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.

BACKGROUND/OBJECTIVES: Carrots are a major source of beta-carotene, but comparative studies on different consumption methods are limited. This study compared the rates of β-carotene absorption from fresh carrots versus fresh carrot juice. SUBJECTS/METHODS: For β-carotene absorption, a separate randomized controlled crossover trial was conducted with 16 healthy adults. The participants consumed 25 mg of β-carotene from raw carrots or fresh carrot juice. Blood samples were collected at the baseline (0 h) and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, and 24 h post-consumption. RESULTS: The carrot juice group exhibited 2.33 times higher peak plasma concentrations 1.5 h post-consumption than those in the raw carrot group. The area under the curve for β-carotene absorption was 2.09 times greater in the carrot juice group than in the raw carrot group. The plasma α-carotene levels increased in both groups, but no significant differences were found. Similarly, no significant changes in the plasma levels of other fat-soluble vitamins were observed. In addition, no significant differences in antioxidant capacity (oxygen radical absorbance capacity and total radical-trapping antioxidant potential) were found between the 2 groups. CONCLUSION Consuming fresh carrot juice, without added sugars, may enhance the bioavailability of β-carotene compared to raw produce.

Background: Sclerostin, initially recognized for its pivotal role in bone metabolism, has gained attention for its multifaceted impact on overall human health. However, its influence on frailty—a condition that best reflects biological age—has not been thoroughly investigated. Methods: We collected blood samples from 244 older adults who underwent comprehensive geriatric assessments. Sclerostin levels were quantified using an enzyme-linked immunosorbent assay. Frailty was assessed using two validated approaches: the phenotypic model by Fried and the deficit accumulation frailty index (FI) by Rockwood. Results: After controlling for sex, age, and body mass index, we found that serum sclerostin levels were significantly elevated in frail individuals compared to their robust counterparts (P<0.001). There was a positive correlation between serum sclerostin concentrations and the FI (P<0.001). Each standard deviation increase in serum sclerostin was associated with an odds ratio of 1.87 for frailty (P=0.003). Moreover, participants in the highest quartile of sclerostin levels had a significantly higher FI and a 9.91-fold increased odds of frailty compared to those in the lowest quartile (P=0.003 and P=0.039, respectively). Conclusion These findings, which for the first time explore the association between circulating sclerostin levels and frailty, have significant clinical implications, positioning sclerostin as one of potential blood-based biomarkers for frailty that captures the comprehensive physical, mental, and social aspects of the elderly, extending beyond its traditional role in bone metabolism.

Background: In vitro and animal studies have demonstrated that bone morphogenetic protein-7 (BMP-7), renowned for its osteogenic properties, also exerts beneficial effects on muscle metabolism by enhancing myogenesis and reversing muscle atrophy. Despite being proposed as a common regulatory factor for both muscle and bone, the impact of BMP-7 on human muscle health has not been thoroughly investigated. Methods: This cross-sectional study involved 182 community-dwelling older adults who underwent a comprehensive geriatric assessment in South Korea. Sarcopenia was diagnosed using Asian-specific cutoffs, and serum BMP-7 levels were quantified via enzyme immunoassay. Results: The mean age of the participants was 72.2±7.3 years, with 62.6% being female. After adjustments for confounders, serum BMP-7 levels were not significantly different between individuals with and without sarcopenia, nor were there differences based on skeletal muscle mass, strength, or physical performance levels (p=0.423 to 0.681). Likewise, no correlations were detected between circulating BMP-7 levels and any sarcopenia assessment metrics such as skeletal muscle index, grip strength, gait speed, or chair stand completion times (p=0.127 to 0.577). No significant associations were observed between increases in serum BMP-7 concentrations and the risk of sarcopenia or poor muscle phenotypes (p=0.431 to 0.712). Stratifying participants into quartiles based on serum BMP-7 levels also indicated no differences in sarcopenia-related parameters (p=0.663 to 0.996). Conclusion Despite experimental evidence supporting BMP-7’s role in muscle metabolism, this study found no significant association between serum BMP-7 levels and clinical indicators of muscle health in older adults. These findings challenge the utility of serum BMP-7 as a biomarker for sarcopenia in this demographic.

Purpose: We aimed to evaluate health-related quality of life (HRQoL) in intestinal failure (IF) patients after different modes of intestinal rehabilitation. Methods: HRQoL was assessed using the generic 36-item Short Form Survey (SF-36, ver. 2) and visual analogue scale (VAS) in 6 different areas: diet, sleep, gastrointestinal (GI) symptoms, diarrhea, musculoskeletal pain, and other symptoms. Results: Twenty-two patients completed the questionnaires, of which 7 had received intestinal transplant (ITx), 9 were continuing home total parenteral nutrition (HPN), and 6 had tapered off total parenteral nutrition (TPN). SF-36 physical component summary scores were highest in the ITx group (median, 65.6; interquartile range [IQR], 31.6–80.3) compared to the HPN (median, 48.4; IQR, 44.7–66.3) or tapered group (median, 54.2; IQR, 45.2–61.6). Mental component summary scores were lowest in the ITx group (median, 48.8; IQR, 37.1–63.6), compared to the TPN (median, 60.2; IQR, 41.6–78.5) or tapered group (median, 51.0; IQR, 48.8–56.0). Differences were not significant in all items of the SF-36. VAS scores showed that patients in the ITx group showed the best results in diet (0.9), gastrointestinal (GI) symptoms (1.4), and musculoskeletal pain (2.4). There was a significant difference in sleep (P = 0.036), with the ITx (1.43) and HPN groups (1.33) showing better outcomes compared with the tapered group (4.67). Patients in the tapered group showed the least favorable results in all performance areas, except GI symptoms. Conclusion SF-36 did not show a significant difference between the ITx, HPN, and tapered groups, but VAS showed a significant difference in sleep between groups. Further studies, including serial data, will allow a better understanding of the effects of different modes of intestinal rehabilitation.