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the official journal of the british dietetic association editor simon langley evans journal of human nutrition and dietetics volume 31 issue 2 april 2018 clinical nutrition dietetic practice dietary patterns ...

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                                              THE OFFICIAL JOURNAL OF THE BRITISH DIETETIC ASSOCIATION
                     Editor: Simon Langley-Evans
                   Journal of 
                   Human Nutrition 
                                          and 
                                                            Dietetics
                                                               VOLUME 31 • ISSUE 2 • APRIL 2018
                                                                 CLINICAL NUTRITION 
                                                                 DIETETIC PRACTICE 
                                                                 DIETARY PATTERNS
                                                                 CARBOHYDRATES 
                                                                 BODY COMPOSITION AND ENERGY EXPENDITURE
          jjhn_v31_i2_Issueinfo.indd   1hn_v31_i2_Issueinfo.indd   1                                 112-Mar-18   11:52:58 AM2-Mar-18   11:52:58 AM
                                                                                                         Journal of
                                                                                                         Human Nutrition and Dietetics
                                                                                                         The Offi cial Journal of the British Dietetic Association
                                                  Editor-in-Chief                                        Editorial Board
                                                  Professor Simon Langley-Evans                          A. Anderson, Centre for Public Health Nutrition Research, University of Dundee, UK
                                                  Deputy Head of School of Biosciences                   T. Baranowski, Bayor College of Medicine, USA
                                                  University of Nottingham,                              J. Bauer, School of Human Movement Studies, University of Queensland, Australia
                                                  UK.                                                    T. Burrows, University of Newcastle, Australia
                                                  E-mail: simon.langley-evans@nottingham.ac.uk J. Coad, Massey University, New Zealand
                                                  Associate Editors                                      C. Collins, University of Newcastle, Australia
                                                  S Burden, University of Manchester, UK                 P. Collins, Faculty of Health, Queensland University of Technology, Australia
                                                  C Green, Nutricia, The Netherlands                     K. Davison, Simon Fraser University, Canada
                                                                                                         J. Harvey, University of Vermont, USA
                                                                                                         M. Hickson, Faculty of Medicine, Imperial College London, UK
                                                                                                         J. Hodgson, University of Western Australia, Australia
                                                                                                         M. Kiely, CountyCollege Cork, Ireland
                                                                                                         F. Kolahdooz, University of Alberta, Canada
                                                                                                         I. Lemieux, Quebec Heart Institute, Laval University, Canada
                                                                                                         S. Lennie, School of Pharmacy and Life Sciences, Robert Gordon University, UK
                                                                                                         A. Madden, School of Health and Emergency Professions, University of Hertfordshire, UK
                                                                                                         M. McInley, Queens University Belfast, UK
                                                                                                         D. Mellor, University of Canberra, Australia
                                                                                                         C. Nowson, Deakin University, Australia
                                                                                                         T. Ong, Sao Paolo University, Brazil
                                                                                                         A. OSullivan, Institute of Food and Health, University College Dublin, Ireland
                                                                                                         M. Pakseresht, University of Alberta, Canada
                                                                                                         Y. Probst, University of Wollongong, Australia
                                                                                                         A. Roefs, Faculty of Psychology, Maastricht University, The Netherlands
                                                                                                         J. Swift, School of Biosciences, University of Nottingham, UK
                                                                                                         M. Taylor, School of Biomedical Sciences, University of Nottingham, UK
                                                                                                         K. Whelan, Kings College London, UK
                                                                                                         L. Williams, Department of Oncology, University of Sheffi eld, UK
                                                                                                         L. Wood, University of Newcastle, Australia
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                       jjhn_v31_i2_Issueinfo.indd   2hn_v31_i2_Issueinfo.indd   2                                                                                                                                                             112-Mar-18   11:52:59 AM2-Mar-18   11:52:59 AM
                                                                                                                             Journal of Human Nutrition and Dietetics
                 CLINICAL NUTRITION
                  Asystematic review of feeding practices among
                  postoperative patients: is practice in-line with
                  evidenced-based guidelines?
                                   1,2                     2,3                   2,3,4                      1,2
                  M. Rattray,               S. Roberts,         A. Marshall            &B. Desbrow
                  1
                   School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
                  2
                   Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
                  3
                   National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia
                  4
                   School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
                  Keywords                                               Abstract
                  early oral feeding, perioperative care,
                  postoperative care, early recovery after surgery.      Background: Early oral feeding after surgery is best practice among adult,
                                                                         noncritically ill patients. Evidenced-based guidelines (EBG) recommend
                  Correspondence                                         commencing liquid and solid feeding within 24 h of surgery to improve
                  Megan Rattray, School of Allied Health Sciences,       patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay)
                  Griffith University, Southport, QLD, Australia.         outcomes. Whether these EBG are adhered to in usual clinical practice
                  Tel.: +61 567 80 154                                   remains unknown. The present study aimed to identify the time to com-
                  E-mail: megan.rattray@griffithuni.edu.au
                                                                         mencement of first oral feed (liquid or solid) and first solid feed among
                  Howtocite this article                                 postoperative, noncritically ill, adult patients.
                  Rattray M., Roberts S., Marshall A. & Desbrow B.       Methods: MEDLINE, CINAHL, SCOPUS and Web of Science databases
                  (2018) A systematic review of feeding practices        were searched from inception to June 2016 for observational studies report-
                  among postoperative patients: is practice in-line      ing liquid and/or solid feeding practices among postoperative patients. Stud-
                  with evidenced-based guidelines? J Hum Nutr            ies reporting a mean/median time to first feed or first solid feed within 24 h
                  Diet. 31, 151–167                                      of surgery or where ≥75% of patients were feeding by postoperative day one
                  https://doi.org/10.1111/jhn.12486                      were considered in-line with EBG.
                                                                         Results: Of 5826 articles retrieved, 29 studies were included. Only 40% and
                                                                         22% of studies reported time to first feed and time to first solid feed in-line
                                                                         with EBG, respectively. Clear and free liquids were the first diet types com-
                                                                         menced in 86% of studies. When solids were commenced, 44% of studies
                                                                         reported using various therapeutic diet types (e.g. light) prior to the com-
                                                                         mencement of a regular diet. Patients who underwent gastrointestinal proce-
                                                                         dures appeared more likely to experience delayed postoperative feeding.
                                                                         Conclusions: Our findings demonstrate a gap between postoperative feeding
                                                                         evidence and its practical application. This information provides a strong
                                                                         rationale for interventions targeting improved nutritional care following
                                                                         surgery.
                  Introduction                                                                  and/or anastomotic leakage thought to occur if fed prema-
                                                                                                turely (1–3). However, there is little evidence to suggest that
                  The traditional postoperative feeding approach dictates                       these adverse outcomes are likely to occur, particularly fol-
                  fasting patients until the return of bowel function (e.g. pas-                lowing nongastrointestinal surgeries (4–6). Traditional post-
                                                                                (1)
                  sage of flatus and/or stool or bowel sounds)                      . This       operative feeding results in substantial periods of avoidable
                  approach was designed to avoid paralytic ileus (leading to                    inadequate nutritional intake among patients who may
                  vomiting, aspiration pneumonia and wound dehiscence)                          already be at nutritional risk, and who require optimal
                  ª2017The British Dietetic Association Ltd.                                                                                                         151
                                  Postoperative feeding in habitual practice                                                                                                                                           M. Rattray et al.
                               nutrition for recovery and prevention of complications (4).                                                  present study will clarify whether delayed postoperative
                               Malnutrition is a prevalent problem among surgical                                                           fluid and/or solid feeding practices persist and to what
                               patients as a result of factors preceding (e.g. diseased state,                                              extent among various postoperative groups. This informa-
                               preoperative dietary practices) and following surgery (e.g.                                                  tion will inform whether (and where) interventions are
                               postoperative symptoms and dietary practices) (7,8).                                                         required to bridge the gap between knowledge and prac-
                                   By contrast to traditional beliefs, recent evidence indi-                                                tice to improve patient and health care-related outcomes.
                               cates early oral or enteral feeding (i.e. within 24 h after                                                  As such, the specific aims of this review, in the context of
                               surgery) is safe and beneficial to adult, noncritically ill,                                                  habitual clinical practice, are to identify:
                                                                         (1,5,6,9–18)
                               postoperative patients                                   .  Early oral feeding has
                               been associated with a faster recovery of intestinal func-                                                    The time to and type of first feed (liquid or solid)
                               tion (i.e. resolution of ileus) (5,6,9,10,19,20), reduced mor-                                               commenced among noncritically ill, adult, postoperative
                               bidity (e.g. less infectious complications and improved                                                      patients;
                               wound healing and immunity) (5,11–13,15,21,22) and improved                                                   The time to and type of first solid feed commenced
                               quality of life (e.g. patient satisfaction and ambulation)                                                   among noncritically ill, adult, postoperative patients; and
                               (12,16–19) among various surgical populations such as upper                                                   Whether specific postoperative patient groups are at
                               and lower gastrointestinal, obstetric and gynaecological                                                     greater risk of delayed feeding than others.
                               patients. In addition, a rapid transition back to solid food
                               is important for reducing the risk of malnutrition and its                                                   Materials and methods
                                                                                                          (23)            (24,25)
                               associated consequences such as infections                                      ,falls              ,
                                                               (26)                                                           (27)
                               pressure injuries                       and morbidity and mortality                                 .        The methodology of this review was devised in accor-
                               Improved              patient-related               outcomes              translate           into           dance with the Meta-Analyses and Systematic Reviews of
                               shorter lengths of hospitalisation and reduced healthcare                                                    Observational Studies Guidelines (MOOSE) (40) and regis-
                                         (5,9,11,13–16,28)
                               costs                          . As such, there are many potential bene-                                     tered at the International Prospective Register for System-
                               fits to the rapid reintroduction of nutrition following sur-                                                  atic Reviews (identification code: CRD 42016052832).
                               gery.
                                   Over the past decade, early oral feeding practice recom-                                                 Search methods
                               mendations have been incorporated into evidenced-based
                               postoperative care guidelines for gynaecological (2), hep-                                                   Potentially eligible studies were identified by searching the
                                       (29)                                          (30)                  (31)
                               atic          ,  pancreaticoduodenal                        ,  gastric           ,   colorectal              online databases MEDLINE (1965–2016), Cumulative
                                                                                        (32–34)
                               and rectal and pelvic patients                                     .   In general, these                     Index of Nursing and Allied Health Literature (CINAHL,
                               guidelines recommend liquid feeding to recommence                                                            1985–2016), SCOPUS (1977–2016) and Web of Science
                               within 24 h, or ideally within 4 h following surgery in                                                      (1956–2016), using a Boolean search strategy developed
                               low-risk patient populations (e.g. lower gastrointestinal).                                                  in collaboration with a librarian. The search strategy
                               Solid feeding is then suggested to commence within 24 h                                                      involved using the AND operator to link keywords used
                               of surgery (2,29–34).                                                                                        for the population (e.g. postoperativ* OR surg* OR hos-
                                   Despite clear guidelines, it is well known that the adop-                                                pital), exposure (e.g. nil by mouth OR clear fluids OR
                               tion of research findings into clinical practice is often a slow                                              oral feeding) and outcome (e.g. time OR practice OR fre-
                               and onerous process, with evidenced-based research taking                                                    quency) of interest. Truncation was used where applicable
                                                                                                                     (35)
                               up to two decades to establish as habitual practice                                        . Fur-            to capture variation in word terminology (e.g. postopera-
                               thermore, studies show that 30–40% of patients do not                                                        tiv*: postoperative, postoperatively) and enclosed quota-
                               receive        healthcare in accordance with evidence-based                                                  tion marks were used to search for exact phrases. The
                                                   (36)
                               knowledge                . Considering traditional practices are diffi-                                       search was not limited to language, nor restricted by any
                                                         (37,38)
                               cult to change                     , investigations into whether this is the                                 other means, with the exception of limits set on research
                               case for early commencement of feeding among noncriti-                                                       fields in Web of Science (restricted to: surgery, cardiovas-
                               cally ill, adult, postoperative patients are warranted.                                                      cular system cardiology, gastroenterology hepatology, res-
                                   The present study aimed to examine feeding practices                                                     piratory system, general internal medicine, oncology,
                               in postoperative patients by performing a systematic                                                         otorhinolaryngology, urology nephrology, anaesthesiology,
                               review of the available evidence. Considering transient                                                      geriatrics         gerontology,             emergency medicine, nutrition
                               improvements are often seen with intervention pro-                                                           dietetics, nursing, obstetrics gynaecology, rehabilitation
                                                                                 (39)
                               grammes in clinical practice                            , this evidence is reviewed                          and physiology). To maximise retrieval of eligible evi-
                               in the context of habitual practice only (i.e. absence of                                                    dence, forward and backward citation tracking was per-
                               recent intervention programmes). Findings from the                                                           formed on all included studies.
                               152                                                                                                                                                         ª2017The British Dietetic Association Ltd.
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...The official journal of british dietetic association editor simon langley evans human nutrition and dietetics volume issue april clinical practice dietary patterns carbohydrates body composition energy expenditure jjhn v i issueinfo indd hn mar am cial in chief editorial board professor a anderson centre for public health research university dundee uk deputy head school biosciences t baranowski bayor college medicine usa nottingham j bauer movement studies queensland australia burrows newcastle e mail ac coad massey new zealand associate editors c collins s burden manchester p faculty technology green nutricia netherlands k davison fraser canada harvey vermont m hickson imperial london hodgson western kiely countycollege cork ireland f kolahdooz alberta lemieux quebec heart institute laval lennie pharmacy life sciences robert gordon madden emergency professions hertfordshire mcinley queens belfast d mellor canberra nowson deakin ong sao paolo brazil osullivan food dublin pakseresht y p...

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