Changes in nutritional status and effectiveness of the dietary intervention of multimodal prehabilitation for patients with colorectal cancer: A secondary analysis of the PREHAB randomized clinical trial

IF 2.6 Q3 NUTRITION & DIETETICS Clinical nutrition ESPEN Pub Date : 2025-02-01 Epub Date: 2024-12-27 DOI:10.1016/j.clnesp.2024.12.024

C. van Erven , D. ten Cate , R. van Lieshout , S. Beijer , J. Dieleman , S. Geertsema , M. Jalink , J. van der Meulen-Franken , N. Rademakers , C. Gillis , G. Slooter

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Abstract

Background & aims

Prehabilitation is a preoperative multimodal program including exercise, nutritional, and psychological support. Little is known about changes in nutritional status during prehabilitation.

Methods

This secondary analysis of the PREHAB trial aims to assess changes in nutritional status and explore the effectiveness of a four-week nutritional intervention. Data were collected at baseline and preoperatively (end of the program), including body composition with bioelectrical impedance analysis (single frequency, 50 kHz), muscle strength (indirect 1RM leg press), three-day food diaries and the scored PG-SGA. Protein requirements were set at 1.5 g/kg body weight.

Results

Sixty-seven participants were enrolled, 34 to standard care and 33 to four-week prehabilitation. Nutritional status improved in both groups: −1 point change in the standard care group (p = , 0.027), and −1.5 point in the prehabilitation group (p = 0.015). Those who received prehabilitation statistically increased fat free mass (0.9 kg, p = 0.017) and appendicular skeletal muscle mass (0.5 kg, p = 0.007. In contrast, an increase in fat mass (0.6 kg, p = 0.016) was observed within the standard care group only. Participants in the prehabilitation group had a substantial increase of 27 % muscle strength (p = <0.001). Optimal protein intake was more often achieved within the prehabilitation group (47 %, p = <0.001).

Conclusion

Our study provides evidence for the positive impact of multimodal prehabilitation on preoperative nutritional status in adult patients with CRC, especially in body composition and muscle strength. Achieving optimal protein intake was challenging, both dietary counseling and supplements are recommended to improve intake.

Trial register

PREHAB RCT: NTR5947.

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多模式预适应对结直肠癌患者营养状况的影响及饮食干预的有效性：PREHAB随机临床试验的二次分析

背景与目的：康复前是一项包括运动、营养和心理支持在内的术前多模式项目。我们对康复期间营养状况的变化知之甚少。方法：这项对PREHAB试验的二次分析旨在评估营养状况的变化，并探讨为期四周的营养干预的有效性。在基线和术前（程序结束）收集数据，包括生物电阻抗分析的身体成分（单频，50kHz），肌肉力量（间接1RM腿部按压），三天饮食日记和评分的PG-SGA。蛋白质需取量设定为1.5 g/kg体重。结果：67名参与者入组，34名接受标准治疗，33名接受四周的康复治疗。两组营养状况均有改善：标准治疗组改善-1点（p = 0.027），康复治疗组改善-1.5点（p = 0.015）。接受康复治疗的患者无脂肪质量（0.9kg, p = 0.017）和阑尾骨骼肌质量（0.5kg, p = 0.007）均有统计学意义上的增加。相比之下，仅在标准护理组中观察到脂肪量增加（0.6kg, p = 0.016）。结论：我们的研究为多模式预康复对成年结直肠癌患者术前营养状况的积极影响提供了证据，特别是在身体成分和肌肉力量方面。达到最佳的蛋白质摄入量是具有挑战性的，建议饮食咨询和补充剂来提高摄入量。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.