OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.
Chronic Disease ; Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Korea ; Organization and Administration ; Parenteral Nutrition, Home Total* ; Quality-Adjusted Life Years

Protein-calories malnutrition is common among patients in the hospital. In particular, elderly patients with neurologic disorders has more risk of nutritional deficiency due to swallowing difficulty. Enteral tube feeding is more economical, physiological and immunological than parenteral nutrition for patients who have adequate gastrointestinal function. This study was conducted patients with neurologic disorders who received enteral nutrition at Asan Medical Center from February 1 to October 10, 2002. The control group (48 patients) were given traditional feeding methods 4 times a day while the treatment group (45 patients) were given improved feeding methods 3 times a day. We assessed nutritional status of patients and compared to both groups. We investigated body weight, serum albumin, hemoglobin, total lymphocyte count by means of nutrition markers. The objectives of this study is to reduce the time needed for nutritional requirement of patients without an increase in gastrointestinal intolerances. The results of this study are as follows: 1. Nutritional status of many patients in both groups were either malnourished or at risk for malnutrition. 2. The time to arrive to the nutritional requirements were 6.21 +/- 0.35 days for the control group and 4.24 +/- 0.52 days for the treatment group. The treatment group showed a significantly shorter amount of time. 3. The changes of the nutritional marker in the control group showed a significant drop in body weight, serum albumin and serum hemoglobin while the treatment group experienced a significant increase in body weight, serum albumin and total lymphocyte count. 4. Feeding intolerane such as diarrhea, high residual volume, ileus, nausea and vomiting were investigated. Diarrhea found in 25.1% (12 patients) of the control group and 22.2% (10 patients) of the treatment group and these findings are not significant.
Aged ; Body Weight ; Chungcheongnam-do ; Deglutition ; Diarrhea ; Enteral Nutrition* ; Feeding Methods ; Humans ; Ileus ; Lymphocyte Count ; Malnutrition ; Nausea ; Nervous System Diseases* ; Nutritional Requirements ; Nutritional Status ; Parenteral Nutrition ; Protein-Energy Malnutrition ; Residual Volume ; Serum Albumin ; Vomiting

Nutritional support is essential for improving the outcome in critically ill patients. Enteral nutrition possesses advantages over total parenteral nutrition in that it maintains the physiologic barrier function of the gastrointestinal mucosa. Short-term enteral nutrition can be achieved through transnasal feeding tubes. Traditionally, feeding tubes have been placed at bedside in a blind fashion. However, blind tube placement is unreliable as it may result in improper positioning of the tubes. Numerous complications arising from misplacement have been reported in the literature. A number of modalities may be used in order to improve the accuracy and safety of transnasal feeding tube placement. Fluoroscopy is widely accepted for this purpose. Together with the use of water-soluble contrast media and over-the-wire technique, fluoroscopy-guided placement of nasogastric or nasojejunal feeding tubes offers a higher rate of technical success while decreasing procedure time as well as the incidence of procedure-related complications.
Contrast Media ; Critical Illness ; Enteral Nutrition ; Fluoroscopy* ; Humans ; Incidence ; Mucous Membrane ; Nutritional Support ; Parenteral Nutrition, Total

Extrauterine growth restriction is much popular in China and it is still challenge job for pediatricians. This article described the benefits for PICC in route of PN choice. New fat emulsions were appeared recently years, however they are no strong evidence for using in premature infants and need do more clinical trial. Parenteral nutrition associated with liver damage still is a serious complication of TPN and we encourage early enteral feeding, appropriate calore intake, anti sepsis for prevention.
Enteral Nutrition ; Humans ; Infant, Newborn ; Infant, Premature ; Nutritional Support ; Parenteral Nutrition, Total ; adverse effects

BACKGROUND: Adequate nutrition support reduces infectious complications, mortality and length of hospitalizationin intensive care unit. However, there are multi factors like frequent null per os (NPO) due to examination, intolerance to tube feeding, complication of TPN (total parenteral nutrition) and ineffective recognition by medical staff. The purpose of this study is to identify detrimental effects of cumulative energy deficiency in critically ill patients. METHODS: The patients who were received tube feeding or total parenteral nutrition for more than 5 days were investigated. Daily and cumulative energy deficiency was tabulated until oral intake was achieved or until they discharged or died. Patients were divided into two groups, severe energy deficient group (>10, 000 kcal) or mild energy deficient group (<5, 000 kcal). Then we compared clinical outcomes between two groups. RESULTS: Total 150 patients were studied. 48 (32%) patients were severe energy deficient group and 42 (28%) patients were mild energy deficient group. Mortality and nosocomial infection were significantly higher in severe energy deficient group than in mild group. Hospital day and ICU day were significantly higher in severe energy deficient group than in mild group. CONCLUSIONS: Severe energy deficiency was very common in critically ill patients and it deteriorated the clinical outcomes such as mortality, nosocomial infection, hospital day and ICU day.
Critical Illness* ; Cross Infection ; Enteral Nutrition ; Humans ; Intensive Care Units ; Medical Staff ; Mortality ; Parenteral Nutrition, Total

BACKGROUND: Infants with chronic respiratory symptoms should be evaluated thoroughly because there are various causes which are different from those of children and adolescents. OBJECTIVE: This study was designed to investigate the relationship between chronic respiratory symptoms and bedtime bottle feeding in infants after the age of 6 months. METHODS: We conducted a prospective study that included 44 infants who presented with respiratory symptoms for more than 8 weeks and also had been bottle-fed during bedtime even after 6 months of age. The infants were divided into 2 groups; infants who discontinued bedtime bottle feeding and those who did not. Respiratory symptom scores were graded with a four-point scale at 0, 1, 2 and 3 months, and were compared between the 2 groups. RESULTS: Twenty eight infants (63.6%) stopped being bottle-fed during bedtime and 16 infants (36.4%) were still bottle-fed. The respiratory symptom scores were significantly decreased in infants who stopped bedtime bottle feeding (p = 0.0003). CONCLUSION: It is suggested that prolonged bedtime bottle feeding might be one of the causes of chronic respiratory symptoms in infants.
Adolescent ; Bottle Feeding ; Child ; Feeding Methods ; Humans ; Infant ; Prospective Studies

OBJECTIVETo explore the optimal postoperative nutritional support in elderly patients with gastric cancer.

METHODSOne hundred and twenty elderly patients with gastric cancer undergoing radical gastrectomy were prospectively enrolled from January 2010 to March 2013 and randomly divided into total parenteral nutrition group(TPN, n=40), early total enteral nutrition group (TEN, n=40) and enteral plus parenteral nutrition group(EN+PN, n=40). Clinical charasteristics including treatment tolerance, nutritional indexes, immune indexes, time to first flatus, incidence of postoperative infection and anastomotic leakage, were analyzed and compared.

RESULTSTreatment tolerance in EN+PN group(97.5%, 39/40) was significantly higher than that in TPN group(82.5%, 33/40) and TEN group(80.0%, 32/40)(both P<0.05). The nutritional indices, including prealbumin, albumin, transferrin, body mass index, and the incidence of anastomotic leakage were similar in the 3 groups(P>0.05). The immune indices, including CD3, CD4, CD4/CD8, were significantly reduced after operation in each group. However, they were significantly higher in EN+PN group and TEN group than those in TPN group(both P<0.05). Furthermore, compared to the TPN group, the incidence of postoperative infection(surgical site infection, pulmonary infection, abdominal infection) was significantly lower and time to first flatus was significantly shorter in EN+PN group and TEN group.

CONCLUSIONSEarly enteral nutrition after gastric cancer surgery is safe, simple and feasible. EN plus PN is the best way to administer postoperative nutritional support in elderly patients with gastric cancer.

Aged ; Anastomotic Leak ; Enteral Nutrition ; Gastrectomy ; Humans ; Nutrition Assessment ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Postoperative Complications ; Postoperative Period ; Stomach Neoplasms ; surgery

This study was done to compare the breast-feeding primiparas' perceptions of their babies with bottle-feeding primiparas' at 2-3 days after delivery. The subjects of this study included 42 breast-feeding mothers and 56 bottle-feeding mothers. Data were collected by using the Neonatal Perception Inventory(NPI) devised by Broussard(1963) and added by Lee, Ja Hyung(1986) form December, 1996 to June, 1997. The results of this study are as follows : 1. Primiparas perceptions of their babies according to their general characteristics. 1) There was no significant difference in mothers' perceptions according to mothers' age and whether they have a job or not. 2) There was a difference in mothers' perceptions according to their educational level(P<0.1). 2. The comparisons of breast-feeding mothers' perceptions of their babies with bottle-feeding mothers'. 1) There was no significant difference in the two group's perceptions of other babies 2) There was no significant difference in the two group's perceptions of their own babies. (1) Breast-feeding mothers' general perceptions of their own babies were better than bottle-feeding mothers', but there was (2) Breast-feeding mothers' perceptions about the basic needs of their own babies were better than bottle-feeding mothers', and there was a significant difference between the two groups(P<0.05). (3) Breast-feeding mothers' perceptions about the sense and motor abilities of their own babies were better than bottle-feeding mothers', but there was no significant difference between the two groups. (4) Breast-feeding mother's perceptions about the necessary care of their own babies were lower than bottle-feeding mothers', but there was no significant difference between the two group. 3) There was no significant difference between the two groups' positive-negative perceptions of their babies (1) 69% of breast-feeding mothers and 69.9% of bottle-feeding mothers had positive perceptions about general conditions, but there was no significant difference between the two groups (2) 57.1% of breast-feeding mothers and 46.4% of bottle-feeding mothers had positive perceptions about the needs of babies, but there was no significant difference between the two groups. (3) 50% of breast-feeding mothers and 48.2% of bottle-feeding mothers had positive perceptions about the sense and motor abilities of babies, but there was no significant difference between the two groups. (4) 57.1% of breast-feeding mothers and 60.7% of bottle-feeding mothers had positive perceptions about the necessary care for babies, but there was no significant difference between the two groups. 3. 54.8% of breast-feeding mothers tried to feed their own babies on the 1st day after delivery. 83.3% of breast-feeding mothers chose the feeding method for themselves. Only 9.5% of breast-feeding mothers took recommendations for breast-feeding from nurses. 78.6% of breast-feeding mothers had no chance to learn about breast-feeding. 69% of breast-feeding mothers complained about the difficulties of breast-feeding. The most serious problems were : 'insufficient milk supply', 'lack of knowledge about feeding technique' and 'problems with nipples'.
Bottle Feeding* ; Breast Feeding* ; Breast* ; Feeding Methods ; Humans ; Milk ; Mothers ; Child Health