For malnourished patients, what is the preferred route for preoperative nutrition?

• A. No nutrition support.
• B. Parenteral nutrition only.
• C. Oral supplements only.
• D. Enteral nutrition preferred; parenteral if needed.

Answer: (D)

When aiming to optimize nutrition before surgery in a malnourished patient, using the gut is preferred. Enteral nutrition delivered by oral intake or a feeding tube preserves gut integrity, supports the immune system, and reduces the risk of infection and other complications after surgery. It provides calories and protein in a physiologic way and is generally safer, cheaper, and easier to manage than parenteral nutrition. Parenteral nutrition, which goes through a central or peripheral IV line, bypasses the gut and carries higher risks such as catheter-related infections, metabolic complications, and higher costs, so it is reserved for when the GI tract cannot be used or enteral feeding cannot meet the patient’s needs. Oral supplements can help, but if they do not achieve adequate intake or if the patient cannot meet needs orally, enteral feeding should be pursued first, with parenteral nutrition as a fallback. In short, feed the gut first and escalate to parenteral support only when necessary. Refeeding syndrome should be monitored in severely malnourished patients as nutrients are reintroduced.