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Nutrition Support Methods in Elderly Patients.

Journal of Clinical Nutrition.2014;6(1):7-10. doi:10.15747/jcn.2014.6.1.7

Nutrition support methods in the elderly is not easy, but similar as young adult. Elderly patients are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. The type of artificial nutrition to use will depend on the current illness and the previous health record. Because enteral feeding is less expensive and aggressive, enteral feeding should be used whenever possible, leaving parenteral nutrition for specific situations where enteral feeding should not be used.
Aged* ; Chronic Disease ; Enteral Nutrition ; Humans ; Malnutrition ; Parenteral Nutrition ; Young Adult

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Metabolic Change and Nutritional Supply in the Elderly.

Sun Wook KIM ; Kwang Il KIM

Journal of Clinical Nutrition.2014;6(1):2-6. doi:10.15747/jcn.2014.6.1.2

During the past decades, the world's population has continued on its remarkable transition from a state of high birth and death rates to low birth and death rates. As a result, the number of elderly people, and particularly of the very elderly people, is increasing throughout the world. This demographic change has profound implication for medical and health care systems. As more people live to advanced old age, it is important to understand the chronic diseases and health problems which affect them from a physiologic standpoint. It has been well established that nutritional status has an important role on functional capacity and health status of the elderly people. Recently, there has been momentous development in perspectives of the metabolic mechanism that associated with ageing. As person live longer, the function of organ system decrease and the functional reservoir against external stress is depleted simultaneously. The concept of nhomeostenosiso emerged to account for the changes, and it is characterized that progressive constriction of homeostatic reserve in every organ system. Comorbidities like hypertension, diabetes mellitus, dementia, depression, and physical limitations are very common in the elderly, and they are often troubled with decreased function of digestive systems and sensory organs. Furthermore, many elderly people have suffered from poverty and social isolation. Accordingly, the older are more prone to malnutrition or undernutrition. In addition, the combination of the mentioned problems with homeostenosis will lead to metabolic derangement, like insulin resistance and visceral fat accumulation. This process makes a deleterious effect on their comorbidities or physical function; consequentially it triggers and exacerbates frailty in the elderly. In this review, we describe the mechanism of metabolic change, and appropriate nutritional supply for the elderly.
Aged* ; Chronic Disease ; Comorbidity ; Constriction ; Delivery of Health Care ; Dementia ; Depression ; Diabetes Mellitus ; Digestive System ; Homeostasis ; Humans ; Hypertension ; Insulin Resistance ; Intra-Abdominal Fat ; Malnutrition ; Metabolism ; Mortality ; Nutritional Status ; Parturition ; Poverty ; Social Isolation

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Letter from Editor.

Hyuk Joon LEE

Journal of Clinical Nutrition.2014;6(1):1-1. doi:10.15747/jcn.2014.6.1.1

No abstract available.

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Evaluation of Postoperative Nutrition Support with Commercial Peripheral Parenteral Nutrition after an Ivor-Lewis Esophagectomy in Patients with Esophageal Cancer.

Sun Woo LEE ; Na Ri LIM ; Hyo Jung PARK ; Yong Won IN ; Jeong Meen SEO ; Young Mee LEE

Journal of Clinical Nutrition.2015;7(3):87-92. doi:10.15747/jcn.2015.7.3.87

PURPOSE: Deteriorated nutritional status is common during a hospital stay for esophagectomy in patients with esophageal cancer. Malnutrition in those patients is often marked compared with other gastrointestinal cancer. The purpose of this study is to evaluate the appropriateness of commercial peripheral parenteral nutrition (CPPN) use in patients who underwent Ivor-Lewis esophagectomy (I-L op). METHODS: Patients who were provided with CPPN after I-L op were enrolled in this study from January to May 2015. Body weight, height, nutritional status, length of hospital stay, duration of CPPN therapy, and parenteral nutrition (PN) induced complications were assessed, respectively, using electronic medical records. RESULTS: Thirty-nine patients were enrolled. Average age was 65.9 years and 36 patients were male. All patients were provided with the same CPPN. The duration of fasting and CPPN use was 5.8+/-1.4 days and 7.5+/-1.8 days, respectively. Calorie supported by CPPN was 22.6+/-3.5 kcal/kg/day and only 20.5% of patients (n=8) reached the daily target calories. Most frequent PN induced complication was phlebitis which occurred in 8 patients (20.5%). Calcium, magnesium, and transthyretin levels in serum were not monitored during the PN support period. CONCLUSION: The indications for CPPN were appropriate because the fasting duration in patients with I-L op was 5 to 10 days. Although a large portion of patients could not be supplied daily target calories, their nutrition status was not significantly changed on admission and at discharge. We did not find it necessary to individualize PN support for a short period after an I-L op in patients with esophageal cancer. Further study will be needed to determine why the incidence of phlebitis was dominant.
Body Weight ; Calcium ; Electronic Health Records ; Esophageal Neoplasms* ; Esophagectomy* ; Fasting ; Gastrointestinal Neoplasms ; Humans ; Incidence ; Length of Stay ; Magnesium ; Male ; Malnutrition ; Nutritional Status ; Parenteral Nutrition* ; Phlebitis ; Prealbumin

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The Efficacy and Safety of Cordyceps militaris in Korean Adults Who Have Mild Liver Dysfunction.

Jin Young HEO ; Hyun Wook BAIK ; Hyuk Jung KIM ; Jae Min LEE ; Hyung Woo KIM ; Yong Sun CHOI ; Jung Ho WON ; Hyun Mi KIM ; Won Il PARK ; Chul Young KIM

Journal of Clinical Nutrition.2015;7(3):81-86. doi:10.15747/jcn.2015.7.3.81

PURPOSE: The aim of this study is to determine the efficacy and safety of Cordyceps militaris in Korean adults with mild liver dysfunction. C. militaris is a mushroom traditionally used for several clinical purposes in East Asian territory, including China, and has been found to be effective in improving liver function through animal studies. METHODS: The C. militaris group was administered 1.5 g/day of C. militaris (2 capsules per dose, twice per day) and the placebo group was administered the same volume of placebo. Laboratory test (white blood cell, hemoglobin, platelet, aspartate aminotransferase, alanine aminotransferase, gamma glutamyltranspeptidase, lactic dehydrogenase, alkaline phosphatase, total bilirubin, blood urea nitrogen, creatinine), liver computed tomography (CT) were performed, and visual analogue scale score for subjective symptoms and fatigue severity scale were measured. RESULTS: In analysis of the liver CT scan at 8 weeks after administration compared to baseline, the mean ratio of change of Hounsfield unit of 8 segments of liver increased by an average of 21.43%+/-45.11% in the C. militaris group and 9.64%+/-11.41% in the placebo group. Others showed no statistically significant inter-group difference. CONCLUSION: C. militaris extract was used safely as a functional food in patients with mild liver dysfunction, and is expected to protect against progression of fatty liver or cirrhosis caused by suppression of lipid accumulation in hepatocytes.
Adult* ; Agaricales ; Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Asian Continental Ancestry Group ; Aspartate Aminotransferases ; Bilirubin ; Blood Cells ; Blood Platelets ; Blood Urea Nitrogen ; Capsules ; China ; Cordyceps* ; Fatigue ; Fatty Liver ; Fibrosis ; Functional Food ; Hepatocytes ; Humans ; Liver Diseases* ; Liver* ; Oxidoreductases ; Tomography, X-Ray Computed

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Analysis of Current Use of Early Parenteral Nutrition and Clinical Significance of Non-protein Calorie: Nitrogen in Surgical Critically Ill Patients.

Eunjeong HEO ; Kayoung PARK ; Sujeong JEON ; Hyungwook NAMGUNG ; Eunsook LEE ; Inae SONG

Journal of Clinical Nutrition.2015;7(3):75-80. doi:10.15747/jcn.2015.7.3.75

PUROPOSE: Surgical critically ill patients require adequate nutrition support and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend low non-protein calorie:nitrogen ratio (NPC:N ratio, 70~100) for critically ill pateints. In this study, we assess the current use of early parenteral nutrition of surgical critically ill patients and analyze the clinical significance of NPC:N. METHODS: This is a retrospective study of critically ill adult patients who remained in the intensive care unit (ICU) for over 3 days and could not receive enteral nutrition for the first 7 days. Data on parenteral intake of patients were collected from electronic medical records. Association of NPC:N scores with clinical outcome (length of ICU stay, length; of hospital stay, duration of ventilation, and mortality) were analyzed using Pearson correlation and multiple regression. RESULTS: The study included 72 cases, average parenteral calorie intake was 14.6 kcal/kg/day and protein intake was 0.5 g/kg/day. We assessed the NPC:N scores to determine the patients' NPC:N for the first 7 days in ICU close to the A.S.P.E.N guidelines. NPC:N scores showed weak negative correlation with length of hospital stay and duration of mechanical ventilation (r=-0.259, P=0.028; r=-0.495, P=0.001). Multiple regression adjusted with APACHE (Acute Physiology and Chronic Health Evaluation) II score, age, and body mass index showed correlation of higher NPC:N score with decreased length of hospital stay and shorter duration of ventilation (P=0.0001, P=0.035, respectively). However, length of ICU stay and mortality within 60 days showed no significant correlation with NPC:N scores. CONCLUSION: Parenteral calories and protein intakes of critically ill patients in ICU were lower in comparison to A.S.P.E.N. recommendation in this study. Low NPC:N scores might be related to shorter length of hospital stay, duration of mechanical ventilation. Consultation of a nutritional support team could have a positive effect in providing appropriate nutrition support.
Adult ; APACHE ; Body Mass Index ; Critical Illness* ; Electronic Health Records ; Enteral Nutrition ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Nitrogen* ; Nutritional Support ; Parenteral Nutrition* ; Physiology ; Protein-Energy Malnutrition ; Respiration, Artificial ; Retrospective Studies ; Ventilation

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Changes in 2015 Canadian Clinical Practice Guidelines.

Dae Sang LEE

Journal of Clinical Nutrition.2015;7(3):70-74. doi:10.15747/jcn.2015.7.3.70

Careful nutritional strategy is an essential component in the management of critically ill patients. Evidence-based clinical practice guidelines can be an effective solution to improving the process and structure of nutritional strategy for critically ill patients. The 2015 Canadian clinical practice guidelines (CPGs) summarized the evidence from approximately 354 randomized controlled trials in the area of critical care nutrition since 1980. The Canadian CPGs were first developed in 2003 and have been updated every 2 years. It is important for the acquisition of new evidence-based knowledge. This paper includes a brief summary on changes in 2015 CPGs compared with 2013 CPGs.
Critical Care ; Critical Illness ; Humans

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Letter from Editor.

Hyuk Joon LEE

Journal of Clinical Nutrition.2015;7(3):69-69. doi:10.15747/jcn.2015.7.3.69

No abstract available.

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Effect of Fish Oil-based Intravenous Fat Emulsion with Parenteral Nutrition in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation.

Ji Hyeong CHOE ; Young Joo LEE ; Hye Jung BAE ; Sun Hoi JUNG ; Hyeon Joo HAHN ; Yungil KOH

Journal of Clinical Nutrition.2016;8(1):29-35. doi:10.15747/jcn.2016.8.1.29

PURPOSE: Omega-3 fatty acid is known for immunonutrition in that it has anti-inflammatory properties and improves the patients' immune function. The objective of this study was to determine the effects of a fish oil-based lipid emulsion for adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: This was a retrospective study of 90 adult allogeneic HSCT patients from July 2011 to June 2015. The patients were divided into two groups according to the lipid type provided; fish oil group (FO group, n=55) and non-fish oil group (NFO group, n=35). The demographics, parenteral nutrition and lipid emulsion duration, length of hospital stay (LOS), weight change, 30 day mortality, survival period, incidence of acute graft-versus-host disease (aGVHD), neutropenic fever, sepsis, and re-hospitalization were collected from the electronic medical records. RESULTS: The patients' characteristics including age, sex, body mass index, and underlying disease were similar in the two groups. The incidence of aGVHD and infectious complications, mortality, LOS, re-hospitalization were also similar. The FO group showed weight gains, whereas the NFO group showed weight loss (FO vs. NFO=0.34% vs. -1.08%, P=0.245). CONCLUSION: The clinical outcomes were similar in the two groups but there was a tendency for gain weight in the FO group. A large, well designed study, and a dosing study will also be needed to determine the optimal dose range for HSCT patients.
Adult ; Body Mass Index ; Demography ; Electronic Health Records ; Fatty Acids ; Fever ; Fish Oils ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Length of Stay ; Mortality ; Parenteral Nutrition* ; Retrospective Studies ; Sepsis ; Weight Gain ; Weight Loss

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Pilot Study for Safety and Efficacy of Newly Developed Oral Carbohydrate-Rich Solution Administration in Adult Surgery Patients.

Won Bae CHANG ; Kyuwhan JUNG ; Sang Hoon AHN ; Heung Gwon OH ; Mi Ok YOON

Journal of Clinical Nutrition.2016;8(1):24-28. doi:10.15747/jcn.2016.8.1.24

PURPOSE: In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients. METHODS: A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables. RESULTS: No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4. CONCLUSION: Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.
Adult* ; Anesthesia ; Anesthesia, General ; Dyspnea ; Fasting ; Herniorrhaphy ; Hoarseness ; Humans ; Hunger ; Nausea ; Pilot Projects* ; Thirst ; Vomiting ; Water

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