Department of Nutrition, Shizuoka General Hospital, Shizuoka, Japan.
Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
PLoS One. 2023 Oct 19;18(10):e0292920. doi: 10.1371/journal.pone.0292920. eCollection 2023.
Outpatient nutritional counseling by a registered dietitian is often performed to prevent weight loss, but evidence supporting this practice is insufficient. In this study, we aimed to clarify the effectiveness of four-time outpatient nutritional counseling in weight-loss prevention compared with conventional intervention limited to one-time nutritional counseling. This study was designed as a retrospective cohort study. The target population was postoperative patients with stage IA and IB gastric cancer. Groups that received one-time and four-time nutritional counseling included patients who underwent gastrectomy from May 2014 to April 2017 and May 2017 to December 2019, respectively. The one-time group received counseling at discharge; the four-time group received counseling at discharge, at the first outpatient visit, and at 3 and 6 months postoperatively. There were 58 patients in the one-time group and 27 patients in the four-time group, with a significant difference in length of hospital stay (p = 0.042). Thirty-six patients (62.1%) in the one-time nutritional counseling group and 12 (44.4%) in the four-time group had a weight loss of 5% or more from hospital discharge to 6 months postoperatively. The adjusted risk ratio for the effectiveness of four counseling sessions compared with one session was 0.69 (95% confidence interval 0.35-1.34). In subgroup analysis, the effect of nutritional guidance was greater for patients with body mass index ≥23 kg/m2, but this depended on the outcome and number of cases, and there was no essential difference between the groups. In postoperative patients with stage IA and stage IB gastric cancer, four sessions of outpatient nutrition counseling may be not superior to one counseling session in preventing weight loss.
门诊营养咨询通常由注册营养师进行，以预防体重减轻，但支持这种做法的证据不足。在这项研究中，我们旨在阐明四次门诊营养咨询在预防体重减轻方面与限于一次营养咨询的常规干预相比的有效性。本研究设计为回顾性队列研究。目标人群为 I 期和 IIA 期胃癌术后患者。接受一次和四次营养咨询的组分别包括 2014 年 5 月至 2017 年 4 月和 2017 年 5 月至 2019 年 12 月接受胃切除术的患者。一次组在出院时接受咨询；四次组在出院时、第一次门诊就诊时以及术后 3 个月和 6 个月时接受咨询。一次组有 58 例患者，四次组有 27 例患者，住院时间有显著差异（p = 0.042）。一次营养咨询组 36 例（62.1%）和四次组 12 例（44.4%）患者从出院到术后 6 个月体重减轻 5%或更多。与一次咨询相比，四次咨询的有效性调整风险比为 0.69（95%置信区间 0.35-1.34）。亚组分析显示，对于 BMI≥23kg/m2 的患者，营养指导的效果更大，但这取决于结果和病例数量，两组之间没有本质区别。对于 I 期和 IIA 期胃癌术后患者，四次门诊营养咨询可能并不优于一次咨询，无法预防体重减轻。
