{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:59:23Z","timestamp":1785473963982,"version":"3.56.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Objective<\/jats:title>\n To investigate the clinical effects of an ERAS-based perioperative nutrition management bundle on nutritional status (indicated by prealbumin), postoperative complications (postoperative nausea and vomiting, PONV), and patient satisfaction in patients undergoing total knee arthroplasty (TKA), and to provide preliminary evidence for the standardization of ERAS nutrition protocols in orthopedic practice.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 96 patients scheduled for TKA between January 2025 and December 2025 were allocated into two groups (control group,\n n<\/jats:italic>\n = 48; nutrition group,\n n<\/jats:italic>\n = 48) using an alternating assignment method based on admission order (quasi-randomization). The control group received traditional fasting regimens, while the nutrition group implemented an ERAS-optimized protocol. The primary outcome was prealbumin (PA) level on postoperative day 3; secondary outcomes included ESR, PONV, patient satisfaction, and fasting times.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The nutrition group had significantly shorter fluid fasting time (2.08 \u00b1 0.28 vs. 7.23 \u00b1 3.72 h,\n P<\/jats:italic>\n &lt; 0.001). On postoperative day 1, the nutrition group showed lower ESR (11.51 \u00b1 8.89 vs. 15.79 \u00b1 11.41 mm\/h,\n P<\/jats:italic>\n = 0.043) and higher PA (199.67 \u00b1 46.98 vs. 177.48 \u00b1 35.32 mg\/L,\n P<\/jats:italic>\n = 0.011); on day 3, PA remained significantly higher (139.29 \u00b1 37.13 vs. 125.31 \u00b1 26.62 mg\/L,\n P<\/jats:italic>\n = 0.037). The incidence of PONV was lower in the nutrition group (4.17% vs. 18.75%,\n P<\/jats:italic>\n = 0.025), with higher patient satisfaction (\n P<\/jats:italic>\n = 0.012). A simplified multivariable logistic regression model adjusting for age confirmed the independent association between the nutrition intervention and reduced PONV (OR = 0.19, 95%CI 0.04\u20130.95,\n P<\/jats:italic>\n = 0.043). No significant differences were observed in total blood loss, drain output, or length of hospital stay (all\n P<\/jats:italic>\n &gt; 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this prospective comparative study, an ERAS-based perioperative nutrition protocol was associated with shorter fluid fasting time, better preservation of early postoperative prealbumin levels, a lower incidence of PONV, and higher patient satisfaction compared with traditional fasting, without increasing perioperative blood loss or prolonging hospital stay. These findings support the safety and feasibility of this protocol; however, due to the quasi-randomized design and exploratory nature of the secondary analyses, these associations should be interpreted with caution. They require confirmation in larger, randomized trials with longer follow-up and functional outcome assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1849639","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:25:02Z","timestamp":1785471902000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimization of perioperative nutrition management based on the ERAS protocol for improving postoperative recovery in patients undergoing total knee arthroplasty: a prospective comparative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Tao","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Shang","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People's Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People's Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Ma","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People's Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinbin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"He","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People's Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumei","family":"Ding","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People's Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People's Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ijnurstu.2019.06.010","article-title":"An integrative review of multimodal pain management on patient recovery after total hip and knee arthroplasty","volume":"98","author":"Zhao","year":"2019","journal-title":"Int J Nurs Stud."},{"key":"B2","doi-asserted-by":"publisher","first-page":"829","DOI":"10.2147\/TCRM.S515992","article-title":"Application of perioperative nursing based on Enhanced Recovery After Surgery (ERAS) principles in patients undergoing total knee arthroplasty","volume":"21","author":"Huang","year":"2025","journal-title":"Ther Clin Risk Manag."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.1016\/j.clnu.2022.05.015","article-title":"Unresolved issues in perioperative nutrition: a narrative review","volume":"41","author":"Ford","year":"2022","journal-title":"Clin Nutr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1002\/jpen.1417","article-title":"Implementation of an Enhanced Recovery After Surgery program can change nutrition care practice: a multicenter experience in elective colorectal surgery","volume":"43","author":"Martin","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1080\/17453674.2019.1683790","article-title":"Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS\u00ae) Society recommendations","volume":"91","author":"Wainwright","year":"2020","journal-title":"Acta Orthop."},{"key":"B6","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1186\/s12871-025-03177-w","article-title":"Effects of postoperative oral carbohydrate intake immediately on the quality of recovery: a propensity score-matched and multivariate analysis","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Anesthesiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"44","DOI":"10.3945\/ajcn.116.148619","article-title":"Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery","volume":"106","author":"Yeung","year":"2017","journal-title":"Am J Clin Nutr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"iii62","DOI":"10.1093\/bja\/aew362","article-title":"Enhanced Recovery After Surgery for primary hip and knee arthroplasty: a review of the evidence","volume":"117","author":"Soffin","year":"2016","journal-title":"Br J Anaesth."},{"key":"B9","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.jor.2024.04.021","article-title":"Improved outcomes with perioperative dietitian-led interventions in patients undergoing total joint arthroplasty: a systematic review","volume":"56","author":"Yee","year":"2024","journal-title":"J Orthop."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2535","DOI":"10.1111\/os.13424","article-title":"Effects of preoperative oral electrolyte-carbohydrate nutrition supplement on postoperative outcomes in elderly patients receiving total knee arthroplasty: a prospective randomized controlled trial","volume":"14","author":"He","year":"2022","journal-title":"Orthop Surg."},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2026.03.088","article-title":"Perioperative nutritional optimization in total joint arthroplasty: from screening to supplementation","author":"Siddiqi","year":"2026","journal-title":"J Arthroplasty"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.10.055","article-title":"Defining preoperative hemoglobin thresholds can help avoid transfusion or adverse events for revision total joint arthroplasty","author":"Sutton","year":"2025","journal-title":"J Arthroplasty."},{"key":"B13","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1016\/j.jvs.2023.04.027","article-title":"Investigating glycemic control in patients undergoing lower extremity bypass within an enhanced recovery pathway at a single institution","volume":"78","author":"Banks","year":"2023","journal-title":"J Vasc Surg."},{"key":"B14","first-page":"8471","article-title":"Effect of different preoperative fasting time on safety and postoperative complications of painless gastrointestinal endoscopy for polyps in patients","volume":"13","author":"Li","year":"2021","journal-title":"Am J Transl Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"277","DOI":"10.20960\/nh.519","article-title":"Oral glutamine reduces myocardial damage after coronary revascularization under cardiopulmonary bypass. A randomized clinical trial","volume":"34","author":"Ch\u00e1vez-Tostado","year":"2017","journal-title":"Nutr Hosp."},{"key":"B16","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1186\/s13018-020-02071-0","article-title":"Does the correction angle affect hidden blood loss in HTO?","volume":"15","author":"Li","year":"2020","journal-title":"J Orthop Surg Res."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.2147\/CIA.S174196","article-title":"Hidden blood loss and its risk factors after hip hemiarthroplasty for displaced femoral neck fractures: a cross-sectional study","volume":"13","author":"Guo","year":"2018","journal-title":"Clin Interv Aging."},{"key":"B18","doi-asserted-by":"publisher","first-page":"35","DOI":"10.5435\/JAAOS-D-20-00089","article-title":"Preoperative carbohydrate drinks do not decrease postoperative nausea and vomiting in type 2 diabetic patients undergoing total knee arthroplasty-a randomized controlled trial","volume":"29","author":"Shin","year":"2021","journal-title":"J Am Acad Orthop Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"476","DOI":"10.29271\/jcpsp.2026.04.476","article-title":"Effect of preoperative oral carbohydrate intake on quality of recovery in elderly patients undergoing total knee arthroplasty","volume":"36","author":"Et","year":"2026","journal-title":"J Coll Physicians Surg Pak."},{"key":"B20","doi-asserted-by":"publisher","first-page":"421","DOI":"10.3390\/jpm13030421","article-title":"Enhanced Recovery After Surgery rehabilitation protocol in the perioperative period of orthopedics: a systematic review","volume":"13","author":"Tao","year":"2023","journal-title":"J Pers Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s00520-023-08091-w","article-title":"Changes in serum prealbumin as a marker for nitrogen balance in surgical oncology patients","volume":"31","author":"Hall","year":"2023","journal-title":"Support Care Cancer."},{"key":"B22","doi-asserted-by":"publisher","first-page":"3505","DOI":"10.1016\/j.arth.2020.06.073","article-title":"Routine preoperative nutritional screening in all primary total joint arthroplasty patients has little utility","volume":"35","author":"Rao","year":"2020","journal-title":"J Arthroplasty."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e0247070","DOI":"10.1371\/journal.pone.0247070","article-title":"Albumin and the fibrinogen-to-albumin ratio: biomarkers for the acute phase response following total knee arthroplasty","volume":"16","author":"Amaro","year":"2021","journal-title":"PLoS ONE."},{"key":"B24","doi-asserted-by":"publisher","first-page":"3186","DOI":"10.1016\/j.arth.2025.06.001","article-title":"Can preoperative carbohydrate drinks and multimodal analgesia reduce nausea, vomiting, and pain after total knee arthroplasty?","volume":"40","author":"Chen","year":"2025","journal-title":"J Arthroplasty."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2050","DOI":"10.1097\/CM9.0000000000002220","article-title":"Length of stay and inpatient charges of total knee arthroplasty in China: analysis of a national database","volume":"136","author":"Long","year":"2023","journal-title":"Chin Med J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1016\/j.arth.2019.04.027","article-title":"Trends in length of stay and 30-day complications after total knee arthroplasty: an analysis from 2006 to 2016","volume":"34","author":"Sarpong","year":"2019","journal-title":"J Arthroplasty."},{"key":"B27","doi-asserted-by":"publisher","first-page":"3390","DOI":"10.1016\/j.arth.2017.06.020","article-title":"Multimodal nutritional management in primary total knee arthroplasty: a randomized controlled trial","volume":"32","author":"Cao","year":"2017","journal-title":"J Arthroplasty."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e833","DOI":"10.5435\/JAAOS-D-21-00960","article-title":"Effects of preoperative carbohydrate-rich drinks on immediate postoperative outcomes in total knee arthroplasty: a randomized controlled trial","volume":"30","author":"Kadado","year":"2022","journal-title":"J Am Acad Orthop Surg."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.2106\/JBJS.20.02169","article-title":"Enhanced recovery after primary total hip and knee arthroplasty: a systematic review","volume":"103","author":"Morrell","year":"2021","journal-title":"J Bone Joint Surg Am."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e90560","DOI":"10.7759\/cureus.90560","article-title":"Role of Enhanced Recovery After Surgery (ERAS) protocols in arthroplasty: a systematic review of RCTs and prospective studies (2018\u20132024)","volume":"17","author":"Aldossari","year":"2025","journal-title":"Cureus."},{"key":"B31","doi-asserted-by":"publisher","first-page":"10225536251407377","DOI":"10.1177\/10225536251407377","article-title":"Enhancing hip and knee arthroplasty outcomes with immunonutrition: a review of the evidence","volume":"33","author":"Taylor","year":"2025","journal-title":"J Orthop Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.3233\/BMR-240013","article-title":"Study of whey protein on muscle mass and functional rehabilitation in postoperative total knee arthroplasty patients","volume":"37","author":"Li","year":"2024","journal-title":"J Back Musculoskelet Rehabil."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s00590-023-03824-3","article-title":"Effects of amino acid supplementation on muscle mass, muscle performance and functional capacity in subjects undergoing total knee arthroplasty: a systematic review of randomized clinical trials","volume":"34","author":"de Souza Borges","year":"2024","journal-title":"Eur J Orthop Surg Traumatol."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1849639\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:25:03Z","timestamp":1785471903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1849639\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":33,"alternative-id":["10.3389\/fnut.2026.1849639"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1849639","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"1849639"}}