Malnutrition Prevalence and Nutritional Change After Preoperative Nutrition Counseling

Preoperative nutrition risk or malnutrition negative impacts patients' ability to tolerate surgical stress, impairs wound healing, delays postoperative physical recovery, prolong hospital stay, and increases risk of infection, anemia, impaired gut function, skeletal muscle loss, overall postoperative complications, and healthcare cost.1-6 Importantly, preoperative nutrition status is a modifiable risk factor that can be optimized to improve surgical outcomes.6 However, malnutrition screening is not yet routinely integrated into all surgical pathways.7 Furthermore, only a small proportion of at-risk patients receive preoperative nutrition therapy.7,8 Recent literatures reports that up to 65% of patients admitted for surgery are either malnutrition or at risk of nutrition.7,9-11 This highlights the necessity of preoperative nutrition screening and intervention are needed to enhance postoperative outcomes. The importance of nutritional optimization extends beyond the immediate preoperative period and into the preadmission phase, forming a critical component of the perioperative care continuum, as emphasized by Enhanced Recovery After Surgery (ERAS) guidelines and prehabilitation program.12 Increased awareness has led to several strategies, including preoperative nutrition education, reducing of perioperative fasting, introduction of oral carbohydrate loading before surgery, and early postoperative feeding -all contributing to improved recovery.13,14 Despite growing awareness, considerable variation exists in the tools and criteria used to screen and assess malnutrition, which contributes to inconsistent prevalence data and may hinder timely intervention. Various nutrition screening tools are used worldwide, including the Malnutrition Screening Tool-Short Form (MST-SF), Mini Nutritional Assessment -Short Form (MNA-SF), Nutrition Risk Screening 2002 (NRS-2002), and the Malnutrition Universal Screening Tool (MUST). In Thailand, the SPENT Nutrition Screening Tool, endorsed by the Society of Parenteral and Enteral Nutrition of Thailand (SPENT), is commonly used in clinical settings. For more comprehensive evaluation, nutritional assessment tools such as the Subjective Global Assessment (SGA), Patient-Generated Subjective Global Assessment (PG-SGA), Global Leadership Initiative on Malnutrition (GLIM) criteria, Mini Nutritional Assessment (MNA), and the ASPEN/Academy of Nutrition and Dietetics Malnutrition Indicators (AAIM) are applied internationally. The modified Nutrition Alert Form (NAF), a simplified nutrition assessment tool, is also widely used in Thailand for preoperative patients due to its practicality and ease of use.15-17 This heterogeneity of tools, each incorporating different parameters and thresholds-such as BMI, recent weight loss, dietary intake, and disease burden-results in variability in sensitivity and specificity, complicating comparisons and underscoring the need for standardization tailored to surgical patients.

The reported prevalence of malnutrition in surgical patients varies widely depending on the type of surgery, socioeconomic background, presence of malignancy, and the screening tool used.15 Preoperative malnutrition screening creates an opportunity to identify and optimize the nutritional status of at-risk patients before surgery. Nevertheless, it remains underutilized due to barriers such as time limit and lack of awareness.16,17 The primary aim of this study is to determine the prevalence of malnutrition among surgical patients enrolled in an Enhanced recovery after surgery (ERAS) program, using the SPENT and modified Nutrition Alert Form (NAF) during their visit to the preoperative clinic. The secondary aim is to evaluate the impact of preoperative nutrition education on body weight and nutrition status prior to surgery.

• The change in Modified NAF score [Time frame: Preoperative period (up to 12 weeks before surgery)]