Annals of Clinical Nutrition and Metabolism

Volume 9 (2); December 2018

Review Article

Effect of Sarcopenia in Patients after Pancreatectomy: In Woong Han; Surg Metab Nutr 2018;9(2):31-35. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.31

Abstract PDF: Sarcopenia is characterized as a syndrome involving the progressive or generalized loss of skeletal muscle mass and strength with or without increased fat mass. This is one of well-known risk factors for adverse treatment outcomes in patients with various medical and surgical diseases. Sarcopenia itself, independent of the body mass index, is a powerful prognostic factor for cancer cachexia, liver cirrhosis, and even all causes of mortality. In terms of gastrointestinal surgery, sarcopenia is a significant prognostic factor in patients with gastric or colorectal cancers. Sarcopenia is related to postoperative complication, 30-day mortality, overall survival, and disease-free survival after gastrointestinal surgery. For patients with hepatic surgery, sarcopenia is also a significant prognostic factor. Several studies, including meta-analysis, proved sarcopenia to be waiting-list mortality and post-transplantation mortality in liver transplantation patients. Similarly, preoperative sarcopenic obesity was an independent risk factor for death and hepatocellular carcinoma recurrence after a hepatectomy. In cases of pancreatic cancer, several studies proposed that sarcopenia was an objective measure of patient frailty that was strongly associated with the long-term outcome independent of tumor-specific factors. In addition, sarcopenia or sarcopenic obesity has been reported to be a strong predictor of major complications after pancreatectomy. As a result, sarcopenia could be used to improve patient selection before a pancreatectomy. The next step to solve the questions to manage sarcopenia and improve the post-pancreatectomy outcomes would be to determine the role of nutrition and physical activity in the prevention or treatment of sarcopenia, and to develop specific medications with an evidence-based treatment of sarcopenia in patients with pancreatectomy.

4 View
0 Download

Original Articles

Relationship of the Psoas Muscle Index with the Other Nutritional Factors in Patients Who Underwent Emergency Operation with Colonic Perforation: Young Hun Kim, Ki Wook Lee, Kyung Jong Kim; Surg Metab Nutr 2018;9(2):36-40. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.36

Abstract PDF: Purpose:

This study examined the correlation between the preoperative nutritional index and Sarcopenia in emergency colonic perforation patients.

Materials and Methods:

Patients undergoing an emergency operation with colorectal perforation at Chosun University Hospital between January 2014 and December 2016 were included in the analysis, and the medical records were reviewed retrospectively. Sarcopenia was defined by the psoas muscle area measured by preoperative computed tomography (CT) cross sectional imaging at L3 vertebra. The clinical nutritional index of patients with PMI (psoas muscle index)-High group were compared with a PMI-Low group.

Results:

The median PMI of the males was 4.48 cm²/m² and the median of females was 3.33 cm²/m² (P=0.002) The PMI-High and PMI-Low groups were not correlated with age and gender (P=0.455 and P=0.806, respectively). The traditional indicators of the nutritional status, such as body mass index (BMI), albumin, and lymphocytes, were not associated with sarcopenia (P=0.094, P=0.676, and P=1.000, respectively). No significant difference was observed between the ASA classification and sarcopenia (P=0.145).

Conclusion:

Sarcopenia using PMI was not associated with previous nutritional indices in patients undergoing emergency surgery due to colonic perforation. In the future, large-scale studies will need to identify its role as a prognostic factor.

6 View
0 Download

Effect of the Remnant Stomach Volume on the Nutritional and Body Composition in Stage 1 Gastric Cancer Patients: Koen Lee, Kyung Won Kim, Jung-Bok Lee, Yongbin Shin, Jin Kyoo Jang, Jeong-Hwan Yook, Byung-Sik Kim, In-Seob Lee; Surg Metab Nutr 2018;9(2):41-50. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.41

Abstract PDF: Purpose:

During the first year after surgery, gastric cancer patients experience weight loss and a decline in physical activity. In addition, depravation of the nutritional status and anemia is observed. The decrease in stomach volume is believed to be one of the causes for these changes. The purpose of this study was to investigate the effects of the remnant stomach volume on nutrition, anemia, and body composition-related parameters in gastric cancer patients after surgery.

Materials and Methods:

A total of 110 patients with stage 1 gastric cancer, who underwent a laparoscopic gastrectomy in 2015 were evaluated in this prospective observational study. Among them, 78 patients received a distal gastrectomy (Billroth 1: 52, Billroth 2: 12, Roux en Y: 14) and 32 underwent a total gastrectomy. The weight, height, and blood test results of the patients were collected during the observation period. The remnant stomach volume, total abdominal muscle area, and subcutaneous/visceral fat area were measured using CT images.

Results:

Patients with a larger remnant stomach volume showed a smaller decrease in the nutritional parameters and better recovery of the hemoglobin level during the first year after surgery. Among the body composition parameters, visceral fat was affected to the greatest extent and subcutaneous/visceral fat were better preserved in the group with a larger remnant stomach volume. In the group with a total gastrectomy, the parameters were worsened significantly compared to the distal gastrectomy group.

Conclusion:

The remnant stomach volume has a protective effect on the body mass index, body weight change, hemoglobin, total protein, cholesterol, and visceral/subcutaneous fat area during the first year after surgery.

5 View
0 Download

Recovery Pattern of the Nutritional Status after Surgical Treatment for Pancreatic Head Disease: Compared with Malignancy and Non-malignancy: Eunjung Kim, Youngmin Han, Hongbeom Kim, Wooil Kwon, Sun-Whe Kim, Jin-Young Jang; Surg Metab Nutr 2018;9(2):51-58. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.51

Abstract PDF: Purpose:

Malnutrition affects the clinical outcomes of pancreatic disease. On the other hand, the changes in the nutritional status stratified by malignant and non-malignant diseases after surgery still need to be determined. The aim was to confirm the changing nutritional status and clinical outcomes after a pancreatoduodenectomy according to malignant and non-malignant disease.

Materials and Methods:

Data were collected prospectively from 157 patients between 2009 and 2015. The nutritional status was classified as well-nourished, at-risk of malnutrition, and malnourished by a Mini Nutrition Assessment. The clinical outcomes were assessed using the postoperative complication, hospital stay, biochemical nutritional markers, and quality-of-life (QOL).

Results:

Preoperatively, the proportion of malnourished status in the malignant disease group (group B) were 66.7% and 33.3% in the non-malignancy group (group A). The malnutrition rate in group B was higher than that in group A at 3, 6, and 12 months after surgery (58.1% vs. 41.9%, 90.0% vs. 10.0, 77.8% vs. 22.2%, respectively). The preoperative QOL was significantly lower in group B than in group A (P<.001); however, the QOL was comparable between the two groups after surgery. The body mass index was unrecovered after surgery in all groups.

Conclusion:

Patients with malignant pancreatic disease are more likely to suffer from a poor nutritional status than those with non-malignant pancreatic disease. One year after the pancreatoduodenctomy, the at-risk of malnutrition and malnourished rate were found to be over 70% in all patients. Therefore, more efforts will be needed to improve the nutritional status in pancreatic head disease.

5 View
0 Download

Is Postoperative Albumin Level Related with Surgical Site Infection?: Kyungtae CHO, Sung Woo CHO, Sangchul YUN, Suyeon Park; Surg Metab Nutr 2018;9(2):59-67. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.59

Abstract PDF: Purpose:

Surgical site infection (SSI) is a hospital-acquired infection (HAI) associated with increased mortality, length of hospital stay, and cost of hospitalization. The aim of this study was to identify the value of albumin as an indicator of the nutritional status, postoperative C-reactive protein (CRP), and white blood cell (WBC) levels in predicting an outbreak of SSI and SSI-related epidemiology after colorectal surgery and identifying the risk factors for SSI.

Materials and Methods:

A total of 198 patients, who underwent colorectal surgery from September 1, 2015 to December 31, 2016, were included in the study. The patient identity, operation characteristics, and SSI data were analyzed retrospectively by a chart review and national SSI reporting sheet. The relationship of the SSI and clinical data was analyzed statistically, and the SSI detection time and post-operative inflammatory laboratory findings were analyzed individually using cumulative incidence analysis and cause-specific hazard model.

Results:

The incidence of SSI post colorectal surgery was 15.7% (31 out of 198 cases). Chronic renal failure (CRF), open surgery, long operation time, and stoma were identified as significant risk factors for SSI using univariate analysis. The CRF, long operation time, and stoma were significant risk factors according to multivariate analysis. The decrease in albumin on post-operative day (POD)#3 and CRP elevation on POD#4 were related to the early detection of SSI.

Conclusion:

The actual incidence of SSI might be higher than expected, particularly in cases where patients have several clinical and operative factors. In addition, the albumin level and multiple postoperative inflammation tests can be employed as an early predictors of SSI.

5 View
0 Download

Nutritional Assessment of Critically Ill Patients after Abdominal Surgery and Predisposing Factors of Prolonged ICU Stay after Surgery: Sung Eun Park, In Kyu Lee, Eun Young Kim; Surg Metab Nutr 2018;9(2):68-74. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.68

Abstract PDF: Purpose:

Patients in prolonged intensive care unit stay were vulnerable to malnutrition which deteriorated recovery and postoperative outcomes. The purpose of this study was to evaluate nutritional status in surgical patients entering the intensive care unit, and to identify the risk factors that influence prolonged intensive care unit stay.

Materials and Methods:

From January 2016 to June 2018, 740 patients (age≥18 years) who were admitted to our surgical intensive care unit after abdominal surgery with general anesthesia (≥4 hours) were enrolled. Patients were classified into short-term stay group (≤4 days) and long-term stay group (>4 days). These groups were analyzed and compared with patient factors and postoperative outcomes and the multivariate analysis was performed to assess the risk factors for prolonged intensive care unit stay.

Results:

A total of 119 patients were analyzed. The univariate and multivariate analysis showed that dialysis status (Odds ratio 7.684, 95% confidence interval 1.038∼1.103, P=0.013), total lymphocyte count (Odds ratio 0.999, 95% confidence interval 0.998∼1.000, P=0.047), and intraoperative transfusion (Odds ratio 1.002, 95% confidence interval 1.001∼1.002, P=0.000) were associated with prolonged intensive care unit stay. Lone-term stay group were significantly longer hospital stay and higher hospital morbidity rate than short-term stay group.

Conclusion:

Patients with risk factors of prolonged intensive care unit stay included dialysis status, low total lymphocyte count, a large amount of transfusion would be more interested and the active intervention such as early nutritional evaluation and adequate nutritional support should be needed.