Annals of Clinical Nutrition and Metabolism

Characteristics and Practice of Parenteral Nutrition in Hospitalized Adult Cancer Patients in Korea: Hyo Jung Park, You Min Sohn, Jee Eun Chung, Jung Tae Kim, Jin A Yang, Hye Jung Bae, Ye Won Sung, Sun Hwa Kim,Ji Yoon Cho, Kyung Mi Jung, Hee Kyung Bae; J Clin Nutr 2020;12(2):34-40. Published online December 31, 2020; DOI: https://doi.org/10.15747/jcn.2020.12.2.34

Abstract PDF ePub: Purpose: There have been no clinical studies on the characteristics of parenteral nutrition (PN) for adult cancer inpatients in South Korea. The published evidence describing modern PN practices in these patients is also extremely limited. Therefore in this retrospective multicenter cross-sectional study, we aimed to investigate the PN support practice in hospitalized adult cancer patients.
Methods: The study included adult cancer patients hospitalized in nine hospitals in South Korea and received PN, during the period from August 1st, 2017 to October 30th, 2017. We evaluated the relevant hospital-based PN practices in this group.
Results: Among the 11,580 inpatient admissions during this period, 759 cancer patients received PN (6.6%). The majority of enrolled patients (97.2%) used commercially available PN and 71.2% of these used peripheral PN formulations. The average in-hospital PN duration was 16.1±19.9 days. Patients received only 65.4±25.4% calories of the recommended target calories. The in-hospital mortality of enrolled patients was 26.1%.
Conclusion: We conclude that commercial PN is the most common form of PN administered to hospitalized adult cancer patients and the overall in-hospital mortality in the patients using PN is higher in South Korea compared to other countries.

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Clinical Impact of Preoperative Sarcopenia to Postoperative Prognosis in Patients with Periampullary Malignancy: Retrospective Multicenter Study: Jee Hyun Park, Youngju Ryu, So Hee Song, Naru Kim, Sang Hyun Shin, Jin Seok Heo, Dong Wook Choi, Woo Kyoung Jeong, Woo Hyun Jung, Yong Chan Shin, Chang-Sup Lim, In Woong Han; Surg Metab Nutr 2020;11(2):40-45. Published online December 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.2.40

Abstract PDF ePub: Purpose: This study compared the preoperative nutritional status between sarcopenic and non-sarcopenic patients and examined the effects of sarcopenia on the prognosis after a pancreatoduodenectomy (PD).
Materials and Methods: From 2015 to 2016, 480 patients who underwent PD with periampullary cancer at Samsung Medical Center, Seoul National University Boramae Medical Center, Ilsan Paik Hospital, and Ajou University Hospital were analyzed retrospectively. Sarcopenia was measured from the cross-sectional visceral fat and muscle area on CT imaging using an automatic calculation program. The dysnutritional grade was assessed according to Controlling Nutritional Status (CONUT) score system.
Results: Preoperative serum albumin (3.9 g/dl) and cholesterol levels (161.7 mg/dl) of sarcopenic patients were significantly lower than those of the non-sarcopenia patients (4.0 g/dl, P=0.024; 176.1 mg/dl, P=0.005). The proportion of moderate-to-severe dysnutritional grade in sarcopenic patients was significantly higher than in the non-sarcopenic patients (20.0 vs. 8.1%, P=0.004). A comparison of the changes in albumin between before and after PD showed a decrease in sarcopenic patients (0.06 vs. 0.05, P=0.024). Sarcopenia itself was not a factor affecting the overall survival (OS) negatively, but moderate-to-severe dysnutritional grade was an independent risk factor for OS (HR 2.418, CI 1.424~4.107, P=0.001).
Conclusion: Patients with sarcopenia showed poorer preoperative nutritional status than those without sarcopenia, and the sarcopenia affected the postoperative nutritional status negatively. No direct correlation was observed between sarcopenia and OS, but the dysnutritional grade was an independent risk factor that affects OS. As a result, patients with sarcopenia could be affected indirectly for survival because of their poor nutritional status.

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Current Status of Calorie Support during the Immediate Post-Operative Period Following a Gastrectomy: Eung Kyu Kim, Jae-Moon Bae, You Na Kim, Ji Yeong An, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Sung Kim; Surg Metab Nutr 2019;10(2):66-74. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.66

Abstract PDF ePub: Purpose:
The aim of this study was to elucidate the patterns of calorie support during the immediate postoperative period following a gastrectomy in gastric cancer patients.
Materials and Methods:
The clinicopathologic characteristics and nutritional parameters, including the actual infused amount of calories during the immediate postoperative period, were retrospectively collected and analyzed, This was data from a total 1,390 cases out of 1,404 patients who underwent curative gastrectomy at Samsung Medical Center, from Jan. 1 2016 through Dec. 31, 2016.
Results:
The actual infused amount of calories during the immediate postoperative period (the first three days following surgery) was only 41.6% of the recommended average intake of calories, which was significantly lower (759.8±139.4 kcal/day vs 1,825.7±251.6 kcal/day, respectively). The target calories supply per unit body weight was 30 kcal/kg. According to the operative method, the average infused amount of calories was lower in open gastrectomy compared to when utilizing the minimal invasive methods (laparoscopic assisted or robot assisted gastrectomy) (742.11 kcal/day:11.7 kcal/kg vs 792.95 kacl/day:12.8 kcal/kg or 791.43 kcal/day:12.8 kcal/kg, respectively). In regards to the operative type, the average infused amount of calories was higher in subtotal gastrectomy compared to that in total gastrectomy (732.1 kcal/day:12.23 kcal/kg vs 689.5 kcal/day:11.7 kcal/kg, respectively). The female group had a higher calorie supply per unit body weight compared to that of the male group (766.0 kcal/day:13.7 kcal/kg vs 758.9 kcal/day:11.3 kcal/kg, respectively). According to body mass index (BMI), the low BMI group had a lower calorie intake compared to that of the normal or high BMI group (700.2 kcal/day:15.3 kcal/kg vs 761.8 kcal/day:13.6 kcal/kg vs 766.5 kcal/day:11.1 kcal/kg, respectively). The actual infused amount of calorie significantly varied day by day in all the groups (range: 31.52 kcal/day to 1,559.31 kcal/day).
Conclusion:
The actual calorie intake significantly varied from day-to-day. Moreover, the intake was significantly lower than the average daily recommended amount of calories following a gastrectomy in gastric cancer patients during the immediate postoperative period.

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Clinical Implications of the Cut-off Value of the Preoperative Prognostic Nutritional Index in Patients with Early Stage Gastric Cancer: Ji Hye Jung, Ji Yeong An, You Na Kim, Min Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim; Surg Metab Nutr 2019;10(2):59-65. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.59

Abstract PDF ePub: Purpose:
The perioperative nutritional status is a potential prognostic factor in gastric cancer patients. This study assessed the optimal cut-off value of the prognostic nutritional index (PNI) for predicting the survival of patients with early stage gastric cancer and evaluated its power for predicting the survival after gastric cancer surgery.
Materials and Methods:
This study reviewed the data of 8,014 patients with stage T1N0~1M0 and T2~3N0M0 gastric cancer who underwent a curative gastrectomy without adjuvant chemotherapy between January 2006 and December 2015. The log-rank test on SAS was conducted to determine the preoperative PNI cut-off value that indicated the most significant difference in survival, and the clinical features and oncological outcomes were analyzed according to the cut-off value of the preoperative PNI.
Results:
The preoperative PNI cut-off value that indicated the most significant difference in survival was 43.7. Using this cut-off value, patients were classified into high PNI and low PNI groups. The five-year overall survival rate was 96.9% and 81.5% for the high and low PNI group, respectively (P<0.001). Considering each stage (Ia, Ib, and IIa), the overall survival rates were significantly higher for the high PNI group than the low PNI group. Multivariable analysis revealed the cut-off value of the preoperative PNI to be among the independent risk factors for survival.
Conclusions:
The cut-off value of the preoperative PNI that could be used to determine the significant differences in the survival of patients with early stage gastric cancer was identified and proven to have a significant impact on predicting survival.

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Relationship of Sarcopenia with the Outcomes of Patients who Underwent Surgery for Bile Duct Cancer: Hye Jin Kim, Min-Su Park, Bum-Soo Kim, Sang-Mok Lee; Surg Metab Nutr 2019;10(2):54-58. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.54

Abstract PDF ePub

Purpose:

This study investigated the impact of Sarcopenia by examining the psoas muscle on the outcomes after bile duct resection for bile duct cancer.

Materials and Methods:

This study retrospectively analyzed 101 patients who underwent surgery for bile duct cancer between January 2006 and December 2015 at Kyung-Hee University Hospital. Skeletal muscle mass was evaluated by performing preoperative computed tomography to define Sarcopenia. Patients were classified into two groups by the median value of the psoas muscle index (PMI).

Results:

The median value of the psoas muscle index in female patients was 463.9 mm²/m², and the median value of the psoas muscle index in males was 688.7 mm²/m². In the sarcopenia group, the 1, 3, and 5-year recurrence free survival rates were 74.5%, 52.9%, and 27.5%, respectively. On the other hand, in the non-sarcopenia group the 1, 3, and 5-year recurrence free survival rates were 50%, 34%, and 28%, respectively. In the sarcopenia group, the 1, 3, and 5-year overall survival rates were 84.3%, 54.9%, and 31.4%, respectively. In the non-sarcopenia group, 1, 3, and 5-year overall survival rates were 58%, 40%, and 32%, respectively. However, recurrence-free survival and overall survival were not correlated with sarcopenia (P=0.131, P=0.163).

Conclusion:

Sarcopenia using the psoas muscle index (PMI) has no impact on outcomes of bile duct cancer patients who underwent surgery. (Surg Metab Nutr 2019;10:-58)

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Sarcopenia increases the risk of major organ or vessel invasion in patients with papillary thyroid cancer
Ja Kyung Yoon, Jung Hyun Yoon, Vivian Youngjean Park, Minah Lee, Jin Young Kwak
Scientific Reports.2022;[Epub] CrossRef

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Postoperative Weight Changes, Nutritional Status and Clinical Significance of Colorectal Cancer Patients: Sun Young Kim, Ji Sun Kim, Eon Chul Han; Surg Metab Nutr 2019;10(2):46-53. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.46

Abstract PDF ePub

Purpose:

Although weight loss is an important factor for assessing the nutritional status, patient counselling or management is limited due to fewer studies on weight loss after colorectal cancer surgery.

Materials and Methods:

Totally, 374 patients were included in the analysis (between August 2010 to December 2016). Patients’ weight was determined before surgery, and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Change in weight was reviewed based on the gender and administration of chemotherapy. Severe weight loss is defined as greater than 5% weight loss after surgery.

Results:

The weight changes post-surgery at 1 week (−2.56±2.62 vs. −3.36±2.68, P<0.005), 6 weeks (−3.23±3.82 vs. −4.57±3.96, P=0.001), and 3 months (−0.93±5.01 vs. −2.79±4.86, P<0.001) were significantly greater in male subjects, as compared to female patients. However, at 6 months post-surgery, most patients showed weight gain with no statistical significance between the genders (1.11±4.64 vs. 1.94±6.26, P=0.143). Weight change based on treatment (with or without chemotherapy) reveal significant differences between the genders at 3 months post-surgery only (−1.33±4.65 vs. −2.52 ±5.15, P=0.027). Multivariate analysis for factors of severe weight loss show that the male gender [adjusted odds ratio (OR): 1.83, P=0.027)], adjuvant chemotherapy (adjusted OR 2.11, P=0.008), and presence of post-operative complications (adjusted OR 2.12, P=0.029) were significant factors.

Conclusion:

In postoperative colorectal cancer patients, the weight and nutritional status require careful monitoring for at least 2 months after surgery, in order to prevent hindrance to chemotherapy. (Surg Metab Nutr 2019;10:-53)

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Serial measurements of body composition using bioelectrical impedance and clinical usefulness of phase angle in colorectal cancer
Seung‐Rim Han, Jung Hoon Bae, Chul Seung Lee, Abdullah Al‐Sawat, Soo Ji Park, Hyo Jin Lee, Mi Ran Yoon, Hyeong Yong Jin, Yoon Suk Lee, Do Sang Lee, In Kyu Lee
Nutrition in Clinical Practice.2022; 37(1): 153. CrossRef

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Nutritional Support for Cancer Patients: Yoontaek Lee; Surg Metab Nutr 2019;10(2):27-31. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.27

Abstract PDF ePub: Cancers are the leading cause of death worldwide, and various modalities of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies, have been applied. Malnutrition and a loss of muscle mass are encountered frequently in cancer patients and adversely affect the clinical outcomes. Therefore, screening for, monitoring, and treating malnutrition are important procedures in treating cancer patients. This paper reviews the guidelines as well as comparative studies describing the nutritional support provided to cancer patients and describes the evidence-based guidelines and recommendation for each topic.

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Risk Factor of Anemia after a Gastrectomy in Patients with Gastric Cancer: In Jun Yang, Dong-Wook Kim, Ye Seob Jee; Surg Metab Nutr 2019;10(1):15-19. Published online June 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.1.15

Abstract PDF ePub

Purpose:

In this study, we evaluate hematologic change of iron and vitamin B₁₂ on post-operative anemia after gastrectomy for gastric cancer.

Materials and Methods:

The patients with gastric cancer who underwent gastrectomy between January 2013 and December 2013 in Dankook university hospital were retrospectively reviewed. The 62 patients were followed up for 36 month postoperatively.

Results:

The incidences of anemia in female patients were turned out to be higher than those in male patients but there were no statistical difference; (44.4% vs 40.9%, P=0.399) at 6 month, (33.3% vs 25.0%, P=0.252) at 12 month, (22.2% vs 15.9%, P=0.277) at 18 month, (27.8% vs 15.9%, P=0.142) at 36 month after surgery. Patients with distal gastrectomy after the surgery showed decreasing incidence of anemia while patients with total gastrectomy showed decreasing incidence of anemia until 12 months but increasing incidence after that time.

Conclusion:

Anemia, Vitamin B₁₂ and iron deficiency must be evaluated after surgery for gastric cancer and active treatment is necessary as needed.

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Post-gastrectomy anemia and ferritin dynamics: key determinants of prognosis and clinical management in patients with gastric cancer
Eun Young Kim, Kyo Young Song, Dong Jin Kim
Frontiers in Oncology.2025;[Epub] CrossRef

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Risk of Malnutrition after Gastrointestinal Cancer Surgery: A Propensity Score Matched Retrospective Cohort Study: Sung-Hoon Yoon, Bong-Hyeon Kye, Hyung-Jin Kim, Kyong-Hwa Jun, Hyeon-Min Cho, Hyung-Min Chin; Surg Metab Nutr 2018;9(1):16-25. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.16

Abstract PDF ePub

Purpose:

Patients with cancers arising from the gastrointestinal tract can suffer from nutritional inadequacies caused by various factors. This study investigated the risk of malnutrition after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various preoperative and postoperative nutritional screening tools.

Materials and Methods:

In the authors’ hospital, 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery between July 2011 and June 2012. The patients from the two groups were matched using the propensity score and then analyzed the nutritional data from 170 patients (85 patients in each group), retrospectively.

Results:

In both groups, the postoperative nutritional status was impaired significantly compared to the preoperative status. The postoperative risk of undernutrition in CRC patients was significantly lower than that of the GC patients according to the Malnutrition Universal Screening Tool (P=0.007). At the time of hospital discharge after surgery, the incidence of a lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in the GC group than in the CRC group. A comparison of the postoperative nutritional status among the types of surgery in each group, total gastrectomy in the GC group (P=0.015) and proctectomy with diverting stoma in the CRC group (P=0.06), were related to more than 5% weight loss.

Conclusion:

Gastrointestinal cancer surgery might increase the patients’ postoperative risk of malnutrition, particularly in GC surgery. Therefore, consecutive assessments of the nutritional status and appropriate nutritional support are necessary after surgery for GC and CRC.

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Feasibility and Safety of Early Oral Feeding After Radical Gastrectomy in Patients With Gastric Carcinoma: A Systematic Review
Wahida Ali, Wahidullah Dost, Mohammad Nazir Zaman, Mohammad Qaher Rasully , Jamaluddin Niazi, Farzad Qasemi, Raisa Dost, Wahida Dost, Danyal Bakht, Syed Faqeer Hussain Bokhari
Cureus.2024;[Epub] CrossRef
Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea
Tak Kyu Oh, In-Ae Song
Journal of Korean Medical Science.2023;[Epub] CrossRef
Nutritional Counseling Protocol for Colorectal Cancer Patients after Surgery Improves Outcome
Isabelle R. Novelli, Bruno A. D. Araújo, Laura F. Grandisoli, Elianete C. G. Furtado, Evelyn K. N. Aguchiku, Marina C. G. Bertocco, Tassiane P. Sudbrak, Isabel C. de Araújo, Ana C. F. Bosko, Nágila R. T. Damasceno
Nutrition and Cancer.2021; 73(11-12): 2278. CrossRef

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Association of Nutrition Status-Related Indices and XELOX Chemotherapy Compliance in Gastric Cancer Patients: Sang Hyun Park, Geum Jong Song, Myoung Won Son, Sun Wook Han, Sang Ho Bae, Sung Yong Kim, Moo Jun Baek, Moon Soo Lee; Surg Metab Nutr 2017;8(2):36-40. Published online December 30, 2017; DOI: https://doi.org/10.18858/smn.2017.8.2.36

Abstract PDF ePub: Purpose:
Cancer-associated malnutrition is common in gastric cancer patients and affects their response to treatment. This study evaluated pre-operative and pre-chemotherapy nutritional status-related indices associated with compliance in post-operation state gastric cancer patients receiving chemotherapy.
Materials and Methods:
We retrospectively reviewed medical records of patients with gastric cancer undergoing curative D2 resection between August 2014 and July 2016. A total of 51 patients who underwent adjuvant chemotherapy with a regimen of capecitabine and oxaliplatin (XELOX) were screened. Nutritional status assessment included body weight (BW), body mass index (BMI), serum albumin, serum total protein, hemoglobin, and total lymphocyte count (TLC).
Results:
Twenty-six patients had stage II gastric cancer, and 25 patients had stage Ⅲ gastric cancer according to the guidelines of the American Joint Committee on Cancer. Eighty-two percent of patients completed their chemotherapy according to the therapy protocol. However, 49% of patients were subjected to drug dose reduction, and 18% of patients needed to cease therapy. We found that pre-chemotherapy serum albumin level was significantly associated with completion of chemotherapy (P=0.043), and there was no significant relationship of BW, BMI, serum total protein, hemoglobin, and TLC with compliance of chemotherapy.
Conclusion:
Our study results suggest that patients with a low serum albumin level are highly susceptible to discontinuation of chemotherapy. Thus, serum albumin concentration could be used as a predictor of successful completion of chemotherapy before starting treatment.

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Evaluation on the Time to Start Parenteral Nutrition in Hospitalized Cancer Patients: Nam Hyo Kim, Hyo Jung Park, Yong Won In, Young Mee Lee; J Clin Nutr 2017;9(1):30-35. Published online June 30, 2017; DOI: https://doi.org/10.15747/jcn.2017.9.1.30

Abstract PDF ePub: Purpose:
Malnutrition is quite prevalent in hospitalized cancer patients, with a 40%∼80% rate. Malnutrition in cancer patients can result in an increase in the number of complications, length of stay, mortality, and morbidity. Therefore, cancer patients with malnutrition must have the appropriate nutritional support to improve the prognosis of cancer. This study evaluated the appropriate time point to start parenteral nutrition (PN) after admission according to the nutrition support guidance in Samsung Medical Center.
Methods:
This study enrolled patients diagnosed with the Korean standard classification of disease 6 (KCD6) code C00-C97 and discharged from March 1st to 31st, 2016. The following data were collected: patients’ age, gender, diagnosis, length of stay, body mass index, nutritional status, and whether to consult nutrition support team (NST).
Results:
Among a total of 2,944 patients, 381 patients (12.9%) were in a malnourished status upon admission. In the malnourished patients, 139 patients were prescribed PN for a median of 6 days (range, 1∼49) and moderate to severe malnourished patients were started on PN within 2 days after admission. The proportion of patients with a poor nutritional status was lower in the NST group than in the non-NST group (50.0% vs. 66.7%) on the 28th day after admission. Among the nourished patients, 229 patients were prescribed PN. Of them, 183 patients (79.9%) were started on PN within 7 days after admission.
Conclusion:
In moderate to severe malnourished cancer patients, the initiation of PN on the day after admission is appropriate.