Effect of Nutritional Prehabilitation on Protein Intake and Diet Quality Assessments in Malnourished Patients Before Cardiac Surgery

Objectives: To determine the effect of nutritional prehabilitation on protein intake and diet quality in malnourished cardiac surgical patients.Methods: This study is from an ongoing single-center, twoarmed, parallel, blinded randomized controlled trial recruiting 132 patients undergoing elective cardiac surgery.Participants are randomized into control (standard care) or treatment (nutritional prehabilitation and Beneprotein) groups (ethics committee approval (CRE no.: 2021.703)).Malnourished patients are defined as those with a MUST score >0 or bioelectrical impedance analysis showing fat-free mass and skeletal muscle mass indices below accepted thresholds.A registered dietitian evaluates dietary intake over the past month using a locally validated Food Frequency Questionnaire.The mean daily energy and protein intake (calculated using Food Processor Nutrition Analysis software) and the Diet Quality Index-International (DQI-I) scores at baseline and admission are compared between groups using mixed-effects regressions.Results: Of the current 23 patients (median [IQR] age 69 [64-74] years; 10 men [43%]) randomized into treatment (n11) and control (n12) groups, 17 (treatment: 9, control: 8) completed surgery.Among the treatment group, 8 patients (89%) met the minimum program compliance of 14 days (median [IQR] 37 [21-48] days).The median (IQR) number of Beneprotein sachets taken by 5 patients in the treatment group was 90 (24-155).The mean protein intake from Beneprotein was higher in the treatment group than the control group (20%, 95% CI: 6%-35%).Overall, there were no changes in energy intake from carbohydrates (p0.93), protein (p0.41),fat (p0.69), or in DQI-I scores (p0.63) between groups over time.Conclusions: A dietitian-guided nutritional prehabilitation program increased the preoperative dietary protein intake in malnourished patients, but did not change the DQI-I score.