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Peer-reviewedCC BY 4.0Nutrients

Immunonutrition vs. Standard Oral Nutritional Supplements in Prehabilitation for Colorectal Cancer Surgery: A Randomized Clinical Trial Assessing Morbidity and Body Composition by Computed Tomography

  • Beatriz Ugalde1,2
  • Luz Juez2,3,4
  • Isabel Ruiz-Torres5
  • Inés Perea-Fuentes3
  • Sara Martos3
  • Irene DeVicente3
  • Daniel Melero2
  • Javier Blázquez2,6
  • José Botella-Carretero1,2,4
6 affiliations
  1. 1Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
  2. 2Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), 28034 Madrid, Spain
  3. 3Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
  4. 4Department of Medicine, Universidad de Alcalá (UAH), 28801 Alcalá de Henares, Spain
  5. 5Department of Anesthesiology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
  6. 6Department of Radiology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
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Abstract

Background/Objectives: Perioperative immunonutrition (IMN) has been proposed to improve outcomes after colorectal surgery. However, the evidence is heterogeneous, and few studies have assessed morbidity together with computed tomography (CT)-derived body composition. We compared IMN with standard oral nutritional supplementation (SONS) in patients undergoing colorectal cancer surgery, evaluating postoperative complications and changes in body composition. Methods: Two-arm open-label randomized clinical trial including sixty patients (SONS: n = 30; IMN: n = 30). Postoperative complications were assessed using the Clavien–Dindo classification, and the Comprehensive Complication Index (CCI). Body composition was quantified using pre- and postoperative CT scans, analyzing the skeletal muscle mass index (SMMI) and psoas area. Results: Baseline characteristics were comparable between groups, except for a higher age in the IMN group (p = 0.036). Overall morbidity was 40% in SONS and 50% in IMN (95%CI: −0.35 to 0.15). No differences were observed in the CCI (14.8 ± 23.1 vs. 15.7 ± 19.0, 95%CI: −11.8 to 10.0). Very major morbidity (Clavien ≥ IIIb) was comparable between groups (p = 0.687). At follow-up there was a decline in handgrip strength in SONS whereas it remained stable in IMN (p = 0.030 for the interaction). Also, there was a decrease in SMMI (−2.33, 95%CI: −1.19 to −3.48 cm2/m2) and psoas area (−1.15, 95%CI: −0.67 to −1.65 cm2) in SONS, whereas in IMN they remained stable: SMMI (−1.48, 95%CI: 1.04 to −3.99 cm2/m2), psoas area (−0.71, 95%CI: 0.36 to 1.78 cm2). Conclusions: IMN did not reduce morbidity compared with SONS when used as prehabilitation for colorectal cancer surgery. Exploratory findings suggested a possible attenuation of postoperative muscle loss with IMN.

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Cite

BibTeXRIS
BibTeX
@article{ugalde2026immunonutrition,
  title = {{Immunonutrition vs. Standard Oral Nutritional Supplements in Prehabilitation for Colorectal Cancer Surgery: A Randomized Clinical Trial Assessing Morbidity and Body Composition by Computed Tomography}},
  author = {Beatriz Ugalde and Luz Juez and Isabel Ruiz-Torres and Inés Perea-Fuentes and Sara Martos and Irene DeVicente and Daniel Melero and Javier Blázquez and José Botella-Carretero},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18203381},
  url = {https://www.mdpi.com/2072-6643/18/20/3381},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Immunonutrition vs. Standard Oral Nutritional Supplements in Prehabilitation for Colorectal Cancer Surgery: A Randomized Clinical Trial Assessing Morbidity and Body Composition by Computed Tomography
AU  - Beatriz Ugalde
AU  - Luz Juez
AU  - Isabel Ruiz-Torres
AU  - Inés Perea-Fuentes
AU  - Sara Martos
AU  - Irene DeVicente
AU  - Daniel Melero
AU  - Javier Blázquez
AU  - José Botella-Carretero
PY  - 2026
DA  - 2026/10/01
JO  - Nutrients
DO  - 10.3390/nu18203381
UR  - https://www.mdpi.com/2072-6643/18/20/3381
AB  - Background/Objectives: Perioperative immunonutrition (IMN) has been proposed to improve outcomes after colorectal surgery. However, the evidence is heterogeneous, and few studies have assessed morbidity together with computed tomography (CT)-derived body composition. We compared IMN with standard oral nutritional supplementation (SONS) in patients undergoing colorectal cancer surgery, evaluating postoperative complications and changes in body composition. Methods: Two-arm open-label randomized clinical trial including sixty patients (SONS: n = 30; IMN: n = 30). Postoperative complications were assessed using the Clavien–Dindo classification, and the Comprehensive Complication Index (CCI). Body composition was quantified using pre- and postoperative CT scans, analyzing the skeletal muscle mass index (SMMI) and psoas area. Results: Baseline characteristics were comparable between groups, except for a higher age in the IMN group (p = 0.036). Overall morbidity was 40% in SONS and 50% in IMN (95%CI: −0.35 to 0.15). No differences were observed in the CCI (14.8 ± 23.1 vs. 15.7 ± 19.0, 95%CI: −11.8 to 10.0). Very major morbidity (Clavien ≥ IIIb) was comparable between groups (p = 0.687). At follow-up there was a decline in handgrip strength in SONS whereas it remained stable in IMN (p = 0.030 for the interaction). Also, there was a decrease in SMMI (−2.33, 95%CI: −1.19 to −3.48 cm2/m2) and psoas area (−1.15, 95%CI: −0.67 to −1.65 cm2) in SONS, whereas in IMN they remained stable: SMMI (−1.48, 95%CI: 1.04 to −3.99 cm2/m2), psoas area (−0.71, 95%CI: 0.36 to 1.78 cm2). Conclusions: IMN did not reduce morbidity compared with SONS when used as prehabilitation for colorectal cancer surgery. Exploratory findings suggested a possible attenuation of postoperative muscle loss with IMN.
SN  - 2072-6643
ER  -