Discussion
malnutrition, skeletal muscle mass, weight loss, FM
MALNOURISHED, MALNUTRITION
This study showed that the majority of patients after oesophagectomy do not meet estimated protein requirements, especially when increasing physical activity levels as part of an exercise programme. Only slightly more than half of all participants meet the estimated energy requirements. These numbers were even lower when energy intake was compared with daily energy requirements calculated using the mREE. Measurement of REE is recommended to personalize energy needsPatients participating in the PERFECT exercise programme were observed to lose more weight compared with controls, which seemed to be mainly loss of FM. FFM, which is commonly used as a proxy for skeletal muscle mass, remained stable over time in the exercise group. Since the exercise programme included progressive resistance training, an increase in muscle mass was expected. This counterintuitive finding could potentially be explained by the decreased protein intake in the exercise group. These findings suggest the need for a structured nutritional intervention, in addition to an exercise programme, which likely will result in larger effects of the exercise programmeExercise had a positive effect on the risk of being malnourished, while energy and protein intake was inadequate and patients participating in the exercise programme lost weight. The questionnaire used to measure risk of malnutrition consists of four domains: weight, food intake, nutrition impact symptoms, and activities and function. The scores for these particular domains remained fairly stable over time and were not different between groups, except for the nutrition impact symptom domain (This study has several limitations. Only half of the PERFECT participants decided to participate in the dietetic study, hampering the generalizability of the findings. Secondary outcomes are reported here, for which the study was not powered. Due to self-selection, patients who participated in the dietetic study had a relatively higher risk of malnutrition at baseline (43.2 per cent) compared with all participants (32.5 per cent). Finally, no data were available regarding the number of consultations with a dietitian during the study period and the specific recommendations that were given during this encounter.The present study shows that patients in the first year after oesophagectomy are at risk of a suboptimal energy and protein intake, especially when increasing physical activity levels as part of an exercise programme. The results suggest that exercise has a small positive effect on the risk of being malnourished, and weight loss was mainly loss of FM and not FFM. These findings highlight the need for specific nutritional recommendations during oncological exercise programmes.