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- Volume 7 (3); December 2015
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Editorial
- Letter from Editor
- Hyuk-Joon Lee
- J Clin Nutr 2015;7(3):69-69. Published online December 31, 2015
- DOI: https://doi.org/10.15747/jcn.2015.7.3.69
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Review Article
- Changes in 2015 Canadian Clinical Practice Guidelines
- Dae-Sang Lee
- J Clin Nutr 2015;7(3):70-74. Published online December 31, 2015
- DOI: https://doi.org/10.15747/jcn.2015.7.3.70
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Abstract
PDF Careful nutritional strategy is an essential component in the management of critically ill patients. Evidence-based clinical practice guidelines can be an effective solution to improving the process and structure of nutritional strategy for critically ill patients. The 2015 Canadian clinical practice guidelines (CPGs) summarized the evidence from approximately 354 randomized controlled trials in the area of critical care nutrition since 1980. The Canadian CPGs were first developed in 2003 and have been updated every 2 years. It is important for the acquisition of new evidence-based knowledge. This paper includes a brief summary on changes in 2015 CPGs compared with 2013 CPGs.
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Original Articles
- Analysis of Current Use of Early Parenteral Nutrition and Clinical Significance of Non-protein Calorie: Nitrogen in Surgical Critically Ill Patients
- Eunjeong Heo, Kayoung Park, Sujeong Jeon, Hyungwook Namgung, Eunsook Lee, Inae Song
- J Clin Nutr 2015;7(3):75-80. Published online December 31, 2015
- DOI: https://doi.org/10.15747/jcn.2015.7.3.75
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Abstract
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Purpose:
Surgical critically ill patients require adequate nutrition support and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend low non-protein calorie:nitrogen ratio (NPC:N ratio, 70∼100) for critically ill pateints. In this study, we assess the current use of early parenteral nutrition of surgical critically ill patients and analyze the clinical significance of NPC:N.
Methods:
This is a retrospective study of critically ill adult patients who remained in the intensive care unit (ICU) for over 3 days and could not receive enteral nutrition for the first 7 days. Data on parenteral intake of patients were collected from electronic medical records. Association of NPC:N scores with clinical outcome (length of ICU stay, length; of hospital stay, duration of ventilation, and mortality) were analyzed using Pearson correlation and multiple regression.
Results:
The study included 72 cases, average parenteral calorie intake was 14.6 kcal/kg/day and protein intake was 0.5 g/kg/day. We assessed the NPC:N scores to determine the patients’ NPC:N for the first 7 days in ICU close to the A.S.P.E.N guidelines. NPC:N scores showed weak negative correlation with length of hospital stay and duration of mechanical ventilation (r=−0.259, P=0.028; r=−0.495, P=0.001). Multiple regression adjusted with APACHE (Acute Physiology and Chronic Health Evaluation) II score, age, and body mass index showed correlation of higher NPC:N score with decreased length of hospital stay and shorter duration of ventilation (P=0.0001, P=0.035, respectively). However, length of ICU stay and mortality within 60 days showed no significant correlation with NPC:N scores.
Conclusion:
Parenteral calories and protein intakes of critically ill patients in ICU were lower in comparison to A.S.P.E.N. recommendation in this study. Low NPC:N scores might be related to shorter length of hospital stay, duration of mechanical ventilation. Consultation of a nutritional support team could have a positive effect in providing appropriate nutrition support.
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The Efficacy and Safety of
Cordyceps militaris in Korean Adults Who Have Mild Liver Dysfunction - Jin Young Heo, Hyun Wook Baik, Hyuk Jung Kim, Jae Min Lee, Hyung Woo Kim, Yong Sun Choi, Jung Ho Won, Hyun Mi Kim, Won Il Park, Chul Young Kim
- J Clin Nutr 2015;7(3):81-86. Published online December 31, 2015
- DOI: https://doi.org/10.15747/jcn.2015.7.3.81
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Abstract
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Purpose:
The aim of this study is to determine the efficacy and safety of
Cordyceps militaris in Korean adults with mild liver dysfunction.C. militaris is a mushroom traditionally used for several clinical purposes in East Asian territory, including China, and has been found to be effective in improving liver function through animal studies.Methods:
The
C. militaris group was administered 1.5 g/day ofC. militaris (2 capsules per dose, twice per day) and the placebo group was administered the same volume of placebo. Laboratory test (white blood cell, hemoglobin, platelet, aspartate aminotransferase, alanine aminotransferase, gamma glutamyltranspeptidase, lactic dehydrogenase, alkaline phosphatase, total bilirubin, blood urea nitrogen, creatinine), liver computed tomography (CT) were performed, and visual analogue scale score for subjective symptoms and fatigue severity scale were measured.Results:
In analysis of the liver CT scan at 8 weeks after administration compared to baseline, the mean ratio of change of Hounsfield unit of 8 segments of liver increased by an average of 21.43%±45.11% in the
C. militaris group and 9.64%±11.41% in the placebo group. Others showed no statistically significant inter-group difference.Conclusion:
C. militaris extract was used safely as a functional food in patients with mild liver dysfunction, and is expected to protect against progression of fatty liver or cirrhosis caused by suppression of lipid accumulation in hepatocytes.
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- Evaluation of Postoperative Nutrition Support with Commercial Peripheral Parenteral Nutrition after an Ivor-Lewis Esophagectomy in Patients with Esophageal Cancer
- Sun-woo Lee, Na-ri Lim, Hyo Jung Park, Yong-won In, Jeong-meen Seo, Young-mee Lee
- J Clin Nutr 2015;7(3):87-92. Published online December 31, 2015
- DOI: https://doi.org/10.15747/jcn.2015.7.3.87
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Abstract
PDF
Purpose:
Deteriorated nutritional status is common during a hospital stay for esophagectomy in patients with esophageal cancer. Malnutrition in those patients is often marked compared with other gastrointestinal cancer. The purpose of this study is to evaluate the appropriateness of commercial peripheral parenteral nutrition (CPPN) use in patients who underwent Ivor-Lewis esophagectomy (I-L op).
Methods:
Patients who were provided with CPPN after I-L op were enrolled in this study from January to May 2015. Body weight, height, nutritional status, length of hospital stay, duration of CPPN therapy, and parenteral nutrition (PN) induced complications were assessed, respectively, using electronic medical records.
Results:
Thirty-nine patients were enrolled. Average age was 65.9 years and 36 patients were male. All patients were provided with the same CPPN. The duration of fasting and CPPN use was 5.8±1.4 days and 7.5±1.8 days, respectively. Calorie supported by CPPN was 22.6±3.5 kcal/kg/day and only 20.5% of patients (n=8) reached the daily target calories. Most frequent PN induced complication was phlebitis which occurred in 8 patients (20.5%). Calcium, magnesium, and transthyretin levels in serum were not monitored during the PN support period.
Conclusion:
The indications for CPPN were appropriate because the fasting duration in patients with I-L op was 5 to 10 days. Although a large portion of patients could not be supplied daily target calories, their nutrition status was not significantly changed on admission and at discharge. We did not find it necessary to individualize PN support for a short period after an I-L op in patients with esophageal cancer. Further study will be needed to determine why the incidence of phlebitis was dominant.
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