High intake of added sugars increases the risk for obesity, type 2 diabetes, and cardiovascular disease. Non-nutritive sweeteners (NNS) are widely used in many beverages and food products to reduce calories and sugar content. NNS have higher intensity of sweetness per gram than caloric sweeteners such as sucrose, corn syrup, and fruit juice concentrates. NNS approved for use have been tested and determined to be safe at levels that are within acceptable daily intake by the Joint Food Agriculture Organization/World Health Organization Expert Committee on Food Additives. The eight items of sweeteners are regulated as food additives in Korea. Dietary intake of the sweeteners was suggested as safety level by the ministry of Food and Drug Safety in 2012. If substituted for caloric sweeteners without intake of additional calories from other food sources, NNS may help consumers limit carbohydrate and energy intake as a strategy to manage blood glucose and weight. Dietitians can provide guidance on the use of NNS that give the desired results in food preparation and use at the table.
Agriculture ; Blood Glucose ; Carbohydrates ; Cardiovascular Diseases ; Diabetes Mellitus ; Energy Intake ; Food Additives ; Food and Beverages ; Fruit ; Joints ; Korea ; No-Observed-Adverse-Effect Level ; Non-Nutritive Sweeteners* ; Nutritionists ; Obesity ; Sucrose ; Sweetening Agents ; Zea mays

Individuals who have diabetes should receive individualized medical nutrition therapy (MNT) based on an assessment of the individual's current eating patterns, preferences, and metabolic goals. The dietician should be able to coordinate food choices with the type of diabetes medicine being taken. Knowledge of the actions, side effects, and contraindication of diabetes medicine can help the dietician coordinate appropriate MNT and physical activity, to assist the individual with diabetes to achieve optimal glycemic control without unwanted effects. Carbohydrate consistency is important for diabetic patients on oral diabetes medications. The primary side effects with initial treatment of biguanides, alpha-glucosidase inhibitors, and incretin mimetics include gastrointestinal discomfort, which can be minimized by taking the medication with food, starting at a low dosage, and increasing the dosage slowly. Common side effects from use of insulin and insulin secretagogues (sulfonylureas and meglitinides) are hypoglycemia and weight gain. Consistent meal times and carbohydrate consistency are important to reduce risk of hypoglycemia. Energy restriction, reduced fat intake, regular physical activity, and avoidance of frequent hypoglycemia can be beneficial in preventing or limiting weight gain. The insulin regimen should be fitted to the meal plan and adjusted over time based on the results of blood glucose monitoring.
alpha-Glucosidases ; Biguanides ; Blood Glucose ; Diabetes Mellitus ; Eating ; Humans ; Hypoglycemia ; Incretins ; Insulin ; Meals ; Motor Activity ; Nutrition Therapy ; Nutritionists ; Weight Gain

Diabetes mellitus is a major health problem in Korea. Although diet is an essential part of diabetes care, many diabetic patients have considerable difficulties with dietary therapy. Preparing meals is burdensome and is one of the main barriers to diet control, especially for those patients who have busy schedules or who have physical difficulties. People with diabetes should consider using HMR (Home Meal Replacement) products to address difficulties in preparing meals. HMRs are purchased meals eaten at home as is or after a brief cooking process. Korean HMR products are categorized as 'ready to eat', 'ready to heat', and 'ready to end-cook' according to the degree of cooking required. The consumption of HMR products is increasing due to the increase in single people living alone, the increasing number of women working outside the home, the aging of the population, and increasing income levels. HMR products could help diabetic patients eat regular meals and minimize barriers to meal preparation. When using HMR products, people with diabetes can have problems with imbalanced nutrition, inconsistent carbohydrate intake, and excess salt intake. When introducing HMR products to people with diabetes, dietitians should provide guidelines for eating a balanced diet and teach patients how to read nutrition facts label and reduce salt intake.
Aging ; Appointments and Schedules ; Cooking ; Diabetes Mellitus ; Diet ; Eating ; Female ; Humans ; Korea ; Meals

Malnutrition is a common problem in hospital settings. A poor nutritional status has been associated with higher rates of infection, poor wound healing, longer hospital stays, and higher hospital costs. Therefore, early recognition and timely treatment of malnutrition is vital. To identify malnourished individuals or those at risk of becoming malnourished, selecting and validated a uniform screening tool is clearly an important issue. Both the Nutritional Risk Screening-2002 (NRS-2002) and Malnutrition Universal Screening Tool (MUST) are recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for a hospital setting. For older patients, the Mini Nutritional Assessment (MNA) is the recommended tool. Short Nutrition Assessment Questionnaire (SNAQ) and Malnutrition Screening Tools (MST) are brief and simple screening tools that use self-reported queries of variables that include weight loss and poor appetite. On the other hand, many of those require considerable time and labor to administer and may not be highly applicable to a Korean population. In Korea, most hospitals use a computerized nutritional screening system with a self-developed nutrition screening index. The variables for the tools, which are based on each hospital setting, include the objective data available in the patient's medical records and limited information collected from the nursing admission questionnaire. The application of different tools hampers any comparison of the malnutrition prevalence between different settings and patients groups. In addition, the absence of a widely accepted malnutrition screening tool hinders both effective recognition and the treatment of malnutrition. Therefore, the development of uniform and valid screening tools and effective nutritional support programs for Korean malnourished patients is needed.
Appetite ; Enteral Nutrition ; Hand ; Hospital Costs ; Humans ; Korea ; Length of Stay ; Malnutrition ; Mass Screening* ; Medical Records ; Nursing ; Nutrition Assessment ; Nutritional Status ; Nutritional Support ; Prevalence ; Weight Loss ; Wound Healing

Purpose: Variations in the iodine contents of foods is critical for estimating the iodine intake. This study aimed to update the iodine database of common Korean foods and evaluated the iodine intake in Korean adults. Methods: A list of 855 Korean foods was selected for the updated iodine database. The updated database was established with Version 1 and 2 by applying an average or minimum value for the imputed values. The iodine intake was estimated in 5,927 Korean adults using the data from the 2013–2015 Korea National Health and Nutrition Examination Survey. Results: The analytical values in the updated database were 166 (19.4%), followed in order by 318 (37.2%), 247 (28.9%), and 124 (14.5%) for the adapted, imputed, and missing values, respectively. The median of dietary iodine intake was 352.1 μg/day (± 2,166.1) and 343.4 μg/day (± 2,161.9) in Version 1 and 2 among the total population. The contribution rates of each food group to the iodine intake were 55.7% for seaweeds, which showed a similar trend in Version 2. When subjects were divided by consumption of seaweeds, the median iodine intake was 495.7 μg in the consumer group, which was almost double (241.2 μg) that of the non-consumer group. The proportion of subjects who consumed below the Estimated Average Requirement of iodine was 11.0% in the non-consumer group. In contrast, 11.6% in the consumer group of seaweed consumed above the Upper Level of iodine. When the dietary iodine and urinary iodine were examined, the regression coefficient was 0.11718 in Version 1 and 0.11512 in Version 2 after adjusting for age and sex. Conclusion This study presented the variation of iodine intake in Korean adults by applying different versions of the iodine database. As the iodine intake can vary due to the highly variable concentrations in the major food sources, an iodine database is necessary to be monitored, and caution should be taken when the database is used in research.

Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.
Enteral Nutrition ; Esophagectomy* ; Humans ; Jejunostomy* ; Nutritional Status

To improve the efficacy of radioactive iodine (RAI) therapy for differentiated thyroid cancer patients, a low-iodine diet (LID) prior to the therapy is recommended. In iodine-rich areas such as Korea, however, a strict LID is very difficult to maintain. We experienced the cases of three patients showing low adherence to the LID before initial RAI therapy, and analyzed the main food source supplying iodine during the LID, and examined the influence of the poorly maintained LID on the efficacy of RAI therapy. The dietary intake during the LID periods were assessed using three-day dietary records and remnant thyroid activity after the second RAI administration was also evaluated. All patients' mean daily iodine intake during two-week LID periods exceeded the 100 microg guideline set by the Korean Thyroid Association (median 110.9 microg, ranges 100.4-117.0 microg). Although the typical food sources of iodine intake are seaweeds in Korea, salted vegetables were the main contributor to the patients' iodine intake during the LID periods. Remnant thyroid activity was shown on a follow-up scan in all of 3 patients suggesting low efficacy of RAI therapy. In summary, the patients with low adherence to the LID guideline showed unsuccessful remnant ablation, and the main food source of iodine was salted vegetables. Further studies are necessary to examine the relationship between adherence of the LID and RAI efficacy according to dietary iodine intake levels, as well as food sources that cause low adherence to the LID. These data can then be used to develop more practical LID guidelines.
Diet Records ; Diet* ; Follow-Up Studies ; Humans ; Iodine* ; Korea ; Patient Compliance ; Radioisotopes ; Thyroid Gland ; Thyroid Neoplasms ; Vegetables

Diabetes in pregnancy is associated with higher rates of miscarriage, pre-eclampsia, preterm labor, and fetal malformation. To prevent these obstetric and perinatal complications, women with diabetes have to control levels of blood sugar, both prior to and during pregnancy. Thus, individualized medical nutrition therapy for each stage of pregnancy is essential. We provided in-depth medical nutrition therapy to a 38-year-old pregnant woman with diabetes at all stages of pregnancy up to delivery. She underwent radiation therapy after surgery for breast cancer and was diagnosed with diabetes. At the time of diagnosis, her glycated hemoglobin level was 8.3% and she was planning her pregnancy. She started taking an oral hypoglycemic agent and received education regarding the management of diabetes and preconception care. She became pregnant while maintaining a glycated hemoglobin level of less than 6%. We provided education program for diabetes management during the pregnancy, together with insulin therapy. She experienced weight loss and ketones were detected; furthermore, she was taking in less than the recommended amount of foods for the regulation of blood sugar levels. By giving emotional support, we continued the counseling and achieved not only glycemic control but also instilled an appreciation of the importance of appropriate weight gain and coping with difficulties. Through careful diabetes management, the woman had a successful outcome for her pregnancy, other than entering preterm labor at 34 weeks. This study implicated that the important things in medical nutrition therapy for pregnant women with diabetes are frequent follow-up care and emotional approach through the pregnancy process.
Abortion, Spontaneous ; Adult ; Blood Glucose ; Breast Neoplasms ; Counseling ; Diagnosis ; Education ; Female ; Follow-Up Studies ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Ketones ; Nutrition Therapy* ; Obstetric Labor, Premature ; Pre-Eclampsia ; Preconception Care ; Pregnancy* ; Pregnant Women ; Weight Gain ; Weight Loss

PURPOSE: The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea. METHODS: From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM). RESULTS: EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE II) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge. CONCLUSION: In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.
Body Mass Index ; Body Weight ; Cholesterol ; Enteral Nutrition ; Humans ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Neurosurgery ; Nutrition Therapy ; Nutritional Support ; Parenteral Nutrition* ; Physiology ; Propensity Score ; Retrospective Studies ; Tertiary Care Centers* ; Thoracic Surgery ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Iodine is essential for thyroid hormone production and the iodine intake of Koreans is high. Few studies have examined the association between iodine intake and thyroid disease in the Korean population due to the lack of an iodine database. Therefore, this study established an iodine database, evaluated iodine intake levels, and explored the association between iodine intake and thyroid disease. MATERIALS AND METHODS: We obtained data for 9998 subjects who had both biochemical and dietary data from the 2007-2009 Korea National Health and Nutrition Examination Survey. RESULTS: An iodine database was established for 667 food items. The median iodine intake in the population was 375.4 microg per day. The iodine contribution by food group was 65.6% from seaweed, 18.0% from salted vegetables, and 4.8% from fish. When subjects were divided into five groups across quintiles of iodine intake per 1000 kcal, excluding extreme subjects who consumed above the upper limit, age, sex, income, education, drinking, and smoking differed across the groups. While the energy and fat intakes decreased, other nutrients increased across the quintile groups. The consumption of seaweeds, fish, eggs, and salted vegetables increased across the quintile groups. After adjusting for all potential confounding variables, the odds ratio for thyroid disease in the highest quintile was 1.63 compared to that in the lowest quintile (p for trend=0.0352). CONCLUSION: The iodine intake of the Korean population is high, with high consumption of seaweeds, salted vegetables, and fish positively associated with thyroid disease.
Adult* ; Confounding Factors (Epidemiology) ; Drinking ; Education ; Eggs ; Humans ; Iodine* ; Korea ; Nutrition Surveys ; Odds Ratio ; Ovum ; Seaweed ; Smoke ; Smoking ; Thyroid Diseases* ; Thyroid Gland* ; Vegetables