Annals of Clinical Nutrition and Metabolism

Letter from Editor: Hyuk-Joon Lee; J Clin Nutr 2014;6(2):43-44. Published online August 30, 2014

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Nutrition Therapy in Major Burns: Yong Suk Cho; J Clin Nutr 2014;6(2):45-50. Published online August 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.2.45

Abstract PDF: Major burns lead to a hypermetabolic response that is more dramatic than that observed in any other disease or injury. In addition, major burns increase the metabolic demands of the body and can lead to severe loss of body weight and increased risk of mortality. The hyper-metabolic response is accompanied by severe catabolism and a loss of lean body mass and by a progressive decline of host defenses, which results in impairment of the immunological response. The protective functions of intact skin are lost, leading to increased risk of infection and protein loss. Therefore, adequate and timely provision of nutritional support is an essential component of care of the critically ill burn patient. Nutrition therapy is also important in burn care from the early resuscitation phase until the end of rehabilitation. Careful assessment of the nutritional state of the burn patient is also important to reducing infection, recovery time, and long-term results. Nutritional therapy in severe burns has evidence-based specificities that contribute to improve clinical outcomes.

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Parenteral Nutrition Support in Preterm Infants: Ji Hye Yoon; J Clin Nutr 2014;6(2):51-55. Published online August 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.2.51

Abstract PDF: Nutrition support for preterm infants is important to achievement of a postnatal growth rate optimizing normal fetal intrauterine growth rates and for improvement of patient outcome. However, sufficient nutrient delivery is not easy because of underlying illness. Although enteral nutrition (EN) is preferred over parenteral nutrition (PN), immature gastrointestinal features and inability to suck and swallow until 33 weeks’ gestation disrupt. In patients with inability to tolerate adequate EN for more than 2 or 3 days, to optimize nutrition support and minimize complications, PN should begin within 24 hours after birth. The purpose of this study is to review the PN in preterm infants for the most appropriate nutritional support to meet each patient’s requirement.

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Protein Metabolism and Glutamine Supplementation in Stress Condition: Sook Hee An; J Clin Nutr 2014;6(2):56-58. Published online August 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.2.56

Abstract PDF: Stress conditions such as sepsis, trauma, burn, fracture, and major surgery are associated with hypermetabolism and hypercatabolism. Protein is mobilized for energy and uptake of amino acids by muscle tissue is decreased in stress conditions. The metabolic response to stress causes movement of amino acids (predominantly alanine and glutamine) from peripheral reserves to metabolically active tissues. Glutamine is a conditionally essential amino acid during stress. Glutamine plays a role in maintenance of intestinal immune function and reinforcement of wound repair. Supplementation of parenteral glutamine (0.3∼0.5 g/kg/day) as a component of nutrition support may improve clinical outcomes in appropriate patients. In patients with multiorgan failure, supplementation with a high dose of glutamine (＞0.5 g/kg/day) in the acute phase of critical illness is not recommended. In stress conditions, provision of adequate protein is essential and glutamine supplementation should be considered in patients without specific contraindications.

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A Prospective Observational Study Evaluating the Change of Nutritional Status and the Incidence of Dumping Syndrome after Gastrectomy: Ju-Ri Na, Yuhn-Suk Suh, Seong-Ho Kong, Jeong Hyun Lim, Dal-Lae Ju, Han-Kwang Yang, Hyuk-Joon Lee; J Clin Nutr 2014;6(2):59-70. Published online August 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.2.59

Abstract PDF: Purpose
The aim of this study was to investigate the change of nutritional status and the incidence of dumping syndrome after gastrectomy for gastric cancer.Methods: From January 2013 to May 2014, 36 patients who underwent gastrectomy for gastric cancer were prospectively investigated in terms of nutritional status by body weight, anthropometric measurements, biochemical data, and Patient-Generated Subjective Global Assessment (PG-SGA). Dumping syndrome was assessed using a newly developed questionnaire based on the Japanese Society of Gastroenterological Surgery survey and Sigstad’s scoring system. Results: Body weight losses were 4.6%, 8.1%, and 6.9% at discharge, six months, and one year after discharge, respectively. Triceps skinfold thickness had no significance, however, mid-arm muscle circumference showed significant loss after gastrectomy. A part of the biochemical data showed significant change after gastrectomy, but almost indicated a restoring tendency within two months after discharge. In terms of PG-SGA, 33 patients (91.7%) were classified as A (well-nourished) before surgery, however, the number of well-nourished patients showed a sharp decrease to 1 (2.8%) at two weeks after discharge, and then gradually increased to 25 (69.4%) at one year. The main obstacles against diet intake were reported as ‘early satiety’ and ‘anxiety’. The number of patients who had experience in at least one dumping syndrome related symptom was 21 (58.3%) at discharge, 26 (72.2%) at two months after discharge, and 11 (30.6%) at one year after discharge. Conclusion: Nutritional deficit as well as dumping syndrome is encountered in a large number of gastric cancer patients after gastrectomy. Postoperative nutritional support and personalized education seem to be very important during the postoperative period.

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Nutritional Status of Korean Hospitalized Patients: A Multi-Center Preliminary Survey: Yeon-Mi Lee, Seon Hyeong Kim, Young Shin Kim, Eun Mee Kim, Jung Yeon Kim, Min Ae Keum, Jae Young Moon, Su Jin Park, Dong Woo Shin, Hong-Yup Ahn, Young Ran Lee, Hae Jun Yim, Suk-Kyung Hong, Hyun Wook Baik; J Clin Nutr 2014;6(2):71-78. Published online August 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.2.71

Abstract PDF: Purpose
The purpose of this study is to examine the prevalence of malnutrition in hospitalized patients aged 18 years old or older at the time of admission in Korea.Methods: This multi-center, preliminary survey included patients over 18 years old who were admitted on a given day from six hospitals in Korea. Nutritional status was assessed using Subjective Global Assessment tool. Data collected included hospital characteristics, patient characteristics, nutrition screening, and nutrition assessment.Results: Among the 99 patients recruited (47 males, 47.5%), 18 (18.2%) and 2 (2.0%) patients were moderately malnourished and severely malnourished, respectively. The mean age of the malnourished group was older than that of the well-nourished group (49.7±17.1 vs. 60.5±13.6 years old, P-value=0.010). Patients admitted for medical treatment were more malnourished than those admitted for surgical treatment. Conclusion: Results of the multi-center preliminary survey showed 20.2% prevalence of malnutrition on admission. A national survey was piloted and will be followed by full implementation.

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Effects of a Nutrition Support Team with Parenteral Nutrition on Gastrointestinal Cancer Patients Who Underwent Surgery: Hyun Jung Lee, Jung-Tae Kim, Byung Koo Lee; J Clin Nutr 2014;6(2):79-86. Published online August 30, 2014; DOI: https://doi.org/10.15747/jcn.2014.6.2.79

Abstract PDF: Purpose
Cancer patients are frequently malnourished, and malnutrition can increase morbidity and mortality. Postoperative malnutrition can cause poor wound healing and failure of the immune response. Administration of parenteral nutrition (PN) after surgery may decrease complication and hospital length of stay. Intervention of a Nutrition Support Team (NST) improves patient outcomes through nutritional assessment and proper nutrition support. In this study we investigated effects of NST intervention with PN on gastrointestinal cancer patients who underwent surgery.Methods: This retrospective study was conducted at Kyung Hee University Hospital at Gangdong from 2012 January to 2013 December. This study reviewed gastrointestinal cancer patients who were administered PN for more than seven days. The patients were divided into two groups: NST group versus non-NST group. Results: In this study, 53 patients with malnutrition were administered PN for more than seven days. Nutrition support between the NST group and non-NST group was not statistically significant, except multivitamin and trace element. Changes in nutritional index were not statistically significant. No difference in incidence of complication, monitoring performance rate was observed between the two groups.Conclusion: Due to a small number of patients and lack of severity of disease in this study, no significant difference in improvement of nutritional index was observed between the NST group and non-NST group. For safe and effective PN, conduct of additional study is necessary in order to determine the effects of NST.

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