Annals of Clinical Nutrition and Metabolism

Micronutrient deficiencies in copper, zinc, and vitamin D as predictors of clinical outcomes in critically ill surgical patients in Korea: a retrospective cohort study: Jiae Kim, Yanghee Jun, Ye Rim Chang, Jong-Kwan Baek, Hak-Jae Lee, Hyewon Han, Suk-Kyung Hong; Ann Clin Nutr Metab 2024;16(3):158-167. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.158

Abstract PDF ePub: Purpose: To investigate the prevalence of copper, zinc, and vitamin D deficiencies in surgical intensive care unit (SICU) patients and the associations between those deficiencies and clinical outcomes.
Methods: We conducted a retrospective study of 210 patients admitted to the SICU of Asan Medical Center between June 2020 and June 2022. Micronutrient levels were measured within 7 days of SICU admission. Primary outcomes were the mortality rate, length of SICU stay, hospital stay duration, and mechanical ventilation duration.
Results: Copper deficiency was found in 35% (68/193), zinc deficiency in 52% (100/193), and severe vitamin D deficiency in 46% (82/179) of patients. Copper-deficient patients showed a significantly higher mortality rate (25.0% vs. 12.8%, P=0.044), longer hospital stays (57.8±47.0 vs. 45.2±36.6 days, P=0.041), and extended mechanical ventilation duration (26.9±23.3 vs. 18.8±15.7 days, P=0.012). Zinc deficiency was associated with higher C-reactive protein levels (16.2±9.5 vs. 11.5±8.8 mg/dL, P=0.001) and lower prealbumin levels (6.5±2.8 vs. 9.9±5.6 mg/dL, P<0.001). Severe vitamin D deficiency (<10 ng/mL) was not significantly associated with mortality or other clinical outcomes (mortality: <10 ng/mL vs. ≥10 ng/mL, 13% vs. 18%, P=0.583).
Conclusion: Micronutrient deficiencies are prevalent in SICU patients. Copper deficiency significantly correlated with poor clinical outcomes, and zinc deficiency showed a strong association with inflammatory markers. Early assessment and supplementation of micronutrients could be beneficial for critically ill surgical patients.

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Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study: Hyun Suk Kim, Jae Do Yang, Se Wung Han, Mi Rin Lee, Da-Sol Kim, Sejin Lee, Seon-Hyeong Kim, Chan-Young Kim; Ann Clin Nutr Metab 2024;16(2):57-65. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.57

Abstract PDF Supplementary Material ePub: Purpose: Early nutritional support (ENS) for critically ill patients is promoted by many studies. However, there is a lack of data evaluating its necessity in general wards. This study aims to determine the impact of ENS on patients in general wards.
Methods: Patients aged 18 and above, admitted to the Jeonbuk National University Hospital in Jeonju from January 2020 to December 2020, who were eligible for nutritional support and hospitalized for at least 7 days were included in the study. We divided the patients into two groups: the ENS group, who received nutritional support within 48 hours of admission, and the control group, who received it after 48 hours.
Results: Among 1,077 patients, 146 met the inclusion criteria. The ENS group (n=38) and the control group (n=108) were compared retrospectively. There was a significant age difference between the two groups (P=0.028). The admission ratio to the intensive care unit (ICU) in the ENS group was significantly lower than that in the control group (10.2% vs. 26.3%, P=0.019). The calorie support rate (%) and protein support rate (%) in the ENS group were significantly higher than in the control group (50.12%±23.30% vs. 38.56%±18.02%, P=0.006; 44.61%±25.07% vs. 32.07%±22.76%, P=0.002, respectively). After propensity score matching, the ENS was significantly associated with ICU low admissions (odds ratio 0.08, 95% confidence interval 0.01–0.69, P=0.022).
Conclusion: A future multi-center study considering underlying diseases is needed to provide additional scientific evidence to support the effects of ENS.

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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

Abstract PDF ePub

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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Comparison of a volume-based feeding protocol with standard feeding for trauma patients in intensive care units in Korea: a retrospective cohort study: Juhong Park, Yesung Oh, Songhee Kwon, Ji-hyun Lee, Mihyang Kim, Kyungjin Hwang, Donghwan Choi, Junsik Kwon; Ann Clin Nutr Metab 2023;15(1):22-29. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.22

Abstract PDF ePub

Purpose: Although early enteral nutrition for critically ill patients is essential, it is difficult to provide enteral nutrition to trauma patients in early hospitalization stages due to frequent surgeries and examinations. We aimed to identify the effect of achieving early enteral nutrition goals and improving outcomes through a volume-based feeding (VBF) protocol for trauma patients.
Methods: Patients who were admitted to the trauma intensive care units (TICUs) of the Ajou University Hospital from January 2020 to September 2021 and received enteral tube feeding for at least 7 days were studied. An institution-specific VBF protocol was developed, and nurses were trained in its execution. We retrospectively compared outcomes, such as in-hospital mortality and initial nutritional goal achievement, between the new and standard protocols.
Results: Among 2,935 patients, 109 met the inclusion criteria. Of these, 64 patients received nutrition through VBF, with no feeding intolerance symptoms. The VBF group started enteral nutrition approximately 16.9 hours earlier and group achieved 80% of the target calorie and protein intake approximately one day faster than the control group (n=45). The average calorie supply per body weight per day was 4.9 kcal/kg/day more in the VBF group. An increase of 0.2 g/kg/day was also observed in protein uptake. However, mortality and adverse hospital events did not differ between the groups.
Conclusion: The VBF protocol for patients admitted to the TICU increased the initial nutrient supply without risk of feeding intolerance, but there was no improvement in major clinical outcomes, including mortality and adverse hospital events.

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Early initiation of gastric tube feeding: ultrasound assessment. A prospective interventional study
Islam M. Elbardan, Ahmed A. Alla Ossman, Nada El Kayal, Assem A. ElRazek Abd-Rabih
Research and Opinion in Anesthesia & Intensive Care.2024; 11(4): 270. CrossRef

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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 ePub: 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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Evaluation of the Clinical Effect of Intravenous Glutamine on Intensive Care Unit Patients: Kwang Joon Kim, Hey Young Jang, Min Ku Kang; J Clin Nutr 2019;11(1):23-28. Published online June 30, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.1.23

Abstract PDF ePub: Purpose:
To evaluate the clinical effect of intravenous glutamine administration on patients admitted to the intensive care unit in general hospitals.
Methods:
Patients with more than 7 days in an intensive care unit were evaluated. The experimental group was the patients who received intravenous glutamine administration for more than 3 days. The laboratory results, intensive care unit length of stay, hospital length of stay, 30 days mortality, and hospital mortality were evaluated with a comparative group.
Results:
The mean number of administration days of intravenous glutamine was 10.12±8.93 days, and the average daily dose was 0.33±0.10 g/kg/day. No adequate improvement in the laboratory results of glutamine-treated group was observed. The intensive care unit length of stay (21.16±15.83 vs. 16.48±11.06, P=0.007), hospital length of stay (35.94±30.75 vs. 27.34±19.09, P=0.010), 30 days mortality (20.0% vs. 10.0%, P=0.034), and hospital mortality (26.3% vs. 13.0%, P=0.001) were higher in the glutamine-treated group.
Conclusion:
The use of intravenous glutamine on intensive care unit patients did not improve the clinical effect. Further large-scale multi-center studies will be needed to assess the proper administration of intravenous glutamine on intensive care unit 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

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