title: 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.
authors.affiliation: 1 Nutrition and Dietetic Service, Hospital de Câncer I, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Viviane
authors.initials: V
authors.lastname: Dias Rodrigues
authors.affiliation: 1 Nutrition and Dietetic Service, Hospital de Câncer I, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Nivaldo
authors.initials: N
authors.lastname: Barroso de Pinho
authors.affiliation: 2 Bone Marrow Transplantation Laboratory, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Eliana
authors.initials: E
authors.lastname: Abdelhay
authors.affiliation: 3 Research Coordination, Cell Biology Division, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: João P B
authors.initials: JP
authors.lastname: Viola
authors.affiliation: 4 Medical School, Universidade Federal de Minas Gerais, Minas Gerais, Brazil.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Correia
authors.affiliation: 1 Nutrition and Dietetic Service, Hospital de Câncer I, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.|5 Nutrition Institute, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Brum Martucci
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D002173:Cancer Care Facilities; D004044:Dietary Proteins / Q000627:therapeutic use*; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D056747:Immunomodulation; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D015995:Prevalence; D011446:Prospective Studies; D012306:Risk; D013270:Stomach / Q000276:immunology / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000601:surgery*
chemical_list: D015415:Biomarkers; D004044:Dietary Proteins; D018836:Inflammation Mediators
keywords: gastrectomy; immunonutrition; inflammation; malnutrition; nutrition assessment; stomach neoplasms