Effect of Oral Nutritional Supplements With Specialized Nutrients on Functional Recovery and Morbidity After Gastrointestinal Surgery

Study Overview
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Brief Summary
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Nutritional supplementation in postoperative recovery is still debated. Functional impairment is known to develop both secondary to inflammatory processes or secondary to reduced nutritional intake (e.g. disease induced anorexia). Since major surgery represents a traumatic event, surgical patients are at increased risk of malnutrition due to starvation, activation of neuroendocrine stress axis, inflammation and the subsequent increase in metabolic rate. Gastrointestinal surgery in particular can create additional problems as it often directly affects and limits dietary intake postoperatively and these effects frequently continue after discharge. Whereas manifest malnutrition occurs in about 15% of general surgical patients and in about 40% of oncology patients, postoperative weight loss of 5 to 9% occur in all surgical patients during the first two months. Moreover studies have shown that the nutritional status generally declines in hospital and both functional and nutritional status deteriorate for two months after discharge in malnourished surgical patients. Most studies that have investigated nutritional support in the surgical setting have concentrated on perioperative or short term postoperative supplementation and focussed on in-hospital infection and complication rate. Hypothesis I: Nutritional intake is decreased after surgery which results in an impaired nutritional status which in turn is associated with a decreased functional status. Protein rich nutritional supplementation is able to reverse nutritional depletion and restore functionality. Hypothesis II: Surgical stress leads to inflammation; inflammation - in addition to reduced nutritional intake - impairs functional status and increases morbidity. Anti-inflammatory, protein rich nutritional supplementation aims to prevent inflammatory complications and therefore improves functional status and reduces morbidity. In patients with high risk for inflammation, a higher effect of anti-inflammatory oral nutrition on recovery of functional status is expected. This study aims to determine whether 4 week oral nutritional supplementation and/ or specialized nutrients is effective in restoring functional status and reducing morbidity in surgical patients.

Conditions
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Patients Following Gastrointestinal Surgery

Intervention / Treatment
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* Dietary Supplement: Resource Support®
* Dietary Supplement: Resource Protein®
* Dietary Supplement: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who are > 50 years of age and < 80 years Patients who have signed a written Informed Consent (Appendix I) prior to admission to the study. Patients who have an ECOG performance status (presurgery) of 0, 1 or 2 (Appendix II). Patients able to orally consume 500 mL or more of liquid a day after adaption Patients undergoing elective gastrointestinal surgery [e.g. Colorectal surgery: colectomy, hemicolectomy, proctectomy; Small bowel resection/surgery; liver resection, splenectomy, non-whipple pancreatic surgery] Exclusion Criteria: Patients who are > 80 years of age and < 50 years Patients who have co-morbid conditions, uncontrolled metabolic conditions or psychiatric conditions that might make tolerance or evaluation of the feeding formula difficult; Patients undergoing Whipple´s procedure, gastrectomy, oesophageal resection Patients who get preoperative nutritional support Patients taking supplements (EPA, DHA) Any concomitant severe disease e.g. Patients with respiratory failure (FEV<0.8l/sec) Patients with renal failure (Cr > 3mg/dl or dialysis patients) Patients with hepatic dysfunction (Child >A) Patients with cardiac failure (NYHA > III) Patients suffering from an intestinal obstruction or ileus Patients with an Hb level of >8 g/dL experiencing gastrointestinal haemorrhaging Patients with HIV Patients requiring immunosuppression treatments Pregnancy Patients undergoing emergency surgery Other patients determined by a study investigator to be inappropriate for enrolment in this study

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Resource Support® Novartis | Dietary Supplement: Resource Support®<br> <br> |
| Active Comparator: 2<br>Resource Protein®, Novartis | Dietary Supplement: Resource Protein®<br> <br> |
| Placebo Comparator: 3<br> | Dietary Supplement: Placebo<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical Component Summary (from SF 36 Quality of life questionnaire) |  | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| hand grip strength |  | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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gastrointestinal surgery, nutritional intervention, functional status, quality of life