Nutritional therapy with total parenteral nutrition (TPN) is usually performed in the critically ill patients who cannot ingest or digest food through the gastrointestinal tract. The process of well managed nutritional support by TPN is not simple, nor easy. Doctors experience various complications, the patients also suffer from much discomfort. Especially the younger patients, they are labile to more complications. The physicians should know thoroughly how to avoid the complications, how to effectively supply TPN solution to the patients. The author reviews the numerous complications during TPN and the methods for the prevention of complications.
Critical Illness ; Gastrointestinal Tract ; Humans ; Nutritional and Metabolic Diseases ; Nutritional Support ; Parenteral Nutrition, Total

Many different additives include preservatives, stabilizers, conditioners, thickeners, colorings, flavorings, sweeteners, and antioxidants. Despite the multitude of additives known, only a small number has been associated with hypersensitivity reactions. A number of investigators have suggested that a significant population of patients with allergic diseases has symptoms related to the ingestion of food additives. However, the incidence and mechanism of reactions to additives in patients with chronic urticaria, angioedema, and atopic dermatitis remain unknown. A few studies of monosodium glutamate is reported to be associated with atopic dermatitis, but their relationship remains unknown. The best known dye is tartrazine. The group of azo dyes includes ponceau and sunset yellow. Amaranth (FD&C red no. 5) was banned from use in the US in 1975 because of claims related to carcinogenicity. Most of them are reported to be associated with aggravation of atopic dermatitis. Parabens are aliphatic esters of parahydroxybenzoic acid. Sodium benzoate is a closely related substance usually reported to cross-react with these compounds. These agents, which are widely used as preservatives in both food and drugs, are well recognized as causes of severe contact dermatitis. Additives would have to act as haptens to create a response mediated by IgE. The majority of these reactions are not of the immediate hypersensitivity type. Many cases of additive-provoked urticaria or dermatitis occur as late as 24 hours after challenge, arguing against an IgE-mediated mechanism. In conclusion, the exact relationship between food additives and the allergic diseases still remains to be solved.
Angioedema ; Antioxidants ; Azo Compounds ; Coloring Agents ; Dermatitis ; Dermatitis, Atopic ; Dermatitis, Contact ; Eating ; Esters ; Food Additives ; Food Hypersensitivity ; Haptens ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Immunoglobulin E ; Incidence ; Parabens ; Research Personnel ; Sodium Benzoate ; Sodium Glutamate ; Sweetening Agents ; Tartrazine ; Urticaria

Gastric cancer is the most common cancer and the third most common cause of cancer deaths in Korea. Gastric resection, especially for the early stages of the disease, results in an excellent survival rate, and has been the mainstay of treatment for gastric cancer patients. Due to increasing use of surveillance endoscopy, the diagnosis of gastric cancer at early stages has increased. The 5-year survival rate for early gastric cancer has now improved to better than 90%, and consequently, the population of long-term survivors after gastrectomy has also increased. Therefore, the quality of life including nutritional support has become an important concern for gastrectomized patients during long-term follow-up. Nutritional capacities after gastrectomy should be evaluated by nutritional assessment and absorption tests. Nutritional deficits are more serious after total gastrectomy than after subtotal gastrectomy. Fat malabsorption has been shown to be a significant concern in patients that have undergone total gastrectomy. Other suggested causes of malnutrition include poor oral intake, relative pancreatic insufficiency, bacterial overgrowth, and shortened intestinal transit time. Food residue and bile reflux are frequently observed in the remnant stomach during surveillance endoscopy after a distal subtotal gastrectomy due to gastric cancer. The bile reflux is often associated with remnant gastritis or esophagitis and has an influence on the quality of life following a distal subtotal gastrectomy. Reconstruction methods have not influenced the food retention phenomenon after a distal gastrectomy over long-term periods. In addition, nutritional status after gastrectomy is significantly associated with postoperative complications. In conclusion, the provision of dietary education and nutritional support is highly recommended in postoperative patients for gastric cancer.
Absorption ; Bile Reflux ; Endoscopy ; Esophagitis ; Exocrine Pancreatic Insufficiency ; Follow-Up Studies ; Gastrectomy ; Gastric Stump ; Gastritis ; Humans ; Korea ; Malnutrition ; Nutrition Assessment ; Nutritional Status ; Nutritional Support ; Postoperative Complications ; Quality of Life ; Retention (Psychology) ; Stomach Neoplasms ; Survival Rate ; Survivors

In the early postnatal period, prematurely born infants, especially those born at the earliest limits of viability, face a nutritional crisis. A lack of essential nutrients may result in substantial developmental morbidity. In particular, because this period is crucial to proper neurodevelopment, a central concern must be providing essential nutrition for proper neurodevelopment, and the prevention of long-term neuro-deficits. Therefore, providing appropriate nutrition for growth and development is one of the most essential concerns in the care of preterm infants. The optimal goal for providing nutrition in the preterm infant is to achieve a postnatal growth rate approximating that of the normal fetus at the same gestational age. However, extra-uterine growth restriction develops during the course of care for most very low birth weight infants admitted to the neonatal intensive care unit. Herein, the optimal nutrient requirements and most recently recommended total parenteral and enteral feeding strategies are reviewed to provide neonatal clinicians with current guidelines for nutritional care that can improve neurodevelopmental outcomes in preterm infants during and after treatment in the neonatal intensive care unit.
Enteral Nutrition ; Feeding Methods ; Fetus ; Gestational Age ; Growth and Development ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Nutritional Status ; Nutritional Support

Inflammatory bowel disease (IBD) develops during childhood or adolescence in approximately 25% of patients. Impairment of growth and malnutrition are significant complications of IBD, especially in Crohn disease. Growth impairment is much less prevalent in pediatric patients with ulcerative colitis. Chronic under-nutrition, nutrient losses, medications, and proinflammatory mediators are increasingly recognized as contributing to the observed growth failure in IBD. A number of studies have further explored the epidemiology and pathogenesis of these nutritional complications of IBD in an effort to provide more effective intervention to prevent the long-term consequences of chronic nutrient deficiencies in childhood. Screening and assessing pediatric patients with IBD for malnutrition and growth failure are an essential component of medical care. A diet well-balanced in all nutrients is advisable for all pediatric patients with IBD. The use of selected nutrients and microorganisms (probiotics) as primary or adjunctive therapy for the treatment of IBD has become an emerging area of great interest. This review introduces nutritional problems in children with IBD, especially in Crohn disease and recent nutritional management as well.
Adolescent ; Child ; Colitis, Ulcerative ; Crohn Disease ; Diet ; Humans ; Inflammatory Bowel Diseases ; Malnutrition ; Mass Screening ; Nutrition Therapy ; Nutritional Status

Perioperative nutritional status is an important factor for the prognosis of cardiac surgery. Preoperatively debilitated or cachectic patients (i.e., more than 10% weight loss over 6 months) with decreased albumin level are exceptionally prone to complications, such as infections following surgery. For better support of the perioperative nutritional intake, exact preoperative monitoring of nutritional status and supplement of essential nutritional factors are necessary for cardiac patients. I will describe here the nutritional states assessment and monitoring methods of infants with congenital heart diseases and consider essential nutritional factors in patients with heart disease. For the conditions where enteral nutrition is not possible, postoperative control of blood sugar is important, or special nutritional considerations for heart disease patients is needed. I will discuss the clinical problems related to these conditions and suggest possible methods of improvement for each condition.
Blood Glucose ; Child ; Enteral Nutrition ; Heart Diseases ; Humans ; Infant ; Nutrition Assessment ; Nutrition Disorders ; Nutrition Therapy ; Nutritional Status ; Prognosis ; Thoracic Surgery ; Weight Loss

Malnutrition is very commonly seen in end stage liver disease. More than 65% of patients with chronic liver disease and more than 90% of patients with end-stage liver disease suffer malnutrition. Multiple reports have clearly shown that malnourishment is a relevant factor in complications and mortality due to chronic liver disease. It is essential that all patients with chronic liver disease have a full assessment of nutritional status at presentation. Supplementary enteral nutrition is indicated when chronic liver disease patients are unable to meet their nutritional requirements in their usual daily diet. Non-alcoholic fatty liver disease (NAFLD) is another type of chronic liver condition characterized by overnutrition and ectopic hepatic fat accumulation and/or hepatic inflammation. Patients diagnosed with obesity, insulin resistance, and/or dyslipidemia are at the greatest risk for developing or having NAFLD. A recent hypothesis is that NAFLD is one manifestation of metabolic syndrome or insulin resistance. Unfortunately, there is no consensus as to what dietary approach is most beneficial for preventing the progression of NAFLD. It seems likely that there will not be any single correct dietary plan for all NAFLD patients, so that diet and life-style modifications will best be tailored for the individual needs of the patient.
Consensus ; Diet ; Dyslipidemias ; End Stage Liver Disease ; Enteral Nutrition ; Fatty Liver ; Humans ; Inflammation ; Insulin Resistance ; Liver ; Liver Cirrhosis ; Liver Diseases ; Malnutrition ; Nutrition Therapy ; Nutritional Requirements ; Nutritional Status ; Obesity ; Overnutrition

Medical nutrition therapy (MNT) is an integral component of diabetes prevention, management, and self-management education, however, the basic principles of nutritional management are often poorly understood by both clinicians and their patients. Individuals with pre-diabetes or diabetes should receive individualized MNT as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. The goals for MNT are outlined in this review for short-term (four to six weeks) and long-term outcomes pertaining to glycemic control, lipid management, blood pressure regulation, weight maintenance, and exercise recommendations. The role of nutrition and the development of a medical nutrition therapy plan such as caloric intake in proportion to amounts of dietary carbohydrate, the use of the glycemic index and glycemic load in dietary management, recommendations for dietary macronutrients, vitamins, minerals, fiber, sodium, and alcohol consumption for a patient with type 2 diabetes are discussed here. My intention is that this paper will provide a comprehensive overview of current clinical recommendations concerning medical nutrition therapy in type 2 diabetes.
Alcohol Drinking ; Blood Pressure ; Diabetes Mellitus ; Diet ; Dietary Carbohydrates ; Energy Intake ; Glycemic Index ; Humans ; Intention ; Minerals ; Nutrition Therapy ; Self Care ; Sodium ; Vitamins

Malnutrition risk during a hospital stay may increase with higher rates of complications and longer lengths of hospital stay. The prevalence of malnutrition in cancer patients is higher than in general patients because of cancer-specific characteristics and treatment processes. Most cancer patients undergo surgery, radiotherapy, chemotherapy, and/or other treatments depending on the type and stage of cancer; these treatments are associated with various side effects. Among these side effects, loss of appetite, sore mouth or throat, dry mouth, change in taste, vomiting, nausea, diarrhea, constipation, and fatigue can negatively affect dietary intake. Patient malnutrition can increase infection risks, side effects of cancer treatment, and mortality rates. Therefore, it is important to evaluate nutritional status as early as possible and to treat the nutritional problems through nutrition intervention and prevention of malnutrition.
Appetite ; Constipation ; Diarrhea ; Fatigue ; Food Habits ; Humans ; Length of Stay ; Malnutrition ; Mouth ; Nausea ; Nutritional Status ; Pharynx ; Prevalence ; Vomiting

Coronary artery diseases in childhood are much less frequently seen than in adulthood. Kawasaki disease is the most prevalent cause of coronary diseases in children. Other significant diseases have congenital origin. These are the coronary arterial fistula and the anomalous origin of left coronary artery from pulmonary artery. Congenital coronary arterial fistulas are rare anomalies. Coronary arterial anatomy can be diagnosed correctly on the echocardiogram. The origin, course, and termination of coronary arterial fistula have to be well demonstrated. Coronary arterial fistulas have been managed by surgical ligation. In recent years, transcatheter coil embolization has been employed with good results. Anomalous origin of the left coronary artery from the pulmonary artery is rare. According to clinical pattern, infantile type and adult type can be classified. It may result in myocardial infarction, congestive heart failure, and sometimes death during the early infantile period. It is more rare in the adulthood. Coronary angiography establishes the diagnosis. There are several surgical options including reimplantation of the left main coronary into the aorta. Early surgical correction is important to preserve cardiac function. Kawasaki disease is an acquired and acute self-limited vasculitis of childhood. Kawasaki disease is characterized by fever, bilateral non-exudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia can develop in untreated children. Intravenous gamma globulin and aspirin were the standard therapy. Recently incomplete Kawasaki disease has been frequently diagnosed. New guidelines have developed in Japan and United States of America.
Adult ; Americas ; Aneurysm ; Aorta ; Aspirin ; Child ; Conjunctivitis ; Coronary Aneurysm ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessel Anomalies ; Coronary Vessels* ; Diagnosis ; Dilatation, Pathologic ; Embolization, Therapeutic ; Erythema ; Exanthema ; Extremities ; Fever ; Fistula ; gamma-Globulins ; Heart Failure ; Humans ; Japan ; Ligation ; Lip ; Lymphatic Diseases ; Mouth Mucosa ; Mucocutaneous Lymph Node Syndrome ; Myocardial Infarction ; Pulmonary Artery ; Replantation ; United States ; Vascular Fistula ; Vasculitis