Clinical Nutrition Open Science · May 15, 2026
Nutritional intake and physical status in older adults with obesity and probable sarcopenic obesity prior to hip and knee arthroplasty
By Oosting E, Holverda M, Elings J et al.
Background Malnutrition and sarcopenia are often overlooked in obese patients, despite their impact on surgical outcomes. In orthopedic care, nutritional risk is typically assessed using BMI or limited biomarkers, which may fail to appraise important deficits in diet, body composition and physical function. Objective To assess preoperative nutritional intake, body composition, and physical function in older adults with obesity and probable sarcopenic obesity awaiting hip or knee arthroplasty. Methods Obese patients (BMI ≥30 kg/m 2 ) scheduled for total hip or knee arthroplasty (TKA, THA) were included. Nutritional intake was evaluated through three-day food diaries, body composition via DEXA, and physical function using standardized functional tests. Nutrient intake was compared with Dutch Recommended Daily Allowances and national references. Results The study population consisted of 21 women and 8 men (mean age 64 ±10, BMI 35 ±3, 69% TKA). Despite obesity, significant variation was observed in muscle mass, strength, physical performance, and dietary intake. Energy intake was below recommended levels for both men and women. Several key micronutrients (e.g., calcium, magnesium, vitamin B6) were frequently consumed at suboptimal levels. A case series of four representative patients (two women, two men) with BMI 30–35 kg/m 2 demonstrated substantial individual diversity in body composition and physical function. Conclusion Obese older patients awaiting arthroplasty show considerable heterogeneity in nutritional intake, body composition, and physical function. They cannot be considered as one homogeneous group. Comprehensive assessments beyond BMI and standard screening are needed to identify at-risk patients for developing surgical complications and guide targeted prehabilitation strategies.