Annals of Clinical Nutrition and Metabolism

Letter from Editor: Hyo Jung Park; J Clin Nutr 2016;8(2):37-37. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.37

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Survey on the State of Nutrition Support Team (NST) Activity: Comparison of the Questionnaire Survey 2016 vs. 2005 and the State of NST Activity since the Introduction of the Medical Insurance Fee: Ji-Yoon Cho, Jung-Tae Kim, Seoung-Lan Kim; J Clin Nutr 2016;8(2):38-44. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.38

Abstract PDF: The Korean Society of Health-System Pharmacists (KSHP) and Korean Society for Parenteral and Enteral Nutrition (KSPEN) jointly performed a nation-wide questionnaire survey on the current state of Nutrition Support Team (NST) activity from March to May of 2016. The aim of the survey was to suggest ways to develop NST as well as to improve the relationship between the KSHP and KSPEN. Compared to the results of the 2005 survey, some progress was made in the activity of NST over the last decade. Not only was the activity of NST settled, but quantitative and qualitative growth was also achieved by activating rounds and regular meeting. On the other hand, the ratio of hospitals providing home care services has decreased. Therefore, further effort is needed for their revitalization.

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Sources and Formulation of Macro- and Micro-Nutrients in Enteral Nutrition Formula: Suhee Kim; J Clin Nutr 2016;8(2):45-50. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.45

Abstract PDF: Enteral feeding therapy has existed since ancient Egypt, but most of the major advances in enteral nutrient techniques and formulas have taken place during the 20th century through the development of sources and ingredients This review provides a historical account of enteral nutrition (EN), including the sources and formulation of macro-and micro-nutrients in the formula and how to manufacture them. The formulas were improved by the development of raw materials that are easier to digest and the next formula is expected to develop functionality using more raw materials, such as ω-3, amino acid, and more functional ingredients to heal the disease.

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Effects of Compliance with the Nutrition Support Team in Critically Ill Pediatric Patients: Soo-Jin Park, Ji-Eun Park, Na-Young Kwon, Jae-Song Kim, Eun-Sun Son, Hyun-Ji Yu, Jae-Yeon Bang, Seung Kim, Ho-Seon Eun; J Clin Nutr 2016;8(2):51-57. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.51

Abstract PDF: Purpose:
This study performed a comparative evaluation of nutritional condition’s improvement and clinical effects in accordance with the Nutrition Support Team (NST) consultation compliance of critically ill pediatric patients.
Methods:
The medical records of 64 critically ill pediatric patients (2 to 18 years old), who were officially referred to a NST consultant in pediatric intensive care unit from January to August 2015, were reviewed. The patients were divided into 2 groups according to the compliance of NST consultation answers. The total delivered/required caloric and protein ratio, weight, serum total protein, serum albumin, hemoglobin, and hematocrit were compared.
Results:
According to the NST consultation answer, ‘nutrition support increase’ occupied the largest proportion at 38.5%; ‘maintenance’ and ‘decrease’ accounted for 35.7% and 18.2% respectively. The NST compliance group and non-compliance group were 20 and 14 patients, respectively. Although total delivered/required caloric ratio was significantly increased in the NST compliance group (19.7%, P=0.036), there was no significant difference in the NST non-compliance group (5.1%, P=0.692). The total delivered/required protein ratio was increased (15.1%, P=0.163) in the NST compliance group and decreased (?4.7%, P=0.774) in the NST non-compliance group. The NST non-compliance group (?8.6%, P=0.219) was further reduced weight than the NST compliance group (?1.0%, P=0.820). The serum albumin was significantly increased in the NST compliance group (13.1%, P=0.003), but there was no difference in the NST non-compliance group (7.1%, P=0.433).
Conclusion:
Although 56.7% of NST consultations were needed for nutritional interventions, a lower NST compliance (53.8%) is the limit of nutritional support. The NST compliance group was supplied adequately with more calories and protein than before consultation and a more improved nutritional status. Therefore, aggressive NST consultation can help increase the therapeutic effect by improving the nutritional status. This study will form the basis to seek ways to further enhance NST compliance.

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Characteristics and Clinical Course of Patients Who Received Enteral or Parenteral Nutrition in Tertiary Referral Hospitals in Korea: Eunmi Seol, Yun-Suhk Suh, Dal Lae Ju, Hye Jung Bae, Hyuk-Joon Lee; J Clin Nutr 2016;8(2):58-65. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.58

Abstract PDF: Purpose:
The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea.
Methods:
From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM).
Results:
EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE II) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge.
Conclusion:
In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.

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The Effects of Early Enteral Nutrition in Patients: A Role of Nutrition Support Team: Kye Wol Park, Hee Ryoung Son, Ji Hoon Kim, Myoung Hee Kim, Eun Jin Choi; J Clin Nutr 2016;8(2):66-70. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.66

Abstract PDF: Purpose:
The study examined the effects of early enteral nutrition on the patients’ length of stay in an intensive care unit (ICU), length of stay and mortality rate.
Methods:
A retrospective design was employed with a total of 461 patients (mean age=69.9±15.6 years; 253 males; 208 females). They were divided into two groups according to when they received enteral feeding: an “early enteral nutrition” (EEN) group of 148 patients (32.1%) who received enteral feeding within 48 hours of their arrival at the hospital and a “delayed enteral nutrition” (DEN) group of 313 patients (67.9%) who received enteral feeding at some point after 48 hours of their arrival at the hospital. The EEN group and control group were similar in terms of age, sex, body mass index, and underlying diseases.
Results:
The EEN group’s total length of stay in hospital was shorter (23.29±27.19 days) than that of the control group (36.74±32.24 days); the difference was significant (P<0.001). The EEN group also showed a shorter length of stay in the ICU (13.67±22.77 days) than the DEN group (17.46±21.02 days) and a lower mortality rate (17.6%) than the control group (18.8%), but these differences were not significant.
Conclusion:
The study found that early enteral nutrition treatment reduced total length of stay in hospital significantly. The findings suggest that early enteral nutrition treatment plays an important role in the patients’ recovery and prognosis.

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