Nutrition Intervention in a Gastric Cancer Patient With Gastrectomy for 12 Months: A Case Report

Abstract

Appropriate nutritional interventions prevent or reduce nutrition-related side effects of surgery and improve nutrition-related outcomes such as energy and protein intake and nutritional status. Counselling is the first line of nutrition intervention and improves oral intake, body weight, and quality of life. For effective nutritional intervention, individualized nutrition counselling is needed because it takes into consideration of patient preferences and specific treatment-related side effects that affect nutritional intake. Periodic follow-up during the first year after surgery is beneficial to the patient, and intensive nutrition education is suggested to be more effective in improving nutritional status, dietary intake, and quality of life than one-time education [4-6]. This case report describes changes in body composition, dietary intake, nutritional status, and nutrition-related side effects of a patient who underwent nutrition counselling from before gastrectomy until one year after surgery. Institutional Review Board approval was obtained from SMC (approval number 2022-09-013-001). CASE A 52-year-old male patient underwent laparoscopic radical gastrectomy with Billroth-I anastomosis after diagnosis with gastric cancer. According to the eighth edition of the American Joint Committee on Cancer (AJCC) staging system, the stage after surgery was T1bN0M0 (stage IA). Nutritional status was evaluated before gastrectomy, and nutrition counselling was conducted five times in total until one year after surgery. To identify eating behavior, questionnaires on the eating pattern were conducted each time, and dietary intake was investigated and analyzed using the 24-hour recall method. The Patient-Generated Subjective Global Assessment (PG-SGA) was used for nutritional assessment and body composition was analyzed using Inbody 720 Bioelectrical Impedance Analyzer (BIA). Albumin and hemoglobin in the blood test were measured as nutrition-related items. One month before surgery The following items were investigated during the outpatient visit before surgery. Height was 175 cm, body weight was 66.8 kg, body mass index (BMI) was 21.8 kg/m 2 , skeletal muscle mass (SMM) was 34.3 kg, which is considered normal, and albumin and hemoglobin levels in blood were 4.0 and 14.4 g/dL respectively, both within the normal range. Our usual dietary intake was 90% or more of the energy and protein requirements being met. No special intervention was required, with a PG-SGA score of 1 point, indicating normal nutritional status. The patient was recommended to consume a balanced diet and maintain body weight and was cautioned against consuming alcohol, tobacco, traditional remedies, and dietary supplements before surgery. During hospitalization On the second day after hospitalization, the initial nutritional assessment was performed, body weight was 65.9 kg, and BMI was 21.5 kg/m 2 , which were similar to one month before hospitalization. The PG-SGA score was 1 point, indicating that nutritional status was normal. Fasting was required on the day of surgery and the first day after surgery. A sip of water was introduced on the second day, a post-surgery semi-fluid diet on the third day, a post-surgery semi-blended diet (SBD) stage 1 on the fourth day, and post-surgery SBD stage 2 on the fifth day. The patient was discharged on the seventh day after surgery. For nutritional management, an initial nutritional assessment was performed on the first day https://doi.