Relationship between preoperative nitrogen balance and energy and protein intake in patients with esophageal cancer.

BACKGROUND & AIMS: Nitrogen balance (NB) is an important indicator of protein utilization in the body, and a positive NB is essential for maintaining and improving nutritional status. However, information is lacking on the target values of the energy and protein levels required to maintain positive NB in cancer patients. This study aimed to verify the energy and protein requirements for positive NB in preoperative esophageal cancer patients. METHODS: This study included patients for esophageal cancer surgery who were admitted for radical surgery. Urine urea nitrogen (UUN) levels were measured based on 24-h urine storage. Energy and protein intakes were calculated from the dietary intake during hospitalization and the amount administered from enteral and parenteral nutrition. The characteristics of the positive and negative NB groups were compared, and patients' characteristics related to UUN excretion were analyzed. RESULTS: Seventy-nine patients with esophageal cancer were included, and 46% of patients were negative NB. All patients with energy intake ≥30 kcal/kg/day and protein intake ≥1.3 g/kg/day had positive NB. Whereas, in the group with energy intake ≥30 kcal/kg/day and protein intake <1.3 g/kg/day, 67% of patients were positive NB. There was a significant positive relation between UUN excretion and retinol-binding protein in multiple regression analyses adjusted for several patients' characteristics (ß = 0.28, p = 0.048). CONCLUSION: In preoperative esophageal cancer patients, 30 kcal/kg/day of energy and 1.3 g/kg/day of protein were the guideline values for positive NB. Good short-term nutritional status was a factor associated with increased UUN excretion.

Effects of body composition on early postoperative discharge and postoperative complications in patients with esophageal cancer.

BACKGROUND: Patients with esophageal cancer are prone to nutrition deterioration during the perioperative period and have a high incidence of postoperative complications, prolonging hospitalization. Decreased muscle mass is a known contributor to this deterioration, but there is insufficient evidence on the effects of preoperative maintenance and improvement of muscle mass. In this study, we evaluated the relationship between body composition, early postoperative discharge, and postoperative complications in patients with esophageal cancer. METHODS: This was a retrospective cohort study. Patients were divided into an early discharge group and a control group, who were discharged ≤21 days postoperatively and >21 days, respectively. The relationship of body composition to postoperative complications and discharge time in patients was evaluated via multivariate logistic regression using isotemporal substitution (IS) models. RESULTS: The early discharge group comprised 31 of the 117 patients (26%) included. This group had significantly lower incidences of sarcopenia and postoperative complications than the control group. In logistic regression analyses estimating the effect of changes in body composition using the IS models, preoperative replacement of 1 kg of body fat with 1 kg of muscle mass was associated with significantly higher odds of early discharge (odds ratio [OR], 1.28; 95% CI, 1.03-1.59) and lower odds of postoperative complications (OR, 0.81; 95% CI, 0.66-0.98). CONCLUSION: In patients with esophageal cancer, a preoperative increase in muscle mass may reduce postoperative complications and hospital stay duration.

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients.

BACKGROUND & AIMS: Malnutrition is common in patients with esophageal cancer, which affects their prognosis. The global leadership initiative on malnutrition (GLIM) criteria was recently proposed as the world's first diagnostic criteria for malnutrition. However, the association between esophageal cancer patients and the GLIM criteria is unclear. The purpose of this study was to evaluate the percentage of patients diagnosed with malnutrition preoperatively using the GLIM criteria, assess the impact of disease-specific symptoms on the severity of malnutrition, and assess the prognostic relevance of GLIM defined malnutrition in patients with esophageal cancer. METHODS: This was a retrospective single-center cohort study. Preoperative nutritional status of patients with esophageal cancer hospitalized between June 2009 and July 2011 was evaluated according to the GLIM criteria. Factors related to severe malnutrition as per the GLIM criteria were analyzed using multivariable logistic regression analysis. The association between the severity of malnutrition based on the GLIM criteria and 5-year survival was assessed using a multivariable Cox proportional hazard model. RESULTS: Overall, 117 esophageal cancer patients were nutritionally assessed. The percentage of moderate malnutrition and severe malnutrition was 21% and 23%, respectively. Subjective dysphagia [odds ratio (OR): 7.39, 95% confidence interval (CI): 1.46-37.52] and subjective esophageal obstruction (OR: 10.49, 95% CI: 3.47-31.70) were independent risk factors for severe malnutrition. The hazard ratio (HR) for 5-year mortality tended to be higher for moderate malnutrition (HR: 2.12, 95% CI: 0.91-4.95); however, it was not significantly associated with either moderate malnutrition or severe malnutrition (HR: 1.30, 95% CI: 0.52-3.27). Cases that were censored during the follow-up period probably affected the survival results. CONCLUSION: Subjective feelings of dysphagia and esophageal obstruction might be related to malnutrition severity in esophageal cancer patients. Malnutrition assessed by the GLIM criteria was not significantly associated with 5-year survival.

Effect of Postoperative Oral Intake on Prognosis for Esophageal Cancer.

BACKGROUND: Patients undergoing surgery for esophageal cancer are at risk of prolonged hospital stay for postoperative malnutrition. Postoperative early oral feeing is a part of the "enhanced recovery after surgery protocol" for coping with this risk. However, the usefulness of early oral intake during perioperatively is questionable. METHODS: In total, 117 patients treated surgically for esophageal cancer were analyzed in the study. We assessed the oral energy sufficiency rate per nutritional requirement (oral-E/NR) at the fourth week postoperatively and classified the patients into two groups: Poor oral intake group (POI group; <25% oral-E/NR) and the control group (≥25% oral-E/NR). We analyzed the relationship among postoperative oral intake and prognoses. RESULTS: The POI group had worse postoperative nutritional status and a lower survival rate than the control group. In a multivariate analysis, <25% oral-E/NR was one of the independent factors contributing to negative outcomes postoperatively (adjusted hazard ratio: 2.70, 95% confidence interval: 1.30-5.61). CONCLUSIONS: In patients undergoing surgery for esophageal cancer, poor postoperative oral intake negatively affected not only on their postoperative nutritional status but also their overall prognosis. It is necessary to improve the adequacy of oral intake postoperatively for patients with esophageal cancer.

Preoperative Depressive Mood of Patients With Esophageal Cancer Might Delay Recovery From Operation-Related Malnutrition.

BACKGROUND: We investigated the relationship between the preoperative psychological state and the perioperative nutritional conditions of patients with esophageal cancer. METHODS: Seventy-three participants underwent operations for esophageal cancer in our hospital. Depressive state was evaluated using the Self-Rating Depression Scale (SDS). General quality of life (QOL) was assessed using the SF-8™, and the nutritional assessments were evaluated through anthropometric analysis, bioelectrical impedance analysis (BIA) and some biochemical assessments. RESULTS: In the preoperative stage, patients with higher SDS scores, representing a more depressive state, had low arm circumference, grip strength, serum albumin levels and prognostic nutritional index. Patients with higher SDS scores also had a tendency for a lower physical component summary, representing physical QOL by the Eight-Item Short Form Health Survey (SF-8™). At 3 months after surgery, patients with higher preoperative SDS scores had significantly lower body mass indexes (BMIs) and had a lower tendency of body fat masses. In the univariate and multivariate analyses on the recovery of BMI at 3 months after surgery, preoperative SDS score was the only independent risk factor (odd ratio (OR): 4.07, 95% confidence interval (CI): 1.15 - 14.35) in this study. CONCLUSION: Preoperative depressive mood, as evaluated by the SDS, was the sole relevant factor for postoperative body weight recovery of patients with esophageal cancer. Preoperative depressive mood of patients with esophageal cancer might delay recovery from operation-related malnutrition. Some measures against preoperative depressive mood might be necessary for early recovery from postoperative malnutrition in patients with esophageal cancer.

Identification and characterization of antimicrobial peptides from the skin of the endangered frog Odorrana ishikawae.

The endangered anuran species, Odorrana ishikawae, is endemic to only two small Japanese Islands, Amami and Okinawa. To assess the innate immune system in this frog, we investigated antimicrobial peptides in the skin using artificially bred animals. Nine novel antimicrobial peptides containing the C-terminal cyclic heptapeptide domain were isolated on the basis of antimicrobial activity against Escherichia coli. The peptides were members of the esculentin-1 (two peptides), esculentin-2 (one peptide), palustrin-2 (one peptide), brevinin-2 (three peptides) and nigrocin-2 (two peptides) antimicrobial peptide families. They were named esculentin-1ISa, esculentin-1ISb, esculentin-2ISa, palustrin-2ISa, brevinin-2ISa, brevinin-2ISb, brevinin-2ISc, nigrocin-2ISa and nigrocin-2ISb. Peptide primary structures suggest a close relationship with the Asian odorous frogs, Odorrana grahami and Odorrana hosii. These antimicrobial peptides possessed a broad-spectrum of growth inhibition against five microorganisms (E. coli, Staphylococcus aureus, methicillin-resistant S. aureus, Bacillus subtilis and Candida albicans). Nine different cDNAs encoding the precursor proteins were also cloned and showed that the precursor proteins exhibited a signal peptide, an N-terminal acidic spacer domain, a Lys-Arg processing site and an antimicrobial peptide at the C-terminus.