Analysis of the trajectory and influencing factors of postoperative nutritional literacy changes in gastric cancer patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Ying , WU Xiaojuan , FAN Jingjing , HONG Pei ,  XIAO Peihua

Department of General Surgery, Suzhou Ninth People’s Hospital, Suzhou, Jiangsu 215200, P. R. China;

Corresponding?author：

XIAO Peihua, Email: xph22@163.com

Keywords：

gastric cancer; nutritional literacy; change trajectory; influencing factor

DOI：

10.7507/1007-9424.202510047

Video：

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Objective To explore the latent classes of the change trajectory of postoperative nutritional literacy in gastric cancer patients, and to analyze its influencing factors. Methods A total of 243 patients with primary gastric cancer who underwent radical gastrectomy for gastric cancer in the Department of General Surgery of Suzhou Ninth People’s Hospital from January 2023 to March 2025 were selected by convenience sampling. The basic data of patients were collected by general information table and Herth hope scale. The nutritional literacy questionnaire was used to evaluate the nutritional literacy of patients on the day of discharge (T0), 1 month after surgery (T1), 3 months after surgery (T2), and 6 months after surgery (T3). Using latent growth mixture model to identify the latent categories of changes in nutritional literacy trajectory, and explore the influencing factors of postoperative nutritional literacy changes in gastric cancer patients through unordered multi-class logistic regression analysis. Results A total of 202 gastric cancer patients completed this study, and their nutritional literacy scores at T0, T1, T2 and T3 were (19.06±1.63), (20.60±2.17), (22.04±2.91) and (23.36±3.57) points respectively, the points were gradually increasing over time (F=96.912, P<0.001). Latent growth mixture model fitting identified three valid latent classes: low literacy-stable group (38 cases), medium literacy-slow increase group (104 cases) and medium literacy-rapid increase group (60 cases). A multi-class logistic regression analysis was conducted using the medium literacy-slow increase group as a control, which showed that: ① older age (OR=1.105, P=0.015), no participation in internet nutrition intervention (OR=3.496, P=0.003), lower Herth hope scale score (OR=0.832, P=0.042) were associated with the formation of low literacy-stable trajectory in patients with gastric cancer after surgery. ② High educational attainment (OR=0.417, P=0.021), presence of nutritional risk before surgery (OR=2.330, P=0.017), higher Herth hope scale score (OR=1.151, P=0.035) were associated with the formation of a medium literacy-rapid increase in gastric cancer patients after surgery. Conclusions There is group heterogeneity in postoperative nutritional literacy among gastric cancer patients and medical staff should take targeted measures to improve patients’ nutritional literacy based on the group characteristics and influencing factors of the patient’s nutritional literacy change trajectory.

Citation： WANG Ying, WU Xiaojuan, FAN Jingjing, HONG Pei, XIAO Peihua. Analysis of the trajectory and influencing factors of postoperative nutritional literacy changes in gastric cancer patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(3): 354-361. doi: 10.7507/1007-9424.202510047 Copy

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2.	許兆萬, 董博. 胃癌胃切除術后微量營養素缺乏癥的研究進展. 中國普外基礎與臨床雜志, 2024, 31(9): 1135-1140.
3.	Kim GH, Choi KD, Ko Y, et al. Impact of comorbidities, sarcopenia, and nutritional status on the long-term outcomes after endoscopic submucosal dissection for early gastric cancer in elderly patients aged ≥ 80 years. Cancers (Basel), 2021, 13(14): 3598. doi: 10.3390/cancers13143598.
4.	Chen WZ, Zhang XZ, Zhang FM, et al. Coexistence of GLIM-defined malnutrition and sarcopenia have negative effect on the clinical outcomes in the elderly gastric cancer patients after radical gastrectomy. Front Nutr, 2022, 9: 960670. doi: 10.3389/fnut.2022.960670.
5.	Yang L, Cui Y, Du J, et al. Association between nutritional literacy and nutrition label use in Chinese community residents. Front Nutr, 2024, 11: 1380310. doi: 10.3389/fnut.2024.1380310.
6.	夏娟, 唐振闖, 余金明, 等. 癌癥幸存者營養素養水平現狀分析. 中國食物與營養, 2024, 30(12): 62-67.
7.	廖芬, 靳峰妮, 石婷娟. 運城地區腫瘤患者營養狀況調查及營養素養影響因素分析. 公共衛生與預防醫學, 2025, 36(2): 156-160.
8.	Guo Y, Chen Y, Miao X, et al. BMI trajectories, associations with outcomes and predictors in elderly gastric cancer patients undergoing radical gastrectomy: a prospective longitudinal observation study. J Cancer Surviv, 2025, 19(2): 468-478.
9.	Mara CA, Carle AC. Understanding variation in longitudinal data using latent growth mixture modeling. J Pediatr Psychol, 2021, 46(2): 179-188.
10.	Hersberger L, Bargetzi L, Bargetzi A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr, 2020, 39(9): 2720-2729.
11.	王艷華. 中文版Herth希望量表用于癌癥病人的可行性研究. 護理研究, 2010, 24(1): 20-21.
12.	吳文娟, 劉嘉斌, 劉娟. 癌癥復發恐懼感對乳腺癌患者希望水平的影響: 一項基于心理復原力、自我倡權能力的鏈式中介模型. 現代醫學, 2024, 52(5): 737-743.
13.	陳圓圓, 楊春軍, 王冬梅, 等. 營養素養評價工具的漢化及在糖尿病患者中的信效度研究—基于CTT和Rasch模型的分析. 中國全科醫學, 2020, 23(26): 3342-3347.
14.	夏娟, 邵劍, 朱文宇, 等. 癌癥幸存者營養素養測評量表的編制及信效度檢驗. 中華全科醫學, 2024, 22(12): 2124-2128.
15.	Lv J, Li X, Li X, et al. Insufficient enteral nutrition is an independent risk factor for poor clinical outcomes in gastric cancer patients following radical gastrectomy. Am J Transl Res, 2025, 17(1): 320-329.
16.	王新濱, 邢方洲, 張連達, 等. 術前NRS 2002評分與胃癌患者腹腔鏡術后并發癥及短期預后的相關性分析. 中國腫瘤外科雜志, 2025, 17(6): 583-587.
17.	Zhang J, Li D, Yan J, et al. Factors influencing nutrition literacy in patients of colorectal cancer: a cross-sectional study. Front Nutr, 2025, 12: 1526388. doi: 10.3389/fnut.2025.1526388.
18.	Kim D, Lee MK. Effectiveness of postoperative dietary intervention in patients with gastric cancer who underwent gastrectomy: quasi-experimental study design. Semin Oncol Nurs, 2025, 41(1): 151797. doi: 10.1016/j.soncn.2024.151797.
19.	Meng Q, Tan S, Jiang Y, et al. Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer: a randomized clinical trial. Clin Nutr, 2021, 40(1): 40-46.
20.	Silva P, Araújo R, Lopes F, et al. Nutrition and food literacy: framing the challenges to health communication. Nutrients, 2023, 15(22): 4708. doi: 10.3390/nu15224708.
21.	朱凱麗, 段培蓓, 許睿, 等. 疾病感知和家庭支持在胃腸道腫瘤患者參與治療決策與營養素養間的中介調節效應. 護理學報, 2025, 32(20): 1-5.
22.	Schapira MM, Swartz S, Ganschow PS, et al. Tailoring educational and behavioral interventions to level of health literacy: a systematic review. MDM Policy Pract, 2017, 2(1): 2381468317714474. doi: 10.1177/2381468317714474.
23.	李瀅, 張培莉, 李效芳, 等. 老年胃癌病人化療期間飲食指導依從性影響因素的質性研究. 護理研究, 2024, 38(16): 2967-2973.
24.	Rinninella E, Cintoni M, Raoul P, et al. Effects of nutritional interventions on nutritional status in patients with gastric cancer: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN, 2020, 38: 28-42.
25.	Miao X, Guo Y, Ding L, et al. A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors. Int J Nurs Stud, 2024, 153: 104716. doi: 10.1016/j.ijnurstu.2024.104716.
26.	姚芮, 劉曉菊, 葉利, 等. 基于KABP理論的延續護理模式在胃癌根治術患者術后康復中的應用. 保健醫學研究與實踐, 2023, 20(12): 97-101.
27.	王李壇, 翁少文, 王余娜, 等. 微信延續性營養干預對院外胃癌術后患者希望水平、生活質量及營養狀態的影響. 中國醫藥導報, 2021, 18(34): 185-188.
28.	Zhang X, Lang S, Liu F. Impact of health education based on protective motivation theory on the mood state, cancer-related fatigue, and hope level of gastric cancer patients. Iran J Public Health, 2024, 53(1): 126-135.

1. 李茁鈺, 劉凱, 張維漢, 等. 全球及中國胃癌的流行病學特點及趨勢: 2018–2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(10): 1236-1245.
2. 許兆萬, 董博. 胃癌胃切除術后微量營養素缺乏癥的研究進展. 中國普外基礎與臨床雜志, 2024, 31(9): 1135-1140.
3. Kim GH, Choi KD, Ko Y, et al. Impact of comorbidities, sarcopenia, and nutritional status on the long-term outcomes after endoscopic submucosal dissection for early gastric cancer in elderly patients aged ≥ 80 years. Cancers (Basel), 2021, 13(14): 3598. doi: 10.3390/cancers13143598.
4. Chen WZ, Zhang XZ, Zhang FM, et al. Coexistence of GLIM-defined malnutrition and sarcopenia have negative effect on the clinical outcomes in the elderly gastric cancer patients after radical gastrectomy. Front Nutr, 2022, 9: 960670. doi: 10.3389/fnut.2022.960670.
5. Yang L, Cui Y, Du J, et al. Association between nutritional literacy and nutrition label use in Chinese community residents. Front Nutr, 2024, 11: 1380310. doi: 10.3389/fnut.2024.1380310.
6. 夏娟, 唐振闖, 余金明, 等. 癌癥幸存者營養素養水平現狀分析. 中國食物與營養, 2024, 30(12): 62-67.
7. 廖芬, 靳峰妮, 石婷娟. 運城地區腫瘤患者營養狀況調查及營養素養影響因素分析. 公共衛生與預防醫學, 2025, 36(2): 156-160.
8. Guo Y, Chen Y, Miao X, et al. BMI trajectories, associations with outcomes and predictors in elderly gastric cancer patients undergoing radical gastrectomy: a prospective longitudinal observation study. J Cancer Surviv, 2025, 19(2): 468-478.
9. Mara CA, Carle AC. Understanding variation in longitudinal data using latent growth mixture modeling. J Pediatr Psychol, 2021, 46(2): 179-188.
10. Hersberger L, Bargetzi L, Bargetzi A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr, 2020, 39(9): 2720-2729.
11. 王艷華. 中文版Herth希望量表用于癌癥病人的可行性研究. 護理研究, 2010, 24(1): 20-21.
12. 吳文娟, 劉嘉斌, 劉娟. 癌癥復發恐懼感對乳腺癌患者希望水平的影響: 一項基于心理復原力、自我倡權能力的鏈式中介模型. 現代醫學, 2024, 52(5): 737-743.
13. 陳圓圓, 楊春軍, 王冬梅, 等. 營養素養評價工具的漢化及在糖尿病患者中的信效度研究—基于CTT和Rasch模型的分析. 中國全科醫學, 2020, 23(26): 3342-3347.
14. 夏娟, 邵劍, 朱文宇, 等. 癌癥幸存者營養素養測評量表的編制及信效度檢驗. 中華全科醫學, 2024, 22(12): 2124-2128.
15. Lv J, Li X, Li X, et al. Insufficient enteral nutrition is an independent risk factor for poor clinical outcomes in gastric cancer patients following radical gastrectomy. Am J Transl Res, 2025, 17(1): 320-329.
16. 王新濱, 邢方洲, 張連達, 等. 術前NRS 2002評分與胃癌患者腹腔鏡術后并發癥及短期預后的相關性分析. 中國腫瘤外科雜志, 2025, 17(6): 583-587.
17. Zhang J, Li D, Yan J, et al. Factors influencing nutrition literacy in patients of colorectal cancer: a cross-sectional study. Front Nutr, 2025, 12: 1526388. doi: 10.3389/fnut.2025.1526388.
18. Kim D, Lee MK. Effectiveness of postoperative dietary intervention in patients with gastric cancer who underwent gastrectomy: quasi-experimental study design. Semin Oncol Nurs, 2025, 41(1): 151797. doi: 10.1016/j.soncn.2024.151797.
19. Meng Q, Tan S, Jiang Y, et al. Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer: a randomized clinical trial. Clin Nutr, 2021, 40(1): 40-46.
20. Silva P, Araújo R, Lopes F, et al. Nutrition and food literacy: framing the challenges to health communication. Nutrients, 2023, 15(22): 4708. doi: 10.3390/nu15224708.
21. 朱凱麗, 段培蓓, 許睿, 等. 疾病感知和家庭支持在胃腸道腫瘤患者參與治療決策與營養素養間的中介調節效應. 護理學報, 2025, 32(20): 1-5.
22. Schapira MM, Swartz S, Ganschow PS, et al. Tailoring educational and behavioral interventions to level of health literacy: a systematic review. MDM Policy Pract, 2017, 2(1): 2381468317714474. doi: 10.1177/2381468317714474.
23. 李瀅, 張培莉, 李效芳, 等. 老年胃癌病人化療期間飲食指導依從性影響因素的質性研究. 護理研究, 2024, 38(16): 2967-2973.
24. Rinninella E, Cintoni M, Raoul P, et al. Effects of nutritional interventions on nutritional status in patients with gastric cancer: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN, 2020, 38: 28-42.
25. Miao X, Guo Y, Ding L, et al. A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors. Int J Nurs Stud, 2024, 153: 104716. doi: 10.1016/j.ijnurstu.2024.104716.
26. 姚芮, 劉曉菊, 葉利, 等. 基于KABP理論的延續護理模式在胃癌根治術患者術后康復中的應用. 保健醫學研究與實踐, 2023, 20(12): 97-101.
27. 王李壇, 翁少文, 王余娜, 等. 微信延續性營養干預對院外胃癌術后患者希望水平、生活質量及營養狀態的影響. 中國醫藥導報, 2021, 18(34): 185-188.
28. Zhang X, Lang S, Liu F. Impact of health education based on protective motivation theory on the mood state, cancer-related fatigue, and hope level of gastric cancer patients. Iran J Public Health, 2024, 53(1): 126-135.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the trajectory and influencing factors of postoperative nutritional literacy changes in gastric cancer patients

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