Special circumstances can alter nutritional needs
The metabolic changes caused by surgery, the increased demands required for successful healing, sepsis
and the stress of the surgical procedure itself, all increase energy needs.22 To supply this energy, protein
stored as muscle is broken down and amino acids released. A septic state will increase this muscle breakdown further.
Nutritional requirements must meet these increased needs. Furthermore, patients may already be malnourished due to
the illness that led to their surgery.
Once discharged, there will be ongoing higher nutritional needs during the recovery phase, although muscle lost may
never be regained. Oral nutritional supplements may be useful during the recovery period.
People with cancer are often malnourished. Physical and metabolic changes can be compounded by social
and psychological problems.23 Cancer may result in cachexic syndrome which is a state of complex metabolic
changes associated with anorexia, progressive weight loss and depletion of reserves of adipose tissue and skeletal
Nutritional advice tailored on an individual basis should be given at an early stage to help prevent nutritional
deficiencies.24 High energy, high protein foods are ideal for maintaining strength and wellbeing (see above).
Loss of appetite, pain, nausea and vomiting all contribute to poor oral intake. Prednisone is used to stimulate appetite,
but its effect tends to be short lived.25
Oral nutritional supplements can be beneficial when a normal balanced diet cannot be tolerated. These supplements
help prevent malnutrition but eventually cannot halt the cachexic state associated with many end-stage cancers.
Chronic renal failure
Nutritional requirements for people with chronic renal failure vary widely.15 In general, they require a
diet that promotes adequate nutrition, minimises uraemic toxicity and delays the progression of renal disease.
The requirements therefore are for a low protein diet with high energy content. The diet should be low in phosphorus
which means limiting foods of animal origin that are rich in phosphorus (such as dairy, egg yolks and meat). In addition,
supplementation of water soluble vitamins may be required (e.g. thiamine, riboflavin, pyridoxine and ascorbic acid).
The fat soluble vitamins A, E & K do not need to be supplemented, however vitamin D does.
Those requiring haemodialysis have some differing needs � they require additional protein, low potassium and phosphate
and high energy but low volume supplements.
There are specialised protein reduced nutritional supplements available on the pharmaceutical schedule that can be
initiated by a specialist. These include Renilon and Nepro.