ABSTRACT
Perioperative nutrition support has remained a controversial issue in nutrition circles. While malnutrition increases the risk of postoperative complications and death in surgical patients, it may be malnutrition-associated immunosuppression, more than malnutrition, that underlies poor outcome statistics. The beneficial effects of providing nutrient components enterally is greater than the sum of their individual effects. This "nutritional potentiation" seems to be specific to enteral therapy, although the mechanism is unclear. When parenteral nutrition therapy is necessary, it should be used as an adjunctive measure until full enteral support is achieved. Use of perioperative parenteral therapy has been shown to be beneficial in only a select group of patients and, therefore, should be used discriminantly. Feeding nutrients in quantities sufficient to support the patient's metabolic state without over- or underfeeding will decrease the undesirable side-effects associated with inappropriate nutrient provision and will maximize nutrition's beneficial effects on patient outcome.
