Annals of Clinical Nutrition and Metabolism

Review

Effectiveness of perioperative rehabilitation and nutrition in esophageal cancer: a narrative review: Ryoma Haneda, Yuki Sakai, Kenichi Sekimori, Tomohiro Murakami, Eisuke Booka, Tomohiro Matsumoto, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Hiroya Takeuchi; Ann Clin Nutr Metab 2026;18(1):18-26. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.25.0021

Abstract PDF: Purpose
Esophageal cancer surgery requires robust perioperative management to reduce its high rate of complications. This review evaluates the clinical utility of comprehensive exercise and nutritional therapy, with a specific focus on initiatives led by the multidisciplinary Hamamatsu Perioperative Care Team (HOPE), established at Hamamatsu University Hospital to optimize patient safety and postoperative recovery outcomes.
Current concept
The HOPE protocol involves a diverse team, including surgeons, nurses, pharmacists, and dietitians, who collaboratively implement a multifaceted perioperative care bundle. These interventions include strict smoking cessation, intensive oral care, and immunonutrition incorporating n-3 fatty acids. A distinctive feature of this program is the integration of patient-reported treatment diaries and wearable fitness tracking devices (WFTs) to visualize daily activity, thereby helping to sustain patient motivation. Preoperative rehabilitation focuses on preventing sarcopenia through combined aerobic and resistance training, while postoperative care emphasizes immediate enteral nutrition and early mobilization. Retrospective analyses demonstrated that HOPE implementation reduced Clavien-Dindo grade III or higher infectious complications, pneumonia and surgical site infections, compared with historical controls. In addition, a propensity score–matched analysis showed that WFT users experienced lower pneumonia rates, shorter hospital stays, and better preservation of nutritional markers, including albumin and transthyretin, during the recovery phase compared with non-users.
Conclusion
The HOPE strategy illustrates that combining standard nutritional support and exercise therapy with digital tools enables individualized rehabilitation. This integrated approach reduces morbidity and preserves function, strongly suggesting that incorporation of wearable technology into established surgical care protocols represents a strategy for improving long-term outcomes in high-risk cancer patients.

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Original Article

Insulinotropic action of L-carnitine and branched-chain amino acids following energy intake in healthy, young Japanese women: a non-randomized controlled trial: Yoichi Sakurai, Hideyuki Namba, Satoshi Odo; Ann Clin Nutr Metab 2025;17(2):139-148. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0011

Abstract PDF: Purpose
The present study uses healthy human volunteers to examine the insulinotropic action of L-carnitine and branched-chain amino acids (BCAAs) after energy intake.
Methods
A total of 39 young, healthy human volunteers were assigned to receive oral doses of either L-carnitine alone (L group, n=10) or L-carnitine combined with a single or long-term continuous dose of BCAAs. Controls (C group, n=16) received none of these. L-carnitine was administered orally at 1,000 mg/d for 14 days, and BCAA was administered orally either once just before exercise (L+SB group, n=6), or every day for 14 days (L+CB group, n=7) until 2 days before the experiment. After overnight fasting, 200 kcal of glucose and oral nutritional supplement were administered to prevent hypoglycemia. Blood glucose, free-fatty acid, and serum insulin levels were measured to examine the insulinotropic action before and after exercise.
Results
Blood glucose and serum insulin levels in the L group were significantly lower than those in the C group. While the serum insulin levels were higher after energy administration than those in the fasting state in all groups, these were significantly higher in the L+SB group and in the L+CB group compared with those in the L group. The insulinotropic action after energy intake remained even after the repeated administration of BCAA discontinued 2 days before the experi¬ment and even after serum BCAA levels remained the same.
Conclusion
While the insulinotropic action appeared after a single dose of BCAA, it was also potentiated by long-term repeated oral administration of BCAA.

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