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.