Annals of Clinical Nutrition and Metabolism

Letter from Editor: Hyuk-Joon Lee; J Clin Nutr 2015;7(1):1-1. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.1

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A community-based study on lower urinary tract symptoms in Malaysian males aged 40 years and above
Mohamad Fuad Mohamad Anuar, Muhammad Solihin Rezali, Mohamed Ashraf Mohamed Daud, Shaiful Bahari Ismail
Scientific Reports.2022;[Epub] CrossRef

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Reimbursement of Nutritional Support Team, What Is the Problem and How Can We Manage It?: Dongwoo Shin; J Clin Nutr 2015;7(1):2-8. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.2

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Korea Ministry of Health and Welfare launched legislation for reimbursement for Nutrition Support Team (NST) activities from August 1st, 2014, which can be applied as a flat rate fee per day once a week. The indicated patients are those with hypoalbuminemia, on parenteral nutrition or enteral nutrition, critically ill patients in intensive care unit’s, and any patient on suspicion of malnutrition by the physician in charge. NST should be comprised of a professional physician, an educated nurse, an educated pharmacist, and a professional and experienced dietitian. The maximum number of patients that can be treated by one NST is 30 per day. Such a reimbursement system has resulted in some complex problems with NSTs. The low price does not provide adequate reward for the team’s workload because the output of NST belongs to the department in charge and there is no ensured incentive. The Department of Health Insurance Review and Assessment Service cannot detect the quality problem of NST, non-compliance of physicians in charge. There are no stratified codes according to severity of disease and no difference between the first visit and the repeated visit. Every NST should be certified with accreditation and should participate in a qualified education program. Korea Health Insurance does not cover the fees for feeding tubes, formulas, and pumps. Evidence that NST activities can reduce medical cost of hospital-admitted in-patients is needed. Cost-effectiveness can be achieved by quality improvement of NST.

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Identifying the nutrition support nurses’ tasks using importance–performance analysis in Korea: a descriptive study
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Journal of Educational Evaluation for Health Professions.2023; 20: 3. CrossRef
Effect of the Timing of Nutritional Support Team Intervention on Nutritional Status on Patients Receiving Enteral Nutrition
Su Hyun Kim, So Young Bu
Clinical Nutrition Research.2021; 10(1): 1. CrossRef
A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region
Alvin Wong, Merrilyn D. Banks, Judith D. Bauer
Nutrients.2018; 10(2): 214. CrossRef

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Use of Bioelectrical Impedance Analysis for Nutritional Treatment in Critically Ill Patients: Yeon Hee Lee, Jae Myeong Lee; J Clin Nutr 2015;7(1):9-14. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.9

Abstract PDF ePub

Patients in the intensive care unit (ICU) easily have large amounts of extracellular fluids, such as edema or ascites, because of cardiovascular instability under septic conditions and also have high risk of malnutrition while staying in the ICU. Traditional nutritional assessment parameters like body mass index have a limitation in ICU patients due to muscle atrophy and decrease of lean body mass. Bioimpedence analyses (BIA) can be used to assess body composition and are useful in performance of nutritional assessments in ICU patients. BIA can simply and noninvasively estimate body composition (total body water, extracellular water, intracellular water, body cell mass, and free fat mass etc.) by sending a weak electric current through the body. In particular, phase angle (PhA, phase difference between the voltage applied to the impedance and the current driven through it), one of the parameters of BIA, is related to cell membrane integrity or cell size. Low PhA can possibly imply malnutrition and PhA has been reported as a useful indicator of clinical outcomes or prognosis of severe patients. Additional study with clinical application of BIA in ICU patients is needed in order to confirm the usefulness of BIA.

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Sequential Changes in Body Composition Using Bioelectrical Analysis during the Metabolic Response in Critically Ill Surgical Patients
Seok Rae Park, Seung Hwan Lee, Kyung Sik Kim, Hosun Lee, Tae Hwa Hong, Jae Gil Lee
Surgical Metabolism and Nutrition.2017; 8(1): 13. CrossRef

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Refeeding Syndrome: Jeong Wook Kim; J Clin Nutr 2015;7(1):15-22. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.15

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Refeeding syndrome refers to a life-threatening shift of electrolytes and fluid with metabolic abnormalities in malnourished patients undergoing refeeding, whether orally, enterally, or parenterally. Clinical findings are fluid-balance abnormalities, abnormal glucose metabolism, hypophosphatemia, hypomagnesemia, hypokalemia and deficiencies of vitamin and trace element. Multiple organ systems including cardiac, respiratory, neurologic, renal, hematologic, and gastrointestinal can be affected. When recognized in a timely manner, these complications can be easily and successfully prevented and treated. Four factors appear fundamental: early identification of patients at risk, correction of abnormalities before refeeding, close monitoring during refeeding, and an appropriate feeding regimen.

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The Current Status of Enteral Feeding Management in General Surgical Ward: Yun Jung Kim, Young Mee Baek, So Yun Kim, Mi Reu Moon, Kyung Hee Park, So Hee Paeck, Moon Young Seo, Sook Young Oh, Eun Ji Lee, Hyun Bin Lim, Ji Ye Hwang, In Sun Chung, Jae Kil Lee, Kyung Sik Kim, Chong Bai Kim; J Clin Nutr 2015;7(1):23-27. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.23

Abstract PDF ePub: Purpose:
Development of a standardized guideline and assessment tool is necessary. Therefore, the aim is to investigate the current state of enteral feeding management and to develop a basis for a standardized guideline.
Methods:
From July 1, 2010 through June 30, 2011, this study was conducted retrospectively for 100 patients who had enteral feeding more than once only in the Intensive Care Unit, after General Surgery at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. The analysis was based on the following factors; age, diagnosis, name of the operation, period of start and the end of enteral feeding, method of injection, flushing method, residual volumes of the stomach, location and the size of the tube, medication through tubing, and complications related to enteral feeding.
Results:
The mean age of the patients was 60.5, 65 men and 35 women. There were 30 malignant tumors of the hepatobiliary system and pancreas, 8 gastric and duodenal cancer, 4 colon and rectal cancer, 11 peritonitis, hemoperitoneum, and bowel obstruction, and 47 others. The average period of performing enteral feeding was 11.7 days and the locations of enteral feeding tube were stomach 56%, jejunum 39%, duodenum 3%, and undescribed 2%. The methods of enteral feeding were as follows; continuous feeding 19%, cyclic feeding 75%, intermittent and bolus feeding 3%, respectively. Only 1% of patients were on flushing and 16% on stomach residual. The most common complication of enteral feeding was clogging of the tube (5%).
Conclusion:
Due to the lack of detailed charting related to enteral feeding, we were unable to analyze the statistics on the relevance of complication which was the primary endpoint. As a result, development of a standardized protocol on charting enteral feeding is suggested for optimal enteral nutritional support.

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Effects of Nutrition Consultation on Nutritional Status in Critically Ill Surgical Patients: Hee Sook Hwang, Seung Hwan Lee, Hosun Lee, Kyung Sik Kim, Seo Jin Chung, Jae Gil Lee; J Clin Nutr 2015;7(1):28-34. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.28

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Purpose:

The aim of this study was to investigate nutritional support status and effects of nutrition consultation in critically ill surgical patients.

Methods:

The medical records of 76 patients, admitted between June 1 and November 30, 2013, were reviewed retrospectively. Patients were divided into 2 groups: the nutrition consultation group (n=17) and the no consultation group (n=59). Patients were also divided into 3 groups: the enteral nutrition (EN) group (n=8), the parenteral nutrition (PN) group (n=25), and the enteral and parenteral mixed nutrition (ENPN) group. Total delivered/required caloric ratio and serum albumin, serum total protein, hemoglobin and other biochemical variables were compared in each group.

Results:

Mean daily required and delivered caloric/protein amount were EN group 60.0%, PN group 64.6%, and ENPN group 86.9%. ENPN group showed statistically significant difference when compared with EN group, PN group (P=0.005). When the proportion of patients who were fed more than 75% of the daily required calories was calculated, EN, PN, and ENPN showed 37.5%, 25.0% and 81.8%, respectively. ENPN group were significantly more supplied (P=0.007). Although neither the nutrition consultation group nor the non-consultation group received more than 80% of the daily required calories, the nutrition consultation group received 73% of the daily required calories whereas the no consultation group only received 46% (P=0.007). The total delivered/required protein ratio was approximately 69% of the nutrition consultation group and approximately 42% of the no consultation group (P=0.006).

Conclusion:

The results of providing nutritional consultation to intensive care unit patients showed an increase in the nutrition support. Nutrition education, continuous monitoring and management for nutritional support by systemic administration of a nutritional support team should be considered in order to achieve effective clinical outcomes in critically ill surgical patients.

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Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study
Hyun Suk Kim, Jae Do Yang, Se Wung Han, Mi Rin Lee, Da-Sol Kim, Sejin Lee, Seon-Hyeong Kim, Chan-Young Kim
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Nutrition in Clinical Practice.2018; 33(5): 633. CrossRef
The Comparison of Improvement Effect in Patient’s Nutrition State according to the Adaptation of Nutrition Support Team’s Consultation
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Journal of Korean Society of Health-System Pharmacists.2017; 34(2): 147. CrossRef

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