Vliv nutriční podpory s vysokým obsahem bílkovin na výsledky léčby a náklady u pa cientů s kolorektálním karcinomem SummaryBackground: The primary objective of this study was to investigate the impact of high protein oral nutrition support (ONS) on clinical outcomes in patients with colorectal cancer (CRC). The secondary aim was to compare the cost of treatment and length of stay (LoS) for CRC patients taking high protein ONS vs. patients on conventional nutritional support. Materials and Methods: The study was conducted on adult patients with CRC undergoing colorectal surgery. Informed consent was obtained before the study. The study group (SG; n = 52) was instructed to take high protein ONS (600 kcal, 40 g protein per day) in addition to a normal diet for at least 10 days before and two weeks after surgery. Data from the comparative group (CG; n = 105) were collected retrospectively. Results: A relative reduction in the frequency of the following complications was observed in SG: wound dehiscence (2.2 times lower), infections (4.3 times lower), anastomosis dehiscence (2.0 times lower), and rehospitalization (1.7 times lower). The mean LoS was shorter in SG (9.4 ± 4.97 vs. CG 12 ± 6.4 days), which resulted in significantly lower treatment costs during hospitalization (SG 479 vs. CG 538 EUR; p = 0.01) and at six months after surgery (SG 4,862 vs. CG 6,456 EUR). Conclusion: Pre-and postoperative high protein ONS reduces LoS, treatment costs, postoperative complications, and re-hospitalizations in CRC, regardless of initial nutritional status.

IntroductionSurgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits.AimTo assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy.Material and methodsThe study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ±4.9 kg/m2. Pre-operative examination included baseline measurements of body composition. Dietary habits and intake frequency were monitored by a questionnaire method. Follow-up examinations were carried out in a scope identical to the pre-operative examination, 6 and 12 months after surgery, respectively.ResultsThe average patient weight loss 12 months after surgery was 31.7 kg. Excess weight loss was 55.2 ±20.6%. Patients reported reduced appetite (p < 0.001), increasingly regular food intake (p < 0.001), intake of more meal portions per day (p = 0.003) and a decrease in consuming the largest portions during the afternoon and evening (p = 0.030). Plasma levels of fasting glucose, leptin and ghrelin significantly decreased (p = 0.006; p = 0.0.043); in contrast, the level of adiponectin significantly increased (p < 0.001).ConclusionsSleeve gastrectomy and follow-up nutritional therapy resulted in a significant body weight reduction within 1 year after surgery. An improvement of certain dietary habits in patients was registered. At 12 months after surgery, there were no statistically significant differences in decreases in ghrelin and leptin concentrations between patients without changed appetite and those reporting decreased appetite.

a,b , Ales Foltys a,b , Anton Pelikan a,b,c,d , Jan Roman a,bBackground. Non-alcoholic fatty liver disease (NAFLD), often associated with obesity and metabolic syndrome, manifests itself as steatosis, hepatic fibrosis, cirrhosis, or even end-stage liver disease. NAFLD causes inflammation, insulin resistance and cardiovascular complications. The current study aimed to evaluate the beneficial effects of bariatric surgery on biochemical parameters of hepatic functions in obese patients by comparing them before and one-year after the surgery. Methods. A total of 72 morbidly obese patients underwent bariatric surgery between 2016 and 2018. The incidence of diabetes mellitus in this group was 29%, median body weight was 124.5 kg (109.0-140.0) and mean body mass index (BMI) was 44.38 ± 6.770 kg/m 2 . The used surgical procedures included gastric bypass, sleeve gastrectomy, laparoscopic gastric plication, and single anastomosis duodeno-ileal bypass-sleeve gastrectomy. Biochemical parameters including ALT/AST ratio (AAR), NAFLD fibrosis score (NFS), hepatic fibrosis index (FIB-4) and Fatty Liver Index (FLI) were evaluated in all patients at the time of surgery and one year after the intervention. Results. Significant improvement after the intervention was observed in 64 patients. A significant reduction in body weight (P<0.0001), waist circumference (P<0.0001), and body mass index (P<0.0001) were observed. NAFLD liver fibrosis index changed significantly (P<0.0001), suggesting a trend of improvement from advanced fibrosis towards stages 0-2. The FIB-4 fibrosis index indicated significant improvement (P=0.0136). Besides, a significant decline in hepatic steatosis (P<0.0001) was observed after bariatric surgery as compared to the pre-surgery fatty liver conditions. Conclusion. Among the strategies to overcome NAFLD-associated impediments, bariatric surgery can be considered effective in reducing obesity and metabolic co-morbidities. Trial Registration: ClinicalTrials.gov (NCT04569396)

The non-alcoholic fatty liver disease (NAFLD) is the predominant etiological factor for liver disease. There is a risk of the development of hepatocellular carcinoma (HCC) in patients suffering from NAFLD. Non-alcoholic steatohepatitis (NASH) is one of the risk factors for the development of HCC. The aim is to discuss an association of NAFLD and HCC in the adult population. HCC is one of the debilitating complications of NAFLD/NASH and obesity is a causative factor for NAFLD/NASH. Various clinical data suggest that obesity appears to be a causative factor in the progression of NAFLD/NASH to HCC. We searched data from the PubMed/Medline and Google Scholar databases including various studies and review articles. Significantly, an increased number of HCC patients with cryptogenic liver disease had well-differentiated tumors than in HCC patients with chronic viral hepatitis and alcoholism. HCC is one of the debilitating complications of NAFLD/NASH and obesity is a causative factor for NAFLD/NASH. Various preclinical and clinical data suggest that obesity appears to be an important causative factor in the progression of NAFLD/NASH to HCC.

Background: In 2016, more than 1.9 billion adult populations were overweight, 650 million of them were obese, which represents around 13% of the world's adult population. Liver steatosis has become the most common chronic liver disease in developed countries. In most cases, non-alcoholic fatty liver disease (NAFLD) is a benign and reversible liver disorder. Under certain circumstances, the disease may result through the image of non-alcoholic steatohepatitis (NASH) and hepatic fibrosis to liver cirrhosis with all known negative consequences, until formation of hepatocellular carcinoma (HCC). Methods: We searched from the Pubmed, Google Scholar and Research gate database and looked for keywords NAFLD, steatohepatitis, steatohepatitic variant of HCC. Results: The pathogenesis of NAFLD and metabolic syndrome seems to have common pathophysiological mechanisms. Although liver biopsy remains the gold standard for NAFLD diagnosis, it seems that new diagnostic procedures and scoring systems are emerging that could non-invasively distinguish simple steatosis from NASH. Conclusion: A higher number of metabolic syndrome risk factors have been registered in patients with steatohepatitic HCC variant. HCC patients with clinical symptoms have a very poor prognosis (median 5-year overall survival is between 0-10%); on the other hand, patients with asymptomatic HCC detected by screening show a higher survival rate, with a total 5-year survival of more than 50 % due to radical treatment. Simple and unassuming diagnostic methods can be used in a wide range of patients, thus systematically preventing the development of diseases and related disorders. Early diagnosis and risk stratification are essential for effective treatment management. We searched from the Pubmed, Google Scholar and Research gate database and looked for keywords NAFLD, steatohepatitis, steatohepatitic variant of HCC. Search strategy and selection criteria The global prevalence of obesity nearly tripled between 1975 and 2016. As the incidence of obesity in the population increases, the number of patients with liver steatosis also increases.