Introduction
In hospitalized patients, daily protein intake remains well below WHO requirements for healthy adults (0.8 g·kg^-1·d^-1) as well as ESPEN guidelines for patients (1.2-1.5 g·kg^-1·d^-1). The time-window between dinner and sleep may be a good opportunity to provide additional protein via a protein-rich snack. However, it remains to be assessed whether the provision of protein prior to sleep will increase total daily protein intake in hospitalized patients.

Methods
Patients admitted to the surgical wards of the Maastricht University Medical Centre+ were randomly allocated to the usual care (n=51) or pre-sleep snack (n=50) group. The pre-sleep snack group was given access to 100 g cheese cubes (30 g protein) every evening between 19.30 and 21.30 h, prior to sleep. All food provided and all food consumed were weighed and recorded throughout hospitalization (2-7 days). Daily energy and protein intake and distribution throughout the day were calculated. Data were analyzed by Independent T-Tests with P<0.05 considered as statistically significant. 

Results
Daily energy intake was higher in the pre-sleep snack group (1353±424 kcal·d^-1) when compared to the usual care group (1190±402 kcal·d^-1; P=0.049). Providing patients access to a pre-sleep snack resulted in a 16% (11±9 g) higher daily protein intake (0.81±0.29 g·kg^-1·d^-1) when compared to the usual care group (0.69±0.28 g·kg^-1·d^-1; P=0.045). Protein intake at breakfast, lunch, and dinner did not differ between the pre-sleep and usual care groups (all P>0.05). 

Conclusion
Pre-sleep protein provision, in the form of protein dense products such as cheese, represents an effective dietary strategy to increase daily energy and protein intake in hospitalized patients. Patients provided with a pre-sleep protein snack do not compensate by lowering energy or protein intake throughout the rest of the day. Pre-sleep protein dense food provision should be implemented in hospital food logistics to improve nutritional status of our patients.