Research
Original Research
Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial

https://doi.org/10.1016/j.jand.2015.06.007Get rights and content

Abstract

Background

A previous comprehensive prehabilitation program, providing nutrition counseling with whey protein supplementation, exercise, and psychological care, initiated 4 weeks before colorectal surgery for cancer, improved functional capacity before surgery and accelerated functional recovery. Those receiving standard of care deteriorated. The specific role of nutritional prehabilitation alone on functional recovery is unknown.

Objective

This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer.

Design

We conducted a double-blinded randomized controlled trial at a single university-affiliated tertiary center located in Montreal, Quebec, Canada. Colon cancer patients (n=48) awaiting elective surgery for nonmetastatic disease were randomized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo. Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery.

Main Outcome Measure

The primary outcome was change in functional walking capacity as measured with the 6-minute walk test. The distance was recorded at baseline, the day of surgery, and 4 weeks after surgery. A change of 20 m was considered clinically meaningful.

Results

The whey group experienced a mean improvement in functional walking capacity before surgery of +20.8 m, with a standard deviation of 42.6 m, and the placebo group improved by +1.2 (65.5) m (P=0.27). Four weeks after surgery, recovery rates were similar between groups (P=0.81).

Conclusion

Clinically meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation. These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery.

Section snippets

Patients

The study was approved by the McGill University Health Centre Research Ethics Board, Montreal, Quebec, Canada, and the protocol was registered at http://clinicaltrials.gov (NCT 01727570). Consecutive adult patients scheduled for elective resection of nonmetastatic colorectal cancer were approached at their first appointment with their surgeon at a single university-affiliated tertiary center located in Montreal, and written informed consent was obtained in eligible patients. Patients with poor

Patients

A total of 68 patients were approached for consent, of which 48 patients were randomized (Figure) between September 2012 and October 2013. Four patients dropped out (ie, did not complete any follow-up assessment), and one patient underwent emergency surgery after randomization. Therefore, a total of 43 patients were analyzed (22 in the whey protein group and 21 in the placebo group). Patient clinical characteristics (Table 1) and baseline measures (Table 2) were similar between groups. The

Discussion

The results of this pilot study provide insight into the role of nutrition prehabilitation on functional capacity. Preoperative nutrition counseling with whey protein supplementation produced a clinically meaningful increase >20 m in functional walking capacity before surgery. Although the results are promising and warrant further larger-scale investigation, practical clinical inferences cannot be made because of the small sample size, variability, and pilot nature of the study.

Gastrointestinal

Conclusion

This pilot study suggested that nutrition played an integral role in preparing patients for surgery. The results are encouraging and justify larger-scale trials to define the specific role of nutritional prehabilitation on functional recovery after surgery.

Acknowledgements

The authors thank the personnel of the McGill University Health Center (Montreal, Canada) colorectal clinic for helping with the recruitment, Mary Guay for her support with the measurements, Immunotec Inc (Quebec, Canada) for graciously supplying the whey protein powder, and Natalie MacLellan, MAdEd, of Best Foot Forward for professional editing.

C. Gillis is a registered dietitian, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.

References (55)

  • J. Kondrup et al.

    Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials

    Clin Nutr

    (2003)
  • U.G. Kyle et al.

    Bioelectrical impedance analysis-part II: utilization in clinical practice

    Clin Nutr

    (2004)
  • A.E. Thalacker-Mercer et al.

    Inadequate protein intake affects skeletal muscle transcript profiles in older humans

    Am J Clin Nutr

    (2007)
  • B. Jie et al.

    Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

    Nutrition

    (2012)
  • A.A. Ferrando et al.

    EAA supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly

    Clin Nutr

    (2010)
  • L.M. van Venrooij et al.

    Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery

    Nutrition

    (2012)
  • J.W. Hartman et al.

    Consumption of fat-free fluid milk after resistance exercise promotes greater lean mass accretion than does consumption of soy or carbohydrate in young, novice, male weightlifters

    Am J Clin Nutr

    (2007)
  • Canadian Cancer Society’s Advisory Committee on Cancer Statistics: Canadian Cancer Statistics 2013

    (2013)
  • F. Carli et al.

    Optimizing functional exercise capacity in the elderly surgical population

    Curr Opin Clin Nutr Metab Care

    (2005)
  • C. Li et al.

    Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: A pilot study

    Surg Endosc

    (2013)
  • N.A. Burd et al.

    Exercise training and protein metabolism: influences of contraction, protein intake, and sex-based differences

    J Appl Physiol

    (2009)
  • Protein Quality Evaluation in Human Diets: Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition Paper...
  • A.S. Yalcin

    Emerging therapeutic potential of whey proteins and peptides

    Curr Pharm Des

    (2006)
  • L.M. Burke et al.

    Preexercise aminoacidemia and muscle protein synthesis after resistance exercise

    Med Sci Sports Exerc

    (2012)
  • A.F. Piccolomini et al.

    High hydrostatic pressure pre-treatment of whey proteins enhances whey protein hydrolysate inhibition of oxidative stress and IL-8 secretion in intestinal epithelial cells

    Food Nutr Res

    (2012)
  • S. Burden et al.

    Pre-operative nutrition support in patients undergoing gastrointestinal surgery

    Cochrane Database Syst Rev

    (2012)
  • F. Carli et al.

    An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

    Can J Anaesth

    (2009)
  • Cited by (0)

    C. Gillis is a registered dietitian, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.

    R. Awasthi is a kinesiologist, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.

    F. Carli is an anesthesiologist, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.

    S.-E. Loiselle is a professional dietitian, School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada.

    L. Wykes is director and professor, School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada.

    J. F. Fiore, Jr, is a physiotherapist, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

    A. S. Liberman is a surgeon, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

    B. Stein is a surgeon, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

    P. Charlebois is a surgeon, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT This research was funded by Canadian Foundation for Dietetic Research (CFDR).

    ClinicalTrials.gov registration: NCT 01727570.

    Certified in Canada.

    Professional dietitian certified in Quebec (equivalent to RD).

    View full text