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Objective: The purpose of the present study was to investigate whether or not lingering low serum albumin (Alb) disturbed the recovery from locomotion disability induced during the hospitalization in patients with disuse syndrome.
Methods: We recruited patients who had to rest on a bed with fasting after admission and showed Alb of 2.5 g/dL during hospitalization. The patients were eligible for this study, if they could orally eat foods and independently walk at home before admission. Consequently, 108 patients were enrolled in the study and were divided into 2 groups according to their walking ability at discharge. Eighty patients could walk independently in the ward at discharge in group A and the remaining 28 could not walk independently in group B. We measured Alb several times during hospitalization and used the concentrations on admission and at discharge, and the minimum Alb during hospitalization. We compared Alb at the three measurement points between the 2 groups. Logistic regression analysis was performed to determine whether lower serum Alb was an independent limiting factor for walking disability.
Results: The Alb measured at discharge was significantly lower in the group B than in the group A (P < 0.001). Logistic regression analysis showed that lower Alb was an independent limiting factor for walking disability (odds ratio, 6.136; 95% confidence interval, 1.175-32.04; P = 0.031).
Conclusion: Lingering low Alb disturbed the recovery from locomotion disability induced during the hospitalization in patients with disuse syndrome.

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Background: Patients undergoing gastrectomy require effective parenteral nutritional support in the early postoperative period because of inadequate oral intake. The present study examined the feasibility and efficacy of our new clinical pathway (CP) for gastric cancer surgery including peripheral parenteral nutrition composed of lipids,amino acids and glucose in the early postgastrectomy period.
Patients and Methods: For the perioperative management of gastric cancer surgery, a new CP was used for 94 patients (NCP group), while the conventional clinical pathway was used for 91 patients (CCP group). Completion of the CP, postoperative morbidity, length of postoperative hospital stay, change in body weight and nutritional status were retrospectively reviewed and compared between the two groups.
Results: There were no differences in the completion of the CP, postoperative morbidity and length of postoperative hospital stay between the two groups.We were no serious adverse events in the postoperative nutritional management using the new CP group including the fat emulsion daily administration. The decrease in serum albumin level at 1 month after surgery was significantly smaller in the NCP group than the CCP group.
Conclusions: Our new CP including peripheral parenteral nutrition composed of lipids,amino acids and glucose in the early postoperative period is feasible for the perioperative management of patients after gastric cancer surgery, and would improve postoperative body weight loss and nutritional status.

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Objective: The objectives of this study were to investigate the prevalence of malnutrition in convalescent rehabilitation wards in Japan and to investigate whether malnutrition affects activities of daily living (ADLs) and the discharge outcome.
Method: This study included 230 elderly patients (111 males and 119 females). Their average age was 78.7 ± 7.5 years. Of the 230 patients, 134 suffered from stroke, 47 from musculoskeletal disorders, 14 from disuse syndrome, and 35 from other ailments or diseases. These patients were discharged from 9 rehabilitation hospitals in February 2012. Age, sex, primary disease, type of nutritional support, nutritional status, anthropometric data, laboratory data, discharge outcome, Functional Independence Measure (FIM) on admission, and FIM at discharge were analyzed.
Results: A total of 43.5% of subjects were defined as malnourished according to the Geriatric Nutritional Risk Index (GNRI). The FIM of malnourished stroke patients was lower than that of well-nourished patients (p < 0.01). Multiple regression analysis revealed that the degree of malnutrition and FIM on admission were significantly correlated with FIM at discharge (R² = 0.734). The degree of malnutrition was also negatively correlated with rate of home discharge (odds ratio = 0.580).
Conclusion: This study suggests a high prevalence of malnutrition in convalescent rehabilitation wards and a negative correlation of malnutrition with improvement of ADLs and rate of home discharge. These findings indicate that it is important that nutritional assessment must be undertaken early in convalescent rehabilitation wards in Japan.

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Objective: We conducted a study of the self-selection of postoperative diets after gastrectomy to evaluate with respect to patients’ choices, safety, energy intake and nutritional parameters.
Methods: 75 patients after gastrectomy (including 10 with total gastrectomy) were assigned to a program in which they selected their own diets from liquid-formula, thin rice porridge, thick rice porridge, soft-cooked rice and regular diet from postoperative day 2 to the day of discharge, and were compared with patients receiving a conventional step-by-step dietary management (n=25) in terms of their energy intake, body weight changes and blood test results as nutritional parameters.
Results: Of 75 patients, 69 completed the program. More than 75% of these patients chose the thin rice porridge or more solid diet on postoperative day 2. As compared with the conventional group, the self-selection group had a significantly higher energy intake on postoperative days 1-5 and a significantly smaller rate of weight reduction at 1 month postoperatively, but showed no marked differences in blood test results or body weight at 6 months postoperatively.
Conclusion: These results suggest that the self-selection of postoperative diets can be performed safely in appropriately selected patients, and that the increased energy intake during the first week after gastrectomy may prevent early postoperative weight reduction, especially the lean body weight.

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Purpose: To evaluate effect of a short-time infusion of semi-solid nutrients (SSN) made out of ordinary foodstuffs by a mixer for gastrostomy patients, regarding improvement of quality of life (QOL) of the patients and caretakers.
Methods: Between July 2008 and February 2013, a short-time infusion (2 to 3 min/50ml) of SSN was introduced to 66 gastrostomy patients, and they were divided into two groups; only SSN was used in Group 1 (N=21), and SSN and liquid nutrients were used in Group 2 (N=45). The results were analyzed by a retrospective chart review.
Results: After the introduction of SSN, total time of feeding was shortened from 8.0 hrs to 1.2 hrs a day in Group 1 and from 6.9 hrs to 3.2 hrs in Group 2. The number of patients passing watery or loosely formed stool decreased from14 to 3 in Group 1 and from 24 to 7 in Group 2. On the other hand, the number of patients who passed well-formed stool increased from 2 to 12 in Group 1, and from 11 to 26 in Group 2, after the introduction of SSN. There were no significant differences in the occurrence of the beneficial effects between the two groups.
Conclusion: The short-time infusion of SSN decreased the total time of daily gastrostomy nutrition and changed the watery or loosely formed stool to well-formed stool. By these effects, it improved QOL of the patients and caretakers. The favorable effects were obtained similarly in the patients who used SSN alone and a combination of SSN and liquid nutrients.

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Background: The aim of this study is to investigate how physical activity and aging impact on resting energy expenditure (REE) and body composition.
Patients and Methods: Firstly, to investigate the impact of physical activity,30 subjects with the age of fifties were recruited in this study (10: healthy people (55.1±5.7), 11: outpatient (54.5±9.2), 9: inpatient (54.0±5.7)). Secondly, to investigate the impact of aging, 128 subjects were recruited and divided into 6 groups at age as follows;<70 ys. old: 18 outpatients,29 inpatients, 70 〜 80 ys.old: 8 outpatients, 21 inpatients, 80 ys. old ≤ : 4 outpatients,48 inpatients. Indirect calorimetry and bioelectrical impedance analysis (BIA) were conducted for all subjects to measure REE and body composition, respectively. The relationship between REE and skeletal muscle mass indices (SMM) was analyzed and those parameters were compared each group statistically.
Results: In the investigation of the impact of physical activity, there was stronger correlation in healthy people groups between REE and SMM among three. Regarding with the aging, almost all SMM in more than 80 ys. old inpatient group were significantly lower than those of other groups. There was a significant correlation between REE and SMM in outpatients and inpatients less than 70 ys. old groups, whereas no significant correlation among them in more than 80 ys. old inpatient group.
Conclusions: The calculational basal metabolism in more than 80 ys. old inpatient group was quite low due to the lower body weight than expected, which differed from REE considerably. Therefore, indirect calorimetry and BIA are useful to calculate the energy requirement of the patient aged over eighties with decreased SMM.

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