Protein-Calorie Malnutrition in Patients with Colorectal Cancer*

JOHN L. ROMBEAU,M.D.,~ STEPHEN L. GOLDMAN, M.D.,$ KEITH N. APELGREN, M.D.S ILDIKO SANFORD, M.D.,w CHARLES 17. FREY, M.D.82

THE PREVALENCEof protein-calorie malnutrition in a d u h hospitalized patients is alarming. P r o t e i n calorie malnutrition has been identified recently as the most widespread type of malnutrition in hospitalized patients~ It has been reported to occur in 50 per cent of surgical patients in a major urban hospital? Protein-calorie malnutrition has been correlated with increased postoperative morbidity that can be prevented by i m p l e m e n t a t i o n of specialized nutritional support such as total parenteral nutrition and dietary supplements, r Protein-calorie malnutrition, although difficult to define, is characterized by abnormalities of visceral protein, skeletal muscle and fat stores. Visceral protein is measured by serum albumin and transferrin. Skeletal muscle is measured by arm-muscle circumference; fat stores are readily approximated from the triceps skinfold thickness. The body weight and percentage weight loss are composite measures of the aforementioned criteria. These tests are readily available and easily performed at the bedside. This report documents the prevalence and types of proteincalorie malnutrition, as m e a s u r e d by the above criteria, in preoperative patients with colorectal cancer. Patients and M e t h o d s

Seventeen consecutive patients admitted to the Surgical Service at the Martinez Veterans Administra* Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, June 11 to 15, 1978. t Staff Surgeon, VA Hospital, Martinez, and Assistant Professor of Surgery, L=niversit? of California, Davis, California. " Resident, Department of Surgery, VA Hospital, Martinez. wChief, Clinical Patholog2/', VA Hospital, Martinez. 82Chief, Surgical Service, VA Hospital, Martinez; Professor and Vice Chairman, Department of Surgery, University of California. Davis. Address reprint requests to Dr. Rombeau: Department of Surgery, Veterans Administration Hospital, 150 Muir Road, Martinez, California 94553.

587

From the Departments of Surger3, and Clinical Patholog;, VA Hospital, Martinez, and the Department of Surgeu, University of California, Davis, California

tion Hospital (MVAH) with biopsy-proven colonic or rectal cancer were prospectively studied. Each patient signed a consent form approved by the MVAH Human Studies Committee prior to parti.cipating in the study. All patients were men. The mean age was 66 years, with a range from 34 to 87 years. The cancer patients were all ambulatory, eating normally, and were judged to be satisfactory operative candidates by their attending surgeons. Patients with known inoperable or advanced metastatic disease were excluded. Forty-seven patients from the MVAH Surgical Outpatient Clinic served as controls. These patients had diagnoses of cutaneous cysts, inguinal hernias, ingrown toenails, and other minor conditions. Outpatients who had diagnoses of internal cancers or problems that might affect their nutritional status were excluded from the control group. T h e following m e a s u r e m e n t s and l a b o r a t o r y examinations were performed on each patient: body height and weight; triceps skinfolds; arm-muscle circumference; serum albumin; serum transferrin; skin test profile consisting of purified protein derivative (PPD), mumps, streptokinase-streptodornase, Candida. Body height was m e a s u r e d against a vertical measuring rod with a headpiece. Body weight was determined on a lever balance scale. Skinfold measurements were obtained with Lange calipers (Cambridge Scientific Industries, Inc., Cambridge, Maryland). Triceps skinfolds were measured by identifying the mid-point between the olecranon and the acromion processes on the nondominant arm and measuring the skin that was pulled gently away from the underlying triceps muscle, The average of three readings was recorded.

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Dis. Col. & Rect.

Nov.-Dec. 1978

ROMBEAU, ET AL.

TABLE 1. Results of Laboratory a'nd Anthropometric Measurements (Mean • SE) Triceps Skinfolds (ram)

Arm Muscle Circumference (crn)

Albumin (g/dl)

Controls (n = 47)

15.0 • 0.8

26.4 • 0.4

4.5 -+ 0.4

216.9 • 5.3

Colorectal cancer (n = 17)

14.8 • 3.8

22.1 •

3.8 • 0.1

179.8 -+ 20.5

Protein-calorie malnutrition in patients with colorectal cancer.

Protein-Calorie Malnutrition in Patients with Colorectal Cancer* JOHN L. ROMBEAU,M.D.,~ STEPHEN L. GOLDMAN, M.D.,$ KEITH N. APELGREN, M.D.S ILDIKO SA...
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