Annals of Clinical Nutrition and Metabolism

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.

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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.

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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.

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Long-Term Changes of Body Mass Index and Nutritional Biochemical Markers in the Obese Elderly with Gastric Cancer: Eunjung Kim, Ji-Hyeon Park, Eun-Mi Seol, Seong-Ho Kong, Do Joong Park, Han-Kwang Yang, Hyuk-Joon Lee; Ann Clin Nutr Metab 2021;13(2):52-61. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.52

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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.

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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.

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