2026/02/26 by Mohini Sharma · 1 voice
Medicine · #Dietary Effects on Health #Enhanced Recovery After Surgery #Gastrointestinal motility and disorders
paper · doi:10.1111/anae.70194
openalex publication_date 2026/02/26 · openalex created_date 2026/02/27 · openalex updated_date 2026/07/27
The international multidisciplinary consensus statement on peri-operative fasting represents an important and progressive step toward minimising unnecessarily prolonged clear-fluid fasting [1]. The endorsement of liberalised clear liquid intake is timely and welcome. However, clarification is required regarding recommendations around clear liquids permitting tea or coffee taken with a small amount of milk. While the statement appropriately distinguishes diluted milk from pure milk, the composition of the milk itself is not specified. Gastric emptying of liquids is determined principally by caloric density and lipid content through duodenal nutrient sensing and cholecystokinin-mediated feedback mechanisms. Experimental data show that pure milk empties significantly more slowly than calorically equivalent clear fluids, with appreciable gastric content persisting 2 h after ingestion [2]. Conversely, ultrasound studies in healthy individuals suggest that small amounts of milk added to tea do not delay gastric emptying compared with black tea [3]. Milk composition varies considerably across clinical settings. Full-fat (3.5–4.0% fat), toned (3.0%), double-toned (1.0–1.5%) and skimmed milk (< 0.5%) differ substantially in lipid content and caloric density. Even when limited to one-fifth of beverage volume, 20 ml full-fat milk contains approximately twice the lipid load of skimmed milk for the same volume. Given that fat content is the principal determinant of gastric emptying kinetics, extrapolation of physiological data without specification of milk composition may introduce interpretative variability. The consensus statement notes delayed gastric emptying following undiluted milk ingestion, underscoring the relevance of nutrient density. However, it does not clarify whether the ‘one-fifth’ allowance presumes a particular fat range, nor whether supporting physiological evidence is generalisable across milk types. In patients with altered gastric physiology, clinicians may question whether any fat-containing beverage should be categorised alongside traditional clear fluids. Clarification regarding assumed milk composition, or alternatively framing guidance in terms of maximum permissible caloric or lipid content rather than proportional volume, may improve physiological precision and facilitate consistent global implementation without undermining the broader liberal fasting framework the statement promotes. Addressing this compositional nuance would further strengthen an otherwise valuable consensus statement and enhance its applicability across diverse healthcare environments.