When Tolerating Diet Is Not Enough: Hidden Underfeeding After Distal Gastrectomy

Area of Science:

• Oncology
• Gastroenterology
• Nutritional Science

Background:

• Post-gastrectomy patients may experience insufficient energy intake, leading to weight loss.
• The adequacy of oral intake within standardized pathways post-gastrectomy is not well understood.
• Early nutritional status is critical for recovery after major surgery.

Purpose of the Study:

• To investigate early postoperative energy intake following gastrectomy.
• To determine the association between energy intake and short-term weight loss.
• To identify factors influencing weight loss after distal gastrectomy for gastric cancer.

Main Methods:

• Retrospective analysis of patients with pStage II-III gastric cancer undergoing distal gastrectomy (2012-2021).
• Assessment of postoperative energy intake and weight loss.
• Multivariable regression analysis to evaluate associations between energy intake, C-Reactive Protein (CRP) levels, and weight loss.

Main Results:

• Median weight loss was 4.2%, with median energy intake of 18.9 kcal/kg/day.
• Oral intake rates were 81.5% (PODs 3-14) and 90.8% (PODs 7-14).
• Lower energy intake (per body weight) and higher preoperative CRP levels were significantly associated with greater weight loss (P < .01 and P = .039, respectively).

Conclusions:

• Insufficient early postoperative energy intake is independently linked to weight loss after distal gastrectomy.
• Elevated preoperative C-Reactive Protein levels also correlate with increased weight loss.
• "Hidden underfeeding" can occur despite standardized oral feeding protocols, necessitating individualized nutritional strategies.