Factors influencing serum albumin concentrations in gastric cancer patients

P.73 Interest of nutrition in COPD piratory failure

complications (COMP) as well as by duration of postoperative hospitalization. For the purposes of this analysis patients were stratified into two groups, based on CHOL concentration: Group I (above 150 mg/lOO ml); Group II (below that figure), as shown: BW ALB LYMPH Age

a lipid-enriched enteral patients with acute res-

J. P. Laaban, S. Oraby, M.F. Do&, E. Frija, B. Kouchakji and J. Rochemaure Department of Pneumology and Intensive Care, Hotel-Dieu, Paris, France The increase in CO2 production (VCO,) that results from a hypercaloric nutrition may hinder weaning from mechanical ventilation (MV). The use of a lipid-enriched nutrition has been proposed to limit the nutrition-induced increase in VCOz. However in patients submitted to MV, the lipidenriched nutrition has only been compared to a 100% carbohydrates nutrition. The aim of this prospective study was to compare the increase in VCO, induced by either a lipid-enriched nutrition (LIP) (lipids = 55%, carbohydrates = 27%, proteins = 18%) or a classical nutrition with predominance of carbohydrates (CHO) (carbohydrates = 55%, lipids = 27%. proteins = 18%). Twenty COPD patients with acute respiratory failure requiring MV were randomly assigned to a LIP (n = 10) or CHO (n = 10) enteral nutrition. The daily caloric intake was 1.5 x REE (REE: measured resting energy expenditure). Metabolic measurements (VC02, V02) were performed using indirect calorimetry (Sensor Medics 2900) before starting (D,) and after six days (Ds) of nutritional support. Results: Nutritional status, simplified acute physiologic score (SAPS), body temperature (BT), VCO,. VOz and REE were not significantly different between the 2 groups at D,,. The changes in SAPS and BTfrom Do to D, were not different between the 2 groups as well as the gastrointestinal tolerance and the mean daily nitrogen balance. p (LIP YS Cl-IO) Jl JS A$J,) LIP 109 (18)
(ml/mnlm2) VQ2 (ml/mn/m*) RQ

Conclusion:

CHO LIP CHO LIP CHO

In receiving enteral nutritional supply VCO? which could

95 1;; 0.77 0.76

(19) 1::; (0.04) (0.04)

1:; 155 151 0.76 0.82

I;:; (34) (33) (0.05) (0.05)

+31% +lo% +22% -0.01 +0.07

I II

60.3k4.8 48.4k f 18.6

110+3 85kll

4.2kO.5 3 6+0.4

2188k359 1540*395 *

I II

Age

60.3k4.8 46.4218.6

TG 109+7 88k61 NS

HB

Group Group Signif.

HGS 32+8 24+4 .

1::: NS-

DHR also indicated significantly poorer findings in Group II (n = 10) than in Group I (n = 6). Perioperative results are seen in the table below: Group Gram Signif.

I II

Operation 67% R 20% R

P.O. stay 22.3k4.5 32.5+15.1 NS -

COMP 0% 40%

It is concluded that: 1) Cholesterol depletion was associated with nutritional and immunologic abnormalities; 2) Affected cases were less amenable to curative surgery and suffered greater post-operative morbidity.

P.75 Factors influencing serum albumin centrations in gastric cancer patients

con-

G. Franch, M. Bossola, J.J. Sancho, R. Bellantone, G.B. Doglietto, M.J. Gil, F. Crucitti and A. Sitges-Serra Departments of Surgery, Autonomous University of Barcelona, Spain; Hospital Universitari del Mar, and Catholic University of Rome, Ospedale dei Gemelli, Italy

NS co.05

Serum albumin concentration (SAC) is a good predictor of postoperative complications and death. However, the causes and pathogenesis of hypoalbuminemia are not well understood. We set up the present prospective study to elucidate the factors influencing SAC in 180 patients with newly detected gastric cancer. The patients were evaluated for age, SAC, percentage of weight loss, hemoglobin, maximum tumour diameter (~2 cm small, 2-5 cm medium, >5 cm big) and stage (Stage I: cancer affecting the stomach with or without positive nodes, Stage II: infiltration of adjacent organs, Stage Ill: distant metastases). Hypoalbuminemia was absent (>35 g/l) in 71.8% of cases, moderate (30-35 g/l) in 19.4% and severe (~30 g/l) in 8.8%. Anemia was severe ( 15%) in 31.5% of the patients and moderate (5-l 5%) in 33%. Patients with a history of weight loss had lower SAC (38.8 vs 37.1 g/l, p = 0.03). The influence of tumor diameter on SAC almost reached statistical significance (small 39; medium 37.5; big 36.1 g/l, p = 0.1). Tumor stage did not correlate with SAC. Compared to young ( < 70 years) patients old individuals showed higher weight loss (13 vs 9%. p i 0.01) and lower SAC (34.3 vs 37.7 g/l, p i 0.01) and hemoglobin (109 vs 125 g/l). Conclusion: In newly detected gastric cancer, SAC appears to be influenced by the severity of chronic blood loss, a history of weight loss and advanced age. All these factors have been associated with extracellular water expansion and it remains to be proved whether hypoalbuminemia in newly detected gastric cancer is true or dilutional.

mechanically ventilated COPD patients hypercaloric nutrition, a lipid-enriched is associated with a marked reduction of facilitate weaning from MV.

P.74 Prognostic in malnourished cinoma

Group Group Signif.

interest of cholesterol levels patients with esophageal car-

J. Faintuch, R. Cabraitz Jr, A.R. Martin Neto, M.Z. Salem, O.K. Yagi, R.B.A. Leme, B. Zilberstein, I. Ceconello and H. W. Pinotti Nutrition Group, Hospital das Clinicas, SBo Paula, SP, Brazil Various nutritional determinations including serum cholesterol (CHOL) can be endowed with prognostic importance in surgical populations, but few investigations have addressed esophageal carcinoma cases. Given the severe malnutrition and fat depletion that is frequently seen in that disease, a prospective study was done in a consecutive surgical group with demonstrated cancer. In addition to CHOL and triglycerides (TG), the following parameters were registered at admission: age, sex, body weight as % of ideal (BW), serum albumin (ALB),total lymphocytes (LYMPH) and hemoglobin (HB). Handgrip strength (HGS) and delayed hypersensitivity response (DHR) were also documented, whereas treatment was classified as radical (R) or palliative (P) in accordance with the performed operation. Surgical outcome was measured by means of incidence of infectious or anastomotic 72