Annals of Clinical Nutrition and Metabolism

A practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Part III. preparation of enteral nutrition formulas: In Seok Lee, Ye Rim Chang, Bo-Eun Kim, Youn Soo Cho, Sung-Sik Han, Eunjung Kim, Hyunjung Kim, Jae Hak Kim, Jeong Wook Kim, Sung Shin Kim, Eunhee Kong, Ja Kyung Min, Chi-Min Park, Jeongyun Park, Seungwan Ryu, Kyung Won Seo, Jung Mi Song, Minji Seok, Eun-Mi Seol, Jinhee Yoon, Jeong-Meen Seo, for the KSPEN Enteral Nutrition Committee; Ann Clin Nutr Metab 2026;18(1):3-9. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.26.0046

Abstract PDF: Purpose
This guideline was developed to provide evidence-based recommendations for the safe preparation and handling of enteral nutrition (EN) formulas in order to improve patient safety and promote standardized clinical practice in Korea.
Methods
The key questions addressed the selection of open versus closed feeding systems, the safe preparation and handling of EN formulas, precautions related to blenderized tube feeding (BTF), and essential labeling requirements. Recommendations were drafted and refined through multidisciplinary expert consensus under the auspices of the Korean Society for Parenteral and Enteral Nutrition (KSPEN).
Results
The choice of feeding system should be determined according to the patient’s condition, risk of infection, and anticipated duration of feeding. Closed feeding systems are recommended because they reduce contamination risk and nursing workload, whereas open feeding systems require strict adherence to aseptic technique. For open or reconstituted EN formulas, hang time at room temperature should not exceed 4 hours, whereas closed feeding systems should follow the manufacturer’s recommended hang time. For BTF, administration time should be limited to 2 hours to minimize bacterial growth, and their use is contraindicated in medically unstable or immunocompromised patients. Accurate labeling, including patient identifiers, formula information, administration route, and hang time, is essential to prevent administration errors.
Conclusion
These guidelines provide a practical framework for the safe preparation and management of EN formulas. Adherence to standardized preparation protocols, including appropriate feeding system selection and strict hygiene practices, is essential for reducing complications and improving the safety of EN therapy.

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A practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Part II. selection and initiation of enteral feeding routes: Ja Kyung Min, Ye Rim Chang, Bo-Eun Kim, In Seok Lee, Jung Mi Song, Hyunjung Kim, Jae Hak Kim, Kyung Won Seo, Sung Shin Kim, Chi-Min Park, Jeongyun Park, Eunjung Kim, Eunmi Sul, Sung-Sik Han, Jeong Wook Kim, Seungwan Ryu, Minji Seok, Jinhee Yoon, Eunhee Kong, Youn Soo Cho, Jeong Meen Seo, for KSPEN Enteral Nutrition Committee; Ann Clin Nutr Metab 2025;17(3):165-171. Published online December 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0037

Abstract PDF: Purpose
We developed evidence-based recommendations for selecting and initiating the enteral nutrition (EN) delivery route in adult and pediatric patients to improve safety and standardize practice in Korea.
Methods
Key questions covered feeding tube selection, methods to verify tube placement, confirmation in pediatric patients, and timing of EN following percutaneous endoscopic gastrostomy (PEG). Recommendations were drafted and refined through multidisciplinary expert consensus under the Korean Society for Parenteral and Enteral Nutrition (KSPEN).
Results
Feeding tube selection should be based on gastrointestinal anatomy, function, and expected EN duration. Short-term feeding is recommended with nasogastric or orogastric tubes, whereas long-term feeding should use percutaneous or surgical routes such as PEG. Tube position must always be verified before use, preferably with radiography or pH testing; auscultation alone is unreliable and should not be used. In pediatric patients, radiographic confirmation remains the gold standard, although pH testing and insertion-length assessment may be considered when imaging is not feasible. After PEG, EN can be initiated safely within 4 hours in both adults and children without increasing complications if trained staff monitor for leakage or infection.
Conclusion
This guideline offers a structured framework for safe and timely EN tailored to patient characteristics. Early verification and multidisciplinary collaboration help reduce complication, improving outcomes of EN therapy.

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Strengthening collaboration: introducing the contributions of Japanese Society for Surgical Metabolism and Nutrition to Annals of Clinical Nutrition and Metabolism: Ye Rim Chang; Ann Clin Nutr Metab 2025;17(2):95-96. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0022

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A practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Part I. prescribing enteral nutrition orders: Ye Rim Chang, Bo-Eun Kim, In Seok Lee, Youn Soo Cho, Sung-Sik Han, Eunjung Kim, Hyunjung Kim, Jae Hak Kim, Jeong Wook Kim, Sung Shin Kim, Eunhee Kong, Ja Kyung Min, Chi-Min Park, Jeongyun Park, Seungwan Ryu, Kyung Won Seo, Jung Mi Song, Minji Seok, Eun-Mi Seol, Jinhee Yoon, Jeong Meen Seo, for KSPEN Enteral Nutrition Committee; Ann Clin Nutr Metab 2025;17(1):3-8. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0002

Abstract PDF

Purpose
This study aimed to develop a comprehensive practical guide for enteral nutrition (EN) designed to enhance patient safety and reduce complications in Korea. Under the leadership of the Korean Society for Parenteral and Enteral Nutrition (KSPEN), the initiative sought to standardize EN procedures, improve decision-making, and promote effective multidisciplinary communication.
Methods
The KSPEN EN committee identified key questions related to EN practices and organized them into seven sections such as prescribing, delivery route selection, formula preparation, administration, and quality management. Twenty-one experts, selected based on their expertise, conducted a thorough literature review to formulate evidence-based recommendations. Drafts underwent peer review both within and across disciplines, with final revisions completed by the KSPEN Guideline Committee. The guide, which will be published in three installments, addresses critical elements of EN therapy and safety protocols.
Results
The practical guide recommends that EN orders include detailed elements and advocates the use of electronic medical records for communication. Standardized prescription forms and supplementary safety measures are outlined. Review frequency is adjusted according to patient condition—daily for critically ill or unstable patients and as dictated by institutional protocols for stable patients. Evidence indicates that adherence to these protocols reduces mortality, complications, and prescription errors.
Conclusion
The KSPEN practical guide offers a robust framework for the safe delivery of EN tailored to Korea’s healthcare context. It emphasizes standardized protocols and interdisciplinary collaboration to improve nutritional outcomes, patient safety, and operational efficiency. Rigorous implementation and monitoring of adherence are critical for its success.

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Bridging evidence and clinical practice: a practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition
Suk-Kyung Hong
Ann Clin Nutr Metab.2025; 17(1): 1. CrossRef

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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: 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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Status of Nutritional Support after Emergency Gastrointestinal Surgery in Korea: Retrospective Multicenter Study: Dae Sang Lee, Young Eun Park, Kyoung Hoon Lim, Ye Rim Chang, Suk-Kyung Hong, Minchang Kang, Jung-Min Bae, Ji Young Jang, Young Goun Jo, Ki Hoon Kim, Gil Jae Lee; Surg Metab Nutr 2020;11(1):1-6. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.1

Abstract PDF: Purpose: Surgery itself causes an inflammatory response to an injury to the patient that leads to a stress metabolic state. Emergency gastrointestinal surgery may cause complications, such as ileus, bowel obstruction, ischemia, or anastomotic leakage, resulting in a delayed oral diet or poor overall nutrition. This study investigated the route of nutrition for patients who underwent emergency gastrointestinal surgery and when to provide nutrition after surgery.
Materials and Methods: Ten hospitals collected data retrospectively on the nutritional status and nutritional status of patients undergoing emergency gastrointestinal surgery for one year from January to December 2016. The clinical outcomes of the nutrient supply method, duration of supply, and type of surgery were performed. The dates from the time of surgery to the start of enteral nutrition, oral nutrition, and parenteral nutrition were calculated.
Results: Of 706 patients, there were 187 (26.5%) trauma patients, of which 63.5% were male. The onset of nutrition began after an average of 10.7 days postoperatively and after an average of 12.1 days of enteral nutrition. On average, it took 7.7 days to provide adequate calories, of which 63.3% had achieved adequate calories within a week. In the case of minimally invasive surgery, such as laparoscopic surgery, the adequate calorie supply time was five days, which was reached within one week.
Conclusion: In a retrospective multicenter analysis, the patients who underwent emergency gastrointestinal surgery had a late start of oral or enteral nutrition, and the ratio of adequate calorie supply within a week was low.

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Esophageal Obstruction Caused by the Solidification of Residue of an Enteral Feeding Formula: Hancheol Jo, Ye Rim Chang, So Mi Kim, Dong Wook Kim, Ye Seob Jee; J Clin Nutr 2018;10(1):25-30. Published online June 30, 2018; DOI: https://doi.org/10.15747/jcn.2018.10.1.25

Abstract PDF

The nutritional support of acutely ill patients is very important and early enteral nutrition is recommended. Feeding via the nasogastric route is used widely for its ease of access if the patient cannot maintain volitional food intake. If the position of the tip or side holes of the nasogastric tube (NGT) is above the gastroesophageal junction, there is the possibility of retention and solidification of the administered enteral feeding formula in the esophagus. Therefore, the tip of the NGT should be checked carefully; a chest radiograph to confirm its position can be considered, especially in patients with a higher risk of aspiration and gastroesophageal reflux. In addition, careful consideration of the risk factors that can trigger esophageal obstruction is required when feeding patients in the intensive care unit. This paper describes two unusual cases of esophageal obstruction caused by the solidification of residue of an enteral feeding formula.

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Body Composition and Physical Performance Measures of a Special Operations Police Unit: Characteristics and Associations Between Determinant Factors of Physical Performance
Braian Fink, Tomás T. Freitas, Santiago Zabaloy
Journal of Science in Sport and Exercise.2024; 6(1): 61. CrossRef

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