Annals of Clinical Nutrition and Metabolism

경장영양의 장점: 김성훈, 김경식; J Clin Nutr 2010;3(1):3-8. Published online December 1, 2010

Abstract PDF: Malnutrition has been known to affect negatively to patients’ prognosis. Especially, it causes considerable side effects when the nutrition supply discontinues for a long period. It can be assumed that artificial nutrition is beneficial when the patient is in undernourished condition or malnutrition is anticipated. Enteral nutrition is widely known as reducing infectious complication by protecting intestinal mucosa. Historically, enteral nutrition existed from ancient period of Egypt, but introduced in 1910 by attempting postpyloric tube insertion, and was widely spread in 1970’s when many kinds of enteral feeding formulas were developed. However, the proving efficacy of enteral nutrition is essential due to the possibility of risks as a medical intervention and cost issues. Therefore, the principal indications of enteral nutrition should be looked into and verify its efficacy through literature review.

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경장영양 국내 실태조사: 라미용; J Clin Nutr 2010;3(1):9-14. Published online December 1, 2010

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경장영양 급식관(Feeding Tube): 홍석경; J Clin Nutr 2010;3(1):15-18. Published online December 1, 2010

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경장영양 주입세트(Feeding Bag & Line)의 감염 위험: 박미선; J Clin Nutr 2010;3(1):19-22. Published online December 1, 2010

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경장영양액 주입펌프(Feeding Pump): 김은미; J Clin Nutr 2010;3(1):23-26. Published online December 1, 2010

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경장영양액(Formula)의 선택: 이호선; J Clin Nutr 2010;3(1):27-32. Published online December 1, 2010

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A Retrospective Study of the Change of the Nutritional Status in Stroke Patients: Be-Na Lee, Soon-Hee Yoo, Duk-Won Cho; J Clin Nutr 2010;3(1):33-39. Published online December 31, 2010; DOI: https://doi.org/10.15747/jcn.2010.3.1.33

Abstract PDF: Purpose
We wanted to compare the nutritional status of stroke patients who are in the acute state with that of stroke patients who are in the chronic state and to evaluate the factors that may affect stroke patients' nutritional status in Korea. Methods: This is a retrospective study. We reviewed the medical histories of stroke patients who were hospitalized in St. Paul's hospital from January 2005 to February 2007. The applied measurements were the body mass index (BMI) and the biochemical findings such as albumin, the total lymphocyte count (TLC) and the hemoglobin level. We considered the factors that might affect the patient's nutritional status, including the patient's mobility, the mode of feeding, the type of medical insurance as an indicator of the socioeconomic status, diabetes mellitus, dysphagia and a medication for depression. Results: Thirty four males and 27 females were studied and the mean age of the patients was 60.13 years old. The mean follow up duration was 456.64 days. The BMI was decreased from 23.85 to 23.16 kg/m² (P-value=0.049), the albumin was decreased from 4.09 to 3.88 g/dl (P-value= 0.012) and the TLC was decreased from 2,056.6 to 1,772.3/L (P-value=0.034) in the chronic state. Specially, the nutritional imbalance was severe in the chronic patients who were undergoing tube feeding, in those who had poor mobility, in those who had dysphagia or those who were taking a medication for depression. Conclusion: Control of stroke patients' nutritional state is crucial for a better outcome, not only at the acute stage but also at the chronic stage. Therefore, medical personnels should be aware of and care for the nutritional state of stroke patients. (KJPEN 2010;3(1):33-39)

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The Outcomes of Critically Ill Patients after Following the Recommendations of the Nutritional Support Team: Ju Hee Kang, Hyun Wook Baek, Dong Woo Shin, Dong Hyun Shin, Hee Jung Son, Soo Hee Chang, Ye Sook Seo, Jung Hyun Min, Young Ah Lee, Yeon Hwa Mo, Min Young Kim; J Clin Nutr 2010;3(1):40-44. Published online December 31, 2010; DOI: https://doi.org/10.15747/jcn.2010.3.1.40

Abstract PDF: Purpose
Several studies that focused on hospital malnutrition have reported that more than 40% of hospitalized patients have nutritional risk factors, and there is a high prevalence of hospital malnutrition. People with a more severe malnutrition status had a longer length of hospital stay and higher hospital costs. Therefore, the net result from early nutritional support may be improved organ function, decreased infection, reduced morbidity and mortality and decrease the hospital stay and cost. Methods: We investigated the patients who received tube feeding or parenteral nutrition for more than 3 days. We recommended the nutritional assessment, the patients' requirements, the route of feeding and the proper formula to the clinicians. Some of them followed our suggestion and some didn't. Thus, we divided groups into two subgroups according to this. The clinical outcomes of the two groups were compared. Results: There were no significant differences in the clinical outcomes between the two groups. However, the patients who received enteral feeding increased from 10% up to 70% in the experiment group. In spite that the gastrointestinal route could have been used, only 44.4% of the patients in the control group received enteral feeding. Conclusion: More rapid and adequate nutritional support through enteral nutrition must be considered to produce the effective clinical outcomes in critically ill patients. The patients who require nutritional support need continuous follow up care and monitoring by a nutritional support team (NST). (KJPEN 2010;3(1):40-44)

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Analysis of Referrals to the Nutrition Support Team for Patients with Postoperative Enterocutaneous Fistula: Mi Jin Jeong, Hee Chul Yu, Si Eun Hwang, Chan Young Kim, Min Ro Lee, Sun Haeng Kim, Hyeong Seon Kim, Ju Sin Kim, Mi Kyung Moon Wan Ki Yoon, Kyung Sook An, Baik Hwan Cho; J Clin Nutr 2010;3(1):45-49. Published online December 31, 2010; DOI: https://doi.org/10.15747/jcn.2010.3.1.45

Abstract PDF: Purpose
The role of nutrition support for the management of enterocutaneous fistula is primarily one of supportive care to prevent malnutrition and thereby halt further deterioration of an already debilitated patient. This therapy is best managed by a nutritional support team (NST). For activation of the NST, physicians must become more aware of the need for nutrition support in patients, and so referrals are required from physicians. This study examined the referrals to the nutritional support team for patients with postoperative enterocutaneous fistula. Methods: Between March 2007 and May 2009, we reviewed 34 patients with postoperative enterocutaneous fistula and who was referred to the NST. Results: The mean age of the patients was 61.1±11.5 years. Twenty seven cases were males and 7 were females. The routes of nutrition support were EN+PN: 32 (55.2%), PN: 16 (27.6%), EN: 8 (13.0%) and oral intake +PN: 2 (3.4%). The direct referrals were 45 (77.6%) and the indirect referrals though the nutritional screening system were 13 (22.4%). The referrals for EN were 40 (69%) and those for PN were 18 (31.0%). The recommendations by the NST were accepted in 48 (82.8%) of the cases. The EN recommendations were accepted in all 40 (100.0%) of the cases. The PN recommendations by direct referral were accepted in 6 of 7 cases, but only 2 of 11 cases were accepted according to indirect referral. Conclusion: More aggressive and thorough follow-up on whether or not to accept the NST recommendation is required. This study shows that regular scheduled nutrition support service orientations for the different staff and departments of the hospital should be held each year. (KJPEN 2010;3(1):45-49)

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Characteristics of ICU Patients on Enteral Nutrition According to the Gastric Residual Volume: Soyoung Yu, Eun-mee Kim, Young Y Cho, Miyong Rha, Jin-young Kim, Dong-kyung Chang, Jeong-meen Seo; J Clin Nutr 2010;3(1):50-53. Published online December 31, 2010; DOI: https://doi.org/10.15747/jcn.2010.3.1.50

Abstract PDF: Purpose
A high gastric residual volume (GRV) occurs early and frequently in patients who are receiving nasogastric tube feeding in the intensive care unit (ICU). This study analyzed the clinical and nutritional characteristics of ICU patients who received nasogastric tube feeding according to the GRV. Methods: The subjects were 76 patients who were admitted to the ICU at S Medical Center from January, 2009 to May, 2009 and who received enteral nutrition (EN) support. Tube feeding was skipped when the GRV was over 50∼100 cc. The patients who experienced meal skipping due to high GRVs comprised the GRV group, and the patients whose feeding was never skipped due to high GRVs comprised the non-GRV group. The general, clinical and nutritional characteristics were determined at the beginning of the EN support, and the method of EN was collected for the first 3 days of tube feeding. Results: Nine patients experienced meal skipping due to GRV. There were no significant differences between the GRV and NGRV group in terms of age (60.4 vs. 61.8 years for GRV and NGRV, respectively; same respective order hereafter), pre-npo (5.0 vs. 4.7 days) and the ICU stay (20.5 vs. 23.7 days). Significant differences were evident in the GRV group concerning the ratio of male patients (55.2% vs. 88.9%; P＜0.05), the medical-ICU patients (35.8% vs. 88.9%; P＜0.05) and the sedated patients (29.8% vs. 66.7%; P＜0.05). The BMI (22.4 vs. 21.8 kg/m²) and TLC (2,252 vs. 1,137 cells/mm³) values were not significantly different between the two groups. The serum albumin level (3.1 vs. 2.6 g/dl) was significantly lower in the GRV group (P＜0.05) and the C-reactive protein level (8.11 vs. 19.02 mg/dl) and the ratio of moderately and severely malnourished patients (25.4% and 77.8%) was significantly higher in the GRV group (P＜0.05). The mean feeding volume (731 vs. 688 cc) and ratio of the feeding rate (129 vs. 127 ml/h) during the first 3 days on EN was not significantly different between the two groups, nor was the required/maximum feeding volume (9.8 vs. 8.2 days). Conclusion: In the GRV group, the ratio of male to sedated patients was significantly higher than that in the other group. The ratio of moderately and severely malnourished patients was also significantly higher in the GRV group. There were no significant differences in the methods of EN support. (KJPEN 2010;3(1):50-53)

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Parenteral Nutrition Support and NST Management in ICU Patients: Yoonjung Do, Miran Cho, Myungchun Kim, Jungtae Kim, Sukhyang Lee; J Clin Nutr 2010;3(1):54-59. Published online December 31, 2010; DOI: https://doi.org/10.15747/jcn.2010.3.1.54

Abstract PDF: Purpose
The purpose of this study is to compare the NST (Nutrition Support Team) group with the non-NST group on the basis of nutritional guidelines and to examine how the NST's intervention influences clinically important end points of critically ill patients. Methods: Between January 2009 and December 2009, 161 patients in the ICU (Intensive Care Unit) and who were provided PN (Parenteral Nutrition) were included.SAS (Statistical Analysis System) was used for the analysis. Results: In this study, 161 patients were administered PN for 7.3±6.7 days and 8.7% of the patients were provided support by NST. The number of PN prescriptions was 235 and among them, only 7.2% were conducted according to the recommendations of the NST. Both of the groups (the NST and non-NST groups) had a marked malnutrition level of 1 when admitted to the ICU. During the hospitalization, the malnutrition level was increased (NST: P=0.03, non-NST: P＜0.01). The NST group was provided macronutrients more often than the non-NST group under the guidelines. Supplement of micronutrients (vitamins) was significantly different between the two groups (82.4% vs. 32.6%, respectively). There was no statistical difference in the administration of amino acid by dialysis between the dialysis and non-dialysis patients. Hyperglycemia was the most common complication related to PN for both of the groups. Also, hepatic dysfunction occurred in the NST group more often than that in the non-NST group (35.7% vs. 12.3%, respectively, P=0.03). Sepsis was associated with hepatic dysfunction and among the 5 patients with hepatic dysfunction in the NST group, 3 patients were sepsis. Conclusion: Regardless of NST consultation, most patients were provided PN under the guideline, but the administration of amino acids to the dialysis patients and the administration of micronutrients were inappropriate in the non-NST group. Therefore, it is necessary to make efforts for providing proper nutritional support to patients through more systematic NST activities and advertisement. (KJPEN 2010;3(1):54-60)

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