Koh Frederick Hong-Xiang, Yik Vanessa, Chin Shuen-Ern, Kok Shawn Shi-Xian, Lee Hui-Bing, Tong Cherie, Tay Phoebe, Chean Esther, Lam Yi-En, Mah Shi-Min, Foo Li-Xin, Yan Clement C, Chua Wei-Tian, Jamil Haziq Bin, G Khasthuri, Ong Lester Wei-Lin, Tan Alvin Yong-Hui, Chue Koy-Min, Ho Leonard Ming-Li, Chong Cheryl Xi-Zi, Ladlad Jasmine, Tan Cheryl Hui-Min, Khoo Nathanelle Ann Xiaolian, Ng Jia-Lin, Tan Winson Jianhong, Foo Fung-Joon
Colorectal Service, Sengkang General Hospital, Singapore 544886, Singapore.
Duke-NUS Medical School, Singapore 169857, Singapore.
Nutrients. 2024 Dec 17;16(24):4351. doi: 10.3390/nu16244351.
Multimodal prehabilitation programs, which may incorporate nutritional supplementation and exercise, have been developed to combat sarcopenia in surgical patients to enhance post-operative outcomes. However, the optimal regime remains unknown. The use of beta-hydroxy beta-methylbutyrate (HMB) has beneficial effects on muscle mass and strength. However, its effect on muscle quality in the perioperative setting has yet to be established. This study aims to explore the impact of a multimodal prehabilitation program using a bundle of care that includes high-protein oral nutritional supplementation (HP ONS) with HMB and resistance exercise on muscle quality and functional outcomes in sarcopenic surgical patients.
Sarcopenic adult patients undergoing elective major gastrointestinal surgeries were recruited for this pilot interventional cohort study. They were enrolled in a 2-4-week multimodal prehabilitation program comprising resistance exercise, nutritional supplementation, vitamin supplementation, comorbid optimization and smoking cessation. Participants were provided three units of HP ONS with HMB per day pre-operatively. The primary outcome was changes in intramuscular adipose tissue (IMAT) as a proxy of muscle quality, assessed using Artificial Intelligence (AI)-aided ultrasonography. Secondary outcomes include changes in anthropometric measurements and functional characteristics. Outcomes were measured before prehabilitation, after prehabilitation and 1 month post-operatively.
A total of 36 sarcopenic patients, with a median age of 71.5 years, were included in this study. There was an increase in the IMAT index after two weeks of prehabilitation ( = 0.032) to 1 month after surgery ( = 0.028). Among functional parameters, improvement was observed in gait speed ( = 0.01) after two weeks of prehabilitation, which returned to baseline post-operatively. The median length of hospital stay was 7 (range: 2-75) days.
The increase in the IMAT index in a sarcopenic surgical cohort undergoing prehabilitation may be due to altered muscle metabolism in elderly sarcopenic patients. A prehabilitation regime in sarcopenic patients incorporating HP ONS with HMB and resistance exercise is feasible and is associated with increased gait speed.
多模式术前康复计划可能包括营养补充和运动，已被开发用于对抗外科手术患者的肌肉减少症，以提高术后效果。然而，最佳方案仍不清楚。β-羟基-β-甲基丁酸酯（HMB）的使用对肌肉质量和力量有有益影响。然而，其在围手术期对肌肉质量的影响尚未确定。本研究旨在探讨一项多模式术前康复计划的影响，该计划采用一系列护理措施，包括含HMB的高蛋白口服营养补充剂（HP ONS）和抗阻运动，对肌肉减少症手术患者的肌肉质量和功能结局的影响。
招募接受择期大型胃肠道手术的肌肉减少症成年患者进行这项试点干预队列研究。他们参加了一个为期2至4周的多模式术前康复计划，包括抗阻运动、营养补充、维生素补充、合并症优化和戒烟。术前每天为参与者提供三个单位含HMB的HP ONS。主要结局是以肌肉内脂肪组织（IMAT）的变化作为肌肉质量的指标，使用人工智能（AI）辅助超声进行评估。次要结局包括人体测量和功能特征的变化。在术前康复前、术前康复后和术后1个月测量结局。
本研究共纳入36例肌肉减少症患者，中位年龄为71.5岁。术前康复两周后（P = 0.032）至术后1个月（P = 0.028），IMAT指数有所增加。在功能参数中，术前康复两周后步速有所改善（P = 0.01），术后恢复至基线水平。中位住院时间为7（范围：2至75）天。
接受术前康复的肌肉减少症手术队列中IMAT指数的增加可能是由于老年肌肉减少症患者肌肉代谢的改变。在肌肉减少症患者中，采用含HMB的HP ONS和抗阻运动的术前康复方案是可行的，并且与步速增加相关。
