Impact of nutritional support on nutritional status and nitrogen balance in surgical patients of a developing country

To assess the nutritional status, its change after surgery and impact of nutritional support on urinary nitrogen losses (UNL) and nitrogen balance (NB) based on changing serum albumin levels in a developing country, 89 patient (58 M) aged 39 yrs ±15 were studied. Nutritional assessment was done at admission and 2 weeks postoperatively. UNL and NB was assessed on postoperative day one (D1), two (D2), four (D4), six (D6), eight (D8) and eleven (D11) respectively. Malnutrition varied from 27 (30.3%) using body mass index to 78 (87%) by triceps skin fold thickness. Patients with falling or static serum albumin levels (Group I) showed a significant decrease (‘p’ = 0.001) in their nutritional parameters compared to those with increasing albumin (Group II). Postoperatively till D2 both groups had similar negative NB but Group II improved earlier to become positively balanced by D11 (‘p’ < 0.001). Regression analysis of nitrogen intake (Ni) on UNL on each day revealed negative association till D2 to become positively associated from D4 onwards being significant on D4 (‘p’ = 0.001) & D6 (‘p’ = 0.05*). There is a significant nutritional depletion after surgery especially in patients with falling/static serum albumin levels and NB improves earlier in patients with rising albumin levels. Increasing Ni helps in decreasing UNL.