Nutritional Support and Recovery: Lesson Learned from ERAS

Malnutrition is a widespread problem in the frail and older population and to a greater extent in those individuals undergoing surgery. They are addressed by the application of Enhanced Recovery After Surgery (ERAS) protocol, an integrated, multidisciplinary approach developed to optimize perioperative care and reduce trauma, physiological stress, and organ dysfunctions induced by surgery. The ERAS protocol involves the patient and the hospital team (including surgeons, anesthesiologists, nursing staff, nutritionists, dietitians, and physical and occupational therapists) and encompasses the three different surgical phases (pre, intra, and post). From a metabolic nutritional perspective, ERAS programs provide minimal preoperative fasting, carbohydrate loading, early resumption of normal solid diet, and early mobilization. There is wide evidence that these practices are associated with reduced surgical stress response, as well as reduced morbidity, length of stay, and hospitalization costs.