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The incidence of malnutrition in surgical patients is high and affects the clinical outcome of patients. Through the extraction and analysis of image data, radiomics can assess changes in the composition of the body, such as skeletal muscle and fat, and it demonstrates tremendous potential in nutritional screening, assessment, diagnosis, and evaluation of treatment effects, emerging as a crucial evaluation tool in nutritional therapy for surgical patients. Furthermore, radiomics can predict patients' clinical outcomes, providing more precise treatment plans. Therefore, the application of radiomics should be fully emphasized in nutritional therapy for surgical patients to promote their enhanced recovery. With the continuous development and improvement of radiomics technology in the future, its application in nutritional therapy for surgical patients is expected to become more extensive and profound, bringing better treatment outcomes and quality of life to patients.
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Surgery is the main approach for treating surgical diseases, but it can bring traumatic stress to the body, causing metabolic changes and nutritional deficiencies. In addition to the primary surgical disease, the underlying health condition can also have an impact, and thus, at different stages, including preoperative, intraoperative, postoperative, and post-discharge, surgical patients often experience varying degrees of metabolic changes and malnutrition. These metabolic changes and nutritional deficiencies at any stage can mutually influence each other, ultimately reducing the therapeutic effect of surgical treatment and affecting both short-term and long-term clinical outcomes. The concept and techniques of nutritional therapy have undergone rapid deve-lopment in recent decades, greatly improving the success rate of disease treatment. It is recommen-ded to promote the application of whole-course nutritional management in surgery, which integrates nutritional screening, assessment, and intervention throughout the entire process of preoperative, intraoperative, postoperative, and post-discharge care during the disease treatment and recovery process. This approach can maximize the therapeutic benefits of nutritional therapy, accelerate postoperative recovery, and improve patient′s prognosis. Based on clinical practices and literatures, the author explores the importance and necessity, primary tasks, key measures, and final guarantees of whole-course nutritional management.
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Objective:To investigate the influence of nutritional therapy on short-term efficacy of gastric cancer patients with malnutrition after radical gastrectomy.Methods:The prospec-tive randomized control study was conducted. The clinicopathological data of patients with malnutri-tion after radical resection of gastric cancer who were admitted to the Zhongshan Hospital of Fudan University from December 2020 to December 2022 were selected. Based on random number table, all patients were allocated into the nutritional therapy group and the control group. Patients in the nutritional therapy group were given dietary guidance and daily oral nutrition supplements for 90 days after discharge, while patients in the control group were only given the same dietary guidance. Observation indicators: (1) grouping situations of the enrolled patients; (2) follow-up; (3) comparison of nutritional indicators at 90 days after discharge; (4) comparison of inflammation and physical function indicators at 90 days after discharge; (5) comparison of clinical outcome indicators at 90 days after discharge. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(IQR), and non-parameter rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Comparison of ordinal data was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 187 patients were selected for eligibility. There were 131 males and 56 females, aged (65±12)years. Of the 187 patients, there were 95 patients in the nutritional therapy group and 92 patients in the control group, respectively. The gender (male, female), age, cases with cardiovascular complications, cases with respiratory complications, cases with diabetes, surgical methods (partial gastrectomy, total gastrectomy), tumor staging (Ⅰ stage, Ⅱ stage, Ⅲ stage), body mass, body mass index (BMI), skeletal muscle index, albumin (Alb), hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR), 6-minutes walking distance, grip strength were 68, 27, (64±12)years, 21, 4, 7, 59, 36, 17, 27, 51, (59±11)kg, (21.5±3.1)kg/m 2, (42±7)cm 2/m 2, (39±5)g/L, (112±25)g/L, 2.3(8.0), (456±97)m, (29±8)kg in patients of the nutritional therapy group, versus 63, 29, (66±13)years, 22, 3, 9, 56, 36, 14, 24, 54, (58±11)kg, (21.1±2.9)kg/m 2, (42±7)cm 2/m 2, (39±4)g/L, (111±26)g/L, 2.2(8.4), (459±98)m, (29±8)kg in patients of the control group, showing no significant difference in the above indicators between the two groups ( χ2=0.21, t=-1.29, χ2=0.09, 0, 0.35, 0.03, 0.51, t=0.80, 0.85, 0.19, 0.14, 0.16, Z=-0.28, t=-0.17, 0.43, P>0.05). (2) Follow-up. All 187 patients were followed up for 90 days after surgery. During the follow-up period, all patients had good compliance and were able to follow the dietary guidance. Five patients in the nutrition therapy group experienced diarrhea and nausea adverse reactions, which were relieved after symptomatic treatment. No adverse reactions were found in the control group. (3) Comparison of nutritional indicators at 90 days after discharge. The body mass, body mass loss, BMI, skeletal muscle index, Alb, Hb were (58±10)kg, 2(6)kg, (21.0±2.9)kg/m 2, (41±7)cm 2/m 2, (41±4)g/L, (125±18)g/L in patients of the nutritional therapy group, versus (56±10)kg, 3(6)kg, (20.4±2.7)kg/m 2, (39±7)cm 2/m 2, (41±4)g/L, (121±21)g/L in patients of the control group. There were significant differences in body mass loss and skeletal muscle index between the two groups ( Z=-4.70, t=2.39, P<0.05), and there was no significant difference in body mass, BMI, Alb, and Hb ( t=1.30, 1.51, 0.80, 1.32, P>0.05). (4) Comparison of inflammation and body function indicators at 90 days after discharge. The NLR, 6-minutes walking distance, grip strength were 2.1(5.1), (478±99)m, and (33±9)kg in patients of the nutritional therapy group, versus 2.2(5.7), (465±96)m, (30±8)kg in patients of the control group. There was a significant difference in grip strength between the two groups ( t=2.08, P<0.05), and there were no significant difference in NLR and 6-minutes walking distance ( Z=-1.28, t=0.91, P>0.05). (5) Comparison of clinical outcome indicators at 90 days after discharge. The quality of life score and readmission rate were (79±14)points, 4.2%(4/95) in patients of the nutritional therapy group, versus (78±16)points, 6.5%(6/92) in patients of the control group, showing no significant difference in the above indicators between the two groups ( t=0.58, χ2=0.14, P>0.05). Conclusion:Nutritional therapy with daily oral nutrition supplements can improve the short-term nutritional status and body function of patients with malnutrition after radical gastrectomy for gastric cancer.
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Malnutrition is closely related to clinical outcomes and accurate evaluation of nutritional status is the cornerstone of nutritional therapy. However, consistent diagnostic criteria for malnutrition have been absent for quite a long period. The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced in September 2018 and served as a consensus-based evaluation tool. As per GLIM criteria, evaluation of malnutrition should follow a two-step approach with nutritional screening as the first step and then malnutrition diagnosis assessment and severity grading based on etiologic as well as phenotypic metrics. Since debut, GLIM criteria have been applied in different countries, healthcare settings and populations, showing good accuracy and prognostic value for outcomes such as complications and survival. However, most of the studies are retrospective in nature and high-quality prospective studies are needed to better validate GLIM criteria. The way to steer nutritional interventions based on GLIM criteria is also worth future investigation.
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Malnutrition and dehydration are prevalent in the elderly poplulation, and obesity is also a growing problem, which pose a serious challenge to the nutritional management in geriatrics. In order to better guide clinical practice, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the practical guideline on clinical nutrition and hydration in geria-trics on March 5, 2022. This guideline provides 82 recommendations on clinical nutrition and hydration in geriatrics based on clinical practicability, covering basic problems and general prin-ciples, prevention and treatment of malnutrition/nutri-tional risk, prevention and treatment of specific diseases, as well as prevention and treatment of obesity, along with flow-charts, hoping to be convenient for doctors, nutritionists and nurses to use in clinical practice.
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Objective:To study the genetic profile of neonatal hyperbilirubinemia with unknown etiology in Guangdong Province and the clinical significance of jaundice-related genetic screening.Methods:From July to September, 2021, neonates with hyperbilirubinemia of unknown etiology born in different hospitals in Guangdong Province were studied. 24 neonatal jaundice-related exons were sequenced using targeted capture and high-throughput sequencing technology. The pathogenic variants were analyzed.Results:A total of 331 cases, 139 (42.0%) cases showed positive screening results with five diseases, including 65 (19.6%) cases of Gilbert syndrome, 48 (14.5%) cases of glucose-6-phosphate dehydrogenase (G6PD) deficiency,18 (5.4%) cases of sodium taurocholate cotransporting polypeptide deficiency, 4 (1.2%) cases of Citrin deficiency and 4 (1.2%) cases of Dubin-Johnson syndrome. 149 (45.0%) cases carried one or more genetic variants and 43 (13.0%) cases showed no clinically significant variants. The 8 high-frequency mutation loci (carrier rate >1%) are UGT1A1 gene c.211G>A and c.1091C>T, G6PD gene c.1466G>T and c.1478G>A, SLC10A1 gene c.800C>T, SLC25A13 gene c.852_855del TATG, HBB gene c.126_129delCTTT and c.316-197C>T.Conclusions:Genetic factors are important for neonatal hyperbilirubinemia with unknown etiology in Guangdong. The common pathogenic genes are UGT1A1, G6PD, SLC10A1, and SLC25A13 and the population carries high-frequency mutation loci. Therefore, genetic screening in neonates with hyperbilirubinemia of unknown etiology has important clinical significance.
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The American Society for Parenteral and Enteral Nutrition (ASPEN) held the annual academic conference online from March 20 to 23,2021. The current hot topics of clinical nutrition were widely discussed on the conference. The authors briefly report and analyze the hot topics of the conference in order to share and exchange with surgical colleagues.
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Skeletal muscle is the largest tissue as well as organ of human body. It is also the major form of lean mass and proteins. Loss of skeletal muscle will reduce the tolerance of illness and trauma, negatively affect clinical treatments, increase the incidence of complications and lead to decreasing of quality of life and increasing of mortality, which will affect the prognosis. Due to the factors such as the underlying disease and surgical trauma, patients undergoing surgeries face a high risk of skeletal muscle loss. However, not enough attention has been paid to the prevention and treatment of skeletal muscle loss. Based on the latest researches and his own clinical and research experience, the author discusses the epidemiologic feature of skeletal muscle loss in surgical candi-dates, and the impacts of skeletal muscle loss on prognosis, its detecting methods as well as preven-tion and treatment strategies, in order to raise the awareness of prevention and treatment of skeletal muscle in surgical patients.
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The European Society for Clinical Nutrition and Metabolism held the 43 rd annual academic conference online from September 9 to 14,2021. Based on reports from the con-ference, the authors launched a review on the current hot topics in clinical nutrition.
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Cancer cachexia is a complex metabolic syndrome characterized by muscle wasting, fat decomposition, unplanned weight loss, anorexia and immune dysfunction. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity on cancer patients. It increases the symptom burden in patients, affects the quality of their life, ultimately shortens patients' survival. Lucubrating the pathogenesis of cachexia is of great significance to provide rationale treatment guidance. Here we reviewed the research progress on pathogenesis of cancer cachexia, including inflammatory response mediated by TNF-α, IL-1, IL-6 and STAT-3 and abnormal nutrition metabolism, as well as mitochondrial dysfunction.
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The European Society for Clinical Nutrition and Metabolism (ESPEN) online released the latest practical guideline on clinical nutrition in cancer on 15th March, 2021. The new practical guideline is shortened from the ESPEN guideline on nutrition in cancer patients in 2017 for easier use in clinical practice and provides 43 recommendations (without changes compared with the previous guidelines), combined with the diagnosis and treatment flow diagram, on general principles of nutritional therapy for cancer patients and individualized nutritional therapy strategies. Therefore, this new practical guideline is a practical tool for all professionals including physicians, dieticians, nutritionists and nurses in clinical practices.
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Objective:To investigate the clinical features of preoperative gastric cancer cachexia patients, with the focus on changes of abdominal fat distribution and serum inflammatory factors.Methods:128 gastric cancer patients admitted to General Surgery Department of Zhongshan Hospital, Fudan University from January 2018 to December 2018 were included. Relevant clinical information was collected, including age, gender, height, weight, hematological test results and blood lipid profiles (including free fatty acids ,FFA). Concurrent serum IL-6 and TNF-α levels were examined using enzyme-linked immunosorbent assay. Areas of subcutaneous and visceral fat were both measured at umbilical level on CT. Data mentioned above were compared between gastric cancer patients with cachexia and pre-cachexia.Results:The 128 patients were divided into stable pre-cachexia group (97 patients) and cachexia group (31 patients). Compared with pre-cachexia group, patients in the cachexia group showed significant decline in BMIs (23.4±0.3 vs 21.9±0.6, t=2.359, P=0.019), apparent elevation in serum IL-6 levels [(3.73±0.32) ng/L vs(5.26±0.77) ng/L, t=2.214, P=0.036], significant decrease in lymphocyte counts [(1.67±0.05)×10 9/L vs (1.42±0.12)×10 9/L, t=2.251, P=0.026], as well as predominant decrease in total protein levels, [(64.9 ± 0.8) g/L vs (61.5±1.1) g/L, t=2.208, P=0.029], total cholesterol levels [(4.09±0.09) mmol/L vs (3.74±0.15) mmol/L, t=2.393, P=0.046] and pre-albumin levels [(0.22±0.01) g/L vs (0.19±0.01) g/L, t=1.987, P=0.049]. Additionally, there was a noticeable decrease in subcutaneous fat area [(151.6±8.73) cm 2vs (112.4±15.9) cm 2, t=2.192, P=0.042]. The other markers displayed no remarkable differences. Conclusion:Based on our investigation, it's highly suspected that IL-6 plays a more important role than TNF-α in the fat loss of gastric cancer cachexia patients, and these patients have increased lipid catabolism predominated by subcutaneous fat loss.
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Postoperative ileus (POI), one of the most common postoperative complications, impacts digestive function through neural reflex and intestine inflammation, and severely influences the therapeutic effect as well as the long-term outcome of the patients. As a major component of comprehensive peri-operative therapies, nutrition support treatment provides necessary daily energy and nutrient support for the patients, effectively prevents POI and promotes digestive motility. Therefore, the authors further elaborate on nutrition support treatment for postoperative ileus based on the latest research worldwide.
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Objective To investigate the effect of oral nutritional supplements (ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. ResultsThe body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge. (2 months after discharge: 1. 65±2. 11vs. 2. 70±1. 90 kg, t = -2. 3853, P = 0. 0193; 3 months after discharge: 1. 95±2. 75vs. 3. 67±2. 29 kg, t = -3. 1347, P = 0. 0024), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score (56. 82±13. 65％vs. 51. 71± 9. 72％, t = 2. 0148, P = 0. 0472) and QOL score (41. 91±6. 92 vs. 38. 39±8. 77, t = 2. 0597, P = 0. 0426) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Objective To establish a quality control model ensuring good stability and compatibility of manually compounded total nutrient admixtures (TNA). Methods A parenteral nutrition medication order entry system was establish for standardizing nutritional medication usage and supporting physician's TNA prescribing. TNA medication orders were reviewed by pharmacists for validating the stability and compatibility. TNAs were compounded by pharmacists in a standard way following "four factors of sterile compounding". The goal of quality control was achieved by establishment of the preliminary standard. Results The quality of manually compounded total nutrient admixtures achieved the goal since pharmacy intravenous admixture service (PIVAS) started on 2003. Conclusions The quality of TNA is well assured while manually compounded by pharmacists in PIVAS.
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Nutritional therapy is one of the most important treatment measures for surgical critically ill patients,and it is also a difficult point in clinical nutritional support practice.In recent years,nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice.Many large-scale,multi-center clinical studies have been completed worldwide.Consensus has been formed on many hot issues and relevant guidelines have been issued.Based on the latest evidence-based medicine achievements,the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years.
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Nutritional therapy is one of the most important treatment measures for surgical critically ill patients, and it is also a difficult point in clinical nutritional support practice. In recent years, nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice. Many large-scale, multi-center clinical studies have been completed worldwide. Consensus has been formed on many hot issues and relevant guidelines have been issued. Based on the latest evidence-based medicine achievements, the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years.
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Objective@#To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer.@*Methods@#All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge.@*Results@#The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients.@*Conclusion@#ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Objective@#To establish a quality control model ensuring good stability and compatibility of manually compounded total nutrient admixtures (TNA).@*Methods@#A parenteral nutrition medication order entry system was establish for standardizing nutritional medication usage and supporting physician's TNA prescribing. TNA medication orders were reviewed by pharmacists for validating the stability and compatibility. TNAs were compounded by pharmacists in a standard way following "four factors of sterile compounding" . The goal of quality control was achieved by establishment of the preliminary standard.@*Results@#The quality of manually compounded total nutrient admixtures achieved the goal since pharmacy intravenous admixture service (PIVAS) started on 2003.@*Conclusions@#The quality of TNA is well assured while manually compounded by pharmacists in PIVAS.
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Objective To evaluate the blood clearance,tissue uptake and distribution as well as safety of high dose-40 mg intravenous fish oil/'medium chain triglycerides (FO/MCT:2 ∶ 8,wt/wt) lipid emulsions iu mice by measuriug the contents of triglycerides (TG) and free fatty acids (FFA) level in blood.Methods FO/MCT emulsions were radiolabeled with nondegradable [3H] cholesteryl ether to trace core particle metabolism in C57BL/6J mice following a bolus injection.For high dose,TG was 40 mg,100 times of low dose.Blood samples were obtained within 25 min to analyze TG and FFA concentrations;extracted organs were used to measure the tissue distribution of lipid emulsions.Results No animal in either group died,and no fat overload syndrome evidence was found after high dose injection.Compared with low dose,high dose injection increased the plasma TG and FFA concentrations rapidly;the emulsions were cleared significantly slower during 25 min after administration in mice;blood has a higher uptake ratio in organs,but heart has a lower one;there was no significant difference in liver and lung uptake ratio between the two groups.Conclusions High dose injection of FO/MCT is not fatal in mice.The animals only experience hypertriglyceridemia and high level of free fatty acids during a significant slower blood clearance period compared to low dose.Although blood clearance is slower,the blood uptake rate increases for further metabolism and clearance.Heart and lung functions are not affected as a lower cardiac and pulmonary uptake;blood uptakes more emulsions to further metabolize.FO/MCT may not induce fat overload syndrome in mice when administered with a super high dose.