Objectives The purpose of this study was to compare the sex-associated differences in the dietary intake of gastric cancer patients in Korea. Methods Data from the Korea National Health and Nutrition Examination Survey (KNHANES) the 7 th (2016-2018) were analyzed in the present study. The subjects included 122 gastric cancer patients aged over 40 years (75 male, 47 female). General characteristics (age, marital status, household income, education, food security, comorbidities, alcohol drinking, and smoking), anthropometric characteristics (height, weight, body mass index, and blood pressure), blood biochemical characteristics [fasting plasma glucose (FPG), blood urea nitrogen (BUN), creatinine, triglyceride, total cholesterol, and HDL-cholesterol)], and quantity and quality of dietary intake were compared between male and female participants. Results Males had higher rates of having a spouse, prevalence of hypertension, alcohol drinking, and smoking than females. The proportion of males with a normal range of FPG, BUN, and HDL-cholesterol was lower than that in females. The total cholesterol levels above the normal range were higher in females than in males. We also found that females had a higher percentage of intakes below the estimated energy requirement (EER) and intakes below the estimated average requirement (EAR) for carbohydrates, niacin, phosphorus, and iron than males.
The index of nutritional quality (INQ) for phosphorus and folate, nutrient adequacy ratio (NAR) for vitamin C, thiamine, niacin, folate, calcium, and phosphorus, and the mean adequacy ratio (MAR) were lower in females than males. Conclusions In Korean gastric cancer patients, management of comorbidities such as diabetes and hypertriglyceridemia, lowering FPG, and raising HDL-cholesterol level management is required for males, whereas management of lowering total cholesterol and raising hematocrit is required for females. The quantitative and qualitative nutritional intakes were poor in gastric cancer patients, especially in females, who had a lower nutritional intake than males. We suggest that nutritional interventions are needed to improve the overall nutritional intake in both male and female gastric cancer patients. In particular, we propose that support is urgently needed for females whose nutritional intake is lower than that of males. In addition, family, social, and national support for nutritional management of female gastric cancer patients is highly necessary.
Objectives This study examined the characteristics of patients according to nutritional status assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 were included. The patients were categorized into malnutrition and normal status according to five nutritional screening tools one month after surgery. The Spearman partial correlation, Cohen’s Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each two screening tools were calculated. Results Malnutrition was observed in 86.24% of patients based on the PG-SGA and 85.82% based on the NUTRISCORE. When NRI or CONUT were applied, the proportions of malnutrition were < 30%. Patients with malnutrition had lower intakes of energy and protein than normal patients when assessed using the PG-SGA, NUTRISCORE, or NRI. Lower levels of albumin, hemoglobin, total lymphocyte count, and total cholesterol and longer postoperative hospital stays were observed among patients with malnutrition compared to normal patients when NRI, PNI, or CONUT were applied. Relatively high agreement for NUTRISCORE relative to PG-SGA was found; the sensitivity was 90.86%, and the AUC was 0.78. When NRI, PNI, and CONUT were compared, the sensitivities were 23.72% for PNI relative to NRI, 44.53% for CONUT relative to NRI, and 90.91% for CONUT relative to PNI. The AUCs were 0.95 for NRI relative to PNI and 0.91 for CONUT relative to PNI. Conclusions NUTRISCORE had a high sensitivity compared to PG-SGA, and CONUT had a high sensitivity compared to PNI. NRI had a high specificity compared to PNI. This relatively high sensitivity and specificity resulted in 77.00% agreement between PNI and CONUT and 77.94% agreement between NRI and PNI. Further cohort studies will be needed to determine if the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.
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Report on the Current Trend of Commercial Enteral/Parenteral Nutrition in Outpatient Hyun Ji Lee, Hyo Jung Park, Seon Young Chung, Myung Sook Min, Ok Soon Jeong, Ja Kyung Min Journal of Korean Society of Health-System Pharmacists.2023; 40(2): 211. CrossRef
Objectives This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools.
Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen’s Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools.
Results: We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools.
Conclusions: Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.
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Effects of Continuous Nutrition Care on Nutritional Status and Dietary Habits of Patients With Colorectal Cancer Receiving Adjuvant Chemotherapy After Surgery Jina Son, Ha I Kang, Eun young Jung, Hae won Ryu, Kyung-Ha Lee Clinical Nutrition Research.2023; 12(2): 99. CrossRef
Objectives We aimed to examine the association between the relative preference for vegetables and meat and cancer incidence, in a population-based retrospective cohort in Korea. Methods We included 10,148,131 participants (5,794,124 men; 4,354,007 women) who underwent national health screening between 2004 and 2005 from the National Health Information Database of the National Health Insurance Service (NHIS-NHID). Participants were asked whether they preferred consuming 1) vegetables more often, 2) both vegetables and meat or 3) meat more often. Participants were followed up to Dec. 31, 2017. All cancer and eighteen common cancer cases were identified through the code from the International Classification of Diseases, 10th revision. We estimated sexspecific relative risks and 95% confidence intervals, adjusting for age, body mass index, alcohol consumption, smoking, physical activity, and income level. Results During an average follow-up of 12.4 years, 714,170 cancer cases were documented. In men, consuming meat more often was associated with lower risk of esophageal, liver, and stomach cancers, but higher risk of lung and kidney cancers. Consuming both vegetables and meat was associated with higher risk of prostate cancer, but with lower risk of esophageal, liver, and stomach cancers in men. In women, consuming meat more often was associated with a higher risk of colorectal cancer and breast, endometrial, and cervical cancers diagnosed before the age of 50. Consuming both vegetables and meat was associated with lower risk of liver cancer in women. Conclusions Our study suggests a potential link between vegetable and meat intake and cancer incidence in the Korean population. Further investigation on the association between the intake of specific types of vegetables and meat and cancer risk in Korean prospective cohort studies is needed.
Objectives The aim of this study was to compare the nutritional intake and Diet Quality Index-International (DQI-I) of gynecological cancer survivors and normal women.
Methods This study compared the anthropometric indices, dietary behavior, nutritional intake, and DQI-I in women with previous history of breast or uterine cancer [Gynecological cancer survivors group (GCSG, n=126)] and normal women [Normal control group (NCG, n=7,011)] using the 2013~2016 Korea National Health and Nutrition Examination Survey data.
Results Body mass index and waist circumference were lower in the GCSG compared the NCG. The frequency of skipping breakfast and eating out was higher in the NCG compared to GCSG. Energy and fat intake were significantly higher in the NCG than in the GCSG, whereas intake of all minerals and vitamins (excluding thiamine), and dietary fiber intake were higher in GCSG. It was observed that the fatty acid intake of the GCSG was significantly lower than that of the NCG. The diet quality evaluation using DQI-I results showed that GCSG was higher in the “within-group” diet variety and adequacy of vegetable group than the NCG, whereas the intake level of the fruit group was higher in NCG. Besides, protein, calcium, and vitamin C intake were higher in the GCSG than in the NCG. The GCSG showed higher levels of total fat and saturated fat moderation than the NCG, whereas cholesterol moderation showed the opposite results. The results of DQI-I comparison according to the cancer survival years showed that the overall score and scores related to diet adequacy and balance were higher in the below 5-year group, whereas the over 5-year group scored higher in terms of moderation of diet.
Conclusions The results of this study suggest that a chronic disease based management approach is needed in cancer survivors. The study provides important data which can help in the preparation of guidelines for long-term lifestyle and diet management, in these patients.
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Comparison of blood biochemical characteristics and dietary intake by sex in gastric cancer patients over 40 years in Korea based on 7th (2016-2018) Korea National Health and Nutrition Examination Survey: a cross-sectional study Hyeon-Ju Lee, Sung-Won Oh, Sook-Bae Kim Korean Journal of Community Nutrition.2023; 28(1): 48. CrossRef
Objective The nutritional status of cancer patients undergoing chemotherapy is closely related to the compliance of nutrition education. However, as chemotherapy is conducted repeatedly, compliance with nutrition management is lowered, leading to malnutrition. Malnutrition is related directly to the quality of life after surgery in cancer patients. Therefore, this study examined the factors related to compliance with nutrition management during chemotherapy. Methods In this study, five subjects with colorectal cancer undergoing adjuvant chemotherapy were interviewed in-depth using the Giorgi study method. The contents of the nutrition education visits and in-depth interviews were transcribed in the language of the subject after recording, and the appropriateness of the data was improved by reflecting the subject’s actions and facial expressions. Results After conducting the in-depth interviews for each subject, the experience of the subject’s diet and adjuvant chemotherapy was drawn into two domains, six elements, and 26 sub-elements. In the cognitive domain, the patients experienced physical and psychological changes, and the need for nutrition management was recognized by analyzing the dietary causes of the diseases. In the domain of practice, a knowing-doing gap was formed, unlike the patient’s will. Factors that inhibited compliance with nutritional management included digestive problems, sensory changes, loss of appetite, and social interaction stress. Conclusions Dietary management is very important for patients receiving periodic anticancer therapy, and step-by-step training and personal monitoring based on the chemotherapy order is necessary to maintain the patient’s will and social and environmental support.
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Effects of Continuous Nutrition Care on Nutritional Status and Dietary Habits of Patients With Colorectal Cancer Receiving Adjuvant Chemotherapy After Surgery Jina Son, Ha I Kang, Eun young Jung, Hae won Ryu, Kyung-Ha Lee Clinical Nutrition Research.2023; 12(2): 99. CrossRef
OBJECTIVES This study examined the effects of nutrition education on the nutritional status, including eating habits and quality of life in gastric cancer patients undergoing a gastrectomy. METHODS Thirty one out-gastric resection patients at C University Hospital in Gwangju, Korea were enrolled in this study. The patients received an individualized nutritional counseling session, and the effects were assessed before and after a 3-month nutrition education intervention. Nutrition education for gastric cancer outpatients included the dietary guidelines (e.g., food intake), the level of nutrient intake, and nutrition support. RESULTS The patients had significantly improved serum albumin and hematocrit levels after nutrition education. Of the dietary habits, the meal time and amount of food compared to the first education were increased significantly. Of the changes in the food intake frequency, fish and meat, and vegetables and fruits intake were increased, but not at a statistically significant level. The score of eating habits related to the gastrectomy was improved significantly after nutrition education from 31.7 to 34.5. The composite scores for the quality of life were also improved significantly after the nutrition education program. CONCLUSIONS The nutrition education for gastric cancer outpatients may be crucial and efficient for improving their lifestyle.
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OBJECTIVES We aimed to examine levels of physical activity, anthropometric features, and health-related quality of life (HRQoL) among Korean breast cancer survivors who reported changes in their diet after diagnosis. METHODS A total of 380 women who had been diagnosed with stage I to III breast cancer and had breast cancer surgery at least six months before the interview were included. Participants provided information on dietary change after diagnosis, post-diagnostic diet, physical activity, anthropometric measures, and HRQoL through face-to-face interview. We assessed HRQoL levels of breast cancer survivors using a validated Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Breast Cancer Module (BR23). We used the logistic regression and generalized linear models to identify the associations of dietary changes in relation with physical activity, anthropometry, and HRQoL. RESULTS The majority of participants (72.6%) reported that they have changed their diet to a healthier diet after diagnosis. Breast cancer survivors who reported to have change to a healthy diet had higher intakes of vegetables and fruits and lower intakes of red and processed meats, and refined grains than those who did not. Also, survivors with a healthy change in their diet were more likely to engage in physical activity (top vs. bottom tertile: odds ratio [OR], 1.85; 95% confidence interval [95% CI], 1.02-3.36) and have lower body mass index (BMI) (OR, 0.90; 95% CI, 0.82-0.98 for one kg/m² increment in BMI) compared to those who did not. We found that a healthy change in diet was associated with higher scores of physical functioning (p=0.02) and lower scores of constipation (p=0.04) and diarrhea (p=0.006) compared to those who did not. CONCLUSIONS Healthy changes in diet after breast cancer diagnosis may be associated with lower levels of BMI, and higher levels of physical activity and HRQoL.
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OBJECTIVES This study investigated the improvement of food habits and eating behavior of cancer patients during treatment through the continuous nutrition counseling and monitoring. METHODS Thirty cancer patients during treatment were participated in this study, and the first nutrition counseling and the first and second monitoring were conducted after 2-3 week intervals. RESULTS As a result of the nutrition counseling and monitoring, all patients improved to a great extent to consume 3 meals a day. The frequency of having breakfast was significantly increased with the nutrition counseling and continuous monitoring as well. The meal fixed quantity was stabilized and the eating speed slowed down as more nutrition counseling were done. The snack intakes of patients did not show any significant difference after the nutrition counseling but showed a slight decline after the monitoring. The frequencies of eating out and a late-night meal significantly decreased after the monitoring. The intakes of fish, meat, vegetables, milk and fruits needed for a well-balanced diet significantly increased as more nutrition counseling were done. The intakes of processed food were significantly decreased after the nutrition counseling and the intakes of fast food were significantly decreased as more nutrition counseling were done. The water intake of patients also significantly increased. In the eating behavior related to health, the frequency of drinking alcohol significantly decreased after nutrition counseling consultation and no patients had dietary supplements after the first monitoring. CONCLUSIONS These results suggested that continuous nutrition counseling is effective in improving eating habits of cancer patients.
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OBJECTIVES We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors. METHODS A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model. RESULTS Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05). CONCLUSIONS Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.
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OBJECTIVES We aimed to evaluate dietary intake among female breast cancer survivors in a cross-sectional study. METHODS A total of 127 women who had breast cancer surgery at least 6 months before baseline were included. Dietary intake of female breast cancer survivors was assessed through self-reported 3 day-dietary records. To compare dietary intake between breast cancer survivors and general female population without cancer, we selected the 1:4 age matched women from the 2011 Korean National Health and Nutrition Examination Survey (KNHANES). In the KNHANES, participants were asked about their dietary intake using the 24-hour dietary recalls. We also examined whether dietary intake varied by age group, cancer stage, or time since surgery among breast cancer survivors. We used the generalized linear model to compare their dietary intakes. RESULTS Intakes of total energy, beta-carotene, folate, vitamin C, plant iron and fruits were lower among breast cancer survivors with longer time since surgery compared to those with shorter time (p < 0.05). Breast cancer patients with higher stage at diagnosis tended to consume less legumes (p = 0.01) than those with lower stage. When we compared dietary intake between breast cancer survivors and the general female population without cancer, breast cancer survivors were more likely to consume most of macro- and micro-nutrients in larger quantity (p < 0.05) and adhere to healthier diet characterized by higher intakes of legumes, seed and nuts, vegetables and fishes and shells than the general female population who never had been diagnosed with cancer (p < 0.05). CONCLUSIONS Our study results suggested that the intakes of nutrients and foods varied by time since surgery and cancer stage among breast cancer survivors and dietary intakes among breast cancer survivors differed from that in the general population. Further prospective studies are warranted to explore the association between dietary intakes of specific food items and survival among Korean breast cancer survivors.
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This study was conducted to develop and evaluate nutrition education media for breast cancer. The booklet was developed and consisted of breast cancer and diet, breast cancer and nutrition, breast cancer and food safety and Ingredients and recipes for breast cancer. The questionnaire requested information related to demographics, importance and satisfaction of evaluation for nutrition education media, evaluation of each chapter, and satisfaction of educational media. The data were analyzed using SPSS for Windows (version 12.0). The results were summarized as follows. The importance score for nutrition education media was higher than the satisfaction score. As a result of IPA analysis, quadrant I included 'comprehension', 'appropriateness of media', 'emphasis of the point'. Quadrant II classified with 'appropriateness of terms', 'interest', 'authenticity', 'appropriateness of illustrations'. Quadrant III included 'appropriateness of color and calligraphy', 'simplicity'. Quadrant IV classified with 'appropriateness of examples', 'concreteness'.
Although it is well known that cancer patients suffer from malnutrition, there are few published studies on malnutrition in outpatients receiving chemotherapy in Korea. This study aimed to evaluate nutritional risk in oncology outpatients receiving chemotherapy and to show the baseline data to set up nutritional management programs for cancer patients. This is a retrospective observational analysis on 1,962 patients referred for nutritional education before or during chemotherapy at Seoul National University Hospital Cancer Center from January 2006 to May 2007. According to a malnutrition screening tool, the proportion of patients having malnutrition risk was 23.0%. In the case of upper gastrointestinal cancer, more than 50% of patients were assessed as being at the risk of malnutrition. They showed more than 7% weight loss compared to their usual body weight and poor oral intake; energy intake was less than 100% of Basal Energy Expenditure (BEE) and protein intake was less than or equal to 0.77 g/kg/d. However, only 6.3% of breast cancer patients had risk of malnutrition and their oral intake was better; energy intake was 121% of BEE, and protein intake was 0.90 g/kg/d. Outpatients receiving chemotherapy had different nutritional risk depending on their cancer site. Nutritional management program should be conducted differently, depending on the cancer site and upper gastrointestinal cancer patients at high risk of malnutrition should basically have nutritional assessment and intervention.
The present study was conducted to evaluate the food and nutrients intakes of stomach cancer patients in the Daegu and Gyeongbuk areas in order to find out the dietary risk factors for stomach cancer. The subjects of the study were 102 patients who had recently been diagnosed with stomach cancer at the Gyeongbuk National University Hospital. The control subjects were 105 people including patients from the Department of Orthopedic Surgery and healthy volunteers who did not have any gastrointestinal diseases. Estimates of nutrients intakes were determined from the food intake frequency data obtained by individual interviews using questionnaires. The mean daily calorie intakes of the control and the case groups were not significantly different. However the energy intake from protein was significantly higher in the case group as compared to the control group. With regard to the nutrients intakes, the case subjects consumed significantly higher amounts of nutrients such as protein, calcium, sodium, phosphorus and niacin than the control group. The case group showed a tendency to consume higher amount of protein, fat, calcium and iron from animal food sources. In the present study dietary factors which were suspected as being risk factors for stomach cancer included high consumption of animal foods, specific nutrients such as protein, sodium and niacin, specific food groups such as meat, spices, and low consumption of fruits and mushrooms. Therefore, it is recommended that more extensive and systematic surveys be conducted to confirm the risk factors for stomach cancer, taking into consideration the dietary cultural characteristics of this region.
The purpose of this study was to compare dietary patterns, dietary behaviors and life styles before and after breast cancer surgery in Korea. The subjects were 220 females who underwent surgery for stage I-III breast cancer at general hospitals. Food intake, eating habits, snacks, eating-out, use of nutritional supplements and healthy foods, and drinking and smoking habits were studied using a questionnaire. SAS program was used for statistical analysis of the data. The results are as follows : 1) Most subjects were housewives aged more than 40 years. 2) After breast cancer surgery, intakes of fruits and vegetables were increased and those of meat, salty and spicy foods were decreased. 3) There was a significant difference in takes of caffeine beverages, snacks, fast foods and instant foods before and after breast cancer surgery. 4) There was a significant difference in meal regularity and skipping breakfast before and after breast cancer surgery. 5) The frequency of eating-out was decreased and low-fat foods, such as Japanese foods, were preferred after breast cancer surgery. 6) Nutritional supplements and natural healthy foods were used more after breast cancer surgery. 7) Most subjects were non-smokers and drank little alcohol and the rate of regular drinking significantly decreased after breast cancer surgery. Therefore, there was a significant difference in dietary patterns and behaviors resulting form breast cancer. Further more, dietary factors may be a contributing factor in the incidence at breast cancer in Korea.