglobin (P=0.065) and low pre-albumin (P=0.056) levels as risk factors for decreased compliance. However, none of them was retained as an independent risk factor after multivariate analysis. Interestingly, 17 potential explanatory parameters, such as upper GI cancer, weight loss, reduced appetite or co-morbidities, did not show any significant correlation with reduced intake of nutritional supplements.

Conclusions:

Reduced compliance with preoperative nutritional interventions remains a major issue because the expected benefit depends on the actual intake. Seemingly, obvious reasons could not be retained as valid explanations. Compliance seems thus to be primarily a question of will and information; the importance of nutritional supplementation needs to be emphasized by specific patients’ education.

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Acknowledgements

This study was presented at the Annual Swiss Surgical Meeting during 12–14 June, 2013, in Bern, Switzerland.

Author Contributions

Study conception and design: M Hübner, F Grass, P Coti Bertrand and N Demartines. Acquisition of data: P Coti Bertrand, M Hübner, F. Grass and Y Cerantola. Analysis and interpretation of data: P. Ballabeni, M Hübner, F. Grass, P Coti Bertrand, M Schäfer and N Demartines. Drafting of manuscript: F Grass, M Hübner, M Schäfer, P Coti Bertrand, N Demartines and Y Cerantola. Critical revision of manuscript: all authors

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Authors and Affiliations

  1. Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland

    F Grass, M Schäfer, N Demartines & M Hübner

  2. Clinical Nutrition Unit, University Hospital CHUV, Lausanne, Switzerland

    P C Bertrand

  3. Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland

    P Ballabeni

  4. Department of Urology, University Hospital CHUV, Lausanne, Switzerland

    Y Cerantola

Authors
  1. F Grass
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  2. P C Bertrand
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Correspondence to N Demartines.

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The authors declare no conflict of interest.

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Grass, F., Bertrand, P., Schäfer, M. et al. Compliance with preoperative oral nutritional supplements in patients at nutritional risk─only a question of will?. Eur J Clin Nutr 69, 525–529 (2015). https://doi.org/10.1038/ejcn.2014.285

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  • DOI: https://doi.org/10.1038/ejcn.2014.285

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