Annals of Clinical Nutrition and Metabolism

Original Articles

Efficacy of high-protein diet protocol and education after distal gastrectomy for gastric cancer patients to prevent loss of lean body mass in Korea: a non-randomized controlled study: Hee Kyung Yoon, Sun Ae Kim, Ji Yoon Han, Dong Jin Kim; Ann Clin Nutr Metab 2024;16(1):10-19. Published online April 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.1.10

Abstract PDF Supplementary Material: Purpose: We studied whether active education of patients about the importance of a high-protein diet can prevent lean body mass loss after gastrectomy for gastric cancer.
Methods: In the study group, intensive high protein diet education and monitoring was performed immediate post operative, 1, 3, and 6 months after surgery. Study group patients were compared with data from the control group formed using propensity matching with the study group for age, sex, resection extent, and TNM stage. Clinicopathologic factors were compared between the groups, and changes in quality of life (QOL) and lean body mass between preoperative levels and 6 months after surgery were assessed.
Results: Among the 100 patients, 31 patients from each group were matched with propensity matching. The groups had no significant clinicopathologic differences. Although the changes in QOL scale and body composition did not differ statistically between the groups, a favorable trend was observed in the study group. Six months after surgery, the mean change in the QOL scale, which measured physical, role, emotional, cognitive, and social functioning, decreased less than the control group or even increased in the study group. In the body composition analysis, the study group showed greater reductions in weight, body mass index, fat mass, and body fat percentage than the control group, and their lean body mass and skeletal muscle mass decreased less.
Conclusion: A high-protein diet protocol and education might increase patient QOL and prevent a decrease in lean body weight 6 months after distal gastric resection.

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Changes in mineral and vitamin profiles after bariatric surgery in Korea: a before and after study: Jong Seob Park, Sang-Moon Han; Ann Clin Nutr Metab 2023;15(2):51-56. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.51

Abstract PDF: Purpose: Bariatric surgery induces nutritional deficiencies that require long-term monitoring and supplementation. This study aimed to evaluate the status of vitamins and minerals pre-operation and 2 years post-operation and to compare the findings according to type of bariatric surgery.
Methods: The study enrolled 302 patients who underwent bariatric surgery, adjustable gastric band (AGB), sleeve gastrectomy (SG), or Roux-en-Y gastric bypass (RYGB) between 2013 and 2017 in the CHA Gangnam Medical Center and the Seoul Medical Center, Korea. Minerals and vitamin status was assessed at baseline (pre-operatively) until 2 years after bariatric surgery.
Results: Mean age was 34.1±8.3 years, 256 patients (84.8%) were female, and mean body mass index was 35.3±5.7 kg/m². Vitamin B1, vitamin B12, and folic acid levels were significantly different at 1 and 2 years after surgery compared to baseline. Hemoglobin, hematocrit, high-density lipoprotein, iron, calcium, and magnesium levels did not differ significantly during the study period.
Conclusion: Although enrolled patients had no clinical symptoms of nutritional deficiences, several indicators related to nutrition decreased at 2 years after bariatric surgery. Despite variations in the alteration of laboratory results across three surgical interventions, namely SG, AGB, and RYGB, a consistent reduction in fasting blood sugar was observed subsequent to the surgical procedures.

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Nutritional Status of Patients with Hepatobiliary-Pancreatic Surgical Disease: Sang Soo Eom, Yong Chan Shin, Chang-Sup Lim, In Woong Han, Woohyun Jung, Yoonhyeong Byun, Dong Wook Choi, Jin Seok Heo, Hongbeom Kim; Surg Metab Nutr 2020;11(2):46-52. Published online December 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.2.46

Abstract PDF: Purpose: This study examined the nutritional status of patients with hepatobiliary-pancreatic diseases before surgery to establish basic reference data.
Materials and Methods: This study evaluated retrospectively 2,322 patients admitted for hepatobiliary-pancreatic surgery between 2014 and 2016 at four Korean medical institutions using the body mass index (BMI) score. The prognostic nutrition index (PNI) was calculated in patients diagnosed with malignant diseases.
Results: The mean BMI was 24.0 kg/m² (range, 13.2~39.1 kg/m²). The patients were classified as low BMI (<21.5 kg/ m², below 25 percentile), intermediate BMI (21.5~25.5 kg/m²), and high BMI (>25.5 kg/m², above 75 percentile). There were significant differences in the age, sex distribution, ASA classification, type of hospitalization, biliary drainage, organ, and pathology diagnosis between the pairs among the low, intermediate, and high BMI groups. Among the three BMI groups, the complication rate of the low BMI group was highest (34.4% vs. 29.7% vs. 25.8% P=0.005). The median lengths of hospital stay in the low, intermediate, and high BMI groups were 9, 9, and 7 days, respectively (P<0.001). Multivariate analysis revealed the risk factors of the low BMI group to be a higher ASA classification, biliary drainage, pancreatic disease, and malignant disease. The group with PNI<45 had significantly longer hospital stays than the group with PNI≥45 (P<0.001).
Conclusion: Patients with a low BMI had a higher ASA classification, preoperative biliary drainage, pancreatic disease, and malignant disease. The low PNI group had significantly longer hospital stays than the high PNI group. Screening of the preoperative nutritional status is necessary for assessing the risk of malnutrition and its treatment.

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Effect of Obesity on 30-Day Mortality in Critically Ill Surgical Patients: Jung Yeob Ko, Yun Tae Jung, Jae Gil Lee; J Clin Nutr 2018;10(2):51-55. Published online December 31, 2018; DOI: https://doi.org/10.15747/jcn.2018.10.2.51

Abstract PDF: Purpose:
This study was conducted to assess how extreme obesity affects 30-day mortality in this patient group.
Methods:
A total of 802 patients who underwent emergency gastrointestinal surgery from January 2007 to December 2017 were retrospectively reviewed. Patients were divided into three groups according to their body mass index (BMI): group 1, normal weight (BMI: 18.5∼22.9 kg/m²); group 2, overweight (BMI: 23.0∼29.9 kg/m²); and group 3, obesity (BMI≥30 kg/m²). Patients with a BMI under 18.5 were excluded from the analysis. Chi-squared test, Fisher’s exact test, Kaplan-Meier survival analysis, and the log-rank test were used to assess and compare 30-day mortality rates between groups.
Results:
The mortality rates of group 1, group 2, and group 3 were 11.3%, 9.0%, and 26.9%, respectively (P<0.017). The mortality rate did not differ significantly between group 1 and 2 (11.3% vs. 9.0%; P=0.341), but group 1 and 2 showed better survival rates than group 3 (11.3% vs. 26.9%; P=0.028, 9.0% vs. 26.9%; P=0.011). Kaplan-Meier survival analysis revealed that group 3 had higher mortality than the other two groups (P=0.001).
Conclusion:
Obesity (BMI≥30 kg/m²) was one of the risk factors influencing critically ill patients who underwent emergency surgery.

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