Nutritional Status in Elderly Gastric Carcinoma

BACKGROUND: Malnutrition is one of the important factors influencing morbidity and mortality in elderly patients with gastric carcinoma. METHODS: Since September to December 2001, we investigated the nutritional parameters of 44 elderly patients with gastric carcinoma by measuring anthropometric and biochemical blood indices and assessing dietary intake along with subjective global assessment. RESULTS: The mean body mass index of subjects was below the physical average of korea on the base of 64 years old. The ratio of carbohydrate, protein and lipid to energy intake was 74.0:13.5:12.5(%). There were significantly positive correlations between three groups according to subjective global assessment and height, body weight, 1 month weight loss %, 6 month weight loss %, body mass index, transferrin and nutrient intake, such as energy, protein and niacin. CONCLUSION: Mean nutrient intake, such as total energy, protein and niacin appear to be related of subjective global assessment in elderly subjects. Nutritional assessment by nutrient intake should be done in elderly patients with gastric carcinoma and be supplied with adequate nutrition for them.

Nutritional Assessment in Gastric Carcinoma

PURPOSE: Protein and energy malnutrition are common in patients with stomach cancer. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase morbidity and mortality in stomach cancer. METHODS: The study subject were 88 patients with stomach cancer admitted at Kosin university Gospel Hospital General Surgery Department during August 2001 to December. We assessed the initial nutrition status by anthropometric, biochemical and dietary intake data along with subjective global assessment (SGA) and stomach cancer stage. RESULTS: The mean body index was under weight, body fat mass and body protein mass were decreased with increase cancer stage. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count were decrease with increase cancer stage. Daily energy intake was 1997.8 kcal, energy, cabohyderate and VitB 1 was decrease with cancer stage. The patient were divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss %, 6 month weight loss %, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake CONCLUSION: The author concluded that nutritional assessment should be done in cancer patients preoperatively and that with adequate nutritional support, the morbidity and mortality would be decreased. Our data show that SGA is a clinically adequate method for assessing nutritional status.

Initial nutritional status of stomach cancer patients

The purpose of this study is to investigate initial nutritional status of stomach cancer patients. The study subjects were 88 patients with stomach cancer admitted at Kosin University Gospel Hospital in Busan. We assessed the initial nutritional status by anthropometric, biochemical and dietary intake data along with subjective global assessment(SGA). The results are as follows. 1. The mean age, weight, height, triceps skinfold thickness, mid arm circumference, and mid arm muscle circumference of the subjects were 55.9+/-11.0years, 60.0+/-9.8kg, 162.4+/-8.5cm, 10.9+/-5.7mm, 26.8+/-3.8cm, and 23.4+/-3.5cm respectively. The mean body mass index was within the normal range, with 22.7+/-2.8kg/m2, while 15.4% of the patients was underweight. The result shows that body fat mass and body protein mass of the patients with stomach cancer were decreased. 2. The mean biochemical data of the subjects were 4.0+/-0.5g/dl for albumin, 174.7+/-41.9mg/dl for cholesterol, 107.6+/-57.2mg/dl for triglyceride, 92.1microgram/dl for Zn, 297.0+/-103.1mg/dl for transferrin, 1980.0+/-0.8mm3 for total lymphocyte count. 3. Daily energy intake was 1997.8+/-579.3kcal. And the ratio of carbohydrate, protein, and lipid to energy intake was 72:14:14. 4. The patients were divided into three groups according to SGA performed by an observer. Group A(well nourished) was 55.7% with 49 patients, Group B(moderately malnourished) was 22.7 % with 20 patients, and Group C(severely malnourished) was 21.6 % with 19 patients. The three groups showed a significant difference in body weight(p<0.01), 1 month weight loss %(p<0.001), 6 months weight loss %(p<0.001), body mass index(p<0.01), and mid arm circumference(p<0.05), albumin(p<0.01), energy intake(p<0.05) as well as carbohydrate intake(p<0.05). From these results, it may be concluded that SGA can be used as a nutrition screening tool, and comprehensive nutrition assessment is desirable for those malnourished.

Abnormalities of Liver Function during Total Parenteral Nutrition (TPN): Alteration of Serum Liver Enzyme during Short-term TPN

PURPOSE: TPN has been widely used to treat nutritional depletion since the late 1960s. However, many metabolic complications may occur as a result of parenteral feeding. Among these, hepatic complications has received increasing attention. A retrospective review of liver function abnormalities in adult patients who underwent TPN was done to determine the frequency and magnitude of the abnormalities in a liver function test. METHODS: From January 2001 to Jun 2001, 160 adult patient receiving TPN were reviewed. Of these, 111 had a malignant disease and 49 had a benign disease. The duration of TPN therapy ranged from 5 days to 52 days, with a mean duration of 14 days. Abnormalities of liver function test were defined as a value greater than the upper normal limit. Forty cases of gastric cancer were analyzed to determine the risk factors that contribute to abnormal liver function in individual patients receiving TPN. RESULTS: Abnormalities of the liver function test appeared after 6~7 days of therapy. Increases in the ALP levels were noted in 34 out of 93 patients (37.6%), in the AST levels in 42 out of 116 patients (36.2%), in the ALT levels in 54 out of 125 patients (43.2%), in the LDH levels in 20 out of 72 patients (27.8%), in the gamma-GTP levels in 44 out of 81 patients (54.3%), and in the bilirubin levels in 30 out of 126 patients (23.8%). The serum ALP level rose to 1.6 times upper the limit of normal; AST, 1.7 times; ALT, 2.0 times; LDH, 1.2 times; gamma-GTP, 2.4 times; bilirubin, 2.4 times. gamma-GTP value was most sensitive. In 40 gastric cancers, factors as age, the amount of TPN solution, the duration of TPN, intraoperative chemotherapy, transfusion, and postoperative infection were investigated. However, no association with TPN-associated liver function abnormalities was found. CONCLUSION: The incidences of an abnormal liver function during TPN were 23.8~54.3%. However, the liver function abnormalities that developed during short term-TPN were reversible and not serious.