scholarly journals Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3349
Author(s):  
Irene Deftereos ◽  
Justin M. C. Yeung ◽  
Janan Arslan ◽  
Vanessa M. Carter ◽  
Elizabeth Isenring ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Regression Coefficient ◽  
Point Prevalence ◽  
Unintentional Weight Loss ◽  
Point Prevalence Study ◽  
Poor Appetite ◽  
Preoperative Nutrition ◽  
Nutrition Impact Symptoms ◽  
Upper Gastrointestinal

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.

scholarly journals Preoperative Nutrition Intervention in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3205
Author(s):  
Irene Deftereos ◽  
Justin M.-C. Yeung ◽  
Janan Arslan ◽  
Vanessa M. Carter ◽  
Elizabeth Isenring ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutrition Intervention ◽  
Nutrition Support ◽  
Preoperative Weight Loss ◽  
Percentage Weight Loss ◽  
Point Prevalence Study ◽  
Preoperative Nutrition ◽  
Percentage Weight ◽  
Preoperative Weight ◽  
Upper Gastrointestinal

Background: Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated. Methods: The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded. Results: Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries (p < 0.001 and p = 0.029, respectively). Neoadjuvant therapy (p = 0.003) and malnutrition (p = 0.046) remained independently associated with receiving dietetics intervention; however, 31.3% of malnourished patients had not seen a dietitian. Patients who received ≥3 dietetics appointments had lower mean (SD) percentage weight loss at the 1-month preoperative timeframe compared with patients who received 0–2 appointments (1.2 (2.0) vs. 3.1 (3.3), p = 0.001). Patients who received ONS for >2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), p = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, p = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient −7.3, 95% CI −14.3, −0.3, p = 0.04). Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support.

scholarly journals Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer–Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2564 ◽  
Author(s):  
Maria Wobith ◽  
Lena Wehle ◽  
Delia Haberzettl ◽  
Ali Acikgöz ◽  
Arved Weimann
Keyword(s):  
Weight Loss ◽  
Clinical Outcome ◽  
Enteral Nutrition ◽  
Nutritional Status ◽  
Biliary Cancer ◽  
Postoperative Course ◽  
Catheter Jejunostomy ◽  
Upper Gastrointestinal ◽  
Late Postoperative Period

The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4–6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.

PS02.179: NUTRITIONAL STATUS DIFFERENCES BETWEEN YOUNG AND ELDERLY PATIENTS UNDERGOING SURGERY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 172-173
Author(s):  
Irene Lidoriki ◽  
Dimitrios Schizas ◽  
Efstratia Mpaili ◽  
Adamantios Michalinos ◽  
Maria Mpoura ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Older Patients ◽  
Laboratory Tests ◽  
Handgrip Strength ◽  
Gastroesophageal Junction ◽  
Anthropometric Measurements ◽  
Unintentional Weight Loss ◽  
Gastroesophageal Junction Cancer

Abstract Background Esophageal cancer patients often suffer from malnutrition. Older people constitute a group of patients more susceptible to nutritional status deterioration. The aim of this study is to investigate the differences in nutritional status between elderly patients and patients younger than 65 years of age with esophageal and gastroesophageal junction cancer. Methods The study sample consisted of 73 patients with esophageal (n = 11) and gastroesophageal junction cancer (n = 62) who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and December 2017. Patients were divided into 2 groups according to their age, those younger than 65 years (n = 39) and those older than 65 years (n = 34). The preoperative assessment of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), laboratory tests, anthropometric measurements, handgrip strength, unintentional weight loss during the last six months and Skeletal Muscle Index (SMI) derived from analysis of CT scans. Results Malnutrition and sarcopenia were more prevalent in the group of older patients compared to the group of younger ones (73.5% vs 41%, P < 0.05 and 60% vs 35.3%, P < 0.05). PG-SGA was significantly higher in elderly patients (12.35 vs 8.23, P < 0.05), while SMI and handgrip strength were significantly lower in elderly patients (48.47 cm2/m2 vs 55.5 cm2/m2, P < 0.05 and 31 kg vs 39.1 kg, P < 0.05 respectively). Among the laboratory tests, albumin, hemoglobin and hematocrit were lower in the group of older patients (3.86 g/dL vs 4.15 g/dL, P < 0.05, 12.25 g/dL vs 13.17 g/dL, P < 0.05 and 36.5 vs 39.5, P < 0.05, respectively), whereas platelet-to-lymphocyte ratio was higher (205.4 vs 156.2, P < 0.05). Concerning anthropometric measurements, corrected mid arm muscle area and calf circumference were lower in older patients (42.15 cm2 vs 49.26 cm2, P < 0.05 and 34.86 cm vs 36.89 cm, P < 0.05, respectively), whereas no significant differences were observed in Body Mass Index values and unintentional weight loss between the two groups. Conclusion Geriatric patients with esophageal and gastroesophageal junction cancer have more compromised nutritional status compared to their younger counterparts. Preoperative nutritional assessment should be performed in all such patients in order to detect those who will benefit from perioperative nutritional support. Disclosure All authors have declared no conflicts of interest.

Nutritional status of patients undergoing upper gastrointestinal cancer surgery: A cross-sectional study at a single centre

2021 ◽  
Vol 148 (12) ◽  
pp. 158-164
Author(s):  
Tran Hieu Hoc ◽  
Nguyen Duy Hieu ◽  
Pham Van Phu ◽  
Tran Thu Huong ◽  
Tran Que Son
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Gastrointestinal Cancer ◽  
Daily Intake ◽  
Cancer Surgery ◽  
Energy Deficit ◽  
Cross Sectional ◽  
Upper Gastrointestinal Cancer ◽  
Digestive Cancers ◽  
Upper Gastrointestinal

Malnutrition is closely related to the outcome of disease treatment, especially in digestive cancer surgery. The aim of this study was to assess the nutritional condition of pre-operative patients with upper digestive cancers (including stomach and oesophagus) at the Department of General Surgery, Bach Mai Hospital in 2016. We conducted a cross-sectional descriptive analysis of 76 malignancies of the upper gastrointestinal tract with surgical treatments. The results revealed that the weight loss rate of hospitalized patients with gastric cancer and esophageal cancer was 76.6% and 66.7%, respectively. The rate of weight loss above 10% of body weight was 19.7%. The prevalence of chronic energy deficit was 29.9%. The risk of malnutrition according to SGA was 77.6%, of which mild to moderate and severe was 67.2% and 10.4%, respectively. The rate of low blood albumin level (less than 35 g/L) was 36.5%. The average net nutritional value was 1146.3 ± 592.7 Kcal (range 246.7 – 3653.5), which equals to 55.7% of the necessary daily intake. Protein, lipid, and glucid contents reached 73.4%, 57.8%, and 52.1% of the recommended levels, respectively. Conclusion: malnutrition was still prevalent among patients undergoing upper gastrointestinal cancer surgery, and pre-operative nutritional status does not achieve recommended levels.

scholarly journals The Role of the Small Bowel in Unintentional Weight Loss after Treatment of Upper Gastrointestinal Cancers

2019 ◽  
Vol 8 (7) ◽  
pp. 942 ◽  
Author(s):  
Dehestani ◽  
le Roux
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Small Bowel ◽  
Cancer Cachexia ◽  
Treatment Modalities ◽  
Unintentional Weight Loss ◽  
Upper Gi ◽  
Gi Cancers ◽  
Upper Gastrointestinal

Upper gastrointestinal (GI) cancers are responsible for significant mortality and morbidity worldwide. To date, most of the studies focused on the treatments’ efficacy and post-treatment survival rate. As treatments improve, more patients survive long term, and thus the accompanying complications including unintentional weight loss are becoming more important. Unintentional weight loss is defined as >5% of body weight loss within 6–12 months. Malignancies, particularly GI cancers, are diagnosed in approximately 25% of patients who present with unintentional weight loss. Whereas some recent studies discuss pathophysiological mechanisms and new promising therapies of cancer cachexia, there is a lack of studies regarding the underlying mechanism of unintentional weight loss in patients who are tumor free and where cancer cachexia has been excluded. The small bowel is a central hub in metabolic regulation, energy homeostasis, and body weight control throughout the microbiota-gut-brain axis. In this narrative review article, the authors discussed the impacts of upper GI cancers’ treatment modalities on the small bowel which may lead to unintentional weight loss and some new promising therapeutic agents to treat unintentional weight loss in long term survivors after upper GI operations with curative intent.

scholarly journals Nutritional Outcomes of patients Undergoing Resection for upper gastroIntestinal cancer in AuStralian Hospitals (NOURISH): protocol for a multicentre point prevalence study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035824 ◽  
Author(s):  
Irene Deftereos ◽  
Justin M C Yeung ◽  
Vanessa M Carter ◽  
Elizabeth Isenring ◽  
Nicole K Kiss
Keyword(s):  
Data Collection ◽  
Gastrointestinal Cancer ◽  
Care Pathway ◽  
Nutritional Intervention ◽  
Point Prevalence ◽  
Prevalence Study ◽  
Limited Information ◽  
Point Prevalence Study ◽  
Upper Gastrointestinal Cancer ◽  
Upper Gastrointestinal

IntroductionNutritional intervention and prevention of malnutrition is significantly important for patients with upper gastrointestinal oesophageal, pancreatic and gastric cancer. However, there is limited information regarding nutritional status, and perioperative nutritional interventions that patients receive when undergoing curative surgery.Methods and analysisPatients diagnosed with upper gastrointestinal cancer, planned for curative intent resection across 27 Australian hospitals will be eligible to participate in this point prevalence study. The primary aim is to determine the prevalence of malnutrition in patients with upper gastrointestinal cancer at the time of surgery using subjective global assessment. Secondary aims are to determine the type and frequency of perioperative nutritional intervention received, the prevalence of clinically important weight loss and low muscle strength, and to investigate associations between the use of an evidence-based nutrition care pathway or protocol for the nutritional management of upper gastrointestinal surgical oncology patients and malnutrition prevalence. Data collection will be completed using a purpose-built data collection tool.Ethics and disseminationEthical approval was granted in May 2019 (LNR/51107/PMCC-2019). The design and reporting of this study comply with the Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting of observational cohort studies. Findings will be published in peer-reviewed scholarly journals and presented at relevant conferences. Results will assist in defining priority areas for research to improve patient outcomes.

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