Annals of Clinical Nutrition and Metabolism

Nutritional Support for Terminal Cancer Patients: Keun Won Ryu, Hyun Jung Jho, Sang-Jae Park, Sang Yoon Park; Surg Metab Nutr 2011;2(2):35-38. Published online December 30, 2011

Abstract PDF: Nutritional support at the end of life for cancer patients is a controversial issue for a variety of reasons. The benefits of survival are weighed against, procedure related complications in this review. Journal articles describing the nutritional support provided to terminal cancer patients were identified in a database. For each study design, the indication, number of enrolled patients, and the results of the relevant articles were interpreted, considering statistical and clinical significance. A subgroup of terminal cancer patients who may have potential benefit from nutritional support were selected. Suggested nutritional guidelines from several institution and organizations were also reviewed. Nutritional support for patients with gastrointestinal cancer and estimated prognosis more than several weeks provided survival benefits. Complication rates associated with gastrostomy or parenteral catheters are considerably higher and include hastened mortality. Benefits associated with providing nutritional support for patients are indicated in cases of gastrointestinal obstruction, expected survival more than 1 month, and good general performance. Even with the limited information available, it appears nutritional support for selected terminal cancer patients may be beneficial, and guideline based intervention minimizes procedure related problems. (SMN 2011;2:35-38)

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Surgical Metabolism and Nutrition: Chyle Leaks: Jae Keun Kim, Hyun Wook Shin, Joon Seong Park; Surg Metab Nutr 2011;2(2):39-40. Published online December 30, 2011

Abstract PDF: Chylous ascites is the accumulation of peritoneal fluid rich in triglycerides in the peritoneal cavity. It commonly develops when there is disruption of the lymphatic system due to traumatic injury or obstruction. Chylous ascites is diagnosed when ascetic fluid appears milky and contains a triglyceride content above 200 mg/dl. Patients identified as suffering with chylous ascites are treated to correct the specific underlying cause. Therapeutic paracentesis and administration of diuretics are recommended for patients with underlying cirrhosis. Appropriate nutritional support for chylous ascites, including a low-fat diet and medium-chain triglyceride supplementation, is of paramount importance. (SMN 2011;2:39-40)

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Metabolic Change in Cancer Patient: Jung Wook Huh; Surg Metab Nutr 2011;2(2):41-44. Published online December 30, 2011

Abstract PDF: Cachexia is a multifactorial process of skeletal muscle and adipose tissue atrophy resulting in progressive weight loss. The prevalence of cachexia is thought to be up to 80% of upper gastrointestinal cancer patients and 60% of lung cancer patients at the time of diagnosis. Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown are frequently associated with cachexia. It is associated with poor quality of life, poor physical function, and poor prognosis in cancer patients. It involves multiple pathways: procachectic and proinflammatory signals from tumor cells, systemic inflammation in the host, and widespread metabolic changes (increased resting energy expenditure and alterations in metabolism of protein, fat, and carbohydrate). Recently, cytokines, metabolic abnormalities, and neurohormonal alterations are believed to be responsible for cachexia and cytokines are the dominant cause but all alterations occur simultaneously. I hereby review the metabolic changes in cancer patients. (SMN 2011;2:41-44)

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Clinical Implication of Enhanced Recovery after Surgery for Gastric Cancer Patients: Seong Il O, Hae Myung Jeon; Surg Metab Nutr 2011;2(2):45-51. Published online December 30, 2011

Abstract PDF: Since quality of life is considered to be an important aspect in surgical patients, the concept of Enhanced Recovery After Surgery, also known as Fast-track surgery, has come from the sum of multimodal efforts to minimize patient surgical stress and to enhance recovery. This article reviews the various reported results about Enhanced Recovery After Surgery for gastric cancer surgery patients. There are many techniques that together are collectively known as Enhanced Recovery After Surgery, which include no bowel preparation, no prolonged fasting, no nasogastric tube, no prophylactic drain, early removal of the catheter, and short-term use of prophylactic antibiotics. Some studies report good results in that the Enhanced Recovery After Surgery program does not increase morbidity, and some other studies report that morbidity is even reduced. The postoperative hospital stay which represents patient recovery is also reduced, and the re-admission rate does not increase. But the number of reports about the clinical effects of Enhanced Recovery After Surgery in the field of gastric cancer surgery is small, and there is also no consensus about that as in colorectal surgery. Enhanced Recovery After Surgery for gastric cancer surgery patients is an important concept to improve the surgical outcome and the quality of life in gastric cancer patients. Further research is needed to improve the clinical effect of Enhanced Recovery After Surgery in the field of gastric cancer surgery and also a consensus must be established about the clinical effects of Enhanced Recovery After Surgery techniques. (SMN 2011;2:45-51)

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Recent Update to Treatment of Type 2 Diabetes Mellitus in Korea: Juyoung Shin, Jeong Ah Shin, Jae Hyoung Cho; Surg Metab Nutr 2011;2(2):52-58. Published online December 30, 2011

Abstract PDF: Diabetes, a metabolic disease of hyperglycemia, is one of the most common metabolic diseases, resulting in increased morbidity and mortality worldwide. The prevalence of diabetes mellitus in Korea is dramatically increasing, especially among younger people. Diabetes has considerable variations depending on ethnicity, culture, socioeconomic status, and genetic susceptibility. In this context, the Korean diabetes association (KDA) revised the clinical practice guideline for diabetes in 2011 based on a review and analysis of all of the related literature, in order to attenuate the rapid increase in prevalence and prevent complications. This review outlines the updated clinical recommendations for screening, diagnosis, monitoring, and management including nutrition therapy, physical activity, pharmacologic treatment, epidemiologic trends, risk factors, and the pathophysiology of diabetes. We then emphasize the importance of diabetes treatment according to a patient's characteristics. (SMN 2011;2:52-58)

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The Results of Nutritional Assessments for Cancer Patients after Surgical Treatments: Myoung Won Son, Bo Young Yeon, Sung Mi Park, Min Ji Han, Eun Ju Lee, Gil Ho Kang, Moon Soo Lee; Surg Metab Nutr 2011;2(2):59-63. Published online December 30, 2011

Abstract PDF: Purpose: In cancer patients, nutritional status is known to be associated with post-operative complications and prognoses after surgical treatments. The aim of this study was to examine the nutritional status of surgical cancer patients, to compare the nutritional status by cancer type, and to evaluate the indicators that can reflect nutritional status.
Materials and Methods: Between January and December 2010, 196 patients who had undergone surgical operations for surgical malignancy were enrolled. A nutritional assessment was conducted by the 1st and 2nd nutritional assessment tools. Types of cancer, body mass index (BMI), serum albumin, hemoglobin, and total lymphocyte count were analyzed.
Results: The patients’ mean age was 59.2±13.3 years, and 29.6% (n=58) of them were rated as having moderate malnutrition by the 1st nutritional assessment. A total of 18.9% (n=37) were overweight, and 3.6% (n=7) were obese. There was a relationship between the type of cancer and the BMI group (P=0.04).
Conclusion: Many surgical cancer patients are accompanied by excess body weight, and these patients should receive adequate nutritional assessments and support. (SMN 2011;2:59-63)

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