P-P51 Assessing the severity of pre and post-operative malnutrition in cancer patients undergoing pancreaticoduodenectomy: A review of a virtual dietetic prehabilitation service

Background The prevalence of malnutrition amongst pancreatic cancer patients is widely reported. This is due to reduced nutritional intake, increased energy expenditure and increased nutrient losses secondary to malabsorption. A Whipple's procedure or pancreaticoduodenectomy is the only potentially curable intervention for pancreatic cancer patients. Malnutrition is associated with increased peri and post-operative complications including delayed wound healing, longer hospital admission and higher mortality rate. Dietetic prehabilitation is a proactive intervention to assess patients’ nutritional status in preparation for elective surgery and, through early dietetic intervention, has the potential to improve perioperative outcomes. This pilot study reviewed the severity of nutritional risk in both the pre and post-operative stages to understand the need for dietetic prehabilitation in this patient group. Methods All patients referred were nutritionally assessed as part of a dietetic cancer prehabilitation pathway, which includes pre-surgical nutritional assessment within one week of referral and early post discharge nutritional assessment. Nutritional assessment was carried out using the PG-SGA short form and patients were triaged as requiring either a universal, targeted or specialist dietetic intervention dependent on severity of nutritional risk. Patients who scored <4 were triaged as universal, and were low nutritional risk. Patients who scored 5-9 were triaged as targeted and were medium nutritional risk, and patients who scored >9 were triaged as specialist, and were high nutritional risk. Results 35 patients were referred for dietetic prehabilitation assessment. 71% of patients were triaged as requiring either a targeted or specialist prehabilitiation intervention. BMI ranged from 15.7kg/m² to 35.9kg/m² and median weight loss was 10.0%. 23 patients received early post surgical nutritional assessment, within 12 days of discharge from hospital. All 23 patients required targeted or specialist dietetic intervention. 22 patients reported post-operative weight loss, with a median weight loss of 7.5%. There was no correlation between pre-surgical and post-surgical nutritional risk. Conclusions Patients undergoing pancreaticoduodenectomy are at high nutritional risk in both the pre and post-operative periods. Patients without evidence of malnutrition in the pre-operative stage remain at high risk of malnutrition and the associated complications in the post operative stage. A prehabilitation programme can identify patients at nutritional risk and institute interventions to optimise perioperative nutritional status. Findings from this review will form the basis of a study examining the effects of a prehabilitation programme on outcomes following pancreaticoduodenectomy.

Impact of Dietetic Intervention on Metabolic Syndrome Patients Attending Diet Therapy Clinic: A prospective, Single-Arm Intervention Study

INTRODUCTION: The prevalence of metabolic syndrome (MetS) is rising globally. Dietetic intervention, as part of a multidisciplinary team approach, is increasingly being recommended for the effective management of patients with MetS. This study was designed to assess the impact of a dietetic intervention on MetS characteristics of patients attending the Diet Therapy Clinic at Tema General Hospital, Ghana. METHODOLOGY: A prospective pre-post single-arm intervention study was conducted among 168 participants who had been diagnosed with MetS and were referred to the Diet Therapy Clinic for dietetic intervention. Data on body mass index (BMI), waist circumference (WC), fasting blood glucose (FBG), high-density lipoprotein (HDL), serum triglyceride (TG), and blood pressure (BP) were collected at baseline and after three months of receiving a dietetic intervention. RESULTS: The MetS measures (BMI, WC, FBG, HDL and TG) of the patients improved at the end of the three months period (32.9 kg/m2 vs 31.7 kg/m2, p = 0.001; 101.2 cm vs 98.9 cm, p = 0.001; 11.0 mmol/L vs 7.7 mmol/L, p = 0.001; 1.1 mmol/L vs 1.2 mmol/L, p = 0.001; 2.0 mmol/L vs 1.9 mmol/L, p = 0.001 respectively). There were improvements in the mean systolic and diastolic BP values recorded after the three months (153 mmHg vs 131 mmHg, p = 0.001 and 98 mmHg vs 85 mmHg, p = 0.001 respectively). CONCLUSION: Dietetic intervention was found to have improved the MetS characteristics of patients.

Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial

IntroductionEuropean Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention.MethodsIn this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA),Results96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention.ConclusionA large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.