Okada Genya, Matsumoto Yoshinari, Habu Daiki, Matsuda Yasunori, Lee Shigeru, Osugi Harushi
Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan.
Department of Nutritional Medicine, Graduate School of Human Life Science, Osaka City University, Osaka, Japan.
Nutr Health. 2023 May 24:2601060231176878. doi: 10.1177/02601060231176878.
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.
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.
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 (β = 0.28, p = 0.048).
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.
氮平衡（NB）是机体蛋白质利用的重要指标，正氮平衡对于维持和改善营养状况至关重要。然而，关于癌症患者维持正氮平衡所需的能量和蛋白质水平的目标值尚缺乏相关信息。本研究旨在验证术前食管癌患者实现正氮平衡所需的能量和蛋白质需求。
本研究纳入了因根治性手术入院的食管癌手术患者。基于24小时尿液收集测量尿尿素氮（UUN）水平。根据住院期间的饮食摄入量以及肠内和肠外营养给予量计算能量和蛋白质摄入量。比较正氮平衡组和负氮平衡组的特征，并分析与UUN排泄相关的患者特征。
共纳入79例食管癌患者，46%的患者为负氮平衡。所有能量摄入量≥30 kcal/kg/天且蛋白质摄入量≥1.3 g/kg/天的患者均为正氮平衡。然而，在能量摄入量≥30 kcal/kg/天且蛋白质摄入量<1.3 g/kg/天的组中，67%的患者为正氮平衡。在对多个患者特征进行校正的多元回归分析中，UUN排泄与视黄醇结合蛋白之间存在显著正相关（β = 0.28，p = 0.048）。
在术前食管癌患者中，30 kcal/kg/天的能量和1.3 g/kg/天的蛋白质是实现正氮平衡的指导值。良好的短期营养状况是与UUN排泄增加相关的一个因素。
