Nutritional Counseling for Patients With Gastric Cancer After Subtotal Gastrectomy: A Randomized Clinical Trial

PURPOSE: Evidence for the effectiveness of intensive nutritional counseling in reducing weight loss among patients who have undergone gastrectomy for gastric cancer is limited. We evaluated the effectiveness of intensive nutritional counseling in reducing weight loss after subtotal gastrectomy. MATERIALS AND METHODS: We conducted a prospective, parallel-assigned, double-blind randomized clinical trial to assess the effectiveness of intensive counseling (IC) compared with simplified counseling (SC) in reducing weight loss among patients who underwent subtotal gastrectomy for early gastric cancer. Patients were randomly assigned to either the IC or SC group between March 2021 and February 2023, with a final follow-up in September 2024. Patients in the IC group participated in an IC program delivered by specialized clinical dietitians. Patients in the SC group received only standard counselling sessions before discharge. The primary outcome was the percentage change in body weight from baseline to 12 months after subtotal gastrectomy. RESULTS: A total of 258 patients were enrolled and randomized (122 in the IC group and 136 in the SC group), with 249 patients (96.5%) completing the 18-month follow-up period. At 12 months postgastrectomy, no statistically significant difference was observed in the percentage change in body weight between the 2 groups (0.09 percentage points; 95% confidence interval, -1.43 to 1.60). Other nutritional factors also showed no significant differences between the groups. CONCLUSIONS: Intensive nutritional counseling did not significantly reduce weight loss among gastric cancer patients after subtotal gastrectomy. Standard dietary counseling may be sufficient for dietary modification, although alternative approaches may be necessary. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04798820.