Annals of Clinical Nutrition and Metabolism

Letter from Editor: Hyuk-Joon Lee; J Clin Nutr 2013;5(3):89-89. Published online December 31, 2013

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Nutrition Support in Trauma Patients: Seung Hwan Lee, Ji Young Jang, Jae Gil Lee; J Clin Nutr 2013;5(3):90-95. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.90

Abstract PDF: Metabolic and gastrointestinal alterations associated with trauma can rapidly lead to malnutrition and its accom-panying complications. Malnutrition is harmful to the pa-tient because it is associated with impaired wound heal-ing, muscle weakness, immune dysfunction, and infec-tious complication, and is an independent risk factor for morbidity and mortality. Thus, adequate nutrition support is essential in management of trauma patients. The pur-pose of this paper is to expound on the metabolic alter-ations and to provide a rationale for nutrition support in trauma patients. (J Korean Soc Parenter Enter Nutr 2013;5(3):90-95)

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Strategy for Activation of Home Total Paren-teral Nutrition: Kwi Suk Kim; J Clin Nutr 2013;5(3):96-101. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.96

Abstract PDF: Since the 1970s, introduction of home parenteral nutrition (HPN) has been possible for patients with gastrointestinal tract malfunction and is a more cost-effective treatment at home than in a hospital or a skilled nursing facility. It has allowed for enhancement of the quality of life and avoidance of repeated hospitalizations and long-term hospitalization. In determining the target subject of HPN, its benefit is evaluated. Management of the environment should be evaluated. If an HPN subject is determined, he is prepare to receive the central venous catheter and the HPN regimen is determined. In addition, education of pa-tients and caregivers on the complications associated with HPN is very important. Regular monitoring of the sta-bility of HPN should be conducted. HPN must be acti-vated in order to increase the patient's quality of life and to reduce the national medical costs, however, there are several limiting factors for HPN expansion. It may be summerized in five points. 1) Home Nutrition Support Team configuration, 2) Patient education guidelines, 3) System for delivery of HPN, 4) The preparation connection system of HPN between the Korean Society for Parenteral and Enteral Nutrition members, 5) Outsourcing of HPN. Efforts of the Nutrition Support Team and national support are needed in order to resolve the limitations. (J Korean Soc Parenter Enter Nutr 2013;5(3):96-101)

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Practical Considerations in Trace Element Supplementation via Adult Parenteral Nutri-tion: Sooan Choi; J Clin Nutr 2013;5(3):102-109. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.102

Abstract PDF: Parenteral nutrition (PN) became an established hospital pharmacy in the 1960s. Some of the early patients on long-term PN developed micronutrient deficiency syn-dromes, emphasizing the importance of a complete nutri-tional formula. Trace elements currently considered es-sential for humans are the metals, copper, chromium, iron, manganese, molybdenum, zinc, and the metalloid selenium. Supplementation of PN regimens with trace ele-ments is now mandatory. Interactions between micro-nutrients and macronutrients can affect their availability and the correct chemical balance must be attained for achievement of maximum stability, metabolic function, and clinical efficacy. A complex relation exists among in-dividual trace elements, where symptoms of toxicity of one element can often be attributed to the resulting defi-ciency of another, due to enhanced excretion of that metal. Routine measurement of most trace elements is not essential in short-term PN. However, careful ob-servation and monitoring of trace element levels is im-portant in patients with renal or hepatic dysfunction, those on long-term PN, or when pharmacologic doses over the normal nutritional recommendations are given. Continual monitoring and reassessment of clinical symptoms is im-portant to determination of any additional micronutrient requirements. Contamination of PN products with sig-nificant amounts of trace elements and absorption to con-tainer surfaces can significantly affect actual dosage, with clinical repercussions over time. Therefore, in 2009, American Society for Parenteral and Enteral Nutrition con-cluded that changes were needed in the recommenda-tions for the daily requirements for these micronutrients in PN. In this review, I provide recent guidelines for the use of trace elements in nutrition therapy. This should be helpful to nutritional professionals in understanding the important role as a critical component, without negative outcome due to inadequate supplementation. (J Korean Soc Parenter Enter Nutr 2013;5(3):102-109)

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Relationship of Combined Consumption of Rice and Kimchi, Korean Traditional Diet and the Risk of Metabolic Syndrome in Healthy Korean Volunteers: In Myung Oh, Hyo Jee Joung, Sang-Woo Oh, Yeong Sook Yoon, Kyoung Hwa Yoo, Ji Eun Park, Ju Sang Park, Eun Jeong Jang, Sang Jong Park, Sang Woon Park, Sang Jung Kim, Hyun Wook Baik; J Clin Nutr 2013;5(3):110-116. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.110

Abstract PDF: Purpose
Metabolic Syndrome (MetS) is defined as the coexistence of several metabolic risk factors. Diet is thought to play a major role in development of MetS. We attempted to determine whether the Korean diet is related to a reduced risk for development of MetS.Methods: A total of 425 healthy Korean adults were re-cruited by advertisement to Bundang Jesaeng Hospital from January 1 to June 30, 2009; those not taking regular medications and without diagnosis of disease were included. Data were collected on three-day dietary intake, anthropometric measurements, and diagnostic parame-ters, including levels of lipid panel, glucose, adiponectin, and inflammatory cytokines (interleukin-6 [IL-6], tumor ne-crosis factor-α [TNF-α]) for MetS from individuals enrolled in the study. The National Cholesterol Education Program (NCEP) scoring system was used for diagnosis of MetS. Results: Out of 425 (11.8%) subjects, 50 were diagnosed as having MetS. As NCEP scores increased, the levels of inflammatory cytokines (IL-6, TNF-α) showed an increas-ing tendency, however, the adiponectin level had de-creased (P＜0.0001). A greater amount of total vegetable consumption appeared to be associated with decreased risk for MetS. A higher carbohydrate consumption repre-sented by the amount of rice intake (refined starch) ap-peared to be associated with higher risk of MetS. However, increasing consumption of rice combined with Kimchi showed an association with increased high-density lip-oprotein cholesterol (56.7±1.6 vs. 62.8±2.2, P for trend: 0.0321) and decreased adiponectin level (9.0±0.8 vs. 11.4±1.2, P for tend: 0.0255). Conclusion: Among healthy Korean volunteers consum-ing an ordinary Korean diet, the prevalence of MetS was found to be 11.8%. Greater consumption of rice showed an association with greater risk of MetS, while greater consumption of rice combined with Kimchi, the main sta-ple of the Korean diet, showed an association with lower risk of MetS. (J Korean Soc Parenter Enter Nutr 2013; 5(3):110-116)

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The Clinical Application Methods of the Nu-tritional Support Team: Eun Young Kim, Ju Mee Kim, Mi Hyung Kim, Taek Su Kwon, Hye Seung Lee, Hee Jung Mok, Jeong Im Hong, Hye Jin Kim, Hyun Kyung Kim, Sungjin Chung, In Kyu Lee; J Clin Nutr 2013;5(3):117-121. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.117

Abstract PDF: Purpose
Most hospitals have been reply to the con-sultation if the needed departments consult with the Nutritional Support Team (NST) for patient evaluation and management. However, as a common occurrence, some people requiring treatment cannot receive care due to lack of cognition of nutritional support and lack of re-sources for assessment of nutritional status. Methods: We provide an indication for screening of pa-tients and for active nutritional support. Indications in-clude symptoms that reflect the conditions of increasing nutritional requirement and decreasing nutritional supply. Two surgical wards and surgical intensive care unit were included and nursing teams recommended patients to the NST by interviewing inpatients if they met the indications. Results: We included 60 patients referred to the NST be-fore applying for screening, from January 2005 to January 2009 and 44 patients selected for only five months by the NST after applying for screening. The number of con-sultations showed a slow decrease, 27 in 2005, 23 in 2006 to 10 in 2007, before applying for screening, but in-creased significantly to 44 for only five months after ap-plying for screening. While the number of departments applying to the NST was five departments in 2005, six departments in 2006, and two departments in 2007, it in-creased significantly to eight departments. After applying for screening, the most common cause was ‘artificial nu-trition longer than five days’ in 48.1%; the second cause was ‘poor nutrition status’ in 13.5%, and the third was ‘significant weight loss’ or ‘gastrointestinal function change’ in 8%. Moderate risk patients showed improvement and shifted to minor risk patients and normal patients. The rate of improvement was approximately 47.7%.Conclusion: The screening tools should be simple, as well as easy to use. Therefore, using this tool, we must actively select patients with poor nutrition and apply the screening tools rapidly. (J Korean Soc Parenter Enter Nutr 2013;5(3):117-121)

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Analysis of Dietitians' Views on Insurance Fee for Enteral Nutrition in Seoul Hospital: Hye Jin Kim, Hee Jung Mok, Jeong Im Hong, Gyn Jin Heo, In Kyu Lee; J Clin Nutr 2013;5(3):122-129. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.122

Abstract PDF: Purpose
Enteral nutrition is an efficient method of pro-viding nutrition, which has significant clinical advantages. However, it presents difficulties of ensuring an adequate supply and management because meal wages are in-surance-inclusive. By understanding the management sta-tus of enteral nutrition in hospitals in Seoul and seeking the opinions of experienced nutritionists on government- paid meal wages, we acquired basic data for review of patient meal wages and the insurance system. Methods: Investigation of medical institutions in Seoul was performed through a survey conducted from October 15 to October 31 2012. Twenty-eight questionnaires on the current situation and 103 questionnaires on individual opinions were analyzed. Descriptive analysis, chi-square test, and ANOVA were performed using PASW Statistics 18.0.Results: Regarding satisfaction with enteral nutrition, 93.0% reported that the major complication was diarrhea. Among the list of difficulties in case of complications, lack of diversity was 56.1%. The No. 1 influence in selection of enteral nutrition was ‘Cannot use expensive products because of insufficient medical fees,’ at 45.0%, while No. 2 was ‘Cannot use a variety of products because of in-sufficient medical fees’ at 26.3%. No. 1 in needs for im-provement of enteral nutrition was ‘modifications and complements to insurance fee,’ at 43.0%, No. 2 was ‘pricing by volume' at 26.0%. More than 98% of re-spondents answered that systematic development of in-surance fees for enteral nutrition according to type of hospital and management was needed.Conclusion: Development of various products and multi-ple team activities through the Nutrition Support Team are needed for the efficient supply of enteral nutrition. In addi-tion, the revision of cost reimbursement for health in-surance by understanding the current status, suggesting an appropriate level of enteral nutrition supply at a gov-ernment level and providing systematic procedures, in-cluding continuous evaluation tools and management, are urgently needed. (J Korean Soc Parenter Enter Nutr 2013;5(3):122-129)

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Pediatric Case of Short Bowel Syndrome: 14-month Experience of Home Parenteral Nutrition: Ja Kyung Min, Hyo Jung Park, Jung Meen Seo; J Clin Nutr 2013;5(3):130-132. Published online December 31, 2013; DOI: https://doi.org/10.15747/jcn.2013.5.3.130

Abstract PDF: Many pediatric patients, particularly those with short bow-el syndrome (SBS), will eventually require long-term pa-renteral nutrition in order to provide adequate nutritional support. This requires an extended hospital stay. We re-port on the case of a four-year-old boy with SBS who was administered home parenteral nutrition (HPN) during a period of 14 months. The goal of HPN therapy is to maintain the patient’s nutrition status while concurrently making all efforts to minimize complications associated with HPN. Central catheter infection did not occur during this period. Despite cyclic PN, liver function test (LFT) val-ue was sometimes increasing. After PN calorie was de-creased, LFT values were normalized. When evaluated according to the corrected age, he belonged to 5%∼25% for weight status, which was considered normal weight compared to height. For all patients requiring prolonged PN support, HPN is the only alternative to long-term hos-pitalization and may be the best option for improvement of patients’ quality of life. However, significant benefit can be gained through collaboration between healthcare pro-viders within the institution. Family training and education are important. Using this case, we evaluate the clinical experiences and considerations of HPN in Korea. (J Korean Soc Parenter Enter Nutr 2013;5(3):130-132)

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