Annals of Clinical Nutrition and Metabolism

Comparative assessment of nutritional characteristics of critically ill patients at admission and discharge from the neurosurgical intensive care unit in Korea: a comparison study: Eunjoo Bae, Jinyoung Jang, Miyeon Kim, Seongsuk Kang, Kumhee Son, Taegon Kim, Hyunjung Lim; Ann Clin Nutr Metab 2023;15(3):97-108. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.97

Purpose: Patients in neurosurgical (NS) intensive care units (ICUs) experience considerable energy and protein deficits associated with adverse outcomes. This study aimed to compare the nutritional status of patients at admission to (baseline) and discharge from the NS ICU.
Methods: This was a single-center, retrospective, before and after study of patients admitted in the NS ICU of the CHA Bundang Medical Center, from January 31, 2019, to February 28, 2020. All anthropometric data, biochemical data, clinical data, and dietary data were collected during the NS ICU stay. Specifically, we investigated the cumulative caloric deficit rate, phase angle and skeletal muscle index as indicators of lean muscle mass, and nitrogen balance according to demographic and clinical characteristics.
Results: A total of 140 NS patients were studied. Calf circumference decreased from 31.4±4.2 cm at baseline to 30.2±4.0 cm at discharge (P<0.001). Energy supply rate increased from 44.4% at baseline to 89.2% at discharge. Phase angle (PhA) patients with an modified Nutrition Risk in the Critically ill (mNUTRIC) score≤5 group had significantly lower PhA values than those with an mNUTRIC score>5 (P=0.005).
Conclusion: Although clinical and dietary parameters of patients in the NS ICU improved from baseline to discharge, anthropometric and biochemical markers of lean muscle mass and nutritional status decreased. PhA and nitrogen balance difference values were significantly different between those with an mNUTRIC score≤5 and those with an mNUTRIC score>5. These data indicate that the nutritional risk of critically ill patients increases during hospitalization in the NS ICU.

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A Review on the Effects of Multiple Nutritional Scores on Wound Healing after Neurosurgery.
Jingqian Ye, Bo Ning , Jianwen Zhi
International Journal of Biology and Life Sciences.2025; 9(2): 82. CrossRef

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Perioperative nutritional practices and attitudes among gastrointestinal oncologic surgeons in Korea: a nation-wide survey study: Dae Hoon Kim, Jeong-Meen Seo, Min-Gew Choi; Ann Clin Nutr Metab 2023;15(3):81-87. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.81

Abstract PDF Supplementary Material ePub: Purpose: This study aimed to investigate the current perioperative nutritional practices and attitudes among gastrointestinal (GI) oncologic surgeons in Korea. Evidence-based perioperative nutritional practices are not well-established in this field.
Methods: A nationwide survey was conducted with 24 items, targeting GI oncologic surgical faculty members from March 2022 to April 2022 through social networking service messaging and email. Whole target number was 3,421.
Results: Out of responding 161 GI surgeons, 83.9% were male and 16.1% were female, and about 49.7% were in their 40s. When asked about their hospital policies, 67.1% reported the existence of formal nutritional screening programs. However, the execution and analysis of these programs varied considerably. Most surgeons conducted preoperative nutritional screening, with albumin testing the most frequently performed. In addition, nutritional supplementation—primarily protein drinks—was given before surgery. The duration for which these supplements were used varied from ≤3 days to 4–7 days. Most respondents recognized the importance of addressing nutritional deficiencies in patients with GI tumors; however, when asked about immunonutrition, 89.4% of surgeons admitted having limited knowledge.
Conclusion: Although there is recognition of the importance of evidence-based nutrition practices in GI and oncologic surgery programs, this study reveals limited implementation of such practices. This study highlights a considerable opportunity to leverage existing positive surgeon beliefs and published data on the benefits of perioperative nutrition to enhance surgical nutrition practices and to improve patient outcomes in Korea.

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Perioperative nutrition support: a narrative review: Rajeev Joshi, Asma Khalife; Ann Clin Nutr Metab 2023;15(2):40-45. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.40

Abstract PDF ePub

Purpose: Proper nutrition and supplementation are paramount in surgical patients. Suboptimal nutrition status is increasingly recognized as an independent predictor of poor surgical outcomes. The purpose of this review is to highlight the need for nutritional protocols, with an emphasis on perioperative nutrition.
Current concept: Perioperative nutrition support is considered an adjunctive strategy in most centers, although it is proven to be the key in improving surgical outcomes. There is a need to increase the standards and formulate policies and protocols to optimize perioperative nutrition support. Components of perioperative nutrition include nutritional screening and assessment, prehabilitation, preoperative metabolic optimization and carbohydrate loading, postoperative early enteral feeding and perioperative parenteral nutrition, immunonutrition and micronutrients, and oral nutritional supplementation vs. hospital-based kitchen feeds. Supplemental parenteral nutrition becomes valuable when enteral nutrition alone cannot fulfil energy needs. In patients in the surgical intensive care unit who are dealing with hemodynamic instability, high levels of serum lactate unrelated to thiamine deficiency, acidosis, significant liver dysfunction, high blood sugar, and high blood lipid levels, parenteral nutrition must be started with caution. In the post-surgery care ward, it is advisable to administer up to 30 kcal/kg/day and 1.2–2 g/kg/day of protein.
Conclusion: The positive impact of comprehensive nutritional support and the importance of setting and executing standards must be highlighted. Emphasis should be placed on overcoming existing challenges in implementing nutrition therapy in current surgical practice, as better perioperative nutrition supports better surgical outcomes.

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Nutritional intervention for weight loss in presurgical phase – case study
Ana-Maria Damian
The Romanian Journal of Nutrition.2024; 4(4): 4. CrossRef

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Clinical Significance of Malnutrition Risk in Severe Trauma Patients: A Single-Center Study: Hohyun Kim, Kum-Hee Hong, Inah Choi, Kyung-A Lee, Geun Am Song; Ann Clin Nutr Metab 2021;13(2):68-74. Published online December 31, 2021; DOI: https://doi.org/10.15747/ACNM.2021.13.2.68

Abstract PDF ePub: Purpose: A suboptimal nutritional status is often observed among hospitalized patients across all medical/surgical specialties. The objective of the present study was to (1) analyze the prevalence of malnutrition in severe trauma patients and (2) evaluate the relationship between malnutrition and select clinical outcomes.
Materials and Methods: This retrospective study was conducted between October 2015 and March 2017 at the Pusan National University Hospital Trauma Center. Of a total of 3,560 patients, 945 were enrolled in this study. Patients were checked for malnutrition using a nutrition assessment tool by the hospital nutrition support team. The parameters assessed included serum albumin, the ratio of actual body weight to ideal body weight (%), total lymphocyte count, appetite, and gastrointestinal problems. Clinical outcomes under consideration included 1) mortality, 2) length of hospitalization, and 3) length of stay in the intensive care unit (ICU).
Results: The total prevalence of malnutrition in hospitalized trauma patients was 55.0% (n=520). Malnutrition risk was the independent prognostic factor of mortality in severe trauma patients (adjusted odds ratio [OR]=3.440; 95% confidence interval [CI]=1.401~8.447, P=0.007). Risk factors of malnutrition were age over 65 years (adjusted OR=2.393; 95% CI=1.699~3.370, P<0.001), injury severity score (adjusted OR=1.034, 95% CI=1.012~1.056, P=0.002), length of hospitalization (adjusted OR=1.104; 95% CI=1.007~1.020, P<0.001), and length of stay in the ICU (adjusted OR=1.050; 95% CI=1.029~1.072, P<0.001).
Conclusion: Malnutrition is widespread in hospitalized patients with severe trauma and results in suboptimal clinical outcomes. Thus, patients at high risk of malnutrition should be monitored carefully during hospitalization.

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Impact of Visceral Fat Area Measured by Bioelectrical Impedance Analysis on Clinico-Pathologic Outcomes of Colorectal Surgery: Kyeong Eui Kim, Woo Jin Song, Minji Seok, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek; J Clin Nutr 2021;13(1):17-23. Published online June 30, 2021; DOI: https://doi.org/10.15747/jcn.2021.13.1.17

Abstract PDF ePub: Purpose: This study investigated the relationship between the visceral fat area (VFA) and clinico-pathological outcomes in patients with colorectal cancer (CRC).
Methods: This retrospective study included 204 patients who underwent anthropometric measurement by bioelectrical impedance analysis (BIA) before surgical treatment for CRC between January 2016 and June 2020.
Results: According to the average value of the visceral fat area, 119 (58.3%) patients had a low visceral fat area, and 85 (59.1%) patients had a high visceral fat area. Patients with visceral obesity showed a higher BMI compared to patients without visceral obesity, (21.8±1.9 vs. 25.7±2.5, P<0.001). There was no significant difference in the overall perioperative outcomes including total operation time, time to gas out, sips of water, soft diet, hospital stay, and morbidity between patients in the low and high VFA groups. We divided patients into two subgroups according to the degree of cancer progression and more advanced cases with low VFA showed significantly more total and positive retrieved lymph nodes (LNs) (20.9±10.3 vs. 16.1±7.1, P=0.021 and 3.3±2.9 vs. 2.2±2.3, P=0.019, respectively) and a higher proportion of more than 12 retrieved LNs compared to patients with a high VFA (95.1% vs. 90.0%, P=0.047). Body composition analysis showed that phase angle, muscle composition, and body fluid composition were not statistically different between the two groups. However, body fat mass was statistically higher in the high VFA group (22.0±4.6 vs. 12.8±3.1, P<0.001).
Conclusion: Visceral obesity measured by BIA showed lower total and positive retrieved LNs and was not associated with adverse peri-operative outcomes, inflammatory and nutritional, and pathologic outcomes for CRC.

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Analysis of Muscle Using CT Anthropometry in Major Trauma Patients: Hang Joo Cho, Yunsup Hwang, Yoon Hyun Lee, Dae Hyun Cho, Dae-Sang Lee, Maru Kim; Surg Metab Nutr 2020;11(1):12-15. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.12

Abstract PDF ePub: Purpose: The feasibility of nutritional assessment using computed tomography anthropometry has been previously proven. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, and especially sarcopenia. However, any studies on nutritional assessment of the brain, face, or neck via computed tomography are still scarce. We retrospectively investigated the applicability of the masseter muscle as a nutritional biomarker.
Materials and Methods: Patients who underwent simultaneous brain and abdominopelvic computed tomography at a regional trauma center were retrospectively analyzed. Their masseter muscles at 2 cm below the zygomatic arch and abdominal muscle at L3 were assessed via computed tomography anthropometry. Basic clinical data including trauma information was also reviewed. The data was analyzed in conjunction with the patients’ mortality.
Results: A total of 411 patients were analyzed in the study (316 men and 95 women, mean age: 50.41 years, mean areas of the masseter and abdominal muscles: 10.6 and 137.3 cm², respectively) and there 146 major trauma patients with an injury severity score higher than 15. The masseter muscle area was decreased in the mortality group of major trauma patients (10.4 vs 7.9 cm², P=0.001). However, abdominal muscles did not show statistical significance (137.9 vs. 117.7 cm², P=0.054).
Conclusion: The masseter muscle, when analyzed via computed tomography anthropometry, showed a statistical association with patients’ mortality and it could prove its feasibility as a nutritional biomarker.

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Survey and Analysis of the Application and Implementations of Enhanced Recovery after Surgery (ERAS) Program for Surgical Patients in the Major Hospitals in Korea: Eun Young Kim, In Kyu Lee; Surg Metab Nutr 2019;10(2):32-45. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.32

Abstract PDF ePub

Purpose:

A questionnaire survey was conducted using e-mail to investigate the application status of ERAS in Korea and its implementation by their institution. The perceptions of ERAS by medical staff and the factors that interfered with the application of ERAS were investigated.

Materials and Methods:

From July 2017 to March 2019, a questionnaire was sent by e-mail to members of the KSSMN. This consisted of 41 questions divided into three parts to investigate 1) respondents’ prior knowledge and understanding of ERAS, 2) actual components of ERAS and its clinical application, and 3) performance and preference of the respondents to ERAS. The items were categorized into “high acceptance” when more than 75% of respondents answered “yes”, or the items into “low acceptance” when less than 25% answered “no”.

Results:

Overall, 86 participants completed the survey. Of these, 59(68.6%) had prior knowledge of ERAS and 29 (33.7%) applied ERAS clinically. Seventy (81.4%) and 40 (46.5%) answered that ERAS would have a positive effect on shortening the hospital stay and reducing the number of complications. Seventy four (86%) indicated that they would implement ERAS in the future. The factors impeding the implementation of ERAS were a lack of understanding of physicians and a shortage of manpower and resources for ERAS.

Conclusion:

The ERAS implementation rate and awareness level of surgeons were low, but the positive expectations of the clinical efficacy of ERAS and the wiliness to accept were high. Overall, it would be necessary to cooperate with institutions to improve the manpower and resources, and supplement the education to overcome the lack of awareness, which has been pointed out as an obstacle to the implementation of ERAS.

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Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef
Perioperative nutritional practice of surgeons in Korea: a survey study
Ji-Hyeon Park, Mi Ran Jung, Sang Hyun Kim, Hongbeom Kim, Gyeongsil Lee, Jae-Seok Min, Heung-Kwon Oh, Jung Hoon Bae, Yoona Chung, Dong-Seok Han, Seung Wan Ryu
Annals of Clinical Nutrition and Metabolism.2024; 16(3): 134. CrossRef
Effects of the Enhanced Recovery After Surgery (ERAS) Program for Colorectal Cancer Patients Undergoing Laparoscopic Surgery
Jeongwon Yeom, Hee-Sook Lim
Clinical Nutrition Research.2022; 11(2): 75. CrossRef
Effect of Non-contact Korean Medical Treatment for Patients Recovering at Home with Positive Coronavirus Disease 2019 Diagnostic Test Results at a Local Public Health Center : A Retrospective Chart Review
Chaeheun Jeon, Daejun Choi, Gyeongmuk Kim, Hyejin Kim, Jungtae Leem, Gyoo-yong Chi
Journal of Physiology & Pathology in Korean Medicine.2022; 36(4): 130. CrossRef
Perception and implementation status of enhanced recovery after surgery
Eun Young Kim
Journal of the Korean Medical Association.2021; 64(12): 826. CrossRef
Background for the introduction of enhanced recovery after surgery and patient outcomes
Do Joong Park
Journal of the Korean Medical Association.2021; 64(12): 801. CrossRef

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Nutritional Assessment of Critically Ill Patients after Abdominal Surgery and Predisposing Factors of Prolonged ICU Stay after Surgery: Sung Eun Park, In Kyu Lee, Eun Young Kim; Surg Metab Nutr 2018;9(2):68-74. Published online December 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.2.68

Abstract PDF ePub: Purpose:

Patients in prolonged intensive care unit stay were vulnerable to malnutrition which deteriorated recovery and postoperative outcomes. The purpose of this study was to evaluate nutritional status in surgical patients entering the intensive care unit, and to identify the risk factors that influence prolonged intensive care unit stay.

Materials and Methods:

From January 2016 to June 2018, 740 patients (age≥18 years) who were admitted to our surgical intensive care unit after abdominal surgery with general anesthesia (≥4 hours) were enrolled. Patients were classified into short-term stay group (≤4 days) and long-term stay group (>4 days). These groups were analyzed and compared with patient factors and postoperative outcomes and the multivariate analysis was performed to assess the risk factors for prolonged intensive care unit stay.

Results:

A total of 119 patients were analyzed. The univariate and multivariate analysis showed that dialysis status (Odds ratio 7.684, 95% confidence interval 1.038∼1.103, P=0.013), total lymphocyte count (Odds ratio 0.999, 95% confidence interval 0.998∼1.000, P=0.047), and intraoperative transfusion (Odds ratio 1.002, 95% confidence interval 1.001∼1.002, P=0.000) were associated with prolonged intensive care unit stay. Lone-term stay group were significantly longer hospital stay and higher hospital morbidity rate than short-term stay group.

Conclusion:

Patients with risk factors of prolonged intensive care unit stay included dialysis status, low total lymphocyte count, a large amount of transfusion would be more interested and the active intervention such as early nutritional evaluation and adequate nutritional support should be needed.

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Analysis of Compliance with Plan of Nutritional Support Team in Intensive Care Unit: Eunkyoung Kim, Jingyeong Kim, YunJu Park, Soyoung Baek, JinJu Lee, AeHee Lee, Jae Im Lee, Chang Hyeok An, Maru Kim; Surg Metab Nutr 2016;7(2):29-31. Published online December 30, 2016; DOI: https://doi.org/10.18858/smn.2016.7.2.29

Abstract PDF ePub

Purpose:

To improve the nutritional state of patients, cooperation between medical and nutritional support teams is needed. The present study analyzed compliance with the plan of the nutritional support team.

Materials and Methods:

From September 2015 to February 2016, patients undergoing consultation with the nutritional support team at an intensive care unit was enrolled in the study. Their medical records were retrospectively reviewed.

Results:

A total of 123 patients were analyzed. Overall compliance was 56.9% (70/123). Main reason of the non-compliant group was change in patient’s condition (44/53).

Conclusion:

To improve compliance with the medical team, there is a need to assess patients’ condition more rapidly.

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Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
Yunjin Sohn, Taisun Hyun
Korean Journal of Community Nutrition.2022; 27(2): 121. CrossRef

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Clinical Application of Bioelectrical Impedance Analysis and its Phase Angle for Nutritional Assessment of Critically III Patients: Hyung-Sook Kim, Eun Sook Lee, Yeon Joo Lee, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho; J Clin Nutr 2015;7(2):54-61. Published online August 31, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.2.54

Abstract PDF ePub

Purpose:

Phase angle (PA) is objectively determined from resistance and reactance measured by bioelectrical impedance analysis (BIA)−a quick, noninvasive method. The aim of this study was to evaluate the clinical application of PA by BIA for nutritional assessment of critically ill patients.

Methods:

Eighty nine adult patients admitted to a medical intensive care unit (ICU) of a tertiary academic hospital from August 2012 to September 2013 were analyzed. PA values were measured by direct segmental multi-frequency BIA. As traditional nutrition assessment tools, body mass index (BMI), serum albumin levels, total lymphocyte counts, and our hospital’s nutrition screening index (NSI) were also recorded. Correlations between the results of BIA and other traditional parameters were analyzed.

Results:

PA showed correlation with traditional nutritional parameters, including BMI (r=0.479), serum albumin (r=0.347), and NSI score (r=0.483). Patients with PA lower than the median value (3.5°) had significantly lower nutritional status, increased duration of mechanical ventilation (P=0.039), and increased length of ICU stay (P=0.041).

Conclusion:

PA, as a reflection of body cell mass, measured by BIA could be a potentially useful parameter for nutritional assessment in critically ill patients.

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Optimal Enteral Nutrition Support Preserved Muscle Mass in Critically Ill Children
Kantisa Sirianansopa, Chavisa Rassameehirun, Sirinuch Chomtho, Orapa Suteerojntrakool, Lalida Kongkiattikul, Eric Gumpricht
Journal of Nutrition and Metabolism.2022; 2022: 1. CrossRef
Prognostic value of phase angle and bioelectrical impedance vector in critically ill patients: A systematic review and meta-analysis of observational studies
Júlia Lima, Igor Eckert, Maria Cristina Gonzalez, Flávia Moraes Silva
Clinical Nutrition.2022; 41(12): 2801. CrossRef
Bioelectrical Impedance Analysis for Prediction of Early Complications after Gastrectomy in Elderly Patients with Gastric Cancer: the Phase Angle Measured Using Bioelectrical Impedance Analysis
Byunghyuk Yu, Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Oh Kyoung Kwon, Ho Young Chung
Journal of Gastric Cancer.2019; 19(3): 278. CrossRef

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Imaging Techniques for Nutritional Assessment: Joohyun Shim, Hoon Hur; J Clin Nutr 2015;7(2):49-53. Published online August 31, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.2.49

Abstract PDF ePub

Accurate measurement of body composition between lean and adipose tissue mass and distribution of lipid burden may be important in the care of nutritional problems in patients observed in clinical practice and the measurement of outcomes in clinical research. In this review, we discuss the most accurate imaging methods for use as clinical tools in measurement of body composition and distribution. Dual-energy x-ray absorptiometry (DXA) is a non-invasive technique for assessment of body composition, and the radiation exposure is relatively minimal. However, measurements are influenced by thickness of tissue and lean tissue hydration. Computed tomography (CT) is a gold-standard imaging method for body composition analysis at the tissue-organ level, however the radiation generated by the CT scan is relatively high, thus it should not be considered for a measurement, which can be repeated frequently. Magnetic resonance imaging (MRI) has been a useful modality in the assessment of body composition changes in various clinical studies. However, limitations of MRI for assessment of body composition are related to its high cost and technical expertise necessary for analysis. Proper methods for measurement of body composition in specific medical situations like sarcopenia should be evaluated for determination of comparative validity and accuracy, within the context of cost-effectiveness in patient care. In conclusion, an ideal body imaging method would have a significant utility for earlier detection of nutritional risks, while overcoming the limitations of current imaging studies such as DXA, CT, and MRI.

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Ex Vivo, In Vitro and In Vivo Bone Health Properties of Grana Padano Cheese
Cristina Martelli, Luisa Ottobrini, Anita Ferraretto, Paola Bendinelli, Stefano Cattaneo, Fabio Masotti, Milda Stuknytė, Margherita Dall’Asta, Angelo Del Sole, Ivano De Noni, Filippo Rossi
Foods.2025; 14(2): 273. CrossRef

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Role of Retinol Binding Protein as a Biochemical Markers for Nutritional Status Assessment: Se Youl Lee, Sang In Bae, Hee Chul Yu; Surg Metab Nutr 2015;6(1):7-10. Published online June 30, 2015; DOI: https://doi.org/10.18858/smn.2015.6.1.7

Abstract PDF ePub

Malnutrition has a significant impact on the recovery of patients. Assessment of nutritional status and appropriateness of nutritional support is of clinical importance. In the various nutritional assessment methods, biochemical markers (albumin, pre-albumin, retinol binding protein, and transferrin) are widely used for high sensitivity and objectivity. For application of the biochemical markers, it should be understood that the markers have merits and de-merits. Author investigates the retinol binding protein, one of the most sensitive biochemical markers, in more detail. Retinol binding protein (RBP) is synthesized in liver (mainly, parenchymal cells) and catalyzed in kidney. RBP transports retinol, alcohol form of vitamin A, from liver to tissue. Also, RBP and transthyretin (TTR, formerly called pre-albumin) form a macromolecular complex to prevent glomerular filtration of the low molecular weight RBP in the kidney. RBP is a very useful biochemical marker because it has short half-life and immediate response to deficiency or in support of calorie and protein. However, because serum RBP level is greatly affected by the liver and kidney function, understanding of the underlying disease of patients is necessary. Moreover, it is not widely used due to very short half-life and non-generalized measurement methods. Consequently, understanding the characteristics of RBP is necessary and effort should be made to properly utilize the RBP in nutrition support and assessment.

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Serum biomarkers for nutritional status as predictors in COVID-19 patients before and after vaccination
Rita Vaz-Rodrigues, Lorena Mazuecos, Margarita Villar, José Miguel Urra, Christian Gortázar, José de la Fuente
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Achwak Mehrez, Om Kalthoum Sallem, Hela Attia, Karim Masmoudi, Kais Gardabou, Ali Majdoub
Nutrition Clinique et Métabolisme.2023; 37(1): 51. CrossRef
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Jungmin Cho, Hyung Mi Kim, Mina Song, Joon Seong Park, Seung-Min Lee
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