Nutrition and Immune‐Modulatory Intervention in Surgical Patients With Gastric Cancer

Abstract

This study evaluated the effect of an immune-modulatory diet on patients with gastric cancer and identified the parameters associated with postoperative outcomes. This was a single-arm prospective intervention study. At baseline, patients were assessed for nutrition (Patient-Generated Subjective Global Assessment), inflammatory markers (albumin, C-reactive protein, and interleukin 6 [IL-6]), and immune markers (percentage NK, CD4, CD8, and CD4:CD8 ratio); they also received nutrition counseling and high-calorie/protein supplement. A week before surgery, they were assessed for nutrition and inflammatory/immune markers and started on an immune-modulatory supplement until the day before surgery, when they were evaluated again. On the second postoperative day, patients were assessed for inflammatory/immune parameters, and a final nutrition evaluation was performed until the day of discharge. Complications were recorded daily and up to 30 days after discharge. Thirty-seven patients (60 ± 10 years old) were included, and 57% were classified as malnourished. Maintenance of nutrition and immune parameters occurred throughout the study period, but we found a preoperative increase in C-reactive protein (0.1-1.5 mg/dL) and IL-6 (2.0-14.2 pg/mL) and a postoperative increase in the CD4:CD8 ratio (2.3 ± 1.0). Complications and death were seen in 35%, especially patients with higher preoperative IL-6 (2.2-46 pg/mL), lower CD4:CD8 ratio (1.7 ± 0.5), and lower protein (1.2 ± 0.5 g/kg/d) and calorie intake (1552 ± 584 kcal/kg/d). The high-calorie/protein supplementation with the immune-modulating diet was able to maintain the nutrition and immune status of patients with gastric cancer.

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

“…In the present study, almost two-thirds (67%) of the patients were malnourished by PGSGA, similar to other studies, showing malnutrition rates of 66% and 57% 26,27 , but lower than the 86% and 88% described in other works [24][25] . Paceli et al 28 found a preoperative weight loss greater than 10% in 42% of gastric cancer patients, similar to those of other Asian studies, of 13% and 31% 6,7 , respectively.…”

Effect of two types of anesthesia on postoperative recovery of patients with gastric cancer and changes in the levels of their T lymphocyte subsets

“…Therefore, CD4+/CD8+ is a vital marker that represents total immunity. A decrease in CD4+/CD8+ indicates a compromise of immunologic function and poor prognosis [10][11][12].…”

Effects of Post-Surgical Parenteral Nutrition on Patients with Gastric Cancer

“…For instance, a recent study showed that high-calorie/protein supplementation with the immune-modulating diet was able to maintain the nutrition and immune status of patients with GC [26]. Furthermore, a study conducted in a population of elderly patients who underwent surgery for GC showed that the combination of enteral and parenteral nutrition was superior to either early enteral nutrition or total parenteral nutrition in promoting the recovery of immunity [27].…”