Feasibility of a Pre-Operative Morphofunctional Assessment and the Effect of an Intervention Program with Oral Nutritional Supplements and Physical Exercise

Abstract

Background: Surgical patients often experience nutritional imbalances due to their underlying condition and the forthcoming surgical procedure. These imbalances can increase the risk of post-operative complications. To mitigate such risks, a comprehensive nutritional assessment-also known as morphofunctional assessment-should be conducted. This includes evaluating body composition (muscle and fat mass), muscle strength, and functional capacity. Methods: We conducted an observational, prospective, pre-post interventional study involving 138 patients undergoing major elective surgery. Each patient received a morphofunctional assessment and an individualized prehabilitation program, including nutritional supplementation, physical exercise, and comorbidity optimization for 21 days before surgery and one month afterward. Outcomes were assessed through bioimpedance (muscle mass), muscle ultrasound (QRF thickness), dynamometry (strength), and visceral fat ultrasound (fat reduction). Results: The patient's morphofunctional assessment and subsequent nutritional and physical exercise optimization performed during the month before surgery in the prehabilitation consultation led to an increase in muscle mass (measured by bioimpedance analysis, p = 0.001), and muscle ultrasound, (QRF thickness: p < 0.001) and dinamometry (muscle strength: p = 0.014); a reduction in preperitoneal visceral fat thickness (reduction p < 0.001); and an improvement in the patients' nutritional status, with a decrease in malnutrition rates (64.8% vs. 31.8%). As a result, post-operative complications were effectively prevented (p < 0.001). Conclusions: Pre-operative patient optimization by means of a prehabilitation program led to increased muscle strength, improved muscle mass, reduced complication rates, and shorter hospital stays. In addition, patients maintained their quality of life and functional capacity following surgery.

Keywords: disease-related malnutrition; morphofuntional assessment; oral nutrient supplementation; surgical prehabilitation.

Figure 1

Ultrasound assessment of the rectus femoris muscle for sarcopenia screening. Shown (top left) is the linear probe (10–12 MHz) used for image acquisition, alongside the portable ultrasound system Mindray Z60 (center). The ultrasound image (top right) corresponds to a transverse view at the distal third of the thigh, identifying from superficial to deep: ultrasound gel, skin, subcutaneous tissue, vastus lateralis muscle, rectus femoris muscle, and femur. The bottom left image depicts the anatomical landmarking process for measurement, based on the distance between the anterior superior iliac spine and the upper edge of the patella. Reference values for the Y-axis measurement of the rectus femoris are included, used to classify sarcopenia risk and diagnosis.

Figure 2

Study flow chart.