Kobayashi Kosuke, Kaneko Junichi, Yamaguchi Takamune, Kawaguchi Yoshikuni, Arita Junichi, Akamatsu Nobuhisa, Ishizawa Takeaki, Sekine Rie, Ijichi Hideaki, Kubota Naoto, Fukatsu Kazuhiko, Kokudo Norihiro, Hasegawa Kiyoshi
Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Nutrition Therapy, The University of Tokyo, Tokyo, Japan.
Gastrointest Tumors. 2019 Oct;6(3-4):81-91. doi: 10.1159/000501452. Epub 2019 Aug 29.
This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery.
Thirty-seven patients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group ( = 10) received no nutritional supplementation. The late-evening snack (LES, = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed.
Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 ( = 0.03) and 12 ( = 0.02) weeks after surgery.
Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.
本前瞻性研究基于生物电阻抗分析（BIA）测量了肝手术患者术前和术后营养支持及状况相关的身体成分。
纳入37例因肝细胞癌或结直肠癌肝转移行肝切除术且肝功能受损（15分钟吲哚菁绿潴留率>15%）的患者。对照组（n = 10）未接受营养补充。晚餐小吃（LES，n = 26）组在术前2周直至术后12周接受一份包含碳水化合物和支链氨基酸的210千卡小吃。对包括身体细胞质量和骨骼肌体积在内的身体成分进行了生物电阻抗分析。
尽管术前2周根据亚洲工作组的共识报告不存在肌肉减少症，但对照组和LES组的骨骼肌体积均处于正常范围下限。术后4周（P = 0.03）和12周（P = 0.02）时，对照组的身体细胞质量和骨骼肌体积显著低于LES组。
术前补充含碳水化合物和支链氨基酸的晚餐小吃可能改善肝功能受损的肝切除患者的营养状况。
