飲食衛教介入對大腸直腸癌患者的營養狀況及體重流失之影響

Intervention of Dietary Education and Its Effects on Nutritional Status and Weight Loss in Colorectal Cancer Patients

目的：大腸直腸癌（CRCA）病人因疾病進展或接受治療常伴隨腸胃道症狀、進食不足導致營養不良，嚴重時會影響情緒與生活品質。因此，本研究為探討飲食衛教介入對CRCA病人營養狀況及體重流失改善之成效。方法：研究對象為澄清綜合醫院中港分院2013年1月至6月及2014年1月至6月期間接受CRCA手術治療及化學治療的病人，病人於手術治療後先進行營養篩選，開始進食的1-3天內進行飲食衛教介入，收集病人血液（分析白血球、白蛋白、淋巴球）、24小時飲食回憶紀錄及迷你營養評估台灣修定二版（MNA-T2）資料，並於每次營養教育時測量血壓和體位（身高、體重、身體脂肪百分比和腰圍）。結果：整體而言，飲食衛教介入使CRCA病人飲食熱量與蛋白質攝取量在2014年比2013年顯著提升了65％與67％（p<0.001），且病人的體重流失有減緩的趨勢。病人的飲食熱量攝取與蛋白質攝取量呈現顯著正相關（p<0.05），且與血液淋巴球也呈現顯著正相關（p<0.05）。而不同營養師之飲食衛教介入成效並無顯著差異性（p>0.05）。顯示，當病人進食狀況愈好，熱量及蛋白質攝取愈多，淋巴球也愈高。結論：本研究結果證明，手術後及化學治療的CRCA病人在營養衛教介入後，能顯著提升飲食中熱量及蛋白質攝取量，且能延緩體重流失。

Purposes: Colorectal cancer (CRCA) patients often suffer associated gastrointestinal symptoms and malnutrition due to disease progression or treatment, with their quality of life and physical functions affected in severe cases. This study evaluates the effects of dietary education on nutritional status and loss of body weight for CRCA patients. Methods: In a retrospective study, patients from 2013 and the first six months of 2014 who had been treated with CRCA surgery and chemotherapy were investigated. First, those patients after surgery were screened by nutrition, and were given individual nutrition education by a nutritionist from the beginning after surgery to eating 1-3 days later. Additionally, blood was taken (white blood cells, albumin, lymphocyte value analysis), and 24-hour dietary recall records were completed together with the mini nutritional assessment-long form Taiwan revision (MNA-T2) information on the CRCA patient. Blood pressure and body measurements (height, weight, body fat percentage and waist circumference) were also recorded for each dietary education assessment. Results: The overall nutritional status of CRCA patients was improved after dietary education intervention. The total calories and protein intake were significantly improved 65% and 67% (p<0.001), respectively, and there was greater improved effectiveness for patients from 2014 than for 2013. At the same time, all patients showed slower weight loss. The correlation of dietary calories and protein intake showed asignificant positive correlation (p<0.05); and there was a significant positive correlation between the blood lymphocytes (p<0.05). The effectiveness of dietary education intervention was not affected by the dietitian (p>0.05). Conclusions: The results of this study demonstrate that CRCA patients undergoingchemotherapy can significantly increase their post-surgery and dietary calories and protein intake, and weight loss is slowed by dietary education intervention.