Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Nutr. 2021 Jan;40(1):40-46. doi: 10.1016/j.clnu.2020.04.043. Epub 2020 Jun 2.
BACKGROUND & AIMS: Malnutrition frequently occurs and deteriorates in patients after surgery for gastric cancer, especially after hospital discharge, which has been consistently associated with negative outcomes. However, information regarding the impact of post-discharge nutritional interventions is poorly described. The aim of this study was thus to evaluate the impact of post-discharge oral nutritional supplements (ONS) with dietary advice compared with dietary advice alone on nutritional outcomes, including body mass index (BMI) and skeletal muscle index (SMI), sarcopenia prevalence, chemotherapy tolerance, the 90-day readmission rate, and quality of life in patients at nutritional risk after surgery for gastric cancer.
Three hundred and fifty-three patients who underwent surgery for gastric cancer and were at nutritional risk (Nutritional Risk Screening 2002 [NRS 2002] score ≥3 points) in our institution were randomly assigned to receive either ONS with dietary advice or dietary advice alone (control) for 3 months after discharge. The primary endpoints were nutritional outcomes and sarcopenia prevalence; the secondary endpoints included chemotherapy tolerance, the 90-day readmission rate, and quality of life.
Three hundred and thirty-seven patients completed the study and were included in the analyses, consisting of 171 in the ONS group and 166 in the control group. The average daily intake of ONS in the intervention group was 370 mL. After 3 months of the intervention, the patients who received ONS and dietary advice had significantly less weight loss and higher BMI and SMI than those given dietary advice alone (P < 0.05). The incidence of sarcopenia was significantly lower in the ONS group than in the control group (P < 0.05). Similar number of patients in the two groups underwent postoperative chemotherapy, but the patients who received ONS and dietary advice had significantly less chemotherapy modifications, including delay, dose reduction, or termination (P < 0.05). The two groups had no significant differences in the 90-day readmission rate (P > 0.05). Regarding the quality of life, the patients who received ONS and dietary advice reported significantly less fatigue and appetite loss than those given dietary advice alone (P < 0.05), but the two groups showed no significant differences in the other outcomes (P > 0.05).
Post-discharge ONS with dietary advice in patients at nutritional risk after surgery for gastric cancer improved nutritional outcomes, skeletal muscle maintenance, chemotherapy tolerance and some quality of life variables. These findings strongly support the concept of the introduction of post-discharge ONS with dietary advice to this patient cohort.
胃癌手术后患者常发生营养不良，并在出院后恶化，这与不良结局一直相关。然而，有关出院后营养干预措施影响的信息描述较差。因此，本研究旨在评估与单纯饮食建议相比，出院后口服营养补充（ONS）联合饮食建议对营养结局（包括体重指数[BMI]和骨骼肌指数[SMI]、肌肉减少症患病率、化疗耐受性、90 天再入院率和胃癌术后营养风险患者的生活质量）的影响。
本研究共纳入我院 353 例胃癌术后营养风险（营养风险筛查 2002 评分[NRS 2002]≥3 分）患者，随机分为 ONS 联合饮食建议组和单纯饮食建议组（对照组），出院后接受 3 个月的治疗。主要终点为营养结局和肌肉减少症患病率；次要终点包括化疗耐受性、90 天再入院率和生活质量。
337 例患者完成了研究并纳入分析，其中 ONS 组 171 例，对照组 166 例。干预组ONS 的平均日摄入量为 370ml。干预 3 个月后，接受 ONS 和饮食建议的患者体重减轻明显减少，BMI 和 SMI 更高，与单纯接受饮食建议的患者相比（P<0.05）。ONS 组肌肉减少症的发生率明显低于对照组（P<0.05）。两组患者术后均接受化疗，但接受 ONS 和饮食建议的患者化疗方案调整（包括延迟、剂量减少或终止）明显较少（P<0.05）。两组 90 天再入院率无显著差异（P>0.05）。在生活质量方面，接受 ONS 和饮食建议的患者报告疲劳和食欲下降明显少于单纯接受饮食建议的患者（P<0.05），但两组在其他方面无显著差异（P>0.05）。
胃癌术后营养风险患者出院后接受 ONS 联合饮食建议可改善营养结局、维持骨骼肌、提高化疗耐受性和某些生活质量指标。这些发现有力地支持了向该患者群体引入出院后 ONS 联合饮食建议的概念。
