胃がん術後患者の栄養状態回復と，摂食行動および心理社会的要因との関連に関する研究―その3．身体計測による栄養状態回復評価指標の検討

Relationship among Recovery of Nutritional Status, Dietary Behavior, and Psychosocial Factors in Patients after Gastrectomy for Cancer of the Stomach：Part 3. Assessment of the Anthropometric Indicators for Evaluation of Recovery of Nutritional Status

要旨

　胃がん術後患者の栄養状態回復評価として，どの身体計測値を重視すべきかを明らかにするために，再発徴候のない患者64例を退院1年後まで追跡し，体重および上腕計測値の推移を調べて，退院後の摂食量，体重回復希望との関連を検討し，以下の知見を得た．

1．胃がん術後患者の体重回復は不良で，退院後半年以降はほとんど変化がなかった．退院後，TSFは顕著な減少を示したが，AMCは僅かに増加していた．

2．退院半年後の摂食量は術前の73％と減少し，各計測値の半年後の低下を裏づけていた．

3．体重回復希望は％体重が低いほど強く，回復希望有無の分岐点はほぼ85％と推定された．

4．半年後の％体重が86％以上の群では，％体重と％AMCの平均値は90％以上を維持していた．％体重が85％以下の群では，％AMCは89％であったが，TSFの枯渇が顕著で，それが％体重の低下に反映し，％体重と％AMCの値の解離が大きかった．

5．％AMCは筋力と関連するため日常生活遂行上重要なこと，体重の変化は，TSF，AMC両者の変化により相殺されることから，回復評価にはAMCを重視すべきことが示された．

Abstract

　The purpose of this study was to investigate which anthropometric measurement to focus on as an indicator of recovery of nutritional status in patints after gastrectomy for the cancer of the stomach. 64 patients with no signs of recurrence were followed for one year after discharge from the hospital, and changes in their body weight (BW) and upper arm measurements were assessed in relation to the amount of food intake and their desire to recover BW.

　The findings were as follows:

1. The postoperative recovery of BW was poor, with almost no change in BW from 6 months after discharge. TSF decreased markedly after dischange, while AMC increased only slightly.

2. Food intake had decreased to 73% of preoperative levels 6 months after discharge, and was consistent with decreased anthropometric measurements at that time.

3. Patient desire to recover BW was greater in those with lower %BW; the critical point for the presence of a desire to recover BW was estimated to be approximately 85%.

4. Among patints with 86% or higher levels of %BW after 6 months, both average of %BW and %AMC were maintained at levels of more than 90%. In those with %BW less than 85%, %AMC was approximately 89%, however, depletion of TSF was remarkable, which was reflected in a lower %BW, contributing to a divergence between %BW and %AMC.

5. Considering that %AMC is related to muscle strength and consequently important to activities of daily livilng, and that changes in BW are compensated for by depletion of TSF and regain of AMC, the above findings indicate that AMC should be given greater importance in the assessment of recovery.