Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2831-2843
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2831
Analysis of nutritional risk, skeletal muscle depletion, and lipid metabolism phenotype in acute radiation enteritis
Chen-Ying Ma, Jing Zhao, Ke-Yan Qian, Zhe Xu, Xiao-Ting Xu, Ju-Ying Zhou
Chen-Ying Ma, Jing Zhao, Ke-Yan Qian, Zhe Xu, Xiao-Ting Xu, Ju-Ying Zhou, Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Author contributions: Ma CY designed the research; Ma CY, Qian KY, and Xu Z performed the research; Zhou JY and Xu XT contributed new reagents tools; Ma CY and Zhao J analyzed the data; Ma CY wrote the paper.
Supported by National Natural Science Foundation of China, No. 81602792; the Maternal and Child Health Research Project in Jiangsu Province, No. F202210; Jiangsu Provincial Medical Key Discipline, No. ZDXK202235; Project of State Key Laboratory of Radiation Medicine and Protection, Soochow University, No. GZK1202101; Suzhou Science and Technology Project, No. SLT201920; Suzhou Science and Technology Development Plan Project, No. KJXW2020008; BOXI Natural Science Cultivation Foundation of China of the First Affiliated Hospital of Soochow University, No. BXQN202107; Zhongguancun Precision Medicine Foundation's Medical and Health Public Welfare Initiative, No. XS-ZGC-0012.
Institutional review board statement: This study was approved by the Hospital Ethics Committee (2016 Ethics Approval No. 100). We certify that the study was performed according to the 1964 Declaration of Helsinki and later amendments.
Informed consent statement: All healthy controls and enrolled patients gave written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The datasets generated and analyzed during the present study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ju-Ying Zhou, MD, Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, China. zhoujuyingsy@163.com
Received: September 14, 2023
Peer-review started: September 14, 2023
First decision: November 2, 2023
Revised: November 15, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: December 27, 2023
Processing time: 104 Days and 4 Hours
Abstract
BACKGROUND

Radiation enteritis, which often occurs during radiation-induced acute intestinal symptoms (RIAIS), is the most common and important complication during radiotherapy for cervical cancer. RIAIS caused by abdominal and pelvic radiotherapy will affect nutrient intake, digestion, absorption, and metabolism, leading to malnutrition or poorer nutritional status. In patients with malignant tumors, malnutrition can adversely affect the curative effect and response of radiotherapy by reducing radiosensitivity, affecting the precision of radiotherapy placement and increasing the incidence of radiotherapy-related adverse reactions.

AIM

To analyze nutritional risk, skeletal muscle depletion, and lipid metabolism phenotype in acute radiation enteritis.

METHODS

Fifty patients with cervical cancer received external beam radiotherapy, and 15 patients received brachytherapy after external beam radiotherapy. Body weight, body composition parameters, nutritional risk screening (NRS) 2002 score, and blood biochemical indices of patients with cervical cancer during periradiation were tested by a one-way repeated measures analysis of variance. Metabolomics analysis was used to identify characteristic lipid metabolism pathways. Clinical factors that affect linoleic acid changes were screened using the generalized evaluation equation.

RESULTS

Among the 50 patients, 37 had RIAIS, including 34 patients with grade 1-2 RIAIS and 3 patients with grade 3 RIAIS. The NRS 2002 score of patients who underwent cervical cancer radiotherapy continued to increase during the periradiation period, and 42 patients who underwent cancer radiotherapy had nutritional deficits (NRS 2002 score ≥ 3 points) at the end of radiotherapy. Correlation analyses revealed that body weight and body mass index changes were closely associated with body fat content (R2 = 0.64/0.51). The results of the univariate analysis showed that radiotherapy time, percentage reduction of serum albumin, and percentage reduction of serum prealbumin were the key factors affecting skeletal muscle exhaustion (P < 0.05). Metabolomic analysis of fecal supernatants of cervical cancer patients during the periradiation period revealed the involvement of linoleic acid, cholic acid, arachidonic acid, and N-acetyl-L-benzene alanine in the metabolic pathway of linoleic acid.

CONCLUSION

Cervical cancer radiotherapy patients faced nutritional risks, decreased serum albumin synthesis, and increased risk of skeletal muscle exhaustion. Linoleic acid was a biomarker of high nutritional risk.

Keywords: Cervical cancer; Metabolomics; Radiation-induced acute intestinal symptoms; Linoleic acid; Nutritional risk

Core Tip: The periradiation period of patients with cervical cancer increases with the time of radiotherapy, and the decrease in serum albumin synthesis increases the risk of skeletal muscle exhaustion. Linoleic acid is a biomarker for patients with radiation-induced acute intestinal symptoms at high nutritional risk. Patients undergoing external irradiation for cervical cancer should undergo regular nutritional risk assessments and individualized nutritional interventions.