• Im-Kyung Kim, Yun Sun Lee, Hyung Sun Kim, So Young Jun, Seung Eun Oh, Hyung Mi Kim, Jin Hong Lim, Young-Tae Lee, Ju Young Park, Minchul Seo, Mi-Ae Kim, Jae-Sam Hwang, and Joon Seong Park.
• Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
• Nutrition. 2022 Feb 1; 94: 111538.

ObjectivePatients with or without cancers who undergo major gastrointestinal surgery experience malnutrition owing to their catabolic status during the postoperative period. In this study, we evaluated the effect of the clinical application of protein-enhanced diet using mealworms in patients who underwent hepato-pancreato-biliary surgeries.MethodsThis study was designed as a prospective, two-armed, and double-blinded phase III study. The target number of enrolled patients was 216, and the patients were randomized on a 1:1 basis, either to the trial group (consuming mealworms) or to the control group (consuming grain powder). The primary endpoint was to examine the changes in body composition, including phase angle. For secondary outcomes, the activities of immune cells were evaluated using the patients' blood samples.ResultsNo difference in the demographic characteristics of patients was observed. The ratio of the actual protein intake to the recommended daily intake in the trial group was significantly higher than that in the control group (110.03% vs. 98.80%, P = 0.023). In the data on body composition measured by InBody S-10 (Biospace, Seoul, South Korea), the ratios in body cell mass, fat free mass, muscle mass, and phase angle at the study endpoint compared with those at admission showed no statistically significant difference between the two groups. Immune cell analyses suggested that cytotoxic T cells in the trial group had higher activity than in the study group (1.192 vs. 0.974, P = 0.028).ConclusionsIn this study, protein-enhanced diet using mealworms clinically improved the activity of immune cells. However, it did not significantly improve the patients' nutritional status after they experienced hepato-pancreato-biliary surgeries.Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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