There is now a growing number of studies showing that supplementation in hospital prior to and after surgery not only speeds up recovery, saving a lot of pain and suffering and tens of thousands of dollars in hospital per person, but also assists post-operative healing and recovery outside the hospital. Benefits reported in the scientific literature include reduced inpatient episode cost, complication rates, depressive symptoms, and readmission rates, and improved lean body mass recovery and so much more. In fact, the nutritional status of patients on admission into hospital is a good predictor of their length of stay.(1)In one study, patients receiving nutrient supplementation had 70% fewer infections, fewer complications and accelerated recovery compared with controls.(2)
Benefits for fractures
A number of studies have shown a benefit for supplementing patients with fractures. In a study of 59 elderly patients (mean age 82) with femoral neck fractures, 27 received an oral nutrition supplement daily while 32 patients acted as controls.(3) Clinical outcomes were significantly better in the supplemented group, with 56% having favourable outcomes, including reduced rates of complications and deaths, compared to 13% in controls. That is a big difference.
In a study of patients who had undergone gastrointestinal surgery, patients treated with oral supplements had a significantly improved nutritional intake and lost less weight compared with control patients.(4) Supplemented patients maintained their handgrip strength, whereas control patients showed a significant reduction in grip strength. Subjective levels of fatigue increased significantly above preoperative levels in control patients but not in the supplemented group. Twelve patients in the control group developed complications, compared with four in the supplemented group - a 300% increase in complications for the non-supplemental group.
One study looked at patients from a geriatric acute care hospital, aged 75 years or older without malignant disease. In the supplemented patients with good acceptance, a median improvement of 20 points was observed between admission and discharge; subjects enjoyed a further improvement of five points at home in functional status based on the Barthel Activities of Daily Living (ADL) score.(5) In the supplement group, the proportion of independent patients (>65 points) increased continuously, from 36% at admission to 63% (compared to 19% in the control) at discharge, then to 72% (compared to 39% in the control) after six months. Sixty four percent of the patients in the supplement group improved during hospitalisation, compared to 23% in the control group. Imagine the reduction in pain and suffering, not to mention the economic benefits by spending a few dollars a day supplementing.
In a study of 101 patients, of which 52 were randomised to a supplement group, anthropometry, grip strength and quality of life were similarly significantly different between groups.(6) Fewer patients in the supplement group (seven out of 52) required antibiotic prescriptions compared with the control group (15 of 49). Postoperative nutritional supplementation improved nutritional status and quality of life and lessened morbidity in these patients. In a study of 116 undernourished patients admitted to a stroke service, patients receiving intensive nutritional supplementation improved more than those on standard treatments on measures of motor function. A higher proportion of patients who received the intensive nutritional supplementation went home compared to the control.
Improved outlook for cardiac surgery
In a prospective, randomised, double-blind, placebo-controlled study, patients scheduled to undergo coronary artery bypass were selected to receive an oral immune-enhancing nutritional supplement or a control for a minimum of five days. For those given the supplement, immune system indicators improved and delayed-type hypersensitivity response improved preoperatively and remained better until hospital discharge.(7) The researchers concluded that intake of an oral immune-enhancing nutritional supplement for a minimum of five days before surgery can improve outlook in high-risk patients who are undergoing elective cardiac surgery.
In a study of prostate cancer survivors, the group that included a change in lifestyle and nutritional supplementation with vitamins C and E, selenium and omega 3 oils had significant improvements in every parameter measured. Operations were avoided, PSA (prostate-specific antigen) declined compared to an increase in the control group; all indicators were positive including the ability of the treatment group to defend against cancerous cells.(8)
In HIV infection, deficiencies of specific nutrients have been shown to be associated with more frequent opportunistic infections, faster progression of disease and higher AIDS mortality.(9,10) Improvements were reported in immune responses indicated by an increase in CD4 cell count in HIV-infected patients receiving micronutrients. Specific nutritional supplements, designed to raise patients' glutathione peroxidase levels, appeared to be able to significantly increase CD4 cell count recovery in HIV-infected patients receiving no other medications.(12) This increase in CD4 cell count was associated with an improvement in quality of life and an increase in body weight. A multivitamin supplement that included vitamin C significantly slowed the onset of AIDS and provided an "effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women." The total cost of the treatment was estimated by the researchers to be about $15 per year.(11)
As the population ages and we see increased demand for hospital beds, a number of hospitals around the world are using supplements to speed the recovery of patients. In addition, studies are showing that supplements can reduce the use of expensive medications. Information from the British Association for Parenteral and Enteral Nutrition (BAPEN) indicated that some 25% of patients admitted to hospitals and care homes were at risk of malnutrition.(13) The group collected data from 11,600 patients and found that, in hospitals, those under 30 years of age had a 27% risk of malnutrition compared with a 34% risk in over 80s. In care homes, those under 70 had a 26% risk compared to 32% for those over 80. In a 10 year follow-up of a group of successfully ageing elderly people in Italy, at the beginning of the study 44% of the men and 60% of the women were already deficient compared to the lowest common denominator of the Recommended Daily Intake.(12) After a decade, the prevalence of vitamins B2 and A deficiencies rose to 50% of the sample. Vitamin C deficiencies rose in a decade from three percent to six percent in men and from 2.3% to 4.5% in women. These were deficiencies below the RDA/RDI, so imagine how many were below optimal levels of nutrients. The study concluded that multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly. According to human studies, changes in immunity associated with ageing are related to oxidative stress, free radical and pro-inflammatory cytokine production that increase with age(14) and all of these are influenced through nutrition and even the healthy ageing need to supplement.
Vitamin D Deficiency
A number of studies have shown that vitamin D deficiency is linked to the immunological status in intensive care unit patients and that vitamin D supplementation can improve patient's immunological status and health outcomes. Studies also demonstrate that vitamin D deficiency is very common in intensive care unit patients, and it is significantly associated with longer discharge times, increased organ failure, and a higher number of infections in intensive care (15). Vitamin D deficiency in intensive care is correlated with many infectious diseases (15) and susceptibility to respiratory infections such as infection by the tuberculosis bacteria (Mycobacterium tuberculosis) (16).
It seems that poor nutrition is a major problem in all areas of hospitals and health care, even trauma care. In a recent study of trauma patients, inadequate nutritional status was found to be associated with reduced wound healing partly by means of oxidative stress and inflammation. Thus, adequate nutritional measures are strongly recommended to trauma patients (17).
With the escalating costs of health care and the hospital system one would think hospitals and medical insurance companies would inform patients of this research and encourage them to improve their nutritional status through supplementation so they can save money, pain and suffering and even save lives. Supplementation saves lives.
DISCLAIMER: Dr Peter Dingle is a researcher, educator and public health advocate. He has a PhD in the field of environmental toxicology and is not a medical doctor.
ReferencesRobuck and Fleetwood 1992Daly et al. 1992Delmi et al. 1990Keele et al. 1997Volkert et al. 1996Beattie et al. 2000Tepaske et al. 2001Ornish et al. 2005Semba and Tang 1999Tang et al. 1996Fawzi et al. 2004Namulemia et al. 2007Victor and de la Fuente 2002Elia et al. 2007Higgins et al. 2012Hughes et al. 2009Blass et al . 2013
Dr Peter Dingle (PhD) has spent the past 30 years as a researcher, educator, author and advocate for a common sense approach to health and wellbeing. He has a PhD in the field of environmental toxicology and is not a medical doctor. He is Australia’s leading motivational health speaker and has 14 books in publication.