Annals of Clinical Nutrition and Metabolism

Original Article

Body composition assessment using bioelectrical impedance analysis and computed tomography in patients who underwent pancreatoduodenectomy in Korea: a before and after study: Juwan Kim, Seung-seob Kim, Ho Kyoung Hwang, Chang Moo Kang, Kyung Sik Kim, Sung Hyun Kim; Ann Clin Nutr Metab 2023;15(3):72-80. Published online December 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.3.72

Abstract PDF Supplementary Material: Purpose: This study focuses on the need for standardized body composition measurements in the hepatobiliary-pancreatic field. It evaluates and compares the effectiveness of bioelectrical impedance analysis (BIA) and computed tomography (CT) scans in assessing body composition of patients undergoing pancreatoduodenectomy (PD), aiming to establish correlations among different body composition indexes.
Methods: Ninety-seven patients who underwent PD between August 2022 and March 2023, were enrolled in this study. Muscular and fatty parameters related to BIA and CT were assessed both preoperatively and on postoperative day 6. The correlation between each parameter related to muscle fat was analyzed according to the measurement modalities.
Results: There was an increase of skeletal muscle area (SMA), total muscle area, and low attenuated muscle area after surgery. Skeletal muscle mass (SMM) measured using BIA exhibited a strong correlation with the SMA and normal attenuated muscle area (NAMA) measured using CT (r=0.86, P<0.001; r=0.76, P<0.001). The trunk muscle measured using BIA demonstrated moderate to strong correlations with SMA and NAMA measured using CT (r=0.84 P<0.001; r=0.73, P<0.001). Body fat measured using BIA and total fat area (TFA) measured using CT showed strong correlations (r=0.74, P<0.001). In the postoperative analysis, a similar trend was observed (SMM vs. SMA: r=0.80, P<0.001; SMM vs. NAMA: r=0.70, P<0.001), (trunk muscle vs. SMA: r=0.79, P<0.001; trunk muscle vs. NAMA: r=0.69, P<0.001), and (body fat vs. TFA: r=0.83, P<0.001).
Conclusion: BIA, akin to CT, serves as a valuable tool for assessing body composition ratios in patients undergoing PD.

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Review Article

Enteral Nutrition in Liver Disease: Kyung Sik Kim; Surg Metab Nutr 2017;8(2):28-35. Published online December 30, 2017; DOI: https://doi.org/10.18858/smn.2017.8.2.28

Abstract PDF: Patients with chronic liver disease have a high risk to malnutrition. Proper nutrition should be provided through a proper nutritional assessment. Enteral nutrition is recommended as a nutritional supplement because it maintains the intestinal mucosa, reduces infectious complications, is less costly than parenteral nutrition, and is more physiological to use intestine. The purpose of this review is to define the nutritional deficiencies of patients with liver disease and to show the indications for enteral nutrition and to validate the efficacy of enteral nutrition. According to the various guidelines and researches, enteral nutrition is used as a solution to the nutritional problems caused by patients with liver disease. The optimal enteral formula will be selected on the nutritional problems. It is expected that the enteral nutrition will reduce especially postoperative complications, intraperitoneal complications, pneumonia, and wound infection. The enteral nutrition for patients with chronic liver disease should be actively implemented.

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Original Articles

Sequential Changes in Body Composition Using Bioelectrical Analysis during the Metabolic Response in Critically Ill Surgical Patients: Seok Rae Park, Seung Hwan Lee, Kyung Sik Kim, Hosun Lee, Tae Hwa Hong, Jae Gil Lee; Surg Metab Nutr 2017;8(1):13-16. Published online June 30, 2017; DOI: https://doi.org/10.18858/smn.2017.8.1.13

Abstract PDF: Purpose:

Assessment of sequential changes in body composition during the metabolic response in critically ill surgical patients is essential for optimal nutritional support and management. Bioelectrical impedance analysis (BIA) is an easy, portable, and quick way to assess body composition. Thus, the aim of this study was to evaluate the sequential changes in body composition and the validity of Direct segmental Multi-frequency BIA in critically ill surgical patients.

Materials and Methods:

Twenty-three patients admitted to the intensive care unit (ICU) after major surgery were measured for body composition by multiple-frequency BIA after intensive care unit admission as well as 3 and 7 days later. Repeated-measures analysis of variance (ANOVA) was used to detect significant changes over time.

Results:

The average length of intensive care unit stay was 4.3 days. Total body water, extracellular water, skeletal muscle mass (SMM), soft lean mass, and fat-free mass (FFM) increased during the first 72 h of intensive care unit admission, after which they decreased slightly. On the other hand, fat mass decreased during the first 72 h of intensive care and then increased. However, arm circumference (AC), arm muscle circumference (AMC), and waist circumference (WC) gradually decreased by day 7 (P<0.001).

Conclusion:

In this study, AC, AMC, WC, and direct segmental Multi-frequency BIA were less affected by initial resuscitation in the intensive care unit (ICU). Therefore, segmental BIA may be useful for critical ill patients in altered hydration states.

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Effects of Nutrition Consultation on Nutritional Status in Critically Ill Surgical Patients: Hee Sook Hwang, Seung Hwan Lee, Hosun Lee, Kyung Sik Kim, Seo Jin Chung, Jae Gil Lee; J Clin Nutr 2015;7(1):28-34. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.28

Abstract PDF: Purpose:
The aim of this study was to investigate nutritional support status and effects of nutrition consultation in critically ill surgical patients.
Methods:
The medical records of 76 patients, admitted between June 1 and November 30, 2013, were reviewed retrospectively. Patients were divided into 2 groups: the nutrition consultation group (n=17) and the no consultation group (n=59). Patients were also divided into 3 groups: the enteral nutrition (EN) group (n=8), the parenteral nutrition (PN) group (n=25), and the enteral and parenteral mixed nutrition (ENPN) group. Total delivered/required caloric ratio and serum albumin, serum total protein, hemoglobin and other biochemical variables were compared in each group.
Results:
Mean daily required and delivered caloric/protein amount were EN group 60.0%, PN group 64.6%, and ENPN group 86.9%. ENPN group showed statistically significant difference when compared with EN group, PN group (P=0.005). When the proportion of patients who were fed more than 75% of the daily required calories was calculated, EN, PN, and ENPN showed 37.5%, 25.0% and 81.8%, respectively. ENPN group were significantly more supplied (P=0.007). Although neither the nutrition consultation group nor the non-consultation group received more than 80% of the daily required calories, the nutrition consultation group received 73% of the daily required calories whereas the no consultation group only received 46% (P=0.007). The total delivered/required protein ratio was approximately 69% of the nutrition consultation group and approximately 42% of the no consultation group (P=0.006).
Conclusion:
The results of providing nutritional consultation to intensive care unit patients showed an increase in the nutrition support. Nutrition education, continuous monitoring and management for nutritional support by systemic administration of a nutritional support team should be considered in order to achieve effective clinical outcomes in critically ill surgical patients.

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The Current Status of Enteral Feeding Management in General Surgical Ward: Yun Jung Kim, Young Mee Baek, So Yun Kim, Mi Reu Moon, Kyung Hee Park, So Hee Paeck, Moon Young Seo, Sook Young Oh, Eun Ji Lee, Hyun Bin Lim, Ji Ye Hwang, In Sun Chung, Jae Kil Lee, Kyung Sik Kim, Chong Bai Kim; J Clin Nutr 2015;7(1):23-27. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.23

Abstract PDF: Purpose:
Development of a standardized guideline and assessment tool is necessary. Therefore, the aim is to investigate the current state of enteral feeding management and to develop a basis for a standardized guideline.
Methods:
From July 1, 2010 through June 30, 2011, this study was conducted retrospectively for 100 patients who had enteral feeding more than once only in the Intensive Care Unit, after General Surgery at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. The analysis was based on the following factors; age, diagnosis, name of the operation, period of start and the end of enteral feeding, method of injection, flushing method, residual volumes of the stomach, location and the size of the tube, medication through tubing, and complications related to enteral feeding.
Results:
The mean age of the patients was 60.5, 65 men and 35 women. There were 30 malignant tumors of the hepatobiliary system and pancreas, 8 gastric and duodenal cancer, 4 colon and rectal cancer, 11 peritonitis, hemoperitoneum, and bowel obstruction, and 47 others. The average period of performing enteral feeding was 11.7 days and the locations of enteral feeding tube were stomach 56%, jejunum 39%, duodenum 3%, and undescribed 2%. The methods of enteral feeding were as follows; continuous feeding 19%, cyclic feeding 75%, intermittent and bolus feeding 3%, respectively. Only 1% of patients were on flushing and 16% on stomach residual. The most common complication of enteral feeding was clogging of the tube (5%).
Conclusion:
Due to the lack of detailed charting related to enteral feeding, we were unable to analyze the statistics on the relevance of complication which was the primary endpoint. As a result, development of a standardized protocol on charting enteral feeding is suggested for optimal enteral nutritional support.

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