Disease-related malnutrition Energy balance, body composition and functional capacity in patients on oral nutritional support after major upper gastrointestinal surgery

.................................................................................................................................................................3 SAMMANFATTNING ..................................................................................................................................................5 LIST OF PAPERS .......................................................................................................................................................7 TABLE OF CONTENTS .............................................................................................................................................8 ABBREVIATIONS ..................................................................................................................................................... 10 INTRODUCTION ....................................................................................................................................................... 11 DISEASE RELATED MALNUTRITION ................................................................................................................. 12 DEFINITION OF DRM................................................................................................................................................ 12 DIAGNOSING DRM................................................................................................................................................... 14 IDENTIFICATION OF DRM......................................................................................................................................... 15 PREVALENCE OF DRM ............................................................................................................................................. 15 CONSEQUENCES OF DRM......................................................................................................................................... 16 NUTRITION CARE PROCESS ....................................................................................................................................... 16 NUTRITION THERAPY IN DRM.................................................................................................................................. 18 BODY COMPOSITION AND ENERGY METABOLISM...................................................................................... 22 BODY WEIGHT .......................................................................................................................................................... 22 BODY COMPOSITION ................................................................................................................................................. 22 TOTAL BODY SKELETAL MUSCLE MASS .................................................................................................................... 24 TOTAL ENERGY EXPENDITURE.................................................................................................................................. 24 RESTING ENERGY EXPENDITURE............................................................................................................................... 26 THERMIC EFFECT OF FOOD........................................................................................................................................ 26 PHYSICAL ACTIVITY ENERGY EXPENDITURE ............................................................................................................. 27 DIETARY INTAKE ...................................................................................................................................................... 27 ENERGY BALANCE .................................................................................................................................................... 29 UPPER GASTROINTESTINAL CANCERS .......................................................................................................... 31 GASTRIC CANCER ..................................................................................................................................................... 31 OESOPHAGEAL CANCER............................................................................................................................................ 32 PANCREATIC CANCER ............................................................................................................................................... 32 MAJOR UPPER GASTROINTESTINAL SURGERY, NUTRITIONAL STATUS AND OUTCOME ............. 33 AIMS OF THE STUDY.............................................................................................................................................. 35 OVERALL DESIGN AND METHODS .................................................................................................................... 36 STUDY POPULATIONS........................................................................................................................................... 37 METHODS .................................................................................................................................................................. 38 BODY WEIGHT .......................................................................................................................................................... 38 BODY COMPOSITION ................................................................................................................................................. 38 SKELETAL MUSCLE MASS ......................................................................................................................................... 39 ENERGY METABOLISM .............................................................................................................................................. 39 FUNCTIONAL CAPACITY............................................................................................................................................ 43 ORAL NUTRITIONAL THERAPY ................................................................................................................................. 43 STATISTICS ............................................................................................................................................................... 46 RESULTS ................................................................................................................................................................... 47 SUBJECTS ................................................................................................................................................................. 47 BODY WEIGHT .......................................................................................................................................................... 50 BODY COMPOSITION ................................................................................................................................................. 52 ENERGY METABOLISM .............................................................................................................................................. 53 SKELETAL MUSCLE MASS ......................................................................................................................................... 56 FUNCTIONAL CAPACITY............................................................................................................................................ 57