Annals of Clinical Nutrition and Metabolism

Metabolism & Nutritional Support in Sepsis: In Kyu Lee; Surg Metab Nutr 2010;1(1):1-4. Published online December 30, 2010

Abstract PDF: There are many controversies regarding the nutritional support of septic patients. Recently, more evidence-based guidelines for feeding intensive care unit patients have been published. Thus, we will focus on routes of nutritional support and the effects of lipid emulsions, glucose control, and immune modulation in septic patients, as well as discuss which nutritional support methods may serve to further enhance the physiologic effects of nutritional therapy and achieve even greater improvement in patient outcome. (SMN 2010;1:1-4)

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Metabolism and Nutritional Support in Liver Transplantation: Young Kyoung You; Surg Metab Nutr 2010;1(1):5-11. Published online December 30, 2010

Abstract PDF: Liver transplantation has been the definitive treatment in end stage liver disease since couple of decades ago. The majority of liver transplant candidates are malnourished and suffer from perioperative morbidity related to undernutrition. To evaluate the status of malnutrition in a liver transplant candidate, a thorough nutritional assessment must be performed. Several adverse effects such as gastrointestinal trouble, renal toxicity, diabetes mellitus, hyperlipidemia and others are commonly seen after liver transplantation in relation to immunosuppressive treatment. Peritransplant obesity as one of the emerging morbidity could be a troublesome issue theses days in our country. Optimal nutrition therapy during all phases of liver transplantation according to ESPEN (European society for parenteral and enteral nutrition) guidelines will lead to improved outcomes. (SMN 2010;1:5-11)

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Metabolism & Nutritional Support in Obesity: Sang-Il Lee; Surg Metab Nutr 2010;1(1):12-16. Published online December 30, 2010

Abstract PDF: Obesity is the failure of weight-homeostasis that controls body weight by a balance between energy intake and consumption. It is suggested that the causes of obesity are genetic variants, environment, loss of satiety, decreased energy consumption, failure of appetite control, and metabolic imprinting. It is necessary to actively treat obesity since it caninduce hypertension, dyslipidemia, diabetes, and osteoarthritis. According to the classification of obesity by the Asia-Pacific region of the World Health Organization, the aim of treatment is to achieve a body mass index (BMI) of 18.5∼22.9 kg/m² and a waist circumference less than 90 cm in males and less than 80 cm in females. Conservative therapies include diet control, exercise, behavior modification, and medication. In the case of Asian individuals, surgery is considered with a BMI over 35 kg/m², or over 30 kg/m² with comorbidity, after failure of conservative therapy. Paradoxically, obese patients can have nutritional deficienciesof vitamin A, C, D, folate, and calcium. Bariatric surgery, especially as a malabsorptive procedure, can cause protein and micronutrient deficiencies or most commonly anemia (10∼74%). Thus, nutritional support is necessary in obesity, including multivitamins, calcium, and iron. Prevention, involving restriction of overeating, a balanced diet with good quality food, and appropriate physical activity, are more important than treatment. (SMN 2010;1:12-16)

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Debate on Fluid Therapy in Perioperative Care: Fluid Restriction: Suk Kyung Hong; Surg Metab Nutr 2010;1(1):17-20. Published online December 30, 2010

Abstract PDF: The great fluid debates continues to rage. There is still no clear consensus or agreement as to whether the perioperative should be treated according to a liberal fluid regimen, or a restrictive one. The debate began a number of years ago in the intensive care unit by Schoemaker and collegues. Large randomized controlled study is peformed about the perioperative fluid management. Most of the study is showing the god result in fluid restriction management including ERAS (Enhanced Recovery After Surgery). Fluid management should be carefully adjusted by the patient’s clinical condition. But, unnecessary fluid challenge can cause pulmonary edema, delayed wound healing, and delayed bowel movement in perioperative patients. Perioperative fluid restriction does not lead to do significant harm in healthy patients undergoing straightforward abdominal surgery. (SMN 2010;1:17-20)

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Immuno-supportive Elements: Jae Gil Lee; Surg Metab Nutr 2010;1(1):21-25. Published online December 30, 2010

Abstract PDF: Immunonutrients can modulate the immune system after infection, surgery, and trauma. They can modulate inflammation and oxidative stress and help to maintain immune function, thus having beneficial effects on the body when used properly. This article reviews immunosupportive macronutrients, such as glutamine, arginine, and ω-3 fatty acids. (SMN 2010;1:21-25)

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Effects of L-alanin-L-glutamine Supplementation after Gastrectomy for Gastric Cancer: Gil Ho Kang, Moon Soo Lee, Yen Kyeung Han, Bo Young Yeon, Su Jin Kim; Surg Metab Nutr 2010;1(1):26-29. Published online December 30, 2010

Abstract PDF: Purpose: The purpose of this study was to investigate the effects of L-alanin-L-glutamine supplementation on postoperative outcomes in patients who underwent gastrectomy for gastric cancer.
Materials and Methods: Between January 2008 and December 2009, 132 patients who had undergone radical gastrectomy for gastric cancer were retrospectively analysed. The patients were divided in two groups. A Gln group (n=63) was given parenteral glutamine (0.5 g/kg/day, Dipeptiven, Fresenius Kabi, Austria, GmbH) with parenteral nutrition, and a non-Gln group (n=69) only received parenteral nutrition postoperative for 7 days. Age, gender, combined disease, body mass index (BMI), preoperative total protein and albumin, stage, operation, operation time, postoperative complications, length of hospital stay, and mortality were analysed.
Results: There were no significant differences between the two groups in patient demographics: age, gender, combined disease, BMI, and preoperative total protein and albumin. In both groups, tumor stage, operation type, and operative time were also similar. For postoperative complications, wound infection (P=0.044) and wound dehiscence (P=0.032) were significantly lower in the Gln group. However, there was no significant difference in terms of anastomotic leakage or other complications. The length of hospital stay was significantly shorter in the Gln group (P<0.001). Finally, there was no significant difference between the groups in mortality.
Conclusion: Parenteral glutamine supplementation had effects of decreasing postoperative wound related complications and length of hospital stay in patients who underwent radical gastrectomy for gastric cancer. But prospective, randomized data from a multicenter study are still needed. (SMN 2010;1:26-29)

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The Clinical Application of Bioelectrical Impedance Analysis in Patients with Critical Illness: Sung Hoon Kim, Jae Gil Lee, Hyoung Won Cho, Hyoung-Il Kim, Kyung Sik Kim, Choong Bai Kim; Surg Metab Nutr 2010;1(1):30-35. Published online December 30, 2010

Abstract PDF: Purpose: Accurate assessments of body fluid balance and nutritional status in patients with critical illness are challenging to clinicians. Because existing parameters have some limitations, this study was designed to evaluate the usefulness of bioelectrical impedance as an assessment tool for body fluid balance and nutritional status.
Materials and Methods: We retrospectively reviewed the medical records of 17 patients treated in surgical intensive care units, which included 16 patients for postoperative care and one patient for medical treatment. Body water status, basal metabolic rate, body cell mass, and fat free mass were examined serially by bioelectrical impedance. Based on body mass index and mortality, we determined whether there were differences among the measured results.
Results: There were 3 mortality cases. According to body mass index, the underweight, normoweight, overweight, and mild obese groups included 2, 7, 2, and 6 patients, respectively. The mixed effects model revealed significant differences within individual extracellular water/total body water (ECW/TBW) (P=0.009), total body water (P=0.025), extracellular water (P=0.033), and intracellular water (P=0.022). The variation of ECW/TBW revealed there was a significant difference between the survival and non-survival patients (P=0.034). Basal metabolic rate (BMR), fat free mass (FFM), and body cell mass (BCM) were directly proportional to arm muscle circumference with high Pearson’s coefficiency (BMR, r=0.727; FFM, r=0.727, BCM, r=0.651).
Conclusion: Bioelectrical impedance analysis is a noninvasive and simple bedside method to assess changes in body fluid balance and nutrition status. Future research should prospectively investigate more patients and compare bioelectrical impedance analysis results with classical assessment tools to validate these results. (SMN 2010;1:30-35)

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Resting Energy Expenditure Measured by Indirect Calorimetry in Major Burn Patients 1) Metabolic Rates 2) The Factors Influencing “Resting Energy Expenditure”: Yong Suk Cho, Haejun Yim, Dohern Kim, Jun Hur, Jong Hyun Kim, Wook Chun; Surg Metab Nutr 2010;1(1):36-41. Published online December 30, 2010

Abstract PDF: Purpose: The purpose of this study was to analyze metabolic rates and factors influencing resting energy expenditure (REE) by indirect calorimetry (IC) in major burn patients.
Materials and Methods: One-hundred and ninety-nine patients who were admitted to Hangang Sacred Heart Hospital with burns on 20% of their total body surface area (TBSA) were enrolled, with 403 measurements of resting energy expenditure (REE) from January 2004 to December 2008. REE was measured by IC. Calculated metabolic rates were compared to five predictive equations. Also, gender, age, burn size, inhalation injury, and ventilation therapy were included in the factors influencing the REE of major burn patients.
Results: The measurement of REE was 1.26 times basal energy expenditure (BEE) as calculated by the Harris-Benedict equation. Prediction by the Curreri formula was 2.19 times greater than measured REE, suggesting the formula’s significant overestimation of energy expenditure. Comparing measured REE with Xie, Zawacki, and Milner’s formula showed that the formula was similar to measured REE (Pearson correlation 0.399). Measured REE and REE/BMR were significantly higher in males (P<0.05), and measured REE and REE/BMI showed significant differences between age groups (P<0.01). Measured REE and REE/BMI also showed significant differences between burn size groups (P<0.01). In patients with inhalation injury, measured REE, REE/BMR, and REE/BMI were significantly higher than in patients without inhalation injury (P<0.01). For patients needing aventilator, measured REE, REE/BMR, and REE/BMI were significantly higher than for those not requiring ventilation therapy (P<0.01).
Conclusion: Indirect calorimetry is useful in detecting variations in energy expenditure among individuals as well as for detecting changes in metabolism. Because the REE of massive burn patients is affected by various factors, these should be considered when determining nutritional support for massive burn patients. (SMN 2010;1:36-41)

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A Case of Wernicke’s Encephalopathy during Long-term Total Parenteral Nutrition (TPN): Su Jin Kim, Yen Kyeung Han, Bo Young Yeon, Sung Mi Park, Seung Yeon Im, Moon Soo Lee, Gil Ho Kang; Surg Metab Nutr 2010;1(1):42-44. Published online December 30, 2010

Abstract PDF: Wernicke’s encephalopathy can develop from vitamin B1 (thiamine) deficiency and presents itself as ataxia, ophthalmoplegia, and mental confusion. One of its predisposing factors is long-term TPN. An adult patient with an entero-cutaneous fistula received total parenteral nutrition (TPN) for 2 months. After one month, the patient presented dizziness and ophthalmophlegia. The patient was diagnosed as thiamine deficient and subsequent thiamine administration brought dramatic recovery. To our knowledge, reports about Wernicke’s encephalopathy during long-term TPN are rare. (SMN 2010;1:42-44)

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