This manuscript represents a significant contribution to our ongoing efforts to combat sarcopenia through optimisation of nutritional status in older adults with or without disease. Not only will it strengthen a potential Impact Case submission I the next REF, but it will also contribute towards gaining British National Formulary approval for the nutritional gels we have developed. This could have a major impact on the healthcare system, as these gels could be prescribed at NHS and help several patients. This is in addition to our extensive collection of publications over the past few years, which have identified effective exercise and nutritional-based interventions to address sarcopenia and improve health and quality of life in specific groups of older adults with or recovering from disease. Moreover, this manuscript is particularly significant because it contains data generated using our state-of-the-art LCMS equipment, following optimisation of a method to analyse 20 amino acids method. This showcases our enhanced capabilities to conduct high-quality research, which could generate further interest for national and international collaborations. Finally, I would like to highlight that the attached manuscript is complete and polished, with a reduced word count of less than 2000 words form almost 4000 initially. I kindly request your support in providing the necessary funding for this manuscript, as I truly believe it has the potential to make a significant impact and help us achieve our strategic research goals. Thank you for your consideration Theocharis Ispoglou Below, I am also including FYI a potential letter to the Editor “Dear Editor, Our Case Study manuscript represents a significant contribution to the literature as it sheds light on the feasibility and synergistic potential of a home-based exercise and nutrition intervention for addressing frailty and lack of physical fitness in females with multiple sclerosis. Our study aims to encourage the integration of such interventions into community-based programmes, which can potentially improve the lives of individuals with multiple sclerosis and help them achieve optimal physical fitness. We confirm that neither the manuscript nor any parts of its contents are currently under consideration or published in another journal. Thank you for considering our manuscript for publication in your journal. We eagerly await your response Sincerely yours Dr Theocharis Ispoglou” 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. References: Butterworth, M., Lees, M., Harlow, P., Hind, K., Duckworth, L., & Ispoglou, T. (2019). Acute effects of essential amino acid supplement-based and whey protein supplements on appetite and energy intake in older women. Appl Physiol Nutr Metab, 44 (11), pp.1141- 1149; Flint, A., Raben, A., Blundell, J. E., & Astrup, A. (2000). Reproducibility, power, and validity of visual analogue scales in assessment of appetite sensations in single test meal studies. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 24(1), 38–48; Ispoglou, T., Witard, O. C., Duckworth, L. C. & Lees, M. J. (2021). The efficacy of essential amino acid supplementation for augmenting dietary protein intake in older adults: implications for skeletal muscle mass, strength and function. Proc Nutr Soc, 80, 230-242; Weimann, A., Braga, M., Carli, F., Waltzberg, D. Bischoff, S.C. & Singer, P.. (2021) ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition 40, pp. 4745-4761; Welchman, S., Hiotis, P., Pengelly, S., Hughes, G., Halford, J., Christiansen, P., & Lewis, S. (2014). Changes in taste preference after colorectal surgery: A longitudinal study. Clinical Nutrition (Edinburgh, Scotland), 34(5), 881–884.
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CORE (COnnecting REpositories)
CORE (COnnecting REpositories)