Besin Desteklerinin Cerrahi Bakımda Kullanımı
Özet
Cerrahi bakım; metabolik stres, inflamatuvar yanıt ve bağışıklık sistemi değişiklikleriyle seyreden, iyileşme sürecinde beslenme desteğinin önemli rol oynadığı karmaşık bir süreçtir. Bu süreçte uygulanan besin destekleri, doku onarımını destekleyen, bağışıklık sistemini güçlendiren ve komplikasyon riskini azaltan doğal içeriklerdir. Kullanımları bilimsel kanıtlara dayalı olarak giderek yaygınlaşmaktadır. Besin destekleri, vitamin, mineral, amino asit ve diğer biyoaktif bileşenleri içeren, normal beslenmeyi destekleyen ve sağlık durumunu olumlu yönde etkileyen tamamlayıcı ürünlerdir. Kavram, 1980’lerde ortaya çıkmış ve 1989 yılında Dr. Stephen L. DeFelice tarafından literatüre “nutrasötik” terimiyle kazandırılmıştır. Cerrahi bakım hastalarında doğal formda tüketilen fonksiyonel gıdaların ve izole edilerek yüksek dozda kullanılan nutrasötiklerin tıbbi besin destekleri olarak kullanımı ile ilgili veriler literatürde bildirilmektedir. Bu bölümde, besin desteklerinin cerrahi bakım sürecindeki yeri, türleri ve klinik uygulamalardaki önemi, literatür ve kanıta dayalı rehberler doğrultusunda ele alınmıştır. Özellikle glutamin, arginin, omega-3 yağ asitleri, probiyotikler ve mikrobesinlerin; metabolik stresin azaltılması, bağışıklık fonksiyonlarının desteklenmesi ve iyileşmenin hızlandırılmasında etkili olduğu, güncel araştırma sonuçlarıyla ortaya konulmaktadır. Sonuç olarak, besin destekleri; cerrahi bakım sürecinde tedaviye katkı sağlayan, bilimsel temellere dayanan geleneksel ve tamamlayıcı tıp uygulaması olarak, disiplinler arası iş birliği ve bireyselleştirilmiş hemşirelik bakım planları çerçevesinde değerlendirilmelidir.
Surgical interventions are complex processes accompanied by metabolic stress, inflammatory responses, and changes in immune function, where nutritional support plays a vital role in recovery. In this context, dietary supplements are natural components that support tissue repair, strengthen the immune system, and help reduce the risk of complications; their use is increasingly supported by scientific evidence. Dietary supplements are products containing vitamins, minerals, amino acids, and other bioactive components that complement normal nutrition and promote health. The concept emerged in the 1980s and was introduced into the scientific literature in 1989 by Dr. Stephen L. DeFelice with the term "nutraceutical." Dietary supplements are classified into two main categories: functional foods, consumed in their natural or processed forms, and nutraceuticals, isolated bioactive substances used in higher doses. These components are frequently studied in the context of oral nutritional supplement as part of medical nutrition therapy in surgical patients. This chapter examines the role, types, and clinical significance of dietary supplements in surgical care, supported by current literature and evidence-based guidelines. In particular, bioactive components such as glutamine, arginine, omega-3 fatty acids, probiotics, and micronutrients have been shown in recent studies to reduce metabolic stress, support immune function, and accelerate recovery. In conclusion, dietary supplements should be considered a scientifically grounded component of traditional and complementary medical practices in surgical care, and be implemented through interdisciplinary collaboration and individualized care planning.
Referanslar
Lindquist, R, Tracy, MF, Snyder M. Complementary therapies in nursing. 7th ed. New York: Springer Publishing Company; 2023.
Aluko RE. Functional foods and nutraceuticals. 1st ed. London: Springer; 2012.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition. 2021;40(7):4745–4761. doi:10.1016/j.clnu.2021.02.001
Hughes MJ, Hackney RJ, Lamb PJ, et al. Prehabilitation before major abdominal surgery: A systematic review and meta-analysis. World Journal of Surgery. 2019;43:1661–1668. doi:10.1007/s00268-019-04997-2
Daniels SL, Lee MJ, George J, et al. Prehabilitation in elective abdominal cancer surgery in older patients: A systematic review and meta-analysis. British Journal of Surgery Open. 2020;4:1022–1041. doi:10.1002/bjs5.50309
Lambert JE, Hayes LD, Keegan TJ, et al. The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery: A PRISMA-accordant meta-analysis. Annals of Surgery. 2021;274(1):70–77. doi:10.1097/SLA.0000000000004479
Wischmeyer PE, Carli F, Evans DC, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesthesia and Analgesia. 2018;126(6):1883–1895. doi: 10.1213/ANE.0000000000002743
Matsui R, Sagawa M, Inaki N, et al. Impact of perioperative immunonutrition on postoperative outcomes in patients with upper gastrointestinal cancer: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2024;16(5):577. doi:10.3390/nu16050577
Fan Y, Li N, Zhang J, et al. The effect of immunonutrition in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis. BMC Cancer. 2023;23(1):351. doi:10.1186/s12885-023-10820-7
Kamocki Z, Matowicka-Karna J, Jurczuk A, et al. Preoperative glutamine supplementation in gastric cancer: Thrombocyte phagocytic activity and early postoperative outcomes. Nutrients. 2023;15(13):2911. doi:10.3390/nu15132911
Yıldız Kopuz T, Fisunoğlu M. Kolorektal kanser cerrahisinde perioperatif beslenme yönetimi. Beslenme ve Diyet Dergisi. 2023;51(2): 85-94. doi: 10.33076/2023.BDD.1771
Bahşi İ, Bahşi A, Çetkin M, et al. The first Turkish illustrated surgical textbook ‘Cerrahiyetü’l-Haniyye’. Child’s Nervous System. 2016;32(12):2275–2276. doi: 10.1007/s00381-016-3196-x
Sabuncuoğlu Ş. Cerrahiyetü’l Haniyye. (2. baskı). Ankara: Türk Tarih Kurumu Yayınları; 1992.
Martirosyan DM, Singh J. A new definition of functional food by FFC: What makes a new definition unique? Functional Foods in Health and Disease. 2015;5(6):209–223. doi: 10.31989/ffhd.v5i6.183.
National Institutes of Health, Office of Dietary Supplements. Evidence-Based Reviews. Available from: https://ods.od.nih.gov/Research/EvidenceBased_Review_Program.aspx (Accessed 10th March 2025)
15. National Institutes of Health, Office of Dietary Supplements. Dietary Supplement Health and Education Act of 1994. Available from: https://ods.od.nih.gov/About/DSHEA_Wording.aspx (Accessed 10th March 2025)
T.C. Tarım ve Orman Bakanlığı. Takviye Edici Gıdalar Hakkında Yönetmelik. Resmî Gazete (Sayı: 28560). (10/03/2025 tarihinde https://resmigazete.gov.tr/eskiler/2017/03/20170307-3.htm adresinden ulaşılmıştır)
Türkiye İlaç ve Tıbbi Cihaz Kurumu. Gıda ve Takviye Edici Gıdalarda Sağlık Beyanı Kullanımı Hakkında Yönetmelik. (11/03/2025 tarihinde https://www.resmigazete.gov.tr/eskiler/2023/04/20230420-5.htm adresinden ulaşılmıştır)
T.C. Tarım ve Orman Bakanlığı. Türk Gıda Kodeksi Beslenme Beyanları Yönetmeliği. (11/03/2025 tarihinde https://www.resmigazete.gov.tr/eskiler/2023/04/20230420-2.htm adresinden ulaşılmıştır)
Özen GÜ, Mutlu AA. Bariatrik cerrahi uygulamaları ve bağırsak mikrobiyotası ilişkisi: Probiyotik ve prebiyotik kullanımının etkisi. Beslenme ve Diyet Dergisi. 2022;50(2):83–91. doi: 10.33076/2022.BDD.1540
Palamutoğlu R. Fonksiyonel probiyotik gıdalar. Baygut H, Beyhan Y. (ed.) Sağlık & Bilim 2024: Beslenme-II içinde. İstanbul: Efe Akademi Yayınları; 2024. p. 131-151.
Demirbağ Z, Alan S, Öksüztepe G. Fonksiyonel gıdalar ve beslenmedeki önemi. Bozok Veterinary Sciences. 2023; 4(2): 54-60. doi: 10.58833/bozokvetsci.1324245
Mohd Fuad AS, Amran NA, Nasruddin NS, et al. The mechanisms of probiotics, prebiotics, synbiotics, and postbiotics in oral cancer management. Probiotics and Antimicrobial Proteins. 2023:15(5): 1298-1311.doi: 10.1007/s12602-022-09985-7
Kiani AK, Dhuli K, Donato K, et al. Main nutritional deficiencies. Journal of Preventive Medicine and Hygiene. 2022; 63(2 Suppl 3): E93. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2752
Wobith M, Weimann A. Oral nutritional supplements and enteral nutrition in patients with gastrointestinal surgery. Nutrients. 2021;13(8): 2655. doi: 10.3390/nu13082655
Chowdhury AH, Adiamah A, Kushairi A, et al. Response to the comment on “perioperative probiotics or synbiotics in adults undergoing elective abdominal surgery: A systematic review and meta-analysis of randomized controlled trials”. Annals of Surgery. 2021;274(6): e676-e677. doi: 10.1097/SLA.0000000000003759
Xie X, He Y, Li H, et al. Effects of prebiotics on immunologic indicators and intestinal microbiota structure in perioperative colorectal cancer patients. Nutrition. 2019;61:132–42. doi: 10.1016/j.nut.2018.10.038
Amitay EL, Carr PR, Gies A, et al. Probiotic/synbiotic treatment and postoperative complications in colorectal cancer patients: Systematic review and meta-analysis of randomized controlled trials. Clinical and Translational Gastroenterology. 2020;11(12):e00268. doi: 10.14309/ctg.0000000000000268
Achilli P, Candioli S, Leonardi F, et al. Preoperative immunonutrition in frail patients with colorectal cancer: An intervention to improve postoperative outcomes. International Journal of Colorectal Disease, 2020; 35:19–27. doi. 0.1007/s00384-019-03438-4
Lee SY, Lee J, Park HM, et al. Impact of preoperative immunonutrition on the outcomes of colon cancer surgery: Results from a randomized controlled trial. Annals of Surgery. 2023;277(3):381–386. doi: 10.1097/SLA.0000000000005140
Bustos NI, Sotomayor CG, Pol RA, et al. Polyphenols and novel insights into post-kidney transplant complications and cardiovascular disease: A narrative review. Frontiers in Cardiovascular Medicine. 2021;8:751036. doi: 10.3389/fcvm.2021.751036
Ávila‐Gálvez MÁ, González‐Sarrías A, Martínez‐Díaz F, et al. Disposition of dietary polyphenols in breast cancer patients’ tumors, and their associated anticancer activity: the particular case of curcumin. Molecular Nutrition & Food Research. 2021;65(12): 2100163. doi: 10.1002/mnfr.202100163.
Henning SM, Wang P, Lee RP, et al. Prospective randomized trial evaluating blood and prostate tissue concentrations of green tea polyphenols and quercetin in men with prostate cancer. Food & Function. 2020;11(5): 4114-4122. doi: 10.1039/d0fo00565g.
Santini A, Novellino E. Nutraceuticals: Beyond the diet before the drugs. Current Bioactive Compounds. 2014;10(1):1-12.
Tehrani SD, Hosseini A, Shahzamani M, et al. Evaluation of the effectiveness of curcumin and piperine co-supplementation on inflammatory factors, cardiac biomarkers, atrial fibrillation, and clinical outcomes after coronary artery bypass graft surgery. Clinical Nutrition ESPEN. 2024;62: 57-65. doi: 10.1016/j.clnesp.2024.05.003
Basu P, Maier C, Basu A. Effects of curcumin and its different formulations in preclinical and clinical studies of peripheral neuropathic and postoperative pain: A comprehensive review. International Journal of Molecular Sciences. 2021;22(9): 4666. doi: 10.3390/ijms22094666
Referanslar
Lindquist, R, Tracy, MF, Snyder M. Complementary therapies in nursing. 7th ed. New York: Springer Publishing Company; 2023.
Aluko RE. Functional foods and nutraceuticals. 1st ed. London: Springer; 2012.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition. 2021;40(7):4745–4761. doi:10.1016/j.clnu.2021.02.001
Hughes MJ, Hackney RJ, Lamb PJ, et al. Prehabilitation before major abdominal surgery: A systematic review and meta-analysis. World Journal of Surgery. 2019;43:1661–1668. doi:10.1007/s00268-019-04997-2
Daniels SL, Lee MJ, George J, et al. Prehabilitation in elective abdominal cancer surgery in older patients: A systematic review and meta-analysis. British Journal of Surgery Open. 2020;4:1022–1041. doi:10.1002/bjs5.50309
Lambert JE, Hayes LD, Keegan TJ, et al. The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery: A PRISMA-accordant meta-analysis. Annals of Surgery. 2021;274(1):70–77. doi:10.1097/SLA.0000000000004479
Wischmeyer PE, Carli F, Evans DC, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesthesia and Analgesia. 2018;126(6):1883–1895. doi: 10.1213/ANE.0000000000002743
Matsui R, Sagawa M, Inaki N, et al. Impact of perioperative immunonutrition on postoperative outcomes in patients with upper gastrointestinal cancer: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2024;16(5):577. doi:10.3390/nu16050577
Fan Y, Li N, Zhang J, et al. The effect of immunonutrition in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis. BMC Cancer. 2023;23(1):351. doi:10.1186/s12885-023-10820-7
Kamocki Z, Matowicka-Karna J, Jurczuk A, et al. Preoperative glutamine supplementation in gastric cancer: Thrombocyte phagocytic activity and early postoperative outcomes. Nutrients. 2023;15(13):2911. doi:10.3390/nu15132911
Yıldız Kopuz T, Fisunoğlu M. Kolorektal kanser cerrahisinde perioperatif beslenme yönetimi. Beslenme ve Diyet Dergisi. 2023;51(2): 85-94. doi: 10.33076/2023.BDD.1771
Bahşi İ, Bahşi A, Çetkin M, et al. The first Turkish illustrated surgical textbook ‘Cerrahiyetü’l-Haniyye’. Child’s Nervous System. 2016;32(12):2275–2276. doi: 10.1007/s00381-016-3196-x
Sabuncuoğlu Ş. Cerrahiyetü’l Haniyye. (2. baskı). Ankara: Türk Tarih Kurumu Yayınları; 1992.
Martirosyan DM, Singh J. A new definition of functional food by FFC: What makes a new definition unique? Functional Foods in Health and Disease. 2015;5(6):209–223. doi: 10.31989/ffhd.v5i6.183.
National Institutes of Health, Office of Dietary Supplements. Evidence-Based Reviews. Available from: https://ods.od.nih.gov/Research/EvidenceBased_Review_Program.aspx (Accessed 10th March 2025)
15. National Institutes of Health, Office of Dietary Supplements. Dietary Supplement Health and Education Act of 1994. Available from: https://ods.od.nih.gov/About/DSHEA_Wording.aspx (Accessed 10th March 2025)
T.C. Tarım ve Orman Bakanlığı. Takviye Edici Gıdalar Hakkında Yönetmelik. Resmî Gazete (Sayı: 28560). (10/03/2025 tarihinde https://resmigazete.gov.tr/eskiler/2017/03/20170307-3.htm adresinden ulaşılmıştır)
Türkiye İlaç ve Tıbbi Cihaz Kurumu. Gıda ve Takviye Edici Gıdalarda Sağlık Beyanı Kullanımı Hakkında Yönetmelik. (11/03/2025 tarihinde https://www.resmigazete.gov.tr/eskiler/2023/04/20230420-5.htm adresinden ulaşılmıştır)
T.C. Tarım ve Orman Bakanlığı. Türk Gıda Kodeksi Beslenme Beyanları Yönetmeliği. (11/03/2025 tarihinde https://www.resmigazete.gov.tr/eskiler/2023/04/20230420-2.htm adresinden ulaşılmıştır)
Özen GÜ, Mutlu AA. Bariatrik cerrahi uygulamaları ve bağırsak mikrobiyotası ilişkisi: Probiyotik ve prebiyotik kullanımının etkisi. Beslenme ve Diyet Dergisi. 2022;50(2):83–91. doi: 10.33076/2022.BDD.1540
Palamutoğlu R. Fonksiyonel probiyotik gıdalar. Baygut H, Beyhan Y. (ed.) Sağlık & Bilim 2024: Beslenme-II içinde. İstanbul: Efe Akademi Yayınları; 2024. p. 131-151.
Demirbağ Z, Alan S, Öksüztepe G. Fonksiyonel gıdalar ve beslenmedeki önemi. Bozok Veterinary Sciences. 2023; 4(2): 54-60. doi: 10.58833/bozokvetsci.1324245
Mohd Fuad AS, Amran NA, Nasruddin NS, et al. The mechanisms of probiotics, prebiotics, synbiotics, and postbiotics in oral cancer management. Probiotics and Antimicrobial Proteins. 2023:15(5): 1298-1311.doi: 10.1007/s12602-022-09985-7
Kiani AK, Dhuli K, Donato K, et al. Main nutritional deficiencies. Journal of Preventive Medicine and Hygiene. 2022; 63(2 Suppl 3): E93. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2752
Wobith M, Weimann A. Oral nutritional supplements and enteral nutrition in patients with gastrointestinal surgery. Nutrients. 2021;13(8): 2655. doi: 10.3390/nu13082655
Chowdhury AH, Adiamah A, Kushairi A, et al. Response to the comment on “perioperative probiotics or synbiotics in adults undergoing elective abdominal surgery: A systematic review and meta-analysis of randomized controlled trials”. Annals of Surgery. 2021;274(6): e676-e677. doi: 10.1097/SLA.0000000000003759
Xie X, He Y, Li H, et al. Effects of prebiotics on immunologic indicators and intestinal microbiota structure in perioperative colorectal cancer patients. Nutrition. 2019;61:132–42. doi: 10.1016/j.nut.2018.10.038
Amitay EL, Carr PR, Gies A, et al. Probiotic/synbiotic treatment and postoperative complications in colorectal cancer patients: Systematic review and meta-analysis of randomized controlled trials. Clinical and Translational Gastroenterology. 2020;11(12):e00268. doi: 10.14309/ctg.0000000000000268
Achilli P, Candioli S, Leonardi F, et al. Preoperative immunonutrition in frail patients with colorectal cancer: An intervention to improve postoperative outcomes. International Journal of Colorectal Disease, 2020; 35:19–27. doi. 0.1007/s00384-019-03438-4
Lee SY, Lee J, Park HM, et al. Impact of preoperative immunonutrition on the outcomes of colon cancer surgery: Results from a randomized controlled trial. Annals of Surgery. 2023;277(3):381–386. doi: 10.1097/SLA.0000000000005140
Bustos NI, Sotomayor CG, Pol RA, et al. Polyphenols and novel insights into post-kidney transplant complications and cardiovascular disease: A narrative review. Frontiers in Cardiovascular Medicine. 2021;8:751036. doi: 10.3389/fcvm.2021.751036
Ávila‐Gálvez MÁ, González‐Sarrías A, Martínez‐Díaz F, et al. Disposition of dietary polyphenols in breast cancer patients’ tumors, and their associated anticancer activity: the particular case of curcumin. Molecular Nutrition & Food Research. 2021;65(12): 2100163. doi: 10.1002/mnfr.202100163.
Henning SM, Wang P, Lee RP, et al. Prospective randomized trial evaluating blood and prostate tissue concentrations of green tea polyphenols and quercetin in men with prostate cancer. Food & Function. 2020;11(5): 4114-4122. doi: 10.1039/d0fo00565g.
Santini A, Novellino E. Nutraceuticals: Beyond the diet before the drugs. Current Bioactive Compounds. 2014;10(1):1-12.
Tehrani SD, Hosseini A, Shahzamani M, et al. Evaluation of the effectiveness of curcumin and piperine co-supplementation on inflammatory factors, cardiac biomarkers, atrial fibrillation, and clinical outcomes after coronary artery bypass graft surgery. Clinical Nutrition ESPEN. 2024;62: 57-65. doi: 10.1016/j.clnesp.2024.05.003
Basu P, Maier C, Basu A. Effects of curcumin and its different formulations in preclinical and clinical studies of peripheral neuropathic and postoperative pain: A comprehensive review. International Journal of Molecular Sciences. 2021;22(9): 4666. doi: 10.3390/ijms22094666
