Korean J Gastroenterol.  2013 Apr;61(4):186-190. 10.4166/kjg.2013.61.4.186.

Nutritional Assessment and Perioperative Nutritional Support in Gastric Cancer Patients

• Seo KW
• Yoon KY

• KMID: 1775756
• DOI: http://doi.org/10.4166/kjg.2013.61.4.186

Abstract

Weight loss and malnutrition are common in cancer patients. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and required for the multidisciplinary approach. Subjective global assessment (SGA) is made by the patients nutritional symptoms and weight loss. The objective assessment, a significant weight loss (>10%) for 6 months is considered an indicator of nutritional deficiency. The mean body index, body fat mass and body protein mass are decreased as cancer stage increases. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count are decreased in advanced cancer stage. Daily energy intake, cabohyderate and Vit B1 intake is decreased according to cancer stage. The patients are divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss%, 6 month weight loss%, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake protein and energy malnutrition. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase in stomach cancer associated morbidity and mortality. The authors concluded that nutritional assessment should be done in cancer patients preoperatively, and with adequate nutritional support, the morbidity and mortality would be decreased.

Keyword

Nutritional assessment; Stomach neoplasms; Perioperative nutritional support

MeSH Terms

Humans
Neoplasm Staging
*Nutrition Assessment
Nutritional Status
*Nutritional Support
Postoperative Complications
Preoperative Care
Stomach Neoplasms/mortality/*pathology/surgery
Weight Loss

Reference

References

1. Sheean PM, Peterson SJ, Chen Y, Liu D, Lateef O, Braunschweig CA. Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU). Clin Nutr. 2013. [Epub ahead of print].

2. Middleton MH, Nazarenko G, Nivison-Smith I, Smerdely P. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals. Intern Med J. 2001; 31:455–461.

3. Chima CS, Barco K, Dewitt ML, Maeda M, Teran JC, Mullen KD. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. J Am Diet Assoc. 1997; 97:975–978.

4. Thorsdóttir I, Eriksen B, Eysteinsdóttir S. Nutritional status at submission for dietetic services and screening for malnutrition at admission to hospital. Clin Nutr. 1999; 18:15–21.

5. Bozzetti F, Gianotti L, Braga M, Di Carlo V, Mariani L. Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr. 2007; 26:698–709.

6. Jung KW, Park S, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat. 2011; 43:1–11.

7. Bae JM, Park JW, Yang HK, Kim JP. Nutritional status of gastric cancer patients after total gastrectomy. World J Surg. 1998; 22:254–260.

8. Yu W, Chung HY. Nutritional status after curative surgery in patients with gastric cancer: comparison of total versus subtotal gastrectomy. J Korean Surg Soc. 2001; 60:297–301.

9. Li QD, Li H, Li FJ, et al. Nutrition deficiency increases the risk of stomach cancer mortality. BMC Cancer. 2012; 12:315.

10. Nitenberg G, Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol. 2000; 34:137–168.

11. Ottery FD. Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition. 1996; 12(1 Suppl):S15–S19.

12. Bistrian BR, Blackburn GL, Hallowell E, Heddle R. Protein status of general surgical patients. JAMA. 1974; 230:858–860.

13. Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition. 1997; 13:878–881.

14. Song DY, Park JE, Shim JE, Lee JE. Trends in the major dish groups and food groups contributing to sodium intake in the Korea National Health and Nutrition Examination Survey 1998–2010. Korean J Nutr. 2013; 46:72–85.

15. Son SH, Lee HJ, Park K, Ha TY, Seo JS. Nutritional evaluation and its relation to the risk of metabolic syndrome according to the consumption of cooked rice and cooked rice with multi-grains in korean adults: based on 2007–2008 Korean National Health and Nutrition Examination Survey. Korean J Community Nutr. 2013; 18:77–87.

16. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987; 11:8–13.

17. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990; 15:458–482.

18. Brown JK, Byers T, Doyle C, et al. American Cancer Society. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2003; 53:268–291.

19. Rose G, Blackburn H, Keys A, et al. Colon cancer and blood- cholesterol. Lancet. 1974; 1(7850):181–183.

20. Herbey II, Ivankova NV, Katkoori VR, Mamaeva OA. Colorectal cancer and hypercholesterolemia: review of current research. Exp Oncol. 2005; 27:166–178.

21. de Boussac H, Pommier AJ, Dufour J, et al. LXR, prostate cancer and cholesterol: the good, the bad and the ugly. Am J Cancer Res. 2013; 3:58–69.

22. Flaim E, Williford WO, Mullen JL, Buzby GP, Crosby LO. The relationship of serum cholesterol and vitamin A in hospitalized patients with and without cancer. Am J Clin Nutr. 1986; 44:370–378.

23. Kirkil C, Bulbuller N, Aygen E, et al. The effect of preoperative nutritional supports on patients with gastrointestinal cancer: prospective randomized study. Hepatogastroenterology. 2012; 59:86–89.

24. Christensen KS, Gstundtner KM. Hospital-wide screening improves basis for nutrition intervention. J Am Diet Assoc. 1985; 85:704–706.

25. Harvey KB, Bothe A Jr, Blackburn GL. Nutritional assessment and patient outcome during oncological therapy. Cancer. 1979; 43(5 Suppl):2065–2069.

26. Velanovich V. The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis. Surgery. 1991; 109:236–243.

27. Studley HO. Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. 1936. Nutr Hosp. 2001; 16:141–143.

28. Smale BF, Mullen JL, Buzby GP, Rosato EF. The efficacy of nutritional assessment and support in cancer surgery. Cancer. 1981; 47:2375–2381.

29. Müller JM, Brenner U, Dienst C, Pichlmaier H. Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet. 1982; 1:68–71.