Annals of Clinical Nutrition and Metabolism

Vitamin D Deficiency is Prevalent in Short Bowel Syndrome Patients on Long-Term Parenteral Nutrition Support: SungHyo An, Sanghoon Lee, Hyun-Jung Kim, Hyo Jung Park, Jeong-Meen Seo; J Clin Nutr 2021;13(1):12-16. Published online June 30, 2021; DOI: https://doi.org/10.15747/jcn.2021.13.1.12

Abstract PDF ePub: Purpose: Short bowel syndrome (SBS) is the most common etiology for intestinal failure (IF) and these patients are at high risk of developing micronutrient deficiencies. This study aimed at assessing the level of vitamins in adult SBS patients at different stages of their disease before the initiation of multidisciplinary intestinal rehabilitation.
Methods: Patient data from November 2015 to March 2017 were retrospectively reviewed. Adult patients who underwent extensive bowel resection and were classified as SBS-IF were selected. Clinical data including age, sex, etiology of IF, biochemical data, nutritional status, nutrition support, and outcome of intestinal rehabilitation were analyzed.
Results: Nine patients with SBS-IF were included in the analysis. There were 6 male patients and 3 female patients, with a median age of 55.0 years. Vitamin levels were analyzed at 306 days (median) after the development of SBS. At the time of vitamin levels screening, 4 patients were receiving daily intravenous vitamin supplementation. Five patients were not receiving vitamin supplementations, either intravenously or orally. Vitamin B12 was within the normal range in 6 patients and higher than normal in 3 patients. Vitamin D was within the normal range in 3 patients and lower than normal in 6 patients. Vitamin E was within the normal range in 7 patients and higher than normal in 2 patients. Folate was within the normal range in 8 patients (not checked in 1 patient). Ambulatory patients had significantly higher vitamin D levels compared to hospitalized patients (P=0.015).
Conclusion: Vitamin D levels had decreased in 67% of patients with SBS in Korea, while vitamin B12, folate, and vitamin E deficiencies were rarely seen.

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Characteristics and Practice of Parenteral Nutrition in Hospitalized Adult Cancer Patients in Korea: Hyo Jung Park, You Min Sohn, Jee Eun Chung, Jung Tae Kim, Jin A Yang, Hye Jung Bae, Ye Won Sung, Sun Hwa Kim,Ji Yoon Cho, Kyung Mi Jung, Hee Kyung Bae; J Clin Nutr 2020;12(2):34-40. Published online December 31, 2020; DOI: https://doi.org/10.15747/jcn.2020.12.2.34

Abstract PDF ePub: Purpose: There have been no clinical studies on the characteristics of parenteral nutrition (PN) for adult cancer inpatients in South Korea. The published evidence describing modern PN practices in these patients is also extremely limited. Therefore in this retrospective multicenter cross-sectional study, we aimed to investigate the PN support practice in hospitalized adult cancer patients.
Methods: The study included adult cancer patients hospitalized in nine hospitals in South Korea and received PN, during the period from August 1st, 2017 to October 30th, 2017. We evaluated the relevant hospital-based PN practices in this group.
Results: Among the 11,580 inpatient admissions during this period, 759 cancer patients received PN (6.6%). The majority of enrolled patients (97.2%) used commercially available PN and 71.2% of these used peripheral PN formulations. The average in-hospital PN duration was 16.1±19.9 days. Patients received only 65.4±25.4% calories of the recommended target calories. The in-hospital mortality of enrolled patients was 26.1%.
Conclusion: We conclude that commercial PN is the most common form of PN administered to hospitalized adult cancer patients and the overall in-hospital mortality in the patients using PN is higher in South Korea compared to other countries.

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Nutritional Support Team Approach Decreases the In-Hospital Mortality Rate after Deceased Donor Liver Transplantation: Sang-Oh Yun, Jong Man Kim, Sangjin Kim, Jinsoo Rhu, Hyun Jung Kim, Soo Hyun Park, Hyo Jung Park, Eunmi Gil, Wonseok Kang, Gyu-Seong Choi, Won Hyuck Chang, Jeong-Meen Seo, Jae-Won Joh; Surg Metab Nutr 2020;11(1):7-11. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.7

Abstract PDF ePub: Purpose: This study compared the mortality rates between a period of time without employing a nutritional support team (NST) and a period of time with an NST.
Materials and Methods: Forty-six patients underwent adult deceased donor liver transplantation (DDLT) in 2016, and their medical records were prospectively collected. All the donor recipients underwent routine enteral feeding after liver transplantation. An NST cared for twenty-one patients after September 2016. The NST consisted of transplant surgeons, hepatologists, a critical care team, a rehabilitation team, dietitians, pharmacists, and nurses. We defined the patients within the time period without an NST as the control group and those patients within the time period with an NST as the case group.
Results: There were no statistically significant differences in baseline or perioperative characteristics between the two groups. The median model for the end-stage liver disease (MELD) score was 36 (range: 21∼40) for the control group and 36 (range: 23∼40) for the case group (P=0.596). The 30-day mortality rate was 24.0% (6/25) for the control group, but it was 4.8% (1/20) for the case group. The patient survival rates at 1-year and 2-year were 68.0% and 64.0% in the control group and 85.7% and 81.0% in the case group, respectively. However, there were no statistically significant differences of the 30-day mortality rate and 1∼2 year patient survival rate between the two groups.
Conclusion: The present study suggests that an NST should be required to prevent 30-day mortality and increase patient survival of adult DDLT patients with a high MELD score.

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Multidisciplinary Intestinal Rehabilitation for Short Bowel Syndrome in Adults: Results in a Korean Intestinal Rehabilitation Team: Sojeong Yoon, Sanghoon Lee, Hyo Jung Park, Hyun-Jung Kim, Jihye Yoon, Ja-Kyung Min, Jeong-Meen Seo; J Clin Nutr 2018;10(2):45-50. Published online December 31, 2018; DOI: https://doi.org/10.15747/jcn.2018.10.2.45

Abstract PDF ePub

Purpose:

Intense multidisciplinary team effort is required for the intestinal rehabilitation of patients afflicted with the short bowel syndrome (SBS). These include enteral and parenteral nutrition (PN) support, monitoring of complications related to treatment, and considering further medical or surgical options for intestinal adaptation.

Methods:

In the Intestinal Rehabilitation Team (IRT) at the Samsung Medical Center, we have experienced 20 cases of adult SBS requiring multidisciplinary intestinal rehabilitation. This study is a retrospective review of the collected medical records.

Results:

Of the 20 subjects treated, 12 patients were male and 8 patients were female. At the time of referral to the IRT, the mean age was 51.5 years, and the mean body weight was 50.1 kg, which was 90% of the usual body weight. The diseases or operative managements preceding massive bowel resection were malignancy in 11 cases, cardiac surgery in 2 cases, trauma in 2 cases and one case, each of tuberculosis, corrosive esophagitis, atrial fibrillation, simultaneous pancreas and kidney transplantation, and perforated appendicitis. Of these, there were 14 survivals and 6 mortalities. The fatalities were attributed to progression of disease, intestinal failure-associated liver disease, and sepsis (unrelated to intestinal failure) (2 cases each). Among the 14 surviving patients, 8 patients have been weaned off PN, whereas 6 are still dependent on PN (mean PN dependence 36%).

Conclusion:

This paper reports the results of multidisciplinary intestinal rehabilitation of adult short bowel patients treated at the Samsung Medical Center. Further studies are required to improve survival and enteral tolerance of these patients.

Citations

Citations to this article as recorded by

The Post-Discharge Caregiving Experiences of Mothers of Children with Intestinal Failure
Yunhyung Kim, Yeon Hee Kim, Jae Sim Jeong
Journal of Korean Association for Qualitative Research.2024; 9(1): 1. CrossRef
Intestinal Rehabilitation Program for Adult Patients with Intestinal Failure: A 20-Year Analysis of Outcomes in the Single-Center Experience at a Tertiary Hospital
Kyoung Moo Im, Jae Hee Chung
Digestive Diseases and Sciences.2024; 69(5): 1770. CrossRef
Vitamin D Deficiency is Prevalent in Short Bowel Syndrome Patients on Long-Term Parenteral Nutrition Support
SungHyo An, Sanghoon Lee, Hyun-Jung Kim, Hyo Jung Park, Jeong-Meen Seo
Journal of Clinical Nutrition.2021; 13(1): 12. CrossRef
Multidisciplinary Intestinal Rehabilitation in Children: Results from a Korean Intestinal Rehabilitation Team
Cheolgu Lee, Sanghoon Lee, Hyo Jung Park, Hyun-Jung Kim, Ja-Kyung Min, Jeong-Meen Seo
Advances in Pediatric Surgery.2020; 26(2): 61. CrossRef

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Early Experience with Serial Transverse Enteroplasty in a Korean Intestinal Rehabilitation Team: Jiyoon Hong, Sang Oh Yun, Sanghoon Lee, Hyun-Jung Kim, Hyo Jung Park, Jeong-Meen Seo; Surg Metab Nutr 2018;9(1):11-15. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.11

Abstract PDF ePub

Purpose:

For patients with short bowel syndrome, surgery can play an important role in the management of intestinal failure (IF). Serial transverse enteroplasty (STEP) has become a popular choice of bowel lengthening among surgeons for its safety and effectiveness in improving enteral autonomy. In this study, we report 5 cases of STEP procedure on 4 patients.

Materials and Methods:

In the Intestinal Rehabilitation Team at Samsung Medical Center, all patients were managed by a multidisciplinary team specialized in the care of intestinal failure patients. Retrospective review of medical records was performed.

Results:

3 patients were children and 1 patient was an adult. Improvement in enteral autonomy was achieved in all patients following each STEP procedure. Suspected suture line leakage was seen in one patient, which was successfully managed by conservative treatment There were no other serious complications related to the procedures.

Conclusion:

STEP procedure continues to be an important management option in intestinal rehabilitation of patients with extreme short bowel. We report a small series of STEP performed safely and effectively in Korea.

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Early Bowel Lengthening Procedures: Bi-Institutional Experience and Review of the Literature
Elisa Negri, Riccardo Coletta, Lynette Forsythe, Francesca Gigola, Maria Chiara Cianci, Antonino Morabito
Children.2022; 9(2): 221. CrossRef

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Evaluation on the Time to Start Parenteral Nutrition in Hospitalized Cancer Patients: Nam Hyo Kim, Hyo Jung Park, Yong Won In, Young Mee Lee; J Clin Nutr 2017;9(1):30-35. Published online June 30, 2017; DOI: https://doi.org/10.15747/jcn.2017.9.1.30

Abstract PDF ePub: Purpose:
Malnutrition is quite prevalent in hospitalized cancer patients, with a 40%∼80% rate. Malnutrition in cancer patients can result in an increase in the number of complications, length of stay, mortality, and morbidity. Therefore, cancer patients with malnutrition must have the appropriate nutritional support to improve the prognosis of cancer. This study evaluated the appropriate time point to start parenteral nutrition (PN) after admission according to the nutrition support guidance in Samsung Medical Center.
Methods:
This study enrolled patients diagnosed with the Korean standard classification of disease 6 (KCD6) code C00-C97 and discharged from March 1st to 31st, 2016. The following data were collected: patients’ age, gender, diagnosis, length of stay, body mass index, nutritional status, and whether to consult nutrition support team (NST).
Results:
Among a total of 2,944 patients, 381 patients (12.9%) were in a malnourished status upon admission. In the malnourished patients, 139 patients were prescribed PN for a median of 6 days (range, 1∼49) and moderate to severe malnourished patients were started on PN within 2 days after admission. The proportion of patients with a poor nutritional status was lower in the NST group than in the non-NST group (50.0% vs. 66.7%) on the 28th day after admission. Among the nourished patients, 229 patients were prescribed PN. Of them, 183 patients (79.9%) were started on PN within 7 days after admission.
Conclusion:
In moderate to severe malnourished cancer patients, the initiation of PN on the day after admission is appropriate.

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Nutrition Therapy for Adult Intestinal Failure Patients: Hyo Jung Park; J Clin Nutr 2016;8(3):72-76. Published online December 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.3.72

Abstract PDF ePub: Intestinal failure (IF) is a condition, in which the intestinal function or length remaining is below the minimum amount required for the absorption of sufficient nutrients and fluid to maintain normal life. The nutritional supply of IF depends on the anatomical site, length, and function of the remaining bowel. The goals of nutritional therapy for patients with IF are to achieve bowel adaptation to absorb nutrients sufficiently to live a healthy life with the current intestinal condition, and to promote the enteral autonomy to control nutrient digestion, absorption, excretion, and bowel movement. To stabilize and recover the patient’s nutrition condition after a huge bowel resection, the intestinal rehabilitation team (IRT) for individual nutritional therapy should be established. IRT carefully monitors the changes in body weight, medication use, patient’s symptoms, nutrient deficiency, hydration status, function of the remaining bowel, degree of bowel adaptation, adverse effects due to nutritional therapy, and enteral balance. To achieve intestinal adaptation and enteral autonomy through complicated and difficult nutritional intensive therapy in IF patients, it is essential to manage the patients through multidisciplinary collaboration involving physicians, pharmacists, dietitians, and nurses.

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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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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

Abstract PDF ePub: 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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Intestinal Rehabilitation after Extensive Bowel Resection in Post-Gastrectomy Patients: Seung Rim Han, Sanghoon Lee, Chae-Youn Oh, Hyun-Jung Kim, Hyo Jung Park, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Jeong-Meen Seo; Surg Metab Nutr 2015;6(2):33-37. Published online December 30, 2015; DOI: https://doi.org/10.18858/smn.2015.6.2.33

Abstract PDF ePub: Purpose:
Surgical complications requiring massive bowel resection after gastrectomy are rare. However, when such an event occurs the patient may develop short bowel syndrome and intestinal failure. We report our experience of intestinal rehabilitation in four post-gastrectomy patients.
Materials and Methods:
From January 2011 to June 2014, four cases of short bowel syndrome were identified in post-gastrectomy patients. All patients were managed by a multidisciplinary team specialized in the care of intestinal failure patients. Patients’ medical records were reviewed retrospectively.
Results:
The original diagnosis was early gastric cancer in all patients. One patient had synchronous esophageal cancer. Patients required extensive bowel resection due to bowel strangulation from internal herniation (3 cases), superior mesenteric artery torsion (1 case). Remnant small bowel length ranged from 10 cm to 80 cm and partial resection of the colon was performed in three cases. One patient received serial transverse enteroplasty (STEP) and one patient is receiving continuous enteral feeding via surgical gastrostomy. There were no cases of intestinal failure-associated liver disease. Two patients are receiving home parenteral nutrition in varying degrees. Two patients have been weaned off parenteral nutrition.
Conclusion:
Four post-gastrectomy patients with short bowel syndrome were managed. Despite application of various medical and surgical measures, weaning off parenteral nutrition was difficult in these patients.

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Role of Parenteral Glutamine in Nutrition Support for Critically Ill Patients: Hyo Jung Park; J Clin Nutr 2015;7(2):42-48. Published online August 31, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.2.42

Abstract PDF ePub

Glutamine is the most abundant amino acid, composed of more than 50 percent of free amino acid in the human body. It had been regarded as a conditional essential amino acid and its concentration is markedly reduced in critically ill patients with trauma, burn, or sepsis. From the early 1990s, many parenteral glutamine studies on critical illness have reported the benefits in mortality, infection, and length of stay. However, its clinical efficacy was based on out-of-date, smaller, single-center studies. Clinical effects of parenteral glutamine have shown no benefits or even harms in recent clinical trials and meta-analysis. Furthermore, it has challenged the hypothesis that low plasma glutamine concentration was associated with poor outcomes in critically ill patients. Although many studies showing the efficacy of glutamine have been reported, parenteral glutamine supplementation may be harmful in patients with multiorgan failure or baseline kidney dysfunction. Further studies should be conducted to identify the use of glutamine supplementation in combination with parenteral and enteral nutrition or enteral/oral nutrition alone, specific adult or pediatric patients, the appropriate time and doses for administration of glutamine, cost-benefit analysis, and the exact mechanisms of action.

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Efficacy of parenteral glutamine supplementation in adult hematopoietic stem cell transplantation patients
Yun Kyung Cho, So Yeon Hong, Su Jeoung Jeon, Hyung Wook Namgung, Eunsook Lee, Euni Lee, Soo-Mee Bang
BLOOD RESEARCH.2019; 54(1): 23. CrossRef