Investigation of Nutritional Risk and Nutritional Support in Patients with Gastrointestinal Tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIA Zhenyi ,  QIN Huanlong.

Department of General Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China;

Corresponding author：

QIN Huanlong., Email: hlqin@sjtu.edu.cn

Keywords：

Gastrointestinal tumor; Nutritional support; Complications; Nutritional risk screening 2002; Tumor staging

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ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.

Citation： JIA Zhenyi,QIN Huanlong.. Investigation of Nutritional Risk and Nutritional Support in Patients with Gastrointestinal Tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1254-1258. doi: Copy

1.	Pirliah M, Sohutz T, Norman K, et al. The German hospital mainutrtion study [J]. Clin Nutr, 2006, 25(4): 563572.
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3.	蒋朱明, 陈伟, 朱赛楠, 等．中国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查 [J]．中国临床营养杂志, 2008, 16(6): 335337．.
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6.	陈伟, 蒋朱明, 张永梅, 等．欧洲营养不良风险调查方法在中国住院患者的临床可行性研究 [J]．中国临床营养杂志, 2005, 13(3): 137141．.
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8.	Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
9.	Buzby GP, Knox LS, Crosby LO, et al. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients [J]. Am J Clin Nutr, 1988, 47(2 Suppl): 366381.
10.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey [J]. Ann Surg, 2004, 240(2): 205213.
11.	Warneke VS, Behrens HM, Hartmann JT, et al. Cohort study based on the seventh edition of the TNM classification for gastric cancer: proposal of a new staging system [J]. J Clin Oncol, 2011, 29(17): 23642371.
12.	刘荫华, 徐玲．第七版《AJCC肿瘤分期手册》结直肠癌内容的更新与解读 [J]．中华胃肠外科杂志, 2010, 13(8): 629631．.
13.	丁国平, 陈平, 易占波, 等. 胃癌患者术前营养风险筛查及预防性肠内营养支持 [J]. 中华胃肠外科杂志, 2009, 12(2): 141144.
14.	郭卫平, 卫洪波, 李玺, 等. 应用营养风险筛查2002评分系统对胃癌患者术前营养风险的评估 [J]. 中华普通外科杂志, 2009, 24(10): 824826.
15.	Guo W, Ou G, Li X, et al. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results [J]. J Gastroenterol Hepatol, 2010, 25(4): 800803.
16.	梁晓坤, 蒋朱明, Nolan MT, 等. 北京教学医院普通外科住院患者营养风险、营养不足、超重、肥胖及营养支持状况 [J]. 中国临床营养杂志, 2009, 17(2): 7578.
17.	Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
18.	Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.
19.	Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
20.	Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer [J]. Br J Surg, 2010, 97(1): 9297.

1. Pirliah M, Sohutz T, Norman K, et al. The German hospital mainutrtion study [J]. Clin Nutr, 2006, 25(4): 563572.
2. 郭志义，胡阳，庞明辉, 等. 高龄胃癌病人的围手术期处理及营养支持 [J]. 中国实用外科杂志， 2005，25(4): 154156.
3. 蒋朱明, 陈伟, 朱赛楠, 等．中国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查 [J]．中国临床营养杂志, 2008, 16(6): 335337．.
4. 陈春明．中国成人体质指数分类的推荐意见简介 [J]. 中华预防医学杂志， 2001, 35(5)： 349350.
5. Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
6. 陈伟, 蒋朱明, 张永梅, 等．欧洲营养不良风险调查方法在中国住院患者的临床可行性研究 [J]．中国临床营养杂志, 2005, 13(3): 137141．.
7. American Gastroenterological Association. American gastroenterological association medical position statement: parenteral nutrition [J]. Gastroenterology, 2001, 121(4): 966969.
8. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
9. Buzby GP, Knox LS, Crosby LO, et al. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients [J]. Am J Clin Nutr, 1988, 47(2 Suppl): 366381.
10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey [J]. Ann Surg, 2004, 240(2): 205213.
11. Warneke VS, Behrens HM, Hartmann JT, et al. Cohort study based on the seventh edition of the TNM classification for gastric cancer: proposal of a new staging system [J]. J Clin Oncol, 2011, 29(17): 23642371.
12. 刘荫华, 徐玲．第七版《AJCC肿瘤分期手册》结直肠癌内容的更新与解读 [J]．中华胃肠外科杂志, 2010, 13(8): 629631．.
13. 丁国平, 陈平, 易占波, 等. 胃癌患者术前营养风险筛查及预防性肠内营养支持 [J]. 中华胃肠外科杂志, 2009, 12(2): 141144.
14. 郭卫平, 卫洪波, 李玺, 等. 应用营养风险筛查2002评分系统对胃癌患者术前营养风险的评估 [J]. 中华普通外科杂志, 2009, 24(10): 824826.
15. Guo W, Ou G, Li X, et al. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results [J]. J Gastroenterol Hepatol, 2010, 25(4): 800803.
16. 梁晓坤, 蒋朱明, Nolan MT, 等. 北京教学医院普通外科住院患者营养风险、营养不足、超重、肥胖及营养支持状况 [J]. 中国临床营养杂志, 2009, 17(2): 7578.
17. Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
18. Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.
19. Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
20. Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer [J]. Br J Surg, 2010, 97(1): 9297.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Investigation of Nutritional Risk and Nutritional Support in Patients with Gastrointestinal Tumor

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