Background and purpose:Malnutrition and deterioration of nutritional status are common in patients after surgery for gastric cancer,especially in the elderly,and severely affect patient prognosis.Studies have shown that oral nutritional supplements(ONS)can improve the nutritional status and clinical outcomes of patients after surgery for gastric cancer with nutritional risk.This study analyzed elderly patients who underwent radical surgery for gastric cancer in a previous randomized controlled trial to explore the impact of ONS on elderly patients after surgery for gastric cancer with nutritional risk.Methods:Patients discharged after gastric cancer radical surgery with nutritional risk who received treatment at Zhongshan Hospital affiliated with Fudan University from January 2017 to December 2018 were selected.The control group received dietary advice three months after discharge,while the ONS group received dietary advice combined with ONS three months after discharge.The weight,body mass index(BMI),hemoglobin,plasma albumin,and chemotherapy tolerance of the two groups were compared three months after discharge.The data for this study was based on a previous randomized controlled trial(ChiCTR2000029708)which had received ethical approval.This study was approved by the Ethics Committee of Zhongshan Hospital Affiliated to Fudan University(B2019-257R2).Results:A total of 125 patients who met the inclusion criteria were finally selected,including 69 in the ONS group and 56 in the control group.After 3 months of intervention,there were no significant differences in weight,BMI,hemoglobin,and plasma albumin levels between the two groups.However,the ONS group showed a significantly smaller decrease in weight change during the intervention period compared to the control group[(2.50±1.60)kg vs(4.24±1.80)kg,P＜0.05].The chemotherapy tolerance of the ONS group was significantly improved compared to the control group,with a decrease in the overall chemotherapy change rate(15.9%vs 41.1%,P=0.002),and fewer patients in the ONS group experienced chemotherapy delays,reduced drug dosages,and discontinuation of chemotherapy than those in the control group.Multivariate analysis showed that body weight,plasma albumin,hemoglobin,NRS2002,and BMI had no significant effect on the normal course of chemotherapy(P＞0.05);only ONS was a significant protective factor,significantly reducing the risk of chemotherapy modification(OR=0.227,P=0.001).Conclusion:ONS helps improve the chemotherapy tolerance of elderly postoperative gastric cancer patients and to some extent enhances their nutritional outcomes.For elderly postoperative gastric cancer patients with nutritional risk,nutritional intervention after discharge has a positive impact on improving clinical outcomes.

Background and purpose:Malnutrition and deterioration of nutritional status are common in patients after surgery for gastric cancer,especially in the elderly,and severely affect patient prognosis.Studies have shown that oral nutritional supplements(ONS)can improve the nutritional status and clinical outcomes of patients after surgery for gastric cancer with nutritional risk.This study analyzed elderly patients who underwent radical surgery for gastric cancer in a previous randomized controlled trial to explore the impact of ONS on elderly patients after surgery for gastric cancer with nutritional risk.Methods:Patients discharged after gastric cancer radical surgery with nutritional risk who received treatment at Zhongshan Hospital affiliated with Fudan University from January 2017 to December 2018 were selected.The control group received dietary advice three months after discharge,while the ONS group received dietary advice combined with ONS three months after discharge.The weight,body mass index(BMI),hemoglobin,plasma albumin,and chemotherapy tolerance of the two groups were compared three months after discharge.The data for this study was based on a previous randomized controlled trial(ChiCTR2000029708)which had received ethical approval.This study was approved by the Ethics Committee of Zhongshan Hospital Affiliated to Fudan University(B2019-257R2).Results:A total of 125 patients who met the inclusion criteria were finally selected,including 69 in the ONS group and 56 in the control group.After 3 months of intervention,there were no significant differences in weight,BMI,hemoglobin,and plasma albumin levels between the two groups.However,the ONS group showed a significantly smaller decrease in weight change during the intervention period compared to the control group[(2.50±1.60)kg vs(4.24±1.80)kg,P＜0.05].The chemotherapy tolerance of the ONS group was significantly improved compared to the control group,with a decrease in the overall chemotherapy change rate(15.9%vs 41.1%,P=0.002),and fewer patients in the ONS group experienced chemotherapy delays,reduced drug dosages,and discontinuation of chemotherapy than those in the control group.Multivariate analysis showed that body weight,plasma albumin,hemoglobin,NRS2002,and BMI had no significant effect on the normal course of chemotherapy(P＞0.05);only ONS was a significant protective factor,significantly reducing the risk of chemotherapy modification(OR=0.227,P=0.001).Conclusion:ONS helps improve the chemotherapy tolerance of elderly postoperative gastric cancer patients and to some extent enhances their nutritional outcomes.For elderly postoperative gastric cancer patients with nutritional risk,nutritional intervention after discharge has a positive impact on improving clinical outcomes.

Trace elements and vitamins are essential micronutrients for metabolism.Micronutrients deficiency results in adverse effects on human body,and brings huge challenge to clinical nutrition therapy.To normalize micronutrients application in clinical practice,European Society for Clinical Nutrition and Metabolism(ESPEN)published ESPENpractical short micronutrient guideline on January 2024.Based on previous version published in 2022,current guideline shortens the interpretation of biochemical and physical mechanisms,focuses on micronutrients deficiency and inflammation,recommends the methods of micronutrients assessment and supplementation in different statuses during clinical practices.This paper summarizes specific recommendations and comments for domestic peers to communicate,and provides reference for the management of micronutrient therapy in China.

Objective:To investigate the influence of nutritional therapy on short-term efficacy of gastric cancer patients with malnutrition after radical gastrectomy.Methods:The prospec-tive randomized control study was conducted. The clinicopathological data of patients with malnutri-tion after radical resection of gastric cancer who were admitted to the Zhongshan Hospital of Fudan University from December 2020 to December 2022 were selected. Based on random number table, all patients were allocated into the nutritional therapy group and the control group. Patients in the nutritional therapy group were given dietary guidance and daily oral nutrition supplements for 90 days after discharge, while patients in the control group were only given the same dietary guidance. Observation indicators: (1) grouping situations of the enrolled patients; (2) follow-up; (3) comparison of nutritional indicators at 90 days after discharge; (4) comparison of inflammation and physical function indicators at 90 days after discharge; (5) comparison of clinical outcome indicators at 90 days after discharge. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(IQR), and non-parameter rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Comparison of ordinal data was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 187 patients were selected for eligibility. There were 131 males and 56 females, aged (65±12)years. Of the 187 patients, there were 95 patients in the nutritional therapy group and 92 patients in the control group, respectively. The gender (male, female), age, cases with cardiovascular complications, cases with respiratory complications, cases with diabetes, surgical methods (partial gastrectomy, total gastrectomy), tumor staging (Ⅰ stage, Ⅱ stage, Ⅲ stage), body mass, body mass index (BMI), skeletal muscle index, albumin (Alb), hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR), 6-minutes walking distance, grip strength were 68, 27, (64±12)years, 21, 4, 7, 59, 36, 17, 27, 51, (59±11)kg, (21.5±3.1)kg/m 2, (42±7)cm 2/m 2, (39±5)g/L, (112±25)g/L, 2.3(8.0), (456±97)m, (29±8)kg in patients of the nutritional therapy group, versus 63, 29, (66±13)years, 22, 3, 9, 56, 36, 14, 24, 54, (58±11)kg, (21.1±2.9)kg/m 2, (42±7)cm 2/m 2, (39±4)g/L, (111±26)g/L, 2.2(8.4), (459±98)m, (29±8)kg in patients of the control group, showing no significant difference in the above indicators between the two groups ( χ2=0.21, t=-1.29, χ2=0.09, 0, 0.35, 0.03, 0.51, t=0.80, 0.85, 0.19, 0.14, 0.16, Z=-0.28, t=-0.17, 0.43, P>0.05). (2) Follow-up. All 187 patients were followed up for 90 days after surgery. During the follow-up period, all patients had good compliance and were able to follow the dietary guidance. Five patients in the nutrition therapy group experienced diarrhea and nausea adverse reactions, which were relieved after symptomatic treatment. No adverse reactions were found in the control group. (3) Comparison of nutritional indicators at 90 days after discharge. The body mass, body mass loss, BMI, skeletal muscle index, Alb, Hb were (58±10)kg, 2(6)kg, (21.0±2.9)kg/m 2, (41±7)cm 2/m 2, (41±4)g/L, (125±18)g/L in patients of the nutritional therapy group, versus (56±10)kg, 3(6)kg, (20.4±2.7)kg/m 2, (39±7)cm 2/m 2, (41±4)g/L, (121±21)g/L in patients of the control group. There were significant differences in body mass loss and skeletal muscle index between the two groups ( Z=-4.70, t=2.39, P<0.05), and there was no significant difference in body mass, BMI, Alb, and Hb ( t=1.30, 1.51, 0.80, 1.32, P>0.05). (4) Comparison of inflammation and body function indicators at 90 days after discharge. The NLR, 6-minutes walking distance, grip strength were 2.1(5.1), (478±99)m, and (33±9)kg in patients of the nutritional therapy group, versus 2.2(5.7), (465±96)m, (30±8)kg in patients of the control group. There was a significant difference in grip strength between the two groups ( t=2.08, P<0.05), and there were no significant difference in NLR and 6-minutes walking distance ( Z=-1.28, t=0.91, P>0.05). (5) Comparison of clinical outcome indicators at 90 days after discharge. The quality of life score and readmission rate were (79±14)points, 4.2%(4/95) in patients of the nutritional therapy group, versus (78±16)points, 6.5%(6/92) in patients of the control group, showing no significant difference in the above indicators between the two groups ( t=0.58, χ2=0.14, P>0.05). Conclusion:Nutritional therapy with daily oral nutrition supplements can improve the short-term nutritional status and body function of patients with malnutrition after radical gastrectomy for gastric cancer.

Malnutrition and dehydration are prevalent in the elderly poplulation, and obesity is also a growing problem, which pose a serious challenge to the nutritional management in geriatrics. In order to better guide clinical practice, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the practical guideline on clinical nutrition and hydration in geria-trics on March 5, 2022. This guideline provides 82 recommendations on clinical nutrition and hydration in geriatrics based on clinical practicability, covering basic problems and general prin-ciples, prevention and treatment of malnutrition/nutri-tional risk, prevention and treatment of specific diseases, as well as prevention and treatment of obesity, along with flow-charts, hoping to be convenient for doctors, nutritionists and nurses to use in clinical practice.

Malnutrition is closely related to clinical outcomes and accurate evaluation of nutritional status is the cornerstone of nutritional therapy. However, consistent diagnostic criteria for malnutrition have been absent for quite a long period. The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced in September 2018 and served as a consensus-based evaluation tool. As per GLIM criteria, evaluation of malnutrition should follow a two-step approach with nutritional screening as the first step and then malnutrition diagnosis assessment and severity grading based on etiologic as well as phenotypic metrics. Since debut, GLIM criteria have been applied in different countries, healthcare settings and populations, showing good accuracy and prognostic value for outcomes such as complications and survival. However, most of the studies are retrospective in nature and high-quality prospective studies are needed to better validate GLIM criteria. The way to steer nutritional interventions based on GLIM criteria is also worth future investigation.

The American Society for Parenteral and Enteral Nutrition (ASPEN) held the annual academic conference online from March 20 to 23,2021. The current hot topics of clinical nutrition were widely discussed on the conference. The authors briefly report and analyze the hot topics of the conference in order to share and exchange with surgical colleagues.

The European Society for Clinical Nutrition and Metabolism held the 43 rd annual academic conference online from September 9 to 14,2021. Based on reports from the con-ference, the authors launched a review on the current hot topics in clinical nutrition.

Cancer cachexia is a complex metabolic syndrome characterized by muscle wasting, fat decomposition, unplanned weight loss, anorexia and immune dysfunction. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity on cancer patients. It increases the symptom burden in patients, affects the quality of their life, ultimately shortens patients' survival. Lucubrating the pathogenesis of cachexia is of great significance to provide rationale treatment guidance. Here we reviewed the research progress on pathogenesis of cancer cachexia, including inflammatory response mediated by TNF-α, IL-1, IL-6 and STAT-3 and abnormal nutrition metabolism, as well as mitochondrial dysfunction.

The European Society for Clinical Nutrition and Metabolism (ESPEN) online released the latest practical guideline on clinical nutrition in cancer on 15th March, 2021. The new practical guideline is shortened from the ESPEN guideline on nutrition in cancer patients in 2017 for easier use in clinical practice and provides 43 recommendations (without changes compared with the previous guidelines), combined with the diagnosis and treatment flow diagram, on general principles of nutritional therapy for cancer patients and individualized nutritional therapy strategies. Therefore, this new practical guideline is a practical tool for all professionals including physicians, dieticians, nutritionists and nurses in clinical practices.