Choline is an essential nutrient that serves as a fundamental structural component of membrane phospholipids and plays critical roles in one-carbon metabolism, acetylcholine synthesis, lipid transport, and signal transduction. Although it is synthesized endogenously in the human body, the amount produced may not be sufficient to meet the nutrient's total biological demand, necessitating consistent dietary intake from various food sources. Since its recognition as an essential nutrient by the Institute of Medicine (U.S.) in 1998, several countries and regions, including Australia and New Zealand, Europe, and China, have established specific Dietary Reference Intakes (DRIs) to monitor and manage choline intake among their respective populations. In response to the growing demand for national dietary guidelines, the Committee for the Establishment and Revision of the 2025 Dietary Reference Intakes for Koreans (KDRIs) conducted a thorough, systematic review. This initiative was undertaken to re-evaluate the necessity and strength of scientific evidence supporting DRIs for choline in the Korean population. Furthermore, the committee analyzed the distribution of actual choline intake among healthy Koreans by applying a newly developed choline database to the recent five-year data from the Korea National Health and Nutrition Examination Survey. By comprehensively reviewing both the calculated reference values based on existing evidence and the actual intake distribution, the committee successfully established the Adequate Intake and Tolerable Upper Intake Level for choline across different age and gender groups in Korea. This review details the development process and core components of the KDRIs for choline and presents the key issues to be addressed in future revisions of these standards.

BACKGROUND/OBJECTIVES: Lutein, a dietary carotenoid, plays a crucial role in protecting eye health as an anti-inflammatory agent and antioxidant. Green leafy vegetables constitute a major source of lutein; however, comparative studies on different consumption methods are limited. Therefore, this study aimed to evaluate the bioavailability of lutein from lutein-rich foods, namely, raw vegetables and raw vegetable juice. SUBJECTS/METHODS: In this study, 18 adults were recruited. They were randomly divided into three groups: commercial lutein supplement (LUT, 20 mg), raw vegetable (RV), and raw vegetable juice (RVJ) groups. Blood was collected at 0-, 4-, 6-, 8-, 12-, 24-, and 30-h intervals after the consumption of each test meal. Participants’ serum lutein levels were analyzed using high-performance liquid chromatography (HPLC). Considering lutein’s wellestablished anti-inflammatory properties, changes in inflammatory status were assessed by measuring serum high-sensitivity C-reactive protein (hs-CRP) levels. Furthermore, urinary metabolomic profiling was conducted using 1 H nuclear magnetic resonance spectroscopy to evaluate metabolic alterations. RESULTS: After consuming each lutein-rich food, participants’ blood lutein levels were analyzed, and the serum concentration peaked at 12 h (0.37 ± 0.13 μg/mL), 24 h (0.61 ± 0.18 μg/mL), and 30 h (0.42 ± 0.16 μg/mL) after RV, LUT, and RVJ consumption, respectively.Additionally, hs-CRP levels decreased following lutein-rich food consumption. Twelve hours after consumption, hs-CRP levels decreased to 0.81 and 0.83 mg/L in the RV and RVJ groups, respectively. Twenty-four hours after consumption, they further decreased to 0.68 and 0.74 mg/L in the LUT and RVJ groups, respectively. Thirty hours after consumption, a reduction to 0.61 mg/L was observed in the RVJ group. Furthermore, after consuming each luteinrich food, N-acetyl glycoprotein levels decreased at 24 h, reflecting metabolic alterations potentially associated with lutein metabolism. CONCLUSION These findings suggest that the short-term consumption of lutein-rich foods, regardless of their type or source, potentially yields health benefits.

Purpose: This study was performed to predict individualized treatment strategies in ruptured abdominal aortic aneurysm (rAAA) by estimating the survival benefit of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) based on anatomical and physiological features using a causal inference model. Methods: This retrospective study included 45 patients with de novo rAAA who underwent EVAR or OSR between 2012 and 2024. Thirty-three variables were analyzed. The model estimated individualized treatment effects (ITE) for 30-day survival.Model interpretability was assessed using Shapley Additive Explanations (SHAP) analysis. Five-fold cross-validation, receiver operating characteristic (ROC) analysis, and calibration plots were used for model evaluation. A clinical decision tree was developed to derive simplified decision rules. Results: The mean ITE was 0.22 ± 0.42, with 33% of patients classified as OSR-benefit candidates. SHAP analysis revealed that suprarenal angle, infrarenal angle, iliac anatomy, and proximal neck characteristics strongly influenced treatment effects. However, some predictors, such as low hemoglobin and systolic blood pressure favoring OSR, conflicted with clinical intuition. ROC analysis showed an area under the curve of 1.00, but calibration suggested overfitting due to a small sample size. Treatment-matched patients had a higher 30-day mortality rate than mismatched patients, suggesting potential bias or unmeasured confounding. The decision tree identified clinically relevant features but displayed structural inconsistencies and impractical cutoff values due to the limited sample size. Conclusion The X-learner model demonstrated the feasibility of individualized treatment prediction in rAAA but suffered from overfitting and limited generalizability. Validation with larger multicenter cohorts is necessary to confirm clinical applicability.

This study was conducted to maximize the functionality of Deodeok (Codonopsis lanceolata) and improve the processing efficiency by introducing a fermentation process supplemented with oligosaccharides, a prebiotic. The quality characteristics, total polyphenol content, total flavonoid content, and antioxidant and anti-inflammatory activities of fermented Deodeok (FD) and oligosaccharide-fermented Deodeok (OFD) were comparatively analyzed. Regarding the quality characteristics, OFD showed a significantly higher pH (5.90±0.00) than FD (5.78±0.00) (P<0.001), whereas lightness (L), redness (a), yellowness (b), and total color difference (ΔE) were all significantly lower in OFD than in FD (P<0.001), indicating enhanced non-enzymatic browning via the Maillard reaction. The stickiness was also significantly higher in OFD (418.33±5.48 g) than in FD (265.97±2.94 g) (P<0.001). The total polyphenol and total flavonoid contents were significantly higher in OFD (1,408.7±9.4 mg GAE/100 g and 37.6±1.3 mg QE/100 g, respectively) than in FD (715.2±4.8 mg GAE/100 g and 0.36±1.26 mg QE/100 g, respectively) (P<0.05), attributed to the accelerated conversion of polyphenol glycosides to aglycones by microbial glycosidases during oligosaccharide-enhanced fermentation. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging activities were significantly higher in OFD at all concentrations (P<0.05), correlating with the elevated polyphenol and flavonoid levels. Furthermore, OFD significantly suppressed lipopolysaccharide (LPS)-induced inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) mRNA expression in RAW 264.7 macrophages compared to FD (P<0.01), suggesting enhanced anti-inflammatory activity occurs through the simultaneous down-regulation of iNOS and COX-2 pathways. These findings show that oligosaccharide supplementation during fermentation effectively enhances the functional properties of Deodeok, supporting its potential as a high-value functional food ingredient.

Purpose: This study aimed to identify research trends in moral resilience in healthcare through text network analysis and topic modeling of abstracts published in domestic and international journals and to propose future research directions. Methods: A quantitative content analysis was conducted on English abstracts of studies related to moral or ethical resilience in healthcare published through May 2025. Sixty-three papers were selected after removing duplicates, and screening was conducted using eight databases: KISS, RISS, DBpia, KCI, CINAHL, Embase, PubMed, and Web of Science. Texts were analyzed using NetMiner 4.5.1 for keyword co-occurrence network construction and Latent Dirichlet Allocation topic modeling. Core keywords were identified using degree and centrality indices, and topics were named through researcher consensus. Results: Research on moral resilience in healthcare began in 2013 and has increased rapidly after 2023, particularly after the coronavirus disease 2019 pandemic. Among 230 extracted keywords, “moral resilience,” “moral distress,” and “care” showed the highest centrality. Five major topics were identified: (1) moral resilience and burnout in practice, (2) moral resilience among nursing students, (3) moral competence and fatigue in practice, (4) moral resilience assessment, and (5) moral injury and secondary traumatic stress among healthcare workers. Conclusion Moral resilience reflects the ethical strength that enables healthcare professionals to sustain integrity amid moral adversity. Although the number of international studies has increased, domestic research remains limited. Further work should clarify this concept, develop training programs, and explore organizational strategies to strengthen moral resilience.

Purpose: This study aimed to evaluate the outcomes and current status of reduced-port laparoscopic distal gastrectomy (RLDG) compared with multiport laparoscopic distal gastrectomy (MLDG) based on a 2019 nationwide survey of surgical gastric cancer treatments by the Korean Gastric Cancer Association (KGCA). Materials and Methods: The study was conducted retrospectively from March to December 2020 using data from the 2019 KGCA nationwide survey database. To compare RLDG and MLDG based on age, sex, body mass index, American Society of Anesthesiologists score, histological type, tumor invasion, and lymph node metastasis, propensity score matching was performed. Results: Of the 14,076 registered patients with gastric cancer, the five-port approach was the most favored for multiport gastrectomy, accounting for 6,396 (70.9%) cases, followed by the four-port approach, with 1,462 (16.2%) cases. The single-port approach was used in 303 (3.4%) cases, the two-port approach in 95 (1.1%) cases, and the three-port approach in 731 (8.1%) cases. RLDG was performed in 805 patients (6.4%), MLDG was conducted in 4,831 patients (34.3%), and 804 patients were 1:1 matched in each group. The average operation time was shorter in the RLDG (168.2±49.1 min vs. 179.5±61.5 min, P<0.001). No significant difference was found in blood loss (84.8±115.9 cc vs. 75.5±119.6 cc, P=0.152), overall complication rates (11.3% vs. 13.1%, P=0.254), or complications ≥ to grade IIIa (3.2% vs. 4.4%, P=0.240). Conclusions This study revealed that RLDG is a safe and effective surgical option for gastric cancer with the potential to offer shorter operation times without increasing the risk of complications.

Purpose: Since 1995, the Korean Gastric Cancer Association (KGCA) has been periodically conducting nationwide surveys on patients with surgically treated gastric cancer. This study details the results of the survey conducted in 2023. Materials and Methods: The survey was conducted from March to December 2024 using a standardized case report form. Data were collected on 86 items, including patient demographics, tumor characteristics, surgical procedures, and surgical outcomes. The results of the 2023 survey were compared with those of previous surveys. Results: Data from 12,751 cases were collected from 66 institutions. The mean patient age was 64.6 years, and the proportion of patients aged ≥71 years increased from 9.1% in 1995 to 31.7% in 2023. The proportion of upper-third tumors slightly decreased to 16.8% compared to 20.9% in 2019. Early gastric cancer accounted for 63.1% of cases in 2023.Regarding operative procedures, a totally laparoscopic approach was most frequently applied (63.2%) in 2023, while robotic gastrectomy steadily increased to 9.5% from 2.1% in 2014.The most common anastomotic method was the Billroth II procedure (48.8%) after distal gastrectomy and double-tract reconstruction (51.9%) after proximal gastrectomy in 2023.However, the proportion of esophago-gastrostomy with anti-reflux procedures increased to 30.9%. The rates of post-operative mortality and overall complications were 1.0% and 15.3%, respectively. Conclusions The results of the 2023 nationwide survey demonstrate the current status of gastric cancer treatment in Korea. This information will provide a basis for future gastric cancer research.

Purpose: Persimmon (Diospyros kaki Thunb.) is rich in phytochemicals (e.g., tannin and beta-carotene.), vitamins (e.g., vitamins A and C), minerals (e.g., calcium and potassium), and dietary fiber. Persimmon exhibits efficacy against diseases such as cancer, hypertension, and heart disease. This study examined the antioxidant and immune-enhancing activities of Fuyu (a sweet persimmon) and Hachiya (an astringent persimmon) and evaluated their potential as functional food ingredients. Methods: The antioxidant and immune-enhancing activities of Fuyu and Hachiya persimmons were evaluated by extracting them with hot water and ethanol (100%). The antioxidant activity was assessed by measuring the total phenolic content (TPC), total flavonoid content (TFC), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity (RSA), and oxygen radical absorbance capacity (ORAC). Six-year domestic red ginseng was used as a reference for assessing the immune-enhancing activity. Nitric oxide (NO) production, phagocytosis, cytokine levels interleukin [IL]-2, IL-4, IL-10, and interferon-γ), and inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) gene expression were analyzed. Results: The hot water extracts of Fuyu and Hachiya persimmon exhibited significantly higher TPC, TFC, DPPH RSA, and ORAC levels than the ethanol extract. The Hachiya persimmon extract generally showed comparable or higher immune-enhancing activity than the Fuyu persimmon extract in NO production, cytokine activity, phagocytosis, and expression of iNOS and COX-2 genes. Conclusion Hachiya persimmon possesses superior antioxidant properties to Fuyu persimmon while exhibiting comparable immune-enhancing activity. These characteristics highlight its potential for beneficial applications. Nevertheless, further research is required to elucidate these effects and optimize their use in health-promoting interventions.