Annals of Clinical Nutrition and Metabolism

Original Articles

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 ePub: 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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Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial: Eun-Mi Seol, Kye Sook Kwon, Jeong Goo Kim, Jung-Tae Kim, Jihoon Kim, Sun-Mi Moon, Do Joong Park, Jung Hyun Park, Je Hoon Park, Ji Young Park, Jung-Min Bae, Seung Wan Ryu, Ji-Young Sul, Dong Woo Shin, Cheung Soo Shin, Byung Kyu Ahn, Soo Min Ahn, Hee Chul Yu, Gil Jae Lee, Sanghoon Lee, A Ran Lee, Jae Young Jang, Hyun Jeong Jeon, Sung Min Jung, Sung-Sik Han, Suk-Kyung Hong, Sun-Hwi Hwang, Yunhee Choi, Hyuk-Joon Lee; J Clin Nutr 2019;11(1):12-22. Published online June 30, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.1.12

Abstract PDF ePub: Purpose:
Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking.
Methods:
Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected.
Results:
A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m². The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay.
Conclusion:
NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

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