Prof. Jonathan ASPRER
Medical Director, Fresenius Kabi, Hong Kong
Prof Jonathan Asprer is a colorectal surgeon with clinical experience in surgery and clinical nutrition at UST Hospital and St. Luke’s Medical Center, Philippines. He trained in general surgery in the Philippines, and in colorectal surgery in Birmingham, UK and in Tokyo, Japan. He has held leadership positions in surgery and clinical nutrition: President, Phil Soc of Colon & Rectal Surgeons, and Founding President, Phil Soc for Parenteral and Enteral Nutrition (PhilSPEN). He is also co-founder of PENSA (Parenteral & Enteral Nutrition Soc of Asia). He continues to be involved in clinical research and is a Reviewer for clinical nutrition and critical care journals. Throughout his surgical career, he has had a strong focus on clinical nutrition, which he has carried with him into his current position as Medical Director of Fresenius Kabi, where he continues to lead scientific and educational platforms, and to provide scientific support for related research.
As surgical teams gear up to address the backlog of surgical cases from pandemic restrictions, it is timely to analyze current practices, and identify potential gaps in perioperative care. This includes optimization of nutrition status or nutrition risk. Complex major surgery and/or critical surgical illness are associated with a hypercatabolic state, in which malnutrition, or protein-calorie deficits, are independently associated with poorer surgical outcomes, such as increased morbidity & mortality. The hypercatabolism results in loss of lean body mass, or lean muscle mass (sarcopenia), associated with perioperative weakness in surgical patients, not unlike ICU-acquired weakness in ICU patients, and associated with increased infection and impaired wound healing. Routine nutritional screening and assessment identifies patients that would benefit from perioperative nutrition. Early EN is preferred because of associated non-nutritional benefits (stimulation of gut immunity & function, and maintenance of microbiome), but is often poorly tolerated due to GI dysfunction or GI failure. Timely supplemental PN must be initiated without delay to prevent the protein-calorie gap associated with increased morbidity & mortality. In addition, the role of clinical nutrition therapy today is concerned not only with adequate provision of calories and protein (emphasis on the key role of protein) but also with the more current concept that nutrition therapy can actually modulate the inflammatory response. Immunomodulation in nutrition therapy can be accomplished by (1) early enteral nutrition which has the potential to stimulate gut immunity and gut function, while maintaining the microbiome; and (2) utilization of specialized nutrients, such as glutamine and fish-oil derived omega-3 fatty acids, which can modulate the immune-inflammatory response and optimize protein synthesis.