What dietary recommendations facilitate postoperative healing?

From the Guidelines

A protein-rich, nutrient-dense diet is optimal for healing after surgery, with a focus on early oral feeding and avoiding long periods of preoperative fasting. The key aspects of perioperative care include the integration of nutrition into the overall management of the patient, re-establishment of oral feeding as early as possible after surgery, and metabolic control, as stated in the ESPEN practical guideline: clinical nutrition in surgery 1. This approach supports healing by providing the building blocks for tissue repair, enhancing immune function, reducing inflammation, and maintaining proper hydration—all critical factors in the body's recovery process after surgical trauma.

Key Nutritional Recommendations

• Focus on consuming 1.2-2.0 grams of protein per kilogram of body weight daily through foods like lean meats, fish, eggs, dairy, legumes, and protein supplements if needed
• Include plenty of fruits and vegetables for their vitamin C and vitamin A, which support collagen formation and immune function
• Zinc-rich foods aid tissue repair, while omega-3 fatty acids help reduce inflammation
• Stay well-hydrated with 8-10 cups of fluid daily, limit sugar and processed foods that can increase inflammation, and avoid alcohol which can interfere with healing and medication effectiveness
• Small, frequent meals may be easier to tolerate than large ones, as recommended in the ESPEN guideline on hospital nutrition 1

Special Considerations

• Patients should be screened for nutritional status and, if deemed to be at risk of under-nutrition, given active nutritional support, as stated in the guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS) society recommendations 1
• For significantly malnourished patients, nutritional supplementation has the greatest effect if started 7-10 days preoperatively, and is associated with a reduction in the prevalence of infectious complications and anastomotic leaks
• Special nutritional considerations should be taken for elderly patients as well as those with chronic diseases and alcohol problems who may also have micronutrient deficiencies or ingest vitamins and minerals below recommended doses and who may need supplementation before and after surgery.

From the Research

Nutritional Requirements for Surgery Healing

• Nutrition plays an essential role in wound healing, as extra nutrients are needed for tissue repair and to restore losses through wound exudate 2
• Insufficient intake of energy, protein, antioxidants, and vitamin D can lead to delayed wound healing and dehiscence 2

Key Nutrients for Healing

• Proteins, amino acids (arginine, glutamine, and methionine), vitamins C and A, and zinc have been used as pharmacological nutrients in pressure ulcer healing 2
• Omega-3 fatty acids, although they appear to slow progression, do not show improved healing rates 2
• Arginine, glutamine, and β-hydroxy-β-methylbutyrate supplementation has shown wound healing benefits, but further evidence is needed to confirm these results 2

Perioperative Enteral Nutrition

• Perioperative enteral nutrition enriched with immune-modulating substrates is preferable for patients undergoing major abdominal cancer surgery 3
• However, a study found that immune-modulating nutrient-enriched enteral nutrition had no prominent immunomodulation effect compared to standard enteral nutrition 3

Immunonutritional Support

• Immunonutrition is an important part of nutritional treatment in patients with cancer, and can help reduce pro-inflammatory cytokines, shorten hospital stay, and improve nutritional status 4
• Arginine, glutamine, omega-3 fatty acids, nucleotides, pre- and probiotics have been shown to have positive effects on immune function and wound healing 5, 4, 6

Clinical Evidence

• A prospective study found that dietary arginine, glutamine, and omega-3 fatty acids supplementation improved nutritional and immunologic parameters in immunocompromised patients 6
• However, further clinical trials are necessary to clarify the necessity of using immunonutrition in critically ill patients 6