Clinical application of protein-enhanced diet using mealworms in patients undergoing hepato-pancreato-biliary surgery

•Patients undergoing major gastrointestinal surgeries experience malnutrition.•Protein-enhanced diet using mealworms clinically improved the activity of immune cells; however, additional oral protein supplements over the recommended dose did not provide nutritional benefits in patients after hepato-pancreato-biliary surgery.•The high dropout rate due to limited compliance and tolerance in both control and trial groups is a limitation of this randomized controlled study. Further studies that include factors associated with adherence and qualitative analysis are needed.