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Original Articles
- 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
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Abstract
PDF - 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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- 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
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Abstract
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- 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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- 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
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Abstract
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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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- 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
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Abstract
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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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Review Articles
- 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
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Abstract
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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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- 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
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Abstract
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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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