Loss of muscle mass in the immediate post-operative period is associated with inadequate dietary protein and energy intake

In this group of patients who lost 9.16 ± 2.0% quadriceps muscle mass (measured as Vastus Lateralis cross sectional area via ultrasound [9]) in the 5 days after surgery [9], mean daily energy intake was 536.6 ± 527.8 kcal across the 4 post-operative days, and 490.0 ± 470.7, 505.0 ± 251.8, 541.0 ± 488.1, 610.5 ± 900.5 kcal on POD 1 to 4 respectively (Fig. 1A). Despite a numerical increase day-on-day, there was no significant difference in energy intake between the days. Mean daily protein intake was 15.6 ± 16.4 g across the 4 post-operative days, and 13.9 ± 14.1, 14.9 ± 10.2, 15.0 ± 15.6, 18.5 ± 25.6 g on POD 1 to 4 respectively (Fig. 1B). No significant difference in protein intake was found between the days. This equated to mean daily energy intake over POD1 to 4 being just 25.3 ± 24.9% of the ESPEN recommendation, reducing to 12.8 ± 2.6% in patients with ileus. Mean daily protein intake was only 12.3 ± 12.9% of the ESPEN recommendations, and only 5.7 ± 0.9% for those with ileus. Overall, only 1 patient consumed the recommended energy intake (on POD4). No patients managed to achieve over 50% of the recommended protein intake on POD1 to 3, with just 1 patient achieving this (78%) on POD4.

Fig. 1: Dietary intake in post-operative patients.figure 1

Mean daily energy intake (A) and mean daily protein intake (B) in post-operative patients’ 1–4 days after surgery (black data points). For daily energy intake, representative ESPEN data is calculated using the average weight of the patients recruited to this study (84.7 kg) and the minimum recommended energy intake (25 kcal/kg/d) [8]. For daily protein intake, representative ESPEN data is calculated using the average weight of the patients recruited to this study (84.7 kg) and the recommended protein intake (1.5 g/kg/d) [8]. Data are presented as mean ± SEM.

Collectively for all patients, the percentage of energy consumed as protein was 11.65 ± 2.0 on POD1, 12.26 ± 4.9 on POD2, 11.12 ± 4.9 on POD3, and 11.9 ± 3.9% on POD4, indicative of a low protein diet across this period. Interestingly, compared to the day-on-day increase in energy intake across the post-operative period, the percentage of energy consumed as protein did not increase.

Patients expressed a clear preference for soft-textured foods (e.g., soup, jelly, ice cream), with these making up 73% of meal choices on POD1, 84% on POD2, 55% on POD3, and 48% on POD4. Overall, 66% of meal choices across POD1 to 4 were soft-textured.

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