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

Abstract

Despite the implementation of ‘Enhanced Recovery After Surgery’ (ERAS) protocols, major abdominal surgery is still associated with significant and detrimental losses of muscle mass and function in the post-operative period. Although ERAS protocols advocate both early mobility and dietary intake, dietary composition in the immediate post-operative period is poorly characterised, despite muscle losses being greatest in this period. Herein, we show in 15 patients (66 ± 6 y, 12:3 M:F) who lost ~10% m. vastus lateralis muscle mass in the 5 days after open colorectal resective surgery, mean energy intake was only ~25% of the minimum ESPEN recommendation of 25 kcal/kg/d and daily dietary protein intake was only ~12% of the ESPEN recommended guidelines of 1.5 g/kg/d. Given the known importance of nutrition for muscle mass maintenance, innovative dietary interventions are needed in the immediate post-operative period, accounting for specific patient dietary preference to maximise compliance (e.g., soft-textured foods).

Skeletal muscle dysfunction with advancing age

“…With inactivity (or SKM disuse) a common experience in hospitalised patients, when this is combined with inadequate nutrition the resultant SKM atrophy is both significant and clinically relevant [ 44 ]. A recent observational study by Hardy et al, in an older post-surgical (for colorectal cancer resection) cohort reported in-hospital nutritional intake in the 5 days after surgery as only ∼25% of ESPEN guidelines for energy and only ∼12% for protein [ 51 ]. Comparing young with older adults, it has been shown that in response to SKM disuse older adults lose SKM mass at a markedly faster rate (∼3–6 times) [ 52 ].…”