Annals of Clinical Nutrition and Metabolism

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.

6 View
0 Download

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.

15 View
0 Download

Refeeding Syndrome after Gastrectomy in a Patient with Hypophosphatemia: A Case Report: Cheong Ah Oh; Ann Clin Nutr Metab 2022;14(2):88-92. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.88

Abstract PDF: This study describes an 81-year-old male who was highly suspicious for refeeding syndrome (RFS) after a retrospective review of his postoperative clinical progression. This highlights the importance of clinicians’ awareness of the possibility of RFS development in surgical patients with any RFS risk factors.

7 View
0 Download

Body Compositions of Elderly and Non-Elderly Patients Following Gastrectomy for Gastric Cancer: Ji Hoon Kang, Mi Ran Jung, Sung Eun Kim, Oh Jeong; Ann Clin Nutr Metab 2022;14(2):81-87. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.81

Abstract PDF: Purpose: Radical gastric resection is the mainstay of treatment in gastric cancer. However, patients can suffer from eating restrictions, weight loss, and malnutrition after gastrectomy, to which elderly patients are more vulnerable. We compared body composition changes in elderly patients and non-elderly patients after gastrectomy.
Materials and Methods: This prospective study enrolled patients who underwent gastrectomy for gastric carcinoma between 2019 and 2021. Body composition was measured using bioelectrical impedance analysis (InBody S10) before surgery and up to 12 months after surgery. Patients were divided into an elderly group (>70 years) and a non-elderly group (≤70 years), and body composition changes were compared between the two groups using the linear mixed model.
Results: There were 69 patients in the elderly group and 164 patients in the non-elderly group. The groups showed no significant differences in gastric resection or pathologic stage. Overall, body composition, including total body water, body weight, lean body mass, skeletal muscle mass, and fat mass, decreased immediately after surgery and gradually improved until postoperative 12 months. A linear mixed model showed no significant time×group interactions for any body composition factors between groups.
Conclusion: Body composition changes did not significantly differ between elderly patients and non-elderly patients after gastrectomy.

5 View
0 Download

Development and Internal/External Validation of a Prediction Model for Weight Loss Following Gastric Cancer Surgery: A Multicenter Retrospective Study: Ji-Hyeon Park, Seong-Ho Kong, Do Joong Park, Han-Kwang Yang, Jong Won Kim, Ki Bum Park, In Cho, Sun-Hwi Hwang, Dong-Wook Kim, Su Mi Kim, Seung-Wan Ryu, Seong Chan Gong, Pil Young Jung, Hoon Ryu, Sung Geun Kim, Chang In Choi, Dae-Hwan Kim, Sung-IL Choi, Ji-Ho Park, Dong Jin Park, Gyu-Yeol Kim, Yunhee Choi, Hyuk-Joon Lee; Ann Clin Nutr Metab 2022;14(2):55-65. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.55

Abstract PDF: Purpose: To develop an individualized model for predicting the extent of unintentional weight loss following gastrectomy in patients with gastric cancer based on related risk factors and to externally validate this model using multicenter clinical data in Korea.
Materials and Methods: Among gastric cancer patients who underwent curative gastrectomy at 14 different gastric cancer centers, clinical data from patients with more than one weight measurement during the three-year follow-up period were retrospectively collected. Risk factors associated with weight loss in gastric cancer patients after gastrectomy were analyzed, and a predictive model was developed. Internal and external validation were performed.
Results: The data from 2,649 patients were divided into a derivation set (n=1,420 from Seoul National University Hospital) and validation set (n=1,229 from 13 different gastric cancers). Postoperative duration (six vs. 12, 24, or 36 months), sex (female vs. male), age, preoperative body mass index, type of surgery (pylorus-preserving vs. total, distal or proximal gastrectomy), and cancer stage (I vs. II or III) were included in the final prediction model. The model showed approximately 20% accuracy in predicting weight loss at each period: R2 at six, 12, 24 and 36 months after gastrectomy in internal validation=0.20, 0.21, 0.17, and 0.18, respectively, and in external validation=0.20, 0.22, 0.18, and 0.18, respectively. Calibration slopes of internal and external validation were 0.95 and 1.0, respectively.
Conclusion: Although predictive accuracy of the model did not reach an acceptable level, repeated external validation measurements showed high reliability. The model may serve as a basic reference in clinical practice.

9 View
0 Download

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.

9 View
0 Download

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.

11 View
0 Download

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: 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.

7 View
0 Download

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: 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.

5 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

Case Report of an Adult Patient Who Underwent a Serial Transverse Enteroplasty Procedure for Short Bowel Syndrome Following an Esophagectomy and Total Gastrectomy: Sang-Yong Son, Long-Hai Cui, Ho-Jung Shin, Hoon Hur, Sang-Uk Han; J Clin Nutr 2017;9(2):68-73. Published online December 31, 2017; DOI: https://doi.org/10.15747/jcn.2017.9.2.68

Abstract PDF: Since its introduction as an alternative intestinal lengthening technique, the serial transverse enteroplasty (STEP) procedure has been used increasingly as the surgical treatment of choice for children with short bowel syndrome (SBS). On the other hand, there are few report of its efficacy in adults with SBS, particularly those who have previously undergone a gastrectomy. This case report describes a 34-year-old woman with a short bowel after an esophagectomy and total gastrectomy due to lye ingestion followed by an extensive intestinal resection due to small bowel strangulation. The STEP procedure was performed successfully and the small intestine was lengthened from 55 to 75 cm. The patient tolerated the procedure well and was weaned off total parenteral nutrition. The frequency and characteristics of diarrhea improved, and her weight remained acceptable via management with intermittent parenteral nutritional support for 6 months postoperatively. This case suggests that the STEP procedure should be considered for gastrectomized patients with SBS.

5 View
0 Download

Postoperative Nutritional Support for Gastrectomized Patients: Han Hong Lee; Surg Metab Nutr 2016;7(2):25-28. Published online December 30, 2016; DOI: https://doi.org/10.18858/smn.2016.7.2.25

Abstract PDF: Nutritional deficiency after gastrectomy is caused by anatomical and physiologic changes in the stomach. In the case of patients with gastric cancer, nausea and loss of appetite due to cancer cachexia syndrome can affect nutritional status after gastrectomy. Prognostic nutritional index based on preoperative nutritional conditions is used for prediction of postoperative outcomes including long-term survival. Generally, enteral nutrition is more effective for post-gastrectomy conditions than parenteral nutrition. In addition, specialized enteral formulas such as immunonutrition (amino acids, ω-3 fatty acids and nucleotide) seem to have benefits for gastrectomy patients, although there is still insufficient evidence. Ghrelin is a next generation agent to stimulate appetite in patients that underwent gastrectomy.

6 View
0 Download

Search

Purpose:

Materials and Methods:

Results:

Conclusion:

Purpose:

Materials and Methods:

Results:

Conclusions:

Purpose:

Materials and Methods:

Results:

Conclusion: