Annals of Clinical Nutrition and Metabolism

How to Access for Enteral Feeding: Gil Ho Kang; Surg Metab Nutr 2011;2(1):1-4. Published online June 30, 2011

Abstract PDF: Enteral nutrition (EN) has been used since the Egyptians, and first began with rectal feeding. EN has several physiological advantages such as reduced complications due to immunological improvements, the prevention of bacterial translocation due to the ability to maintain the integrity of the intestinal barrier, and more convenience but less expense. Yet, there is much difficulty implementing EN because of medical insurance. A Levin tube is most often selected as the route for enteral feedings and patients must bear the high cost of radiologic and endoscopic procedures for enteral feeding. Among the efforts to overcome these difficulties, we review tips for feeding tube placement as well as tube selection and routes. (SMN 2011;2:1-4)

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How to Perform Enteral Feeding: Won-Gyoung Kim, Hyuk-Joon Lee; Surg Metab Nutr 2011;2(1):5-10. Published online June 30, 2011

Abstract PDF: Enteral nutrition (EN) is generally regarded as the most important and efficient nutritional support for patients who are malnourished or at risk of becoming malnourished. EN is commonly used when patients have a functional gastrointestinal tract but are unable to safely swallow. Osmolality, renal solute load, pH, residue, and caloric density should be considered to select an enteral formula. Infusion methods for EN, including bolus, intermittent, and continuous feeding, should be determined by patient age, location of the feeding tube, total energy intake, and intestinal status. Monitoring of vital signs, body weight changes, input/output balance, body fluid status, nutrient intake, essential laboratory data, and medications are essential to evaluate the appropriateness of nutritional support and to prevent EN-related complications, such as tube occlusion, aspiration, diarrhea, constipation, dehydration, or refeeding syndrome. (SMN 2011;2:5-10)

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Clinical Application of Antioxidants: Yong Ho Kim; Surg Metab Nutr 2011;2(1):11-15. Published online June 30, 2011

Abstract PDF: Free radical generation increases in inflammatory disorders, trauma, sepsis, and catabolic states. Reactive oxygen species (ROS) play an important role in arachidonic acid metabolism, immune cell activation, and cytokine production. However, they mediate damage to DNA, proteins, and cell membranes by oxidization and lipid peroxidation. Antioxidants are molecules capable of inhibiting the oxidation of other molecules. Enzymatic antioxidants include superoxide dismutase, glutathione peroxidase, and catalase. These antioxidants are dependent on nutrient trace elements such as selenium, copper, zinc, and manganese. Nutrient antioxidants include vitamin C, vitamin E, β-carotene, and cysteine. Critically ill patients requiring nutritional support have impaired antioxidant defenses. Many trials have been conducted on the administration of antioxidant nutrients, trace elements for antioxidant enzyme function, and oxygen radical scavengers to critically ill patients. Very low concentrations of plasma ascorbate occur in patients in shock. The vitamin C requirement for parenteral nutrition is the recommended dose of 100 mg/day, which may be insufficient. Research on the therapeutic use of high-dose vitamin C (500 mg/d?2 g/day) for antioxidant therapy is progressing. The recommended vitamin E requirement is 10 IU/d (9.1 mg/d) for adult parenteral solutions. However, whether this is sufficient to ensure antioxidant activity is controversial. Therapeutic dose of vitamins and other nutrients as antioxidants have not been determined yet, and ROS production is unavoidable. Anti-oxidative systems are critically important for human health; therefore, the imbalance between ROS and anti-oxidants should be normalized. (SMN 2011;2:11-15)

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The Effect of Early Enteral Feeding after a Pancreaticoduodenectomy: Ji Hoon Kim, Ho-Seong Han, Yoo-Seok Yoon, Do-Joong Park, Jai Young Cho, Keun Soo Ahn, So Youn Kim, Soo Ahn Choi; Surg Metab Nutr 2011;2(1):16-20. Published online June 30, 2011

Abstract PDF: Purpose: Pancreaticoduodenectomy (PD) is associated with high rates of postoperative morbidity. The benefits of enteral nutritional support compared with parenteral nutrition are widely accepted. However, fear of postoperative ileus and anastomotic leakage has been the barrier for early feeding after abdominal surgery. The aim of this study was to prospectively assess the safety, tolerability, and outcome of early enteral feeding after PD.
Materials and Methods: All patients who underwent PD between October 2008 and March 2009 were prospectively divided into one of the following two study groups: early enteral nutrition (EN) and traditional nutrition (TN). Fourteen patients received EN, and 13 patients received TN. Fully informed consent was obtained from all the patients.
Results: Twenty-seven patients were enrolled in this study. EN was discontinued in two patients due to abdominal bloating and abdominal pain. Age, gender, preoperative weight loss, and medical comorbidity were similar between the two groups. The overall postoperative morbidity was 33.3% (EN group) and 30.7% (TN group), and the differences in the values were not statistically significant. The results of blood tests obtained on postoperative days 7 and 14 showed no statistically significant difference between the two groups. On postoperative day 7, patients in the EN group showed a weight gain, but patients in the TN group showed continuing weight loss.
Conclusion: Early enteral feeding following PD is a feasible procedure associated with improvements in early postoperative nutritional status. (SMN 2011;2:16-20)

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Nutritional Risks as Identified by Nutritional Risk Screening 2002 and Nutritional Status of Patients Awaiting Surgery for Gastric Cancer: Seung Soo Lee, Kyung Eun Lee, Seung Wan Ryu, In Ho Kim; Surg Metab Nutr 2011;2(1):21-25. Published online June 30, 2011

Abstract PDF: Purpose: Nutritional Risk Screening 2002 (NRS-2002) requires data on changes in weight and the amount of oral intake with a certain level of accuracy, while information given by patients is often unclear and non-quantitative. The time interval between diagnosis and surgery is becoming shorter, and it is difficult to obtain objective confirmation about these changes from medical records before surgery. The aim of this study was to compare nutritional risks as estimated by NRS-2002 with nutritional status in patients with gastric cancer when data on changes in weight and the amount of oral intake were limited.
Materials and Methods: Only objectively confirmed data (body mass index, age) and severity of disease were used to estimate the nutritional risk of 277 patients by NRS-2002. The results were compared to nutritional status assessed by percent ideal body weight and serum albumin levels.
Results: Of 277 patients, 220 were classified as nutritionally not at risk by NRS-2002. Out of those 220 patients, 28 patients were malnourished and 192 patients were not malnourished. Only serum albumin levels were significantly different between malnourished and non-malnourished groups (P<0.001).
Conclusion: When data on changes in weight and the amount of oral intake are limited,patients with protein malnutrition are likely to be overlooked by NRS-2002. (SMN 2011;2:21-25)

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Evaluation of Parenteral Nutrition Use in Critically Ill Patients: Mi-Ra On, Young-Mi Han, Ji-Hoi Kim, Jin-Young Moon, Young-Ju Kim, Ki-Won Kim, Jun-Ho Lee, Jong-Mog Lee, Sang-Jae Park; Surg Metab Nutr 2011;2(1):26-33. Published online June 30, 2011

Abstract PDF: Purpose: Malnutrition often appears in critically ill cancer patients, thus proper nutritional support is essential according to a patient’s condition. The purpose of this study was to evaluate the appropriateness and safety of PN (parenteral nutrition) in critically ill cancer patients.
Materials and Methods: The indications and appropriateness of nutrition support and monitoring along with complications of PN were evaluated based on ASPEN-SCCM guidelines (2009) in hospitalized adult cancer patients in the National Cancer Center Intensive Care Unit from March to August 2010 from electronic medical records, retrospectively.
Results: The percentage of overfeeding more than 120% of caloric requirement at the start of PN was 43.2% (16 pts) among the total population, and an average ratio of less than 80% of caloric requirements was found in 16% (6 pts) among 37 patients. Lipids were supplied in the majority of patients (34 pts, 91.9%), but the supply rates of vitamins (15 pts, 44.1%) and trace elements (12, 37.8%) were relatively low. All the monitoring for PN was performed appropriately in over 80% of patients except for serum triglycerides and serum Mg. For the assessment of complications of PN, hyperglycemia (≥200 mg/dl) presented in 56.8% (21 pts), hepatic enzyme elevations associated with PN were found in 16.2% (6 pts), and catheter infection occurred in 5.4% (2 pts).
Conclusion: PN in critically ill cancer patients was not performed according to guidelines, and some complications occurred related to PN. Therefore, reinforced education of medical team members on the hospital system of nutritional support are needed to appropriately utilize PN in critically ill cancer patients. (SMN 2011;2:26-33)

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