Abstract
BackgroundChronic radiation enteritis (CRE) is defined as loss of absorptive capacity after irradiation due to chronic inflammation and damage of intestinal mucosa, which may lead to varying degrees of malnutrition. The aim of this study was to evaluate the potential correlation between the nutritional status and systemic inflammation in patients with CRE.MethodsMedical records of 92 patients with CRE and 184 age- and sex-matched controls in a single center from January 2010 to October 2015 were retrospectively reviewed. All enrolled subjects underwent nutritional status analysis, including three different nutritional indices: Nutritional Risk Screening-2002 (NRS-2002), Patient-generated Subjective Global Assessment (PG-SGA) and Controlling Nutritional Status (CONUT), bioelectrical impedance spectroscopy (BIS), and biochemical markers, within 24 h of admission.ResultsThe results showed that NRS-2002, PG-SGA and CONUT were all positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.304, 0.384 and 0.425, all p < 0.001) and C-reactive protein (CRP) (r = 0.357, 0.479 and 0.230, all p < 0.001), while negatively correlated with albumin (r = −0.612, −0.727 and −0.792, all p < 0.001) and total cholesterol (TC) (r = −0.485, −0.545 and −0.473, all p < 0.001) in patients with CRE, respectively. Body cell mass (BCM) has been deemed a key body composition parameter. It was positively correlated with albumin (r = 0.489, p < 0.001) and TC (r = 0.237, p < 0.001), while negatively correlated with NLR (r = −0.140, p = 0.02) and CRP (r = −0.215, p < 0.001). A multivariate linear regression analysis showed that values of intracellular water (β coefficient = 0.760, p < 0.001), extracellular water (β coefficient = 0.006, p = 0.011), protein (β coefficient = 0.235, p < 0.001) and CRP (β coefficient = 0.001, p = 0.009) were independent determinants of BCM.ConclusionThis study revealed that BIS combined with nutritional assessments and biochemical markers were appropriate methods to assess the nutritional and inflammatory status in patients with CRE. Furthermore, the nutritional status was verified to be significantly correlated with systemic inflammation.
Highlights
Chronic radiation enteritis (CRE) is defined as loss of absorptive capacity after irradiation due to chronic inflammation and damage of intestinal mucosa, which may lead to varying degrees of malnutrition
There were no differences between the two groups in terms of age (53 ± 11.54 vs. 52.98 ± 11.51 years, p = 0.998) and height (161.96 ± 8.06 vs. 161.21 ± 7.28 cm, p = 0.440), while the results showed that patients with CRE had lower values of body weight (45.68 ± 8.68 vs. 63.79 ± 11.55 kg, p < 0.001) and Body mass index (BMI) (17.39 ± 2.67 vs. 24.44 ± 3.42 kg/m2, p < 0.001) than those in the healthy control group
The results demonstrated that patients with CRE had significantly lower values of fat-free mass (FFM) (38.18 ± 7.38 vs. 45.50 ± 8.43 kg, p < 0.001), fat mass (FM) (7.45 ± 4.77 vs. 18.30 ± 5.64 kg, p < 0.001), Body cell mass (BCM) (23.86 ± 4.77 vs. 31.42 ± 5.99 kg, p < 0.001), intracellular water (ICW) (16.66 ± 3.34 vs. 22.44 ± 4.28 kg, p < 0.001), TCW (28.13 ± 5.41 vs. 33.51 ± 6.26 kg, p < 0.001), protein (7.16 ± 1.48 vs. 8.98 ± 1.71 kg, p < 0.001), mineral (2.88 ± 0.64 vs. 3.01 ± 0.45 kg, p = 0.048) and a slightly higher value of extracellular water (ECW) (11.51 ± 2.25 vs. 11.06 ± 2.05 kg, p = 0.094) than those in the control group
Summary
Chronic radiation enteritis (CRE) is defined as loss of absorptive capacity after irradiation due to chronic inflammation and damage of intestinal mucosa, which may lead to varying degrees of malnutrition. Radiation enteritis (RE) is defined as inflammation and damage of intestinal mucosa by short exposure to radiation at the abdomen and pelvis level, which can be subdivided into acute (ARE) and chronic radiation enteritis (CRE). Because of insufficient intestinal mucosa for nutrition absorption, most CRE patients suffer from mild, moderate or severe malnutrition [3]. Acute inflammation may resolve and develop into a more chronic state with arteriolar endarteritis and fibrosis. This progressive vasculitis causes intestinal ischemia that in turn leads to mucosal friability and neovascularization as well as an exaggerated submucosal fibrosis
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