Supplementation Protocol
For patients at moderate or severe nutritional risk (GNRI < 98).
Timing: Begin supplementation 2 weeks prior to surgery and continue for at least 6 weeks postoperatively.
Essential Amino Acids (EAAs)
EAAs stimulate muscle protein synthesis and attenuate perioperative lean mass loss. They are especially critical when patients cannot meet protein needs through whole foods alone.
Recommended Dosage
6–12 g twice daily (total 12–24 g/day). Take between meals or immediately post-exercise. Higher end of range for patients >80 kg.
Whey Protein Isolate
Fast-absorbing, leucine-rich protein source to support positive nitrogen balance. Whey protein supplementation (20–40 g/day) has been associated with improved wound healing and reduced infection rates in surgical populations.
Recommended Dosage
20–40 g/day (0.3–0.4 g/kg bodyweight per serving). Divided into 1–2 servings. Target total daily protein intake of 1.5–2.0 g/kg/day.
Creatine Monohydrate
Enhances phosphocreatine stores, supports lean mass maintenance during immobilization, and may reduce inflammatory markers perioperatively.
Recommended Dosage
5 g/day (maintenance dose). No loading phase required. Take with a carbohydrate-containing meal to enhance uptake. Weight-independent dosing is standard.
HMB (β-Hydroxy β-Methylbutyrate)
A leucine metabolite that attenuates muscle protein breakdown via the ubiquitin-proteasome pathway. Particularly beneficial during periods of immobilization and reduced physical activity post-surgery.
Recommended Dosage
3 g/day divided into 3 doses of 1 g each (calcium HMB salt). Take with meals. Dosing is weight-independent per current literature.
Clinical Notes
- All dosages are oral and evidence-based per current orthopaedic perioperative nutrition literature.
- Adjust protein and EAA intake for patients with renal impairment.
- Creatine loading phase optional — maintenance dosing preferred for surgical patients.
- HMB may be combined with whey protein for synergistic muscle-sparing effects.