High protein diet is a usual recommendation for patients in the post operative orthopedic ward.
#1. 6 ways a good diet will help in Faster Recovery
Boosts immunity.
Faster Wound healing.
Decreases muscle loss due to immobilisation.
Reduced infection rates.
Post-surgical amino acid supplementation has been shown to effectively reduce whole-body muscle break down, by increasing whole-body protein synthesis by 40% and reducing whole-body protein breakdown by 20%.
Enhances functional outcome and aids in Faster recovery.[3]
After 1 week of immobilization, thigh muscle volume decreased by 6% and there was a decrease in calf strength by 8% and knee extensor strength by 20 % in healthy young men.
Older adults have been shown to experience up to 15% decrease in muscle volume within two weeks following major surgery.[3]
#2. Calorie requirement after surgery
Resting calorie requirement for a male is 2000 kcals and for a female is 1450k cals.
Energy requirement increases in minor surgery by 1.2 times (2000+400kcals) and major surgery by 1.5 times(2000+1000kcals).[6]
Approximate calorie intake can be calculated using the tables 1 and 2.
| Portion(gm) | Calories(kcal) | Protein(gm) |
Cereals & millets | 30 | 100 | 3.0 |
Pulses | 30 | 100 | 6.0 |
Egg | 50 | 85 | 6.0 |
Roots & Tubers | 100 | 80 | 1.3 |
Fruits | 100 | 40 | 0 |
Green leafy vegetables | 100 | 46 | 3.6 |
Other vegetables | 100 | 28 | 1.7 |
Sugar | 5 | 20 | 0 |
Fats and Oil | 5 | 45 | 0 |
Milk products | 100 | 70 | 3.0 |
Table.1 Common food items and their nutritive values.[7]
Preparation | Quantity | Calories |
Rice | 1cup | 170 |
Phulka | 1 | 80 |
Paratha | 1 | 150 |
Puri | 1 | 80 |
Dosa | 1 Nos | 125 |
Idli | 2 Nos | 150 |
Dhal | 1cup | 100 |
Sambar | 1 cup | 110 |
Dry-Vegetable | 1 | 150 |
Mutton curry | 3/4cup | 260 |
Chicken curry | 3/4cup | 240 |
Fried fish | 2 big pieces | 190 |
Ommelette | 1 | 160 |
Vada | 2 | 140 |
Samosa | 1 | 200 |
Bread | 2 slices | 170 |
Table.2 Common Indian preparations and their nutritive values.[7]
#3. Protein requirement in the post op period
Fig.1 showing recommended protein intake in the immediate Post-Op period adopted from Smith-Ryan et al.[4]
Immediate post op diet trends have a significant impact on the entire process of recovery, as it prevents muscle breakdown and helps in Faster Recovery.
It is recommended that protein supplementation be started immediately after surgery, though it's really challenging as people have a low appetite during this period.
During the rehabilitation period, protein intakes of at least 1.6 g/kg/day and up to 2.0–3.0 g/kg/day is generally recommended( a 60 kg man requires 120gm of protein,but may need upto 180 gm) from high-quality protein sources distributed throughout the day (20–40 g of protein per meal ) is recommended to help ensure protein needs are met.[2]
Dietary Source | Proteins available in gm |
1.Soybeans/pulses/lentils (1/2 cup, cooked) | 14 grams |
2.Milk (1 cup) | 8 grams |
3.Yogurt (1 cup) | 8 to 12 grams |
4.Mozzarella cheese (30gm) | 6 grams |
5.Five hard-boiled eggs | 30 grams |
6.Egg white only from 8 eggs | 30 grams |
7.Chicken meat, cooked (125 gm) | 35 grams |
8.Chicken thigh (average size) | 10 grams |
Table.3 Common food items and their nutritive values.
Note:For Patients that require intense physical rehabilitation, nutrient timing around rehabilitation sessions will be more beneficial.
#4. Dietary recommendation during physiotherapy
Nutrient intake around an exercise/rehabilitation session can help increase lean mass, strength, and functionality, ultimately leading to faster return to activities of daily living [5].
Starting 3–4 h before a therapy session, patients should consume a small meal, containing carbohydrates (50–100 g) and quality protein (30–40 g).
Then, 15–45 min prior to therapy, a carbohydrate and protein containing beverage should be consumed, followed by another protein beverage after the therapy session.[4]
Fig.2 Showing recommended protein intake before and after intense Physio&Rehab, adopted from Smith-Ryan et al.[4]
Note:
Indian dietary habits are predominantly carbohydrate based, hence try to add as much dietary protein as possible depending on what you prefer.
All recommendations provided here are based on evidence in latest literature and are for educational purposes only.
Kindly consult your doctor for more clarification.
References:
Kilroe SP, Fulford J, Jackman SR, VAN Loon LJC, Wall BT. Temporal Muscle-specific Disuse Atrophy during One Week of Leg Immobilization. Med Sci Sports Exerc. 2020 Apr;52(4):944-954. doi: 10.1249/MSS.0000000000002200. PMID: 31688656.
Dreyer HC, Strycker LA, Senesac HA, Hocker AD, Smolkowski K, Shah SN, Jewett BA. Essential amino acid supplementation in patients following total knee arthroplasty. J Clin Invest. 2013 Nov;123(11):4654-66. doi: 10.1172/JCI70160. Epub 2013 Oct 25. PMID: 24135139; PMCID: PMC3809795.
Azhar G, Wei JY, Schutzler SE, Coker K, Gibson RV, Kirby MF, Ferrando AA, Wolfe RR. Daily Consumption of a Specially Formulated Essential Amino Acid-Based Dietary Supplement Improves Physical Performance in Older Adults With Low Physical Functioning. J Gerontol A Biol Sci Med Sci. 2021 Jun 14;76(7):1184-1191. doi: 10.1093/gerona/glab019. PMID: 33475727; PMCID: PMC8202157.
Smith-Ryan AE, Hirsch KR, Saylor HE, Gould LM, Blue MNM. Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation. J Athl Train. 2020 Sep 1;55(9):918-930. doi: 10.4085/1062-6050-550-19. PMID: 32991705; PMCID: PMC7534941.
Hulmi JJ, Lockwood CM, Stout JR. Effect of protein/essential amino acids and resistance training on skeletal muscle hypertrophy: A case for whey protein. Nutr Metab (Lond). 2010 Jun 17;7:51. doi: 10.1186/1743-7075-7-51. PMID: 20565767; PMCID: PMC2901380.
Smith-Ryan AE, Hirsch KR, Saylor HE, Gould LM, Blue MNM. Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation. J Athl Train. 2020 Sep 1;55(9):918-930. doi: 10.4085/1062-6050-550-19. PMID: 32991705; PMCID: PMC7534941.
https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf .
Wu, X. T.; Poon, K. M.; Goh, M. L. Prevention and management of constipation in an adult orthopaedic ward, International Journal of Evidence-Based Healthcare: September 2014 - Volume 12 - Issue 3 - p 213-214 doi: 10.1097/01.XEB.0000455234.61002.4c
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