Evaluation of Nutritional Index in Postoperative Management after Digestive Organ Surgery

Yuichi Shimazu, Kazuaki Sasaki, Hajime Takasaka, Ken Tarumi, Tamotsu Tsutsui, Mitsuhiro Mukaiya, Kazuhiro Suzuki, Morio Tozuka, Koichi Hirata

First Department of Surgery, Sapporo Medical College

Postoperative (PO) nutritional management is an important factor in improvement of surgical treatment. Hitherto, nitrogen balance (N.B.) was conventionally used as the most reliable index. To evaluate the validity of other parameters during the postoperative period, we investigated the relationship between N.B and various nutritional indices in 48 patients undergoing alimentary tract operations. The results were as follows. Total protein level (r=0.393, p<0.01), transferrin (r=0.358, p<0.02) and Δ retinol binding protein (RBP) (r=0.493, p<0.01) on day 7 PO had a significant correlation with N.B. But albumin, prealbumin, peripheral lymphocyte count, total cholesterol, creatinine height index and anthropometric measurement exhibited no correlation. Urinary 3-methylhistidine (3 Mehis) excretion had a significant negative correlation with N.B. (r=-0.494, p<0.01), however, the 3 Mehis/creatinine ratio showed no correlation. RBP on PO day 3 had a significant correlation with N.B. (r=0.367, p<0.05). From these findings, it can be concluded that rapid turnover proteins, especially RBP whose half life is about 12 hours, and 3 Mehis excretion, reflecting muscle protein breakdown, are of great clinical value in nutritional assessment in the postoperative state, because both indices appear to indicate protein turnover of a short interval.

Key words
postoperative nutritional management, index of nutritional status, nitrogen balance, urinary 3-methylhistidine excretion, rapid turnover protein

Reprint requests
Yuichi Shimazu First Department of Surgery, Sapporo Medical College
S-1 W-16, Chuo-ku, Sapporo, 060 JAPAN

Accepted
November 20, 1991

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