Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2025-01, Vol.129, p.112597, Article 112597
• Main Authors: Tan, Shanjun, Xi, Qiulei, Zhang, Zhige, Yan, Mingyue, Meng, Qingyang, Zhuang, Qiulin, Wu, Guohao
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Cancer surgery; Cancer therapies; Chemotherapy; Clinical outcome; Clinical outcomes; Comorbidity; Dietary Supplements; Disease management; Fatalities; Female; Follow-Up Studies; Gastric cancer; Health risks; Hospitals; Humans; Intervention; Male; Malnutrition; Medical prognosis; Medical screening; Middle Aged; Mortality; Musculoskeletal system; Nutrition; Nutritional risk; Nutritional Status; Nutritional support; Nutritional Support - methods; Patient Discharge - statistics & numerical data; Patients; Postoperative Complications - etiology; Postoperative Complications - mortality; Prospective Studies; Quality of life; Questionnaires; Radiation; Regression analysis; Secondary analysis; Sex; Sex ratio; Statistical analysis; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Subgroups; Surgery; Treatment Outcome
• ISSN: 0899-9007; 1873-1244; 1873-1244
• DOI: 10.1016/j.nut.2024.112597

•Nutritional support after hospital discharge reduced long-term mortality among patients at nutritional risk after gastric cancer surgery.•Nutritional support after hospital discharge improved handgrip strength among patients at nutritional risk after gastric cancer surgery.•The current investigation provides the guarantee of nutritional support after hospital discharge for patients after surgery in cancer management guidelines. Nutritional support after hospital discharge was found to enhance the nutritional condition of patients after cancer surgery. However, the effect of such support on long-term clinical outcomes is controversial. We thus investigated the effect of nutritional support after hospital discharge on long-term clinical outcomes in patients after gastric cancer surgery. This was a secondary analysis on individuals at nutritional risk who underwent gastric cancer surgery and were included in a randomized controlled trial. The intervention group received oral nutritional supplements combined with dietary advice, and the control group received dietary advice alone. The long-term mortality (primary outcome) and other clinical outcomes were compared between the groups. In total, 321 patients were included in this analysis, with a median follow-up duration of 60.5 months. According to the Nutritional Risk Screening 2002 (NRS 2002), the presence of nutritional risk was found to be a significant predictor of death. This association remained independent even after adjusting for age, sex, comorbidity, and American Joint Committee on Cancer stage. The adjusted hazard ratio for mortality increased by 1.30 (95% confidence interval [CI] 1.05–1.60, P = 0.016) for each additional point rise in NRS. During the follow-up, a total of 64 individuals (39.5%) in the intervention group and 81 patients (50.9%) in the control group died. Consequently, the adjusted hazard ratio for mortality between the two groups was 0.69 (95% CI 0.50–0.96, P = 0.026). The results of interaction tests did not yield statistically significant variations in fatality rates across the age, sex, comorbidity, NRS, and American Joint Committee on Cancer stage subgroups. Nutritional support after hospital discharge significantly improved handgrip strength (adjusted coefficient 5.05, 95% CI 3.01–7.08, P = 0.000) in addition to other functional outcomes. Nutritional support after hospital discharge reduced long-term mortality and improved handgrip strength among patients at nutritional risk a