title: Gastrectomized patients are in a state of chronic protein malnutrition analyses of 23 amino acids.
abstract: OBJECTIVE
  Malnutrition is one of the major postoperative complications of radical subtotal or total gastrectomy for gastric cancer. This study was conducted to clarify the nutritional consequences of radical gastrectomy with respect to protein metabolism.
  
  
  METHODS
  To evaluate the nutritional status and the abnormalities in protein metabolism in such cases, serum concentrations of 23 amino acids were measured by high performance liquid chromatography in 40 patients who had undergone either subtotal (n = 20) or total (n = 20) gastrectomy more than 6 months prior to this analysis.
  
  
  RESULTS
  Serum concentrations of total amino acids and nonessential amino acids were the same between gastrectomized patients and healthy controls (n = 50). However, concentrations of essential amino acids, essential amino acid/nonessential amino acid and branched-chain amino acid/total amino acid ratios were significantly lower in patient groups than in normal controls. Each essential amino acid was decreased and concentrations of glutamate and citrulline were increased in both patient groups compared with controls. The major differences between patients with subtotal and total gastrectomies included an increased ornithine and a decreased arginine concentration in patients with subtotal gastrectomy.
  
  
  CONCLUSIONS
  These changes suggest that malabsorption of protein from the intestinal tract causes persistent proteolysis in the skeletal muscle for long periods of time after surgery in these patients and that changes in ornithine and citrulline levels may reflect more severe alterations in those with total gastrectomy.
authors.affiliation: First Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004 Japan. a-saito@rf6.so-net.ne.jp
authors.forename: A
authors.initials: A
authors.lastname: Saito
authors.forename: Y
authors.initials: Y
authors.lastname: Noguchi
authors.forename: T
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: C
authors.initials: C
authors.lastname: Doi
authors.forename: K
authors.initials: K
authors.lastname: Fukuzawa
authors.forename: A
authors.initials: A
authors.lastname: Matsumoto
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.forename: A
authors.initials: A
authors.lastname: Tsuburaya
authors.forename: N
authors.initials: N
authors.lastname: Nagahara
mesh_terms: D000368:Aged; D000596:Amino Acids / Q000097:blood*; D002851:Chromatography, High Pressure Liquid; D002908:Chronic Disease; D002956:Citrulline / Q000097:blood; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D018698:Glutamic Acid / Q000097:blood; D006801:Humans; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology*; D009752:Nutritional Status; D009952:Ornithine / Q000097:blood; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D000596:Amino Acids; D002956:Citrulline; D018698:Glutamic Acid; D009952:Ornithine