J.Jpn. Surg. Soc.. 92(11): 1552-1562, 1991

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Original article

THE EFFECT OF VARIOUS COMPOSITIONS OF TPN ON NUTRITIONAL
AND IMMUNOLOGICAL ASSESSMENT IN PATIENTS
WITH ESOPHAGEAL CANCER

The purpose of this clinical study was to determine 1) whether high calorie diet gives any advantages for nutritional assessment and immunological furictions after eliophagectomy, 2) whether BCAA is useful to improve immunological parameters postoperatively and 3) which energy source is mainly utilized, fat or glucose, postoperatively.
To accomplish the purpose of this study, three experiments were carried out. The subjects were 210 patients with esophageal cancer. Exp.1 : Either high (over 40kcal/kg/day) or low (under 35kcal/kg/day) calorie diet was administered postoperatively. Exp.2 : 30% BCAA versus 22.6% BCAA diet was compared under high calorie diet. Exp.3 : 24% fat versus 13% fat diet was compared, giving high calorie diet with 30% BCAA.
Nutritional assessment was done by postoperative performance nutritional index, fatty acid analysis, energy expenditure, nitrogen balance and A-V difference of alanine and glutamine, and also immunological function by PHA, lymphocytes, NK activity of lymphocyte and leu 7 positive cells.
Regardless of composition of TPN, high calorie diet improved nutritional assessment and immunological functions. A-V difference and fat combustion were improved with high fat diet in postoperative courses.
It was concluded that high calorie diet with 30% BCAA and 24% fat was beneficial after esophagectomy.

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