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

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, 50kHz), 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 (0.9kg, p = 0.017) and appendicular skeletal muscle mass (0.5kg, p = 0.007. In contrast, an increase in fat mass (0.6kg, 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.