Annals of Clinical Nutrition and Metabolism

Letter from Editor: Hyuk-Joon Lee; J Clin Nutr 2014;6(1):1-1. Published online April 30, 2014

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Metabolic Change and Nutritional Supply in the Elderly: Sun-Wook Kim, Kwang-Il Kim; J Clin Nutr 2014;6(1):2-6. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.2

Abstract PDF: During the past decades, the world’s population has continued on its remarkable transition from a state of high birth and death rates to low birth and death rates. As a result, the number of elderly people, and particularly of the very elderly people, is increasing throughout the world. This demographic change has profound implication for medical and health care systems. As more people live to advanced old age, it is important to understand the chronic diseases and health problems which affect them from a physiologic standpoint. It has been well established that nutritional status has an important role on functional capacity and health status of the elderly people. Recently, there has been momentous development in perspectives of the metabolic mechanism that associated with ageing. As person live longer, the function of organ system decrease and the functional reservoir against external stress is depleted simultaneously. The concept of ‘homeostenosis’ emerged to account for the changes, and it is characterized that progressive constriction of homeostatic reserve in every organ system. Comorbidities like hypertension, diabetes mellitus, dementia, depression, and physical limitations are very common in the elderly, and they are often troubled with decreased function of digestive systems and sensory organs. Furthermore, many elderly people have suffered from poverty and social isolation. Accordingly, the older are more prone to malnutrition or undernutrition. In addition, the combination of the mentioned problems with homeostenosis will lead to metabolic derangement, like insulin resistance and visceral fat accumulation. This process makes a deleterious effect on their comorbidities or physical function; consequentially it triggers and exacerbates frailty in the elderly. In this review, we describe the mechanism of metabolic change, and appropriate nutritional supply for the elderly.

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Nutrition Support Methods in Elderly Patients: Soon Sup Chung; J Clin Nutr 2014;6(1):7-10. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.7

Abstract PDF: Nutrition support methods in the elderly is not easy, but similar as young adult. Elderly patients are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. The type of artificial nutrition to use will depend on the current illness and the previous health record. Because enteral feeding is less expensive and aggressive, enteral feeding should be used whenever possible, leaving parenteral nutrition for specific situations where enteral feeding should not be used.

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Drug-nutrient Interactions in Elderly Patients: Juhyun Rho; J Clin Nutr 2014;6(1):11-18. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.11

Abstract PDF: Physiological changes associated with aging affect the absorption, distribution, metabolism, and excretion of drugs and thus therapeutic outcomes. These changes may be further amplified by interactions with nutrients. The purpose of this review was to summarize drug-nutrient interactions found in elderly patients. Mechanisms of the interactions can be categorized as ex vivo bio-inactivations, interactions in absorption and elimination phases, and physiological interactions. The goal of enteral nutrition (EN) is to maximize the therapeutic response of medication without adversely affecting EN tolerance. Therefore, to ensure safety, consistent monitoring is necessary for enteral feeding of patients receiving medication via an enteral tube. Elderly patients receiving parenteral nutrition (PN) are often treated concomitantly with medication via the parenteral route. The stability and compatibility of PN formulations infused with other additives, including medication, may be influenced. Limitation of the number of prescriptions to essential medications only during the minimum period along with periodic re-evaluations of the treatment are thus necessary to minimize undesirable drug-nutrient interactions in elderly patients.

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Nutrition Support for Pediatric Short Bowel Syndrome: Ji-Young Song, Hyun-Young Kim; J Clin Nutr 2014;6(1):19-23. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.19

Abstract PDF: Short bowel syndrome (SBS) develops in infants and children with inadequate small intestine for digestion and absorption of enteral nutrients for normal growth and development. This can lead to malabsorption of macronutrients or micronutrients, electrolyte imbalance, dehydration, malnutrition, and growth failure. The goals of nutrition support in pediatric SBS are to promote intestinal adaptation, avoid complications associated with intestinal resection and parenteral nutrition (PN), and, ultimately, maintain normal growth. In the initial phase of SBS, PN support is important in order to meet energy requirements and for avoidance of electrolyte imbalance or dehydration. Enteral nutrition should be initiated as soon as possible after bowel resection in order to promote intestinal adaptation. In order to stimulate oral motor activity and to avoid feeding aversion behavior, tolerable volumes of bottle-feeding or solid food should be accepted. In addition, feeding volume might be gradually increased in small amounts with monitoring of stool quantity and consistency. Because not all enterally administered calories are absorbed, PN should not be decreased isocalorically against enteral nutrition. In order to enhance bowel adaptation by maximizing nutrient delivery, it is necessary to determine the potential advantages of administration mode, continuous vs. bolus feeding, and what formula should be considered, polymeric vs. monomeric or oligomeric formula. Optimal enteral feeding regimen for pediatric SBS is still being debated, how to feed or what to feed, therefore, nutritional management of SBS should be adjusted according to the patient’s medical condition.

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Prevalence of Malnutrition in Hospitalized Elderly Korean Patients Based on Mini Nutritional Assessment-Short Form: Hosun Lee, Ju Hee Kang, Eunmee Kim, Won Gyoung Kim; J Clin Nutr 2014;6(1):24-29. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.24

Abstract PDF: Purpose
To determine the prevalence of malnutrition in hospitalized elderly Korean patients using Mini Nutritional Assessment-Short Form (MNA-SF) in Korea. Methods: A cross-sectional, multi-center study was performed. We enrolled 300 patients aged ≥65 years from 10 hospitals. We collected subjects’ general characteristics, including age, sex, height, weight, and diagnosis. Patients’ nutritional status was assessed using MNA-SF within 48 hours since hospital admission.Results: The subjects were 74.2±6.3 years old, and 155 patients were male (51.7%). Cancer was the most common diagnosis (26.3%), followed by musculoskeletal (11.3%), neuromuscular (10.3%), pulmonary (9.0%), and cardiovascular disease (8.7%). The length of hospital stay was 8.7±5.9 days. According to MNA-SF, 99 patients (33.0%) were at risk of malnutrition, and 51 patients (17.0%) were malnourished. MNA-SF score showed negative correlations with age (r=?0.259, P＜0.001) and hospital stay (r=?0.168, P=0.006). Patients in the malnourished or at risk of malnutrition groups were more likely to be admitted to and stayed longer in the intensive care unit (ICU) than those of normal nutritional status (8.7% vs. 17.3%, P=0.026; 1.6±1.0days vs. 3.7±3.2 days, P=0.033). The patients who were malnourished or at risk of malnutrition were hospitalized significantly longer than those of normal nutritional status (9.8±6.2 vs. 7.7.±5.4 days, P=0.004). After adjusting for age and ICU admission, nutritional status by MNA-SF was the only risk factor for prolonged hospitalization (β=1.384, P=0.005). Conclusion: About half of hospitalized elderly patients were at risk of malnutrition or malnutrition status at admission, and nutritional status was the only risk factor for longer hospital stay. Thus, more attention should be paid to the nutritional care of elderly patients to improve clinical outcomes.

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Validation of Geriatric Nutritional Risk Index and Percent Weight Loss as a Predictor of Post-operative Complications after Gastrectomy in Elderly Patients: Kyung Eun Lee, Young Gil Son, Seung Wan Ryu; J Clin Nutr 2014;6(1):30-36. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.30

Abstract PDF: Purpose
Gastric cancer surgery is expected to increase in frequency in elderly patients aged over 65 years. The aim of this study was to validate the Geriatric Nutritional Risk Index (GNRI) and percent weight loss as a predictor of post-operative complications after gastrectomy in elderly patients.Methods: We retrospectively collected data on elderly patients (over 65 years) who underwent gastrectomy for gastric cancer at Keimyung University Dongsan Medical Center between January 2010 and December 2012. Data included patients’characteristics(body mass index [BMI], underlying disease, body weight loss during 3 months before gastrectomy, American Society of Anesthesiologists [ASA] score, and stage of disease), operative characteristics (operation method, operation time, and blood loss during operation), GNRI, and post-operative complications after gastrectomy.Results: A total of 321 patients were included. The patients’mean age was 72.4±4.7 years, and 49.5% of patients were rated as being at risk by the GNRI. There were no differences in post-operative complications by GNRI, age, sex, ASA score, BMI, serum albumin, co-morbidity, stage of disease, surgical approach, type of surgery, extent of lymph node dissection, operation time, or blood loss during surgery. However, percent weight loss during 3 months was correlated independently with post-operative complications (P＜0.001). In logistic regression analysis, a 1% increase in percent weight loss was associated with a 1.102 times increase in the incidence of postoperative complications (P=0.012, 95% confidence interval 1.021~1.189).Conclusion: The percent weight loss during 3 months before gastrectomy could help predict post-operative complications in elderly patients.

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Attitudes of Medical Staff and Factors Related to Nutritional Support for Patient Care in a University Hospital: Hwee Soo Jeong, Chen Hsuen Teong, You Jung Choi, Woo Jeng Kim, Ah Ran Lee; J Clin Nutr 2014;6(1):37-41. Published online April 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.1.37

Abstract PDF: Purpose
Knowledge of nutritional support and attitudes of medical staff both affect patient care. We identified attitudes regarding nutritional support among medical staff as well as changes in attitudes when a nutritional support team is present. Methods: Data were collected from 172 medical staff members who served at a university hospital located in Gyeongju by self-administered questionnaire from June 12∼August 30, 2013. The questionnaire inquired about importance of nutritional support, self-confidence about nutritional support, consideration of nutritional support for patient care, consideration of nutritional support when a nutritional support team is present, and nutritional knowledge training during the past year.Results: A total of 169 subjects (98.3%) thought that nutritional support is important for patient care. Only 19 subjects (11.0%) were highly self-confident about nutritional support. In total, 147 subjects (85.5%) considered nutritional support for some or all patients, whereas 169 (98.3%) considered nutritional support for patient care when a nutritional support team is present. Thirty-eight subjects (22.1%) received nutritional knowledge training during the past year. High self-confidence for nutritional support was related to nutritional knowledge training and service part. Positive changes regarding nutritional support when a nutritional support team is present were associated with nutritional knowledge training and high self-confidence for nutritional support.Conclusion: No differences in nutritional support attitudes for patient care were observed among the medical staff. Nutritional knowledge training and service part affected self-confidence of nutritional support and induced positive changes in attitudes for nutritional support.

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