{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:39:51Z","timestamp":1772087991425,"version":"3.50.1"},"reference-count":116,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Medical Research Council Clinical Trial Grant \u2013 Industry Collaborative Trials","award":["CTGICTR25-0002"],"award-info":[{"award-number":["CTGICTR25-0002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Sarcopenia is associated with adverse surgical outcomes. Recent literature suggested that pre-surgery prehabilitation, nutrition and \u03b2-Hydroxy \u03b2-methylbutyric acid (HMB) supplementation improve myological and functional outcomes. However, long-term outcomes remain uncertain. Thus, we aimed to analyse findings from the long-term follow-up of surgical patients undergoing oral supplementation and prehabilitation. Methods: A prospective single-centre pilot cohort study was conducted to evaluate the effects of multimodal prehabilitation using high-protein oral nutritional supplementation (HP-ONS) with HMB. Sarcopenic patients between 40 and 90 years old and undergoing gastrointestinal surgery were included from June 2022 to January 2024. Patients were followed up from two to four weeks pre-operatively to six months post-operatively. Paired Wilcoxon signed-rank tests were conducted to evaluate outcomes between time points. Results: 36 patients were included with a median age of 71.5 years (IQR: 55\u201390), and 50% were male. 12 (33.3%) patients were sarcopenic, while 24 (66.7%) were severely sarcopenic. No significant difference in IMAT% was observed at post-operative six months. Number of chair rise repetitions (Median:15 vs. 11, p &lt; 0.001) and six-min walk test (Median: 387 m vs. 349 m, p = 0.020), mid-arm muscle circumference (Median: 23.7 cm vs. 22.5 cm, p = 0.013), mid-arm muscle area (Median: 44.8 cm2 vs. 39.3 cm2, p = 0.005), weight (Median: 51.6 kg vs. 50.8 kg, p = 0.023) and BMI (Median: 23.2 kg\/m2 vs. 21.8 kg\/m2, p = 0.025) increased significantly at six-months post-operatively from surgery. Conclusions: Our findings suggest that improvements in anthropometric and functional outcomes from prehabilitation may persist beyond the acute recovery period. If supported by future works, multimodal prehabilitation has the potential to optimise postoperative recovery amongst sarcopenic older adult surgical patients.<\/jats:p>","DOI":"10.3390\/nu18040703","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T14:05:11Z","timestamp":1771855511000},"page":"703","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Outcomes of Multimodal Prehabilitation with High Protein Oral and HMB Supplementation in Sarcopenic Surgical Patients: The HEROS Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3988-7971","authenticated-orcid":false,"given":"Irving Yu Le","family":"Shua","sequence":"first","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3755-7606","authenticated-orcid":false,"given":"Yong Yi","family":"Tan","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Yik","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2173-9192","authenticated-orcid":false,"given":"Jing Han","family":"Hong","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"SingHealth Duke-NUS Muscle Health Programme, Singapore 168582, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Xia","family":"Liu","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuen-Ern","family":"Chin","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1680-4380","authenticated-orcid":false,"given":"Shawn Shi-Xian","family":"Kok","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Bing","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1931-8928","authenticated-orcid":false,"given":"Cherie","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phoebe","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Chean","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-En","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi-Min","family":"Mah","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Xin","family":"Foo","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3039-3047","authenticated-orcid":false,"given":"Clement C.","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Tian","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haziq bin","family":"Jamil","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khasthuri","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8375-9220","authenticated-orcid":false,"given":"Lester Wei-Lin","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvin Yong-Hui","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4504-4512","authenticated-orcid":false,"given":"Koy-Min","family":"Chue","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard Ming-Li","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl Xi-Zi","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmine","family":"Ladlad","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl Hui-Min","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9500-152X","authenticated-orcid":false,"given":"Nathanelle Ann Xiaolian","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Lin","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winson Jianhong","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fung-Joon","family":"Foo","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin Tean","family":"Teh","sequence":"additional","affiliation":[{"name":"SingHealth Duke-NUS Muscle Health Programme, Singapore 168582, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yibin","family":"Wang","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3717-4480","authenticated-orcid":false,"given":"Frederick Hong-Xiang","family":"Koh","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"SingHealth Duke-NUS Muscle Health Programme, Singapore 168582, Singapore"},{"name":"Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"Sayer","year":"2019","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"155533","DOI":"10.1016\/j.metabol.2023.155533","article-title":"Epidemiology of Sarcopenia: Prevalence, Risk Factors, and Consequences","volume":"144","author":"Yuan","year":"2023","journal-title":"Metabolism"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Tey, S.L., Chew, S.T.H., How, 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