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Original Articles
- Incidence and risk factors of nonalcoholic fatty liver disease after pancreaticoduodenectomy in Korea: a multicenter retrospective cohort study
- Chang-Sup Lim, Hongbeom Kim, In Woong Han, Won-Gun Yun, Eunchae Go, Jaewon Lee, Kyung Chul Yoon, So Jeong Yoon, Sang Hyun Shin, Jin Seok Heo, Yong Chan Shin, Woohyun Jung
- Ann Clin Nutr Metab 2024;16(3):125-133. Published online December 1, 2024
- DOI: https://doi.org/10.15747/ACNM.2024.16.3.125
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Abstract
PDF
ePub - Purpose: This study aimed to investigate the incidence, risk factors, and clinical course of nonalcoholic fatty liver disease (NAFLD) following pancreaticoduodenectomy, focusing on the role of adjuvant chemotherapy and other metabolic changes.
Methods: A retrospective analysis was conducted on 189 patients who underwent pancreaticoduodenectomy between 2013 and 2016. NAFLD was diagnosed using computed tomography (CT) imaging, defined as a liver-to-spleen attenuation ratio <0.9. Sarcopenia and sarcopenic obesity were assessed using preoperative CT scans. Logistic regression analysis was performed to identify risk factors for NAFLD development.
Results: The cumulative incidence of NAFLD increased over time, with rates of 15.9% at one year, 20.4% at three years, and 35.2% at five years post-pancreaticoduodenectomy. Adjuvant chemotherapy was identified as the only significant independent predictor of NAFLD development (odds ratio, 2.74; 95% confidence interval, 1.16-6.70; P=0.023). No significant associations were found between NAFLD and pancreatic enzyme replacement therapy (PERT), sarcopenia, or sarcopenic obesity. Serial analysis of NAFLD status in long-term survivors revealed dynamic changes, with some patients experiencing spontaneous remission or recurrence.
Conclusion: NAFLD is a common, progressive complication following pancreaticoduodenectomy, particularly in patients receiving adjuvant chemotherapy. Although no significant associations with PERT or sarcopenia were observed, these areas warrant further investigation. Long-term monitoring and targeted management strategies are recommended to address NAFLD in this population. Future prospective studies are needed to elucidate the natural history and contributing factors of NAFLD after pancreaticoduodenectomy.
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- Determination of the Stress Factor Calculated from the Changes in the Measured Resting Energy Expenditure with Indirect Calorimetry in Patients Undergoing Pancreaticoduodenectomy
- Seon Hyeong Kim, Baik Hwan Cho, Sook Bae Kim, Mi Jin Jeong, Hee Chul Yu
- J Clin Nutr 2017;9(2):62-67. Published online December 31, 2017
- DOI: https://doi.org/10.15747/jcn.2017.9.2.62
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Abstract
PDFePub
Purpose
To predict the energy expenditure using the stress factor representing the ratio of the metabolic variation between pre-operation and post-operation in a pancreaticoduodenectomy (PD).
Methods
This was a prospective study conducted on 17 patients (11 males and 6 females) who underwent PD at Chonbuk National University Hospital between March 2010 and October 2011. The rest energy expenditure was measured by indirect calorimetry 1 day before and 3 days after surgery. The height, weight, and fat free mass were also measured 1 day before surgery.
Results
The mean measured rest energy expenditure 1 day before PD (mREEpre) and 3 days after PD (mREEpost) were significantly different (16.8±2.6 vs. 18.8±3.5 kcal/kg/d, P=0.0076). The stress factor, representing the ratio of the metabolic changes between pre- and post-PD, was 1.12±0.17. The recommended energy requirement for PD patients is estimated to be 23∼24 kcal/ideal body weight/d [determined from the measured preoperative rest energy expenditure (16.8±2.6 kcal/kg/d)×activity factor (1.2∼1.3)×stress factor (1.12)].
Conclusion
PD patients maintained a hypermetabolic status and the applicable stress factor was 1.12.
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