Annals of Clinical Nutrition and Metabolism

Current Challenges of Clinical Nutrition: Kyung Uk Jung; Ann Clin Nutr Metab 2022;14(2):39-39. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.39

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Exploring Human Muscle Dynamics In Vivo Using Stable Isotope Tracers: Il-Young Kim, Sanghee Park, Jiwoong Jang, Yeongmin Kim, Hee-Joo Kim; Ann Clin Nutr Metab 2022;14(2):40-49. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.40

Abstract PDF: The body protein pool constantly turns over while achieving a dynamic steady state in healthy living organisms to accomplish homeostasis, indicating a close match between the rate of protein synthesis and breakdown (i.e., protein turnover). However, dysregulation of protein turnover in muscle over time leads to muscle wasting conditions such as sarcopenia, cachexia, and heart failure. Furthermore, altered muscle metabolism in obesity, insulin resistance, and diabetes. Therefore, skeletal muscle in wasting conditions is an important target for drug development. Since muscle mass is controlled by the balance between the rate of muscle protein synthesis (MPS) and muscle protein breakdown (MPB), a change in muscle mass can occur due to various permutations of the two rates (i.e., MPS and MPB). Elucidation of molecular mechanisms involved in the control of protein turnover provides invaluable data but misses the dynamic (i.e., kinetic) nature of the proteome, information of which stable isotope tracer methodology can provide. Combining stable isotope tracer methodology and molecular biology tools enables an in-depth understanding of protein metabolism in physiological and pathophysiological conditions, consequently facilitating the development of effective therapeutic approaches (optimal nutrition, exercise, and drugs) to treat muscle wasting diseases. In this review, we will discuss the significance of obtaining kinetic information for a better understanding of protein metabolism, and stable isotope tracer methodologies that enable exploration of muscle protein kinetics and direct muscle mass in vivo. These methodologies can be applied to metabolic research regarding pathophysiological conditions in both humans and animals.

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Selection of the Enterostomy Feeding Route in Enteral Nutrition: Dong-Seok Han; Ann Clin Nutr Metab 2022;14(2):50-54. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.50

Abstract PDF: Enteral nutrition has several physiologic advantages. For example, it can reduce complications, result in immunological improvement, and prevent bacterial translocation by maintaining the integrity of the intestinal barrier. Enteral tube feeding has a major role in nutritional support of patients with swallowing disorders caused by stroke or other neurologic disorders, neoplasms of the upper digestive tract, and benign esophageal stricture. This review article aimed to present the current knowledge on the clinical application of enteral tube feeding. Especially, based on a literature search on PubMed using the index terms of enteral tube feeding; the indications, advantages, and disadvantages; and insertion methods of various enteral tubes were identified.

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Development and Internal/External Validation of a Prediction Model for Weight Loss Following Gastric Cancer Surgery: A Multicenter Retrospective Study: Ji-Hyeon Park, Seong-Ho Kong, Do Joong Park, Han-Kwang Yang, Jong Won Kim, Ki Bum Park, In Cho, Sun-Hwi Hwang, Dong-Wook Kim, Su Mi Kim, Seung-Wan Ryu, Seong Chan Gong, Pil Young Jung, Hoon Ryu, Sung Geun Kim, Chang In Choi, Dae-Hwan Kim, Sung-IL Choi, Ji-Ho Park, Dong Jin Park, Gyu-Yeol Kim, Yunhee Choi, Hyuk-Joon Lee; Ann Clin Nutr Metab 2022;14(2):55-65. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.55

Abstract PDF: Purpose: To develop an individualized model for predicting the extent of unintentional weight loss following gastrectomy in patients with gastric cancer based on related risk factors and to externally validate this model using multicenter clinical data in Korea.
Materials and Methods: Among gastric cancer patients who underwent curative gastrectomy at 14 different gastric cancer centers, clinical data from patients with more than one weight measurement during the three-year follow-up period were retrospectively collected. Risk factors associated with weight loss in gastric cancer patients after gastrectomy were analyzed, and a predictive model was developed. Internal and external validation were performed.
Results: The data from 2,649 patients were divided into a derivation set (n=1,420 from Seoul National University Hospital) and validation set (n=1,229 from 13 different gastric cancers). Postoperative duration (six vs. 12, 24, or 36 months), sex (female vs. male), age, preoperative body mass index, type of surgery (pylorus-preserving vs. total, distal or proximal gastrectomy), and cancer stage (I vs. II or III) were included in the final prediction model. The model showed approximately 20% accuracy in predicting weight loss at each period: R2 at six, 12, 24 and 36 months after gastrectomy in internal validation=0.20, 0.21, 0.17, and 0.18, respectively, and in external validation=0.20, 0.22, 0.18, and 0.18, respectively. Calibration slopes of internal and external validation were 0.95 and 1.0, respectively.
Conclusion: Although predictive accuracy of the model did not reach an acceptable level, repeated external validation measurements showed high reliability. The model may serve as a basic reference in clinical practice.

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Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study: Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung; Ann Clin Nutr Metab 2022;14(2):66-71. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.66

Abstract PDF: Purpose: Timely enteral nutrition (EN) is important in critically ill patients. However, use of EN with critically ill surgical patients has many limitations. This study aimed to analyze the current status of EN in surgical intensive care units (ICUs) in South Korea.
Materials and Methods: A multicenter, prospective, observational study was conducted on patients who received EN in surgical ICUs at four university hospitals between August 2021 and January 2022.
Results: This study included 125 patients. The mean time to start EN after admission to the surgical ICU was 6.2±4.6 days. EN was provided to 34 (27.2%) patients within 3 days after ICU admission. At 15.7±15.9 days, the target caloric requirement was achieved by 74 (59.2%) patients through EN alone. Furthermore, 104 (83.2%) patients received supplemental parenteral nutrition after a mean of 3.5±2.1 days. Only one of the four hospitals regularly used enteral feeding tubes and post-pyloric feeding tubes.
Conclusion: Establishing EN guidelines for critically ill surgical patients and setting an appropriate insurance fee for EN-related devices, such as the feeding pump and enteral feeding tube, are necessary.

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Refeeding Syndrome in Critically Ill Patients: Sang Woo Ha, Suk-Kyung Hong; Ann Clin Nutr Metab 2022;14(2):72-80. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.72

Abstract PDF Supplementary Material: Purpose: The aim of this study is to demonstrate clinical characteristics of refeeding syndrome (RS) and clinical utility of several guidelines including American Society for Parenteral and Enteral Nutrition consensus recommendations for RS and National Institute for Clinical Excellence guidelines.
Materials and Methods: Eighty-six patients screened for RS based on two guidelines were enrolled in this study. We evaluated the severity of RS after the initiation of ‘dextrose infusion’ and ‘balanced nutrition support’ with calculation of 5-day electrolyte changes. The primary outcome was 6-month mortality and secondary outcomes were duration of intensive care unit stay in days, duration of mechanical ventilation in days, and ventilator-free days at the 28th day.
Results: We observed statistically different distributions in terms of prevalence of RS on the basis of two different start times of caloric support (P=0.021). There was no statistically significant relationship between the risk of RS and severity of RS based on both guidelines. Also, the relevance between severity of RS and outcomes was not significant in our study. In multivariable logistic regression analysis of factors associated with outcomes, the significant factor for primary outcome was the ‘patients with significant risk’ (odds ratio, 9.65; 95% confidence interval, 1.83~50.90; P=0.007).
Conclusion: We demonstrated that even initial administration of dextrose solution and propofol could cause severe RS in critically ill patients. In addition, significant risk of RS was a predictive factor for 6-month mortality. Thus, it is essential to monitor the occurrence of RS even during initial resuscitation in patients with unstable metabolism.

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Body Compositions of Elderly and Non-Elderly Patients Following Gastrectomy for Gastric Cancer: Ji Hoon Kang, Mi Ran Jung, Sung Eun Kim, Oh Jeong; Ann Clin Nutr Metab 2022;14(2):81-87. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.81

Abstract PDF: Purpose: Radical gastric resection is the mainstay of treatment in gastric cancer. However, patients can suffer from eating restrictions, weight loss, and malnutrition after gastrectomy, to which elderly patients are more vulnerable. We compared body composition changes in elderly patients and non-elderly patients after gastrectomy.
Materials and Methods: This prospective study enrolled patients who underwent gastrectomy for gastric carcinoma between 2019 and 2021. Body composition was measured using bioelectrical impedance analysis (InBody S10) before surgery and up to 12 months after surgery. Patients were divided into an elderly group (>70 years) and a non-elderly group (≤70 years), and body composition changes were compared between the two groups using the linear mixed model.
Results: There were 69 patients in the elderly group and 164 patients in the non-elderly group. The groups showed no significant differences in gastric resection or pathologic stage. Overall, body composition, including total body water, body weight, lean body mass, skeletal muscle mass, and fat mass, decreased immediately after surgery and gradually improved until postoperative 12 months. A linear mixed model showed no significant time×group interactions for any body composition factors between groups.
Conclusion: Body composition changes did not significantly differ between elderly patients and non-elderly patients after gastrectomy.

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Refeeding Syndrome after Gastrectomy in a Patient with Hypophosphatemia: A Case Report: Cheong Ah Oh; Ann Clin Nutr Metab 2022;14(2):88-92. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.88

Abstract PDF: This study describes an 81-year-old male who was highly suspicious for refeeding syndrome (RFS) after a retrospective review of his postoperative clinical progression. This highlights the importance of clinicians’ awareness of the possibility of RFS development in surgical patients with any RFS risk factors.

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Development of Wernicke’s Encephalopathy during Total Parenteral Nutrition Therapy without Additional Multivitamin Supplementation in a Patient with Intestinal Obstruction: A Case Report: Cheong Ah Oh; Ann Clin Nutr Metab 2022;14(2):93-96. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.93

Abstract PDF: Wernicke’s encephalopathy (WE) is a serious neurological disorder that can be fatal if not properly treated. In this current paper, I present the case of a 51-year-old male with a perivesical fistula between a presacral abscess and the rectus abdominis muscle. He received total parenteral nutrition therapy during a fasting period because of small bowel obstruction and later developed WE. The patient’s WE-related symptoms improved following rapid treatment with high doses of thiamine.

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