Perioperative Nutritional Optimization in Inflammatory Bowel Diseases: When and How?
Abstract Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoper...
Saved in:
Published in | Journal of Coloproctology Vol. 41; no. 3; pp. 295 - 300 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Thieme Revinter Publicações Ltda
01.09.2021
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Abstract
Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient. |
---|---|
AbstractList | Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient. Abstract Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient. |
Author | da Silva, Isadora Sayuri Macedo Cambi, Maria Paula Carlini Kotze, Paulo Gustavo Magro, Daniéla Oliveira |
Author_xml | – sequence: 1 givenname: Isadora Sayuri Macedo orcidid: 0000-0002-0057-9935 surname: da Silva fullname: da Silva, Isadora Sayuri Macedo organization: Nutritionist, IBD Outpatient Clinics – sequence: 2 givenname: Maria Paula Carlini orcidid: 0000-0002-9565-0836 surname: Cambi fullname: Cambi, Maria Paula Carlini organization: Colorectal Surgery Unit, IBD Outpatient Clinics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil – sequence: 3 givenname: Daniéla Oliveira orcidid: 0000-0002-8180-6254 surname: Magro fullname: Magro, Daniéla Oliveira organization: Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas UNICAMP-SP, Campinas, São Paulo, SP, Brazil – sequence: 4 givenname: Paulo Gustavo orcidid: 0000-0002-2053-5315 surname: Kotze fullname: Kotze, Paulo Gustavo organization: Colorectal Surgery Unit, IBD Outpatient Clinics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil |
BookMark | eNp1kMlOwzAQhi0EEuuVs18gxVtszAVB2SpVwAHE0Zo4E3CVxJUdqODpSSnixmkWzf9p9O2T7T72SMgxZxPOyvIkF4wpXnAjmdR2i-wJyU2hlZDbYy-kKazUcpcc5RwqJoQxpVJyjzw9YgpxiQmG8IH0_n1IYQixh5Y-LIfQhS9YjzT0dNY3LXQdDDF90su4wpZehYyQMZ_RlzfsKfQ1vYur80Oy00Cb8ei3HpDnm-un6V0xf7idTS_mhZfS2EJzWaG1AGXjtWDGCF8KKxVT0mhvFW8UqPJUM699pVFXHnB8vDK89NJaIw_IbMOtIyzcMoUO0qeLENzPIqZXB2kIvkWnTN2gqcfYqVe8QqhEXWqBckTVwrORNdmwfIo5J2z-eJy5tWKX3Vqx-1U8BopNYHgL2KFbxPc0asv_3X8D1Jx91w |
CitedBy_id | crossref_primary_10_1093_ecco_jcc_jjac129 |
Cites_doi | 10.1001/archsurg.2009.170 10.1093/ecco-jcc/jjz160 10.1186/s12937-015-0024-1 10.1016/j.clnu.2017.02.013 10.1136/gutjnl-2019-318484 10.14309/ctg.0000000000000050 10.1155/2018/7890161 10.1093/ecco-jcc/jjx060 10.1056/NEJMoa1409860 10.1097/MIB.0000000000000110 10.3390/nu9060562 10.3390/nu12051320 10.1007/s11938-019-00231-8 10.1097/MEG.0000000000001162 10.3109/00365521.2011.648954 10.1016/j.ijsu.2009.03.003 10.1213/ANE.0000000000002743 10.1186/s12957-018-1393-7 10.3748/wjg.v23.i35.6385 10.1155/2011/739347 10.1016/j.clnu.2019.11.002 10.3390/nu12020372 10.1016/j.clnu.2020.06.020 |
ContentType | Journal Article |
Copyright | Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. |
Copyright_xml | – notice: Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. |
DBID | 0U6 AAYXX CITATION DOA |
DOI | 10.1055/s-0041-1730369 |
DatabaseName | Thieme Connect Journals Open Access CrossRef DOAJ Directory of Open Access Journals |
DatabaseTitle | CrossRef |
DatabaseTitleList | CrossRef |
Database_xml | – sequence: 1 dbid: 0U6 name: Thieme Connect Journals Open Access url: http://open.thieme.com sourceTypes: Publisher – sequence: 2 dbid: DOA name: Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2317-6423 |
EndPage | 300 |
ExternalDocumentID | oai_doaj_org_article_47dfe7d3998c41beab2d562e35c3d2c0 10_1055_s_0041_1730369 |
GroupedDBID | .1- .FO 0SF 0U6 1P~ 4.4 457 5VS 6I. AACTN AAEDT AAEDW AAFTH AAIKJ AALRI AAXUO ABMAC ACGFS ADBBV ADCUG ADEZE AEVXI AEXQZ AFCTW AFRHN AFTJW AGHFR AITUG AJRQY AJUYK ALMA_UNASSIGNED_HOLDINGS AMRAJ APOWU AZFZN BAWUL BCNDV DIK EBS EJD FDB FNPLU GROUPED_DOAJ IPNFZ IXB KQ8 LCYCR M41 NCXOZ OC. OK1 ON0 RIG RNS ROL RSC RTC SSZ Z5R 0R~ AAYXX ADVLN AHRAW AKRWK CITATION |
ID | FETCH-LOGICAL-c3379-613be99aa5fc620772c5293404376c941f4a45860c6cb6e6bcae277b715c39973 |
IEDL.DBID | DOA |
ISSN | 2237-9363 |
IngestDate | Tue Oct 22 15:15:48 EDT 2024 Fri Aug 23 01:19:30 EDT 2024 Fri Aug 04 23:37:17 EDT 2023 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 3 |
Keywords | inflammatory bowel diseases nutritional optimization perioperarive nutrition |
Language | English |
License | CC BY-NC-ND 4.0 |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c3379-613be99aa5fc620772c5293404376c941f4a45860c6cb6e6bcae277b715c39973 |
ORCID | 0000-0002-8180-6254 0000-0002-0057-9935 0000-0002-9565-0836 0000-0002-2053-5315 |
OpenAccessLink | https://doaj.org/article/47dfe7d3998c41beab2d562e35c3d2c0 |
PageCount | 6 |
ParticipantIDs | doaj_primary_oai_doaj_org_article_47dfe7d3998c41beab2d562e35c3d2c0 crossref_primary_10_1055_s_0041_1730369 thieme_journals_10_1055_s_0041_1730369 |
PublicationCentury | 2000 |
PublicationDate | 20210900 |
PublicationDateYYYYMMDD | 2021-09-01 |
PublicationDate_xml | – month: 09 year: 2021 text: 20210900 |
PublicationDecade | 2020 |
PublicationPlace | Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil |
PublicationPlace_xml | – name: Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil |
PublicationTitle | Journal of Coloproctology |
PublicationYear | 2021 |
Publisher | Thieme Revinter Publicações Ltda |
Publisher_xml | – name: Thieme Revinter Publicações Ltda |
References | P E Wischmeyer (ref12) 2018; 126 C A Lamb (ref4) 2019; 68 L Bn (ref8) 2019; 2 R Sigall-Boneh (ref19) 2014; 20 T Yamamoto (ref7) 2019; 10 N Lakananurak (ref17) 2020; 12 G T Brennan (ref1) 2018; 30 P L Stoner (ref16) 2018; 2018 S C Bischoff (ref11) 2020; 39 A Weimann (ref10) 2017; 36 P Balestrieri (ref2) 2020; 12 F Grass (ref9) 2015; 14 M AR Araújo (ref13) 2010; 21 A El Nakeeb (ref28) 2009; 7 O M Damas (ref3) 2019; 17 A Vasudevan (ref21) 2017; 23 F Grass (ref5) 2017; 9 Y Cerantola (ref20) 2011; 2011 M Adamina (ref6) 2020; 14 P P Nunes (ref14) 2015; 30 J de S Junior (ref15) 2016; 31 D K Heyland (ref22) 2001; 44 M Jankowski (ref25) 2018; 16 K Lassen (ref27) 2009; 144 S Jacobson (ref23) 2012; 47 S E Harvey (ref24) 2014; 371 J Connors (ref18) 2017; 11 C Fiorindi (ref26) 2021; 40 |
References_xml | – volume: 2 start-page: 1 issue: 02 year: 2019 ident: ref8 article-title: Dietary interventions for induction and maintenance of remission in inflammatory bowel disease publication-title: Cochrane Libr contributor: fullname: L Bn – volume: 144 start-page: 961 issue: 10 year: 2009 ident: ref27 article-title: Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations publication-title: Arch Surg doi: 10.1001/archsurg.2009.170 contributor: fullname: K Lassen – volume: 14 start-page: 431 issue: 04 year: 2020 ident: ref6 article-title: Perioperative Dietary Therapy in Inflammatory Bowel Disease publication-title: J Crohn's Colitis doi: 10.1093/ecco-jcc/jjz160 contributor: fullname: M Adamina – volume: 14 start-page: 37 issue: 01 year: 2015 ident: ref9 article-title: Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors publication-title: Nutr J doi: 10.1186/s12937-015-0024-1 contributor: fullname: F Grass – volume: 36 start-page: 623 issue: 03 year: 2017 ident: ref10 article-title: ESPEN guideline: Clinical nutrition in surgery publication-title: Clin Nutr doi: 10.1016/j.clnu.2017.02.013 contributor: fullname: A Weimann – volume: 68 start-page: s1 year: 2019 ident: ref4 article-title: British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults publication-title: Gut doi: 10.1136/gutjnl-2019-318484 contributor: fullname: C A Lamb – volume: 10 start-page: e00050 issue: 06 year: 2019 ident: ref7 article-title: Impact of preoperative nutritional status on the incidence rate of surgical complications in patients with inflammatory bowel disease with vs without preoperative biologic therapy: A case-control study publication-title: Clin Transl Gastroenterol doi: 10.14309/ctg.0000000000000050 contributor: fullname: T Yamamoto – volume: 2018 start-page: 7890161 year: 2018 ident: ref16 article-title: Perioperative care of patients with inflammatory bowel disease: Focus on nutritional support publication-title: Gastroenterol Res Pract doi: 10.1155/2018/7890161 contributor: fullname: P L Stoner – volume: 11 start-page: 1063 issue: 09 year: 2017 ident: ref18 article-title: Exclusive enteral nutrition therapy in paediatric Crohn's disease results in long-term avoidance of corticosteroids: Results of a propensity-score matched cohort analysis publication-title: J Crohn's Colitis doi: 10.1093/ecco-jcc/jjx060 contributor: fullname: J Connors – volume: 371 start-page: 1673 issue: 18 year: 2014 ident: ref24 article-title: Trial of the route of early nutritional support in critically ill adults publication-title: N Engl J Med doi: 10.1056/NEJMoa1409860 contributor: fullname: S E Harvey – volume: 20 start-page: 1353 issue: 08 year: 2014 ident: ref19 article-title: Partial enteral nutrition with a Crohn's disease exclusion diet is effective for induction of remission in children and young adults with Crohn's disease publication-title: Inflamm Bowel Dis doi: 10.1097/MIB.0000000000000110 contributor: fullname: R Sigall-Boneh – volume: 9 start-page: 2 issue: 06 year: 2017 ident: ref5 article-title: Preoperative Nutritional Conditioning of Crohn's Patients-Systematic Review of Current Evidence and Practice publication-title: Nutrients doi: 10.3390/nu9060562 contributor: fullname: F Grass – volume: 12 start-page: 1 issue: 05 year: 2020 ident: ref17 article-title: The role of preoperative parenteral nutrition publication-title: Nutrients doi: 10.3390/nu12051320 contributor: fullname: N Lakananurak – volume: 17 start-page: 313 issue: 02 year: 2019 ident: ref3 article-title: Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature publication-title: Curr Treat Options Gastroenterol doi: 10.1007/s11938-019-00231-8 contributor: fullname: O M Damas – volume: 21 start-page: 331 issue: 04 year: 2010 ident: ref13 article-title: Análise comparativa de diferentes métodos de triagem publication-title: Com Ciências Saúde. contributor: fullname: M AR Araújo – volume: 30 start-page: 997 issue: 09 year: 2018 ident: ref1 article-title: Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn's disease patients: a meta-analysis publication-title: Eur J Gastroenterol Hepatol doi: 10.1097/MEG.0000000000001162 contributor: fullname: G T Brennan – volume: 47 start-page: 170 issue: 02 year: 2012 ident: ref23 article-title: Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition publication-title: Scand J Gastroenterol doi: 10.3109/00365521.2011.648954 contributor: fullname: S Jacobson – volume: 44 start-page: 102 issue: 02 year: 2001 ident: ref22 article-title: Total parenteral nutrition in the surgical patient: a meta-analysis publication-title: Can J Surg contributor: fullname: D K Heyland – volume: 7 start-page: 206 issue: 03 year: 2009 ident: ref28 article-title: Early oral feeding in patients undergoing elective colonic anastomosis publication-title: Int J Surg doi: 10.1016/j.ijsu.2009.03.003 contributor: fullname: A El Nakeeb – volume: 126 start-page: 1883 issue: 06 year: 2018 ident: ref12 article-title: American Society for Enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway publication-title: Anesth Analg doi: 10.1213/ANE.0000000000002743 contributor: fullname: P E Wischmeyer – volume: 30 start-page: 120 issue: 02 year: 2015 ident: ref14 article-title: Nutritional Risk Screening (NRS 2002) como instrumento preditor de desfechos pós-operatórios em pacientes submetidos a cirurgias gastrointestinais publication-title: Rev Bras Nutr Clínica. contributor: fullname: P P Nunes – volume: 16 start-page: 1 issue: 01 year: 2018 ident: ref25 article-title: Contemporary enteral and parenteral nutrition before surgery for gastrointestinal cancers: a literature review publication-title: World J Surg Oncol doi: 10.1186/s12957-018-1393-7 contributor: fullname: M Jankowski – volume: 23 start-page: 6385 issue: 35 year: 2017 ident: ref21 article-title: Time to clinical response and remission for therapeutics in inflammatory bowel diseases: What should the clinician expect, what should patients be told? publication-title: World J Gastroenterol doi: 10.3748/wjg.v23.i35.6385 contributor: fullname: A Vasudevan – volume: 2011 start-page: 739347 year: 2011 ident: ref20 article-title: Perioperative nutrition in abdominal surgery: recommendations and reality publication-title: Gastroenterol Res Pract doi: 10.1155/2011/739347 contributor: fullname: Y Cerantola – volume: 39 start-page: 632 issue: 03 year: 2020 ident: ref11 article-title: ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease publication-title: Clin Nutr doi: 10.1016/j.clnu.2019.11.002 contributor: fullname: S C Bischoff – volume: 31 start-page: 305 issue: 04 year: 2016 ident: ref15 article-title: Comparison of subjective global assessment and the new nutritional diagnosis proposed by ASPEN in surgical patients publication-title: BRASPEN J contributor: fullname: J de S Junior – volume: 12 start-page: 1 issue: 02 year: 2020 ident: ref2 article-title: Nutritional aspects of inflammatory bowel disease publication-title: Nutrients doi: 10.3390/nu12020372 contributor: fullname: P Balestrieri – volume: 40 start-page: 928 issue: 03 year: 2021 ident: ref26 article-title: Effect of long-lasting nutritional prehabilitation on postoperative outcome in elective surgery for IBD publication-title: Clin Nutr doi: 10.1016/j.clnu.2020.06.020 contributor: fullname: C Fiorindi |
SSID | ssib022775443 ssj0000652016 ssib031354472 |
Score | 2.2359645 |
Snippet | Abstract
Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in... Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional... |
SourceID | doaj crossref thieme |
SourceType | Open Website Aggregation Database Publisher |
StartPage | 295 |
SubjectTerms | inflammatory bowel diseases nutritional optimization perioperarive nutrition Review Article |
SummonAdditionalLinks | – databaseName: Thieme Connect Journals Open Access dbid: 0U6 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1LS8QwEA66gngRn_gmB9FTMc2z9SK-llVw9bALeytJOkXB7Yq74t930nbXF4LHhoQJM8l8k07mCyGHnlnLYuCRLJjDA4pxURqKfZhzSSGs9okM1ch3Xd3py9uBGnz-7_iZwVfqZBwFTqgoNsHZpvNkgSPEhctbrD8DUs6_E7mJWOBnUxFa-2SFSFe9NMeFiVKhxZTB8ZeIbwhVEfkjOk0en2AIX6CnvUKWm5iRntdGXiVzUK6RxbsmK75Oeg-4jEYvUJN40-6UYB_H3KNHGDallvSppDdlgUtgWKXW6cXoHZ7pVZ2iGZ9SdMwltWVOO6P3sw3Sb1_3LjtR81pC5IUwKZ4BhYM0tVYVXnOGUbNXiOWBPcdon8q4kFaqRDOvvdOgnbeAanMmVh6jFCM2SasclbBFKAY13qGREonjFCgrNYoAJoscjJNsmxxPNZS91KQYWZXMViobZ0GXWaPLbXIRFDjrFcisqwa0cNbsjUyavACT4yQSL2MH1vEcwzIQOLGcexR3VKs_a_bX-A9pO__tuEuWeLibUt0V2yOtyesb7GNwMXEH1br6ADwxwNI priority: 102 providerName: Thieme |
Title | Perioperative Nutritional Optimization in Inflammatory Bowel Diseases: When and How? |
URI | http://dx.doi.org/10.1055/s-0041-1730369 https://doaj.org/article/47dfe7d3998c41beab2d562e35c3d2c0 |
Volume | 41 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1LS8QwEA7qQbyIT1xf5CB6KqbNq_Eirg9WwcfBhb2VJJ2i4HYXd8W_76TpynoQL14KLQ0p30znwcx8IeTIM2tZClkiKuYwQdEuMWHYhzmXV9wqn4swjXz_oHp9cTeQg7mjvkJPWKQHjsCdCl1WoEv0o7kXqQPrshJ9NnDpeZn5mK2nci6ZQk3Ksp_EbjzleNtOiEYbLdHzNSfPZVwnhis-Y3SU8nSSBBqqJNXBvpsfHqsh9kdvNX15hSHMuaKbNbLaxpD0In77OlmAeoMs37dV8k3y_IRqNRpDJPWmDzPCfVzziBZi2I5e0tea3tYVqsSwKbXT7ugT3uhVLNlMziga6prauqS90ef5FunfXD9f9pL29ITEc64N5oTcgTHWysqrjGEU7SX69sCmo5U3Iq2EFTJXzCvvFCjnLSBsTqeIrDGab5OlelTDDqEY5HiHQssFrpMgrVC4BTBRlaCdYB1yMkOoGEeSjKIpbktZTIqAZdFi2SHdAOD3W4HcunmAIi9akRd_ibxDjiP8Rfu_TX7Zbfc_dtsjK1noY2n6yvbJ0vT9Aw4wEJm6Q7LI-uqw0Ty83g66X4G21Vs |
link.rule.ids | 315,786,790,870,2115,20918,27955,27956,54936,54964 |
linkProvider | Directory of Open Access Journals |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1LT9wwELZaKpVeqraAoC2tD1U5RevEr6SXCkrR8tgth12Jm2U7E0BikxVJxd9nnHhREULqMZGtsb5MZsaamW8I-eaZtSyFLBEVc3hB0S4pQrMPcy6vuFU-F6EbeTJV47k4uZAXsT26jWWV3dU1LCDxodLDd6HUYjmwn7YjiAi3o6tucRPn1MpRmwTeqCTVwSAXL8krvPWowKTP5g_ONssek73xlONj7Bod7LZEb9hPo8u4Tgqu-Irl8YmIR16sJ_tHDzac-x_3dPSOvI1xJd0fFOE9eQH1B_J6EjPnG2R2jqrWLGEg-qbTFQk_7vmDVmMR2zHpdU2P6wrVZNGn3-lBcwc39HBI47Q_KBrvmtq6pOPm7ucmmR_9nv0aJ3GiQuI51wXeE7mDorBWVl5lDCNrL9HfB4YdrXwh0kpYIXPFvPJOgXLeAsLmdCo9RjKab5G1uqlhm1AMfLzDD5kL3CdBWqFQBDBRlaCdYDtkb4WQWQ7EGaZPeEtpWhOwNBHLHXIQAHxYFQiv-xfN7aWJ_48RuqxAl3iI3IvUgXVZiaEbcDxYmXkU932A36w05BlpH_934VeyPp5NzszZ8fT0E3mThVqWvrbsM1nrbv_CLgYjnfvS69g9BjjSRQ |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1LT9wwELaASogLakurbqGtDxU9pevEr6SXqpSultfCgZW4WbYzAaRusiKL-PsdJw4CVZV6TGJnrC-TmbFm5jMhnz2zlqWQJaJiDjco2iVFaPZhzuUVt8rnInQjn83UdC6Or-TVGjkfemFCWeXq5hYWkPhQ6eFXodRi2bOftmOICLfjZVnFY2rluE0CbVSS6mCPi6_4aJ28wI0PDyrP5o_-Nsue873xlONlbBztTbdEh9gdSJdxneAL-ED0-JeYZ46s4_tHJ9Yv_YmHmrwk2zG0pD96XXhF1qB-TTbPYvJ8h1xeoLY1S-i5vuls4OHHOedoOBaxI5Pe1vSorlBTFl0Gnh40D_CbHvaZnPYbRftdU1uXdNo8fH9D5pNflz-nSTxUIfGc6wK3itxBUVgrK68yhsG1l-jyA8mOVr4QaSWskLliXnmnQDlvAWFzOpUegxnN35KNuqnhHaEY-3iH3zIXOE-CtEKhCGCiKkE7wUbky4CQWfbcGabLeUtpWhOwNBHLETkIAD6OCpzX3Y3m7trEX8gIXVagS1xE7kXqwLqsxOgNOC6szDyK2-_hN4OS_EPa-_8d-IlsXhxOzOnR7GSXbGWhmqWrLtsjG6u7e_iA4cjKfexU7A_ka9LY |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Perioperative+Nutritional+Optimization+in+Inflammatory+Bowel+Diseases%3A+When+and+How%3F&rft.jtitle=Journal+of+Coloproctology&rft.au=Isadora+Sayuri+Macedo+da+Silva&rft.au=Maria+Paula+Carlini+Cambi&rft.au=Dani%C3%A9la+Oliveira+Magro&rft.au=Paulo+Gustavo+Kotze&rft.date=2021-09-01&rft.pub=Thieme+Revinter+Publica%C3%A7%C3%B5es+Ltda&rft.issn=2237-9363&rft.eissn=2317-6423&rft.volume=41&rft.issue=3&rft.spage=295&rft.epage=300&rft_id=info:doi/10.1055%2Fs-0041-1730369&rft.externalDBID=DOA&rft.externalDocID=oai_doaj_org_article_47dfe7d3998c41beab2d562e35c3d2c0 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2237-9363&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2237-9363&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2237-9363&client=summon |