Discussion
muscle mass, MH, deaths, LBM loss, gastric cancer
INSULIN RESISTANCE, DISEASES, COMPLICATIONS, GASTRIC CANCER
Previous reports theoretically proposed that postoperative administration of BCAA may be effective in preventing muscle catabolism in terms of nitrogen balance [Sufficient energies have been considered to optimize the effects of BCAA on nitrogen (N) retention that may represent suppression of LBM loss [The BCAA (leucine, isoleucine, and valine) are components of skeletal muscle, and they are involved in the promotion of protein synthesis and suppression of its degradation, representing protein anabolism [BCATm (mitochondria type), which encodes the enzyme catalyzing the first step in peripheral BCAA catabolism and BCAA, in blood is high in BCATm knockout mice, in which BFM and BW are decreased even though increased food intake [In the present study, we therefore interpreted the clinical efficacy of BCAAs as actually being confirmed in patients after gastrectomy, since not only LBM was maintained but also BFM was reduced in the BCAA group. We do not consider the reduction in BFM to be an undesirable clinical response, as it is thought to have a favorable effect on decreasing insulin resistance and controlling blood glucose levels.In our study, we demonstrated that our original early postoperative nutritional enhancement regimen may be effective in maintaining muscle mass after gastrectomy. The clinical significance of maintaining of muscle mass after gastrectomy differs in early and advanced gastric cancer. The former is expected to be related to a possible reduction of deaths from other diseases, while the latter is anticipated to provide oncological benefits of improving adherence to adjuvant chemotherapy.Our treatment regimen was able to achieve increasing of LBM at 1 month after gastrectomy, but was not able to maintain this effect until 3 months after gastrectomy. Hence, early postoperative nutritional enhancement alone may not be sufficient for such long-lasting maintenance of LBM staus beyond 3 months after surgery. On the other hand, the possibility of maintaining LBM after 1 month after gastrectomy by nutritional enhancement only in the early postoperative period was herein proposed, hence which could serve as an adjuvant chemotherapy to enhance the effect of adjuvant chemotherapy in advanced gastric cancer. In fact, it has been reported that the LBM loss after gastrectomy is associated with continuation of adjuvant chemotherapy and even affects prognosis [In our current clinical trial, all the patients were required to take part in the postoperative exercise rehabilitation program. In maintaining musculoskeletal health, exercise has been shown to increase the sensitivity of even senescent muscle to the anabolic properties of protein-based nutrition [Our current study still has limitations. First, the patient number was small and the study was conducted at a single institute, however the patients’ number was determined based on the pertinent statistical processes instructed by professional medical statistician (MH). Second, while the patients of this study had few complications, such complications may have affected the final outcomes. Third, our original BCAA-regimen group was different from the control group in terms of fat emulsion and glucose concerntration in addition to BCAA, and the final effect might be obtained by factors other than BCAA.In conclusion, after gastric cancer surgery, a five-day early postoperative intervention of BCAA administration does not significantly suppress the % reduction in LBM at 7 days, but it has a great potential to suppresse the % reduction in LBM at 1 month. Based on these promising study outcomes, we will conduct a multi-institutional larger trial to validate % reduction in LBM at 1 month after gastrectomy for gastric cancer in the near future.