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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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Attitudes of Medical Staff and Factors Related to Nutritional Support for Patient Care in a University Hospital.

Hwee Soo JEONG ; Chen Hsuen TEONG ; You Jung CHOI ; Woo Jeng KIM ; Ah Ran LEE

Journal of Clinical Nutrition.2014;6(1):37-41. doi:10.15747/jcn.2014.6.1.37

PURPOSE: Knowledge of nutritional support and attitudes of medical staff both affect patient care. We identified attitudes regarding nutritional support among medical staff as well as changes in attitudes when a nutritional support team is present. METHODS: Data were collected from 172 medical staff members who served at a university hospital located in Gyeongju by self-administered questionnaire from June 12~August 30, 2013. The questionnaire inquired about importance of nutritional support, self-confidence about nutritional support, consideration of nutritional support for patient care, consideration of nutritional support when a nutritional support team is present, and nutritional knowledge training during the past year. RESULTS: A total of 169 subjects (98.3%) thought that nutritional support is important for patient care. Only 19 subjects (11.0%) were highly self-confident about nutritional support. In total, 147 subjects (85.5%) considered nutritional support for some or all patients, whereas 169 (98.3%) considered nutritional support for patient care when a nutritional support team is present. Thirty-eight subjects (22.1%) received nutritional knowledge training during the past year. High self-confidence for nutritional support was related to nutritional knowledge training and service part. Positive changes regarding nutritional support when a nutritional support team is present were associated with nutritional knowledge training and high self-confidence for nutritional support. CONCLUSION: No differences in nutritional support attitudes for patient care were observed among the medical staff. Nutritional knowledge training and service part affected self-confidence of nutritional support and induced positive changes in attitudes for nutritional support.
Gyeongsangbuk-do ; Humans ; Inpatients ; Medical Staff* ; Nutritional Status ; Nutritional Support* ; Patient Care* ; Surveys and Questionnaires

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Validation of Geriatric Nutritional Risk Index and Percent Weight Loss as a Predictor of Post-operative Complications after Gastrectomy in Elderly Patients.

Kyung Eun LEE ; Young Gil SON ; Seung Wan RYU

Journal of Clinical Nutrition.2014;6(1):30-36. doi:10.15747/jcn.2014.6.1.30

PURPOSE: Gastric cancer surgery is expected to increase in frequency in elderly patients aged over 65 years. The aim of this study was to validate the Geriatric Nutritional Risk Index (GNRI) and percent weight loss as a predictor of post-operative complications after gastrectomy in elderly patients. METHODS: We retrospectively collected data on elderly patients (over 65 years) who underwent gastrectomy for gastric cancer at Keimyung University Dongsan Medical Center between January 2010 and December 2012. Data included patientsocharacteristics (body mass index [BMI], underlying disease, body weight loss during 3 months before gastrectomy, American Society of Anesthesiologists [ASA] score, and stage of disease), operative characteristics (operation method, operation time, and blood loss during operation), GNRI, and post-operative complications after gastrectomy. RESULTS: A total of 321 patients were included. The patients'mean age was 72.4+/-4.7 years, and 49.5% of patients were rated as being at risk by the GNRI. There were no differences in post-operative complications by GNRI, age, sex, ASA score, BMI, serum albumin, co-morbidity, stage of disease, surgical approach, type of surgery, extent of lymph node dissection, operation time, or blood loss during surgery. However, percent weight loss during 3 months was correlated independently with post-operative complications (P<0.001). In logistic regression analysis, a 1% increase in percent weight loss was associated with a 1.102 times increase in the incidence of postoperative complications (P=0.012, 95% confidence interval 1.021~1.189). CONCLUSION: The percent weight loss during 3 months before gastrectomy could help predict post-operative complications in elderly patients.
Aged* ; Body Weight ; Gastrectomy* ; Humans ; Incidence ; Logistic Models ; Lymph Node Excision ; Malnutrition ; Postoperative Complications ; Retrospective Studies ; Serum Albumin ; Stomach Neoplasms ; Weight Loss*

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Prevalence of Malnutrition in Hospitalized Elderly Korean Patients Based on Mini Nutritional Assessment-Short Form.

Hosun LEE ; Ju Hee KANG ; Eunmee KIM ; Won Gyoung KIM

Journal of Clinical Nutrition.2014;6(1):24-29. doi:10.15747/jcn.2014.6.1.24

PURPOSE: To determine the prevalence of malnutrition in hospitalized elderly Korean patients using Mini Nutritional Assessment-Short Form (MNA-SF) in Korea. METHODS: A cross-sectional, multi-center study was performed. We enrolled 300 patients aged > or =65 years from 10 hospitals. We collected subjects' general characteristics, including age, sex, height, weight, and diagnosis. Patients' nutritional status was assessed using MNA-SF within 48 hours since hospital admission. RESULTS: The subjects were 74.2+/-6.3 years old, and 155 patients were male (51.7%). Cancer was the most common diagnosis (26.3%), followed by musculoskeletal (11.3%), neuromuscular (10.3%), pulmonary (9.0%), and cardiovascular disease (8.7%). The length of hospital stay was 8.7+/-5.9 days. According to MNA-SF, 99 patients (33.0%) were at risk of malnutrition, and 51 patients (17.0%) were malnourished. MNA-SF score showed negative correlations with age (r=-0.259, P<0.001) and hospital stay (r=-0.168, P=0.006). Patients in the malnourished or at risk of malnutrition groups were more likely to be admitted to and stayed longer in the intensive care unit (ICU) than those of normal nutritional status (8.7% vs. 17.3%, P=0.026; 1.6+/-1.0 days vs. 3.7+/-3.2 days, P=0.033). The patients who were malnourished or at risk of malnutrition were hospitalized significantly longer than those of normal nutritional status (9.8+/-6.2 vs. 7.7.+/-5.4 days, P=0.004). After adjusting for age and ICU admission, nutritional status by MNA-SF was the only risk factor for prolonged hospitalization (beta=1.384, P=0.005). CONCLUSION: About half of hospitalized elderly patients were at risk of malnutrition or malnutrition status at admission, and nutritional status was the only risk factor for longer hospital stay. Thus, more attention should be paid to the nutritional care of elderly patients to improve clinical outcomes.
Aged* ; Cardiovascular Diseases ; Diagnosis ; Hospitalization ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Male ; Malnutrition* ; Nutritional Status ; Prevalence* ; Risk Factors

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Nutrition Support for Pediatric Short Bowel Syndrome.

Ji Young SONG ; Hyun Young KIM

Journal of Clinical Nutrition.2014;6(1):19-23. doi:10.15747/jcn.2014.6.1.19

Short bowel syndrome (SBS) develops in infants and children with inadequate small intestine for digestion and absorption of enteral nutrients for normal growth and development. This can lead to malabsorption of macronutrients or micronutrients, electrolyte imbalance, dehydration, malnutrition, and growth failure. The goals of nutrition support in pediatric SBS are to promote intestinal adaptation, avoid complications associated with intestinal resection and parenteral nutrition (PN), and, ultimately, maintain normal growth. In the initial phase of SBS, PN support is important in order to meet energy requirements and for avoidance of electrolyte imbalance or dehydration. Enteral nutrition should be initiated as soon as possible after bowel resection in order to promote intestinal adaptation. In order to stimulate oral motor activity and to avoid feeding aversion behavior, tolerable volumes of bottle-feeding or solid food should be accepted. In addition, feeding volume might be gradually increased in small amounts with monitoring of stool quantity and consistency. Because not all enterally administered calories are absorbed, PN should not be decreased isocalorically against enteral nutrition. In order to enhance bowel adaptation by maximizing nutrient delivery, it is necessary to determine the potential advantages of administration mode, continuous vs. bolus feeding, and what formula should be considered, polymeric vs. monomeric or oligomeric formula. Optimal enteral feeding regimen for pediatric SBS is still being debated, how to feed or what to feed, therefore, nutritional management of SBS should be adjusted according to the patient's medical condition.
Absorption ; Child ; Dehydration ; Digestion ; Enteral Nutrition ; Growth and Development ; Humans ; Infant ; Intestine, Small ; Malnutrition ; Micronutrients ; Motor Activity ; Nutritional Support ; Parenteral Nutrition ; Polymers ; Short Bowel Syndrome*

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