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Ann Thorac Surg 2001;71:766-768
© 2001 The Society of Thoracic Surgeons

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Editorial

Malnutrition, outcome, and nutritional support: time to revisit the issues

^a Surgical Metabolism and Nutrition Laboratory, Department of Surgery, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, USA

Address reprint requests to Dr Meguid, State University of New York (SUNY) Upstate Medical University, University Hospital, 750 East Adams St, Syracuse, NY 13210
e-mail: meguidm@upstate.edu

Two remarkable articles appear in this issue of The Annals of Thoracic Surgery by Jagoe and colleagues [1, 2] that reinforce the well-known fact that preoperative nutritional status affects the outcome of patients undergoing curative lung cancer operation. This is remarkable because, as Jagoe and colleagues’ references indicate, surgeons and physicians worldwide from a variety of clinical disciplines together with their "statistical pundits" have grappled for several decades with the same two questions: (1) Does a patient’s preoperative nutritional status have an impact on surgical outcome? (2) What are the preoperative risk indicators?

The evolution of the investigations relevant to these questions and their resultant data proceeded independently but in parallel over the past 120 years [3]. Emotionally, we understand that famine and malnutrition worldwide are causes of disease and death. Intellectually, we understand the deleterious biochemical effects of long-term fasting leading to significant clinical malnutrition, data generated in normal volunteer(s) by Benedict [4] in 1915 and Keys and colleagues [5] in 1950. On the human side, no doubt exists concerning the cause-effect relationship between malnutrition, morbidity, and mortality, based on the documentary evidence of Jewish doctors in the Warsaw ghetto during World War II [6]. However, a lingering doubt somehow still appears to exist concerning such a link in our surgical patients, even though every practicing surgeon intuitively knows that operating on a debilitated or malnourished patient can spell disaster and often becomes a rueful and costly experience.

Clinically, Warren [7] in 1932 noted that more than 20% of cancer deaths were from disease-related malnutrition. In 1936, Studley [8] documented that in patients operated on for chronic peptic ulcer, if preoperative weight loss was 20% or more the postoperative complications including mortality were 33.5% compared with 3.5% in those who had lost less weight. . . . [Full Text of this Article]

This article has been cited by other articles:

				D. E. Carney and M. M. Meguid Current Concepts in Nutritional Assessment Arch Surg, January 1, 2002; 137(1): 42 - 45. [Full Text] [PDF]