Effects of oral nutritional supplement on postoperative orthognathic surgery patients’ nutritional status: a randomised clinical trial

Effects of oral nutritional supplement on postoperative orthognathic surgery patients’ nutritional status: a randomised clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of oral nutritional supplement on postoperative orthognathic surgery patients’ nutritional status: a randomised clinical trial Naratorn Prachasartta, Kiti Siriwatana, Vorapat Trachoo, Suwimol Sapwarobol, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3993957/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Orthognathic surgery limits oral intake and increases metabolic demand, leading to decreased muscle mass. To mitigate these effects, incorporating oral nutritional supplements (ONS) into a nutritional therapy plan is recommended. However, nutrition therapy has not received much attention in orthognathic surgery. This study aimed to assess the effect of ONS on postoperative orthognathic surgery patients’ nutritional status. Methods A 12-week randomised controlled trial was conducted between June and December 2022 at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok. Patients were included if they were 18 years of age or older, underwent orthognathic surgery involving at least one jaw, and had no metabolic-related diseases, milk or soy allergies, or galactosemia. Patients who underwent segmental procedures or genioplasty alone were excluded. The predictor variable was ONS. Subjects were randomly assigned by the block randomisation method into two groups: 1) subjects who received ONS, and 2) subjects who did not receive ONS. The primary outcome variable was nutritional status, which was measured using anthropometric, biomarker, and muscle strength assessments at 5 time points: a day before surgery (T0), the day of discharge (T1), 2 weeks (T2), 4 weeks (T3), and 12 weeks postoperatively (T4). Covariates were subjects’ demographics, oral health-related quality of life, and dietary record assessment. The T-test, or Mann-Whitney U test, was used to compare the mean difference of continuous data, where appropriate. The differences were considered statistically significant when the p-value was less than 0.05. Results A total of 36 subjects were included in the study. Subjects receiving either nutritional counselling alone or both nutritional counselling and ONS experienced postoperative weight and muscle mass loss, with no significant differences observed across all nutritional status parameters after the 12-week postoperative mark. Conclusion These results suggest the need for more personalised and intensive nutrition therapy plans to reduce the negative impact of muscle mass loss and the associated risk of postoperative infection in orthognathic surgery patients. Trial registration: This study has been registered with the Thai Clinical Trial Registration ( https://www.thaiclinicaltrials.org/ ), with the registration number TCTR20220624006, registered on June 24, 2022. orthognathic surgery oral nutritional supplement nutritional therapy Figures Figure 1 Figure 2 Background Nutritional therapy is a fundamental aspect of medical care for surgeries. 1 Patients who undergo orthognathic surgery is subject to a maxillomandibular fixation (MMF), a traditional method to immobilise the jaws for the management of maxillofacial fractures. Even though MMF can promote bone healing, it can also pose a significant impact on nutrient intake. 2 This surgical procedure elicits physiological stress and also triggers metabolic alterations. Orthognathic surgery may cause several metabolic derangements including metabolic stress. It also increases energy demands while energy intake is limited. These metabolic imbalances, arising from increased energy demands and inadequate nutritional supply, can compromise immunity, impair wound healing, and increase the risk of infection. 3 – 7 Therefore, it is imperative not to underestimate the importance of ensuring adequate nutrition during postoperative phase, as it plays a crucial role in promoting optimal healing, facilitating recovery, and improving the overall well-being of patients undergoing orthognathic surgery. 8 This is highlighted by the observed changes in anthropometric and nutritional biomarkers after orthognathic surgery. Previous study has shown that patients show a 3.9% decrease in body weight at two weeks post-surgery, followed by an additional 8.3% decrease at four weeks. 9 , 10 The nutritional biomarker data indicates a significant decline at one week after surgery, which persists at the two-week mark, indicating ongoing nutritional changes during this critical period. 9 In the context of orthognathic surgery, patients experience reduced nutrient intake and increased metabolic demand. A nutritional therapy plan incorporating the use of oral nutritional supplements (ONS) to provide additional energy and nutrients is recommended. 11 Nonetheless, nutrition therapy has not received much attention in the field of orthognathic surgery, despite its potential benefits. Therefore, the purpose of this study was to investigate the impact of ONS on the postoperative nutritional status of patients undergoing orthognathic surgery. The investigators hypothesised that subjects receiving ONS after the operation would maintain their overall nutritional status better than those not given ONS. The specific aims of the study were to compare postoperative anthropometric, biomarker, and muscle strength between the two groups, as well as to assess their oral health-related quality of life and dietary intakes. Methods Study design/Sample The study recruited patients scheduled for orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand, between June 2022 and December 2022. Patients were screened for inclusion criteria, which are: being 18 years of age or older; being enrolled in orthognathic surgery for at least one jaw surgery; and having no known metabolic-related diseases, milk or soy allergies, or galactosemia. Patients who underwent segmental procedures or only genioplasty were excluded from the study. A 12-week randomised controlled trial was conducted to investigate the effects of ONS on the postoperative nutritional status of subjects undergoing orthognathic surgery. To monitor dietary intake, subjects were asked to record all foods and beverages they consumed over two weekdays and one weekend. Variables The predictor variable was ONS. Subjects were randomly assigned by the block randomisation method into two groups: 1) subjects who received ONS, and 2) subjects who did not receive ONS. Subjects received nutritional counselling administered by registered dietitians from the Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand, according to the nutrition counselling protocol. The counselling sessions were conducted via the tele-nutrition method (a video call) and took place three times over the course of the 12-week study: the first session was held a day prior to the surgery (baseline, T0), the second session was conducted before the transition from a liquid diet to a soft diet (2nd week, T2), and the final session was conducted before the transition from a soft diet to a regular diet (4th week, T3). During the nutrition counselling course, subjects were explained the diet regimen (liquid diet, soft diet, and regular diet). During a liquid diet phase, only fluids and foods that are normally liquid and foods that turn to liquid when they are at room temperature were allowed. A daily caloric intake ranging from 700 to 800 kcal was recommended during a phase of a liquid diet. In a soft diet period, subjects were advised to consume soft and easy-to-digest foods. Hard-to-digest foods, as well as those that are tough to chew, should be restricted. A soft diet provided 1000–1200 kcal daily. After week 4, subjects were encouraged to make a transition to a regular diet or more solid foods. During this regular diet, energy and macronutrient content returned closely to their habitual diet. In the NC + group, subjects were given nutrition counselling and ONS, which is called Ensure Plus Advance® in vanilla flavour, developed by Abbott Laboratories, Illinois, United States of America. This is to be consumed as one serving daily for one month following the surgery, in addition to their meals. One serving of ONS was 220 ml, containing 330 kcal, 37 grams of carbohydrate, 20 grams of protein, and 7 grams of fat. The primary outcome variable was nutritional status, which was measured using anthropometric, biomarker, and muscle strength assessments. The covariates were the subjects’ demographics, oral health-related quality of life, and dietary record assessment. Data collection methods For the anthropometric assessment, body weight, muscle mass, and fat mass were measured using a bioelectrical impedance analyser (MC-580 MA body composition analyser, TANITA Corporation, Tokyo, Japan) at a day before surgery (T0), a day of discharge (T1), and 2 weeks (T2), 4 weeks (T3), and 12 weeks postoperatively (T4). A blood sample of approximately 15 ml was obtained through vein puncture by either a medical technologist or an anaesthetic nurse. Subsequently, the collected blood samples were divided into four tubes and transferred to a private medical laboratory, National Healthcare Systems Company Limited, Bangkok, Thailand, for the analysis of specific biomarkers of interest. Albumin, BUN, and creatinine were collected at five time points: T0, T1, T2, T3, and T4. Prealbumin and hs-CRP were collected at four time points: T0, T1, T2, and T3. Random plasma glucose (RPG), HbA1C, and lipid profiles (HDL, LDL, and triglycerides) were collected at two time points: T0 and T4. Muscle strengths were measured at five time points: T0, T1, T2, T3, and T4 by a hand-held Camry digital dynamometer (90 kg/200 lbs, Camry Scale from California, United States of America). Oral health-related quality of life was measured at five time points: T0, T1, T2, T3, and T4 using the Oral Health Impact Profile 14 (OHIP-14) questionnaire (Fig. 2). The OHIP-14 questionnaire is based on Locker’s conceptual model and commonly used to determine quality of life related to oral health in children, adults, and the dentate elderly. 12 It has been translated into Thai and validated for use with Thai patients 13 . The questionnaire consisted of 7 aspects, with 2 questions allocated to each aspect, resulting in a total of 14 questions. A five-point response format (Likert scale) was employed, ranging from “not at all” (score 0), “hardly ever” (score 1), “occasionally” (score 2), “fairly often” (score 3), and “very often” (score 4). Throughout the 12-week study period, a weekly diet record was collected from each participant, encompassing dietary information from two weekdays and one weekend day. The average energy intake, as well as the intake of macronutrients such as carbohydrate, protein, and fat, were calculated and assessed. Data was reported at the liquid diet period, the soft diet period, and the regular diet period. Data analyses The study employed an intention-to-treat analysis. The normality of the data was tested using the Shapiro-Wilk test. The T-test or Mann-Whitney U test was used to compare the mean difference of continuous data, where appropriate. All statistical analyses were carried out using SPSS 23.0 software (SPSS Inc., Illinois, the United States of America). The differences were considered statistically significant when the p-value was less than 0.05. Results The sample size calculation was conducted via an online statistical calculator (Statulator, https://statulator.com/ ) based on a study by Popat, S. P., Rattan, V., Rai, S., Jolly, S. S., & Malhotra, S. (2021) 14 The Calculator for Comparing Two Independent Means was accessed on November 28, 2021, at http://statulator.com/SampleSize/ss2M.html . Assuming a pooled standard deviation of 6 units, the study required a sample size of 14 for each group (total sample size of 28, assuming equal group sizes) to achieve a power of 80% and a level of significance of 5% (two-sided) for detecting a true difference in means between the test and the reference group of 6.63 (i.e., 61.33–54.70) units. Accounting for an assumed dropout rate of 20%, the final sample size recruited was 17 patients per group. A total of 41 patients were assessed for eligibility. Thirty-four eligible subjects then were randomly assigned to either the nutritional counselling (NC) group (n = 17) or the nutritional counselling with ONS (NC+) group (n = 17) by block randomisation method via https://www.randomizer.org/ . Twenty-eight subjects (NC, n = 12 and NC+, n = 16) completed the study (Fig. 1) with a mean age of 26 ± 4 years in NC group and 28 ± 7 in NC + group. In the NC group, there were 8 male and 9 female subjects, while in the NC + group, there were 5 male and 12 female subjects. Regarding the types of surgery, the NC group comprised 7 subjects who underwent single-jaw surgery, 9 subjects who underwent double-jaw surgery, and 1 subject who underwent double-jaw surgery with genioplasty. In the NC + group, there were 5 subjects who underwent single-jaw surgery, 10 subjects who underwent double-jaw surgery, and 2 subjects who underwent double-jaw surgery with genioplasty (Table 1 ). Anthropometric Parameters There was a significant difference in weight loss between the two groups at T2 and T3. However, no significant difference was observed in muscle mass loss between the groups at any time point. Both groups exhibited fluctuations in fat mass, although no consistent pattern of change was evident. A significant difference in fat mass was observed between the two groups at T1 and T2 (Table 2 ). Biomarker Parameters There were no statistically significant differences between the groups in terms of changes in the values nutritional status biomarkers throughout any of the follow-up periods (Table 2 ). Both groups demonstrated a notable initial increase in hs-CRP levels at T1, but subsequently decreased over time. Furthermore, there were no significant differences observed in the changes of RPG, HbA1c, HDL, LDL, or triglyceride levels at the 12-week postoperative period (Table 2 ). Muscle strength parameter The results of the handgrip strength test indicated that there were no significant differences in the changes of handgrip strength between the two groups at any of the postoperative periods. Both groups exhibited a decrease in handgrip strength immediately after surgery (T1), which gradually improved over time. By T4, both groups had regained their handgrip strength and were comparable to their respective preoperative levels (Table 2 ). Oral health-related quality of life parameter The OHIP-14 scores gradually improved from T1 to T4 for both groups. However, there were no significant differences observed between the two groups in any of the aspects at any point during the postoperative period (Table 3 ). Dietary record parameter The analysis of the diet logs provided by the subjects revealed that there were no significant differences between the two groups in terms of total energy and macronutrient consumption during any of the diet periods. This finding was observed even though the NC + group received ONS (Table 4 ). Discussion The primary objective of this study was to examine how ONS affects the postoperative nutritional status of orthognathic surgery patients. The investigators hypothesised that subjects who received ONS following their surgery would exhibit better maintenance of their overall nutritional status compared to those who did not receive ONS. The specific aims of the study included comparing postoperative anthropometric measurements, biomarkers, and muscle strength between the two groups, as well as evaluating their oral health-related quality of life and dietary intake. Subjects in both group (NC vs NC+) experienced the loss of body weight and muscle mass after 12 week follow up. The difference in weight loss between the two groups was significant at T2 and T3. However, there was no significant difference in muscle mass loss between the groups at any time point. In terms of fat mass changes, the NC group had significantly greater fat mass loss than the NC + group at T1 and T2. Our findings suggest that current orthognathic patients show weight loss patterns comparable to those observed over four decades ago 15 , 16 , despite receiving nutrition counselling and ONS, possibly attributed to the prolonged trismus resulting from MMF. According to a hospital’s guideline, patients undergoing orthognathic surgery were subjected to a 2-week period of MMF, during which their diets were restricted to a liquid diet. Subsequently, a post-operative dietary regimen advancing from liquid to soft, and regular diets over a span of 4 weeks. Consistent with our study, Worrall's study demonstrated that by the sixth week following surgery, the MMF group experienced a significantly higher degree of weight loss in comparison to the non-MMF group 17 . During periods of restricted food intake, the body undergoes adaptations to cope with the lack of food, including the breakdown of liver glycogen and muscle protein to provide glucose for the brain and the gradual depletion of fat stores 18 . Surgical procedures can also trigger metabolic changes mediated by hormone and cytokine release, resulting in catabolic processes. Cortisol secretion further contributes to muscle tissue breakdown, promoting proteolysis and the release of amino acids for tissue repair and synthesis. Inadequate nutrition or high energy demand disrupts metabolic balance, compromising immune function, impairing wound healing, and increasing infection risk 3 – 7 , especially in individuals with reduced muscle mass who lack essential amino acid sources 19 .Limited research has focused on the loss of muscle mass among orthognathic surgery patients. A recent study investigated acute muscle loss after gastrectomy and found that over 31.82% of patients experienced a loss of more than 10% of their muscle mass within a week post-surgery, leading to decreased quality of life, increased postoperative complications, longer hospital stays, and higher medical costs 20 . Although the muscle loss observed in our orthognathic surgery study may be comparatively lower, it is crucial to recognise the potential adverse effects of such loss. The addition ONS in our study, along with nutritional counselling, did not result in a significant difference in postoperative nutritional status biomarkers between the groups. Similarly, there was no significant difference observed between the groups in terms of inflammatory biomarkers, specifically TLC and hs-CRP. In addition to the traditional protein nutrition index, Lymphocyte count is often considered a valuable indicator of nutritional status, as undernutrition can cause immunological alterations. Measurement of hs-CRP as an inflammatory marker was also conducted due to the protein consumption associated with inflammation 21 – 23 . Overall, the addition of ONS did not provide substantial benefits beyond those achieved through nutritional counselling alone. Both groups might have received high-quality nutritional counselling that was equally effective. If the counselling was standardised and provided with the same level of expertise to both groups, this could reduce the differences between them. Handgrip strength measurement is considered an important indicator of functional status and is commonly included in nutritional assessments 24 , 25 , with evidence supports the correlation between handgrip strength and markers of nutritional status, muscle mass, and overall health and function. Lower handgrip strength has also been associated with increased mortality rates and longer hospital stays 26 , 27 . However, we did not observe a significant improvement in handgrip strength recovery with the addition ONS among orthognathic surgery patients. This suggests that handgrip strength recovery after orthognathic surgery is influenced by a complex interplay of multiple factors. While nutrition is undeniably important, its direct impact on handgrip strength recovery may be overshadowed by the intricate nature of the recovery process and individual variability. The assessment of quality of life is crucial in predicting the benefits of nutritional therapy 28 . However, there is limited past research on the effects of ONS on quality of life following orthognathic surgery, highlighting the lack of available data in this area. During the postoperative period, no significant differences were observed in any of the aspects of OHIP-14 scores between the two groups. The lack of significant differences between the groups could be attributed to various factors. The impact of ONS on quality of life following orthognathic surgery might be limited to specific unmeasured domains within the OHIP-14 questionnaire. Additionally, the questionnaire's sensitivity might not be adequate to detect subtle changes in oral health-related quality of life. It is noteworthy that the addition of ONS to nutritional counselling did not significantly affect patients' quality of life related to oral health in this study. However, it is important to recognise that nutritional counselling alone may be sufficient to support their quality of life in this aspect following orthognathic surgery. In general, the subjects' postoperative nutritional status showed signs of improvement at T3, which is 4 weeks after the surgery. Consistent with our findings, Ooi et al. observed that biomarker parameters such as total protein, serum albumin, total cholesterol, were decreased at 1 week after surgery and continued to show significant decreases at 2 weeks after surgery 9 . This suggests that it may take several weeks for the nutritional status of patients to recover following orthognathic surgery. This improvement can be attributed to the transition from a liquid to a soft diet, which occurred after the removal of MMF at the 2-week postoperative period. Analysis of the subjectts' diet log revealed an increase in macronutrient intake and total energy consumption during this period. It is noteworthy that there were no significant differences in total energy and macronutrient intake between the two groups throughout the postoperative diet phases, as indicated by the diet log. We proposed that nutrition counselling by a registered dietitian could improve patients’ dietary intake. During nutrition counselling, patients were advised on how to meet their daily caloric and macronutrients requirements. Recommendations on food choices in liquid or soft diet were introduced. Our participants in this study could eventually maintain their body weight and others anthropometric indices. Lack of significant differences in nutritional intake between the groups may be a key attribution to insignificant differences found in this study. In addition, it is possible that the ONS in the NC + group was consumed as a replacement for a main meal rather than as a supplement. This is because all patients in the study were treated with MMF, which made it difficult for them to have a normal diet, forcing them to rely on liquid food at least 2 week post-operatively. The physical disability caused by MMF was reflected in the OHIP-14 score for physical pain (pain and being uncomfortable to eat) and physical disability (diet unsatisfactory and interrupted meals), which showed improvement from T1 to T4 as patients progressed from a liquid diet to a soft diet and eventually a regular diet. A study revealed that 17% of patients had significant concerns about their appearance prior to undergoing orthognathic surgery, and 10% of patients showed positive screening results for body dysmorphic disorder 29 . But our results show that ONS can be used without negatively impacting glucose and lipid metabolism in the postoperative period. At 12 weeks after surgery, there were no significant differences between the two groups in changes to random plasma glucose, HbA1c, HDL, LDL, and triglyceride levels. This emphasises the importance of providing nutritional counselling which helps patients to understand the importance of proper nutrition and guide them in making healthy dietary choices that support postoperative recovery. Proper nutritional support is essential for postoperative recovery and maintaining homoeostasis in orthognathic surgery patients 30 , 31 . However, nutrition therapy has been overlooked in this field. Earlier studies conducted in the 1980s indicated that a liquid supplement after surgery can help maintain nutrient intake and preserve body weight 15 , 16 . More recent research by Hammond et al. demonstrated that despite receiving dietary advice and ONS, patients still experienced weight loss and reduced body fat following orthognathic surgery 10 . These findings, along with ours, highlight the need for a tailored nutritional therapy protocol to optimise healing and minimise postoperative complications. It is also important to note that this study's findings do not necessarily suggest that ONS should not be considered as part of nutritional therapy after orthognathic surgery. The decision to use ONS should be based on individual patient needs and may vary depending on the patient's nutritional status and recovery goals. Nevertheless, nutritional counselling remains a crucial element of nutritional therapy, and the study's results emphasise the importance of providing extensive nutritional guidance to patients who have undergone orthognathic surgery. This approach can help ensure that patients are receiving appropriate dietary support tailored to their individual needs, which is essential for promoting optimal healing and a successful recovery process. Acknowledging the study's limitations, including the small sample size and absence of a control group without nutritional therapy due to ethical reason, caution is needed when interpreting the results. Future research should address these limitations by conducting larger-scale, international multicentre studies to improve generalisability and reliability. Inclusion of diverse patient populations and multiple centres would provide a more comprehensive understanding of the role of ONS in nutritional therapy for orthognathic surgery patients. Such studies would offer valuable insights into the potential benefits, optimal dosage, duration of ONS, and variations in response among different patient groups. Conclusion In conclusion, this study aimed to evaluate the impact of ONS on the postoperative nutritional status in orthognathic surgery patients. The results indicated that patients who were receiving nutritional counselling alone and those who were receiving nutritional counselling as well as in ONS both experienced postoperative weight and muscle mass loss, with no significant differences observed across all nutritional status parameters at the 12-week postoperative mark. These findings suggested the need for more personalised and intensive nutrition therapy plans to reduce the negative impact of muscle mass loss and associated risk of postoperative infection in orthognathic surgery patients. Table 1 Preoperative clinical background of the subjects Nutritional counselling alone (NC) (N = 17) Nutritional counselling with ONS (NC+) (N = 17) Age 26 ± 4 28 ± 7 Sex Male (n) 8 (47%) 5 (29%) Female (n) 9 (53%) 12 (71%) Types of surgery Single-jaw surgery (n) 7 (41%) 5 (29%) Double-jaw surgery (n) 9 (53%) 10 (59%) Double-jaw surgery with genioplasty (n) 1 (6%) 2 (12%) Anthropometrics Body weight (kg) 64.5 ± 14.8 54.6 ± 9.4 BMI (kg/m 2 ) 22.7 ± 3.8 20.8 ± 3.6 Muscle mass (kg) 44.2 ± 9.9 37.0 ± 5.3 Fat mass (kg) 18.0 ± 6.8 15.4 ± 7.1 Muscle strength Handgrip strength (kg) 32.0 ± 11.5 26.3 ± 7.1 Biomarkers Total lymphocyte count (%) 30.4 ± 6.5 25.8 ± 8.9 Albumin (g/L) 4.8 ± 0.2 4.7 ± 0.2 Prealbumin (mg/dL) 28.7 ± 5.1 28.2 ± 3.5 C-reactive protein (mg/L) 2.4 ± 4.3 1.2 ± 1.2 BUN (mg/dL) 11.9 ± 2.1 12.6 ± 3.7 Creatinine (mg/dL) 0.9 ± 0.1 0.8 ± 0.2 Random plasma glucose (mg/dL) 86.7 ± 10.9 87.5 ± 13.6 HbA1c (%) 5.1 ± 0.4 5.2 ± 0.4 HDL (mg/dL) 57.4 ± 11.1 63.6 ± 11.9 LDL (mg/dL) 153.1 ± 37.5 149.8 ± 32.8 Triglyceride (mg/dL) 93.1 ± 48.5 101.2 ± 44.9 Data are mean ± SD. Table 2 Changes on postoperative nutritional status parameters Parameters NC(n = 17) NC+(n = 17) T0 T1 T2 T3 T4 T0 T1 T2 T3 T4 Anthropometrics Body weight (kg) 64.5 ± 14.8 63.3 ± 15.5 61.2 ± 13.2* 61.3 ± 13.9* 60.8 ± 11.8 54.6 ± 9.4 54.8 ± 8.4 51.6 ± 9.1* 52.1 ± 9.8* 51.6 ± 9.4 BMI (kg/m 2 ) 22.7 ± 3.8 21.9 ± 3.7 21.6 ± 3.3 21.6 ± 3.5 21.8 ± 3.0 20.8 ± 3.6 20.9 ± 3.3 19.7 ± 3.4 19.8 ± 3.4 19.6 ± 3.3 Muscle mass (kg) 44.2 ± 9.9 43.4 ± 11.0 42.3 ± 9.6 42.4 ± 9.5 43.2 ± 9.5 37.0 ± 5.3 36.5 ± 5.1 35.3 ± 5.1 35.5 ± 5.4 35.7 ± 5.5 Fat mass (kg) 18.0 ± 6.8 16.3 ± 6.8* 16.6 ± 2.4* 16.5 ± 6.7 15.0 ± 4.9 15.4 ± 7.1 16.1 ± 7.1* 14.3 ± 6.7* 14.4 ± 6.5 13.5 ± 6.3 Muscle strength Handgrip strength (kg) 32.0 ± 11.5 30.1 ± 11.8 30.3 ± 10.9 31.5 ± 12.2 32.3 ± 11.5 26.3 ± 7.1 24.5 ± 7.8 24.7 ± 7.1 25.1 ± 6.8 25.5 ± 7.4 Biomarkers TLC (%) 30.4 ± 6.5 25.1 ± 8.8 32.1 ± 9.7 32.5 ± 6.8 33.9 ± 6.5 25.8 ± 8.9 21.8 ± 9.7 26.1 ± 7.2 30.4 ± 7.8 30.4 ± 5.9 Albumin (g/L) 4.8 ± 0.2 4.2 ± 0.3 4.7 ± 0.3 4.8 ± 0.3 4.8 ± 0.3 4.7 ± 0.2 4.2 ± 0.1 4.6 ± 0.2 4.8 ± 0.2 4.8 ± 0.2 Prealbumin (mg/dL) 28.7 ± 5.1 21.7 ± 2.9 23.1 ± 5.3 26.1 ± 5.1 N/A 28.2 ± 3.5 24.6 ± 2.5 23.9 ± 4.2 25.9 ± 4.5 N/A hs-CRP(mg/L) 2.4 ± 4.3 17.3 ± 19.4 2.4 ± 2.6 1.6 ± 2.4 N/A 1.2 ± 1.2 15.1 ± 10.4 4.2 ± 5.6 2.2 ± 3.0 N/A BUN (mg/dL) 12.0 ± 2.1 11.3 ± 3.0 9.5 ± 2.4 10.2 ± 3.3 12.8 ± 2.5 12.6 ± 3.7 12.2 ± 5.0 9.9 ± 3.7 8.8 ± 2.3 11.0 ± 3.9 Creatinine (mg/dL) 0.9 ± 0.1 0.8 ± 0.1 0.8 ± 0.2 0.8 ± 0.2 0.8 ± 0.1 0.8 ± 0.2 0.7 ± 0.2 0.8 ± 0.2 0.8 ± 0.2 0.8 ± 0.2 RPG(mg/dL) 86.7 ± 10.9 N/A N/A N/A 77.4 ± 11.1 87.5 ± 13.6 N/A N/A N/A 80.6 ± 7.4 HbA1c (%) 5.1 ± 0.4 N/A N/A N/A 5.1 ± 0.3 5.2 ± 0.4 N/A N/A N/A 5.3 ± 0.4 HDL (mg/dL) 57.4 ± 11.1 N/A N/A N/A 61.6 ± 12.44 63.6 ± 11.9 N/A N/A N/A 63.9 ± 10.6 LDL (mg/dL) 153.1 ± 37.5 N/A N/A N/A 157.8 ± 59.8 149.8 ± 32.8 N/A N/A N/A 137.7 ± 32.2 Triglyceride (mg/dL) 99.1 ± 48.5 N/A N/A N/A 117.3 ± 51.0 101.2 ± 44.9 N/A N/A N/A 109.1 ± 57.3 Data are mean ± SD. Significant difference between study groups were determined by t-tests or Mann-Whitney U tests as appropriate. *refers to significant differences between study groups (t-test). A P-value < 0.05 is considered statistically significant. Table 3 Comparison of OHIP-14 scores Aspect NC(n = 17) NC+ (n = 17) T0 T1 T2 T3 T4 T0 T1 T2 T3 T4 Functional limitation 2.1 3.9 2.9 2.6 1.7 2.4 3.4 3.2 2.6 2.2 Physical pain 2.4 3.6 2.3 2.8 2.6 2.7 3.5 3.5 2.6 2.7 Psychological discomfort 3.3 3.0 2.7 2.4 2.0 3.4 3.5 2.9 2.4 2.5 Physical disability 1.9 3.5 3.2 2.6 1.8 2.3 3.7 3.1 2.2 2.3 Psychological disability 2.8 2.8 2.5 2.3 1.9 3.1 3.3 2.6 2.1 2.1 Social disability 2.0 2.8 2.8 2.2 1.8 2.5 3.2 2.7 2.2 1.9 Handicap 2.5 3.5 2.0 2.5 1.8 2.7 3.3 2.9 2.3 2.1 Data are mean. Significant difference between study groups were determined by Mann-Whitney U test. *refers to significant differences between study groups. A P-value < 0.05 is considered statistically significant. Table 4 Comparison of postoperative food energy intake Parameters NC(n = 17) NC+ (n = 17) Liquid diet period Soft diet period Regular diet period Liquid diet period Soft diet period Regular diet period Total energy (kcal) 744.96 ± 381.73 1,082.04 ± 418.46 1,080.86 ± 358.91 867.14 ± 539.39 1,146.68 ± 417.82 1,091.44 ± 336.97 Carbohydrate consumption (g) 108.69 ± 76.05 127.61 ± 27.12 99.91 ± 17.26 130.38 ± 82.11 144.21 ± 65.25 136.41 ± 57.13 Protein consumption (g) 31.28 ± 20.74 62.33 ± 25.77 74.89 ± 25.78 29.78 ± 20.21 53.48 ± 20.82 47.07 ± 13.76 Fat consumption (g) 20.56 ± 14.77 35.81 ± 19.87 42.20 ± 18.33 25.06 ± 16.68 36.68 ± 17.49 39.73 ± 21.15 Data are mean ± SD. Significant difference between study groups were determined by t-tests. *refers to significant differences between study groups. A P-value < 0.05 is considered statistically significant. Declarations Ethics approval and consent to participate The study protocol was approved by the Human Research Ethics Committee of the Faculty of Dentistry at Chulalongkorn University with the approval number HREC-DCU 2022–008. The study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments. Each subject was fully informed about the study's purpose and provided written consent for the use of their clinical data. This study has been registered with the Thai Clinical Trial Registration (https://www.thaiclinicaltrials.org/), with the registration number TCTR20220624006, registered on June 24, 2022. Consent for publication Not applicable Availability of data and materials All data generated or analysed during this study are included in this published article Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Not applicable Authors' contributions Conceptualisation Vorapat Trachoo and Suwimol Sapwarobol conceptualised the study. Methodology All authors designed the experimental protocols. Data Collection Naratorn Prachasartta collected and compiled the research data. Analysis and Interpretation Naratorn Prachasartta and Kiti Siriwatana conducted the statistical analysis and interpreted the results. Writing – Original Draft Naratorn Prachasartta drafted the initial manuscript. Writing – Review & Editing Kiti Siriwatana, Suwimol Sapwarobol and Praew Chantrasilapin critically reviewed and edited the manuscript. Supervision Kiti Siriwatana provided guidance and supervision throughout the project. All authors read and approved the final manuscript. Acknowledgements Not applicable References Howard L, Ashley C. Nutrition in the perioperative patient. Annu Rev Nutr . 2003;23:263-82. Hayter JP, Cawood JI. The functional case for miniplates in maxillofacial surgery. Int J Oral Maxillofac Surg . 1993;22(2):91-6. Margraf A, Ludwig N, Zarbock A, Rossaint J. Systemic Inflammatory Response Syndrome After Surgery: Mechanisms and Protection. Anesth Analg . 2020;131(6):1693-707. Badwal RS, Bennett J. Nutritional considerations in the surgical patient. Dent Clin North Am . 2003;47(2):373-93. Ruberg RL. Role of nutrition in wound healing. Surg Clin North Am . 1984;64(4):705-14. Felblinger DM. Malnutrition, infection, and sepsis in acute and chronic illness. Crit Care Nurs Clin North Am . 2003;15(1):71-8. Argilés JM, Campos N, Lopez-Pedrosa JM, Rueda R, Rodriguez-Mañas L. Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease. J Am Med Dir Assoc . 2016;17(9):789-96. Giridhar VU. Role of nutrition in oral and maxillofacial surgery patients. Natl J Maxillofac Surg . 2016;7(1):3-9. Ooi K, Inoue N, Matsushita K, Yamaguchi HO, Mikoya T, Kawashiri S, et al. Factors related to patients' nutritional state after orthognathic surgery. Oral Maxillofac Surg . 2019;23(4):481-6. Hammond D, Williams RW, Juj K, O'Connell S, Isherwood G, Hammond N. Weight loss in orthognathic surgery: a clinical study. J Orthod . 2015;42(3):220-8. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr . 2003;22(4):415-21. Mijiritsky E, Lerman Y, Mijiritsky O, Shely A, Meyerson J, Shacham M. Development and Validation of a Questionnaire Evaluating the Impact of Prosthetic Dental Treatments on Patients' Oral Health Quality of Life: A Prospective Pilot Study. Int J Environ Res Public Health . 2020;17(14). Nammontri O. Validation of the Thai Version of the 14- Item Oral Health Impact Profile (Thai OHIP-14) amongst the General Thai Adult Population in a Community Setting. Journal of Health Research . 2017;31(6):481-6. Popat SP, Rattan V, Rai S, Jolly SS, Malhotra S. Nutritional intervention during maxillomandibular fixation of jaw fractures prevents weight loss and improves quality of life. Br J Oral Maxillofac Surg . 2021;59(4):478-484. Kendell BD, Fonseca RJ, Lee M. Postoperative nutritional supplementation for the orthognathic surgery patient. J Oral Maxillofac Surg . 1982;40(4):205-13. Olejko TD, Fonseca RJ. Preoperative nutritional supplementation for the orthognathic surgery patient. J Oral Maxillofac Surg . 1984;42(9):573-7. Worrall SF. Changes in weight and body composition after orthognathic surgery and jaw fractures: a comparison of miniplates and intermaxillary fixation. Br J Oral Maxillofac Surg . 1994;32(5):289-92. Kersten S. The impact of fasting on adipose tissue metabolism. Biochim Biophys Acta Mol Cell Biol Lipids . 2023;1868(3):159262. Fischer M, JeVenn A, Hipskind P. Evaluation of muscle and fat loss as diagnostic criteria for malnutrition. Nutr Clin Pract . 2015;30(2):239-48. Huang DD, Ji YB, Zhou DL, Li B, Wang SL, Chen XL, et al. Effect of surgery-induced acute muscle wasting on postoperative outcomes and quality of life. J Surg Res . 2017;218:58-66. Bharadwaj S, Ginoya S, Tandon P, Gohel TD, Guirguis J, Vallabh H, et al. Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep (Oxf) . 2016;4(4):272-80. Keller U. Nutritional Laboratory Markers in Malnutrition. J Clin Med . 2019;8(6). Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med . 1999;340(6):448-54. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet . 2012;112(5):730-8. Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr . 2011;30(2):135-42. Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care . 2015;18(5):465-70. Mendes J, Azevedo A, Amaral TF. Handgrip strength at admission and time to discharge in medical and surgical inpatients. JPEN J Parenter Enteral Nutr . 2014;38(4):481-8. Darmon P, Lochs H, Pichard C. Economic impact and quality of life as endpoints of nutritional therapy. Curr Opin Clin Nutr Metab Care . 2008;11(4):452-8. Vulink NC, Rosenberg A, Plooij JM, Koole R, Bergé SJ, Denys D. Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery. Int J Oral Maxillofac Surg . 2008;37(11):985-91. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr . 2017;36(3):623-50. Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials. J Acad Nutr Diet . 2017;117(12):1941-62. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3993957","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275442002,"identity":"6d1d6776-ffa5-4765-99ac-2fa541725b41","order_by":0,"name":"Naratorn Prachasartta","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Naratorn","middleName":"","lastName":"Prachasartta","suffix":""},{"id":275442003,"identity":"5d3f7d70-aaeb-4f96-b867-db828056e599","order_by":1,"name":"Kiti Siriwatana","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIie3OMQrCMBiG4a8EdAm4plT0CnXSQepVGgqewqFSiJtzj+HqFhF0EbsWOokXyCQORWyqg5OJm0PeJeEnT/gBl+sPYwSQwBQhSPoeGQnRZN4Q70WokYDoY/8D8Ve9nURdDMeMLxUWEWZB+p0EejFPVKNtzjOGQwLal9/JoCVpFYclTxk6slkstiCoz5pkdzwsSLtY87kmgnnCgvgZCSUXyWhzuogJXyeUlgbCit1VqToahsdkX6pbNOjmBtIWf1yoxXuXy+VymXoC58w91fDq2+YAAAAASUVORK5CYII=","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":true,"prefix":"","firstName":"Kiti","middleName":"","lastName":"Siriwatana","suffix":""},{"id":275442004,"identity":"f1e3766a-ba50-494f-8e1f-ad27f60b6ce2","order_by":2,"name":"Vorapat Trachoo","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Vorapat","middleName":"","lastName":"Trachoo","suffix":""},{"id":275442005,"identity":"b22dde18-1173-42c0-bd78-8594ba91632c","order_by":3,"name":"Suwimol Sapwarobol","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Suwimol","middleName":"","lastName":"Sapwarobol","suffix":""},{"id":275442006,"identity":"05323180-0b9f-4eab-ae55-c24d0f435510","order_by":4,"name":"Praew Chantrasilapin","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Praew","middleName":"","lastName":"Chantrasilapin","suffix":""}],"badges":[],"createdAt":"2024-02-27 13:05:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3993957/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3993957/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51972896,"identity":"6c2e5511-246b-48a2-bfb4-f572601f7ee3","added_by":"auto","created_at":"2024-03-04 18:58:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":209360,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of the study\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3993957/v1/b92fa507bd84897c711bd7ae.jpg"},{"id":51974314,"identity":"c1fb03a4-268b-48bb-b297-0d3faa9bfddc","added_by":"auto","created_at":"2024-03-04 19:06:48","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":125787,"visible":true,"origin":"","legend":"\u003cp\u003eOral health impact profile 14 scores\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3993957/v1/ff022b4dd3884cc7ead05f08.jpg"},{"id":57629640,"identity":"cf8dfaa4-5924-403c-9d74-06992d931746","added_by":"auto","created_at":"2024-06-03 14:37:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1266779,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3993957/v1/a5b851d9-b9af-400b-906a-b5e7ae0866af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of oral nutritional supplement on postoperative orthognathic surgery patients’ nutritional status: a randomised clinical trial","fulltext":[{"header":"Background","content":"\u003cp\u003eNutritional therapy is a fundamental aspect of medical care for surgeries.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Patients who undergo orthognathic surgery is subject to a maxillomandibular fixation (MMF), a traditional method to immobilise the jaws for the management of maxillofacial fractures. Even though MMF can promote bone healing, it can also pose a significant impact on nutrient intake.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e This surgical procedure elicits physiological stress and also triggers metabolic alterations. Orthognathic surgery may cause several metabolic derangements including metabolic stress. It also increases energy demands while energy intake is limited. These metabolic imbalances, arising from increased energy demands and inadequate nutritional supply, can compromise immunity, impair wound healing, and increase the risk of infection.\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Therefore, it is imperative not to underestimate the importance of ensuring adequate nutrition during postoperative phase, as it plays a crucial role in promoting optimal healing, facilitating recovery, and improving the overall well-being of patients undergoing orthognathic surgery.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003eThis is highlighted by the observed changes in anthropometric and nutritional biomarkers after orthognathic surgery. Previous study has shown that patients show a 3.9% decrease in body weight at two weeks post-surgery, followed by an additional 8.3% decrease at four weeks.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003eThe nutritional biomarker data indicates a significant decline at one week after surgery, which persists at the two-week mark, indicating ongoing nutritional changes during this critical period.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the context of orthognathic surgery, patients experience reduced nutrient intake and increased metabolic demand. A nutritional therapy plan incorporating the use of oral nutritional supplements (ONS) to provide additional energy and nutrients is recommended.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Nonetheless, nutrition therapy has not received much attention in the field of orthognathic surgery, despite its potential benefits.\u003c/p\u003e \u003cp\u003eTherefore, the purpose of this study was to investigate the impact of ONS on the postoperative nutritional status of patients undergoing orthognathic surgery. The investigators hypothesised that subjects receiving ONS after the operation would maintain their overall nutritional status better than those not given ONS. The specific aims of the study were to compare postoperative anthropometric, biomarker, and muscle strength between the two groups, as well as to assess their oral health-related quality of life and dietary intakes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design/Sample\u003c/h2\u003e \u003cp\u003e The study recruited patients scheduled for orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand, between June 2022 and December 2022. Patients were screened for inclusion criteria, which are: being 18 years of age or older; being enrolled in orthognathic surgery for at least one jaw surgery; and having no known metabolic-related diseases, milk or soy allergies, or galactosemia. Patients who underwent segmental procedures or only genioplasty were excluded from the study.\u003c/p\u003e \u003cp\u003eA 12-week randomised controlled trial was conducted to investigate the effects of ONS on the postoperative nutritional status of subjects undergoing orthognathic surgery. To monitor dietary intake, subjects were asked to record all foods and beverages they consumed over two weekdays and one weekend.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cp\u003eThe predictor variable was ONS. Subjects were randomly assigned by the block randomisation method into two groups: 1) subjects who received ONS, and 2) subjects who did not receive ONS. Subjects received nutritional counselling administered by registered dietitians from the Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand, according to the nutrition counselling protocol. The counselling sessions were conducted via the tele-nutrition method (a video call) and took place three times over the course of the 12-week study: the first session was held a day prior to the surgery (baseline, T0), the second session was conducted before the transition from a liquid diet to a soft diet (2nd week, T2), and the final session was conducted before the transition from a soft diet to a regular diet (4th week, T3). During the nutrition counselling course, subjects were explained the diet regimen (liquid diet, soft diet, and regular diet). During a liquid diet phase, only fluids and foods that are normally liquid and foods that turn to liquid when they are at room temperature were allowed. A daily caloric intake ranging from 700 to 800 kcal was recommended during a phase of a liquid diet. In a soft diet period, subjects were advised to consume soft and easy-to-digest foods. Hard-to-digest foods, as well as those that are tough to chew, should be restricted. A soft diet provided 1000\u0026ndash;1200 kcal daily. After week 4, subjects were encouraged to make a transition to a regular diet or more solid foods. During this regular diet, energy and macronutrient content returned closely to their habitual diet. In the NC\u0026thinsp;+\u0026thinsp;group, subjects were given nutrition counselling and ONS, which is called Ensure Plus Advance\u0026reg; in vanilla flavour, developed by Abbott Laboratories, Illinois, United States of America. This is to be consumed as one serving daily for one month following the surgery, in addition to their meals. One serving of ONS was 220 ml, containing 330 kcal, 37 grams of carbohydrate, 20 grams of protein, and 7 grams of fat. The primary outcome variable was nutritional status, which was measured using anthropometric, biomarker, and muscle strength assessments. The covariates were the subjects\u0026rsquo; demographics, oral health-related quality of life, and dietary record assessment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection methods\u003c/h2\u003e \u003cp\u003eFor the anthropometric assessment, body weight, muscle mass, and fat mass were measured using a bioelectrical impedance analyser (MC-580 MA body composition analyser, TANITA Corporation, Tokyo, Japan) at a day before surgery (T0), a day of discharge (T1), and 2 weeks (T2), 4 weeks (T3), and 12 weeks postoperatively (T4). A blood sample of approximately 15 ml was obtained through vein puncture by either a medical technologist or an anaesthetic nurse. Subsequently, the collected blood samples were divided into four tubes and transferred to a private medical laboratory, National Healthcare Systems Company Limited, Bangkok, Thailand, for the analysis of specific biomarkers of interest. Albumin, BUN, and creatinine were collected at five time points: T0, T1, T2, T3, and T4. Prealbumin and hs-CRP were collected at four time points: T0, T1, T2, and T3. Random plasma glucose (RPG), HbA1C, and lipid profiles (HDL, LDL, and triglycerides) were collected at two time points: T0 and T4. Muscle strengths were measured at five time points: T0, T1, T2, T3, and T4 by a hand-held Camry digital dynamometer (90 kg/200 lbs, Camry Scale from California, United States of America). Oral health-related quality of life was measured at five time points: T0, T1, T2, T3, and T4 using the Oral Health Impact Profile 14 (OHIP-14) questionnaire (Fig.\u0026nbsp;2). The OHIP-14 questionnaire is based on Locker\u0026rsquo;s conceptual model and commonly used to determine quality of life related to oral health in children, adults, and the dentate elderly. \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e It has been translated into Thai and validated for use with Thai patients \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The questionnaire consisted of 7 aspects, with 2 questions allocated to each aspect, resulting in a total of 14 questions. A five-point response format (Likert scale) was employed, ranging from \u0026ldquo;not at all\u0026rdquo; (score 0), \u0026ldquo;hardly ever\u0026rdquo; (score 1), \u0026ldquo;occasionally\u0026rdquo; (score 2), \u0026ldquo;fairly often\u0026rdquo; (score 3), and \u0026ldquo;very often\u0026rdquo; (score 4). Throughout the 12-week study period, a weekly diet record was collected from each participant, encompassing dietary information from two weekdays and one weekend day. The average energy intake, as well as the intake of macronutrients such as carbohydrate, protein, and fat, were calculated and assessed. Data was reported at the liquid diet period, the soft diet period, and the regular diet period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analyses\u003c/h2\u003e \u003cp\u003eThe study employed an intention-to-treat analysis. The normality of the data was tested using the Shapiro-Wilk test. The T-test or Mann-Whitney U test was used to compare the mean difference of continuous data, where appropriate. All statistical analyses were carried out using SPSS 23.0 software (SPSS Inc., Illinois, the United States of America). The differences were considered statistically significant when the p-value was less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample size calculation was conducted via an online statistical calculator (Statulator, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://statulator.com/\u003c/span\u003e\u003cspan address=\"https://statulator.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) based on a study by Popat, S. P., Rattan, V., Rai, S., Jolly, S. S., \u0026amp; Malhotra, S. (2021) \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e The Calculator for Comparing Two Independent Means was accessed on November 28, 2021, at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://statulator.com/SampleSize/ss2M.html\u003c/span\u003e\u003cspan address=\"http://statulator.com/SampleSize/ss2M.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Assuming a pooled standard deviation of 6 units, the study required a sample size of 14 for each group (total sample size of 28, assuming equal group sizes) to achieve a power of 80% and a level of significance of 5% (two-sided) for detecting a true difference in means between the test and the reference group of 6.63 (i.e., 61.33\u0026ndash;54.70) units. Accounting for an assumed dropout rate of 20%, the final sample size recruited was 17 patients per group. A total of 41 patients were assessed for eligibility. Thirty-four eligible subjects then were randomly assigned to either the nutritional counselling (NC) group (n\u0026thinsp;=\u0026thinsp;17) or the nutritional counselling with ONS (NC+) group (n\u0026thinsp;=\u0026thinsp;17) by block randomisation method via \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.randomizer.org/\u003c/span\u003e\u003cspan address=\"https://www.randomizer.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Twenty-eight subjects (NC, n\u0026thinsp;=\u0026thinsp;12 and NC+, n\u0026thinsp;=\u0026thinsp;16) completed the study (Fig.\u0026nbsp;1) with a mean age of 26\u0026thinsp;\u0026plusmn;\u0026thinsp;4 years in NC group and 28\u0026thinsp;\u0026plusmn;\u0026thinsp;7 in NC\u0026thinsp;+\u0026thinsp;group. In the NC group, there were 8 male and 9 female subjects, while in the NC\u0026thinsp;+\u0026thinsp;group, there were 5 male and 12 female subjects. Regarding the types of surgery, the NC group comprised 7 subjects who underwent single-jaw surgery, 9 subjects who underwent double-jaw surgery, and 1 subject who underwent double-jaw surgery with genioplasty. In the NC\u0026thinsp;+\u0026thinsp;group, there were 5 subjects who underwent single-jaw surgery, 10 subjects who underwent double-jaw surgery, and 2 subjects who underwent double-jaw surgery with genioplasty (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric Parameters\u003c/h2\u003e \u003cp\u003eThere was a significant difference in weight loss between the two groups at T2 and T3. However, no significant difference was observed in muscle mass loss between the groups at any time point. Both groups exhibited fluctuations in fat mass, although no consistent pattern of change was evident. A significant difference in fat mass was observed between the two groups at T1 and T2 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBiomarker Parameters\u003c/h2\u003e \u003cp\u003eThere were no statistically significant differences between the groups in terms of changes in the values nutritional status biomarkers throughout any of the follow-up periods (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Both groups demonstrated a notable initial increase in hs-CRP levels at T1, but subsequently decreased over time. Furthermore, there were no significant differences observed in the changes of RPG, HbA1c, HDL, LDL, or triglyceride levels at the 12-week postoperative period (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eMuscle strength parameter\u003c/h2\u003e \u003cp\u003eThe results of the handgrip strength test indicated that there were no significant differences in the changes of handgrip strength between the two groups at any of the postoperative periods. Both groups exhibited a decrease in handgrip strength immediately after surgery (T1), which gradually improved over time. By T4, both groups had regained their handgrip strength and were comparable to their respective preoperative levels (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOral health-related quality of life parameter\u003c/h2\u003e \u003cp\u003eThe OHIP-14 scores gradually improved from T1 to T4 for both groups. However, there were no significant differences observed between the two groups in any of the aspects at any point during the postoperative period (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDietary record parameter\u003c/h2\u003e \u003cp\u003eThe analysis of the diet logs provided by the subjects revealed that there were no significant differences between the two groups in terms of total energy and macronutrient consumption during any of the diet periods. This finding was observed even though the NC\u0026thinsp;+\u0026thinsp;group received ONS (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary objective of this study was to examine how ONS affects the postoperative nutritional status of orthognathic surgery patients. The investigators hypothesised that subjects who received ONS following their surgery would exhibit better maintenance of their overall nutritional status compared to those who did not receive ONS. The specific aims of the study included comparing postoperative anthropometric measurements, biomarkers, and muscle strength between the two groups, as well as evaluating their oral health-related quality of life and dietary intake.\u003c/p\u003e \u003cp\u003eSubjects in both group (NC vs NC+) experienced the loss of body weight and muscle mass after 12 week follow up. The difference in weight loss between the two groups was significant at T2 and T3. However, there was no significant difference in muscle mass loss between the groups at any time point. In terms of fat mass changes, the NC group had significantly greater fat mass loss than the NC\u0026thinsp;+\u0026thinsp;group at T1 and T2. Our findings suggest that current orthognathic patients show weight loss patterns comparable to those observed over four decades ago\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, despite receiving nutrition counselling and ONS, possibly attributed to the prolonged trismus resulting from MMF. According to a hospital\u0026rsquo;s guideline, patients undergoing orthognathic surgery were subjected to a 2-week period of MMF, during which their diets were restricted to a liquid diet. Subsequently, a post-operative dietary regimen advancing from liquid to soft, and regular diets over a span of 4 weeks. Consistent with our study, Worrall's study demonstrated that by the sixth week following surgery, the MMF group experienced a significantly higher degree of weight loss in comparison to the non-MMF group\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. During periods of restricted food intake, the body undergoes adaptations to cope with the lack of food, including the breakdown of liver glycogen and muscle protein to provide glucose for the brain and the gradual depletion of fat stores\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Surgical procedures can also trigger metabolic changes mediated by hormone and cytokine release, resulting in catabolic processes. Cortisol secretion further contributes to muscle tissue breakdown, promoting proteolysis and the release of amino acids for tissue repair and synthesis. Inadequate nutrition or high energy demand disrupts metabolic balance, compromising immune function, impairing wound healing, and increasing infection risk \u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, especially in individuals with reduced muscle mass who lack essential amino acid sources\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.Limited research has focused on the loss of muscle mass among orthognathic surgery patients. A recent study investigated acute muscle loss after gastrectomy and found that over 31.82% of patients experienced a loss of more than 10% of their muscle mass within a week post-surgery, leading to decreased quality of life, increased postoperative complications, longer hospital stays, and higher medical costs\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Although the muscle loss observed in our orthognathic surgery study may be comparatively lower, it is crucial to recognise the potential adverse effects of such loss.\u003c/p\u003e \u003cp\u003eThe addition ONS in our study, along with nutritional counselling, did not result in a significant difference in postoperative nutritional status biomarkers between the groups. Similarly, there was no significant difference observed between the groups in terms of inflammatory biomarkers, specifically TLC and hs-CRP. In addition to the traditional protein nutrition index, Lymphocyte count is often considered a valuable indicator of nutritional status, as undernutrition can cause immunological alterations. Measurement of hs-CRP as an inflammatory marker was also conducted due to the protein consumption associated with inflammation\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Overall, the addition of ONS did not provide substantial benefits beyond those achieved through nutritional counselling alone. Both groups might have received high-quality nutritional counselling that was equally effective. If the counselling was standardised and provided with the same level of expertise to both groups, this could reduce the differences between them.\u003c/p\u003e \u003cp\u003eHandgrip strength measurement is considered an important indicator of functional status and is commonly included in nutritional assessments\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, with evidence supports the correlation between handgrip strength and markers of nutritional status, muscle mass, and overall health and function. Lower handgrip strength has also been associated with increased mortality rates and longer hospital stays\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. However, we did not observe a significant improvement in handgrip strength recovery with the addition ONS among orthognathic surgery patients. This suggests that handgrip strength recovery after orthognathic surgery is influenced by a complex interplay of multiple factors. While nutrition is undeniably important, its direct impact on handgrip strength recovery may be overshadowed by the intricate nature of the recovery process and individual variability.\u003c/p\u003e \u003cp\u003eThe assessment of quality of life is crucial in predicting the benefits of nutritional therapy\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. However, there is limited past research on the effects of ONS on quality of life following orthognathic surgery, highlighting the lack of available data in this area. During the postoperative period, no significant differences were observed in any of the aspects of OHIP-14 scores between the two groups. The lack of significant differences between the groups could be attributed to various factors. The impact of ONS on quality of life following orthognathic surgery might be limited to specific unmeasured domains within the OHIP-14 questionnaire. Additionally, the questionnaire's sensitivity might not be adequate to detect subtle changes in oral health-related quality of life. It is noteworthy that the addition of ONS to nutritional counselling did not significantly affect patients' quality of life related to oral health in this study. However, it is important to recognise that nutritional counselling alone may be sufficient to support their quality of life in this aspect following orthognathic surgery.\u003c/p\u003e \u003cp\u003eIn general, the subjects' postoperative nutritional status showed signs of improvement at T3, which is 4 weeks after the surgery. Consistent with our findings, Ooi et al. observed that biomarker parameters such as total protein, serum albumin, total cholesterol, were decreased at 1 week after surgery and continued to show significant decreases at 2 weeks after surgery\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. This suggests that it may take several weeks for the nutritional status of patients to recover following orthognathic surgery. This improvement can be attributed to the transition from a liquid to a soft diet, which occurred after the removal of MMF at the 2-week postoperative period. Analysis of the subjectts' diet log revealed an increase in macronutrient intake and total energy consumption during this period. It is noteworthy that there were no significant differences in total energy and macronutrient intake between the two groups throughout the postoperative diet phases, as indicated by the diet log.\u003c/p\u003e \u003cp\u003eWe proposed that nutrition counselling by a registered dietitian could improve patients\u0026rsquo; dietary intake. During nutrition counselling, patients were advised on how to meet their daily caloric and macronutrients requirements. Recommendations on food choices in liquid or soft diet were introduced. Our participants in this study could eventually maintain their body weight and others anthropometric indices. Lack of significant differences in nutritional intake between the groups may be a key attribution to insignificant differences found in this study. In addition, it is possible that the ONS in the NC\u0026thinsp;+\u0026thinsp;group was consumed as a replacement for a main meal rather than as a supplement. This is because all patients in the study were treated with MMF, which made it difficult for them to have a normal diet, forcing them to rely on liquid food at least 2 week post-operatively. The physical disability caused by MMF was reflected in the OHIP-14 score for physical pain (pain and being uncomfortable to eat) and physical disability (diet unsatisfactory and interrupted meals), which showed improvement from T1 to T4 as patients progressed from a liquid diet to a soft diet and eventually a regular diet. A study revealed that 17% of patients had significant concerns about their appearance prior to undergoing orthognathic surgery, and 10% of patients showed positive screening results for body dysmorphic disorder\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. But our results show that ONS can be used without negatively impacting glucose and lipid metabolism in the postoperative period. At 12 weeks after surgery, there were no significant differences between the two groups in changes to random plasma glucose, HbA1c, HDL, LDL, and triglyceride levels. This emphasises the importance of providing nutritional counselling which helps patients to understand the importance of proper nutrition and guide them in making healthy dietary choices that support postoperative recovery.\u003c/p\u003e \u003cp\u003eProper nutritional support is essential for postoperative recovery and maintaining homoeostasis in orthognathic surgery patients \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. However, nutrition therapy has been overlooked in this field. Earlier studies conducted in the 1980s indicated that a liquid supplement after surgery can help maintain nutrient intake and preserve body weight\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. More recent research by Hammond et al. demonstrated that despite receiving dietary advice and ONS, patients still experienced weight loss and reduced body fat following orthognathic surgery\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. These findings, along with ours, highlight the need for a tailored nutritional therapy protocol to optimise healing and minimise postoperative complications. It is also important to note that this study's findings do not necessarily suggest that ONS should not be considered as part of nutritional therapy after orthognathic surgery. The decision to use ONS should be based on individual patient needs and may vary depending on the patient's nutritional status and recovery goals. Nevertheless, nutritional counselling remains a crucial element of nutritional therapy, and the study's results emphasise the importance of providing extensive nutritional guidance to patients who have undergone orthognathic surgery. This approach can help ensure that patients are receiving appropriate dietary support tailored to their individual needs, which is essential for promoting optimal healing and a successful recovery process.\u003c/p\u003e \u003cp\u003eAcknowledging the study's limitations, including the small sample size and absence of a control group without nutritional therapy due to ethical reason, caution is needed when interpreting the results. Future research should address these limitations by conducting larger-scale, international multicentre studies to improve generalisability and reliability. Inclusion of diverse patient populations and multiple centres would provide a more comprehensive understanding of the role of ONS in nutritional therapy for orthognathic surgery patients. Such studies would offer valuable insights into the potential benefits, optimal dosage, duration of ONS, and variations in response among different patient groups.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study aimed to evaluate the impact of ONS on the postoperative nutritional status in orthognathic surgery patients. The results indicated that patients who were receiving nutritional counselling alone and those who were receiving nutritional counselling as well as in ONS both experienced postoperative weight and muscle mass loss, with no significant differences observed across all nutritional status parameters at the 12-week postoperative mark. These findings suggested the need for more personalised and intensive nutrition therapy plans to reduce the negative impact of muscle mass loss and associated risk of postoperative infection in orthognathic surgery patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative clinical background of the subjects\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutritional counselling alone (NC) (N\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNutritional counselling with ONS (NC+) (N\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle-jaw surgery (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble-jaw surgery (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (59%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble-jaw surgery with genioplasty (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnthropometrics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMuscle strength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandgrip strength (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiomarkers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal lymphocyte count (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrealbumin (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRandom plasma glucose (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153.1\u0026thinsp;\u0026plusmn;\u0026thinsp;37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149.8\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglyceride (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93.1\u0026thinsp;\u0026plusmn;\u0026thinsp;48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101.2\u0026thinsp;\u0026plusmn;\u0026thinsp;44.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges on postoperative nutritional status parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNC(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNC+(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnthropometrics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e54.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e51.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e51.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e19.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e19.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e35.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e35.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMuscle strength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandgrip strength (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiomarkers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLC (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrealbumin (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehs-CRP(mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRPG(mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e80.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e63.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153.1\u0026thinsp;\u0026plusmn;\u0026thinsp;37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e157.8\u0026thinsp;\u0026plusmn;\u0026thinsp;59.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e149.8\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e137.7\u0026thinsp;\u0026plusmn;\u0026thinsp;32.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglyceride (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.1\u0026thinsp;\u0026plusmn;\u0026thinsp;48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e117.3\u0026thinsp;\u0026plusmn;\u0026thinsp;51.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.2\u0026thinsp;\u0026plusmn;\u0026thinsp;44.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e109.1\u0026thinsp;\u0026plusmn;\u0026thinsp;57.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Significant difference between study groups were determined by t-tests or Mann-Whitney U tests as appropriate. *refers to significant differences between study groups (t-test). A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of OHIP-14 scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNC(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNC+ (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandicap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are mean. Significant difference between study groups were determined by Mann-Whitney U test. *refers to significant differences between study groups. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of postoperative food energy intake\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNC(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNC+ (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiquid diet period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSoft diet period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRegular diet period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiquid diet period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSoft diet period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRegular diet period\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal energy (kcal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e744.96\u0026thinsp;\u0026plusmn;\u0026thinsp;381.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,082.04\u0026thinsp;\u0026plusmn;\u0026thinsp;418.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,080.86\u0026thinsp;\u0026plusmn;\u0026thinsp;358.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e867.14\u0026thinsp;\u0026plusmn;\u0026thinsp;539.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,146.68\u0026thinsp;\u0026plusmn;\u0026thinsp;417.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,091.44\u0026thinsp;\u0026plusmn;\u0026thinsp;336.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbohydrate consumption (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108.69\u0026thinsp;\u0026plusmn;\u0026thinsp;76.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127.61\u0026thinsp;\u0026plusmn;\u0026thinsp;27.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.91\u0026thinsp;\u0026plusmn;\u0026thinsp;17.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e130.38\u0026thinsp;\u0026plusmn;\u0026thinsp;82.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e144.21\u0026thinsp;\u0026plusmn;\u0026thinsp;65.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e136.41\u0026thinsp;\u0026plusmn;\u0026thinsp;57.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein consumption (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.28\u0026thinsp;\u0026plusmn;\u0026thinsp;20.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.33\u0026thinsp;\u0026plusmn;\u0026thinsp;25.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.89\u0026thinsp;\u0026plusmn;\u0026thinsp;25.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.78\u0026thinsp;\u0026plusmn;\u0026thinsp;20.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.48\u0026thinsp;\u0026plusmn;\u0026thinsp;20.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47.07\u0026thinsp;\u0026plusmn;\u0026thinsp;13.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat consumption (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.56\u0026thinsp;\u0026plusmn;\u0026thinsp;14.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.81\u0026thinsp;\u0026plusmn;\u0026thinsp;19.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.20\u0026thinsp;\u0026plusmn;\u0026thinsp;18.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.06\u0026thinsp;\u0026plusmn;\u0026thinsp;16.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.68\u0026thinsp;\u0026plusmn;\u0026thinsp;17.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39.73\u0026thinsp;\u0026plusmn;\u0026thinsp;21.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Significant difference between study groups were determined by t-tests. *refers to significant differences between study groups.\u003c/p\u003e \u003cp\u003eA P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Human Research Ethics Committee of the Faculty of Dentistry at Chulalongkorn University with the approval number HREC-DCU 2022\u0026ndash;008. The study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments. Each subject was fully informed about the study\u0026apos;s purpose and provided written consent for the use of their clinical data. This study has been registered with the Thai Clinical Trial Registration (https://www.thaiclinicaltrials.org/), with the registration number TCTR20220624006, registered on June 24, 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualisation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVorapat Trachoo and Suwimol Sapwarobol conceptualised the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors designed the experimental protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNaratorn Prachasartta collected and compiled the research data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis and Interpretation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNaratorn Prachasartta and Kiti Siriwatana conducted the statistical analysis and interpreted the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting \u0026ndash; Original Draft\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNaratorn Prachasartta drafted the initial manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting \u0026ndash; Review \u0026amp; Editing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKiti Siriwatana, Suwimol Sapwarobol and Praew Chantrasilapin critically reviewed and edited the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKiti Siriwatana\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eprovided guidance and supervision throughout the project.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHoward L, Ashley C. Nutrition in the perioperative patient. \u003cstrong\u003eAnnu Rev Nutr\u003c/strong\u003e. 2003;23:263-82.\u003c/li\u003e\n\u003cli\u003eHayter JP, Cawood JI. The functional case for miniplates in maxillofacial surgery. \u003cstrong\u003eInt J Oral Maxillofac Surg\u003c/strong\u003e. 1993;22(2):91-6.\u003c/li\u003e\n\u003cli\u003eMargraf A, Ludwig N, Zarbock A, Rossaint J. Systemic Inflammatory Response Syndrome After Surgery: Mechanisms and Protection. \u003cstrong\u003eAnesth Analg\u003c/strong\u003e. 2020;131(6):1693-707.\u003c/li\u003e\n\u003cli\u003eBadwal RS, Bennett J. Nutritional considerations in the surgical patient. \u003cstrong\u003eDent Clin North Am\u003c/strong\u003e. 2003;47(2):373-93.\u003c/li\u003e\n\u003cli\u003eRuberg RL. Role of nutrition in wound healing. \u003cstrong\u003eSurg Clin North Am\u003c/strong\u003e. 1984;64(4):705-14.\u003c/li\u003e\n\u003cli\u003eFelblinger DM. Malnutrition, infection, and sepsis in acute and chronic illness. \u003cstrong\u003eCrit Care Nurs Clin North Am\u003c/strong\u003e. 2003;15(1):71-8.\u003c/li\u003e\n\u003cli\u003eArgil\u0026eacute;s JM, Campos N, Lopez-Pedrosa JM, Rueda R, Rodriguez-Ma\u0026ntilde;as L. Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease. \u003cstrong\u003eJ Am Med Dir Assoc\u003c/strong\u003e. 2016;17(9):789-96.\u003c/li\u003e\n\u003cli\u003eGiridhar VU. Role of nutrition in oral and maxillofacial surgery patients. \u003cstrong\u003eNatl J Maxillofac Surg\u003c/strong\u003e. 2016;7(1):3-9.\u003c/li\u003e\n\u003cli\u003eOoi K, Inoue N, Matsushita K, Yamaguchi HO, Mikoya T, Kawashiri S, et al. Factors related to patients\u0026apos; nutritional state after orthognathic surgery. \u003cstrong\u003eOral Maxillofac Surg\u003c/strong\u003e. 2019;23(4):481-6.\u003c/li\u003e\n\u003cli\u003eHammond D, Williams RW, Juj K, O\u0026apos;Connell S, Isherwood G, Hammond N. Weight loss in orthognathic surgery: a clinical study. \u003cstrong\u003eJ Orthod\u003c/strong\u003e. 2015;42(3):220-8.\u003c/li\u003e\n\u003cli\u003eKondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. \u003cstrong\u003eClin Nutr\u003c/strong\u003e. 2003;22(4):415-21.\u003c/li\u003e\n\u003cli\u003eMijiritsky E, Lerman Y, Mijiritsky O, Shely A, Meyerson J, Shacham M. Development and Validation of a Questionnaire Evaluating the Impact of Prosthetic Dental Treatments on Patients\u0026apos; Oral Health Quality of Life: A Prospective Pilot Study. \u003cstrong\u003eInt J Environ Res Public Health\u003c/strong\u003e. 2020;17(14).\u003c/li\u003e\n\u003cli\u003eNammontri O. Validation of the Thai Version of the 14- Item Oral Health Impact Profile (Thai OHIP-14) amongst the General Thai Adult Population in a Community Setting. \u003cstrong\u003eJournal of Health Research\u003c/strong\u003e. 2017;31(6):481-6.\u003c/li\u003e\n\u003cli\u003ePopat SP, Rattan V, Rai S, Jolly SS, Malhotra S. Nutritional intervention during maxillomandibular fixation of jaw fractures prevents weight loss and improves quality of life. \u003cstrong\u003eBr J Oral Maxillofac Surg\u003c/strong\u003e. 2021;59(4):478-484.\u003c/li\u003e\n\u003cli\u003eKendell BD, Fonseca RJ, Lee M. Postoperative nutritional supplementation for the orthognathic surgery patient. \u003cstrong\u003eJ Oral Maxillofac Surg\u003c/strong\u003e. 1982;40(4):205-13.\u003c/li\u003e\n\u003cli\u003eOlejko TD, Fonseca RJ. Preoperative nutritional supplementation for the orthognathic surgery patient. \u003cstrong\u003eJ Oral Maxillofac Surg\u003c/strong\u003e. 1984;42(9):573-7.\u003c/li\u003e\n\u003cli\u003eWorrall SF. Changes in weight and body composition after orthognathic surgery and jaw fractures: a comparison of miniplates and intermaxillary fixation. \u003cstrong\u003eBr J Oral Maxillofac Surg\u003c/strong\u003e. 1994;32(5):289-92.\u003c/li\u003e\n\u003cli\u003eKersten S. The impact of fasting on adipose tissue metabolism. \u003cstrong\u003eBiochim Biophys Acta Mol Cell Biol Lipids\u003c/strong\u003e. 2023;1868(3):159262.\u003c/li\u003e\n\u003cli\u003eFischer M, JeVenn A, Hipskind P. Evaluation of muscle and fat loss as diagnostic criteria for malnutrition. \u003cstrong\u003eNutr Clin Pract\u003c/strong\u003e. 2015;30(2):239-48.\u003c/li\u003e\n\u003cli\u003eHuang DD, Ji YB, Zhou DL, Li B, Wang SL, Chen XL, et al. Effect of surgery-induced acute muscle wasting on postoperative outcomes and quality of life. \u003cstrong\u003eJ Surg Res\u003c/strong\u003e. 2017;218:58-66.\u003c/li\u003e\n\u003cli\u003eBharadwaj S, Ginoya S, Tandon P, Gohel TD, Guirguis J, Vallabh H, et al. Malnutrition: laboratory markers vs nutritional assessment. \u003cstrong\u003eGastroenterol Rep (Oxf)\u003c/strong\u003e. 2016;4(4):272-80.\u003c/li\u003e\n\u003cli\u003eKeller U. Nutritional Laboratory Markers in Malnutrition. \u003cstrong\u003eJ Clin Med\u003c/strong\u003e. 2019;8(6).\u003c/li\u003e\n\u003cli\u003eGabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. \u003cstrong\u003eN Engl J Med\u003c/strong\u003e. 1999;340(6):448-54.\u003c/li\u003e\n\u003cli\u003eWhite JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). \u003cstrong\u003eJ Acad Nutr Diet\u003c/strong\u003e. 2012;112(5):730-8.\u003c/li\u003e\n\u003cli\u003eNorman K, Stob\u0026auml;us N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. \u003cstrong\u003eClin Nutr\u003c/strong\u003e. 2011;30(2):135-42.\u003c/li\u003e\n\u003cli\u003eBohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. \u003cstrong\u003eCurr Opin Clin Nutr Metab Care\u003c/strong\u003e. 2015;18(5):465-70.\u003c/li\u003e\n\u003cli\u003eMendes J, Azevedo A, Amaral TF. Handgrip strength at admission and time to discharge in medical and surgical inpatients. \u003cstrong\u003eJPEN J Parenter Enteral Nutr\u003c/strong\u003e. 2014;38(4):481-8.\u003c/li\u003e\n\u003cli\u003eDarmon P, Lochs H, Pichard C. Economic impact and quality of life as endpoints of nutritional therapy. \u003cstrong\u003eCurr Opin Clin Nutr Metab Care\u003c/strong\u003e. 2008;11(4):452-8.\u003c/li\u003e\n\u003cli\u003eVulink NC, Rosenberg A, Plooij JM, Koole R, Berg\u0026eacute; SJ, Denys D. Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery. \u003cstrong\u003eInt J Oral Maxillofac Surg\u003c/strong\u003e. 2008;37(11):985-91.\u003c/li\u003e\n\u003cli\u003eWeimann A, Braga M, Carli F, Higashiguchi T, H\u0026uuml;bner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. \u003cstrong\u003eClin Nutr\u003c/strong\u003e. 2017;36(3):623-50.\u003c/li\u003e\n\u003cli\u003eMitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials. \u003cstrong\u003eJ Acad Nutr Diet\u003c/strong\u003e. 2017;117(12):1941-62.\u003cstrong\u003e \u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"orthognathic surgery, oral nutritional supplement, nutritional therapy","lastPublishedDoi":"10.21203/rs.3.rs-3993957/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3993957/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOrthognathic surgery limits oral intake and increases metabolic demand, leading to decreased muscle mass. To mitigate these effects, incorporating oral nutritional supplements (ONS) into a nutritional therapy plan is recommended. However, nutrition therapy has not received much attention in orthognathic surgery. This study aimed to assess the effect of ONS on postoperative orthognathic surgery patients\u0026rsquo; nutritional status.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A 12-week randomised controlled trial was conducted between June and December 2022 at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok. Patients were included if they were 18 years of age or older, underwent orthognathic surgery involving at least one jaw, and had no metabolic-related diseases, milk or soy allergies, or galactosemia. Patients who underwent segmental procedures or genioplasty alone were excluded. The predictor variable was ONS. Subjects were randomly assigned by the block randomisation method into two groups: 1) subjects who received ONS, and 2) subjects who did not receive ONS. The primary outcome variable was nutritional status, which was measured using anthropometric, biomarker, and muscle strength assessments at 5 time points: a day before surgery (T0), the day of discharge (T1), 2 weeks (T2), 4 weeks (T3), and 12 weeks postoperatively (T4). Covariates were subjects\u0026rsquo; demographics, oral health-related quality of life, and dietary record assessment. The T-test, or Mann-Whitney U test, was used to compare the mean difference of continuous data, where appropriate. The differences were considered statistically significant when the p-value was less than 0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 36 subjects were included in the study. Subjects receiving either nutritional counselling alone or both nutritional counselling and ONS experienced postoperative weight and muscle mass loss, with no significant differences observed across all nutritional status parameters after the 12-week postoperative mark.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese results suggest the need for more personalised and intensive nutrition therapy plans to reduce the negative impact of muscle mass loss and the associated risk of postoperative infection in orthognathic surgery patients.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eThis study has been registered with the Thai Clinical Trial Registration (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thaiclinicaltrials.org/\u003c/span\u003e\u003cspan address=\"https://www.thaiclinicaltrials.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), with the registration number TCTR20220624006, registered on June 24, 2022.\u003c/p\u003e","manuscriptTitle":"Effects of oral nutritional supplement on postoperative orthognathic surgery patients’ nutritional status: a randomised clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-04 18:58:43","doi":"10.21203/rs.3.rs-3993957/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63d9e989-e55e-47ba-9e48-bed207360344","owner":[],"postedDate":"March 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-03T14:36:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-04 18:58:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3993957","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3993957","identity":"rs-3993957","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}