Late-Evening Carbohydrate and Branched-Chain Amino Acid Snacks Improve the Nutritional Status of Patients Undergoing Hepatectomy Based on Bioelectrical Impedance Analysis of Body Composition

Kosuke Kobayashi; Junichi Kaneko; Takamune Yamaguchi; Yoshikuni Kawaguchi; Junichi Arita; Nobuhisa Akamatsu; Takeaki Ishizawa; Rie Sekine; Hideaki Ijichi; Naoto Kubota; Kazuhiko Fukatsu; Norihiro Kokudo; Kiyoshi Hasegawa

doi:10.1159/000501452

Late-Evening Carbohydrate and Branched-Chain Amino Acid Snacks Improve the Nutritional Status of Patients Undergoing Hepatectomy Based on Bioelectrical Impedance Analysis of Body Composition

Gastrointest Tumors. 2019 Oct;6(3-4):81-91. doi: 10.1159/000501452. Epub 2019 Aug 29.

Affiliations

¹ Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Clinical Nutrition Therapy, The University of Tokyo, Tokyo, Japan.
³ Surgical Center, The University of Tokyo, Tokyo, Japan.
⁴ National Center for Global Health and Medicine, Tokyo, Japan.

Abstract

Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery.

Methods: Thirty-seven patients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed.

Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery.

Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.

Keywords: Bioelectrical impedance analysis; Colorectal liver metastases; Hepatectomy; Hepatocellular carcinoma; Late-evening snack; Nutritional status.