Association Between Preoperative Mediterranean Diet Adherence and Postoperative Bowel Motility

Postoperative bowel motility is one of the most important indicators of recovery following abdominal surgery. Delayed gastrointestinal motility is associated with postoperative ileus, prolonged hospital stay, delayed oral feeding, and increased healthcare costs. Several factors, including surgical stress, anesthesia, inflammation, and preoperative nutritional status, may influence the recovery of bowel function after surgery.

The Mediterranean diet is characterized by a high intake of vegetables, fruits, legumes, whole grains, olive oil, nuts, and fish, and a low intake of red and processed meat. This dietary pattern provides dietary fiber, unsaturated fatty acids, polyphenols, antioxidants, and other bioactive compounds that may improve gut microbiota composition, reduce inflammation, and support normal gastrointestinal function. Previous studies have demonstrated beneficial effects of the Mediterranean diet on gastrointestinal health; however, evidence regarding its association with postoperative bowel motility remains limited.

This prospective observational cohort study aims to investigate the association between preoperative adherence to the Mediterranean diet and postoperative bowel motility in adults undergoing elective laparoscopic cholecystectomy. A total of 110 participants will be enrolled after ethics committee approval. Preoperative nutritional status, dietary intake, and adherence to the Mediterranean diet will be assessed using the Mediterranean Diet Adherence Screener (MEDAS), food frequency questionnaires, and three-day dietary records. Demographic, anthropometric, clinical, and perioperative data will also be collected.

Postoperative bowel function will be prospectively evaluated by recording the time to first bowel sound, first passage of flatus, first defecation, first oral intake, and hospital discharge. Dietary nutrient intake will be analyzed using a nutrition analysis software program. The association between Mediterranean diet adherence and postoperative bowel motility outcomes will be examined using appropriate statistical methods. The findings are expected to improve understanding of the role of preoperative dietary quality in postoperative gastrointestinal recovery and may contribute to optimizing perioperative nutritional management in patients undergoing abdominal surgery.

Inclusion criteria

• Adults aged 18 years or older and younger than 70 years.
• Scheduled to undergo elective laparoscopic cholecystectomy.
• Able to provide written informed consent.
• Able to complete the preoperative Food Frequency Questionnaire (FFQ) and 3-day dietary record.
• Able to complete all study assessments and postoperative follow-up.

Exclusion criteria

• Cesarean section (obstetric surgery).
• Emergency abdominal surgery.
• Structural bowel obstruction following bowel resection or presence of a temporary ileostomy or colostomy.
• Active inflammatory bowel disease (Crohn's disease or ulcerative colitis) during the preoperative period.
• Impaired consciousness or inability to provide informed consent.
• Pregnancy.
• Previous bowel surgery within the last 3 months.
• Short bowel syndrome or conditions requiring chronic parenteral nutrition.
• Severe systemic disease.