Annals of Clinical Nutrition and Metabolism

Volume 2 (1); December 2009

Original Articles

Evaluating Total Parenteral Nutrition after Pylorus-preserving Pancreatoduodenectomy (PPPD): Yun Hee Park, Sung Eun Kim, Jae Youn Kim, Young Cheon Song, Suk Kyung Hong; J Clin Nutr 2009;2(1):1-5. Published online December 31, 2009; DOI: https://doi.org/10.15747/jcn.2009.2.1.1

Abstract PDF: Purpose
Pylorus-preserving pancreatoduodenectomy (PPPD) is considered the treatment of choice for various periampullary diseases. Although patients who undergo PPPD require postoperative parental nutrition, no guideline has currently been established for this specific group. The aim of this study is to evaluate the TPN given to patients after PPPD and to identify a standard protocol for these patients. Methods: We conducted a retrospective study that reviewed the patients in Asan Medical Center who had undergone PPPD and who had received TPN from January to December in 2007. TPN utilization was evaluated with assessing the supplemented calories and the duration of the TPN. The observed outcomes were the changes in the nutritional status of each patient, the morbidity, the mortality and the length of the hospital stay. Results: A total of 160 patients were enrolled in this study and of these, 118 patients were malnourished. The worse the preoperative nutritional status was for each patient, the longer the TPN was required and this was also true for the length of the hospital stay. The mean calories and protein values given through TPN were 35.15 kcal/kg and 1.39 g/kg, respectively. This was more excessive than the recommended levels (33.02 kcal/kg and 1.34 g/kg, respectively) when considering each patient's nutritional status. We classified the patients by the ratio of supplied calories to the recommended calories; the low-calories group (＜90%; n=26), the adequate calories group (90∼110%; n=74) and high-calories (＞110%; n=60) group. The duration of TPN (9.5d, 10.3d and 12.6d) and the length of the postoperative hospital stay (22.0d, 23.3d and 26.4d) were not statistically different between the groups. The rate of metabolic abnormalities and infectious complications were higher in the over-calories group (71.7% and 25%, respectively) when compared to that of the other two groups (67% and 14%, respectively). Major complications such as delayed gastric emptying, fistulae and anastomotic leakage were not significantly different between the groups. Conclusion: In this study, excessive calorie supplementation had no significant benefit on the outcome of patients after PPPD. Therefore, we suggest that an adequate amount of nutrition, with giving consideration for the pre-existing nutritional status, will be advantageous for the cost-benefit aspect. (KJPEN 2009;2(1):1-5)

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Comparison of Tools for Nutritional Risk Screening at Hospital Admission: So-Youn Kim, Hae-Sun Yeom, Young-Mi Park, Su-Hyun Chung, Ah-Reum Shin, Ho-Seong Han, Do-Joong Park; J Clin Nutr 2009;2(1):6-12. Published online December 31, 2009; DOI: https://doi.org/10.15747/jcn.2009.2.1.6

Abstract PDF: Purpose
Nutritional risk screening has been emphasized to predict those patients who are malnourished or at high nutritional risk. In 2006, we developed the Seoul National University Bundang Hospital Nutrition Screening Tool (SNUBH- NST) using a nutritional screening index (NSI) based on the predictors of the nutritional status. The aim of this study was to compare the SNUBH-NST and the Nutritional Risk Screening 2002 (NRS 2002) recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) as the preferred nutritional risk screening tool for hospitalized patients. Methods: Three hundred and eighty two patients hospitalized in medical and surgical wards were screened and classified as being well nourished or at nutritional risk by the SNUBH-NST and the NRS 2002 within 48 h of admission. The anthropometric measurements and laboratory data were assessed and the length of hospital stay was obtained from the medical chart. Differences between independent groups were assessed with Student's t test and the agreement between both tools was analyzed by the ?²-test. Spearman's rank correlation coefficients were calculated for the correlation between the nutritional risk and the variables. Results: The SNUBH-NST and the NRS 2002 identified 14.7% and 20.9% of all the assessed patients as being at nutritional risk, respectively, and agreement was observed for 340 of the 382 (89%) patients with using both tools (?=0.627, P＜0.001). The anthropometrics and laboratory data were lower and the length of hospital stay was longer for the patients who were screened as being at nutritional risk by both tools (P＜0.001). Conclusion: The nutritional risk screened by the SNUBH- NST correlated significantly with age, the anthropometrics, the laboratory data and the length of stay. Agreement was substantial between the SNUBH-NST and the NRS 2002. Therefore, the SNUBH-NST can be used to screen patients who are at nutritional risk on admission. This study suggested that nutritional information and nutrition care plans should be shared with clinicians. Further studies are needed to investigate whether the SNUBH-NST can predict the clinical outcomes. (KJPEN 2009;2(1):6-12)

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Verification of the Appropriateness When a Shortened Version of the Mini Nutritional Assessment (MNA) Is Applied for Determining the Malnutrition State of Elderly Patients: Hwa-kyung Park, M.P., Bo-kyoung Lim, M.C.N., Sung-hee Choi, B.P., Hye-ryeon Lee, B.N., Do-sang Lee; J Clin Nutr 2009;2(1):13-18. Published online December 31, 2009; DOI: https://doi.org/10.15747/jcn.2009.2.1.13

Abstract PDF: Purpose
The Mini Nutritional Assessment (MNA) is a shortened version of the longer tool, and this was developed to assess the nutritional state of the elderly. This tool uses measurements of the mid-arm circumference and calf circumference, which are among the MNA's list of items relating to anthropometric measurements. But due to the difficulty and complication of placing measuring tools everywhere, we attempted to use a shortened version of the tests by transforming the tests into three different types to get easier and quicker results. Methods: The three types of transformation were as follows: 1) deleting the problems related to anthropometric measurement, which are Q (Mid-arm circumference in cm) and R (Calf circumference in cm) 2) deleting two items, and 2 points were reduced from the standard test (Q, R: 1 point reduced from each) and 3) the original, screening part and assessment part were transformed and the assessment was carried out to the end and evaluated regardless of the screening score. Results: The subjects of the study consisted 121 women and men who were admitted as patients; they were all aged 65 or over and capable of communication. The results of the assessment of the MNA, the anthropometric Measurements and the laboratory data were compared to determine if there were any correlations among them. The average age of the study subjects were 73.79±6.01. The nutritional assessment results were as follows: those in well nourished state (A) were 19%, those at risk of a malnourished state (B) were 52.1%, and those with a malnourished state (C) were 28.9%. According to the MNA results, each group's average age, BMI, PIBW and laboratory data showed a significant difference between the three groups. Conclusion: As the group's nutritional state tended towards a well nourished status, the score of the shortened version of the MNA also increased. Therefore, we conclude that we can predict the malnutrition tendency of elderly patients by using the results of the shortened version of the MNA. (KJPEN 2009;2(1):13-18)

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Development of a Numeric Table for Determination of the Amount of Nutrient Solution in an Infusion of Nutrient Stock Solution: Jeong Hong, Young Joo Lee, Mee Kyung Song, Myoung On Eun, Mee Hyang Kim, Youn Hee Lee, Youn Hee Ahn, Jee Yang Kim; J Clin Nutr 2009;2(1):19-23. Published online December 31, 2009; DOI: https://doi.org/10.15747/jcn.2009.2.1.19

Abstract PDF: Purpose
The purpose of this study was to make a numeric table for easy adjustment of the amount of 5% dextrose solution or 10% fat emulsion solution when added to a 2- or 3-chamber nutrient stock solution. Methods: Nutrient stock solutions were designated as group A or B according to the non-protein calorie-to-nitrogen ratio (NCR). The NCR of groups A and B was approximately 100 : 1 and 150 : 1, respectively. The weight (g) of protein which is to be administered to the patient was arranged in increasing order from 30∼100 g in increments of 2 g. An imaginary NCR was arranged from 110 : 1 to 150 : 1. The difference between the imaginary NCR and the NCR of the nutrient stock solution (A) was multiplied by the grams of protein, which is the equivalent amount of additionally administrable calories. Each calorie value was divided by 3.4 or 1.1 to obtain a volume of 5% dextrose solution or 10% fat emulsion, and arranged in increasing order. All calculations were made with a Microsoft Excel program. Results: The numeric table was made for 2- and 3-chamber solutions in group A. The numeric table for the 2-chamber solution was set for determination of the volume and infusion rate of a 10% fat emulsion. The numeric table for the 3-chamber solution was for determination of the volume of a 5% dextrose solution. Conclusion: This numeric table can be easily used in adjusting the amount of 5% dextrose solution and 10% fat emulsion at the bedside. (KJPEN 2009;2(1):19-23)

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A Current Survey of the Gastric Residual Volume in Critically Ill Patients Who Are Receiving Enteral Nutrition: Young-Ok Park, Eun-Hee Kang, So-Jung Park, Min-A Park, So-Yoon Yoon, Seung-Lan Kim, Jeong-Yun Park, Young- Sun Jung, Suk-Kyung Hong, Byong-Duk Ye, Kyung-Mo Kim; J Clin Nutr 2009;2(1):24-29. Published online December 31, 2009; DOI: https://doi.org/10.15747/jcn.2009.2.1.24

Abstract PDF: Purpose
High gastric residual volumes (GRVs) are known to be one of the frequent causes of stopping enteral nutrition. This study was performed to investigate the gastric residual volume status in critically ill patients who were admitted to intensive care units. Methods: The subjects were 96 critically ill patients who were admitted to the ICU at ASAN Medical Center between October 1, 2008 and March 31, 2009. The measured volumes were categorized in 50 ml intervals from 0 to 500 ml. Results: Of the total GRVs measured, 46% were ＜50 ml. The patients with a GRV ≥50 ml were 54% and 4% had a GRV ≥250 ml, whereas none of the patients' GRVs were ≥500 ml. When admitted to the hospital, There was a correlation between the APACHE 2 score and the gastric residual volume. This shows that the higher the APACHE 2 score was the gastric residual volume. And there was a correlation between the APACHE 2 score and the loss of calories. This shows that the higher the APACHE 2 score was the loss of calories. Conclusion: The gastric residual volume of the critically ill patients under enteral nutrition in our hospital was not higher than that presented on the guidelines from the US and Canada. In addition, there was a big difference in the gastric residual volume among the critically ill patients depending on their clinical characteristics. Strict criteria for the gastric residual volume could be a factor for inhibiting proactive enteral nutrition. (KJPEN 2009;2(1):24-29)

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The Validity of a Nutritional Assessment Tool for Home Care Patients: Kyoung Rye Kim, Mi Ye Kim; J Clin Nutr 2009;2(1):30-33. Published online December 31, 2009; DOI: https://doi.org/10.15747/jcn.2009.2.1.30

Abstract PDF: Purpose
This study examined whether a nutritional assessment tool is valid for evaluating the nutritional status of home care patients and suggested its clinical usefulness. Methods: This study included 73 patients receiving home care services that were registered in a home care center. An investigator performed a clinical survey with physical measurements, history taking, and visual inspection at the first visit and obtained blood samples to assess biochemical albumin levels. which were taken to reflect nutritional status. Nutritional status was correlated with serum albumin level. Results: The albumin level was significantly higher for the good nutrition group than for the poor nutrition group. Conclusion: A nutritional assessment tool was validated for the evaluation of the nutritional status of home care patients and to predict poor nutrition. We suggest that further studies done on a larger scale be performed to generalize these study results. (KJPEN 2009;2(1):30-33)

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