Nutritional Status, Sarcopenia and the Importance of Prehabilitation of Gastrointestinal Tumor Patients: a Surgical Point of View

Abstract

Our prospective research included all of the patients who were admitted to the Surgical Department of St. John Hospital diagnosed with a malignant gastrointestinal tumor. Demographic (gender, age) and morphologic Abstract: Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality. However, there are limited data on the nutritional status of surgical patients and the effects of prehabilitation on the outcomes of surgery. Methods A prospective analysis was conducted on all patients surgically-treated for malignant gastrointestinal tumors at St. John Hospital during a two-year period. The patient's gender, age, body weight, height, BMI and weight loss were registered, then a risk score was determined by the MUST survey. Measurement of the triceps and thigh skin-fold thickness and the circumference of the upper arm and thigh were done to calculate muscle area and muscle index, respectively. The body composition was assessed using an OMRON-BF511 device. Muscle function was evaluated based on hand clamping force measurement and activity tests. Patients who were diagnosed as being at-risk received preoperative prehabilitation, which included physiotherapy and nutritional therapy. Results A total of 231 patients (133 males/98 females) were analyzed. They had a mean age of 68.9 years (18~98). Seventy-four patients (32%) lost weight, with an average loss of 7 kilograms (3~15 kg). Anthropometric data showed an average upper-arm circumference of 27.4 cm (14.3~38.1) and thigh circumference of 44.7 cm (19.3~60.1), so the median muscle index was 1.29. The mean BMI was 26, which is above normal, and the elevated BMI was consistent documented in each patient subgroup stratified by age and tumor type. A body composition analysis was performed for 75 patients (44 male/31 female), who had a median age of 68 (37~88 y). The average BMI of these patients was 25.7 y and their average MUST score was 1.12. The total body fat percentage (of the total body mass) was 29.5%, total muscle was 30.1% and visceral fat was 10%. Thirty patients (40%) had sarcopenia, with a mean BMI of 28.7, fat comprising 34.2% of the body mass, visceral-fat 11%, and muscle 27.1 %, and their median MUST score was 1.23. Patients who received preoperative training (physiotherapy) showed improvements in physical function ranging from 12%~33%. Conclusion Gastrointestinal tumor patients have a higher than normal BMI regardless of age or tumor type. Patients with sarcopenia show measurable improvement after two weeks of prehabilitation.