DOI: https://doi.org/10.14710/jnc.v14i3.48773

COMPREHENSIVE NUTRITIONAL THERAPY ON A 60-YEAR-OLD MALNOURISHED MALE PATIENT WITH PULMONARY ADENOCARCINOMA AND ESOPHAGEAL STENOSIS

1Post Graduate Student, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia

2Clinical Nutrition Department of Bali Mandara Public Hospital, Denpasar, Bali, Indonesia

Received: 1 Jan 2025; Revised: 16 Feb 2025; Accepted: 17 Feb 2025; Available online: 30 Jul 2025; Published: 30 Jul 2025.

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Abstract

Background: Pulmonary adenocarcinoma with esophageal stenosis can trigger severe malnutrition due to catabolism, inflammation, and anabolic resistance compounded by impaired oral intake.

Objective: To Describe the nutritional challenges and impact enteral nutrition strategy used, evaluate its impact on body weight, nutritional status and functional capacity. Evidence based nutritional support
Method: The Subject was selected based on unique clinical feature. Malnourished patient’s journey with pulmonary adenocarcinoma and esophageal stenosis enteral nutrition via a gastrostomy tube. 60-year-old male with Shortness of breath, cough and throat obstruction causing vomiting and difficulty swallowing. Biomarker complete blood count, electrolyte test, body weight changes, BMI, Barthel index scale. Weight loss exceeding 10kg within three months, required assistance for daily activities. Examination severe loss of subcutaneous fat and muscle mass, Bedridden status. Body weight of 54kg, height 172cm, BMI of 18,25kg/m². Laboratory indicated anemia and hyponatremia RBC (3.70 x 10^6/µL), HGB (7.8 g/dL), HCT (26.2%), MCV (70.8fL), MCH (21.1pg), MCHC (29.8g/dL), and Na (121mmol/L). Diagnosed in January 2024 with pulmonary adenocarcinoma with esophageal stenosis, necessitating gastrotomy tube. Nutritional intervention adjustments from oral to enteral feeding formulas and caloric targets. Gradual increase nutritional therapy, initial target of 40kcal/kg and 1.3g protein/kg, providing 2160kcal and 85g protein daily. The diet began at 15 kcal/kg, with supplementation. Follow-ups reaching 2560kcal and 100g protein. Assessment since July 6 until October 14. Location at Bali Mandara Hospital.

Results: Weight gain 54 kg to 61 kg. an increase in caloric intake to 2500 kcal/day, tolerated enteral feeding well, without complication. Improved energy, improve functional capacity, better lab values, preparing him for radiotherapy. Caloric escalation countering anabolic resistance. Protein intake stimulates muscle synthesis. Omega-3fattyacids reduce inflammation, Zinc support immunity, Vitamin B6 support hematopoiesis, VCO quick energy for hypermetabolism.

Conclusion: Comprehensive nutritional therapy with supplementation improved nutritional status and stabilized metabolic state in this patient.

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Keywords: malnutrition; pulmonary adenocarcinoma; esophageal stenosis; nutritional therapy

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