Curriculum Vitae

Name : dr Taslim Poniman SpB(K)BD

Place and Date of Birth : Tasikmalaya, 29 th of September 1961
Professional Experience : Digestive surgeon consultant RSUP Fatmawati
Education Background : Doctor of medicine 1988 at University of Chrstian Indonesia ; General
Surgery 1999 at University of Indonesia ; digestive surgeon consultant 2003 at University of
Indonesia
CLINICAL NUTRITION IN SURGERY AND CRITICAL ILLNESS

taslim poniman
 Nutritional status is probably one of the most
throughly studied and well-known determinants of
surgical outcomes. Between 40-50% of patients
undergoing surgery have some degree of
malnutrition.

Brunn,L; Bosaeus,L; Bergstad,L; Nygaard,K. Prevalence of malnutrition in surgical patient: Evaluation of nutritional support and documentation. Clin.Nutr.1999,18,141-147
Katie RH.; Robet RW.; Arny AF.; Pre ad Post Surgical nutrition for perservation of muscle mass,strength following orthopaedic surgey. Nutrients 2021,13,1675
Jonas Nygren. ERAS Society Congress Lecture Series ,The role of nutrition in ERAS surgery. Spain, 2014.
 NUTRITIONAL SCREENING

Jonas Nygren. ERAS Society Congress Lecture Series ,The role of nutrition in ERAS surgery. Spain, 2014.
Jonas Nygren. ERAS Society Congress Lecture Series ,The role of nutrition in ERAS surgery. Spain, 2014.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679209/
 Albumin is a direct measure of nutritional and
immunological status of the essential component of wound
healing process

Jonas Nygren. ERAS Society Congress Lecture Series ,The role of nutrition in ERAS surgery. Spain, 2014.
 • For many years albumin was a great interest
for surgeons as an indicator of malnutrition.

Kudsk, K.A.; Tolley, E.A.; DeWitt, R.C.; et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J. Parenter. Enteral Nutr. 2003, 27, 1–9
Normal range : 3.5 to
5.5gram/dl
 Physiology of Albumin :
• Structure – consist of a single polypeptide chain of 585
amino acids with a molecular weight of 66,500 Dalton.
• 3D – heart shape molecule
• Synthesis in the liver 12-25g/day , nearly all of this is
reabsorbed by lymphatic drainage
• Can be optimally produced under optimal osmotic
pressure, hormonal condition, and suitable nutritional

www.dreamstime.com/illustration/serum-albumin.html

Nicholson, JP. ; Wolmarans, MR. ; Park GR. The role of albumin in critical illness. Br J Anaesth,2000;85:599-610
 Functions of Albumin

• Oncotic pressure
• Normal – colloid osmotic pressure 25mmHg
• Binding of substances
• Medium size anion
• Endogenous compounds (bile acids, copper, zinc,
folate)
• Secondary carrier to vitamin D, thyroxine
• Drug-binding sites (I,II,III)

National Center for Biotechnology

Nicholson, JP. ; Wolmarans, MR. ; Park GR. The role of albumin in critical illness. Br J Anaesth,2000;85:599-610
 Functions of Albumin
• Antioxidant
• Polymorphonuclear leukocytes inhibit the production
of free radical (Sulfhydryl group on molecule
albumin)
• Anticoagulant effect
• A heparin-like action (similar structure) through
enhance neutralization factor Xa by antirombin III
• Maintain microvascular integrity
• Space-occupying reduces size of channel
• Strong negative charge repelling other molecules in
membrane
• Prevent apoptosis endothelial cells
Nicholson, JP. ; Wolmarans, MR. ; Park GR. The role of albumin in critical illness. Br J Anaesth,2000;85:599-610
 WHAT IF HYPOALBUMINEMIA ?

• Reduced synthesis : decrease gene transcription (trauma, sepsis –

cytokines, hepatic disease, diabetes, decrease growth hormone) or
ribosome disaggregation (fasting, especially protein depletion
• When plasma proteins especially serum albumin decrease there will be
decreased plasma oncotic pressure which cannot counterbalance
hydrostatic pressure resulting in the development of edema.
• Many researches found hypoalbumenia is a risk factor for postoperative
complications.
• Hypoalbumenia has been shown to be associated with increased
morbidity and mortality in acute surgical patients due to increased
catabolism

https://journals.sagepub.com/doi/pdf/10.1177/2192568218797095
ESPEN (European Society for Parenteral and Enteral Nutrition)
- latest published 2021
- contains 37 recommendations

Weiman,A.;Braga,M.;Carli.F.; et al. ESPEN Guideline: Clinical Nutrition in Surgery. Clin.Nutr.2021,40,4745-4761.

CONCLUSION
• Nutritional status is probably one of the most throughly studied and well -
known determinants of surgical outcomes
• The tools of nutritional screning are NRS-2002 and SGA are the simplest
and quickest
• Albumin is one a direct measure of nutritional status. Hypoalbuminemia is
a risk factor for postoperative complications.
• Oral intake, including clear liquids, shall be initiated within hours after
surgery in most patients
THANK YOU
• Nicholson, JP. ; Wolmarans, MR. ; Park GR. The role of albumin in critical illness. Br J
Anaesth,2000;85:599-610.
IN A SINGLE-BLIND STUDY, PATIENTS
DO NOT KNOW WHICH STUDY GROUP
THEY ARE IN (FOR EXAMPLE
WHETHER THEY ARE TAKING THE
EXPERIMENTAL DRUG OR A
PLACEBO). IN A DOUBLE-BLIND STUDY,
NEITHER THE PATIENTS NOR THE
RESEARCHERS/DOCTORS KNOW
WHICH STUDY GROUP THE PATIENTS
ARE IN.