• Journal of Digestive Cancer Research
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• v.2 no.1
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• pp.15-20
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• 2014

Cancer, especially GI cancer itself and any associated treatments have profound effect on the patient's nutritional status. It is therefore very important to understand various nutritional issues in GI cancer patients for the cure and for increasing the compliance during the course of the treatment. Screening and identification of nutritional risk for the GI cancer patients is very essential and is plays a critical part of the treatment to help improve patient outcomes. Maintaining optimal nutritional status is an important goal in the management of individuals diagnosed, treated with cancer. Maintenance of adequate nutritional intake is important whether patients are undergoing active therapy, recovering from cancer therapy, or are in remission and striving to avoid cancer recurrence. The goals of nutrition therapy are to prevent or reverse nutrient deficiencies, preserve lean body mass, help patients better tolerate treatments and minimize nutrition-related side effects and complications, etc. Recent interest in clinical settings is also in maximizing quality of life of the patients which can also be modulated by appropriate nutrition.

• Quality Improvement in Health Care
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• v.19 no.1
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• pp.44-52
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• 2013

Objectives: Several studies on hospital malnutrition have reported that malnutrition among patients is highly prevalent and that more than 40% of hospitalized patients have nutritional risk factors. The purpose of this study was to assess the implementation of physicians' prescribed nutrition therapy before and after a protocol on nutrition therapy for malnourished inpatients was instituted. Methods: Data regarding the rates of physician implementation of nutritional therapy and the duration of therapy were collected and analyzed using SPSS version 20. Results: The percentages of physicians who prescribed nutrition therapy before and after the protocol was initiated were 47.5% and 74.6%, respectively, which statistically significant with 95% confidence. The rates of therapy lasting less than 24 hours before and after the protocol was in place were 100% and 86.4%, respectively, which was not statistically significant. This result suggests that the improvement activity was not effective. Conclusion : The percentage of physicians who prescribed nutritional therapy based on improved nutritional program was significantly increased. Nutrition therapy for malnourished inpatients can be advanced through this new model.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.4
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• pp.350-361
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• 2013

aksun(藥饍), or 'Traditional oriental medicine nutrition therapy', is expected to be an effective nutritional intervention for the patients suffering from chronic diseases. However, there are no systemized protocol that utilize Yaksun as an effective nutrition therapy for Asian patients even though they are accustomed to traditional oriental diet. We investigated the possibility of using Yaksun for developing an effective Medical Nutrition Therapy for Asian patients and proposed factors that have to be considered. Articles published between 1995-2012 about MNT (Medical Nutrition Therapy) and Yaksun were reviewed. Male and female patients of two Korean Medicine Hospitals (n=93) and one Korean Medicine Clinic (n=20) answered a questionnaire asking about their thoughts on the effectiveness of nutritional intervention for their disease management and about their expectations toward Medical Nutrition Therapy on Korean Medicine. 92.9% of the patients have perceived that nutritional intervention is important in disease management. 79.6% of the patients have positively responded that they are willing to use the Medical Nutrition Therapy on Korean Medicine as a clinical nutrition therapy if developed. Female patients, aged in their forties and fifties, educated equivalent to high school graduates and more, and who visited Korean medicine clinic were most interested in the Medical Nutritional Therapy on Korean Medicine. The factors considered in developing the protocol are 1. effectiveness 2. safety 3. expense, in order of importance. Nutritional intervention protocol using Yacksun is necessary for the patients. Medical Nutrition Therapy on Korean Medicine is in need of development. Accumulated case-control studies, cost effectiveness studies, and studies about programming and systemizing the protocol are needed.

• Journal of the Korean Society of Food Culture
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• v.28 no.6
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• pp.562-575
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• 2013

Century-old nutrition and health concepts can be revived and applied in the modern age in the forms of newly developed menus, recipes, and lifestyle education. Current medical nutrition therapy concepts were first described in the Chosun Dynasty (1392-1897) in Korea based on the philosophy that food and medicine originate from the same source, which is known as 'food as medicine'. Recognizing the importance of culture, tradition, local diet, and lifestyle on health and medical nutrition therapy, we tried to rediscover traditional Korean approaches towards food consumption and nutrition through systematic review of the literature and developed contemporary menus accordingly. The medical nutrition therapy prescriptions described in 'Shikryochanyo' (1460) by the Chosun Dynasty's royal physician Soonyi Jeao cover 45 different diseases. In this project, we developed contemporary menus for those disease models that are most prevalent in modern society. Menus developed with foods that are readily available today were evaluated for their nutritional content and adequacy using a computer-aided nutritional analysis program (CAN pro 3.0, developed by the Korean Nutrition Society for comparison with RDA for Koreans). Therefore, century-old nutrition and health concepts can be revived and applied in modern society as newly developed menus recipes and lifestyle education.

• Nutritional Sciences
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• v.5 no.2
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• pp.75-83
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• 2002

A case-controlled, 12 week follow-up, study was designed to investigate the effect of dietician-delivered medical nutrition therapy (MNT) on the nutritional status and quality of life in hemodialysis patients. Subjects were recruited at Kyung-Hee Medical Center and were randomly assigned to two groups : the control and the MNT group. The MNT group received individualized MNT for 12 weeks. The results were as follows: 1) The mean ages of the control (n = 20) and MNT (n = 24) groups were 50.6 $\pm$ 14.8 and 45.7 $\pm$ 14.0 years, and the mean durations of dialysis were 2.3 $\pm$ 2.3 and 1.7 $\pm$ 1.9 years, respectively. The interdialysis weight gain of the subjects was higher than that recommended. 2) The indicators of the subjects nutritional status showed that S to 25% of the subjects had some degree of malnutrition, with most of them in the mild malnutrition category. 3) After 12 weeks of the experiment, the percentage of the ideal body weight (% IBW) of the control group decreased, but that of the MNT group increased. Changes in other anthropometric parameters in both groups during the study period were not significantly different. 4) At the beginning of the study, the 54% of the MNT group consumed more than 28 kcal/kg body weight/day and 50% consumed more than 1.0g protein/kg body weight/day. However, these percentages rose to 71% and 75%, respectively, after 12 weeks of the individualized MNT. 5) The serum albumin and blood urea nitrogen (BUN) levels of the control group decreased significantly artier 12 weeks of the experiment, while those of the MNT group did not change. 6) After 12 weeks of individualized MNT, the mean score of nutrition knowledge and total mean score of quality of life (QL) of the MNT group were significantly higher than that of th\ulcorner control group. Body pain and social functioning scores of the MNT group were significantly higher than those of the control group. The positive effect of individualized MNT on the hemodialysis patients consisted of their improved nutritional status, nutritional knowledge, and the quality of life. These results suggest that individualized MNT continuously performed by a dietitian can be helpful for hemodialysis patients. However, larger and longer term studies are needed to confirm these positive effects of MNT. In addition, the development of nutritional education programs for MNT is needed to increase the positive impact of MNT.

• Korean Journal of Clinical Pharmacy
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• v.23 no.4
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• pp.365-372
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• 2013

Background: Malnutrition of inpatients has been associated with higher morbidity, mortality, cost, and longer hospital stay. Total parenteral nutrition (TPN) therapy plays an important role in decreasing morbidity and mortality among critical inpatients in hospitals, and has been commonly used to improve clinical outcomes. However, only a few studies were conducted regarding patients' nutritional improvement by TPN. Method: This study therefore evaluated the changes in nutritional parameters by TPN therapy for early malnourished inpatients. Data from early malnourished inpatients who were treated with TPN therapy between January 2012 and June 2013 at the ${\bigcirc}{\bigcirc}$ university Hospital were studied retrospectively. Information regarding sex, age, underlying diseases, division, TPN (peripheral and central), and changes in nutritional parameters were collected by reviewing electronic medical records. The criteria for evaluation of the changes in nutritional parameters were included physical marker, body mass index (BMI), and biochemical markers, including albumin (Alb), total lymphocyte count (TLC), and cholesterol. Nutritional parameters were collected three times: pre-TPN, mid-TPN and end-TPN. A total of 149 patients (peripheral, 97; central, 52) was evaluated. Results: In all patients, the malnutrition number was significantly decreased following the complete TPN therapy (peripheral patients, pre-TPN: $3.33{\pm}0.12$, mid-TPN : $3.06{\pm}0.17$, and end-TPN: $2.85{\pm}0.21$ (p < 0.05); central patients, pre-TPN: $3.38{\pm}0.11$, mid-TPN: $3.06{\pm}0.13$, and end-TPN: $2.75{\pm}0.21$ (p < 0.05). The malnutrition number means number of nutrition parameters below normal range of malnutrition. In addition, all of the four nutritional parameters (BMI, Alb, TLC and cholesterol) were increased with duration of TPN periods for all patients, and the changes in the early stage were larger than in the late stage (p < 0.05). The nutritional parameters of non-cancer patients were increased to a greater extent compared to cancer patients with longer TPN therapy, but it was not significant. The nutritional parameters of younger patients (50-60 years) were also increased more than of older patients (70-80 years), but it was not significant. Conclusion: In conclusion, the TPN therapy decreases malnutritional status and improves nutritional parameters in malnourished patients, thereby decreasing morbidity and mortality. The combined evaluation of all four nutritional parameters is more accurate for nutritional assessment than a single one.

• Journal of the Korean Dietetic Association
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• v.9 no.1
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• pp.32-39
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• 2003

Although medical nutrition therapy (MNT) is considered as a cornerstone of medical treatment for hypercholesterolemia, few studies have evaluated medical and economical outcome of MNT. This study was conducted to identify whether MNT administered by registered dieticians could lead to a beneficial clinical and cost outcome in persons with hypercholesterolemia. A prospective clinical trial was carried out at outpatient clinics, which involved an initial visit with a dietitian followed by another visit at first 4 weeks during the 6 weeks study periods. Thirty-nine subjects took part in a 6 weeks nutrition intervention program. Clinical and economical outcomes were compared before and after MNT. Medical nutrition therapy lowered total serum cholesterol level 6.1% (P<0.05), low-density lipoprotein cholesterol (LDL-C) 9.4% (P<0.05) and high-density lipoprotein cholesterol (HDL-C) 3.0% (P<0.05). The cost-effective ratio was ￦ 1,520/cholesterol mg/dl and ￦ 1,441/LDL-cholesterol mg/dl, respectively. After dietitian's intervention, lipid drug eligibility was obviated in 16 of 39(41%) subjects. The cost savings from the avoidance of lipid medications was ￦ 151,107 per patient annually. In conclusion, it is suggested that provision of systemic intensive nutritional care for persons with hypercholesterolemia has significant effects on serum cholesterol reduction and clinical cost savings.

• Korean Journal of Community Nutrition
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• v.8 no.1
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• pp.83-90
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• 2003

The purpose of this study was to investigate the relationship between changes in the Department of Nutrition and patient satisfaction, following the changes in Food Services Management. Statistical data analyses were completed using the SAS/Win 6.12 program. The results can be summarized as follows. The working environment for dietitians and cooking and meal serving assistants was improved following to a change catering of food service management. The number of dietitians who worked in medical nutritional therapy and food services was increased from one to four, and the number of dietary consultations and meal rounds were increased 2.5-fold and 5-fold, respectively after the change services were implemented. Among the 10 items included in the patient satisfaction questionnaire, "Taste of meals" (p< 0.01) and "Satisfaction of offered menus" (p < 0.01) showed significantly higher scores before the catering. "Kindness of meal sewing assistant" this increase was not statistically significant, showed increased satisfaction after the catering, however.n after the catering, however.

• Journal of the Korean Dietetic Association
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• v.5 no.1
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• pp.48-53
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• 1999

This study was prospectively conducted to investigate any relationship of nutritional status at the time of admission to length of hospital stay and mortality. All patients admitted to the Asan Medical Center between October 13 and November 12, 1997 who met the study criteria were included in the study. Patients were classified as Not-at-risk, At-risk Ⅰ or At-risk Ⅱ based on the levels of serum albumin and total lymphocyte count in a computerized nutrition screening program. Sixty three percent of the patients were classified as Not-at-risk Group, 29% as At-risk Group Ⅰ and 8% as At-risk Group Ⅱ. Significant correlation was observed between nutritional status and LOS (P＜0.01) as well as mortality rate (P＜0.05). The more the patient had the nutritional risk factors, the longer the LOS and the higher the mortality rate were. Further studies have to be done in order to demonstrate cost-effectiveness of medical therapy for the malnourished hospitalized patients.

• Korean Journal of Community Nutrition
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• v.7 no.6
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• pp.852-862
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• 2002

The purposes of this study were 1) to review the Medical Nutrition Therapy (MNT) Act of the United States, 2) to introduce the efforts of the American Dietetic Association (ADA) to expand the Medicare coverage for MNT and 3) to provide information about the reimbursement under Medicare Part B for the cost of MNT. The MNT Act defined MNT services as “the nutritional diagnostic, therapeutic, and counseling services provided by a Registered Dietitian or nutritional professional for the purpose of managing diabetes or renal diseases”. Also, the MNT Act defined “conditions for coverage of MNT”, “limitations on coverage of MNT”, and “qualifications of MNT service provider”. To expand the coverage of Medicare to include MNT, the ADA realized the need for development of a protocol for MNT, as well as studies to evaluate the effectiveness and cost-effectiveness of the MNT protocol developed. Therefore, the ADA supported the studies to develop a strong database of scientific investigations of nutritional services. Furthermore, the ADA needed credible data that could be used by Policy makers, so the ADA contracted with the Lewin Group to if out the study to gather the additional data needed to strengthen the ADA's position. In the report of the Lewin Group, which was entitled, “The Cost of Covering Medical Nutrition Therapy under Medicare : 1998 through 2004”, it was concluded, that if coverage for MNT in the Part B portion of Medicare had begun in 1998, by 2004, approximately $ 2.3 billion would have been saved through reduced hospital spending under Part A of Medicare ($ 1.2 billion) and reduced physician visits under Part B ($ 1.1 billion) Effective January 1 2002, the US Congress extended Medicare coverage to include MNT to beneficiaries with diabetes or renal diseases. The Centers for Medicare and Medicaid Services (CMS) established the duration and frequency for the MNT based on published reports or generally accepted protocols (for example, protocols suggested by the ADA). The number of hours covered by Medicare is 3 hours for the initial MNT and 2 hours for a follow-up MM. In 2002, a Medicare coverage policy was made to define the Physician's Current Procedural Terminology (CPT) codes 97802, 97803, and 97804 for MNT.