Annals of Clinical Nutrition and Metabolism

Letter from the Editor: Suk-Kyung Hong; Ann Clin Nutr Metab 2021;13(2):25-25. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.25

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Perioperative Management of Morbidly Obese Patients during Major Abdominal Surgery: Byeong-Gon Na, Sang-Jae Park; Ann Clin Nutr Metab 2021;13(2):26-33. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.26

Abstract PDF: The population with obesity is seeing a steady increase globally. Obesity is known to be associated with morbidity and mortality after major abdominal surgery, and this correlation becomes more prominent in morbidly obese (MO) patients. Accordingly, adequate preoperative evaluation and preparation should be performed with an understanding of the pathophysiological changes associated with the MO. Precise surgery and adequate postoperative management are also mandatory to reduce complications and unplanned readmissions. However, adequate guidelines for the perioperative management of MO patients undergoing major abdominal surgery are lacking. We provide an overview of the pathophysiologic changes and practical guidelines on the perioperative management of major abdominal surgery in MO patients.

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Comparison of Post-Operative Nutritional Status according to the Extent of Gastrectomy and the Reconstruction Method in Patients with Gastric Cancer: Kyung Hwan Kim, Jong Hyuk Yoon, Geum Jong Song, Myoung Won Son, Sung Yong Kim, Moo Jun Baek, Moon Soo Lee; Ann Clin Nutr Metab 2021;13(2):34-42. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.34

Abstract PDF: Purpose: Malnutrition is the main complication after gastrectomy and the degree may vary depending on the extent of resection. This study sought to help determine an appropriate type of resection and provide methods for addressing malnutrition after gastrectomy.
Materials and Methods: We retrospectively reviewed medical records of patients with gastric cancer who underwent radical resection at the Soonchunhyang University Cheonan Hospital between December 2012 and December 2013. A total of 100 patients were screened, and all patients were followed for 1 to 3 years. Among this group, 12 underwent total gastrectomy, 5 underwent proximal gastrectomy, 46 underwent distal gastrectomy with Billroth I anastomosis, and 37 with Billroth II anastomosis. The nutritional status assessment included body weight, body mass index, serum albumin, serum hemoglobin, vitamin B12, ferritin, and Nutritional Risk Index (NRI).
Results: Patients who underwent total gastrectomy had lower hemoglobin and vitamin B12 levels compared to patients who underwent distal gastrectomy. The NRI was statistically significantly lower in patients who underwent total gastrectomy than patients who underwent distal gastrectomy. Patients who underwent total gastrectomy had lower vitamin B12 than patients who underwent proximal gastrectomy till the second year after gastrectomy. Regarding postdistal gastrectomy reconstruction, there was no statistically significant difference between the Billroth I and Billroth II groups.
Conclusion: This study showed that patients who underwent total gastrectomy were more susceptible to malnutrition than those who underwent distal or proximal gastrectomy. Patients who undergo gastrectomy should be monitored carefully for nutritional status and given appropriate nutritional support in the post-operative period.

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Longitudinal Change in Health-Related Quality of Life after Total Gastrectomy: Approach Based on the Minimally Important Difference: Sang Chun Park, Oh Jeong, Ji Hoon Kang, Mi Ran Jung; Ann Clin Nutr Metab 2021;13(2):43-51. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.43

Abstract PDF: Purpose: The post-operative quality of life (QoL) is a significant concern for patients undergoing gastrectomy. Unlike subtotal gastrectomy, the detailed aspects of QoL involving the ability to perform everyday activities that reflect physical, psychological, and social well-being; and satisfaction with levels of functioning and control of the disease after total gastrectomy remain poorly investigated.
Materials and Methods: We enrolled 170 patients who underwent total gastrectomy for gastric carcinoma and completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaires (QLQ) C30 and STO22 preoperatively and post-operatively at 1, 6, and 12 months. We investigated the QoL change in terms of the minimally important difference (MID), which refers to a score change patients would perceive as clinically important (effect size >0.5).
Results: At 1-month post-surgery, MID in global health, physical, social, role, emotional, and cognitive functions was observed at 44.0%, 68.0%, 42.7%, 38.7%, 32.0%, and 16.0% respectively. Of QLQ-C30 symptoms, MID was frequently observed in appetite (52.9%). Of the QLQ-STO22 symptoms, MID was frequently observed in eating restrictions (74.1%), dysphagia (63.5%), pain (51.8%), and anxiety (50.6%). At 12 months post-surgery, MID in global health, physical, role, cognitive, social, and emotional functions was 32.9%, 58.8%, 42.4%, 40.0%, 36.5%, and 17.6%, respectively. Of QLQ-C30 symptoms, MID was frequently observed in diarrhea (52.9%). Of the QLQ-STO22 symptoms, MID was frequently observed in eating restrictions (63.5%), dysphagia (52.9%), body image (55.3%), pain (55.3%), and anxiety (51.8%). Male sex, comorbidity, D2 lymphadenectomy, and post-operative morbidity were associated with MID in global health at 12 months post-surgery.
Conclusion: This study provides information about the detailed aspects of impairment in various functions and symptoms of QoL after total gastrectomy. This information can be used to develop a tailor-made management plan for QoL.

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Long-Term Changes of Body Mass Index and Nutritional Biochemical Markers in the Obese Elderly with Gastric Cancer: Eunjung Kim, Ji-Hyeon Park, Eun-Mi Seol, Seong-Ho Kong, Do Joong Park, Han-Kwang Yang, Hyuk-Joon Lee; Ann Clin Nutr Metab 2021;13(2):52-61. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.52

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Clinical Significance of Sarcopenia in Patients with Advanced Hepatocellular Carcinoma Undergoing Sorafenib Treatment: Min-Hyuk Lee, Min-Su Park; Ann Clin Nutr Metab 2021;13(2):62-67. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.62

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Clinical Significance of Malnutrition Risk in Severe Trauma Patients: A Single-Center Study: Hohyun Kim, Kum-Hee Hong, Inah Choi, Kyung-A Lee, Geun Am Song; Ann Clin Nutr Metab 2021;13(2):68-74. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.68

Abstract PDF: Purpose: A suboptimal nutritional status is often observed among hospitalized patients across all medical/surgical specialties. The objective of the present study was to (1) analyze the prevalence of malnutrition in severe trauma patients and (2) evaluate the relationship between malnutrition and select clinical outcomes.
Materials and Methods: This retrospective study was conducted between October 2015 and March 2017 at the Pusan National University Hospital Trauma Center. Of a total of 3,560 patients, 945 were enrolled in this study. Patients were checked for malnutrition using a nutrition assessment tool by the hospital nutrition support team. The parameters assessed included serum albumin, the ratio of actual body weight to ideal body weight (%), total lymphocyte count, appetite, and gastrointestinal problems. Clinical outcomes under consideration included 1) mortality, 2) length of hospitalization, and 3) length of stay in the intensive care unit (ICU).
Results: The total prevalence of malnutrition in hospitalized trauma patients was 55.0% (n=520). Malnutrition risk was the independent prognostic factor of mortality in severe trauma patients (adjusted odds ratio [OR]=3.440; 95% confidence interval [CI]=1.401~8.447, P=0.007). Risk factors of malnutrition were age over 65 years (adjusted OR=2.393; 95% CI=1.699~3.370, P<0.001), injury severity score (adjusted OR=1.034, 95% CI=1.012~1.056, P=0.002), length of hospitalization (adjusted OR=1.104; 95% CI=1.007~1.020, P<0.001), and length of stay in the ICU (adjusted OR=1.050; 95% CI=1.029~1.072, P<0.001).
Conclusion: Malnutrition is widespread in hospitalized patients with severe trauma and results in suboptimal clinical outcomes. Thus, patients at high risk of malnutrition should be monitored carefully during hospitalization.

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