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Effects of Nutrition Consultation on Nutritional Status in Critically Ill Surgical Patients.

Hee Sook HWANG ; Seung Hwan LEE ; Hosun LEE ; Kyung Sik KIM ; Seo Jin CHUNG ; Jae Gil LEE

Journal of Clinical Nutrition.2015;7(1):28-34. doi:10.15747/jcn.2015.7.1.28

PURPOSE: The aim of this study was to investigate nutritional support status and effects of nutrition consultation in critically ill surgical patients. METHODS: The medical records of 76 patients, admitted between June 1 and November 30, 2013, were reviewed retrospectively. Patients were divided into 2 groups: the nutrition consultation group (n=17) and the no consultation group (n=59). Patients were also divided into 3 groups: the enteral nutrition (EN) group (n=8), the parenteral nutrition (PN) group (n=25), and the enteral and parenteral mixed nutrition (ENPN) group. Total delivered/required caloric ratio and serum albumin, serum total protein, hemoglobin and other biochemical variables were compared in each group. RESULTS: Mean daily required and delivered caloric/protein amount were EN group 60.0%, PN group 64.6%, and ENPN group 86.9%. ENPN group showed statistically significant difference when compared with EN group, PN group (P=0.005). When the proportion of patients who were fed more than 75% of the daily required calories was calculated, EN, PN, and ENPN showed 37.5%, 25.0% and 81.8%, respectively. ENPN group were significantly more supplied (P=0.007). Although neither the nutrition consultation group nor the non-consultation group received more than 80% of the daily required calories, the nutrition consultation group received 73% of the daily required calories whereas the no consultation group only received 46% (P=0.007). The total delivered/required protein ratio was approximately 69% of the nutrition consultation group and approximately 42% of the no consultation group (P=0.006). CONCLUSION: The results of providing nutritional consultation to intensive care unit patients showed an increase in the nutrition support. Nutrition education, continuous monitoring and management for nutritional support by systemic administration of a nutritional support team should be considered in order to achieve effective clinical outcomes in critically ill surgical patients.
Critical Illness* ; Education ; Enteral Nutrition ; Humans ; Intensive Care Units ; Medical Records ; Nutritional Status* ; Nutritional Support ; Parenteral Nutrition ; Retrospective Studies ; Serum Albumin

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The Current Status of Enteral Feeding Management in General Surgical Ward.

Yun Jung KIM ; Young Mee BAEK ; So Yun KIM ; Mi Reu MOON ; Kyung Hee PARK ; So Hee PAECK ; Moon Young SEO ; Sook Young OH ; Eun Ji LEE ; Hyun Bin LIM ; Ji Ye HWANG ; In Sun CHUNG ; Jae Kil LEE ; Kyung Sik KIM ; Chong Bai KIM

Journal of Clinical Nutrition.2015;7(1):23-27. doi:10.15747/jcn.2015.7.1.23

PURPOSE: Development of a standardized guideline and assessment tool is necessary. Therefore, the aim is to investigate the current state of enteral feeding management and to develop a basis for a standardized guideline. METHODS: From July 1, 2010 through June 30, 2011, this study was conducted retrospectively for 100 patients who had enteral feeding more than once only in the Intensive Care Unit, after General Surgery at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. The analysis was based on the following factors; age, diagnosis, name of the operation, period of start and the end of enteral feeding, method of injection, flushing method, residual volumes of the stomach, location and the size of the tube, medication through tubing, and complications related to enteral feeding. RESULTS: The mean age of the patients was 60.5, 65 men and 35 women. There were 30 malignant tumors of the hepatobiliary system and pancreas, 8 gastric and duodenal cancer, 4 colon and rectal cancer, 11 peritonitis, hemoperitoneum, and bowel obstruction, and 47 others. The average period of performing enteral feeding was 11.7 days and the locations of enteral feeding tube were stomach 56%, jejunum 39%, duodenum 3%, and undescribed 2%. The methods of enteral feeding were as follows; continuous feeding 19%, cyclic feeding 75%, intermittent and bolus feeding 3%, respectively. Only 1% of patients were on flushing and 16% on stomach residual. The most common complication of enteral feeding was clogging of the tube (5%). CONCLUSION: Due to the lack of detailed charting related to enteral feeding, we were unable to analyze the statistics on the relevance of complication which was the primary endpoint. As a result, development of a standardized protocol on charting enteral feeding is suggested for optimal enteral nutritional support.
Colon ; Diagnosis ; Duodenal Neoplasms ; Duodenum ; Enteral Nutrition* ; Female ; Flushing ; Hemoperitoneum ; Humans ; Intensive Care Units ; Jejunum ; Korea ; Male ; Nutritional Support ; Pancreas ; Peritonitis ; Rectal Neoplasms ; Residual Volume ; Retrospective Studies ; Seoul ; Stomach

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Refeeding Syndrome.

Jeong Wook KIM

Journal of Clinical Nutrition.2015;7(1):15-22. doi:10.15747/jcn.2015.7.1.15

Refeeding syndrome refers to a life-threatening shift of electrolytes and fluid with metabolic abnormalities in malnourished patients undergoing refeeding, whether orally, enterally, or parenterally. Clinical findings are fluid-balance abnormalities, abnormal glucose metabolism, hypophosphatemia, hypomagnesemia, hypokalemia and deficiencies of vitamin and trace element. Multiple organ systems including cardiac, respiratory, neurologic, renal, hematologic, and gastrointestinal can be affected. When recognized in a timely manner, these complications can be easily and successfully prevented and treated. Four factors appear fundamental: early identification of patients at risk, correction of abnormalities before refeeding, close monitoring during refeeding, and an appropriate feeding regimen.
Electrolytes ; Glucose ; Humans ; Hypokalemia ; Hypophosphatemia ; Metabolism ; Nutritional Support ; Refeeding Syndrome* ; Vitamins

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Use of Bioelectrical Impedance Analysis for Nutritional Treatment in Critically Ill Patients.

Yeon Hee LEE ; Jae Myeong LEE

Journal of Clinical Nutrition.2015;7(1):9-14. doi:10.15747/jcn.2015.7.1.9

Patients in the intensive care unit (ICU) easily have large amounts of extracellular fluids, such as edema or ascites, because of cardiovascular instability under septic conditions and also have high risk of malnutrition while staying in the ICU. Traditional nutritional assessment parameters like body mass index have a limitation in ICU patients due to muscle atrophy and decrease of lean body mass. Bioimpedence analyses (BIA) can be used to assess body composition and are useful in performance of nutritional assessments in ICU patients. BIA can simply and noninvasively estimate body composition (total body water, extracellular water, intracellular water, body cell mass, and free fat mass etc.) by sending a weak electric current through the body. In particular, phase angle (PhA, phase difference between the voltage applied to the impedance and the current driven through it), one of the parameters of BIA, is related to cell membrane integrity or cell size. Low PhA can possibly imply malnutrition and PhA has been reported as a useful indicator of clinical outcomes or prognosis of severe patients. Additional study with clinical application of BIA in ICU patients is needed in order to confirm the usefulness of BIA.
Ascites ; Body Composition ; Body Mass Index ; Body Water ; Cell Membrane ; Cell Size ; Critical Illness* ; Edema ; Electric Impedance* ; Extracellular Fluid ; Humans ; Intensive Care Units ; Malnutrition ; Muscular Atrophy ; Nutrition Assessment ; Nutritional Support ; Prognosis

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Reimbursement of Nutritional Support Team, What Is the Problem and How Can We Manage It?.

Dongwoo SHIN

Journal of Clinical Nutrition.2015;7(1):2-8. doi:10.15747/jcn.2015.7.1.2

Korea Ministry of Health and Welfare launched legislation for reimbursement for Nutrition Support Team (NST) activities from August 1st, 2014, which can be applied as a flat rate fee per day once a week. The indicated patients are those with hypoalbuminemia, on parenteral nutrition or enteral nutrition, critically ill patients in intensive care unit's, and any patient on suspicion of malnutrition by the physician in charge. NST should be comprised of a professional physician, an educated nurse, an educated pharmacist, and a professional and experienced dietitian. The maximum number of patients that can be treated by one NST is 30 per day. Such a reimbursement system has resulted in some complex problems with NSTs. The low price does not provide adequate reward for the team's workload because the output of NST belongs to the department in charge and there is no ensured incentive. The Department of Health Insurance Review and Assessment Service cannot detect the quality problem of NST, non-compliance of physicians in charge. There are no stratified codes according to severity of disease and no difference between the first visit and the repeated visit. Every NST should be certified with accreditation and should participate in a qualified education program. Korea Health Insurance does not cover the fees for feeding tubes, formulas, and pumps. Evidence that NST activities can reduce medical cost of hospital-admitted in-patients is needed. Cost-effectiveness can be achieved by quality improvement of NST.
Accreditation ; Critical Illness ; Education ; Enteral Nutrition ; Fees and Charges ; Humans ; Hypoalbuminemia ; Insurance, Health ; Critical Care ; Korea ; Malnutrition ; Motivation ; Nutritional Support* ; Nutritionists ; Parenteral Nutrition ; Pharmacists ; Quality Improvement ; Reward

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Letter from Editor.

Hyuk Joon LEE

Journal of Clinical Nutrition.2015;7(1):1-1. doi:10.15747/jcn.2015.7.1.1

No abstract available.

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Effects of a Nutrition Support Team with Parenteral Nutrition on Gastrointestinal Cancer Patients Who Underwent Surgery.

Hyun Jung LEE ; Jung Tae KIM ; Byung Koo LEE

Journal of Clinical Nutrition.2014;6(2):79-86. doi:10.15747/jcn.2014.6.2.79

PURPOSE: Cancer patients are frequently malnourished, and malnutrition can increase morbidity and mortality. Postoperative malnutrition can cause poor wound healing and failure of the immune response. Administration of parenteral nutrition (PN) after surgery may decrease complication and hospital length of stay. Intervention of a Nutrition Support Team (NST) improves patient outcomes through nutritional assessment and proper nutrition support. In this study we investigated effects of NST intervention with PN on gastrointestinal cancer patients who underwent surgery. METHODS: This retrospective study was conducted at Kyung Hee University Hospital at Gangdong from 2012 January to 2013 December. This study reviewed gastrointestinal cancer patients who were administered PN for more than seven days. The patients were divided into two groups: NST group versus non-NST group. RESULTS: In this study, 53 patients with malnutrition were administered PN for more than seven days. Nutrition support between the NST group and non-NST group was not statistically significant, except multivitamin and trace element. Changes in nutritional index were not statistically significant. No difference in incidence of complication, monitoring performance rate was observed between the two groups. CONCLUSION: Due to a small number of patients and lack of severity of disease in this study, no significant difference in improvement of nutritional index was observed between the NST group and non-NST group. For safe and effective PN, conduct of additional study is necessary in order to determine the effects of NST.
Gastrointestinal Neoplasms* ; Humans ; Incidence ; Length of Stay ; Malnutrition ; Mortality ; Nutrition Assessment ; Parenteral Nutrition* ; Retrospective Studies ; Wound Healing

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Nutritional Status of Korean Hospitalized Patients: A Multi-Center Preliminary Survey.

Yeon Mi LEE ; Seon Hyeong KIM ; Young Shin KIM ; Eun Mee KIM ; Jung Yeon KIM ; Min Ae KEUM ; Jae Young MOON ; Su Jin PARK ; Dong Woo SHIN ; Hong Yup AHN ; Young Ran LEE ; Hae Jun YIM ; Suk Kyung HONG ; Hyun Wook BAIK

Journal of Clinical Nutrition.2014;6(2):71-78. doi:10.15747/jcn.2014.6.2.71

PURPOSE: The purpose of this study is to examine the prevalence of malnutrition in hospitalized patients aged 18 years old or older at the time of admission in Korea. METHODS: This multi-center, preliminary survey included patients over 18 years old who were admitted on a given day from six hospitals in Korea. Nutritional status was assessed using Subjective Global Assessment tool. Data collected included hospital characteristics, patient characteristics, nutrition screening, and nutrition assessment. RESULTS: Among the 99 patients recruited (47 males, 47.5%), 18 (18.2%) and 2 (2.0%) patients were moderately malnourished and severely malnourished, respectively. The mean age of the malnourished group was older than that of the well-nourished group (49.7+/-17.1 vs. 60.5+/-13.6 years old, P-value=0.010). Patients admitted for medical treatment were more malnourished than those admitted for surgical treatment. CONCLUSION: Results of the multi-center preliminary survey showed 20.2% prevalence of malnutrition on admission. A national survey was piloted and will be followed by full implementation.
Humans ; Inpatients ; Korea ; Male ; Malnutrition ; Mass Screening ; Nutrition Assessment ; Nutritional Status* ; Prevalence

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A Prospective Observational Study Evaluating the Change of Nutritional Status and the Incidence of Dumping Syndrome after Gastrectomy.

Ju Ri NA ; Yuhn Suk SUH ; Seong Ho KONG ; Jeong Hyun LIM ; Dal Lae JU ; Han Kwang YANG ; Hyuk Joon LEE

Journal of Clinical Nutrition.2014;6(2):59-70. doi:10.15747/jcn.2014.6.2.59

PURPOSE: The aim of this study was to investigate the change of nutritional status and the incidence of dumping syndrome after gastrectomy for gastric cancer. METHODS: From January 2013 to May 2014, 36 patients who underwent gastrectomy for gastric cancer were prospectively investigated in terms of nutritional status by body weight, anthropometric measurements, biochemical data, and Patient-Generated Subjective Global Assessment (PG-SGA). Dumping syndrome was assessed using a newly developed questionnaire based on the Japanese Society of Gastroenterological Surgery survey and Sigstad's scoring system. RESULTS: Body weight losses were 4.6%, 8.1%, and 6.9% at discharge, six months, and one year after discharge, respectively. Triceps skinfold thickness had no significance, however, mid-arm muscle circumference showed significant loss after gastrectomy. A part of the biochemical data showed significant change after gastrectomy, but almost indicated a restoring tendency within two months after discharge. In terms of PG-SGA, 33 patients (91.7%) were classified as A (well-nourished) before surgery, however, the number of well-nourished patients showed a sharp decrease to 1 (2.8%) at two weeks after discharge, and then gradually increased to 25 (69.4%) at one year. The main obstacles against diet intake were reported as 'early satiety' and 'anxiety'. The number of patients who had experience in at least one dumping syndrome related symptom was 21 (58.3%) at discharge, 26 (72.2%) at two months after discharge, and 11 (30.6%) at one year after discharge. CONCLUSION: Nutritional deficit as well as dumping syndrome is encountered in a large number of gastric cancer patients after gastrectomy. Postoperative nutritional support and personalized education seem to be very important during the postoperative period.
Asian Continental Ancestry Group ; Body Weight ; Diet ; Dumping Syndrome* ; Education ; Gastrectomy* ; Humans ; Incidence* ; Nutritional Status* ; Nutritional Support ; Observational Study* ; Postoperative Period ; Prospective Studies* ; Skinfold Thickness ; Stomach Neoplasms ; Surveys and Questionnaires

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Protein Metabolism and Glutamine Supplementation in Stress Condition.

Sook Hee AN

Journal of Clinical Nutrition.2014;6(2):56-58. doi:10.15747/jcn.2014.6.2.56

Stress conditions such as sepsis, trauma, burn, fracture, and major surgery are associated with hypermetabolism and hypercatabolism. Protein is mobilized for energy and uptake of amino acids by muscle tissue is decreased in stress conditions. The metabolic response to stress causes movement of amino acids (predominantly alanine and glutamine) from peripheral reserves to metabolically active tissues. Glutamine is a conditionally essential amino acid during stress. Glutamine plays a role in maintenance of intestinal immune function and reinforcement of wound repair. Supplementation of parenteral glutamine (0.3~0.5 g/kg/day) as a component of nutrition support may improve clinical outcomes in appropriate patients. In patients with multiorgan failure, supplementation with a high dose of glutamine (>0.5 g/kg/day) in the acute phase of critical illness is not recommended. In stress conditions, provision of adequate protein is essential and glutamine supplementation should be considered in patients without specific contraindications.
Alanine ; Amino Acids ; Burns ; Critical Illness ; Glutamine* ; Humans ; Metabolism* ; Sepsis ; Wounds and Injuries

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