Early post-operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study

Background Malnutrition is prevalent across acute care facilities, particularly in older patients, and contributes to poor surgical outcomes. Clinical practice guidelines recommend the early reintroduction of a full oral diet post-operatively. The present study aimed to compare estimated energy (EEI) and protein (EPI) intake of patients who received early diet upgrade with those who did not. Methods Patients >= 65 years admitted post-operatively to general surgical wards were included. EEI and EPI were calculated and dichotomised as meeting >= 50% or <50% estimated energy (EER) and protein (EPR) requirements. Mean intake and proportion of patients meeting <50% estimated requirements were compared between those who received early upgrade and those who did not at post-operative day (POD)2. Results Thirty-four patients [mean (SD) age 72.9 (5.7) years, 59% male] were analysed at POD2 [EEI: mean 4.2 (2.6) MJ day(-1), 56% (n = 19) met >= 50% EER; EPI: mean 38.7 (29.5) g day(-1), 26% (n = 9) met >= 50% EPR]. The majority (n = 25, 74%) were upgraded to a nonfluid diet by POD2. More patients on fluid diets consumed EER (P = 0.025) and EPR (P = 0.073). No patient on a fluid diet met >= 50% of EPR. Conclusions Although the majority of older patients received early diet upgrade and these patients consumed more energy and protein than those on fluid diets, as a whole, older patients ate poorly post-operatively. Fluid diets should therefore not be used indiscriminately and other approaches to improve post-operative intake of older patients, such as fortified diets, oral nutritional supplements and meal environment interventions, should be adopted.