The Feasibility of an Essential Amino Acid Supplement for Addressing Protein and Energy Deficiencies in Postoperative Elective and Emergency Colorectal Patients

Background: Patients undergoing abdominal surgery are likely to have sarcopenia and reduced appetite, while associated energy and protein intake deficiencies can pose an issue to older surgical patients (Weimann et al, 2021). Protein enhances satiety so it has the potential to exacerbate energy deficiencies. Essential amino acid (EAA) supplements have been proposed as acceptable alternative means to address protein deficiencies since they do not suppress appetite in older adults (Ispoglou et al., 2021). However, it is not known if these supplements are acceptable to surgical patients. Objectives: To investigate the feasibility and acceptability of a nutritional supplement in two groups of surgical patients. Methods: A feasibility study was conducted in older (>60 years) postoperative elective (n=8) and emergency (n=8) abdominal surgery patients. Mean palatability scores of the supplement were obtained using visual analogue scales (Flint et al. 2000). Patients were then asked to consume the gel twice daily for four weeks. Results: Sixteen patients (5 female and 11 male) with a mean age of 68.81 (± 6.31) years completed palatability assessments. Elective patients found the gel more acceptable than the emergency patients by giving better scores in visual appeal, taste, and palatability. The aftertaste score was worse in the emergency group. Half of the elective patients complied with regime, one patient completed two weeks, two completed five and ten days and one patient withdrew. The emergency patients contrasted with elective patients where one person completed the regime. Conclusion: The acceptability of the supplement and compliance with the postoperative regime was better in the elective patients. Our data suggests that an EAA supplement could be part of nutritional support for elective patients, however, we would advise clinical trials to further test its efficacy. Postoperative taste is known to alter following colorectal surgery (Welchman et al, 2014), but it has not been previously identified that postoperative patients’ taste may differ in elective or emergency cases. Our palatability assessments suggest that a bitter aftertaste, likely due to the addition of EAAs, was more evident to the emergency patients. This further highlights the need for bespoke approaches to develop supplements to address protein deficiencies.