• Journal of Clinical Nutrition
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• v.10 no.2
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• pp.38-44
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• 2018

Purpose: Parenteral nutrition (PN) is known to provide therapeutic beneficial improvements in malnourished patients for whom enteral nutrition is not feasible. The objective of this study was to investigate the current clinical characteristics and utilization of PN in Korea. Methods: We analyzed the Health Insurance Review Agency National Inpatients Sample database from 2014 to 2016, which included 13% of all hospitalized patients in Korea. Adult patients aged 20 years or older and receiving premixed multi-chamber bag containing PN were included for this study. Patient characteristics, admission type, primary diagnosis, and hospital demographics were evaluated. SAS version 9.4 was used for data analysis. Results: From 2014 to 2016, 149,504 patients received premixed PN, with 226,281 PN prescriptions being written. The mean patient age was 65.0 years, and 81,876 patients (54.8%) were male. Premixed 3-chamber bag and 2-chamber bag PN solutions were utilized in 131,808 (88.2%) and 32,033 (21.4%) patients, respectively. The number of patients hospitalized through the emergency department were 70,693 (47.3%), whereas 43,125 patients (28.8%) were administered PN in intensive care units. In the adult PN patients, the highest primary diagnosis was malignant neoplasm of the stomach (8,911, 6.0%), followed by organism unspecified pneumonia (7,008, 4.7%), and gastroenteritis and colitis of unspecified origin (6,381, 4.3%). Overall, 34% of adult PN patients were diagnosed with malignancies, the most common being neoplasm of the stomach (17.7%), neoplasm of bronchus/lung (11.2%), neoplasm of colon (11.1%), and neoplasm of liver/intrahepatic bile ducts (10.0%). PN solutions were most frequently administered in the metropolitan area (55.0%) and in hospitals with more than 1,000 beds (23.6%). Conclusion: PN was commonly administered in older patients, with primary diagnosis of malignancy in a significant number of cases. This study is the first large-scale description of PN-prescribing patterns in real-world clinical practice in South Korea.

• Quality Improvement in Health Care
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• v.17 no.1
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• pp.79-88
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• 2011

Background : Evidence-based guidelines are now used for enteral nutrition(EN) in neurosurgical intensive care unit patients who mostly depend on EN. This study compared and analyzed the nutritive conditions of patients before and after they underwent guideline based nutritional interventions in order to determine whether using these guidelines improved their calorie supply. Methods : Data on the patients' nutritional requirements, maximum calorie supply through EN, serum albumin level, and total lymphocyte count were collected and analyzed using SAS version 9.1.3. All the statistical analyses were performed at a significance level of P<0.05. Result : The maximum calorie supply through EN was $923.1{\pm}359.7$ kcal before the intervention and $1254.4{\pm}196.3$ kcal after the intervention; this difference was statistically significant(P<0.05). The ratio of nutritional requirements to maximum calorie supply through EN was $55.5{\pm}22.4%$ and $74.2{\pm}13.9%$ before and after the intervention, respectively; this difference was statistically significant(P<0.05). This indicates a 19% increase in the ratio after the nutritional intervention. The serum albumin level also significantly increased from $2.7{\pm}0.6g/dL$ before the intervention to $3.2{\pm}0.4g/dL$ after the intervention(P<0.05). The total lymphocyte count slightly increased from $1267.7{\pm}728.2cells/mm^3$ before the intervention to $1801.9{\pm}1211.5cells/mm^3$ after the intervention; this difference was not statistically significant. Conclusion : The results showed that using the evidence-based feeding guidelines for interventions increased the calorie supply and improved the patients' nutritive conditions from moderate malnutrition to mild malnutrition.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup1
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• pp.111-116
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• 2008

Immunonutrition is the provision of specific nutrients that modulate the activity of the immune system. Several nutrients including arginine, glutamine, nucleotides, omega-3 fatty acids, vitamins, minerals, and prebiotics can be provided to enhance immunity in critically ill patients. Supplying immunonutrition to critically-ill children, better prognosis and shortening of the hospital stay are expected from its immuno-modulating effects. Therefore, immune-enhancing enteral and parenteral formulas can be recommended in children with severe illness.

• Preventive Nutrition and Food Science
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• v.8 no.1
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• pp.1-6
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• 2003

Catechins exhibit a hypocholesterolemic effect in cholesterol-fed animals. The present study was conducted to examine whether (+)-catechin influences the absorption of cholesterol in rats. Male Sprague-Dawley rats were fed ad libitum an AIN-93G diet containing soybean oil for 5 wk. Rats with lymph cannulae were infused at 3.0 mL/h for 8 h via a duodenal catheter with a lipid emulsion containing radiolabeled cholesterol with or without (+)-catechin. Lymph was collected hourly for 8 h. The enteral infusion of (+)-catechin significantly lowered the lymphatic absorption of $^{14}$ C-cholesterol (21.1 $\pm$ 3.6% dose/B h) compared with controls infused with the lipid emulsion devoid of (+)-catechin (38.2 $\pm$ 1.2% dose/8 h). The intestinal absorption of $\alpha$-tocopherol (24.2$\pm$3.0% dose/8 h) also was significantly decreased by (+)-catechin infusion, relative to controls (32.2$\pm$2.2% dose/8 h). However, the lymphatic outputs of oleic acid and phospholipid were not affected by enteral (+)-catechin infusion. The results indicate that (+)-catechin has a profound inhibitory effect on the intestinal absorption of cholesterol and $\alpha$-tocopherol without affecting the absorption of fat.

• Korean Journal of Clinical Pharmacy
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• v.23 no.2
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• pp.167-174
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• 2013

Objective: The study evaluated the impact of pharmacist inventions with the implementation of pharmacistinvolved nutritional support service at neonate intensive care unit in a tertiary teaching hospital. Method: A retrospective and observational study was carried out. The total of 58 infants in neonate intensive care unit was enrolled between January 2011 and October 2012. The pharmacist-involved total parenteral nutritional program was initiated in June of 2012. During the program, pharmacist actively participated in the multidisciplinary round with performing the interventions from reviewing the amount of combined total parenteral nutrition and enteral fluid intakes, the amount of total calories, the glucose infusion rate, and the amounts of proteins per weight in kilogram. The outcome was compared with the results from the control group which reflected the prior period of the program initiation. Result: The number of days of regaining birth weight was significantly shorter (14.5 vs. 19 days, p=0.049) and the percentage of total calorie days with >90 kcal/kg/day was increased significantly (40 vs. 13%, p=0.008) in intervention group compared to the values in control group. In addition, the total mean daily caloric intakes ($84.78{\pm}13.8$ vs. $74.86{\pm}15.36$ kcal/kg/day, p=0.018) was significantly higher in intervention group than those results in control group. There were no significant differences in safety parameters between two groups related to nutritional services of necrotizing enterocolitis, intraventricular hemorrhage, proven sepsis, and also parenteral nutrition-induced hepatotoxicity. Conclusion: Pharmacist-involved total parenteral nutrition managed program was successfully implemented. The outcome showed the improved effectiveness of total parenteral nutrition with pharmacist interventions and no differences in adverse reactions. This could prove the positive effects of pharmacist involvement on nutritional therapy for neonate population.

• Korean Journal of Clinical Pharmacy
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• v.8 no.1
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• pp.35-46
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• 1998

A retrospective study was conducted to evaluate the appropriateness of total parenteral nutrition (TPN) for 200 hospitalized adult patients in Samsung Medical Center from January 1st in 1995 to June 31st in 1997. Standard criteria were modified and determined from those stated by AJHP (American Journal of Health System Pharmacy) and ASPEN (American Society of Parenteral and Enteral Nutrition). The justification for indications was appropriate in $35\%,\;44\%,\;and\;32\%$ of the patient's in 1995, 1996, and 1997, respectively, without significant improvement over the last two and half years. Before and during the administration of TPN, several monitoring indicators were well documented, and monitoring frequencies were increased over two and half years period. However, the majority of the monitoring indicators were not found in the standard criteria range of $90\%$. The monitoring indicators for electrolyte balance, $PO_4$ and Mg, were not measured appropriately and resulted in the complications which could have been prevented. The indicator for lipid tolerance, triglyceride and the indicator for hemorrhagic incidence, prothrombin time (PT), were not well documented in comparison with other indicators. The indicators for the improvement in nutritional status, albumin and total protein, were appropriate in $90\%$ of the patients. Determination of TPN formula was based on the laboratory data and chart reviews, and it was appropriate in $98\%$. But the administration of lipid and vitamin K for the prevention of essential fatty acid deficiency and hemorrhage, respectively, was not carried out appropriately when the administration of TPN was prolonged, lasting more than 7 days. When a patient returned to oral or enteral feeding, TPN was terminated. However, increase in albumin level or weight was rarely observed. In conclusion, healthcare professionals should all work as a team and active participation to provide optimized nutrition support for partners.

• Journal of Korean Critical Care Nursing
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• v.3 no.1
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• pp.79-88
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• 2010

Optimal nutrition serves to maintain normal organ function and to preserve body energy stores to guarantee survival during times of shortage of food. Adequate nutrition of intensive care unit (ICU) patients improves outcome, while malnutrition is strongly associated with increased morbidity and mortality rates among critically ill patients. Previously published researches showed that trials of nutritional support in critical illness rarely fulfill basic quality requirements. Nutrition support plays a vital role in the prevention and treatment of nutritional deficiencies in at-risk, critically ill patients. This paper reviewed the challenges in determining critically ill patients' nutrition requirements including nutrition assessment, determination of caloric requirements then providing them with adequate nutrition support while in the ICU with the guidelines published by Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Nutrition support can be effectively enhanced by using the guidelines.

• Preventive Nutrition and Food Science
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• v.16 no.2
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• pp.104-109
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• 2011

Recently, we have demonstrated that green tea extract (GTE) decreases the intestinal absorption of benzo[a]pyrene (BAP), which is an extremely lipophilic food contaminant. The present study was conducted to examine if an enteral infusion of GTE would influence the biliary secretion of BAP and lipids in rats. Female rats were fed an AIN-93G diet with or without (control) GTE at 5 g/kg diet for 4 week. Following the 4-week dietary treatment, rats with bile duct cannula were infused continuously for 8 hr at 3.0 mL/hr via a duodenal catheter with a lipid emulsion containing $4.0\;{\mu}mol$ BAP labeled with $^{14}C$ ($^{14}C$-BAP), $20.7\;{\mu}mol$ cholesterol, $452\;{\mu}mol$ triolein, and $3.1\;{\mu}mol$ ${\alpha}$-tocopherol, and $396.0\;{\mu}mol$ Na-taurocholate with or without 76.1 mg GTE powder in PBS buffer (pH, 6.4). Bile was collected hourly via bile cannula for an 8 hr period. Our results showed that bile flow did not differ between groups. However, the biliary secretion of $^{14}C$-BAP was significantly enhanced by GTE infusion, compared with those infused with the lipid emulsion alone. However, GTE did not affect the biliary outputs of cholesterol, fat, phospholipid and ${\alpha}$-tocopherol. These findings indicate that GTE has a profound stimulatory effect on the biliary excretion of BAP in rats, without affecting other biliary lipids. The mechanism(s) by which GTE enhances the biliary secretion of BAP remains to be investigated.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.3
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• pp.146-155
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• 2023

Purpose: The starting time for probiotic supplementation in preterm infants after birth varies widely. This study aimed to investigate the optimal time for initiating probiotics to reduce adverse outcomes in preterm or very low birth weight (VLBW) infants. Methods: Medical records of preterm infants born at a gestational age (GA) of <32 weeks or VLBW infants in 2011-2020 were reviewed respectively. The infants who received Saccharomyces boulardii probiotics within 7 days of birth were grouped into an early introduction (EI) group, and those who received supplemented probiotics after 7 days of birth were part of the late introduction (LI) group. Clinical characteristics were compared between the two groups and analyzed statistically. Results: A total of 370 infants were included. The mean GA (29.1 weeks vs. 31.2 weeks, p<0.001) and birth weight (1,235.9 g vs. 1491.4 g, p<0.001) were lower in the LI group (n=223) than in the EI group. The multivariate analysis indicated that factors affecting the LI of probiotics were GA at birth (odds ratio [OR], 1.52; p<0.001) and the enteral nutrition start day (OR, 1.47; p<0.001). The late probiotic introduction was associated with a risk of late-onset sepsis (OR, 2.85; p=0.020), delayed full enteral nutrition (OR, 5.44; p<0.001), and extrauterine growth restriction (OR, 1.67; p=0.033) on multivariate analyses after adjusting for GA. Conclusion: Early supplementation of probiotics within a week after birth may reduce adverse outcomes among preterm or VLBW infants.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.4
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• pp.234-247
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• 2018

The goal of nutrition of the preterm infant is to "provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients" (American Academy of Pediatrics 2014). Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. This continues to be true despite many efforts to increase nutrition of the preterm infants. In contrast, enhanced nutrition of very preterm infants, both intravenous and enteral, beginning right after birth, promotes positive energy and protein balance and improves longer term neurodevelopmental outcomes. The benefits are long lasting too, particularly for prevention of later life chronic diseases.