Food and Nutrient Intake among People Following Major Upper Gastrointestinal Surgery

Introduction: Surgery to the upper gastrointestinal region of the gut results in symptoms greatly impacting on dietary intake, and a diet high in energy and protein is encouraged. The aim of this study was to examine the food and nutrient intakes of people having had major upper gastrointestinal surgery, and compare them to current food and nutrient recommendations. Materials and Methods: People having had major upper gastrointestinal rouxeny surgery greater than 6 months ago were recruited. Each person completed a three day food diary and food intakes were compared to the Healthy Food Guide for Australians. Macro and micro-nutrient intakes were compared to the Estimated Average Requirement reference values for Australia and New Zealand. Results: Thirty people were recruited and analysis of dietary intakes indicated inadequate serves of cereals, vegetables, fruit and dairy products compared to recommendations, resulting in below Estimated Average Requirements for many vitamins and minerals. Severely malnourished people, and those having had total gastrectomy surgery, were at greatest risk of not meeting macro and micro-nutrient recommendations. Conclusions: People having had major upper gastrointestinal surgery are encouraged to have a diet high in energy and protein. However this advice seems to be followed at the expense of other food groups, leading to low intakes of many micronutrients. Careful monitoring of dietary intakes and signs of nutrient deficiencies should be included as part of routine follow-up for this group of people. Further research is required to determine whether poor dietary intakes result in clinical deficiencies.

The Importance of Nutrition during Treatment for Oesophageal Cancer—The Patient’s Perspective

Background and Objectives: Nutritional issues are prevalent in patients with oesophageal cancer (OC) across all aspects of treatment, including chemoradiotherapy (CRT) and surgery. There are limited studies investigating nutritional issues faced by people undergoing neoadjuvant or definitive CRT from the patient’s perspective. This study aimed to explore the importance that people with OC place upon nutrition during their treatment which included neoadjuvant or definitive CRT, explore the nutritional issues faced in this patient group and identify areas for improvement of dietetic services. Methods and Study Design: Nine people who had undergone curative treatment for OC in the previous 2 - 25 months participated in semi-structured phone interviews. Interviews were tape-recorded and transcribed verbatim and analysed using an inductive thematic analysis approach. Results: Interviews revealed severe difficulties in food consumption during and following CRT and a period of struggling to adjust eating habits post oesophagectomy. There was significant difficulty in following nutrition advice and, despite participants expressing the importance of nutrition;this was not reflected in attitudes towards weight loss. The medical team significantly influenced the perceptions of some participants in regards to their weight loss. Conclusions: Implications for clinical practice include the need for dietetic services before, during and after treatment for OC, irrespective of treatment type. Patient education regarding detrimental effects of rapid weight loss and effects on body composition is crucial, and this should be consistent from all members of the healthcare team.

Feasibility of Home Jejunal Feeding Following Discharge after Major Gastrointestinal Surgery—A Randomised Controlled Trial

Purpose: Following major upper gastrointestinal surgeries, patients often struggle to eat after discharge from hospital. Home jejunal feeding is a potential nutrition support method, but few studies have explored such practice. The aim of this study is to quantitatively and qualitatively assess the feasibility of home jejunal feeding. Methods: Thirteen people having had major upper gastrointestinal surgeries were recruited and randomised into one of two isocaloric nutrition support interventions;oral supplement (OS) or jejunal feeding (JF), for one month post-discharge at home. Anthropometric, patient-generated subjective global assessment, food intake and quality of life surveys were collected at baseline, one month and three months post-discharge. Qualitative interviews were conducted with 6 participants after the three month review. Results: No statistically significant baseline differences were found between the two groups. At one month post-discharge, median weight loss was found to be significantly greater in OS group compared to JF group, 7.7% (inter-quartile range (IQR) = 7.3) and 0.5% (IQR = 3.5) respectively (p = 0.035). No significant differences were found in other parameters. Qualitative interviews showed positive feelings towards JF, while OS was deemed as not very helpful. Conclusions: This preliminary research shows the use of home JF is feasible when compared to oral nutrition support. This parallels with the limited existing literature, which indicate that JF is clinically beneficial. Larger studies are required to validate clinical and quality of life outcomes.

Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.